Ruptured Tubal Pregnancy with Massive Retroperitoneal Hemorrhage

Ectopic pregnancy is an implantation of the fertilized ovum on a place except the endometrium. Most of the ectopic pregnancies are located at the fallopian tube. Few cases of retroperitoneal hematoma associated with ectopic pregnancy have been reported on previously; in each the retroperitoneal space had been the site of implantation. In contrast, we treated a patient with an ectopic pregnancy that implanted in the tube and then perforated through into the retroperitoneal space. To our knowledge this is very rare case of retroperitoneal hematoma caused by a ruptured tubal pregnancy.

Complete tubular duplication of colon in an adult: a rare cause of colovaginal fistula

Alimentary tract duplications are uncommon congenital anomalies that usually present during the first decade of life. Complete duplication of the colon in adults is very rare and difficult to diagnose preoperatively. We report a case of a 40-year-old female with complete tubular duplication which was initially misdiagnosed as a salpingeal abscess due to colovaginal fistula.

A comparison of oxycodone and fentanyl in intravenous patient-controlled analgesia after laparoscopic hysterectomy / 대한마취과학회지

BACKGROUND: We planned to compare the effect of intravenous oxycodone and fentanyl on post-operative pain after laparoscopic hysterectomy. METHODS: We examined 60 patients were randomized to postoperative pain treatment with either oxycodone (n = 30, Group O) or fentanyl (n = 30, Group F). The patients received 10 mg oxycodone/100 microg fentanyl with ketorolac 30 mg before the end of anesthesia and then continued with patient-controlled analgesia for 48 h postoperatively. RESULTS: The accumulated oxycodone consumption was less than fentanyl during 8, 24 and 48 h postoperatively. Numeric rating score of Group O showed significantly lower than that of Group F during 30 min, 2, 4, 8 and 24 h postoperatively. The incidences of adverse reactions were similar in the two groups, though the incidence of nausea was higher in the Group O during the 24 and 48 h postoperative period. CONCLUSIONS: Oxycodone IV-PCA was more advantageous than fentanyl IV-PCA for laparoscopic hysterectomy in view of accumulated oxycodone consumption, pain control and cost beneficial effect. However, patient satisfaction was not good in the group O compared to group F.

Carnosic acid inhibits TLR4-MyD88 signaling pathway in LPS-stimulated 3T3-L1 adipocytes

BACKGROUND/OBJECTIVES: Carnosic acid (CA), found in rosemary (Rosemarinus officinalis) leaves, is known to exhibit anti-obesity and anti-inflammatory activities. However, whether its anti-inflammatory potency can contribute to the amelioration of obesity has not been elucidated. The aim of the current study was to investigate the effect of CA on Toll-like receptor 4 (TLR4) pathways in the presence of lipopolysaccharide (LPS) in 3T3-L1 adipocytes. MATERIALS/METHODS: 3T3-L1 adipocytes were treated with CA (0-20 microM) for 1 h, followed by treatment with LPS for 30 min; mRNA expression of adipokines and protein expression of TLR4-related molecules were then measured. RESULTS: LPS-stimulated 3T3-L1 adipocytes showed elevated mRNA expression of tumor necrosis factor (TNF)-alpha, interleukin-6, and monocyte chemoattractant protein-1, and CA significantly inhibited the expression of these adipokine genes. LPS-induced up regulation of TLR4, myeloid differentiation factor 88, TNF receptor-associated factor 6, and nuclear factor-kappaB, as well as phosphorylated extracellular receptor-activated kinase were also suppressed by pre-treatment of 3T3-L1 adipocytes with CA. CONCLUSIONS: Results of this study suggest that CA directly inhibits TLR4-MyD88-dependent signaling pathways and decreases the inflammatory response in adipocytes.

Struma Ovarii: A Case of Struma Ovarii and Literature Review

Struma ovarii is a rare, monodermal and highly specialized teratoma, composed entirely or predominantly (>50%) of thyroid tissue. Presenting symptoms are not specific. Despite containing thyroid tissue, only 5% of struma ovarii have features of hyperthyroidism. Therefore, preoperative diagnosis of struma ovarii is difficult. Recently, the authors experienced a case of struma ovarii found in a young woman who presented with known pelvic mass and dysmenorrhea. A transabdominal ultrasonography and computed tomography detected a 16-cm sized multiloculated mass in pelvic cavity. She underwent laparoscopic unilateral ovarian wedge resection. The final histopathologic diagnosis was struma ovarii of the mature cystic teratoma. Therefore, we report this rare case with a brief review of the literature.

A Case of Mixed Small and Large Cell Neuroendocrine Carcinoma of the Uterine Cervix

A rare case of mixed carcinoma of the cervix is reported, composed of a small and large cell neuroendocrine carcinoma. Neuroendocrine cervical carcinomas are very rare and aggressive. The prognosis is very poor despite multimodal treatment. Earlier reports have shown that the majority of patients present with advanced stage disease, have lymph node metastasis, and are at a high risk for recurrence and disease progression. In this study, we report the case of a 26-year-old woman with composite small and large cell neuroendocrine carcinoma of the cervix. A woman presented with vaginal bleed since 2 months of presentation. Gynecologic examination revealed cervical enlargement, and punch biopsy of the cervical lesion was performed. The biopsy was disclosed a large cell neuroendocrine carcinoma. The patient underwent a radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection. The final histopathologic findings are mixed small and large cell neuroendocrine carcinoma of cervix.

Primary malignant melanoma arising in a cystic teratoma

The malignant transformation of a cystic teratoma is a rare event, occurring in about 0.2% to 1.8%. Primary malignant melanoma arising from the ovary is extremely rare. A primary melanoma in an ovarian cystic teratoma originates most frequently at the dermoepidermal junction, similar to a cutaneous melanoma. Though there are no standard adjuvant regimens for the treatment of primary malignant melanoma of the ovary. We present another case report of malignant melanoma developing in cystic teratoma.

Dietary carnosic acid suppresses hepatic steatosis formation via regulation of hepatic fatty acid metabolism in high-fat diet-fed mice

In this study, we examined the hepatic anti-steatosis activity of carnosic acid (CA), a phenolic compound of rosemary (Rosmarinus officinalis) leaves, as well as its possible mechanism of action, in a high-fat diet (HFD)-fed mice model. Mice were fed a HFD, or a HFD supplemented with 0.01% (w/w) CA or 0.02% (w/w) CA, for a period of 12 weeks, after which changes in body weight, blood lipid profiles, and fatty acid mechanism markers were evaluated. The 0.02% (w/w) CA diet resulted in a marked decline in steatosis grade, as well as in homeostasis model assessment of insulin resistance (HOMA-IR) index values, intraperitoneal glucose tolerance test (IGTT) results, body weight gain, liver weight, and blood lipid levels (P < 0.05). The expression level of hepatic lipogenic genes, such as sterol regulating element binding protein-1c (SREBP-1c), liver-fatty acid binding protein (L-FABP), stearoyl-CoA desaturase 1 (SCD1), and fatty acid synthase (FAS), was significantly lower in mice fed 0.01% (w/w) CA and 0.02% (w/w) CA diets than that in the HFD group; on the other hand, the expression level of beta-oxidation-related genes, such as peroxisome proliferator-activated receptor alpha (PPAR-alpha), carnitine palmitoyltransferase 1 (CPT-1), and acyl-CoA oxidase (ACO), was higher in mice fed a 0.02% (w/w) CA diet, than that in the HFD group (P < 0.05). In addition, the hepatic content of palmitic acid (C16:0), palmitoleic acid (C16:1), and oleic acid (C18:1) was significantly lower in mice fed the 0.02% (w/w) CA diet than that in the HFD group (P < 0.05). These results suggest that orally administered CA suppressed HFD-induced hepatic steatosis and fatty liver-related metabolic disorders through decrease of de novo lipogenesis and fatty acid elongation and increase of fatty acid beta-oxidation in mice.

A case of laparoscopic treatment of collision tumor: Huge serous cystadenoma and dermoid cyst arising in the same ovary / 대한산부인과학회지

Collision tumor means the coexistence of two adjacent, but histologically distinct tumors without histologic admixture in the same tissue and is rare incidence involving ovary. Because of their incidence of occurrence, benign cystic teratomas often occur coincidentally with other abnormalities of the ovary. Most common histologic combination of collision tumor in the ovary is coexistence of teratoma with mucinous tumors. But its association with serous tumor has been noted rare and incidence is unknown. We have experienced a case laparoscopic treatment of a huge serous cystadenoma combined with ovarian benign cystic teratoma in right ovary, and report it with a brief review of literature.

A case of unusual premature ovarian failure with 46,X,dup(Xq) / 대한산부인과학회지

Premature ovarian failure (POF) is defined as the complete cessation of menses less than 40 years of age. The criteria are more than four months of amenorrhea, with serum follicle stimulating hormone value of >40 mIU/mL and the frequency of POF is about 1% of all women. Although the etiologies of POF remain unknown, suggested factors are genetic, autoimmune, chemotherapy, radiotherapy and environmental toxins. The cytogenetic abnormalities predominantly concern the X chromosome, including Turner syndrome, Fragile X syndrome and deletion, translocation, or duplication of X chromosome. We report a very rare case of premature ovarian failure with the following karyotype: 46,X,dup(Xq), and report it with a brief review of literature.

The indications, effectiveness and complications of the selective arterial embolization in the management of obstetrical hemorrhage / 대한주산의학회잡지

PURPOSE:The objective of this study was to evaluate the indications, effectiveness and complications associated with uterine arterial embolization as an alternative treatment of obstetrical hemorrhage. METHODS:From January 2006 to December 2008, 25 patients who underwent angiographic embolization for the obstetrical hemorrhage that was not responsive to conventional treatments, like obstetric maneuvers and uterotonic drugs, were included in our study. All medical records were reviewed and detailed clinical data such as clinical status, underlying conditions, amount of transfusion, embolized arteries, hospital stay, the success rate and the complications were collected. RESULTS:We have experienced clinically successful embolization in 22 (88%) of 25 patients with obstetrical hemorrhage resulting from various causes. After embolization, the patients' vital signs were stabilized. The causes of hemorrhage were atony of uterus (n=10), myomectomy during cesarean section (n=6), abnormal placentation (n=5), arterio-venous malformation (n=3), and cervical pregnancy (n=1). The average amount of blood transfusion was 7.2 units (range; 0~39 units). The average length of the time for the procedure was 55 minutes (range: 25~96 minutes). The average duration of hospitalization was 5.5 days (range: 2~14 days). In 22 patients, menses resumed spontaneously after procedures. The main complications after embolization were numbness and pain on lower extremities (n=1), and hypomenorrhea (n=1). CONCLUSION:The atrerial embolization is one of the safe and effective procedures that offers patients an alternative to hysterectomy for the treatment of intractable postpartum hemorrhage.

Acute renal failure associated with ureteral stone of the unilateral kidney and uterus didelphys with hemivaginal obstruction / 대한산부인과학회지

The unique clinical syndrome of the uterus didelphys, a unilateral partially or completely obstructed vagina, and ipsilateral renal agenesis is quite rare, and observed on the right side in greater frequency than on the left. The case of fifteen year old girl with uterus didelphys, unilateral partially obstructed vagina and acute renal failure associated with ureteral stone in unilateral kidney is described. Extracorporealshock wave lithotripsy (ESWL) and evacuation of the hematocolpos and excision of the vaginal septum were done. Aware of this relatively rare condition is mainstay of prompt diagnosis which will prevent permanent renal failure and unnecessary and destructive surgery.

Cornual pregnancy diagnosed at 9 weeks of atypical ultrasonographic findings / 대한산부인과학회지

A cornual pregnancy occurs when the conceptus implants at the cornus of the uterus which is the junction between the fallopian tube and uterine cavity. Cornual pregnancy is a rare form of ectopic pregnancy and its diagnosis is difficult. It accounts for 2 to 4% of tubal pregnancy and rupture usually occurs between 8 weeks and 16 weeks of gestation. The rich vascularity in this location makes the rupture particularly dangerous, resulting in higher maternal mortality. We have experienced a case of unruptured cornual pregnancy at 9 weeks of atypical ultrasonographic findings, which was hourglass appearance. We present this case with a brief review of the literature.

Spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy / 대한산부인과학회지

Ectopic pregnancy and appendicitis in pregnancy are two most common causes of acute abdomen in young women and differenciation of these diseases is very difficult. Heterotopic pregnancy is a rare event, occuring less than 1:30,000 pregnancies in natural conception cycles. However, with assisted reproduction techniques, this incidence has increased. We experienced a case of spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy. So we report this case with brief review of literature.

Uterine prolapse complicating pregnancy / 대한산부인과학회지

Uterine prolapse is extremely rare during pregnancy. However in some cases significant complications such as urinary tract infection, voiding difficulty, abortion, and preterm labor may develop. Conservative management consisted of bed rest and use of a pessary. An elective cesarean section near term is the safest mode of delivery in cases where the cervix is edematous and elongated. We present a case of a patient developing uterine prolapse at 12 weeks of gestation, treated with bed rest and use of a pessary. A repeat cesarean section was performed at 38 weeks of gestation and report with a brief review of literatures.

A case of treatment of peritoneal trophoblastic tissue implants after laparoscopic salpingectomy / 대한산부인과학회지

The incidence of ectopic pregnancy has increased considerably a decade. And treatment has changed from salpingectomy by laparotomy to conservative laparoscopic surgery or medical treatment. This procedure has many advantages, but there are also disadvantages with the conservative approach and several studies have reported a higher incidence of residual trophoblastic tissue remaining in the tube after treatment. Postoperative follow up of human chorionic gonadotropin (hCG) levels and ultrasonography are needed. This report describes a rare case of persistent trophoblastic implants to the ovary and peritoneum 40 days after laparoscopic salpingectomy. Treatment consisted of laparoscopic excision with biopsy forceps and bipolar, followed by medical treatments. So we report with a brief review of literatures.

A case of cesarean scar ectopic pregnancy / 대한산부인과학회지

Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. With increasing incidence of caesarean section worldwide, more and more cases are diagnosed and reported. Transvaginal ultrasound and colour flow Doppler provides a high diagnostic accuracy with very few false positives. A delay in diagnosis and/or treatment can lead to uterine rupture, major haemorrhage, hysterectomy and serious maternal morbidity. Surgical management can be safe and effective and medical treatment can be selected as appropriate selection criteria. Patients with history of a pregnancy in a cesarean delivery scar should be advised of the risk for future uterine rupture and placenta accreta. We experienced a case of ectopic pregnancy with treatment of surgical excision and report with a brief review of literatures.

A Case of Normal Vaginal Delivery in the Pregnant Woman after Treatment of Pulmonary Edema During Dextran Therapy of the Sudden Deafness / 대한산부인과학회잡지

Dextran of a low molecular weight (dextran 40) is frequently used to improve regional perfusion after surgery in spite of the potentially serious complications such as noncardiogenic pulmonary edema, oliguric renal failure, and coagulopathy that have been widely reported. Dextran is used to improve cochlear microcirculation in sudden deafness of vascular origin, but the frequency of complications is rarely reported in the field of otolaryngology. We reviewed the literature of a case we experienced in which a pregnant woman, after recovering from pulmonary edema caused by treatment for sudden deafness with dextran, had a successful vaginal delivery.

Toremifene-associated endometrial polyp: A case report and review of the literature / 대한산부인과학회잡지

Antiestrogens have been widely used in the treatment of breast cancer patients. Although tamoxifen is one of the most prevalent antiestrogens, some reported its hepatocarcinogenic effects and the long-term treatment may increase the risk of endometrial and gastrointestinal cancer. Toremifene is an interesting new antiestrogen and have a similar antitumor efficacy as tamoxifen, with less side-effect including less uterotrophic effect compared to tamoxifen, in mice. we report a case of endometrial polyp which were associated with toremifene use, in postmenopausal woman with breast cancer, with a brief review of literature.