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 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.

Clinical Relevance of the CA 125 Assay in Monitoring of Epithelial Ovarian Cancer Patients / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine the significance of preoperative serum CA-125 level of primary epithelial ovarian carcinoma with respect to prognostic factors (histologic grade, tumor stage, success of cytoreductive operation) and to assess the relationship between the changes of serum CA-125 level and 5-year survival rate after the cytoreductive operation and chemotherapy. METHODS: We retrospectively investigated the results of 101 patients with primary epithelial ovarian cancer staged over IC, who had been diagnosed and treated at Kyung-Hee University Medical Center from January 1991 to April 2003. They were managed with cytoreductive operation and chemotherpy. They were monitored by serum CA-125 level serially during treatments. RESULTS: There were significant differences of preoperative serum CA-125 level in histologic types, histologic grades, presence of ascites, presence of lymph node involvement, success of cytoreduction and success of 5-year survival (P0.05). There were significant differences of 5-year survival rate in groups divided by pre- and postoperation serum CA-125 level (P<0.05). And significant differences were shown between serum CA-125 values and 5-year survival rate in three cycles of chemotherapy (P<0.05). CONCLUSION: Serum CA-125 level is a valid tumor marker in predicting the responsiveness of cytoreduction and combined chemotherapy in epithelial ovarian cancer. Measurement of serum CA-125 levels during treatment might permit an early change to optimal forms of therapeutic management or alternatives.

A Case of Malignant Melanoma of Vulva / 대한산부인과학회잡지

Malignant melanoma of the vulva is a rare neoplasm and accounts for approximately 10% of all vulvar malignancies. Five-year survival rates range from 8% to 54%, with occuring predominantly in postmenopausal white women. As compared with malignant melanoma of the skin, vulvar melanoma infiltrates early deep into the tissues with abundant lymphatic channels and blood vascularization, so its prognosis is mostly poor. Depth of invasion has been reported as the single most important indicator of prognosis. Historically the treatment of choice for vulvar melanoma has been en bloc radical vulvectomy with bilateral inguinofemoral lymphadenectomy. But recently there have been reports suggesting that acceptable survival may be achieved by less radical operation. The authors report a 84-year old woman with malignant melanoma of the vulva. She underwent wide local excision of the lesion. Now we are following her up with no clinical evidence of cancer recurrence and remnant.

A Case of Superimposed Tuberculous Peritonitis on Chemical Peritonitis Arising in Ruptured Both Ovarian Cystic Teratoma / 대한산부인과학회잡지

Rupture of teratoma is rare. Ovary cystic teratoma was occurred 95% in benign ovary tumor, but chemical peritonitis arising from ruptured cystic teratoma is a scarce case. Peritoneal tuberculosis is also rare disease nowadays. It causes easily fatigue, abdominal distension, intermittent abdominal pain and ascities insidiously. We have recently experienced a case of chemical peritonits from ruptured both ovary cystic teratoma of ovary with superimposed peritoneal tuberculosis in 44 year-old woman and report our scarce case with a brief review of the literature.

Clinicopathologic Characteristics and Prognosis of Endometrial Cancer: A study of 56 Cases / 대한산부인과학회잡지

OBJECTIVES: This study was performed to evaluate the clinicopathologic characteristics and prognosis of uterine endometrial cancer to identify risk factors of the therapeutic and prognostic values. METHODS: This retrospective study was based on medical records including operation records and pathologic reports of 56 patients who underwent surgical treatment with histologically proven endometrial cancer at Kyung-Hee University Medical Center from Sep. 1979 to Aug. 2001. The survival of patients was determined by description of last follow up date in medical records. If more than 3 months passed from last follow up date, we used mail and phone call to identify the status of patients. Univariate analysis was carried out to compare the importance of prognostic variables. RESULTS: The mean age of these patients was 52.4 years, the most common presenting symptom was abnormal vaginal bleeding (91.1%). All except 2 cases of papillary serous carcinoma (3.6%) and 1 case of clear cell carcinoma (1.8%) were endometrioid adenocarcinoma (94.6%). And there are 6 cases of endometrial carcinoma with squamous differentiation. The grades were classified into grade 1 (53.6%), grade 2 (26.8%), grade 3 (19.6%). The FIGO surgical stages were classified into stage\\'a5\\'b0 (55.4%), stage \\'a5\\'b1 (7.1%), stage \\'a5\\'b2 (30.4%), stage \\'a5\\'b3 (7.1%). Most of the patients (87.5%) were treated by surgery only or surgery followed by adjuvant radiotherapy. The overall 5 years survival rate (5YSR) was 65.6%: The FIGO surgical stage \\'a5\\'b0 83.3%; stage \\'a5\\'b1 66.7%; stage \\'a5\\'b2 37.5%; stage \\'a5\\'b3 33.3%. Recurrent case was only one case. The age, parity, and preoperative Pap test were not significant prognostic factors. The depth of myometrium invasion (p<0.05), FIGO surgical stage (p<0.05), peritoneal cytology (p<0.05) and lymph node metastasis (p<0.05) were significant prognostic factors by univariate analysis. CONCLUSIONS: Although the number of patients was not enough, the depth of myometrial invasion, FIGO surgical stage and lymph node metastasis seemed to be significant prognostic factors of uterine endometrial cancer.

Clinicopathologic Characteristics and Treatment Modalities about Vulvar Vestibulitis Syndrome: A study of 30 Cases / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate and introduce the clinicopathologic characteristics and treatment modalities of vulvar vestibulitis, a subset of vulvodynia, may cause physical disabilities, phycological or emotional distress, sexual dysfunction and limitation of daily activities. But its etiologies and treatments are not defined yet. We want to summarize the diagnostic methods and treatments patients of vulvar vestibulitis syndrome, could be easily overlooked in your offices. METHODS: This retrospective study was based on medical records including pathologic reports of 30 patients who underwent skin biopsy among the patients who were diagnosed as vulvar vestibulitis syndrome from August 1999 to February 2002 at Kyung-Hee University Medical Center. Skin biopsy was taken at a most painful area of vestibule in Dermatology Department to improve the accuracy of diagnosis. We evaluated the clinicopathologic characteristics of patients RESULTS: The mean age of these patients was 53.4+/-10.4 years and the mean parity was 3.13+/-1.4 times. The mean duration from symptom onset to diagnosis was 26.2+/-24.1 months. The skin biopsies showed chronic inflammation in 21 cases (70.0%), chronic inflammation with koilocytosis in 5 cases (16.7%), subacute inflammation in 3 cases (10.0%), and acute inflammation in 1 case (3.3%). The most predominant painful area is right posterior vestibular site and all patients felt pain on that site with swab test. There were 70% improvement among 30 patients with non-surgical modalities. CONCLUSION: Vulvar vestibulitis syndrome is a syndrome of severe pain, burning, stinging, irritative or raw sensation within the vestibular area by vestibular touch or attempted vaginal entry such as tampon use or intercourse. It also has vestibular redness, urge to urinate frequently or suddenly and is confirmed by history, moistened cotton-tipped swab test and gentian violet staining on the lesions. Its prevalence is 15% and it is frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. Even though it could be seen frequently in our offices and has a tendency to become a chronic disease requiring long-term treatments, it has been being overlooked in offices due to lack of understanding of its etiologies, diagnostic criteria and treatments. Here we need more concerns and studies of vulvar vestibulitis syndrome.

A Case Of Intraperitoneal Hemorrhage Of Intraligamentous Pregnancy / 대한산부인과학회잡지

The incidence of ectopic pregnancy has been increasing for many years and ectopic pregnancy is still a leading cause of maternal death although its mortality is reduced significantly with improved early diagnosis and treatment. Intraligamentous pregnancy, a subset of ectopic pregnancy, is one of the most unusual accident so that the diagnosis of intraligamentous pregnancy is hardly ever made prior to laparotomy. We experienced intraligamentous pregnancy with hemoperitoneum. So we presented a case with brief review of literature.

A Case Of Intraperitoneal Hemorrhage Of Intraligamentous Pregnancy / 대한산부인과학회잡지

The incidence of ectopic pregnancy has been increasing for many years and ectopic pregnancy is still a leading cause of maternal death although its mortality is reduced significantly with improved early diagnosis and treatment. Intraligamentous pregnancy, a subset of ectopic pregnancy, is one of the most unusual accident so that the diagnosis of intraligamentous pregnancy is hardly ever made prior to laparotomy. We experienced intraligamentous pregnancy with hemoperitoneum. So we presented a case with brief review of literature.

A Case of Ruptured Juvenile Granulosa Cell Tumor / 대한산부인과학회잡지

Sex cord-stromal tumors of the ovary are the third most common types of neoplasms that develop in the ovary and account for about 5-8% of all ovarian malignancies. Juvenile granulosa cell tumor (JGCT) is one of the sex cord-stromal tumors of the ovary has distinct differences from adult granulosa cell tumor (AJCT) with regard to clinical and pathological features as well as biological behavior most frequently occuring in the first two decades of life. Usually Call-exner bodies are rare, and luteinization is frequent in JGCT. The tumor may be solid, cystic, or both. In premenarcheal girls, juvenile granulosa cell tumor usually (82%) elicits the signs of sexual precocity. The tumor should removed as soon as the diagnosis is established. Surgery is the best treatment choice for low stage juvenile granulosa cell tumor in children, but for those with high stage juvenile granulosa cell tumor or recurrent tumor, the best treatment and sensitivity of tumor to radiation therapy and chemotherapy have not yet been determined clearly. About 90% are diagnosed in early stage so, prognosis of juvenile granulosa cell tumor in children is good in most cases, but tumor with more advanced stage has worse clinical outcome correlated with its stage, presence of ruptures, grade of nuclear atypia, degree of mitotic activity. And the clinical stage at the time of diagnosis is considered most important prognostic factor. We experienced a case of ruptured juvenile granulosa cell tumor so, we present a case with brief review of literature.