Reproductive Outcomes after Metroplasty in Patients with Congenital Uterine Anomalies / 대한산부인과학회잡지

OBJECTIVE: Metroplasty has been shown to improve the reproductive outcomes in patients with congenital uterine anomalies, especially for those suffering from multiple fetal losses. This study was performed to evaluate the impact of abdominal metroplasty on the reproductive outcomes in patients with infertility or recurrent abortions. METHODS: Among fifty cases diagnosed as Mullerian anornalies at SNUH from Oct. 1988 to Dec. 1996, only 26 cases were included in this retrospective study. Inclusion criteria was the patients with primary infertility(n=7) or recurrent spontaneous abortions(n 19) who underwent abdominal metroplasty for the correction of uterine anomalies. Statistical analysis was carried out by chi-square test using SPSS ver 7.0. RESULTS: Bicornuate uterus was the most common uterine anomaly as 53.9%(14/26). After metroplaty, the overall live birth rate was increased from 0% to 57.7%(15/26), and the live birth rate in patients with recurrent abortions, 68.4%(13/19), was significantly higher than that in patients with primary infertility, 28.6%(2/7). The rate of fetal wastage was dropped from 96.0%(48/50) to 41.7%(10/24) after metroplasty in 19 patients with recurrent abortions. Pelvic pathologic lesions associated with uterine anomalies were diagnosed in 11(42.3%) patients, and 45.5%(5/11) of them succeeded in live births postoperatively. CONCLUSION: These data showed that metroplasty may improve the reproductive outcomes definitely in patients with recurrent abortions. Although the impact of metroplasty on the fertility in infertile patients was not definite, it seems better to perform metroplasty in infertile patients with uterine anomaly, which offers the opportunity to correct the combined pelvic lesions such as myoma, ovarian cyst or endometriosis, and to avoid the chance of abortion after ART(assisted reproductive technology) such as 1VF-ET.

Treatment Efficacy of High-Dose Megestrol Acetate (Megace) in Young Women with Early Stage of Endometrial Carcinoma / 대한부인종양콜포스코피학회잡지

The effectiveness of progestogens in advanced and recurrent endometrial carcinoma has been widely accepted. But the use of progestogens in young women with early stage of endometrial carcinoma (Stage Ia) is controversial. Some authors reported that progestogens alone therapy improved or cured the endometrial pathology in young patients with early stage of endometrial carcinoma. The response to the progestogens has known to be better in cases of early stage, well-differentiated histologic type and narrow depth of invasion. We used the high-dose megestrol acetate (Megace(R)) as the primary treatment in four young women with early stage of endometrial carcinoma (Stage Ia) for the purpose of saving the fertility. We made the patients to have 320~400 mg of Megace(R) per day for 3 months, and then repeated the endometrial curettage for the purpose of finding changes of endometrial pathology. Three cases revealed no response to the Megace(R), so they were operated later. One case showed the resolution of endometrial pathology and delivered a baby following therapy. There have been no evidences of clinical recurrence in all cases. Even though the therapeutic efficacy is limited, high-dose therapy with megestrol acetate can be used as primary therapy in young women with early stage of endometrial carcinoma.

Reproductive Outcomes after Microsurgical Reversal of Tubal Sterilization in Women 36 Years Age or Older / 대한불임학회지

OBJECTIVE: To determine the reproductive outcomes of women undergoing microsurgical reversal of tubal sterilization at age 36 years or older. MATERIALS AND METHODS: A series of 133 patients who received microsurgical reversal of the previously sterilized fallopian tubes at Seoul National University Hospital from July, 1980 to January, 1992 was reviewed and evaluated for clinical characteristics, pregnancy rates, and factors influencing the outcome of tubal reversal. RESULTS: Of 133 patients, 78 (58.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading cause for tubal reversal. The mean interval from tubal sterilization to tubal reversal was 65.0 months. The overall pregnancy rate was 52.6% (70/133), and the mean interval was 9.4 months from tubal reversal to pregnancy. Excluding 7 patients who were lost to follow-up, 76 pregnancies were confirmed in 63 patients with the delivery rate per patient of 66.7% (42/63). There were no significant differences in age, duration of tubal sterilization, postoperative tubal length between pregnant and non-pregnant groups. CONCLUSIONS: Microsurgical reversal of tubal sterilization could be a justifiable method in women 36 years age or older.

Cardiac Arrest following Epidural Block for Postoperative Pain Control / 대한마취과학회지

The continuous epidural anesthesia is an effective method for postoperative pain control and improvement of pulmonary function. A 39-year-old man was scheduled for postoperative intestinal obstruction. After adhesiolysis under the general anesthesia, epidural anesthesia was done for postoperative pain control. Because an accidental dural puncture was noticed, the adjacent interspace of epidural anesthesia was tried and catheter was inserted. Respiratory depression, hypotension, loss of consciousness and cardiac arrest were developed about 20 minutes after the first injection of 1% lidocain 10ml. Endotracheal intubation was performed and the respiration was controlled using 100% oxygen. Self respiration and alert mentality returned after 180 minutes. No CSF leakage, delayed onset time, severe hypotension, complete recovery may be the result of subdural anesthesia and postoperative hypoxia. But radiological examination was not performed.