Sometimes, it is difficult to distinguish Churg-Strauss syndrome from idiopathic hypereosinophilic syndrome and there may be overlap syndrome in the differential diagnosis of systemic vasculitis with hypereosinophilia. Recently, we experienced a 42-year-old female patient who presented signs and symptoms of cardiac failure and neuropathy with peripheral hypereosinophilia. She had no history of asthma. She had erythematous skin lesions and distal digit necrosis. The cause of hypereosinophilia could not be identified. Skin and nerve biopsy revealed vasculitis with eosinophilic infiltration. Cardiac failure improved dramatically with steroid, inotropics and diuretics. Other symptoms including digital necrosis also improved. During steroid, tapering peripheral eosinophilia recurred. For maintenance therapy, we added daily cyclophosphamide to every-other-day prednisolone therapy. We report the case with a review of the literature.
Adult ; Asthma ; Biopsy ; Churg-Strauss Syndrome* ; Cyclophosphamide ; Diagnosis, Differential ; Diuretics ; Eosinophilia ; Eosinophils ; Female ; Heart Failure ; Humans ; Hypereosinophilic Syndrome* ; Necrosis ; Prednisolone ; Skin ; Systemic Vasculitis ; Vasculitis

OBJECTIVE: To compare clinical results of laparoscopic assisted vaginal hysterectomy for uteri weighing 500 g or more with less than 500 g. And we compared clinical results between laparoscopic coagulation of uterine vessel (LH) and conventional LAVH. METHODS: We reviewed medical records of 296 patient who underwent LAVH from February 2004 to May 2006. They were divided into two groups, uteri weighing greater than 500 g and less than 500 g. And each group was divided into two groups, LH and conventional LAVH. Each groups were compared by operative time, hemoglobin change, complication, transfusion and hospital days. RESULTS: Operation time ,hemoglobin change on the 1st postoperative day and transfusion were significant greater in the uteri > or =500 g group than in the <500 g. However, there was no significant difference in hospital days, hemoglobin change on the 4th postoperative day and complication. In the <500 g group, LH group was lower than conventional LAVH group in operative time, hemoglobin change on the 1st and 4th postoperative day. In the > or =500 g group, there was no signicant difference in hospital days, operative time, hemoglobin change on the 1st postoperative day. However, hemoglobin change was smaller in the LH group than conventional LAVH group on the 4th postoperative day. CONCLUSION: This study demonstrates that despite the increased operating time and blood loss, LAVH can be safely performed for large uterus. However, surgeons need to be aware of high risk of blood transfusion. Modification of surgical method can decrease operating time and blood loss in LAVH.
Blood Transfusion ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Medical Records ; Operative Time ; Uterus*

A non-communicating rudimentary uterine horn is a rare Mllerian duct anomaly. We experienced a case of unruptured rudimentary uterine horn pregnancy. The patient was diagnosed by laparoscopy and removed by laparoscopic resection of the pregnant rudimentary uterine horn was performed. We report our case with brief review of literatures.
Animals ; Diagnosis* ; Horns* ; Humans ; Laparoscopy* ; Pregnancy*

Uterine sacculation is a very rare complication associated with pregnancy in which a part of the uterine wall balloons, and it is difficult to diagnose because it is usually asymptomatic. It frequently contains the placenta and sometimes may be involved with the trapped placenta after delivery due to its structural characteristic. It is impossible to remove the retained placenta in the sac by using usual methods such as manual delivery or curettage so most of patients with it end up with having a laparotomy. Especially, if the placenta in it is accompanied by abnormal adherence of the placenta or serious hemorrhage, hysterectomy should be considered. Currently several conservative methods for the retained placenta including selective uterine artery embolization and administration of methotrexate have been introduced and these may be tried to treat the retained placenta in the uterine sacculation for avoiding operation and preserving future reproductive potential in selective cases. We experienced a case of placenta increta in the uterine sacculation that was diagnosed first during cesarian section and was treated with selective uterine artery embolization followed by methotrexate administration. This case is reported with a brief review of the literatures.
Curettage ; Hemorrhage ; Humans ; Hysterectomy ; Laparotomy ; Methotrexate ; Placenta Accreta* ; Placenta* ; Placenta, Retained ; Pregnancy ; Uterine Artery Embolization

Uterine sacculation is a very rare complication associated with pregnancy in which a part of the uterine wall balloons, and it is difficult to diagnose because it is usually asymptomatic. It frequently contains the placenta and sometimes may be involved with the trapped placenta after delivery due to its structural characteristic. It is impossible to remove the retained placenta in the sac by using usual methods such as manual delivery or curettage so most of patients with it end up with having a laparotomy. Especially, if the placenta in it is accompanied by abnormal adherence of the placenta or serious hemorrhage, hysterectomy should be considered. Currently several conservative methods for the retained placenta including selective uterine artery embolization and administration of methotrexate have been introduced and these may be tried to treat the retained placenta in the uterine sacculation for avoiding operation and preserving future reproductive potential in selective cases. We experienced a case of placenta increta in the uterine sacculation that was diagnosed first during cesarian section and was treated with selective uterine artery embolization followed by methotrexate administration. This case is reported with a brief review of the literatures.
Curettage ; Hemorrhage ; Humans ; Hysterectomy ; Laparotomy ; Methotrexate ; Placenta Accreta* ; Placenta* ; Placenta, Retained ; Pregnancy ; Uterine Artery Embolization

BACKGROUND: There have been no reports concerning asthma prevalence in the Korean adult population using objective parameters such as methacholine bronchial provocation tests. OBJECTIVE: The purpose of this study was to evaluate the prevalence of asthma using an objective parameter, and the atopy rate in an adult population living in Seoul. METHOD: A total of 718 subjects (aged from 16 to 70 years) were enrolled in this study. They responded to a modified ATS respiratory questionnaire and underwent methacholine bronchial challenge and skin prick testing to common aeroallergens. RESULTS: The prevalence of current asthma, based on the questionnaire and bronchial challenge, was 3.4%. The prevalences of current asthma and bronchial hyperresponsiveness were higher in subjects over 50 years of age than in those under 50 years of age. The atopy rate, based on the skin prick testing, was 26.9%, and common sensitizing allergens in decreasing frequency were Dermatophagoides farinae (15.5%), D. pteronyssinus (14.2%), Tyrophagus putrescentiae (5.9%), cockroach (5.0%) and Tetranychus urticae (4.9%). CONCLUSION: The prevalence of current asthma and the rate of atopy in an urban adult population were 3.4% and 26.9%, respectively.
Adult* ; Allergens ; Asthma* ; Bronchial Provocation Tests* ; Cockroaches ; Dermatophagoides farinae ; Humans ; Methacholine Chloride* ; Prevalence* ; Seoul* ; Skin ; Surveys and Questionnaires

Peripartum cardiomyopathy is a dilated cardiomyopathy of unexplained cause that occurs during the last trimester of pregnancy or within 5 months after delivery. And, It is a rare disease that has a frequency of 1 in 1,300-15,000 deliveries. It has not yet been reported that peripartum cardiomyopathy has occurred in an preeclampsia woman superimposed on idiopathic thrombocytopenic purpura. Moreover, the association between idiopathic thrombocytopenic purpura and peripartum cardiomyopathy has not been studied. Recently, we experienced a case of a woman who has undergone emergency Cesarean section due to complicated severe preeclampsia superimposed on idiopathic thrombocytopenic purpura. On the postoperative day, this patient developed respiratory distress and pumonary edema. Peripartum cardiomyopathy was diagnosed by echocardiography and we present with a brief review of literatures.
Cardiomyopathies* ; Cardiomyopathy, Dilated ; Cesarean Section ; Echocardiography ; Edema ; Emergencies ; Female ; Humans ; Peripartum Period* ; Pre-Eclampsia* ; Pregnancy ; Pregnancy Trimester, Third ; Purpura, Thrombocytopenic, Idiopathic* ; Rare Diseases

BACKGROUND: In a previous linkage analysis, a marker locus on chromosome 5q31-33 showed evidence of linkage to bronchial responsiveness to methacholine and atopy. The beta2-adrenoceptor (beta2AR) gene is located on chromosome 5q32 and is considered to be a candidate gene in the development of asthma phenotype. OBJECTIVE: The aim of this study was to evaluate the association between asthma phenotypes and beta2AR polymorphism at amino acids 16 and 27. METHODS: From the general population, 440 unrelated Korean subjects were randomly selected, and asthma phenotypes were determined using a questionnaire, skin prick tests, and methacholine bronchial provocation tests. Haplotypes of 16 and 27 polymorphisms on the beta2AR gene were determined using PCR-based methods. RESULTS: Frequencies of haplotypes of beta2AR gene for polymorphic positions 16 and 27 were Arg16-Gln27:53.2%, Gly16-Gln27:36.4%, Arg16-Glu27:0.1% and Gly16-Glu27:10.3%. No significant association was found between haplotype of beta2AR gene and asthma phenotypes. Among the atopic subjects, however, we observed that Arg16-Gln27 and Gly16-Gln27 haplotypes were significantly associated with nocturnal cough. There was linear association between the development of nocturnal cough and the number of Arg16-Gln27 and Gly16-Gln27 haplotypes, respectively. CONCLUSION: This study demonstrates that the linkage of a gene marker on chromosome 5q31-33 with atopy and bronchial responsiveness is not related with genetic variations in the beta2AR gene. However, beta2AR polymorphisms may play an important role in the expression of nocturnal cough in atopic subjects.
Amino Acids ; Asthma* ; Bronchial Provocation Tests ; Cough ; Genes, vif ; Genetic Variation ; Haplotypes ; Methacholine Chloride ; Phenotype* ; Skin ; Surveys and Questionnaires