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Central nervous system (CNS) toxicity has been reported in approximately 10-30% of patients receiving intravenous infusions of ifosfamide. Encephalopathy is a rare but serious CNS adverse reaction in these patients, and although usually transient and reversible, may cause persistent neurological dysfunction or death. Clinical features range from fatigue and confusion to coma and death. Although methylene blue can be used to treat ifosfamide-induced neurotoxicity, including encephalopathy, its mechanism of action remains poorly defined. We describe here two patients with recurrent epithelial ovarian cancer who experienced fatal encephalopathy following ifosfamide/mesna treatment.

To evaluate the effects of combined administration of gonadotropin-releasing hormone (GnRH) agonist with human chorionic gonadotropin (hCG)for final oocyte maturation in GnRH antagonist cycles for in vitro fertilization (IVF).A total of 120 infertile women undergoing GnRH antagonist multiple-dose protocol for controlled ovarian stimulation were recruited and randomized into 2 groups: a study group (n=60) and a control group (n=60). For the study group, both GnRH agonist and recombinant hCG (rhCG) were injected concomitantly for final oocyte maturation when 1 or more follicles reached a mean diameter of 18 mm. For the control group, rhCG alone was administered for final oocyte maturation.There were no significant differences in patient characteristics. The 2 groups were also similar with respect to the number of oocytes retrieved, fertilized oocytes and good-quality embryos. Embryo implantation rate (24.7% vs. 14.9%), clinical pregnancy rate per cycle (53.3% vs. 33.3%), and live birth rate (50.0% vs. 30.0%) were significantly higher in the study group than in the control group (p = 0.006, p = 0.027, and p = 0.025, respectively).Combined administration of GnRH agonist with rhCG may be beneficial in improving endometrial receptivity and pregnancy rate in GnRH antagonist cycles for IVF.

through procedure at an OSH via a sagittal incision for treatment of the imperforate anus. A small vagina was identified high on the right which was found to be “short” and connected to a “short uterus” with an associated tube and ovary. It was surgically lengthened with flaps from the labia and connected to the introitus. A small fistula going from the vagina to a ureteral remnant from a dysplastic kidney was identified, divided, and ligated. She subsequently did well. Signs of pubertal development were evident at age 10 e 11, with normal breast development and accelerated growth; however, menarche was absent. At age 14, she presented for evaluation of primary amenorrhea and pain. Ultrasound identified two uterine horns, a right ovary, and a distended fluid filled vagina. MRI showed a hematocolpos which appeared contiguous with the right corpus and tube. Left rudimentary uterine corpus and tube were not fluid filler. A re-do vaginoplasty was planned. EUA demonstrated extensive scar tissue with a stricture at 1.5cm from the introitus. Given the history of prior urologic and rectal surgery, and the fact that her unicornuate system was not midline, intra-operative ultrasound was used to identify the inferior aspect of the hematocolpos. With ultrasound guidance a long spinal needle was advanced until it was noted to enter the inferior aspect of the obstructed vagina (Figure 2). Once the angle and direction of dissection was determined, electrocautery was used to carry the dissection upwards. The intervening tissue was excised and 900cc of old blood was evacuated. Vaginal mucosa was identified and a standard pull through vaginalplasty was performed. Vaginal pull through is the standard treatment for lower vaginal agenesis. With a single midline uterus, cervix and upper vagina, the distal aspect of the obstructed upper vagina can be identified by palpation, and

Uterus didelphys with unilateral obstructed hemivagina, and ipsilateral renal agenesis is a rare congenital anomaly due to Mullerian duct malformation. The most common clinical manifestation is dysmenorrhea, pelvic pain, vaginal or pelvic mass after menarche. Early diagnosis is important, to preserve fertility, to prevent adhesion due to retrograde menstruation, hematometra, hematosalpinx and endometriosis which lead to distorted pelvic anatomy. These anomalies could be diagnosed with ultrasonography and magnetic resonance imaging. Resection or incision of vaginal septum is adequate treatments to relieve symptoms and reserve fertility. We report a case of uterus didelphys with unilateral obstructed hemivagina and ipsilateral renal agenesis with a brief review of the literature.

�Objective: To investigate the effects of pioglitazone on controlled ovarian stimulation (COS), IVF outcomes, and follicular fluid (FF) cytokine concentrations in patients with polycystic ovary syndrome (PCOS). Methods: Eighty-six infertile patients with PCOS resistant to clomiphene citrate were randomized to receive pioglitazone (30 mg/day) or placebo on the starting day of oral contraceptive (OC) pretreatment, followed by an IVF protocol using a GnRH antagonist. Pioglitazone or placebo was administered once daily from the starting day of OC to the day of hCG injection. Results: Total dose and days of recombinant follicle-stimulating hormone administered, and the numbers of retrieved and mature oocytes, were significantly lower in the pioglitazone group than in the control group. FF tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) concen trations at oocyte retrieval were also significantly lower in the pioglitazone group. The clinical pregnancy rate was higher and the incidence of severe ovarian hyperstimulation syndrome was lower in the pioglitazone group, but the differences were not statistically significant. Conclusion: Pioglitazone reduces FF TNF-α and IL-6 levels, and may improve ovarian response to COS in patients with PCOS.

�Objective: To investigate the effectiveness of GnRH antagonist multiple-dose protocol (MDP) with oral contraceptive pill (OCP) pretreatment in poor responders undergoing IVF/ICSI, compared with GnRH antagonist MDP without OCP pretreatment and GnRH agonist low-dose long protocol (LP). Methods: A total of 120 poor responders were randomized into three groups according to controlled ovarian stimulation (COS) options; GnRH antagonist MDP after OCP pretreatment (group 1), GnRH antagonist MDP without OCP pretreatment (group 2) or GnRH agonist luteal low-dose LP without OCP pretreatment (group 3). Patients allocated in group 1 were pretreated with OCP for 21days in the cycle preceding COS, and ovarian stimulation using recombinant human FSH (rhFSH) was started 5 days after discontinuation of OCP. Results: There were no differences in patients’ characteristics among three groups. Total dose and days of rhFSH used for COS were significantly higher in group 3 than in group 1 or 2. The numbers of mature oocytes, fertilized oocytes and grade I, II embryos were significantly lower in group 2 than in group 1 or 3. There were no significant differences in the clinical pregnancy rate and implantation rate among three groups. Conclusion: GnRH antagonist MDP with OCP pretreatment is at least as effective as GnRH agonist low-dose LP in poor responders and can benefit the poor responders by reducing the amount and duration of FSH required for follicular maturation.

A 58-year-old woman who presented with inguinal hernia for the first time was diagnosed as seminoma and complete androgen insensitivity syndrome (CAIS). The patient received a late diagnosis, and therefore she could not take a proper management. CAIS is a rare X-linked recessive disease with an XY karyotype that is caused by androgen receptor defects. It usually present with primary amenorrhea or inguinal hernia. The risk of malignant transformation of undescended testis increases with age, thus gonadectomy should be performed after puberty. We present a case of large advanced seminoma in a woman with CAIS who was neglected and diagnosed lately.

목적: 본 연구는 배꼽을 통한 단일공 복강경하 자궁외 임신 수술의 방법, 유용성과 안전성을 평가하기 위함이다. 연구 방법: 2009년 10월부터 2010년 2월까지 울산대학교병원 산부인과에서 자궁외 임신으로 단일공 복강경 수술을 시행 받은 총 6명의 환자들의 의무기록지를 후향적 연구 방법으로 분석하였다. 결과: 환자의 나이의 중앙값은 33.5세 (범위, 32~36)였고 BMI의 중앙값은 20.6 kg/m2 (범위, 16.5~28.7)이었다. 자궁외 임신낭의 가장 큰 직경의 중앙값은 4.8 cm (범위, 3.0~5.4)이었고 모든 환자에서 임신낭 파열과 복강내 출혈을 보였다. 수술에 소요시간의 중앙값은 77.5분 (범위, 59~95)이었고, 수술 중 실혈량의 중앙값은 40 mL (범위, 20~50)이었다. 수술 후 재원 기간의 중앙값은 2일 (범위, 1~3)이었고, 재원기간과 마지막 추적 관찰 기간 동안에 합병증이 발생한 경우는 없었다. 결론: 배꼽을 통한 단일공 복강경하 자궁외 임신 수술은 자궁외 임신 치료에서 안전하고 유용하였고, 기존 다공법 복강경하 수술에 대안이 될 가능성이 있다.

Pseudo-Meigs’ syndrome is a syndrome that includes hydrothorax and ascites secondary to ovarian tumors other than solid benign fibroma. In this report, we present the case of a 29-years-old female who complained of abdominal distension with peripheral edema during her third trimester. Two solid masses of 15 cm dimension in the left abdomen and 7 cm dimension in the right abdomen were detected by ultrasound and chest X-ray revealed right pleural effusion. Magnetic resonance imaging (MRI) confirmed the ovarian masses and ascites. As the patient had regular uterine contractions, we decided to perform emergency cesarean section because of previous cesarean section history. A laparotomy was performed and pathologists confirmed the presence of a metastatic adenocarcinoma. Four days following the surgery, gastroduodenoscopy revealed a huge ulcerofungating mass was visible in greater curvature of stomach. The final diagnosis was metastatic adenocarcinoma from gastric cancer. Although pseudo-Meigs’ syndrome is very rare, it should be carefully considered when evaluating female complaining with ascites in ovarian tumor.