Perinatal outcomes in hyperemesis gravidarum patients as compared to normal pregnancy / 대한산부인과학회잡지

OBJECTIVE: To study perinatal outcomes in hyperemesis gravidarum (HG) patients as compared to normal pregnancy. METHODS: We performed retrospective analysis of pregnancy records of obstetric admission during 9-years period (between 1995 and 2003). We identified 77 women who admitted for control of HG after diagnosed as HG and delivered during the study period. Women treated as out-patients for hyperemesis and delivered at other hospital were excluded. Multiple gestation and stillbirth were also excluded from analysis. Subjects were stratified into groups of mild and severe HG according to the presence of at least one of the following criteria: ketonuria, increased hematocrit, and/or abnormal electrolytes. All patients without HG on whom records were available and who delivered during the study period were included as controls. Student T-test, chi square test, Kruskal-Wallis test and Mann-Whitney's U test were used. RESULTS: Among 77 women, 31 patients were diagnosed as having mild HG and 46 patients as having severe; 41205 patients were defined as controls. Maternal age, gravidity, maternal weight gain from preconception to delivery, maternal anemia were not significantly different between hyperemesis patients and control group. Mean birth weight, mean gestational age, neonatal sex ratio, Apgar score, delivery route were not significantly different. Pregnancy outcome variables and maternal characteristics for mild, severe HG and control group were also similar. CONCLUSION: Women with hyperemesis have similar maternal characteristics to the general population and have similar pregnancy outcomes. And there were no significantly difference between mild and severe hyperemesis patients.

A Case of Prenatally Diagnosed Congenital Cystic Adenomatoid Malformation of the Lung / 대한산부인과학회잡지

Congenital cystic adenomatoid malformation of the lung (CCAM) is a rare benign pulmonary lesion characterized by abnormal overgrowth of the fetal bronchiole. The prenatal diagnosis of CCAM is important because the prognosis of the CCAM is depend on the type, bilaterality, and other associated abnormalities, which can be detected by prenatal ultrasonography. We experienced a case of CCAM that was detected by prenatal ultrasonography and report the case with a review of several related literatures.

Three Cases of Conservative Management of Ectopic Pregnancy Implanting in The Previous Cesarean Section Scar / 대한산부인과학회잡지

Ectopic pregnancy developing in the previous cesarean section scar is the rarest forms of ectopic pregnancy and very dangerous because of the risk of uterine rupture and hemorrhage. Hysterectomy was usually done in the management but, conservative treatment is desirable for young women who want to maintain her fertility. We present three cases of ectopic pregnancy developing in the previous cesarean section scar in which successfully treated with conservative management.

Acute gastroparesis in Duchenne's muscular dystrophy

Duchenne's muscular dystrophy (DMD) is an X-linked recessive disease. Clinical descriptions of the disorder focus principally on skeletal muscle degeneration. Another manifestation, which involves the gastrointestinal tract, may be fatal. But its prevalence remains undefined. We report here a case of acute gastroparesis associated with Duchenne's muscular dystrophy. In our case, the patient's symptoms were improved by prokinetic agents and timely decompression in life-threatening acute gastric dilatation.

The Significance of Erosive Prepyloric Change or Helicobacter pylori Infection in Patients with Functional Dyspepsia / 대한소화기내시경학회지

BACKGROUND/AIMS: The etiology of funetional dyspepsia remains unknown, with inconclusive evidence for several factors, including abnormal gastroduodenal motility, personal traits, infection of Helicobactor pylori (H. pylori) and erosive prepyloric change (EPC). Therefore, we evaluated the relation between H. pylori or EPC and gastric emptying in patients with functional dyspepsia. METHODS: We performed an ultrasonographic gastric emptying test in 18 patients with functional dyspepsia comparing 6 healthy volunteers as the control. The presence of BPC in the stomah was diagnosed by esophogogastroduodenoscopy, and the Helicobacter pylori infection was evaluated using a rapid urease test. RESULTS: The erosive prepyloric change in the antrum was revealed in five patients with dyspepsia. Amang the EPC (+), EPC (-) with dyspepsia, and healthy volunteers, the parameters of the ultrasonographic gastric emptying test and subjective symptom scores did not reveal significant differences. Among the H. pylori (+), H. pylori (-) patients with dyspepsia and healthy volunteers, the parameters of the ultrasonographic gastric emptying test and subjective symptom scores did not reveal significant differences. CONCLUSIONS: No association was found between dyspeptic symtoms and the presence of H. pylori infection or EPC. The two factors, Helicobacter pylori infection and erosive prepyloric change, did not affect the gastric motility in functional dyspepsia.

The Effect of Regional Anesthesia for Premedication of Esophagogastroduodenoscopy on Swallowing Motor Function / 대한소화기내시경학회지

Regianal anesthesia applied by means of a gargle provides satisfactory analgesia for premedication of esophagogastroduodenoscopy (EGD). To access the influence of 2% lidocaine hydrochloride after regional anesthesia on oropharyngeal components of swal- lowing, we used the videofluorographic swallowing study for the evaluation of pharyngeal architecture, time of pharyngeal barium passage, and the submental surface EMG(S-EMG) for the evaluation of functional changes in skeletal muscle. Measurements were made in 10 healthy volunteers without any oropharyngeal problems. There was no liquid aspiration symptoms or signs before and after regional anesthesia application. Also, there were no structural changes in pharyngeal swallowing motion and no significant prolongation of pharyngeal barium transit time. But regional anesthesia affected the eletro-activities in swallowing skeletal muscle, i.e, the swallowing durations, peak amplitudes of peristaltic wave, and area under curves in S-EMG, which returned to pre-anesthesia levels in 60 minute's time. Therefore, it will be recommended to avoid meal within 60 minute's after regional anesthesia for EGD.

A case of flutamide-induced acute cholestatic hepatitis: a case report

Flutamide, an oral nonsteroidal, antiandrogenic, anilid compound which inhibits the uptake and binding of androgens to nuclear receptors in the prostate, is used with or without LH-RH analogues for treatment of patients with metastatic carcinoma of the prostate. Clinically significant hepatotoxicities such as toxic hepatitis, cholestatic hepatitis, hepatic failure, and even death have rarely been reported in the English literature, but no case has been reported in Korea. A 75-year-old man with metastatic carcinoma of the prostate had taken flutamide (750 mg/day) for 7 months and suddenly developed jaundice and general weakness. The findings of blood chemistries were compatible with cholestatic hepatitis, but ultrasonography, viral marker and auto-antibody studies did not reveal any attributable causes. Histologic examination of a sono-guided liver biopsy only disclosed centrilobular cholestasis, nuclear glycogenosis and mild sinusoidal lymphocytic infiltration. Discontinuation of flutamide resulted in an almost full recovery of the patient's liver function in 2 months. We, herein, report a case of flutamide-induced acute choestatic hepatitis with a brief review of the literature.

Obstructive jaundice due to compression of the common hepatic duct by right hepatic artery: a case associated with the absence of the lateral segment of the left hepatic lobe

Various benign and malignant conditions can cause biliary obstruction. We present a rare case of obstructive jaundice due to the compression of the common hepatic duct by the anteriorly overriding right hepatic artery. This case was also associated with the absence of the lateral segment of the left hepatic lobe. The patient was a 39 year-old housewife with a 4-day history of jaundice and occasional febrile sensation. An abdominal computed tomography showed absence of the lateral segment of the left hepatic lobe and a percutaneous transhepatic cholangiography showed a band-like filling defect of 2 mm width at the level of the upper common hepatic duct. The anteriorly overriding right hepatic artery compressing the common hepatic duct and the absence of the lateral segment of the left hepatic lobe were confirmed by operation.

A Case of SVC Obstruction in Behcet's Syndrome

The clinical triad of relapsing iritis, ulcers of the mouth and genitalia was first described in 1939 by Hulusi Behcet. This entity, originally confined to the above triad of symptoms appears to be systemic disease manifested by skin lesion, thrombophlebitis, neurologic, cardiovascular or visceral symptoms. The vascular involvement in Behcet's syndrome has been reported since Mischima first described a case in 1961, four types of vascular lesion are freuqnetly observed most commonly on the inferior or superior vena cava. Treatments consist of anticoagulation and administering oral steroids. We report a case of SVC obstruction in 36 years old female patient with Behcet's syndrome.