PURPOSE: To evaluate therapeutic effects and usefulness of a combination treatment of intravitreal injection of triamcinolone acetonide (IVTA) and panretinal photocoagulation (PRP) in patients with clinically significant macular edema secondary to proliferative diabetic retinopathy (PDR). METHODS: Visual acuity test, fundoscopy, fluorescein angiography, and optical coherence tomography (OCT) were taken in 20 patients (20 eyes) of macular edema and PDR. A combination of intravitreal injection of triamcinolone acetonide and PRP was performed in 10 patients (10 eyes) and a combination of focal or grid laser photocoaqulation and PRP in the remaining 10 eyes. The postoperative outcomes were compared between the two combination treatments by best corrected visual acuity (BCVA), tonometry, fluorescein angiography, and OCT at 2 weeks, 1, 2, and 3 months. RESULTS: Average BCVA (log MAR) significantly improved from preoperative 0.56+/-0.20 to 0.43+/-0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of IVTA and PRP in 10 eyes (P=0.007). The thickness of fovea decreased from average 433.3+/-114.9 micrometer to average 279.5+/-34.1 micrometer at 2 weeks after combined treatment of IVTA and PRP (P=0.005), which was significantly maintained until 3 months, but there was a transient visual disturbance and no significant difference in thickness of the fovea before and after treatment in the groups with PRP and focal or grid laser photocoagulation. CONCLUSIONS: A combination of IVTA and PRP might be an effective treatment modality in the treatment of macular edema and PDR and prevent the subsequent PRP-induced macular edema result in visual dysfunction. In combination with PRP, IVTA might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.
Vitreous Body ; Triamcinolone Acetonide/*administration & dosage/therapeutic use ; Treatment Outcome ; Middle Aged ; Macular Edema, Cystoid/*drug therapy/etiology/*surgery ; *Laser Coagulation ; Injections ; Humans ; Glucocorticoids/*administration & dosage/therapeutic use ; Diabetic Retinopathy/*complications ; Aged

OBJECTIVE: To evaluate patients with adnexal masses that were managed surgically during pregnancy and their effect on fetal outcome. METHODS: The data were reviewed concerning pregnant women who required surgery at Samsung Cheil hospital between January 1996 to December 2001. Among 50,126 deliveries, 255 cases of ovarian tumors were evaluated for clinical aspects, histologic patterns, and obstetrics and fetal outcome. RESULTS: 1. The prevalence of ovarian mass in pregnancy was 0.5% (255 cases in 50,126 deliveries). 14 cases of malignant tumors were founded. 2. The maternal mean age was 28.7+/-3.6 years old, mean gavida was 1.8+/-1.1, and mean parity was 0.3+/-0.5. 3. The mean gestational weeks of diagnosis was 11.9+/-8.6 weeks. Prenatal operations were performed in 160 cases, and 95 cases of ovarian masses were operated at delivery time by cesarean section. 4. In the group of prenatal operation, preterm delivery and caesarian section rate were decreased at operation before 23 gestational weeks (P<0.05). 5. In 42 cases, Emergency operations were done. Mean delivery weeks was 36.7+/-7.2 weeks and was earlier than elective operation group (P<0.05). 6. The mean size of ovarian mass was 9.5+/-3.8 cm. The pathologic features of the 255 lesions were as follows: 98 benign cystic teratomas, 43 mucinous cystadenomas, 31 endometriomas, 20 serous cystadenomas, 14 simple cysts, 14 paraovarian cysts, 6 follicular cysts, 5 corpus luteal cysts, 5 theca luteal cysts, 3 hydrosalpinx, 2 fibromas, and 14 malignant tumors. 7. The 231 patients for whom the outcome of pregnancy was available, 18 (7%) gave birth before 37 weeks of gestation, while 3 (1.2%) experienced spontaneous abortions, 2 artificial abortions, and 1 hysterotomy. CONCLUSION: Most adnexal masses identified by sonography during pregnancy were small, simple cysts that did not pose a risk a pregnancy. However the percentage of malignant tumors or tumors of low malignant potential was 1.8 fold greater than previously reported. Surgical intervention at <23 weeks of gestation might have not been adverse outcomes.
Abortion, Spontaneous ; Cesarean Section ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis ; Emergencies ; Endometriosis ; Female ; Fibroma ; Follicular Cyst ; Humans ; Hysterotomy ; Obstetrics ; Parity ; Parturition ; Pregnancy* ; Pregnant Women ; Prevalence ; Teratoma

BACKGROUND: Aortic intramural hemorrhage (IMH), which presents clinical manifestations identical to acute aortic dissection, is suggested to have different pathology and pathophysiology. The purposes of this study were to diagnose IMH by transesophageal echocardiography (TEE) prospectively and to compare clinical and echocardiographic outcome of IMH with those of aortic dissection. METHODS: Between August 1991 and November 1996, 27 IMH and 73 acute aortic dissection were diagnosed using TEE in 202 consecutive patients with suspected aortic dissection. TEE diagnoses of IMH and aortic dissection were initially compared with computed tomography and magnetic resonance imaging and later confirmed by operative findings (n=39) or follow-up changes (n=12). RESULTS: In the 49 patients whose diagnosis was confirmed by operation or follow-up changes, the sensitivity and specificity for the diagnosis of IMH were 27 of 27 (100%) and 20 of 22 (91%), respectively. There were 11 deaths (15%) in acute aortic dissection and 1 death (4%) in IMH during follow-up of 1.7+/-1.5 years (p=NS). Stanford classification and types of treatment were not related to death in both groups. Complications were less frequently noted in IMH (3/27) than in acute aortic dissection (24/73) (p<0.001) and no death occurred in uncomplicated IMH who were medically treated. Follow-up study of 12 IMH patients showed 8 complete resolution, 3 regression, 1 progression. CONCLUSION: TEE is very useful in diagnosis of IMH and IMH has better outcome than the aortic dissection due to absence of communication and intimal tear.
Classification ; Diagnosis ; Echocardiography* ; Echocardiography, Transesophageal ; Follow-Up Studies ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Pathology ; Prospective Studies ; Sensitivity and Specificity

BACKGROUND: Aortic intramural hemorrhage (IMH), which presents clinical manifestations identical to acute aortic dissection, is suggested to have different pathology and pathophysiology. The purposes of this study were to diagnose IMH by transesophageal echocardiography (TEE) prospectively and to compare clinical and echocardiographic outcome of IMH with those of aortic dissection. METHODS: Between August 1991 and November 1996, 27 IMH and 73 acute aortic dissection were diagnosed using TEE in 202 consecutive patients with suspected aortic dissection. TEE diagnoses of IMH and aortic dissection were initially compared with computed tomography and magnetic resonance imaging and later confirmed by operative findings (n=39) or follow-up changes (n=12). RESULTS: In the 49 patients whose diagnosis was confirmed by operation or follow-up changes, the sensitivity and specificity for the diagnosis of IMH were 27 of 27 (100%) and 20 of 22 (91%), respectively. There were 11 deaths (15%) in acute aortic dissection and 1 death (4%) in IMH during follow-up of 1.7+/-1.5 years (p=NS). Stanford classification and types of treatment were not related to death in both groups. Complications were less frequently noted in IMH (3/27) than in acute aortic dissection (24/73) (p<0.001) and no death occurred in uncomplicated IMH who were medically treated. Follow-up study of 12 IMH patients showed 8 complete resolution, 3 regression, 1 progression. CONCLUSION: TEE is very useful in diagnosis of IMH and IMH has better outcome than the aortic dissection due to absence of communication and intimal tear.
Classification ; Diagnosis ; Echocardiography* ; Echocardiography, Transesophageal ; Follow-Up Studies ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Pathology ; Prospective Studies ; Sensitivity and Specificity

OBJECTIVE: To evaluate the recent trend of indication for pregnancy termination. METHOD: From 1993 to 2000, 1,087 cases of termination out of 61,842 cases of deliveries in Samsung cheil hospital were analyzed. We reviewed retrospectively the data-base and charts of delivery, and analyzed the indication for pregnancy termination. RESULTS: Among 61,842 cases of deliveries, indications of pregnancy termination were fetal structure anomalies in 399 cases (0.7%), IUFD in 261 cases (0.4%), PROM in 215 cases (0.4%), chromosomal anomalies in 138 cases (0.2%), anhydroamnios in 32 cases (0.05%), rubella infection of mother or fetus in 24 cases (0.04%), and others in 20 cases (0.03%). Autopsy was performed in 242 cases of fetal anomalies (60.7%), 116 cases of UIFD (44%), and 59 cases of fetal chromosomal abnormalities (43%). The cases of chromosomal anomaly as indication of termination increased and rubella infection of mother or fetus decreased recently, and it is statistically significant r=0.95(P=0.00) and r=-0.73(P=0.04). The fetal weight terminated due to PROM is significantly decreased (Y=517-26 x year P=0.002). CONCLUSION: The indications of termination for fetal chromosomal abnormalities were increased, but for rubella infections were decreased. In cases of PROM, the terminated fetal weight were significantly decreased. However, no change was observed in cases of fetal anomaly, IUFD,and PROM.
Autopsy ; Chromosome Aberrations ; Fetal Weight ; Fetus ; Humans ; Mothers ; Pregnancy ; Retrospective Studies ; Rubella

OBJECTIVE: The objective of this study was to evaluate the safety and timing of the surgery and fetal outcome of pregnancy complicated by a persistent adnexal mass that was required surgical intervention METHODS: We retrospectively reviewed 171 cases of adnexal masses during pregnancy that were required surgery at Samsung Cheil Hospital and Women's Healthcare Center between 1996 to 2001. We analysed medical records for characteristics of tumor, indication and timing of surgery and the effect of pregnancy outcome. Adverse pregnancy outcome is defined as preterm delivery, spontaneous abortion, intrauterine fetal death and perinatal death. The obtained data were analysed using t-test and Fisher's exact test by SPSS. RESULTS: The incidence of adnexal masses during pregnancy that required surgical management was 1 in 292.3 live births. A malignant tumor or a tumor of low malignant potential was found in 7% of cases. A total of 43 patients underwent surgery under emergency condition, 31 (72%) of which were done due to torsion. There were 14 preterm delivery, 3 spontaneous abortion, 1 intrauterine fetal death, 1 perinatal death and 2 artificial abortion in this study. There was a significant difference in adverse pregnancy outcome between elective and emergency group (7/118 [5.9%] versus 11/43 [25.6%] P=.001), and surgery group that before 20 week's gestation and those of after 20 week's gestation (12/145 [8.3%] versus 6/16 [37.5%] P=.004). CONCLUSION: When necessary and feasible, surgery should be scheduled for the early portion of the second trimester, when organogenesis is complete and most spontaneous abortion have occurred, but before later risks of technical difficulties and premature labor. Also we recommend early diagnostic evaluation and immediate surgical intervention of adnexal masses as problematic adnexal mass diagnosed during pregnancy to prevent the risk of emergency surgery associated with adnexal complication (torsion, rupture and hemorrhage) and the risk of delayed diagnosis of malignancy.
Abortion, Spontaneous ; Delayed Diagnosis ; Delivery of Health Care ; Emergencies ; Female ; Fetal Death ; Humans ; Incidence ; Live Birth ; Medical Records ; Obstetric Labor, Premature ; Organogenesis ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Pregnancy* ; Retrospective Studies ; Rupture