A case of full term normal spontaneous vaginal delivery after radiofrequency myolysis / 대한산부인과학회지

Radiofrequency (RF) myolysis is a minimally invasive treatment by create thermal energy in targeted uterine fibroid and cause the aseptic necrosis of leiomyoma cells. Unlike hysterectomy which is considered to be the most common treatment of uterine leiomyoma, RF myolysis can preserve the uterus, and unlike myomectomy which can preserve the uterus but requires the hospitalization and general anesthesia, it can be performed as outpatient procedure using only sedation for pain relief without additional need for medication. There are many published studies reporting the pregnancy complications and outcomes after myomectomy, but few studies regarding pregnancy and myolysis are available. We have experienced a full term vaginal delivery after RF myolysis of subserosal myoma and hereby we report our case with a brief review.

Clinical characteristics of 110 women with uterine anomalies / 대한산부인과학회지

OBJECTIVE: To investigate the clinical characteristics of symptoms, diagnostic procedures, infertility, obstetrical complications, and surgical corrections in women with congenital uterine anomalies. METHODS: Between January 1990 and December 2007, 110 patients diagnosed with uterine anomalies from Kangnam St. Mary's Hospital, the Catholic University of Korea were included in this study. The charts of patients were reviewed retrospectively for uterine anomaly type, clinical symptom, diagnostic workup, fertility, fetal presentation, and uteroplasty. Congenital anomaly was categorized according to classification by the American Fertility Society (1988). RESULTS: Uterine anomaly was noticed in 1 in 752 patients (0.13%) who visited the inpatient department. The diagnosis was made by pelvic ultrasonography and manual examination (45.5%), incidental discovery during Cesarean section (24.5%), and other surgical procedures and salpingography. Most common types of uterine anomaly were bicornuate uterus (42 cases, 38.2%) and uterine didelphys (39 cases, 35.5%). Renal anomaly was accompanied in 21 patients (19.1%), frequently associated with bicornuate uterus and uterine didelphys. Uteroplasty was performed in 26 patients with 9 cases of bicornuate uterus (34.6%) and 8 cases of septate uterus (30.8%). The cases diagnosed incidentally during prenatal ultrasound examination were 35.5%. Other initial symptoms were dysmenorrhea, pelvic pain and habitual abortion. Primary infertility was reported in 3 cases (2.7%) which was fewer than abortion. Primary dysmenorrhea was observed in 2 cases (1.8%). One case of PID (0.9%) and one asymptomatic case were noted. Among 241 pregnancies, there were 46.9% full term birth, 24.34% abortion, 9.5% preterm birth, and 0.83% ectopic pregnancy. Fetal presentations were 16.67% breech and 1.51% transverse lie. Cesarean section rate was 81.3%. CONCLUSIONS: Women with uterine anomaly complain symptoms such as dysmenorrhea and pelvic pain, but most are aymptomatic and diagnosed incidentally. They are frequently accompanied with urologic anomalies and complicated with obstetrical challenges such as preterm labor, habitual abortion, malpresentation, intrauterine growth retardation and uterine atony. Thus, when diagnosis of uterine anomaly is made, it is crucial to discuss sufficiently with patients about their expected prognosis on fertility and possible obstetrical outcomes and complications and to provide appropriate therapy accordingly.

Factors affecting the satisfaction rate of radiofrequency myolysis: 18 months follow up / 대한산부인과학회지

OBJECTIVE: To report 18 months follow up results of radiofrequency myolysis and analysis the factors which effect the success rate of myolysis. METHODS: 153 patients who took radiofrequency myolysis between October 2004.~June 2006 in this hospital were enrolled this retrospective study. Except 14 patients which had incomplete data, total 139 patient's charts were reviewed. Sonographic evaluations were checked after a week, 1 month, 3 months, 6 months, 12 months, and 18 months after myolysis. Questions about complications like vaginal bleeding, abdominal pain, feber and vaginal discharge were asked to patients in every visits. Volume of the myoma were checked via 3D ultrasonography. RESULTS: Reduction rate of the volume of myoma after 18 months were 73% and reoperation rate were 4.3%. Improvement rates of patients symptom were 87% (menorrhagea 95%, dysmenorrheal 75%, pelvic pain 60%) The patients who had myomas sized over 100 ml before treatments showed statistically higher rate of reoperation, and decreased rate of satisfaction. Reoperation rate and reduction rate of myoma showed no difference through pathologic diagnosis. The patients who had initial symptoms showed higher rate of satisfaction after myolysis. Total satisfaction rate were 62%, and no serious complications like bowel injury, bladder injury, sepsis and peritonitis were not reported. CONCLUSION: Satisfaction rate after radiofrequency myolysis was increased in symptomatic leiomyoma especially smaller than 6.5 cm in diameter.

Mullerian inhibiting substance as a predictive marker of menopausal transition / 대한산부인과학회지

OBJECTIVE: To identified whether serum Mullerian inhibiting substance (MIS) level may be used as a predictive marker of menopausal transition. METHODS: Serum MIS level was measured in reproductive women (n=87), in menopausal transition women (n=58), and in menopausal women (n=5) by ELISA. And we examined the immunohistochemical staining of the MIS in the ovarian tissues of 15 reproductive, 15 menopausal transition, and 5 menopausal women. RESULTS: 1. In the reproductive women, mean serum MIS level was 1.73+/-1.07 ng/ml. In the menopausal transition women, mean serum MIS level was 0.18+/-0.11 ng/ml. Serum MIS level did not show any significant fluctuation patterns according to follicular development. In menopausal transition women, serum MIS level was significantly lower than that of reproductive women (P<0.001). The cutoff value of serum MIS level for menopausal transition was 0.5 ng/mg. In the menopausal women, serum MIS level was not detected. 2. Serum MIS level was significantly decreased as patient age was increased. 3. In the reproductive group, the immunohistochemical staining demonstrated strong expression of MIS in the granulosa cells of the primary follicles and the growing follicles, but not in corpus luteum, preovulatory mature follicle, atretic follicle, and corpus luteum. In the menopausal transition women, immunohistochemical staining for MIS was observed in the nearly same pattern as that of thereproductive women, but with weaker expression. In the menopausal women, immunohistochemical staining of the MIS was not observed. CONCLUSION: MIS is a good candidate for predictive marker for ovarian aging and perimenopausal transition.

A case of Fitz-Hugh-Curtis syndrome diagnosed by pelvic CT imaging prior to diagnostic laparoscopy / 대한산부인과학회지

Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of PID. It is associated with right upper quadrant pain that likely results from the inflammation of liver capsule and diaphragm. The liver capsule becomes involved with inflammatory exudates that later forms violin string adhesion between two liver capsule and adjacent diaphragm or peritoneum. Previously, Neisseria gonorrhea was thought to be the only etiological agent, but recent studies have reported cases of Fitz-Hugh-Curtis syndrome due to Chlamydia trachomatis infection. 15 to 30 percents of women with PID develop symptom of Fitz-Hugh-Curtis syndrome. It is often mistakenly diagnosed as either pneumonia or acute cholecystitis. Laparoscopy may be the definitive method in diagnosis of Fitz-Hugh-Curtis syndrome. However, we have experienced one cases of Fitz-Hugh-Curtis syndrome, which was diagnosed preoperative by pelvic CT imaging and report with the brief review of the literatures.

Effectiveness of sacrospinous colpopexy in vault prolapse patients / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness of sacrospinous colpopexy in vault prolapse patients. METHODS: It is the retrospective study including 10 vault prolapse patients who received sacrospinous colpopexy at St. Paul Hospital, the Catholic University from July 1999 to April 2004. RESULTS: The 10 patients receiving sacrospinous colpopexy had the average age of 58.9 years, and the parity of 3.4. They were moderately overweighted with average BMI of 24.5. The average period from hysterectomy to diagnosis of vault prolapse was 11.1 years. Hypertension was noted on most of patients (70.0%). The average operation time was 68.5 minutes and postoperative hemoglobin decrement was 2.4 on average. During 2-month period of postoperative follow-up, there were no significant complications noted except one case of wound infection associated with diabetes and one case of transfusion due to anemia. After sacrospinous colpopexy, protruding mass out of vagina was resolved on 100% and urologic and other complications were improved over 50% of cases. CONCLUSION: Considering that several underlying medical conditions such as hypertension, obesity are associated with vault prolapse patients, sacrospinous colpopexy in case of vault prolapse is an excellent operative approach with low complication and recurrence rates.

Secondary acute myeloid leukemia after platinum based chemotherapy for ovarian cancer / 대한산부인과학회지

Among chemotherapeutic regimens used for advanced ovarian cancer, platinum-based combination chemotherapy remains a mainstay of the treatment of advanced ovarian cancer, providing significant response rates and survival benefits. However, with widespread use of long-term chemotherapy in treating ovarian cancer, emergence of secondary leukemia has become medical concern as one of the most unfavorable late complications. Depending upon the type, duration, and dosage of previous chemotherapy, the risk of developing acute myeloid leukemia has been estimated to be between 2% and 10%. Moreover, the frequency of this complication might increase as the survival in patients with ovarian cancer undergoing chemotherapy continues to increase with developing therapeutic options. Recently, we experienced a case of secondary acute myeloid leukemia developing 3.5 years after platinum-based chemotherapy. In this report, clinical course of the patient and contributing factors for the secondary leukemia were presented.

A case of ovarian metastasis of the recurrent uterine cervical cancer after adjuvant radiation therapy / 대한산부인과학회지

Cervical carcinoma is currently the second most common gynecologic malignancy worldwide with high incidence in developing countries. However, ovarian metastasis in cervical carcinoma is rare. Especially in squamous cell carcinoma of cervical cancer, ovarian metastasis is even more rare. And adenocarcinoma of cervical cancer with gradual increase in incidence, has low ovarian metastasis of 2.0-3.6% in the early stage, although it has high ovarian metastasis in the advanced stage. We experience one case of ovarian metastasis in recurrent cervical adenocarcinoma of stage IB1, and then we report it together with brief review of literatures.

The Changes of Cell Cycle Regulatory Proteins Expression by AdCMVp53 in Cervical Cancer Cell Lines / 대한산부인과학회잡지

OBJECTIVE: In this study, we investigated the cell growth inhibition, regulation of cell cycle and induction of apoptosis through recombinant p53 adenoviral vector delivery into cervical cancer cell line SiHa, to explore the possibility of p53 gene therapy. METHODS: We infected SiHa with AdCMVp53 at 50 MOI. After 48 hours, the regulation of cell cycle and apoptosis were investigated with FACS. The gene expression profiling associated with cell cycle was also investigated with cell cycle DNA membrane chip. RESULTS: SiHa cells were arrested in the G1 phase by AdCMVp53 and showed cell growth inhibition via apoptosis. The gene expression profiles involved in cell cycle including cyclin-dependent kinase inhibitor 1C (p57, Kip2), RAD9 (S.pombe) homolog, and MAD2 (mitoticarrest deficient, yeast, homolog)-like 2 were up-regulated by more than three-fold, as compared to control group. In contrast, 6 genes such as retinoblastoma-like 2 (p130), and cyclin H were down-regulated by more than three-fold. Several genes known as being differentially up- or down-regulated compared to control were confirmed by RT-PCR and Western blotting assays. CONCLUSION: The adenoviral p53 gene delivery into cervical cancer cell line, suggesting the possibility of p53 gene therapy in cervical neoplasia make the cell growth inhibition and changes of cell cycle-associated gene expression.