OBJECTIVE: To evaluate the clinical effect and reproductive outcome of pelviscopic ovarian drilling in infertile patients with polycystic ovarian syndrome resistant to clomiphene citrate. METHODS: Twenty two patients involved in this study were taken pelviscopic ovarian drilling with needle electrocautery. Change of characteristic LH/FSH ratio before and after operative treatment, ovulation and pregnancy success were followed up. Paired t-test was applied for hormonal change (p<0.05). RESULTS: Thirteen of 14 patients (93%) treated only with pelviscopic ovarian drilling showed successful ovulation with or without clomiphene citrate and among these 10 patients (71%) were success in pregnancy and 9 patients delivered full term babies. When including patients who needed other assisted reproductive technique and specific medication of endometriosis 17 of 22 patients (77%) were successfully pregnant and 15 patients (68%) delivered healthy babies. The mean LH/FSH ratio 2.0+/-0.5 before treatment were decreased to 1.26+/-0.37 after treatment (p<0.05). Interestingly, among 22 patients, various degree endometriosis were found during pelviscopy and specific medication with GnRH analogue were followed. CONCLUSION: Pelviscopic ovarian drilling showed successful ovulation rate and effective reproductive outcome in clomiphene-resistant infertile patients with PCO. This surgical technique seems to be an alternative step for the management of clomiphene-resistant infertile patients with PCO and also for the diagnosis of possible high rate of endometriosis in these patents.
Clomiphene* ; Diagnosis ; Electrocoagulation ; Endometriosis ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Needles ; Ovulation ; Polycystic Ovary Syndrome* ; Pregnancy ; Reproductive Techniques, Assisted

No abstract available.
Compliance* ; Humans ; Psychopathology*

'I'he adult form of myasthenia gravis (MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor immunoglobulin G antibodies (anti-ACHRIgG) which blocks the formation of acetylcholine at the motor end plate and causes anatomic deterioration of this structure. 'I'he end result is defective neuromuscular transmission manifested by progressive skeletal muscle weakness. We have experienced a full term pregnancy complicated with the myasthenia gravis. We experienced a case of myathenia gravis associated with pregnancy who underwent cesarean section. The case is presented here with a brief review of literatures concerned.
Acetylcholine ; Adult ; Antibodies ; Cesarean Section ; Female ; Humans ; Immunoglobulin G ; Motor Endplate ; Muscle, Skeletal ; Myasthenia Gravis ; Pregnancy*

No abstract available.
Calcium* ; Estrogens* ; Female ; Metabolism* ; Ovulation Induction* ; Ovulation*

No abstract available.
Leiomyoma*

BACKGROUND: Leptin, produced in the adipose tissue, is involved in the regulation of body weight. The release of the leptin is increased in obese adults even in children. This study investigated whether the serum leptin in cord blood was related to babys birth weight and metabolic parameters. METHODS: 71 pairs of singleton pregnancy babies and their mother were studied. Babies are classified in LGA (large for gestational age), AGA (appropriate for gestational age), SGA (small for gestational age) three groups. After delivery, cord blood and maternal venous blood samples were drawn. We measured the plasma leptin, insulin-like growth factor (IGF)-1, insulin and proinsulin in cord and maternal serum. RESULTS: The concentration of leptin from cord blood was increased in LGA babies and decreased in SGA babies compued with the level in AGA babies. There was positive correlatian (r=0.55, p<0.01) between the plasma leptin level in cord and birth weight. There were positive correlatian between both the plasma proinsulin (r=0.37, p<0.01) and IGF-1 (r=0.32, p<0.01) and birth weight, too. But there was no difference between female and male baby's cord blood leptin level. In multiple regression analysis, cord blood leptin level was found independent factor related to birth weight ( p=0.001) CONCLUDION : The plasma leptin, proinsulin and IGF-1 is correlates to the birth weight. These data provide evidence that leptin and proinsulin are highly related to the nutritional status already during the fetal periods, and effect on the intrauterine fetal growth.
Adipose Tissue ; Adult ; Birth Weight* ; Body Weight ; Child ; Female ; Fetal Blood* ; Fetal Development ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Leptin* ; Male ; Mothers ; Nutritional Status ; Parturition* ; Plasma ; Pregnancy ; Proinsulin

The treatment of choice for Cushing's disease is surgical removal of tumor, the source of ACTH overproduction. In occasional patients in whom a surgical approach including total adrenalectomy is not feasible or surgical removal of tumor is not complete, medical treatment may be necessary because pituitary irradiation requires a long 1ag time to remission. Although ketoconazole, an imidazole derivative with inhibitory activity on adrenal steroidogenesis has been reported to be effective in the treatment of Cushing's disease, the limited effectiveness in lowering very high level of cortisol and occasional hepatotoxicity restrains its wide use. In this report, we describe a woman with Cushing's disease due to pituitary microadenoma. Transsphenoidal pituitary adenomeetomy followed by ketoconzole treatment had been unsuccessful in achieving remission of the disease, but combined treatment with ketoconazole and octreotide accomplished successful reduction in cortisol production.
Adrenalectomy ; Adrenocorticotropic Hormone ; Female ; Humans ; Hydrocortisone ; Ketoconazole* ; Octreotide* ; Pituitary Irradiation

We present a 37-year-old male who was found to had mas within the bronchus. This patients was admitted for the evaluation of cough. Chest CT scan showed endobronchial mass in the bifurcation of LUL and LLL bronchus. The left lower lobe was atelectatic. Lobectomy of the left lower lobe was done. On opening of the bronchus, there was a 2x1x1 cm sized endobronchial mass. Histologically, the mass was smooth muscle tumor composed of densely packed eosinophilic spindle cells in interlacing bundles with pale elongated nuclei covered by bronchial epithelium. On immunohistochemical staining, the tumor cells were positive for desmin. Ultrastructurally, the tumor cells exhibited numberous cytoplasmic microfilaments with focal densities, pinocytotic vesicles, and a thick basal lamina.
Male ; Humans

Heat stroke, a medical emergency, occurs when the body's thermal regulation is upset and unable to dissipate adequate amounts of heat with a rise in body temperature. It is characterized by hyperyrexia, with a core temperature of 40degrees C or more, hot dry skin, and central nervous system disturbance and usually results in rhabdomyolysis and multiorgan failure. Our case, a 43-year-old healthy male, was caused by a marathon, half course, on a sunny day in late summer. He suddenly fell down on the road and was delivered to a nearby hospital, where a seizure developed. He was transfered to our hospital and then displayed Central Nervous System disturbance, hot dry skin, acute liver failure, rhabdomyolysis, anuric acute renal failure, and disseminated intravasculular coagulopathy. He was treated with general supportive care and hemofiltration. Despite the aggressive management, he died of shock on the fifth day after admission.
Acute Kidney Injury ; Adult ; Body Temperature ; Central Nervous System ; Emergencies ; Heat Stroke* ; Hemofiltration ; Hot Temperature* ; Humans ; Liver Failure, Acute ; Male ; Rhabdomyolysis ; Seizures ; Shock ; Skin

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
Aged ; Airway Obstruction ; Analgesics, Opioid ; Asthma ; Diagnosis, Differential ; Female ; Femur Neck ; Fentanyl* ; Humans ; Intensive Care Units ; Lung Diseases, Obstructive ; Muscle Rigidity ; Oxygen ; Periprosthetic Fractures ; Physical Examination ; Thoracic Wall* ; Thorax* ; Ventilation