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To evaluate the surgical effects of robotic paravaginal repair and sacrocolpopexy in patients diagnosed with lateral cystocele due to paravaginal defect.Robotic paravaginal repair and sacrocolpopexy were performed contemporaneously in 43 patients with high-grade pelvic organ prolapse combined with a lateral or mixed cystocele. To objectively evaluate prolapse correction, the Pelvic Organ Prolapse Quantification (POP-Q) test was performed at the 12-month visit and the results compared to those of the preoperative period. Subjective satisfaction was scored using the Patient Global Impression of Improvement (PGI-I) questionnaire.POP-Q measurement results before and after surgery, an objective indicator of surgery, the Ba and C scores improved significantly from 2.1 ± 1.2 preoperatively to -2.0 ± 1.1 postoperatively (P.01), and from 0.3 ± 1.3 preoperatively to -4.3 ± 1.1 postoperatively (P.01), respectively. In PGI-I questionnaire, the numbers of patients who awarded scores of 1 and 2 (evidencing high-level symptom improvement) were 33 at 1 month (76.7%), 30 at 3 months (69.8%), and 28 (65.1%) at 12 months. When respondents awarding 3 points (a little improvement) were included, the numbers rose to 38 (88.4%) at 1 and 3 months and 35 (81.4%) at 12 months, indicating satisfaction with symptom improvement. There were no critical complications during and after surgery, but complications such as de novo stress urinary incontinence that lower patient satisfaction occurred in some cases.Robot-assisted paravaginal repair and sacrocolpopexy can be safely performed in patients with cystocele-predominant pelvic organ prolapse and good surgical results can be expected with excellent effects.

IntroductionDocosahexaenoic acid (DHA) supplementation has been reported to negatively correlate with cancer cell proliferation and tumour development in many cancer types. Although cumulative evidence has demonstrated the apoptotic effect and cytotoxicity of DHA against tumour development in many cell types, the precise cellular and biochemical mechanisms of DHA-induced apoptosis in human endometrial cancer cells have not been investigated.Material and methodsMTT assay was performed to confirm the degree of apoptosis by combining treatment with DHA and triacsin C in endometrial cancer cell line. The synergistic effects of triacsin C and DHA were identified by performing flowcytometry and immunoblotting analysis.ResultsCombined treatment with DHA and triacsin C significantly induced apoptosis in RL95-2 endometrial carcinoma cells. Combined treatment with 125 µM DHA and 5 µM triacsin C significantly increased the sub-G1 population and apoptotic fragments in endometrial carcinoma cells. It was also demonstrated that DHA and triacsin C induced apoptosis through mitochondrial pathways via caspases-9, -3, and -7 as well as through the extrinsic pathway by activation of caspase-8/BID.ConclusionsFurther elucidation of the apoptotic mechanisms involving DHA treatment with ACS ablation could shed light on possible new treatment strategies for endometrial cancer. In addition, further research into the mechanisms of DHA and triacsin C-induced apoptotic mechanisms may lead to the development of therapeutic strategies for endometrial cancer.

Introduction: Vaginal pessaries are commonly used to manage pelvic organ prolapse. Pessaries are usually tolerated although some severe complications can occur in cases of negligence, including vesicovaginal and rectovaginal fistulas. Case Presentation: This is a report of two cases of a neglected vaginal pessary and migration into the rectovaginal space to form a vaginal orifice. Based on examinations, no vaginal pessaries in both cases migrated into the rectum. These pessaries were removed by cutting and rotating movements. Finally, the two patients were discharged after surgery without any complications. Conclusions: Neglected pessaries can lead to serious complications. Thus, patient education, local estrogen treatment, and careful follow-ups are important to prevent such complications.

Endometriosis is a benign gynecologic disease that highly influences women of childbearing age. It is characterized by ectopic endometrial tissue. Primary umbilical endometriosis is a rare condition. It is a benign disease with endometrial tissue in an abnormal site in the navel. It may be accompanied with pain in the navel and a discolored bump. Among all locations with the potential for endometriosis, the navel has less than 1% incidence of primary umbilical endometriosis. In the present study, we reported a rare case of umbilical endometriosis revealed via a biopsy performed for a 49-year-old menopausal woman with the complaint of pain in the navel who underwent surgical excision and a biopsy after a scan.

Fifty-pair Bi2Te3-based thermoelectric (TE) modules were produced by spreading Sn alloy solder on Cu electrodes before heating at 270℃ for 10 min to connect Bi2Te3-based legs with Cu electrodes. To suppress unexpected reactions between solder and TE materials, a conventional electroless nickel (EN) layer and a novel coating encompassing EN, electroless palladium, and immersion gold (ENEPIG) layers were adopted for Bi2Te3 materials as diffusion barriers. Influence of variant diffusion barriers, namely, EN and ENEPIG, on TE performance of module was ascertained. Interfacial structure at Bi2Te3/solder/Cu electrode interface revealed that intermetallic compounds were generated owing to interdiffusion among Cu, Sn, and coating elements, and they mostly concentrated at Bi2Te3/solder and solder/Cu electrode interfaces. Additionally, ENEPIG coating exhibited much better wettability with solder than the EN coating, resulting in fewer defect sites at Bi2Te3/solder interface. When current flowed through TE modules, the ENEPIG-coated module yielded lower temperatures on both hot and cold sides than the EN-coated module. While the modules had temperature differences between two substrates, output power generated by the ENEPIG-coated module was higher than that of the EN-coated module. In addition, the ENEPIG-coated module showed a smaller internal resistance than the EN-coated module. After heating at 200℃ for 200 h, both modules presented markedly reduced output power, whereas internal resistance was escalated.

A 21-year-old unmarried woman was admitted to our neurology department because of severe headache that lasted for the past 10 days and persistent incoherent speech, repeated seizures lasting for a ...

Uterine leiomyomas are the most common benign uterine neoplasms. Undegenerated uterine leiomyomas are easily recognizable by the typical imaging findings on radiologic studies. However, degenerated fibroids can have unusual and variable appearances. The atypical appearances due to degenerative changes may cause confusion in diagnosis of leiomyomas. In this article, we report a case of a patient with extensive cystic and myxoid degeneration of uterine leiomyoma, mimicking malignant bilateral ovarian surface epithelial tumors.

Pelvic organ prolapse (POP) is bulging of one or more of the pelvic organs into the vagina and triggered by multiple causes. It is a very common disorder, especially among older women. POP is characterized by protrusion of the presentation part visible by the naked eye, and problems with urination or bowel movements. POP can be diagnosed based on the onset of symptoms and a pelvic exam, and management options include medical and surgical treatment. Although medical treatment cannot correct the abnormal herniation of the pelvic structures, this can help alleviate symptoms. One of the disadvantages of surgical interventions is recurrence, and advances in surgical techniques have decreased recurrence rates of POP. Therefore, author will explain the gynecology and urology approach and treatment.

The goal of this study was to investigate differential expression of the cell cycle signaling proteins p27 and Jun activation domain-binding protein 1 (Jab1) in benign ovarian cysts of patients with endometriosis compared to controls.Ovarian tissues of 26 endometriosis and 28 non-endometriosis patients were used to evaluate expression of p27 and Jab1 by immunohistochemistry.There are no differences in clinical characteristics between the endometriosis and non-endometriosis group. In the endometriosis group, CD10, Jab1 and p27 were positive in 50, 48.3 and 57.7 % of cases, respectively, compared to 14.3, 17.9 and 50 %, respectively, in the non-endometriosis group. Jab1 and p27 were positive in 69.2 and 84.6 %, respectively, of the definite endometriosis cases.These results demonstrate that Jab1 expression was increased in endometriosis, while p27 expression was similar in the endometriosis and non-endometriosis groups.

Objective: The purpose of this study was to evaluate the efficacy, safety, and benefits of hysteroscopic surgery in the treatment of dysfunctional uterine bleeding (DUB) or intrauterine lesions causing uterine bleeding. Methods: This study prospectively enrolled 100 patients who underwent operative hysteroscopy in tertiary referral university center because of uterine bleeding due to endometrial polyps or uterine submucosal leiomyomas diagnosed by transvaginal ultrasonogram. Indications for the operative hysteroscopies included abnormal uterine bleeding (AUB), ultrasound findings indicative of intrauterine lesions, and DUB. After operative hysteroscopic management, we inserted anti-adhesive solution, sodium hyaluronate and carboxymethyl cellulose into the uterine cavity. Results: Operative hysteroscopy was a successful procedure in 100 of 100 cases (100%) but it needed to be repeated in three cases with large uterine submucosal leiomyoma and after two endometrial polypectomy. Mean duration of the procedure was 23.2 minutes (range 5 - 67) and postoperative hospital stay was 7 hours (range 3 - 48). Most common indication was DUB (39%), submucosal leiomyoma was 21%, and endometrial polyp was 17%. There were five cases with postoperative uterine bleeding and none with fluid overload syndrome. During postoperative follow-up (3 - 28 months) the majority of patients (90/100, 90%) were free of symptoms. Conclusion: Hysteroscopic procedure is an effective and safe method for the management of benign intracavitary pathology or the treatment of dysfunctional uterine bleeding. Although sodium hyaluronate and carboxymethyl cellulose seems to be effective in the prevention of adhesion in uterine cavity, further study will be needed to prove the effectiveness of anti-adhesive solution.

Basal cell carcinoma (BCC) of the perineal or genital regions is uncommon, accounting for 2–3% of all vulval cancers (Breen et al. 1975). Reports on perineal BCC are available, but to the best of o...

Endometriosis is an inflammatory disease. The etiology of endometriosis is exactly unknown. A 42-year-old virgin experienced a sudden increase in pain that began one day prior to examination. She had been suffering from dysmenorrhea and menorrhagia. The patient had abdominal guarding with severe rebound tenderness. On computed tomography, both ovaries were normal, and sigmoid colon was seen in the peripheral portion of the pelvic hematoma. Pathologic findings revealed endometriosis in the colonic serosa cyst. Our data provide a new diagnostic key for hemoperitoneum caused by endometriosis in the colonic serosa. Key words: Hemoperitoneum, endometriosis, colon.

A 23-year-old primigravid woman at 14 1/7 weeks of gestation arrived at the emergency department with abdominal pain. Two months earlier, she began having intermittent pain and constipation. She had performed an enema three times and had received intermittent medicated laxatives for 2 months from local clinics. The patient reported having had severe constipation for 7 days 1 year perviously. Her past medical, surgical and family histories were negative. On physical examination, she was 155 cm tall and weighed 38 kg. She had diffuse abdominal tenderness without rebound tenderness. Her bowel sounds were normal. She displayed intermittent colicky pain, which subsided only with opioid treatment. She was treated with stool softeners and laxatives. One day after admission, the patient’s hemoglobin was 9.7 g/dL, hematocrit was 27.1%, and white blood cell count was 9,840/microliter. We prescribed rehydration, electrolyte control, and analgesics for intermittent severe pain. Three days after admission, she developed night fevers (maximum temperature 38°C) and sweating. Considering our differential diagnosis, which included infection and connective tissue disorder, we ordered various other laboratory studies including erythrocyte sedimentation rate; urine culture; hepatitis A, B, and C evaluation; antinuclear antibody testing; and rheumatic factor; all were within normal limits. The C-reactive protein level was elevated to 3.40 mg/dL. We began cefotetan intravenously 4 days after admission; the physician recommended she receive nothing by mouth. Six days after admission, a magnetic resonance imaging scan revealed marked dilatation (6-cm diameter) of the transverse and descending colon (Fig. 1). Seven days after admission, glutamyl oxaloacetic transaminase and glutamyl pyruvic transaminase levels increased to 102 and 134, respectively. Eight days after admission, the C-reactive protein level increased to 11.73 mg/dL, and upper endoscopy revealed gastritis. Colonoscopy revealed multiple colon ulcers, colonic atony, and colonic inertia (Fig. 2). The physician and patient agreed to radiologic studies to evaluate possible colon perforation. An X-ray computed tomography scan revealed a sigmoid colon collapse with fecal content; the transverse colon was 10 cm in diameter, and the colon was dilatated from the cecum to the transverse colon (Fig. 3). No perforation was seen. Ogilvie syndrome (acute colonic pseudo-obstruction) then was suspected. Nine days after admission, we performed a diatrizoate meglumine and diatrizoate sodium (Gastrografin) enema. Rectal and nasogastric tubes were placed for decompression, and erythromycin, piperacillin, and tazobactam were given intravenously. (We did not prescribe neostigmine because it is contraindicated in a setting of gastrointestinal ulcers.) The From the Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea.

To evaluate the usefulness of additional random biopsies in the diagnosis of cervical intraepithelial neoplasia grade 2 (CIN 2) or worse (CIN 2+) after colposcopy-directed biopsy.A retrospective chart review was performed in 107 women with satisfactory colposcopy results after colposcopy-directed biopsy with random biopsy for abnormal cervical cytological evaluation at Soonchunhyang University Hospital between April 2008 and November 2009. Random biopsies were performed at the cervical squamocolumnar junction in lesion-free quadrants of the cervix. Loop electrosurgical excision procedure conizations were performed in 59 women. Age, referral cytology, lesion size, human papilloma virus (HPV) viral load, and HPV type were analyzed as possible indicators of lesion severity detected using random biopsy.The mean age was 39.3 years (range = 21-72 y), and 96 (89.7%) women were premenopausal. Sixty-three women had CIN 2+; of those, 8 (12.7%) were diagnosed using random biopsies: 6 had high-grade squamous intraepithelial lesions; 1 had low-grade squamous intraepithelial lesions; and 1 had atypical squamous cells of undetermined significance. Lesions diagnosed as CIN 2+ using random biopsies were significantly correlated with high-grade cytology (p.001) and lesion size (p.001) but not age (cutoff = 40 years), HPV viral load (cutoff = 300 relative light units; Hybrid Capture 2), or HPV genotype. Of 59 patients who underwent loop electrosurgical excision procedure conization, the disease severity of 9 (15.3%) cases was upgraded 1 or more grades, compared with the punch biopsy results.The detection of CIN 2+, particularly high-grade cytological abnormalities and large lesion size, can be increased by additional random biopsies after satisfactory colposcopy. Loop electrosurgical excision procedure conization can detect lesions not detected by punch biopsy.

Cervical cancer is the third most prevalent cancer in women around the world. Recently in Korea, the incidence of cervical cancer has decreased, but in all stages of cervical intraepithelial neoplasia (CIN), CIN has shown a 91% increase from 1999 to 2008. Persistent human papillomavirus (HPV) infection has been found to be the main cause of cervical cancer. HPV types 16 and 18 have been found in 70% of cervical cancer patients around the world. Cervical cancer screening such as cytology has limitations in terms of sensitivity and specificity. A discussion about the need for the HPV test is becoming active in order to compensate for the limitation of cytology. After the role of HPV in cervical cancer was identified, the importance of HPV detection test as a screening was emphasized. Several tests have been developed and each test has its own advantages and disadvantages, and new test method to overcome the disadvantages is still being developed. Today's guidelines and tests are those you would choose from among the large number of cervical cancer screening guidelines and tests, based on the consideration that the selected guidelines and the test are effective.

Lack of adequate sleep has become increasingly common in our 24/7 modern society. Reduced sleep has significant health consequences including metabolic and cardiovascular disorders, and mental problems including depression. In addition, although the increase in life expectancy has provided a dream of longevity to humans, the occurrence of osteoporosis is a big obstacle to this dream for both male and female. It is known that insomnia and bone health problems, which are very critical conditions in human life, interestingly, share a lot of pathogenesis in recent decades. Nevertheless, due to another side effects of the synthetic drugs being taken for the treatment of insomnia and osteoporosis, patients have substantial anxiety for the safety of drugs with therapeutic expectation. This review examines the pathogenesis shared by sleep and osteoporosis together and herbal medicine, which has recently been shown to be safe and efficacious in the treatment of both diseases other than synthetic drugs. We suggestions for how to treat osteoporosis. These efforts will be the first step toward enabling patients to have comfortable and safe prescriptions through a wide selection of therapeutic agents in the future.

Operating room fires occur very rarely. Nevertheless, a disaster can complicate almost any kind of surgery. The majority of operating room fires result from the use of alcohol- based surgical preparation solutions, electro-surgical equipment, or flammable drapes in an oxygen-rich environment. We report a patient with an ovarian cyst and uterine myomas who suffered a flame burn while undergoing gynecological surgery.

We read with interest the article on the safe removal of an intrauterine device (IUD) that had perforated the rectum when a rectal approach was used [1]. In contrast, our case of perforation caused by an IUD had serious results. We report the laparoscopic findings and history of our patient to increase awareness of the potential adverse outcomes of IUDmigration. A 53-year-old postmenopausal womanwas transferred from a local clinic with hematochezia 1 month in duration. She had no history of previous surgery or medication for hypertension or hypothyroidism. An IUD had been inserted 5 years earlier. The ultrasonographic findings revealed an atrophic uterus lacking the IUD. Colonoscopic findings revealed a bleeding focus with erythematous mucosa and hemorrhagic spots 20 cm from the anus. Computed tomography (CT) scans showed that the IUDhadmigrated to the neighboring rectosigmoid junction, and the laparoscopic findings revealed severe bowel adhesion to the left cornual side of uterus (Fig. 1). We performed a laparoscopic colectomy 10.5 cm in length and 6.5 cm in diameter. The pathological findings revealed perforation with peritonitis and foreign-body reactions; see note in colectomy site and reactive hyperplasia of the lymph node. The IUD was

Fetal thrombotic vasculopathy, a rare condition, is defined as thrombosis in the fetal circulation of placenta causing fibrotic villi and its detection before delivery is difficult. Thrombosis in fetal placenta involves various problems such as uteroplacental insufficiency, central nervous system injury and even perinatal death. Here, we report a case of fetal arterial thrombosis predisposed to neonatal neurologic impairment. This case emphasizes an importance of placental biopsy, especially when the neonate seems to have problems. We recommend that pathological examination of placenta be performed not only when abnormal gross findings of placenta, but also when fetal abnormalities are observed.

h Abstract: A retrospective case series of 14 patients were diagnosed with pyometra for 10 years at our hospital. We reported iatrogenic causes, such as radiofrequency or uterine artery embolization, and other pyometra causes in our hospital to provide guidance for diagnosis by a gynecologist. h

Endometrial cancer is the most common gynecologic malignancy in developed countries. Clear cell carcinoma typically occurs in the ovaries, and very rarely occurs in the endometrium; it accounts for less than 3% of all endometrial cancers. It is presumed that clear cell carcinomas are of Müllerian duct origin, and an association with exposure to diethylstilbestrol (DES) or other nonsteroidal follicle stimulating hormones has been described. We report a case of a postmenopausal woman who presented with vaginal bleeding without a specific medical history. Under the impression of an endometrial mass, we performed a laparoscopic operation. Pathologic results showed clear cell carcinoma of the endometrium. Depth of invasion was 0.2 cm out of a 0.5 cm total thickness, and the rectal shelf mass was clear cell carcinoma. We report the case with a brief review of the relevant literature.

Uterine serous adenocarcinoma (USC) is rare and invasive cancer. This cancer is more often reported in the ovary, the fallopian tube, and the endometrium than uterine cervix. No matter where the tumor is located, the tumor exhibits similar histological characteristics. So when uterine cancer is proven to be serous adenocarcinoma, it is necessary to see if the tumor originated from ovary or endometrium and invaded the cervix. We report a case of a 73-year-old postmenopausal woman with USC arising near the internal os of endocervical canal, clinically misdiagnosed as uterine cervix cancer.

Uterine cervix tuberculosis (TB) is very rare, and accounts for 0.1–0.65% of TB, with atypical symptoms. The symptoms of cervix TB are diverse, and include amenorrhea, menstrual irregularities, infertility, vaginal discharge, and uterine bleeding [1]. We found uterine cervix tuberculosis (TB) by Gupta very interesting [2]. Our postmenopausal case and Gupta’s case about 20-year-old lady gave the educational guideline to diagnosis of uterine TB in endemic TB area. A 53-year-old multiparous postmenopausal woman presented with vaginal discharge refractory to antibiotics from 3 months at local clinic. She had been performed a laparoscopic tubal sterilization. Her husband had died of pulmonary emphysema 20 years earlier. She had no sexual partner after her husband’s death. Her son-in-law had developed pulmonary TB 10 years earlier. In the past 3 months, she had lost 4 kg of body weight while on a diet of kohlrabi and brown rice. She was worked up for the microbiologic culture, including Chlamydia trachomatis, Neisseria gonorrhea, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Trichomonas vaginalis, Gardnerella vaginalis, Candida albicans, and herpes simplex virus 1 and 2. All the ten results were negative. We performed human papilloma virus (HPV) genotyping of cervix. It was positive for HPV type 16. A liquid-based Pap test showed reactive cellular changes with inflammatory findings. Pelvic examination revealed multiple red round ulcerations (Fig. 1). A colposcopy-guided cervix biopsy revealed ulcerated fragments of markedly inflamed granulation tissue and granuloma of the cervix with severe chronic active inflammation (Fig. 2). A nested PCR and serological test for M. tuberculosis were positive. The chest X-ray, gynecologic ultrasonography and X-ray computed tomography (CT) of pelvic cavity showed no abnormalities. Thus, we were able to confirm as primary cervix TB. She responded to antitubercular treatment (Fig. 3).

In gynecology, endosalpingiosis is a benign condition in which the fallopian tube-like epithelium is found outside the fallopian tube. The thirty-four point five percent of endosalpingiosis cases have concurrent endometriosis and 40% of the endosalpingiosis group are in postmenopausal states. In contrast with endometriosis, there are no significant links between infertility, chronic pelvic pain and endosalpingiosis. The symptoms of endosalpingiosis are not yet settled. Endosalpingiosis is almost always an incidental finding; it is commonly found through microscopic examinations, and is then confirmed by pathologists for excision and biopsy. Therefore, the clinical differential diagnosis of an intramural mass is more important for clinicians when discussing further surgery with the patients. We report case of woman who has endosalpingiosis and is presented with vaginal bleeding. We first suspect the disease during physical examination. Under the impression of pelvic mass, laboratory tests and radiological images of contrast enhanced chest computer tomography are taken. Images show multisepted cystic masses in left adnexa. To rule out the pelvic mass, we executed exploratory laparotomy. Pathologic results show endosalpingiosis near the ovary section. But the endosalpingiosis, is not generally considered a pathology, and thus, no treatment is necessary.

Objectives To evaluate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) of perimenopausal women at a university hospital along with their menstrual characters. Methods A questionnaire survey regarding premenstrual symptoms was carried out in 100 perimenopausal women (43 to 53, years). The pattern of menstruation and, the intensity of dysmenorrhea were assessed; and further, the symptoms were classified according to their number, intensity, and persistence. The PMS criteria of American College of Obstetrics and Gynecology (ACOG) and PMDD criteria by American Psychiatric Association (APA) were evaluated. Results The approximate prevalence of PMS criteria was 95% and that of PMDD criteria was 23%. The most dominant symptoms were 'breast tenderness', 'abdominal bloating', 'and headache'. PMDD was significantly associated with the severity of dysmenorrhea (P = 0.020). There was no significant relation with age, height, weight, body mass index and the cycle of menstruation. Conclusion Most women experience PMS and PMDD, which and have a significant impact on the activity of perimenopause women. However in most women that do not know well about PMS and PMDD. We should educate and inform women of PMS and PMDD, thus helping them increase their quality of life.