Tsutsugamushi Disease in Pregnant Woman: a Case of Successful Treatment with Azithromycin / 대한산부인과학회잡지

Tsutsugamushi disease is a acute infectious disease caused by Orientia tsutsugamushi. Therapy with doxycycline or chloramphenicol is currently recommended for the treatment of this disease. However, these drugs, which are pregnancy category D, should not be used to treat pregnant woman. Recently, azithromycin, which is pregnancy category B, has been reported to be effective in treatment of tsutsugamushi disease. Moreover, there is no evidence that azithromycin causes harmful effects to the fetus. Here we report a case of tsutsugamushi disease in a 30 year old woman at pregnant 21 weeks of gestation who was successfully treated with azithromycin. She completely recovered with the treatment of azithromycin and delivered healthy baby at 40 weeks of gestation.

The impact of serum albumin level on maternal and fetal morbidity in women with preeclampsia / 대한내과학회지

BACKGROUND: Preeclampsia, pregnancy induced hypertension, is considered to be associated with increased vascular permeability leading to albumin loss from the intravascular space. Although hypoalbuminemia is common in pregnant women with preeclampsia, the impact of hypoalbuminemia on maternal and fetal morbidity in preeclampsia is not well known yet. METHODS: This study included 392 pregnant women with preeclampsia. The patients were divided into hypoalbuminemia group (serum albumin or=3.0 g/dL) based on the lowest serum albumin level. And we compared clinical factors representing maternal and fetal morbidity between the two groups. The mean age of the patients was 30+/-5 years and mean pregnant duration was 35.5+/-3.4 weeks. RESULTS: Of the total 392 patents, 280 patients (71.4%) had hypoalbuminemia. Compared to normal group (n=112), hypoalbuminemia group (n=280) had higher incidence of twin pregnancy (7.5% vs. 1.8%, p=0.030), acute renal failure (12.5% vs. 3.6%, p=0.008), hepatic dysfunction (33.5% vs. 12.2%, p3.5 g/day) (34.4% vs. 10.8%, p=0.002), respectively. But there was no difference in maternal age, pulmonary edema, abruptio placenta, postpartum hemorrhage between the two groups. Concerning fetal morbidity, the incidence of intrauterine growth retardation in hypoalbuminemia group was higher than that in normal group (25.0% vs. 12.5%, p=0.011) and birth weight in hypoalbuminemia group was smaller than that in normal group (2.5+/-0.8 vs. 2.8+/-0.8 kg, p=0.002). CONCLUSION: This data suggest that hypoalbuminemia frequently occurs in pregnant women with preeclampsia and it is closely associated with maternal and fetal morbidity.

A Clinical Study on 1594 Cases of Operative and Diagnostic Laparoscopy / 대한산부인과학회잡지

OBJECTIVE: Laparoscopic surgery provides patients with the benefits of shortened hospital stay and faster return to normal activity. The objective is to evaluate the efficacy of laparoscopic surgery in gynecologic patients. METHODS: From January, 1999 to December, 2002, total 1594 patients were performed laparoscopic surgery at Uijongbu St. Mary's Hospital. We reviewed the medical record and analyzed these cases about age, parity, diagnosis, name of operation, operation time, duration of hospitalization and side effect. RESULTS: The results of this study summarized as follows: 1. The mean age of patients was 34.0 years old and the great incidence occurred in 26-30 years old group (24.7%). 2. The average parity of patients was 1.05. 3. The common indications were ovarian cyst (34.4%), myoma uteri (19.1%), infertility (9.5%), ectopic pregnancy (15.0%), etc. In diagnostic pelviscopy, the most common indication was infertility (50.6%), and ovarian cyst (38.3%) was the most common indication in operative pelviscopy. 4. The major types of operative pelviscopy were cystectomy, LAVH, TLH, salpingectomy, adnexectomy, electrocauterization. 5. The mean duration of hospitalization was 3.72 days. 6. The major complication of surgery were intestinal injury, postoperative paralytic ileus, bleeding at resection site, but they were controlled without difficulty. CONCLUSION: Pelviscopic surgery is useful and recommended for the treatment of gynecologic disease, because this is safe and has many advantages.

A case of gastrointestinal stromal tumor of ileum preoperatively diagnosed as extrauterine myoma / 대한산부인과학회잡지

Gastrointestinal stromal tumor (GIST) of ileum is a rare tumor of gastrointestial tract that arise from primitive mesenchymal cells. GIST occur predominantly in persons over 40 years of age with an equal sex incidence. GIST expresses a heterogenous clinical course and the most important prognostic factors are tumor size, site, degree of mitotic activity, tumor necrosis. We report a case of GIST of ileum, which was misdiagnosed as extrauterine leiomyoma preoperatively.

A Case of Acardiac Parabiotic Twin / 대한산부인과학회잡지

Acardia is a very rare congenital anomaly occurring in less than 1 in 35,000 deliveries. Acardiac parabiotic twin has been reported only in multiple, monochronic pregnancies. This anomalous fetus is sustained in utero by parasitic anastomoses to the circulation of its usually normal co-twin and is therefore not compatible with extrauterine survival. A case of an acardiac parabiotic twin is described, and the literature concerning the incidence, classification and etiology of acardiac is reviewed.