Usefulness of modified BRB technique in treatment to ablate uterine fibroids with magnetic resonance image-guided high-intensity focused ultrasound

OBJECTIVE: If bowels and other structures are in the pathway of high-intensity focused ultrasound (HIFU) beam during magnetic resonance image-guided HIFU (MRgFUS) therapy, filling to the bladder and the rectum and then emptying the bladder (i.e., the BRB technique) is used to avoid them. A modified BRB technique might be useful method to using a uterine elevator method or by inducing uterus downward traction to lower the position of the uterus. METHODS: A total of 156 patients who had undergone MRgFUS surgery treatment for uterine fibroids from March 2015 to February 2016 were included in this retrospective study. Of the 156 patients, 40 were treated using a uterine elevator while 29 were treated using downward traction of uterus. HIFU was performed using Philips Achieva 1.5 Tesla MR and Sonalleve HIFU system. RESULTS: MRgFUS surgery was feasible with modified BRB technique in 69 cases. Using uterine elevator method, the intensity of HIFU for group with antefletxio uteri was significantly lower than that for the group without antefletxio uteri (105.37±17.62 vs. 118.71±26.88 W). The group with downward traction of uterus induced was found to have significantly lower intensity of HIFU compared to the group without downward traction of uterus induced (110.26±22.60 vs. 130.51±27.81 W). CONCLUSION: Modified BRB technique was useful in avoiding bowels and other structures located in HIFU beam pathway during MRgFUS treatment to ablate uterine fibroids.

Comparison of Surgical Outcomes according to Suturing Methods in Single Port Access Laparoscopic Myomectomy

OBJECTIVES: This study was performed to consider the clinical experience of surgical outcome of single port access (SPA) laparoscopic myomectomy according to suturing methods. METHODS: The authors operated with 2 suturing method in SPA laparoscopic myomectomy for 246 patients and compared the surgical outcomes. RESULTS: The some significant difference of surgical outcome according to two suturing methods was demonstrated. Operating time was 100.50 minutes (+/- 42.09 minutes) in interrupted suture method group than 121.04 minutes (+/- 61.56 minutes) in continuous interlocking suture method group (P = 0.021). Estimated blood loss was less 222.59 mL (+/- 144.94 mL) in interrupted suture group than 340.11 mL (+/- 380.62 mL) in continuous interlocking suture method group (P = 0.042). CONCLUSION: This experience suggests that interrupted suture method was effective for operating time and estimated blood loss than continuous interlocking method in SPA laparoscopic myomectomy.

The Clinical Experience of an Ultrasound-guided Vacuum-assisted Resection (Mammotome) for Benign Breast Lesions through a Core Needle Biopsy / 대한폐경학회지

OBJECTIVES: This study was performed to consider the clinical experience of an ultrasound-guided vacuum-assisted resection (Mammotome) for benign breast lesions through a core needle biopsy. METHODS: The authors carried out a core needle biopsy and Mammotome for 347 patients and investigated the pathologic results. RESULTS: The significant difference of core needle biopsy and Mammotome results was demonstrated, Spearman correlation coefficient is 0.413 in a correlation analysis. CONCLUSION: This experience suggest Mammotome is a useful procedure for providing more correct pathologic findings through complete resection of benign breast lesions.

Relationship between CD44v6 Expression and Clinicopathologic Parameters in Endometrial Carcinomas / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the clinical usefulness of CD44v6 in patients with histologically confirmed endometrial cancer. METHODS: Immunohistochemistry was used to determine the expression of CD44v6 in 39 hysterectomy specimens with the diagnosis of endometrial cancer. RESULTS: CD44v6 expression was detected in 8 specimens with no myometrial invasion of endometrial cancer, one specimen with 50% myometrial invasion. There was a significant association between CD44v6 expression and no myometrial invasion of endometrial cancer. There was a statistically significant association between CD44v6 expression and lymph node metastasis, lymphovascular involvement. And all cases of CD44v6 expression were FIGO stage I with histological grade 1 or 2. CD44v6 expression was statistically related with estrogen receptor expression. Although statistical significance was not revealed, it was likely that CD44v6 expression was related with progesterone receptor expression with positive predictive value of 6/9 (66.7%). CONCLUSION: Significant relationships between myometrial invasion, lymph node metastasis, lymphovascular involvement, surgical stage and expression of estrogen receptor and CD44v6 expression suggest that CD44v6 expression could be a good prognostic factor. CD44v6 expression may have potential clinical usefulness if this expression is demonstrated in a further study with prehysterectomy sampling specimens containing endometrial cancer.

A Case of Endometriosis of Ovary and Cervix Combined with Huge Uterine Myoma / 대한산부인과학회잡지

Uterine leiomyomas are the most common solid pelvic tumors in women and endometriosis is an exceedingly common gynecologic problem. The most common site of endometriosis is the ovary, and other organs affected are posterior cul-de-sac, anterior uterovesical peritoneum, uterosacral ligaments, tube, uterus, rectovaginal septum, sigmoid colon, cervix and vulva. Cevical endometriosis is usually regarded as an uncommon lesion. We experienced a case of endometriosis of ovary and cervix with huge uterine myoma.

Two Cases of Endometrial Adenocarcinoma Associated with Tamoxifen Use / 대한산부인과학회잡지

Tamoxifen citrate is a non-steroidal agent that has demonstrated estrogen agonist and antagonist properties and has found successful application for all stages, as adjuvant therapy, in the treatment of primary breast cancer. The drug was originally introduced for the treatment of high risk postmenopausal women or for postmenopausal patients with advanced disease. Since then, it was reported that long term treatment schedules could provide maximal benefit in preventing recurrences. Recent analyses of clinical trials have demonstrated an increase of disease-free survival in breast cancer among patients with positive estrogen receptor tumor. Tamoxifen is now recommended for chemoprevention of breast cancer in healthy high risk women. An agonist estrogenic effect upon the endometrium, the so called "paradoxical" effect, is suggested when proliferative changes, such as endometrial hyperplasia, adenocarcinoma, polyps. We report a case of endometrial cancer which developed in premenopausal patients with breast cancer under tamoxifen therapy.

Angiomyofibroblastoma Occupying Paravesical Space / 대한산부인과학회잡지

Angiomyofibroblastoma is a benign, distinctive, and rare soft tissue tumor of vulva and vagina that might be mistaken for aggressive angiomyxoma. It is suggested that angiomyofibroblastoma is slow-growing in nature and consistent with the benign clinical course reported in the literatures. 21-year-old woman complained of lower abdominal pain and odorous vaginal discharge. She had a large paravaginal mass obliterating vaginal canal. It was maybe absent 3 months ago, but it was occupied in paravesical space later. It revealed angiomyofibroblastoma, which rapid grew and located in vagina. It was removed by vaginal approach. This report describes a case of angiomyofibroblastoma in paravaginal space characterized by rapid growth.