Pelvic actinomycosis associated with bilateral hydronephrosis developed in a nulligravida woman / 대한산부인과학회지

Pelvic actinomycosis is well-known to be associated with the longstanding use of intrauterine devices, sometimes related with a pregnancy history and an obstetric and/or gynecologic surgery. It can extend to the retroperitoneum and may also be associated with ureteral obstruction. In this case, pelvic actinomycosis in the form of bilateral tubo-ovarian abscess extending to the retroperitoneum resulting in bilateral hydronephrosis occurred in a nulligravida woman who had only few prior sexual intercourses. Apparently, pelvic actinomycosis can occur without any specific history. Moreover, such could possibly give rise to hydronephrosis by direct extension to the retroperitoneum.

Mesothelial Cyst of the Round Ligament Mimicking a Metastasis: a Case Report

A mesothelial cyst of the round ligament is a rare cause of an inguinal mass. Clinically, it is frequently misdiagnosed as one of commoner diseases such as an inguinal hernia, femoral hernia, lipoma, and lymphadenopathy upon physical examination. Some previous reports elaborated the sonographic features of a mesothelial cyst of the round ligament. However, to our knowledge, few reports have described the CT features of a mesothelial cyst. We illustrated here the sonographic and multidetector CT features of a case of a mesothelial cyst of the round ligament that presented as an inguinal palpable mass and mimicked a metastasis in a patient with a Sertoli-Leydig cell tumor of the ovary.

LEEP conization: Risk factors of positive margin / 대한산부인과학회지

OBJECTIVE: Conization is the popular procedure to diagnose or treat in most cases of cervical intraepithelial neoplasia (CIN) and some cases of early cervical cancer. Many reports show the conservative management of positive margin is reasonable. Nevertheless, it is generally accepted the positive margin of conization is the major cause of being received additional operation such as hysterectomy. The aim of this study is to evaluate the risk factors of positive margin. PATIENTS AND METHODS: 283 CIN or early cervical cancer women who underwent conization were enrolled this study. We evaluated many possible risk factors for positive margin, including age, weight, height, body mass index (BMI), gravity, parity, abortion, severity of disease, glandular involvement, and human papillomavirus (HPV) infection. RESULTS: Of the 283 patients, 80 (28.2%) had positive margin in their conization specimens. Statistical significant risk factors of positive margin included older age (P(trend) < 0.001), higher BMI (P(trend) = 0.036), more severity of disease (P(trend) < 0.001), and involvement of endocervical gland (OR = 2.5, 95% CI 1.5-4.2). Parity (P(trend) = 0.054) showed statistically marginal significance. Weight (P(trend) = 0.154), height (P(trend) = 0.456), gravity (P(trend) = 0.194), abortion (P(trend) = 0.813), and HPV infection (OR = 1.2, 95% CI 0.5-2.5) were not statistically significant risk factors. CONCLUSIONS: The data of present study demonstrated that older age, high BMI, and higher pathologic diagnosis are statistical risk factors of positive margin we can know preoperatively.

Gonadotropin-releasing hormone agonist treatments reduce aromatase and cyclooxygenase-2 in ovarian endometrioma and eutopic endometium in women with endometriosis / 대한산부인과학회지

OBJECTIVE: We investigated whether GnRH agonists reduce aromatase cytochrome P450 and cyclooxygenase-2 by direct action in the eutopic endometrium of endometriosis and ovarian endometrioma. METHODS: Endometrial specimens and endometriotic tissues were obtained from infertility women undergoing laparoscopic surgery. Biopsy samples of the endometrium were obtained before and after GnRH agonist therapy. The stromal cells of eutopic endometrium in women with endometroisis and ovarian endometrioma were cultured in the presence of GnRH agonist (leuprolide acetate 0, 1, 5, and 10 uM) for 24 hours. The expression of aromatase cytochrome P450 and COX-2 was examined by Western blot. RESULTS: Protein of aromatase cytochrome P450 and COX-2 were decreased in the eutopic endometrium of patients treated with GnRH agonist for 3 months. The stromal cells culture of endometrial explants and ovarian endometrioma with GnRH agonist reduced aromatase cytochrome P450 and COX-2. Phosphorylated ERK was decreased in endometriotic stromal cultures with GnRH agonist. CONCLUSION: These findings demonstrate that GnRH agonist not only promoted a hypoestrogenic state but also reduced aromatase cytochrome P450 and COX-2 by direct action on eutopic endometrium in patients with endometriosis and ovarian endometrioma.

A case of solitary fibrous tumor arising from the vagina / 부인종양

Solitary fibrous tumor (SFT) arising from the vagina is a very rare benign stromal tumor, which has a well-demarcated margin and proliferation of spindle cells with the absence of any atypical features. Immunohistochemically, the cells are strongly positive for CD34. Surgical resection of the tumor is recommended as a definite treatment. Clinical courses of SFT are almost benign but long-term follow-up of SFT of the vagina have not been reported yet. We have experienced a case of solitary fibrous tumor arising from the vagina and report this case with a brief of literature.

Ovarian Pregnancy: Two Cases Report / 대한산부인과학회지

Ovarian pregnancy is an uncommon variant of ectopic pregnancy. Spiegelberg's criteria should be fulfilled for the diagnosis of ovarian pregnancy. The reported incidence is 0.5-3% of all ectopic pregnancies. The reported frequency of ovarian pregnancies remained stable. It seems that the frequency is underestimated because some of the suspected tubal pregnancies treated conservatively with methotrexate, without laparoscopic validation, are in fact early ovarian pregnancy. The improvements in ultrasonography, methods for hCG detection, and operative laparoscopy have led to earlier and more accurate diagnosis of ovarian pregnancies. The therapy of ovarian pregnancy is surgical in the first place, and medical treatment with systemic or local methotrexate injection can be applicable after confirming diagnosis of ovarian pregnancy by laparoscopy, in women in a stable condition. Two cases of histologically proven primary ovarian pregnancy are presented with brief review of literature.

Survivin and Bcl-2 expression in eutopic endometrium with and without endometriosis / 대한산부인과학회지

OBJECTIVE: To examine expression of survivin and Bcl-2 in eutopic endometrium with endometriosis and without endometriosis by immunohistochemical stain. METHODS: Expression of survivin and Bcl-2 was immunohistochemically investigated in eutopic endometrium with endometriosis (n=30, study group I; laparoscopy-proved endometriosis, study group II; adenomyosis) or without endometriosis (n=34, control group). The score of immunohistochemical staining was evaluated semi-quantitative method modified by Sinicrope and Lu. Statistical analyses was carried out using one-way ANOVA with Turkey test. RESULTS: Survivin expression was significantly higher in nucleus of glandular epithelium of eutopic endometrium with endomtriosis compared to that without endometriosis (p<0.05). Increased expression of Bcl-2 was found in glandular epithelium of eutopic endometrium with endometriosis than without endometriosis, but there was no significantly difference. CONCLUSION: Our findings suggest that increased survivin expression may contribute to survival of endometriosis. Moreover, survivin could play an important role in pathogenesis of endometriosis.

4 Cases of pelvic actinomycosis associated with intrauterine contraceptive device / 대한산부인과학회지

Pelvic actinomycosis is a rare chronic anaerobic infectious disease, which occurs most commonly in association with an IUD. It is difficult to diagnose the disease initially. In most cases, the diagnosis is made postoperatively because of its diverse clinical manifestations and courses. Besides it is frequently misdiagnosed as pelvic malignancy or endometriosis. If physician has a full understand to these characteristics of pelvic actinomycosis, the use of preoperative antibiotics can reduce the risk of pelvic structure injuries and then a patient can be saved from an extensive surgical procedure. We experienced four cases of pelvic actinomycosis complicated by tubo-ovarian abscess in women wearing IUD and report it with a brief review. In three cases, it was helpful that preoperative intravenous antibiotics therapy.

Increased Proliferating Activity of Endometrium in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: We investigated the expression of Ki-67, NF-kappa B, and COX-2 in endometrial tissue, and the incidence of polyps by hysteroscopic biopsy with or without endometriosis. METHODS: The study group was 92 patients with endometriosis and the control group was 90 patients without endometriosis. The subjects were 20 samples. The 10 samples consisted of eutopic endometrium with endometriosis. The control subjects were 10 samples of normal endometrium. Expression of Ki-67, NF-kappa B, and COX-2 was immunohistochemically investigated by polyclonal antibody. RESULTS: Endometrial polyps were found in 53 of 92 (57.6%) women with endometriosis but only in 15 of 90 (16.7%) women without endometriosis. High expression of Ki-67 was shown in eutopic endometrium with endometriosis. The expression of NF-kappa B and COX-2 was increased in eutopic endometrium with endometriosis, but normal endometrium showed lower expression. CONCLUSION: The increase of endometrial polyps and hyperexpression of NF-kappa B, COX-2, Ki-67 could explain that proliferation activity of eutopic endometrium with endometriosis is increased.

An Effect of Massive Proteinuria in Pregnancy Induced Hypertension / 대한산부인과학회잡지

OBJECTIVE: This study was investigated on the relationship the degrees of proteinuria with the maternal characteristics, maternal and the neonatal outcomes. The correlation between the result of single urine protein- to-creatinine ratio and the amount of 24 hour urine protein was also investigated. METHODS: From December 1999 to June 2002, 63 patients were enrolled in this study. They were divided into two groups by the degree of proteinuria at 24 hour urine, single urine and dip stick test, respectively. Each two groups was compared with the maternal characteristics, gestational age, the maternal and the neonatal outcomes. The correlation between single urine protein-to-creatinine ratio and the amount of 24 hour urine protein was analyzed statistically. RESULTS: Each two groups of single urine and dip stick test had no differences in maternal characteristics, gestational age, maternal and the neonatal outcomes. However, in two of 24 hour urine, massive proteinuria group had poor maternal and neonatal outcomes compared with control group (p value 0.01). Single urine protein-to-creatine ratio and the amount 24 hour urine protein had borderline correlation (p value 0.064). CONCLUSION: The presence of proteinuria influences on maternal and neonatal outcomes. Moreover, the massive proteinuria group had more maternal and neonatal complication than control group. The result of single urine protein-to-creatine ratio had borderline correlation with the amount of protein in 24 hour urine collection.

Preterm delivery between 34-36weeks of gestation; Is it danger? / 대한산부인과학회잡지

OBJECTIVE: We performed this study to determine the safety and danger of preterm delivery at gestational age 34-36 weeks through antenatal profiles, neonatal conditions, neonatal morbidities. METHODS: We reviewed our antenatal and neonatal data between December 1999 and April 2001 to determine the morbidities of infants delivered at gestational age 34-36 weeks using x2test and Fisher's exact test. RESULTS: 1. Mean age was 30.8+/-4.58yrs and mean gravida was 2.68+/-1.56. Preterm premature rupture of membrane was higher in preterm delivery at gestational age 34 and 35weeks(respectively 58.6%, 50%). There was no difference in using tocolytics but, antenatal steroid treatment for prevention of respiratory distress syndrome(RDS) was most frequent in gestational age 34weeks.(20.68%). 2. There was no difference in the risk factor of preterm labor at each group. 3. 1-minute Apgar score<7 was significantly more frequent in neonates at gestational age 34weeks but neonatal weight and meconium staining were not different. 4. The rate of neonatal intensive care unit(NICU) admission was significantly higher in neonates delivered at gestational age 34weeks(93.1%), and RDS occurred in 3 cases delivered at gestational age 34weeks(10.34%). 2 cases delivered at gestational age 34 weeks needed the use of ventilator. CONCLUSION: Our study shows significant differences in neonatal morbidities between 34weeks and the others. In particular, all cases of Respiratory distress syndrome(n=3) occur in neonates delivered at 34weeks gestation not receiving antenatal steroid treatment and neonatal morbidities at 35 and 36weeks of gestation were not different with full term gestation.

A Case of Amnioreduction in Prolapsed Membranes After McDonald Cerclage / 대한산부인과학회잡지

Incompetent internal os of cervix is treated with McDonald or Shirodkar cerclage after 14 weeks of gestation. In rare case, after 20 weeks of gestation fetal membrane is bulging into vaginal cavity, but cerclage in that period is risk factor for preterm labor and preterm premature rupture of membranes. So many complications are reported in that period. So many experiences for reducing fetal membranes into uterine cavity were performed. We report a case of amnioreduction in prolapsed fetal membranes after McDonald cerclage, and delivered in 33 weeks of gestation with brief review of literature.

A Clinical Study on the Recent Tendency of Pregnancy and Delivery in Women Aged 35 Years and Older / 대한산부인과학회잡지

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 35 years and older. METHODS: From December 1999 to May 2001, 954 deliveries were in Ilsan Paik Hospital. Among them we compared 89 cases of pregnant women aged 35 years and older with under 30 year of age as control group 99 cases. The statistical analysis was performed using Chi-square tests, Mantel-Haenszel trend test, and statistical significance was defined as p value<0.05. RESULTS: The preterm delivery was higher in women aged 35 years and older (study group) (31.5%) than control group (8.1%) and cesarean birth (C/SEC) rate also higher in study group (61.8%) than control group (36.3%). In antenatal complications, there are no differences in both groups, but in postpartum complications, 4 cases hysterectomy were in study group compared with control group 1 case. In comparison of neonatal outcomes, neonatal intensive care unit (NICU) admission and congenital anomalies are higher in study group. Especially, in comparison of nulliparous women, study group (n=21) have higher C/SEC rate and preterm delivery than control group (n=63), but in pregnancy outcome there was no differences in both groups. CONCLUSION: There are no significant differences in pregnancy outcomes in both group, although preterm delivery and C/SEC rate are higher in elderly gravida. So elderly gravida is no more than high risk group, if appropriate management will be done.

A Case of Heterotropic Pregnancy After In Vitro Fertilization / 대한산부인과학회잡지

Heterotropic pregnancy is defined as coexistent intrauterine and ectopic pregnancy. The natural incidence is 1 per 30,000 pregnancies, but in case of ovulation induction and in vitro fertilization, it is 1 per 100 pregnancies. Heterotropic pregnancy is increased with pelvic inflammatory disease and the use of various ovulation induction method. Because heterotropic pregnancy is clinically difficult to early diagnosis, close monitoring of pregnancy is important to prevent a deleterious delay in the treatment of ectopic pregnancy, maternal morbidity, and fetal loss. We experienced a case of heterotropic pregnancy diagnosed by ultrasonography in a 32-year-old woman, who complained of vaginal spotting and low abdominal pain after in vitro fertilization and report the case with brief review of literature.

A Case of Hysteroscopic Removal of Intrauterine Device with Missing Tail during Early Pregnancy: Successful Ongoing Pregnancy / 대한산부인과학회잡지

In case of intrauterine pregnancy with an intrauterine device(IUD), it is recommended, to remove the device because of the risk of abortions or septic complications. If the thread of the IUD is not visible, which often occurs because of growth of the uterus in pregnancy, it is advisible, to perform extraction with hysteroscopy and ultrasonic guidance. We report on one case with hysteroscopic IUD removal in early pregnancy, which pregnancy is continuing without complications.

The Effects on Sperm Parameters and Membrane after Treatment with Progesteroneand/or Acetyl-L-Carnitine; Cryopreservation-Thawing / 대한불임학회지

OBJETIVE: To assess the effects of progesterone and acetyl-L-carnitine used after treated with IsolateR gradient before semen cryopreservation-thawing on sperm parameters and membrane integrity. MATERIALS AND METHODS: From April 2001 to July 2001, ten normal male partner of couples who were visited in vitro fertilization (IVF) clinics. the semens were treated with IsolateR gradient before cryopreservation, spermatozoa was incubated with progesterone (1, 5 and 10 micrometer), acetyl-L-carnitine (2.5, 5 and 10 micrometer), or both (progesterone, 1 micrometer; and acetyl-L-carnitine, 5 micrometer) for 30 min. RESULTS: There were no differences in sperm parameters and vital stain among isolate only treated group, progesterone (1, 5 and 10 micrometer), acetyl-L-carnitine (2.5, 5 and 10 micrometer) and both (progesterone, 1 micrometer; and acetyl-L-carnitine, 5 micrometer). But, in high concentration of acetyl-L-carnitine (10 micrometer) treated group, sperm parameters and vital stain were decreased. The statistical method was used ANOVA (Kruskal-Wallis test) and p value was <0.01. CONCLUSIONS: Neither progesterone nor acetyl-L-carnitine show to be protective effect on the cryodamage assessed by sperm parameters and vital stain (eosin-Y stain) in normal sperm. High concentration of acetyl-L-carnitine (10 micrometer), however, was harmful effect on cryoprevention.

Pregnancy Outcome of Natural and In-vitro Fertilization Twin Pregnancy / 대한주산의학회잡지

No abstract available.

3 Cases of Monozygotic Twin Pregnancy after IVF-ET / 대한불임학회지

OBJECTIVE: To report three cases of monozygotic twinning after IVF-ET transfer. METHODS: Private practice in two different assisted reproductive technology clinics. RESULTS: Three intrauterine monozygotic twin pregnancies occurred after IVF-ET. One of them was complicated by cord entanglement, another is progressing normal pregnancy without complication and the other was had a normal pregnancy without complication and delivered twin by cesarean section. CONCLUSION: The reported prevalence of multiple gestations in IVF-ET is a approximately 30%, and it is only 2.7% to be monozygotic twinning in IVF-ET. We report three cases of monozygotic twining after IVF-ET.

Squamous Cell Carcinoma Arising from Mature Cystic Teratoma of the Ovary: A report of three cases

Malignant transformation develops in a little less than 2% of mature cystic teratomas. A wide variety of malignant tumors may arise within benign mature cystic teratomas, and the most common of these is squamous cell carcinoma, which account for 75~85%. In general, the tumors are in an advanced stage and the prognosis is poor as most patients die within a year. However, when the tumor is confined to the ovary, they have a good prognosis and the 5-year survival rate is 63~83%. We experienced three cases of squamous cell carcinoma arising in mature cystic teratoma. Two of the carcinomas occurred in postmenopausal women: 58-(case 1) and 66-(case 2) year-old, and were confined to the ovaries. They were alive 37 months and 18 months after the operation, respectively. The third case was a 45-year-old premenopausal woman who had an extraovarian extension of the tumor and early recurrence within two months. Histologically, cases 1 and 3 were conventional well to moderately differentiated squamous cell carcinomas and case 2 showed a well-differentiated squamous cell carcinoma with exuberant proliferating trichilemmal tumor-like areas.

Transformation of Ovarian Dysgerminoma to Yolk Sac Tumor: Immunohistochemical Consideration / 대한산부인과학회잡지

OBJECTIVE: The purpose of this article is to report mixed germ cell tumor, which revealed changes compatible with early transformation of dysgerminoma to endodermal sinus tumor(EST) through histogenetic considerations and immunohistochemical stains. METHODS: Ovarian germ cell tumors were reviewed from files of Dept. Ob/Gyn. Seoul Paik Hospital fiom 1992.1 to 1996.12. Total of 5 cases include 4 pure dysgerminoma and 1 mixed germ cell tumars. All tissues were fixed in 10% neutral buffered formalin and embedded in paraffin and reviewed by two pathologists with immunohistochemical staining for cytokeratin, vimentin, AFP, PCNA, p53 & bc1-2. RESULTS: Grossly, the areas of transformation were located at the middle of the mixed tumor. The outer layer of the tumor mass was filled with typical pure dysgerminoma. They were characterised as the presence of microcysts and small glandular structures in hematoxylin-eosin(H-E) stains with positive stain for vimentin, except the tissue of the EST. The cells in the intermediate layer were characterised as the mixed form of dysgerminomatous and EST structures in H-E stains. AFP in the dysgerminomatous cells in intermediate layer and EST were stained, but not in outer layer. CONCLUSION: Dysgerminoma may possess the ability to transform to EST. There might be intermediate stage between dysgerminoma and EST, and Immunohistochemical staining for AFP, cytokeratin, vimentin, PCNA also can be used for prognosis of germ cell tumor.