A clinical study on the trocar-guided mesh repair system for pelvic organ prolapse surgery

OBJECTIVE: To evaluate the complication and recurrence rates in patients undergoing trocar-guided mesh implant for pelvic organ prolapse (POP) treatment. METHODS: A retrospective study was performed based on the medical records of patients who had undergone mesh implant by one surgeon from May 2006 to August 2013 at the Presbyterian Medical Center in Korea. We evaluated perioperative complications such as bladder injury, mesh exposure, urinary symptoms, infections, and chronic pelvic pain. Recurrence was defined as a POP-quantification system stage ≥II or any symptomatic prolapse. RESULTS: Sixty-seven patients were evaluated, and the mean age of patients was 65.4±7.2 years. Stage ≥III POP-quantification Ba was noted in 61 patients (91%). Intraoperative complications included three cases of bladder injury (4.5%). The mean follow-up period was 44.1±7.9 months. Postoperative complications occurred in seven women (10.5%): four cases of urinary symptoms (6%), two cases of infections (3%), and one case of chronic pelvic pain (1.5%). Mesh exposure did not occur (0%). Prolapse recurrence was reported in five patients (7.5%). CONCLUSION: Based on our operational result, the trocar-guided mesh implant seems to provide safe and effective outcomes.

Effective factor of vaginal birth after cesarean / 대한산부인과학회지

OBJECTIVE: The aim of this study is to determine prognostic factor affecting the mode of delivery in women with one previous low transverse cesarean section by comparing success group with failure group in Vaginal birth after cesarean (VBAC). METHODS: In this retrospective study, 79 patients with one previous low transverse cesarean section who attempted vaginal birth at Jeon-Ju Jesus Presbyterian hospital from January 1, 1997 to December 31, 2007. Information was collected and analyzed to see if there is significant difference between success group and failure group in VBAC. and the significance was set at P<0.05. RESULTS: The VBAC success rate turned out to 88.6%. There was one case of uterine rupture which was associated with hypoxic -ischemic encephalopathy in neonate. But, there was no case of the fetal death or mother death. There were significant difference between two groups in gestational age, expected fetal body weight, cervical dilation, Bishop score, thickness of lower uterine segment. CONCLUSION: The prognostic factors on success of VBAC can be aid in deciding the mode of delivery after cesarean section. Patient being chosen under strict indication, can enhance the VBAC trial and success rate.

Clinical analysis of the endometriosis / 대한산부인과학회지

OBJECTIVE: We studied clinical characteristics of patients have endometriosis to provide basic knowledge for diagnosis, treatment, and futher study of endometriosis. METHODS: We have performed a retrospective clinical study on 163 patients diagnosed with endometriosis during laparotomy, cesarean section, laparoscopic surgery at our medical center from January, 2000 to December, 2004. RESULTS: Incidence of endometriosis was 4.38%. The more frequent occurrence was noted in the young women with low parity and in the nulliparous women. Most frequent symptom comprised dysmenorrhea and lower abdominal pain. 33.7% of patients were asymptomatic. And 82.3% of the patients were in stage III and IV. The frequent sites involved were ovaries, Cul-de sac, uterus, tubes, peritoneum and rectum in order. Frequently combind gynecologic disease were uterine myoma, benign ovarian tumor. In Stage III & IV, there are more patients, who had abnormal elevated serum CA 125 level than patients of stage I & II. CONCLUSION: Early diagnose and appropriate management of Endometriosis for young women can lowered the development of hihger stage case and it is important for fertility and better life quality.

Two Cases of Endometriosis at the site of Episiotomy Scar and Abdominal Scar following Cesarean Section / 대한산부인과학회잡지

The most frequent ectopic locations of endometriosis include, in descending order of frequency, the ovaries, uterine ligaments, the rectovaginal septum, and peritoneum covering the pelvic organs, that is, uterus, fallopian tubes, rectum, sigmoid colon, and bladder. Endometriosis at the site of episiotomy scar and abdominal scar following cesarean section are very rare conditions among the extrapelvic endometriosis. We have experienced two cases of endometriosis. One occurred from episiotomy scar and the other occurred from abdominal scar following cesarean section. The diagnosis of scar endometriosis is suggested if the symptoms are cyclic or in association with the patient's menstrual cycle. We can use ultrasonography, computerized tomography, magnetic resonance imaging to differentiate from other tumors. Surgical excision is the method of choice for diagnosis and treatment. We report the two cases with review of rare extrapelvic endometriosis.

A Case of Metastatic Malignant Melanoma of the Ovary / 대한산부인과학회잡지

Malignant melanoma is a neoplasm of the skin and mucous membrane. Extragenital malignant melanoma that metastasizes to the ovary is seen rarely, and in only a few cases has the diagnosis been made before autopsy. The most common histologic feature that should raise the question of metastatic melanoma is the presence of numerous epitheloid cells with abundant eosinophilic cytoplasm. Despite advances in chemotherapy and immunotherapy the efficacy of treatment of advanced melanoma remains limited and the prognosis of metastatic disease remains guarded. We describe a case of malignant melanoma metastatic to the ovary and right axillae occurring one year and four months after diagnosis of cutaneous malignant melanoma on the patient's back.

Breast Cancer that was detected during Pregnancy / 대한산부인과학회잡지

The pregnancy-associated breast cancer is one of the most common malignancy developed during pregnant period and occupies 1-2% of the all breast cancer patients. There is no evidence to implicate pregnancy or lactation in either the etiology and the progression of breast cancer. Careful breast examination early in the pregnancy is very important to find solid masses before breast engorgement hides them. But unfortunately, delay in the diagnosis is common and most of patients with operable primary lesions have positive axillary lymph nodes. The treatment of choice is the modified radical mastectomy and adjuvant chemotherapy. The authors report a patient of breast cancer diagnosed and treated during pregnancy with review of literature.

A Case of Fetal Cardiac Tumor Diagnosed by Ultrasonography / 대한산부인과학회잡지

Perinatal cardiac tumors are rare and the vast majority are histologically benign. Clinical manifestations depend on their size and location. Most of them are clinically unimportant but an arrhythmia or a cardiac failure may present as a feature of obstruction of the outflow tract. Cardiac rhabdomyoma is the most common type of the cardiac tumor and associated with the tuberous sclerosis, and may be the only sign of the tuberous sclerosis, especially, in fetus. We report a case of a cardiac tumor detected during routine prenatal ultrasonographic evaluation, which demonstrated features of rhabdomyoma. After birth, the newborn was diagnosed as tuberous sclerosis with brain MRI scanning.