ABSTRACT
OBJECTIVE: Patient-controlled-analgesia (PCA) using intravenous (IV) opioids is recognized a safe and effective method for pain control. However, postoperative analgesia with opioids is associated with a high incidence of postoperative nausea and vomiting (PONV) exceeding 30%. The 5-hydroxytryptamine receptor 3 (5-HT3) antagonists alleviate nausea and vomiting. This study aims to compare the effectiveness of ramosetron and ondansetron in preventing PONV following laparoscopic hysterectomy for benign uterine diseases under general anesthesia. METHODS: The medical records of 1483 patients who underwent laparoscopic hysterectomy between January 2005 and May 2009 were reviewed. Of the 1483 patients, 1184 patients who received IVPCA with ramosetron 0.3 mg (n=761) or ondansetron 8 mg (n=423) were analyzed. Fentanyl-based IVPCA was administered for 48 hours after surgery. The overall incidence of postoperative nausea and vomiting, bowel ileus, Levin tube insertion for severe bowel ileus, additional usage of pain killers and discontinuation of the IVPCA infusion with PCA-related severe nausea and vomiting were assessed for 48 hours after surgery. The amount of time until bowel gas passage resumption after surgery was measured. RESULTS: There was a significant difference between the two groups regarding the duration until post-operative bowel gas passage resumption (1.78+/-0.79 days in the ramosetron group, and 2.23+/-0.83 days in the ondansetron group; p=0.005); however, there were no significant differences found in other aspects. CONCLUSION: Ramosetron is superior to ondansetron in terms of faster recovery in bowel mobility, with similar effects in preventing the incidence of PONV.
Subject(s)
Humans , Analgesia , Analgesia, Patient-Controlled , Analgesics, Opioid , Benzimidazoles , Hysterectomy , Ileus , Incidence , Medical Records , Nausea , Ondansetron , Postoperative Nausea and Vomiting , Serotonin , Uterine Diseases , VomitingABSTRACT
OBJECTIVE: The purpose of this study is to identify the cooperation between histologic diagnosis and sonographic pattern of functional ovarian cyst. And also determine performances of ultrasound, computed tomography, and tumor markers in diagnosis of functional ovarian cyst. METHODS: We retrospectively reviewed the medical records of 129 patients with ovarian cystic tumors undergone an adnexectomy between 2006 and 2008 at Kyung Hee medical center. All patients performed sonographic examinations, and a computed tomography or CA-125 or CA-19-9 were done if needed. RESULTS: Among 129 patients, 35 patients were diagnosed to be functional ovarian cyst. Sensitivity and specificity of ultrasound for functional cyst was 37.1% and 82.9%, respectively. Sensitivity and specificity of computed tomography was 47.6% and 69.3%, respectively. Tumor markers were not useful to detect functional ovarian cyst. If any one of the two appeared functional ovarian cyst, the sensitivity and specificity was 66.6%, 67.7% each. CONCLUSION: Computed tomography can be used as an alternative option replacing ultrasound, but combination of computed tomography and ultrasound does not provide the additional benefit in early diagnosis of functional ovarian cyst.
Subject(s)
Female , Humans , Early Diagnosis , Medical Records , Ovarian Cysts , Retrospective Studies , Sensitivity and Specificity , Biomarkers, TumorABSTRACT
OBJECTIVE: The impact of maternal stress on pregnancy outcome has been a focus of research and cortisol is known as a biomarker of psychological stress. The aim of this study is to evaluate the relationship between salivary cortisol levels and pregnancy outcomes prospectively. METHODS: The subjects of this study were healthy pregnant women who collected morning samples of saliva (10~12 AM) at 10~13, 20~23 weeks of gestation, and postpartum 2 days between April 2007 to March 2008. Saliva was collected with commercial collector, Salivette(R), and cortisol level was analyzed by enzyme immunoassay. They also underwent ultrasonographic examination of umbilical and uterine artery Doppler between 20~23 weeks of gestation. Statistical analysis was assessed between salivary cortisol levels and pregnancy outcomes, including Doppler findings. RESULTS: A total 39 pregnant women collected salivary cortisol as indicated. They showed increase in cortisol level in 2nd trimester compared to 1st trimester, which decreased after delivery. Salivary cortisol level was not associated with maternal age, parity, occupation, body mass index, blood pressure, delivery mode, fetal sex, and fetal weight. However higher cortisol level was associated with lower resistance index of uterine artery, even there was no statistical significance. CONCLUSION: Our data could not show any association between salivary cortisol levels and pregnancy outcomes. Although this study presents a number of methodological and conceptual challenges, this does not necessarily preclude the use of salivary cortisol measures, but rather point to the importance of careful research design.
Subject(s)
Female , Humans , Pregnancy , Blood Pressure , Body Mass Index , Fetal Weight , Hydrocortisone , Immunoenzyme Techniques , Maternal Age , Occupations , Parity , Postpartum Period , Pregnancy Outcome , Pregnant Women , Research Design , Saliva , Stress, Psychological , Uterine ArteryABSTRACT
A 35-yr-old woman carrying a 17-week-old fetus presented with right hydronephrosis and a single umbilical artery. Karyotyping was normal and targeted ultrasonography showed an otherwise normal fetus. After 28 weeks of gestation, the mother felt rapid, repetitive fetal movement and an ultrasound at 30 weeks of gestation revealed tonic clonic movements of the fetal trunk and extremities. At 36 weeks of gestation, an emergency repeat Cesarean section was performed because of a premature rupture of the membranes and a male infant weighing 4,295 gm was delivered. After birth, the infant continued to have movements suggestive of a generalized tonic clonic seizure. Brain computed tomography and magnetic resonance imaging revealed normal structures and an electroencephalography showed generalized suppression. Treatment with phenobarbital resulted in substantial improvement in the number of seizure episodes, however fine seizure-like movement continued in both of the hands, feet and in the tongue until the five-month follow-up. This is the first Korean report of a fetal seizure being diagnosed during the prenatal period.
Subject(s)
Female , Humans , Infant, Newborn , Male , Pregnancy , Fetal Diseases/diagnosis , Karyotyping , Magnetic Resonance Imaging/methods , Phenobarbital/pharmacology , Prenatal Diagnosis/methods , Seizures/diagnosis , Tomography, X-Ray Computed/methods , Ultrasonography, Prenatal/methodsABSTRACT
OBJECTIVES: To compare the efficacy of additional vaginal dressing disinfectants for reduction of wound-related complications in laparoscopic hysterectomy. METHODS: From September 2006 to June 2007, 226 of 243 patients underwent laparoscopic hysterectomy were enrolled. The patients were classified into three groups (no additional disinfectant (n=76), povidone-iodine (n=68), and chlorhexidine (n=82) for disinfectants) and the short term postoperative complications related with wound morbidity were recorded by 2 months out-patient follow up. RESULTS: The mean age of all patients was 46.6+/-7.6 years old, and the mean BMI (body mass index) was 24.2+/-3.4, mean operation time was, 137.2+/-48.0 minutes, and the mean estimated blood loss was 451.8+/-240.2 ml. There was no significant difference among three groups in their mean age, mean BMI, frequency of vaginal culture (+) before surgery, frequency of wound/stump infection after surgery, frequency of wound disruption, and frequency of fever. The significant difference was shown in mean operation time and mean estimated blood loss but those did not affect frequency of vaginal culture (+) before surgery, frequency of wound/stump infection after surgery, frequency of wound disruption, and frequency of fever. CONCLUSIONS: We conclude that the kind of disinfectant for additional vaginal dressing for laparoscopic hysterectomy does not matter deeply in causing short term wound-related complications after the surgery.
Subject(s)
Humans , Bandages , Chlorhexidine , Disinfectants , Fever , Hysterectomy , Outpatients , Postoperative Complications , Povidone-IodineABSTRACT
Recently, we experienced the conservative management of ovarian cyst torsion using transvaginal ultrasonography-guided aspiration in 39 years old woman at 9 weeks of gestational age. The patient had a 7.3 cm-sized ovarian cyst suspected torsion. The symptom was acute lower abdominal pain. Transvaginal cyst aspiration was performed twice. The symptom was resolved after the procedures. The full term delivery was done by vaginal route and the ovarian cyst disappeared.
Subject(s)
Adult , Female , Humans , Pregnancy , Abdominal Pain , Gestational Age , Ovarian CystsABSTRACT
Ovarian Sertoli-Leydig cell tumors are rare sex cordstromal tumors, and these neoplasms account for less than 0.5% of all ovarian tumors. Those are more often encountered in young women between the ages of 20 and 30 years who usually become virilized. Recently, we experienced an unusual case of Sertoli-Leydig cell tumor with mucinous heterologous elements in a 71-year-old postmenopauseal woman. We present it with brief review of literatures.
Subject(s)
Aged , Female , Humans , Cystadenoma, Mucinous , Mucins , Postmenopause , Sertoli-Leydig Cell TumorABSTRACT
OBJECTIVE: Several aspects of female reproduction, from folliculogenesis to corpus luteum function, are related to angiogenesis. The purpose of this study is to measure the concentrations of vascular endothelial growth factor (VEGF) in follicular fluid and serum in patients during In Vitro Fertilization-Embryo Transfer (IVF-ET) cycles. METHODS: In our prospective study, twenty-nine patients who underwent in vitro fertilization by GnRH agonist short protocol were assessed at the our infertility clinic from Aug. 2003 to July 2005. Serum VEGF and follicular fluid VEGF levels were measured in all patients at the time of oocytes retrieval. The assay technique used in this study was ELISA for serum and follicular fluid VEGF. RESULTS: Of 29 cycles, 10 cycles were pregnant (34.5%). A positive correlation existed for follicular fluid VEGF and chronologic age (r=0.428, p-value=0.021). Follicular fluid VEGF concentration showed an inverse relationship with the total number of oocytes retrieved and follicles (r=-0.493, p-value=0.007; r=-0.474, p-value=0.009). But there was no statistically significant relationship between follicular fluid VEGF concentration and serum VEGF concentration (rho=0.347). Follicular fluid VEGF concentration was significantly higher in the non-pregnant group (1468.38+/-727.33 pg/mL) compared to the pregnant group (676.48+/-542.07 pg/mL) (p-value=0.003). CONCLUSION: Our data provide some of the evidences that elevated VEGF concentrations in the follicular fluid are associated with poor conception rates in the IVF-ET cycles.
Subject(s)
Female , Humans , Corpus Luteum , Enzyme-Linked Immunosorbent Assay , Fertilization , Fertilization in Vitro , Follicular Fluid , Gonadotropin-Releasing Hormone , Infertility , Oocytes , Prospective Studies , Reproduction , Vascular Endothelial Growth Factor AABSTRACT
This is the first case report of a patient with a large serous cystadenoma accompanied by a juvenile granulosa cell tumor that was discovered in the remaining ovarian tissue. A 25-year-old female was presented with constipation and amenorrhea. Ultrasonography revealed a large cystic mass in the left ovary with a normal uterus. The remaining ovarian tissue seemed normal at first look after cystectomy, but showed abnormal consistency on palpation. The remaining ovarian tissue was removed and granulosa cell tumor was confirmed by pathologic examination. The patient has been followed up for 30 months without evidence of recurrence. We would like to emphasize the importance of inspection, and palpation of remaining ovarian tissue during operation to avoid risks of remaining ovarian pathology.
Subject(s)
Adult , Female , Humans , Amenorrhea , Constipation , Cystadenoma, Serous , Cystectomy , Granulosa Cell Tumor , Granulosa Cells , Ovarian Neoplasms , Ovary , Palpation , Pathology , Recurrence , Ultrasonography , UterusABSTRACT
Accessory ovary is a rare gynecologic condition, and tumors arising in accessory ovaries are extremely rare. Accessory ovary may result from separation of migrating ovaries during embryogenesis and injuries such as inflammation and operation on normal ovary. Congenital malformations, most frequently malformations of the genitourinary organ, are seen in connection with the accessory ovary. We experienced the first case of two dermoid cysts developing in an accessory ovary located in the left infundibulopelvic ligament and another in the eutopic ovary at the same side concurrently. Here, we present this extremely rare case with a review of the literature.
Subject(s)
Adult , Female , Humans , Dermoid Cyst/diagnosis , Ovarian Cysts/diagnosis , Ovarian Diseases/congenital , Ovary/abnormalities , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The purpose of this report is to determine the predictable factors for successful vaginal birth after cesarean (VBAC). METHODS: In this study, 382 women who attempted VBAC at Kyung-Hee university hospital were included. The medical records of them were reviewed retrospectively. Informations was collected about demographics, medical history, obstetric history, neonatal birth weight, complications, treatment, and outcome of the index pregnancy. RESULTS: The overall success rate was 76.5% (292 cases). Among variables, neonatal birth weight (odds ratio, 0.2; 95% confidence interval, 0.1-0.4), Bishop score at admission (odds ratio, 1.8; 95% confidence interval, 1.5-2.1 ; p<0.05), and history of vaginal delivery (odds ratio, 3.6 ; 95% confidence interval, 1.1-11.6 ; p<0.05) were significant. The Bishop score showed most significant relationship with successful VBAC. The Bishop score 5 at admission had a sensitivity of 47.4% and a specificity of 87.6% in the prediction of successful VBAC. Malpresentation as indications of previous cesarean delivery showed more tendency to succeed than others. CONCLUSION: Several factors such as birth weight, Bishop score at admission, and history of vaginal delivery may be used to predict the success of VBAC.
Subject(s)
Female , Humans , Pregnancy , Birth Weight , Demography , Medical Records , Retrospective Studies , Sensitivity and Specificity , Vaginal Birth after CesareanABSTRACT
The incidence of ectopic pregnancy has been increasing for many years and ectopic pregnancy is still a leading cause of maternal death although its mortality is reduced significantly with improved early diagnosis and treatment. Intraligamentous pregnancy, a subset of ectopic pregnancy, is one of the most unusual accident so that the diagnosis of intraligamentous pregnancy is hardly ever made prior to laparotomy. We experienced intraligamentous pregnancy with hemoperitoneum. So we presented a case with brief review of literature.
Subject(s)
Female , Pregnancy , Diagnosis , Early Diagnosis , Hemoperitoneum , Hemorrhage , Incidence , Laparotomy , Maternal Death , Mortality , Pregnancy, EctopicABSTRACT
The incidence of ectopic pregnancy has been increasing for many years and ectopic pregnancy is still a leading cause of maternal death although its mortality is reduced significantly with improved early diagnosis and treatment. Intraligamentous pregnancy, a subset of ectopic pregnancy, is one of the most unusual accident so that the diagnosis of intraligamentous pregnancy is hardly ever made prior to laparotomy. We experienced intraligamentous pregnancy with hemoperitoneum. So we presented a case with brief review of literature.
Subject(s)
Female , Pregnancy , Diagnosis , Early Diagnosis , Hemoperitoneum , Hemorrhage , Incidence , Laparotomy , Maternal Death , Mortality , Pregnancy, EctopicABSTRACT
OBJECTIVES: Vaginal birth or trial of labor after previous cesarean section has become one of the most remarkable changes in obstetric practice. The safety and efficacy of a trial of labor and vaginal birth after previous cesarean are well documented. The purpose of this report is to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission. METHOD: In this retrospective study, 120 women who attempted vaginal birth at Kyung-Hee University Hospital from March 1997 to March 1999. An attempt to identify possible prognostic factors for success of such a trial was made and we evaluated the variables of significant predictive value and the patients' characteristics in the success group and failure group of women who attempted VBAC. RESULT: 87 cases(72.5%) in 120 cases succeeded in VBAC and 33 cases(27.5%) failed. In this comparative groups in VBAC, there was significant difference in CPD index(cephalopelvic disproportion index) and Bishop score, but no significant difference in gestational age, the estimated fetal weight by sonography and newborn birth weight. CONCLUSION: In this study, Bishop score and CPD index and age may be useful and valid predictor of success in VBAC and this information could be particularly valuable. The CPD index may prove most important in determining if a vaginal birth should occur after a cesarean section because it can clearly identify some patients who need a repeat cesarean section.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Birth Weight , Cesarean Section , Cesarean Section, Repeat , Fetal Weight , Gestational Age , Parturition , Retrospective Studies , Trial of Labor , Vaginal Birth after CesareanABSTRACT
Implantation is a cascade of process which fertilized conceptal tissue move into maternalendometrium. Recently, with development of life science, the informations about humanimplantation process have been important topic with regard to the reproductive medicaltechnology. However, the precise mechanism and the factors involved in the process is notclearly understood, because the human experiments have been inhibited due to ethical andreligious views to the point. To study the human implantation process, we develop the modelto culture the human endometrium and trophoblast in vitro. The microscopic findings ofcultured monolayer of endometrial glandular epithelium and stroma in respond to co-culturedtrophoblast cells were observed. As results, trophoblasts didn't change the microscopicmorphology of endometrial glandular layer. However, trophoblast cells destructed the higherconcentration of epidermal growth factor in culture media. These results suggests thatepidermal growth factor may be a important factor for trophoblast invasion to stromal layerand trophoblast may invade the glandular layer by different mechanism to endometrial stroma.