Learning Curve of Capsule Endoscopy

BACKGROUND/AIMS: Capsule endoscopy (CE) has become an important tool for the diagnosis of small bowel disease. Although CE does not require the skill of endoscope insertion, the images should be interpreted by a person with experience in assessing images of the gastrointestinal mucosa. This investigation aimed to document the number of cases needed by trainees to gain the necessary experience for CE competency. METHODS: Fifteen cases were distributed to 12 trainees with no previous experience of CE during their gastroenterology training as clinical fellows. Twelve trainees and an expert were asked to read CE images from one patient each week for 15 weeks. The diagnosis was reported using five categories (no abnormalities detected, small bowel erosion or ulcer, small bowel tumor, Crohn disease, and active small bowel bleeding with no identifiable source). We then examined, using the kappa coefficient, how the degree of mean agreements between the trainees and the expert changed as the training progressed each week. RESULTS: The agreement rate of CE diagnosis increased as the frequencies of interpretation increased. Most of the mean kappa coefficients were >0.60 and >0.80 after week 9 and 11, respectively. CONCLUSIONS: Experience with approximately 10 cases of CE is appropriate for trainees to attain CE competency.

Atypical Guillain-Barre Syndrome Misdiagnosed as Lumbar Spinal Stenosis

Guillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. In typical cases, the first symptoms of GBS are pain, numbness, paresthesia, weakness in the limbs. Autonomic involvement is common and causes urinary retention and ileus. Much of these symptoms overlap with those of lumbar spinal stenosis. Therefore, correct diagnosis of GBS in a patient with symptomatic lumbar spinal stenosis or in a patient with atypical manifestations of GBS can be difficult, especially early in the course of GBS. Here, we report on a case of atypical GBS in a 74-year-old previously healthy patient with lumbar spinal stenosis and discuss the differential diagnosis of the GBS and lumbar spinal stenosis.

Clinical Characteristics of 17 Cases of Eosinophilic Gastroenteritis / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic gastroenteritis (EG) is a rare disease characterized by prominent eosinophilic infiltration that may involve a variable depth of one or more gastrointestinal organs. We analyzed the largest number of patients with EG among the studies carried out at a single center in Korea. METHODS: We retrospectively analyzed the clinical, laboratory, endoscopic, and radiologic features, management, and clinical outcome in 17 patients who were diagnosed as EG from January 1994 to Febuary 2008. RESULTS: Median age was 36 (2-67 years). Two of the 17 patients had a history of allergy. The most common symptoms were abdominal pain and diarrhea. Fifteen patients (88.2%) had hypereosinophilia. The ESR was moderately raised in 6 out of 14 patients. Eleven patients (64.7%) had predominant involvement of the mucosa, 1 (5.9%) of muscularis, and 5 (29.4%) of subserosa. EGD revealed non-specific findings such as erythema and edema. Abdominal Computed tomography revealed gastrointestinal wall thickenings of the involved organ, and all of 5 cases of the subserosal type had ascites. Thirteen patients (76.5%) were improved by corticosteroid treatment. Among five patients who had been followed for more than one year (12-84 months), two experienced relapse after discontinuing corticosteroids. CONCLUSIONS: EG should be considered in the differential diagnosis of unexplained gastrointestinal symptoms even in the absence of peripheral eosinophilia and in non-specific endoscopic findings.

A Case of mesenchymal dysplasia of the placenta / 대한산부인과학회지

Placental mesenchymal dysplasia is a rare condition of pregnancy that present as macroscopic feature of molar change in the placenta and normal karyotype fetus, and has been reported at birth in 15 cases of Beckwith-Wiedmann syndrome and 25 cases of normal fetus in literatures. It may mimic the partial hydatidiform mole, but the mesenchymal dysplasia is different that it may be compatible with a normal fetus. A nulliparous woman was suspected to be a partial mole with a coexistent live fetus in gestational age of 14 weeks because of the partially cystic placenta on ultrasonography examination. She delivered a healthy female vaginally at 36+6 weeks of gestation and the histological examination of placenta established the diagnosis of mesenchymal stem villous dysplasia. We report here an unusual pregnancy.

Polymorphisms of matrix metalloproteinase-1 and -2 genes in the pregnant women with preterm premature rupture of membranes / 대한산부인과학회지

OBJECTIVE: To elucidate whether polymorphisms of matrix metalloproteinase (MMP)-1 and -2 promotor genes are associated with preterm delivery caused by preterm premature rupture of membranes (PPROM) in Korean pregnant women. METHODS: We conducted a case-control study of korean pregnant women admitted to our labor and delivery unit. PPROM group (n=31) was defined as women whom delivered before 37 weeks of gestation due to PPROM. Control group (n=291) included women who were delivered after 37 weeks of gestation and had no history of preterm delivery. Genomic DNA was extracted from maternal peripheral blood. Polymerase chain reaction (PCR) and direct sequencing were done to determine the genotype of MMP-1 promotor -1607 and MMP-2 promotor -1306 of each participant. Data was analyzed by 2-tailed unpaired t test, x2 test, odds ratio with 95% confidence interval (CI) using SPSS 10.0. RESULTS: The carrier rate of MMP-1*1G was significantly higher in the PPROM group than that in the control group (p=0.020; odds ratio 3.09, 95% CIl 1.14-8.35). The frequency of 1G allele of MMP-1 was also significantly higher in the PPROM group than that in the control group (p=0.011, odds ratio 1.97, 95% CI 1.16-3.36). There was, however, no significant difference in the carrier rate of genotype as well as in the allelic frequencies of MMP-2*T in PPROM group compared with the control group (p=0.430, odds ratio 1.48, 95% CIl 0.56-3.96; p=0.377, odds ratio 1.58, 95% CI 0.57-4.40). CONCLUSION: Our data suggest that polymorphism of MMP-1 promotor -1607 might be associated with PPROM in Korean pregnant women.

Cytogenetic Analysis in 1,565 Cases of Midtrimester Amniocentesis: CUMC Experience(I) / 대한산부인과학회잡지

OBJECTIVES: To analyze chromosomal abnormalities according to patient's age and indications of patients in midtrimester amniocentesis for prenatal genetic diagnosis. METHODS: We retrospectively analyzed 1,565 cases of midtrimester prenatal genetic amniocentesis cases which were done in the cytogenetics laboratory at Kangnam St. Hospital, Catholic University Medical College from November1997 to May 2000. RESULTS: In 1,565 cases, the most common maternal and gestational age distributions were 35 to 39 years old and 17 to 17+6 weeks (32.78% and 21.47%, respectively). Abnormal maternal serum markers were the most common indication for amniocentesis (43.64%), and followed by advanced maternal age (40.45%) and abnormal ultrasonographic findings (3.64%). The overall incidence of chromosomal abnormalities was 4.47% (70 cases), of which numerical abnormalities and structural abnormalities were 1.86% (29 cases) and 2.61% (41 cases), respectively. Among the autosomal abnormalities, Down syndrome was most common (10 cases, 0.65%), and followed by Edward syndrome (9 cases, 0.59%). Among the sex chromosomal abnormalities, both of 47,XXX and 47,XXY were most common (3 cases, 0.20%, respectively). Chromosomal abnormalities were most frequently noted in the maternal age of 25 to 29 years old (5.10%), 30 to 34 years old (4.82%), 40 to 44 years old (4.31%), and followed by 35 to 39 years old (3.90%). On the other hand, chromosomal abnormalities were most frequently noted in abnormal ultrasonographic findings (7.02%), previous history of aneuploidy (5.88%), and followed by advanced maternal age (3.95%). CONCLUSION: This study suggested that although advanced maternal age is still important indication in midtrimester amniocentesis for prenatal diagnosis, abnormal maternal serum markers and ultrasonographic findings might be also important as indications. Therefore, they should be considered in prenatal genetic counseling.

Expression of alpha-smooth muscle actin and collagenIV in villous stroma of placental terminal villi and congestion fetal capillary in growth restricted pregnancies with severe preeclampsia / 대한산부인과학회잡지

OBJECTIVE: Preeclampsia is the major cause of prenatal mortality and morbidity. The functional disorder of uteroplacental insufficiecy is caused by the impaired uteroplacental blood flow and diffusion barrier in the villi. Functional disorders like placental circulating disorders results in morphological changes of terminal. villi as functional unit of placenta. We studied to investigate the differences in villous stoma of placental terminal villi and fetal capillary between growth restricted pregnancies with severe preeclampsia and normal preterm pregnancies. METHOD: Terminal villi was examined using light microscopy and by immunohistochemical localization of matrix molecule (alpha-smooth muscle actin and collagenIV) and the immunoreactivity of alpha-smooth muscle actin and collagenIV were evaluated in 17 cases of severe preeclampsia with intrauterine growth restriction as a study group and in 17 cases of gestational age matched normotensive preterm pregnancies as a control group. Fetal capillary congestion in terminal villi was also evaluated by Hematoxylin-Eosin staining. The patterns of immunohistochemical staining were all determinated in a visual qualitative manner (0-25%: -, 25-50%: +, 50-75%: ++, 75-100%: +++) by one pathologist. Congestion was considered to be present in a failed where the majority (>90%) of the capillaries demonstrated densely packed erythrocyte. RESULT: Expression of alpha-smooth muscle actin in the terminal villous stroma was significantly increased in study group compared with control group (P=0.0001). Expression of collagen IV in the terminal villous stroma was significantly increased in study group compared with control group (P=0.0001). Fetal capillary congestion was also significantly increased in study group compared with control group (P=0.049). CONCLUSION: The result suggests that there be the structural or biochemical difference in the villous stroma between normotensive preterm pregnancies and severe preeclampsia with intrauterine growth restriction and that the extravascular contractile system might be in the villous stroma in the severe preeclampsia intrauterine growth restriction.

The Utility of Matrix Metalloproteinase-2 as a tumor marker in cervical cancer / 대한산부인과학회잡지

OBJECTIVE: Degradation of the extracellular matrix and the basement membrane is believed to be associated with tumor invasion and metastasis. To evaluate the roles of Matrix metalloproteinase-2 (MMP-2) in cervical cancer and its utility as a potential diagnostic tumor biomarker, we investigated the expression of MMP-2 in cervical cancer tissue and sera. METHODS: Through the zymography of MMP-2 in cervical cancer tissues from 35 patients, we investigated the extent and distribution of MMP-2. Also, up-regulation of its gene expression was examined by reverse transcription-polymerase chain reaction (RT-PCR) analysis. Then, we attempted to investigate by ELISA serologic responses in the sera obtained from 35 cervical cancer patients, and examined its utility as diagnostic and prognostic tumor marker in cervical cancer by comparing it with conventional tumor markers SCCA and CEA. RESULTS: In zymography, the active form of MMP-2 was detected in 66kDa. In cervical cancer the active form of MMP-2 is more strongly reacted with the substrates than those in normal tissues. Also, the mRNA of MMP-2 was more up-regulated in cervical cancer tissue than in normal one. MMP-2 was detected in the sera of cervical cancer patients, and its amount differed according to clinical situations. While it was not more effective than previous tumor markers SCCA and CEA in diagnosis, it was more useful in monitoring of the cancer. The effect was especially remarkable when it was combined with any other conventional tumor markers. CONCLUSIONS: The results suggest that the expressions of MMP-2 correlate with cervical cancer invasion and metastasis. Also, it may be useful in the monitoring of the cervical cancer lesion.

A Case of Nonimmune Hydrops Fetalis with neuroblastoma / 대한산부인과학회잡지

Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartmnets including abdominal ascite, pleural effusion, percardial effusion, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was historically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. Neuroblastoma is a malignant tumor which originates in the autonomous nervous system. Congenital neuroblastoma is the most common solid malignant tumor of the neonatal period, incidence ranges 1:10,000 of all live births, retroperitoneal space being the most frequent localization. We have experienced a case of nonimmune hydrops fetalis with neuroblastoma at 32 weeks of gestation in 39 year old woman and reported that with brief review of related literatures.

Expression of insulin-like growth factorIGF-II and IGF binding proteinIGFBP-1 in preeclamptic placentas / 대한산부인과학회잡지

No abstract available.

Tumor necrosis factor - a ( TNF - a ) , Vascular cell adhesion molecule - 1 ( VCAM - 1 ) and Lipid peroxide in Maternal plasma of Uncomplicated Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of study was to assess in a longitudinal study of maternal plasma concentrations of Tumor necrosis factor-alpha(TNF-alpha), Vascular cell adhesion molecule-1(VCAM-1), Lipid peroxide (malonaldehyde, MDA) in uncomplicated pregnancy. METHODS: Blood was collected from healthy women at 4 to 41 weeks' gestation and non-pregnant women. Plasma samples were measured by immunoassay for TNF-alpha, VACM-1 and by colorimetric assay for lipid peroxide, and data were statistically analyzed. RESULTS: Plasma concentration of TNF-alpha was not significantly elevated during first trimester compared with non-pregnant women, but significantly elevated during second and third trimester compared with non-pregnant women. Plasma concentration of VCAM-1 was significantly elevated during first trimester compared with non-pregnant women. Plasma concentration of lipid peroxide was not significantly elevated during pregnancy compared with non-pregnant women. CONCLUSION: The plasma concentration of TNF-alpha and VCAM-1 were significantly higher than that of non-pregnant state during second and third trimester in case of TNF-alpha, and during first trimester in case of VCAM-1. But the plasma concentration of lipid peroxide during pregnancy was not significantly different from that of non-pregnant, and the plasma concentration was kept up constant levels during gestation. These were seems to be meant that abnormal pregnancy would be happened if the level is above or below the measured level.

Expression of Hepatocyte Growth Factor and its receptor in Placentas of Mild and Severe Preeclampsia / 대한산부인과학회잡지

No abstract available.

Temporal response of ovine fetal plasma erythropoietin induced by fetal hemorrhage / 대한산부인과학회잡지

OBJECTIVE: The ovine fetus responds to hemorrhage with a 10-20 fold increase in plasma erythropoietin (EPO) concentration at 24 hr and a return toward normal at 48 hr after the hemorrhage. The objective of the present study was more accurately to compare the magnitude and time course of the plasma EPO response after fetal hemorrhage. METHODS: Chronically catheterized, 12 of late gestation ovine fetus were gradually hemorrhaged 40% of their blood volume over 2 hr (1ml/min). Plasma was sampled for EPO concentration at 1, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 30, 36 hr after initiating the hemorrhage were collected at these times. Radioimmunoassay was used to measure plasma EPO concentrations. Analysis of variance was used for statistical analysis. RESULT: After a slow hemorrhage in the ovine fetus (1ml/min over 2hr), plasma EPO concentration increased significantly at 4hr (2.3 times basal values), reached a maximum at 16 hr (33.3 times basal values), and declined thereafter. CONCLUSION: We studied change in time course of the fetal plasma EPO after slow hemorrhage and recent studies have shown that the fetal kidney, liver and placenta express EPO mRNA. These observation suggest that plasma EPO increase may be mediated by a tissue specific up-regulation of EPO transcription in the fetal kidney, liver and placenta. We have studied change in Epo mRNA expression in various fetal tissue after slow haemorrhage.

Influence of Hypoxic Condition on Invasion of Cultured Trophoblast / 대한주산의학회잡지

OBJECTIVE: To investigated whether lowering oxygen tension affects invasion of cultured trophoblast. METHODS: Trophoblasts were isolated from the normal placenta in early pregnancy(6-10 weeks in gestation). Isolated trophoblasts were cultured under normoxic(5% CO2, 95% humid air in incubator) and hypoxic(MERCK, 1% O2, 99% CO2) conditions for 24, 48 and 72 hours, respectively. The proliferation ability was measured using [H3] thymidine assay. Total RNA was extracted from the cultured trophoblasts. The expressions of matrix metalloproteinase(MMP-2) and tissue inhibitor of metallo- proteinase(TIMP-2) were determined by reverse transcription- polymerase chain reaction(RT-PCR) and Northern blot analysis. The invasiveness of cultured trophoblast was observed using in vitro invasion assay. RESULTS: [H] thymidine assay indicated that cellular DNA synthesis was not affected by the culture condition. The expression of MMP-2 mRNA was decreased at 24 hours and then progressively increased in the time-dependent manner in each culture condition. The expression of TIMP-2 was decreased in the time-dependent manner under hypoxic condition. In vitro invasion assay revealed that the cultured trophoblasts under hypoxic condition has more invasive ability than them under normoxic condition. CONCLUSION: These data suggests that hypoxic condition may stimulates the invasion of trophoblast in the human placentation. And MMP-2 and TIMP-2 may be related to control their invasiveness under hypoxic condition.

A Gestational Age Calculator Pregram Using Personal Computer / 대한주산의학회잡지

OBJECTIVE: Since the management of pregnancy is gestational age dependent, accurate knowledge of the dating of gestational age is essential. The gestational age calculation system(GACS) was made to get a precise informations of exact gestational age of pregnant mothers. METHODS: Using the personal computer and Microsoft Visual Basic soft ware, the GACS program was made to meet obstetrician's desire. This program is designed and embodied to calculate gestational age controlling many variables such as last menstrual period(LMP), expectant date of confinement(EDC), gestational age on the calculating date, ultrasonographical gestational age, and conceptional date. RESULTS: The accurate gestational age was displayed by GACS according to various input data. The work sheet of whole gestational age can be printed by GACS. CONCLUSION: The GACS is a tool to calculate gestational age of pregnant mothers precisely. This can be used very conveniently and informatively by obstetric clinicians. We recommend this program for the members of perinatologists and obstetricians.

The Effect of Blood and Meconium Contamination on the TDx - FLM Assay for the Assessment of Fetal Lung Maturity / 대한산부인과학회잡지

OBJECTIVE: We studied to determine the effect of blood or meconium contamination on the TDx-FLM assay for the assessment of fetal lung maturity. We also studied to evaluate the degree of diluted contaminants that affect the results. METHODS: Nineteen samples of amnotic fluid-14 cases GA 37weeks-were collected and assayed for assessment of fetal lung maturity using tbe TDx-FLM assay. Among the above 19 samples, we used 12 samples-7 cases GA37 weeks-to contaminate with blood or meconium. Maternal blood was added to the amniotic fluid at increasing concentrations fro 1:10 to 1:1280. Diluted meconium (0.5g meconium/10ml amniotic fluid) was added at increasing concentration fiom 1:1 to 1:128. Each samples were assessed by TDx assay. RESULTS: TDx values in the cases of gestational age 37 weeks or more were matured level or borderline level(TDx value > 50mg/g), but below 37 weeks, TDx values wae immature level(TDx value < 50mg/g) except one case. In preterm cases, blood or meconium contamination did not affect the TDx values significantly, although the thick meamium contamination (diluted meconium: amniotic fluid 1:1 - 1:4) increased the TDx values. In term cases, they did not affect the TDx values. CONCLUSION: TDx test was suitable for the evaluation of fetal lung maturity regardless of blood or meconium contamination.

Diagnosis of Chlamydia trachomatis Infection from Transcervical Cells of Pregnant Women by PCR Assay / 대한주산의학회잡지

BACKGROUND: Chlamydia trachomatis is most common sexually transmitted pathogen in the world, and a common cause of urethritis and cervicitis. Also it is common cause of preterm premature rupture of membranes and premature labor in pregnant women, and pneumonitis and conjunctivitis in neonate. A rapid and sensitive polymerase chain reaction(PCR)-based assay for detection of C. trachomatis is recently introduced. OBJECTIVES: We studied to determine whether a PCR assay is useful to detect Chlamydial infection in pregnant women. We also studied to compare its prevalence rate according to maternal age, trimester and parity, respectively. Study Design: Specimens were collected from 149 pregnant women by transcervical swab or endocervical lavage. If a specific band was detected in PCR assay, we considered as Chlamydial infection. RESULTS: In general, the positive bands were detected in the 45 of 149 pregnant women(30.2%). The positive bands were detected the 6 of 55(10.9%), 16 of 49(32.7%), and 23 of 45(51.1%) pregnant women in each trimester, respectively. Therefore, there was significantly increased according to the gestational age(p 0.05). CONCLUSION: We concluded that the PCR assay is a fast and useful test for the detection of C. trachomatis in transcevical cells from the pregnant women. This study suggested that Chlamydial infection seems to be increased according to the gestational age.

Clinical analysis of brain metastasis of choriocarcinoma / 대한암학회지

No abstract available.

Prognosis of the small cell carcinoma of the uterine cervix:a comparative study / 대한암학회지

No abstract available.