A case of torsion of normal adenexa misdiagnosed as left inguinal hernia in a neonate / 대한산부인과학회지

A palpable mass in lower abdomen of a neonate or an infant can be most frequently considered as an inguinal hernia, whereas pediatric adnexal torsion is less commonly considered in differential diagnosis but can occur. Pediatric adnexal torsion may be difficult to diagnose clinically but the immediate diagnosis may lead to more frequent salvage of affected adnexa. Sonography is the preferred imaging study. It usually confirms a pelvic mass but may not establish the diagnosis. The correct diagnosis of adnexal torsion is often made at exploration. Therapy for adnexal torsion remains controversial. While extirpation has been the standard of treatment in the past, there are current proponents of conservative therapy with adnexal preservation.

A case of endometrial actinomycosis of a virgin / 대한산부인과학회지

Actinomyces species are anaerobic or microaerophilic non-spore-forming gram-positive rods that may reach, occasionally, the normal female genital tract. Actinomycosis is uncommon and often presents as a complication of an intrauterine device (IUD). IUD and pessaries facilitate the access of the microorganisms to the pelvis. Almost 85% of cases occur in women who have had an IUD in place for 3 or more years. In fact, the detection rate of Actinomyces in patients with pelvic actinomycosis is as low as 2%. The diseases caused by Actinomyces spp. is often of difficult diagonsis. The diagnosis of actinomycosis can be confirmed by culture. However, it is often difficult to culture Actinomyces. Therefore a diagnosis of actinomycosis can be made from the finding of sulfur granules within inflammatory exudate on histologic examination after surgery. However, it may be possible to diagnose actinomycosis before surgery by the finding of Actinomyces-like organisms on Papanicolaou smears. The endometrial involvement is extremely rare. The authors report an unusual case of endometrial infection by Actinomyces in a 21 year-old female without intercourse, admitted into the institute with menorrhagia. She had received oral pills. Abdominal ultrasonography showed a endometrial thickening. The pre-diagnosis was endometrial hyperplasia. The endometrial biopsy was done. The sample from the endometrium developed actinomycosis. After procedure and treatment, the menorrhagia was disappeared.

A Case of Left Ventricular Outflow Tract Obstruction and Microangiopathic Hemolytic Anemia after Mitral Valve Repair

Many cases have been reported hemolytic anemia and left ventricular outflow obstruction with systolic anterior motion developing after bioprosthetic valve replacement. We report a case of hemolytic anemia and left ventricular outflow tract obstruction occured after mitral valve repair using Duran ring and were resolved by preservative therapy.

A Case of Ovarian Abscess Caused by Salmonella Typhi infection / 대한산부인과학회지

Samonella infection is usually a short febrile self-limiting disease localized to the gut, acquired by ingestion of contaminated food or water. The infection is seldom accompanied by extraintestinal complication. If such a complication does occur, the abscess is often located in bone and periost. Isolated suppurative ovarian infections are rare, but have descirbed, particularly in dermoid cysts, cystadenomas or endometrioma. We report a case of a patient with a Salmonella typhi infection in a serous cystadenoma.

The Clinical Feature of Regional Wall Motion Abnormality on Apex of the Left Ventricle with Normal Coronary Angiogram

BACKGROUND AND OBJECTIVES: Stress induced cardiomyopathy has been reported as reversible left ventricular dysfunction with electrocardiographic changes. Although the exact mechanism of this dysfunction has not been clarified, catecholamine "surge" is suspected as a potential cause of this disease. It has not been undergone the studies about the effect of chronic or recurrent psychological stress on the myocardium. We suspect that reversible ischemic change of myocardium could be induced by chronic or recurrent emotional stress. MATERIALS AND METHOD: The clinical, echocardiographic and angiographic data of 189 patients (72 women) who presented with ischemic symptoms and eletrocardiographic changes were participated. BAI (Beck anxiety inventory) and BDI (Beck Depression inventory) were obtained and analyzed for evaluation of degree of psychological stress. RESULTS: 54 patients who had left ventricular apical wall motion abnormalities without significant angiographical stenosis in the coronary artery were younger than the others with left ventricular wall motion abnormalities and angiographic stenosis. And they increased the BAI and BDI as tools of evaluation of psychological stress (p<0.05). CONCLUSION: Data of this study suggested that psychological stress can be associated with myocardial dysfunction. It can be postulated that psychological stress should be considered as one of the cause of non-coronary myocardial injury.

Usefulness of an Unconjugated Estriol for prediction of Gestational Diabetes Mellitus / 대한산부인과학회지

OBJECTIVE: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy. It is associated with adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean section, preeclampsia, and birth trauma, and perinatal morbidities, such as macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Therefore, screening for gestational diabetes mellitus and early diagnosis of this condition allows intervention to be carried out, thereby, the reduction of the untoward effects mentioned above can be minimized. But selective screening based on clinical or historic risk factors has been reported ineffective to identify the women with GDM. BACKGROUND: Circulating sex hormones have a role in the development of insulin resistance associated with certain physiological states including hyperandrogenism and polycystic ovary syndrome. Throughout pregnancy, normal human pregnancy is a hyperestrogenic state of major proportions. To evaluate the clinical correlation between Gestational diabetes mellitus and unconjugated estriol, we used it to screening protocol using three biochemical markers for unconjugated estriol levels. METHODS: In our retrospective between January 2002 and December 2003 at Korea university medical center, 137 women were screened for three biochemical tests and 50 gm Glucose challenge test at second trimester of pregnancy. The 50 gm GCT positive (n=56) women were performed 100 gm oral glucose tolerance test and by NDDG diagnosic criteria, women were diagnosed as Gestational diabetes mellitus (n=42). RESULTS: With logistic regression analysis, the significant risk factors were family history of DM (odd ration 16.59 95% CI 2.66-103.52), previous macrosomia birth (odd ratio 9.02 95% CI 1.98-41.6), maternal BMI (odd ratio 1.29 95% CI 1.09-1.49), parity (odd ratio 0.31 95% CI 0.11-0.83), glucosuria (odd ratio 0.68 95% CI 0.26-1.76) and among three biochemical test, estriol (odd ratio 1.60 95% CI 0.49-5.27), AFP (odd ratio 1.35 95% CI 0.35-5.28), hCG (odd ratio 0.59 95% CI 0.27-1.28). CONCLUSION: The screening test of GDM would be preferable and intensified management approach needed for patients with obesity, previous macrosomia birth. In three biochemical test, estriol and AFP levels were elevated in GDM but these odd ratio were not statistically significant.

Echocardiograpic Findings of Coronary Sinus in Heart Failure

BACKGROUND AND OBJECTIVES: The coronary sinus (CS) is a small tubular structure just below the tricuspid valve. The dilatation of the coronary sinus as well as the inferior vena cava and the hepatic vein may provide echocardiographic signs of systemic congestion. The aim of this study was to evaluate the correlation of size of coronary sinus that had abnormal echocardiographic findings with or without congestive heart failure. SUBJECTS AND METHODS: Echocardiographic examinations of coronary sinus were performed on 58 patients (M : F=20 : 38) who had abnormal echocardiographic findings with current or previous symptoms or signs of congestive heart failure (group 1), and on 63 patients (M:F=27:36) who had abnormal echocardiographic findings but that had never had symptoms or signs of heart failure(group 2) and 94 healthy volunteers (control group, M:F=52:42). The CS was mesured using a two-dimensional echocardiogram in the right ventricular inflow view (5-10 mm below the Thebesian valve at end-systolic phase). RESULTS: In the normal control group, the median size of the CS was 6.2+/-1.2 mm, and showed no difference between gender and age. The sizes of the CS in groups 1 and 2 were 9.0+/-2.3 and 6.4+/-1.3 mm, respectively. There were differences between groups 1 and the normal control group (p<0.001), and between groups 1 and 2 (p<0.001), but a slight change between group 2 and the normal control group. In group 1, the size of the coronary sinus was related with the duration of heart failure (r=0.32, p=0.016), but no correlations to body surface area, left ventricle dimension and TR peak velocity were shown. In the presence of heart failure, as diagnosed according to the size of the CS, the predictive value was high when the size of the CS exceeded 8.0 mm, with an accuracy of 84%. In heart failure, the median size of the IVC was 16.6+/-5.4 mm, the variation rate of the IVC during the respiratory cycle was 0.40+/-0.13, and the variation rate of the CS during cardiac cycle was 0.31+/-0.20. The size of the CS was not related with the size of the IVC, but there was an inverse correlation between the size of the IVC and its variation rate (r=-0.434, p=0.037). The size of the IVC was inversely correlated with the variation rate of the CS (r=-0.490, p=0.024). There was a correlation between the variation rate of the CS and that of the IVC (r=0.411, p=0.021). Comparing the groups with and without systolic flow reversal into the CS in congestive heart failure patients with tricuspid regurgitation, in the former there wrer distensions of the CS, IVC and LA dimensions and reductions in the variation rates of the CS. CONCLUSION: The measurement of the size of the CS and the variation rate of CS may provide valuable information concerning the presence and duration of congestive heart failure.

The efficacy of tumor markers SCC, CEA, and CA-125 in patients with cervical cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the positive rate of squamous cell carcinoma antigen (SCC), carcinoembryonic antigen (CEA), and CA-125 according to clinical stage and histology. We also determine the rate of normalization of SCC after surgical and radiation therapy. RESULTS: In 222 patients with cervical cancer, the pre-treatment positive rate of SCC, CEA, and CA- 125 were 38.7%, 24.3%, and 19.8%, respectively. The positive rate of SCC by clinical stage were 12.9% for stage I, 60.5% for stage II, 88.2% for stage III, and 87.5% for stage IV. The positive rate of CEA by stage were 7.8% for stage I, 36.4% for stage II, 83.3% for stage III, and 75% for stage IV. The positive rate of CA-125 by stage were 5.9% for stage I, 23.3% for stage II, 83.3% for stage III, and 75% for stage IV. The positive rates of SCC, CEA, and CA-125 were significantly increased by clinical stage. According to histology, the positive rate of SCC (39.8%) was more significantly higher than the positive rates of other tumor makers in squamous cell carcinoma of the uterine cervix. The positive rate of CA-125 was higher than the positive rate of other tumor markers in adenocarcinoma and adenosquamous carcinoma of the uterine cervix, but it was not statistically significant difference. CONCLUSION: SCC have been shown to be higher positive rate than any other tumor markers in patients with cervical cancer. The positive rates of SCC, CEA, and CA-125 were significantly increased by clinical stage. Concomitant measurement of SCC, CEA, and CA-125 may be more useful than measurement of SCC alone, and further study was needed.

A Case of Juvenile Granulosa Cell Tumor / 대한산부인과학회잡지

Granulosa cell tumors costitute 1% to 2% of all ovarian tumors and occur mostly in adult women. Juvenile granulosa cell tumor (JGCT) differs from the adult type in clinical and pathologic features as well as biological behavior. Usually associated with estrogen production, the tumor leads to endocrinologic symptoms such as isosexual precocity in premenarcheal girl and menstrual irregularities or amenorrhea in postpubertal woman. JGCT is diagnosed in early stage with favorable prognosis in most cases while in more advanced stage with grave outcome. The clinical stage at the time of diagnosis is considered the most important prognostic factor. If fertility is desired in the absence of contralateral or pelvic involvement, unilateral salpingo- oophorectomy is justifiable. We experienced a case of JGCT in 22 years old woman who presented with amenorrhea and low abdominal pain, and report this case with a brief review of literatures.

A Case of Term Delivery in Heterotopic Pregnancy / 대한산부인과학회잡지

Heterotopic pregnancy is that intrauterine pregnancy is accompanied by a coexisting ectopic pregnancy. The incidence of this disease was very rare, but it has been increased considerably with increasing cases of assisted reproductive technologies and tubal injuries resulted from tubal surgery, endometriosis, and PID. These are prerequisites for diagnosis that close monitoring of early pregnancy including serial serum hCG level and transvaginal sonography. We experienced a case of term delivery in heterotopic pregnancy following natural conception, so report this case with brief review of literatures.

A Clinical Review of Midtrimester Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: We performed this study to analyze the indications, distributions of maternal age and cytogenetic results of midtrimester amniocentesis and to determine the complications and risks of it. METHODS: This study was retrospectively reviewed 674 cases of midtrimester genetic amniocentesis from January 1997 to October 2001 in Kangdong Sacred Hospital, Hallym University. We analyzed the indications, distributions of maternal and gestational age, chromosomal results, and of which accorded to indications of cytogenetic studies. RESULTS: The indications of amniocentesis were abnormal maternal serum screening (46.2%), advanced maternal age (> OR =35: 44.8%), abnormal ultrasonographic findings (5.9%), familial history of fetal anomaly (2.8%) and previous history of fetal chromosomal abnormalities (0.3%), in order. The overall incidence of chromosomal aberration was 3.6% (24/674), which were composed of 18 cases of numerical aberrations and 6 cases of structural aberrations. In autosomal aberrations, there were 7 cases of Down's syndrome, 6 cases of Edward syndrome, 1 case of Patau syndrome and 3 cases of Mosaicism. In sex chromosomal aberration, there was a case of Turner syndrome. In chromosomal aberrations according to indications, there was 7.5% (3/40) of chromosomal abnormalities in abnormal ultrasonographic findings group, 3.2% (10/311) in abnormal maternal serum screening group and 3.0% (9/302) in advanced maternal age group. There was statistical significance only in abnormal ultrasonographic findings group. There was no significant complication after amniocentesis except 0.3% (2 cases) of fetal loss. CONCLUSION: Maternal serum screening, advanced maternal age and antenatal ultrasonograms should be important screening methods for amniocentesis which is considered to the most effective diagnostic procedure for prenatal cytogenetic studies. The karyotyping analysis of midtrimester amniocentesis is efficacious method for evaluation of chromosomal aberrations and genetic counselling for parents.