ABSTRACT
Spontaneous intra-abdominal hemorrhage from uterine leiomyomas is rarely encountered. We present a case of a 46-year-old who presented to the emergency room with acute abdominal pain as same as that has experienced for 5-6 times. On examination, the abdomen was diffusely tender, with rebound tenderness in the suprapubic area and in both iliac fossae. Pregnancy test was negative. She had an acute abdomen, dizziness, decreasing hematocrit, and a pelvic mass with free fluid in the pelvic cavity. On transvaginal sonography, 6.3 x 6.1 cm sized hyperechoic mass was visible beside the uterus and CDS. This mass had an ill-defined margin. Large amount of fluid was visible in the CDS and uterovesical pouch. Hemoperitoneum was confirmed by culdocentesis. Magnetic Resonance Imaging revealed a mass with cystic components, diffusely heterogeneous signal intensity and T1 high signal intensity in the left superolateral aspect of uterus. An moderate amount of fluid was found in the pelvic cavity. The patient underwent an exploratory laparotomy. A ruptured, pedunculated, cystic degenerated uterine myoma with active bleeding was found, as well as approximately a liter of free, blood-stained peritoneal fluid and blood-clots. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.
Subject(s)
Female , Humans , Middle Aged , Pregnancy , Abdomen , Abdomen, Acute , Abdominal Pain , Ascitic Fluid , Diagnosis , Dizziness , Emergency Service, Hospital , Hematocrit , Hemoperitoneum , Hemorrhage , Laparotomy , Leiomyoma , Magnetic Resonance Imaging , Pregnancy Tests , UterusABSTRACT
Miller-Dieker Syndrome (MDS) is a contiguous gene deletion syndrome of chromosome 17p13.3, characterized by classical lissencephaly (lissencephaly type 1) and distinct facial features. Children with MDS present with severe developmental delay, epilepsy and feeding problems. The lissencephaly represents the severe end of the spectrum with generalized agyria, or agyria and some frontal pachy- gyria. Prenatal diagnosis is available and consists of fetal chromosomal analysis by karyotyping or fluorescence in situ hybridization (FISH), on chorion villus sampling or amniocentesis. Sonographic diagnosis in general cannot be accomplished earlier than late second trimester, when the characteristic cerebral anomalies can be noted. The progressive microcephaly and failure of development of both sulci and gyri are suggestive of lissencephaly. We report the case of a pregnant woman of 24 weeks gestation who presented with ventriculomegaly on antenatal sonography and hydrocephalus, and corpus callosum agenesis on fetal MRI, which was diagnosed as MDS by karyotyping and FISH on amniocentesis.
Subject(s)
Child , Female , Humans , Pregnancy , Agenesis of Corpus Callosum , Amniocentesis , Chorion , Classical Lissencephalies and Subcortical Band Heterotopias , Diagnosis , Epilepsy , Fluorescence , Gene Deletion , Hydrocephalus , In Situ Hybridization , Karyotyping , Lissencephaly , Magnetic Resonance Imaging , Microcephaly , Pregnancy Trimester, Second , Pregnant Women , Prenatal Diagnosis , UltrasonographyABSTRACT
OBJECTIVE: To evaluate the usefulness of alendronate for prevention and treatment of postmenopausal osteoporosis this study was taken. METHODS: This prospective randomized clinical trial examined the effects of oral alendronate and HRT(conjugated estrogen plus medroxyprogesterone acetate), in combination and seperately, on BMD, biochemical markers of bone turnover in 79 women with low bone mass. Treatment included alendronate(10mg daily) plus HRT(group I, n=38), or HRT(group II, n=41) for 6 months. Bone density measurements were performed at months 0 and 6 at the lumbar spine. Biochemical markers of bone turnover were also measured every three months. RESULTS: Serum Osteocalcin decreased by 19.2% in group I and by 10.0% in group II at 3 months(p<0.05), and by 30.9% in group I and by 19.8% in group II at 6 months(p<0.05). Urinary deoxypyridinoline showed decrease of 19.75%(I) vs. 10.4%(II) at 3 months, 30.1%(I) vs. 20.7%(II) at 6 months, the difference was significant. Percent change of BMD measurements from baseline at 6 months in group I was 6.2% and in group II 0.6% on the lumbar spine(p<0.05). CONCLUSION: The treatment with alendronate is useful to postmenopausal women with osteoporosis by decreasing bone turnover markers, and by increasing the BMD.
Subject(s)
Female , Humans , Alendronate , Biomarkers , Bone Density , Estrogens , Medroxyprogesterone , Osteocalcin , Osteoporosis , Osteoporosis, Postmenopausal , Prospective Studies , SpineABSTRACT
Prenatal diagnosis of genetic disorders is now an established part of routine antenatalcare. This is a study of our experience with 1,046 cases that have been undergone amniocentesisat the Guro Hospital of the Korea University Medical School from October 1983 toJune 1996. Advanced maternal age was by far the most common indication of amniocentesis.Chromosomal aberrations were diagnosed in 15 cases(1.4%) of which numerical aberrationwas 9 cases(60/0%) and structural aberration was 6 cases(40.0%). Autosomal aberrationwas observed in fourteen cases(93.3%) and sex chromosomal aberration was observedin one case(6.7%). Among the 14 autosomal aberrations, trisomy 21 was most common,being 5 cases, and one case of trisomy 13 and another case of trisomy 18 was found respectively.The others were 4 cases of translocation, one case of inversion and another case ofisochromosome. Sex chomosomal aberration case was only one and it was a Klinefeltersyndrome.