Uterine arteriovenous malformation with repeated vaginal bleeding after dilatation and curettage

Uterine arteriovenous vascular malformation (UAVM) is a disease that causes excessive bleeding. The symptoms do not subside without proper treatment and this can lead to life-threatening situations. The correct diagnosis of UAVM can be complicated if the patient's uterus did not completely discharge everything during abortion (in broader terms, retaining remnants of the products of conception). In this case, Doppler ultrasonography and computed tomography angiography with 3-dimensional rendering were used to analyze the cause of bleeding and provide proper treatment of this patient. Then, uterine artery embolization, dilatation, and curettage were performed safely and successfully. The patient no longer had symptoms of vaginal spotting during the planned follow up care. UAVM is uncommon; however, if reproductive-age women show repeated abnormal vaginal bleeding after dilatation and curettage, a diagnosis of UAVM must be considered based on the medical history and examination.

Various Clinical Presentation of Post-Transplant Lymphoproliferative Disorder in Head and Neck: A Case Series of 3 Patients / 대한이비인후과학회지

The outcome of solid organ and bone marrow transplantation has been dramatically improved with the development of immunosuppressive agent. However, the use of immunosuppressive agents could increase the risk of malignancies such as post-transplant lymphoproliferative disorder (PTLD). PTLD is regarded as the lymphoid malignancy of patients using immunosuppressive agents, and it could present diverse and non-specific symptoms. It involves various organs including the tonsil, adenoid, lymph node, and the brain. Because of its poor prognosis, an early suspicion of pathologic diagnosis is crucial for the treatment of PTLD. In this report, we demonstrate the case of three pediatric patients who had been treated for PTLD of various clinical presentations by early suspicion and pathologic diagnosis.

Paraquat Induces Apoptosis through Cytochrome C Release and ERK Activation

Paraquat has been suggested to induce apoptosis by generation of reactive oxygen species (ROS). However, little is known about the mechanism of paraquat-induced apoptosis. Here, we demonstrate that extracellular signal-regulated protein kinase (ERK) is required for paraquat-induced apoptosis in NIH3T3 cells. Paraquat treatment resulted in activation of ERK, and U0126, inhibitors of the MEK/ERK signaling pathway, prevented apoptosis. Moreover, paraquat-induced apoptosis was associated with cytochrome C release, which could be prevented by treatment with the MEK inhibitors. Taken together, our findings suggest that ERK activation plays an active role in mediating paraquat-induced apoptosis of NIH3T3 cells.

Extra-renal anomalies associated with fetal renal dysgenesis / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate other anomalies associated with the fetal renal dysgenesis and prognosis. METHODS: Level II sonography were reviewed in the pregnant women who had been diagnosed with fetal renal dysgenesis antenatally from March 1998 to February 2005. Diagnosis was comfirmed by the autopsy or the postnatal studies including sonographic and radiologic evaluation. RESULTS: Thirty fetuses had a fetal renal dysgenesis. There were 2 cases of polycystic kidney, 4 cases of bilateral renal agenesis, 4 cases of unilateral renal agenesis, 3 cases of bilateral multicystic dysplastic kidney and 17 cases of unilateral multicystic dysplastic kidney. The common associated anomalies were congenital heart disease (7 cases), single umbilical artery (5 cases), imperforate anus (2 cases) and tracheo-esophageal fistula (2 cases). Hypospadia and scoliosis with hemivertebra were also noted. CONCLUSION: The most common anomaly associated with renal dysgenesis was congenital heart diseases. If fetal renal dysgenesis is detected antenatally, fetal echocardiography should be performed.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors / 부인종양

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors / 부인종양

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

Prenatal Detection of a Congenital Pancreatic Cyst by Ultrasound

We present a case of a fetal pancreatic cyst, a rare disease in fetal life, detected prenatally at 30 weeks' gestation by ultrasound. Routine ultrasound examination at 30 weeks' gestation by primary obstetrician showed a cyst on the fetal abdomen. Initially, the suspected diagnosis was a mesenteric cyst. Subsequent ultrasound examination at weeks 32, 36 showed a fetal retroperitoneal cyst. A 3.6 kg female neonate was born to 23 yr old woman by spontaneous vaginal delivery at 38 weeks' gestation. The fetus underwent exploratory laparotomy. Histopathologic and immunohistochemical diagnosis revealed the cyst to be a pancreatic cyst. Surgical outcome was excellent. Thus, we report this case of a pancreatic cyst detected via prenatal ultrasonography.

A Case of Congenital Myotonic Dystrophy Diagnosed by Molecular Genetics

Congenital myotonic dystrophy is a progressive degenerative disease of the neuromuscular system, usually inherited in an autosomal dominant fashion. Affected infant presents with varying degrees of respiratory failure, often necessitating immediate and prolonged ventilatory assistance. An expression of a CTG (cystosine-thymine-guanine) repeat in the 3'-unsaturated region of a protein kinase gene contributes to the development of myotonic dystrophy. We experienced a case of congenital myotonic dystrophy in a male neonate with respiratory difficulty, hypotonia and difficulty in sucking and swallowing. His mother had mild manifestations of adult type myotonic dystrophy. PCR analysis revealed that CTG repeats in the myotonic dystrophy gene of the neonate and the mother were about 800 and 100 respectively.

Laparoscopic Burch Colposuspension with the Choi's Hook / 대한산부인과학회지

OBJECTIVE: Burch operation has been effective method for the treatment of stress incontinence. Burch operation is a well-accepted procedure for treating stress urinary incontinence secondary to urethral hypermobility without intrinsic sphincter deficiency and is the reference standard with which other procedures are compared. This study is to evaluate the effectiveness of the Choi's hook in laparoscopic Burch operation. METHODS: This study included 47 patients who had undergone laparoscopic Burch operation from October 2000 through March 2005. Of these 47 patients, 27 patients underwent traditional laparoscopic Burch operation (Group 1) and 20 patients underwent laparoscopic Burch operation with Choi's Hook on anchoring the endopelvic fascia to the Cooper's ligament (Group 2). RESULTS: The mean age of patients of Group 1 was 55.6+/-9.37 years of age and that of Group 2 was 56.0+/-5.93 years of age. There is no difference in the mean age of patients (P>0.05). The mean operating time was 90.5+/-15.32 minutes for Group 1 and 38.5+/-10.14 minute for Group 2. The mean operating time was shorter in Group 2 than Group 1 (P0.05). CONCLUSION: We performed laparoscopic Burch operation with the Choi's Hook on anchoring the endopelvic fascia to the Cooper's ligament. When we compared traditional laparoscopic Burch operation with laparoscopic Burch operation with Choi's Hook, we could shorten the operation time using the Choi's Hook.

Laparoscopic Paravaginal repair for the Treatment of Symptomatic Cystocele / 대한산부인과학회지

OBJECTIVE: Cystocele is caused by generalized relaxation or attenuation of the endopelvic fascia. The most common etiology is birth injury. The patient with cystocele usually complains stress incontinence, bearing down sensation, difficult urination, uterine prolapse. Anterior repair is the gold standard for cystocele repair, the recurrence rate is varied from 2 to 22% at a mean follow-up of 2 and 20 years. Paravaginal repair is more effective method in the patient with cystocele combined with lateral defects. The purpose of this study was to determine effects of paravaginal repair for the patients with symptomatic cystocele and paravaginal defect METHODS: We performed laparoscopic paravaginal repair to the 9 patients with cystocele (Grade II, III). Coincidental operations were Burch colposuspension (5), uterosacral ligament plication (2), anterior colporrhaphy (2), posterior colporrhaphy (9). RESULTS: Mean operation time of paravaginal repair was 58 minutes. Blood (PRC) transfused to only one patients. Postoperative outcome was excellent. There was no postoperative complication and recurrence after a follow up of 5-25 months. CONCLUSION: We think that laparoscopic paravaginal repair is highly effective method for the correction of cystocele with lateral defect.

Laparoscopic Paravaginal repair for the Treatment of Symptomatic Cystocele / 대한산부인과학회지

OBJECTIVE: Cystocele is caused by generalized relaxation or attenuation of the endopelvic fascia. The most common etiology is birth injury. The patient with cystocele usually complains stress incontinence, bearing down sensation, difficult urination, uterine prolapse. Anterior repair is the gold standard for cystocele repair, the recurrence rate is varied from 2 to 22% at a mean follow-up of 2 and 20 years. Paravaginal repair is more effective method in the patient with cystocele combined with lateral defects. The purpose of this study was to determine effects of paravaginal repair for the patients with symptomatic cystocele and paravaginal defect METHODS: We performed laparoscopic paravaginal repair to the 9 patients with cystocele (Grade II, III). Coincidental operations were Burch colposuspension (5), uterosacral ligament plication (2), anterior colporrhaphy (2), posterior colporrhaphy (9). RESULTS: Mean operation time of paravaginal repair was 58 minutes. Blood (PRC) transfused to only one patients. Postoperative outcome was excellent. There was no postoperative complication and recurrence after a follow up of 5-25 months. CONCLUSION: We think that laparoscopic paravaginal repair is highly effective method for the correction of cystocele with lateral defect.

A Case of Fetal Anesthesia with Fentanyl for Thoracentesis of Fetal Pleural Effusion / 대한산부인과학회지

Fentanyl is an opiate-like, pain-killing drug. It was found in the 1950s and prescribed from the 1960s. Fentanyl shows its effect by acting on opiate-like receptors. This case was a case of a 24-year-old primiparous woman who was referred from local clinic due to fetal pleural effusion in the left lung on antenatal ultrasonographic examination at 32 weeks of gestational age. The amount of pleural effusion increased and fetal heart deviated to the right side. We injected fentanyl 2 microgram intramuscularly into the fetal left thigh under ultrasound-guide for fetal anesthesia at 34 weeks of gestational age. After 5 minutes, we inserted 22 gage spinal needle to the left pleural cavity and aspirated 50 mL pleural fluid under ultrasound-guided. After aspiration, follow-up was performed oat one week interval and there was no more pleural fluid until delivery. At gestational age 41 weeks, the fetus was delivered vaginally as a 3.2 kg, healthy male baby. This is a case of fentanyl injection to fetus as a fetal anesthesia during thoracentesis for fetal pleural effusion at gestational age 34 weeks, we think that fentanyl is useful drug for fetal anesthesia.

A Case of Thrombotic Thrombocytopenic Purpura Detected after Delivery in Preeclamptic Woman / 대한주산의학회잡지

TTP is a thrombotic microangiopathy not unique to pregnancy and with the increasing incidence in reproductive aged women. The estimated incidence is around one case per million people, sixty percent of the cases occur in women, the median age of onset is 35 years. Pregnancy is a predisposing factor of TTP and may be an inciting state for relapse. TTP usually develops during the antepartum, the mean gestational age of onset of the symptoms is 23.5 weeks, and 58% of patients initially present at or before 24 weeks of gestation. This report was a case of 36 years old mother who was performed cesarean-section at 31 weeks gestational age because of severe preeclampsia. Febrile sensation, convulsion, comatous mentation abruptly developed after cesarean section and we diagnosed TTP. The patient recovered after she was treated with plasmapheresis for 7 days. We recently experienced a unique case of TTP, which was diagnosed after cesarean delivery, because it overlapped with symptoms and thus report this case.

Two Cases of Prenatal Diagnosis of Congenital Cytomegalovirus Infection / 대한산부인과학회잡지

Cytomegalovirus (CMV) is the most common viral cause of intrauterine infection, and it is the major infectious factor known to be associated with congenital mental retardation and deafness. We had experienced two cases of congenital cytomegalovirus infection at our department of Obstetrics and Gynecology, Chosun University School of Medicine. In both cases, prenatal ultrasonography was abnormal and suggested intrauterine infection and their outcome were different. We present these cases with brief literatures.

The Effects of Diagnostic Amnioinfusion to Severe Oligohydramnios with Intact Membrane / 대한산부인과학회잡지

OBJECTIVE: To quantify the improvement in ultrasonographic fetal imaging following diagnostic amnioinfusion for the indication of unexplained midtrimester oligohydramnios. METHODS: Eight patients were referred for unexplained midtrimester oligohydramnios were retrospectively reviewed. Videotapes of those undergoing diagnostic antenatal amnioinfusion were analyzed for quality of visualiztion of routinely imaged structures before and after the infusion procedure. And genetic amniocentesis was performed in all patients. RESULTS: The overall rate of adequate visualization of fetal structures improved from 64.1% to 95.2% (P=0.008). In most cases we were able to achieve a definitive diagnosis. CONCLUSION: Diagnostic amnioinfusion can facilitate fetal imaging and increase diagnostic precision in the setting of unexplained severe oligohydramnios.

The role of CD24 in ovarian carcinoma / 대한산부인과학회잡지

OBJECTIVE: CD24 is a small heavily glycosylated glycosyl-phosphatidylinositol-linked cell surface protein, which is expressed in hematologic malignancies as well as in a large variety of solid tumors. It appears to function as a ligand of P-selectin, an adhesion molecule that is present in activated platelets and endothelial cells. The authors aimed to evaluate CD24 expression in adenoma and adenocarcinoma of ovary to correlate to clinicopathologic data. METHODS: Benign and malignant ovarian tumors were stained immunohistochemically. The staining was evaluated as stainability (negative, weak-, moderate-, strong-positive) and staining patterns (membranous vs. intracytoplasmic) for statistical analysis. RESULTS: A highly significant association of cytoplasmic CD24 expression with adenocarcinoma of the ovary compared to the adenoma group of this organ. The stainability and positive rate of CD24 in adenocarcinoma group was much higher than in adenoma group, but it was not statistically significant. CONCLUSION: The intracytoplasmic staining pattern of CD24 was an important molecular marker for ovarian epithelial neoplasm which could help to define malignant transformation.

The Study about the change of Fetal Adrenal Gland Hormone during Pregnancy and Labor / 대한산부인과학회잡지

OBJECTIVE: Fetal adrenal gland hormone was known to have close association with fetal weight and labor pain in response to fetal stress. Our purpose was to analyze the correlation between cortisol, DHEA-S in cord blood and obstetric status of fetuses. METHODS: We collected cord blood samples from 60 neonates immediately after delivery of baby. Six cases were complicated by intrauterine growth restriction and fourteen patients were complicated by preeclampsia. We measured cortisol, DHEA-S levels by using the RIA commercial Kits for the ELISA. We performed statistic analysis of the data on the SPSS computer program. RESULTS: Cortisol was significantly higher in intrauterine growth restriction (23.4 +/- 16.2 microgram/dL) statistically than control group (13.7 +/- 9.5 microgram/dL) (P=0.022). Cortisol and DHEA-S had negative correlation each other (P=0.025). DHEA-S was significantly lower in intrauterine growth restriction (1202.2 +/- 1005.9 ng/ mL) than control group (1714.8 +/- 978.6 ng/mL) (P=0.01). DHEA-S had increased with advancing gestational age (P=0.03) and fetal weight (P=0). CONCLUSION: Cord blood cortisol level and DHEA-S level has close association with intrauterine growth restriction and negative correlation with each other.

The Changes of Superoxide Dismutase Isozymes in the Placenta of Patients with Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: The aim of this article was investigated whether changes of superoxide dismutase isozymes in the placenta of patients with preeclampsia contribute to radical-induced tissue injury. METHODS: The activities of antioxidant enzymes (superoxide dismutase (SOD), catalase, glutathione peroxidase (GSHPx)) and the contents of thiobarbituric acid reactive substance (TBARS) in the erythrocytes and in the placenta were assayed from 35 women with preclampsia and 35 normotensive pregnant women. RESULTS: The superoxide dismutase (SOD) activities were significantly reduced in the erhtyrocytes and the placenta of patients with pre-eclampsia compared with normotensive pregnant women. The activity of catalase was increased in the erythrocytes of patients with preeclampsia but the statistically significant difference of catalase activity in the placenta and GSHPx activity in both erythrocytes and placenta were not observed. The contents of TBARS were increased significantly in the erythrocytes and placenta of patients with preeclampsia. In preeclamptic placenta, copper and zinc containing superoxide dismutase (CuZn-SOD) was decreased (3.9+/-0.5 vs 5.1+/-0.6 U/mg protein) whereas manganeus containing superoxide dismutase (Mn-SOD) was increased (2.0+/-0.3 vs 2.7+/-0.4 U/mg protein). CONCLUSION: In these results, the decreased CuZn-SOD activity may some roles in increment of TBARS contents in pre-eclamptic placenta and decreased CuZn-SOD activity may be more prone to oxidative stress in the placenta.

A Clinical Analysis on Sacrospinous Ligament Suspension for Management of Pelvic Organ Prolapse / 대한산부인과학회잡지

OBJECTIVE: To assess the therapeutic results and complications of the transvaginal sacrospinous ligament suspension for the treatment of vault prolapse following hysterectomy and pelvic organ prolapse. METHODS: A retrospective analysis was performed from thirty patients with follow-up visits questionnaires and medical records that underwent sacrospinous ligament suspension with concomitant pelvic reconstruction in the department of obstetrics and gynecology, chosun university hospital. Clinical data included age distribution, parity, functional symptom, operative time, and postoperative complications. Outcomes of the procedures were assessed on postoperative follow up data. RESULTS: The median age of 30 patients was 52.7+/-9.6 and the median parity was 2.7+/-1.7. According to the POP-Q system approved by ICS, stage II pelvic prolapse was in 4 cases (13.4%), stage III in 16 cases (53.3%), stage IV in 10 cases (33.3%). The average operation time was 108.32 minutes. Postoperative complications consist of 1 case of femoral sciatic nerve ligation, 8 cases of postoperative temporary gluteal pain, 5 cases of hemorrhage requiring transfusion. The average follow up duration was 10.8+/-2.3 months and postoperative complications like dysuria, relapsing pelvic organ prolapse, vault prolapse, dyspareunia were not detected. CONCLUSION: This results suggest that the transvaginal sacrospinous ligament suspension is effective method for vaginal vault prolapse after hystectomy and preventing recurrent pelvic organ prolapse.

A Clinical Study on the Ovarian Tumors in Pregnancy / 대한주산의학회잡지

No abstract available.