Possible Antiphospholipid Syndrome Presenting as Peripartum Cardiomyopathy and Diffuse Alveolar Hemorrhage / 대한내과학회지

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of circulating antiphospholipid antibodies in combination with at least one other clinical manifestation, such as vascular thrombosis or recurrent pregnancy loss. APS is further characterized by the presence of vasculitis affecting multiple organ systems, resulting in a wide variety of clinical outcomes. Common cardiac manifestations of APS include valve abnormalities, occlusive arterial disease, intra-cardiac emboli, ventricular dysfunction, and pulmonary hypertension, along with rare instances of dilated cardiomyopathy. Simultaneously diffuse alveolar hemorrhage and peripartum cardiomyopathy have also been reported, though these manifestations remain extremely rare. Here, we report a case of a 34-year-old woman with possible APS who presented with peripartum cardiomyopathy and diffuse alveolar hemorrhage.

Infective Endocarditis with Unusual Location of Vegetation in a Patient with Hemodialysis Followed by Recurrent Catheter-Related Blood Stream Infection

The incidence of infective endocarditis (IE) in hemodialysis patients is higher than the general population. Hemodialysis patients with IE have a poorer prognosis than other patients with IE. The most common sites of IE in hemodialysis patients are the mitral valve and aortic valve. A 47-year-old woman had suffered from recurrent catheter-related blood stream infection and she was strongly suspected of IE. Despite repeated transthoracic echocardiography and transesophageal echocardiography (TEE), IE was revealed several months later by TEE due to the unusual location of the vegetation. The vegetation was detected on the left ventricle outflow tract. She recovered well without any complication after mitral valve replacement surgery.

The Effect of Counseling for Interpersonal Relationship Using Myers-Briggs Type Indicator / 한국의학교육

PURPOSE: There are large differences between medical school curricula and those of other disciplines and graduate schools. Counseling program is designed to help participants understand their innate tendencies and have indirect experiences with the 16 Myers-Briggs Type Indicator (MBTI) types, which can lead to better interpersonal relationships. METHODS: The experimental and control groups, which were sampled randomly, comprised 34 students each. Each group was consisted of 17 females and 17 males. We implemented a counseling program (understanding oneself, understanding others) only to the experimental group, not the control group. The effects of the program were analyzed by t-test and analysis of covariance (ANCOVA). The data were analyzed using SPSS 17.0 Window. RESULTS: For the Human relationship scale as a whole, the experimental group showed an increase from 3.641 to 3.846 (p=0.001). With regard to the subcategories, satisfaction increased from 3.705 to 4.022 (p=0.000), trust increased from 3.480 to 3.715 (p=0.015), intimacy increased from 3.833 to 4.019 (p=0.007), and openness increased from 3.435 to 3.700 (p=0.006). CONCLUSION: This program improved interpersonal relationships by helping new students understand each other, build a rapport, and understand their personalities well with open minded attitudes. Their relationships gradually became more intimate than awkward through this program.

Endovascular Stent Placement for the Treatment of Superficial Femoral Artery Stenoses and Occlusions

PURPOSE: The aim of this study was to evaluate effectiveness of an endovascular stent placement in the treatment of superficial femoral artery stenoses and occlusions. MATERIALS AND METHODS: An angioplasty and stent placement was performed in forty four patients (42 men and 2 women; mean age: 71.2 years; age range: 50-82 years). A total of 27 patients were diagnosed with intermittent claudication, in addition to 8 patients with resting pain, and 9 patients with gangrene. A follow-up evaluation accompanied with a physical examination, catheter angiography, and a color Doppler sonography was performed. The patency rates were analyzed after 3 months, 6 months, 1 year and 2 years. The predictors of restenosis, according to the clinical and anatomical classification, risk factors, as well as the correlation of stent fracture and restenosis were analyzed. RESULTS: Initial technical success was achieved in all patients. The stent placement resulted in an initial improvement of the clinical category in more than one level for 95.5% of cases. Over the course of the follow-up period (mean: 17 months; range, 1-106 months), restenosis occurred in 16 patients (36.4%). The highest patency rates were 87.9% after 3 months, 81.5% after 6 months, 78.0% after 1 year, 54.2% after 2 years, and 46.0% after 3 years. No significant difference was found for the patency rates as a function of the clinical and anatomical classifications, or the risk factors. A stent fracture was identified on only two occasions; however, no clinical symptoms or good intra-stent blood flow was observed in a follow-up angiography. CONCLUSION: A mid-term patency after the stent placements for superficial femoral artery stenoses and occlusions was found to be unfavorable despite an initial success rate. Consequently, greater clinical experience and analysis is necessary.

A Case of Discovery of Heterotopic Pregnancy After Missed Abortion / 대한산부인과학회지

Heterotopic pregnancy, the potentially fatal condition in which simultaneous gestations occurs at two or more implantation sites, was first reported in 1708 as an autopsy finding. In natural conception cycles it is a rare event, occuring less than 1:30,000 pregnancies. However, with assisted reproduction techniques, this incidence increase. Also the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, former tubal surgery. We report a case of discovery of heterotopic pregnancy after missed abortion with brief review of literature.

Expression of c-erbB-2 Oncoprotein and DNA Topoisomerase II-alpha in Premalignant Lesions and Invasive Squamous Cell Carcinomas of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: The relationship was studied between expression of c-erbB-2 oncoprotein and topoisomerase II-alpha as proliferating marker in precancerous lesions and invasive squamous carcinomas of the uterine cervix. METHODS: Total 81 formalin-fixed, paraffin-embedded sections of low-grade intrasquamous lesion (22 cases), high-grade intraepithelial lesions (42 cases) and invasive squamous cell carcinomas (17 cases) in the uterine cervix were stained by immunohistochemistry for expression of the c-erbB-2 oncoprotein and topoisomerase II-alpha. RESULTS: The expression of c-erbB-2 oncoprotein and staining index (mean+/-S.D) of topoisomerase II-alpha were statistically significant between precancerous lesions and invasive carcinoma. The expression of c-erbB-2 oncoprotein has correlation with staining index (mean+/-S.D) of topoisomerase II-alpha. CONCLUSION: There results suggest that the expression of c-erbB-2 protein has relationship with progression of squamous lesions and topoisomerase II-alpha is an useful proliferating marker in the uterine cervix. And, the expression of c-erbB-2 protein has correlation with expression of topoisomerase II-alpha.

Stationary outward and transient Ca2+-dependent currents in hamster oocytes

The outward currents elicited in hamster eggs by depolarizing pulses were studied. The currents appeared to comprise at least two components, a transient outward component (Ito) and a steady-state outward component (Iinfin). Ito was transiently followed by the cessation of inward Ca2+ current (ICa), and its current-voltage (I-V) relation was a mirror image of that of ICa. Either blockade of ICa by Co2+ or replacement of Ca2+ with Sr2+ abolished Ito without change in Iinfin. Intracellular EGTA (10 mM) inhibited Ito but not Iinfin. suggesting strongly that generation of Ito requires intracellular Ca2+. Apamin (1 nM) abolished selectively Ito, indicating that Ito is Ca2+-dependent K+ current. On the other hand, Iinfin was Ca2+-independent. Both Ito and Iinfin were completely inhibited by internal Cs+ and external TEA. The estimated reversal potential of Ito was close to the theoretical EK. Taken together, both outward currents were carried by K+ channels. From these results, Ito is likely to be a current responsible for the hyperpolarizing responses seen in hamster eggs at fertilization.

Two cases of ovarian leiomyoma / 대한산부인과학회잡지

Ovarian myoma is a rare mesenchymal tumor, accounting for only 1% of benign ovarian neoplasm. These tumors only originate from smooth muscle on the walls of blood vessels in the cortical stroma, in the corpus luteum and in the ovarian ligaments at the point of attachment to the ovary. Most patients are asymptomatic and the tumors are usually found incidently during operations or at autopsies. Two cases of ovarian myoma experienced in our hospital recently are reported with a brief review of the literatures."

Effects of bradykinin on intracellular calcium transients in cardiac myocytes

In spite many evidences has supported the cardioprotective effect of bradykinin, its direct effects at the cell level are still under question. We investigated the both effects of bradykinin (BK) on Ca2+-related ionic currents using whole cell voltage clamp technique in rabbit cardiomyocytes and on the intracellular Ca2+ transient using calcium sensitive fluorescence dye, indo-1AM. Simultaneously with recording intracellular Ca2+ transients, cell contractility was estimated from the changes in length of the electrical stimulated rat cardiac myocytes. L-type Ca2+ current decreased by bradykinin at the entire voltage range. Inward tail current increased initially up to its maximum about 4 min after exposing myocytes to BK, and then gradually decreased again by further exposure to BK. This tail current decreased remarkably at washing BK off but slowly recovered ca. 20 min later. The change in cell contractility was similar to that in tail current showing initial increase followed by gradual decrease. Removal of BK brought remarkable decrease in contractility, which was recovered 15~20 min after cessation of electrical stimulation. Bradykinin increased Ca2+ transient initially but after some time Ca2+ transient also decreased coincidentally with contractility. From these results, it is suggested that bradykinin exerts directly its cardioprotective effect on the single myocytes by decreasing the intracellular Ca2+ level followed by an initial increase in Ca2+ transient.

One Case of Displacement of Copper - T IUD into Urinary Bladder / 대한산부인과학회잡지

Uterine perforation is a serious complication in users of intrauterine devices for contraception. Authors encountered one case of displacement of Copper-T IVD into urinary blpossibly due to uterine perforation on insertion of the Copper-T IUD in a 28 year old 1-multipara, who experienced normal intrauterine pregnancy in the circumstances. This patient was in silent, asymptomatic condition and underwent cesarean section. And Copper-T IUD was removed under the cystotomy. So we report one case with brief review of literatures