OBJECTIVE: To compare the efficacy and safety of intravaginal administerd misoprostol and PGE2 (dinoprostone) with oxytocin for inducing labor in women with an unfavorable cervix. METHODS: One hundred thirteen patients with indicated for labor induction and unfavorable cervix were randomly assigned and received either misoprostol 50microgram intravaginal with oxytocin intravenous injection or prostaglandin E2(dinoprostone) 3mg intravaginal with oxytocin intravenous injection. RESULTS: Thirty-nine subjects were assigned to misoprostol with oxytocin group and 74 to the PGE2 with oxytocin group. The median interval from induction to vaginal delivery was significantly shorter in the misoprostol with oxytocin group(1274+/-496 versus 1512+/-501 minutes)(p<0.001). No significant difference between two groups were mode of delivery, neonatal and maternal outcomes. CONCLUSION: Intravaginal misoprostol and PGE2 vaginal insert appear to be safe agents for cervical ripening and labor induction. Misoprostol is more effective than PGE2 vaginal insert with oxytocin injection.
Cervical Ripening* ; Cervix Uteri* ; Dinoprostone* ; Female ; Humans ; Injections, Intravenous ; Misoprostol* ; Oxytocin ; Pregnancy ; Pregnancy*

OBJECTIVE: We analyzed the frequency, clinical symptom, physical exam, site and the degree of torsion, ultrasound findings, histological aspects and the relationship between the pregnancy of ovarian torsion in order to help the early detection of the disease and conservation of the ovary. METHODS: Out of 510 operative cases of adnexal mass patients in Dongguk university hospital from March 1993 to March 2003, 50 histologically confirmed cases of ovarian torsion were selected and retrospectively analyzed. RESULTS: Operative cases of adnexal mass were 510 including the 42 complicated by pregnancy and out of these, torsion occurred in 50 cases (10%) with 16 pregnancy complication. Clinical features of 50 torsion cases are as follows. The frequencies of uterine adnexal tumor torsion were reported by age, 36 cases (72%) in their twenties and thirties, with 21 (42%) nulliparous women at the highest. 42 (84%) had no previous operative history. On the clinical features and physical exam, in the order of frequency, 48 cases (96%) of lower abdominal pain were the highest, and 42 (84%) of GI symptoms, 11 (22%) of urogenital symptoms, and 4 cases (8%) of vaginal bleeding was noted. Under CBC study, 28 (56%) leukocytosis were reported. And on the ultrasound findings, 46 cases (90%) of tumor with hypertrophic wall were noted, septum existed in 12 cases (24%), and 40 (78%) represented internal shadow of the solid portion. The tumor size between 5 to 9 centimeters were the most with 30 cases (58%), and the sum of torsions with 360 and 720 degrees consisted of 40 (78%), occupying for the most of the cases. 27 (55%) of right side existed compared to the 22 (45%) of left. 42 had no previous transabdominal surgery. In the method of operation, 41 (82%) explorative surgeries and 9 cases (18%) of laparoscopic surgery was done, and 5 of these were conservative (12%). The necrosis was noted in 44 cases, and internal bleeding was present in 39 cases. Histologically, functional cyst consisted highest in numbers with 25 (49%), where benign neoplasm with 22, and one malignant neoplasm. About relationship with pregnancy, 9 cases (56%) of corpus luteal cyst were the most. Outcome of the pregnancy was 9 (56%) full term deliveries, 2 abortions (12%), and 1 (6%) preterm delivery. CONCLUSION: Ovarian torsion should be considered when women in between their twenties and thirties with abrupt onset of lower abdominal pain along with nausea and vomiting, leukocytosis, and 5 to 9 cm sized cystic mass with the wall hypertrophy present in ultrasound. Immediate and accurate diagnosis and treatment should follow.
Abdominal Pain ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hypertrophy ; Laparoscopy ; Leukocytosis ; Nausea ; Necrosis ; Ovary ; Pregnancy ; Pregnancy Complications ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage ; Vomiting

OBJECTIVE: We analyzed the frequency, clinical symptom, physical exam, site and the degree of torsion, ultrasound findings, histological aspects and the relationship between the pregnancy of ovarian torsion in order to help the early detection of the disease and conservation of the ovary. METHODS: Out of 510 operative cases of adnexal mass patients in Dongguk university hospital from March 1993 to March 2003, 50 histologically confirmed cases of ovarian torsion were selected and retrospectively analyzed. RESULTS: Operative cases of adnexal mass were 510 including the 42 complicated by pregnancy and out of these, torsion occurred in 50 cases (10%) with 16 pregnancy complication. Clinical features of 50 torsion cases are as follows. The frequencies of uterine adnexal tumor torsion were reported by age, 36 cases (72%) in their twenties and thirties, with 21 (42%) nulliparous women at the highest. 42 (84%) had no previous operative history. On the clinical features and physical exam, in the order of frequency, 48 cases (96%) of lower abdominal pain were the highest, and 42 (84%) of GI symptoms, 11 (22%) of urogenital symptoms, and 4 cases (8%) of vaginal bleeding was noted. Under CBC study, 28 (56%) leukocytosis were reported. And on the ultrasound findings, 46 cases (90%) of tumor with hypertrophic wall were noted, septum existed in 12 cases (24%), and 40 (78%) represented internal shadow of the solid portion. The tumor size between 5 to 9 centimeters were the most with 30 cases (58%), and the sum of torsions with 360 and 720 degrees consisted of 40 (78%), occupying for the most of the cases. 27 (55%) of right side existed compared to the 22 (45%) of left. 42 had no previous transabdominal surgery. In the method of operation, 41 (82%) explorative surgeries and 9 cases (18%) of laparoscopic surgery was done, and 5 of these were conservative (12%). The necrosis was noted in 44 cases, and internal bleeding was present in 39 cases. Histologically, functional cyst consisted highest in numbers with 25 (49%), where benign neoplasm with 22, and one malignant neoplasm. About relationship with pregnancy, 9 cases (56%) of corpus luteal cyst were the most. Outcome of the pregnancy was 9 (56%) full term deliveries, 2 abortions (12%), and 1 (6%) preterm delivery. CONCLUSION: Ovarian torsion should be considered when women in between their twenties and thirties with abrupt onset of lower abdominal pain along with nausea and vomiting, leukocytosis, and 5 to 9 cm sized cystic mass with the wall hypertrophy present in ultrasound. Immediate and accurate diagnosis and treatment should follow.
Abdominal Pain ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hypertrophy ; Laparoscopy ; Leukocytosis ; Nausea ; Necrosis ; Ovary ; Pregnancy ; Pregnancy Complications ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage ; Vomiting

OBJECTIVE: To assess the effect of fentanyl and midazolam on in vitro fertilization rate and early embryo development in a mouse IVF model. METHODS: Mouse oocytes were exposed in vitro to fentanyl at a concentration of 0(control), 50, 250, 500, 1000, 5000 pg/ml, and midazolam, 0(control), 2.5, 12.5, 25, 50, 250 ng/ml for 30 minutes, washed and inseminated. Thereafter fertilization was assessed. And subsequent in vitro development to the blastocyst stage was monitored daily. RESULTS: Where fertilization occurred, subsequent embryo cleavage and development up to the blastocyst stage was affected significantly by the presence of fentanyl and midazolam solution in the medium(i.e., 14% to 31%, 10% to 35%), in comparison with control group( 60%, 62%). CONCLUSION: It can be concluded from these experiments that even a brief exposure of cumulus enclosed oocytes to a low concentration of fentanyl, midazolam is deleterious to subsequent cleavage.
Anesthetics ; Animals ; Blastocyst ; Embryonic Development ; Embryonic Structures* ; Female ; Fentanyl* ; Fertilization ; Fertilization in Vitro* ; Mice* ; Midazolam* ; Oocytes ; Pregnancy

OBJECTIVE: The degree of destruction of primordial follicles was investigated following the administration of cyclophosphamide or paclitaxel respectively in mouse ovaies. And then the effect of GnRHa I, GnRH antagonist and GnRHa II on the primordial follicles was evaluated following the administration of cyclophosphamide or paclitaxel. METHODS: Saline or cyclophosphamide (50 mg/kg or 75 mg/kg) were intraperitoneally injected into seven-week old female ICR mice. GnRHa I (Leuplin(R)), GnRH antagonist (Cetrotide(R)) or GnRHa II (H-6038) was injected into mice, and administered with 50 mg/kg and 75 mg/kg of cyclophosphamide following 9 days treatment with GnRH analogues. After collecting ovaries, H&E staining was performed and the number of primordial follicles was counted. To confirm the induction of apoptosis, TUNEL assay was performed. Another experimental groups of mice were administered with a low concentration (12.5 mg/kg) or a high concentraion (19 mg/kg) of paclitaxel. RESULTS: Cyclophosphamide and paclitaxel cause mild to moderate destruction of primordial follicles in mouse ovaries. The number of primordial follicles in the group of high dose was noted less than in that of low dose treated with cyclophosphamide or paclitaxel. Increased the apoptotic indices were shown in the group of cyclophosphamide or paclitaxel compared to in saline only treated group. Treatment with GnRHa I, GnRH antagonist and GnRHa II significantly increased the number of primordial follicles at a low concentration of cytotoxic agents (P<0.05), whereas the number of primoridal follicle increased only in GnRHa I antagonist treated group at a high concentration of cyclophosphamide or paclitaxel (P<0.05). CONCLUSION: The present study shows that GnRH analogues alleviate destruction of primordial follicles caused by cyclophosphamide and paclitaxel in mouse ovaries, suggesting that GnRH analogues may be applicable to increase fertility opportunity in malignant cancer patients of reproductive age planning future pregnancies.
Animals ; Apoptosis ; Cyclophosphamide ; Cytotoxins ; Female ; Fertility ; Gonadotropin-Releasing Hormone ; Humans ; In Situ Nick-End Labeling ; Mice ; Mice, Inbred ICR ; Ovarian Follicle ; Ovary ; Paclitaxel ; Pregnancy

OBJECTIVE: To ascertain if hydrosalpinges are associated with reduced pregnancy rates and increased pregnancy loss after IVF-ET, a study was conducted. Increased volume and leakage of hydrosalpinx fluid may exert negative effects on follicular development and embryo quality and/or render the uterine environment hostile to embryogenesis. This study was undertaken to examine the effect of hydrosalpinx fluid on mouse embryogenesis in vitro. METHODS: The study was designed by comparison of mouse embryo blastulation rate in media containing increasing concentrations of hydrosalpinx fluid. In vitro fertilization rate and the development of one-, two-, four-cell mouse embryos in medium containing 0% (Control), 0.3%, 0.6%, 0.9%, 5%, 10% and 20% of human hydrosalpinx fluid-containing media was observed. RESULTS: In vitro fertilization and culture of mouse embryo at 0% (control), 0.3%, 0.6%, 0.9%, 5%, 10%, 20% hydrosalpinx fluid concentrations demonstrated significantly lower blastulation rate at each level compared with the controls (p<0.05). In vivo fertilization and culture of embryo at the same increasing concentration of hydrosalinx fluid showed the same results (p<0.05). And the difference of each embryo development (zygote, 2cell, 4cell) was not significant. CONCLUSION: Hydrosalpinx fluid is highly embryotoxic. Procedures such as salpingectomy or proximal tubal occlusion to circumvent the passage of hydrosalpinx fluid into the uterine cavity may have beneficial effects on the developmental environment for embryos in vivo.
Animals ; Embryonic Development* ; Embryonic Structures* ; Female ; Fertilization ; Fertilization in Vitro* ; Humans* ; Mice* ; Pregnancy ; Pregnancy Rate ; Salpingectomy ; Sterilization, Tubal

Sinking skin flap syndrome is defined by a series of neurological symptoms with skin depression at the site of cranial defect. We experienced neurological improvement in a patient with markedly sunken craniectomy site after ventriculoperitoneal shunt (V-P shunt) clamping operation. A 17-year old female patient was in vegetative state and spastic quadriplegia after traumatic brain injury. She was suffered from frequent vomiting. To evaluate central nervous system problem we checked brain computed tomography which showed that right frontotemporoparietal craniectomy area was markedly sunken and midline was shifting to the left. After V-P shunt clamping operation, craniectomy site was elevated and midline shifting was improved. Vomiting was disappeared. Coma Recovery Scale-revised (CRS-R) score was improved from 3 to 6.

OBJECTIVES: To determine the effect of clomiphene/hMG combined superovulation with intrauterine insemination on pregnancy outcomes. MATERIALS AND METHODS: Eighty-one cycles of clomiphene/hMG combined superovulation with intrauterine insemination in forty-three infertile couples were analysed retrospectively. RESULTS: The overall pregnancy rate was 39.5% per patient and 20.9% per cycle. Each pregnancy rate of infertility due to ovulatory dysfunction, unexplained infertility and endometriosis was 43.8%, 40.0%, and 25.0% per patient respectively. CONCLUSIONS: Clomiphene/hMG superovulation with intrauterine insemination is a simple, cost effective and safe treatment modality in the management of infertility, and may improve a pregnancy rate.
Endometriosis ; Family Characteristics* ; Female ; Humans ; Infertility ; Insemination* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Superovulation*

Testicular feminization is an uncommon genetic disorder with considerably familial predisposition and results in total feminization due to end-organ unresponsiveness to androgens. It is characterized by the presence of testes in phenotypically female with adequate breast development, normal extemal genitalia, absence of mullerian structures, and meager or absence of body hair. These patients characteristically have male karyotype(XY) and negative sex chromatin and are at increased risk of undergoing malignant transformation of the undescended gonad. In recent times, the malignant potential of the dysgenetic gonads in the intersex patients with a Y chromosome has been stressed by many authors, but few reports of an association between testicular feminization syndrome and benign tumors such as Sertoli cell adenomas. In the present study, postoperative pathology revealed that the gonads were Sertoli cell adenomas. The main features of clinical presentation and histological studies are briefly discussed with a review of the literature.
Adenoma* ; Androgen-Insensitivity Syndrome* ; Androgens ; Breast ; Female ; Feminization ; Genitalia ; Gonads ; Hair ; Humans ; Male ; Pathology ; Sex Chromatin ; Testis ; Y Chromosome

OBJECTIVE: This study was performed to assess agreements among screening tests, to estimate prevalence, and to identify related factors with postpartum depression. METHODS: For 323 women at 7 days postpartum, self-administered questionnaires were given including postpartum depression screening test such as EPDS, QIDS-SR16, BDI and questionnaires for their demographic and psycho-social information. Obstetric information were collected from medical records. Simultaneous positive cases in EPDS and BDI were defined as gold standard and used to estimate the prevalence of postpartum depression and agreements between 3 kind of screening test and gold standard. Related factors of postpartum depression were analysed by using SPSS. RESULTS: The prevalence of postpartum depression was 19.8% and the Kappa indices were 0.711 in BDI, 0.803 in EPDS, and 0.395 in QIDS-SR16. Feeding method, smoking history, antenatal anxiety/depression symptoms, residence status, marital satisfaction, relationship with husband's parents, and postpartum care method in univariate analysis and premature delivery (odds ratio: 2.9), formulated feeding (odds ratio: 3.8), marital dissatisfaction (odds ratio: 4.3), professional husband's occupation (odds ratio: 4.4), and antenatal anxiety/ depression symptoms (odds ratio: 4.4) in the logistic regression analysis were significantly related to postpartum depression (P<0.05). CONCLUSIONS: Simultaneous test of BDI and EPDS was effective to evaluate postpartum depression prevalence at 1-week postpartum and highly agree with EPDS. Significant related factors were defined and further prospective community-based studies are warranted.
Depression ; Depression, Postpartum ; Feeding Methods ; Female ; Humans ; Logistic Models ; Marital Status ; Mass Screening ; Medical Records ; Occupations ; Parents ; Postnatal Care ; Postpartum Period ; Prevalence ; Surveys and Questionnaire ; Smoke ; Smoking