Pyometra is an accumulation of purulent fluid in the uterine cavity. Generalized peritonitis secondary to a perforated pyometra is extremely rare. Most of the pyometra perforation is associated with malignancy. We have experienced a case of generalized peritonitis secondary to a perforated pyometra with no associated malignancy.
Abdomen, Acute ; Peritonitis ; Pyometra ; Uterine Perforation

Clear cell carcinoma of the uterine cervix is rare cancer that accounts for 4 to 9% of the adenocarcinoma of uterine cervix. Although intrauterine exposure to diethylstilbestrol (DES) during early pregnancy is one of the established risk factors, DES exposure may not be confirmed in all patients. We experienced a case of clear cell carcinoma in the uterine cervix of 67-year-old woman who was not exposed to DES. She was initially diagnosed as endometrial clear cell carcinoma because of the normal colposcopic finding and histologically proven clear cell carcinoma from endometrial aspiration biopsy and endocervical curettage. We performed a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and lymphadnectomy including both pelvic and para-aortic regions. On the final pathologic diagnosis of clear cell carcinoma confined to endocervix, the patient was received adjuvant concurrent chemoradiation with weekly cisplatin. We present the case with a brief review of related literature.
Adenocarcinoma ; Aged ; Biopsy, Needle ; Cervix Uteri ; Cisplatin ; Curettage ; Diethylstilbestrol ; Female ; Humans ; Hysterectomy ; Pregnancy ; Risk Factors

Endometriosis is estrogen dependent disease in reproductive age. Endometriosis is a chronic inflammatory gynecologic disease. Problems associated with endometriosis include dysmenorrhea, dyspareunia, and infertility. Postmenopausal endometriosis is rare. Also, malignant transformation in endometriosis is rare. There is no report in Korea about serous adenocarcinoma arising from endometriosis after menopause. The authors present a case of serous adenocarcinoma arising from endometriosis after menopause with brief review of the literature.
Adenocarcinoma ; Dysmenorrhea ; Dyspareunia ; Endometriosis ; Estrogens ; Female ; Genital Diseases, Female ; Infertility ; Korea ; Menopause

Angular pregnancy refers to implantation of the embryo just medial to uterotubal junction in the lateral angle of the uterine cavity. This is differentiated from interstitial pregnancy in which the gestational sac is located within intramural portion of the tube. Angular pregnancy is categorized as intrauterine pregnancy and the outcome is known favorable. However, there have been few reports about adverse perinatal complications such as abortion, retained placenta, placenta accreta, placenta percreta and uterine rupture. We report a case of angular pregnancy complicated with preterm labor at 25 gestational weeks, placenta accreta and postpartum endometritis. This case suggests that angular pregnancy should be differentiated from normal intrauterine pregnancy because of its potential risk of adverse outcome.
Embryonic Structures ; Endometritis ; Female ; Gestational Sac ; Obstetric Labor, Premature ; Placenta Accreta ; Placenta, Retained ; Postpartum Period ; Pregnancy ; Uterine Rupture

OBJECTIVE: To determine whether or not pomegranate extract can affect postmenopausal syndrome in ovariectomized rats. METHODS: Seventy-nine female Sprague-Dawley rats were used: A, no intervention; B, sham operation and distilled water; C, ovariectomy and distilled water; D, ovariectomy and 10% dilute pomegranate; E, ovariectomy and 20% pomegranate; and F, ovariectomy and 40% pomegranate. The study samples were obtained 4 weeks later. The following parameters were investigated for analyses: the thickness of urogenital epithelium, tail skin temperature, serum levels of sex hormones, lipid profile, homocysteine, and thiobarbituric acid reactive substances. RESULTS: 20% pomegranate had a transient thickening effect of bladder epithelial layer. There was an intermittent lowering effect of tail skin temperature of pomegranate extract, however, it was not consistent. There were lowering effect in serum homocysteine and elevating effect in serum high density lipoprotein-cholesterol. Pomegranate did not reverse post-ovariectomy reduced sex hormone levels. CONCLUSION: Pomegranate extract showed a tendency to reverse ovariectomy-related urothelial changes. Also pomegranate had a serum homocysteine-lowering effect.
Animals ; Epithelium ; Female ; Gonadal Steroid Hormones ; Homocysteine ; Humans ; Ovariectomy ; Punicaceae ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Skin Temperature ; Tail ; Thiobarbiturates ; Thiobarbituric Acid Reactive Substances ; Urinary Bladder

OBJECTIVE: Aromatase is the key enzyme for the conversion of C19 steroids into estrogen in certain human tissues. We studied to evaluate the aromatase expression in eutopic endometirum and endometriotic lesion and its relationship to clinical and laboratory parameters. METHODS: The study included 78 cases of endometriotic lesion and 14 cases of eutopic endometrium and 30 cases of normal uterine endometrium obtained through laparoscopic surgery and curettage. The frozen tissue specimens were examined by immunohistochemistry using aromatase. Clinical symptoms, laboratory findings, and operative findings were analyzed and compared in according to aromatase expression. RESULTS: We observed positive immunohistochemical expression for aromatase in endometriotic lesion from 46/78 patients (59.0%). Aromatase expression was elevated in comparison to eutopic endometrium (5/14 patients, P=0.032) and the difference was more pronounced when eutopic endometriums from patients with endometriosis were compared with those of healthy controls (2/30 patients, P<0.001). Aromatase-positive patients had more moderate-to-severe chronic pelvic pain, higher CA-125 level significantly. Also in operative findings, severe grade endometriosis, bilateral endometriomas, and associated leiomyoma and adenomyosis were more frequent in aromatase positive patients. High values of white blood cell count, erythrocyte sedimentation rate, CA 19-9 were more frequent in aromatase positive patients notwithstanding insignificant differences. CONCLUSION: Unopposed local biosynthesis of estrogens by increased expression of aromatase in eutopic endometrium and endometrial tissue could be involved in the development or maintenance of endometriosis and other uterine estrogen-triggered diseases. Our findings suggest increased expression of aromatase may be related with severity, activity, and chronic pelvic pain in patients with endometriosis.
Adenomyosis ; Aromatase ; Blood Sedimentation ; Curettage ; Endometriosis ; Endometrium ; Estrogens ; Female ; Humans ; Immunohistochemistry ; Laparoscopy ; Leiomyoma ; Leukocyte Count ; Pelvic Pain ; Steroids ; Biomarkers, Tumor

OBJECTIVE: Aim of this study is to evaluate the pregnancy and implantation rates in fresh-embryo transfer (ET) and frozen-thawed ET cycles in women with polycystic ovarian syndrome (PCOS). METHODS: PCOS was diagnosed by the Rotterdam criteria. In 4 cases of 72 stimulation cycles, ET was not conducted due to severe ovarian hyperstimulation syndrome (OHSS). Sixty eight cycles of fresh-ET and 40 cycles of frozen-thawed ET were included in this retrospective study. Age, gravidity, body mass index, infertility duration were compared between two groups. Number of embryos transferred, implantation rate, clinical pregnancy rate and multiple pregnancy rate were compared between two groups by using chi-square test and student's t-test. RESULTS: Number of embryos transferred showed significant difference between two groups. Fresh-ET group was 4.7 and frozen-thawed ET group was 2.8 (P<0.001). However, overall clinical outcomes with fresh-ET and frozen-thawed ET cycles were similar. Implantation rates were 8.3% vs 11.5%, clinical pregnancy rates were 27.9% vs 25.0% and multiple pregnancy rates were 36.8% vs 20.0%. CONCLUSION: Although more number of embryos were transferred in fresh-ET cycles, the clinical outcomes were similar between fresh-ET and frozen-thawed ET cycles. It may be due to decreased uterine receptivity in fresh-ET cycles. Frozen-thawed ET may be used as alternative plan for cases of severe OHSS and decreased uterine receptivity expected.
Body Mass Index ; Embryo Transfer ; Embryonic Structures ; Female ; Gravidity ; Humans ; Infertility ; Ovarian Hyperstimulation Syndrome ; Polycystic Ovary Syndrome ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Retrospective Studies

OBJECTIVE: The objectives of this study was to evaluate the correlation between myeloid differentiation protein 88 (MyD88) expression and paclitaxel effects on epithelial ovarian cancer cells and to evaluate whether paclitaxel had anti-apoptotic signals. METHODS: Epithelial ovarian cancer cells isolated from ascites and established cell lines were treated with increasing concentrations of paclitaxel (0.2 to 20 microM) for 24 and 48 hours and cell viability was determined using the CellTiter 96 AQueous One Solution Cell Proliferation Assay. Cytokine profiling was performed from culture supernatants using the Luminex 200 system. Nuclear factor-kappaB (NF-kappaB) activity was determined using a Luciferase reporter system. Levels of phospho-extracellular signal-regulated kinase (p-ERK) were measured by Western blot analysis. RESULTS: A strong signal for MyD88 expression was observed in R182, 01-19b and SKOV3 cells (MyD88-positive). A2780, R454 and 01-28 cells showed low levels of MyD88 (MyD88-negative). Paclitaxel effectively decreased cell viability in MyD88-negative A2780, R454, 01-28 cells after 24 and 48 hours (57%, 49%, 42% and 35%, 28%, 29%, respectively). MyD88-positive cells were resistant to paclitaxel. There was a significant increase in caspase-3/7 activity following paclitaxel treatment in MyD88-negative cells. No significant change in caspase-3/7 activity was detected in MyD88-positive cells. Paclitaxel induced NF-kappaB activation and enhanced the secretion of interleukin-6 (IL-6) and IL-8 in a dose dependent manner and induced ERK phosphorylation on MyD88-positive cells. CONCLUSION: Paclitaxel treatment for MyD88-positive ovarian cancer could have detrimental effects due to the paclitaxel-induced enhancement of NF-kappaB, ERK activities and pro-inflammatory cytokine production, which promote chemoresistance and tumor progression.
Ascites ; Blotting, Western ; Cell Line ; Cell Proliferation ; Cell Survival ; Interleukin-6 ; Interleukin-8 ; Luciferases ; Myeloid Differentiation Factor 88 ; Neoplasms, Glandular and Epithelial ; NF-kappa B ; Ovarian Neoplasms ; Paclitaxel ; Phosphorylation ; Phosphotransferases

OBJECTIVE: To evaluate and compare the rate and etiologies of second trimester pregnancy loss in monochorionic (MC) or dichorionic (DC) twins, and natural or assisted reproductive technology (ART) twins. METHODS: Between January 1997 and December 2008, there were 146 cases of second trimester twin pregnancy losses (between 12 and 24 weeks gestation) from 2,467 twin pregnancies. They were divided into four groups according to chorionicity and fertilization. Chorionicity was established by ultrasound at early gestation and confirmed by histologic examination after delivery. From a total of 2,467 twin deliveries, 392 MC, 2058 DC, and 17 unknown chorionicity were observed. Fertilization methods were classified as 736 natural, 1,590 ART, and 141 unknown conceptions. The pregnancy loss rate and possible mechanisms were compared in each group. RESULTS: During the study period, there were 43 MC, 86 DC, and 17 unknown chorionicities and 45 natural, 78 ART, and 23 unknown fertilizations. Total twin pregnancy loss rate was 5.9% (146/2,467), with 11.0% (43/392) and 4.2% (86/2,058) for MC twin group and DC twin group, respectively. Likewise, it was 6.1% (45/736) and 4.9% (78/1,590) for natural twin group and ART twin group. The most common cause was intrauterine fetal death (IUFD) in 22 (51.2%) in MC twin group and preterm premature rupture of membranes (PPROM) in 40 (46.5%) in DC twin group, followed by preterm labor (PTL) in 37 (43%). In natural pregnancy, IUFD was the most common etiology in 20 (44.5%) and for ART twin group, it was PTL in 35 (44.9%). CONCLUSION: Twin pregnancy loss rate was higher in MC twin group compared with DC twin group in the second trimester. MC twin group had a higher incidence of IUFD as a cause of second trimester pregnancy loss. The etiologies in DC twin group were PPROM and PTL. It is suggested that antenatal care in twin pregnancy should be explored for preventing fetal loss and promoting neonatal well-being.
Chorion ; Female ; Fertilization ; Fetal Death ; Humans ; Incidence ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Reproductive Techniques, Assisted ; Rupture ; Twins

Congenital epulis, a kind of hamartoma, is a very rare tumor, which appears in front of maxillary alveolar ridge in most cases, and accompanies no malformations. As the tumor protrudes from the oral cavity, it may lead to respiratory difficulties and feeding problems. Therefore it is important for pregnant women to receive comprehensive prenatal counseling with accurate diagnosis of the fetal oral tumor. We report a rare case of prenatal detection of oral tumor with a brief review of literatures, which was confirmed to be a congenital epulis or granular cell tumor after birth.
Alveolar Process ; Counseling ; Female ; Gingival Neoplasms ; Granular Cell Tumor ; Hamartoma ; Humans ; Mouth ; Parturition ; Pregnant Women ; Ultrasonography, Prenatal