Hye-Ji Jeon

A case of vaginal delivery in β-thalassemia minor pregnant woman

The thalassemias are a group of autosomal recessive genetic disorders of hemoglobin synthesis. The thalassemias are classifi ed into two main varieties, αand β-, depending on which of the adult globin chain is produced in reduced amounts. The β-thalassemia is the homozygous and heterozygous state, and common in the Mediterranean region. Homozygous β-thalassemia is usually associated with severe anemia. β-Thalassemia minor, the heterozygous state, is characterized by hypochromia, microcytosis and an elevated of HgA2. No treatment is required for thalassemia minor, but it is important to exclude iron defi ciency anemia and postpartum genetic counseling. Recently, β-thalassemia minor keeps rising steadily in Korea due to the increase in international marriges. Recently we have experienced a vaginal delivery in a β-thalassemia minor Vietnam woman associated with mild anemia. We describe this case with a brief review of the literature.

Women with Endometriosis, Especially Those Who Conceived with Assisted Reproductive Technology, Have Increased Risk of Placenta Previa: Meta-analyses

Background Many women with endometriosis have become pregnant through assisted reproductive technology (ART), and have often experienced placenta previa (PP) during pregnancy. The objective of this study was to assess the association between women with endometriosis, especially those who conceived with ART, and the risk of PP. Methods Two reviewers independently determined studies that were considered suitable for meta-analyses published in various medicine-related databases from March 1, 2004 through July 31, 2017 without language restrictions. Eight studies met the inclusion criteria, with a combined sample size of 21,930 women. Of these 21,930 pregnancies, 6,256 had endometriosis (endometriosis) and 15,674 had no endometriosis. Four of these studies included 8,161 women who conceived with ART, 1,640 of whom had endometriosis (endometriosis + ART), and 6,521 of whom did not have endometriosis. Meta-analyses were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies. Results These meta-analyses showed women with endometriosis (endometriosis) have an increased risk of PP (OR, 4.038; 95% CI, 2.291–7.116; P = 0.000). These results showed women who conceived with ART (endometriosis + ART), have a substantially increased risk of PP (OR, 5.543; 95% CI, 1.659–18.523; P = 0.005). Conclusion These meta-analyses demonstrate women with endometriosis have an increased risk of PP.

Ovarian torsion of mixed epithelial tumor misdiagnosed as a malignancy in postmenopausal woman: A case report

Rationale: Adnexal torsion is 1 of the most common emergency gynecological disease. It is more often diagnosed in reproductive age, but rarely in postmenopausal women. The clinical symptoms of adnexal torsion are nonspecific in postmenopausal women. Epithelial ovarian tumors are common in adults, and the risk of malignancy increases with age, especially after menopause. So, it is difficult to diagnose adnexal torsion precisely compared with reproductive women, and most cases of adnexal torsion with postmenopausal women are diagnosed as a malignancy preoperatively. We report a case of ovarian torsion with mixed epithelial tumor misdiagnosed as a malignancy in postmenopausal woman. Patient concerns: A 65-year-old woman presented lower left abdominal pain, and there was slight abdominal distension, but no tenderness or rebound tenderness on abdominal palpation. Diagnoses: Radiologic assessments showed a huge multiseptated cystic mass with solid portion in the left ovary, and malignancy was suspected. The test for serum tumor markers revealed normal levels of cancer antigen 125 (CA-125). Interventions: The patient underwent a laparotomy and there was torsion of the left ovary. We conducted frozen biopsy of left ovary for confirming malignancy before performing staging surgery. Outcomes: The result of a frozen section biopsy confirmed a borderline Brenner tumor associated with a benign mucinous tumor. Subsequently, total hysterectomy and right salpingo-oophorectomy were performed. The operation was completed without addition procedures Lessons: Ovarian torsion is benign in most cases and malignancy is rare. Although very rare, ovarian torsion can occur in postmenopausal women, and it should be taken into consideration that the possibility of malignancy is low in postmenopausal women with normal CA-125 levels. Instead of performing staging surgery, it appears to be appropriate to carry out surgery based on the result of intraoperative frozen section biopsy so that we were able to avoid unnecessary surgical procedures.

A case of ruptured gravid uterus at 35 weeks' gestation after cornual resection

임신 중 자궁파열은 드물게 발생하지만, 모성 및 태아사망까지 초래할 수 있는 치명적인 산과적 응급 질환이다. 파열부위의 출혈이 가장 흔한 합병증으로, 자궁파열 시 사망률은 파열 진단시기와 즉각적인 수술에 달려 있기 때문에 자궁파열을 의심할 수 있는 이러한 증상과 징후를 보이는 경우에는 신속한 진단과 처치가 필요하다. 이러한 자궁파열의 가장 흔한 원인은 기존의 제왕절개술 반흔의 파열이며, 다른 원인으로는 태위이상, 분만 2기의 난산, 유도분만, 무통분만, 조기분만과 42주 이후 분만 등이 있다. 저자들은 1년 전 자궁각절제술 시행 후 임신 35주에 조기진통 치료 중 발생한 자궁파열을 경험하여 보고하는 바이다.

A case of spindle cell carcinoma of the uterine cervix

Spindle cell carcinoma is a rare variant of squamous cell carcinoma characterized histologically by a biphasic pattern with both squamous and spindle cell component. There is controversy in the histogenesis, biologic behavior, optimal treatment and prognostic factor for tumor. Treatment must be similar for squamous cell carcinoma. With a review of literature, we report a case of a 52-yearold female with spindle cell carcinoma in the uterine cervix, which has been managed by total hysterectomy.

A CASE OF PRIMARY PULMONARY HYPERTENSION DIAGNOSED AT POSTPARTUM

Primary pulmonary hypertension is a rare disorder and rarely present in pregnant woman, but it make high risk of maternal morbidity and mortality. When a woman with subclinical primary pulmonary hypertension is pregnant, physiologic increase in maternal plasma volume aggravates pulmonary pressure cause cardiac arrest and maternal death. We diagnosed primary pulmonary hypertension in parous woman who didn’t present at any symptom during pregnancy but had dyspnea 7 days after preterm vaginal delivery at 30 weeks 6 days. We report this case with brief review of literatures.

A case of diaphragmatic endometriosis presenting with catamenial pneumothorax

Endometriosis is a relatively common gynecologic disease. Thoracic endometriosis syndrome occupies half of various types of external endometriosis, however it is very rare condition. We experienced a case of 40-year-old woman who presented with recurrent episodes of spontaneous right-sided pneumothorax that occurred during her menstrual periods. After the localization of the disease site by means of chest radiography and high resolution computed tomography of the thorax, thoracoscopic assisted diaphragm endometriosis resection and suture were performed. After pathologic diagnosis, a hormonal treatment with gonadotropin-releasing hormone agonist was also conducted. We report this case with a brief review of the concerned literatures.

A case of treatment by embolization of uterine arterial pseudoaneurysm following laparoscopic supracervical hysterectomy

137 A CASE OF TREATMENT BY EMBOLIZATION OF UTERINE ARTERIAL PSEUDOANEURYSM FOLLOWING LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY Mi-Ra Lee, MD, Min-Jeong Kim, MD, Hye-Ji Jeon, MD, Sl-A Choi, MD, Yun-Sook Kim, MD, Dong-Han Bae, MD, DongErk Goo, MD Departments of Obstetrics and Gynecology, Interventional Radiology, Soonchunhyang University Chunan Hospital, University of Soonchunhyang College of Medicine, Chunan, Korea

A case of atypical hemolytic uremic syndrome in a patient with preeclampsia

성인에서 발생하는 비전형적인 용혈성요독증후군은 미세혈관성 용혈성 빈혈, 혈소판감소증, 신장의 미세혈류 혈소판 혈전에 의해 발생하는 급성 신부전증 등의 특징적인 임상증상이 대장균에 의한 독소와 무관하게 나타나는 위험한 질환이다. 원인은 자간증, 태반박리, 양수합병증과 같은 임신 합병증을 포함한 다양한 스트레스이며, 치료는 헤파린과 혈장교환으로 이로 인해 최근 생존율이 급격히 향상되었다. 저자들은 최근 임신 34주에 핍뇨와 혈뇨, 용혈성 빈혈, 혈소판감소증을 보인 임신중독증 임신부에서 태아심박동 저하로 응급 제왕절개수술후 수혈과 알부민 및 헤파린 치료 후 신기능을 회복한 비전형적인 용혈성요독증후군을 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다.