A case of unrecognized foreign body in vagina presenting with chronic lower abdominal pain in 20-year-old patient / 대한산부인과학회지

The foreign bodies in vagina cause intense inflammation. Genital complaints in patients could indicate the presence of a vaginal foreign object. Vaginal bleeding and blood-stained, foul-smelling discharge are considered to be the main clinical manifestations of vaginal foreign bodies, and toilet tissue reported as the most commonly found foreign body. The insertion of foreign bodies into the vagina is not uncommon but presentation as lower abdominal pain in an gynaecological clinic is rare. The causes of insertion are sexual stimulation, sexual abuse, accident of post-surgery and most cases find a solution after vaginal speculum examination. We describe a case of foreign body in the vagina of a patient presenting with chronic lower abdominal pain but undetectable and unrecognized in general examination.

Relationship between Body Composition and Bone Mineral Density in Pre- and Post-menopausal Women / 대한폐경학회지

OBJECTIVES: We analyzed the relationship between body composition, metabolic parameters, and lumbar and femur bone mineral density (BMD) in pre-and post-menopausal women. METHODS: Of 394 females who participated in a medical check-up program, anthropometric measurements and fasting glucose levels and lipid profiles were measured. Body composition analysis was performed using the bioimpedence method and the BMD of the lumbar spine, femur neck, trochanter, ward's triangle, and total were measured by dual energy X-ray absorptiometry. RESULTS: The mean age was 49.5 +/- 9.8 years, and among the subjects, 203 (51.5%) were pre-menopausal and 191 (48.5%) were post- menopausal women. Skeletal muscle mass, fat- free mass, lean body mass, and basal metabolic rate had a positive correlation with the lumbar and femur spine BMD, even after adjustment for age and weight in pre-menopausal women. The abdominal fat ratio, fat mass, waist circumference, percent fat, and total cholesterol had a negative correlation with the lumbar and femur spine BMD, even after adjustment for age and weight in pre-menopausal women. The lean body mass in the legs and trunk, skeletal muscle mass, and fat free mass had a positive correlation with the BMD of the lumbar spine and femur neck, unlike the lean body mass of the arms did not, after adjustment for age and weight in post-menopausal women. CONCLUSION: In pre- and post-menopausal Korean women, body composition, lean body mass, fat -free mass, and skeletal muscle mass were positive correlates, and fat mass and percent fat were negative correlates with the lumbar spine and femur BMD.

Relationship between serum leptin level and bone mineral density and bone markers in postmenopausal women / 대한산부인과학회지

OBJECTIVE: This study was performed to prove the relationship between serum leptin level and bone mineral density of lumbar spine, femur neck and bone markers in postmenopausal Korean women. METHODS: We measured serum leptin, serum osteocalcin, urine deoxypyridinoline levels and bone mineral density of lumbar spine, femur neck in 88 premenopausal and 118 postmenopausal women who visited St. Vincent Hospital of Catholic University of Korea from March 1st, 2007 to December 31th, 2007. RESULTS: Statistically significant correlation was shown between serum leptin level and body mass index (BMI) in both premenopausal (r= 0.343, P<0.0001) and postmenopausal women (r=0.360, P<0.0001). And no significant correlation was observed between serum leptin level and bone mineral density (BMD) of lumbar spine and femur neck in premenopausal women (r=0.013, P=0.107 and r=0.004, P=0.425, respectively), but in postmenopausal women, there was a positive correlation between serum leptin and lumbar spinal BMD (r=0.085, P=0.02). But after the adjustment with age and BMI, the serum leptin and BMD of lumbar spine did not showed a significantly correlation in the same group (r=0.088, P=0.939). Also, no significant correlations were observed between serum leptin level and serum osteocalcin and urine deoxypyridinoline in premenopausal (r=0.004, P=0.566 and r=0.002, P=0.707, respectively) and postmenopausal women (r=0.026, P=0.096 and r=0.000, P=0.933, respectively). CONCLUSIONS: In our study, there is no significant correlation between serum leptin level and bone mineral density and bone markers in premenopausal and postmenopausal Korean women. Our own data would suggest that leptin has both negative and positive effects in bone mass regulation. Furthermore, larger clinical studies are necessary to clarify leptin's role to assess the contribution of the central and peripheral role of leptin in the overall maintenance of bone turnover.

Clinical value of serum vascular endothelial growth factor (VEGF) in ovarian diseases / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the concentration of serum VEGF and its relationship with the clinical parameters and the tumor markers in ovarian diseases. METHODS: We measured the serum VEGF concentrations by ELISA in 76 patients with benign ovarian disease, as well as 9 normal volunteers, 4 patients with ovarian borderline malignancy and 53 patients with ovarian cancer. RESULTS: There is a significant statistical difference between the serum VEGF levels in patients with benign ovarian disease (157.7+/-197.8 pg/ml) and ovarian cancer (344.7+/-372.2 pg/ml) (p<0.005). CONCLUSION: Serum VEGF may help in the differential diagnosis between benign and malignant ovarian disease. We suggest that serum VEGF may be useful as a diagnostic tool in ovarian disease.

Effects of laparoscopic surgery on the immune system of the patients with gynecologic diseases / 대한산부인과학회지

OBJECTIVE: Elective surgical approaches and trauma cause changes in the production of different cytokines. The aim of this study was to evaluate the effects of laparoscopic surgery on the immune system of patients with gynecologic diseases. METHODS: We recruited the open surgery group (n=20) and laparoscopic surgery group (n=33). In a prospective study we examined the C-reactive protein (CRP) level, the production of the cytokines Interleukin-1beta (IL-1beta), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10) and TNF-alpha concentrations by ELISA. In addition the fibrinogen, transferrin, albumin, hemoglobin and hematocrit were measured. Statistical analysis was made by Mann-Whitney U test and Kruskal-Wallis test. RESULTS: There were significant statistical differences in the CRP, IL-6 and IL-8 between the open surgery group and laparoscopic surgery group after surgery. The CRP and IL-8 showed a more distinct increase in open surgery group 24 hours after surgery, the differences between the two surgical approaches were significant (p<0.05). CONCLUSION: Elective surgical approaches cause changes in the immune system, which can be evaluated by the reaction of cytokines. Laparoscopic surgery cause less activation of the CRP and IL-8 than open surgery.

Association of Fas gene polymorphisms with bone mineral density in postmenopausal Korean women / 대한산부인과학회지

OBJECTIVE: To examine the relationship between Fas gene polymorphisms, and bone mineral density (BMD). METHODS: Restriction fragment length polymorphisms at the Fas A670G, G1377A gene site, and BMD at the lumbar spine and proximal femur were analyzed in 229 postmenopausal Korean women (81 normal, 111 osteopenic and 37 osteoporotic patients). BMDs were measured by DEXA. RESULTS: The distribution of A670G and G1377C polymorphisms in all postmenopausal women was as follows: AA 18.3%, AG 46.3%, GG 35.4%; GG 38.0%, GA 39.7%, AA 22.3%, respectively. After adjusting for potential confounding factors such as age, BMI, and menopause duration, A670G polymorphism was significantly associated with BMD at the lumbar spine, the femur neck and trochanter in osteopenic and osteoporotic patients, and G1377A polymorphism was significantly associated with BMD at lumbar spine and the femur neck in osteopenic patients. CONCLUSION: These findings suggest that Fas gene polymorphisms may be an important contributor to the variation of BMD among postmenopausal Korean women.

Enlarged leiomyoma after myolysis with radiofrequency / 대한산부인과학회지

Radiofrequency myolysis is newly developed method for management of myoma. Patients do not need to under general anesthesia neither admission. It decrease the size of myoma with preserve uterus. But the complication and side effect of radiofrequency myolysis had not been published. We have experienced two cases of increased size of the myoma with secondary degeneration after myolysis, so report that with a brief review of literatures.

A Clinical analysis of sonographic and operation findings of peritoneal inclusion cyst / 대한산부인과학회지

OBJECTIVE: The aim of this study is to review 4 years' experience of peritoneal inclusion cysts at Kangnam St. Mary's Hospital. METHODS: A retrospective study of 50 cases of peritoneal inclusion cyst between April 1, 1999 and June 30, 2003 was carried out and then clinical feature, preoperative diagnostic findings, operative findings and recurrence were compared with previous reports. RESULTS: The mean age of patients was 40.2 years old and most of them were premenopausal. The majority (94%) of patients had history of laparotomy and most (70.2%) of them had history of total hysterectomy. The values of tumor makers such as CA125 and CA19-9 were normal in most of the patients. The peritoneal inclusion cysts usually generate on the left side of the pelvic cavity, size of them were often (59.6%) 5 to 10 cm and they usually (65.4%) have septum in ultrasonographic findings. They probably had pelvic adhesion or ovarian cyst with them in operative findings. Most of the recurrence occurred after only adhesiolysis was done. CONCLUSION: Because peritoneal inclusion cyst is benign and uncommon disease, its preoperative diagnosis rate was low. In our experience of 50 cases of peritoneal inclusion cyst, most of the patients have history of laparotomy and were premenopausal. When the ultrasonographic findings of cyst are 5 cm to 10 cm in size and have septum, they are likely to be peritoneal inclusion cyst. Their recurrence might be more common when adhesiolysis only was performed.

Effects of magnesium sulfate on VEGF and Caspase-3 of HUVECs (Human umbilical vein endothelial cells) / 대한주산의학회잡지

OBJECTIVES: To determine the effects of magnesium sulfate on Caspase-3 and Vascular endothelial growth factor (VEGF) of human umbilical vein endothelial cells (HUVECs) under presence or absence of Tumor necrosis factor (TNF-alpha). METHODS: HUVECs were isolated from normal term umbilical cords and cultured in several physiolo gically relevant concentrations of magnesium sulfate with or without exposure of TNF-alpha. The concentrations of VEGF and caspase-3 were estimated by colorimetric assay and ELISA assay, respectively. RESULTS: The concentration of VEGF in HUVECs significantly increased in the presence of TNF-alpha compared with in the absence of TNF-alpha. However, the concentration of VEGF did not show significant difference in several concentrations of magnesium sulfate concentrations with addition of TNF-alpha and it showed the lowest concentration under 4 mM and 8 mM of magnesium sulfate concentration without addition of TNF-alpha. The concentration of caspase-3 in HUVECs did not show statistically significant difference with the addition of TNF-alpha and magnesium sulfate. CONCLUSION: TNF-alpha induce HUVECs to stimulate the VEGF, and magnesium sulfate might not have the effects on the expression of VEGF with addition of TNF-alpha However, the concentration for treatment of magnesium sulfate inhibits the expression of VEGF without addition of TNF-alpha. Magnesium sulfate might not have an effect of the expression of caspase-3 with or without addition of TNF-alpha.

Midtrimester Amniotic Fluid Levels and Each Ratio of Activn A, Inhibin A and B in Down's Syndrome and Other Complicated Pregnancies / 대한산부인과학회잡지

OBJECTIVE: To evaluate the amniotic fluid levels and each ratio of activin A, inhin A and B in Down's syndrome and other complicated pregnancies. METHODS: This study was performed in 71 women who had undergone a midtrimester amniocentesis with the clinical indications and whose pregnancy outcome was retrospectively determined. Ten Down's syndrome, 15 complicated pregnancies including, preeclamsia, gestational diabetesis mellitus, preterm labor, intrauterine growth restriction (IUGR), and 46 noncomplicated pregnancies with normal chromosome were included in this study. Amniotic fluid activin A, inhibin A and B were measured using enzyme linked immunosorbent assays (ELISA). Statistical analysis was performed with Mann-Whitney U test and regression analysis. RESULTS: There were significant positive correlation (r=0.277, p=0.011) between the ratio activin A/ inhibin B level and maternal age and significant positive correlation (r=0.261, p=0.015) between maternal age and the ratio inhibin A/inhibin B level. There were also significant positive correlation (r=0.202, p=0.045) between gestational weeks and inhibin A levels and significant positive correlation (r=0.474, p<0.001) between gestational weeks and inhibin B levels. Amniotic fluid inhibin A and inhibin B levels were significantly (p<0.05) decreased in Down's syndrome compared with the normal chromosomal groups but there was no difference in the ratio activin A/inhibin A and in the ratio activin A/inhibin B between these groups. The amniotic fluid levels of activin A, inhibins (A and B), each ratio of complicated pregnancies groups with normal chromosome was not significantly different from those of uncomplicated pregnancies with normal chromosome. CONCLUSION: This study revealed that amniotic inhibin levels were significantly decreased in Down's syndrome. But, activin A and each ratio were unchanged. The results suggest that activin A may be relatively decreased in each case of Down's syndrome.

The Effect of Gonadotropins and Cytokines on Human Luteal Cell Apoptosis / 대한산부인과학회잡지

OBJECTIVE: Our object is to evaluate the detailed mechanisms of support and regression of the human corpus luteum. METHODS: To investigate the regulation of luteal function by gonadotropins, cytokines, and prostaglandins, the frequency of apoptosis and expression of Fas, Fas-L, Bcl-2, Bax, p53, caspase-8 were examined in cultured human luteal cells after treatment with various doses of FSH (30, 100, or 300 ng/mL), LH (30, 100, or 300 ng/mL), TGFbeta1 (1, 10, or 100 ng/mL), TNFalpha (1, 10, or 100 ng/mL), or PGF2alpha (1, 10, or 100 ng/mL) for 24 h. Cells were tested for apoptosis by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-digoxigenin nick end labeling TUNEL) method and cell death detection ELISA. Immunostaning was performed using anti-Fas, Fas ligand, Bcl-2, Bax, and p53 antibodies. RESULTS: Incidence of apoptosis determined by TUNEL method in the group without treatment was 1.7+/-0.5% (0 h), 10.8+/-1.6% (24 h), and 12.9+/-1.2% (48 h), respectively. Spontaneous increase was significant at the latter time points. Significant suppression of incidence of apoptosis was observed with LH and TGFbeta1 (P<0.05). On the other hand, significant induction of incidence of apoptosis was observed with TNFalpha and PGF2alpha (P<0.05). Immunostaining revealed that p53 and Bax expressions after treatment with LH or TGFbeta1 were significantly lower than those without treatment. Bcl-2 and caspase-8 expressions were not significantly affected by any substance addition. Also we found that inductions of apoptosis by TNFalpha and PGF2alpha were not correlated with the expression of Fas, Fas ligand, Bcl-2, Bax, p53 and caspase-8. CONCLUSION: Our results suggest that LH and TGFbeta1 may be involved in the support of luteal function via suppression of apoptosis, and that TNFalpha and PGF2alpha may contribute to luteal regression via its induction in human corpus luteum during early luteal phase. Also, Fas, Fas-L, Bax and p53 may play roles in this apoptosis controlled by LH, and TGFbeta1.

The Changes of Cell Cycle Phase Fractions and Expression of p53 by the Treatment of Staurosporine in MCF-7 Cell Line / 대한산부인과학회잡지

OBJECTIVE: We investigated the effects on the cell cycle and p53 expression by the treatment of various concentrations of staurosporine to elucidate the molecular mechanism of staurosporine induced cell cycle arrest in MCF-7 cell line. METHODS: Various concentrations of staurosporine were treated in MCF-7 cells cultured with RPMI 1640 media. The harvested cells were fixed and permeabilized with 1% paraformaldehyde and absolute methanol. Then the cells were stained indirectly with anti-p53 primary antibody and FITC conjugated goat anti-mouse(GAM)-IgG secondary antibody. Sequentially DNA were stained with 0.1% RNase and PI solution. These stained cells were analyzed by the standard FACScan flow cytometer. The obtained results were analyzed further with WinList 3.0, and ModiFit LT software program. RESULTS: MCF-7 cells were arrested mostly in G1 phase of cell cycle at 5-10 nM of staurosporine, however, the cells were arrested in G2 phase at 20-100 nM of staurosporine. The expressions of p53 protein were higher in the MCF-7 cells treated with both concentrations of 10 nM and 100 nM of staurosporine compaired with the control cells. This suggests that the p53 may be involved in the mechanism of G1 and G2M arrest of cell cycle in MCF-7 cell. CONCLUSIONS: The points of arrest in cell cycle differred depending on the concentrations of staurosporine and these cell cycle arrests at G0G1 and G2M pahse were related with p53 protein expression. It suggested that these results could be extended to study for staurosporine to be usefull as a potential anti-tumor agent.

A Clinical Study of Ectopic Pregnancy during Recent 5 years / 대한산부인과학회잡지

OBJECTIVE: The incidence of ectopic pregnancy is increasing recently. To establish the quick and accurate diagnosis of ectopic pregnancy, we reviewed and analyzed the cases during recent 5 years. METHODS: Study datas was acquired from the 448 cases of the ectopic pregnancies who were managed and confirmed histopathologically at the our hospital from Jan. 1 1995 to Dec. 31 1999. RESULTS: The incidence of ectopic pregnancy was 1 in 20 deliveries. The most common age group was 26-30 years of age(34.4%). A previous history of abdominal or pelvic surgery was in 42.1% and tubal sterilization was in 14.1%, pelvic inflammatory disease was in 8.3%. Hemoglobin value over 10.0 gm/dl was in 79.2% and below 8.0 gm/dl in 4.5%. Initial systolic blood pressure risen above 100mmHg was in 79.0%. The most frequent intervals between last menstrual period and the onset of symptom was 6~8 weeks in 56.0%. The clinical manifestations were appeared in 78.8% from the last menstrual period to the next 4~8 weeks. In clinical symptoms, amenorrhea was encountered in 91.7%, lower abdominal pain in 88.3% and vaginal spotting in 47.3%. Ectopic gestation was implanted on the fallopian tube in 97.1%, the ovary in 1.1%, the cervix in 0.7%, the intraabdominal in 0.9% and 1 case was intramural pregnancy. Total amount of intraperitoneal hemorrhage between 100-999ml was in 59.5%, above 1,000ml in 37.5% and less than 100 ml in 3.0%. Of total 448 cases, laparotomy was done in 229 cases(51.0%) and pelvisopic surgery in 219 cases(49.0%). The mean hospital stay was 3.1 days in pelviscopy procedure and 5.0 days in laparotomy. The operative precedures were salpingectomy in 87.5%, salpingo-oophorectomy in 4.9%, cornual resection in 6.3%, ovarian wedge resection in 0.7%, and oophorectomy in 0.2%. There was no dead case in all ectopic pregnancy. Average admission period after laparoscopy was 3.1 day and after laparotomy was 5.0 day. CONCLUSION: The cognizing of increasing incidence of ectopic pregnancy, early diagnosis and early treatment is presumed to decrease mortality and increase fertility. The successful treatment and decision is a challenge to the clinician who must consider the patient's needs with appropriate tactfulness.

Effect of postmenopausal hormone replecement therapy on leptin level and body composition / 대한산부인과학회잡지

OBJECTIVE: To compare the women who use postmenopausal hormone replacement therapy to never user for the serum leptin level and degree of obesity, then evaluate the precausing factor of postmenopausal obesity. METHOD: We checked the serum leptin level, blood chemistry and body composition in three groups, two groups are postmenopause groups which is HRT user (n=125) and HRT never user (n=194), and the other is premenopause groups(n=82). We used SPSS and Excel for analyzed the difference between the groups. RESULT: BMR is decreased after menopause, body fat ratio, abdominal fat ratio, BMI, leptin, sugar, and cholesterol level are increased after menopause. There is no difference between the postmenopausal HRT group and non-HRT group in body fat composition, abdominal fat ratio, BMI,BMR,AMC and leptin levels. Serum sugar level shows positive correlation with the leptin level in pre and postmenopausal women after exclude the effect of body fat ratio. Serum estradiol and leptin level shows positive correlation.(correlation coefficient 0.68 in postmenopausal non-HRT group and 0.735 in postmenopausal HRT group). CONCLUSION: Serum estradiol and sugar level have some correlation with leptin level and leptin resistance in postmenopausal women, and decreased estradiol level caused obesity through increased leptin resistance.

Change of serum sex hormone levels in hysterectomized patients according to type of adnexal surgery / 대한산부인과학회잡지

OBJECTIVE: To describe the change of serum estradiol, follicul-stimulating hormone and testosterone after hysterectomy, and its difference according to the type of adnexal surgery in pre, and postmenopausal women. MATERIALS AND METHOD: Three hundred twenty four women presenting for hysterectomies for nononcologic reasons. We divide the women into four groups, who only hysterectomized, who with both adnexectomized, who with unilateral adnexectomized, and who with both salpingectomized. We collect the blood samples for serum estradiol and testosterone in preoperative day, 1 day after, 3 day after, 6 day after and 1 month after operation. And check FSH in a day before operation and 1month after operation. RESULT: Estradiol shows significant decrease in both adnectomy group compared to the unilateral adnexectomized and only hysterectomized. The both salpingectomized shows no difference with the both adnectomized. Testosterone shows no difference between groups in premenopausal women. In postmenopausal women, testosterone decreased 3 days after both adnexectomy compared to the only hysterectomized and the unilateral adnexectomized. The both salpingectomized shows no difference with the both adnexectomized. CONCLUSION: Testosterone decreases significantly in postmenopausal women after hysterectomy with both adnexectomy or both salpingectomy. So we think it was appropriate treatment to replace estrogen and testosterone in postmenopausal women who both adnexectomized or both salpingectomized.

Change of serum sex hormone levels in hysterectomized patients according to type of adnexal surgery / 대한산부인과학회잡지

OBJECTIVE: To describe the change of serum estradiol, follicul-stimulating hormone and testosterone after hysterectomy, and its difference according to the type of adnexal surgery in pre, and postmenopausal women. MATERIALS AND METHOD: Three hundred twenty four women presenting for hysterectomies for nononcologic reasons. We divide the women into four groups, who only hysterectomized, who with both adnexectomized, who with unilateral adnexectomized, and who with both salpingectomized. We collect the blood samples for serum estradiol and testosterone in preoperative day, 1 day after, 3 day after, 6 day after and 1 month after operation. And check FSH in a day before operation and 1month after operation. RESULT: Estradiol shows significant decrease in both adnectomy group compared to the unilateral adnexectomized and only hysterectomized. The both salpingectomized shows no difference with the both adnectomized. Testosterone shows no difference between groups in premenopausal women. In postmenopausal women, testosterone decreased 3 days after both adnexectomy compared to the only hysterectomized and the unilateral adnexectomized. The both salpingectomized shows no difference with the both adnexectomized. CONCLUSION: Testosterone decreases significantly in postmenopausal women after hysterectomy with both adnexectomy or both salpingectomy. So we think it was appropriate treatment to replace estrogen and testosterone in postmenopausal women who both adnexectomized or both salpingectomized.

A Case of Acardiac Parabiotic Twin / 대한산부인과학회잡지

Acardia is a very rare congenital anomaly occurring in less than 1 in 35,000 deliveries. Acardiac parabiotic twin has been reported only in multiple, monochronic pregnancies. This anomalous fetus is sustained in utero by parasitic anastomoses to the circulation of its usually normal co-twin and is therefore not compatible with extrauterine survival. A case of an acardiac parabiotic twin is described, and the literature concerning the incidence, classification and etiology of acardiac is reviewed.

Alterations of HLA Class I and II Antigen Expressions in Borderline, Invasive and Metastatic Ovarian Cancers / 대한암학회지

PURPOSE: The relationship between altered HLA expressions and ovarian carcinogenesis is not fully elucidated. MATERIALS AND METHODS: Histological evaluation comprised 20 serous adenocarcinoma, 5 borderline serous malignancy, 10 mucinous adenocarcinoma, 15 borderline mucinous malignancy. We used monoclonal antibodys to HLA class I beta2-microglobulin, class I B/C and class II heavy chain. RESULTS: There was no statistical difference in HLA expressions between borderline serous malignancy and normal ovarian tissue. In serous adenocarcinoma, beta2-microglobulin, B/C and class II heavy chain expressions were down-regulated. In metastatic cancer, B/C and class II ex pressions were also down-regulated. But the HLA expression of tumor or normal stromal tissue in primary tumor, were not down-regulated compared with the tissues in metastasis. In borderline mucinous malignancy, class II expressions were down-regulated. In mucinous adenocarcinoma, beta2-microglobulin, B/C and class II expressions were down-regulated. In metastatic ovarian cancer, B/C and class II expressions were down-regulated. But, in borderline malignancy, the result failed to reach statistical significance except class II of borderline mucinous malignancy. CONCLUSION: Loss of HLA class I and II molecules in invasive ovarian cancers raises the possibility that this could be a mechanism for tumor cells to have invasiveness.

A Case of Wernicke's Encephalopathy due to Hyperemesis gravidarum / 대한산부인과학회잡지

Hyperemesis gravidarum is a complication defined as nausea and vomiting during early pregnancy. Wernickes encephalopathy is an illness of acute onset characterized by mental disturbance, paralysis of eye movements, and ataxia of gait cause by thiamine deficiency. We recently experienced a case of Wernickes encephalopalhy due to hyperemesis gravidarum, which is treated by administration of thiamine even though outcome of serious healthy problem to both mother and fetus, and reported it with a brief review of the literature.

Comparison of Cost Efficacy of Ectopic Pregnancy Management / 대한산부인과학회잡지

The incidence of ectpic pregnancy has increased rapidly over the past decade. Currently, the complications of this disorder make it one of the leading causes of maternal mortality and morbidity. In the late 1980s, reports of successful use of methotrexate (MTX) as a non surgical treatment for ectopic pregnancy (EP) also began to appear in the literature. With MTX emerging as a possible alternative management of selected women with an EP, an analysis of its comparative costs is now needed. We examined retrospectively the costs associated with management of EP in our hospital. We selected 30 women with EPand divided them into two groups of MTX treated group (n= l0) and surgically treated group (n=20). There were no statistically significant differences in the doctors fee, room, charge and cost of laboratory and radiologic examination between two groups. But We found significant reduction in cost with regard to pharmacy, injection, procedure and operation of MTX treated group compared to surgically treated group (p<0.05). Consequently the use of MTX for EP should still be considered investigational; we recognize and agree that the evolution of this remedial option should be based primarily on its ability to decrease morbidity and mortality rather than on its ability to reduce costs. If medical treatment proves to be effective, the potential cost savings demonstrated in this report will become an important influential factor on selecting alternative remedy.