The Studies of Modified Doos SACSIH Operation , Electrode for Resection of Endocervical Canal , and Hysterectomy Scoring System / 대한산부인과학회잡지

The methods of hysterectomy for intrapelvic benign disease include total, subtotal, la-paroscopic-assisted transvaginal, and SACSIH operation. There have been 298 cases of SACSIH operation for benign uterine or pelvic diseases at the Chonbuk National University Hospital from November 16, 1992 to March 31, 1997. Patients were 41.8 years old on the average ranging from 29 to 50. Their indications cover uterine myoma(211), adenomyosis(37), uterine myoma with pelvic adhesion(16), uterine my- oma with endometriosis(11), and others(23), the uterine myoma being the most common. Both CIN and CIS is excluded after the full evaluation of the cervical disease through Pap. smear, cervicography, ECC biopsy, and HPV typing etc, and the consent of patient is secu- red. The modified SACSIH operation, when compared with other simple hysterectomy oper- ation, has the following advantages;1) minimal surgery, 2) easy adaptation, 3) avoidance of stump cancer, 4) rapid recovery and 5) less postoperative care as far as psychosomatic posthysterectomy problems are concerned. One of the new equipment for new modified technique is the Electro-Surgical Unit system with Electrode for endocervical canal resection. This is developed at this hospital as a part of the G-7 project supported by the Ministry of Health and Welfare. It is made of electrode and rod from electrosurgical unit system and operated by high frequency of current. Thus, we introduce, herein, the modified SACSIH operation and propose the postopera- tional scoring system to estimate postoperative sequelae and to help carry on personal well- being in terms of sexuality and normal life.

The Current Trend in the Diagnosis and Management of Ectopic Pregnancy / 대한산부인과학회잡지

This retrospective study was undertaken to investigate the current clinical trend in the management of ectopic pregnancy. 562 patients of ectopic pregnancy were admitted and managed at the Department of Obstetrics and Gynecology, Chonbuk National University Hospital from Jan. 1. 1985 to Dec. 31. 1996. All cases had a reliable medical record and were divided into two groups, of which group A includes patients admitted from Jan. 1. 1985 to Dec. 31. 1990, group B from the Jan. 1. 1991 to Dec. 31. 1996. The results were obtained as follows. 1. The number of cases of ectopic pregnancy were 248 in group A and 314 in group B. 2. The age group of 20 to 29 years of age was top ranked in group A(49.6%) as well as in group B(46.8%). The age group of 30 to 39 years was 43.2% in group A and 46.6% in group B, respectively. 3. In group A, the case who experienced two deliveries was 31.9%, and nulliparous woman was 30.6%. In group B, the case who experienced two deliveries was 33.1%, nulliparous woman was 33.1%. 4. On reviewing the past medical history, ectopic pregnancy was 11.2% in group A, 10.8% in group B, respectively. Pelvic inflammatory disease was 8.1% in group A and 11.0% in group B, respectively. 5. The interval between the last menstrual period and the onset of symptoms was prevalently in 4 to 8 weeks(64.5% in group A, 61.8% in group B). The terval of 12 weeks or more was 2.0% in group A and 6.0% in group B, respectively. 6. In considering the chief complaints, low abdominal pain was 85.9% and vaginal spotting was 69.0% in group A. On the other hand, low abdominal pain was 91.4% and vaginal spotting was 76.4% in group B, meanwhile nausea and vomitting was 8.6% and dizziness was 3.5% in group A, there were 23.4% of nausea and vomitting and 9.7% of dizziness in group B,7. In relation of the diagnostic methods, the positive rate of culdocentesis in group B was lower than the rate in group A. Diagnostic laparoscopy was done in 5.6% of group A and 14% of group B. The detection rate of adnexal mass and fluid collection in the pelvic cavity was higher in group B than in group A on the ultrasonographic examination. 8. Initial hemoglobin value of 10.1mg/dl or more was 70.9% in group A and 73.2% in group B. The value of 8.0gm/dl or less was 6.4% in group A and 7.0% of group B, respectively. Initial systolic pressure of 110mmHg or more was 74.6% in group A and 66.6% in group B. The systolic pressure of 90mmHg or less was 3.6% in group A and 8.3% in group B.9. The conceptus was almost implantd in the fallopian tube. The ampullary portion was the most common site of ectopic implantation in both groups. 10. Intraabdominal hemorrhage of 500ml or less in amount was 52.4% in group A and 61.1% in group B, individually. However transfusion was not given in 55.6% of group A and in 71.0% of group B. 11. In the therapeutic modalities, laparotomy was performed in 96.8% of group A and in 82.8% of group B, respectively. The pelviscopic operation was done in 2.4% of group A and in 22.3% of group B. In conclusion, ectopic pregnancy was diagnosed increasingly prior to the onset of the hypovolemic symptoms according to developement of high-resolution ultrasonogram, diagnostic laparoscopy and beta-hCG test, therefore the use of minimally invasive techniques in the management of ectopic pregnancy was increasing.