Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.
Abortion, Spontaneous ; Blastocyst ; Blood Vessels ; Cervix Uteri ; Curettage ; Cytochrome P-450 CYP1A1 ; Early Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Leucovorin ; Ligation ; Methotrexate ; Pregnancy* ; Pregnancy, Ectopic ; Uterine Hemorrhage ; Uterus

Uterine artery ligation was performed to control postpartum hemorrhage in 17 cases at Han-Il hospital from July, 1994 to June, 1996. In 14 cases among them, postpartum hemorrhage was controlled successfully(82.4%) and there were no significant complications such as ureteral injury. Twelve cases could be followed up for 6 months to 2 years after uterine artery ligation. Menstruation occurred in all cases(12 cases) and it was normal in rhythm, duration and amount of bleeding. This procedure had significantly saved operation time, estimated blood loss and transfused packed RBC volume than the hysterectomy. It can be concluded that uterine artery ligation is an effective and safe alternative to hysterectomy for management of uncontrollable postpartum hemorrhage.
Female ; Hemorrhage ; Hysterectomy ; Ligation* ; Menstruation ; Methods ; Postpartum Hemorrhage* ; Postpartum Period* ; Ureter ; Uterine Artery*

Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action. Factors that affect the onset time include the potency of the NMBDs, the rate of NMBDs reaching the effect site, the onset time by dose control, metabolism and elimination of NMBDs, buffered diffusion to the effect site, nicotinic acetylcholine receptor subunit affinity, drugs that affect acetylcholine (ACh) production and release at the neuromuscular junction, drugs that inhibit plasma cholinesterase, presynaptic receptors responsible for ACh release at the neuromuscular junction, anesthetics or drugs that affect muscle contractility, site and methods for monitoring neuromuscular function, individual variability, and coexisting disease. NMBDs with rapid onset without major adverse events are expected in the next few years, and the development of lower potency NMBDs will continue. Anesthesiologists should be aware of the use of NMBDs in the management of anesthesia. The choice of NMBD and determination of the appropriate dosage to modulate neuromuscular blockade characteristics such as onset time and duration of neuromuscular blockade should be considered along with factors that affect the effects of the NMBDs. In this review, we discuss the factors that affect the onset time of NMBDs.
Acetylcholine ; Anesthesia ; Anesthesia, Obstetrical ; Anesthetics ; Cholinesterases ; Diffusion ; Drug Interactions ; Emergencies ; Humans ; Metabolism ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Neuromuscular Junction ; Neuromuscular Monitoring ; Pharmacokinetics ; Plasma ; Receptors, Nicotinic ; Receptors, Presynaptic ; Respiration

The prognosis of unresectable advanced gastric cancer is extremely poor. We tried a neoadjuvant chemotherapy in locally advanced unresectable stomach cancer diagnosed by initial explo-laparotomy. After chemotherapy with the FADE regimen (5-fluorouracil + adriamycin + cisplatin + etoposide), the patient was diagnosed clinically as a complete response state on re-staging with radiological gastrointestinal study, fiber-gastroscopy and computerized tomography. During the second-look operation, the advanced cancer was completely resected and the pathological diagnosis was early gastric cancer (EGC) type IIc, stage II (T1N2Mo).
Adenocarcinoma/*drug therapy/radiography ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Case Report ; Cisplatin/*administration & dosage ; Combined Modality Therapy ; Doxorubicin/*administration & dosage ; Etoposide/*administration & dosage ; Fluorouracil/*administration & dosage ; Human ; Male ; Middle Age ; Stomach/pathology/radiography ; Stomach Neoplasms/drug therapy/radiography/*surgery ; Tomography, X-Ray Computed

PURPOSE: To assess the usefulness of intracellular pH (pHi), calculated by determining the shift of a high-energy metabolite such as inorganic phosphate (Pi) or gamma-ATP after performing MRS with ECG-gated two-dimensional 31P CSI (chemical shift imaging), as a parameter for the overall state of the intracellular milieu. MATERIALS AND METHODS: Proton decoupled 31P CSI was performed on a 1.5-T scanner using a (1)H-(31)P dual-tuned surface coil. Cardiac MRS data were obtained from eight normal volunteers aged 24-32 years with no history of heart disease. From the spectra obtained from several regions of the heart, peak position and peak area were estimated. The metabolic ratios of alpha-, beta-, gamma-ATP, PCr, Pi, phosphodiester and diphosphoglycerate were calculated, and pHi was estimated from the chemical shift of Pi and gamma-ATP resonance. We then compared the data for the anterior myocardium with those previously published. RESULTS: The major phosphorous metabolites identified in these human hearts were as follows: PCr, at -0.1 to +0.1 ppm; three phosphate peaks from ATP, with a chemical shift centered at about -2.7 ppm (gamma-ATP), -7.8 ppm (alpha-ATP), and -16.3 ppm (beta-ATP); and phosphodiester (PDE) at 2-3 ppm, inorganic phosphate (Pi) at 4.5-5.4 ppm, and diphosphoglycerate (DPG) at 5.4-6.3 ppm. The PCr/beta-ATP ratio was 2.20+/-0.17 and the PDE/beta-ATP ratio, 1.04+/-0.09. pHi readings were 7.31+/-0.23 (calculated by the shift of Pi) and 6.81+/-0.20 (calculated by the shift of gamma-ATP). Pi/PCR was 0.539, a ratio higher than that mentioned in previously published reports. CONCLUSION: The measurement of intracelluar metabolism was affected by various kinds of factors. We believe, however, that pHi readings indicate the overall state of the cardiac intracelluar milieu. An unexpected pHi readings, seen at MRS, may reflect errors in the MR procedure itself and, or in the alanytical method.
Adenosine Triphosphate ; Healthy Volunteers ; Heart Diseases ; Heart* ; Humans* ; Hydrogen-Ion Concentration* ; Metabolism ; Myocardium ; Polymerase Chain Reaction ; Protons ; Reading

OBJECTIVE: To evaluate the clinical significance of AGUS including histologic results and diagnostic modalities according to menopausal status. METHODS: One hundred and four patients with AGUS were identified. Corresponding biopsies were available for 87 of these cases. The evaluation for histologic results and diagnostic modalities was made according to menopausal status. RESULTS: Among the 87 patients with AGUS, the number of premenopausal and menopausal patients were 46 (52.9%) and 41 (47.1%), respectively. Over all, 70 (80.5%) of 87 patients were found to have important histologic findings and of them, premenopausal and menopausal patients with invasive diseases were 19 (41.3%) and 31 (75.6%) respectively. There were significant differences in pathologic findings between premenopausal and menopausal patients indicating more invasive lesions in menopausal than premenopausal patients (p=0.002). For the evaluation of diagnostic modality, the second arm was significantly more needed for menopausal than premenopausal patients (p=0.018). CONCLUSION: AGUS on pap smear represents a cytologic diagnosis associated with high incidence of underlying preinvasive and invasive lesions, especially in postmenopausal patients. Thus aggressive work-up is recommended to rule out the potential pathologic conditions in endocervix, endometrium and rarely extrauterine lesions such as gastrointestinal, tubal, ovarian or breast in patients otherwise unexplained AGUS after careful first arm work-up.
Arm ; Biopsy ; Breast ; Diagnosis ; Endometrium ; Female ; Humans ; Incidence ; Menopause