A Case of Endometrioid Stromal Sarcoma of ovary / 대한산부인과학회잡지

Endometrioid stromal sarcoma of ovary is so rare that it has been reported 45 cases in the world. Endometrioid stromal sarcoma of ovary is concomitant with endometriosis at 40%, with same tumor in uterus at 30%. The age of pateint is between 11 and 76, half of them are fifties and sixties. Most frequent presenting symptom is abdominal distension and abdominal pain. Surgery, chemotherapy, radiotherapy, progesterone was helpful, but any management do not result in conclusion because of rarity of cases. Clinical course is indolent because lesion is well-differentiated and grows slowly, so only cytoreductive surgery will be effective. Progesterone may be effective in residual or recurrent low-grade endometrioid stromal sarcoma of ovary. If endometriotic tissue is origin of tumor, estrogen play a role in malignant transformation. We had experienced a case of endometrioid stromal sarcoma of ovary of 42 years old woman. We managed by TAH and BSO, radiotherapy, progesterone therapy. Until now no recurrence was found for 15 months. So, we report this case with review of the literature.

Comparison of Misoprostol vaginal application and Sulprostone with cervical laminaria tent insertion in mid-trimester termination of pregnancy / 대한산부인과학회잡지

OBJECTIVE: To compare the abortion time, success rate and efficiency of application of intravaginal misoprostol versus intracervical laminaria insertion and intravenous sulprostone administration for mid-trimester pregnancy termination. MATERIAL: Patients requesting termination of second trimester pregnancy were randomized into two groups. In Group I, the women were given 200 microg tablet of misoprostol placed in the posterior vaginal fornix. In Group II, the women were given laminaria insertion in cervical canal with intravenous sulprostone administration. Altogether 50 subjects were recruited with 25 women in each group. RESULTS: The mean interval from start of induction to vaginal delivery was 1480.84+/-37.73 minutes in Group I and 1236.16+/-77.59 minutes in Group II(p=0.232). The success rate of termination within 48 hours in Group I and Group II were 84%, 92%(p=0.384). There were no significant differences in the mean interval time and success rates. Measurement of blood loss(differs in hemoglobin between the admission and postabortive 24 hours) shows in Group I(1.0352+/-0.5774) and in Group II(1.5640+/-0.8976). Mean changes in hemoglobin level were significantly lesser in the misoprostol group(p=0.017). No serious complication occurred. CONCLUSION: Intravaginal misoprostol appears to be acceptably safe and effective agents for second trimester pregnancy termination.

A case of Intramural Pregnancy following currettage , treated with Laparoscopic exicision and MTX / 대한산부인과학회잡지

Intramural pregnancy is one of the rarest form of ectopic pregnancy that only 20 cases have been reported in the world so far. Pathologically, the location of the gestational sac is completely isolated from the uterine cavity and entirely surrounded by myometrium without any contact of endometrium. Many reports noted that there would be possible relationship between the intramural pregnancy and prior uterine traumatic factor- curettage, cesarean section, myomectomy, salpingectomy, and manual removal of the placenta and so on. We have recently experienced a case of intramural pregnancy following curettage, managed completely by the laparoscopic excision and additive single dose intramuscular MTX treatment. So, we report this case with a brief review of the literature.

A Case of Acute Fatty Liver of Pregnancy / 대한산부인과학회잡지

Acute fatty liver of pregnancy is a rare, clinically distinct cause of jaundice occuring during the third trimester of pregnancy, with maternal death as the usual outcome and first described in 1,940 by Sheehan, which may be characterized by nausea, vomiting, epigastric pain, jaundice and confirmed by liver biopsy. We have experienced a case of acute fatty liver at 38 weeks of gestation in 30 year-old primigravida woman and reproted with a brief review of related literatures.

Medical care expenditure of residents in urban poor area / 영남의대학술지

This study was carried out to assess medical care expenditure of residents in urban poor area. The study population included 377 family members of 85 households in the poor area of Daemyung 8-Dong, Nam-Gu, Taegu and 442 family members of 96 households in a control area. The data was collected through self-administered q'iestionnaires completed by housewives. The survey was conducted. from , March 1 to May 31; 1992. The mean age was 31. 1 years in the poor area and 37. 1 years in the control area. The average number of households per house was 4.5 in the poor area and 4.5 in the control area. The frequency of medical care utilization per household in a one month period was 4.6 in the poor area and 4.3 in the control area. The average number of days of utilization was 12.9 in the poor area and 12.5 in the control area. The averge monthly income of a househlod in the poor area was 848,600 Won compared to the control area's 1,752,300 Won. The average monthly consumption expenditure of a household in the poor area was 568,800 Won and that in the control area 1,238,400 Won. The average medical care monthly expenditure per household was 34,500 Won in the poor area and 58,400 Won in the control area. The proportion of the medical care expenditure to monthly income and to monthly consumption expenditure was 4.1% and 6.1% respectively in the poor area, and 3.3% and 4.7%, respectively in the control area. The premium of medical insurance was 1.5% in both areas. The proportion of cost for drug was 57.4%, for medical appliance was 1.2%, and for medical treatment was 41.1% in the poor area and in the control area 52.4%, 1.9%, 45.7%, respectively. The highest proportion of medical care expenditures in the poor area was herb clinic utilization (36.9%). while hospital and clinic (37.8%) was the highest proportion in the control area. Mean medical care expenditure per visit was 7,400 Won in the poor area and 12,600 Won in the control area. Mean medical care expinditure per day was 2,800 Won in the poor area and 6.300 Won in the control area.

An epidemiologic study on clonorchiasis and metagonimiasis in riverside areas in Korea

A study was carried out to figure the cases and to observe the endemic status of clonorchiasis and metagonimiasis in endemic areas in Korea. Total 13,373 inhabitants living in 40 villages along 7 main rivers and 9 small streams were subjected to stool examination. They were selected randomly among the riverside population. Their specimens were examined both by cellphane thick smear method and Stoll's egg countung technique. This study was performed during the period from May 1979 to April 1980. The results obtained are as follows: The egg positive rate of any kind of helminths was 58.7% out of 13,373 examned cases, and the egg positive rates by each helminth were; Clonorchis sinensis 21.5%, Metagonimus yokogaqai 4.8%, large type Metagonimus eggs 0.4%, Ascaris lumbricoides 22.9%, Trichuris trichiura 35.2%, hookworm 0.2%, Taenia sp. 0.5%, Hymenolepis nana 0.07%, Paragonimus westermani 2 cases, Fasciola sp. 4 cases, Echinostoma sp. 1 case and Hymenolepis diminuta 1 case respectively. Many endemic foci of clonorchiasis were revealed along the 7 major rivers. The egg positive rates of each river basin differed from each other significantly; Nagdonggang 40.2%, Yeongsangang 30.8%, Seomjingang 17.3%, Hangang 15.7%, Tamjingang 15.9%, Geumgang 12.0% and Mangyeonggang 8.0%. The cases of clonorchiasis were estimated in range 830,000 to 890,000 in riverside areas of the 7 rivers. By grading the infection intensity, 64.7% was in Grade I(EPG 0-900), 28.6% in Grade II (EPG 1000-9,900), 5.5% in Grade III (EPG 10,000-29,900) and 1.3% in Grade IV (EPG over 30,000). The proportion of the cases in Grade III and IV was 6.8% among positive cases. Therefore 60,000 cases at least were regarded to suffer from it clinically. Males of 30-60 years of age showed higher positive rate and heavier burden of infection. This makes clonorchiasis more important socially because the patients lose their social productivity. A few endemic foci of metagonimiasis were detected newly by egg detection; Samcheong 28.5% egg positive rate, Uljin 21.3%, Yeuongdeog 46.3%, Milyang 6.7%, Yeongil 9.2% and Geoje 18.2%. The mean EPG values were in range of 320-7, 120 by the focus. The egg positive rate and proportion of EPG Grade varied greatly by the area, and mean proportion of the positive cases were 69.7% in Grade I, 24.1% in Grade II, 5.0% in Grade III and 1.2% in Grade IV. Males of 30-60 years were infected in higher rate also. The large sized eggs of Metagonimus were found also in upper basin of Hangang and Geumgang mainly. They were regarded as eggs of M. takahashii which is mediated by the cyprinid fishes. Its significance should be studied further. Clonorchiasis and metagonimiasis should be realized as important public health problems in Korea by their wide distribution, high prevalence rate and heavy infection intensity. Comprehensive measures against them are needed urgently.