A Case of Intramural Pregnancy / 대한산부인과학회잡지

Intramural pregnancy is one of the rarest forms of ectopic pregnancy. The pathologic diagnosis of the intramural ectopic pregnancy requires that the myometrium surrounds the products of conception separated from the endometrial cavity or fallopian tubes. Because the early diagnosis is very difficult, most cases are found after the onset of complications such as a uterine rupture or hemoperitoneum. The previous histories of curettage, cesarean section, myomectomy, salpingectomy and manual removal of the placenta are known as possible etiology of the intramural pregnancy. We have recently experienced a case of intramural pregnancy after 10 times of curettages and are reporting with a brief review of the literatures.

The role of Interferon-gamma on the Expression of Class I Human Leukocyte Antigens in a Human First Trimester Trophoblast Cell Line / 대한산부인과학회잡지

Precise mechanism which the fetus can escape from mother's immune rejection is not well understood yet during last 50 years. The clarification of immune mechanism at the feto-maternal interface is very important, because this can be a common pathogenesis of various pathologic conditions including spontaneous abortion and habitual abortion. The pivot of this mechanism is cross-talk between the expression of HLA-C, E, G on the extravillous cytotrophoblasts and their receptors on decidual NK (natural killer) cell. The mechanism through which HLA-C, E, G regulation on the extravillous trophoblast is poorly understood. The IFN-gamma is known to be harmful to the successful maintenance of early pregnancy. OBJECTIVE: To clarify whether the IFN-gamma could be involved in the regulation of the HTR-8/SVneo human first trimester cell line. METHODS: We investigated the effects of IFN-gamma only or with other cytokines on the HLA-C, E, G transcripts in human first trimester trophoblast cell-line by using Reverse Transcription Polymerase Chain Reaction (RT-PCR). RESULTS: The trophoblast cells expressed HLA-C, E constitutively. When cultured in the presence of IFN-gamma only or with other cytokines, HLA-C, E transcripts were not significantly affected. CONCLUSION: These results suggest that harmful IFN-gamma to maintain early pregnancy may affect through another mechanism besides regulation of HLA-C, E on the extravillous cytotrophoblasts at the feto-maternal interface.

Dysphagia associated with Jugular Foramen Syndrome due to Traumatic Brain Injury

OBJECTIVE: To present one case of dysphagia associated with jugular foramen syndrome (Vernet syndrome) by trauma. The jugular foramen syndrome refers to paralysis of the IX, X and XI cranial nerves. Dysphagia due to jugular foramen syndorme without pseudobular palsy is rare in traumatic brain injury. CASE SUMMARY: A 16-year-old boy with the left occipital skull fracture and skull base fracture was not able to take any food by mouth. There was no other significant symptom without dysphagia. Physical examination, laryngoscopic examination and electromyography revealed paralysis of the left IX, X and XI cranial nerves. Videofluoroscopic examination demonstrated atonic ballooned pyriformis sinus and closed upper esophageal sphincter. Brain CT and MRI showed fracture line in the left jugular foramen without brain stem or diffuse cortical lesion. Feeding gastrostomy was performed. CONCLUSION: We report an unusual case of dysphagia due to jugular foramen syndrome in traumatic brain injury patient.

The Usefulness of Supine Position on Swallowing of Liquid Diet in Neurogenic Dysphagia: Comparison with Sitting Position

OBJECTIVE: The purpose of this study is to find the proper feeding posture for the safe liquid meal in the patients with neurogenic dysphagia. METHOD: Fifty patients of neurogenic dysphagia with tracheal aspiration diagnosed with the videofluoroscopic swallowing test (VFST) were evaluated. VFST using 5 cc of barium solution was done for each patient in the sitting and supine position. The results of VFST of supine position were analyzed and compared with those of sitting position for the tracheal aspiration, laryngeal penetration, premature leakage, and laryngeal spillage. RESULTS: The incidence of premature leakage, tracheal aspiration, and laryngeal penetration is significantly decreased in the supine position (56%, 14% and 46%) compared to the sitting position (96%, 100% and 100%) (p<0.001). The incidence of laryngeal penetration referable to the swallowing reflex is significantly decreased in the supine position (0%, 46%, 0%) compared to the sitting position (14%, 96%, 44%) (p<0.001). The incidence of nasal regurgitation is 2% in the sitting position and 30% in the supine position. CONCLUSION: The incidence of tracheal aspiration of liquid diet is significantly decreased in the supine position compared to the sitting position. The supine position would be safer than the sitting position in the feeding of liquid diet.

Scapulohumeral Rhythm of Hemiplegic Patients by Plain X-ray Examination

OBJECTIVE: 1. To determine the difference of scapulohumeral rhythm (SHR) between the affected and unaffected side in hemiplegic patients. 2. To discover the influencing factors on altered scapulohumeral rhythm of affected side in hemiplegic patients. METHOD: Fifteen hemiplegic subjects, 18 to 54 years of age, participated in this study. Subjects were divided into two groups according to muscle tone on the basis of modified Ashworth scale (MAS). Plain X-ray of the shoulders were taken in neutral, 90 degree abduction, and full elevation of the arm in both affected and unaffected side. The arm angle, scapula angle, and glenohumeral angle were recorded for each individual in each of the three positions. RESULT: In the unaffected shoulders of hemiplegic patients, the mean values of SHRs from neutral to the 90o and from neutral to the 180o were 1 : 1.82 and 1 : 2.12, respectively. In the affected shoulders, the mean values of SHRs between 0~90o abduction and 0 to full abduction were 1 : 2.35 and 1 : 2.25, respectively. The mean value of SHRs from neutral to 90 degree of affected side was significantly decreased than unaffected side in the low tone group and increased in the high tone group (p<0.05). In addition, the SHRs of hemiplegic shoulders were significantly increased in the high tone group than the low tone group (p<0.05). CONCLUSION: Spasticity tends to result in decreased motion of scapula, which alters the SHR. A glenohumeral-to-scapulothoracic ratio of hemiplegic shoulder could be affected by spasticity and presence of subluxation.

Relationship between the Type of Laryngeal Penetration and Severity of Tracheal Aspiration in the Brain Injured

OBJECTIVE: To assess the incidence of tracheal aspiration in the brain injury patients with laryngeal penetration, and to investigate the relationship between the type of laryngeal penetration and the severity of tracheal aspiration. METHOD: One hundred videofluoroscopic swallowing tests in brain injury patients who showed laryngeal penetration were analyzed retrospectively. Laryngeal penetrations were classified into three groups: anterior, posterior and both. The incidence of the tracheal aspiration among the laryngeal penetration was evaluated. The severity of the tracheal aspiration was analyzed into the three groups: mild, moderate and severe. Each type of the laryngeal penetration were compared with the severity of the tracheal aspiration. RESULTS: Seventy-one patients showed the tracheal aspiration among the 100 patients with laryngeal penetration. The incidence of tracheal aspiration according to the type of the laryngeal penetration was 100% in both, 86.8% in posterior, and 50.9% in anterior type. The more severe tracheal aspiration was associated with the higher proportion of the posterior and both types. CONCLUSION: The incidence of tracheal aspiration in laryngeal penetration was 71%. More severe tracheal aspiration occurred with both & posterior laryngeal penetration than anterior type.