Heterotopic pregnancy occurs when an intrauterine pregnancy co-exists with an ectopic pregnancy. It is a potentially fatal condition, rarely occuring in natural conception cycle. But its incidence is increased since the rise in PID, pelvic surgery, IUD, and advent of assisted reproductive technology involving use of superovulatory drugs and/or in vitro-fertilization. We present a case of intrauterine twin pregnancy and right tubal pregnancy following treatment with in vitro-fertilization. The right tubal pregnancy was diagnosed after rupturing at 6th gestational weeks, and resected via laparoscopy. And healthy twin babies were delivered without complication at 38th gestational week. So we report this case with a brief review of the literatures.
Female ; Fertilization ; Humans ; Incidence ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic* ; Pregnancy, Tubal ; Pregnancy, Twin ; Reproductive Techniques, Assisted

PURPOSE: The aim of this study is to correlate the non-characteristic dual-phase CT imaging findings of hepato-cellular carcinoma with the observed characteristics of surgical specimens. MATERIALS AND METHODS: We studied four cases in which homogeneous low attenuation was observed during the arterial and delayed phases of dynamic CT scanning and in which hepatocellular carcinoma with coagulation necrosis above 95% was pathologically confirmed. We compared the findings of dual phase CT scanning, ultrasonography, angiography and Lipiodol CT scanning with the observed features of surgical specimens. RESULTS: Nodules were 30-50 (mean, 41) mm in size, and were round in three cases and oval in one. In all four cases, a low density lesion was observed during the arterial and delayed phases of dual-phase CT scanning. Ultrasonography demonstrated internal echo and the presence of a hypoechoic halo, implying that in all cases a capsule was present. At angiography and LiCT, minimal peripheral and central tumor staining or lipiodol up-take was observed. In all surgical specimens a complete capsule was visible, and histologic structures were mainly of the trabecular type, Edmondson grade II or III was recorded, and the mass had undergone extensive coagulation necrosis (above 95%). CONCLUSION: In cirrhotic liver which is hepatitis B-antigen positive, clear sonographic findings of internal echo and a capsule, rather than a simple cyst, indicate the possibility of hepatocellular carcinoma with extensive coagulation necrosis. This is so even if the arterial and delayed phases of dual-phase CT scanning indicate the presence of a low-density lesion, and in such cases additional work-up is therefore required.
Angiography ; Carcinoma, Hepatocellular* ; Diagnosis* ; Ethiodized Oil ; Hepatitis ; Liver ; Liver Neoplasms ; Necrosis* ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: Histological analysis of tuberculosis shows a spectrum of findings, from well formed granulmatous inflammation with few bacilli in patient with normal immune response to M. tuberculosis to poorly formed granulomatous inflammation with many bacilli in patient with defective immune response. To evaluate the degree of immune response to M. tuberculosis, we studied the histologic features, including the presence of acid fast bacilli(AFB) in lymph node of patients with cervical tuberculous lymphadenitis, and compared them with clinical characteristics. METHODS: We reviewed the histologic features of 33 cases of cervical tuberculous lymphadenitis and processed the excised nodes for auramine-rhodamine staining to detect AFB. The AFB positivity in tissue was compared with the histologic features(degree of granuloma formation, presence of caseation necrosis, presence of neutrophilic infiltration) and clinical characteristics (lymph node size, duration of symptom, presence of local symptom or radiologic evidence of pulmonary tuberculosis). RESULTS: 1) The mean age at diagnosis was 42.4 years, and male to female ratio was 1 : 45. 2) Histologically, all cases showed well formed granuloma and variable degrees of caseation necrosis, and 39% of the cases showed neutrophilic infiltration in the granulomatous inflammation. 3) AFB were confirmed in 52% of the cases, and they were found extracellularly and at the periphery of caseation necrosis. 4) There was no association between AFB Positivity and histological features or clinical characteristics. CONCLUSION: Cervical tuberculous lymphadenitis showed well formed granulomatous inflammation with caseation necrosis, and there was no association between AFB positivity in the tissue and histological or clinical characteristics.
Diagnosis ; Female ; Granuloma ; Humans ; Inflammation ; Lymph Nodes ; Lymphadenitis ; Male ; Necrosis ; Neutrophils ; Tuberculosis ; Tuberculosis, Lymph Node*

OBJECTIVE: The purpose of our study was to assess prevalence of carotid intraplaque hemorrhage (IPH) and associations between territorial acute infarction and IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. METHODS: 83 patients with suspected acute neurologic symptoms were evaluated with both brain diffusion weighted imaging (DWI) and carotid MPRAGE sequences. Carotid plaque with high signal intensity on MPRAGE of >200% that of adjacent muscle was categorized as IPH. We analyzed the prevalence of IPH and its correlation with territorial acute infarction. RESULTS: Of 166 arteries, 39 had a carotid artery plaque. Of these arteries, 26 had carotid artery stenosis less than 50%. In all carotid arteries, MR-depicted IPH was found in 7.2% (12/166). High-signal intensity on DWI was found in 17.5% (29/166). Combined lesion with ipsilateral high-signal intensity on DWI and IPH on carotid MPRAGE sequence was found in 6 lesions (6/166, 3.6%). Of patients with carotid artery plaque, MR-predicted IPH was found in 30.8% (12/39) and match lesions with high-signal intensity on DWI and MPRAGE was found in 15.4% (6/39). MR-predicted IPH was significantly higher prevalence in high-grade stenosis group (p=0.010). Relative risk between carotid MPRAGE-positive signal and ipsilateral high-signal intensity on DWI in arteries with carotid artery plaques was 6.8 (p=0.010). CONCLUSION: Carotid MPRAGE-positive signal in patients was associated with an increased risk of territorial acute infarction as detected objectively by brain DWI. The relative risk of stroke was increased in high-grade stenosis categories.
Arteries ; Atherosclerosis ; Brain ; Carotid Arteries ; Carotid Stenosis ; Constriction, Pathologic ; Diffusion ; Hemorrhage* ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Prevalence ; Stroke

OBJECTIVE: The optimal management of cervical intraepithelial neoplasia (CIN) after loop electrosurgical excisional procedure (LEEP) remains controversial and reliable predictive factors of residual disease after LEEP have not been consistently identified. This study was performed to identify predictive factors for residual disease after LEEP in patients with CIN. METHODS: From June 1996 to May 2000, 166 patients who received subsequent hysterectomy after LEEP according to indication in Dept. of Obstet. and Gynecol. at Chonbuk National University Hospital. The age of patients, the severity of disease, the status of resection margin, and high-risk HPV infection were analyzed for predictive values of residual disease. The student t-test and chi-square test were used for statistical analysis. RESULTS: 1. The residual disease after hysterectomy was negative in 68.1% (113/166) and positive in 31.9% (53/166). 2. The mean age of patients with no residual disease was 45.7 years (range;27-67) and that of patients with residual disease was 49.7 years (range;32-67), showing significant difference (p=0.008). 3. Thirty-three out of 129 cases (25.6%) with negative resection margin and 20 out of 37 cases (54.1%) with positive resection margin in LEEP had residual disease, showing significant difference (p=0.001). 4. Residual disease after hysterectomy was more frequent in patients with more high grade lesions in LEEP, but there was no statistical significant difference (p>0.05). 5. There was no significant difference in the possibility of positive residual disease after hysterectomy between HPV-positive group and HPV-negative group (p=0.84). CONCLUSION: The negative resection margin in LEEP does not always guarantee that there is no residual disease. More aggressive treatment plan (wide conization or hysterectomy) should be considered in patients who has higher possibility of residual disease such as old age and positive resection margin in LEEP.
Cervical Intraepithelial Neoplasia* ; Conization ; Humans ; Hysterectomy ; Jeollabuk-do

OBJECTIVE: The purpose of this study was to compare the neonatal and maternal infectious morbidity between single and multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes. METHODS: One hundred seventy patients who delivered neonates between 28 and 34 weeks' gestation after preterm premature rupture of membranes from January 1992 to July 2000 were reviewed retrospectively. Patients were divided into 3 groups on the basis of the following betamethasone exposures: (1) none (control subjects), (2) betamethasone 4 mg IM, IV simultaneously and then 4 mg IV q 8 hours for 24 hours (single course) and (3) weekly administration after initial single course (multiple courses). All included patients received prophylactic antibiotics for group B streptococci. The statistical analyses were done using x2 test, Fisher's exact test and one way analysis of variance (ANOVA). Multiple logistic regression analysis was performed to determine the confounding effect of the multiple variables those were considered as risk factors for neonatal sepsis. RESULTS: This study included 67 patients in the control group, 60 patients in the single course group, and 43 patients in the multiple courses group. The latency (p=.0001) was significantly longer in the patients exposed to multiple course than the patients in the control group and those in the single course group. No significant difference was demonstrated in the incidence of neonatal sepsis (p=.881) and postpartum endometritis (p=.619) among the three groups. Neonatal sepsis was significantly associated with clinical chorioamnionitis (p=.022). CONCLUSION: According to our data, multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes was not associated with the increased incidence of neonatal sepsis and postpartum endometritis.
Anti-Bacterial Agents ; Betamethasone* ; Chorioamnionitis ; Endometritis ; Female ; Humans ; Incidence ; Infant, Newborn ; Logistic Models ; Membranes* ; Postpartum Period ; Pregnancy ; Retrospective Studies ; Risk Factors ; Rupture* ; Sepsis

A case of Cessation of massive vaginal bleeding after TAE in giant Arteriovenous Malformation (AVM) of the Uterus. A 68-year old woman who had massive vaginal bleeding was diagnosed of AVM of uterus by ultrasonogram, CT, MRI, and angiography. In our case report, we tried transarterial embolization 2 times by spring coils and detachable balloons. She was treated successfully by TAE resulting in prompt cessation of life- threatened vaginal bleeding. Color and duplex doppler US is an appropriate modality for the detection and diagnosis of uterine AVMs and for follow-up after embolization. Transarterial embolization is a safe and effective method of treating this disease.
Aged ; Angiography ; Arteriovenous Malformations* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Ultrasonography ; Uterine Hemorrhage ; Uterus*

The effects of statins on insulin resistance and new-onset diabetes are unclear. The purpose of this study was to evaluate the effects of rosuvastatin on insulin resistance and adiponectin in patients with mild to moderate hypertension. In a randomized, prospective, single-blind study, 53 hypertensive patients were randomly assigned to the control group (n=26) or the rosuvastatin (20 mg once daily) group (n=27) during an 8-week treatment period. Both groups showed significant improvements in systolic blood pressure and flow-mediated dilation (FMD) after 8 weeks of treatment. Rosuvastatin treatment improved total cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglyceride levels. The control and rosuvastatin treatment groups did not differ significantly in the change in HbA1c (3.0+/-10.1% vs. -1.3+/-12.7%; p=0.33), fasting glucose (-1.3+/-18.0% vs. 2.5+/-24.1%; p=0.69), or fasting insulin levels (5.2+/-70.5% vs. 22.6+/-133.2%; p=0.27) from baseline. Furthermore, the control and rosuvastatin treatment groups did not differ significantly in the change in the QUICKI insulin sensitivity index (mean change, 2.2+/-11.6% vs. 3.6+/-11.9%; p=0.64) or the HOMA index (11.6+/-94.9% vs. 32.4+/-176.7%; p=0.44). The plasma adiponectin level increased significantly in the rosuvastatin treatment group (p=0.046), but did not differ significantly from that in the control group (mean change, 23.2+/-28.4% vs. 23.1+/-27.6%; p=0.36). Eight weeks of rosuvastatin (20 mg) therapy resulted in no significant improvement or deterioration in fasting glucose levels, insulin resistance, or adiponectin levels in patients with mild to moderate hypertension.
Adiponectin ; Blood Glucose ; Blood Pressure ; Cholesterol ; Fasting ; Fluorobenzenes ; Glucose ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; Insulin ; Insulin Resistance ; Lipoproteins ; Plasma ; Prospective Studies ; Pyrimidines ; Single-Blind Method ; Sulfonamides ; Rosuvastatin Calcium

OBJECTIVE: To evaluate the safety and benefit of laparoscopic surgery compared with laparotomy for the management of adnexal tumor during pregnancy. METHODS: We reviewed 54 cases of adnexal tumor during pregnancy which were managed surgically at Chonbuk National University Hospital between January 1996 and July 2002. Laparoscopy was performed in 17 patients. The remaining 37 patients had laparotomy. The medical records were reviewed retrospectively to confirm variable factors, such as gestational age, operating time, surgical methods, pathologic results, and pregnancy outcomes and complications. RESULTS: Mean gestational age at surgery was significantly different between two groups (85.2 vs 103.0 days). Operating time was not significantly different between two groups. Hospital stay (4.6 vs 7.0 days) was significantly shorter in the laparoscopy group than laparotomy group. No operative or postoperative maternal complications occured in the pregnant women who had laparoscopic surgery. Five preterm deliveries and one intrauterine fetal death occured in the laparotomy group. CONCLUSION: Comparing with laparotomy, laparoscopic surgery allows a shorter hospital stay, a reduced rate of postoperative complications and a maternal and fetal morbidity compared. Laparoscopic surgery appears to be safe and effective during pregnancy.
Female ; Fetal Death ; Gestational Age ; Humans ; Jeollabuk-do ; Laparoscopy ; Laparotomy ; Length of Stay ; Medical Records ; Operative Time ; Postoperative Complications ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Retrospective Studies

OBJECTIVE: To evaluate the efficacy of the twisting-off method in transvaginal removal of the pedunculated submucous myoma. METHODS: After paracervical block and vaginal dressing with Povidone iodine, the myoma was grasped at its widest diameter and twisted to avulse it from its attatchment. Several kinds of grasping instruments, ie. kelley clamp, tenaculum, ring forcep, was used. If there was bleeding from its detachment site, vaginal gauze or tampon was inserted for bleeding control. RESULTS: The procedure was perfomed successfully on all 33 patients (100%). In most patients, bleeding was scanty in amount. But in one patient, emergency hysterectomy was performed because of massive uterine bleeding. The myoma varied greatly in size. Largest volume was 62.24 cm3, and mean volume was 13.79 cm3. Pathology revealed classic leiomyomas in most cases. Some showed endocervical polyp or endometrial polyp. Follow up examination was done, and its mean interval was eighteen weeks and no patient was recurred. CONCLUSION: The transvaginal removal of pedunculated submucous myoma utilizing grasping instruments may be an effective and safe procedure and the complication is minimal. Twisting-off method was may be a safe alternative to abdominal myomectomy and hysterectomy. Reproductive capacity can be preserved, also.
Anesthesia, Obstetrical ; Bandages ; Emergencies ; Follow-Up Studies ; Hand Strength ; Hemorrhage ; Humans ; Hysterectomy ; Leiomyoma ; Myoma* ; Pathology ; Polyps ; Povidone-Iodine ; Surgical Instruments ; Uterine Hemorrhage