Extrapelvic endometriosis is a rare disease. The majority of extrapelvic endometriosis cases involve scar tissue following obstetric and gynecologic procedures. We have treated two cases of extrapelvic incisional endometriosis. A 39 year old female patient with cyclic vaginal spotting after laparoscopic assisted vaginal hysterectomy due to uterine myoma and a 35 year old female patient with a painful palpable abdominal mass after cesarean section. Both underwent complete excision and were proven to have endometriosis by pathology. Here we report on both cases and review the medical literatures.
Adult ; Cesarean Section* ; Cicatrix ; Endometriosis* ; Female ; Humans ; Hysterectomy, Vaginal* ; Leiomyoma ; Metrorrhagia ; Pathology ; Pregnancy ; Rare Diseases

Granular cell tumor (GCT) is a very rare tumor of mesodermal origin. Among genital GCT (of which less than 60 cases reported worldwide), vaginal GCT has been reported as only 1 case. Malignant GCT has been reported in 1-2% of GCT. 37-year-old woman was admitted with urinary frequency and incidentally identified anterior vaginal wall mass. Complete surgical excision was performed and confirmed as vaginal GCT by histopathology. The postoperative follow-up was uneventful. We present the first case of vaginal GCT in Korea we could excise completely and report with a brief review of the literature.
Adult ; Female ; Follow-Up Studies ; Granular Cell Tumor* ; Humans ; Korea ; Mesoderm ; Vagina

Prepubertal vulval fibroma is a very rare tumor arising at vulva. Iwasa firstly reported 11 cases of prepubertal vulva fibroma in 2004 and until recently no case was reported in literature. A 8-year-old girl complained the painless growing mass at the left labium major. The mass was excised and confirmed as prepubertal vulval fibroma by immunohistochemistry. We report the first case of prepubertal vulva fibroma in a 8-year-old Korean female with a brief review of the literature.
Child ; Female ; Fibroma* ; Humans ; Immunohistochemistry ; Vulva

OBJECTIVE: The aim of this study was to analyse the characteristics, severity of Fitz-Hugh-Curtis syndrome (FHCS), pelvic adhesions and hematologic findings of incidentally founded FHCS in laparoscopy. METHODS: We retrospectively reviewed the medical records of 40 patients incidentally found laparoscopically as FHCS at the department of obstetrics and gynecology of Yeungnam University Hospital from Jan. 2001 to Dec. 2006. Severity of FHCS and pelvic adhesions were classified and characteristics of patients, hematologic findings, past medical histories and symptoms after surgery were analysed. RESULTS: The ages of the cases varied between 16 and 65 years old. Mean age of cases was 32.9 years. Indications of surgery were uterine myoma, benign adnexal mass, ectopic pregnancy, endometriosis, chronic pelvic pain and pelvic tuberculosis. From this study we can notice that FHCS can be found out most frequently in the patient with pelvic inflammatory disease (PID). Past medical history were pelvic inflammatory disease, ectopic pregnancy, abdominal surgery and pelvic tuberculosis. 17 patients had been suffered from RUQ pain and 10 patients (58.8%) were in good health after adhesiolysis. CONCLUSION: Laparoscopy is a confirmative tool in the diagnosis of FHCS. Direct observation of perihepatic space is the most definitive method of diagnosing this syndrome. From our study, we can find that FHCS can be diagnosed frequently in the patient with pelvic inflammatory disease, ectopic pregnancy and pelvic tuberculosis. So, We recommend that investigating the perihepatic space during surgery is a good treatment especially in patients with PID, vague abdominal discomfort and pains.
Chlamydia Infections ; Endometriosis ; Female ; Gynecology ; Hepatitis ; Humans ; Laparoscopy ; Medical Records ; Myoma ; Obstetrics ; Pelvic Inflammatory Disease ; Pelvic Pain ; Peritonitis ; Pregnancy ; Pregnancy, Ectopic ; Retrospective Studies ; Tuberculosis

OBJECTIVE: The aim of this study was to analyse the characteristics, severity of Fitz-Hugh-Curtis syndrome (FHCS), pelvic adhesions and hematologic findings of incidentally founded FHCS in laparoscopy. METHODS: We retrospectively reviewed the medical records of 40 patients incidentally found laparoscopically as FHCS at the department of obstetrics and gynecology of Yeungnam University Hospital from Jan. 2001 to Dec. 2006. Severity of FHCS and pelvic adhesions were classified and characteristics of patients, hematologic findings, past medical histories and symptoms after surgery were analysed. RESULTS: The ages of the cases varied between 16 and 65 years old. Mean age of cases was 32.9 years. Indications of surgery were uterine myoma, benign adnexal mass, ectopic pregnancy, endometriosis, chronic pelvic pain and pelvic tuberculosis. From this study we can notice that FHCS can be found out most frequently in the patient with pelvic inflammatory disease (PID). Past medical history were pelvic inflammatory disease, ectopic pregnancy, abdominal surgery and pelvic tuberculosis. 17 patients had been suffered from RUQ pain and 10 patients (58.8%) were in good health after adhesiolysis. CONCLUSION: Laparoscopy is a confirmative tool in the diagnosis of FHCS. Direct observation of perihepatic space is the most definitive method of diagnosing this syndrome. From our study, we can find that FHCS can be diagnosed frequently in the patient with pelvic inflammatory disease, ectopic pregnancy and pelvic tuberculosis. So, We recommend that investigating the perihepatic space during surgery is a good treatment especially in patients with PID, vague abdominal discomfort and pains.
Chlamydia Infections ; Endometriosis ; Female ; Gynecology ; Hepatitis ; Humans ; Laparoscopy ; Medical Records ; Myoma ; Obstetrics ; Pelvic Inflammatory Disease ; Pelvic Pain ; Peritonitis ; Pregnancy ; Pregnancy, Ectopic ; Retrospective Studies ; Tuberculosis

Endothelin-1 (ET-1) has been characterized as a potent vasoconstrictor secreted by the endothelium, and play a major role in the regulation of vascular tone. It has been also known to participate in inflammatory reactions. The production of ET-1 by macrophages during infection and inflammation is related to tissue perfusion and leukocyte extravasation. The aim of this study is to investigate the role of IL-8/CXCL8, as a major inflammatory chemokine, for ET-1 expression in macrophges. Expression of ET-1 mRNA in mouse peritoneal macrophages (PeM phi) was weaker than that in vascular smooth muscle cells (VSMCs) from spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto rats (WKY). However, expression of IL-8/CXCL8-induced ET-1 mRNA in PeM phi was much more stronger than that in SHR and WKY VSMCs. Maximum expression of ET-1 mRNA was observed at 50 ng/ml dose of IL-8/CXCL8 and occurred at 2 h after addition of IL-8/CXCL8. Expression of ET-1 by IL-8/CXCL8 was dependent on NF-kappaB activation and ERK1/2 phosphorylation. Baicalein, a 12-lipoxygenase (LO) inhibitor, inhibited the expression of IL-8/CXCL8-induced ET-1 mRNA. This inhibitory action of baicalein was mediated via ERK1/2 inactivation. Induction of 12-LO mRNA by IL-8/CXCL8 and expression of ET-1 mRNA by 12-LO metabolite, 12(S)-HETE were also detected. The expression of IL-8/CXCL8-induced ET-1 mRNA was not detected in PeM phi transfected with 12-LO siRNA. These results suggest that IL-8/CXCL8 can act as one of main inducers of ET-1 in vascular inflammatory reactions, and ET-1 expression by IL-8/CXCL8 is related to 12-LO pathway in PeM phi.
Animals ; Arachidonate 12-Lipoxygenase ; Endothelin-1 ; Endothelium ; Flavanones ; Inflammation ; Leukocytes ; Macrophages ; Macrophages, Peritoneal ; Mice ; Muscle, Smooth, Vascular ; NF-kappa B ; Perfusion ; Phosphorylation ; Rats ; Rats, Inbred SHR ; RNA, Messenger ; RNA, Small Interfering

Mycolactone is a recently reported lipid toxin of Mycobacterium ulcerans that causes Buruli ulcer, a severe human skin disease. However, the mechanism of cell death by mycolactone is still unclear. In this paper, we demonstrate that mycolactone induces apoptosis in Hep 3B hepatocellular carcinoma (HCC) cells. Morphological and biochemical evidences of apoptosis, such as membrane blebbing, cell shrinkage, increase of TUNEL-positive cells and a sub-G 1 cell population, were observed. To explain the mechanism of mycolactone-induced apoptosis, we examined the expression of Bcl-2 family genes. The mRNA expression of anti-apoptotic BclXL gene was decreased after 8 hours, while that of Mcl-l, another anti-apoptotic gene, was slowly decreased with an initial increase at second hour after treatment. Bcl-2 gene expression was extremely low both in the presence and absence of mycolactone. The expression of other Bcl-2 family genes, such as Bclw, Bad, Bak, and Bax, was not affected. By Western blotting analysis, Mcl-1 expression (not BclXL) was down-regulated. Our results suggest that the down-regulation of Mcl-1 protein expression is involved in the apoptosis of Hep 3B cells by mycolactone.
Apoptosis ; Blister ; Blotting, Western ; Buruli Ulcer ; Carcinoma, Hepatocellular* ; Cell Death ; Down-Regulation ; Genes, bcl-2 ; Humans ; Membranes ; Mycobacterium ulcerans ; RNA, Messenger ; Skin Diseases

BACKGROUND: Secretory phospholipase A2 (sPLA2) are a group of extracellular enzymes that release fatty acids at the sn-2 position of phospholipids. Group IIA sPLA2 (sPLA2-IIA) has been detected in the inflammatory fluids, and its plasma level increases in the inflammatory disease. This study examined the effect of sPLA2-IIA on mouse macropahges in order to investigate the potential mechanism of sPLA2-induced inflammation. MATERIALS AND METHODS: Wild type PLA2 and mutant H48Q PLA2 were purified from HEK293 cells transfected with the corresponding plasmids, and the PLA2 activities were measured using 1-palmitoyl-2-[1- (14) C]linoleoyl-3-phosphatidylethanolamine as substrates. The TNF-alpha and IL-6 released in the supernatants were determined by ELISA. In addition, the TNF-alpha and IL-6 mRNA were analyzed by RT-PCR. RESULTS: sPLA2-IIA stimulated the production of TNF-alpha and IL-6 in a dose- and time-dependent manner. In addition, the effect of sPLA2-IIA on cytokine production from the macrophage was found to be associated with the accumulation of their specific mRNA. The mRNA levels of TNF-alpha and IL-6 peaked at 2 and 6 hours in a time-dependent manner, respectively. CONCLUSION: In conclusion, the production of proinflammatory cytokine might be mediated by the binding of sPLA2-IIA to the receptors.
Animals ; Enzyme-Linked Immunosorbent Assay ; Fatty Acids ; Group II Phospholipases A2* ; HEK293 Cells ; Inflammation ; Interleukin-6* ; Macrophages ; Mice ; Phospholipases A2, Secretory ; Phospholipids ; Plasma ; Plasmids ; RNA, Messenger ; Tumor Necrosis Factor-alpha*

OBJECT: Pelvic actinomycosis is a relatively rare chronic suppurative and granulomatous infectious disease, caused by a gram-positive anaerobic bacteria. Actinomyces israelli is the most common subtype in human disease commonly associated with intrauterine device (IUD). This study was designed to analyze clinical and laboratory characteristics of patients with pelvic actinomycosis. METHODS: We reviewed medical records of 12 patients with pelvic actinomycosis who were admitted between January 1, 1995 and December 31, 2005. The clinical characteristics, diagnostic evaluation and surgical treatment results were retrospectively analyzed. RESULTS: The ages of the cases varied between 30 and 53 years old. Of the 12 patients, 11 patients had been using an IUD. Two cases had hydronephrosis due to infection. All our cases involved ovary and/or uterus and had predisposing factors of disease progression, including IUD, dilatation and curretage. Most common presenting symptom of patients were abdominal pain (75%). Preoperatively, 5 cases were diagnosed as actinomycosis, but 7 cases misconceived as a pelvic malignancy, secondary degenerated myoma and tuboovarian abscess. Exploration were performed in all patients. All cases were cured following surgery with subsequent antibiotics. CONCLUSION: Actinomycosis should be considered preoperatively, especially in long-term IUD usage, fever and laboratory findings that indicate the presence of pelvic infection. Radiologic findings (CT) can assist in making the diagnosis of pelvic actinomycosis. Appropriate antibiotics, as well as surgery, are important in the treatment of pelvic actinomycosis.
Abdominal Pain ; Abscess ; Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Bacteria, Anaerobic ; Causality ; Communicable Diseases ; Diagnosis ; Dilatation ; Disease Progression ; Female ; Fever ; Humans ; Hydronephrosis ; Intrauterine Devices ; Medical Records ; Middle Aged ; Myoma ; Ovary ; Pelvic Infection ; Retrospective Studies ; Uterus

Arcanobacterium haemolyticum is a beta-hemolytic coryneform bacillus. It has been implicated as an etiologic agent of non-streptococcal pharyngitis and less frequently a cause of skin and wound infections, osteomyelitis, pneumonia, endocarditis, sepsis, and central nervous system infections. We describe a case of A. hemolyticum sepsis reported for the first time in Korea. A 61-year-old man with a diabetic foot was admitted due to a high fever. Three sets of blood cultures taken at the emergency room yielded coryneform bacilli. The organism was beta-hemolytic on blood agar plate, catalase-negative, and non-motile. It was identified as A. haemolyticum by Rapid CB Plus (Remel, Kansas, USA) and API Coryne (BioMerieux SA, Marcy l`Etoile, France) and confirmed by CAMP inhibition reaction. It was susceptible to penicillin, ceftriaxone, erythromycin, ciprofloxacin, and vancomycin by the disk diffusion method using the breakpoint criteria of National Committee for Clinical Laboratory Standards for streptococci other than Streptococcus pneumoniae. The patient was improved with partial amputation of the right big toe and antimicrobial therapy with ampicillin/sulbactam. If Arcanobacterium is isolated from normally sterile sites or culture specimens properly collected from infected tissues, it should be identified to the species level. Commercial biochemical test kits specialized in corynebacteria and CAMP test are useful for species identification of A. haemolyticum.
Agar ; Amputation ; Arcanobacterium* ; Bacillus ; Ceftriaxone ; Central Nervous System Infections ; Ciprofloxacin ; Diabetic Foot ; Diffusion ; Emergency Service, Hospital ; Endocarditis ; Erythromycin ; Fever ; Humans ; Kansas ; Korea ; Middle Aged ; Osteomyelitis ; Penicillins ; Pharyngitis ; Pneumonia ; Sepsis* ; Skin ; Streptococcus pneumoniae ; Toes ; Vancomycin ; Wound Infection