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Ka Yeong YUN ; Si Eun HAN ; Seung Chul KIM ; Jong Kil JOO ; Kyu Sup LEE

Obstetrics & Gynecology Science.2017;60(1):133-137. doi:10.5468/ogs.2017.60.1.133

Pregnancy-related osteoporosis is a very rare condition characterized by the occurrence of fracture during pregnancy or the puerperium. Despite its relative rarity, it can be a dangerous condition that causes severe back pain, height loss and disability. Normal physiologic changes during pregnancy, genetic or racial difference, obstetrical history and obstetrical disease, such as preterm labor or pregnancy-induced hypertension, are presumed risk factors of pregnancy-related osteooporosis. However, exact etiology and pathogenesis are uncertain. The management and natural history are still poorly defined. Traditional medications for osteoporosis are calcium/vitamin D and bisphosphonate. Concerns with bisphosphonate include accumulation in bone and fetal exposure in subsequent pregnancies. The newly developed medication, teriparatide, has shown good results. We report six cases of pregnancy-related osteoporosis and spinal fracture with literature review.
Back Pain ; Female ; Hypertension, Pregnancy-Induced ; Natural History ; Obstetric Labor, Premature ; Osteoporosis* ; Postpartum Period ; Pregnancy ; Risk Factors ; Spinal Fractures* ; Teriparatide

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Right ventricular metastatic tumor from a primary carcinoma of uterine cervix: A cause of pulmonary embolism.

Gwan Hee HAN ; Do Youn KWON ; Roshani ULAK ; Kyung Do KI ; Jong Min LEE ; Seon Kyung LEE

Obstetrics & Gynecology Science.2017;60(1):129-132. doi:10.5468/ogs.2017.60.1.129

The presence of intracavitary cardiac metastasis from squamous cell carcinoma of the uterine cervix is extremely rare. The diagnosis is made almost exclusively postmortem. Apart from causing intracardiac obstruction, it can present as pulmonary emboli and the prognosis is extremely poor. It is important to suspect this diagnosis in patient with recurrent pulmonary emboli. Due to the rarity of this condition it is very difficult to standardize care for these patients. However, it is possible that aggressive therapy may lengthen patients' survival and quality of life. We present a case of isolated intracavitary cardiac metastasis arising from a squamous cell carcinoma of the cervix, 44-year-old woman, diagnosed as stage complaint of fatigue and dyspnea on mild exertion. The echocardiogram showed a mass in the right ventricle and suspicious pulmonary embolism. We took an aggressive therapeutic approach. The pathological examination of the resected tissue revealed metastatic squamous cell carcinoma.
Adult ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Diagnosis ; Dyspnea ; Fatigue ; Female ; Heart Ventricles ; Humans ; Neoplasm Metastasis ; Prognosis ; Pulmonary Embolism* ; Quality of Life ; Uterine Cervical Neoplasms

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Extrauterine epithelioid trophoblastic tumor in hysterectomized woman.

Ji Hye KIM ; Sun Kyung LEE ; Soo Hyun HWANG ; Jung Sun KIM ; Gun YOON ; Yoo Young LEE ; Tae Joong KIM ; Chel Hun CHOI ; Byoung Gie KIM ; Duk Soo BAE ; Jeong Won LEE

Obstetrics & Gynecology Science.2017;60(1):124-128. doi:10.5468/ogs.2017.60.1.124

Epithelioid trophoblastic tumor (ETT) is a very rare variant of gestational trophoblastic disease (GTD) which arises in reproductive age women with prior gestational history. Although abnormal vaginal bleeding is the most common symptom of ETT, there are no reported pathognomonic symptoms of ETT because of its rarity. ETT is similar to placental site trophoblastic tumor in terms of its slow growing characteristic and microscopic findings. Therefore, it could be misdiagnosed as placental site trophoblastic tumor or other types of GTD. Unlike other types of GTD, primary treatment of ETT is surgical resection because of its chemo-resistant nature. Accordingly, immunohistochemical staining is essential for accurate diagnosis and appropriate treatment. Here, we report a case of a 42-year-old hysterectomized woman with pelvic masses who suffered from abdominal pain. Through laparotomy, tumors were resected completely and they were diagnosed as ETT through immunohistochemical stain. This report provides more evidence about its clinical features, diagnosis, and treatment including a brief review of the literature.
Abdominal Pain ; Adult ; Diagnosis ; Female ; Gestational Trophoblastic Disease ; Humans ; Laparotomy ; Trophoblastic Neoplasms* ; Trophoblastic Tumor, Placental Site ; Trophoblasts* ; Uterine Hemorrhage

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Lymphoepithelioma-like carcinoma of the uterine cervix.

Hyun Sil YUN ; Sun Kyung LEE ; Gun YOON ; Hwi Gon KIM ; Dong Hyung LEE ; Yong Jin NA ; Ook Hwan CHOI ; Dong Hoon SHIN ; Yong Jung SONG

Obstetrics & Gynecology Science.2017;60(1):118-123. doi:10.5468/ogs.2017.60.1.118

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is exceedingly uncommon. We herein report a rare case of cervical LELC. A 45-year-old woman was admitted to gynecology department with vaginal bleeding for one month. Liquid-based cytology revealed atypical endometrial cells, not otherwise specified on her cervix. On a hysteroscopy, an endocervical mass was identified and the pathologic result was consistent with poorly differentiated squamous cell carcinoma. Magnetic resonance imaging and positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography revealed a 3.1-cm endocervical mass without distant metastasis or enlarged lymph nodes. The International Federation of Gynecology and Obstetrics stage was IB1. A radical hysterectomy and bilateral pelvic lymph node dissection were performed. The pathologic diagnosis was a poorly differentiated carcinoma, showing features of LELC. She has been followed for 8 months without adjuvant treatment since the surgery, during which time there has been no evidence of tumor recurrence or metastasis.
Carcinoma, Squamous Cell ; Cervix Uteri* ; Diagnosis ; Female ; Gynecology ; Herpesvirus 4, Human ; Humans ; Hysterectomy ; Hysteroscopy ; Lymph Node Excision ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis ; Obstetrics ; Positron-Emission Tomography ; Recurrence ; Uterine Cervical Neoplasms ; Uterine Hemorrhage

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Syndrome of inappropriate antidiuretic hormone secretion following irinotecan-cisplatin administration as a treatment for recurrent ovarian clear cell carcinoma.

Do Youn KWON ; Gwan Hee HAN ; Roshani ULAK ; Kyung Do KI ; Jong Min LEE ; Seon Kyung LEE

Obstetrics & Gynecology Science.2017;60(1):115-117. doi:10.5468/ogs.2017.60.1.115

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) has various causes including central nervous system disorders, pulmonary and endocrine diseases, paraneoplastic syndromes, and use of certain drugs. SIADH induced by chemotherapy with irinotecan-cisplatin is not a common complication. Here, we review a case of SIADH after treatment with irinotecan-cisplatin. A 45-year-old woman received adjuvant chemotherapy (paclitaxel-carboplatin) for ovarian clear cell carcinoma, but the cancer recurred within 9 months of chemotherapy. Subsequently, a second line of combination chemotherapy containing irinotecan-cisplatin was initiated. However, 5 days after chemotherapy administration, her general condition began to deteriorate; her hematological tests revealed hyponatremia. Therefore, it is imperative to consider the possibility of SIADH in patients being treated with irinotecan-cisplatin–based chemotherapy. Proper monitoring of serum sodium levels and assessment of clinical symptoms should be performed in such patients for early diagnosis and prompt management.
Central Nervous System Diseases ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination ; Early Diagnosis ; Endocrine System Diseases ; Female ; Hematologic Tests ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Middle Aged ; Paraneoplastic Syndromes ; Sodium

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Laparoendoscopic single-site radical hysterectomy for early stage cervical cancer.

Ju Young PARK ; Yoo Min KIM ; Yoo Young LEE ; Tae Joong KIM ; Jeong Won LEE ; Byoung Gie KIM ; Duk Soo BAE ; Chel Hun CHOI

Obstetrics & Gynecology Science.2017;60(1):110-114. doi:10.5468/ogs.2017.60.1.110

Technical developments have made laparoendoscopic single-site (LESS) surgery increasingly more feasible for treating gynecological conditions, including cancer. However, complex surgeries such as radical hysterectomy have rarely been performed with single-port access because of technical difficulties. The majority of the difficulties are due to the inefficient retraction of tissue during dissection. Here, we report a detailed description of LESS radical hysterectomy plus pelvic lymph node dissection that was successfully performed in two patients with stage IB1 cervical cancer. We used our expertise with LESS to perform space development as much as possible before the ligaments were resected. The oncologic clearance was comparable to that of conventional laparoscopic radical hysterectomy.
Humans ; Hysterectomy* ; Ligaments ; Lymph Node Excision ; Uterine Cervical Neoplasms*

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First reported case of fetal aortic valvuloplasty in Asia.

Sun Young YOON ; Hye Sung WON ; Mi Young LEE ; Min Kyong CHO ; Euiseok JUNG ; Ki Soo KIM ; Young Hwue KIM

Obstetrics & Gynecology Science.2017;60(1):106-109. doi:10.5468/ogs.2017.60.1.106

Prenatal intervention of severe fetal aortic valve stenosis by ultrasound-guided percutaneous balloon valvuloplasty has been performed to prevent the progression to hypoplastic left heart syndrome, and achieve biventricular circulation in neonates. Here we report a case of fetal aortic valvuloplasty prenatally diagnosed with aortic stenosis at 24 weeks of gestation and showed worsening features on a follow-up echocardiography. Prenatal aortic valvuloplasty was performed at 29 weeks of gestation, and was a technical success. However, fetal bradycardia sustained, and an emergency cesarean delivery was performed. To the best of our knowledge, this is the first reported case of fetal aortic valvuloplasty which was performed in Asia.
Aortic Valve Stenosis ; Asia* ; Balloon Valvuloplasty ; Bradycardia ; Echocardiography ; Emergencies ; Fetal Heart ; Fetal Therapies ; Follow-Up Studies ; Humans ; Hypoplastic Left Heart Syndrome ; Infant, Newborn ; Pregnancy ; Prenatal Diagnosis

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Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial.

Fatemeh SHOBEIRI ; Fahimeh Ezzati ARASTE ; Reihaneh EBRAHIMI ; Ensiyeh JENABI ; Mansour NAZARI

Obstetrics & Gynecology Science.2017;60(1):100-105. doi:10.5468/ogs.2017.60.1.100

OBJECTIVE: Premenstrual syndrome (PMS) affects millions of women and is known as the most important disorder among them. The very aim of the present study was to evaluate the effects of low dose calcium on severity of PMS. METHODS: This study can be considered as a double-blind randomized clinical trial. Female students of Hamadan University of Medical Sciences diagnosed with PMS in 2014 participated in the present study. Sixty-six female students diagnosed with PMS were involved in the experimental and control groups. The participants were randomly assigned into two groups to receive 500 mg of calcium daily or placebo for two months. Severity of PMS was detected by Daily Record of Severity of Problems, which was used to measure symptoms during one menstrual cycle before and two menstrual cycles after the intervention. RESULTS: No signifcant differences were observed in the mean scores of PMS symptoms between calcium and placebo groups before the treatment (P=0.74). However, signifcant differences were noticed between the two intervention groups in the first (P=0.01) and second menstrual cycles (P=0.001) after the intervention. The differences were significant in subgroups of anxiety, depression, emotional changes, water retention, and somatic changes in calcium group compared with placebo group in the menstrual cycle before the intervention and two menstrual cycles after the intervention and among menstrual cycles (0, cycle 1, cycle 2) in calcium group (P=0.01). CONCLUSION: Overall, the results of the present study suggest that treatment with calcium supplements is an effective method for reducing mood disorders during PMS.
Anxiety ; Calcium* ; Depression ; Female ; Humans ; Menstrual Cycle ; Methods ; Mood Disorders ; Premenstrual Syndrome* ; Water

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Usefulness of modified BRB technique in treatment to ablate uterine fibroids with magnetic resonance image-guided high-intensity focused ultrasound.

Jae Heok JEONG ; Kil Pyo HONG ; Yu Ri KIM ; Jae Eun HA ; Kyu Sup LEE

Obstetrics & Gynecology Science.2017;60(1):92-99. doi:10.5468/ogs.2017.60.1.92

OBJECTIVE: If bowels and other structures are in the pathway of high-intensity focused ultrasound (HIFU) beam during magnetic resonance image-guided HIFU (MRgFUS) therapy, filling to the bladder and the rectum and then emptying the bladder (i.e., the BRB technique) is used to avoid them. A modified BRB technique might be useful method to using a uterine elevator method or by inducing uterus downward traction to lower the position of the uterus. METHODS: A total of 156 patients who had undergone MRgFUS surgery treatment for uterine fibroids from March 2015 to February 2016 were included in this retrospective study. Of the 156 patients, 40 were treated using a uterine elevator while 29 were treated using downward traction of uterus. HIFU was performed using Philips Achieva 1.5 Tesla MR and Sonalleve HIFU system. RESULTS: MRgFUS surgery was feasible with modified BRB technique in 69 cases. Using uterine elevator method, the intensity of HIFU for group with antefletxio uteri was significantly lower than that for the group without antefletxio uteri (105.37±17.62 vs. 118.71±26.88 W). The group with downward traction of uterus induced was found to have significantly lower intensity of HIFU compared to the group without downward traction of uterus induced (110.26±22.60 vs. 130.51±27.81 W). CONCLUSION: Modified BRB technique was useful in avoiding bowels and other structures located in HIFU beam pathway during MRgFUS treatment to ablate uterine fibroids.
Elevators and Escalators ; Humans ; Leiomyoma* ; Methods ; Rectum ; Retrospective Studies ; Traction ; Ultrasonography* ; Urinary Bladder ; Uterus

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Delayed hemorrhage effect of local anesthesia with epinephrine in the loop electrosurgical excisional procedure.

Yong Jae LEE ; Yunjin PARK ; In Ok LEE ; Jung Won YOON ; Jung Yoon LEE ; Sang Wun KIM ; Sunghoon KIM ; Young Tae KIM ; Eun Ji NAM

Obstetrics & Gynecology Science.2017;60(1):87-91. doi:10.5468/ogs.2017.60.1.87

OBJECTIVE: The aim of this study was to investigate factors preventing delayed hemorrhage after the loop electrosurgical excisional procedure (LEEP). METHODS: Medical records of patients who underwent LEEP at one university affiliated hospital from October 2013 to January 2015 were reviewed. Patients with or without delayed hemorrhage were classified. LEEP was performed either in an operating room under general anesthesia or in a procedure room with local anesthesia in the outpatient clinic. Delayed hemorrhage was defined as excisional site bleeding occurring between 1 and 30 days after the LEEP requiring intervention such as electro-cauterization, gauze packing, or application of another hemostatic agent. RESULTS: During the study period, 369 patients underwent LEEP. Twenty-three (6.2%) patients with delayed hemorrhage returned to our hospital either to the outpatient clinic or to the emergency unit. A third of the population (103, 27.9%) underwent LEEP in the operating room under general anesthesia without injection of local anesthesia. The remaining patients (266, 72.1%) underwent LEEP with local anesthesia (lidocaine HCl 2% with epinephrine 1:100,000) in the office procedure room. Patients given local anesthesia including epinephrine had significantly lower delayed hemorrhage compared to patients with general anesthesia without injection of local anesthesia (P=0.001). Hemostats, such as fibrin glue or patch, were used for the majority of patients (346, 93.8%) during the procedure. However, using hemostats was not statistically associated with delayed hemorrhage (P=0.163). CONCLUSION: Local anesthesia with the powerful vasoconstrictor epinephrine is effective not only to control perioperative bleeding, but also to prevent delayed hemorrhage after LEEP.
Ambulatory Care Facilities ; Anesthesia, General ; Anesthesia, Local* ; Emergency Service, Hospital ; Epinephrine* ; Fibrin Tissue Adhesive ; Hemorrhage* ; Humans ; Medical Records ; Operating Rooms

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