High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

Effects of Menopausal Hormone Therapy on Uterine Myoma in Menopausal Women

OBJECTIVES: The aim of the present study is to evaluate the long term effects of estrogen-progestogen therapy (EPT) on uterine myomas volume in postmenopausal women. METHODS: We performed a retrospective analysis on postmenopausal women with asymptomatic uterine myoma during the period between April, 2008 and September, 2012. Postmenopause was defined as amenorrhea for longer than a year or serum follicle stimulating hormone levels higher than 40 IU/L. The volume of the myoma was assessed by transvaginal ultrasonography for every 6 months after administration of EPT. RESULTS: Thirty-eight women were included in the study, with 32 in the EPT group and 6 in the control group. Overall, uterine myoma volume (mean +/- standard deviation, cm3) in the EPT group was 19.5 +/- 24.6 at baseline, and those at 6 and 12 months were 24.7 +/- 35.1 and 28.5 +/- 56.4, respectively. Myoma volume did not change significantly with EPT, and these changes were not significantly different from the control group. Myoma volume changes were not significantly different in the subgroups according to the route of estrogen administrations and the method of progestogen administrations. Clinically significant volume increases during one year of EPT was noted in 28.1% (9/32), however, only one showed transient increases. CONCLUSION: Our results suggest that treating postmenopausal woman with EPT on a long-term basis does not increase the volume of uterine myomas.

The Relationship between Uterine Myoma Growth and the Endocrine Disruptor in Postmenopausal Women

OBJECTIVES: To investigate the number of leiomyoma patients-exposed to bisphenol A (BPA) and to observe whether the serum concentration of BPA is related to leiomyoma growth. METHODS: A total of 158 patients were recruited for this study. Leiomyoma patients were divided into three groups, mild (n = 48), moderate (n = 32) and severe (n = 28), according to the size of leiomyomas. The control (n = 30) group was defined as having no leiomyomas. Transvaginal ultrasonography was used to identify and measure the leiomyomas. Serum BPA concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: BPA was detected in 87.0% out of a total of 158 samples, and in 86.0% out of 108 leiomyoma patients. In detail, the detection rates of serum BPA were 88.0% in the control group, 77.2% in the mild group, 90.0% in the moderate group and 96.0% in the severe group. The mean BPA concentration in the control group was 0.558 +/- 0.097 ng/mL, the leiomyoma groups, the mean BPA concentrations were 0.274 +/- 0.063 ng/mL (mild), 0.346 +/- 0.064 ng/mL (moderate) and 0.647 +/- 0.039 ng/mL (severe) (P = 0.0003). Values represent the mean +/- standard error. CONCLUSION: The detection rates of serum BPA in the control and leiomyoma groups were 88.0% and 86.0%, respectively. However, there was no significant difference in the serum BPA concentrations between the control and leiomyoma groups. To verify the effect of BPA on leiomyoma growth, a close and sequential monitoring is recommended for people who are at risk for uterine leiomyoma.

A Case of Clopidogrel-induced Neutropenia in Chronic Renal Failure / 대한신장학회지

Clopidogrel, a thienopyridine derivative, is an anti-platelet agent that acts as an antagonist of the platelet adenosine diphosphate receptor and considered for essential prophylaxis for intracoronary stent thrombosis in the treatment of ischemic heart disease. Clopidogrel is considered as safe as aspirin but a few cases of severe hematologic adverse reactions associated with clopidogrel had been reported such as neutropenia, aplastic anemia, thrombocytopenic purpura, and thrombocytopenia. We report a rare case of neutropenia induced by clopidogrel in chronic renal failure in a patient who underwent percutaneous coronary intervention.

A case of Henoch-Schonlein purpura with intracerebral hemorrhage / 대한내과학회지

Henoch-Sch?nlein purpura (HSP) is an immunologically medicated systemic vasculitis of small blood vessels affecting the skin, gastrointestinal tract, joints, and kidneys predominantly. Neurological complications in HSP include headache, focal cerebral deficit, coma, convulsion, subarachnoid hemorrhage, and chorea. However, intracerebral hemorrhage complicating HSP is rare. We describe a case of HSP with an intracerebral hemorrhage in a 67-year-old female who was diagnosed with HSP and complained of left homonymous hemianopsia and numbness in the right hand during treatment. Brain imaging showed an intracerebral hemorrhage in the occipital lobe. Her symptoms improved after conservative care. Ultimately, the patient died because of vasculitis and a worsening infection. We report the case of an elderly female with an intracerebral hemorrhage in HSP and review the literature.

A case of huge extrauterine endometrioid-type adenomyoma with cystic change: A case report and literature review / 대한산부인과학회지

Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is a rare entity. Cystic degeneration of adenomyoma is also very rare case. We report a case of huge extrauterine endometrioid-type adenomyoma with cystic change with brief review of literature.

Laparoscopically assisted vaginal hysterectomy with bilateral salpingo-oophorectomy of adult granulosa cell tumor with endometrial carcinoma: A case report and literature review / 대한산부인과학회지

Granulosa cell tumors of ovary are rare neoplasms, which account for 2~5% of all ovarian malignancies. Ovarian granulosa cell tumors are often associated with endometrial hyperplasia or carcinoma. The endometrial carcinoma is thought to occur under the influence of the estrogen receptor pathway and is typically a low-grade endometrioid adenocarcinoma. We present a case of granulosa cell tumor of the ovary and synchronous endometrial carcinoma that were managed with laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy, with brief review of literature.

Bacterial etiology in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease / 대한내과학회지

(AECOPD). While critically ill patients requiring admission need proper antibiotic treatment for the causative pathogen, little is known about the bacterial etiology of AECOPD in Korea. We therefore studied the bacterial etiology of hospitalized patients with COPD in our institution. METHODS: The study enrolled 149 patients who were admitted to the hospital in Sungnam with the diagnosis of AECOPD between July 1, 2004 and June 1, 2007. We retrospectively reviewed the clinical data and results of sputum cultures. RESULTS: Of the 149 subjects with sputum collected, 51% (76 cases) had positive bacterial cultures [age 70.7+/- 9.2 years (mean+/- SD); 116 males] of sputum. Pseudomonas aeruginosa (24 cases, 30.4%) was the organism cultured in sputum most commonly, followed by Streptococcus pneumonia (15 cases, 18.9%), Acinetobacter sp. (9 cases, 11.4%), and Klebsiella pneumonia (7 cases, 8.9%). Patients whose FEV1 was 50% (17/96 vs. 4/53, respectively, p=0.002). Patients taking systemic steroids also had a higher rate of sputum culture of P. aeruginosa (85.7%). CONCLUSIONS: P. aeruginosa was the pathogen most commonly isolated in hospitalized patients with COPD. This species should be considered when physicians select empirical antibiotics to treat patients with AECOPD.

Hyponatremia with Non-Cardiogenic Pulmonary edema, Seizure and Rhabdomyolysis after Bowel Preparation / 대한신장학회지

Oral sodium phosphate is commonly used to evacuate the colon and rectum before colonoscopy or colorectal surgery. However, this substance is known to cause electrolyte abnormalities including hyponatremia. The hyponatremic patient usually presents with headache, nausea, vomiting and confusion, but can also present with non-cardiogenic pulmonary edema, seizure and rhabdomyolysis. However, non-cardiogenic pulmonary edema, seizure and rhabdomyolysis caused by hyponatremia associated with bowel preparation have only rarely been reported. We report a case of severe complications including non-cardiogenic pulmonary edema, seizure and rhabdomyolysis associated with hyponatremia following ingestion of sodium phosphate for colonoscopy in a 41-year-old healthy male.

Fibroadenoma of the Vulva: A Case Report / 대한산부인과학회지

Fibroadenoma is a rare lesion of the vulva. It has been proposed that the origin of the tissue is either ectopic breast tissue or vulvar mammary-like glands (MLG). We report a case of vulvar fibroadenoma in a 33-year-old woman with a right vulvar mass presenting clinically as vulvar cyst. The cut surface of the tumor showed a white and homogenous appearance that was 2.5 cm in maximum dimension. Microscopically, the lesion was well-circumscribed but non-encapsulated. It revealed nodular, glandular and stromal proliferation, consistent with fibroadenoma of breast. Immunohistochemical staining for the estrogen receptor and progesteron receptor revealed nuclear positivity in the epithelium. Smooth muscle actin confirmed the presence of a myoepithelial cell layer. Staining for pancytokeratin showed epithelial cytoplasmic positivity.

A Study on Correlation of Vascular Endothelial Growth Factor in Preeclampsia / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to assess the impact of vascular endothelial growth factor (VEGF) in pregnancies with mild and severe preeclampsia. METHODS: From January 1999 to June 2001, we studied the severity for pregnant women with pregnancy induced hypertension between 28 and 40 weeks gestation. In the mild (n=46) and severe preeclamptic women (n=28), the laboratory evaluation included liver function test, platelet counts, and serum creatinine. The systolic/diastolic (S/D) ratio of the fetal umbilical artery flow for placental resistance was measured by ultrasonographic doppler velocimetry. To detect the damage of vascular endothelial cells in all preeclamptic women, serum concentrations of VEGF were measured. RESULTS: Severe preeclampsia had more elevated liver enzymes, thrombocytopenia, high creatinine than mild preeclampsia. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) was encountered in 8/28 (28.6%) of severe preeclampsia. Fifteen out of twenty-eight cases (53.6%) in severe preeclampsia had elevated S/D ratio from 3.0 to 4.5 including 6 cases with absent end diastolic velocity, whereas 4/46 (8.7%) was elevated SD ratio (>3.0) in mild preeclampsia. Serum concentrations of VEGF were elevated in both mild (7.5+/-4.9 ng/mL, p<0.05) and severe preeclampsia (19.3+/-8.8 ng/mL, p<0.05) compared to normal pregnancy (0.5~2.1 ng/mL). CONCLUSION: The higher serum concentration of VEGF and elevated S/D ratio of umbilical artery were responsible for the changes of the resistance of placental blood flow in severe preeclampsia. Furthermore, elevated S/D ratio of umbilical artery velocity was essential as a surveillance method of fetal health status with IUGR (Intrauterine growth restriction) by vascular declination of placenta.

A Case of Faciocervical Immature Teratoma which was Antenatal Diagnosed by Ultrasonography at 20 weeks Gestation / 대한산부인과학회잡지

Fetal teratomas are histologically diverse masses containing variety of tissues foreign to the anatomic site in which they reside. Sacrococcygeal teratomas are the most common and account for 50% of neonatal teratoma. Faciocervical teratomas are rare and accounts for only 5.5% of all neonatal teratoma, having an incidence of only 20,000:1 to 40,000:1 of live births. Immature teratoma was composed of poor differentiated or embryonal tissue which coexisted mature tissue and immature tissue was originated from neuroepithelium. We have experienced a large faciocervical teratoma and present this case with a brief review of literatures.

The Effect of Leukemia Inhibitory Factor on Embryos to the Blastocyst Formation / 대한불임학회지

OBJECTIVE: To determine the effects of leukemia inhibitory factor (LIF) on embryonal development in in vitro culture. METHODS: This is designed in vitro model using eggs from mouse. The eggs from mouse were assigned 29 for control group, 53 for 20 ng/ml of LIF, 88 for 40 ng/ml of LIF, 68 for 80 ng/ml of LIF respectively for in vitro fertilization. And 26 fertilized eggs at 2 cell stage from mouse also were assigned. The mouse embryos of all groups were cultured in medium supplemented with LIF in different concentrations, whereas the eggs in control group was cultured in medium without supplement of LIF. RESULTS: At 72 hours culture of eggs from in vitro fertilization, there was a slight increas in rate of embryonal development to morula in both LIF-20 and LIF-40 as results of 64.15% and 75% respectively, while 42.65% in inferior rate of LIF-80, compare with 51.72% in control group. But the difference between these each groups were not significant in statistically (p< or =0.05). And after 96 hours culture of eggs, the rates blastocyst formation was significantly higher in both LIF-20 and LIF-40 as 56.6% and 63.63% than those in control and LIF-80 as 44.83% and 35.29% respectively. On culturing eggs from in vivo fertilization, the rates of blastocyst formation was significantly not only higher as 85% and 81.81% respectively in medium supplemented with LIF-40 and LIF-80 than 42.3% in LIF-20 but also embryonal cell viability were remakedly improved at 96 hours after culture. CONCLUSION: The LIF in low dose is embryotrophic, but LIF in high dose is embryotoxic on eggs from in vitro fertilization. Whereas on culturing eggs from in vivo fertilization, LIF is more beneficial with dose dependent in high concentration.

The Clinical Characteristics of Pregnancy Induced Hypertension / 대한주산의학회잡지

OBJECTIVE: To study the clinical characteristics of pregnancy induced hypertension(PIH). METHODS: Five hundred seventy-five cases of PIH and 7,702 cases of normotensive pregnancies who were delivered their infants at Wonkwang University Hospital from January, 1994 to December, 1998 were selected for the study. The data were collected by review of the hospital record and the statistical analysis was performed using Chi-square tests, and statistical significance was defined as p<0.05. RESULTS: The incidence of PIH was 7.1% of total deliveries. Among the PIH, the incidence of mild preedampsia was found in 59%, severe preeclampsia in 36%, and edampsia in 5%. The most prevalent gestational period was 38-42wks gestation in mild PIH and 33-37wks gestation in severe PIH & eclampsia. The incidence of cesarean section was significantly higher in severe PIH & eclampsia(72.2%) than in mild PIH(48.7%) and normotensive pregnancies(39.7%). The incidence of hypoalbuminemia, preterm labor, placental abruption, disseminated intravascular coagulation, and pulmonary edema were significantly higher in severe PIH & edampsia than in mild PIH and normotensive pregnancies. Compared with normotensive pregnancies or mild PIH, severe PIH & eclampsia had significantly elevated risks for low birth weight, intrauterine growth retardation, fetal distress, low apgar score, meconium stained, and neonatal deaths. CONCLUSION: The incidence of PIH is not decreasing and it still an important role in the cause of maternal and perinatal mortality and morbidity in Korea. So, further studies are necessary to prepare a guide for the treatment of PIH.

The Effect of Nitric Oxide on the Embryonal Development in Mouse / 대한불임학회지

OBJECTIVE: To ananlyze the direct effect of nitric oxide (NO), generated from sodium prusside (SNP) on the embryo developments in reproductive process. DESIGN: ova from mouse were treated to allow fertilization in in vitro culture. And the samples of fertilized ova were alloted into five alliqutos. Each alliquot was cultured in media treated with either concentration at 0 (n=92), 25microM (n=84), 50microM (n=80), 100microM (n=77), 500microM (n=54) of SNP. Main Outcome MEASURE: Rates of embryonal cell cleavages, viability and cell morphology were assessed during in vitro fertilization and culture. RESULTS: As analyse the cell cleavage at 24 hours after in vitro culture of fertilised egg in variuos NO concentration, all of egg cells of each alliquot were developed to 2~4 cell stage. But the alliquot of egg cells treated with 500microM, which were totally degenerated. And also all embryonal cells of each alliquot were developed to 8 cell stage and morula stage on culture continuosly. And the embryonal cells of each alliquot were analysed at 24 and 48 hours following the in vitro culture. The rates of cell fragmentation and fusion were 4.2+/-3.4% in control group which is not treated with NO, while experimental groups was high, as rated 23.4+/-6.2% in 25microM, 28.2+/-5.7% in 50microM and 32.1+/-6.4% in 100microM concentration of NO. Accordingly the rate of abnormal morphology of embryonal cell in control was lower significantly than that in each alliquot of experimental groups (p<0.05). And the degenerated rates of embryonal cells were 0% in control, 17.8+/-6.7% in 25microM, 23.6+/-4.7% in 50microM and 26.8+/-11.2% in 100microM at 8 cells and morula on culture of 48 and 72 hours. On the examination of embryonal cells developed to blastocyst through in vitro culture, the rates of degenerated cells were 16.8+/-7.2% in control, 37.5+/-6.2% in 25microM, 73.4+/-4.6% in 50microM, 100% in 100microM. CONCLUSION: This results suggeted that the No in any concentrations is harmful on embryos in view of morphology as well as viability of cell, and the toxicity of No on embryo is stronger at condition in higher concentration of NO.

Retal Sex Determination by Polymerase Chain Reaction / 대한산부인과학회잡지

Ror fetal sex determination by the PCR method, oilgoprimers to Y- chromosome gene, DYZI, SRY, and AMGL were synthesized genomic DNA was extracted from male and female placenta for the control use. DYZI represented 154 bp single band to 0.001 pg/ml male genomic DNA but did not represent 154 bp band in female genomic DNA, SRY represented 341 bp bandto 1 pg/ml male genomic DNA in 2% agarose gel eleftrophoresis stained with ethidium bromide. DYZI was 1,000 fold sensitive than Sry and AMGL. DYZI and SRY could not identify the PDR failure from female but AMGL identified to 1,000-fold. During the dyal ampiification of female genomic DNA mixed with male genomic DNA, 0.00125 pg/nl, 1:400 part, male genomic DNA contamination represented male band but SRY amplification did not represent male band. It was suggested that SRY gene was deleted in two 46,XY felmle cases. For fetal sex determination, PCR with DYZL, SRY, and AMGL was performed in 10 cases. For fetal sex determination, PCR with DYZL, SRY, and AMGL with karyotyping in 10 cases of chorionic villi sex dietermination, PCR with DYZI, SRY, and AMGL was performed in 10 cases. For feral sex determination, PCR with DYZI, SRY, and AMGL with karyothping result, fetal sex determination, PCR with DYZI, SRY, and AMGL was performed in 10 Cases of choricinic villi and 15 cases of amnionic cells. By the comparison with karyotyping result, fetal sex determination was achieved successfully in all 23 samlies using PCR of SRY and AMGL but false result was detected in 3 cases(13%) using DYZI. Acording to our results, it was concluded that DYZL was 1,000-fold sensitive than SRY and AMGL but could not be used because of its false results, and AMGL and SRY must be used concomitantly for precise sex determination.

Effect of Antioxidant on the Toxicity Induced by Cadmium in Preimplantatio Embryos In Vitro / 대한산부인과학회잡지

In order to elucidate the mechanism of oxidative damage of cadimu(Cd) on culturedmouse preimplantation embyors.The embryotoxocity of Cd was examined after cultured mouse preimplantation embryoswere exposed to various concentrations of CdCl2. In addition, the protected effect of antioxidant,catalase against Cd-induced embryotoxicity was investigated.CdCl2 decreased the development of cultured mouse preimplantation embryos in dose andtime-dependent manners, and also oxidative damage was involoved in Cd-induced embryotoxicityin mouse preimplantation embryos by the prevention of catalase on Cd-induced toxicity.

Effect of Antioxidant on the Toxicity Induced by Cadmium in Preimplantatio Embryos In Vitro / 대한산부인과학회잡지

In order to elucidate the mechanism of oxidative damage of cadimu(Cd) on culturedmouse preimplantation embyors.The embryotoxocity of Cd was examined after cultured mouse preimplantation embryoswere exposed to various concentrations of CdCl2. In addition, the protected effect of antioxidant,catalase against Cd-induced embryotoxicity was investigated.CdCl2 decreased the development of cultured mouse preimplantation embryos in dose andtime-dependent manners, and also oxidative damage was involoved in Cd-induced embryotoxicityin mouse preimplantation embryos by the prevention of catalase on Cd-induced toxicity.

Clinical Value of Preoperative CA-125 Assay in Patients with Ovarian Mass / 대한부인종양콜포스코피학회잡지

This study was undertaker to define the usefuness of preoperative CA-125 assay as a diagnostic bmor marker in differentiating malignancy from benign ovarian mass. Senun CA-125 were imneasured by Microparticle Enzyme Immunoassay(MEIA) in 94 patients with ovarian mass. The results were of follows ; 1. The mean value of preopentive senun CA-125 was 18.40u/ml in benign ovarian mass and 225.99u/ml in malignant ovarian mass (P<0.001). 2. The positive rete of Ca-125 in benign ovarian mass was 10%, compared 80% in malignant ovarian mass. 3. In analysis of histolovgic type, posisitive rate of serum CA-125 in malignant serous tumor was 82%, cornpared 50% in malignant mucinoins tumor. 2. No statistically significant correlation was observed between CA-125 value and patient's age. 5. The sensitivitiy, specifieity, positive predictive value & negative predictive value were 80%, 90%, 60% & 96%, respectively in cut off value, 35u/ml, And increasing cut off value 65u/ml, sensitivity, specificity, positive predictive value & negative predictive value were 40%, 96%, 67%, 90%, resqxetively. These data suggest the preperative serum CA-125 level correlate with maignant stattis in ovarian mass. And cut off value 35u/ml was better than 65u/ml in screening for ovarian cancer.