No abstract available.
Epidermal Growth Factor* ; Gonadotropin-Releasing Hormone* ; Myoma* ; Receptor, Epidermal Growth Factor*

OBJECTIVE: To investigate the effect of the type of placenta and the portion of umbilical cord insertion on birthweight and growth discordancy in twin pregnancies. METHODS: We selected 120 twins of 146 multiple pregnancies between March, 2000 and March, 2002, and one fetus of all cases at least weighed 500 g or more and over 24 weeks of gestation. The fetuses were included that 44 twins (88 fetuses) had monochorionic placentas and the 76 twins (152 fetuses) had dichorionic placentas. The dichorionic twins were divided into two groups; one (38 twins, 76 fetuses) showed the fused type of placenta and the other (38 twins, 76 fetuses) showed the separate type of placenta. The types of umbilical cord insertion were also divided into the central portion and the peripheral portion, the peripheral portion was defined within 2 cm of margin of placenta, and included marginal and velamentous insertion of umbilical cord. Stastical analysis were performed with Student t-test and runs test. p<0.05 was defined significantly. RESULTS: 1. The central type of umbilical cord insertion in dichorionic placenta was more frequent than that of monochorionic placenta (p<0.01). 2. The dichorionic infants, regardless the number of placenta, who weighed more than monochorionic infants at birth (p<0.01). 3. Twin pairs with over 25% of growth discordancy were 16 cases (13.3%), which included 9 cases (9/76, 11.8%) of dichorionic placenta and 7 cases (7/44, 15.9%) of monochorionic placenta. The severe growth discordancy was more commonly developed in monochorionic twins than dichorionic twins (p<0.01). 4. Perinatal deaths in twin pairs with over 25% of GD were 12 cases, which included 3 cases (3/18, 16.7%) of dichorions, and 9 cases (9/14, 64.3%) of monochorions. Therefore, perinatal death was showed more commonly in monochorinic twin infants (p<0.01). CONCLUSION: The type of umbilical cord insertion affected the birthweight of dichorionic separated infants. Monochorionic placenta attributed to more severe growth discordancy and increased perinatal death rate than the dichorionic placenta. Antenatal detection of chorionicity and the portion of umbilical cord insertion may improve the perinatal outcome.
Chorion ; Female ; Fetus ; Humans ; Infant ; Mortality ; Parturition ; Placenta* ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Umbilical Cord*

BACKGROUND: Recently, the prevalence of diabetes mellitus and its complications have been increased in Korea and they cause many socioeconomic losses in both patients and their families. But, there are neither sufficient medical assistance including concern of medical personnel nor social assistance in Korea nowadays. OBJECTIVES: In this study, we tried to reduce the risk of amputation and preserve the function of the foot by an early evaluation, proper treatment and consultation by dermatologists. METHODS: We randomly chose 18 cases of diabetic foot ulcer and took care of them with proper and earlier debridement, dressing, antibiotics and cooporation with departments of internal medicine, especially endocrinology, nephrology and division of infectious disease. After healing of the ulcer, we recommended specially designed shoes and foot care products to prevent the recurrence of the foot problems. RESULTS: The average duration of diabetes was 18 years and preexisting complications were neuropathy, nephropathy, vasculopathy and/or foot deformities. The precipitating factors of foot ulcer were burn, callus, fungal infection, bony deformity or trauma. Three cases underwent toe amputation and one case with severe vasculopathy was transferred to the vascular surgery. Average healing time was 14 weeks. CONCLUSION: Proper evaluation and management of diabetic foot ulcer patients with multidisciplinary approach should achieve good wound healing. Consequently, it can reduce the risk of amputation and improve the quality of life in the patient with diabetic foot ulcer. Among them, dermatologists who has a point of view of both a medical and surgical doctor may play a pivotal role in the management of diabetic foot ulcer.
Amputation ; Anti-Bacterial Agents ; Bandages ; Bony Callus ; Burns ; Communicable Diseases ; Congenital Abnormalities ; Debridement ; Diabetes Mellitus ; Diabetic Foot* ; Endocrinology ; Foot ; Foot Deformities ; Foot Ulcer ; Humans ; Internal Medicine ; Korea ; Medical Assistance ; Nephrology ; Precipitating Factors ; Prevalence ; Quality of Life ; Recurrence ; Shoes ; Toes ; Ulcer* ; Wound Healing