Acute Lymphoblastic Leukemia Diagnosed in a Patient with Acromegaly / 대한내과학회지

Acromegaly is a rare disorder caused by excessive amounts of growth hormone. The incidence of colorectal, breast, and thyroid carcinomas is increased in acromegaly. However, there have been few reports on hematological malignancies in acromegaly. We describe a patient who developed acute lymphoblastic leukemia during the course of acromegaly. A 35-year-old woman presented in February 2012 with unexplained lactation and amenorrhea for 4 months. Her growth hormone level was 12.6 microg/L, insulin-like growth factor 1 592.26 ng/mL, and prolactin 242 microg/L. A pituitary macroadenoma secreting GH and prolactin causing acromegaly was diagnosed. Considering her fertility, the dopamine agonist cabergoline 0.5 mg was administered in March 2012. In February 2014, she presented with cytopenia (hemoglobin 12.2 g/dL, white cell count 2.69 x 10(9)/L, platelets 39 x 10(9)/L) and hepatosplenomegaly. A bone marrow examination showed acute B cell lymphoblastic leukemia. She underwent chemotherapy and bone marrow transplantation. A follow-up bone marrow biopsy showed remission.

Barotrauma after Manual Ventilation in a Patient with Life-Threatening Massive Hemoptysis / 대한구급학회지

A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxy-genation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.

ST-Segment Elevation Myocardial Infarction as a Result of Coronary Artery Ectasia-Related Intracoronary Thrombus in a Patient with Liver Cirrhosis / 대한구급학회지

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.

ST-Segment Elevation Myocardial Infarction as a Result of Coronary Artery Ectasia-Related Intracoronary Thrombus in a Patient with Liver Cirrhosis / 대한중환자의학회지

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.

Barotrauma after Manual Ventilation in a Patient with Life-Threatening Massive Hemoptysis / 대한중환자의학회지

A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxy-genation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.

Analysis of Risk Factors for Early Tube Exchange in Percutaneous Endoscopic Gastrostomy

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a widely-performed procedure for patients undergoing enteral feeding. Due to frequent complications, careful management after the PEG is required. In this study, we investigated the risk factors associated with early exchange of PEG tube. MATERIALS AND METHODS: We did a retrospective survey of 72 patients who received a PEG between January 2009 and April 2014. All patients underwent a tube exchange or removal after the first PEG. Patients who had an exchange within 6 months were defined as 'early exchange' group and the others, as 'late exchange' group. We analyzed the relationship between early exchange and pre-PEG status. RESULTS: Mean age of patients was 67.5+/-18.3 years. The most frequent mental status and performance status before the first procedure, was 'alert' (n=48, 66.7%) and Eastern Cooperative Oncology Group (ECOG) score was 4 (n=28, 39.8%). Mean BMI was 20.2+/-3.7 kg/m2 and the majority of PEG cause was cerebrovascular accidents (n=23, 31.9%). Many patients had a tube exchange (or removal) because of tube dysfunction (n=32, 44.4%). The 'early exchange' group showed a lower BMI than 'late exchange' group (19.7+/-3.57 kg/m2 vs. 22.4+/-3.87 kg/m2, P value 0.009). 'Underweight' (BMI less than 18.5 kg/m2) group was more frequently observed in 'early exchange' group. There was no significant difference in pre-PEG status and post-PEG complication between the 2 groups. CONCLUSIONS: A lower BMI was associated with early exchange of PEG. Health providers should pay attention to the nutritional status of PEG patients.

A Clinical Study of Comparison with Success Group and Failure Group in Vaginal Birth after Cesarean Delivery / 대한산부인과학회잡지

OBJECTIVES: Vaginal birth or trial of labor after previous cesarean section has become one of the most remarkable changes in obstetric practice. The safety and efficacy of a trial of labor and vaginal birth after previous cesarean are well documented. The purpose of this report is to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission. METHOD: In this retrospective study, 120 women who attempted vaginal birth at Kyung-Hee University Hospital from March 1997 to March 1999. An attempt to identify possible prognostic factors for success of such a trial was made and we evaluated the variables of significant predictive value and the patients' characteristics in the success group and failure group of women who attempted VBAC. RESULT: 87 cases(72.5%) in 120 cases succeeded in VBAC and 33 cases(27.5%) failed. In this comparative groups in VBAC, there was significant difference in CPD index(cephalopelvic disproportion index) and Bishop score, but no significant difference in gestational age, the estimated fetal weight by sonography and newborn birth weight. CONCLUSION: In this study, Bishop score and CPD index and age may be useful and valid predictor of success in VBAC and this information could be particularly valuable. The CPD index may prove most important in determining if a vaginal birth should occur after a cesarean section because it can clearly identify some patients who need a repeat cesarean section.

Latzko partial colpocleisis of vesicovaginal fistula / 대한산부인과학회잡지

Vesicovaginal fistula is a uncommon status in the developed countries. In the past it was mostly by obstetric causes. But now a days, posthysterectomy fistulas are seen. Fistula is a discomfort to the patient because of urine leakage, odor, and its inconvenience. We have experienced one case of fistula after abdominal hysterectomy and have repaired it by Latzko partial colpocleisis. So we report a case with some references.

Predictive Value of Clinical Examination, Computed Tomography and Magnetic Resonance Imaging in the Clinical Staging of the Cervical Carcinoma / 대한부인종양콜포스코피학회잡지

A total of 162 patients with invasive cervical cancer was investigated retrospectively with a view to elucidate the efficacy of pretreatment staging procedures of application with intravenous pyelography, cystoscopy, rectosigmoidoscopy. All 72 intravenous pyelograms, 155 sigmoidoscopies, 158 cystoscopies were normal. Of 111 patients with stage Ib who had paraaortic lymph node biopsies, two patients had a positive node(0.02%). Of 51 patients with stage II who had paraaortic lymph node biopsies, five patients had positive paraaortic lymph node(10%). And the accuracy of computed tomography and magnetic resonance imaging in the evaluation of invasive cervical cancer was assessed. In evaluating stage of cervical cancer, clinical staging had an accuracy of 78.9%, compared with 65.7% for CT and 58.9% for MRI. And for detection of parametrial invasion, clincal staging had an accuracy of 85.9%, compared with 85.1% for CT and 78.9% for MRI. Both modalities were comparable in evaluating lymph node metastasis ( 76.1% for CT, 74.4% for MRI ). IVP, cystoscopy and sigmoidoscopy for staging procedure evaluated in this study are unnecessary and should no longer be performed in patients with early stage cervical cancer. In addition, paraaortic lymph node biopsies in the absence of clinically suspicious nodes are not warranted. Compared with CT and MRI, pelvic examination offered improved evaluation of cervical cancer staging, parametrial invasion, but CT and MRI was useful in detecting the pelvic lymph node metastasis which was nearly impossible by clinical evaluation.

Two Cases of Primary Carcinoma of the Fallopian Tube / 대한산부인과학회잡지

Carcinoma of the fallopian tube accounts for less than 1% of all cancers of the female genital tract. The histology and behavior of fallopian tube cancer are simillar to ovarian cancer; thus evaluation and treatment are also essentially the same. Unlike ovarian cancer, fallopian tube cancer begins in a hollow viscus, and early lesions may be less likely to be associated with extensive intraperitoneal carcinoma. Two postmenopausal women presented with a pelvic mass. Pathologic examination of the resected specimens revealed primary adenocarcinoma of the fallopian tube. We have experienced two cases of fallopian tube cancer and reported with brief review of literature

Torsion of Benign Cystic Teratoma of Ovary at 37 Weeks Gestation / 대한주산의학회잡지

Ovarian tumor in pregnancy is not rare and benign cystic teratoma is most common ovarian tumor in pregnancy. Most ovarian tumor in pregnancy is found at first and second trimester but sometimes found at third trimester and it is difficult to make a decision for management. Moreover physician should consider fetal age and mother's condition, and weigh outcome of operation for complicated ovarian tumor in pregnancy. Torsion of ovarian tumor is not an uncommon complication during first trimester of pregnancy and puerperium but rare occurs during the third trimester of pregnancy. We have experienced a case of torsion of benign cystic teratoma of ovary which occurred at 37 weeks gestation in a 25 year-old woman. So we report this case with a brief review of literature.