Matrix Metalloproteinase Inhibitors Attenuate Neuroinflammation Following Focal Cerebral Ischemia in Mice

The aim of this study was to investigate whether matrix metalloproteinase (MMP) inhibitors attenuate neuroinflammation in an ischemic brain following photothrombotic cortical ischemia in mice. Male C57BL/6 mice were anesthetized, and Rose Bengal was systemically administered. Permanent focal ischemia was induced in the medial frontal and somatosensory cortices by irradiating the skull with cold white light. MMP inhibitors, such as doxycycline, minocycline, and batimastat, significantly reduced the cerebral infarct size, and the expressions of monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-alpha), and indoleamine 2,3-dioxygenase (IDO). However, they had no effect on the expressions of heme oxygenase-1 and neuroglobin in the ischemic cortex. These results suggest that MMP inhibitors attenuate ischemic brain injury by decreasing the expression levels of MCP-1, TNF-alpha, and IDO, thereby providing a therapeutic benefit against cerebral ischemia.

A Case of Hypermagnesemia with Cardio-respiratory Failure in a Patient with Chronic Renal Failure / 대한신장학회지

A 46-year-old woman with chronic renal failure due to polyarteritis nodosa was referred to the hospital for evaluation of abdominal pain. She had been treated with cathartics (magnesium oxidate 2.0 g/day) for constipation for several days. One day before the admission, the patient had been taken magnesium enema twice at another hospital. On admission, she was comatose, suffering from lethargy and respiratory failure. Her serum magnesium and amylase concentrations were markedly elevated (8.2 mg/dL and 1,698 IU/L respectively), and plain abdominal image and abdominal computed tomography revealed acute pancreatitis and non-obstuctive ileus. Thereafter, aggressive cardiopulomonary support with mechanical ventilation and continuous renal replacement therapy using continuous veno-venous hemofiltration (CVVH) applied due to cardio-respiratory failure and hypermagnesemia. After 3 days of CVVH treatment, the concentration of serum magnesium was normalized to 3.2 mg/dL, and respiratory failure and abdominal ileus were markedly improved. Four days after aggressive treatment, her hemodynamic and gastroenteric symptoms stabilized. Therefore, we report the case of hypermagnesemia with acute pancreatitis, severe hypotension and respiratory failure after cathartic ingestion and enema containing magnesium oxidate treated with CVVH.

A Case of ST-Segment Elevation Myocardial Infarction Mimicking Stress-Induced Cardiomyopathy

ST-segment elevation myocardial infarction (STEMI) is a disease decribed by typical chest pain, ST-segment elevation on eletrocardiogram, elevated cardiac enzymes, along with wall motion abnormality under echocardiographic findings, and it is caused by vulnerable plaques. However, stress induced cardiomyopathy (SICM) may show similar clinical symptoms, but specific echocardiographic findings (i.e. transient left ventricular regional wall motion abnormalities with peculiar apical ballooning appearance) and normal coronary angiography may differentiate it from STEMI. Therefore, one may mistake STEMI for SICM, and lead to serious error in diagnosis and treatment of the disease. We report a case of STEMI mimicking SICM, and suggest an idea to approach the patient with SICM.

A Case of Eosionophilic Gastroenteritis Involving EntireGastrointestinal Tract with Eosinophilic Ascites / 대한소화기내시경학회지

Eosinophilic gastroenteritis is a rare condition of unknown cause characterized by pheripheral eosinophilia and eosinophilic infiltration of the gastrointestinal tract. Eosonophilic gastroenteritis is generally classified according to the layer of the gastrointestinal tract that is involved. Serosal eosinophilic infiltration is the rarest form of presentation and can result in the development of eosinophilic ascites. We experienced a case of eosinophlilic gastroenteritis involving the entire gastrointestinal tract in a 34-year-old female patient with abdominal pain that was confirmed by multiple biopsies of the gastrointestinal tract with eosinophilic ascites. The patient was successfully treated with corticosteroids. We report this case with a brief review of the literature.

Two Cases of Pulmonary Thromboembolism in Young Patients with Hyperhomocysteinemia / 결핵및호흡기질환

Incidences of pulmonary thromboembolism markedly increase with age. Risk factors of pulmonary thromboembolism are surgery, trauma, acute medical illness, immobilization, pregnancy, usage of hormone, and advanced age. In the cases of thrombomembolism occurred in young age, the possibility of thrombophilc state is needed to be investigated. Among many diseases or state associated thrombophilic state, homocyteinemia should be considered a cause of thromboembolism before fifth decade. Homocyteinemia is caused by deficiency of N-5-methyltetrahydrofolate, cystathionie beta-synthase and vitamin B12. The presence of the mutation of 5,10-methyleneterahydrofolate lead to homocyteinemia by deficiency of N-5-methyltetrahydrofolate. Homocysteine is acknowledged the risk factor of cardiovascular event, and storke. Homocysteinemia can be the cause of thromboemboism via damaging endotheial cell. We present two cases of pulmonary thromboembolism in young age which seem to be associated with homocysteinemia precipitated by mutation of 5,10-methyleneterahydrofolate.

A Case of Bilateral Coronary to Pulmonary Artery Fistulas Associated With Severe Aortic Regurgitation

Coronary artery fistula (CAF) is a rare form of congenital anomalies of the coronary arteries, and this is usually discovered by chance during coronary angiography. However, this type of fistula can cause important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. Bilateral CAFs are even rarer, and especially when combined with valvular heart disease. The coincidence of CAF with aortic regurgitation is relatively rare and this might sometimes cause myocardial ischemia. We present here a case of bilateral coronary-pulmonary artery fistulas that arose from the first diagonal branch of the left anterior descending artery and the conal branch of the right coronary artery combined with severe aortic regurgitation, and this all caused myocardial ischemia.

A Case of Mitochondrial Myopathy With Cardiac Involvement

Mitochondrial myopathy is a disease caused by structural, biochemical or genetic disturbance of the mitochondria and this affects many organs, and it may also involve the cardiac muscles. We experienced a case of myocardial involvement in a 21 years old male patient with mitochondrial myopathy.

Leukocytes and lactobacilli of vaginal discharge as a predictor of pelvic inflammatory disease / 대한산부인과학회지

OBJECTIVE: We performed this study to evaluate whether the vaginal polymorphonuclear leukocytes and few lactobacilli on microscopic evaluation of a saline wet preparations would be associated with pelvic inflammatory disease (PID) in Korean women. MATERIALS AND METHODS: We performed a cross-sectional study of 556 women between 16 and 78yrs of age from May 2001 to May 2003. Wet-mount microscopic examination of vaginal discharge was done on all patients. Positive vaginal polymorphonuclear leukocytes was defined as more than 10 white blood cells per high-power field on microscopic examination, and few lactobacilli was defined as less than 30 per high-power field on microscopic examination. The diagnosis of PID was relied on the minimal criteria delineated by the Centers for Disease Contral and Prevention, elevated CRP or ESR and positive anaerobic cultures. RESULTS: On univariate analysis, positive vaginal polymorphonuclear leukocytes and few lactobacilli were associated with PID, but age (less than 25) and marital status were not. On multivariate analysis using multiple logistic regression, odds ratios of positive vaginal polymorphonuclear leukocytes and few lactobacilli for PID were 5.995 (95%CI: 3.056-11.761) and 24.39 (95%CI: 10.989-55.556) respectively. The sensitivity and negative predictive value of positive vaginal polymorphonuclear leukocytes or few bacilli for predicting PID were 90.6% and 94.42% respectively. CONCLUSION: Positive vaginal polymorphonuclear leukocytes and few lactobacilli were strongly associated with PID. Positive vaginal polymorphonuclear leukocytes and few lactobacilli have a high sensitivity and negative predictive value for predicting PID. Therefore the existence of vaginal polymorphonuclear leukocytes and few lactobacilli are thought hereafter to be useful marker to diagnose PID.

Peripartum Cardiomyopathy: Review of Cases during a 10-year Period, Between 1995 and 2004 / 대한주산의학회잡지

OBJECTIVE: To review and characterize the initial presentation and risk factors of peripartum cardiomyopahty. METHODS: We reviewed the medical records of 28 women with a history of heart disease confirmed by echocardiography during pregnancy or the postpartum period between 1995 and 2004. RESULTS: Of a total of 28 women with a history of heart disease during pregnancy or the postpartum period, 15 women met traditional criteria of peripartum cardiomyopathy. Mean age of 32.5+/-6.5 years and common associated conditions were preeclampsia (40%), twin pregnancy (33.3%), preterm labor (20%), and myocarditis (6.7%). 5 of them (33.3%) including postpartum uterine atony (13.3%) had had ICU care but no deaths occurred (0% mortality) and all of them (100%) had regression of cardiomyopathy. CONCLUSION: Cardiomyopathy acoounts for an increasing proportion of reported pregnancy-related deaths in western countries, but we experienced no mortality from peripartum cardiomyopathy during a 10-year period. Further studies are required to identify risk factors and racial disparity.

A comparison of the effect of Anastrozole and Clomiphene citrate in anovulatory patients / 대한산부인과학회지

OBJECTIVE: To compare the clinical effectiveness of Anastrozole in ovulation induction with that of clomiphene citrate. METHODS: Sixty anovulatory women were randomly divided into 4 groups (1 mg, 2 mg and 4 mg of Anastrozole groups and Clomiphene citrate group). The ovulation induction was tried with 3 dosages of Anastrozole or 100 mg of Clomiphene citrate for 5 days. The serum level of estradiol, testosterone, FSH and LH were serially monitored (on 3rd, 5th and 8th days of treatment). Serum estradiol level at the time of hCG injection was also measured. Ovulation rate, number of dominant follicles, endometrial thickness, and pregnancy rate were measured and compared across the study groups. RESULTS: There was no statistically significant difference in estradiol, testosterone, or LH level between women treated with Anastrozole and Clomiphene citrate. In patients treated with 4 mg of Anastrozole, serum FSH level was higher than that of the women treated with Clomiphene citrate (P<0.05). Endometrial thickness was greater in patients treated with Anastrozole than women treated with Clomiphene citrate (P<0.05). Number of dominant follicles in patients treated with Clomiphene (1.56) was slightly greater than in women treated with Anastrozole (1.0-1.1), but there was no statistically significant difference. CONCLUSION: Anastrozole had similar clinical effectiveness in ovulation induction when compared to Clomiphene citrate. At 1 mg or 2 mg of Anastrozole, ovulatory rate remained below the effectiveness of Clomiphene citrate, therefore considering the expensive cost of Anastrozole, it should not be considered as first-line medication for ovulation induction but reserved for those who have certain conditions such as thin endometrium and polycystic ovarian syndrome.

Complete androgen insensitivity syndrome due to androgen receptor gene mutation in the amino acid position 607 which bilateral testes situated in the normal ovary sites / 대한산부인과학회지

Androgen insensitivity syndrome (AIS) is a disorder of male sexual differentiation caused by mutations within the androgen receptor gene, represents a variety of phenotypes from females with 46,XY karyotype over individuals with ambiguous genitalia to infertile males. Single base mutations resulting in amino acid substitution represent the most common mutations of the androgen receptor (AR) gene and are associated with complete AIS. The location of the gonads can be variable including, the intra-abdominal cavity, the labioscrotal folds, and the inguinal regions. Testicular descent is a two-stage process comprising transabdominal and transinguinal phases. The first phase is not controlled by androgen and may be regulated by mullerian inhibiting substance, by contrast the second phase is androgen dependent. Recently we have identified a point mutation CGA to TGA at position 607 of exon 3 in complete AIS patient, so we report it with brief review of literatures.

Clinical characteristics and pregnancy outcomes of hyperemesis gravidarum / 대한산부인과학회지

OBJECTIVE: It is controversial that hyperemesis gravidarum has adverse effect on pregnancy. The purpose of this study is to evaluate clinical characteristics and pregnancy outcomes in women with hyperemesis gravidarum. METHODS: We identified 52 women who was treated as inpatients for hyperemesis gravidarum and had delivered babies between Jan. 2001 and Oct. 2004. The control group was 123 women who had not suffered from hyperemesis gravidarum. We performed a retrospective analysis of obstetric and pediatric medical records. We analyzed the data using student's t-test and Chi-square test and p-value<0.05 was considered as statistically significant. RESULTS: The average height (162.5+/-0.6 vs. 160.6+/-0.4 cm, Mean+/-SE) was significantly higher in hyperemesis group. The average pre-pregnancy BMI (20.2+/-0.3 vs. 21.0+/-0.2 kg/m2) and maternal age (29.8+/-0.5 vs. 31.2+/-0.3 years) were significantly lower in hyperemesis group. The average weight loss was 2.6 kg and the average hospital stay was 5.4 days. The average concentration of serum electrolytes were within normal limits. The hematocrit (35.4+/-0.4 vs. 34.3+/-0.2%) and unconjugated estriol (1.336+/-0.055 vs. 1.126+/-0.034 MoM) were significantly higher in hyperemesis group. Vaginal bleeding during the first trimester was more common in hyperemesis group (16.4 vs. 4.7%). Pregnancy outcomes between hyperemesis and control group were similar in average gestational age, average birth weight, average Apgar scores, sex ratio, congenital malformation and neonatal morbidity. CONCLUSION: Pregnant women with hyperemesis had significant differences in some demographic characteristics, hematocrit, unconjugated estriol and vaginal bleeding during the first trimester, but had similar pregnancy outcomes.

Clinical characteristics and pregnancy outcomes of hyperemesis gravidarum / 대한산부인과학회지

OBJECTIVE: It is controversial that hyperemesis gravidarum has adverse effect on pregnancy. The purpose of this study is to evaluate clinical characteristics and pregnancy outcomes in women with hyperemesis gravidarum. METHODS: We identified 52 women who was treated as inpatients for hyperemesis gravidarum and had delivered babies between Jan. 2001 and Oct. 2004. The control group was 123 women who had not suffered from hyperemesis gravidarum. We performed a retrospective analysis of obstetric and pediatric medical records. We analyzed the data using student's t-test and Chi-square test and p-value<0.05 was considered as statistically significant. RESULTS: The average height (162.5+/-0.6 vs. 160.6+/-0.4 cm, Mean+/-SE) was significantly higher in hyperemesis group. The average pre-pregnancy BMI (20.2+/-0.3 vs. 21.0+/-0.2 kg/m2) and maternal age (29.8+/-0.5 vs. 31.2+/-0.3 years) were significantly lower in hyperemesis group. The average weight loss was 2.6 kg and the average hospital stay was 5.4 days. The average concentration of serum electrolytes were within normal limits. The hematocrit (35.4+/-0.4 vs. 34.3+/-0.2%) and unconjugated estriol (1.336+/-0.055 vs. 1.126+/-0.034 MoM) were significantly higher in hyperemesis group. Vaginal bleeding during the first trimester was more common in hyperemesis group (16.4 vs. 4.7%). Pregnancy outcomes between hyperemesis and control group were similar in average gestational age, average birth weight, average Apgar scores, sex ratio, congenital malformation and neonatal morbidity. CONCLUSION: Pregnant women with hyperemesis had significant differences in some demographic characteristics, hematocrit, unconjugated estriol and vaginal bleeding during the first trimester, but had similar pregnancy outcomes.

Endocrine response to step-up microdose GnRH agonist / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the endocrine response to step-up microdose GnRH agonist. METHODS: Administration of triptorelin acetate was initiated from 2 mg and gradually increased to 50 mg during 6-day period to five normal menstruating women. Serum FSH, LH, and estradiol levels were serially measured for 6 days. The same set of experiment was duplicated after taking oral contraceptive for 3 weeks. Serum testosterone and progesterone levels were measured on day 1 and day 5 of experiment. RESULTS: The flare of gonadotropin continued for 6 days. When subjects were pretreated with oral contraceptive, serum FSH levels 4 hrs after GnRH agonist injection were 17.35+/-7.88 mIU/mL, 11.26+/-4.81 mIU/mL, and 9.60+/-4.08 mIU/mL for day 1, 2, and 3 respectively. The FSH levels were not statistically different when pretreatment with oral contraceptive was not applied. The level of serum LH was significantly lower in the cycle, which was pretreated by oral contraceptive (32.13+/-9.61 mIU/mL vs. 14.12+/-5.63 mIU/mL for day 1, 28.95+/-3.09 mIU/mL vs. 15.76+/-9.92 mIU/mL for day 2, and 24.45+/-2.52 mIU/mL vs. 16.86+/-8.56 mIU/mL for day 3). The sign of corpus luteum rescue was found in 2 out of 5 subjects only in non-treated cycle. CONCLUSION: Step-up microdose GnRH agonist protocol could induce persistent gonadotropin flare for 6 days and this regimen could be applied in controlled ovarian hyperstimulation especially for poor responders. The pretreatment with oral contraceptive is necessary to prevent supraphysiologic LH elevation and corpus luteum rescue.

A Case of Miliary Tuberculosis During Pregnancy / 대한주산의학회잡지

Although miliary tuberculosis is uncommon during pregnancy. it is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection, and it is difficult to diagnose when associated with pregnancy. There is no solid evidence that pregnancy has an adverse effect on tuberculosis, thus routine therapeutic abortion is not indicated. If the early diagnosis and promptly adequate chemotherapy was done, the outcome of pregnancy in a women with miliary tuberculosis is likely to be good. Recently we have experienced a case of miliary tuberculosis at 20 weeks gestation without any risk factors of tuberculosis. So we report this case with a brief review of literature.

Two Cases of Mullerian Agenesis Undergone Vaginal Reconstruction by McIndoe Technique / 대한산부인과학회잡지

Vaginal agenesis is uncommon gynecologic condition, and the most common etiology is Mullerian agenesis also called Mayer-Rokitansky-Kster-Hauser (MRKH) syndrome. In such patients, the evaluation for associated malformations as well as careful non-surgical and surgical approach are essential. The neovaginoplasty is an important issue for these patients from a functional and a psychological standpoint. We describe two patients with Mullerian agenesis, who have undergone vaginal reconstruction by McIndoe technique.

Two Cases of Mullerian Agenesis Undergone Vaginal Reconstruction by McIndoe Technique / 대한산부인과학회잡지

Vaginal agenesis is uncommon gynecologic condition, and the most common etiology is Mullerian agenesis also called Mayer-Rokitansky-Kster-Hauser (MRKH) syndrome. In such patients, the evaluation for associated malformations as well as careful non-surgical and surgical approach are essential. The neovaginoplasty is an important issue for these patients from a functional and a psychological standpoint. We describe two patients with Mullerian agenesis, who have undergone vaginal reconstruction by McIndoe technique.

Clinical Consideration on the Method of Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The most common operation in gynecology is hysterectomy. To compare the indications, patient characteristics and clinical outcome, complication between total abdominal hysterectomy (TAH) and vaginal total hysterectomy (TVH), laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: This study was designed to analyze 147 patients of TAH (Group I) from January 2003 to September 2003, 48 patients of TVH (Group II), 108 patients of LAVH (Group III) at Eulji medical center of obstetrics and gynecology from January 2002 to September 2003. We analyzed the result with patient characteristics, parity, medical disease, history of previous operation, indication of hysterectomy, uterine weight, concurrent surgical procedure, operation time, bleeding amount, complication and length of hospital stay. Uterine prolapse was excluded in the analysis of this study. RESULTS: Patient characteristics, parity, medical disease were no differences. Number of previous operation were 63 cases (42.9%) in TAH group, 10 cases (20.8%) in TVH group, 43 cases (39.8%) in LAVH group, and the most common of operation was tubal ligation in three gropups. Most common indication of hysterectomy was uterine leiomyoma. The mean uterine weight was 374.31 +/- 250.26 gm in TAH group, 187.70 +/- 109.62 gm in TVH group and 203.26 +/- 94.92 gm in LAVH group. The mean operation time was 89.61 +/- 25.24 min in TAH group, 73.39 +/- 21.80 min in TVH group and 96.18 +/- 27.98 min in LAVH group. Postoperative complication was observed 60 cases (40.8%) in TAH group, 8 cases (16.7%) in TVH group, 19 cases (17.6%) in LAVH group. Most common complication was bleeding and required transfusion (TAH 32 cases (21.8%), TVH 3 cases (6.3%), LAVH 10 cases (9.3%)). CONCLUSION: LAVH and TVH present superior result in terms of complication when compared with TAH. LAVH and TVH have advantage of lower morbidity, less pain, shorter hospital stay and convalescence. LAVH should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.

Late Postpartum Eclampsia: A Case Report / 대한주산의학회잡지

Although the technique of antenatal care is developed, the incidence of late postpartum eclampsia has been increased and its prevention is difficult. In addition, the diagnosis is more difficult if the patient did not show any symptoms of preeclampsia before delivery. We described one case of late postpartum eclampsia that occurred on 7th day after preterm delivery and has not been diagnosed before delivery including a review of this literature.

Intracerebral Hemorrhage and HELLP Syndrome in Eclampsia: A Case Report / 대한산부인과학회잡지

Eclampsia is defined as the occurrence of convulsions, not caused by any coincidental neurologic disease such as epilepsy, in a woman whose condition also meets the criteria for preeclampsia. Intracerebral hemorrhage with eclampsia is rare but maternal mortality is 30-40%. Fetal outcome parallels that of the mother and reflects the maternal condition as well as gestational age at delivery. With noninvasive imaging technique of CT, the early diagnosis and proper management of intracerebral hemorrhage in a patient can be achieved. The syndrome of Hemolysis, Elevated Liver enzyme, Low Platelets (HELLP) is considered to be complication of severe preeclampsia-eclampsia. We report a case of intracerebral hemorrhage and HELLP syndrome in a patient with eclampsia.