RESUMO
A 21-year-old man admitted complaining of sudden severe epigastric pain for 1 day. He had been diagnosed as ulcerative colitis (UC) and taking mesalazine for two months. UC was in nearly complete remission at admission. He never drank an alcohol, and serum amylase was 377 IU/L. CT scan showed inferior vena cava (IVC) thrombosis in addition to mild acute pancreatitis. To evaluate the cause of acute pancreatitis and IVC thrombosis, magnetic resonance cholangiopancreatogram (MRCP), endoscopic ultrasonogram (EUS), lower extremity Doppler ultrasonogram (US) and blood test of hypercoagulability including factor V, cardiolipin Ab, protein C, protein S1, antithrombin III, and anti phospholipids antibody were performed. There was no abnormality except mild acute pancreatitis and IVC thrombosis in all the tests. He was recommended to stop taking mesalazine and start having anticoagulation therapy. After all symptoms disappeared and amylase returned normal, rechallenge test with mesalazine was done. Flare-up of abdominal pain occurred and the elevation of serum amylase was observed. Ulcerative colitis came to complete remission with short-term steroid monotherapy. Acute pancreatitis and IVC thrombosis were completely resolved after 3-month anticoagulation therapy with no more mesalazine. We postulated that IVC thrombosis occurred due to hypercoagulable status of UC and intra-abdominal inflammation caused by mesalazine-induced pancreatitis.
Assuntos
Humanos , Masculino , Adulto Jovem , Doença Aguda , Amilases/sangue , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticoagulantes/uso terapêutico , Colangiopancreatografia por Ressonância Magnética , Colite Ulcerativa/complicações , Endossonografia , Mesalamina/efeitos adversos , Pancreatite/induzido quimicamente , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/complicaçõesRESUMO
OBJECTIVE: Based on the pathophysiology of preeclampsia and the hypothesis that the iron was a catalyzer of the oxidative stress and lipid peroxidation and that the ferritin and soluble transferrin receptors (sTfR) were the good iron status parameters, this study was performed to investigate the alteration of these parameters in preeclampsia. METHODS: Predelivery and 72 hour postpartum venous blood were collected from 12 healthy pregnant women and 20 pregnant women with severe preeclampsia at 34 week to 40 weeks of gestation. Serum ferritin, and sTfR were measured using the commercial kits, respectively. RESULTS: Predelivery serum ferritin concentration was significantly higher in patients with preeclampsia than in healthy pregnant women (p=0.01). Predelivery serum sTfR concentration in patients with preeclmapsia was not significantly different from that in healthy pregnant women (p=0.22). Postdelivery serum ferritin concentration was significantly higher in preeclamptic patients than in healthy pregnant women (p=0.04). Postdelivery serum sTfR concentration was significantly lower in preeclamptic patients than in healthy pregnant women (p=0.02). There was a significant negative correlation between postdelivery serum ferritin concentration and sTfR concentration in all subjects including healthy and preeclamptic patients (r=-0.37, p=0.04). CONCLUSION: The serum ferritin was the best sensitive marker of the iron status parameters reflecting the preeclampsia. And the result may support the role of iron as a catalyzer of oxidative stress and lipid peroxidation in preeclampsia pathophysiology.
Assuntos
Feminino , Humanos , Gravidez , Ferritinas , Ferro , Peroxidação de Lipídeos , Estresse Oxidativo , Período Pós-Parto , Pré-Eclâmpsia , Gestantes , Receptores da TransferrinaRESUMO
OBJECTIVE: Pregnancy-associated aplastic anemia remains a rare occurrence. The aim of this study was to examine the maternal and fetal outcomes of pregnancy-associated aplastic anemia treated with supportive care. METHODS: From January 1995 to December 2004, a total of 14 women newly diagnosed with pregnancy-associated aplastic anemia were recruited for the study. RESULTS: Eleven (78%) of the 14 women were diagnosed with pregnancy-associated aplastic anemia during the second or third trimester. There were eight severe cases; three of which were diagnosed at the initial presentation. All 14 women had conservative management with transfusions but not specific immunological or hormonal therapies during pregnancy. Blood transfusions were performed prenatally in seven mothers and perinatally in 13. Of the 12 patients eligible for follow-up, one achieved complete remission and another eight showed partial remission after delivery. During the follow up period, there was no case of maternal-fetal death in our series. The pregnancies were continued uneventfully in most cases. CONCLUSIONS: This study demonstrated favorable maternal and neonatal outcomes with transfusion support alone for pregnancy-associated aplastic anemia. Therefore, pregnancy continuation with meticulous blood support should be considered, rather than therapeutic termination, for women with pregnancy-associated aplastic anemia.
Assuntos
Feminino , Humanos , Gravidez , Anemia Aplástica , Transfusão de Sangue , Seguimentos , Mães , Terceiro Trimestre da Gravidez , PrognósticoRESUMO
OBJECTIVE: To determine whether severity of proteinuria or urinary protein fractional analysis correlates with adverse maternal and fetal outcomes in women with severe preeclampsia. METHODS: Thirty-six women diagnosed of severe preeclampsia from January, 2002 to April, 2003 were studied. The correlation between proteinuria or urinary albumin fraction, and maternal mean arterial pressure, neonatal birth weight, 1 minute apgar score were analyzed statistically. Thirty-six patients were divided into two groups according to the pattern of urinary protein fraction. One group was a selective proteinuria group if the albumin fraction was over 70%, and another was a non-selective proteinuria group if the fraction was below 70%. The maternal and neonatal outcomes were compared between the two groups. RESULTS: Significant positive correlation was observed between proteinuria and mean arterial pressure, between urinary albumin fraction and neonatal birth weight. Negative correlation was significantly present between proteinuria and neonatal birth weight, 1 minunte apgar score, between proteinuria and albunin fraction. Increased proteinuria, higher mean arterial pressure, higher serum uric acid level, lower creatinine clearance, lower neonatal birth weight, and lower 1 minunte Apgar score were observed in the non-selective proteinuria group than those in the selective proteinuria, although there was no statistical significance. CONCLUSION: With increasing proteinuria and decreasing albumin fraction, there is increased risk of adverse maternal and fetal outcome. Proteinuria fractional analysis by electrophresis might provide useful information regarding the prediction of pregnancy outcomes.
Assuntos
Feminino , Humanos , Gravidez , Índice de Apgar , Pressão Arterial , Peso ao Nascer , Creatinina , Pré-Eclâmpsia , Resultado da Gravidez , Proteinúria , Ácido ÚricoRESUMO
The present study was aimed to investigate whether and to what extent hypertension affects the relaxation of the corpus cavernosum. The corpus cavernosum was isolated from 12-week 2- kidney, 1-clip hypertensive rats. The corporal strips were isolated and suspended longitudinally in an organ bath. They were precontracted with phenylephrine, and their responses to electrical field stimulation (EFS) were examined. EFS caused a frequency-dependent contraction (60%) or relaxation (40%) of the corpus cavernosum precontracted with phenylephrine. The contraction response was inhibited or abolished and only frequency-dependent relaxation appeared in the presence of atropine (0.00001mol/L) and guanethidine (0.00001mol/L). The relaxation response to EFS of the corporal preparation precontracted with phenylephrine was attenuated or abolished in the presence of L-NAME (0.0001mol/L). The corporal preparation from the hypertensive rats also showed a frequency-dependent relaxation, however, the degree of which was lower at a low frequency of stimulation than that from the normotensive control. These results suggest that endothelium-derived nitric oxide released upon neural stimulation partly mediate the relaxation of the corpus cavernosum. It is also suggested that hypertension is associated with a partly attenuated relaxation response to EFS.
Assuntos
Animais , Ratos , Atropina , Banhos , Guanetidina , Hipertensão , Rim , NG-Nitroarginina Metil Éster , Óxido Nítrico , Fenilefrina , RelaxamentoRESUMO
Based on the histopathologic findings of the lacrimal gland tumor, the lesion is classified as either epithelial or nonepithelial tumor. 22% of lacrimal gland lesions were primary epithelial neoplasm. 4%of epithelial tumor of lacrimal glands were primary malignant tumor. Squamous cell carcinoma arising from pleomorphic adenoma of lacrimal gland is a very rare(0.4%). Inspite of surgical intervention, postoperative radiation and chemotherapy, the mortality and recurrence rate of the carcinoma ex pleomorphic adenoma of lacrimal gland is very high. We report a case of squamous cell carcinoma ex pleomorphic adenoma of lacrimal gland, which was completely removed via lateral orbitotomy with bicoronal incision and had no major complication or recurrence.
Assuntos
Adenoma , Adenoma Pleomorfo , Carcinoma de Células Escamosas , Tratamento Farmacológico , Aparelho Lacrimal , Mortalidade , Neoplasias Epiteliais e Glandulares , RecidivaRESUMO
OBJECTIVE: We studied to determine the effect of blood or meconium contamination on the TDx-FLM assay for the assessment of fetal lung maturity. We also studied to evaluate the degree of diluted contaminants that affect the results. METHODS: Nineteen samples of amnotic fluid-14 cases GA 37weeks-were collected and assayed for assessment of fetal lung maturity using tbe TDx-FLM assay. Among the above 19 samples, we used 12 samples-7 cases GA37 weeks-to contaminate with blood or meconium. Maternal blood was added to the amniotic fluid at increasing concentrations fro 1:10 to 1:1280. Diluted meconium (0.5g meconium/10ml amniotic fluid) was added at increasing concentration fiom 1:1 to 1:128. Each samples were assessed by TDx assay. RESULTS: TDx values in the cases of gestational age 37 weeks or more were matured level or borderline level(TDx value > 50mg/g), but below 37 weeks, TDx values wae immature level(TDx value < 50mg/g) except one case. In preterm cases, blood or meconium contamination did not affect the TDx values significantly, although the thick meamium contamination (diluted meconium: amniotic fluid 1:1 - 1:4) increased the TDx values. In term cases, they did not affect the TDx values. CONCLUSION: TDx test was suitable for the evaluation of fetal lung maturity regardless of blood or meconium contamination.
Assuntos
Feminino , Líquido Amniótico , Idade Gestacional , Pulmão , MecônioRESUMO
OBJECTIVE: Since the management of pregnancy is gestational age dependent, accurate knowledge of the dating of gestational age is essential. The gestational age calculation system(GACS) was made to get a precise informations of exact gestational age of pregnant mothers. METHODS: Using the personal computer and Microsoft Visual Basic soft ware, the GACS program was made to meet obstetrician's desire. This program is designed and embodied to calculate gestational age controlling many variables such as last menstrual period(LMP), expectant date of confinement(EDC), gestational age on the calculating date, ultrasonographical gestational age, and conceptional date. RESULTS: The accurate gestational age was displayed by GACS according to various input data. The work sheet of whole gestational age can be printed by GACS. CONCLUSION: The GACS is a tool to calculate gestational age of pregnant mothers precisely. This can be used very conveniently and informatively by obstetric clinicians. We recommend this program for the members of perinatologists and obstetricians.
Assuntos
Humanos , Gravidez , Idade Gestacional , Microcomputadores , MãesRESUMO
No abstract available.
Assuntos
Gravidez , Índice de Apgar , Cardiotocografia , Concentração de Íons de Hidrogênio , MecônioRESUMO
Respiratory distress syndrome (RDS) is a major cause of death in premature neonates, and it is caused by the failure of morphological and biochemical lung maturation (synthesis and secretion of lung surfactant). It is known that cortisol, thyroxine, prolactin, epidermal growth factor (EGF), and estrogen accelerate the lung maturation. Cortisol and thyroxine are currently used in the antenatal treatment for the prevention of RDS in premature neonates. In order to evaluate the effect of EGF on the levels of cortsol, thyroxine, and prolactin, this study was undertaken. Phosphate buffered saline (PBS) with and without EGF was directly injected into the 25 days gestational fetus in uterus. Blood was collected for the measurement of cortisol, thyroxine, and prolactin one day or two days after the injection. Body weights and lung weights were also measured. The results were as follows: 1. There was no significant difference in body weights and lung weights between PBS-treated group(control group) and EGF-treated poup(experimental group), 24 hours and 48 hours after the injection. 2. 24 hours after the injection, the levels of cortisol were significantly inaeased in the EGF-treated group compared with those in the PBS-treated group. However 48 hours after the injection, there was no significant difference in the levels of cortisol between the two groups. The levels of thyroxine and prolactin in the EGF-treated group did not significantly differ from those in the PBS-treated group 24 hours and 48 hours after the injection. In conclusion, in vivo, the synthesis of cortisol may be affected by EGF treatment, which suggests that the action of EGF for lung maturation may be partially mediated by the increased endogenous levels of cortisol.
Assuntos
Humanos , Recém-Nascido , Coelhos , Peso Corporal , Causas de Morte , Fator de Crescimento Epidérmico , Estrogênios , Feto , Hidrocortisona , Pulmão , Prolactina , Tiroxina , Útero , Pesos e MedidasRESUMO
OBJECTIVE: This study was performed to evaluate the diagnostic value of polymerase chain reaction (PCR) for multiple microorganisms in female lower genital infection, because infections of the vaginal are caused by multiple microorganisms. METHODS: A total of 222 patients (161 cases of gynecologic patients and 61 cases of obstetric patients) who complained of profuse vaginal discharge or had excessive vaginal discharge were evaluated for detection of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, and Trichomonas vaginalis infections using PCR. RESULTS: Infecting microorganisms by PCR were found in 61 out of 161 gynecologic patients (37.6%). Among the 61 patients, single infection was present in 45 patients (78.3%), and infection by multiple microorganisms (26.6%) in the remaining 16. In these same patients, 72 showed an abundance of WBCs with the Gram stain. Among these 72 patients, 26 (74.3%) were infected with a single microorganism, and 9 (25.7%) were infected with multiple microorganisms. In 61 pregnant women, 26 patients (42.6%) were positive for infection. Single infection was found in 25 patients (96.2%) and infection by multiple microorganisms was present in one patient (3.8%). Many WBCs were observed in 19 out of the 61 pregnant women with the detection of single infection in 9 patients and none of the mixed forms. CONCLUSION: The majority of female lower genital infections are due to multiple organisms. Individual tests, cultures, and Gram staining must be done in order to detect all involved organisms which may potentially double cost and time loss. However, with the use of PCR, this can be achieved all at once. We therefore suggest that PCR may be precise and economically beneficial in the detection of female lower genital infection.
Assuntos
Feminino , Humanos , Chlamydia trachomatis , Mycoplasma hominis , Reação em Cadeia da Polimerase , Gestantes , Trichomonas vaginalis , Ureaplasma urealyticum , Descarga VaginalRESUMO
Objectives: To determine whether the clinical aspect of aplastic anemia is influenced by pregnancy. METHODS: We reviewed 37 cases of pregnant aplastic anemia patients during Jan. 1989 to Dec. 1998, and examined age, parity, progress of pregnancy, termination methods, obstetrics & neonatal complications, hematologic change, and treatment modality by medical records. RESULTS: According to onset of disease, patients were divided into pre-pregnant diagnosed group(n=12) and during-pregnancy diagnosed group(n=25). Mean age of diagnosis was 29.4yr, 89.2% were nulliparous, and 51.4% were severe aplastic anemic patients. All patients underwent 50 pregnancy. Mean gestational period was 37wks, birth weight was 2569gram, and, except in 7 cases of abortion, 43 cases were delivered transvaginally or transabdominally(51.2% vs. 48.8%). Preeclampsia, eclampsia, preterm labor, restricted growth, and distress were complicated and decreased hemoglobin, hematocrit, reticulocyte, platelet were reversed after termination in pregnancy associated group. Treatment modality during pregnancy included transfusion, steroid, anti-lymphocytic globulin, anti-thymocytic globulin and IVGV, and remission rate was 45.5% in pregnancy associated group. CONCLUSION: We concluded that pregnancy is associated with aplastic anemia as a high risk factor, and intensive treatment is needed.