A study for Pertinence in Emergent Cesarean Section / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to analyze the inclination, pertinence and influential factor in emergent cesarean section according to the assortment and analysis of the indication of emergent cesarean section. METHODS: The retrospective study was performed with the review of 360 emergent cesarean section cases from January 2003 to December 2003. RESULTS: The indication of cesarean section was followed by the order of progress failure (47.5%), previous cesarean section (19.2%), and fetal distress (15.8%). The improper operation of emergent cesarean section was done in fetal distress (28.1%), progress failure (8.6%), and induction failure (16.7%). The absence of acceleration with prolonged bradycardia was the most common (50.0%) type of fetal distress. The emergent cesarean section were done more commonly on Tuesday and Friday during weekdays and it was the peak time in a whole day of cesarean section from 11 o'clock to 12 o'clock and 16 o'clock to 17 o'clock. CONCLUSION: It was proved that twenty six (7.2%) cases of emergent cesarean section were done improperly. Now, work through the non-medical factors are considered more important to reduce improper section rate.

Comparative Study of Maternal and Perinatal Complications in Overt and Gestational Diabetes / 대한주산의학회잡지

OBJECTIVES: The purpose of this study is to evaluate and compare the maternal and neonatal complications of the overt diabetes with that of gestational diabetes. METHOD : The medical records of 65 pregnant patients complicated by diabetes mellitus at Eulji medical center from January, 2001 to December, 2002 were reviewed retrospectively. Thirteen patients of them were diagnosed as a overt diabetes and the others were diagnosed as a gestational diabetes. RESULTS: Maternal complications were that preeclampsia in 15.4% and preterm labor in 15.4% in overt diabetes patients and preeclampsia in 9.6%, fourth degree laceration in 1.9%, preterm labor in 3.8%, placenta abruption in 1.9%, cardiomyopathy in 1.9% and polyhydroamnios in 1.9% in gestational diabetes patients. Neonatal complications were that hypoglycemia in 38.5% and respiratory distress syndrome in 15.4% in overt diabetes patients and hypoglycemia in 25%, hyperbilirubinemia in 9.6% and shoulder dystocia in 1.9% in gestational diabetes patients. There were no statistic differences in maternal and neonatal complications in two groups when management had done. And in gestational diabetes group, maternal and neonatal complications were significantly higher in no management group than management group regardless of management types. CONCLUSION: If early detection and management were done in overt and gestational diabetes, there were no difference in maternal and neonatal complications. Regardless of types of diabetes, early detection and management were important.

GnRH-agonist Induces Apoptosis of Human Granulosa-luteal Cells Via Caspase-3 and -9 and PARP Cleavage / 대한산부인과학회잡지

OBJECTIVE: GnRH-agonist (GnRH-Ag) used in controlled ovarian hyperstimulation (COH) for IVF-ET has been known to affect directly on apoptosis of human ovarian cells, but its mechanism is not clearly understood. Therefore, the purpose of the present study was to investigate whether caspase-3 and -9 activation and poly-(ADP-ribose)-polymerase (PARP) cleavage are involved in the mechanism(s) by which GnRH-Ag induces apoptosis in human granulosa-luteal cells. METHODS: Human granulosa-luteal cells collected from IVF-ET patients were cultured and treated with 10(-6) M GnRH-Ag or saline as a control. To access apoptosis in the cells, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end-labeling (TUNEL) assay and DNA fragmentation analysis were preformed 24 h after the treatment. Activity of caspase-3 and -9 in the cells was examined by using a fluorogenic substrate. Caspase-3 and -9 activation and poly (ADP-ribose) polymerase (PARP) cleavage were analyzed by Western blotting. RESULTS: DNA fragmentation in the cells increased in the higher concentration over 10(-6) M GnRH-Ag. In the result of TUNEL assay, the rate of apoptotic cells in GnRH-Ag treatment increased significantly compared with that of saline treatment (p<0.05). The activity of caspase-3 and -9 investigated by using a fluorogenic substrate increased only in the apoptotic cells. In Western blot analysis, the cells treated with GnRH-Ag revealed an increase in active forms of caspase-3 and -9 compared with those of the saline treatment. In addition, cleavage of PARP also increased in the cells treated with GnRH-Ag. CONCLUSION: These results suggest that activation of caspase-3 and -9 and cleavage of PARP might be involved in apoptosis of human granulosa-luteal cells induced by GnRH-Ag.

Clinical Consideration on the Method of Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The most common operation in gynecology is hysterectomy. To compare the indications, patient characteristics and clinical outcome, complication between total abdominal hysterectomy (TAH) and vaginal total hysterectomy (TVH), laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: This study was designed to analyze 147 patients of TAH (Group I) from January 2003 to September 2003, 48 patients of TVH (Group II), 108 patients of LAVH (Group III) at Eulji medical center of obstetrics and gynecology from January 2002 to September 2003. We analyzed the result with patient characteristics, parity, medical disease, history of previous operation, indication of hysterectomy, uterine weight, concurrent surgical procedure, operation time, bleeding amount, complication and length of hospital stay. Uterine prolapse was excluded in the analysis of this study. RESULTS: Patient characteristics, parity, medical disease were no differences. Number of previous operation were 63 cases (42.9%) in TAH group, 10 cases (20.8%) in TVH group, 43 cases (39.8%) in LAVH group, and the most common of operation was tubal ligation in three gropups. Most common indication of hysterectomy was uterine leiomyoma. The mean uterine weight was 374.31 +/- 250.26 gm in TAH group, 187.70 +/- 109.62 gm in TVH group and 203.26 +/- 94.92 gm in LAVH group. The mean operation time was 89.61 +/- 25.24 min in TAH group, 73.39 +/- 21.80 min in TVH group and 96.18 +/- 27.98 min in LAVH group. Postoperative complication was observed 60 cases (40.8%) in TAH group, 8 cases (16.7%) in TVH group, 19 cases (17.6%) in LAVH group. Most common complication was bleeding and required transfusion (TAH 32 cases (21.8%), TVH 3 cases (6.3%), LAVH 10 cases (9.3%)). CONCLUSION: LAVH and TVH present superior result in terms of complication when compared with TAH. LAVH and TVH have advantage of lower morbidity, less pain, shorter hospital stay and convalescence. LAVH should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.

The Macular Circulatory Change in Branch Retinal Vein Occlusion

We evaluated the macular circulatory change with fluores- cein angiography in 41patients (44eyes) who were diagnosed to have branch retinal vein occlusion and followed for 6 months or longer. Final visual acuity improved to 0.5 or better in more than half of cases in their last follow up. The initial corrected visual acuity and size of macular ischemic area were the potent prognostic factors. All cases that showed initial visual acuity of above 0.5 had smaller macular ischemic area and obtained final visual acuity of above 0.5. Visual prognosis of patients with ischemic area less than 1quadrant was much better than those with larger ischemic area. The state of perifoveal capillary network was also potent prognostic factor. Final visual prognosis was slightly better in patients with intact perifoveal capil-lary network than those with broken network. Systemic hypertension and venous occlusive site were not associated with visual prognosis. The relationship between visual improvement and state of perifoveal capillary network was not certain.

Retinal Arterial Macroaneurysms

Retinal arterial macroaneurysm may be presented with diverse clinical manifestations, such as various types of hemorrhage, exudate, edema or serous detachment especially in the elderly patients. Correct diagnosis can sometimes be difficult. A high index of suspicion is always required, and the characteristic findings of fluorescein angiography are useful for the correct diagnosis. Especially it is inevitably revealed as extrafoveal round hyperfluorescence on indocyanine green angiography(ICGA) which has recently become a useful tool in hemorrhagic and exudative disease, and can be misinterpreted as hot spot in choroidal neovascularization(CNV). So it may be misdiagnosed and treated as CNV associated with age-related macular degeneration(AMD), and the risk of branch retinal artery occlusion will be increased. We experienced four cases of retinal arterial macroaneurysms that showed various types of hemorrhagic and exudative change, and one case with serous retinal detachment. Two of these cases were misdiagnosed and treated as CNV associated with AMD, and branch retinal artery occlusion was developed in one of them. In the case presented with serous retinal detachment, it revealed as mass like lesion adjacent to the optic disc, and differential diagnosis with vascualr tumors was necessary. Our purpose is calling attention to the possibility of retinal arterial macroaneurysm in the diagnosis of various hemorrhagic and exudative lesions, especially in the elderly patients with hypertension.

The Surgical Outcome of Intermittent Exotropia and the Prognostic Factors

Surgical results of intermittent exotropia have been reported variabiy according to the criteria of surgical success and the length of follow-up.There have been also controversies about the factors affect the surgical outcoine of intermittent exotropia The surgical outcome and the factors which may affect the surgical results were retrospectively investigated in 165 patients who had undergone surgery for intermittent exotropia with at least 6 months (average 16.6 months, range 6-60 months) of post-operative follow-up.A `satisfactory result` , defined as a final alignment of orthophoria,esotropia less than 5PD or exotropia less than 10PD at far primary position,was achieved in 123 patients (74.5%). The diplopia at. postoperative one day tended to ensure 8 more satisfactory result (P0.05).

Acute Central Serous Choricoretinopathy and Choroidal Circulatory Changew: Indocyanine Green Angiographic Findings

We performed indocyanine green angiography(ICGA) in 21 eyes of 21 patients with acute central serous chorioretinopathy(CSC) to investigate choroidal cirulatory changes in this disease. Heidelberg retina angiograph (HRA) that using confocal scanning laser ophthalmoscope was used for ICGA. In the very early phase of HRA, 19 eyes(90%) demonstrated focal areas of delayed filling usually followed by distinctively fluorescent, dilated choroidal vessels running through or around these areas. After mid-phase, diffuse intrachoroidal hyperfluorescence surrounding these dilated vessels and suggesting increased leakage from them was seen in 19 eyes(90%). The focal delays of choroidal filling seemed to reveal choroidal ischemia involved in this disease process rather than physiological delays as they were topographically associated with choroidal hyperfluorescence in the later phase of HRA and leaking points on fluoresecein angiogram. Based on these findings, we suggest the choroid as the primary pathologic focus of acute CSC. Also we propose a scenario of pathogenesis, beginning with choroidal ischemia that leads to increased leakage from choroidal vessels, secondary changes of retinal pigment epithelium and passage of fluid in the subretinal space.