Vesicouterine fistula, a fistula between bladder and uterus, is one of the rarest urogenital fistula. Most cases are associated with repeat Cesarean section and with vaginal birth after Cesarean section (VBAC). During Cesarean section, it is important to dissect and move the bladder away from uterus carefully, especially in case of adherent bladder to the anterior vaginal wall or lower segment wall and it is necessary to explain the possibility of vesicouterine fistula development in case of VBAC. Patients usually present with urinary incontinence in the early postoperative period or present months or years later with cyclic hematuria, amenorrhea, vaginal leakage of urine, urinary tract infection and secondary infertility. The diagnosis is made by cystoscopic visualization of the fistula orifice in the bladder and outlining the fistula tract on cystogram, hysterosalpingogram or transvaginal ultrasonogram. There have been varied approaches to the treatment of vesicouterine fistula with conservative therapy or surgical therapy. We experienced two cases of vesicouterine fistulas in women with previous Cesarean section, the one is delivered with repeat Cesarean section after trying VBAC, the other is delivered with vacuum assisted VBAC, and treated with surgical repair.
Amenorrhea ; Cesarean Section* ; Cesarean Section, Repeat ; Diagnosis ; Female ; Fistula* ; Hematuria ; Humans ; Infertility ; Postoperative Period ; Pregnancy ; Ultrasonography ; Urinary Bladder ; Urinary Incontinence ; Urinary Tract Infections ; Uterus ; Vacuum ; Vaginal Birth after Cesarean

OBJECTIVE: The aim of this study was to evaluate whether the presence of phIGFBP-1 in cervical secretion of patients with symptoms suggestive of preterm labor predicts preterm delivery. METHODS: Patients who were examined at the Department of Obstetrics and Gynecology, Daegu Fatima hospital between 24 weeks' and 34 weeks' gestation with intact membrane, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilatation <3 cm were recruited. Cerviacal swab samples were assayed for the presence of phIGFBP-1 by immunoenzymometric assay, with a positive result defined as >or=10 microgram/L. Tocolysis and corticosteroids were used when clinically indicated after specimen collection. RESULTS: phIGFBP-1 was detected in 21 patients among 50 patients analysis. Compared with patients who had negative results, patients who had positive results for phIGFBP-1 were more likely to deliver before 37 weeks (p<0.001), before 34 weeks (p=0.008) and within 7 days (p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value were 77.3%, 85.7%, 81.0%, and 8.28%. Patients with positive results were also treated more with tocolysis and corticosteroids use than patients with negative results. Gestational age at delivery (p<0.001) and birthweight (p<0.001) were lower for patients with positive results. CONCLUSION: In a population of patients with symptoms, the presence of phIGFBP-1 in cervical secretions defines a subgroup at increased risk for preterm delivery.
Adrenal Cortex Hormones ; Daegu ; Female ; Gestational Age ; Gynecology ; Humans ; Labor Stage, First ; Membranes ; Obstetric Labor, Premature ; Obstetrics ; Pregnancy ; Sensitivity and Specificity ; Specimen Handling ; Tocolysis

Bowel obstruction is a rare complication of pregnancy. The usual causes include previous abdominal surgery, volvulus, intussusception, colonic neoplasm, or the enlarging uterus. Bowel obstruction secondary to uncorrected Hirschsprung's disease as a complication of pregnancy is difficult to diagnosis, its occurrence can have grave implications for both mother and fetus, and anticipation of dystocia. Hirschsprung's disease is diagnosed and treated in the neonatal period. Persistence of Hirschsprung's disease into adulthood is very rare and confirmed by rectal biopsy providing the absence of the ganglion cell in Auerbach and Meissner's plexus. We experienced vaginal Delivery in Hirschsprung's disease complicating pregnancy and report our own case study with a brief literature review.
Biopsy ; Colonic Neoplasms ; Diagnosis ; Dystocia ; Female ; Fetus ; Ganglion Cysts ; Hirschsprung Disease* ; Humans ; Intestinal Volvulus ; Intussusception ; Mothers ; Pregnancy* ; Submucous Plexus ; Uterus

Prolactin-secreting adenomas are the most common pituitary tumors resulting in hyperprolactinemia which is one of the most important causes of female infertility with amenorrhea or galactorrhea. Although it is reported that spontaneous pregnancy occured in these patients using bromocriptine treatment or ovulation induction, it is very rare to find a pituitary tumor during a pregnancy by having neurological symptoms of headache, diplopia or visual disturbance. We experienced a case of normal delivery after symptom improvement and maintenance of pregnancy by administration of bromocriptine in a 27 year-old primigravida with diplopia and visual disturbance due to prolactin-secreting pituitary macroadenoma, which is diagnosed by brain MRI scan and serum prolactin level. A brief review of related literature was done.
Adenoma ; Adult ; Amenorrhea ; Brain ; Bromocriptine ; Diplopia ; Female ; Galactorrhea ; Headache ; Humans ; Hyperprolactinemia* ; Infertility, Female ; Magnetic Resonance Imaging ; Ovulation Induction ; Pituitary Neoplasms ; Pregnancy ; Prolactin

Malignant mixed mullerian tumor (MMMT) of the uterus are uncommon tumor and highly malignant containing epithelial and stromal components which is classified as homologous or heterologous based on the nature of sarcomatous component. It is highly malignant and the prognosis is poor due to frequent metastasis and recurrence, which most patients were associated with postmenopausal status. We experienced one case of malignant mixed mullerian tumor of uterus with neuroendocrine differenciation. So we report this case with a brief review of literature.
Humans ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Uterus*

Hypermesis gravidarum is a complication defined as vomiting severe enough to require hospital admission during early pregnancy. Thiamine deficiency is known to lead to certain neurological seguelae including Wernicke-Korsakoff syndrome. Wernicke's encephalopathy is an illness of acute onset characterized by global confusion, paralysis of eye ball movements, and gate ataxia due to a deficiency of thiamine. The immediate administration of thiamine prevents progression of the disease and reverses brain lesions that have not yet progressed to the point of fixed structural change. We have experienced a case of Wernicke-Korsakoff syndrome associated with hyperemesis gravidarum, which seemed to be developed by prolonged thiamine-free fluid therapy. We emphasize the need for thiamine supplementation in hyperemesis gravidarum patients.
Ataxia ; Brain ; Female ; Fluid Therapy ; Humans ; Hyperemesis Gravidarum* ; Korsakoff Syndrome* ; Paralysis ; Pregnancy ; Thiamine ; Thiamine Deficiency ; Vomiting ; Wernicke Encephalopathy

Uterine papillary serous carcinoma (UPSC) behave more aggressively than other endometrial carcinomas and have a propensity for intraabdominal spread, simulating the behavior of ovarian carcinoma. Because of high relapsing rate, and high mortality rate of UPSC, many gynecologist studied about its treatment regimen and recommended many treatment method. Many investigators recommended that patients with UPSC should undergo a staging laparotomy and they suggested the surgery should include at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic lymphadenectomy, paraaortic lymphadenectomy, peritoneal washing and peritoneal cytology, By and large, adjuvant systemic Platinum based chemotherapy or, paclitaxel based chemotherapy and adjuvant whole abdominal irradiation or pelvic irradiation was prescribed. We experienced two cases of the UPSC stage IIIc and stage IV diagnosed after explolaparotomy. We present these cases and review the literatures about the optimal treatment regimen of UPSC.
Drug Therapy ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Laparotomy ; Lymph Node Excision ; Mortality ; Paclitaxel ; Platinum ; Research Personnel

PURPOSE: To evaluate the clinical features and incidence of separation of the symphysis pubis during childbirth, and to evaluate the risk factors of the lesion and the outcome of treatment. MATERIALS AND METHODS: Seventy two cases of separation of symphysis pubis among 66,721 delivery between January 1992 and December 2004 was selected. The control group was composed of 498 cases without separation of symphysis pubis during childbirth. Several factors increasing the risk of this lesion were assessed using χ
Birth Weight ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Parturition* ; Pelvis ; Postpartum Period ; Risk Factors

Objective To investigate the anti-inflammatory effects of decursin and decursinol angelate-rich Angelica gigas Nakai (AGNE) on dextran sulfate sodium (DSS)-induced murine ulcerative colitis (UC). Methods The therapeutic effect of an AGNE was analyzed in a mouse model of UC induced by DSS. Disease activity index values were measured by clinical signs such as a weight loss, stool consistency, rectal bleeding and colon length. A histological analysis was performed using hematoxylin and eosin staining. Key inflammatory cytokines and mediators including IL-6, TNF-α PGE

Background/Aims: Elevated troponin levels predict in-hospital mortality and influence decisions regarding thrombolytic therapy in patients with acute pulmonary embolism (PE). However, the usefulness of high-sensitivity troponin T (hsTnT) regarding PE remains uncertain. We aimed to establish the optimal cut-off level and compare its performance for precise risk stratification. Methods: 374 patients diagnosed with acute PE were reviewed. PE-related adverse outcomes, a composite of PE-related deaths, cardiopulmonary resuscitation incidents, systolic blood pressure < 90 mmHg, and all-cause mortality within 30 days were evaluated. The optimal hsTnT cut-off for all-cause mortality, and the net reclassification index (NRI) was used to assess the incremental value in risk stratification. Results: Among 343 normotensive patients, 17 (5.0%) experienced all-cause mortality, while 40 (10.7%) had PE-related adverse outcomes. An optimal hsTnT cut-off value of 60 ng/L for all-cause mortality (AUC 0.74, 95% CI 0.61–0.85, p < 0.001) was identified, which was significantly associated with PE-related adverse outcomes (OR 4.07, 95% CI 2.06–8.06, p < 0.001). Patients with hsTnT ≥ 60 ng/L were older, hypotensive, had higher creatinine levels, and right ventricular dysfunction signs. Combining hsTnT ≥ 60 ng/L with simplified pulmonary embolism severity index ≥1 provided additional prognostic information. Reclassification analysis showed a significant shift in risk categories, with an NRI of 1.016 ± 0.201 (p < 0.001). Conclusions We refined troponin’s predictive value in patients with acute PE, proposing a new cut-off value of hsTnT ≥ 60 ng/L. Validation through large-scale studies is essential to offer clinically useful guidance for managing patient population.