Tuberculous peritonitis in the first trimester of pregnancy

Tuberculous peritonitis in pregnancy is a rare form of extrapulmonary tuberculosis that is not easily diagnosed. The clinical presentations of tuberculous peritonitis are usually non-specific and mimic those of other diseases, such as ovarian malignancy or chronic liver disease, and this non-specificity can cause diagnostic delays and complications. The authors report the case of a 31-year-old primigravida woman who presented with uncontrolled fever, dyspnea, elevated liver enzymes, and mild abdominal distension at 13+2 weeks of gestation. At 14+2 weeks, a therapeutic abortion was conducted and tuberculous peritonitis was confirmed by laparoscopic excisional biopsy of peritoneal nodules and histopathologic examination. The patient recovered on antituberculosis therapy and abdomen and chest follow up radiographic findings have confirmed improvement.

Antiangiogenic Activity of Acer tegmentosum Maxim Water Extract in Vitro and in Vivo

Angiogenesis, the formation of new blood vessels, is critical for tumor growth and metastasis. Notably, tumors themselves can lead to angiogenesis by inducing vascular endothelial growth factor (VEGF), which is one of the most potent angiogenic factors. Inhibition of angiogenesis is currently perceived as one of the most promising strategies for the blockage of tumor growth. In this study, we investigated the effects of Acer tegmentosum maxim water extract (ATME) on angiogenesis and its underlying signal mechanism. We studied the antiangiogenic activity of ATME by using human umbilical vein endothelial cells (HUVECs). ATME strongly inhibited VEGF-induced endothelial cell proliferation, migration, invasion, and tube formation, as well as vessel sprouting in a rat aortic ring sprouting assay. Moreover, we found that the p44/42 mitogen activated protein (MAP) kinase signaling pathway is involved in the inhibition of angiogenesis by ATME. Moreover, when we performed the in vivo matrigel plug assay, VEGF-induced angiogenesis was potently reduced when compared to that for the control group. Taken together, these results suggest that ATME exhibits potent antiangiogenic activity in vivo and in vitro and that these effects are regulated by the extracellular regulated kinase (ERK) pathway.

Incidental diagnosis of vaginal schwannoma in a patient with thigh pain

Schwannoma commonly arises from Schwann cells of the neural sheath, and is rare in the groin region. Here, we describe a vaginal schwannoma incidentally detected by magnetic resonance imaging (MRI) in a patient with thigh pain. A 43-year-old woman presented with thigh pain with burning and tingling sensations in the medial aspect of her left thigh. MRI revealed a mass lesion of heterogeneous intensity 5.2 x 5.7 cm in the left vaginal wall. The mass was resected and histology revealed schwannoma.

Effect on Bone Mineral Density in Postmenopausal Invasive Cervical Cancer Patients with Radical Operation and CCRT / 대한골다공증학회지

OBJECTIVES: This study evaluated the effect on bone mineral density (BMD) in postmenopausal invasive cervical cancer patients treated with radical operation and concurrent chemoradiotherapy (CCRT). METHODS: We analyzed the BMD of spinal bone and the femur in 48 invasive cervical cancer patients treated with CCRT after radical operation. All BMD was measured by dual-energy X-ray absorptiometry. For comparison with control women, 96 patients without gynecological disease whose age and body mass index are consistent with the case group were selected. The measurement interval was 1 year. All of the patients and control women had reached their menopause. RESULTS: Age, height, body weight and body mass index were not significantly different between the two groups. The serum levels of calcium and phosphate were not significantly different between the patients with cervical cancer and control women before and after treatment. On the other hands, the concentrations of total alkaline phosphatase and osteocalcin of patients with invasive cervical cancer were significantly lower (P<0.05) than those of control women after treatment. BMD showed inconsistent outcomes, but there is a trend of decrease after operation and CCRT in invasive cervical cancer. CONCLUSIONS: Our study suggests that invasive cervical cancer patients treated with radical operation and CCRT have a lower BMD, resulting in an increased risk of osteoporosis.

A Retrospective Study of Bone Mineral Density in Patients with Endometrial Cancer without Bone Metastases / 대한골다공증학회지

OBJECTIVES: This retrospective study evaluated bone mineral density (BMD) in postmenopausal endometrial cancer patients without bone metastases. MATERIALS AND METHODS: We retrospectively analyzed the BMD of spinal bone and the femur in 26 endometrial cancer patients and 32 control women. All of the patients and control women had reached their menopause. The control group was treated with benign uterine myoma whose age and body mass index are consistent with the case group. All BMD was measured by dual-energy X-ray absorptiometry.

Liver recurrence in early endometrial cancer with focal myometrial invasion

Endometrial cancer is the most common malignancy of the female genital tract. The cancer spreads by direct extension, transtubal dissemination, lymphatic dissemination, and/or by hematogenous spread, usually results in lung metastasis, but may less commonly involve liver, brain, and bone. Here, we describe a patient with stage IA endometrial cancer who developed liver recurrence 17 months after surgery.

Discrimination between Benign and Malignant Pelvic Masses Using the Risk of Malignancy Index 1 / 대한폐경학회지

OBJECTIVES: To assess the ability of risk of malignancy index (RMI) 1 to discriminate between benign and malignant pelvic masses. METHODS: Between January 2007 and December 2010, 547 women with pelvic masses were evaluated. Their medical records are reviewed here retrospectively. The sensitivity, specificity and positive and negative predictive values of the cancer antigen (CA) 125 level, ultrasound findings and menopausal status in the prediction of malignant pelvic masses were calculated and compared individually or combined using the RMI 1. RESULTS: The receiver operating characteristic (ROC) curves of CA 125, the ultrasound score and the RMI 1 were all found to be relevant predictors of malignancy. ROC analysis of the RMI 1, CA 125 serum levels, ultrasound score and menopausal status showed areas under the curves of 0.795, 0.782, 0.784 and 0.594, respectively. The RMI 1 was found to be statistically significantly correlated with menopausal status (P = 0.001), while not statistically significantly correlated with CA 125 (P = 0.628) or the ultrasound score (P = 0.541). The RMI 1 at a cut-off of 150 - with a sensitivity of 77.9%, specificity of 81.1%, positive predictive value of 51.7% and negative predictive value of 93.4% - showed the highest performance in determining the malignant tendency of pelvic masses. CONCLUSION: Accepting a RMI 1 cut-off value of 150 results in statistically more significant diagnostic criteria than menopausal status for the discrimination of benign and malignant pelvic masses.

Epidemiologic Survey of Menopausal and Vasomotor Symptoms in Korean Women / 대한폐경학회지

OBJECTIVES: Vasomotor symptoms (VMS) are one of the most annoying symptoms experienced by postmenopausal women. Generally, 75% of women over 50 years of age experience VMS. This study is an epidemiologic survey of menopausal symptoms and VMS in Korean menopausal women. METHODS: Survey participants were recruited from Korean provinces based on the Korean population study conducted in 2010 and using multi-level stratification by age and geographic location, and random sampling. Healthy perimenopausal and menopausal Korean women aged between 40 to 60 years and who participated in the interview survey were included in the study. The Korean version of the Menopause Rating Scale (MRS) and the Korean version of Women's Health Questionnaire (WHQ) was used to investigate the prevalence of menopausal related symptoms and to assess quality of life. RESULTS: Among the 1,500 women, 66% were classified as perimenopause, 28% as menopause, and 7% had undergone hysterectomy. Typically, 41.6% of women in perimenopause reported having experienced VMS in recent six months. About 53.1% of women in early menopause and 36.5% of women in late menopause had experienced VMS in the past six months. Whereas, 30.6% of women with hot flashes, and 27.9% of women with sweating stated that these symptoms were not related to menopause. CONCLUSION: The prevalence of VMS in Korean women seems to be less than women of Western countries. Overall subjective experience of menopause was perceived as increasingly positive with age. Awareness of menopausal symptoms appeared lower than expected. Perimenopausal and menopausal women in Korea rarely sought medical care.

Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome in a Child with Idiopathic Precocious Puberty

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital disorder characterized by the congenital absence or hypoplasia of the uterus and the upper two thirds of the vagina due to mullerian duct malformation during embryogenesis. MRKH syndrome usually presents as primary amenorrhea in adolescence in females showing normal development of secondary sexual characteristics and a normal 46, XX karyotype. For this reason, MRKH syndrome usually remains undiagnosed until primary amenorrhea or difficulty in sexual intercourse occurs. In this study, a case of MRKH syndrome diagnosed in a child with idiopathic precocious puberty is reported.

Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome in a Child with Idiopathic Precocious Puberty

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital disorder characterized by the congenital absence or hypoplasia of the uterus and the upper two thirds of the vagina due to mullerian duct malformation during embryogenesis. MRKH syndrome usually presents as primary amenorrhea in adolescence in females showing normal development of secondary sexual characteristics and a normal 46, XX karyotype. For this reason, MRKH syndrome usually remains undiagnosed until primary amenorrhea or difficulty in sexual intercourse occurs. In this study, a case of MRKH syndrome diagnosed in a child with idiopathic precocious puberty is reported.

Serous adenocarcinoma arising from ovarian endometriosis after menopause / 대한산부인과학회지

Endometriosis is estrogen dependent disease in reproductive age. Endometriosis is a chronic inflammatory gynecologic disease. Problems associated with endometriosis include dysmenorrhea, dyspareunia, and infertility. Postmenopausal endometriosis is rare. Also, malignant transformation in endometriosis is rare. There is no report in Korea about serous adenocarcinoma arising from endometriosis after menopause. The authors present a case of serous adenocarcinoma arising from endometriosis after menopause with brief review of the literature.

Clinical Applications of Hysteroscopic Surgery in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: To evaluate the spectrum of hysteroscopic surgery to be extended. METHODS: Forty-three women who underwent hysteroscopic procedures with Urione(R) solution or normal saline as distension media between March 2001 and March 2009 were randomized. The clinical characteristics, laboratory data, and post-operative results were retrospectively analyzed. RESULTS: The following hysteroscopic procedures were performed: endometrial biopsy, 26; endometrial polypectomy, 8; myomectomy, 7; ablation for dysfunctional uterine bleeding and endometrial hyperplasia, 1; and excision of an endometrial mass, 1. The mean size of the myomas was 3.2 cm. The average duration of hospitalization was 2 days. The average change in hemoglobin was 1.1 g/dl. The mean operative time was 36 minutes. CONCLUSION: The indications for hysteroscopic procedures can be extended. Pure intramural myomas, submucosal myomas, endometrial polyps, adenomyosis, endometrial hyperplasia, hydrometra, and abnormal uterine bleeding can be treated via a hysteroscope. Intra-operative transabdominal ultrasonographic guidance can be helpful during hysteroscopic procedures, and reduces the complication and morbidity rates.

Clinical data of patients with endometrioid endometrial adenocarcinoma at a single institution / 대한산부인과학회지

OBJECTIVE: The incidence of endometrial cancer is increasing. We would like to report our institution's clinical data of endometrioid adenocarcinoma (EC) which is the most frequent type. METHODS: From 1998 to 2009, patients' clinical data were reviewed through medical records, retrospectively. RESULTS: For 11 years, there were 96 patients with EC. The average age was 51.1 years old and mean follow duration was 36.6 months. There were 73 patients with stage I, 10 patients with stage II, and 12 patients with stage III. 42 patients were treated by operation only and 46 patients were treated by operation and adjuvant radiotherapy. Among 95 patients who underwent operations, 32 patients did not get lymph node removal and 63 did, and 10 patients had malignant cells at the lymph nodes removed. 6 patients died of EC, 1 with stage I, 3 with stage II and 1 with stage III. CONCLUSION: This study had retrospective limitation but could show the profile of 96 patients with EC.

E-cadherin expression and mutation in endometrial carcinomas and endometrial hyperplasias / 대한산부인과학회지

OBJECTIVE: Reduced tumor cell adhesion is associated with invasive growth and unfavorable prognosis. In endometrial carcinoma, the prognostic impact of adhesion marker such as E-cadherin is partly known. The purpose of this study is to investigate the correlation of the expression and the mutation of E-cadherin in endometrioid endometrial adenocarcinomas and endometrial hyperplasias and to correlate their results with various clinicopathological factors. METHODS: The expression of E-cadherin by using immunohistochemical staining (IHC) and the mutation of E-cadherin gene by using polymerase chain reaction-single stranded conformational polymorphism (PCR-SSCP) and sequencing were performed in tissues of 20 endometrial adenocarcinomas and 30 endometrial hyperplasias. The results were compared with previously known prognostic factors such as the stage, tumor grade and lymph node metastasis. RESULTS: Decreased expression of E-cadherin was detected in 13 of 30 (43.3%) endometrial carcinomas and in 1 of 20 (5%) endometrial hyperplasias (P=0.009). There was no statistical significance of the mutation of E-cadherin gene in between the endometrial carcinomas and endometrial hyperplasias (6.7%: 0%) (P=0.06). The incidence of the expression loss of E-cadherin in endometrial carcinomas also showed significantly higher with tumor grade 3, tumor stage above Ic or lymph nodal metastasis (P=0.01, P=0.02, P=0.03). CONCLUSION: Decreased expression of E-cadherin was detected significantly higher in endometrial carcinomas than endometrial hyperplasias. And the incidence of decreased expression of E-cadherin was more frequent in advanced stage, high histopathologic grade, and lymph nodal metasis. The mutation of E-cadherin gene was detected in only 2 cases. These results suggests that the expression of E-cadherin seems to be important in endometrial carcinomas and associated with aggressive subgroups. But the mutation of E-cadherin gene would not be related to endometrial carcinomas.

The analysis of the clinical results of total laparoscopic hysterectomy according to body mass index / 대한산부인과학회지

OBJECTIVE: To know impacts of BMI on clinical results of total laparoscopic hysterectomy (TLH). METHODS: We reviewed medical records of patients with myoma uteri who undergone TLH between March 2003 and February 2007, retrospectively. We classified group 1 when BMI was or =28. We reviewed age, parity, body weight and height, operation time, amount of blood loss, change of hemoglobin change and days of hospital stay, and analyze these. RESULTS: There were 83 patients (Group 1; 30, Group 2; 40, Group 3; 13). The body weight distributions of Group 1, 2, and 3 were 52.2, 60.9, and 72.0 kg and there were significant differences. But there was no difference of height distributions. The age distributions were 44.3, 47.0, 43.8 year old, and there were differences. But there was no difference of parity distribution. The weight distribution of removed uterus were 250.5, 257.4, 242.7 gm and there was no difference. The operation time distributions were 155.0, 168.2, 160.8 minutes, and there was no difference. The amount distributions of bleeding were 342.7, 356.5, 396.2 ml, and there was no difference. The change distributions of hemoglobin were 2.1, 1.8, 2.2 g/dL, and there was no difference. The day distributions of hospital stay were 5.2, 5.5, 4.8, and there was no difference. CONCLUSION: We could not find any trend between operation time, amount of bleeding, change of hemoglobin, and days of postoperative hospital stay after TLH with BMI.

A case of pelvic congestion syndrome diagnosed by venography / 대한산부인과학회지

Pelvic congestion syndrome (PCS), which is said to occur due to ovarian vein incompetence, is a recognized cause of chronic pelvic pain (CPP). It is difficult to diagnose PCS because of a variety of symptoms. In addition, it can be underestimated by Computed Tomographic or Magnetic Resonance Imaging. At this time, gonadal venography remains the definitive imaging modality to evaluate patients with PCS. Medical and surgical approaches are available to treat PCS. More recently, however, transcatheter embolotherapy (TCE) has been shown to be both safe and effective. We have experienced a case of pelvic congestion syndrome that was diagnosed by venography.

A case of fibroepithelial polyp of vulva / 대한산부인과학회지

Vulvar fibroepithelial polyp is a relatively uncommon benign polypoid tumor of the vulva commonly known as skin tag or occasionally acrochordon. In this case, a 18 years old girl complained of painless bulging mass at the right labium major. She has been suffering from slowly growing a vulva tumor for ten years. It was arising from the right labium major and measured 12 cm in its largest diameter. We have experienced an unusually large vulva mass that was surgically excised and histologically diagnosed as benign fibroepithelial polyp and presented this case with a brief review of literature.

Hypertriglyceridemia induced acute pancreatitis in pregnancy / 대한산부인과학회지

Hypertriglyceridemia is a rare cause of pancreatits. However the relationship between acute pancreatits and severe hypertrigyceridemia is well recognized. It can be a life- threatening complication if the degree of hypertrigyceridemia is severe enough. A serum triglyceride level of more than 1,000 to 2,000 mg/dL is the identifiable risk factor. The clinical course and management of hypertriglyceridemia induced acute pancreatitis is not different from other causes. The clinical course and management of hypertriglyceridemia induced acute pancreatitis during pregnancy are similar to the one during nonpregnant state. The prevalence of acute pancreatitis in pregnancy ranges between 1 in 1,000 to 1 in 3,000. Gestational hypertrigyceridemic pancreatits can be fatal, and maternal morbidity rate has an upward trend of 20%. We report a 31-year-old woman with coexistence of hypertrigyceridemia and acute pancreatits at 32 weeks gestation with a brief review of the literatures.

Uterine artery embolization for the management of uterine artery bleeding after transobturator tape operation: A case report / 대한산부인과학회지

Transobturator tape (TOT) operation for urinary stress incontinence is associated with less complication rate than Tension free vaginal tape (TVT). The two procedures yield similar rates of success. The TOT is lead through the obturator foramen, reducing the risk of bladder injury as well as damage of structures located in the Retzii cave, e.g. nerves and blood vessels. However the complications of TOT procedure may have several complications associated with obturator foramen. They are the injury of obturator nerve and vessels, abscess formation on th obturator foramen, vulvar hematoma, etc. There is no report the uterine artery injury after TOT procedure so far. Recently we experienced a case of successful control of bleeding of the uterine artery after TOT operation via uterine artery embolization. Therefore we report our case with brief review of the literatures.

The short-term effect of black cohosh on vaginal atrophy and safety in postmenopausal women / 대한산부인과학회지

OBJECTIVE: To evaluate the short-term therapeutic effect of black cohosh on vaginal atrophy and safety in postmenopausal women. METHODS: A total of 80 postmenopausal women having moderate to severe degree of climacteric symptoms were randomly allocated to receive black cohosh combined preparation (n=40) or placebo (n=40) daily for 12 weeks. Fifty eight subjects completed this clinical study. The effect of black cohosh on vaginal atrophy in postmenopausal women was evaluated by measuring Maturation Value. Maturation Value was determined from vaginal smear at 0 and 12 weeks of treatment. Safety assessment included vital signs, physical examinations, adverse events, and routine laboratory parameters (hematology, biochemistry and urinalysis). It was carried out at the beginning, and after 4, 8, 12 weeks of treatment. RESULTS: The mean (+/-standard deviation) Maturation Value decreased 0.18 (0.47+/-0.32 to 0.29+/-0.23) in black cohosh group and 0.13 (0.43+/-0.30 to 0.30+/-0.21) in placebo group. There was no statistical difference in change of Maturation Value from the baseline between the groups after 12 weeks. No serious adverse events were seen. Adverse events were observed in 7 (17.5%) patients in black cohosh group and 6 (15%) patients in placebo group. Prevalence of the adverse events did not differ statistically in the two treatment groups. No significant effects were seen on blood pressure, heart rate, body temperature, physical findings and laboratory values. Black cohosh was well tolerated. CONCLUSION: Black cohosh did not exert estrogenic effects on the vaginal atrophy but appears to be a safe alternative medicine for postmenopausal short-term use.