Endometriosis in a Postmenopausal Woman 16 Years after a Hysterectomy: A Case Report / 대한폐경학회지

Endometriosis, which is the presence of endometrial glands and stroma in extrauterine locations, is a benign gynecologic disease that may cause dysmenorrhea, chronic pelvic pain and infertility. Endometriosis is a relatively common disease that is estimated to occur in 6~10% of reproductive-aged women. Various theories have been proposed regarding the pathogenesis of endometriosis, but a definitive theory remains obscure. Diagnosis of endometriosis in postmenopausal women is rare, but it has been reported in 2~5% of postmenopausal women receiving hormone therapy. However, endometriosis can also occur in postmenopausal women not receiving hormone therapy, altogether indicating the complex pathogenesis of endometriosis. We report left ovarian endometriosis in a postmenopausal woman who had a hysterectomy a uterine myoma 16 years ago and review the relevant literature.

Endometriosis in a Postmenopausal Woman 16 Years after a Hysterectomy: A Case Report / 대한폐경학회지

Endometriosis, which is the presence of endometrial glands and stroma in extrauterine locations, is a benign gynecologic disease that may cause dysmenorrhea, chronic pelvic pain and infertility. Endometriosis is a relatively common disease that is estimated to occur in 6~10% of reproductive-aged women. Various theories have been proposed regarding the pathogenesis of endometriosis, but a definitive theory remains obscure. Diagnosis of endometriosis in postmenopausal women is rare, but it has been reported in 2~5% of postmenopausal women receiving hormone therapy. However, endometriosis can also occur in postmenopausal women not receiving hormone therapy, altogether indicating the complex pathogenesis of endometriosis. We report left ovarian endometriosis in a postmenopausal woman who had a hysterectomy a uterine myoma 16 years ago and review the relevant literature.

White blood cell differential count and adnexal mass size may predict potential malignancies in laparoscopic surgery / 대한산부인과내시경학회지

OBJECTIVE: We investigated the clinical value of using preoperative differential white blood cell (WBC) count to predict the potential for malignancy of adnexal masses in laparoscopic surgery. METHODS: The electronic medical records of 1325 patients who underwent laparoscopic surgery for adnexal masses between July 2005 and December 2008 were analyzed retrospectively. RESULTS: Of 1325 patients, 30 (2.3%) had adnexal masses with malignant potential. Analysis of differential WBC count, neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR), serum CA 125, mass size showed that only cyst size was significantly different between patients with potentially malignant adnexal masses, those with benign disease (averages of 9.45 cm vs. 6.23 cm, p=0.001). Further analysis was performed using a combination of various markers and multiplication of cyst size and NMR yielded the highest area under the curve, at 0.711(95% confidential interval 0.619~0.806, p<0.001), with a sensitivity and specificity of 86.7% and 48.3% respectively, at a cut off value of 67.23. These values were also significantly different between patients with potentially malignant adnexal masses, and dermoid cyst or endometrioma (p=0.038 and 0.002 respectively, by analysis of variance, post hoc test). CONCLUSION: Preoperative measurement of NMR in conjunction with cyst size may be used as a simple, non invasive marker for predicting the malignant potential of adnexal masses before laparoscopic surgery.

Comparison of Factors Which Influence the Brachial-Ankle Pulse Wave Velocity in Pre- and Postmenopausal Women / 대한폐경학회지

OBJECTIVES: The aim of this study was to compare the factors which influence the brachial-ankle pulse wave velocity (baPWV) in pre- and post-menopausal women. We also investigated the association of menopause with arterial stiffness measured by baPWV. METHODS: We performed a retrospective review of 241 postmenopausal women who attended the health promotion center for a routine checkup. Simple and multiple regression analyses were performed to determine the parameters influencing baPWV in pre- and postmenopausal women. Multiple logistic regression analysis was performed to identify the independent parameters related to increased of arterial stiffness. RESULTS: Multiple regression analysis showed that diastolic blood pressure (DBP; beta = 0.402, P = 0.009) was identified as an independent determinant for baPWV in premenopausal women, and DBP (beta = 0.329, P = 0.021) and the neutrophil-to-lymphocyte ratio (NLR; beta = 0.210, P = 0.016) were identified as independent determinants for baPWV in postmenopausal women. The odds ratio (95% CI) of menopause for a high baPWV was 2.666 (1.025~6.937). CONCLUSION: The NLR is associated with arterial stiffness in postmenopausal women. Consequently, inflammation is thought to play a crucial role in increased arterial stiffness in postmenopausal women. Menopause is associated with a high baPWV, suggesting that changes in the concentrations of sex hormones during the menopausal transition may influence arterial stiffness in clinically healthy women.

Comparison of Factors Which Influence the Brachial-Ankle Pulse Wave Velocity in Pre- and Postmenopausal Women / 대한폐경학회지

OBJECTIVES: The aim of this study was to compare the factors which influence the brachial-ankle pulse wave velocity (baPWV) in pre- and post-menopausal women. We also investigated the association of menopause with arterial stiffness measured by baPWV. METHODS: We performed a retrospective review of 241 postmenopausal women who attended the health promotion center for a routine checkup. Simple and multiple regression analyses were performed to determine the parameters influencing baPWV in pre- and postmenopausal women. Multiple logistic regression analysis was performed to identify the independent parameters related to increased of arterial stiffness. RESULTS: Multiple regression analysis showed that diastolic blood pressure (DBP; beta = 0.402, P = 0.009) was identified as an independent determinant for baPWV in premenopausal women, and DBP (beta = 0.329, P = 0.021) and the neutrophil-to-lymphocyte ratio (NLR; beta = 0.210, P = 0.016) were identified as independent determinants for baPWV in postmenopausal women. The odds ratio (95% CI) of menopause for a high baPWV was 2.666 (1.025~6.937). CONCLUSION: The NLR is associated with arterial stiffness in postmenopausal women. Consequently, inflammation is thought to play a crucial role in increased arterial stiffness in postmenopausal women. Menopause is associated with a high baPWV, suggesting that changes in the concentrations of sex hormones during the menopausal transition may influence arterial stiffness in clinically healthy women.

Outcome of mid urethral sling procedures according to age / 대한산부인과학회지

OBJECTIVE: To compare the morbidity and treatment outcomes of mid urethral sling procedures for older women and younger women, and to evaluate whether mid urethral sling procedures can be effectively used in older women. METHODS: This retrospective study included 381 patients who underwent mid urethral sling procedures, tension free vaginal tape (TVT) or transobturator tape (TOT) for urodynamic stress urinary incontinence from March 2000 to June 2006. The patients were divided into two age groups: younger women (30~69 years old) and older women (70~90 years old). Patients were followed up with clinic visits at 1, 3, 6, 12 months, and every year thereafter. RESULTS: 341 (89.7%) were in younger women, 40 (10.5%) in older women. The rates of intra and perioperative complications including hemoglobin difference, urinary retention, UTI, mesh erosion, wound infection were no significant differences between the groups. De novo urgency was more common in older women than younger women (15.9% vs. 30.0%: P0.05) showed no significant differences. CONCLUSION: Our data showed subjective cure rates without any significant increase in intraoperative complications in older women. Postoperative complications of de novo urgency were more common in the older women. Hospital stay and recovery period were short, making TVT and TOT a suitable procedure for all ages.

A Long-Term Treatment Outcome of Abdominal Sacrocolpopexy

PURPOSE: The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). MATERIALS AND METHODS: This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. RESULTS: The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse > or = stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. CONCLUSIONS: ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.

Pachydermoperiostosis in a 19 Year-old Boy Presenting as an Acromegaly-like Syndrome / 대한소아내분비학회지

A nineteen year-old boy with progressive enlargement of the joints and distal extremities, clubbing, coarse facial features and hyperhidrosis was investigated. In physical examination, thickening of the scalp with furrowing (cutis verticis gyrata) and greasy thickening of skin (pachyderma) was prominent. His endocrine profile was normal. Radiological studies demonstrated bilateral symmetrical periosteal new bone formation with acroosteolysis and incidental microadenoma of pituitay gland. After extensive investigation to exclude systemic and endocrine causes, the patient was diagnosed as pachydermoperiostosis (PDP). PDP is a rare syndrome manifested clinically by finger clubbing, extremity enlargement, hypertrophic skin changes, and periosteal bone formation. The pathogenesis of the disorder has not been clarified though few endocrine abnormalities were seen. To aware of these clinical phenotype would help to differentiate PDP from acromegaly.

A Case of Primary Benign Histiocytosis X of the Stomach / 대한소화기내시경학회지

To our knowledge, there are only six cases of histiocytosis X confined to the stomach. A rare case of gastric polyposis caused by infiltration of histiocytes is reported. A 35-year-old Korean woman with no particular complaints was found to have numerous polyps all over the gastric wall revealed by radiographic and endoscopic examination. Endoscopic biopsy of polyps showed that there were diffuse solid infiltration of hidstiocytes with indistinct cytoplasmic membrane and an absence of phagocytosis in laminar propria mucosae. Immunohistiochemical stain showed positive reaction for S-100 and CD68 and a negative reaction for cytokeratin in the infiltrating histiocytes. Electron microscopic examination showed foamy vacuoles with digested debris around nucleus and displaced cellular organelles to periphery. Systemic examination showed no abonormalities outside the stomach.

A Case of Malignant Lymphoma during Treatment with Methotrexate for Rheumatoid Arthritis / 대한류마티스학회지

Rheumatoid arthritis (RA)is a multisystemic inflammatory disease with a prevalance of approximately 1%of the population.The use of disease modifying anti-rheumatic drug (DMARD)is an essential regimen for the treatment of RA. Among DMARDs,methotrexate (MTX)is used worldwide with confirmed effectiveness.However,cytopenia,pulmonary injury,and hepatic toxicity are a few side effects limiting its use.In addition,although the oncogenic potential of MTX is low,several cases have been reported.Recently an increased risk of developing lymphoproliferative disorders has been reported in patients with RA. The incidence is higher in elderly individuals with severe longstanding seropositive RA,those with Sjogren's or Felty's syndrome,and in patients with RA treated with prolonged low dose MTX.We describe a case of RA who developed non-Hodgkin's lymphoma during low dose MTX therapy.

Predictable Factors for Paradoxical Reactions in Conscious Sedation with Midazolam During ERCP / 대한소화기내시경학회지

BACKGROUND/AIMS: Paradoxical reaction after midazolam administration is relatively uncommon and can obstruct the performance of ERCP. But it can not be predicted before drug administration. We investigate the difference in occurrence of paradoxical reaction according to personal characteristics and clinical status of patients. METHODS: During 155 ERCP procedures, we injected midazolam and meperidine intravenously for conscious sedation until deep sleep occurred. Among 155 patients, 108 patients did not showed paradoxical reaction (group I) and 47 patients (30.3%) showed gross behavioral disturbance and/or agitation (group II). Paradoxical agitation was seen in 9 (7.1%) procedures. RESULTS: Type A-like personality (p=0.002), sleep-talking habit (p=0.026) and presence of pain at the beginning of ERCP (p=0.036) and during ERCP (p=0.021) were seen more frequently in group II. Duration of ERCP was longer (p=0.034) and dosage of midazolam was larger (p=0.009) in group II. In multivariate analysis, having sleep-talking (OR, 5.5), type A-like personality (OR 3.9) and dosage of midazolam (OR 1.3) were risk factors of paradoxical reaction. CONCLUSIONS: Paradoxical agitation after midazolam administration was uncommon and can be managed with flumazenil. Paradoxical reaction can be predicted more often in patients with type A-like personality, sleep-talking habit, complaining pain before ERCP, and in patients injected large dosage of midazolam.

A Case of Adult Onset Still's Disease Associated with Epstein-Barr Virus / 대한류마티스학회지

Adult onset Still 's disease (AOSD)is a rare,distinct clinical entity which affects predominantly young adults aged 16-35.It affects multiple organs,and at present,the etiology is still unclear.Because this disease has few diagnostic or confirmative test,the diagnosis is made by the differential diagnosis and by excluding other diseases.Several reports have suggested a viral trigger in the pathogenesis of this disease.It has some common clinical features ;abrupt onset, high fever,sore throat,transient maculopapular rash,lymphadenopathy,and hepatosplenomegaly.We describe a 17-year-old man who fulfilled the proposed diagnostic criteria of AOSD and had evidence of acute Epstein-Barr virus infection.He complained of intermittent high fever and myalgia for a week.He also had maculopapular rash,sore throat,multiple right cervical lymphadenopahty, and right ankle pain and swelling.After admission,intermittent fever persisted for a month,but diffuse myalgia and migrating arthralgia fluctuated.