Successful Vaginal Delivery Following Immunologic Thrombocytopenic Purpuric Woman: Case Report With Prior History / 대한산부인과학회잡지

Thrombocytopenia is hematologic disorder commonly occurs during pregnancy (5%) with different severity. It doesn't cause severe problem during pregnancy and after the delivery if it is not below certain level which will cause spontaneous bleeding. But in this case, patient was previous cesarean section status and platelet number didn't arise more than 20,000/microliter even after transfusion which will cause spontaneous bleeding. Vaginal delivery was done because transverse cesarean section was considered relatively safe although there was the risk of rupture of uterus, and was successful-both mother and baby is in good health condition. Here now we report this case because vaginal delivery of Immunologic thrombocytopenic purpuric woman with prior history of cesarean section has not reported.

Relation of placental size to large-for-gestational-age infants in women with gestational diabetes mellitus controlled with insulin / 대한산부인과학회잡지

OBJECTIVE: To determine if the placental size is disproportionately increased in the large-for-gestational age infants in pregnancies complicated by impaired glucose tolerance controlled with insulin. PATIENS AND METHODS: A retrospective study was performed on 104 singleton pregnancies complicated by gestational impaired glucose tolerance controlled with insulin. The cases were categorized by the infant birthweight percentile into three groups, i.e. small-for-gestational age (90th percentile). Maternal and infant anthropometric data, glycemic status, and placental weight-to-birthweight ratio were compared among three groups. RESULTS: The maternal glucose level just after delivery, infant body mass index and placental weight showed a significant increment from the small-for-gestational age to the large-for-gestational age groups (p<0.05). The placental weight-to-birthweight ratio was significantly higher in the small-for-gestational group. On the other hand, there was no significant difference in the values of the oral glucose test, hemoglobin A1c and maternal body mass index among three groups. Maternal body mass index showed a increasing trend from the small-for gestational age to the large-for-gestational age groups. Placental weight-to-birthweight ratio was not significantly correlate with maternal glucose level. CONCLUSIONS: The results indicate that the placenta is disproportionately bigger, and rigid control of maternal blood glucose does not prevent the development of placental overgrowth. Maternal obesity in well- controlled gestational diabetes mellitus may be more significant than glucose control in the development of large-for-gestational-age infants. Different management strategies for women with gestational diabetes mellitus with different pregravid weights are warranted.

A Simple Technique for Up-and-in Screw Placement on Fifth Lumbar Vertebra: Technical Notes

A simple technique for transpedicular screw fixation of L5 is presented. This percutaneous screwing allows up-and-in screw placement without excessive lateral stretching and lessens the length of incision.

A Simple Technique for Up-and-in Screw Placement on Fifth Lumbar Vertebra: Technical Notes

A simple technique for transpedicular screw fixation of L5 is presented. This percutaneous screwing allows up-and-in screw placement without excessive lateral stretching and lessens the length of incision.

Proptosis from a cephalhematoma in a twelve-year-old girl: a case report

We report a unique case of a 12-year-old girl with unilateral proptosis form orbital extension of an extensive bilateral cephalhematoma. Loss of vision in the left eye due to severe proptosis was reversed by prompt aspiration and tarsorrhaphy.

Clinical course of spontaneous gangliothalamic hemorrhage in the acute period: who requires surgical removal?

We analyzed the clinical courses of 93 consecutive patients with gangliothalmic hemorrhage for the first three weeks after the ictus and investigated the factors affecting the clinical course and the final outcome. The clinical status was assessed daily using the Glasgow Coma Score (GCS) and patients were divided into two groups according to the clinical course; Group I included those who improved and Group II consisted of patients who deteriorated. There were 44 patients (47.3%) in Group I and 49 patients (52.7%) in group II. Each group was subdivided into the conservative group and the surgical group. In Group I only eight patients (18.2%) received surgery while twenty-five patients (51.0%) received surgery in Group II. Clinical features and computed tomography characteristics of these four groups were compared. Our results suggested that the surgery is rarely required for patients 1) whose GCS values are 12 or more without deterioration; 2) with hematomas smaller than 3 cm in diameter or 20 ml in volume; 3) with midline shifts of less than 3 mm, and 4) whose subtypes of the hematomas are P1, P2a, T1, T2a, and T2b. For proper comparison of the results of medical and surgical treatment, the patient population should include the patients 1) who became deteriorated progressively regardless of initial GCS values; 2) whose GCS values are below 12; 3) with hematomas larger than at least 3cm in diameter or 20ml in volume; 4) with midline shift of more than 3mm, and 5) whose subtypes of the hematoma are P2b or GT.

Decompressive Craniectomy for Acute Cerebral Infarction

We present a series of 10 Patients(Seven men and three women with an average age of 53 years) who underwent decompressive craniectomy for treatment to massive brain swelling following acute cerebral infarction. Clinical signs of cerebral herniation(anisocoria or fixed and dilated pupil, and/or hemiplegia with decerebrate righidity) were present in all patients. Computed tomography and magnetic resonance imaging showed the mass effect by cerebral edema through midline shift. All patients were treated with an extensive craniectomy and duroplasty. Among them, one recovered without neurological deficit, three were moderately disabled but functionally dependent, three remained in a persistent vegetative state and three died within 9 days after surgery(good recovery=1, moderate disability=3, persistent vegetative state=3, death=3). The results suggest that decompressive craniectomy can be an useful lifesaving procedure for massive cerebral edema following widespread hemispheric infarction.

Two Cases of Primary Intracranial Melanoma

Primary malignant melanoma arising from the leptomeninges is a rare entity. We report two cases of primary intracranial melanoma developed in one aged 65 years female and the other 70 years male. One case died 2 years after the operation, and the other case is still living more than 1 year after operation. Both cases seems to have a relatively long survival. The literature on this subject is briefly reviewed.

Plasma Aldosterone Levels in Acute Stage of Cerebral Stroke

We measured plasma aldosterone levels to determine whether or not the values obtained reflect the severity of cerebral stroke. All 36 patients with cerebral stroke studied were diagnosed with CT & MRI, and they were classified into 3 groups according to the Glasgow coma scale(GCS)-mild(GCS 14-15), moderate(GCS 9-13) and severe(GCS<8) group, and control of 10 patients, who were scheduled for elective lumbar laminectomy. Blood samples were taken on admission, the 3rd, and 7th hospital day. Aldosterone was measured by radioimmunoassay(normal values : below 150pg/ml). The results obtained were as follows ; 1) Aldosterone levels in control group(n=10) were 128pg/ml(SD+/-21) on admission, 109pg/ml(SD+/-4) on the 3rd day and 102pg/ml(SD+/-18) on the 7th day after admission. 2) Aldosterone levels in mild group(n=12) were 137.0pg/ml(SD+/-137.4) on admission, 107.5pg/ml(SD+/-89.9) on the 3rd day and 64.4pg/ml(SD+/-65.4) on the 7th day after admission. 3) Aldosterone levels in moderate group(n=6) were 195.1pg/ml(SD+/-159.1) on admission, 153.1pg/ml(SD+/-116.3) on the 3rd day and 85.7pg/ml(SD+/-53.0) on the 7th day after admission. 4) Aldosterone levels in severe group(n=18) were 230.3pg/ml(SD+/-107.3) on admission, 219.7pg/ml(SD+/-135.8) on the 3rd day and 267pg/ml(SD+/-233) on the 7th day after admission. The results of this study indicate that aldosterone levels on admission, the 3rd, and 7th day were significantly higher in severe group than in control group and aldosterone may be useful as biochemical markers in the acute stage of cerebral stroke, especially in severe group.