Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

OBJECTIVE: To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H2O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy.METHODS: A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively.RESULTS: The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions.CONCLUSION: The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01039441

Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.

Immune Cells in the Female Reproductive Tract

The female reproductive tract has two main functions: protection against microbial challenge and maintenance of pregnancy to term. The upper reproductive tract comprises the fallopian tubes and the uterus, including the endocervix, and the lower tract consists of the ectocervix and the vagina. Immune cells residing in the reproductive tract play contradictory roles: they maintain immunity against vaginal pathogens in the lower tract and establish immune tolerance for sperm and an embryo/fetus in the upper tract. The immune system is significantly influenced by sex steroid hormones, although leukocytes in the reproductive tract lack receptors for estrogen and progesterone. The leukocytes in the reproductive tract are distributed in either an aggregated or a dispersed form in the epithelial layer, lamina propria, and stroma. Even though immune cells are differentially distributed in each organ of the reproductive tract, the predominant immune cells are T cells, macrophages/dendritic cells, natural killer (NK) cells, neutrophils, and mast cells. B cells are rare in the female reproductive tract. NK cells in the endometrium significantly expand in the late secretory phase and further increase their number during early pregnancy. It is evident that NK cells and regulatory T (Treg) cells are extremely important in decidual angiogenesis, trophoblast migration, and immune tolerance during pregnancy. Dysregulation of endometrial/decidual immune cells is strongly related to infertility, miscarriage, and other obstetric complications. Understanding the immune system of the female reproductive tract will significantly contribute to women's health and to success in pregnancy.

Dedifferentiated Endometrioid Adenocarcinoma of the Uterus: Highly Aggressive and Poor Prognostic Tumor

No abstract available.

A study for diagnosis of squamous cell carcinoma arising from mature cystic teratoma / 대한산부인과학회지

OBJECTIVE: To evaluate factors for diagnosis of squamous cell carcinoma arising from ovarian mature cystic teratoma and whether squamous cell carcinoma (SCC) antigen, CA125, CA19-9 and CEA is useful for detection of the malignant transformation of mature cystic teratoma of ovary. METHODS: From October 1999 to December 2008, 11 patients with malignant transformation arising from ovarian mature cystic teratoma were treated at Departments of Obstetric and Gynecology in Samsung Medical Center. Demographic characteristics, symptoms, sign, preoperative images, stage, mode of therapy and results of follow up were reviewed retrospectively. RESULTS: The incidence of squamous cell carcinoma arising from ovarian mature cystic teratoma was 0.15% (11/7,345) in this hospital. The median age of patients was 60.8 years (range, 48~73 years). The most common preoperative diagnosis is mature cystic teratoma (n=5), followed by malignant transformation of mature cystic teratoma (n=3), colon cancer (n=2), primary epithelial ovarian cancer (n=1). SCC antigen level was elevated in five patients (45.4%) and CA125 was elevated in seven patients (63.6%). Median longitudinal diameter of ovarian tumors was 11.1 cm. All the patients were surgically staged. CONCLUSION: We should consider women, old aged and had large sized ovarian teratoma, were associated with development of malignant transformation of ovarian mature cystic teratomas, especially squamous cell carcinoma. CEA, CA19-9, and SCC antigen, in addition to CA125, should be used for tumor markers.

Selected Adnexal Cystic Masses in Postmenopausal Women Can be Safely Managed by Laparoscopy

The aim of this study was to assess the efficacy and safety of laparoscopic treatment for adnexal cystic masses that were predicted to be benign in postmenopausal women. Postmenopausal women found to have an adnexal cystic mass were retrospectively evaluated with transvaginal ultrasonography, and serum CA-125 levels. The selection criteria were adnexal cystic masses greater than 3 cm but less than 10 cm, the masses were in the benign range (4-8) of Sassone's scoring system for transvaginal ultrasonography, and the patients had serum CA-125 levels less than 65 IU/mL. Two hundred nineteen women fulfilled the criteria and underwent operative laparoscopy. Almost all the masses (99.5%) were accurately predicted to be benign except for one borderline ovarian tumor. Two hundreds thirteen (97.3%) women were successfully managed by operative laparoscopy and six (2.7%) required laparotomy. For the patients managed by laparoscopy, the mean operative time was 51.3 min; the mean hospital stay was 2.5 days. There was no significant morbidity and surgery-related mortality. The combination of the Sassone's scoring system for transvaginal ultrasonography and serum CA-125 level can accurately predict benign cystic masses, and operative laparoscopy is technically feasible and safe for the management of adnexal mass in postmenopausal women.

The efficacy of combination of paclitaxel, ifosfamide, and cisplatin for the treatment of recurrent carcinoma of the uterine cervix / 대한산부인과학회잡지

OBJECTIVE: Paclitaxel, ifosfamide, and cisplatin have moderate single-agent activity in patients with metastatic or recurrent cancer of the uterine cervix. We administered a combination of these three agents (TIP) to patients with recurrent cervical carcinoma to evaluate its activity. METHODS: Forty-three patients were treated with ifosfamide (I) 1500 mg/m2 intravenously over 3 hours on Days 1-3, paclitaxel (T) 135 mg/m2 as a 3-hour intravenous infusion and cisplatin (P) 50 mg/m2 intravenously over 30 min on Day 1. The chemotherapy was repeated every 3 weeks. RESULTS: Thirty-five patients received at least three courses of treatment and were evaluable for response. Eighteen patients (51.4%) achieved an objective response, including 5.7% complete and 45.7% partial responses. The median time to progression and overall survival for all patients were 8.0 and 16.0 months, respectively. The site of recurrence relative to prior radiation field and histopathology (squamous vs other pathology) did not affect the response rate and survival. Patients treated with another chemotherapy regimen before the initiation of TIP regimen showed lower response rate (28.6% vs 66.6%, p=0.027) and shorter survival (14 month vs 25 month, p=0.028). Grade 3 or 4 toxicity included granulocytopenia in 13% of patients, anemia in 8%, thrombocytopenia in 5%. CONCLUSION: The TIP regimen is relatively well tolerated and moderately active in patients with recurrent carcinoma of the uterine cervix. Patients more likely to benefit are those who received TIP regimen for the first time after recurrence.

A Case of Cloacal Anomaly with Multiple Associated Anomalies / 대한산부인과학회잡지

Cloacal anomaly is an extremely rare congenital malformation results from a failure in the development of the urorectal fold that separates the rectum from uterovaginal tract. It is characterized by the presence of a single duct where the gastrointestinal, genital and urinary tracts join. It presents with highly variable forms, which make it difficult to be diagnosed antenatally. We report a case of cloacal anomaly confirmed with autopsy, which was initially detected by the presence of a huge cystic fetal abdominal mass by ultrasound at a 22 weeks of gestation.

Clinical profiles of 10 cases of ovarian malignant mixed mullerian tumor / 대한산부인과학회잡지

Malignant mixed mullerian tumors (MMMT) of the ovary are rare, constituting less than 1% of all primary ovarian tumors. Histologically, tumors include malignant epithelial and sarcomatous elements. MMMT of the ovary is a highly aggressive and rapidly progressive tumor with a poor long-term prognosis. The survival rate is very low inspite of surgery, chemotherapy and radiotherapy. The prognostic factors and optimal treatments for this tumor are still controversial because of its rarity. We experienced ten cases of malignant mixed mullerian tumors of the ovary and report our experiences with a brief review of literature.

A Case of Vulvar Carcinoma: Squamous Cell Carcinoma with Sarcomatoid Features / 대한산부인과학회잡지

An extremely rare case of squamous cell carcinoma with sarcomatoid features of the vulva in a 43- year-old woman is reported. Squamous cell carcinoma with sarcomatoid features of the vulva is known as a rapidly growing tumor with poorer clinical outcomes than squamous cell carcinoma. To date only 15 cases of squamous cell carcinoma with sarcomatoid features of the vulva have been reported in the world literature, none in our country. We report a case of a squamous cell carcinoma with sarcomatoid features that we have experienced recently with a brief review of the literature.

A Case of Clear Cell Adenocarcinoma in the Uterine Cervix of 22 Years-Old Virgin / 대한산부인과학회잡지

Clear cell carcinoma of the uterine cervix is rare malignancy that accounts for 4% to 9% of the adenocarcinoma of the cervix. It is thought to originate from Mullerian duct, not from mesonephric duct. The etiology and pathogenesis are yet unclear. But among the suspected etiologies, the prenatal diethyl stilbestrol (DES) exposure is well known to be linked to clear cell carcinoma of the vagina and cervix. This cancer occurs primarily during young age (17 to 23 years) in DES-exposure women, but occurs mainly after menopause in non DES exposure women. The biological behavior and prognosis of the cancer are poorer than those of squamous cell carcinomas and non-clear cell adenocarcinomas. Also DES associated clear cell carcinomas behave less aggressively than those that develop in the absence of a history of DES exposure. We experienced a case of clear cell carcinoma in the uterine cervix of 22 years-old virgin who was not related to DES. So, we presented the case with a brief review of related literature.

A study on the physical growth and development of Korean based on the '92 national anthropometric survey / 체질인류학회지

No abstract available.

A Study on the Physical Growth and Development in Korean / 체질인류학회지

The physical conditions of the Koreans aged 10-30 were studied by obtaining physical and nutritional indices on a sample of 10,535 males and 7,175 females which were surveyed in 1986 National Anthropometric Survey for the purpose of grasping the state of arts of the physique and physical development of Korean. The summary results are as follows :1. Anthropometric measurements : 1) Compared with the results of 1979 survey, the stature and body weight in young ages increased markdly while the sitting height increased a little or rather decreased in the males aged above 16 and in the females aged above 14. The chest circumference shows similar or rather decreased values compared with that of the past. 2) Compared with the results of 1984 anthropometric survey in Japan, the stature and body weight of the Korean young males and females in ages up to 14 show larger values than those of the Japanese. But in ages above 15, those of the Korean show similar or rather smaller values than those of the Japanese. In chest circumference, the Korean turn out to be smaller than the Japanese up to age 16. 3) Compared with the results of 1977 anthropometric survey in U.S.A., difference in the stature, chest circumference and body weight between the Korean and the American start to appear around age 12, but in sitting height there is no big difference.2. Physical and nutritional indices by ages : 1) The relative body weit to stature increases linearly up to age 16 in the males and up to 14 in the females and is larger in the females than the males at ages between 11 to 13. Compared with the results of 1979, it decreased slightly, which indicates that the growth of stature was more prominent than that of body weight. 2) The relative sitting height to stature decreased by 2-3 points than in 1979 which means that the lower part of the body grows more, and the values in the males at age 14 and in the females at age 12 are smallest. Compared with the Japanese, it shows 2-3 points smaller value. 3) The relative chest circumference shows 1-3 points smaller value compared with that of 1979, but similar vaiue compared with that of the Japanese. 4) The R hrer indices, compared with the 1979 data, become smaller in the males at ages above 12 and larger in the females above 12. But the Korean shows similar R hrer index values compared with the Japanese. 5) The Pelidisi indices of the nutritional status turn out to be increasing with advancing ages and show 2-3 points larger values compared with the past. Compared with the Japanese, the pelidisi indices of the Korean males are similar but those of the Korean females are larger. 6) The surface areas of body increase lineally up to age 15 in the males and age 13 in the females which shows a similar tendency with the past.3. Estimation of mean body weight in the Korean : A equation for the estimation of body weight in the Korean by age, sex and stature is developed.