Youngran Kim

A case of postmenopausal pyometra caused by endometrial tuberculosis

Mycobacterium infection manifesting pyometra in postmenopausal women is a extremely rare disease that hardly responds to the usual treatment of pus drainage and antibiotics therapy. We present a case of a postmenopausal woman with pyometra caused by endometrial tuberculosis. Almost all of the pus could be drained through the stenotic cervical canal, with diffi cultly. The result of Pipelle endometrial biopsy was negative. However, her symptoms continued and fl uid gradually re-accumulated in the uterine cavity, despite successful pus drainage and suffi cient antibiotics use. Therefore, the endometrial tissue was obtained by fractional curettage after cervical dilatation to identify the accurate cause of pyometra. A pathologic examination and polymerase chain reaction confi rmed the diagnosis of endometrial tuberculosis. After completion of antituberculous medication, she was doing well without further development of pyometra. In a case of postmenopausal pyometra, endometrial sampling should be performed to rule out endometrial tuberculosis.

Ultrasound-guided local injection of methotrexate and systemic intramuscular methotrexate in the treatment of cesarean scar pregnancy

Objective To assess the efficacy and safety of ultrasound-guided intragestational injection of methotrexate (MTX) and systemic intramuscular MTX in the management of cesarean scar pregnancies. Methods This was a retrospective case-control study that included women diagnosed with cesarean scar pregnancy at CHA Bundang Medical Center unit between 2009 and 2015. The 26 cases were managed with local injection of MTX under ultrasound guidance and 15 cases were treated with systemic intramuscular of MTX. After the procedure, serial follow-up sonographic examination and serum beta-human chorionic gonadotropin (β-hCG) measurement were performed. Results The mean initial β-hCG level was 20,610.73 mIU/mL and ranged from 263.00–71,316.50 mIU/mL. Mean gestational age was 6.3 weeks and ranged from 4.8 to 8.5 weeks. The majority of ectopic cases were treated successfully and follow-up β-hCG level declined abruptly following the first dose of MTX. The rate of success of local MTX treatment was significantly higher than that of systemic MTX treatment. It was 93.75% vs. 73.33%, respectively (P<0.05). Conclusion Ultrasound-guided intragestational injection of MTX is an effective method for the management of cesarean scar pregnancies and is associated with minimal side effects and high treatment success.

Prenatal diagnosis of double aneuploidy, 48, XXY, +21 (Down-Klinefelter syndrome)

한 개체에서 중복홀배수체 염색체 이상의 발생은 상대적으로 매우 드문 형태로 그 발생률은 문헌에 따라 다양하다. 본 사례는 클라인펠터 성염색체 이상과 여기에 보통염색체 21번이 추가된 중복 홀배수체가 진단된 경우이다. 산전검사를 위해 임신 1분기에 시행한 초음파 검사에서 태아 목덜미투명대가 3.8 mm로 증가되었으며 이에 염색체검사를 위해 융모막융모생검을 시행하였다. 그 결과 48, XXY, +21인 중복홀배수체로 진단되었으며 태아는 임신 13주에 자연유산 되었다. 이에 본 저자들은 다운-클라인펠터 중복홀배수체 염색체 이상을 문헌고찰과 함께 보고하고자 한다.

Successful management of abdominal pregnancy implanted on posterior cul-de-sac with postoperative selective transcatheter artery embolization: A case report

812 SUCCESSFUL MANAGEMENT OF ABDOMINAL PREGNANCY IMPLANTED ON POSTERIOR CUL-DE-SAC WITH POSTOPERATIVE SELECTIVE TRANSCATHETER ARTERY EMBOLIZATION: A CASE REPORT Young-Ran Kim, MD, Gyeong-Sik Jeon, MD, Young-Ju Jeong, MD, Jeong-Heon Lee, MD, Dong-Hyu Cho, MD Departments of Obstetrics and Gynecology, Radiology, CHA Bundang Medical Center, CHA University, Seongnam; Department of Obstetrics and Gynecology, Chonbuk National University Medical School, Jeonju, Korea