Endometriosis is defined as the growth of endometrial tissue outside the uterine cavity and its occurrence is usually related anatomically to the uterus and its attachments. Cutaneous endometriosis occurs most commonly as a secondary process in scars after abdominal or pelvic procedures including hysterotomy, hysterectomy, cesarean section, episiotomy, and laparoscopy. Because of the rarity of cutaneous endometriosis, and the failure of the recognition of the correlation between the intensity of the pain and the menstrual cycle, the diagnosis can be easily missed. We present a case of cutaneous endometriosis occurred in the scar of a previous cesarean section in a 27-year-old woman.
Adult ; Cesarean Section ; Cicatrix ; Diagnosis ; Endometriosis* ; Episiotomy ; Female ; Humans ; Hysterectomy ; Hysterotomy ; Laparoscopy ; Menstrual Cycle ; Pregnancy ; Uterus

Congenital intracranial teratoma is a very rare tumor. We recently experienced a case of massive congenital intracranial teratoma that discovered in a male infant of 28 weeks of gestation. A 33-year old multigravida was observed at 28 weeks gestation for prenatal ultrasound examination and ultrasonography revealed the fetus was severely macrocephalic with marked hydrocephalus. For therapeutic termination, Hysterotomy and fetal cephalocentesis was performed to deliver a stillborn infant. Autopsy revealed a 2,420 g male infant with severe macrocephaly. A multilobulated intracerebral tumor was found a diameter 18 cm involving both cerebral hemisphere. The tumor was considered to have originated in the vicinity of pineal gland and suprasellar region. Microscopic examination showed the characteristic picture of a teratoma. The predominent component is immature neuroepithelium in the form of primitive neural tubules variably mature somatic tissure from other germ cell layers accompany the neuroepithelium. We report a case of congenital intracranial immature teratoma.
Adult ; Autopsy ; Cerebrum ; Fetus ; Germ Cells ; Humans ; Hydrocephalus ; Hysterotomy ; Infant ; Macrocephaly ; Male ; Pineal Gland ; Pregnancy ; Teratoma* ; Ultrasonography

Advances in prenatal diagnosis have led to the prenatal management of a variety of congenital diseases. Fetal surgery was born of clinical necessity. Observations by pediatric surgeons and neonatologists of neonates that were born with irreversible organ damage led to the conclusion that one possible approach to prevent this alteration of developmental physiology, was fetal surgical intervention. The demonstration in animal models that the correction of an anatomical defect could reverse the associated pathophysiology led to the first systematic application of fetal surgery at the University of California, San Francisco, in the early 1980s . There has been a dramatic improvement in our ability to diagnose, select and safely operate on an expanding number of fetal anomalies. Many fetal interventions remain investigational but for a number of conditions randomized trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programs. Although prenatal stem cell and gene therapy await clinical application, they offer tremendous potential for the treatment of many genetic disorders. Here we review the prenatal evaluation, current status and future potential of various prenatal operative approaches, such as open hysterotomy, fetoscopy, and percutaneous, including tissue engineering, and prenatal cellular and genetic therapy.
California ; Fetal Therapies ; Fetoscopy ; Genetic Therapy ; Humans ; Hysterotomy ; Infant, Newborn ; Models, Animal ; Prenatal Diagnosis ; San Francisco ; Stem Cells ; Tissue Engineering

Endometriosis is defined as the presence of endometrial tissue outside the uterus and located usually within the pelvis. It may be detected as a rare complication associated with surgery. Endometriosis following obstetric and gynecologic procedure, which is localized mostly in the surgical scar including Cesarean section scar, hysterotomy scar, trocar scar, Bartholin cyst exision scar, or episiotomy scar, may caused by implantation of endometrial gland and stroma. Endometriosis developing after hysterectomy, especially, is a quite rare condition except a recurrent disease. We have experienced a case of a 47-year-old woman who had diagnosed ovarian endometriosis two years after laparoscopically assisted vaginal hysterectomy for a large leiomyomatous uterus with no evidence of endometriosis, so we report this case with a brief review of literature.
Cesarean Section ; Cicatrix ; Endometriosis* ; Episiotomy ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Hysterotomy ; Middle Aged ; Pelvis ; Pregnancy ; Surgical Instruments ; Uterus

To our knowledge, implantation into the uterine muscle wall is one of the rare form of ectopic pregnancy, with only 16 cases reported until 1995. The early diagnosis depends upon the sonographic finding of intramural gestational sac-like growth and persistent high beta human chorionic gonadotropin (beta-hCG) levels after dilatation and curettage. But, nobody can't exclude intramural pregnancy in case that associated with adenomyosis in uterus in spite of negative beta-hCG. Hsieh et al. and Dousias et al. mentioned 2 cases of such situation with negative beta-hCG result. And confirmative diagnosis depends upon the pathologic finding for specimen obtained from laparoscopic or explorative hysterotomy. The authors have experienced one case of intramural pregnancy in uterus and report our case with a brief review of literature.
Adenomyosis ; Animals ; Chorionic Gonadotropin ; Diagnosis ; Dilatation and Curettage ; Early Diagnosis ; Female ; Hysterotomy ; Mice ; Myometrium ; Pregnancy* ; Pregnancy, Ectopic ; Ultrasonography ; Uterus*

Endometriosis is generally confined to the pelvic viscera and the peritoneum, but it can proliferate in other areas like pleura, skin, extremities, lung, gallbladder, stomach, kidney and surgical scar. Scar endometriosis usually occurs in the surgical scar of previous cesarean sections, hysterotomy and episiotomy. The occurrence of endometrioma in cesarean scar is an infrequent event, usually presenting as a tender abdominal wall mass. We report two cases of abdominal wall endometrioma after cesarean section, which is presented with a brief review of the literature.
Abdominal Wall ; Cesarean Section* ; Cicatrix* ; Endometriosis* ; Episiotomy ; Extremities ; Female ; Gallbladder ; Hysterotomy ; Kidney ; Lung ; Peritoneum ; Pleura ; Pregnancy ; Skin ; Stomach ; Subcutaneous Tissue* ; Viscera

Implantation of a pregnancy within the scar of previous cesarean section is the rarest form of ectopic pregnancy. Delayed diagnosis and treatment can lead to uterine rupture, hemorrhage and maternal morbidity. But diagnosed early by transvaginal sonography, treatment options are capable of preserving the uterus and subsequent fertility. Suction curettage, exploratory laparotomy, laparoscopic surgery, systemic or local injection of methotrexate is the treatment method currently performed. In this report, we treated a case of this patient by transvaginal hysterotomy. This is the first case report in the recent literature. By this surgery, we could successfully remove gestational sac from the implantation site and repair the defect by primary suture and preserve uterus.
Cesarean Section ; Cicatrix ; Delayed Diagnosis ; Female ; Fertility ; Gestational Sac ; Hemorrhage ; Humans ; Hysterotomy ; Laparoscopy ; Laparotomy ; Methotrexate ; Pregnancy ; Pregnancy, Ectopic ; Sutures ; Uterine Rupture ; Uterus ; Vacuum Curettage

Venous air embolism(VAE) can occur by the entry of air into open veins, being facilitated if the operative field is above the level of the heart. Among the many diagnostic methods, precordial ultrasonic Doppler is currently the more sensitive. Thus we have attempted to define the incidence of VAE using this device. 103 ASA physical status 1 or 2 parturients undergoing Cesarean section with general anesthesia in 73 parturients and epidural anesthesia in 30 parturients were studied with the ultrasonic Doppler transducer placed parasternally over the 4th right intercostal space. Total incidence of venous emboli was 31%(32/103) during surgery. In some parturients, embolism occurred more than once during operation and leaded to total 45 episodes of venous emboli. The incidence of venous emboli was 26%(19/73 ) during general anesthesia and 43.3%(13/30 ) during epidural anesthesia. No statistical difference existed in the incidence of venous emboli detected related to the type of anesthesia. Among the 45 episodes of venous emboli, 19 episodes(42.2%) were detected during repair of the hysterotomy. As even small air bubbles in the circulation are potentially harmful especially in patent foramen ovale and emboli events may occur at risk cases involving profound hypovolemia, abruptio placenta, or placenta previa, clinically insignificant venous air emboli, although low, is still worrisome. Thus above the cases, the use of additional precordial Doppler monitoring may be considered during cesarean section to detect VAE promptly, efficiently.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Cesarean Section* ; Embolism ; Embolism, Air* ; Female ; Foramen Ovale, Patent ; Heart ; Hypovolemia ; Hysterotomy ; Incidence* ; Placenta ; Placenta Previa ; Pregnancy ; Transducers ; Ultrasonics* ; Veins

Despite of advances in perinatal management and treatment modalities, congenital diaphragmatic hernia (CDH) remains a frustrating problem. Although the sheep has been the most reliable experimental animal of fetal surgery in CDH, the rabbits has some possible advantages over sheep; lower cost, smaller body size, year-round availability, high number of fetuses per pregnancy, and short gestational period. The purpose of this study is to evaluate the feasibility of the animal model of CDH in rabbits. Twenty seven pregnant New Zealand rabbits underwent hysterotomy and fetal operation on gestational day 24 or 25. Two fetuses of each pregnant rabbit were operated. In the fetus of one end of bicornuate uterus, left diaphragmatic hernia was created by excision of fetal diaphragm through open thoracotomy (DH Group). In the fetus of the other end of bicornuate uterus, left diaphragmatic hernia was created and tracheal ligation by small-sized Surgiclip(R) (USSC, Norwalk, Conn., USA) was performed through cervical incision (TL Group). Among twenty seven pregnant rabbits, twelve were born alive with diaphragmatic hernia and eight were born alive with diaphragmatic hernia & tracheal ligation. The most commonly herniated abdominal organ was the left lobe of liver. In DH group, the lungs were hypoplastic with a decrease in lung weight/body weight ratio, a reduction in number of alveoli, an increase of vascular medial wall thickness of pulmonary arteries. The alveoli were immature with thick alveolar septum and increased interstitium. In TL group, the alveoli were more mature than that of DH group and no significant difference from control group was existed. Thus this study demonstrates that (1)Diaphragmatic hernia can be created in rabbits by fetal surgery, (2)Tracheal ligation can be performed in rabbits by fetal surgery, (3)Experimental diaphragmatic hernia results in pulmonary hypoplasia, (4)Concurrent tracheal ligation prevents pulmonary hypoplasia that resulted from diaphragmatic hernia. The above mentioned results show that pregnant New Zealand rabbit is appropriate as the animal model of CDH.
Animals ; Body Size ; Diaphragm ; Fetus ; Hernia ; Hernia, Diaphragmatic* ; Hysterotomy ; Ligation* ; Liver ; Lung ; Models, Animal ; Pregnancy ; Pulmonary Artery ; Rabbits ; Sheep ; Thoracotomy ; Uterus

OBJECTIVE: To evaluate patients with adnexal masses that were managed surgically during pregnancy and their effect on fetal outcome. METHODS: The data were reviewed concerning pregnant women who required surgery at Samsung Cheil hospital between January 1996 to December 2001. Among 50,126 deliveries, 255 cases of ovarian tumors were evaluated for clinical aspects, histologic patterns, and obstetrics and fetal outcome. RESULTS: 1. The prevalence of ovarian mass in pregnancy was 0.5% (255 cases in 50,126 deliveries). 14 cases of malignant tumors were founded. 2. The maternal mean age was 28.7+/-3.6 years old, mean gavida was 1.8+/-1.1, and mean parity was 0.3+/-0.5. 3. The mean gestational weeks of diagnosis was 11.9+/-8.6 weeks. Prenatal operations were performed in 160 cases, and 95 cases of ovarian masses were operated at delivery time by cesarean section. 4. In the group of prenatal operation, preterm delivery and caesarian section rate were decreased at operation before 23 gestational weeks (P<0.05). 5. In 42 cases, Emergency operations were done. Mean delivery weeks was 36.7+/-7.2 weeks and was earlier than elective operation group (P<0.05). 6. The mean size of ovarian mass was 9.5+/-3.8 cm. The pathologic features of the 255 lesions were as follows: 98 benign cystic teratomas, 43 mucinous cystadenomas, 31 endometriomas, 20 serous cystadenomas, 14 simple cysts, 14 paraovarian cysts, 6 follicular cysts, 5 corpus luteal cysts, 5 theca luteal cysts, 3 hydrosalpinx, 2 fibromas, and 14 malignant tumors. 7. The 231 patients for whom the outcome of pregnancy was available, 18 (7%) gave birth before 37 weeks of gestation, while 3 (1.2%) experienced spontaneous abortions, 2 artificial abortions, and 1 hysterotomy. CONCLUSION: Most adnexal masses identified by sonography during pregnancy were small, simple cysts that did not pose a risk a pregnancy. However the percentage of malignant tumors or tumors of low malignant potential was 1.8 fold greater than previously reported. Surgical intervention at <23 weeks of gestation might have not been adverse outcomes.
Abortion, Spontaneous ; Cesarean Section ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis ; Emergencies ; Endometriosis ; Female ; Fibroma ; Follicular Cyst ; Humans ; Hysterotomy ; Obstetrics ; Parity ; Parturition ; Pregnancy* ; Pregnant Women ; Prevalence ; Teratoma