Showing papers in "Obstetrics & gynecology science in 2005"

A case of primary transitional cell carcinoma of the fallopian tube

Abstract: Primary carcinoma of the fallopian tube is a rare entity that accounts for about 1% of all gynecologic malignancies, and most are discovered during or after surgery. Primary transitional cell carcinoma of the fallopian tube is an extremely rare tumor that is reported only occasionally in the worldwide literature. Histologically, fallopian tube carcinomas are almost always papillary adenocarcinomas, but other histologic types such as endometrioid carcinoma, clear cell carcinoma, and mixed carcinoma have been reported. As primary transitional cell carcinoma (TCC) of the fallopian tube is so rare, the clinicopathologic characteristics are as yet unknown. The authors recently experienced a case of primary transitional cell carcinoma arising in the fallopian tube, and thus report the clinical features, management, and also a review of the past pertinent literature.

A survey on premenstrual syndrome

Abstract: Objective: To investigate the epidemiology of premenstrual syndrome (PMS) and actual status of women with PMS seeking a medical advice. Methods: The survey included a total of two hundred healthy women visited to Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital (n=78) or working at the same hospital (n=122) in reproductive age during March to June 2004. The subjects were asked to fill-up PMS sheet developed by our Department as giudance by one interviewer. Diagnosis to PMS was made by DSM-IV algorithms. Results: PMS was noted in 8%. The major five symptoms were low abdominal discomfort or pain, easy fatigability, breast tenderness, and irritability. The following factors were not different statistically between PMS and non-PMS group; mean age, dysmenorrhea, menstrual cycle characteristics, occupation, education, marrital status, smoking or alcohol habit. In PMS group, 7 women out of 16 had a need for treatment (43.8%), in contrast, a few women had seeked a medical advice (12.5%). Moreover, a few women had experienced prescribing medications (12.5%) or non-prescribing medications (12.5%). In non-PMS group, the corresponding figures were 11.4%, 4.9%, 2.7% and 20.1%. Conclusion: Our results indicate that women diagnosed as PMS seldom seek a medical advice. The women with various premenstrual complaints commonly use non-prescribing medications.

임상연구 : 월경전증후군에 관한 실태 조사

Abstract: 목적: 우리나라 여성에서 월경전증후군의 역학과 더불어 의료 이용의 행태를 알아보고자 하였다. 연구 방법: 2004년 3월부터 6월까지 분당서울대학교병원 산부인과에 정기 검진을 목적으로 내원하였거나 또는 본 병원에 근무하는 가임기 여성 200명을 대상으로 자체 개발된 설문지를 이용하여 설문조사를 시행하였다. 월경전증후군의 진단은 DSM-IV의 기준을 적용하였다. 결과: 대상 여성 중 8%가 월경전증후군으로 진단되었다. 주요한 증상으로는 하복부 더부룩 및

Psychosocial and Obstetric Predictors of Depressive Symptomatology at Postpartum 4 Weeks.

Abstract: Objective: The aim of this study was to examine the psychosocial and obstetric predictors of depressive symptomatology at postpartum 4 weeks in Korea. Methods: At their 1-week and 4-week postpartum visits, 61 postpartum women completed the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Symptom Check List-90-Revised (SCL-90-R). Data related to the psychiatric and obstetric characteristics, pregnancy and delivery related events were collected from the standardized medical records. 42 women with no history of pregnancy or delivery within the previous 6 months were selected as the control group. The postpartum group was divided into the depressive and non-depressive subgroups, according to their EPDS and BDI results at postpartum 4 weeks. Results: Compared to the control group, the mean score of the BDI at postpartum 4 weeks was significantly higher in the postpartum group. The percentages of women having experienced severe emotional stress during pregnancy and of smokers and drinkers before pregnancy were significantly higher in the postpartum depressive subgroup (EPDS 10 and BDI 10) when compared to the postpartum non-depressive subgroup. The percentage of women having experienced depressive symptoms at postpartum 1 week was also significantly higher in the depressive subgroup. A depressive symptomatology at postpartum 1 week was identified as a significant risk factor for depressive symptoms at postpartum 4 weeks. Conclusion: The results of this study suggest that screening for depressive symptomatology in the immediate postpartum period might provide an effective means of detecting women at risk of developing postpartum depression in Korea. The finding that severe emotional stress experienced during pregnancy is associated with the development of postpartum depressive symptoms confirms the results of previous studies.

Conventional Papanicolaou smear, fluid-based thin-layer method와 cervicography의 비교 분석

Abstract: Objective: The aim of this study was to evaluate the diagnostic performance of Papanicolaou smear, a fluid-based thin-layer method and cervicography as a primary screening test of cervical cancer. Methods: Among all patients screened by cervicography from January 2003 to Jun 2004, 357 patients who were examined by the Pap smear or ThinPrep Pap test and cervicography as a screening procedure for cervical cancer and taken by the subsequent colposcopy directed biopsy as required, were analyzed with a receiver operating characteristic (ROC) curves and divided into two groups: conventional Pap group (n=256) and ThinPrep group (n=101). Results: ThinPrep group showed higher sensitivity (86.0%>64.0%), higher negative predictive value (78.4%>65.0%), lower false negative rate (21.6%21.2%). Cervicography showed no significant difference between each group. In ThinPrep group, ROC curves showed the AUC of ThinPrep 0.848, the AUC of cervicography 0.585. ThinPrep group was higher with statistical significance (P=0.0001). In conventional Pap group, the result of ROC curves showed the AUC of conventional Pap 0.750, the AUC of cervicography 0.680. Conventional Pap group was somewhat higher but there was no statistical significance (P=0.0975). Conclusion: ThinPrep Pap test showed significantly higher diagnostic accuracy than cervicography. However, conventional Pap test revealed somewhat better screening performance than cervicography without statistical significance. Therefore, the ThinPrep Pap test might be an effective screening test in detecting precancerous lesion of the uterine cervix.

The effect of fish consumption on blood mercury level in pregnant women.

Abstract: Objective: We studied relationship between average amount of fish consumption and blood mercury level in pregnant women, in addition we would like to know the blood mercury level in pregnant women in Korea and we compared the initial blood mercury level in pregnant women and followed up how much blood mercury level decreased after counseling and prenatal education. Methods: Pregnant women who received prenatal care at the Yonsei medical center from March 2004 to September 2004, were targeted. They were divided into two groups. One was the study group who was educated to restrict the intake of fish, the other was the control group who was not given any prenatal education. We measured their blood mercury level and followed up until 2nd and 3rd trimester, to find out the differences between two groups. Results: Out of the 63 pregnant women who participated in our study, we followed up 11 pregnant women in the study group and 13 pregnant women of control group. The initial mean blood mercury level of both groups was 2.94 (0.14-10.75) . Blood mercury level in fish eating group of more than 4 times a month was higher than the others, which was statistically significant (p=0.02). Followed up blood mercury levels were increased in both groups, but there was not statistically significant between two groups. Conclusion: Pregnant women who consume a large amount of fish may have high blood mercury level. As fish intake seems to influence blood mercury level, to lower their blood mercury level, periconceptional education to decrease fish consumption might be necessary.

The prevalence of HBsAg positive parturients in Korea.

Abstract: Objective: To study prevalence rate of HBsAg positive parturient women in Korea and compare different rates according to the locations of delivery. Methods: Total 848 institutions which reported more than 100 deliveries during 2001, were included for this study. Designed questionnaire were used to study the numbers of HBsAg positive parturients and total deliveries. The survey was conducted by mail, telephone and visit. Total 279,734 deliveries (55.2% of estimated total deliveries) were obtained to complete the study. Results: Prevalence rates of HBsAg positive parturient women in Korea were 3.23% and 3.3% in 2001 and 2002 respectively. Cheju area showed highest prevalence rates. Women delivering in urban area showed higher prevlance rate than those in rural area. Conclusion: Prevalence rates of HBsAg positive parturient women were 3.3% in 2001-2002 and the rates sustained around 3.5% since 1992 in Korea.

A Clinical Study of Pregnancy and Delivery in The Early Thirties.

Abstract: Objective: To access the pregnancy and delivery in the early thirties. Methods: From January 1994 to December 2003, we statistically compared and investigated the 21,744 deliveries in Sung Ae Hospital, considering pregnant women aged 30-34 as study groups, and pregnant women aged 35 or older (elderly gravidas) as control groups. Results: The rate of Cesarean section, preterm delivery, gestational diabetes, pregnancy-induced hypertension, placenta previa, placenta abruptio, low birth weight was low statistically in the study groups. But, the percentage of the pregnant complication in the early thirties were increased than of in pregnant women younger than 30. Conclusion: Pregnant women in the early thirties were safer from the maternal complication, and neonatal complication than women aged 35 or older (elderly gravidas), but were exposed to these illnesses more than women aged younger than 30. Therefore, to improve the pregnant outcome of women in the early thirties, it is needed to concern their pregnancy and delivery and to take care of before and after childbirth thorougly.

Cytogenetic and clinical analysis of midtrimester amniocentesis.

Abstract: Objective: To analyze the clinical features and cytogenetic results of midtrimester amniocentesis. Methods: We reviewed retrospectively medical records of 1,622 women who received amniocentesis from 1998 to 2003. The maternal age and gestational age at amniocentesis, indications, cytogenetic results and complications of amniocentesis were analyzed. Results: A total of 1,653 cases of amniocentesis were performed in 1,590 singleton pregnancies and 32 twin pregnancies. The mean age at amniocentesis of singleton pregnancies was 33.5±4.3 years, and the most common age group was from 35 to 39 (38.6%) and those of twin pregnancies were 33.13.6 years and from 30 to 34 (50.0%), respectively. Majority of the cases (78.9%) were performed between 16th and 19th weeks of gestation. Advanced maternal age was the most common indication of amniocentesis (46.2%), followed by abnormal serum screening test (32.9%) and abnormal ultrasonographic findings (10.0%). Abnormal fetal karyotype results were identified in 34 cases (2.1%). 24 cases were numerical aberration and the other 10 cases were structural aberration. Trisomy 21 was the most common abnormal karyotype (23.5%). There was no abnormal karyotype results from 63 amniocentesis performed in twin pregnancies. Positive predictive value of abnormal ultrasonographic finding, advanced maternal age and abnormal serum screening test were 3.0%, 2.5%, 1.5% respectively. The procedure-related fetal death occurred in 7/1,353 (0.51%). Conclusion: Among the several indications of midtrimester amniocentesis, advanced maternal age was the most common indication, whereas abnormal ultrasonographic finding had the most powerful predictive value for abnormal fetal karyotype.

The guideline of management of sexual assault victim.

Abstract: Because violent injury have increased in recent years, the sexual assault, or rape, is a significant and serious crime in our society. It is important that the physician be knowledgeable about the management of sexual assault victims. The role of physician evaluating the sexual assault victims has both medical and legal. The goals of intervention of sexual assault include identification and treatment of injury and infection, pregnancy prevention, evidence collection, and psychological assessment. Care violently injured victims that follows these guidelines is likely to ease assess and manage the patients and to promote patient’s physical and psychological recovery.

Updated treatment of vaginitis

Abstract: Three common vaginal infections are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomonas vaginitis (TV). However their symptoms and signs are similar and atypical and other non-infectious vaginal inflammations will be the causes of id

Pathogenesis and Management Guideline of Dysmenorrhea

Abstract: Dysmenorrhea presents as painful periods that start two to three years after menarche. The pain usually begins when the bleeding starts and lasts for 32-48 hours. The cause of menstrual cramps and associated symptoms in primary dysmenorrhea is related to prostaglandin production. In secondary dysmenorrhea, there is documented pelvic pathology that causes the painful menstrual cramps, and treatment is cause related. Risk factors for dysmenorrhea include nulliparity, heavy menstrual flow, smoking, and depression. Empiric therapy can be initiated based on a typical history of painful menses and a negative physical examination Nonsteroidal anti-inflammatory drugs are the initial therapy of choice in patients with presumptive primary dysmenorrhea. Oral contraceptives also may be considered. If pain relief is insufficient, prolonged-cycle oral contraceptives or intravaginal use of oral contraceptive pills can be considered. If dysmenorrheal remains uncontrolled with any of these approaches, pelvic ultrasonography should be performed and referral for laparoscopy should be considered to rule out secondary causes of dysmenorrhea. the use of danazol or leuprolide may be considered and, rarely, hysterectomy. The effectiveness of surgical interruption of the pelvic nerve pathways has not been established.

Usefulness of preoperative CA 125 level in decision making of lymphadenectomy in endometrial cancer patients

Abstract: Objective: The purpose of this study was to evaluate whether the preoperative serum level of CA 125 in patients with endometrial cancer could provide an additional information on determining the extent of surgical staging and which cutoff value might be optimal in this respect. Methods: CA 125 levels were measured in 42 patients with endometrial carcinoma who underwent surgery at our institution between March 2000 and December 2004. Operative and postoperative pathologic findings were then correlated with preoperative CA 125 values. Statistical analysis was performed using Mann-Whitney U test, Kruskal-Wallis test, chi-square test and logistic regression model to evaluate the association of preoperative CA 125 levels with various factors. Receiver operating characteristic (ROC) curve was used to determine which cutoff value of the preoperative CA 125 was optimal. Results: Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, larger tumor size, increasing depth of the myometrial invasion, extrauterine disease, and lymph node metastasis (P30 U/mL whereas lymph node metastasis can be predicted at the CA 125 level of >50 U/mL.

The Effect of black cohosh with St. John's wort (Feramin-Q(R)) on climacteric symptoms: multicenter randomized double-blind placebo-controlled trial.

Abstract: Objective: Results of several recent randomized clinical trials and epidemiological studies casted many doubts about the validity and safety of conventional hormone therapy for postmenopausal women. More and more women want to try more natural and safe ways of treating their climacteric symptoms. Black cohosh combined with St. John’s wort may be effective in climacteric symptoms alternative to hormone therapy. This multicenter randomized double-blind placebo-controlled prospective clinical trial was carried out to evaluate the effect of the combined preparation of black cohosh and St. John’s wort, Feramin-Q, on the general climacteric symptoms, hot flushes and climacteric depression. Methods: Total of 80 postmenopausal women having moderate to severe degree of climacteric symptoms were randomly allocated to receive Feramin-Q (n=40) or placebo (n=40) daily for 12 weeks. Fifty eight subjects completed this clinical study. The primary endpoint, the relief of general climacteric symptom and hot flushes were evaluated by measuring Kupperman index and the secondary endpoint, the relief of climacteric depression by Beck Depression Inventory at 4 and 12 weeks of treatment. Results: After 4 and 12 weeks of treatment, Feramin-Q and placebo groups showed significant decline of Kupperman index and BDI scores compared with baseline scores, but Kupperman index and BDI scores between the groups were not significantly different at 12 weeks. The changes of BDI scores between the groups were different at borderline significant level (p=0.07). Hot flush scores of Feramin-Q groups were significantly decreased after 12 weeks of therapy, which showed significantly different at borderline level (p=0.07) from that of placebo. There was no statistical difference in change of hot flush scores from the baseline between the groups after 12 weeks. Among the 45 postmenopausal women with moderate to severe hot flush, Feramin-Q group showed significant decrease of hot flush scores, which was significantly different compared with placebo group at 12 weeks of therapy.

Efficacy of controlled ovarian hyperstimulation using GnRH antagonist in women with polycystic ovary syndrome undergoing IVF-ET.

Abstract: 목적: GnRH antagonist가 최근 개발되어 과배란유도에 있어 새로운 치료책으로 제시되고 있다. 그러나 다낭성 난소증후군 환자들과 같이 기본 혈중 황체호르몬 농도가 상승되어 있는 환자들에서 GnRH antagonist를 사용하는 것은 여러 문제점으로 인해 망설여져 왔다. 본 연구는 다낭성 난소증후군 환자들에서 체외수정시술을 위한 과배란유도 방법으로 GnRH antagonist 다회투여법의 두 가지 방법과 표준화된 GnRH agonist장기요법을 비교 분석함으로써 효용성을 평가하기 위함이다. 연구 방법: 체외수정시술을 시행하는 24-38세 사이의 다낭성 난소증후군으로 진단받은 65명의 환자를 대상으로 하였다. 무작위적인 방법으로 초기와 후기 난포기에 GnRH antagonist를 투여하는 다회투여법을 시행한 환자군 (GnRH-ant MDPEL, 1군)과 후기난포기에만 투여하는 다회투여법을 시행한 환자군 (GnRH-ant MDPL, 2군), 그리고 GnRH agonist 장기요법을 시행한 환자군 (GnRH-a luteal LP, 3군)으로 분류하였다. 모든 환자들은 단주기성의 경구용 피임제로 전처치를 시행하였다. 세 군간에 과배란유도에 대한 난소의 반응, 체외수정시술의 결과 그리고 임신율 등을 비교하였다. 결과: 각 군간에 환자의 나이, 체질량지수, 불임기간과 내분비적 호르몬 수치 및 당부하검사상 차이는 나타나지 않았다. hCG 투여일에 혈중 황체호르몬의 농도나 자궁내막두께는 세군간에 유의한 차이가 없었으나 혈중 estradiol 농도는 GnRH agonist를 사용한 3군에서 1, 2군에 비하여 유의하게 높았다 (P

A Study on Pregnancy and Social Welfare of Unmarried Mother.

Abstract: Objective: To find out general characteristics, common problems, outcomes of delivery of unmarried mothers and related social factors, and to provide basic information based on the results in order to change social systems and to have a correct understanding of unmarried mothers. Methods: We studied 196 unmarried mothers who delivered from Jan. 2003 to Aug. 2004. All data were collected by survey whose groups were divided into three by ages, and they were analyzed by Fisher’s exact test obstetrically and socially. It verified 95% significant level. Results: Cesarean section rate was 14.3% which is remarkably lower than married mothers. However, it is getting higher (p=0.003) as they are older, and the rate of group of 30s is similar to that of married mothers. Also, the average birth weight of unmarried mothers’ babies is 3,056 gm and it is similar to that of married mothers. They took prenatal care only 3.27 times and 22% of them did not commence it until the 3rd trimester. Fifty seven percent drank alcohols, 51% smoked, and 49% used drugs during pregnancy. Most unmarried mothers who took this survey had a lower level and economic status. After delivery, 16.3% of them raise their babies and 83.7% of them had their babies adopted through welfare facilities. Conclusion: We conclude that it is necessary to have a social system, welfare facilities, and financial supports that educate contraceptive measures to potential unmarried mothers, let them recognize their situations, and protect them.

The Effect of intraperitoneal instillation of Mistletoe extract during the diagnostic laparoscopy for pain of endometriosis.

Abstract: Objective: Immune alternation is related to the pathogenesis and progression of endometriosis. Helixor-A, mistletoe extract, has been known that it has immune modulation effect. Therefore the purpose of this study is to determine the effects of Helixor-A for pain of endometriosis by intraperitoneal instillation of mistletoe extract during the diagnostic laparoscopy. Methods: Among the paitients who visited to outpatient clinic due to chronic pelvic pain, 30 patients who had laparoscopically-confirmed endometriosis were included in this study. Helixor-A 5 mg was instilled into the posterior cul-de-sac during the diagnostic laparoscopy. Before diagnostic laparoscopy and one month after laparoscopy, the patients recorded pain scores. Results: In 11 of 30 patients (36.7%), pelvic pain of endometriosis improved after laparoscopy. In 2 of 30 patients, the side-effect of Helixor-A appeared and they were easily controlled by antihistamines. Conclusion: The instillation of Helixor-A during diagnostic laparoscopy, that is essential for confirmation of endometriosis, may be helpful as a supportive treatment for treatment of pelvic pain due to endometriosis with classical treatment such as GnRH agonist therapy.

Evaluation of prevention program for neonatal vertical transmission from HBsAg positive mother in Korea.

Abstract: Objective: For evaluation of prevention program for neonatal vertical transmission from HBsAg positive mother in Korea Methods: From January 15th to February 15th 2003, the status of neonatal vaccination, immunoglobuline injection and breast feeding of HBsAg positive mother was evaluated by using mailed questionnaire in 848 hostpitals with more than 100 deliveries in the year of 2001. 341 out of 848 (40.2%) hospitals returned questionnaires. Results: 91.9% of total hospital reported that the vaccination of hepatitis B and immunoglobulin injection was done within 12 hours after birth in more than 90% of neonate. The most commonly used vaccine type was 0-1-6 method. In case of unknown result of HBsAg/HBsAb in mother, 84.4% of hospitals delayed immunoglobulin injection until complete report, however 63% of hospitals gave hepatitis vaccine without delay before complete result. The breast feeding of HBsAg positive mother was recommended according to the result of HBeAg in 66.3% of hospitals while 24.9% of hospitals recommend breast feeding. Conclusion: Most hospitals in Korea reported that vaccination of Hepatitis B and immunoglobulin injection was done within 12 hours after in over 90% of neonate whose mother was HBsAg Positive. But continuous education and careful monitoring are required for injection method and vaccination policy in neonates of mothers with unknown result of HBsAg/HBsAb of mother.

Performance of Risk Indices for Prediction of Osteoporosis in Post- and Perimenopausal women

Abstract: Objective: To examine the ability of published osteoporosis risk indices for prediction of osteoporosis in post- and perimenopausal women. Methods: Subjects included 1559 of post- and perimenopausal women, 45 year old and older, recruited from Menopause Clinic from January 2002 to June 2004. Their bone mineral density (BMD) of femur neck was determined by dual energy x-ray absorptiometry (DXA), and their historical and clinical risk factors were assessed. We employed the World Health Organization (WHO) diagnostic criteria of osteoporosis for calculating the T scores, using race/ethnic and gender-specific young adult mean values. We applied 6 published osteoporosis risk indices (OSTA, ORAI, SCORE, SOFSURF, ABONE, NOF practice guideline) to each subject. Also, the predictive abilities of risk indices were assessed using the area under receiver operating characteristic (ROC) curve. Results: The prevalence of osteoporosis and osteopenia was 8.7% and 32.6% for femur neck, 16.0% and 30.1% for lumbar spine, respectively. The prevalence of osteoporosis for femur neck was increased dramatically in the coming decades (1.6% for fifties, 8.7% for sixties, 43.0% for seventies, 64.1% for over eighties). ROC curve for predicting osteoporosis according to femur neck by OSTA showed the area under the curve (AUC) of 0.920. Sensitivity, specificity, and positive predictive value (PPV) were 93.4%, 75.4%, 26.6%, respectively. AUC for ORAI, SCORE, SOFSURF, ABONE, and NOF practice guideline was 0.896, 0.916, 0.871, 0.846, and 0.856, respectively. Conclusion: Validated risk indices have varying complexity, but similar sensitivity, specificity, and PPV for identifying individuals who are likely to have osteoporosis. However, OSTA is the most excellent risk index and simple tool.

Abdominal Wall Endometriosis after Cesarean Section: A Report of Two Cases

Abstract: Extrapelvic endometriosis remains quite rare phenomenon. The majority of extrapelvic endometriosis involve scar tissue following obstetric/gynecologic procedures. Endometriosis involving a cesarean section scar may be more common than previously recongnized. The classic symptom is a painful scar that became swollen and more tender during menstruation. The cause of surgical scar endometriosis is believed to be iatrogenic transplantation of endometrial tissue to the surgical wound. The surgical excision remains the treatment of choice for expected cures and presents the most appropriate diagnostic and therapeutic intervention. We present two cases of endometriosis appearing on the abdominal wall scar of cesarean section with a brief review of the concerned literatures.

Current Treatment of Postmenopausal Osteoporosis

Abstract: Osteoporosis is a silent disease which causes a serious morbidity such as fracture. Once osteoporosis risk has been established in postmenopausal women, dietary and lifestyle changes, such as exercise, discontinuing tobacco and alcohol use, are helpful in the prevention of osteoporosis. Fall prevention, calcium and vitamin D supplementation remain the foundation. When pharmacologic intervention is warranted, bisphosphonates and selective estrogen receptor modulator have shown the benefit in preventing bone loss and lowering fracture rates. Short term use of estrogen can be considered for the prevention and treatment of osteoporosis in the postmenopausal women with vasomotor symptoms. Calcitonin and parathyroid hormone are also options for the treatment of osteoporosis. Several new agents are in late-stage development and may offer another treatment alternatives.

A Case of Vaginal Angiomyofibroblastoma

Abstract: Angiomyofibroblastoma is an uncommon mesenchymal tumor and was first described by Fletcher as a well-circumscribed, benign subcutaneous vulvovaginal tumor. The tumor occurs mainly, but not exclusively, in the vulva of premenopausal women. It can also arise in other sites such as perineum, inguinal area, fallopian tube, vaginal portion of cervix and vagina in females and scrotum in males. The importance of this entity is related to its potential mimicry of a more infiltrative and prognostically less favorable lesion found in the same anatomic area, namely aggressive angiomyxoma. The occurrence of angiomyofibroblastoma is uncommon and its vaginal presentation is exceedingly rare. We experienced a case of vaginal angiomyofibroblastoma in a 50-year-old female and present it with a review of literatures.

A case of pelvic splenosis after splenectomy:A cause of pelvic pain

Abstract: Splenosis represents the autotransplantation of splenic tissue, after splenic trauma or surgery. These splenic implants may be located anywhere in the abdominal cavity. These implants may misinterpreted as endometriosis or malignancy. We present a case of multiple pelvic splenic implants after a splenectomy.

임상연구 : 제왕절개분만의 빈도와 적응증의 변화양상 -1980-2003년의 24년간 부산백병원에서 시행한 총 6,051 제왕절개분만 예의 분석-

Abstract: Objective: To evaluate chronological pattern of the frequencies and indications for cesarean section performed at one university hospital for 24 years. Methods: This study was carried out retrospectively based on the clinical records of 6,051 patients who had cesarean sections among total 28,836 delivery cases at our hospital from January, 1980 to December, 2003 to show the frequencies and indications for cesarean section. Results: The relative frequencies of cesarean section among total delivery cases for 24 years was 21.0%. The frequencies was 16.6% in the 1980s, 21.9% in the 1990s and 34.3% in the 2000s, which shows a tendency to marked increment. The common indications of cesarean section for 24 years was previous cesarean section (40.9%) followed by abnormal presentation (16.3%), dystocia (12.2%), fetal distress (7.9%), placenta previa (6.8%). Repeat cesarean section showed increasing frequencies from 1980 to 1992 and dropped again from 2002. Dystocia and abnormal presentation showed decreasing frequencies, but multiple pregnancy, placenta previa and other indications showed increasing frequencies, especially in late 1990s and 2000s. Conclusion: The frequencies for cesarean section was increasing, especially from 1990s. There are many changes in indications for cesarean section. Recent changes was decreasing frequencies for repeat cesarean section, increasing for multiple pregnancy, placenta previa and other indications. This might be related to low birth rate and high elderly mother’s proportion.

A Case of Acute Pancreatitis of the Pregnancy

Abstract: Acute pancreatitis is a rarely occurred during pregnancy, with few reports in the literature addressing the problem. Pregnancy complicated by pancreatitis may lead to significant fetal and maternal morbidity and mortality. The disease occurs predominantly in later pregnancy, and rarely during the postpartum period. We report a case of acute alcoholic pancreatitis during pregnancy with a brief review of literature.

A Case of Pseudo-Meigs' Syndrome

Abstract: Pseudo-Meigs’ syndrome is a rare syndrome associated with struma ovarii, yolk sac tumor, ovarian carcinoma, leiomyoma and tuberculosis, which is combined with ascites and pleural effusion. The cause and pathophysiology of Pseudo-Meigs’ syndrome are uncertain. The diagnosis is done by characteristic clinical finding. We have experienced a case of Pseudo-Meigs’ syndrome associated with uterine smooth muscle tumor of uncertain malignant potential and elevated CA-125, so report this case.

A Case of Prenatally Diagnosed Jacobsen syndrome.

Abstract: Jacobsen syndrome is a rare condition associated with the deletion of the long arm of chromosome 11. Though several authors reported prenatal sonographic findings of the Jacobsen syndrome, there are no common disease-specific features. The majority of affected cases were identified postnatally by chromosomal analysis of the dysmorphic or mentally retarded patients. We present a prenatal case of Jacobsen syndrome with a brief review of literature. A routine scanning in a 32-year-old primigravida at 17.3 weeks’ gestation showed abnormal ultrasonographic findings consistent with increased nuchal thickening and subtle cardiac abnormalities (levorotated heart axis of greater than 60 degrees and thickened ventricular wall). The patient underwent amniocentesis, and the karyotype showed deletion of the long arm of chromosome 11, 46,XX, del (11) (q23.1q24). The fetal autopsy performed following medical termination confirmed the prenatal findings. The present case represents that the prenatal sonographic detection of the nuchal thickening and subtle cardiac abnormality should warrant a careful assessment of fetal anatomy and prompt cytogenetic analysis looking for chromosomal aberrations.

A Case of Placenta Increta Presenting as Delayed Postabortal Hemorrhage.

Abstract: Placenta increta is a life-threatening complication of pregnancy characterized by invasion of placenta villi into the underlying myometrium. Usually, presentation is in the early postpartum period with hemorrhage during difficult placental removal. Although placenta increta may complicate first and early second-trimester pregnancy loss, this lesion is rarely found, whose diagnosis can be very difficult during these trimester. We had experienced a case of placenta increta which was found about 14 days after dilatation and curettage (D&C) due to missed abortion at private obstetrics’ clinic and report this with brief reviewed the literatures.