Changes of Interleukin-6, C-reactive Protein, and Lipid Peroxide Levels in the Umbilical Venous Plasma of Preterm Birth with or without Chorioamnionitis / 대한주산의학회잡지

OBJECTIVE:To investigate interleukin-6 (IL-6), C-reactive protein (CRP), and lipid peroxide levels in the umbilical venous plasma of preterm birth with or without histologic chorioamnionitis and to evaluate their roles in the pathophysiology in preterm labor and perinatal outcome. METHODS:This cohort study included 66 cases of preterm delivery with preterm labor and intact membranes (PTL) (n=39) and preterm premature rupture of membranes (PPROM) (n=27). The umbilical venous blood samples were collected at the time of delivery. IL-6, CRP, and lipid peroxide levels were measured by ELISA Kit, latex agglutination assay, and thiobarbituric acid reaction. Histologic chorioamnionitis was diagnosed by the presence of neutrophil infiltration into the subamnionic space. RESULTS:The prevalence of histologic chorioamnionitis was significantly higher in PPROM (59.3 %, 16/27) than in PTL (20.5%, 8/39). IL-6, CRP, and lipid peroxide levels in the umbilical venous plasma of histologic chorioamnionitis were significantly higher than those without histologic chorioamnionitis. IL-6, CRP, and lipid peroxide levels in the umbilical venous plasma of PTL with histologic chorioamnionitis were significantly higher than those of PTL without histologic chorioamnionitis. CRP levels in the umbilical venous plasma of PPROM with histologic chorioamnionitis were significantly higher than those of PPROM without histologic chorioamnionitis. Three suspected neonatal sepsis patients have increased IL-6 and lipid peroxide levels in the umbilical venous plasma compared with patients without neonatal sepsis. IL-6 levels in the umbilical venous plasma of histologic funisitis were significantly higher than those without funisitis. CONCLUSION:Preterm birth with chorioamnionitis is associated with an increased level of IL-6, CRP, and lipid peroxide in umbilical venous blood. Preterm birth with chorioamnionitis may have an effect on perinatal outcome.

Chronic Hypoxia Alters Vasoconstrictive Responses of Femoral Artery in the Fetal Sheep

The purpose of this study was to determine if mild hypoxia alters the responsiveness to vasoactive agents in the renal and the femoral arteries in the fetal sheep. Ten pregnant sheep were operated under halothane anesthesia at 116 to 124 days' gestation. A maternal tracheal catheter was placed for infusing compressed air (control group, n=5) or nitrogen (hypoxia group, n=5) starting on post operative day 6 and maintained for 5 days. Femoral and renal arteries were harvested from the fetus to study the constriction response to phenylephrine (PE 10(-9) to 10(-5) mol/L). To determine the involvement of nitric oxide as a modulator of vessel constriction, N-nitro-Larginine methyl ester (L-NAME) was used at a concentration of 10(-4) mol/L in parallel chambers. In the hypoxia group, maternal Pao2 significantly decreased from a base-line of 110.4 +/-1.4 to 80.5 +/-1.6 (mmHg, p <0.01), fetal Pao2 significantly decreased from a baseline of 20.9 +/-0.3 to 15.5 +/-0.1 (mmHg, p <0.01). Hypoxia was associated with a significant increase in PE maximal response in the absence (184.5 +/-6.6 vs. 146.2 +/-4.3) and presence (166.9 +/-6.3 vs. 145.0 +/-4.5) of L-NAME, and a decrease in EC50 in the absence (6.0 +/-1.1 vs. 27.0 +/-4.1) of L-NAME of femoral arteries. However, there were no significant differences in PE maximal response and EC50 in the absence and presence of L-NAME of renal arteries. We concluded that mild chronic hypoxia seems to increase the fetal femoral artery response to PE, but not in the fetal renal artery. This observation is consistent with a redistribution of cardiac output away from the carcass.

Prenatal Diagnosis of Congenital Rubella Using Percutaneous Umbilical Blood Sampling in Pregnant Women with Rubella Infection / 대한산부인과학회잡지

OBJECTIVE: To evaluate the usefulness of percutaneous umbilical blood sampling (PUBS) and prevalence of fetal infection in the pregnant women with suspicious fetal rubella infection. METHODS: Between June 1996 and May 2002 in Chonnam National University Hospital, the rubella specific IgG, IgM antibody and RT-PCR were checked in fetal blood obtained from 31 pregnant women with high risk of rubella infection. Eighteen women (58.1%) had rubella specific IgM, 11 women (35.5%) high titer of rubella specific IgG, and 2 women had a history of recent rubella vaccination within 3 months. RESULTS: PUBS was performed in all cases, successful in 27 cases (87.1%) and failed in 4 cases (12.9%). Cardiocentesis was performed in failed cases. Performing the PUBS, fetal bradycardia was observed in 7 cases (25.9%), fetal tachycardia in 1 case (14.8%), and preterm labor in 2 cases (7.4%). Performing cardiocentesis, fetal bradycardia was observed in 1 case (25.0%), fetal tachycardia in 2 cases (50.0%), and preterm labor in 1 case (25.0%). There was no fetal death. All samples of fetal blood were positive for rubella specific IgG but rubella specific IgM was detected in only 1 case. RT-PCR was negative in all cases. CONCLUSION: Fetal blood sampling is relatively safe and a great precaution is necessary before termination of pregnancy with suspicious fetal rubella infection and without typical maternal rash to reduce unnecessary termination of pregnancy. Several tests such as rubella specific IgM and PCR from placental villi, amniotic fluid, and fetal blood should be considered before termination of pregnancy.

Ovarian Malignant Mixed Mullerian Tumor Managed with Neoadjuvant Chemotherapy and Cytoreductive Surgery / 대한산부인과학회잡지

Malignant mixed Mullerian tumor(MMMT) of the ovary is very uncommon neoplasm consisting of both a sarcomatous and carcinomatous component. These tumors usually present in an advanced stage and are characterized by rapid growth and poor survival and appropriate treatment remained controversial. The patients with advanced stage ovarian cancer could only benefit from an optimal surgical debulking. However, the optimal cytoreductive surgery may often be difficult to achieve due to the initial extent of the disease. Thus primary surgery for this subset of patients may be questionable. So, we tried neoadjuvant Taxol and/or cis-platinum combined chemotherapy as primary treatment. At the end of neoadjuvant chemotherapy, the patient showed markedly decrease of serum CA 125 level(from 210 U/ml to 59 U/ml) and optimal cytoreductive surgery was performed. After surgery, adjuvant chemotherapy was administered and the serum CA 125 level decreased to the normal range. This case shows our experience of neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy in patient with primarily unresectable ovarian malignant mixed Mullerian tumor(MMMT).

Ovarian Malignant Mixed Mullerian Tumor Managed with Neoadjuvant Chemotherapy and Cytoreductive Surgery / 대한산부인과학회잡지

Malignant mixed Mullerian tumor(MMMT) of the ovary is very uncommon neoplasm consisting of both a sarcomatous and carcinomatous component. These tumors usually present in an advanced stage and are characterized by rapid growth and poor survival and appropriate treatment remained controversial. The patients with advanced stage ovarian cancer could only benefit from an optimal surgical debulking. However, the optimal cytoreductive surgery may often be difficult to achieve due to the initial extent of the disease. Thus primary surgery for this subset of patients may be questionable. So, we tried neoadjuvant Taxol and/or cis-platinum combined chemotherapy as primary treatment. At the end of neoadjuvant chemotherapy, the patient showed markedly decrease of serum CA 125 level(from 210 U/ml to 59 U/ml) and optimal cytoreductive surgery was performed. After surgery, adjuvant chemotherapy was administered and the serum CA 125 level decreased to the normal range. This case shows our experience of neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy in patient with primarily unresectable ovarian malignant mixed Mullerian tumor(MMMT).

Clinical Significance of Multiple Serum Tumor Markers in the Detection of Ovarian Carcinoma / 대한산부인과학회잡지

OBJECTIVE: This study evaluated the possible role of 2 additional tumor markers to CA125 in discriminating between benign and malignant ovarian tumors. METHODS: Serum samples from 1,346 patients were obtained on seven days before operation. All patients underwent surgery for ovarian tumors. Serum levels of 3 tumor markers were compared to histology. Concentrations of tumor markers (CA125, CA72-4, CA19-9) were detected by enzyme immuno- or immunoradiometric assays. Normal range of these markers was defined as CA125

Oral Nicardipine Versus Intravenous Ritodrine for the Treatment of Preterm Labor / 대한산부인과학회잡지

OBJECTIVE: This study was conducted to compare the efficacy and safety of oral nicardipine in acute therapy for preterm labor with those of parenteral ritodrine hydrochloride. METHODS: Patients between 24 and 34 weeks' gestation with documented preterm labor were randomly assigned to receive oral nicardipine (n=31) or intravenous ritodrine (n=32) as initial tocolytic therapy. Patients in the nicardipine group received a 40-mg loading dose and then 20 mg every 2 hours as needed to stop contractions (total 80 mg). Patients in the ritodrine group received a 0.05 mg/min as initial dose. The dose was increased at 15-minute intervals until uterine contractions were inhibited or side effects became intolerable. The maximum recommended dose was 0.35 mg/min. Patients could be switched to another tocolytic regimen if they continued to have contractions after 6 hours of therapy. The main outcome variables examined were failure of tocolysis, time to uterine contractions equal or less than 5 times per hour, time to uterine quiescence, time gained in utero, and frequency of adverse medication effects. RESULTS: There were no significant differences in maternal demographic characteristics between the groups. Successful tocolysis, defined as cessation of uterine contractons less than 6 hours from initial dose, was observed in 58.1% in the nicardipine group and 65.6% in the ritodrine group (P=.544). Among patients with successful tocolysis who responded with uterine quiescence within 6 hours, there was no significant difference in the time to uterine quiescence in the ritodrine group (P=.087). Time to uterine contractions equal or less than 5 times per hour from initial treatment showed no significant difference between the two groups with successful tocolysis (P=.097). The patients in the ritodrine hydrochloride group had more adverse side effects, mainly maternal tachycardia (P=.013) and nausea and/or vomiting (P=.006). CONCLUSION: Oral nicardipine was effective, safe, and well-tolerated tocolytic agent. Patients who received ritodrine hydrochloride were more likely to have adverse medication effects.

Ovarian Tumors Associated with Pregnancy / 대한주산의학회잡지

No abstract available.

A Clinical Observation on Tumors of the Genitourinary Tract / 대한비뇨기과학회지

A clinical observation was made on 282 patients with tumors of the genitourinary tract during the period from Jan. 1978 to Mar. 1982. The results were as follows: 1. 282 of the 1457 inpatients (19.35%) were the patients with tumor of the genitourinary tract. Men with thetumor were predominated (male to female: 17.8:1). 2. Prostate was the most commonly involved organ (66.8%) and the bladder. kidney, ureter, penis were followed. 3. Age was ranged from 8 months to 84 years, showing the highest incidence in the 8th decade (39.3%) andover 50 years old were 89.3%. 4. Urinary retention was the most common symptom (34.7%) and dysuria, gross hematuria, palpable mass were followed. 5. On histologic examination, begin prostatic hyperplasia was the most common (66.9%) and transitional cell carcinoma of the bladder, adenocarcinoma of the prostate, renal cell carcinoma. squamous cell carcinoma ofthe penis were followed. 6. 223 of the 282 patients with tumor (79.1%) were performed various type of operation. Transurethral surgerywas the most commonly performed (46.2%).

A Case of Adrenal Adenoma / 대한비뇨기과학회지

Adrenoal adenomas are relatively rare tumor in retroperi toneum, most cases are nonsteroid-producing and 1-5 cm in diameter. Herein a case of large adrenal adenoma is presented with a brief review of literatures.

A Case of Simple Unilateral Renal Ectopia / 대한비뇨기과학회지

A case of right simple unilateral renal ectopia with left malrotated kidney in 26 years old female is presented with a brief review of literature. Right ectopic kidney was located between 4th and 5th lumber vertebra Numerous aberrant vessels of ectopic kidney disclosed during nephroureterectomy.