Preventive effect of ramosetron on patient-controlled analgesia-related nausea and vomiting after laparoscopic hysterectomy / 대한산부인과내시경학회지

OBJECTIVE: Patient-controlled-analgesia (PCA) using intravenous (IV) opioids is recognized a safe and effective method for pain control. However, postoperative analgesia with opioids is associated with a high incidence of postoperative nausea and vomiting (PONV) exceeding 30%. The 5-hydroxytryptamine receptor 3 (5-HT3) antagonists alleviate nausea and vomiting. This study aims to compare the effectiveness of ramosetron and ondansetron in preventing PONV following laparoscopic hysterectomy for benign uterine diseases under general anesthesia. METHODS: The medical records of 1483 patients who underwent laparoscopic hysterectomy between January 2005 and May 2009 were reviewed. Of the 1483 patients, 1184 patients who received IVPCA with ramosetron 0.3 mg (n=761) or ondansetron 8 mg (n=423) were analyzed. Fentanyl-based IVPCA was administered for 48 hours after surgery. The overall incidence of postoperative nausea and vomiting, bowel ileus, Levin tube insertion for severe bowel ileus, additional usage of pain killers and discontinuation of the IVPCA infusion with PCA-related severe nausea and vomiting were assessed for 48 hours after surgery. The amount of time until bowel gas passage resumption after surgery was measured. RESULTS: There was a significant difference between the two groups regarding the duration until post-operative bowel gas passage resumption (1.78+/-0.79 days in the ramosetron group, and 2.23+/-0.83 days in the ondansetron group; p=0.005); however, there were no significant differences found in other aspects. CONCLUSION: Ramosetron is superior to ondansetron in terms of faster recovery in bowel mobility, with similar effects in preventing the incidence of PONV.

A case of peritoneal desmoplastic small round cell tumor / 대한산부인과학회지

Desmoplastic small round cell tumor is a rare and aggressive tumor that affects young males. It is usually an abdominopelvic malignancy that demonstrates distinct histological appearances and a unique cytogenetic profile. There have been many different approaches to the treatment of desmoplastic small round cell tumor, but unfortunately it remains incurable and has poor long-term survival rates. However, with an aggressive approach to the treatment using multiple modalities, some temporary benefit to survival can be achieved. There has not yet been a case in which treatment has led to a curative outcome. Recently, we also experienced a case of very poor outcome of 31-year-old female with small round cell tumor in peritoneum. Here, we report the case with a brief review of literatures.

A case of warfarin embryopathy / 대한주산의학회잡지

Warfarin is an oral anticoagulant which is known to cross the placenta causing birth defects, known as warfarin embryopathy; fetal effects of early gestational exposure to warfarin is known to cause marked nasal hypoplasia, rhizomelia, and stippled epiphyses. The period of greatest sensitivity is 6 to 9 weeks of gestational age. Clinical studies have suggested that discontinuing warfarin before 6 weeks of gestational age could avoid the teratogenic effect. We experienced a women who had been taking warfarin for 15 years because of SLE (Systemic Lupus Erythematosus) and CRF (Chronic renal failure), who was found to be pregnant at 9 weeks of gestation. She discontinued warfarin and started heparin treatment, however the ultrasound examination showed shortened long bone, scalp edema, and cardiac anomaly (Ventricular septal defect), and termination of pregnancy was performed at 17 weeks of gestation. We report a case of warfarin embryopathy resulting from warfarin exposure until 9 weeks of gestation with a brief review of literature.

A case of prenatally detected fetal scalp mass / 대한주산의학회잡지

Prenatal ultrasonographic appearance and Doppler characteristics of extracranial masses are variable, depending on the location, vasculature, amount of arteriovenous shunting, and degree of proliferation. Epidermoid cysts are found in a variety of locations around the skull and midface. They are thought to occur as a result of the persistence of ectodermal elements at sites of suture closure, neural tube closure, and diverticulation of the cerebral hemispheres. They contain ectoderm but no skin element. We experienced 33-year-old primigravida with fetal extracranial mass at 23 weeks gestation. We presumed that this extracranial mass was hemangioma. However, the mass was suspected as scalp epidermoid cyst on postnatal ultasonography.