OBJECTIVE: To assess the association with autoimmune endocrine diseases and detection rate of autoimmune antibodies and its clinical significance in patients with premature ovarian failure. METHODS: Twenty eight patients with primary or secondary amenorrhea manifesting hormonal and clinical features of premature ovarian failure (primary POF: 7, secondary POF: 21) were investigated. We tested them TFT, 75 g OGTT, ACTH and S-cortisol for thyroiditis, IDDM, Addison's disease, and antithyoglobulin antibody, antimicrosomal antibody, antinuclear antibody, rheumatic factor, anti-smooth muscle antibody, anti-acetylcholine receptor antibody for non-organ specific autoimmune disorders. RESULTS: Only one patient was diagnosed as IDDM and no patients had abnormal TFT or adrenal function test. More than one kind of autoantibody was detected in 11 patients of all (39.2%): 5 patients (71.4%) of primary POF group and 6 patients (21.4%) of secondary POF group. Eleven patients (39.3%) had antithyroglobulin antibody, 4 (14.3%) had antimicrosomal antibody, 2 (7.1%) had antinuclear antibody, 2 (7.1%) had rheumatic factor, 1 (3.6%) had anti-smooth muscle antibody, 1 (3.6%) had anti-acetylcholine receptor antibody. CONCLUSIONS: Premature ovarian failure may occur as a component of an autoimmune polyglandular syndrome, so patients should be measured with free thyroxine, thyroid-stimulating hormone, fasting glucose and electrolytes. Measurement of thyroid autoantibodies in POF patients may be important in identifying patients at risk of developing overt hypothyoidism, but other autoantibodies may not be suitable for screening test.
Addison Disease ; Adrenocorticotropic Hormone ; Amenorrhea ; Antibodies ; Antibodies, Antinuclear ; Autoantibodies ; Autoimmune Diseases* ; Diabetes Mellitus, Type 1 ; Electrolytes ; Endocrine System Diseases ; Fasting ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Mass Screening ; Primary Ovarian Insufficiency* ; Thyroid Gland ; Thyroiditis ; Thyrotropin ; Thyroxine

Although there have been several reported cases of enterocolitis caused by Yersinia enterocolitica, its colonoscopic findings have not been reported in Korea. We recently experienced two cases of Y. enterocolitica enterocolitis, where the colonoscopic examinations were performed. Two patients visited our hospital due to right lower quadrant pain. The thickened terminal ileum and right side colon with enlarged mesenteric nodes were observed on ultrasonography using graded compression method. Y. enterocolitica was isolated from stool in both cases, The colonascopy revealed nodular elevations, erosion., hyperemia, and edema on the terminal ileum and small hyperemic erosions or aphthoid ulcers on the colon, especially on the right side of the colon. In one of the cases, the aphthoid ulcers could be also seen on the sigmoid colon. Their clinical symptoms and signs improved 3-5 days after their visit without using antibiotics. We report these cases with a review of the relevant literature.
Anti-Bacterial Agents ; Colon ; Colon, Sigmoid ; Colonoscopy ; Edema ; Enterocolitis* ; Esophagus* ; Humans ; Hyperemia ; Ileum ; Intestines* ; Korea ; Lymphadenitis* ; Stomach* ; Ulcer ; Ultrasonography ; Yemen* ; Yersinia enterocolitica* ; Yersinia*

Malakoplakia is an uncommon granulomatous disease most frequently found in the bladder or ureter. Howevcr, it has been reyorted in almost every ather organ and structure, the colon is the most common site of malakoplakia outside the urogenital tract and colonic carcinoma is the most commonly associated disease. A case of malakoplakia of the colon in a 54-year-old female is reported. Sigmoidoscopy revealed multiple whiteyellowish nodules simulating polypoid lesion at 10cm from the anal verge. The biopsy showed characteristically comprised submucosal proliferations of histiocyte and chronic inflammatory cells with typical cytoplasmic inclusions known as Michaelis-Gutmann bodies. Intravenous pyelogram showed no evidence of involvement of the urinary system. These nodules were removed by endoscopic polypectomy, So far, this is the first case of isolated colonic malakoplakia in Korea.
Biopsy ; Colon ; Female ; Histiocytes ; Humans ; Inclusion Bodies ; Korea ; Malacoplakia* ; Middle Aged ; Rectum ; Sigmoidoscopy ; Ureter ; Urinary Bladder

The intestine is the third most commonly injured abdominal organ in blunt trauma. But we had a paucity of experience with these injuries. We experienced bowel ischemia in 55 year-old woman after motor-vehicle accident. She complained nausea, vomiting and weight, loss after traffic accident. We found mucosal hyperemia and intraluminal stenosis of duodenal second portion by the gastroscopy. So, we performed hypotonic duodenography and SMA and celiac angiograpby. Hypotonie duodenography showed a luminal narrowing from duodenojejunal junction to proximal jejunum and proximal dilatation, and SMA angiography showed 10 cm segment hypervascular staining of contrast medium in proximal portion. Therefore we performed jejunal loop segmentectomy. After operation she was discharged without complication.
Accidents, Traffic ; Angiography ; Constriction, Pathologic ; Dilatation ; Female ; Gastroscopy ; Humans ; Hyperemia ; Intestines ; Ischemia* ; Jejunum ; Mastectomy, Segmental ; Middle Aged ; Nausea ; Phenobarbital ; Vomiting

A case of resected primary duodenal cancer associated with early gastric cancer is reported. A 67-year-old male complaining of nausea and vomiting was admitted. Endo-scopic examination showed an ulcerative lesion withblood clot in the angle of the stomach and stricture in the duodenum. The stomach lesion was proven to be signet ring cell carcinoma by biopsy. Exploratory laparotomy was done and frozen specimen of duodenum was revealed to be malignant. Subtotal gastrectomy and pancreaticoduodenectomy with lymph node dissection were done and the specimen from stricture of duodenum was proven to be adenocarcinoma. The gastric cancer was limited to the mucosa and metastasis was not recognized in regional lymph node, Furthermore, there was normal mucosa between gastric cancer and duodenal cancer. Therefore, cancers in the stomach and duodenum were considered to be a case of double prim~iary cancer.
Adenocarcinoma ; Aged ; Biopsy ; Carcinoma, Signet Ring Cell ; Constriction, Pathologic ; Duodenal Neoplasms* ; Duodenum ; Esophagus* ; Gastrectomy ; Humans ; Intestines* ; Laparotomy ; Lymph Node Excision ; Lymph Nodes ; Male ; Mucous Membrane ; Nausea ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Stomach Neoplasms* ; Stomach* ; Ulcer ; Vomiting

BACKGROUND/AIMS: Computed tomography during arterial portography and computed tomography during hepatic arteriography (CTAP and CTHA), one of the most sensitive method in detection of hepatocellular carcinoma (HCC) nodules , is reported to reduce unnecessary operation of HCC. However, it is not clear whet her CT AP and CT HA can reduce early post operative recurrence rate of HCC. We performed this study to find any differences in early postoperative recurrence rate of HCC according to the imaging modalities used for preoperativest aging. METHODS: Ninety-seven patients with HCC who had underg one curative hepat icres ection from Dec.1994 to Mar. 1998 were included (median age = 52 years (26-78), M:F = 85:12). They were classified into 3 groups according to the imaging methods used for preoper ative staging: CTAP & CTHA group (n=56), Lipiodol CT group (n=24), and three phase helical CT group (n=16). No significant inter-group difference was found in preoperative status of the patients or characteristics of HCC. One-year recurrence rates were compared by log-rank test. RESULTS: HCC recurred in 17 of 97 patients (18.7%) within 12 months. A significant difference in 1- year recurrence rate was observed between the groups: helical CT , may be a superior imaging modality for preoperative staging of HCC that can reduce early postoperative recurrence rate.
Aging ; Angiography ; Carcinoma, Hepatocellular* ; Ethiodized Oil* ; Humans ; Portography ; Recurrence* ; Tomography, Spiral Computed*

Chronic renal failure (CRF) is associated with amenorrhea and impaired fertility, and pregnancy occurs uncommonly in patients requiring dialysis. Even though it occurs, obstetrical complications such as spontaneous abortion, still birth, polyhydramnios, preterm birth, fetal growth restriction, preeclampsia are common. So successful live birth in those patients is very rare. The intensive dialysis to maintain a predialysis BUN <50 mg/dL is very important, and the management of anemia, hypertension, electrolytes, bone minerals, and nutrition is also concerned. We report a case of successful live birth in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD) and a case of preterm birth in a patient undergoing hemodialysis (HD).
Abortion, Spontaneous ; Amenorrhea ; Anemia ; Dialysis* ; Electrolytes ; Female ; Fertility ; Fetal Development ; Humans ; Hypertension ; Kidney Failure, Chronic ; Live Birth ; Minerals ; Parturition ; Peritoneal Dialysis, Continuous Ambulatory ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy* ; Premature Birth ; Renal Dialysis ; Renal Insufficiency*

OBJECTIVE: To evaluate the efficacy and prognostic factors of methotrexate treatment in cervical/previous cesarean scar pregnancy. METHODS: This study was retrospectively performed in 25 women who had diagnosed cervical/previous cesarean scar pregnancy. Clinical and demographic characteristics, methotrexate regimen, concomitant invasive procedures, complications, and outcomes were analyzed. RESULTS: Among the 25 cases, 64% of women was succeeded by only methotrexate injection, and 96% of women could preserved her fertility after concomitant procedures. There were no significant differences in the patients' age, parity, gestational age and serum beta-hCG, but significant differences in methotrexate administration route and presence of initial hematoma formation between success group and failure group of methotrexate therapy. A concomitant feticide could enhance the therapeutic effect. CONCLUSIONS: The presence of hematoma formation before treatment is important predictor of methotrexate treatment in cervical/previous cesarean scar pregnancy, rather than gestational age, serum beta-hCG. And direct local injection of methotrexate with concomitant feticide procedure could be better route of administration in cervical/previous cesarean scar pregnancy.
Cicatrix* ; Female ; Fertility ; Gestational Age ; Hematoma ; Humans ; Methotrexate* ; Parity ; Pregnancy* ; Retrospective Studies

OBJECTIVE: To evaluate the efficacy and prognostic factors of methotrexate treatment in cervical/previous cesarean scar pregnancy. METHODS: This study was retrospectively performed in 25 women who had diagnosed cervical/previous cesarean scar pregnancy. Clinical and demographic characteristics, methotrexate regimen, concomitant invasive procedures, complications, and outcomes were analyzed. RESULTS: Among the 25 cases, 64% of women was succeeded by only methotrexate injection, and 96% of women could preserved her fertility after concomitant procedures. There were no significant differences in the patients' age, parity, gestational age and serum beta-hCG, but significant differences in methotrexate administration route and presence of initial hematoma formation between success group and failure group of methotrexate therapy. A concomitant feticide could enhance the therapeutic effect. CONCLUSIONS: The presence of hematoma formation before treatment is important predictor of methotrexate treatment in cervical/previous cesarean scar pregnancy, rather than gestational age, serum beta-hCG. And direct local injection of methotrexate with concomitant feticide procedure could be better route of administration in cervical/previous cesarean scar pregnancy.
Cicatrix* ; Female ; Fertility ; Gestational Age ; Hematoma ; Humans ; Methotrexate* ; Parity ; Pregnancy* ; Retrospective Studies

OBJECTIVE: This study was performed to evaluate the accuracy of hysterosalpingography (HSG) for evaluating female infertility patients by comparison with hysteroscopic and laparoscopic examination. METHODS AND MATERIAL: Total 219 infertile patients were retrospectively analyzed between January 1, 2002 and December 31, 2003. Ninety seven patients (44.3%) were primary infertility, 122 patients (55.7%) were secondary infertility. We performed hysteroscopic and laparoscopic examination on next cycle when HSG revealed any abnormal finding, and 3~6 cycles later if HSG was normal. RESULTS: The accuracy of HSG was 65.2% compared with hysteroscopic examination (sensitivity 88.4%, specificity 46.4%, false positive rate 53.6%, false negative rate 11.6%). The most common abnormal finding of hysteroscopy was uterine synechia (67.4%) followed by endometrial polyp, uterine anomaly (e.g. uterine septum), endometrial hyperplasia. Compared with laparoscopic examination, the accuracy of HSG was 76.9% (sensitivity 98.9%, specificity 70.6%, +LR 3.36, -LR 0.02). The positive predictive value of normal patent tube was excellent (99.6%) but that of proximal tubal blockage was only 46.7%. The unilateral tubal obstruction of HSG was poor accuracy (+LR 3.85 -LR 0.68) and 70% of those was patent by laparoscopic examination. Laparoscopic examination also revealed that 53% of patients had peritubal adhesion and 37% of patients has additional pelvic findings, especially endometriosis. Among the patients had normal HSG, 53.5% patients with normal ultrasonography was diagnosed endometriosis (25.6% of them had endometriosis stage I-II). CONCLUSION: Normal HSG shows a high negative predictive value. Nevertheless, the incidence of associated pelvic disease in the normal HSG group is high enough to warrant diagnostic laparoscopy if nonsurgical treatment is unsuccessful. Because HSG has poor accuracy in predicting distal tubal blockage and peritubal adhesion, and poor positive predictive value of proximal tubal blockage, laparoscopic examination could be considered in abnormal HSG group.
Endometrial Hyperplasia ; Endometriosis ; Fallopian Tube Diseases ; Female ; Female* ; Humans ; Hysterosalpingography* ; Hysteroscopy ; Incidence ; Infertility ; Infertility, Female* ; Laparoscopy ; Polyps ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography