Insulinoma is the most frequent endocrine tumor of the pancreas and the first of the endocrine-secreting tumor of the gut to be recognized by Nicholls in 1902. Recurrent episodes of hypoglycemia is the main cause of the symptoms and signs which were sweating, pallor, dizziness, habitual change, convulsion and coma. In 1935, Whipple and Frants were described so-called “Whipple's triad”: the patient's symptoms occur with fasting or exercise; at the time of symptoms, the serum glucose in 50mg/dl or less; and the symptoms are relieved by the administration of glucose. While these criteria were timely, they proved to be rather nonspecific and may be found in other conditions that result in fasting hypoglycemia. We experienced a 44-year-old female patient who had repeated attacks of convulsion, unconsciousness and coma for 3 years. Although she has been treated with anticonvulsant, the symptoms and signs were not disappeared. At the time of administration, she was a full coma state due to hypoglycemia and was dramatically reversed by intravenous administration of the glucose solution. The preoperative test such as provocative test, abdominal CT and celiac angiography revealed insulinoma and after enucleation the pathologic diagnosis was the same. We like to report an adult female patient with insulinoma and the review of literatures briefly.
Administration, Intravenous ; Adult ; Angiography ; Blood Glucose ; Coma ; Diagnosis ; Dizziness ; Fasting ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulinoma* ; Pallor ; Pancreas ; Seizures ; Sweat ; Sweating ; Tomography, X-Ray Computed ; Unconsciousness

No abstract available.
Fetal Development*

No abstract available.
Female ; Humans ; Necrosis*

OBJECTIVE: Our purpose was to assess the efficacy of routine ultrasonographic prediction of macrosomic fetal weight, to determine its influences on subsequent delivery type and to assess perinatal outcome by delivery type. METHODS: The hospital records of 177 patients delivered infants weighing > or =4000gm between January 1997 and December 1998 were reviewed. Statistical comparisons were made between patients in whom fetal macrosomia was predicted before delivery(n=71) and those in whom it was not(n=106) and between the perinatal outcomes for macrosomic fetuses delivered vaginally and by cesarean section. The statistical analysis was performed by student-t test, and Chi-square test and Fisher's exact test. RESULTS: The fetuses were consecutive singleton fetuses in vertex presentation delivered at a single institute. The sensitivity for identifying macrosomic fetus(birth weight >4000gm) with an estimated weight of > or =4000gm was 40%, Overall 60% of the infants had birth weights within 10% of the ultrasonographic estimates and 29% had birth weights within 5% of the ultrasonographic estimates. Cesarean sections were performed in 69% of the 'predicted' group and in 35% of the 'not predicted' group(69% vs 35%, p<0.0001, Fisher's exact test). Predicated group were more likely to be performed by elective cesarean section(48% vs 19%, p<0.0001, Fisher's exact test) and more like due to failed progress at<4cm cervical dilatation(27% vs 7%, p<0.05, Fisher's exact test). The proportion of patients delivered by cesarean section for failed progress at > or =4cm cervical dilatation was similar in the predicted and not predicted groups(19% vs 12%, NS). There was no significant difference in the incidences of the occurrence of birth trauma. CONCLUSION: There appears to be a limitation to obtain estimation of fetal weight by ultrasonography. The antenatal prediction of fetal macrosomia is associated with a marked increase in cesarean deliveries without a significant reduction in the incidence of fetal injury
Birth Weight ; Cesarean Section ; Female ; Fetal Macrosomia ; Fetal Weight* ; Fetus ; Hospital Records ; Humans ; Incidence ; Infant ; Labor Stage, First ; Parturition ; Pregnancy ; Ultrasonography*

OBJECTIVE: Our purpose was to evaluate the effect of epidural anesthesia on labor course. METHODS: Between January 1998 and December 1998, we evaluated pregnant women at term with singleton fetus in vertex presentation and with spontaneous onset of labor at our hospital. Comparison of 120 women (100 cases of primiparous women, 20 cases of multiparous women) who received epidural anesthesia in labor with 120 women (100 cases of primiparous women, 20 cases of multiparous women) who did not receive epidural anesthesia was performed. Adverse pregnancy outcomes were obtained from hospital delivery records and neonatal records. Statistical analysis were performed by Student's t-test and Chi square test. RESULTS: The results of this study were as followings; 1. There was no significant difference in mean age, body weight, height, and gestational age between epidural anesthesia group and control group (P>0.05). 2. The frequency of oxytocin augmentation was significantly greater in the primiparous epidural anesthetic group than in primiparous control group (p<0.05). 3. The effect of epidural anesthesia on the first stage of labor revealed no significant difference in both group. 4. Prolongation of second stage of labor was noticed in nullipara of epidural anesthesia group compared to control group (p<0.05). 5. The incidence of instrumental delivery was significantly increased in the primiparous epidural group than in the primiparous control group(p<0.05). 6. The meconium-stained amnionic fluid, Apgar score and birth weight were similar in both groups. 7. The maternal blood loss was similar in both groups. CONCLUSION: Epidural anesthesia, significantly prolongs second stage of labor in induced patients. While instrumental delivery was more prevalent in these parturients, C-section rate and intra-partum complications were not increased in these patients.
Amnion ; Anesthesia, Epidural* ; Apgar Score ; Birth Weight ; Body Weight ; Female ; Fetus ; Gestational Age ; Humans ; Incidence ; Oxytocin ; Pregnancy ; Pregnancy Outcome ; Pregnant Women

OBJECTIVE: Unexplained elevations of midtrimester human chorionic gonadotrophin(hCG) or alpha fetoprotein(AFP) have known to be at increased risk for a variety of third trimester pregnancy complication, such as preeclampsia. The causes of these were thought to be made by impaired placental function, as a reflection of impaired uteroplacental circulation. Our purpose was to determine if amniotic fluid total -hCG and AFP levels are elevated in women with severe preeclampsia and if these levels correlated with other laboratory features of disease severity. METHODS: Seventeen women with severe preeclampsia were matched with 16 women with the diagnosis of either preterm labor and intact membranes(n=10) or preterm premature rupture of membranes(n=6) who met the following criteria: 1) singleton gestation 2) absence of congenital anomaly 3) absence of active labor 4) confirmed getational age by ultrasonography 5) transabdominal amniocentesis performed to obtain amniotic fluid to assess fetal lung maturity. Amniotic fluid total -hCG and AFP were measured by double antibody radioimmunoassay(RADIM, Italy). Mann-Whitney U test and multiple linear regression analysis were used. RESULTS: 1) Concentrations of amniotic fluid total -hCG but not amniotic fluid AFP, maternal blood total -hCG and AFP were significantly higher in severely preeclamptic women than in their matched controls(amniotic fluid total -hCG; median 28.5, range 4.3-120.3 IU/ml vs. median 9.4, range 2.7-99 IU/ml, p < 0.01). 2) Amniotic fluid total -hCG levels correlated positively with maternal blood BUN(blood urea nitrogen) levels(r= 0.66, regression coefficients 5.57, standard error 2.4021, p< 0.05, multiple linear regression) after correction for known confounding variables(i.e., maternal weight, gestational age at sampling, hematocrit). CONCLUSION: Amniotic fluid total -hCG levels are elevated in women with severe preeclampsia and correlate closely with maternal blood BUN levels. These observation suggest that the pathologic changes of preeclampsia might occur in the placenta and involve in change of a significantly secretory reaction of the placenta.
alpha-Fetoproteins* ; Amniocentesis ; Amniotic Fluid* ; Chorion ; Chorionic Gonadotropin* ; Diagnosis ; Female ; Gestational Age ; Humans* ; Linear Models ; Lung ; Obstetric Labor, Premature ; Placenta ; Placental Circulation ; Pre-Eclampsia* ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Rupture ; Ultrasonography ; Urea

No abstract available.
Humans ; Infant, Newborn* ; Necrosis* ; Subcutaneous Fat*

OBJECTIVE: In a rabbit model using hysteroscopy-guided inoculation of E.coli with antibiotic administration, we determine the effects of persistent intrauterine infection on perinatal outcome including fetal death, congenital sepsis, and abnormal fetal-placental growth and amniotic fluid volume in live fetuses. METHODS: Rabbits with timed pregnancies underwent hysteroscopy at 20 to 21 days of gestation(70%). Animals were inoculated with E. coli (0.2 ml containing 10 cfu/ml) and administered ampicillin-sulbactam(100 mg/kg/day; Unasyn; Pfizer) every 8 hours beginning 30 minutes after microbial inoculation until they were killed 5 days after hysteroscopy. In the first study, the following outcome parameters were evaluated between fetuses with and without pe#rsistent intrauterine infection: fetal survival, congenital sepsis, maternal morbidity, and placental pathology. In second study was performed in 16 rabbits having only both live fetuses with and without persistent intrauterine infection in a rabbit simultaneously. We evaluate the effects of persistent intrauterine infection on fetal-placental weight and amniotic fluid volume in live fetuses. RESULTS: 1) Fetuses with persistent intrauterine infection had significantly fewer live fetuses, more positive cord blood cultures than those without (live fetuses: 44% vs 82%, p<0.000001; positive cord blood cultures: 44% vs 3%, p<0.000001, respectively; Fishers exact test). However the rates of maternal morbidity and placental inflammatory lesions were similar between the two groups. 2) The placental weight and amniotic fluid volume were significantly less in live fetuses with than in those without persistent intrauterine infection. Moreover the fetal weight was decreased in live fetuses with persistent intrauterine infection, but it was not statistically significant(placental weight: p<0.05; amniotic fluid volume: p<0.05; fetal weight: p 0.051, respectively; Wilcoxon matched-pairs signed ranks test). CONCLUSION: Fetal complications including fetal death, congenital sepsis, and decreased fetal-placental weight and amniotic fluid volume wae produced in utero when pasistent intrauterine infection was present with antibiotics administration after inoculstion of E. coli. Therefore, when treating with antibiotics in intrauterine infection, it is needed to observe and monitar the presence of persistent intrauterine infection, and if it is peristent, delivery may be considered for the improvement of pregnancy outcome.
Amniotic Fluid ; Animals ; Anti-Bacterial Agents ; Female ; Fetal Blood ; Fetal Death ; Fetal Weight ; Fetus ; Hysteroscopy ; Obstetric Labor, Premature ; Pathology ; Pregnancy ; Pregnancy Outcome ; Rabbits ; Sepsis

OBJECTIVE: Disseminated intravascular coagulation (DIC) is a serious and life-threatening complication of amniotic fluid embolism and chorioamnionitis. DIC results from excessive thrombin activity leading to a consumptive coagulopathy. The mechanisms responsible for the increased availability of thrombin in intrauterine infection remain to be elucidated. The purpose of this study was to determine if thrombin activation in amniotic fluid, as measured by thrombin-antithrombin III (TAT) concentration, was associated with intrauterine infection and preterm delivery. METHODS: A cross-sectional study included women who underwent transabdominal amniocentesis (n=129) in the following group: (1) mid-trimester (n=10) (2) preterm labor and intact membranes in the presence (n=17) or absence (n=72) of microbial invasion of the amniotic cavity, (3) term, not in labor and absence (n=30) of microbial invasion of the amniotic cavity. Intrauterine infection was defined as a positive amniotic fluid culture for microorganism. Thrombin was detected by assaying the thrombin-antithrombin III complex in amniotic fluid by means of sensitive and specific immunoassay (Enzygnost TAT micro; Behring Diagnostics Inc Westwood MA). RESULTS: 1) TAT complex was detected in all amniotic fluid samples and its concentration did not have a relation with gestational age. 2) The women with a positive amniotic fluid culture had a significantly higher median TAT complex concentration than those with a negative cultures (median, 168 micro gram/l; range, 23.1-288 vs median 80 micro gram/l; range, 10.7-507; p<0.05). 3) Multivariate analysis showed that amniotic fluid TAT complex was an independent predictor for preterm delivery (odd ratio 4.72, p<0.05) after correction for known confounding variables (i.e. gestational age, cervical dilatation at amniocentesis and positive amniotic fluid culture). CONCLUSION: This study showed that TAT complex in amniotic fluid was elevated in women with preterm labor and intact membranes who had a intrauterine infection or were destined to deliver before term. Our findings support the hypothesis that the excess thrombin released during the course of intrauterine infection may play a role in the genesis of DIC in this condition.
Amniocentesis ; Amniotic Fluid* ; Chorioamnionitis ; Confounding Factors (Epidemiology) ; Cross-Sectional Studies ; Dacarbazine ; Disseminated Intravascular Coagulation ; Embolism, Amniotic Fluid ; Female ; Gestational Age ; Humans ; Immunoassay ; Labor Stage, First ; Membranes ; Multivariate Analysis ; Obstetric Labor, Premature ; Parturition* ; Pregnancy ; Thrombin*

OBJECTIVE: To determine whether there is correlation between serum concentrations of lipoproteins (VLDL, HDL, LDL) and development of preedampsia. METHODS: The authors measured serum concentrations of lipoproteins(VLDL, HDL, LDL) and lipids(which are major components of lipoproteins) in 12 preeclamptic women admitted to Sanggye Paik Hospital, Inje University from March 1999 to August 1999 and 12 normal pregnant women matched in age, weight, parity and gestational age. RESULTS: The first, the values of median and range of VLDL are higher in preeclamptic women than in normal pregnant women(preeclamptic women : 244mg/dL & 124-521mg/dL, normal pregnant women : 149mg/dL & 68-308mg/dL, p=0.0005). But there are no difierences in serum concentrations of HDL(high-density lipoprotein) and LDL(low-density lipoprotein) between two groups. The second, the values of median and range of triglyceride and free fatty acids are higher in preedamptic women than in normal pregnant women(preeclamptic women : triglycerides : 305.5mg/dL & 231-545mg/dL, free fatty acids : 1,333mmol/L & 842- 1523mmol/L, normal pregnant women,: triglycerides : 239mg/dL & 151-414mg/dL, free fatty acids : 806.5mmol/L & 314-1517mmol/L, p=0.019 in triglycerides and p=0.033 in free Fatty acids). But the serum concentrations of cholesterol are similar in two groups. CONCLUSIONS: Overall, the results of this study showed the serum concentrations of VLDL, triglycerides and free fatty acids are significantly higher in preeclamptic women than in normal pregnant women. So, the high serum concentration of VLDL is thought to be important in the pathogenesis of preeclampsia. In the next study, the prospective analysis will be necessary to identify whether serum concentration of VLDL is abnormaUy high in early gestational pregnant women who are destined to preeclamsia. Also, the measurement of pI 5.6 isoelectric form of albumin which is suggested to prevent VLDL toxicity will be necessary.
Cholesterol ; Fatty Acids, Nonesterified ; Female ; Gestational Age ; Humans ; Lipoproteins* ; Parity ; Pre-Eclampsia* ; Pregnant Women ; Triglycerides