The Clinical Features of Idiopathic Thrombocytopenic Purpura in Pregnancy and Prediction of Neonatal Thrombocytopenia / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to expect the possibility of developing fetal thrombocytopenia by observation of the clinical features of pregnant women with ITP and their neonates, and to know the effect of steroid and IVIG therapy. METHODS: The patient group was 21 cases of pregnancies with ITP diagnosed by Bone marrow biopsy or suspective to have ITP due to thrombocytopenia (150 K/micro L) not complicated by sepsis, preeclampsia or massive bleeding resulting DIC, who were admitted and delivered at Dongsan Medical Center, Keimyung University from Jul. 1998 to Jun. 2002. The study was performed retrospectively. We defined severe thrombocytopenia as less than 70 K/micro L and treated them with Prednisolone or IVIG during pregnancy and Platelet concentrate in some perinatal condition. On admission, we performed a history taking about splenectomy etc., antiplatelet antibody test and serial follow up of CBC, coagulation test during perinatal period. We used Fisher's exact test to detect statistical significance between clinical features of pregnancy women with ITP and severe neonatal thrombocytopenia and concluded to be significant if p-value was less than 0.05. RESULTS: The delivery mode of pregnancies with ITP was Cesarean section for 9 cases and vaginal delivery for 12 cases. The decision was purely dependant on obstetric indication. Because there was no significant bleeding during prenatal period even among the women with severe thrombocytopenia, they were treated with steroid in 8 cases followed by IVIG in 1 case, only IVIG in 1 case under no transfusion of Platelet concentrate. Platelet count was not normalized completely but increased over 100% in 7 cases and there was no response in only 1 case. Soon after delivery, neonatal thrombocytopenia was seen in 2 cases (9.5%). There was no ecchimosis or intracranial hemorrhage in spite of vaginal delivery in both cases. CONCLUSION: There were no prospective factors to predict the relationship between the clinical features of pregnant women with ITP and fetal thrombocytopenia. Most of the cases in which steroid therapy was done did not show neonatal thrombocytopenia but there was no statistical significance. There needs to be further study with much more cases.

Surgical Experience with Intrahepatic Duct Stones

BACKGROUND: Stones in the biliary tree situated proximal to the origin of the common hepatic duct are considered intrahepatic duct stones. This condition causes serious problems, including cholangitis, obstructive jaundice and liver abscess. METHODS: This study was a clinical review of the results from 178 patients with intrahepatic stones who were surgically treated at the Department of Surgery, Gyeongsang National University Hospital from January 1991 to December 1997. RESULTS: The sex ratio of males to females was 1:2.1, and the most prevalent age group was the 6th decade. Common symptoms and signs were RUQ pain (83.2%) and tenderness (64.7%). Common laboratory findings were elevated alkaline phosphatase (56.6%), elevated serum GOT (47.4%), leukocytosis (44.5%) and hyperbilirubinemia (36.4%). C. sinensis was identified in 22 (12.4%) of the operation cases. Intrahepatic stones were located in the left hepatic duct in 87 cases (48.9%), the right duct in 27 cases (15.2%), and both intrahepatic ducts in 64 cases (35.9%). A partial hepatectomy was performed in 94 cases (52.8%); other procedures without a hepatectomy were performed in 84 cases (47.2%). The remaining stones were noted in 57 (32%) of the operation cases. Among them, 39 cases (68%) were in the non-hepatic resection group, and 18 cases (32%) were in the hepatic resection group. The postoperative complication rate in hepatic resection group (29.8%) was higher than that in the non-hepatic resection group (15.5%). The most common complication was wound infection. The operative mortality was 2.1% in the hepatic resection group and 2.4% in the non-hepatic resection group. The follow-up study showed that 146 cases (82%) were graded as a good result, 7 cases (3.9%) as fair, and 25 cases (14%) as poor and that the relative incidence of good results in the hepatic resection group(88.3%) was higher than that in the non-hepatic resection group (75%). CONCLUSIONS: We conclude that a hepatic resection, rather than a biliary bypass procedure alone, is satisfactory as an initial treatment for hepatolithiasis.