OBJECTIVES: Our purpose was (1) to determine whether amniotic fluid concentrations of interleukin-6 are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of significant perinatal morbidity and mortality in patients with preterm premature rupture of membranes and (2) to compare the diagnostic performance of amniotic fluid interleukin-6 with that of amniotic fluid microbial culture for these outcome variables. METHOD: The relation among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid interleukin-6 concentrations were examined in 65 patients with preterm premature rupture of membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Interleukin-6 level was determined by enzyme-linked immunosorbent assay. Receiver-operator characteristic curve, Mann-Whitney U test, and Fisher's exact test were used for analysis. RESULTS: 1) Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than those without histologic chorioamnionitis (median 12.6 ng/ml, range 0.03 to 142.2 ng/ml vs median 0.5 ng/ml, range 0.03 to 16 ng/ml; P < 0.0001). 2) Amniotic fluid having interleukin-6 concentrations higher than 3.2 ng/ml had a sensitivity of 78% (35/45) and specificity of 95% (19/20) in the diagnosis of acute histologic chorioamnionitis and sensitivity of 74% (25/34) and specificity of 65% (20/31) in the prediction of significant neonatal morbidity and mortality. 3) These sensitivities were significantly higher than those of amniotic fluid culture, but there were no significant difference in specificities between amniotic fluid interleukin-6 and culture (histologic chorioamnionitis: 78% vs 51%, p<0.01; significant neonatal morbidity and mortality: 74% vs 47%, p<0.01, respectively). CONCLUSIONS: Test of amniotic fluid interleukin-6 is of value and more sensitive than amniotic fluid culture for the antenatal diagnosis of histologic chorioamnionitis and for the prediction of perinatal outcome in patients with preterm premature rupture of membranes.
Amniocentesis ; Amniotic Fluid* ; Chorioamnionitis ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Infant, Newborn ; Interleukin-6* ; Membranes* ; Mortality ; Placenta ; Pregnancy ; Prenatal Diagnosis* ; Rupture* ; Sensitivity and Specificity

PURPOSE: Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. MATERIALS AND METHODS: From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. RESULTS: Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. CONCLUSIONS: Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.
Abscess/etiology/radiography/*surgery ; Aged ; Aged, 80 and over ; Calcinosis/complications/surgery ; Drainage/methods ; Holmium ; Humans ; Lasers, Solid-State/*therapeutic use ; Male ; Middle Aged ; Prostatic Diseases/etiology/radiography/*surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Transurethral Resection of Prostate/*methods ; Treatment Outcome ; Urinary Bladder Neck Obstruction/complications/surgery

OBJECTIVES: To compare the diagnostic and prognostic performance of amniotic fluid white blood cell(AF WBC) count and amniotic fluid culture for the prenatal diagnosis of intrauterine infection and the prediction of neonatal outcomes in patients with preterm labor and intact membranes. Methods: Amniocentesis was performed in 75 patients with preterm labor and intact membranes, who delivered preterm neonates within 72 hours after amniocentesis. AF WBC was determined and amniotic fluid was cultured for aerobic and anaerobic bacteria as well as mycoplasma. The relations among placental histologic findings, perinatal outcome, AF WBC count, and AF culture were examined. Student t test, Mann Whitney U test, lamda2 test, Fisher's exact test, modified t test, and logistic regression analysis were used for statistical analysis. RESULTS: Microbial invasion of the amniotic fluid was more frequent in the patients with histologic chorioamnionitis than patients without histologic chorioamnionitis (28.9% vs 5.4%, p<0.05), and patients with histologic chorioamnionitis had significantly higher amniotic fluid white blood cell counts than those patients without such lesion (median 99, range 0-3024 cells/mm3 vs median 1, range 0-180 cells/mm3, p<0.01). Amniotic fluid white blood cell count (> or = 50cell/mm3) had a sensitivity of 55.3%(21/38) and a specificity of 94.6%(35/37) for the diagnosis of histologic chorioamnionitis and a sensitivity of 47.5%(19/40) and specificity of 90.9%(30/33) for the prediction of significant neonatal morbidity (defined as neonatal sepsis, respiratory distress syndrome, pneumonia, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis). These sensitivities were significantly higher than those of amniotic fluid culture (for histologic chorioamnionitis, 55.3% vs 28.9% ; for significant neonatal morbidity, 47.5% vs 25.0%, p<0.01 for each). CONCLUSION: Amniotic fluid WBC count is a more sensitive test for the prenatal diagnosis of intrauterine infection and for the prediction of significant neonatal morbidity than amniotic fluid culture in the patients with preterm labor and intact membranes.
Amniocentesis ; Amniotic Fluid* ; Bacteria, Anaerobic ; Bronchopulmonary Dysplasia ; Chorioamnionitis ; Diagnosis ; Female ; Hemorrhage ; Humans ; Infant, Newborn ; Leukocyte Count* ; Leukocytes* ; Logistic Models ; Membranes* ; Mycoplasma ; Obstetric Labor, Premature* ; Pneumonia ; Pregnancy ; Prenatal Diagnosis* ; Sensitivity and Specificity ; Sepsis

OBJECTIVES: Organizations have recently introduced Employee Assistance Programs (EAPs) to promote work performance by helping employees to solve their current problems and reduce stress levels. This cross-sectional, retrospective study was conducted to measure features of work performance among EAP users in Korea. METHODS: Measurements were taken by employee surveys and employee records. Lost productivity time, job/organizational involvement, and job satisfaction were measured among 332 EAP users in ten organizations in Korea, which had introduced EAPs as of 2009. EAP users responded to measurements after one to three months after enrollment in EAP counseling service. A convenience sample of 297 workers, who had not used an EAP counseling service during the study period, was used as a comparison group. RESULTS: Compared with non-users, the EAP users showed more presenteeism (53.22 vs. 47.63 hours per four weeks, p=0.025) and more total lost productivity time (p=0.020). Job satisfaction was correlated with presenteeism. CONCLUSION: EAP users showed decreased productivity. It would appear that EAP counseling is a useful program for those who are present at workplace but suffering from decreased performance due to personal stress. This study indicates the need for a prospective outcome study to assess the economic and clinical value of EAPs.
Absenteeism ; Counseling ; Efficiency ; Employment ; Humans ; Job Satisfaction ; Korea ; Outcome Assessment (Health Care) ; Retrospective Studies ; Stress, Psychological

Stress-induced cardiomyopathy is a recently described acute and transient cardiomyopathy with typical left ventricular apical ballooning mimicking the clinical scenario of an acute myocardial infarction. Cesarean delivery causes intense emotional and physical stresses, which may precipitate stress-induced cardiomyopathy. We report a case presenting stress-induced cardiomyopathy occurring during ICU care in the early postpartum period following cesarean delivery.
Cardiomyopathies ; Myocardial Infarction ; Postpartum Period ; Pregnancy

PURPOSE: Myocardial scintigraphy has been reported to be useful in adults, but its usefulness in children is limited. This study was done to determine the feasibility and accuracy of 99mTc-MIBI SPECT(sestamibi , methoxy-isobutyl-isonitrarite myocardial single emirs sion computed tomography, Dp-SPECT) after dipyridamole infusion to detect coronary obstructive lesions in Kawasaki disease(KD). METHODS: Dp-SPECT was performed in 21 control(group 1), 8 with coronary aneurysm(group 2) and 16 with coronary obstructive lesion(group 3) in children with KD. The spatial distribution of Dp-SPECT was determined and analyzed visually. Group 2 and 3 underwent coronary angiogram within 3 months of Dp-SPECT. RESULTS: Chest pain occurred more frequently in group 2. No subject required supplemental oxygen or were complicated by myocardial ischemia. The specificity of Dp-SPECT for control subject was 95% & 62% if using a cut-off criterion of abnormality, utilizing moderate or mild perfusion defect, respectively. The false positive rate was high in anterior, apical and anteroseptal segments but not related to age. The abnormalities found on Dp-SPECT was observed in 25% of aneurysmal coronary arteries but not related to its size. The sensitivity, specificity, and accuracy of Dp-SPECT was 100%, 84.5% and 79% in coronary stenosis greater than 75%, respectively. CONCLUSION: The interpretation of Dp-SPECT should be careful in KD because of discrepancies between Dp-SPECT & angiography, But DP-SPECT is noninvasive and easily applicable. It monitors the occurrence and progression of coronary stenosis due to KD. Besides Dp-SPECT may be applicable after arterial switch operation or to myocardial sinusoid.
Adult ; Aneurysm ; Angiography ; Chest Pain ; Child ; Coronary Stenosis ; Coronary Vessels ; Dipyridamole ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Ischemia* ; Myocardial Perfusion Imaging ; Oxygen ; Perfusion* ; Sensitivity and Specificity

BACKGROUND: The arterial switch operation (ASO) has become a procedure of choice for transposition of the great arteries (TGA) with or without ventricular septal defect (VSD). In spite of current low surgical mortality in immediate surgical period, there are potential problems of late morbidity and mortality. In this study, we evaluate the prevalence and severity of aortic insufficiency (AI) and associated factors with AI. METHOD: We retrospectively reviewed medical records and echocardiogram of 125 patients (M89, F36) underwent ASO for TGA at Seoul National University Children's Hospital from July, 1987 to June, 1997. To evaluate for associated factors, we divided patients of TGA to four hemodynamic groups (Group I, simple TGA (n-53); Group II, associated with ventricular septal defect (VSD) (n-50); Group III, associated with VSD and PS (n-18); Group IV, associated with PS (n-4)). Grade of AI was assessed by color Doppler analysis (Perry's et al). RESULTS: Total prevalence rate of AI was 35.2% (31/88) and grade of AI were mild in 61%, moderate in 39%. The incidence of AI in each group was: Group I 25.0% (10/40), Group II 26.0% (9/36), Group III 92.0% (12/13). According to this study, pulmonary stenosis was the only significant factor to AI. During follow-up (39+/-24 Months), in spite of the normal left ventricular function in most patients with AI, a few patients (3 cases) suffered from progressive AI and some moderate AI patients (2 cases) showed slightly decreased LV function. Two moderate and progressive AI lossed. CONCLUSION: In this study, AI (after ASO) was not uncommon and pulmonary stenosis was an important factor to AI. In some cases, AI became worse and developed decreased LV function. This suggests that meticulous follow-up after ASO is necessary.
Arteries* ; Follow-Up Studies ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Incidence ; Medical Records ; Mortality ; Prevalence ; Pulmonary Valve Stenosis ; Retrospective Studies ; Seoul ; Ventricular Function, Left

BACKGROUND: New onset diabetes is a common complication after kidney transplantation. However, the clinical course of post-transplant diabetes mellitus (PTDM) remains unclear. The aim of the present study is to analyze the natural courses and risk factors of PTDM according to the time of onset. METHODS: A total of 216 consecutive kidney transplant recipients were enrolled and patient medical records were investigated retrospectively. PTDM was defined as glucose > or =126mg without previous diabetic history. Patients were classified according to the onset (12 months): early PTDM (E-PTDM) and late PTDM (L-PTDM). RESULTS: PTDM was observed in 34 (17.4%) patients. The number of E-PTDM and L-PTDM patients was 17 and 17. Compared with normoglycemic patients, the PTDM group was older and showed higher pre-transplant HbA1c level. The use of tacrolimus was associated with the development of E-PTDM (OR=4.87, 1.71~13.8 in 95% CI) but not L-PTDM (OR=0.34, 0.04~2.70 in 95% CI) CONCLUSIONS: The development of E-PTDM and L-PTDM may have different risk factors. It will be important to choose different therapeutic strategy according to the onset of PTDM.
Diabetes Mellitus ; Glucose ; Humans ; Kidney ; Kidney Transplantation ; Medical Records ; Retrospective Studies ; Risk Factors ; Tacrolimus ; Transplants

OBJECTIVE: Our purposes were (1) to determine whether amniotic fluid concentrations of tumor necrosis factor- are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of congenital sepsis in patients with preterm labor and intact membranes and (2) to compare the diagnostic performance of placental histologic finding and amniotic fluid culture with that of amniotic fluid tumor necrosis factor- for this outcome variable. METHODS: The relations among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid tumor necrosis factor- concentrations were examined in 61 consecutive patients with preterm labor and intact membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Tumor necrosis factor- was determined by enzyme-linked immunosorbent assays. Mann-Whitney U test, Fisher's exact test, receiver-operator characteristic curve, and multiple logistic regression were used for analysis. RESULTS: 1) Women with acute histologic chorioamnionitis had significantly higher median amniotic fluid tumor necrosis factor- concentrations than those without histologic chorioamnionitis (median 83.2 pg/ml, range 1.4 to 7241 pg/ml vs median 1.6 pg/ml, range 0 to 59.9 pg/ml, p <0.0001). Amniotic fluid tumor necrosis factor- concentrations > or =4.6 pg/ml had a sensitivity of 88% (28/32) and specificity of 80% (23/29) in the diagnosis of acute histologic chorioamnionitis. 2) Amniotic fluid concentrations of tumor necrosis factor- were significantly higher in neonates with congenital sepsis than in those without congenital sepsis (median 227.5 pg/ml, range 1.2 to 7241 pg/ml vs median 3.8 pg/ml, range 0 to 735 pg/ml, p <0.0005). Amniotic fluid tumor necrosis factor- concentrations > or =41 pg/ml had a sensitivity of 82% (23/29) and specificity of 79% (38/48) in the prediction of congenital sepsis. 3) Multiple logistic regression indicated that elevated amniotic fluid tumor necrosis factor- (> or =41 pg/ml) was the only independent predictor of congenital sepsis (odd ratio 12.9, 95% confidence interval 1.3 to 125.3, p<0.05) after correction for known confounding variables [i.e., low gestational age at birth (< or =32 weeks), positive amniotic fluid culture, histologic or clinical chorioamnionitis, low Apgar score (<7)]. CONCLUSION: Test of amniotic fluid tumor necrosis factor- is of value in the antenatal diagnosis of histologic chorioamnionitis and congenital sepsis in patients with preterm labor and intact membranes. Amniotic fluid tumor necrosis factor- is a better independent predictor of congenital sepsis than placental histologic finding or amniotic fluid culture.
Amniocentesis ; Amniotic Fluid* ; Apgar Score ; Chorioamnionitis* ; Confounding Factors (Epidemiology) ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Logistic Models ; Membranes ; Necrosis* ; Obstetric Labor, Premature* ; Parturition ; Placenta ; Pregnancy ; Prenatal Diagnosis ; Sensitivity and Specificity ; Sepsis*

PURPOSE: Endothelial dysfunction is an event in the atherosclerotic process usually considered reversible at its early stage. Early detection, therefor, may improve the prognosis in the cardiovascular disease. The aim of this study was to investigate the vascular function in hemodialysis (HD) patients and to explore its relation to other various parameters with a specific emphasis on systemic inflammatory reaction (SIR), nutritional status and the presence of ischemic heart disease (IHD). METHODS: Flow-mediated endothelium-dependent vasodilatation (FMD) was measured, using Doppler sonogram, in 37 stable HD patients, 11 healthy people and 24 hypertensive controls. Nitroglycerine- induced endothelium-independent vasodilatation (EIV) and peak reaction time (PT) of each FMD and EIV were also measured. RESULTS: FMD in HD patients was decreased compared to healthy group whereas it was comparable in HD patients and hypertensive control. EIV in HD patients was significantly decreased compared to healthy and hypertensive controls. PT of each FMD and EIV was significantly delayed in HD patients. Each FMD and EIV showed a negative correlation with serum hsCRP level, but no significant correlations of FMD with other parameters were noted. Both FMD and EIV were further decreased in HD patients with IHD than non-IHD group. CONCLUSION: Our study confirmed a characteristic pattern of vascular dysfunction in HD patients: the impaired endothelial and smooth muscle function with a delayed reaction time. Importantly, SIR was one of the important factors determining vascular dysfunction in HD patients. Further studies will be necessary to define the causative role of SIR on endothelial dysfunction and the effect of inflammation- modulating therapy.
C-Reactive Protein ; Cardiovascular Diseases ; Humans ; Inflammation ; Muscle, Smooth ; Myocardial Ischemia ; Nutritional Status ; Prognosis ; Reaction Time ; Renal Dialysis ; Vasodilation