A Clinical Study of Pelvic Actinomycosis / 대한산부인과학회잡지

OBJECTIVE: Actinomycosis is a rare entity, especially in the female genital tract, which presents some difficulties in establishing a correct preoperative diagnosis. Pelvic actinomycosis can mimick pelvic or intra- abdominal malignancy leading to mutilating surgical exercise. The authors surveyed 12 cases of pelvic actinomycosis for advice to detection and treatment of the pelvic actinomycosis. METHODS: The authors studied retrospectively 12 cases which have admitted to Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center for pelvic actinomycosis from January. 1, 1991 to December. 31, 2000. RESULTS: 41.7% of the cases occurred in 31-40 years age group, 91.7% of cases associated with intrauterine devices for 5-21 years. Most common complaints were abdominal pain and palpable mass, and other complaints were vaginal discharge, bowel habit change, nausea, vomiting and fever. The actinomycosis lesions involved one or both ovaries in all 12 cases. In 11 cases, the lesions extended to other areas, such as the uterus, parametrium, pelvic walls, cul-de-sac, colon and bladder. All patients underwent surgery that included removal of the lesions with ipsilateral or bilateral adnexa and, in specific cases, with extension of the lesions, hysterectomy, colostomy and primary repair of bladder or rectum. After surgery, 9 patients were treated with penicillin and the duration of treatment was 12 months in 2 patients, 6 months in 3, < or = 3 months in 3 and one patient was being treated for 2 months. Other 3 patients were treated with metronidazole, cephalosporin and aminoglycoside during 1-3 weeks. All patients were alive and well. CONCLUSION: It is needed to make an earlier and more correct diagnosis of actinomycosis, and high-dose intravenous antibiotic therapy can reduce the risk of nearby pelvic structure injuries. In cases of pelvic actinomycosis where the abscess can be completely resectable, a shorter period of antibiotic therapy can be required.

In-utero fetal therapy of posterior urethral valve syndrome: A case of vesicoamniotic shunting using a basket-shaped catheter / 대한산부인과학회잡지

We present a case of in-utero treatment of posterior urethral valve syndrome(PUVS) by vesicoamniotic shunting. The shunt was established by basket-shaped catheter at the 22 weeks' gestation. Enlarged bladder and hydronephrosis were improved after the shunt procedure. The baby was delivered at the 39 weeks' gestation and had normal serum range of BUN and creatinine. Because the outer opening of catheter was burried under abdominal skin on the day before delivery, posterior urethral valve excision and basket removal through urethra were operated by endoscopy on the 2nd day of birth. The baby has been followed up for 5 months and in good health. We report this case with a brief review of literature. Shunt operation in-utero is considered as a safe and effective therapy for lower urinary tract obstruction caused by PUVS.

Clinical Analysis of Hysteroscopic Treatment of Intrauterine Adhesion / 대한산부인과학회잡지

OBJECTIVES: To evaluate the causes of intrauterine adhesion (IUA) and the efficacy of hysteroscopic adhesiolysis in patients with IUA METHODS: From January 1995 to June 1999, a total of 63 patients with IUA were underwent hysteroscopic adhesiolysis. The patients with IUA only were trying to be pregnant spontaneous whereas, intrauterine insemination (IUI) or in vitro fertilization and embryo transfer (IVF-ET) were performed in the patients who have other infertility factors and IUA as well. The data such as the changes of menstrual amount and pattern, fertility, and full-term live birth rate were analyzed. RESULTS: The most common cause of IUA was curettage related problems; after incomplete abortion 20.6%, postpartum bleeding 9.5%, elective abortion 47.6%, missed abortion 11.1%, and for treatment of hydatidiform mole 1.6%. All patients with amenorrhea or oligomenorrhea had improvement of their menstrual patterns. Forty seven patients wanted pregnancy and 31 patients achieved pregnancy (68.4%). Full-term live birth rate 38.3% and there was one placenta accreta in full-term live birth case, which was resolved by postpartum curettage. CONCLUSION: Hysteroscopic adhesiolysis of IUA could be effective for restoring the normal menstrual pattern and fertility.