A clinical study on the trocar-guided mesh repair system for pelvic organ prolapse surgery

OBJECTIVE: To evaluate the complication and recurrence rates in patients undergoing trocar-guided mesh implant for pelvic organ prolapse (POP) treatment. METHODS: A retrospective study was performed based on the medical records of patients who had undergone mesh implant by one surgeon from May 2006 to August 2013 at the Presbyterian Medical Center in Korea. We evaluated perioperative complications such as bladder injury, mesh exposure, urinary symptoms, infections, and chronic pelvic pain. Recurrence was defined as a POP-quantification system stage ≥II or any symptomatic prolapse. RESULTS: Sixty-seven patients were evaluated, and the mean age of patients was 65.4±7.2 years. Stage ≥III POP-quantification Ba was noted in 61 patients (91%). Intraoperative complications included three cases of bladder injury (4.5%). The mean follow-up period was 44.1±7.9 months. Postoperative complications occurred in seven women (10.5%): four cases of urinary symptoms (6%), two cases of infections (3%), and one case of chronic pelvic pain (1.5%). Mesh exposure did not occur (0%). Prolapse recurrence was reported in five patients (7.5%). CONCLUSION: Based on our operational result, the trocar-guided mesh implant seems to provide safe and effective outcomes.

Clinical analysis of the endometriosis / 대한산부인과학회지

OBJECTIVE: We studied clinical characteristics of patients have endometriosis to provide basic knowledge for diagnosis, treatment, and futher study of endometriosis. METHODS: We have performed a retrospective clinical study on 163 patients diagnosed with endometriosis during laparotomy, cesarean section, laparoscopic surgery at our medical center from January, 2000 to December, 2004. RESULTS: Incidence of endometriosis was 4.38%. The more frequent occurrence was noted in the young women with low parity and in the nulliparous women. Most frequent symptom comprised dysmenorrhea and lower abdominal pain. 33.7% of patients were asymptomatic. And 82.3% of the patients were in stage III and IV. The frequent sites involved were ovaries, Cul-de sac, uterus, tubes, peritoneum and rectum in order. Frequently combind gynecologic disease were uterine myoma, benign ovarian tumor. In Stage III & IV, there are more patients, who had abnormal elevated serum CA 125 level than patients of stage I & II. CONCLUSION: Early diagnose and appropriate management of Endometriosis for young women can lowered the development of hihger stage case and it is important for fertility and better life quality.

Clinical Analysis of 501 Cases of Mid-trimester Genetic Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: To analyze the change of indications and chromosomal abnormalities according to pateint's age and indications in midtrimester genetic amniocentesis. METHODS: This study reviewed 501 prenatal genetic amniocentesis cases from June 1995 to April 2004 which were done at Presbyterian Medical Center. We analized the changes of the indication, age distribution and chromosomal results according to maternal age and indications of amniocentesis. RESULTS: In 501 cases, the most common maternal and gestational age distributions were 30-34 years old and 17 weeks (32.54% and 25.98%, respectively). Abnormal maternal serum markers were the most common indications for amniocentesis (46.9%), and followed by old age (24.96%), combined old age and abnormal maternal serum screening (14.38%), ultrasonographic abnormality (4.60%). The overall incidence of chromosomal abnormalities were 3.79% (19 cases), of which numerical abnormalities and structural abnormalities were 1.79% (9 cases) and 2.0% (10 cases), respectively. In autosomal disorders, Down syndrome 4 cases, translocation 3 cases, mosaicism 2 cases, deletion 1case were diagnosed. In sex chromosomal disorders, Turner syndrome 1 case and mosaicism 2 cases (Turner syndrome 1 case, Triple X chromosome 1 case) were diagnosed. No statistic significance was found among different age groups. Those who had ultrasonographic abnormalities were found to have correlation with chromosomal abnormalities than other indications. CONCLUSION: Among the several indications for prenatal cytogenetic diagnosis, ultrasonographic abnormalities and abnormal maternal serum markers might be important indications. Especially, ultrasonographic abnormalities could be the most predictive markers for abnormal fetal karyotypes.

A Case of Sertoli-Leydig Cell Tumor with Raised Alpha-Fetoprotein In a Patient with Thyroid Adenoma / 대한산부인과학회잡지

Sertoli-Leydig cell tumor (SLCT) which belong to the group of sex-cord stromal tumors is a rare ovarian tumor. It usually develops the symptom of masculinization by excessive testosterone from the Leydig cell. In most cases, SLCTs are unilaterally localized (97-98%) and prognosis prove generally favorable with 5-year survival rate (79-90%). Recurrence is rare after a complete resection as well. Rare SLCTs secrete the alpha-fetoprotein (AFP). There is a increasing tendency for the SLCTs that have heterologous elements and low differentiation to secrete the AFP, which is useful in diagnosis of recurrence. The association of a thyroid adenoma and a SLCT has been described rarely. The relation between these two tumors has been suggested on the basis of a relatively high incidence of thyroid adenomas in the presence of such an uncommon ovarian neoplasm. It seems likely that this tumor complex is genetically determined by the aspect of familial neoplastic syndromes. We experienced a case of Sertoli-Leydig cell tumor with AFP-producing Sertoli cells in a 33-years old woman who has past history of thyroid adenoma, amenorrhea and a huge abdominal mass. Therefore, we present it with a brief review of literature.

Two Cases of Endometriosis at the site of Episiotomy Scar and Abdominal Scar following Cesarean Section / 대한산부인과학회잡지

The most frequent ectopic locations of endometriosis include, in descending order of frequency, the ovaries, uterine ligaments, the rectovaginal septum, and peritoneum covering the pelvic organs, that is, uterus, fallopian tubes, rectum, sigmoid colon, and bladder. Endometriosis at the site of episiotomy scar and abdominal scar following cesarean section are very rare conditions among the extrapelvic endometriosis. We have experienced two cases of endometriosis. One occurred from episiotomy scar and the other occurred from abdominal scar following cesarean section. The diagnosis of scar endometriosis is suggested if the symptoms are cyclic or in association with the patient's menstrual cycle. We can use ultrasonography, computerized tomography, magnetic resonance imaging to differentiate from other tumors. Surgical excision is the method of choice for diagnosis and treatment. We report the two cases with review of rare extrapelvic endometriosis.