No abstract available.
Gynecology/*organization & administration/*standards ; Humans ; Patient Escort Service/*organization & administration/*standards ; Physical Examination/*methods/*standards ; Physicians/*ethics ; Sex Factors

This study reviews the various types of medical accidents that have emerged over the past two years in hospitals where an agency specializing in medical disputes has been established, as well as the process through which medical accidents are resolved and the results thereof. In addition, the role of these specialized agencies in resolving medical disputes is also analyzed herein. The effective resolution of medical disputes through either judicial or non-judicial means requires that the organization overseeing the resolution of the relevant issue be objective and fair, able to forge independent decisions, and possess specialized knowledge of the issue at hand. The most significant advantage possessed by medicolegal offices since their inception has been the fact that they have featured specialists in the relevant fields who have been able in many cases to correctly perceive the central issues at play in a medical dispute from early onwards, and that these have promoted the establishment of reasonable means through which to resolve such medical disputes based on medical reviews and legal analyses. These medicolegal offices have been designed to create an opportunity to directly discuss the medical complaints raised by the plaintiffs with the medical staff, and for the plaintiffs to receive firsthand explanations with regards to their medical questions and suspicions. This process has helped to resolve numerous medical disputes. To this end, medicolegal offices are encouraged to play the role of objective mediators helping those involved in medical disputes reach settlements acceptable to all parties, and to shy away from the extreme method known as medical litigation that seeks resolutions which favor only one of the concerned parties.
Dissent and Disputes* ; Hand ; Humans ; Jurisprudence* ; Medical Staff ; Specialization

OBJECTIVE: The purpose of this study was to describe the clinical presentation and histopathologic findings that help in decisions about management of ovarian mass in childhood and adolescence. METHODS:We retrospectively analyzed the data on 307 patients with surgically treated ovarian mass under 20 years of age at the Cheil General Hospital, between January 1995 and December 2005. RESULTS: Of the 307 cases, 40 cases (13%) were ovarian malignancy. The incidence of malignant ovarian tumor increased to 16.9% in 237 neoplastic tumors. Epithelial, germ cell, and sex-cord stromal malignancies accounted for 57.5%, 30% and 12.5%, respectively, of the 40 ovarian malignancies. The stage of the 35 cases (87.5%) with the ovarian malignancy was the FIGO stage I. The incidence of ovarian malignancies increased with larger size, higher CA125 level. Solid ovarian masses on ultrasound were more likely ovarian malignancy. But age and menarchal status was not correlated with ovarian malignancy. Mature cystic teratoma seen in 132 patients (55.7%), was the most common neoplasm of ovary in this age group, and the incidence of bilaterality was 12.1%. On follow up, 4.9% (13/267) of previously diagnosed benign ovarian tumor were reoperated due to recurred or newly developed ovarian tumor. After cystectomy, the recurrence rate of ipsilateral ovarian tumor was 2.8% (4/142). CONCLUSION: If there is no evidence of malignancy, conservative surgical treatment should be employed to preserve future endocrine function and fertility in this age group.
Adolescent ; Cystectomy ; Female ; Fertility ; Follow-Up Studies ; Germ Cells ; Hospitals, General ; Humans ; Incidence ; Ovary ; Recurrence ; Retrospective Studies ; Teratoma

OBJECTIVE: The purpose of this study was to describe the clinical presentation and histopathologic findings that help in decisions about management of ovarian mass in childhood and adolescence. METHODS:We retrospectively analyzed the data on 307 patients with surgically treated ovarian mass under 20 years of age at the Cheil General Hospital, between January 1995 and December 2005. RESULTS: Of the 307 cases, 40 cases (13%) were ovarian malignancy. The incidence of malignant ovarian tumor increased to 16.9% in 237 neoplastic tumors. Epithelial, germ cell, and sex-cord stromal malignancies accounted for 57.5%, 30% and 12.5%, respectively, of the 40 ovarian malignancies. The stage of the 35 cases (87.5%) with the ovarian malignancy was the FIGO stage I. The incidence of ovarian malignancies increased with larger size, higher CA125 level. Solid ovarian masses on ultrasound were more likely ovarian malignancy. But age and menarchal status was not correlated with ovarian malignancy. Mature cystic teratoma seen in 132 patients (55.7%), was the most common neoplasm of ovary in this age group, and the incidence of bilaterality was 12.1%. On follow up, 4.9% (13/267) of previously diagnosed benign ovarian tumor were reoperated due to recurred or newly developed ovarian tumor. After cystectomy, the recurrence rate of ipsilateral ovarian tumor was 2.8% (4/142). CONCLUSION: If there is no evidence of malignancy, conservative surgical treatment should be employed to preserve future endocrine function and fertility in this age group.
Adolescent ; Cystectomy ; Female ; Fertility ; Follow-Up Studies ; Germ Cells ; Hospitals, General ; Humans ; Incidence ; Ovary ; Recurrence ; Retrospective Studies ; Teratoma

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.
Abdominal Pain ; Abortion, Missed ; Dilatation ; Early Diagnosis ; Female ; Fertilization in Vitro ; Follow-Up Studies ; Gestational Age ; Humans ; Infertility ; Laparoscopy ; Laparotomy ; Ovulation Induction ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic ; Pregnancy, Heterotopic ; Pregnant Women ; Reproductive Techniques, Assisted ; Retrospective Studies ; Risk Factors ; Twins ; Uterine Hemorrhage

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.
Abdominal Pain ; Abortion, Missed ; Dilatation ; Early Diagnosis ; Female ; Fertilization in Vitro ; Follow-Up Studies ; Gestational Age ; Humans ; Infertility ; Laparoscopy ; Laparotomy ; Ovulation Induction ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic ; Pregnancy, Heterotopic ; Pregnant Women ; Reproductive Techniques, Assisted ; Retrospective Studies ; Risk Factors ; Twins ; Uterine Hemorrhage

OBJECTIVE: To evaluate factors associated with fetal losses following mid-trimester diagnostic amniocentesis. METHODS: 412 pregnancy outcomes following amniocentesis were analyzed for each variables(maternal age, gestational age, indication for the amniocentesis, placental penetration by aspiration needle, needle touch by the fetus, color of amniotic fluid) with statistical methods(student t-test, chi-square test and multiple logistic regression test). RESULTS: Mean maternal age was 31.8+/-4.9 years, fetal loss rate was increased slightly with the age of the mother. If the indications were abnormally high maternal serum alpha-fetoprotein level, the pregnancy courses after the procedure were worse than other indication groups. In cases of discolored amniotic fluid, the dark brown discoloration made the pregnancy outcome poor. Gestational age at the time of the procedure, penetration of the placenta by the aspirating needle, needle touch during the procedure by the fetus, did not influence the outcomes after the procedure. CONCLUSION: Maternal age, indication as neural tube defect in triple test and dark brown discoloration of amniotic fluid are associated with fetal losses following mid-trimester diagnostic amniocentesis.
alpha-Fetoproteins ; Amniocentesis* ; Amniotic Fluid ; Female ; Fetus ; Gestational Age ; Humans ; Logistic Models ; Maternal Age ; Mothers ; Needles ; Neural Tube Defects ; Placenta ; Pregnancy ; Pregnancy Outcome