Pseudo-Meigs' syndrome is a syndrome that includes hydrothorax and ascites secondary to ovarian tumors other than solid benign fibroma. In this report, we present the case of a 29-years-old female who complained of abdominal distension with peripheral edema during her third trimester. Two solid masses of 15 cm dimension in the left abdomen and 7 cm dimension in the right abdomen were detected by ultrasound and chest X-ray revealed right pleural effusion. Magnetic resonance imaging (MRI) confirmed the ovarian masses and ascites. As the patient had regular uterine contractions, we decided to perform emergency cesarean section because of previous cesarean section history. A laparotomy was performed and pathologists confirmed the presence of a metastatic adenocarcinoma. Four days following the surgery, gastroduodenoscopy revealed a huge ulcerofungating mass was visible in greater curvature of stomach. The final diagnosis was metastatic adenocarcinoma from gastric cancer. Although pseudo-Meigs' syndrome is very rare, it should be carefully considered when evaluating female complaining with ascites in ovarian tumor.
Abdomen ; Adenocarcinoma ; Ascites ; Cesarean Section ; Edema ; Emergencies ; Female ; Fibroma ; Humans ; Hydrothorax ; Laparotomy ; Magnetic Resonance Imaging ; Pleural Effusion ; Pregnancy ; Pregnancy Trimester, Third ; Stomach ; Stomach Neoplasms ; Thorax ; Uterine Contraction

OBJECTIVE: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). METHODS: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary's Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim's Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. RESULTS: There was no significant difference in patients' age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients' mean age was 46.1+/-7.0 years (SPA-LAVH) and 45.5+/-6.3 years (MPA-LAVH). The mean operating time was 87.2+/-21.0 minutes (SPA-LAVH) and 83.3+/-20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4+/-139.7 g (SPA-LAVH) and 257.8+/-132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1+/-0.7 g/dL (SPA-LAVH) and 1.2+/-0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6+/-0.6 days [SPA-LAVH] and 3.3+/-0.7 days [MPA-LAVH], P<0.05). CONCLUSION: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.
Adenomyosis ; Blood Transfusion ; Female ; Fever ; Hemoglobins ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Incidence ; Leiomyoma ; Length of Stay ; Medical Records ; Urinary Tract

OBJECTIVE: To investigate the clinical characteristics and reproductive outcomes of women with Mullerian anomalies. METHODS: One hundred and eighty-six patients were diagnosed with Mullerian anomalies at the Asan Medical Center from 1990 to 2009 and their clinical characteristics and reproductive outcomes were analyzed. Mullerian anomalies were categorized according to the classification by the American Fertility Society (1988). RESULTS: Mullerian anomaly was noticed in 1 in 1,326 patients (0.075%). Most cases were found in adulthood (84.9%) whereas only 15.1% cases in adolescent or pediatric period. More than 40% of cases were asymptomatic and found incidentally but others suffered from amenorrhea (12.4%), dysmenorrhea (10.8%), abnormal menstruation (10.2%), etc. Most common type of uterine anomalies was uterine didelphys (30.6%), followed by bicornuate uterus (19.4%), Mayer-Rokitansky-Kuster-Hauser syndrome (10.8%), septate uterus (9.1%) and unicornuate uterus (8.6%). On the reproductive outcomes of 251 pregnancies identified, spontaneous miscarriages and preterm labor were quite common (55.8%), and the overall live birth rate was 48.6%. When each anomaly was individually analyzed, the live birth rate was 60.0% in the arcuate uterus and 58.0% in the uterine didelphys. The unicornuate and bicornuate uterus presented a similar chance of having a living child (42.1%, 46.7%), while the septate uterus showed a relatively lower live birth rate (32.4%). CONCLUSION: Although most cases of Mullerian anomalies are diagnosed in adulthood, many patients may suffer from menstrual abnormalities, dysmenorrhea or recurrent miscarriages since adolescence. The reproductive outcomes of the arcuate uterus and uterine didelphys were better, while those of septate uterus were poor in our study.
Abnormalities, Multiple ; Abortion, Habitual ; Abortion, Spontaneous ; Adolescent ; Amenorrhea ; Child ; Dysmenorrhea ; Female ; Fertility ; Humans ; Kidney ; Live Birth ; Menstruation ; Mullerian Ducts ; Obstetric Labor, Premature ; Pregnancy ; Somites ; Spine ; Urogenital Abnormalities ; Uterus ; Vagina

OBJECTIVE: To compare inhibition of cell growth and apoptosis in human cervical cancer cell lines (CaSki) by paclitaxel, cisplatin, arsenic trioxide and tetraarsenic oxide. METHODS: Inhibition of cell growth was determined by the water-soluble tetrazolium salts (WSTs) -1 assay. For apoptosis analysis in CaSki cell line treated with single or combination of two agents, CaSki cell line treated with each agent was stained with annexin-V/PI and flow cytometry was performed. RESULTS: Progression of apoptosis in CaSki cell line treated with paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide was time dependent. Inhibition of cell growth in CaSki cell line by paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide was dose and time dependent. Especially, tetraarsenic oxide was more effective in inhibition of CaSki cell growth compared to arsenic trioxide. Group treated with combination of cisplatin and tetraarsenic oxide showed more progressive apoptosis compared to other combination group. CONCLUSION: Tetraarsenic oxide has more potent anti-tumor effects than other agents on CaSki cell line. We need to consider further study about antitumor effect of tetraarsenic oxide through clinical study.
Apoptosis ; Arsenic ; Arsenicals ; Cell Line ; Cisplatin ; Flow Cytometry ; Humans ; Oxides ; Paclitaxel ; Tetrazolium Salts ; Uterine Cervical Neoplasms

OBJECTIVE: To investigate the association between preterm birth and cytokine genes (IFN-gamma, interleukin (IL)-10) in intrauterine infection and enzyme gene (CYP1A1) in oxidative stress response. METHODS: This study involved a case-control study conducted at Ewha Womans University Hospital in Seoul, Korea. Subjects with preterm deliveries (<37 weeks of gestation) and normal controls with term deliveries (> or =37 weeks of gestation) were selected from gravidas who had undergone prenatal examinations in the hospital and were followed until infant delivery. The weight, height, and blood samples of each participants were obtained according to standard protocols. We included subjects who gave birth to a singleton infant and had a gestational age between 24 and 42 weeks. Mutiple births, stillbirths, and congenital anomalies were excluded. Finally, 164 gravidas with preterm births and 305 normal controls with term deliveries were enrolled in the present study. RESULTS: Preterm delivery group and term delivery group had significant difference in gestational age and neonatal body weight (P<0.0001). There were no statistically significant association between preterm birth and IFN-gamma, IL-10, CYP1A1 genes (P>0.05). CONCLUSION: In this study, IFN-gamma (874A/T), IL-10 (1082A/G), IL-10 (819C/T), IL-10 (592A/C) and CYP1A1 (T6235C), CYP1A1 (Ile462val [A/G]) genes had no significant association with preterm birth.
Body Weight ; Case-Control Studies ; Cytochrome P-450 CYP1A1 ; Female ; Gestational Age ; Humans ; Infant ; Interleukin-10 ; Interleukins ; Korea ; Oxidative Stress ; Parturition ; Premature Birth ; Stillbirth

OBJECTIVE: To evaluate placental causes of fetal death intrauterine (IUFD) bases on placental pathologic findings. METHODS: Retrospective review of 123 placental pathological reports of singleton fetal deaths from 20 weeks of gestation to 41 weeks of gestation. RESULTS: The incidences of maternal causes, fetal causes, inflammatory causes, miscellaneous and unremarkable findings were 45.5%, 28.4%, 16.2%, 23.5%, respectively. The incidence of fetal anomaly was 8.9%. Fetal anomalies were deeply related to fetal cause (P=0.000). Intrauterine growth restriction was significantly associated with maternal causes (P=0.038). CONCLUSION: No pathological guideline regarding placental examination of intrauterine fetal death exists. In future studies, a better definition of fetal death causes and associated placental pathological findings might aid clinicians in counseling, assessing the risk of recurrence and even preventing fetal death in subsequent pregnancies.
Counseling ; Fetal Death ; Incidence ; Placenta ; Pregnancy ; Recurrence ; Retrospective Studies

OBJECTIVE: To estimate the predictive factors associated with traffic injury severity and pregnancy outcomes in traffic accidents during pregnancy. METHODS: We performed a retrospective case review study to assess 109 pregnant women who were injured by traffic accidents and were admitted to Gangneung Asan Hospital and KyungHee University Hospital from September 1996 to January 2009. The clinical data of maternal age, parity, gestational age, symptoms of the patients that happened after accidents, accident location, seat position in vehicle, maternal injury severity which was quantified with injury severity score (ISS), pregnancy outcomes, and subchorionic hematoma were reviewed with the medical records or the telephone interviews. Adverse pregnant outcomes included abortion, preterm delivery and fetal death in uterus. Multiple logistic regression analysis was performed to evaluate the predictive factors for injury severity and pregnancy outcomes after traffic accidents. RESULTS: Pedestrian injury and first trimester were significantly associated with severity of maternal injury. Multivariate analysis revealed that abdominal pain was independently predictive factor for the severity of maternal injury. The second trimester, pedestrian injury, right front seat of vehicle, severity of maternal injury and subchorionic hematoma were significantly associated with adverse pregnancy outcomes. Multivariate analysis revealed that severity of maternal injury and subchorionic hematoma were independently predictive factors for adverse pregnancy outcomes. CONCLUSION: According to predictive factors for pregnancy outcomes, the severity of maternal injury estimated with ISS score and subchorionic hematoma seems to be helpful indicators in the management of traffic accident injuries during pregnancy.
Abdominal Pain ; Accidents, Traffic ; Female ; Fetal Death ; Gestational Age ; Hematoma ; Humans ; Injury Severity Score ; Interviews as Topic ; Logistic Models ; Maternal Age ; Medical Records ; Multivariate Analysis ; Parity ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnant Women ; Retrospective Studies ; Uterus

A complete interaction in the hypothalamic-pituitary-ovary-uterus (H-P-O-U) axis must take place in order for normal menstruation occurs. If any of the components in the H-P-O-U axis are nonfunctional, amenorrhea could occur. The prevalence of amenorrhea not due to pregnancy or lactation is approximately 3% to 4% in reproductive women. Because there are many causes of amenorrhea, the clinicians should be concerned with array of potential diseases and disorders involving unfamiliar organ systems, some carrying morbid and even lethal consequences for the patients. To explore the causes of amenorrhea, thorough evaluation of H-P-O-U axis and endocrinologic profiles are needed. The etiologic diagnosis is almost always possible with proceeding step by step approaches.
Amenorrhea ; Axis, Cervical Vertebra ; Female ; Humans ; Hypogonadism ; Lactation ; Lifting ; Menstruation ; Mitochondrial Diseases ; Ophthalmoplegia ; Pregnancy ; Prevalence

Breast is a female reproductve organ and breast disease is closely related to female reproductive function. In recent years, becoming the most frequent cancer in female, breast cancer has emerged as a major health concern for Korean women. Obtaining basic knowledge about breast disease is crucial for the specialists dealing with female reproductive organs. In this article a brief overview over the management of breast cancer as well as benign breast disease will be presented. In addition, the current stauts of training system for breast cancer in Europe will be discussed. Examinations of the current practices in Europe will be able to guide the effort in Korea to incorporate breast diseae into the field of gynecology.
Breast ; Breast Diseases ; Breast Neoplasms ; Europe ; Female ; Gynecology ; Humans ; Korea ; Specialization

The intestinal obstruction during pregnancy is rare but early diagnosis and treatment is essential. This disease can be diagnosed very late because the presenting symptoms such as nausea, vomiting and abdominal pain are often seen in normal pregnancies and most pregnant women avoid radiologic examinations. Moreover, this disease can be accompanied by high aspartate transaminase/alanine transaminase (AST/ALT) which can be also found in acute fatty liver of pregnancy or preeclampsia, and it makes diagnosis to be much delayed. If the diagnosis were delayed much, maternal and perinatal mortality would be increased highly. Therefore, the previous record of abdominal surgery or above mentioned symptom should be considered as the intestinal obstruction, and simple abdominal x-ray for early diagnosis and prompt operation step are critical. We present a case of small bowel obstruction accompanied with high AST/ALT during pregnancy which had the history of previous cesarean section with a brief review of the literature.
Abdominal Pain ; Aspartic Acid ; Cesarean Section ; Early Diagnosis ; Fatty Liver ; Female ; Humans ; Intestinal Obstruction ; Nausea ; Perinatal Mortality ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Third ; Pregnant Women ; Vomiting