Rectouterine fistula after laparoscopic ultrasound-guided radiofrequency ablation of a uterine fibroid

In the conservative management of uterine fibroids is radiofrequency ablation (RFA) considered to be one of the safe, effective and minimal invasive approaches in selected women who desire to retain their uterus. Few studies were conducted on its adverse outcomes and most of the reported complications were minor events such as pain, discharge, adhesion which didn't require any intervention. However, although safe and effective, the RFA of a uterine myoma can be the cause for severe complications such as penetration and burn injuries of pelvic organs. In general, a rectouterine fistula is one of the rarest complications but can lead to serious adverse outcomes. Herein, to our knowledge, we report the first case involving a rectouterine fistula after laparoscopic ultrasound-guided RFA of a uterine myoma with pelvic endometriosis. In addition, we provide a brief review of the relevant literature.

Pulmonary Toxicity after a Quick Course of Combinatorial Vincristine, Bleomycin, and Cisplatin Neoadjuvant Chemotherapy in Cervical Cancer

Pulmonary toxicity is one of the most serious adverse effects associated with a quick course of vincristine, bleomycin, and cisplatin neoadjuvant chemotherapy (NAC-VBP). The aim of this study was to evaluate pulmonary toxicity related to a quick course NAC-VBP. A total of consecutive 61 patients, who underwent at most 3 cycles of NAC-VBP every 10 days in the International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIB cervical cancer from 1995 to 2007, were retrospectively analyzed. Of the 61 study subjects, 7 (11.5%) were identified to have pulmonary toxicity and 2 (3.3%) died of pulmonary fibrosis progression despite aggressive treatment and the use of a multidisciplinary approach. No factor predisposing pulmonary toxicity was identified. Initial symptoms were non-specific, but bronchiolitis obliterans organizing pneumonia and interstitial pneumonitis were characteristic findings by high-resolution computed tomography of the chest. The benefit of steroid therapy was uncertain and was associated with steroid-induced diabetes mellitus requiring insulin therapy in two patients. Fatal pulmonary toxicity is a major concern of a quick course NAC-VBP. In conclusion, these patients require special monitoring for bleomycin-induced pulmonary toxicity.

Expression and mutational analysis of TGF-beta/Smads signaling in human cervical cancers / 부인종양

OBJECTIVE: To define the molecular basis of TGF-beta1 function in cervical carcinogenesis, we explored the expression and mutational status of TGF-beta1, TGF-beta1 receptors, and Smads, the regulators of the TGF-beta1 signaling pathway, in human cervical cancers. METHODS: Expression of TGF-beta1, TGF-beta1 receptors, and Smads transcripts were determined by quantitative reverse transcription-polymerase chain reaction (RT-PCR), and sequence alteration was analyzed using RT-PCR-single-strand conformation polymorphism (SSCP) analysis. Genomic levels of TGF-beta1, TGF-beta1 receptors and Smads was also measured by quantitative genomic PCR. RESULTS: Abnormal overexpression of TGF-beta1 and abnormal reduction of type II TGF-beta1 receptor were identified in 36% (18 of 50) and 20% (10 of 50) of cervical cancer tissues, respectively. 22% (11 of 50) in Smad2 and 14% (7 of 50) in Smad4 revealed tumor specific mRNA reduction less than a half of normal means. In addition, no evidence for sequence alterations of the gene was found by RT-PCR-SSCP analysis. CONCLUSION: Our study demonstrates that disruption of TGF-beta/Smad signaling pathway exist in human cervical cancer, suggesting that abnormal expressions of the member of TGF-beta/Smad signaling pathway might contribute to the malignant progression of human cervical tumors via suppressing the tumor suppression function of TGF-beta1 1's tumor suppression function.

The effect of HER-2 polymorphism according to age on the risk and pathologic feature of endometrial cancer / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between single nucleotide polymorphisms (SNPs) in the HER-2 gene and age on the risk and pathologic feature of endometrial cancer. METHODS: We included 125 women with histologically confirmed endometrioid adenocarcinoma who underwent complete surgical staging. The control group consisted of 302 patients with benign gynecologic disease who underwent hysterectomy. Nine SNPs spanning the HER-2 gene were genotyped by SNP-IT assay using SNPstream(r) Genotyping System. Of 9 SNPs, 5 that were either monomorphic or had a lowallele frequency ( or =10%; these were included in the final analysis. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for BMI. RESULTS: The mean age for endometrial cancer patients was 53.4+/-11.5 (range, 29-81) years. Forty-seven patients (38%) were or =50 years. Cases had a significantly higher BMI than controls (P<0.001). After adjustment for BMI, there was no significant relationship between HER-2 polymorphism and the risk of endometrial cancer based on age. Furthermore, HER-2 polymorphism did not affect the pathologic features of endometrial cancer based on age. CONCLUSION: Although there is no potential association among HER-2 polymorphisms, age, and endometrial cancer risk, large studies are needed in the future to assess the role of this polymorphism in endometrial cancer and for its combined effect.

The effect of HER-2 polymorphism according to age on the risk and pathologic feature of endometrial cancer / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between single nucleotide polymorphisms (SNPs) in the HER-2 gene and age on the risk and pathologic feature of endometrial cancer. METHODS: We included 125 women with histologically confirmed endometrioid adenocarcinoma who underwent complete surgical staging. The control group consisted of 302 patients with benign gynecologic disease who underwent hysterectomy. Nine SNPs spanning the HER-2 gene were genotyped by SNP-IT assay using SNPstream(r) Genotyping System. Of 9 SNPs, 5 that were either monomorphic or had a lowallele frequency ( or =10%; these were included in the final analysis. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for BMI. RESULTS: The mean age for endometrial cancer patients was 53.4+/-11.5 (range, 29-81) years. Forty-seven patients (38%) were or =50 years. Cases had a significantly higher BMI than controls (P<0.001). After adjustment for BMI, there was no significant relationship between HER-2 polymorphism and the risk of endometrial cancer based on age. Furthermore, HER-2 polymorphism did not affect the pathologic features of endometrial cancer based on age. CONCLUSION: Although there is no potential association among HER-2 polymorphisms, age, and endometrial cancer risk, large studies are needed in the future to assess the role of this polymorphism in endometrial cancer and for its combined effect.

Endometrioid Adenocarcinoma in Urethrovaginal Septum: A Diagnostic Pitfall

Primary endometrioid adenocarcinoma developed at urethrovaginal septum has not been reported. A 61-yr-old woman presented with recurrent urinary tract infection. She had received hormone replacement treatment with estrogen and progesterone for 5 yr. A pinpoint ulceration at slightly elevated anterior vaginal wall was found and biopsy revealed endometrioid adenocarcinoma. Magnetic resonance imaging showed the 4.3 cm sized mass in urethrovaginal septum. She has undergone anterior pelvic exenteration, pelvic lymph node dissection, and urostomy with ileal conduit. Microscopic finding of the pathology revealed endometrioid adenocarcinoma. Co-existence of endometriosis was not identified. Tumor at urethrovaginal septum was difficult to be detected till growing to be bulky, because of vaginal axis, misunderstanding of the tumor as symphysis pubis, no definitive symptom, and its rarity. This is the first reported case of extraovarian endometrioid adenocarcinoma developed at the urethrovaginal septum. Understanding normal functional anatomy and meticulous physical examination are essential to detect this rare tumor in the urethrovaginal septum.

Prenatal Diagnosis of Fetal Seizure: A Case Report

A 35-yr-old woman carrying a 17-week-old fetus presented with right hydronephrosis and a single umbilical artery. Karyotyping was normal and targeted ultrasonography showed an otherwise normal fetus. After 28 weeks of gestation, the mother felt rapid, repetitive fetal movement and an ultrasound at 30 weeks of gestation revealed tonic clonic movements of the fetal trunk and extremities. At 36 weeks of gestation, an emergency repeat Cesarean section was performed because of a premature rupture of the membranes and a male infant weighing 4,295 gm was delivered. After birth, the infant continued to have movements suggestive of a generalized tonic clonic seizure. Brain computed tomography and magnetic resonance imaging revealed normal structures and an electroencephalography showed generalized suppression. Treatment with phenobarbital resulted in substantial improvement in the number of seizure episodes, however fine seizure-like movement continued in both of the hands, feet and in the tongue until the five-month follow-up. This is the first Korean report of a fetal seizure being diagnosed during the prenatal period.

Surgical complications in 1,049 cases of cervical intrafascial semm hysterectomy (CISH) / 대한산부인과학회지

OBJECTIVE: The aim of this study is to evaluate the complication rate of Cervical Intrafascial Semm Hysterectomy (CISH). METHODS: 1,049 CISH were carried out from April 1997 to August 2006 at our department. Retrospective review of medical records was performed to investigate the incidence and the type of complications during CISH procedures. RESULTS: 281 (26.79%) of the patients had a history of laparotomy. Overall 98 (9.34%) complications occurred. There were 30 (2.86%) transfusion, 19 (1.81%) transient bladder dysfunction, 12 (1.14%) cervical stump bleeding, 11 (1.05%) abdominal wound infection or disruption, 7 (0.67%) paralytic ileus, 6 (0.57%) incisional hernia, 4 (0.38%) cervical stump infection, 2 (0.19%) ureter injuries and 2 (0.19%) bladder injuries. And there were one case of transient peroneal nerve palsy, trocar site bleeding, trocar site endometriosis, foreign body in bladder and pelvic abscess. CONCLUSIONS: CISH procedure lessens the risk of ureteral and bladder injury, but this procedure increases the risk of cervical stump bleeding and infection morbidity.

Comparison of the efficacy of additional vaginal dressing disinfectants for reduction of wound-related complications in laparoscopic hysterectomy / 대한산부인과학회지

OBJECTIVES: To compare the efficacy of additional vaginal dressing disinfectants for reduction of wound-related complications in laparoscopic hysterectomy. METHODS: From September 2006 to June 2007, 226 of 243 patients underwent laparoscopic hysterectomy were enrolled. The patients were classified into three groups (no additional disinfectant (n=76), povidone-iodine (n=68), and chlorhexidine (n=82) for disinfectants) and the short term postoperative complications related with wound morbidity were recorded by 2 months out-patient follow up. RESULTS: The mean age of all patients was 46.6+/-7.6 years old, and the mean BMI (body mass index) was 24.2+/-3.4, mean operation time was, 137.2+/-48.0 minutes, and the mean estimated blood loss was 451.8+/-240.2 ml. There was no significant difference among three groups in their mean age, mean BMI, frequency of vaginal culture (+) before surgery, frequency of wound/stump infection after surgery, frequency of wound disruption, and frequency of fever. The significant difference was shown in mean operation time and mean estimated blood loss but those did not affect frequency of vaginal culture (+) before surgery, frequency of wound/stump infection after surgery, frequency of wound disruption, and frequency of fever. CONCLUSIONS: We conclude that the kind of disinfectant for additional vaginal dressing for laparoscopic hysterectomy does not matter deeply in causing short term wound-related complications after the surgery.

A study of stress reactivity in the development of chronic endometriosis / 대한산부인과학회지

OBJECTIVES: To determine whether there is an association between the characteristics of pain in endometriosis and chronic stress. METHODS AND MATERIALS: Fifteen women were diagnosed as endometriosis by diagnostic laparoscopy and 14 asymptomatic volunteers were enrolled. Case group was divided into two groups with their pain duration and severity. Saliva was collected four times a day with commercial collector, Salivette. Salivary cortisol was analyzed by enzyme immunoassay. Statistical association was assessed with Kruskal-Wallis test, Mann-Whitney U test, and repeated measures ANOVA test. RESULTS: In the curve showing diurnal changes of cortisol level, morning rise in cortisol level was significantly blunted among patients compared with control group (p<0.05). Among two patient groups, there was no significant correlation with disease severity, but with duration (p<0.05). CA 125 level, pain scaling score, and age showed no significant correlation. CONCLUSION: Morning rise in salivary cortisol level is blunted in women especially with chronic endometriosis. These is findings might be a small clues that the changes in the salivary cortisol level can be a sign of chronic stress state.

A case of Sertoli-Leydig cell tumor with mucinous heterologous element in a postmenopausal woman / 대한산부인과학회지

Ovarian Sertoli-Leydig cell tumors are rare sex cordstromal tumors, and these neoplasms account for less than 0.5% of all ovarian tumors. Those are more often encountered in young women between the ages of 20 and 30 years who usually become virilized. Recently, we experienced an unusual case of Sertoli-Leydig cell tumor with mucinous heterologous elements in a 71-year-old postmenopauseal woman. We present it with brief review of literatures.

The Follicular Fluid and Serum Concentrations of Vascular Endothelial Growth Factor in patients during IVF-ET Cycles / 대한산부인과학회지

OBJECTIVE: Several aspects of female reproduction, from folliculogenesis to corpus luteum function, are related to angiogenesis. The purpose of this study is to measure the concentrations of vascular endothelial growth factor (VEGF) in follicular fluid and serum in patients during In Vitro Fertilization-Embryo Transfer (IVF-ET) cycles. METHODS: In our prospective study, twenty-nine patients who underwent in vitro fertilization by GnRH agonist short protocol were assessed at the our infertility clinic from Aug. 2003 to July 2005. Serum VEGF and follicular fluid VEGF levels were measured in all patients at the time of oocytes retrieval. The assay technique used in this study was ELISA for serum and follicular fluid VEGF. RESULTS: Of 29 cycles, 10 cycles were pregnant (34.5%). A positive correlation existed for follicular fluid VEGF and chronologic age (r=0.428, p-value=0.021). Follicular fluid VEGF concentration showed an inverse relationship with the total number of oocytes retrieved and follicles (r=-0.493, p-value=0.007; r=-0.474, p-value=0.009). But there was no statistically significant relationship between follicular fluid VEGF concentration and serum VEGF concentration (rho=0.347). Follicular fluid VEGF concentration was significantly higher in the non-pregnant group (1468.38+/-727.33 pg/mL) compared to the pregnant group (676.48+/-542.07 pg/mL) (p-value=0.003). CONCLUSION: Our data provide some of the evidences that elevated VEGF concentrations in the follicular fluid are associated with poor conception rates in the IVF-ET cycles.

A Case of Ovarian Malignant Melanoma showing Peritoneal Dissemination with Unknown Primary Origin / 대한산부인과학회지

Malignant melanoma is a neoplasm of the skin and mucous membrane which very rarely occurs in the ovary. Malignant melanomas occurring in the ovary must be differentiated from primary and metastatic malignant melanoma. Primary malignant melanoma of the ovary is extremely rare and is thought to originate from a cystic teratoma. Malignant melanoma of ovary without evidence of residual teratoma must be considered metastatic even in the absence of a previously cutaneous or mucocutaneous lesion. Opinions about its histogenesis, diagnostic criteria and elective treatment are controversial because of rare manifestations, and the prognosis remains poor in spite of the variety of therapeutic measures. After thoroughly surveying the specific literature, we report case of malignant melanoma with multiple metastases located in the stomach, the omentum and both ovaries with unknown site of primary origin.

Simultaneous occurrence of a granulosa cell tumor and a serous cystadenoma in the same ovary: A case report / 대한산부인과학회지

This is the first case report of a patient with a large serous cystadenoma accompanied by a juvenile granulosa cell tumor that was discovered in the remaining ovarian tissue. A 25-year-old female was presented with constipation and amenorrhea. Ultrasonography revealed a large cystic mass in the left ovary with a normal uterus. The remaining ovarian tissue seemed normal at first look after cystectomy, but showed abnormal consistency on palpation. The remaining ovarian tissue was removed and granulosa cell tumor was confirmed by pathologic examination. The patient has been followed up for 30 months without evidence of recurrence. We would like to emphasize the importance of inspection, and palpation of remaining ovarian tissue during operation to avoid risks of remaining ovarian pathology.

A Case of hypercalcemia caused by metastasis of cervical carcinoma to the right acetabulum / 대한산부인과학회지

In cancer patient, hypercalcemia may develop. The mechanism is local osteolysis by metastasis of cancinoma, or secretion of hormone such as PTHrP (parathyroid hormone related peptides). Bone metastasis in carcinoma of uterine cervix is uncommon. In this report, we present a case of hypercalcemia caused by metastasis of cervical carcinoma to the right acetabulum with a brief review of the literature.

A case of myasthenia gravis aggravated and diagnosed after repeat cesaerian section / 대한산부인과학회지

Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction. It may considerably affect the course of the pregnancy and cause serious compications in both the mother and the infant. Antibodies to nicotinic acetylcholine receptors are the cause of the disturbant nerve impulse transmission to muscle fibers. The clinical state at the beginning of pregnancy does not predict the occurrence of exacerbations or remissions. Each pregnancy has its effect on myasthenia gravis symptoms and does not predict the course of subsequent pregnancies. We experienced a patient received respiratory support because of poor ventilation after repeat caesarean section, but she recovered without complications soon. Two days later after operation, she complained of dysphasia, dysarthria. Then, Tensilon test and acetylcholine receptor antibody test were done. She was diagnosed as myasthenia gravis and administered pyridostigmine as therapeutic dose. We present this case with brief review of the concerned literatures.

A Case of Prenatally Diagnosed Jacobsen syndrome / 대한산부인과학회지

Jacobsen syndrome is a rare condition associated with the deletion of the long arm of chromosome 11. Though several authors reported prenatal sonographic findings of the Jacobsen syndrome, there are no common disease-specific features. The majority of affected cases were identified postnatally by chromosomal analysis of the dysmorphic or mentally retarded patients. We present a prenatal case of Jacobsen syndrome with a brief review of literature. A routine scanning in a 32-year-old primigravida at 17.3 weeks' gestation showed abnormal ultrasonographic findings consistent with increased nuchal thickening and subtle cardiac abnormalities (levorotated heart axis of greater than 60 degrees and thickened ventricular wall). The patient underwent amniocentesis, and the karyotype showed deletion of the long arm of chromosome 11, 46,XX, del (11) (q23.1q24). The fetal autopsy performed following medical termination confirmed the prenatal findings. The present case represents that the prenatal sonographic detection of the nuchal thickening and subtle cardiac abnormality should warrant a careful assessment of fetal anatomy and prompt cytogenetic analysis looking for chromosomal aberrations.

A Case Report of Intrafacial Vaginal Hysterectomy Performed in Patient of Adenomyosis with Cystocele and Rectocele / 대한산부인과학회잡지

The modified supracervical hysterectomy with intrafascial cylindriform enucleation of cervix via endoscopy or vaginal approach enables to do an minimal invasive and organ preserving surgery. The pelvic floor support is maintained and sexual sensation is preserved, and there may be nearly little concern of cancer on cervix. The physical stress to the patient is minimized. But, Intrafascial Vaginal Hysterectomy is rarely performed in case of large uterus size. We performed Intrafascial Vaginal Hysterectomy in patient of adenomyosis with cystocele and rectocele and then report that with review of journal and text book.

Emergency Cervical Cerclage Using Shirodkar Method / 대한산부인과학회잡지

Cervical incompetence is characterized by painless dilation and effacement of the cervix in the second trimester of pregnancy leading to premature rupture of membranes and preterm delivery. Various surgical and nonsurgical approaches have been advocated as treatment for incompetent cervix. The most widely used surgical methods are the Shirodkar and McDonald methods of cervical cerclage. Shirodkar method is more difficult to perform than the McDonald method, but it makes it possible for the cervix to return to more anatomically safe position. We experienced two cases of mild amniotic membrane bulging associated with incompetent cervix; one during 28(+4) weeks of pregnancy and the other during 25(+6) weeks of pregnancy. We were able to perform the emergency cervical cerclage with Shirodkar method by using the allis clamp on the edge of the incision site to traction the dilated and effaced cervix effectively, and were able to maintain the two cases of pregnancy. Both delivered healthy babies at term. So we report this case with a brief review of literature.

Emergency Cervical Cerclage Using Shirodkar Method / 대한산부인과학회잡지

Cervical incompetence is characterized by painless dilation and effacement of the cervix in the second trimester of pregnancy leading to premature rupture of membranes and preterm delivery. Various surgical and nonsurgical approaches have been advocated as treatment for incompetent cervix. The most widely used surgical methods are the Shirodkar and McDonald methods of cervical cerclage. Shirodkar method is more difficult to perform than the McDonald method, but it makes it possible for the cervix to return to more anatomically safe position. We experienced two cases of mild amniotic membrane bulging associated with incompetent cervix; one during 28(+4) weeks of pregnancy and the other during 25(+6) weeks of pregnancy. We were able to perform the emergency cervical cerclage with Shirodkar method by using the allis clamp on the edge of the incision site to traction the dilated and effaced cervix effectively, and were able to maintain the two cases of pregnancy. Both delivered healthy babies at term. So we report this case with a brief review of literature.