Comparison of blood methotrexate level according to the route of administration in non-surgical treatment of ectopic pregnancy / 대한산부인과학회지

OBJECTIVE: This study was performed to compare the pharmacokinetics of methotrexate (MTX) in unruptured ectopic pregnancy according to the injection route. METHODS: Between May 2005 and August 2009, thirty-five patients of unruptured ectopic pregnancy in Chungbuk National University Hospital were treated medically either by intramuscular (IM) or intraamniotic (IA) injection of MTX according to the presence of fetal heart beat. Serum concentration of MTX was measured by fluorescent immunoassay using the blood samples withdrawn serially after its injection. RESULTS: The peak plasma MTX level was achieved at the 30-minute after injection sample in both groups. The mean peak plasma level of MTX in IM group was significantly higher than that of IA in 60-minute (2.296+/-0.64 umol/L vs 1.535+/-0.31 umol/L; p<0.006), 90-minute (1.9+/-0.51 umol/L vs 1.225+/-0.21 umol/L; p<0.002), and 240-minute (1.443+/-0.33 umol/L vs 1.077+/-0.18 umol/L; p<0.011) samples. The mean pretreatment plasma beta-hCG level was significantly higher in IA group, both tubal pregnancy (48,405+/-37,811.7 IU/L vs 18,452.05+/-19,205.34 IU/L; p<0.007) and cervical pregnancy (94,574.2+/-45,037.1 IU/L vs 42,446+/-34,778.12 IU/L; p<0.037), than those of IM group. But neither plasma MTX level nor pretreatment beta-hCG level were related to the treatment outcome. CONCLUSION: The plasma level of MTX increased rapidly in both IM and IA groups; the peak level reached at 30 minutes, and decreased to less than 1 umol/L after 240 minutes. Moreover, it was higher in IM group than IA group. Nevertheless, IA injection may be useful in patients who had high beta-hCG level or fetal heart beat, which are not usually indicated to medical treatment.

The safety of cesarean delivery through transplacental incision in anterior placenta previa / 대한산부인과학회지

OBJECTIVE: This study was to evaluate the safety of cesarean delivery through transplacental incision in anterior placenta previa and its effect on mother and neonate. METHODS: We examined 74 cases of placenta previa retrospectively who underwent cesarean section from May 2006 to December 2009, in Chungbuk National University Hospital. They were divided into two groups according to the placental incision. Transplacental incision was made in all cases of anterior placenta previa. We compared postoperative maternal hemoglobin change, neonatal hemoglobin and hematocrit, intra and/or postoperative transfusion volume, neonatal intensive care unit (NICU) admission days between the two groups. RESULTS: There were no differences in maternal characteristics, hemoglobin changes, transfusion volume between the two groups. Nor the neonatal hemoglobin and hematocrit level, Apgar score and admission days were different. There was no neonatal acidosis below pH 7.20. CONCLUSION: The cesarean delivery through transplacental incision in anterior placenta previa seems to be safe because it did not increase maternal and fetal blood loss nor NICU admission days.

Ceramic-on-Ceramic Bearing Total Hip Arthroplasty in Young Patients with Osteonecrosis of Femoral Head / 대한정형외과학회잡지

PURPOSE: To evaluate the short-term clinical and radiographic results associated with use of the ceramicon-ceramic articulation uncemented total hip arthroplasty (THA) in patients less than fifty years old with osteonecrosis of femoral head. MATERIALS AND METHODS: Sixty-eight THAs with use of the ceramic-on-ceramic articulation were performed in fifty-nine patients who were younger than fifty years old with the implantation of an uncemented plasma coated Plasma cup and Bicontact stem. All patients were available for complete clinical and radiographic analysis after a mean duration of a follow-up of 31.6 months (range; 24-50 months). The average age of the patients at the index operation was 39.4 years (range; 16-49 years). Preoperative diagnosis was osteonecrosis of femoral head in all hips. The causative factors were idiopathic in twenty-one hips; alcohol abuse in twenty-eight hips, steroid in eleven hips, and posttraumatic in eight hips. Clinical evaluation was done by Harris Hip score (HHS). Radiographic evaluation was done in terms of stability of components and prevalence of osteolysis. RESULTS: The mean preoperative HHS of 61 points improved to 95 points at the time of the final follow-up. Excellent results were found in 57 hips (84%), good results were 11 hips (16%). No acetabular or femoral components were loosened radiographically. There was no evidence of osteolysis. There were two postoperative dislocation, one intraoperative femoral fissuring, and one transient sciatic nerve palsy. CONCLUSION: Short-term clinical and radiographic results associated with use of the ceramic-on-ceramic articulation uncemented THA in patients less than fifty years old with osteonecrosis of femoral head were excellent. However, longer-term follow up is needed.

Arthroscopic Analysis of Lateral Meniscal Variants

PURPOSE: We classified lateral meniscal variants according to types and tear pattern, and compared MR images with arthroscopic findings. MATERIALS AND METHODS: We reviewed 164 consecutive cases (158 patients) of arthroscopic examination for lateral meniscal variants during last ten years. We classified lateral meniscal variants into four types of arthroscopic appearance by modified Watanabe 's classification, and into six tear patterns by modifying O 'Connor 's classification. RESULTS: Regarding four types, 131 cases were complete; 25, incomplete; 4, Wrisberg, and 4, ringshaped. Six tear patterns were as follows: 33 simple horizontal, 21 complicated horizontal, 37 longitudinal, 27 central, 14 complex, and 12 radial. Among 31 cases with central tear or ring-shaped meniscus, we reviewed 25 MR images. Fifteen (60%) MRI 's were interpreted as displaced meniscal tear(bucket handle tear), 7 (28%) as discoid meniscal tear, and other 3 (12%) as simple tear: misinterpretation rate was 72%. Twelve patients (13 cases, 7.9%) had osteochondritis dissecans of lateral femoral condyle: nine patients (10 cases) of them had central tear, two patients (2 cases) had simple horizontal tear, and one patient (1 case) had ring-shaped meniscus. CONCLUSION: MR findings of ring-shaped meniscus or central tear should be differentiated from displaced meniscal tear(bucket-handle tear) considering history of trauma.

B-cell Prolymphocytic Leukemia Involving Entire Female Genital Tract: A case report

Prolymphocytic leukemia is a chronic lymphoproliferative disorder, characterized by prominent splenomegaly, prolymphocytes accounting for more than 55% of circulating lymphocytes, no significant peripheral lymphadenopathy and short term survival with terminal fatal multi-organ failure. We report a case of B-cell prolymphocytic leukemia in a 57-year-old woman who presented with easy bruising and arthritis for 1 year and low abdominal pain for 2 months. Physical examination revealed gingival hypertrophy and mild splenomegaly. On peripheral blood smears the leukocytes were markedly increased in number due to leukemic cells that count about 62% of leukocytes. The bone marrow aspiration smear and biopsy revealed diffuse infiltration of medium to large prolymphocytes having moderate amount of basophilic cytoplasm, round to oval nuclei with coarse chromatin, and prominent nucleoli. Abdominal pain aggravated despite chemotherapy, and pelvic computed tomography (CT) revealed a huge lobular pelvic mass which had increased in size on the follow-up CT. Total hysterectomy with bilateral adnexectomy was performed. Microscopic findings included massive infiltration of prolymphocytic cells in the uterus, upper vaginal wall, bilateral ovaries, and bilateral mesosalpinges. On immunohistochemistry, the leukemic cells showed B cell gamma light chain phenotype.

Solitary myeloma with massive extracellular crystalline structures: a case report

We describe a case of solitary myeloma showing cystic change filled with massive crystalline structures in a 54-year-old woman. A bone X-ray showed a solitary cystic osteolytic lesion in the right iliac bone. Serum and urine protein electrophoresis showed no demonstrable M-protein, and bone-marrow aspirates did not show any myeloma cells. Histologic examination of the tumor revealed aggregation of plasma cells with massive extracellular infiltration of the rhomboid-shaped crystalline structures. In immunoperoxidase staining, both these crystalline structures and the cytoplasms of the myeloma cells demonstrated a positive reaction for lambda light chain. By electron microscope, the large extracellular crystalline structures were observed, and we found unique rhomboid or rectangular-shaped crystalline structures in the cytoplasms of the myeloma cells.

Contents of Lead, Cadmium and Zinc in Bone, Muscle and Fin of Carassius carassius from Middle Stream of Nakdong River, Korea / 예방의학회지

In order to determine the contents of lead, cadmium and zinc, the tissues of the crussian carp, Carassius carassius, collected from the middle streams of the Nakdong river were examined. During the dry season from 8 to 15, March, 1987, six loci were selected to sample the fish and river water; five of them were the midstreams of the Nakdong river i.e., the vicinities of the Andong dam, the Nakdong bridge, the Waegwan bridge, Gangjung and Gaepori, the other one was the Kumho river around the Paldal bridge(see Fig.1). The microanalyses of lead and cadmium contents were undertaken by the atomic absorption spectrophotometer(Model IL-551) connected with CTF-IL 655, while that of zinc by the flame method with IL-551 only. The contents of lead and cadmium in water sampled from Gaepori distant from about 30km downward from the junction with the Kumho river were about 1.5 times higher than those from Gangjung distant about 0.5km upward from the junction, and the content of zinc from Gaepori was slightly higher than that from Gangjung. However, the contents of lead and cadmium in water sampled from Gaepori were three fifth of those from the vicinity of Paldal bridge far about 2km upperward from the junction. In the other words, the contents of lead and cadmium in the samples from the vicinity of the Paldal bridge were about 2.5 to 3 times higher than those from the Gangjung and 5 times higher than those from the Andong dam. The contents of the heavy metals in the tissues of Carassius carassius were relatively consistent to those of the aquatic environments were the fish were collected, with higher contents in the tissues of the crussian carp collected from the vicinity of Gaepori and the Paldal bridge which were so much polluted than in those from other loci in upper stream from the junction. And the contents of lead and cadmium in tissues were positively correlated with the age of the fish, however, that zinc was not. The contents of lead in bone of crussian carp from the vicinity of the Paldal bridge in the group of 0-1 year old fish were similar to those of 4-5 years old fish from Gaepori, and higher than those of 3-4 years old fish collected from the upper stream of the junction. It is likely that fishing from Gaepori and the paldal bridge is not recommended, and all the industrial producers have to pay intensive attention to the water pollution due to the sewage disposal.