A Case of Primary Malignant Melanoma of Posterior Vaginal Fornix / 대한산부인과학회잡지

Primary malignant melanoma of the vagina is a very rare disease with incidence of 0.026 per 100,000 women. The opinion of several types of treatment is suggested but the prognosis is extremely poor. Although malignant melanoma is generally regarded as a radioresistant tumor, recent reports show that definitive irradiation with high-dose fractionation regimen demonstrates high response rates in primary and metastatic lesions. A case of primary malignant melanoma of the vagina which was treated with intensity-modulated radiation therapy is presented with a brief review of concerned literature.

Emergency Cervical Cerclage: A Retrospective Study of 5 Years' Practice in 71 Cases / 대한산부인과학회잡지

OBJECTIVE: We investigated the outcome of emergency cervical cerclage in women with cervical incompetence. Cervical incompetence was diagnosed when cervical dilatation exceeded 2 cm with intact but bulging membranes. METHODS: Retrospective chart review of 71 cases of patients who underwent emergency cervical cerclage using Mcdonald suture after amnioreduction performed for cervical incompetence with cervical dilatation and membrane bulging from March 1998 through August 2003 at Kang-Nam Sacred Heart Hospital, Hallym University. Clinical variables evaluated included gestational age at cerclage, cervical dilatationa at cerclage, prolongation of pregnancy, and neonatal outcome. RESULTS: Emergency cerclage was performed successfully in 67 cases (94%). Gestational age at cerclage ranged from 16 weeks to 29 weeks, with the mean being 23.6 +/- 3.3 weeks. Cervical dilatation at cerclage was between 2 cm and 9 cm (mean 3.8 +/- 1.6 cm). Gestational age at delivery ranged from 16 to 40 weeks (mean 28.2 +/- 6.0 weeks). Prolongation of pregnancy following cerclage varied from between 1 to 134 days (mean 31.5 +/- 33.1 days). The median birth weight was 1370.29 +/- 72.6 g (range 140-3640 g). Thirty-seven babies were born live, and 30 of them survived (survival rate 49%). CONCLUSION: The possibility of a 49% survival rate is considered a good result for emergency cerclage. Emergency cervical cerclage can prolong pregnancy and influence the outcome of pregnancy favorably, and may be considered one potential method of treatment in such cases.

Comparision of Vaginal Hysterectomy and Abdominal Hysterectomy for a Nonprolapsed, Benign Uterine Disease in Women Without Vaginal Delivery / 대한산부인과학회잡지

OBJECTIVE: This study was designed to compare the vaginal hysterectomy and abdominal hysterectomy for a non-prolapsed, benign uterus in women without vaginal delivery. METHODS: A retrospective study in Hallym-university hospital analysed 182 total hysterectomies in women without vaginal delivery performed from January 2000 to December 2001. Vaginal route was used for 98 (53.8%) patients and 84 (46.2%) had laparotomies. RESULTS: The mean uterine weight was 217 g in vaginal route, 270 g in abdominal route. Mean operation time was 70 minutes in vaginal route, 125 minutes in abdominal route. There was one serious re-operation due to hemorrhge in each group and other complication was not much different at each gruops. The hospital stay was 6.2 days in vaginal route and 8.4 days in abdominal route. CONCLUSION: Vaginal hysterectomy for a non-prolapsed uterus is indicated for women without vaginal delivery and is feasible to performance. Vaginal hyterectomy is less morbidity, shorter hospitalization and faster convalescence. So training in vaginal surgury should allow safe performance of the procedure at most center.

A Case of Acute Fatty Liver of Pregnancy / 대한주산의학회잡지

Acute fatty liver of pregnancy(AFLP) is rare, potentially fatal disorder developing in the third trimester of pregnancy. It is characterized by nausea, vomiting, jaundice and malaise. Initially the disease is often mistaken for preeclampsia, HELLP(hemolysis, elevated liver enzymes, low blood platelet count)syndrome, fulminant hepatitis and cholestasis of pregnancy. But acute fatty liver of pregnancy has clinical manifestations, biochemical findings and complications clearly distinguished of HELLP syndrome, fulminant hepatitis and cholestasis of pregnancy. We report a case of pregnancy complicated with fatty liver with brief review of the common causes of acute hepatic failure associated with pregnancy.

A Study on the Effects of CO2 Pneumoperitoneum and Trendelenburg position on Arterial Acid-Base Balance and Middle Cerebral Artery Hemodynamics in Gynecologic Laparoscopic Surgery / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to identify arterial acid-balance and cerebral hemodynamics in patients undergoing gynecologic laparoscopic operations according to induction of CO2 pneumoperitoneum and Trendelenburg position. METHODS: Twenty patients without cardiopulmonary disease undergoing various laparoscopic pelvic surgeries were resulted in data of arterial blood and hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pCO2, pH, pO2, middle cerebral blood flow velocity (MCABFV), pulsatile index (PI), resistance index (RI). Under the standardized setting of general anesthesia, arterial blood and hemodynamic parameters were determined in supine position (base line) before CO2 insufflation, and 15 minutes, 30 minutes, 45 minutes in Trendelenburg position after CO2 insufflation, and 10 minutes in supine position after CO2 defflation. RESULTS: The arterial BP, pCO2 and MCABFV increased significantly in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. PI decreased significantly compared with control in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. RI decreased significantly as compared with control in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. CONCLUSION: Intraoperative arterial blood gas analysis is required in patients with high risk of hypercarbia during gynecologic laparoscopic surgery, and clinicians should anticipate an increase in cerebral blood flow and decrease in cerebral vascular resistance after CO2 pneumoperitoneum and Trendelenburg position, and gynecologic laparoscopy may be safe in view point of cerebral hemodynamics.

Clinical usefulness of transabdominal cervicoisthmic cerclage in IIOC patients for whom transvaginal cervicoisthmic cerclage is unsuitable / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to review the clinical use of transabdominal cervicoishmic cerclage to determine whether it is a valid alternative to transvaginal cerclage. Study design : A retrospective review was carried out of transabdominal cerclage patients at our hospital from Jan. 1999 to May. 2001. Analysis of the clinical use of transabdominal rather than the vaginal approach in some IIOC patients was performed and fetal outcomes was evaluated. RESULTS: Fifteen patients underwent transabdominal cerclages. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 9 patients and anatomic unsuitability for transvaginal cerclage in 6 patients. Follow-up was conducted for all except one patient. All patients were successfully delivered of live babies by Cesarean section. Complications including blood loss requiring transfusion did not occur. However one baby died at postpartal 1 day because of congenital Tetralogy of Fallot. CONCLUSION: All patients had histories compatible with incompetent cervix requiring cerclage, and none were suitable candidates for vaginal cerclage. Our results and review of the literature confirm that Transabdominal cervicoisthmic cerclage has an important role to play for carefully selected patients.