In order to find out the distribution of fibronectin and fibrinogen in placenta among pregnancy induced hypertensive (PIH) patients, 6 normotensive pregnancies and 17 PIH patients were chosen. The placentas were obtained right after delivery and soaked in the 10% formalin solution. The score was measured in terms of the positiveness of the stain in immunohistochemical stain by using I antibody with the rabbit antihuman fibronectin and the rabbit anti-human fibrinogen. Comparison between two groups are as following: 1.The placenta of PIH patients showed significantly reduced positiveness of fibronectin in their fetal villous vessels and villous stroma. 2. In the PIH patients, the positiveness was reduced in the group giving the birth to intrauterine fetal growth retardation compared to giving birth to normal baby. 3. In both normotensive and PIH patients, the villous basement membrane did not show the staining response to fibronectin, while showing heavy staining response to fibrinogen. 4. The positiveness of fibrinogen in fetal vessels, villous basement membrane, intervillous space and stroma were almost same in both normotensive and PIH patients. From above results, we can conclude that there is abnormality in the distribution of fibronectin especially in the fetal vessels and the villous stroma of placenta among PIH patients. The cause of this result needs further study.
Basement Membrane ; Fetal Growth Retardation ; Fibrinogen* ; Fibronectins* ; Formaldehyde ; Humans ; Parturition ; Placenta* ; Pre-Eclampsia ; Pregnancy*

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.
Body Weight ; Cause of Death ; Epidermal Growth Factor* ; Estrogens ; Fetus ; Humans ; Hydrocortisone ; Infant, Newborn ; Lung ; Prolactin* ; Rabbits* ; Thyroxine* ; Uterus ; Weights and Measures

Long, severe, and fixed congenital tracheal stenosis is a life-threatening anornaly and not relieved by endotracheal or tracheostomy intubation. The rarity of congenital tracheal stenosis has not allowed sufficient experience for the development of standard treatment methods, therefore, congenital tracheal stenosis still carries significant morbidity, with a mortality rate as high as 70%. We have followed up two patients managed by different methods, but O(2)-isoflurane-Fentanyl-vecuronium was used for induction and maintenace. We experienced one case of tracheoplasty with pericardial patch for extensive tracheal stenosis under extracorporeal circulation, and one case of slide tracheoplasty for funnel-shaped tracheal stenosis. The first case was noticed incidentally during anesthetic induction and the vocal cord was visible but 2.5 mm sized tube could not be advanced,so we used the guide wire which is used for central line, then we could intubate with some resistance. Tracheostomy was not allowed due to diffuse tracheal stenosis reaching from cricoid cartilage to carina. During the extra corporial circulation, the guide wire was inserted from operation field, and 3.5 mm sized tube was introduced via guide wire by anesthesiologist. After operation the grannulation tissue that obstructing airway, was noticed by bronchoscopy, and was removed, then he was weaned from ventilator successfully. The second case was discovered due to diffcult weaning from ventilator after open heart surgery. the bronchogrm showed right tracheal bronchus and diffuse tracheal stenosis from T2 to carina. He was ventilated initially with 4.0 mm sized endotracheal tube, and ventilated intermittently with other 2.5 mm sized endotracheal tube from operation field during tracheal anastomosis. After operation, he died with increased airway pressure and airway bleeding.
Bronchi ; Bronchoscopy ; Cricoid Cartilage ; Extracorporeal Circulation ; Heart* ; Hemorrhage ; Humans ; Intubation ; Mortality ; Thoracic Surgery* ; Tracheal Stenosis* ; Tracheostomy ; Ventilators, Mechanical ; Vocal Cords ; Weaning

PURPOSE: To investigate the efficacy of SPIO (superparamagnetic iron oxide) enhanced MR imaging for the detection of colorectal liver metastasis, compared to the intraoperative ultrasound (IOUS). MATERIALS AND METHODS: Thirteen patients who underwent IOUS during surgery for colorectal liver metastasis as well as a liver MR before and after administration of SPIO. The mean patient age was 57 years (age range: 43-77). Two observers reviewed the SPIO-enhanced MR via a double blind test. We evaluated the efficacy of the SPIO-enhanced MR compared to the results of IOUS. RESULTS: Following IOUS, 55 lesions were found, including 32 metastases, 20 cysts, 2 calcifications, and 1 coagulation necrosis. The interobserver correlation of the SPIO-enhanced MR is significant, with a kappa index of 0.839. Radiologist 1 and 2 missed three lesions in three patients. Two of the patients had multiple liver lesions (six and eight, respectively), whereas the other patient had tumor recurrence following hepatic surgery for liver metastasis. In the other nine patients, MR detected all lesions. The sensitivity and positive predictive value of the SPIO-enhanced MR was 94.5%, and 100%, respectively. CONCLUSION: The SPIO-enhanced liver MR shows a good correlation to IOUS, especially in the case of patients who had fewer than three lesions. Therefore, the SPIO-enhanced MR may help to plan a surgical resection of colorectal liver metastasis.
Contrast Media ; Humans ; Iron ; Liver ; Liver Neoplasms ; Necrosis ; Neoplasm Metastasis ; Recurrence

PURPOSE: The template-guided implant surgery offers several advantages over the traditional approach. The purpose of this study was to evaluate the accuracy of coordinate synchronization procedure with 5-axis milling machine for surgical template fabrication by means of reverse engineering through universal CAD software. MATERIALS AND METHODS: The study was performed on ten edentulous models with imbedded gutta percha stoppings which were hidden under silicon gingival form. The platform for synchordination was formed on the bottom side of models and these casts were imaged in Cone beam CT. Vectors of stoppings were extracted and transferred to those of planned implant on virtual planning software. Depth of milling process was set to the level of one half of stoppings and the coordinate of the data was synchronized to the model image. Synchronization of milling coordinate was done by the conversion process for the platform for the synchordination located on the bottom of the model. The models were fixed on the synchordination plate of 5-axis milling machine and drilling was done as the planned vector and depth based on the synchronized data with twist drill of the same diameter as GP stopping. For the 3D rendering and image merging, the impression tray was set on the conbeam CT and pre- and post-CT acquiring was done with the model fixed on the impression body. The accuracy analysis was done with Solidworks (Dassault systems, Concord, USA) by measuring vector of stopping's top and bottom centers of experimental model through merging and reverse engineering the planned and post-drilling CT image. Correlations among the parameters were tested by means of Pearson correlation coefficient and calculated with SPSS (release 14.0, SPSS Inc. Chicago, USA) (alpha = 0.05). RESULTS: Due to the declination, GP remnant on upper half of stoppings was observed for every drilled bores. The deviation between planned image and drilled bore that was reverse engineered was 0.31 (0.15 - 0.42) mm at the entrance, 0.36 (0.24 - 0.51) mm at the apex, and angular deviation was 1.62 (0.54 - 2.27)degrees. There was positive correlation between the deviation at the entrance and that at the apex (Pearson Correlation Coefficient = 0.904, P = .013). CONCLUSION: The coordinate synchronization 5-axis milling procedure has adequate accuracy for the production of the guided surgical template.
Chicago ; Collodion ; Cone-Beam Computed Tomography ; Gutta-Percha ; Mandrillus ; Models, Theoretical ; Silicones

We report a case of ring chromosome 13 with a distal deletion of 13q32.2-->qter observed in a fetus who was referred to our institution at term due to severe growth restriction and multiple congenital malformations on ultrasonographic examination.This boy was born by vaginal delivery at 39 weeks in gestation. His weight, head circumference and height were less than the 3 percentile of gestational age. Apgar score was 7 at 1 minute and 9 at 5 minutes. He showed microcephaly, large forehead, low set ears, hypertelorism, flat nasal bridge, and micrognathia. The genitalia was ambiguous, showing severe hypoplasia of the penis. The anus was ectopic, displaced anteriorly from its normal position but with a normal opening and function. Neurologic examination was normal. Echocardiogram done at 2 weeks of life showed a persistent foramen ovale and a ventriculoseptal defect (type II) with increased pulmonary hypertension. MRI examination of the brain showed poorly demarcating corpus callosum suspecting agenesis of corpus callosum. Also, cerebellar vermis was small and hypoplastic, mimicking a variant form of Dandy-Walker malformation. MRI of the pelvis showed a tubular structure in pelvic cavity, suspicious of uterine remnant, between urinary bladder and rectum, and a inguinal hernia was noted in the left side. In the abdominal cavity enlarged adrenal glands were noted, and hormonal study showed elevated 17-alpha-OH-progesterone (168.9 ng/ml) with normal 17-KS and 17-OHCS levels. Gastrointestinal and urogenital system were otherwise normal. Cytogenetic analysis of the parents were both normal but the newborn showed 46, XY, r (13), de novo, with deletion points q32.2-->qter. Our findings are in line with previous reports about chromosome 13 deletions, in which loss of the "critical point" leads to major malformations like brain anomalies and ambiguous genitalia.
Abdominal Cavity ; Adrenal Glands ; Agenesis of Corpus Callosum ; Anal Canal ; Apgar Score ; Brain ; Chromosomes, Human, Pair 13 ; Corpus Callosum ; Cytogenetic Analysis ; Dandy-Walker Syndrome ; Disorders of Sex Development ; Ear ; Fetus ; Foramen Ovale ; Forehead ; Genitalia ; Gestational Age ; Head ; Hernia, Inguinal ; Humans ; Hypertelorism ; Hypertension, Pulmonary ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Microcephaly ; Neurologic Examination ; Parents ; Pelvis ; Penis ; Pregnancy ; Rectum ; Ring Chromosomes ; Urinary Bladder ; Urogenital System

OBJECTIVE: Much emphasis has been placed on the morbidity and mortality of infants delivered before 32 weeks of gestation, including intraventricular hemorrhage and respiratory distress. The incidence of these complications and their association with long-term sequelae are well defined. This information is important, especially when decisions regarding delivery have to be made. Although delivery at >32 weeks of gestation may be considered free of serious sequelae of prematurity, morbidities are still associated with delivery between 32 and 36 weeks of gestation. The purpose of this study is to determine the incidence of minor morbidities associated with premature delivery between 32 and 36 weeks of gestation. We tried to find out the proper time to decrease the minor perinatal morbidities and the adverse effect of tocolytic treatment. METHOD: The study population is consisted of infants delivered between 20 and 36 weeks of gestation at Kang Nam St. Mary's hospital from 1995 to 1999. Maternal and neonatal charts were abstracted for maternal past history, pregnancy complications and neonatal demographics comparing complications present at each gestational week. Mann-Whitney test and x2 test were used to assess statistical significance. RESULTS: There was no significant difference of delivery time due to maternal age and parity. There was increased risk of low Apgar score and low birth weight before 34 weeks of gestation. Neonatal death was significantly high before 32 weeks of gestation. Neonatal death, sepsis, intraventricular hemorrhage, respiratory distress, ventilatory equipment use was significantly high before 32-33 weeks of gestation. Hypothermia, feeding difficulty, jaundice, NICU admission was significantly high before 30, 32, 35, 35 weeks of gestation. So it is approved that minor perinatal morbidity was decreased after 34-35 weeks of gestation. CONCLUSION: Major morbidity was significantly high before 32-33 weeks of gestation and Minor morbidity was significantly high before 34 weeks of gestation. Therefore considering of minor and major morbidity, it is reasonable to postpone the preterm delivery until 34 weeks of gestation.
Apgar Score ; Demography ; Female ; Hemorrhage ; Humans ; Hypothermia ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Jaundice ; Maternal Age ; Mortality ; Parity ; Pregnancy ; Reproductive History ; Sepsis ; Tocolysis

The neonatal lupus syndrome is characterized by skin lesions, hepatic and hematologic abnormalities and congenital heart block. Congenital heart block which is believed to be caused by transplacental passage of the anti-Ro (SSA)/La (SSB) antibodies from mother to infant, is known to occur in 1 in 20,000 live births. In contrast to other manifestation of neonatal lupus syndrome, which usually subside within 6 months after birth, congenital heart block is a permanent and potentially fatal complication. We experienced a case of neonatal lupus syndorme with congenital complete heart block in a newborn of asyptomatic mother with anti-Ro (SSA)/ La (SSB) antibodies.
Antibodies ; Heart Block* ; Heart* ; Humans ; Infant ; Infant, Newborn ; Live Birth ; Mothers ; Parturition ; Skin

Since Sampson first described the development of ovarian carcinoma in endometriosis in 1925, numerous case reports have documented the development of malignancies arising from foci of endometriosis. Clear cell carcinoma arising from endometriosis is very rare in the vulva. To date only two cases that originated in the vulva have been reported. We report a case of clear cell carcinoma in the vulva arising from endometriosis with a brief review of literatures.
Endometriosis* ; Female ; Vulva*

OBJECTIVE: The purpose of study was to assess in a longitudinal study of maternal plasma concentrations of Tumor necrosis factor-alpha(TNF-alpha), Vascular cell adhesion molecule-1(VCAM-1), Lipid peroxide (malonaldehyde, MDA) in uncomplicated pregnancy. METHODS: Blood was collected from healthy women at 4 to 41 weeks' gestation and non-pregnant women. Plasma samples were measured by immunoassay for TNF-alpha, VACM-1 and by colorimetric assay for lipid peroxide, and data were statistically analyzed. RESULTS: Plasma concentration of TNF-alpha was not significantly elevated during first trimester compared with non-pregnant women, but significantly elevated during second and third trimester compared with non-pregnant women. Plasma concentration of VCAM-1 was significantly elevated during first trimester compared with non-pregnant women. Plasma concentration of lipid peroxide was not significantly elevated during pregnancy compared with non-pregnant women. CONCLUSION: The plasma concentration of TNF-alpha and VCAM-1 were significantly higher than that of non-pregnant state during second and third trimester in case of TNF-alpha, and during first trimester in case of VCAM-1. But the plasma concentration of lipid peroxide during pregnancy was not significantly different from that of non-pregnant, and the plasma concentration was kept up constant levels during gestation. These were seems to be meant that abnormal pregnancy would be happened if the level is above or below the measured level.
Cell Adhesion ; Female ; Humans ; Immunoassay ; Longitudinal Studies ; Necrosis ; Plasma* ; Pregnancy Trimester, First ; Pregnancy Trimester, Third ; Pregnancy* ; Tumor Necrosis Factor-alpha* ; Vascular Cell Adhesion Molecule-1*