ABSTRACT
OBJECTIVE: The study was designed to ascertain a proper method of early diagnosis and treatment of ectopic pregnancy by analyzing its clinical and epidemiological characteristics. METHODS: The medical records of patients who were diagnosed to ectopic pregnancy at Hallym medical center during the period from January 1, 2000 to December 31, 2007 have been reviewed. RESULTS: The incidence of ectopic pregnancy was 7.3% (1,067) out of 14,519 deliveries. The most frequent age group was 26~30 (29.5%). Risk factors they had were previous histories of abdominal or pelvic surgery (37.0%), artificial abortion (30.8%), pelvic inflammatory disease (12%), and tubal sterilization (9.6%). Most frequent clinical symptoms were amenorrhea (88.7%), lower abdominal pain (81.2%), and vaginal spotting (60.0%). Percentage of patients with hemoglobin level over 10.0 gm/dL was 79% and below 8.0 gm/dL 3.9%. The clinical symptoms of ectopic pregnancy most commonly occurred after 6~8 weeks from last menstrual period (47%). Ectopic gestation was implanted on the fallopian tube in 89%, cornus in 7.2%, ovary in 1.1% and the cervix in 2.7%. Laparosopic surgeries were performed in 755 cases (71.6%) and laparotomies in 273 cases (25.9%) and dilatation and curettages in 26 cases (2.5%). Salpingectomy was performed most frequently (82.4%). Methotrexate (MTX) treatment was successful in 13 cases (1.21%). CONCLUSION: The early diagnosis of ectopic pregnancy is most useful when serum beta-hCG and vaginal sonography are used together. Laparoscopy would be a preferred method because of its short hospitalization period and low complication rate compared with laparotomy in ectopic pregnancy treatment.
Subject(s)
Female , Humans , Pregnancy , Abdominal Pain , Amenorrhea , Cervix Uteri , Cornus , Curettage , Dilatation , Early Diagnosis , Fallopian Tubes , Hemoglobins , Hospitalization , Incidence , Laparoscopy , Laparotomy , Medical Records , Methotrexate , Metrorrhagia , Ovary , Pelvic Inflammatory Disease , Pregnancy, Ectopic , Risk Factors , Salpingectomy , Sterilization, TubalABSTRACT
Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated CA 125 in Meigs'syndrome is unusual clinical condition reported in few cases. We report here, a 49-year-old postmenopausal woman with right ovarian fibrothecoma with ascites, right pleural effusion and high serum levels of CA 125. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA 125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.
Subject(s)
Female , Humans , Middle Aged , Ascites , Diagnosis, Differential , Meigs Syndrome , Ovary , Pleural EffusionABSTRACT
Mature cystic teratoma of the ovary is the most commom ovarian germ cell tumor and almost benign. Malignant transformation occurs in less than 2% of benign mature teratoma. Squamous cell carcinoma derived from ectoderm is the most frequent malignancy. Prognosis of squamous cell carcinoma in ovarian mature teratoma is generally poor but there is no consensus on optimal thrapy. We report one case of squamous cell carcinoma arising from mature cystic teratoma with a brief review of the literature.
Subject(s)
Female , Carcinoma, Squamous Cell , Consensus , Ectoderm , Hydronephrosis , Neoplasms, Germ Cell and Embryonal , Neoplasms, Squamous Cell , Ovary , Prognosis , Teratoma , Ureter , Ureteral ObstructionABSTRACT
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.
Subject(s)
Female , Humans , Chlamydia trachomatis , Cholecystitis, Acute , Diagnosis , Diaphragm , Exudates and Transudates , Gonorrhea , Inflammation , Laparoscopy , Liver , Neisseria , Peritoneum , PneumoniaABSTRACT
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.
Subject(s)
Female , Adenocarcinoma , Carcinoma, Squamous Cell , Cervix Uteri , Developing Countries , Incidence , Neoplasm Metastasis , Ovary , Uterine Cervical NeoplasmsABSTRACT
Acute pancreatitis is a rarely occurred during pregnancy, with few reports in the literature addressing the problem. Pregnancy complicated by pancreatitis may lead to significant fetal and maternal morbidity and mortality. The disease occurs predominantly in later pregnancy, and rarely during the postpartum period. We report a case of acute alcoholic pancreatitis during pregnancy with a brief review of literature.
Subject(s)
Pregnancy , Mortality , Pancreatitis , Pancreatitis, Alcoholic , Postpartum PeriodABSTRACT
OBJECTIVE: Laparoscopic surgery provides patients with the benefits of shortened hospital stay and faster return to normal activity. The objective is to evaluate the efficacy of laparoscopic surgery in gynecologic patients. METHODS: From January, 1999 to December, 2002, total 1594 patients were performed laparoscopic surgery at Uijongbu St. Mary's Hospital. We reviewed the medical record and analyzed these cases about age, parity, diagnosis, name of operation, operation time, duration of hospitalization and side effect. RESULTS: The results of this study summarized as follows: 1. The mean age of patients was 34.0 years old and the great incidence occurred in 26-30 years old group (24.7%). 2. The average parity of patients was 1.05. 3. The common indications were ovarian cyst (34.4%), myoma uteri (19.1%), infertility (9.5%), ectopic pregnancy (15.0%), etc. In diagnostic pelviscopy, the most common indication was infertility (50.6%), and ovarian cyst (38.3%) was the most common indication in operative pelviscopy. 4. The major types of operative pelviscopy were cystectomy, LAVH, TLH, salpingectomy, adnexectomy, electrocauterization. 5. The mean duration of hospitalization was 3.72 days. 6. The major complication of surgery were intestinal injury, postoperative paralytic ileus, bleeding at resection site, but they were controlled without difficulty. CONCLUSION: Pelviscopic surgery is useful and recommended for the treatment of gynecologic disease, because this is safe and has many advantages.
Subject(s)
Female , Humans , Pregnancy , Cystectomy , Diagnosis , Genital Diseases, Female , Hemorrhage , Hospitalization , Incidence , Infertility , Intestinal Pseudo-Obstruction , Laparoscopy , Length of Stay , Medical Records , Myoma , Ovarian Cysts , Parity , Pregnancy, Ectopic , Salpingectomy , UterusABSTRACT
Moyamoya disease is rare, progressive, occlusive cerebrovascular disease with characteristic angiographic bilateral stenosis or occlusion of the distal internal cerebral arteries with compensatory development of a fine vascular network at the base of the brain. The etiology and pathogenesis are unknown. The disease shows a familial incidence, and mutifactorial inheritance has been suspected. The diagnosis of Moyamoya disease is made on the basis of angiographic fingings: In its early stage there is stenosis of the supraclinoid portion of the internal carotid artery, frequently bilaterally. Later there is enlargement of extracranial transdural collateral circulation. Clinically, this disease is found with a higher incidence in young female, but there are few cases of Moyamoya disease in pregnancy. The disease usually presents in children with paroxysmal hemiplegia, hemiparesis, involuntary movement, headache, and seizures. In adults of reproductive age the disease usually occurs as alterations of consciousness caused by cerebral ischemia or intracranial hemorrhage. We report a case of Moyamoya disease that presented as cerebral infarction during pregnancy complicating severe preeclampsia.
Subject(s)
Adult , Child , Female , Humans , Pregnancy , Brain , Brain Ischemia , Carotid Artery, Internal , Cerebral Arteries , Cerebral Infarction , Collateral Circulation , Consciousness , Constriction, Pathologic , Diagnosis , Dyskinesias , Headache , Hemiplegia , Incidence , Intracranial Hemorrhages , Moyamoya Disease , Paresis , Pre-Eclampsia , Seizures , WillsABSTRACT
OBJECTIVE: To estimate false-negative rate of cervical smears in histologically confirmed squamous intraepithelial lesion and squamous cell carcinoma METHOD: From 1993 to 1998, total 186 cases of cervical smear performed within 1 year before histological confirmation squamous intraepithelial lesion and squamous cell carcinoma, were reviewed and the false negative rate of the each group was analyzed. RESULTS: 1. Histologic diagnosis of 186 cases includes 8 cases of low grade SIL, 87 cases of high grade SIL, 91 cases of squamous cell carcinoma. 2. Overall false negative rate was 18.8% (35/186). False negative rate of LSIL was higher (50%; 4/8) compared with the other two groups. (HSIL:23% ;20/87, SCC:12.1% ;11/91) 3. 18 of 35 false negative cases were reviewed. 8 cases(44.4%) were sampling error and 10 cases(55.6%) were interpretation error. 4. Estimated overall sampling error was 8-9% ; interpretation error 10-11%. CONCLUSION: Reducing the false negative rate of cervical smears, especially in cervical intraepithelial neoplasia lesion is important to save the patients from invasive cervical cancer. Further studies on the causes of false negatives and the efforts to eliminate these barriers are actually needed.
Subject(s)
Humans , Carcinoma, Squamous Cell , Uterine Cervical Dysplasia , Diagnosis , Selection Bias , Uterine Cervical Neoplasms , Vaginal SmearsABSTRACT
To evaluate the risk factors and clinical characteristics of acute renal failure(ARF) in patients with severe preeclampsia, we retrospectively investigated medical and obstetric histories, clinical and laboratory findings, maternal morbidity, and perinatal outcome between renal insufficiency and normal groups in patients with severe preeclampsia. Of the total 307 patients with severe preeclampsia, ARF occurred in 36 patients and its incidence was 11.7%. ARF developed before labor in 17 patients and postpartum in 19 patients. Oliguria occurred in 13 patients(36.1%) and 3 out of these patients required hemodialysis. Of the 31 patients who was observed for 3 months, renal function did not recover in 3 patients(9.7%). The systolic and diastolic blood pressures in renal insufficiency group(n=36) were higher than those in normal group(systolic:173+/-22 vs 164+/-19mmHg, p<0.02, diastolic:119+/-17 vs 108+/-14mmHg, p<0.01). In addition to degree of blood pressure, this study demonstrated that the risk factors of acute renal failure at admission were history of chronic hypertension, twin pregnancy, hypoalbuminemia, and thrombocytopenia. The incidences of maternal complications such as syndrome of hemolysis, elevated liver enzymes, and low platelets(HELLP syndrome), abruptio placenta, pulmonary edema and perinatal morbidity in renal insufficiency group were higher than those in normal group, respectively. In conclusion, acute renal failure in severe preeclampsia occur frequently in patients with history of chronic hypertension, twin pregnancy, severe hypertension, severe hypoalbuminemia, and thrombocytopenia.
Subject(s)
Humans , Pregnancy , Acute Kidney Injury , Blood Pressure , Hemolysis , Hypertension , Hypoalbuminemia , Incidence , Liver , Oliguria , Placenta , Postpartum Period , Pre-Eclampsia , Pregnancy, Twin , Pulmonary Edema , Renal Dialysis , Renal Insufficiency , Retrospective Studies , Risk Factors , ThrombocytopeniaABSTRACT
OBJECTIVES: To investigate whether the aspects of Pap smear affect cervical abnormality in our country. METHODS: We compared the sensitivity of Pap smear of 241 cases of pathologic proven CIN & invasive cancer, compared to that of 655 cases with normal cervical biopsy, and reviewed the history of the test of 138 cases, retrospectively. RESULTS: The sensitivity of the test was 89.6%, 92.7% in CIN & invasive cancer group, respectively, with 96.9% specificity. Among 241 cases, 138 cases were examined for the frequency of test during the 3 years with the result of 2.42, 2.17/3yr in CIN and invasive cancer. And distribution of the test was not different between the two groups. The mean intervals of last two Pap smear before diagnosing final pathology in CIN and cancer were 12.1, 13.7 months, respectively, with no statistical significance (p>0.05). CONCLUSION: We concluded that in our country the aspects of Pap smear such as frequency and interval do not influence the result of cervical abnormality, so recommend the annual Pap test as a screening.
Subject(s)
Biopsy , Uterine Cervical Dysplasia , Mass Screening , Papanicolaou Test , Pathology , Retrospective Studies , Sensitivity and SpecificityABSTRACT
An isolated granulocytic sarcoma (chloroma) of the left ovary occured in the absence of leukemia in a 12-year-old woman. This lesion is defined as a localized tumor mass composed of immature cells of the granulocytic series. Granulocytic sarcomas can occur at extramedullary sites including ovary but, isolated myelosarcoma in the absence of usual manifestations of AML may be rare and has some difficulties in diagnosis. Contrary to findings in other series, granulocytic sarcoma arising in this nonleukemic patient did not progress to acute leukemia during two years she has been followed.
Subject(s)
Child , Female , Humans , Diagnosis , Leukemia , Ovary , Sarcoma, MyeloidABSTRACT
OBJECTIVES: The trial was performed to obtain an unbiased comparison of the relative merits of endocervical and vaginal prostaglandin E2(PGE2) in the case of parous and nulliparous woman with favorable and unfavorable cervical features. This study was performed to determine the clinical usefullness of endocervical PGE2 comparing with the vaginal PGE2 in cervical ripening and induction of labor. METHOD: The randomized trial with 65 Participants was performed with sealed envelopes for parity and Bishop score (from March to september, 1998). PGE2 tablet(3mg Dinoprostone) was administrated intravaginally to the 32 pregnant women and endocervically to the 33 pregnant women every eight hours with maximum three times until the regular labor develped. RESULT: Outcomes of labor and delivery were clearly related to cervical score at trial entry. endocerval PGE2 had a more marked effect on cervical ripeness than did vaginal PGE2. There were no significant differences on age distribution, gestatioanal period, primiparity, cervical status, initial B-score in each group. There were no significant differences in cesarian section rate, fetal distress, uterine hyperstimulation, side effect and poor infant outcome between the groups The mean induction time was statistically shorter in cervical group with multiparous women than other group(p=0.0195). In the induction-active labor time, cervical with primi group was statistically shorter than other group(p=0.0245). Statistically significant differences were noted between the nulliparous woman and multiparous women in mean induction time, induction-active labor time, time to B-score 8. In the factor that effects induction-active labor, route was significantly better than other factor.(p=0.0001) CONCLUSION: edocervical PGE2 is more effctive than vaginal PGE2 in cervical ripening and induction of active labor. the endocervical PGE2 resulted in a significantly shorter induction to active labor time compared with vaginal PGE2 and has almost no side effect. Because differences in effectiveness between endocervical and vaginal PGE2 are marginal, preference of woman and clinicians can the choice between them.
Subject(s)
Female , Humans , Infant , Pregnancy , Age Distribution , Cervical Ripening , Dinoprostone , Fetal Distress , Parity , Pregnant WomenABSTRACT
Primary peritoneal leiomyoma is histologically benign and rare non-neoplastic proliferation of smooth muscle that occurs in the peritoneal wall during the reprodutive years of women. A 51-year old patient had a solid tumor of 18cm diameter in the peritoneal wall, which was pathologically confirmed as a benign leiomyoma primarily originated from the retroperitoneal wall. Laparotomy revealed a solid tumor in the peritoneal wall, about 18cm, and histologically diagnosed as a leiomyoma. We report a case of primary peritoneal leiomyoma with a brief review of literatures.
Subject(s)
Female , Humans , Middle Aged , Laparotomy , Leiomyoma , Muscle, SmoothABSTRACT
Screening is for the early detection and treatment of diseases in prior to development of symptoms, so that more favourable prognosis could be obtained. To evaluate efficiency of screening test for cervical neoplasms, we compared the histopathologic stages of asymptomatic cervical neoplasm patients diagnosed by screening test, with those of symptomatic patients confirmed by pathology. Total 1,120 cases of cervical neoplasm patient, diagnosed at Kang-nam St. Mary's hospital from Jan. 1990 to Dec. 1996, were reviewed by chart, and classified as asymptomatic and symptomatic group based on the presence of subjective symptoms on their hospital visit. Their histopathologic stages were analysed. The results were as follows, 1. From the total of 1,120 patient, asymptomatic group comprised 264 cases (25.5%). Asymptomatic proportion increased 15.3% in 1991 to 34.7% in 1996. 2. Mean age for the occurrence of cervical neoplasm was 44.3 +/- 10.4 years for the asymptomatic group, and 49.3+/-13.2 years for the symptomatic group, showing statistically significant differences(p=0.001). 3. Among the study subjects, 465 cases(45.0%) had CIS(carcinoma in situ), and 569 cases(55.0%) had invasive cancers. 4. Percentage of cervical neoplasm patient diagnosed at asymptomatic stages were 45.8% in twenties, 32.0% in thirties, 27.7 % in forties, 21.7% in fifties, 18.7% in sixties and 1.8% in above seventies, showing statistically significant differences according to age group(p=0.001). 5. In thirties, 87.2% of the asymptomatic patients were diagnosed as CIS and 45.0% of symptomatic patient were diagnosed as CIS. With increment of ages, CIS proportion were markedly decreased. 6. 76.9% of asymptomatic patients were diagnosed as CIS, and 34.0 % of symptomatic patients were diagnosed as CIS, suggesting screening test at asymptomatic stage can increase CIS proportion. 7. CIS proportion of asymptomatic patient was highest in thirties(40.4%) and 2nd highest in forties(34.0%). Screening test for cervical neoplasm should be actively carried out from the thirties.