Efficacy of loop electrosurgical excision procedure with cold coagulation for treating cervical intraepithelial neoplasia: A two center cohort study

OBJECTIVE: To evaluate the efficacy of loop electrosurgical excision procedure (LEEP) combined with cold coagulation for treating cervical intraepithelial neoplasia (CIN). METHODS: We reviewed clinic-pathologic data of 498 patients treated with LEEP alone (n=354), and LEEP combined with cold coagulation (n=144) between January 2000 and December 2011. After LEEP, we followed up all patients by using Papanicolaou smear and human papillomavirus (HPV) test, and evaluated abnormal cervical cytology-free interval and high-risk HPV infection-free interval. Moreover, we investigated independent factors affecting abnormal cervical cytology or high-risk HPV infection after LEEP. RESULTS: Abnormal cervical cytology-free interval was longer in patients treated with LEEP combined with cold coagulation than in those treated with LEEP alone (mean, 92.4 vs. 84.4 months; P=0.01), and patients treated with LEEP combined with cold coagulation also showed longer high-risk HPV infection-free interval than those treated with LEEP alone (mean, 87.6 vs. 59.1 months; P=0.01). Moreover, CIN 3 and cold coagulation were factors affecting abnormal cervical cytology after LEEP (adjusted hazard ratios, 1.90 and 0.61; 95% confidence intervals, 1.27 to 2.84 and 0.39 to 0.96), and CIN 3, positive deep cervical margin and cold coagulation were also factors affecting high-risk HPV infection after LEEP (adjusted hazard ratios, 2.07, 4.11, and 0.64; 95% confidence intervals, 1.38 to 3.08, 1.63 to 10.39, and 0.43 to 0.96). When we performed subgroup analyses for patients with CIN 2 or CIN 3, the result were similar. CONCLUSION: LEEP combined with cold coagulation may be more effective for treating CIN than LEEP alone. Moreover, cold coagulation may decrease the risk of potential of recurrence after LEEP.

A case of vulvar hematoma with rupture of pseudoaneurysm of pudendal artery

Vulvar hematomas are uncommon outside of the obstetric population and may be the result of trauma to the perineum. Vulvar hematomas most often present with low abdominal pain and urologic and neurologic symptoms. The vulva has rich vascularization that is supplied by the pudendal artery, a branch of the anterior division of the internal iliac artery. We describe a rare case of a 15-cm-sized vulvar hematoma with the suggested rupture of a pseudoaneurysm of the left pudendal artery without trauma injury. A 14-year-old girl presented with sudden pain and swelling in her left labium and was successfully treated with selective arterial embolization and surgical evacuation. We provide a literature review and discuss patient treatment and management strategies.

A clinical study on wheezing of mycoplasma pneumoniae pneumonia in children

The relationship between respiratory infections and exacerbations of wheezing in patients with wheezy bronchitis or asthma has been described. Most respiratory infections were viral or Mycoplasma pneumoniae. This study was performed to evaluate the effect of Mycoplasma pneumoniae infection on bronchial reactivity and atopic background. 106 patients with Mycoplasma pneumoniae pneumonia who were admitted to the department of pediatrics, Fatima Hospital, Taegu during the period of two years from January 1989 to December 1990 were involved in this study. The results were as follows 1) Out of 106 cases, 69 were male,37 were female and 34.9% of the cases were between 5~6 years of age. 35 cases(33.0%) had wheezing and the incidence of wheezing were higher in male than in female. 2) The incidence of wheezing was high in the patients with serum IgE level higher than 200IU/ml, patients with past and family history of allergy and the patients fed with formula feeding in infancy. 3) Eosinophils and the associated maxillary sinusitis had no effect on the incidence of wheezing. 4) The recurrence of wheezing was higher in Mycoplasma pneumoniae pneumonia with wheezing(26.8%) than in patients without wheezing(3.8%).

A case of Bartter's syndrome

Bartter's syndrome is a rare tubular disorder characterized by hypokalemic, hypochloremic metabolic alkalosis, hyperreninemic hyperaldosteronism, hyporesponsiveness to pressor agents, and juxtaglomerular apparatus hyperplasia. We report here a case of Bartter's syndrome in a 5 month-old male infant who improved with potassium supplements. In addition to a case report, brief review of related literatures was done.