Is cardiovascular disease more common in Vietnam veterans exposed to agent orange? / 대한내과학회지

BACKGROUND: TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin), a material of agent orange, was reported as a deadly poison in spite of its presence at extremely small doses. It has been reported that TCDD can cause various kinds of cancers and harmful effects on humans. However, a correlation between exposure to TCDD and cardiovascular disease is not yet known. Thus, we intended to examine the correlation between TCDD exposure and cardiovascular disease through an analysis of coronary angiograms in veterans of the Vietnam War. METHODS: A consecutive 115 patients undergoing coronary angiograms between April 2004 and June 2005 at Gwangju Veterans Hospital were analyzed. The patients were divided into two groups: 57 patients exposed to TCDD (Group I, average age 59.2+/-4.2 years) and 58 patients that were not exposed to TCDD (Group II, Average age 60.1+/-5.6 years). The clinical and coronary angiographic findings were evaluated. RESULTS: Baseline clinical characteristics, inflammatory markers and echocardiographic parameters were not different between patients in the two groups. The incidence of diabetes (43.9% vs. 25.0%, p=0.035) and hyperlipidemia (47.4% vs. 27.6%, p=0.028) were higher in group I patients than group II patients. Significant coronary artery stenosis was more common in group I (45 cases, 78.9%) thanin group II (33 cases, 56.9%) (p=0.011). CONCLUSIONS: There was a higher incidence of diabetes, hyperlipidemia, and significant coronary artery stenosis in patients that underwent a diagnostic coronary angiogram that were previously exposed to TCDD.

A Case of Huge Ascending Aortic Aneurysm with Wall Calcification

Although ascending aortic aneurysm is a uncommon disease, it has fatal complications such as aortic rupture, dissection, or death. So, experts recommend a preemptive aortic operation. A 77-year-old man with hypertension visited for slow progressive exertional dyspnea and general weakness. Chest X-ray showed deviation of trachea to right, mediastinal widening, cardiomegaly, and bulging of right heart border to right. Transthoracic echocardiography(TTE) and transesophageal echocardiography(TEE) showed marked dilated ascending aorta with wall calcification associated with severe aortic regurgitation and pericardial effusion. Measured diameter of ascending aorta was 12 x 11 cm on Chest Computed Tomography (CT) scan, 8.35 cm on TTE, and 10.2 cm on TEE. Our exam found out the obstructive pneumonia and aortic regurgitation as consequences of complications of huge aneurysm. We report a case of huge ascending aortic aneurysm without any previous aortic operation, aortic complications, trauma, or other etiologic factors.

Carcinoid Tumor of the Stomach

A carcinoid tumor of the stomach is a neuroendocrine tumor originating from enterochromaffin cells in the submucosa of the stomach and has no specific clinical symptoms. They are uncommon, accounting for no more than 0.3% of all gastric tumors. However, this frequency has increased markedly due to endoscopic screening. Herein, the case of a 47-year-old man with a polypoid lesion (2 cm diameter) detected on endoscopic examination is reported. It was diagnosed as a carcinoid tumor before an operation. Although the tumor size was slightly larger than 2 cm in diameter, the lesion was treated by wedge resection as there was no lymph node involvement or other distant metastasis. The postoperative has course was uneventful. The patient has continued to do well for over 15 months of follow up.

Localized Peritonitis due to Perforation of Multiple Jejunal Diverticula

We report the case of a 77-year-old woman who presented with periumbilical pain from perforation of jejunal diverticula. The patient underwent surgery and multiple jejunal diverticula were found distributed from 30 cm to 60 cm distal to the ligament of Treitz. A segment of the jejunum containing all diverticula was resected and end-to-end anastomosis was performed. The postoperative course was uneventful. The patient continued to do well at last follow-up, 26 months after operation. Diverticulum of the jejunum is uncommon and the majority of patients are asymptomatic. Symptoms indicating diverticulum are few and often nonspecific; they may present either as generalized abdominal pain associated with intestinal disturbances or in more serious case, they can lead to complications requiring emergency surgery. In light of these considerations, we thought it useful to report a case of complicated multiple jejunal diverticula and draw attention to its complications that can be a source of gastrointestinal symptoms.

Loss of Fhit Expression in Cervical Intraepithelial lesion and Invasive Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The author evaluated the relationship between the loss of Fhit and prognostic factors of invasive cervical carcinomas. METHODS: The formalin prepared tissue specimens of 64 CINs and 27 invasive cervical carcinomas patients diagnosed and treated at the department of obstetrics and gynecology, Yeungnam university hospital from June 1977 to February 2001 were obtained. And then the tissue specimens were analysed & measured by immunohistochemical methods. RESULTS: The loss of Fhit was significantly reduced in invasive cervical carcinomas compared to CINs. But we found there is no relationships between the loss of Fhit and prognostic factors, stage, tumor marker, lymphatic spread and radiation therapy of invasive cervical carcinomas. CONCLUSIONS: Although the loss of Fhit was not related to the precancerous lesion of cervix, we could confirm that the loss of Fhit was important in the progression of precancerous lesions to invasive cervical carcinomas.

A case of Adnexal Torsion in Pregnancy / 영남의대학술지

Adnexal torsion is not a common surgical emergency in Obstetrics and Gynecology. and is not observed frequently during pregnancy with its incidence being one out of about 5,000 pregnancies: Pregnancy is a factor that encourages torsion. The traditional treatment for ischemic and twisted adnexa consists of oophorectomy or salpingo-oophorectomy. with early diagnosis, a conservative approach is recommended in cases of young women to assure future fertility. with a brief review ofliterature, we report a case of unilateral salphingo-oophorectomy during pregnancy due to adnexal torsion with the delivery of a normal baby.

Effects of Obesity on Pregnancy Outcomes / 대한주산의학회잡지

OBJECTIVE:To compare pregnancy outcomes between obese and nonobese women and to determine the effect of gestational weight gain on pregnancy outcome in obese women. METHODS: A retrospective cohort study was conducted comparing 100 obese and 300 nonobese women who delivered a singleton live birth at Yeungnam university hospital from June 1998 to Dec 1998. Morbid obesity was defined as a body mass index greater than 30. The incidence of selected perinatal and neonatal outcome was assessed for two groups. RESULTS: Morbidly obese patients were more likly to experience pregnancy complications including gestational diabetes mellitus, preeclampsia, placental abruption, fetal distress, meconium aspiration, cesarean delivery & birth trauma. However, these were not affected by gestational weight gain in morbidly obese women. Weight gains more than 12kg were strongly associated with birth of a large for gestational age(LGA) neonate, however, poor weight gain did not appear to incrcase the risk of delivery of a low birth weight neonate. CONCLUSION: To optimize fetal growth, weight gain of 7-12kg for obese women appear to be appropriate. To reduce the risk of delivery of an LGA neonate, the optimal gestational weight gain for obese women should not exceed 12kg.

A Case of Prenatal Ultrasonic Diagnosis of Extrathoracic Ectopia Cordis / 대한주산의학회잡지

Ectopia cordis is a rare congenital anomaly in which the heart is situated outside the chest cavity and has been known for many years, being reported first in 1671 by Neil Stenson. Ectopia cordis appears closely related with defective embryonic development, arising as the result of defective formation and differentiation of the ventral mesoderm at 14 to 18 days of embryonic life. Ectopia cordis is usually classified into many types according to the site at which the heart protrudes: thoracic type, abdominal type, thoraco-abdominal type, cervical type. We have experinced one case of ectopia cordis which was diagnosed by ultrasonography at 16th gestational weeks in 30 year old multiparity. We report this case with brief review of literatures.