In the conservative management of uterine fibroids is radiofrequency ablation (RFA) considered to be one of the safe, effective and minimal invasive approaches in selected women who desire to retain their uterus. Few studies were conducted on its adverse outcomes and most of the reported complications were minor events such as pain, discharge, adhesion which didn't require any intervention. However, although safe and effective, the RFA of a uterine myoma can be the cause for severe complications such as penetration and burn injuries of pelvic organs. In general, a rectouterine fistula is one of the rarest complications but can lead to serious adverse outcomes. Herein, to our knowledge, we report the first case involving a rectouterine fistula after laparoscopic ultrasound-guided RFA of a uterine myoma with pelvic endometriosis. In addition, we provide a brief review of the relevant literature.
Burns ; Catheter Ablation* ; Endometriosis ; Female ; Fistula* ; Humans ; Leiomyoma* ; Uterus

Pulmonary toxicity is one of the most serious adverse effects associated with a quick course of vincristine, bleomycin, and cisplatin neoadjuvant chemotherapy (NAC-VBP). The aim of this study was to evaluate pulmonary toxicity related to a quick course NAC-VBP. A total of consecutive 61 patients, who underwent at most 3 cycles of NAC-VBP every 10 days in the International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIB cervical cancer from 1995 to 2007, were retrospectively analyzed. Of the 61 study subjects, 7 (11.5%) were identified to have pulmonary toxicity and 2 (3.3%) died of pulmonary fibrosis progression despite aggressive treatment and the use of a multidisciplinary approach. No factor predisposing pulmonary toxicity was identified. Initial symptoms were non-specific, but bronchiolitis obliterans organizing pneumonia and interstitial pneumonitis were characteristic findings by high-resolution computed tomography of the chest. The benefit of steroid therapy was uncertain and was associated with steroid-induced diabetes mellitus requiring insulin therapy in two patients. Fatal pulmonary toxicity is a major concern of a quick course NAC-VBP. In conclusion, these patients require special monitoring for bleomycin-induced pulmonary toxicity.
Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*adverse effects/therapeutic use ; Bleomycin/administration & dosage/*adverse effects/therapeutic use ; Cisplatin/administration & dosage/*adverse effects/therapeutic use ; Female ; Humans ; Lung Diseases/*chemically induced/pathology ; Middle Aged ; *Neoadjuvant Therapy ; Pulmonary Fibrosis/chemically induced/mortality/pathology ; Retrospective Studies ; Tomography, X-Ray Computed ; Uterine Cervical Neoplasms/complications/*drug therapy ; Vincristine/administration & dosage/*adverse effects/therapeutic use

Primary endometrioid adenocarcinoma developed at urethrovaginal septum has not been reported. A 61-yr-old woman presented with recurrent urinary tract infection. She had received hormone replacement treatment with estrogen and progesterone for 5 yr. A pinpoint ulceration at slightly elevated anterior vaginal wall was found and biopsy revealed endometrioid adenocarcinoma. Magnetic resonance imaging showed the 4.3 cm sized mass in urethrovaginal septum. She has undergone anterior pelvic exenteration, pelvic lymph node dissection, and urostomy with ileal conduit. Microscopic finding of the pathology revealed endometrioid adenocarcinoma. Co-existence of endometriosis was not identified. Tumor at urethrovaginal septum was difficult to be detected till growing to be bulky, because of vaginal axis, misunderstanding of the tumor as symphysis pubis, no definitive symptom, and its rarity. This is the first reported case of extraovarian endometrioid adenocarcinoma developed at the urethrovaginal septum. Understanding normal functional anatomy and meticulous physical examination are essential to detect this rare tumor in the urethrovaginal septum.
Carcinoma, Endometrioid/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Endometrial Neoplasms/*diagnosis/pathology/surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Urethral Neoplasms/*diagnosis/pathology/surgery ; Vaginal Neoplasms/*diagnosis/pathology/surgery

OBJECTIVE: To define the molecular basis of TGF-beta1 function in cervical carcinogenesis, we explored the expression and mutational status of TGF-beta1, TGF-beta1 receptors, and Smads, the regulators of the TGF-beta1 signaling pathway, in human cervical cancers. METHODS: Expression of TGF-beta1, TGF-beta1 receptors, and Smads transcripts were determined by quantitative reverse transcription-polymerase chain reaction (RT-PCR), and sequence alteration was analyzed using RT-PCR-single-strand conformation polymorphism (SSCP) analysis. Genomic levels of TGF-beta1, TGF-beta1 receptors and Smads was also measured by quantitative genomic PCR. RESULTS: Abnormal overexpression of TGF-beta1 and abnormal reduction of type II TGF-beta1 receptor were identified in 36% (18 of 50) and 20% (10 of 50) of cervical cancer tissues, respectively. 22% (11 of 50) in Smad2 and 14% (7 of 50) in Smad4 revealed tumor specific mRNA reduction less than a half of normal means. In addition, no evidence for sequence alterations of the gene was found by RT-PCR-SSCP analysis. CONCLUSION: Our study demonstrates that disruption of TGF-beta/Smad signaling pathway exist in human cervical cancer, suggesting that abnormal expressions of the member of TGF-beta/Smad signaling pathway might contribute to the malignant progression of human cervical tumors via suppressing the tumor suppression function of TGF-beta1 1's tumor suppression function.
Humans ; Polymerase Chain Reaction ; RNA, Messenger ; Transforming Growth Factor beta1 ; Uterine Cervical Neoplasms

OBJECTIVE: To evaluate the relationship between single nucleotide polymorphisms (SNPs) in the HER-2 gene and age on the risk and pathologic feature of endometrial cancer. METHODS: We included 125 women with histologically confirmed endometrioid adenocarcinoma who underwent complete surgical staging. The control group consisted of 302 patients with benign gynecologic disease who underwent hysterectomy. Nine SNPs spanning the HER-2 gene were genotyped by SNP-IT assay using SNPstream(r) Genotyping System. Of 9 SNPs, 5 that were either monomorphic or had a lowallele frequency (<10%) in this population were removed, leaving 4 SNPs (SNP1- rs1801200, SNP2- rs1810132, SNP3- rs2517951, SNP4- rs1058808) with allele frequencies > or =10%; these were included in the final analysis. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for BMI. RESULTS: The mean age for endometrial cancer patients was 53.4+/-11.5 (range, 29-81) years. Forty-seven patients (38%) were <50 years of age, and 78 patients (62%) were > or =50 years. Cases had a significantly higher BMI than controls (P<0.001). After adjustment for BMI, there was no significant relationship between HER-2 polymorphism and the risk of endometrial cancer based on age. Furthermore, HER-2 polymorphism did not affect the pathologic features of endometrial cancer based on age. CONCLUSION: Although there is no potential association among HER-2 polymorphisms, age, and endometrial cancer risk, large studies are needed in the future to assess the role of this polymorphism in endometrial cancer and for its combined effect.
Carcinoma, Endometrioid ; Endometrial Neoplasms ; Female ; Gene Frequency ; Genes, erbB-2 ; Genital Diseases, Female ; Humans ; Hysterectomy ; Logistic Models ; Odds Ratio ; Polymorphism, Single Nucleotide

OBJECTIVE: To evaluate the relationship between single nucleotide polymorphisms (SNPs) in the HER-2 gene and age on the risk and pathologic feature of endometrial cancer. METHODS: We included 125 women with histologically confirmed endometrioid adenocarcinoma who underwent complete surgical staging. The control group consisted of 302 patients with benign gynecologic disease who underwent hysterectomy. Nine SNPs spanning the HER-2 gene were genotyped by SNP-IT assay using SNPstream(r) Genotyping System. Of 9 SNPs, 5 that were either monomorphic or had a lowallele frequency (<10%) in this population were removed, leaving 4 SNPs (SNP1- rs1801200, SNP2- rs1810132, SNP3- rs2517951, SNP4- rs1058808) with allele frequencies > or =10%; these were included in the final analysis. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for BMI. RESULTS: The mean age for endometrial cancer patients was 53.4+/-11.5 (range, 29-81) years. Forty-seven patients (38%) were <50 years of age, and 78 patients (62%) were > or =50 years. Cases had a significantly higher BMI than controls (P<0.001). After adjustment for BMI, there was no significant relationship between HER-2 polymorphism and the risk of endometrial cancer based on age. Furthermore, HER-2 polymorphism did not affect the pathologic features of endometrial cancer based on age. CONCLUSION: Although there is no potential association among HER-2 polymorphisms, age, and endometrial cancer risk, large studies are needed in the future to assess the role of this polymorphism in endometrial cancer and for its combined effect.
Carcinoma, Endometrioid ; Endometrial Neoplasms ; Female ; Gene Frequency ; Genes, erbB-2 ; Genital Diseases, Female ; Humans ; Hysterectomy ; Logistic Models ; Odds Ratio ; Polymorphism, Single Nucleotide

A 35-yr-old woman carrying a 17-week-old fetus presented with right hydronephrosis and a single umbilical artery. Karyotyping was normal and targeted ultrasonography showed an otherwise normal fetus. After 28 weeks of gestation, the mother felt rapid, repetitive fetal movement and an ultrasound at 30 weeks of gestation revealed tonic clonic movements of the fetal trunk and extremities. At 36 weeks of gestation, an emergency repeat Cesarean section was performed because of a premature rupture of the membranes and a male infant weighing 4,295 gm was delivered. After birth, the infant continued to have movements suggestive of a generalized tonic clonic seizure. Brain computed tomography and magnetic resonance imaging revealed normal structures and an electroencephalography showed generalized suppression. Treatment with phenobarbital resulted in substantial improvement in the number of seizure episodes, however fine seizure-like movement continued in both of the hands, feet and in the tongue until the five-month follow-up. This is the first Korean report of a fetal seizure being diagnosed during the prenatal period.
Female ; Fetal Diseases/*diagnosis/ultrasonography ; Humans ; Infant, Newborn ; Karyotyping ; Magnetic Resonance Imaging/methods ; Male ; Phenobarbital/pharmacology ; Pregnancy ; Prenatal Diagnosis/*methods ; Seizures/*diagnosis ; Tomography, X-Ray Computed/methods ; Ultrasonography, Prenatal/*methods

OBJECTIVES: To compare the efficacy of additional vaginal dressing disinfectants for reduction of wound-related complications in laparoscopic hysterectomy. METHODS: From September 2006 to June 2007, 226 of 243 patients underwent laparoscopic hysterectomy were enrolled. The patients were classified into three groups (no additional disinfectant (n=76), povidone-iodine (n=68), and chlorhexidine (n=82) for disinfectants) and the short term postoperative complications related with wound morbidity were recorded by 2 months out-patient follow up. RESULTS: The mean age of all patients was 46.6+/-7.6 years old, and the mean BMI (body mass index) was 24.2+/-3.4, mean operation time was, 137.2+/-48.0 minutes, and the mean estimated blood loss was 451.8+/-240.2 ml. There was no significant difference among three groups in their mean age, mean BMI, frequency of vaginal culture (+) before surgery, frequency of wound/stump infection after surgery, frequency of wound disruption, and frequency of fever. The significant difference was shown in mean operation time and mean estimated blood loss but those did not affect frequency of vaginal culture (+) before surgery, frequency of wound/stump infection after surgery, frequency of wound disruption, and frequency of fever. CONCLUSIONS: We conclude that the kind of disinfectant for additional vaginal dressing for laparoscopic hysterectomy does not matter deeply in causing short term wound-related complications after the surgery.
Bandages ; Chlorhexidine ; Disinfectants ; Fever ; Humans ; Hysterectomy ; Outpatients ; Postoperative Complications ; Povidone-Iodine

OBJECTIVE: The aim of this study is to evaluate the complication rate of Cervical Intrafascial Semm Hysterectomy (CISH). METHODS: 1,049 CISH were carried out from April 1997 to August 2006 at our department. Retrospective review of medical records was performed to investigate the incidence and the type of complications during CISH procedures. RESULTS: 281 (26.79%) of the patients had a history of laparotomy. Overall 98 (9.34%) complications occurred. There were 30 (2.86%) transfusion, 19 (1.81%) transient bladder dysfunction, 12 (1.14%) cervical stump bleeding, 11 (1.05%) abdominal wound infection or disruption, 7 (0.67%) paralytic ileus, 6 (0.57%) incisional hernia, 4 (0.38%) cervical stump infection, 2 (0.19%) ureter injuries and 2 (0.19%) bladder injuries. And there were one case of transient peroneal nerve palsy, trocar site bleeding, trocar site endometriosis, foreign body in bladder and pelvic abscess. CONCLUSIONS: CISH procedure lessens the risk of ureteral and bladder injury, but this procedure increases the risk of cervical stump bleeding and infection morbidity.
Abscess ; Endometriosis ; Female ; Foreign Bodies ; Hemorrhage ; Hernia ; Humans ; Hysterectomy ; Incidence ; Intestinal Pseudo-Obstruction ; Laparotomy ; Medical Records ; Paralysis ; Peroneal Nerve ; Retrospective Studies ; Surgical Instruments ; Ureter ; Urinary Bladder ; Wound Infection

Ovarian Sertoli-Leydig cell tumors are rare sex cordstromal tumors, and these neoplasms account for less than 0.5% of all ovarian tumors. Those are more often encountered in young women between the ages of 20 and 30 years who usually become virilized. Recently, we experienced an unusual case of Sertoli-Leydig cell tumor with mucinous heterologous elements in a 71-year-old postmenopauseal woman. We present it with brief review of literatures.
Aged ; Cystadenoma, Mucinous ; Female ; Humans ; Mucins* ; Postmenopause ; Sertoli-Leydig Cell Tumor*