TSH and Free T4 Concentrations in Korean Pregnant Women / 대한주산의학회잡지

PURPOSE: To determine the means, medians and reference intervals for TSH (thyroid-stimulating hormone) and fT4 (free thyroxine) for each month of gestation and for three trimesters in Korean pregnant women. METHODS: Serum samples were collected from 265 pregnant women with singleton gestation. Levels of TSH, fT4 were measured by immunoassay. After exclusion of subjects with positive antimicrosomal autoantibodies, the means, medians and reference intervals based on 2.5th and 97.5th percentiles for TSH, fT4 were determined. RESULTS: The study population consisted of 94 women in first trimester, 49 women in second trimester, and 122 women in third trimester. The trimester-specific reference intervals were: TSH (1st trimester: 0.03~2.72, 2nd: 0.27~2.29, and 3rd: 0.03~2.88 mIU/L), fT4 (1st trimester 4.50~19.75, 2nd: 4.70~12.98 and 3rd: 5.07~11.84 pg/mL). fT4 levels were significantly lower in the second and third trimesters. TSH levels were lower in the first trimester than second and third trimester, with gradual elevation in the second and third trimester. CONCLUSION: Levels of TSH, fT4 during pregnancy differ from those in non-pregnant women. Gestational age specific reference intervals will play a cental role in screening and diagnosis of thyroid disorders. Further studies for normal reference ranges during pregnancy are needed to create reference intervals in Korean pregnant women.

A case of spontaneous rupture of liver melanoma diagnosed during pregnancy / 대한산부인과학회지

The incidence of all malignant tumor in pregnancy is 0.07-0.1%. The most frequent tumors in pregnancy are breast cancer, gynecologic tumors (cervical cancer, ovarian cancer), melanoma and lymphomas. Any malignant tumor in pregnancy has a diagnostic and therapeutic problem. Melanoma is 8% of all malignancies in pregnancy. Surgery is a definitive therapy for early-stage disease. Melanoma in pregnancy metastasize early and rapidly. So we have difficulty in making therapeutic plan. Most frequent metastatic lesions are liver and lung. We experienced melanoma of liver in pregnancy. This report represents melanoma in pregnancy with a review of literature.

Clinical Analysis of Placental Abruption / 대한주산의학회잡지

OBJECTIVE: Placental abruption is one of the obstetric hemorrhage diseases that needs emergent treatment. But there is no predictable tool for placental abruption at present, we clinically analyzed its incidence, etiological factors, signs and symptom and neonatal outcome for reducing complications of this disease. METHODS: The data presented here were based on 80 cases of placental abruption among 20,483 deliveries during 13 years of period from January, 1991 to December, 2003. RESULTS: The incidence of placental abruption was 0.4%. Most of cases (97.5%) occurred over 28 weeks of gestational age. The incidence of unknown etiological factor was 67.5% and pregnancy-induced hypertension was related in 22.5% of cases. The most common signs and symptom was vaginal bleeding (46.3%). Lower abdominal pain (33.8%), fetal distress (10%), premature labor (5%) were also noted. The half of the patients was diagnosed before delivery and the mode of delivery was cesarean section in 93.8%. The survival rate of newborns in severe degree group (14.3%) of placental abruption was lower than that of mild degree group (94.1%) or moderate degree group (84.6%). Additionally, Apgar scores at 1min and 5min of newborns in severe degree group (1.3+/-2.4/1.3+/-3.0) were significantly lower than that of mild degree group (5.9+/-2.5/7.5+/-2.2) or moderate degree group (5.5+/-2.7/7+/-2.8) (p<0.01). There was no maternal death in our study. CONCLUSION: Because the etiological factor of this disease was uncertain in two thirds of cases, comprehension of etiological factor such as pregnancy-induced hypertension and signs and symptom is emphasized. Bleeding and uteroplacental insufficiency caused by placental abruption affect fetal jeopardy in severe cases. Accurate diagnosis and adequate treatment including management of premature baby should be conducted in suspicious case of placental abruption for prevention of progression of this disease.

A case of primary tubal cancer evaluated with laparoscopy / 대한산부인과학회지

Malignant neoplasm of the fallopian tube is the rarest of the gynecologic cancers. Vaginal bleeding, vaginal discharge, and pelvic pain are the most common symptoms. Because of these non-specific symptoms, the diagnosis of this least common neoplasm is rarely made before laparotomy. The tumor is typically unilateral and has histologic subtypes, endometrioid and serous adenocarcinoma being the most common subtypes. Surgery, clearly the mainstay of treatment, is also the first approach to diagnosis. The procedure of choice is total abdominal hysterectomy with bilateral salpingo-oopho-rectomy. We had experienced one patient with primary tubal cancer, successfully evaluated with laparoscopy. And then we intend to report the case of the above patient and have a brief discussion about that.

Changes in Plasma Dehydroepiandrosterone-Sulfate ( DHEA-S ) Level & DHEA-S / cortisol Ratio by Age in Healthy Korean / 대한내분비학회지

BACKGROUND: DHEA-S is the most abundant steroid hormone in circulation, and primarily secreted from the adrenal cortex, but its physiological role is little known. One of the characteristic features of DHEA-S is progressive decrement of plasma DHEA-S level with advancing age, in contrast, plasma levels of other adrenal hormones are not chaging or littie decreasing. To grasp the trends of plasma DHEA-S level and DHEA-S/cortisol ratio by age in healthy Korean, we measured the plasma DHEA-S levels and DHEA-S/cortisol ratios in healthy Korean. METHODS: Healthy Korean (men: 99, women: 102, age range: 15-97 year old)were studied. Subjects were not taking drugs (such as glucocorticoid or androgenic medication) or cigarettes known to modify the plasma level of DHEA-S and cortisol, and had no evidence of hepatic, renal disease or hyperlipidemia as determined by serum lipid, bilirubin, SGOT, SGPT, BUN, creatinine. Data were analyzed by 10-year age group for men and women: i.e, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89 and 90 year or more. Plasma DHEA-S levels were measured by using a commercially available RIA kit with 125I labeled-DHEA-SO4 (Coat-A Count DHEA-SO4), and for the measurement of plasma cortisol levels, commercial Gamma Coat TM[125I] Cortisol Radioimmunassay Kit was used. RESULTS:. 1) In both men and women, plasma DHEA-S level showed high interindividual variation within the same age group. 2) There were individual sex differences in plasma levels of DHEA-S, in all age groups, plasma DHEA-S levels were significantly higher values for men than for women. 3) Maximum plasma DHEA-S levels (men; 237+-3.35 ug/dL, women; 108+-17.5 ug/dL) were at third decade in both men and women. 4) Both men and women showed the continuous decline in plasma DHEA-S level with age. These age-related decline was more prominent in men than in women (men; y=-3.152 * +292.6, r2= 0.8459, P<0.05, women; y= -1.417 * +143.3, r2 = 0.7278, P< 0.05). 5) As an index of aging, there was no stastical difference between DHEA-S and DHEA-S/cortisol ratio. CONCLUSION: In healthy Korean, there were high interindividual variation of plasrna DHEA-S levels. In both men and women plasma DHEA-S level was peak at third decade, and from when it declined progressively with age. These results suggest that although the reliability of single plasma DHEA-S measurement are limited, the decline of DHEA-S with advancing age might be a specific marker of endocrinologic hormonal milieu (aging index). Also, concerning to individual adrenal secreting capacity, we measured DHEA-S/cortisol ratio. But we did not found that plasma DHEA-S/cortisol ratio is superior to the plasma DHEA-S level as an aging index.