Differential usefulness of pelviscopy for PID: 4 cases of acute appendicitis / 대한산부인과학회지

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.

Differential usefulness of pelviscopy for PID: 4 cases of acute appendicitis / 대한산부인과학회지

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.

Clinical review of 40 cases of Fitz-Hugh-Curtis syndrome incidentally found by laparoscopy / 대한산부인과학회지

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.

Clinical review of 40 cases of Fitz-Hugh-Curtis syndrome incidentally found by laparoscopy / 대한산부인과학회지

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.

Two Cases of Extrapelvic endometriosis following Laparoscopy-assisted vaginal hysterectomy and Cesarean section / 영남의대학술지

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.

A case of granular cell tumor of anterior vaginal wall / 대한산부인과학회지

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.

A clinical analysis of pelvic actinomycosis / 대한산부인과학회지

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.

A case of xanthogranulomatous oophoritis developed in a virgin / 대한산부인과학회지

Xanthogranulomatous inflammation is an uncommon form of chronic granulomatous inflammation that is characterized by the presence of lipid-filled histiocytes with lymphocytes, plasma cells and neutrophils. It is best known to occur in the kidney. Other organs in which xanthogranulomatous inflammation has been reported are the gallbladder, stomach, anorectal area, bone, urinary bladder, testis, epididymis and female genital tract. Only a few cases of xanthogranulomatous oophoritis have been reported to date. Infection has been thought to be the main etiologic factor in the pathogenesis of xanthogranulomatous lesion. The pathogenesis of xanthogranulomatous inflammation remains still unclear. Other proposed causes are abnormality in lipid metabolism, endometriosis and ineffective clearance of bacteria by phagocytes. We describe a case of a xanthogranulomatous oophoritis in a 23-year-old virgin which associates with hemorrhagic ovarian cyst and minimal association of pelvic inflammatory disease.

Clinical Analysis of Early Intervention of Pelviscopic Pus Drainage in the Acute Pelvic Inflammatory Disease / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of the early pelviscopic intervention in the acute pelvic inflammatory disease of reproductive aged female. METHODS: A clinical evaluation for 30 women who underwent pelviscopic pus drainage in the pelvic inflammatory disease from September 2001 to December 2004 was done. This study group was compared with the control group that 34 cases of intravenous antibiotics treatment performed and we evaluated the clinical and laboratory findings were recorded for all patients before and after treatment. RESULTS: The mean hospital stay was 7.8 days and 6.9 days respectively (p=0.25). There was statistical difference in regarding to febrile status period, that is febrile status was significantly improved in pelviscopy group. The febrile status of the study group was normalized within postoperative third day except 1 case that postoperative hematoma was formed in cul de sac, but it was not normalized within hospital fifth day in 6 cases (27%) of the control group (p=0.05). But there was no statistical difference between the two groups in regarding to clinical symptom free period except febrile status, WBC count change, and ESR/CRP count change. CONCLUSION: In this study, no significant difference was found between the two groups in regarding to clinical progress. But this study suggested that the early pelviscopic pus drainage was effective first line treatment method for the acute pelvic inflammatory disease with less complications and relatively rapid clinical improvement. However further study with more expanded cases that early pelviscopic intervention was done for the prevention of long term complications of pelvic inflammatory disease will be needed.

Two Cases of Intravenous Leiomyomatosis of the Uterus / 영남의대학술지

Intravenous leiomyomatosis of the uterus is a rare tumor that presents with benign histological features. It is characterized by intravenous proliferation of smooth muscle cells originating from the uterus that sometimes extends to the inferior vena cava and the right heart. It may spread elsewhere, usually to the lung. The first case of intravenous leiomyomatosis was described in 1896 by Birsh-Hirshfeld,1) and only a few cases have been reported since then. Its pathogenesis and optimal treatment have not yet been established. We report a case of metastasizing leiomyomatosis found to have multiple nodular densities in both lower lung fields seven months after myomectomy. In another case the leiomyomatosis was confined to the pelvis after a laparoscopy assisted vaginal hysterectomy, the patient is alive without evidence of disease. Here we provide a detailed report of two cases of intravenous leiomyomatosis of the uterus with a brief review of the literature.

A Case of Uterine Serosal Pregnancy with Both Ovarian Cysts / 대한산부인과학회지

Ectopic pregnancies accout for 1% of all pregnancies and abdominal pregnancies account for almost 1% of ectopic pregnancies. The causes of abdominal pregnancy are two. First is primaries implantation of gestational sac in the abdomen, second is migration of the embryo through a fistulous tract of the tube or uterus. Their early symptom is absent and diagnosis by ultrasonography is difficult. Thus the mortality is very high because of complications such as hemorrhage and infection due to delayed diagnosis. The accurate diagnosis mostly made by laparoscopy or laparotomy is usual. Nowadays the treatment of choice must be laparoscopy according to the development of efficient laparoscopic instrumentation and accumulating experience and skill of laparoscopic surgeon. Here we report a case of uterine serosal pregnancy at 8(+1) weeks with both ovarian cysts which was undergone pelviscopy at the impression of right tubal pregnancy. At local gynecologic clinic, they guessed the patient's lower abdominal pain was due to the torsion of both ovarian masses and transferred the patient for an operation. beta-hCG was 52,509 mIU/mL. By ultrasonographic finding both ovarian cysts and 2 cm sized gestational sac with fetal pole and fetal heart tone were found nearby right fallopian tube. Under the impression of right tubal pregnancy she underwent the emergent pelviscopic operation. Mass consisted with the gestational sac and placenta was attatched to the posterior surface of uterus and minimal amount of fresh blood in the posterior cul de sac was observed. Both tubes and the uterus were intact, and both ovarian cysts were not torted or ruptured. The mass was detached and the bed of implantation was biopsyed. Gestational sac contained the intact embryo within.

Pelviscopic Management Of The Chemical Panperitonitis Due To Ruptured Ovarian Endometrioma: Two Cases / 대한산부인과학회지

Rupture of ovarian endometrioma is rarely occurred. It causes chemical panperitonitis resulting in low fertility and requiring differential diagnosis of acute abdomen. So it needs fast and accurate diagnosis. We have experienced two cases of chemical panperitonitis due to ruptured ovarian endometrioma managed by pelviscopy with a brief review of the literature.

A Clinical Usefulness of Office Hysteroscopy / 영남의대학술지

BACKGROUND: Hysteroscopy is considered to be the gold standard not only for visualizing the cervical canal and the uterine cavity, but also for treating many different types of benign pathologies localized to those regions. The advent and evolution of endoscopic imaging and surgery during the last two decades has added new dimensions to the armamentarium of a gynecologist to combat intrauterine lesions. Office hysteroscopy is increasingly being used as a first line investigation for abnormal uterine bleeding and other diseases involving the uterine cavity. The aim of our study is to assess the diagnostic and operative efficacy of office hysteroscopy. MATERIALS AND METHODS: In our department, 140 patients underwent a hysteroscopy examination and 18 of these underwent an office based hysteroscopy examination from September 1995 to March 2005. The cases who underwent an office based hysteroscopy examination were reviewed in order to assess the clinical usefulness and significance in the management of intrauterine lesions. RESULTS: Major indication was abnormal uterine bleeding (12 cases, 66.7%). The others were a missed IUD and infertility. The hysteroscopic findings were a normal uterine cavity (6 cases, 33.3%), IUD in situ, polyp, submucosal myoma, endometrial hyperplasia and a placenta remnant. CONCLUSION: Office hysteroscopy is a safe, quick and effective method for making an intrauterine evaluation. In addition, it provides immediate results, offers the capacity of direct targeted biopsies of suspicious focal lesions, and offers the direct treatment of some intrauterine conditions.

A Case of Prepubertal Vulval Fibroma / 대한산부인과학회지

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.

The Prevalence of Urinary Incontinence of The Women in Daegu / 영남의대학술지

BACKGROUND: The aim of this study was to estimate the prevalence of urinary incontinence and its correlation to the underlying diseases of women in Daegu. MATERIALS AND METHODS: Urinary incontinence questionnaire regarding age, body weight, height, body mass index (BMI), parity, delivery mode, menopausal status, history of hormonal replacement therapy, abortion history, and any underlying diseases were administered from May to November, 2001 to 412 women over 20 who had been randomly selected from the Outpatient Department of Obstetrics and Gynecology of Yeungnam University. The clinical characteristics of women who experience, and those who do not experience urinary incontinence were compared by means of the Student's t-test for continuous variables and by the Pearson's Chi-square test or Fisher's exact test for categorical variables. A p value of < 0.05 was considered statistically significant. RESULTS: The mean age of the urinary incontinent group (N=193) was 44.2 years. There was a significant increase in the prevalence of incontinence with the increase of age (p=0.000). The prevalence of urinary incontinence was significantly related to the number of deliveries and the mode of delivery (p=0.007, p=0.001) No significant relationship was demonstrated between urinary incontinence and BMI (body mass index) ; the number of abortions; hormonal status; or any underlying diseases such as thyroid disease, diabetes mellitus, and chronic respiratory disease. Also, most of the urinary incontinent women didn't recognize their incontinence as pathological and consequently, didn't consult a physician. CONCLUSION: Our study indicates that the prevalence of urinary incontinence is significantly correlated to age, parity, and the mode of delivery. Most of the middle-aged women who suffered from urinary incontinence didn't recognize their incontinence a pathological. Those results suggest that women in this age group need more information and more education about urinary incontinence.

A Case of Fibroepithelial Polyp of Vulva / 대한산부인과학회잡지

Fibroepithelial polyp is a very rare tumor mostly arising at the urogenitalia. Norris and Taylor firstly reported 12 cases of fibroepithelial polyp in 19661 and until recently under 100 cases were reported in literature. A 11-year-old girl complainted the painless bulging mass at the left labium major. The bulging tumor was measured 5x3 cm in diameter. The margin of the mass was not demarcated ever from the skin and underlying dermis and the mass was not clearly differentiated from surrounding tissues grossly but could be delineated by palpation. The mass was excised by palpation under the general anesthesia. In microscopic finding it was primarily composed of stromal portion containing fibroblast-like stromal cells, with bundles of collagen, skin appendages, and small numbers of blood vessels. We report a case of fibroepithelial polyp of the vulva in a 11-year-old female with a brief review of the literature.

A Case of Suburethral Leiomyoma of the Vagina / 대한산부인과학회잡지

Vaginal leiomyoma is rare. They usually arise from the anterior vaginal wall and may be confused with a variety of vaginal tumors. Correct preoperative diagnosis is difficult. We experienced leiomyoma of suburethral area. We report this case with a brief review of literature.

Extensive Condyloma Acuminatum Managed by Cauterization under Microscopic and Hysteroscopic Visualization to Lessen Injury of Skin and Mucosa / 대한산부인과학회잡지

Condyloma acuminatum is a manifestation of human papillomavirus (HPV) infection. The genital warts tend to occur in areas most directly affected by coitus, namely external genitalia, perineum and perianal areas. The warts are highly contagious; more than 75% of sexual partners developed when exposed. We have experienced one case of microscopic and hysteroscopic cauterization of extensive condyloma acuminatum to lessen injury of skin and mucosa. We presented this case with a brief review of literature.

Laparoscopic Extirpation of the Term Sized Huge Ovarian Cyst / 영남의대학술지

A 23 years old single nulligravida woman underwent laparoscopic removal of a huge cystic adnexal mass that occupied her entire abdomen, giving the appearance of a full term pregnancy. After anesthesia, a vertical infra-umbilical incision, 1 cm long, was made and a telescope was introduced through the port to determine the status of the intra-abdomen and the surface contour of the mass. A needle tipped with a laparoscopic suction apparatus was inserted into the cyst through the infra-umbilical port, directly under the mass. Subsequently, 3, 200 ml of cystic fluid was aspirated without spillage. A huge cyst, reaching to the level of the xyphoid process was effectively excised through the operative laparoscopy after prelaparoscopic drainage. Operation time was 140 minutes and hospital stay was 2 days. There were no complications during hospital stay and after discharge. It seems the size of the cyst is not a criteria for the contraindication of laparoscopic surgery.

A Case of High Grade Endometrial Stromal Sarcoma Metastatic to the Lung / 대한산부인과학회잡지

The High grade endometrial stromal sarcoma is very rare. It has occasional local recurrence, which might be arisen from endometrial stroma, from adenomyosis, rarely from endometriosis. We experienced this infrequent malignant tumor in a 33 years old woman showing invasion to endometrium, cervix, adenomyosis and even penetration to the uterine serosa. She underwent total abdominal hysterectomy with bilateral salpinogo-oophorectomy followed by cisplatin-epirubicin chemotherapy. Metastatic pulmonary lesion was found after hysterectomy. The authors report this case with the clinicopathologic findings and brief review of literatures.