No abstract available.
Gynecology*

Hyperreactio luteinalis is a rare disease characterized by marked cystic enlargement of the ovary due to multiple benign theca lutein cyst. The cause of this disease is not well known but is believed to be induced by high serum levels of human chorionic gonadotropins (hCG). It occurs usually in gestational trophoblastic disease, multiple pregnancies, and rarely in normal pregnancy. In nature, hyperreactio luteinalis is a benign condition. Therefore, the appropriate management is conservative, but surgical intervention is definitely indicated to remove infarcted tissue, control hemorrhage, or decrease androgen production in virilized patients. Here we report a case of hyperreactio luteinalis which was diagnosed at 11 weeks gestation. Lower abdominal pain was developed and progressed. Emergent right wedge oophorectomy and left salpingoophorectomy was performed due to probable torsion of left ovarian cyst and the pregnancy maintained. Theca lutein cysts were confirmed on pathologic examination.
Abdominal Pain ; Chorionic Gonadotropin ; Female ; Gestational Trophoblastic Disease ; Hemorrhage ; Humans ; Lutein ; Ovarian Cysts ; Ovariectomy ; Ovary ; Pregnancy* ; Pregnancy, Multiple ; Rare Diseases

OBJECTIVES: To evaluate whether the day of delivery for women with regular menstrual history was predicted best from the last menstrual period (LMP), crown rump length (CRL) and or biparietal diameter (BPD). METHODS: All of 561 women had estimated the day of delivery by LMP, CRL in the first trimester (In case of 217 women, it was available) and BPD in the second trimester. The accuracy of each method in predicting the day of delivery was determined. Those who were delivered after the spontaneous onset of labor were included. Differences among these methods were evaluated with nonparametric tests. RESULTS: The percentage of women who delivered within 3 days of the estimated day of delivery was 254(45.3%) and 216(38.5%) of the women with pregnancies by BPD and LMP, respectively. And within 7days of the estimated day were 408(72.7%), 390(69.5%) of the women from BPD and the LMP. In the women, the BPD estimate was significantly better predictor within the 7days of the day of delivery than LMP estimate (p=0.027). Compared to LMP estimate, CRL and BPD estimates seemed to be advanced the day of delivery about 2.6 days in CRL, and 0.9 days in BPD (p=0.004, p=0.034). But we could not find any advantage of the CRL measurement in first trimester than single BPD measurement in the second trimester for the predictor of the day of delivery. CONCLUSIONS: When the difference between the methods in predicting the day of delivery was less than 7 days, the BPD measurement was better than the last menstrual period.
Biometry* ; Crown-Rump Length ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Ultrasonography

PURPOSE: A decline in the circulating levels of estrogen impairs vaginal engorgement, which leads to histopathological changes in the vaginal tissues. The aim of this study was to evaluate the effect of delayed estrogen replacement on the vagina structure in castrated rabbits. Materials and Methods: New Zealand White female rabbits were randomly divided into three groups; two groups (the castration and castration estrogen replacement groups) were castrated: the control group underwent sham operations. Nine weeks after surgery, the estrogen replacement group received subcutaneous injections of estrogen (50microgram/kg/day) for 4 weeks. Vaginal tissue was processed for histology with Masson's trichome stain. The expressions of e-NOS and n-NOS were examined by immunohistochemistry and Western blot. RESULTS: From the histology, marked thinning of the vaginal epithelial layers, and decreased smooth muscle content and submucosal microvasculatures were evident, but with no increase in the collagen fibers in the castrated group was noted. The vaginal tissue of the estrogen replaced animal showed similar morphological features to those in the control rabbits. From the histomorphometry, the percentage of vaginal smooth muscle in the castrated group was significantly decreased compared to those in the control and estrogen replaced groups. The expression and signal intensity of e-NOS were decreased in the vagina of the castrated animals compare to those in the control group. In the estrogen replaced group, the expression of e-NOS was normalized. CONCLUSIONS: Delayed estrogen replacement showed structural restoration of vaginal tissues. These results suggest that delayed estrogen replacement therapy could improve the sexual function in menopausal women.
Animals ; Blotting, Western ; Castration ; Collagen ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Humans ; Immunohistochemistry ; Injections, Subcutaneous ; Menopause ; Muscle, Smooth ; New Zealand ; Rabbits ; Trichomes ; Vagina

OBJECTIVE: In vitro studies have revealed that treatment of various human cancer cell lines with specific cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to investigate the benefits of combining COX-2 inhibitors with existing treatment modalities in the management of ovarian cancer. METHODS: In this study we sought to determine the effects of combining paclitaxel and the COX-2 inhibitor celecoxib on apoptosis of epithelial ovarian cancer (EOC) cells. SK-OV-3 cells were exposed to increasing concentrations of paclitaxel (10(-7) M, 10(-6) M and 10(-5) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 hours of continuous exposure. But concomitant treatment of SK-OV-3 EOC cell line with paclitaxel and celecoxib resulted in marked impairment of paclitaxel-induced apoptosis. The pattern of apoptosis induced by paclitaxel on SK-OV-3 EOC cell line was caspase-3 independent. CONCLUSION: Combining COX-2 inhibitors and paclitaxel does not have an additive or synergistic tumoricidal effect. On the contrary, celecoxib treatment markedly inhibited the apoptotic effects of paclitaxel in SK-OV-3 EOC cell line.
Adenosine Diphosphate Ribose ; Apoptosis* ; Caspase 3 ; Cell Death ; Cell Line* ; Cyclooxygenase 2 ; Cyclooxygenase 2 Inhibitors ; Humans ; Ovarian Neoplasms* ; Paclitaxel ; Celecoxib

BACKGROUND: This retrospective review examines the preoperative condition, postoperative course, mortality and cause of death for the patients who underwent modified Blalock-Taussig shunt for complex congenital heart defects in early infancy. MATERIALS AND METHOD: Fifty eight patients underwent modified Blalock-Taussig shunts from January 2000 to November 2003. The mean age at operation was 23.1+/-16.2 days (5~81 days), and the mean body weight was 3.4+/-0.7 kg (2.1~4.3 kg). Indications for surgery were pulmonary atresia with ventricular septal defect in 12 cases, pulmonary atresia with intact ventricular septum in 17, single ventricle (SV) in 18, and hypoplastic left heart syndrome (HLHS) in 11. Total anomalous pulmonary venous return (TAPVR) was associated with SV in 4 cases. RESULT: There were 11 (19.0%) early, and 5 (10.6%) late deaths. Causes of early death included low cardiac output in 9, arrhythmia in 1, and multiorgan failure in 1. Late deaths resulted from pneumonia in 2, hypoxia in 1, and sepsis in 1. Risk factors influencing mortality were preoperative pulmonary hypertension, metabolic acidosis, use of cardiopulmonary bypass, HLHS and TAPVR. Twenty four patients (41.4%) had hemodynamic instability during the 48 postoperative-hours. Six patients underwent shunt revision for occlusion, and 1 shunt division for pulmonary overflow. CONCLUSION: Modified Blalock-Taussig shunt for complex congenital heart defects in early infancy had satisfactory results except in high risk groups. Many patients had early postoperative hemodynamic instability, which means that continuous close observation and management are mandatory in this period. Aggressive management may appear warranted based on understanding of hemodynamic changes for high risk groups.
Acidosis ; Anoxia ; Arrhythmias, Cardiac ; Blalock-Taussig Procedure* ; Body Weight ; Cardiac Output, Low ; Cardiopulmonary Bypass ; Cause of Death ; Heart Defects, Congenital* ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Hypoplastic Left Heart Syndrome ; Infant ; Mortality ; Pneumonia ; Pulmonary Atresia ; Retrospective Studies ; Risk Factors ; Scimitar Syndrome ; Sepsis ; Ventricular Septum

BACKGROUND: We evaluated the early and mid-term results for repair of Ebstein's anomaly. MATERIAL AND METHOD: Between January 1989 and June 2004, 29 patients underwent repair of Ebstein's anomaly. The median age was 11.4 years (4 days-50 years). Tricuspid insufficiency equal to or greater than grade 3 was present in 21 (72.4%) patients. Surgical techniques included tricuspid valve repair with vertical plication of the atrialized ventricle (n=14), Carpentier's technique (n=7), tricuspid valve replacement (n=4), systemic-to-pulmonary arterial shunt (n=2), tricuspid valve repair (n=1), and Fontan operation (n=1). Bi-directional cavopulmonary shunt (BCPS) was required in 5 patients. Among the 2 neonates, one patient underwent successful biventricular repair, and the other patient underwent systemic-to-pulmonary arterial shunt. Follow-up was possible in 21 patients (75%), and the average follow-up was 37.6 months (3 months~11.3 years). RESULT: There were 1(3.4%) early and 1 late deaths. Reoperation was required in 4 patients. Two patients underwent tricuspid valve re-replacement, and the other 2 tricuspid valve repair. At recent follow-up, only 2 patients showed tricuspid insufficiency equal to or greater than grade 3, and most patients showed clinical improvement. Excluding the patients who underwent tricuspid valve replacement, the actuarial rate of freedom from reoperation at 1 and 5 years were 94.7% and 79.0%, respectively. CONCLUSION: Tricuspid valve repair was possible in most patients with good mid-term outcome. Most patients showed clinical and hemodynamic improvement. Indications for the BCPS should be clarified.
Ebstein Anomaly* ; Follow-Up Studies ; Fontan Procedure ; Freedom ; Heart Bypass, Right ; Hemodynamics ; Humans ; Infant, Newborn ; Reoperation ; Tricuspid Valve

OBJECTIVE: Anterior abdominal wall defects are classified into three basic types: omphalocele, gastroschisis and bodystalk anomaly. Its incidence and prognosis are different according to each type of anomaly. We aimed at investigating its demographic characteristics and risk factors. METHODS: From Jan. 1996 to Jun. 2002, 20 cases of anterior abdominal wall defects were diagnosed by prenatal ultrasonography and all ultrasonographic findings and delivery records were reviewed. RESULTS: We had experienced 13 cases of omphalocele, 5 cases of gastroschisis and 2 cases of bodystalk anomaly. Mean maternal age was 29.9 (+/-5.5) years in omphalocele, 25.6 ( +/- 1.7) in gastroschiss, 32 ( +/- 4.2) in bodystalk anomaly. The median gestational weeks at the time of diagnosis was 17.6 for omphalocele, 20 for gastroschisis, 14.5 for bodystalk anomaly. Live born cases were 3 in omphalocele, 1 in gastroschisis and none in bodystalk anomaly. Of the 13 cases of chromosomal analyses, there was one case of trisomy 18 in omphalocele. Multiple anomalies were found in all bodystalk anomalies including kyphoscoliosis, facial defect, central nervous system defects. 54% of associated anomalies were found in omphalocele and no associated anomaly in gastroschisis. CONCLUSION: Omphaloceles were most frequently detected in abdominal wall defects and the gastroschisises were the next. Our results suggested that the pathogenesis of anterior abdominal wall defect might be different one another, but we could not find out definite risk factors for the individual type of defect.
Abdominal Wall* ; Central Nervous System ; Diagnosis ; Gastroschisis ; Hernia, Umbilical ; Incidence ; Maternal Age ; Prognosis ; Risk Factors ; Trisomy ; Ultrasonography, Prenatal

BACKGROUND: Surgery for Stanford type A aortic dissection shows a high operative mortality rate and frequent postoperative brain injury. This study was designed to find out the risk factors leading to operative mortality and brain injury after surgical repair in patients with type A aortic dissection. MATERIAL AND METHOD: One hundred and eleven patients with type A aortic dissection who underwent surgical repair between February, 1995 and January, 2005 were reviewed retrospectively. There were 99 acute dissections and 12 chronic dissections. Univariate and multivariate analysis were performed to identify risk factors of operative mortality and brain injury. RESULT: Hospital mortality occurred in 6 patients (5.4%). Permanent neurologic deficit occurred in 8 patients (7.2%) and transient neurologic deficit in 4 (3.6%). Overall 1, 5, 7 year survival rate was 94.4, 86.3, and 81.5%, respectively. Univariate analysis revealed 4 risk factors to be statistically significant as predictors of mortality: previous chronic type III dissection, emergency operation, intimal tear in aortic arch, and deep hypothemic circulatory arrest (DHCA) for more than 45 minutes. Multivariate analysis revealed previous chronic type III aortic dissection (odds ratio (OR) 52.2), and DHCA for more than 45 minutes (OR 12.6) as risk factors of operative mortality. Pathological obesity (OR 12.9) and total arch replacement (OR 8.5) were statistically significant risk factors of brain injury in multivariate analysis. CONCLUSION: The result of surgical repair for Stanford type A aortic dissection was good when we took into account the mortality rate, the incidence of neurologic injury, and the long-term survival rate. Surgery of type A aortic dissection in patients with a history of chronic type III dissection may increase the risk of operative mortality. Special care should be taken and efforts to reduce the hypothermic circulatory arrest time should always be kept in mind. Surgeons who are planning to operate on patients with pathological obesity, or total arch replacement should be seriously consider for there is a higher risk of brain injury.
Aorta, Thoracic ; Brain Injuries* ; Brain* ; Emergencies ; Hospital Mortality ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Neurologic Manifestations ; Obesity ; Retrospective Studies ; Risk Factors* ; Survival Rate

Melanosis ilei is a condition that's characterized by gross greyish-black or brownish-black pigmentation of the mucosa of the terminal ileum. There were several substances that produce gastrointestinal tract pigmentation such as lipofuscin, iron sulphide (FeS), Hemosiderin and exogenous material such as silicates and titanium. We report here on a case of a 58-year-old female who ingested charcoal for a long time, and she was diagnosed with melanosis ilei by colonoscopy. Her condition improved after she stopped ingesting the charcoal.
Charcoal ; Colonoscopy ; Female ; Gastrointestinal Tract ; Hemosiderin ; Humans ; Ileum ; Iron ; Lipofuscin ; Melanosis* ; Middle Aged ; Mucous Membrane ; Pigmentation ; Silicates ; Titanium