Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study

OBJECTIVE: The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH). METHODS: We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital). Data such as age, body weight, height, parity, operation time, intra/post-operative complications, and uterus weight were obtained from the clinical charts. NAVH and LAVH recipients were matched 1:3 in terms of baseline characteristics, and the 2 groups were compared regarding surgical outcomes. RESULTS: Of the 160 patients with benign uterine disease included in the present study. Forty received NAVH and remaining 120 received LAVH. There were significant differences between the groups regarding operation time and hemoglobin change. Notably, although the operation time was shorter for LAVH, hemoglobin change was lower for NAVH. Additionally, although maximum hospitalization duration was shorter for LAVH, the average length of hospitalization was similar between NAVH and LAVH. There were no significant differences between the groups in terms of other variables. CONCLUSION: NAVH may become a new alternative surgical method of choice for hysterectomy, as it represents a clinically feasible and safe approach; moreover is superior to LAVH in terms of bleeding loss.

Practice patterns in the management of threatened preterm labor in Korea: A multicenter retrospective study

OBJECTIVE: This study aimed to examine clinical practice patterns in the management of pregnant women admitted with threatened preterm labor (TPL) in Korea. METHODS: Data from women admitted with a diagnosis of TPL were collected from 22 hospitals. TPL was defined as regular uterine contractions with or without other symptoms such as pelvic pressure, backache, increased vaginal discharge, menstrual-like cramps, bleeding/show and cervical changes. Data on general patient information, clinical characteristics at admission, use of tocolytics, antibiotics, and corticosteroids, and pregnancy outcomes were collected using an online data collections system. RESULTS: A total of 947 women with TPL were enrolled. First-line tocolysis was administered to 822 (86.8%) patients. As a first-line tocolysis, beta-agonists were used most frequently (510/822, 62.0%), followed by magnesium sulfate (183/822, 22.3%), calcium channel blockers (91/822, 11.1%), and atosiban (38/822, 4.6%). Of the 822 women with first-line tocolysis, second-line tocolysis were required in 364 (44.3%). Of 364 with second-line, 199 had third-line tocolysis (37.4%). Antibiotics were administered to 29.9% of patients (284/947) with single (215, 22.7%), dual (26, 2.7%), and triple combinations (43, 4.5%). Corticosteroids were administered to 420 (44.4%) patients. Betamethasone was administered to 298 patients (71.0%), and dexamethasone was administered to 122 patients (29.0%). CONCLUSION: Practice patterns in the management of TPL in Korea were quite various. It is needed to develop standardized practice guidelines for TPL management.

A meningomyelocele with normal intracranial signs on ultrasound and false-negative amniotic fluid alpha-fetoprotein and acetylcholinesterase

Neural tube defects are the major targets of prenatal diagnoses, along with Down syndrome. Prenatal diagnosis of spina bifida is possible at second trimester of gestation through alpha-fetoprotein and acetylcholinesterase biochemistry assays and ultrasound. In particular, the discovery of characteristic intracranial signs on ultrasound leads to a very high diagnosis rate. However, it is rare for spina bifida to present without intracranial signs while also showing normal values of maternal serum alpha-fetoprotein, amniotic fluid alpha-fetoprotein, and acetylcholinesterase. In our hospital, a fetus with spina bifida was delivered at 37+5 weeks' gestation by cesarean section, and was continually followed up over 2 years to date.

The Association between Components of the Metabolic Syndrome and Bone Mineral Density

OBJECTIVE: The aim of this study was to evaluate the association between the components of the metabolic syndrome (MS) and bone mineral density (BMD). METHODS: We conducted a retrospective cross-sectional analysis for 128 men (mean age 50.4 +/- 8.3 years) and 391 women (mean age 46.9 +/- 11.6 years) in Korea University Guro Hospital, Korea. Height (cm), weight (kg), waist circumference (cm), and blood pressure (mmHg) were measured. Fasting plasma glucose (FPG), high-density lipoprotein cholesterol (HDL-C), and triglycerides were measured. BMD at the total hip and lumbar spine was measured by dual X-ray densitometry. All participants completed a standardized questionnaire including medical history, smoking history, alcohol consumption, physical activity and menopausal status. RESULTS: Women with MS had lower BMD at lumbar and total hip sites (0.937 +/- 0.136 g/cm2, P-value 0.010; 0.875 +/- 0.113 g/cm2, P-value 0.045, respectively) than did women without MS. These differences at the spine and femoral neck were persisted after adjusting for age, body mass index, menopause status, alcohol consumption, smoking and physical activity. However, no significant differences in BMD were found in men between those with and without MS. In linear regression analyses, waist circumferences were highly associated with BMD at lumbar and total hip sites in women (beta -0.003, P-value < 0.001; beta -0.001, P-value 0.001, respectively). However, no significant differences were found in men between BMD and components of the MS. CONCLUSION: Among components of MS, waist circumference was associated with BMD in women. But no association was found in men. Women with MS had lower BMD than did women without MS.

A case of postpartum spontaneous ovarian artery rupture in patient with preeclampsia / 대한산부인과학회지

Spontaneous ovarian artery rupture is exceedingly rare case that occur in the postpartum period. There were the cases that occurred aneurysmal rupture of ovarian artery and the coronary artery rupture in the women postpartum period without preeclampsia. There were the cases that occurred the cerebral artery rupture or retinal artery rupture in preeclampsia, but ovarian artery rupture is unreported. The cause of ovarian artery rupture in the postpartum period is unknown, but we thought that thinned arterial wall may be the cause during this period. The women in preeclampsia have high risk factors such as hypertension and pathologic disorder of the vessel. The retroperitoneal hemorrhage due to ovarian artery rupture cause hypovolemic shock, eventually death, therefore, it is necessary to immediate diagnosis and treatment. We described a case of spontaneous right ovarian artery rupture that occurred 2 days after vaginal delivery in preeclampsia including a review of the literature.

A case of normal spontaneous vaginal delivery after transvaginal radiofrequency myolysis / 대한주산의학회잡지

Radiofrequency myolysis does not require general anesthesia and is safe and effective treatment for uterine myomas tried to women in women who wish to conserve the uterus. However, a controversial issue is whether radiofrequency myolysis is safe to women who desire future pregnancies. We report a case who experienced full term spontaneous vaginal delivery without uterine rupture after radiofrequency myolysis.

A case of Larsen syndrome / 대한산부인과학회지

Larsen syndrome is a rare congenital skeletal malformation (1 in 100,000 births) caused by a generalized mesenchymal connective tissue disorder. This disorder leads to a broad spectrum of anomalies. Major diagnostic criteria are multiple dislocations of large joints (especially knees), short metacarpals with cylindrical nontapering fingers and craniofacial abnormalities. Clinical variations range from mild clinical expression to lethal forms. Sporadic occurrence as well as autosomal dorminant and recessive inheritance are described.