Comparison of Clinical Pregnancy Rates and Affecting Factors Between Elderly and Young Infertile Females After Intra-Uterine Insemination: Benefited by ‘National Medical-aid Program for ART (assisted reproductive technology) in 2016

Purpose@#The purpose of this study was to evaluate the intrauterine insemination (IUI) success rate and to define the variables for predicting success. @*Methods@#The secondary data analysis was used with data collected from infertile females who underwent IUI in Fertility and IVF (In Vitro Fertilization) clinics, who benefited from the ‘National Medical-aid Program for ART (assisted reproductive technology) in 2016’, in which the data of 34,920 IUI cases were retrospectively reviewed. The primary outcome measure was the clinical pregnancy rate in elderly and young infertile females. Data were analyzed by descriptive statistics, χ2 test and logistic regression. @*Results@#The pregnancy rate was 12.1% (2,095 cases) in elderly infertile females and 15.6% in young infertile females (2,758 cases) (χ2 = 87.90, p < .001). Using the logistic regression analysis, clinical pregnancy was positively associated with the ovulatory factor (OR= 1.48, p< .001) and male factor (OR= 1.19, p< .05) in elderly infertile females. It was positively associated with the ovulatory factor (OR= 1.30, p= .001) and the peritoneal cavity factor (OR= 0.58, p< .05) in young infertile females. @*Conclusion@#Our results indicate that the pregnancy rate in young infertile females was higher than that in old infertile females, and the IUI is the effective option in pregnancies in all ages with infertility due to the ovulatory factor. Additionally, further studies are necessary to fully describe pregnancy experiences for all the infertile females.

Primary Pelvic Peritoneal Yolk Sac Tumor in the Post-Pubertal Female: a Case Report with Literature Review

Yolk sac tumors are rare malignant germ cell neoplasms that usually arise from the gonads. Extragonadal yolk sac tumors (EGYSTs) frequently occur in the mediastinum in post-pubertal females. EGYSTs in the pelvis are extremely rare, and to date, only thirteen cases have been reported in the English literature. Among them, the primary EGYST of the pelvic peritoneum in post-pubertal females has only been reported in ten cases. The present case describes a 26-year-old female diagnosed with primary peritoneal yolk sac tumor located in the rectouterine pouch. We report clinical and tumor imaging features, including ultrasound, computed tomography (CT), magnetic resonance images (MRI), positron emission tomography-computed tomography (PET-CT), and present a review of the literature.

Research Trend about Complementary and Alternative Therapy in Korea using Text Network Analysis / 재활간호학회지

PURPOSE: This study was aimed to identify research trends related to complementary and alternative therapy (CAT) in Korea. METHODS: Data were collected from 2000 to 2018 articles in Korean database (KISS, RISS and DBPIA). 295 semantic morphemes were extracted from 123 articles by network analysis program. Co-occurrence matrixes of the morphemes were generated by weighting Jaccard-coefficient and then we did network analysis and visualization. RESULTS: Common morphemes with high centralities were ‘Complementary and alternative medicine (CAM)’, ‘CAT’, ‘Aged’, ‘Diet therapy’, ‘Herbal medicine’, ‘Acupuncture’, and ‘Oriental medicine’. Since 2000, studies on complementary and alternative therapies have been actively involved in biological and manipulative therapies, and it has been found that the main target of CAT is the elderly. CONCLUSION: Despite much attention of complementary alternative therapies, the scientific basis is insufficient. Through this study, we could find research trends in complementary alternative therapies and set the direction of future research. It is necessary to expand research on complementary replacement therapy for various diseases and age groups.

Efficacy and safety of drospirenone 2 mg/17β-estradiol 1 mg hormone therapy in Korean postmenopausal women

This regulatory post-marketing surveillance study aimed to evaluate the therapeutic efficacy and safety of drospirenone (DRSP) 2 mg/estradiol (E₂) 1 mg tablet in Korean postmenopausal women. A total of 4,149 patients were enrolled and the study was conducted at 207 clinical research centers. The patients' source data was collected between November 2006 and November 2012. More than 85% of patients experienced improvement of menopausal symptoms. The most frequently reported adverse events were vaginal bleeding and breast pain; most of the women suffering from these symptoms fully recovered. The incidence of adverse event was higher in patients of younger age (20 to 39 years), in patients with concomitant diseases, previous hormone replacement therapy in medical history, those treated with DRSP 2 mg/E₂ 1 mg for shorter duration (3 years or less) and in patients using concomitant medication. In conclusion, the results from this large post-marketing surveillance study confirm the efficacy and safety of DRSP 2 mg/E₂ 1 mg tablet in Korean postmenopausal women.

Primary Fallopian Tube Carcinoma Diagnosed with Endoscopic Ultrasound Elastography with Fine Needle Biopsy

Primary fallopian tube carcinoma (PFTC) is a rare gynecological cancer that is very difficult to diagnose preoperatively. Here, we report the case of a 66-year-old female patient with PFTC that was diagnosed preoperatively on the basis of the characteristic features on endoscopic ultrasound (EUS) elastography and fine needle biopsy (FNB). EUS showed a sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa. EUS elastography revealed that the mass had a blue color pattern, representing hard stiffness, and a heterogeneous green/red color pattern distributed outside the tumor, representing intermediate stiffness. Histopathologic analysis of the FNB and operative specimens confirmed the diagnosis of fallopian tube carcinoma. This is the first reported case of a combined EUS elastography and FNB of an adnexal mass leading to a preoperative diagnosis of fallopian tube carcinoma.

Menopausal Symptoms and Quality of Life according to Hormone Replacement Therapy in Rural Postmenopausal Women / 재활간호학회지

PURPOSE: This study was conducted to identify menopausal symptoms and quality of life (QOL) according to hormone replacement therapy (HRT) in rural menopausal women. METHODS: Menopausal symptoms and QOL were measured by questionnaires. A total of 50 participants in HRT group had received hormone replacement therapy for 12 weeks and another 50 who had not received hormone therapy were assigned to non-HRT group. RESULTS: Vasomotor symptom score of non-HRT group was significantly higher than that of HRT group (p=.013). There were no statistically significant differences between two groups in all menopausal symptoms except for vasomotor symptom. There were no significant differences between two groups in the total scores and sub-scores of QOL. Total scores and sub-scores of QOL were very low in both group. Menopausal symptoms were significantly negatively correlated with QOL. CONCLUSION: These results showed that there were no statistically significant differences between HRT group and non-HRT group in menopausal symptoms except for vasomotor symptom and QOL. Menopausal symptoms were moderate and QOL was very low in menopausal women. It is necessary to develop nursing interventions to improve menopausal symptoms and QOL in menopausal women.

Diagnosis of a Malignant Tumor in a Patient with an Adnexal Mass Using Endoscopic Ultrasound Elastography

Elastography is an imaging modality for the evaluation of tissue stiffness, which has been used for the analysis of superficial organs, such as those of the breast and prostate. The measurement of tissue elasticity has been reported to be useful for the diagnosis and differentiation of tumors, which are stiffer than normal tissues. Endoscopic ultrasonography elastography (EUS-EG) is a promising imaging technique with a high accuracy for the differential diagnosis of solid pancreatic tumors. However, to date EUS-EG has not been used to provide complementary information for biologic behavior of adenxal mass. We report our experience of EUS-EG in a patient with adnexal mass.

Hysteroscopic management of cornual pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study introduces a safe, effective method for treating cornual pregnancy. METHODS: Between April 2005 and December 2008, seven patients with cornual pregnancy underwent hysteroscopic surgery at a minimally invasive surgery clinic. An 18F Foley catheter was inserted after dilating the cervix; then, the uterine cavity was irrigated with 300 mL of H2O2 solution to prevent excessive bleeding. The cornual gestation was removed by hysteroscopy without complications under ultrasonographic guidance. RESULTS: The serum beta-human chorionic gonadotropin levels were monitored postoperatively and decreased optimally in all patients. All tissues removed from the uterus were confirmed to be gestational products. The estimated blood loss was less than 30 mL. All patients were discharged on the first or second postoperative day. CONCLUSION: Hysteroscopic removal of a cornual pregnancy with H2O2 is very practical and safe.

A case of pelvic retroperitoneal benign schwannoma presenting as a gynecologic malignancy with pulmonary thromboembolism / 대한산부인과학회지

Retroperitoneal schwannomas are rare tumors difficult to diagnose preoperatively. It may originate at the cranial nerves or nerves of the upper extremities, but origin along the nerves of the retroperitoneal space is very rare. Most of the retroperitoneal schwannomas are benign neoplasm. These tumor can be misdiagnosed as adnexal mass or carcinoma. Venous thromboembolism or pulmonary embolism is increasingly recognized as a common complication in patients with malignant disease. We report a 37-year-old woman presented with pulmonary thromboembolism and a pelvic mass which was incidentally found and misdiagnosed as ovarian cancer. Histopathologic results of the extirpated mass turned out to be a benign schwannoma.

Sister Mary Joseph's nodule from advanced ovarian carcinoma / 대한산부인과학회지

Umbilical metastasis may be the first presenting sign of the disease, or an indication of a recurrence from a previous malignancy. We recently encountered a 19-year-old woman with advanced ovarian adenocarcinoma whose first sign was having a Sister Mary Joseph's nodule. This patient only presented an umbilical nodule with slight lower abdominal discomfort, without any other subjective symptom. The lesion was fresh red, firm, ulcerating and has 1.5 cm in diameter. A punch biopsy from the lesion revealed metastatic adenocarcinoma and a PET-CT scan showed hypermetabolism on the umbilicus. After a systemic evaluation, she had a laparotomy including right salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy, appendectomy, and extirpation of the umbilicus. The patient received a postoperative combination of chemotherapy with paclitaxel and carboplatin, and still remains alive. This case demonstrates the importance of careful evaluation of any umbilical lesion and pathologic examination.

Rupture of mucinous adenocarcinoma of ovary and pseudomyxoma peritonei with pregnancy: Case report / 대한산부인과학회지

The occurrence of ovarian cancer during pregnancy is a very rare, and the incidence is 1:10,000 to 1:50,000. However, this number is likely to increase since childbearing is more and more frequently delayed. The clinical outcome of patients with ovarian cancer is the same regardless of whether the diagnosis of ovarian carcinoma is done during pregnancy or in non-pregnant women; therefore, the same surgical staging procedures are recommended in the two groups. However, it should be considered to performed a diagnostic operation and preservation of pregnancy, advantage of the administration of chemotherapy, what time give birth to, what time perform a staging operation. We here report our experience with a case of advanced ovarian carcinoma during pregnancy, which was managed conservative surgery with chemotherapy until delivery.

Massive hemoperitoneum from spontaneous venous rupture overlying a uterine myoma: A case report / 대한산부인과학회지

Spontaneous intraperitoneal hemorrhage from uterine leiomyomas is rarely encountered. The cause of hemorrhage is mainly trauma and torsion of myoma. Massive intraperitoneal hemorrhage from spontaneous rupture of a superficial uterine vein overlying a subserous myoma is extremely rare. A 48-year-old woman complained general weakness, lower abdominal discomfort and lower back pain. On admission to the hospital, hypovolemic shock, severe anemia and ascites were noticed. Ultrasonography and CT scan showed huge pelvic mass and much amount of fluid in the pelvic cavity. During emergent laparotomy, 3,500 mL of blood were drained from the abdominal cavity and a ruptured superficial vein was noted, located on the serosal surface of a fundal myoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to spontaneous rupture of a superficial uterine vein overlying a subserous myoma.

Immunohistochemical analysis of pelvic lymph node micrometastases in cervical cancer patients with histologically negative nodes / 부인종양

OBJECTIVE: The purpose of this study was to identify, by immunohistochemistry, possible micrometastasis in the pelvic lymph nodes previously considered free by conventional histopathological examination, and to assess their influence on the survival of patients with cervical cancer. METHODS: This retrospective study included patients (n=51) operated on between February 2001 and May 2004 for cervical cancer without histopathologic lymph node involvement. Lymph nodes (n=282) from 51 patients with histologically node-negative cervical cancer were evaluated for micrometastasis. These were submitted to immunohistochemical study using AE1/AE3 anti-cytokeratin monoclonal antibodies to identify neoplastic epithelial cells. RESULTS: The mean age of the patients was 45.3 years (range, 27-72). Lymph node micrometastases were immunohistochemically detected in 3 of the 51 patients (5.9%), comprising 3 of 282 (1.1%) pelvic lymph nodes examined. One patient (Ib2) had adenocarcinoma and others (Ib1,Ib2), squamous cell carcinoma. All of them had negative lymph-vascular space invasion. In three patients, there were recurrences (66.7%, 2/3), and one patient (Ib1) died from the pelvic recurrence. CONCLUSION: We recommend an immunohistochemical examination for lymph node micrometastases in cervical cancer patients with histologically negative nodes. This immunohistochemical method can be employed successfully in the detection of neoplastic cells in lymph nodes previously considered free. Micrometastasis could provide important information for further treatment strategies and follow up. Its clinical significance in cervical cancer warrants further study.

Comparison of the solution of ThinPrep(TM) Pap test with the Cervical Sampler(TM) of Hybrid Capture (HC) II for detecting Human papillomavirus (HPV) DNA / 부인종양

OBJECTIVE: Our purpose was to compare the difference and the positivity rate between Preserv Cyt(TM) solution of Thin-Prep(TM) Pap test and Cervical Sampler(TM) of Hybrid Capture II for detecting HPV DNA. METHODS: We collected samples of the cervix by using Preserv Cyt(TM) solution of Thin-Prep(TM) Pap test and a Cervical Sampler(TM) of Hybrid Capture II from ninety one women who screened for cervical carcinoma and precancerous cervical lesions between January 2003 and March 2003. At the same time, we tested the sample using the Preserv Cyt(TM) solution left over with a sample conversion kit. The cut off value for positive test result was above 1 pg/mL. RESULTS: The results of comparing the test using the Preserv Cyt(TM) solution of Thin-Prep(TM) Pap test with the one using Cervical Sampler(TM) showed negative results and 34 patients showed positive results with a significant high kappa coefficient of 0.674. The HPV titer of 10. Agreement rates of Preserv Cyt(TM) solution according to the HPV titer of Cervical Sampler(TM) were as follows: 97.7% in values below 1, 96.8% in values above 10, but 17.6% in values 1 to 10. So, the agreement rate was low between Cervical Sampler(TM) and Preserv Cyt(TM) solution in low value of HPV of Cervical Sampler(TM). CONCLUSION: Comparing the test using Preserv Cyt(TM) solution with Cervical Sampler(TM), there was a high correspondence and the Preserv Cyt(TM) solution was facilitated to detection for HPV at a time.