PURPOSE:The objective of this study was to evaluate the indications, effectiveness and complications associated with uterine arterial embolization as an alternative treatment of obstetrical hemorrhage. METHODS:From January 2006 to December 2008, 25 patients who underwent angiographic embolization for the obstetrical hemorrhage that was not responsive to conventional treatments, like obstetric maneuvers and uterotonic drugs, were included in our study. All medical records were reviewed and detailed clinical data such as clinical status, underlying conditions, amount of transfusion, embolized arteries, hospital stay, the success rate and the complications were collected. RESULTS:We have experienced clinically successful embolization in 22 (88%) of 25 patients with obstetrical hemorrhage resulting from various causes. After embolization, the patients' vital signs were stabilized. The causes of hemorrhage were atony of uterus (n=10), myomectomy during cesarean section (n=6), abnormal placentation (n=5), arterio-venous malformation (n=3), and cervical pregnancy (n=1). The average amount of blood transfusion was 7.2 units (range; 0~39 units). The average length of the time for the procedure was 55 minutes (range: 25~96 minutes). The average duration of hospitalization was 5.5 days (range: 2~14 days). In 22 patients, menses resumed spontaneously after procedures. The main complications after embolization were numbness and pain on lower extremities (n=1), and hypomenorrhea (n=1). CONCLUSION:The atrerial embolization is one of the safe and effective procedures that offers patients an alternative to hysterectomy for the treatment of intractable postpartum hemorrhage.
Arteries ; Blood Transfusion ; Cesarean Section ; Female ; Hemorrhage ; Hospitalization ; Humans ; Hypesthesia ; Hysterectomy ; Length of Stay ; Lower Extremity ; Medical Records ; Menstruation Disturbances ; Placentation ; Postpartum Period ; Pregnancy ; Uterus ; Vital Signs

PURPOSE:Leukemoid reaction (LR) represents inflammatory reaction in very low birth weight (VLBW) infants, and has been reported to relate with the development of bronchopulmonary dysplasia (BPD). This study was done to assess the relationship between perinatal characteristics and neonatal outcome of leukemoid reaction in VLBW infants. METHODS:Three hundred and seventy two VLBW infants admitted to the NICUs of SNUCH and SNUBH between June 2005 to June 2008 were studied in a retrospective case-controlled manner. Of these VLBW infants, 32 LR (+) infants were compared with 83 LR (-) infants who were matched for gestational age and birth weight with respect to perinatal and neonatal clinical characteristics. LR was defined as a white blood cell (WBC) count of more than 40,000 cells/mm3 or absolute neutrophil count of more than 30.000 cells/mm3 during the first month of life. RESULTS:Of 413 VLBW infants, There was no significant difference between the LR (+) and LR (-) infants in sex, Apgar scores, maternal peripheral WBC count, the use of antenatal steroids and maternal age. Comparing with LR (-) infants, LR (+) infants had a higher positive rate for amniotic fluid culture (67% vs 11%; P< or =0.01), U. ureaplasma in amniotic fluid (52% vs 10%; P=0.01), histologic chorioamnionitis (81% vs 33%; P=0.01) and funisitis (50% vs 7%; P=0.01). The incidences of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, sepsis, intraventricular hemorrhage and BPD showed no significant difference between LR (+) and LR (-) infants. CONCLUSION:LR during the first month of life in VLBW infants was associated with chorioamnionitis, but not with the incidence of bronchopulmonary dysplasia or other neonatal morbidities. These findings suggest that LR may be a simple reflection of transient accelerated neutrophil production induced by prenatal inflammation without significant neonatal consequences.
Amniotic Fluid ; Birth Weight ; Bronchopulmonary Dysplasia ; Case-Control Studies ; Chorioamnionitis ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Female ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Inflammation ; Leukemoid Reaction ; Leukocytes ; Maternal Age ; Neutrophils ; Polymethacrylic Acids ; Pregnancy ; Retrospective Studies ; Sepsis ; Steroids ; Ureaplasma

PURPOSE:To investigate the change in the antioxidant vitamin levels in maternal uterine venous plasma (MUVP), amniotic fluid (AF), and chorioamnion after vitamin C and E supplementation during pregnancy. METHODS:Thirty pregnant women who were scheduled for elective cesarean section between 37 and 39 gestational weeks were randomized in this study. Fifteen women were given a daily oral dose of vitamin C 1,000 mg and vitamin E 400 IU from 33~34 gestational weeks to delivery. The other fifteen women were not given, as a control group. Maternal uterine venous blood, AF, and chorioamnion were obtained after cesarean section. Lipid peroxides and oxygen-radical absorbance capacity value were measured by thiobarbituric acid reaction and Cao's method respectively. Ascorbic acid, uric acid, beta-carotene, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography. The tissue sections of chorioamnion were stained with hematoxylin-eosin and Masson-trichrome stain, and immunohistochemical stain for collagen type IV was also performed. RESULTS:The lipid peroxide levels in MUVP of the study group were significantly lower than those of the control group but in contrast, ORAC (Oxygen-radical absorbance capacity) values were lower in the control group. The alpha-tocopherol levels in MUVP, AF, and chorioamnion study group were significantly higher than those of the control group. Amniotic membrane and subepithelial stromal tissue in the study group were thicker than those in the control group. And subchorionic type IV collagen of placenta tissue in the study group was more stained than that of the control group. CONCLUSION:Maternal vitamin C and E supplementation may be beneficial in the prevention of diseases caused by oxidative stress such as preeclampsia and PROM and in increasing fibrin and type IV collagen in chorioamnion.
alpha-Tocopherol ; Amnion ; Amniotic Fluid ; Ascorbic Acid ; beta Carotene ; Cesarean Section ; Chromatography, Liquid ; Collagen Type IV ; Female ; Fibrin ; gamma-Tocopherol ; Humans ; Lipid Peroxides ; Oxidative Stress ; Placenta ; Plasma ; Pre-Eclampsia ; Pregnancy ; Pregnant Women ; Thiobarbiturates ; Uric Acid ; Vitamin A ; Vitamin E ; Vitamins

Women with gestational diabetes mellitus (GDM) are at increased risk for adverse outcome during pregnancy and the development of type 2 diabetes, cardiovascular disease, metabolic syndrome after pregnancy. Offspring of women with GDM are at increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood. For preventing complication, patients diagnosed with GDM should monitor their blood glucose level, physical activity, and undergo nutritional counseling for the purpose of maintaining normoglycemia, but not meeting glycemic goals with dietary changes alone should begin insulin therapy. After delivery, patients with prior gestational diabetes mellitus, especially history of obesity, hyperglycemia, insulin treatment during pregnancy, should be tested for diabetes annually. Offspring of women with GDM should be followed closely for the developing of obesity and impaired glucose tolerance.
Adolescent ; Blood Glucose ; Cardiovascular Diseases ; Counseling ; Diabetes, Gestational ; Female ; Glucose ; Glucose Intolerance ; Humans ; Hyperglycemia ; Insulin ; Mass Screening ; Motor Activity ; Obesity ; Organothiophosphorus Compounds ; Pregnancy

Low birth weight has been defined by the World Health Organization (WHO) as weight at birth of less than 2,500 g. This practical cut-off for international comparison is based on epidemiological observations that infants weighing less than 2,500 g are approximately 20 times more likely to die than heavier babies. The low birth weight rate is one of the most important indicators that represent the health care situation of a nation. The low birth weight rate for industrialized countries was around 7 percent, and in less developed countries it ranged between 5 and 33 percent, with an average of 17 percent. In Korea, low birth weight rate was presented between 4 and 9.8 percent. but I thought that the true low birth weight rate in Korea was around 5 percent recently.
Delivery of Health Care ; Developed Countries ; Developing Countries ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Korea ; Parturition ; World Health Organization

Interleukin-12 (IL-12), consisting of p35 and p40, plays important roles in linking innate and adaptive immunity. While p35 is constitutively expressed, IL-12 p40 gene expression is induced upon activation by Toll-like receptor ligands. Recently, with gene targeting technology, the cytokine IL-12 p40 reporter mouse has been developed to express the p40 gene linked via a viral IRES element with yellow fluorescence protein (YFP) fluorescent reporter. We investigated whether this novel system would be useful to reveal IL-12 p40-producing immune cells. We first investigated whether macrophages and dendritic cells from these mice faithfully reported p40 induction. Next, we tested if microglial cells, macrophages in the brain, could induce IL-12 p40. Finally we tested whether B cells could produce IL-12 p40 because there were very few reports for IL-12 production by B cells. Our results confirmed that macrophages and dendritic cells are main producer of IL-12 p40. Then, we found that microglial cells could produce IL-12 p40 upon stimulation with various TLR ligands. Finally we found that a subset of B cells could produce IL-12 p40 in TLR9-dependent manner. Taken all together, our system will be a valuable tool to identify the type of immune cells that produce IL-12 p40.
Adaptive Immunity ; Animals ; B-Lymphocytes ; Brain ; Corynebacterium ; Dendritic Cells ; Fluorescence ; Gene Expression ; Gene Targeting ; Interleukin-12 ; Ligands ; Macrophages ; Mice ; Microglia ; Toll-Like Receptors

Neuropathy is a general term referring to disorders of nerves, and produces when the nerves are damaged. It is characterized by spontaneous pain, allodynia and hyperalgesia. The purpose of present study is to observe the number of WGA-HRP (wheat germ agglutinin-horseradish peroxidase) labelded sensory neurons of DRG (dorsal root ganglia), and distributions according to cell size of sensory neuron in tibial nerve ligation model (NLM). The tibial nerve ligation was performed with 3-0 silk by the application of three tight ligatures at the mid-thigh level. In the neuropathy model of rat tibial nerve ligation, morphological changes of sensory neurons in DRG were observed using WGA-HRP. Rats of NLM showed the neuropathic behaviors. Rats were shown guarding affected limb and limping. Their toes and ankle joint of operated limb were hyperflexed. Under light microscopy, tibial nerve showed degeneration of axons in NLM. In control and NLM, labeled sensory neurons of tibial nerve distributed L4 and L5 DRG. In control group, the labeled sensory neurons were round or oval in shape. They were large and small cells, and mixed pattern. Total number of labeled sensory neurons in NLM decreased significantly from control group. The number of labeled sensory neurons in L4 and L5 DRG decreased significantly from control group. Labeled large and small cells decreased significantly from control group. Present study may serve as the basic information about the changes of DRG sensory neurons in NLM.
Animals ; Ankle Joint ; Axons ; Cell Size ; Diagnosis-Related Groups ; Extremities ; Hyperalgesia ; Ligation ; Light ; Microscopy ; Peripheral Nervous System Diseases ; Rats ; Sensory Receptor Cells ; Silk ; Tibial Nerve ; Toes ; Wheat Germ Agglutinin-Horseradish Peroxidase Conjugate

The bear bile has been used as a traditional drug medicine and has been known to have anti-tumor, anti-inflammatory and anti-oxidant effects. The purpose of this study is to investigate the inhibitory effect of bear bile on compound 48/80-induced mast cell activation in vitro and anti-dinitrophenyl (DNP) IgE-mediated vascular permeability in vivo. For this, the effects of bear bile on the degranulation, histamine release, calcium influx and the change of the intracellular cAMP levels of rat peritoneal mast cells (RPMCs) and the influences of the oral treatment of bear bile on IgE-mediated cutaneous vascular permeability were studied. the results were as follows; the compound 48/80-induced degranulation, histamine release and calcium influx of RPMCs were inhibited by pretreatment with bear bile, the cAMP levels of RPMCs were increased by pretreatment with bear bile, and bear bile inhibited anti-DNP IgE-mediated cutaneous vascular permeability. From the above results, it is suggested that bear bile contains some substances which inhibit anti-DNP IgE-mediated vascular permeability and mast cell activation. Bear bile potentially may serve as an effective therapeutic agent for allergic diseases.
Animals ; Antioxidants ; Bile ; Calcium ; Capillary Permeability ; Histamine Release ; Immunoglobulin E ; Mast Cells ; Rats ; Ursidae

In the traditional cadaver dissection course, it is hard to demonstrate dissection skills to all the medical students because of limitations such as the high ratio of students to instructors and the lack of facilities. To overcome these limitations, we developed a digital anatomy dissection course. Through this system, it was possible to perform effective instruction of anatomic dissection. This method could provide the appropriate teaching in a short period of time. Furthermore, students can review the dissection course on digital files saved on a CD-ROM. Clinical cadaveric workshops can be provided by this method not only for students but also for continuing medical education for clinicians.
Cadaver ; CD-ROM ; Education, Medical, Continuing ; Humans ; Students, Medical

This study aimed to develop and implement a progressive e-learning teaching method in the teaching of human anatomy. For analysis of the effect of new teaching methods, we made a survey of user satisfaction, content difficulty, and course management. The e-learning content was developed by the authors and implemented to class, practice, and tests, for 16 weeks. The survey was conducted on sophomores of nursing science (NS, n=42) and sports science (SS, n=26), at Kangwon National University. These two groups of students filled out a questionnaire related to effectiveness of e-learning content and tool in learning human anatomy. The results were compared between two groups. The majority of the students were satisfied with the content, difficulty level, and management of the e-learning course. Through the board of virtual classroom, all of the students played positive manners in communication and activity. Students pointed out 'reinforcement of multimedia data', 'improvement of technical service' and 'addition of broad information' as the most notable improvements of content. Therefore, we conclude that an e-learning course for undergraduate nursing science and sports science students can provide an effective learning model.
Humans ; Learning ; Multimedia ; Surveys and Questionnaires ; Sports ; Teaching