Genital tract cavernous hemangioma as a rare cause of postpartum hemorrhage

Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.

Unusual presentation of retroperitoneal leiomyosarcoma mimicking an adnexal tumor with highly elevated serum CA-19-9

When retroperitoneal leiomyosarcoma develops in pelvic cavity, it often presents similar symptoms and radiological findings to adnexal tumor, therefore obscures diagnostic approaches until an exploratory laparotomy is performed. We report an unusual presentation of retroperitoneal leiomyosarcoma mimicking an adnexal tumor with extremely elevated serum CA-19-9. Though the most of the prominent mass was removed during surgery, there was massive bleeding due to tearing of internal iliac vein while dissecting the ureter close to vessels. This case focuses on the significance of considering retroperitoneal tumor even if the mass is located in ovarian fossa and has highly elevated serum level of CA-19-9. And in attempt of tumor removal, the excision needs to be clean-cut without damaging nerves or vessels around the mass and avoid causing any prospective complications.

Spinal Subdural Hematoma After Lumbar Puncture

Lumbar puncture is a simple bedside procedure that is essential for the diagnosis and treatment of several neurologic diseases. Known complications include headache, backache, infection, and hemorrhage, with the most common being postpuncture headache. We report a case of postpuncture spinal subdural hematoma-which is extremely rare-in a 29-year-old female. Although most cases of postpuncture spinal hematomas are associated with coagulation abnormalities, this case shows that it can occur in the absence of predisposing factors.

Interrelationship between Cerebral Vasospasm and Vasogenic Edema in Eclampsia Complicated by Posterior Reversible Encephalopathy Syndrome (PRES): a Case Report / 대한주산의학회잡지

Posterior reversible encephalopathy syndrome (PRES) is a transient clinical neuroradiological disease entity characterized by clinical signs and symptoms including hypertension, generalized seizure, mental status change, headache, and vision change. It is most commonly reported in the literature in association with obstetrical patients suffering from preeclampsia and eclampsia. Two theories of vasospasm and vasogenic edema have been suggested to explain cerebral abnormalities associated with eclampsia. But, the pathophysiology of PRES remains unclear. Here we present one patient who suffered from eclampsia complicated by PRES and we could assume the pathophysiological mechanism in the development of PRES through this case.

Involvement of MITF-A, an alternative isoform of mi transcription factor, on the expression of tryptase gene in human mast cells

Mast cells play a central role in the initiation and development of allergic diseases through release of various mediators. Tryptase has been known to be a key mediator in mast cell-mediated inflammatory reactions. In the present study, we investigated whether the transcription of tryptase gene in human mast cells was induced by microphthalmia (mi)-associated transcription factor (MITF). We observed that the human CD34+ progenitor-derived cultured mast cells and human mast cell line HMC-1 expressed strongly the transcripts of tryptase-beta1 and MITF-A, which is a MITF alterative splicing isoform. The transcriptional activity of tryptase gene was specifically higher in HMC-1 cells compared to the tryptase-negative cells. Using mutant constructs of tryptase promoter, we observed that two E-box (CANNTG) motifs including between -817 to -715 and -421 to -202 are able to involve in the transactivation of tryptase gene by MITF-A. In addition, the binding of these motifs-containing oligonucleotides to MITF proteins was detectable by EMGA using the nuclear extracts of HMC-1 cells and anti-MITF mAb. The overexpression of MITF-A elevated tryptase production by HMC-1 cells, while the introduction of specific siRNA against MITF attenuated the expression and enzymatic activity of tryptase. These data suggest that MITF might play a role in regulating the transcription of tryptase gene in human mast cells.

The predictive value of abnormal ultrasonographic finding for fetal trisomy in the second trimester / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate obstetrical characteristics related to fetal trisomies and to survey the predictive value of abnormal second trimester ultrasonographic findings for fetal trisomies. METHODS: We reviewed the medical records of 3,023 patients who had fetal karyotyping performed between May 1989 and May 2005, and then retrospectively examined 71 cases of trisomies diagnosed prenatally. All patients were classified into three groups according to indications of fetal karyotyping such as positive triple test result, maternal age older than 35 at delivery, and abnormal ultrasonographic findings and we compared the obstetrical features and positive predictive value of each indication. RESULTS: Thirty two cases (39%) of total trisomies had abnormal ultrasonographic findings. Abnormal ultrasonographic findings were significantly more common (16 cases, 76%, P=0.001) in fetuses with trisomy 18 compared to the other trisomies. Structural anomalies in fetuses with trisomy were usually detected in late second trimester. The positive predictive value of abnormal ultrasonographic findings was 3.0% (elderly woman; 1.4%, positive triple test; 1.7%) in trisomy 21 and 6.3% (elderly woman; 1.6%, positive triple test; 1.8%) in both trisomy 21 and 18. CONCLUSION: The positive predictive value of abnormal ultrasonographic findings for diagnosis of fetal trisomy is higher than the other indications for fetal karyotyping. In addition, screening of trisomy 18 with an ultrasonography may be still more important because the majority of fetuses with trisomy 18 show various congenital anomalies.

Awareness and knowledge of human papillomavirus infection among female public health personnel / 대한산부인과학회지

OBJECTIVE: To assess the level and accuracy of understanding of human papillomavirus (HPV) infection among female public health personnel in Chonbuk province. METHODS: Nine hundred ninety-one female public health personnel were asked to complete a questionnaire assessing HPV awareness and specific knowledge about the virus. The questionnaire contained 11 demographic informations and nine true-false questions on knowledge about HPV infection. RESULTS: Questionnaires were completed by 546 women, of whom 145 (37.6%) had heard of HPV. Married women (P=0.019), those with a history of candida, genital warts (P<0.001), or an abnormal smear result (P=0.001), annually visitor for a Pap smear (P=0.023) were more likely to have heard of human papilloma virus. Medical doctor (38.6%) was the most common source of hearing of HPV. Overall percentage of knowledge among those who had heard of HPV was 56.3%. Responses indicated than more than 70% had up-to-date knowledge about several issues: HPV is the main cause of cervical cancer, HPV is sexually transmitted, The pill protects against HPV, and Men can carry HPV. Fewer than 50% knowledge of HPV infection were as follows: HPV viruses are divided to low-risk and high-risk type, HPV infections persist forever, condoms protect against HPV. CONCLUSION: In this well educated samples, awareness of HPV infection was poor. And also, knowledge about HPV infection was relatively low. We recommend that more educational effort is needed for improving women's knowledge and awareness of HPV infection.

A huge branchial cleft cyst detected prenatally: Differential diagnosis from other neck cystic lesions / 대한산부인과학회지

Though branchial cleft cysts (BCC) are common cause of congenital cyst formation in the neck, the prenatal cases have been reported very rarely. We discovered fetal neck cyst at 32 weeks of gestation and eventually diagnosed it as BCC by postnatal surgical excision and histologic findings. It is hard to establish differential diagnosis of BCC from other congenital neck cysts on fetal ultrasonography. The anatomic locations and clinical features of each cystic lesions are important to diagnose accurately and then to achieve complete surgical excision for recurrence-free treatment. We present a case of a BCC detected prenatally and survey the points of differential diagnosis of a BCC from other neck cystic lesions on fetal ultrasonography.

A Case of Oular Sparganosis in Korea

PURPOSE: To present a case of ocular sparoganosis presenting as itching sensation. METHODS: A 60-year-old woman presented for removal of an itchy subconjunctival mass in her left eye. Her ocular findings were normal, except for a subconjunctival mass (1.5 x 1.5 mm). RESULTS: A parasite excised from the subconjunctival mass was identified as a sparganum, by microscopic examination after hematoxylin-eosin staining. The mummified parasite was identified as the plerocercoid phase of the sparganum, by microscopy. CONCLUSIONS: Although rare, parasitic disease should be suspected in a palpable subconjunctival mass unresponsive to the medical treatment.

Prognosis of pregnancy and perinatal outcomes in epileptic pregnant women used antiepileptic drugs / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to investigate the prognosis of pregnancy and perinatal outcomes of epileptic women used antiepileptic drugs. METHODS: A retrospective analysis of 66 consecutive pregnancies of 41 epileptic women from January 1989 through December 2005 was performed. The maternal and perinatal outcomes of pregnancies with epilepsy were compared with those of 1,000 normal pregnancies of similar age and parity occurred during the same period. We also compared the perinatal outcomes regarding protocol of antiepileptic drugs (monotherapy vs polytherapy), existence of gestational seizure, and duration of epileptic history. Statistical analyses with chi-square test and t-test were performed. RESULTS: In our comparison study between epilepsy and normal groups, with the exception of primigravida (43.8% vs 31.8%, p=0.009), induction of labor (43.1% vs 22.1%, p=0.001) and major congenital malformation (6.9% vs 2.0%, p=0.015), no other significant differences regarding maternal and perinatal outcomes were noted between two groups. There were no different obstetrical outcomes between monotherapy and polytherapy groups. In epileptic women with gestational seizure, the rate of fetal distress (20.0% vs 2.3%, p=0.02) was significantly increased. In longer epileptic history (> or =10 years), the rates of preterm birth, low birth weight, and major congenital malformation were increased, but there was no statistical significance. CONCLUSION: There are no increased maternal and perinatal complications in epileptic women used antiepileptic drugs, except for major congenital malformation.

Clinical Efficacy of Human Papillomavirus DNA test after Loop Electrosurgical Excision Procedure in Cervical Intraepithelial Neoplasia / 대한산부인과학회지

OBJECTIVE: The aim of this study was to analyze a relation between the recurrence of cervical intraepithelial neoplasia (CIN) and the detection of high-risk human papillomavirus (HPV) DNA after loop electrosurgical excision procedure (LEEP), and to evaluate the clinical efficacy of HPV DNA test by Hybrid Capture Assay as a predictor of the recurrence of CIN after LEEP. METHODS: From January 2000 through March 2003, the charts of 238 women diagnosed as CIN and treated with LEEP were reviewed retrospectively. HPV DNA test (Hybrid Capture System I) for high-risk HPV was performed in all patients before LEEP. They were followed up with Papanicolaou smears and HPV DNA tests at the interval of 3 months during the first 6 months and then at the interval of 6 months. The Chi-square test was used for the statistical analysis. RESULTS: The rate of detection of high-risk HPV declined chronologically after LEEP. A higher recurrence rate was noted in the HPV DNA positive group after LEEP, comparing with the negative group, at 3 months (54.5% in positive vs. 6.5% in negative; p<0.05), at 6 months (61.1% in positive vs. 5.4% in negative; p<0.05), at 12 months (50.0% in positive vs. 14.0% in negative; p<0.05), and at 18 months (50.0% in positive vs. 15.2% in negative; p<0.05). The negative predictive value was high at 3 months (93.5%), at 6 months (94.6%), at 12 months (86.0%), and at 18 months (84.6%). There were significant associations between the recurrence of CIN and positive resection margin except for glandular involvements. CONCLUSION: The detection of high-risk HPV is a risk factor for the presence of CIN after LEEP. HPV DNA test by Hybrid Capture Assay after LEEP may be useful marker for the negative prediction of recurrence of CIN after LEEP.

Comparison of Secondary Surgical Methods in Congenital Nasolacrimal Duct Obstruction after Failed Primary Probing

PURPOSE: Evaluate the surgical results and clinical value of monocanalicular stenting (Monaka(R))(FCI Ophthalmics, Marshfield Hills, MA, U.S.A) and balloon catheter dacryoplasty (DCP) using PTCA balloon (Stormer(R)) for congenital nasolacrimal duct (NLD) obstruction in children. METHODS: The authors performed monocanalicular stenting (Monaka(R)) and balloon catheter (Stormer(R)) DCP as a secondary treatment of 25 children (27 lacrimal systems) over 12 months of age who had undergone ineffective probing treatment. The patients were followed up over 3 months and the postoperative outcome was assessed by fluorescein dye test. RESULTS: Nine of eleven children (nine of eleven lacrimal systems, 81.8%) and seven of nine children (seven of nine lacrimal systems, 77.7%) showed objective and subjective improvement, respectively. CONCLUSIONS: Monocanalicular stenting and balloon dacryoplasty are excellent secondary treatments for congenital nasolacrimal duct obstruction after initial probing and irrigation surgery have been failed. Balloon dacryoplasty is a new procedure in improve the life-quality and reduce the complications rather than monocanalicular stenting.

An Autopsy Case of Postpartum Acute Myocardial Infarction Associated with Postpartum Ergot Alkaloids Administration in Old-Aged Pregnant Women

Cases of acute myocardial infarction (AMI) that occur during pregnancy or postpartum are rarely reported. Ergot derivatives are known to induce the spasmodic contraction of coronary arteries. Administration of ergot derivatives can cause AMI, even in normal healthy people. In several reported cases, ergot derivatives triggered severe AMI during the postpartum period. Here, we report the case of a forty-year-old woman who was successfully impregnated by artificial fertilization and died after treatment with ergot derivatives. The autopsy revealed AMI with severe coronary atherosclerosis. This is the first case that reports aggravation of pre-existent severe coronary atherosclerosis after postpartum infusion of ergot derivtives.

A clinical study on gestational trophoblastic disease / 부인종양

OBJECTIVE: To evaluate the clinical characteristics and the outcome of the management for gestational trophoblastic disease (GTD) patients diagnosed at our hospital and to report the current situation of GTD in Korea. METHODS: Between January, 1991, and December, 2000, One hundred and eleven women were diagnosed as GTD and managed in our hospital. Patients were classified according to clinical diagnosis and their medical records were investigated. RESULTS: Cases of benign, malignant nonmetastatic, malignant metastatic low risk and malignant metastatic high risk GTDs were 62, 36, 2 and 11 respectively. The mean age (year), gravidity and parity (number) of GTD patients were 33.3+/-9.9 (range: 19-54), 3.2+/-3.0 (range: 0-16) and 1.7+/-1.8 (range: 0-7) overall. About 75% of GTD patients were women in their 20s and 30s, and 85% occurred in patients with parity of 3 or less. The most common prior gestational event was abortion (37.1%) for molar pregnancy and molar pregnancy (61.2%) for persistent gestational trophoblastic tumor (PGTT). The progression rate of molar pregnancies to PGTT was 38.0%. MTX (16.3%) was mainly used as a single agent, and EMACO (28.6%) or MAC (22.4%) were primarily used for multidrug chemotherapy for the treatment of PGTT. In the treatment of PGTT, overall remission rate was 95.9% (n=47/49). CONCLUSION: The trends for GTD in Korea revealed significant changes, not only a decrease in the incidence of GTD, but also an improvement in the outcome of the management. There is a necessity of further community-based surveys for GTD.

The study of patients-reported functional changes and satisfaction after total abdominal hysterectomy / 대한산부인과학회지

OBJECTIVE: Our purpose was to investigate women's perception and satisfaction before and after hysterectomy comparing urinary, lower gastrointestinal, and sexual function. METHODS: It was a prospective study of 89 women ages 31-65 years undergoing total abdominal hysterectomy for nonmalignant conditions. These women were interviewed before surgery and 1, 3 and 6 months later. Patients-reported symptoms of urinary, lower gastrointestinal, and sexual function and woman's satisfaction of hysterectomy were assessed. Only P< or =0.001 was considered statistically significant. RESULTS: The most common reason of patients for hysterectomy was abnormal uterine bleeding. Secondary complication after hysterectomy was negligible. Hysterectomy has got lead to the improvements in pelvic/abdominal pain, gastrointestinal symptoms, and urinary symptoms. The frequency of orgasm was reduced, but other sexual variables were not changed significantly. The level of satisfaction after hysterectomy was very high. CONCLUSION: Abdominal hysterectomy for benign conditions improves urinary and lower gastrointestinal function with no consistent changes in sexual function. Hysterectomy gives patients high degree of satisfaction as well as marked improvement of quality of life.

A Case of Mesenteric Panniculitis in Pelvic Cavity / 대한산부인과학회지

Mesenteric panniculitis is a infrequent, benign idiopathic inflammatory disease of the mesenteric fat tissues. It is characterized by infiltration of lipid-laden macrophages and associated with variable degree of inflammation and fibrosis. Common symptoms are abdominal pain and palpable mass. The diagnosis is made by ultrasound, computed tomogram (CT), magnetic resonance imaging (MRI), combined with the histologic findings. However, definitive diagnosis is difficult in many cases and it is often misdiagnosed as abdominal tumor before laparotomy is performed. Because mesenteric panniculitis can occur in pelvic cavity, it should be differentiated from tumor of pelvic organ. We report a case of mesenteric panniculitis of rectosigmoid colon mimicking pelvic tumor with a brief review of literatures.

Clinicopathologic Findings after Nasolacrimal Polyurethane Stent Implantations

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction. METHODS: This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period. RESULTS: During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatroy reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.

A clinical analysis of uterine myoma / 대한산부인과학회지

From January 1998 to December 2002, 3,259 cases of uterine myoma were treated at the department of Obstetrics and Gynecology, Chunbuk National University Hospital. A clinico-stastical study of uterine myoma was perfomed to analyse the clinical characteristics. The results were as follows. 1. The incidence of uterine myoma was 9.8%. 2. The most frequent age group was 40 to 49 years, and the mean age was 44.6 years. 3. The average parity was 2.29, the infertility was 163 cases (5.0%), while the primary infertility, 2.4%, the secondary, 2.6% respectively. 4. The most frequent chief complaint was pain which was observed in 2,648 cases (81.2%), abnormal bleeding in 1,775 cases (53.8%). dizziness in 270 cases (8.3%). 5. The corporeal myomas were observed in 2,879 cases (95.9%). Intramural type was observed in 1,687 cases (58.2%), subserous in 529 cases (18.2%), submucous in 191 cases (6.5%), mixed type in 483 cases (17.0%). 6. The mean value of preoperative hemoglobin was 11.1 gm/dL, and the anemia (Hb<10.0 gm/dL) was observed in 481 cases (11.7%). Transfusion was necessary in 215 cases (6.5%). 7. The mean weight of the uterine myoma operated was 335.0 gm. 8. The secondary change of myoma was found in 54 cases (1.7%) and hyaline degeneration was the most common (0.7%). 9. The most common associated condition was chronic cervicitis, which was observed in 784 cases (24.1%). 10. The gynecologic surgery were performed in 1,456 cases (44.7%), medical therapy in 25 cases (0.8%), observation in 1,792 cases (55.0%). 11. Total abdominal hysterectomy was performed in 607 cases (41.7%), total abdominal hysterectomy with unilateral adnexectomy in 115 cases (7.9%), total abdominal hysterectomy with both adnexectomy in 164 cases (11.3%), subtotal hysterectomy in 304 cases (20.9%), myomectomy in 153 cases (10.5%), total laparoscopic hysterectomy in 103 cases (7.0%), laparoscopy assisted vaginal hysterectomy in 8 cases (0.5%), diagnostic laparoscopy in 2 cases (0.1%) respectively. 12. The postoperative complication were found in 113 cases (3.5%) and the wound infection was the most common (1.6%). 13. The mean period of hospitalization was 8 days, and the period less than 10 days in 1,177 cases (80.9%).

A case of prenatally detected bilateral multicystic dysplastic kidney with chromosomal abnormality / 대한산부인과학회잡지

Multicystic dysplastic kidney (MCDK) is one of the most common causes of an abdominal mass in infants and it is the cystic anomaly most frequently identified antenatally by prenatal ultrasonography. The incidence of bilateral MCDK incidence is 1 in 5,000-10,000 births, but the prognosis is very poor due to association with other anomalies as well as chromosomal abnormalities. Recently, we performed prenatal diagnosis on a 26-year-old primigravida after a detection of oligohydramnios with bilateral MCDK on fetal ultrasonographic examination at 24 weeks gestation. Chromosomal analysis of the amniotic fluid cell cultures revealed a 46, XX, t(15;17)(p3;p12) karyotype. Bilateral MCDK was confirmed after autopsy, therefore we report this case with a review of brief literatures.

Cavernous Hemangioma of Clitoris and Clitoral Hood / 대한산부인과학회잡지

Although hemangioma is not infrequent among gynecological patients, misdiagnosis is possible in clitoral hemangioma because of it's anatomical location and the shape. It is difficult to consider hemangioma rather than another disease as the cause of clitoral enlargement. To our knowledge, there are only 2 reported cases with clitoral involvement of hemangioma in the literature and we report first in Korea. Here we describe a patient with a large and ulcerative clitoral hemangioma, who recovered completely after a simple treatment.