Objective : It is unclear whether young patients, as well as elderly patients, can safely receive laparoscopic surgery. The aim of this study was to evaluate the feasibility of laparoscopic surgery for elderly patients with endometrial cancer. Methods: We reviewed 163 patients who underwent laparoscopic surgery or open surgery for endometrial cancer over a four year period. Laparoscopic surgery was performed on patients under 70 years of age (Group A: n=122), and on those over 70 years of age (Group B: n=21). A third group of patients over 70 years old underwent open surgery (Group C: n=20). Preoperative cheracteristics and surgical outcomes were evaluated. Results: In the comparison between Group A and B, postoperative delirium was significantly higher in group B, and walking after surgery was significantly earlier in groupA. In the comparison between Group B and C, operation time, blood loss, postoperative delirium, and length of hospital stay were significantly higher in group C, operation time was significantly shorter in groupC, Walking after surgery was significantly earlier in groupB. Conclusion: In elderly patients, laparoscopic surgery is less invasive than open surgery. Laparoscpic surgery can also be safely performed on elderly patients as well as young patients. [Adv Obstet Gynecol, 72 (2) : 59-66, 2020(R2.5)]

Uterine artery embolization (UAE) is being established as an alternative to surgical treatment for symptomatic uterine fibroids. We retrospectively analyzed the medical records of 73 cases from December 2014 to June 2019, in which UAE using microspheres was performed for symptomatic uterine fibroids. Complications, rates of fibroid reduction after UAE, and the degree of improvement of subjective symptoms were examined. For comparison, we also analyzed 13 cases of UAE using gelatin sponges. UAE was performed by interventional radiologists, and the procedural success rate was 100%. The patient’s mean age were 45±7 years, and postembolization syndrome was the most profound complication, affecting all 73 cases. No uterine infections, sloughing, or other serious complications (such as necrosis, thrombosis or other organ damage) were observed. Pain within 24 hours post-UAE was milder when microspheres were used than when gelatin sponges were used. The mean volume ratio of dominant fibroid after 1-, 3-, 6-, and 12-months was 75%, 58%, 50%, and 45%, respectively. Subjective symptoms, such as abdominal swelling, dysmenorrhea, and menorrhagia, improved by 89%, 80%, 91%, respectively. UAE for symptomatic uterine fibroids using microspheres is safe and effective and could be alternative to traditional surgical treatments for women who wish to avoid hysterectomy. [Adv Obstet Gynecol, 72(2) :67-75, 2020(R2.5)]

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare disease characterized by a double uterus, blind hemivagina, and ipsilateral renal agenesis. In this disease, menstrual blood pools in the closing vaginal cavity within several years from the first menstruation, often causing periodic lower abdominal pain, dysmenorrhea, and atypical genital bleeding. This case report describes a case of OHVIRA syndrome treated with transvaginal endoscopy. A 17-year-old adolescent girl who had her first menstruation at age nine years, with a 28-day menstrual cycle, gravida 0, coitus (-), visited her previous physician with a chief complaint of lower abdominal pain and atypical genital bleeding. She was referred to our hospital and underwent a medical examination. We diagnosed OHVIRA syndrome by magnetic resounance imaging, computed tomography and drip infusion pyelography and then performed surgery for the closed vaginal cavity using laparoscope transvaginally. In this case, Using laparoscope transvaginally was effective for the treatment of OHVIRA syndrome. [Adv Obstet Gynecol, 72 (2) :76-81, 2020 (R2.5)]

Cerebral palsy is a disease which impairs movement and posture maintenance. Deep vein thrombosis, pre-eclampsia, preterm delivery and Cesarean delivery rates have been increasing in cases of pregnancy complicated with cerebral palsy, and strict management is therefore required. In this report, we present a case where we managed a pregnancy with cerebral palsy. A 31-year-old female with cerebral palsy (gravida one, para zero) was determined to be pregnant. She uses a wheelchair for mobility in her daily life. From the first trimester, anticoagulation therapy with heparin was started, and her fetal growth was normal. From the evaluation of her mobility, it was judged that the delivery position was possible, and vaginal delivery was attempted. Induction of labor due to the premature rupture of the membranes was performed at 40 gestational weeks, and an emergency Cesarean section due to non-reassuring fetal status was carried out. We immediately restarted to inject the heparin after the operation and began warfarin five days after delivery. Thereafter, the patient was discharged on the 6th day after delivery. Currently, she is receiving support such as at-home nursing. [Adv Obstet Gynecol, 72(2) : 82-87, 2020(R2.5)]

Ovarian steroid cell tumors (SCTs) are rare and account for 0.1% of ovarian tumors. Among patients affected by tumors, 56-77% have virilizing symptoms. This symptom is useful for detecting of SCT. The patient in the present study did not show any virilizing symptoms. Therefore, diagnosis of an SCT was difficult. Magnetic resonance imaging showed a heterogenous mass on T2-weighted imaging and hyperintensity on diffusion-weighted imaging in the right ovary. 18F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography showed high ¹⁸F-FDG uptake (maximal standardized uptake value (SUV max) :17). Therefore, ovarian cancer was suspected. Before surgery, we measured testosterone levels to determine the possibility of ovarian sex cord-stromal tumor because she had amenorrhea for nine months and had a solid ovarian tumor. Exploratory laparotomy was performed for diagnosis of ovarian cancer or a sex cord-stromal tumor because the testosterone level was high. Intraoperative frozen section analysis showed a benign sex cord-stromal tumor and R oophorectomy was then performed. Histomorphology and immunohistochemistry of the tumor suggested the diagnosis of a benign ovarian SCT. Postoperatively, testosterone levels became normal in 1 week and menstruation appeared in 1 month. The patient continued to have a regular menstrual cycle and good health for 30 months. [Adv Obstet Gynecol, 72(2) : 88-95, 2020 (R2.5)]

We report three cases of a pregnant woman infected with syphilis exhibiting different clinical courses. In Case one, a 41-year-old woman was diagnosed as syphilis at eight weeks of gestation and treated with Amoxicillin. A healthy male baby was delivered at 38 weeks of gestation. In Case two, 22-year-old, a sex worker, who was absent of prenatal visit. She was diagnosed as intrauterine fetal death at the previous hospital. The exact week numbers in pregnancy was unknown. Case two presented with a substantial lesion suspicious of condyroma latum on the vulva and annular erythema on the face. RPR and TPHA were both positive, and the patient was diagnosed with syphilis infection. In Case three, a 28-year-old woman had an ultrasound abnormality detected at 36 weeks of gestation and was referred to our hospital. The fetus showed shortened femur length and polyhydramnios. She then delivered a female infant the next day. Further examination, the infant was diagnosed as congenital syphilis. The serology of Case three demonstrated negative RPR and TPHA in early pregnancy and positive after delivery. She was expected to be infected with syphilis during pregnancy. Immediate diagnosis and appropriate perinatal treatment is critical to prevent mother to infant infection. Furthermore, we should not hesitate to repeat serological tests for syphilis when pregnant women presented with suspicious finding of syphilis or ultrasound finding of intrauterine infection of syphilis, even if their serological tests were negative in early pregnancy.[Adv Obstet Gynecol, 72(2) : 96-101, 2020 (R2.5)]