OBJECTIVE: In a pregnant rabbit model using hysteroscopy-guided inoculation of E. coli, we investigated pregnancy outcome according to elapsing time with immediate antibiotic treatment after E. coli inoculation, and in turn determined which of the maintenance of pregnancy with antibiotic and tocolytic administration or prompt delivery in the management of preterm labor complicated with intrauterine infection offered the improvement of pregnancy outcome. METHODS: Timed-pregnant rabbits underwent hysteroscopy at 20-21 days of gestation(70%). Animals were inoculated with either E. coli(0.2 ml containing 10' cfu/ml) or saline, and administered ampicillin-sulbactam(100 mg/kg/day; Unasyn; Pfizer) in divided doses every 8 hours beginning 30 minutes after microbial inoculation until euthanasia with one of the following; 3 days(n 10), 5 days(n 8), or 7 days(n-8) after hysteroscopy. In the first study, which performed in animals with inoculation of E. coli, pregnancy outcome including fetal survival rate and results of microbial studies and placental pathology were compared among three groups. In second study, which performed in animals with inoculation with saline, pregnancy outcome were compared among three groups for the purpose of elucidating effects of antibiotic administration during inoculation-to-euthanasia interval on pregnancy outcome. RESULTS: Of rabbits inoculated with E. coli and receiving antibiotics immediately, the rate of fetal survival and positive intrauterine cultures in total and live fetuses decreased significantly, and the rate of placental inflammation in total and live fetuses increased significantly with time from intracervical inoculation with E. coli to euthanasia(p<0.05, respectively). Of rabbits inoculated with saline and receiving antibiotics immediately, the rates of fetal survival, positive intrauterine cultures in total and live fetuses, and placental inflammation in total and live fetuses have no difference with time from intracervical inoculation with saline to euthanasia. CONCLUSION: Fetal complications including fetal death could be induced in utero if persistent subclinical intrauterine infection was present in spite of earlier antibiotics administration initiated after inoculation of E, coli. Therefore, when treating with antibiotics in intrauterine infection, it is needed to observe and monitor the presence of persistent intrauterine infection, and if it is persistent, prompt delivery may be better than maintenance of pregnancy with antibiotic and tocolytic administration for the improvement of pregnancy outcome.
Animals ; Anti-Bacterial Agents* ; Euthanasia ; Female ; Fetal Death ; Fetus ; Hysteroscopy ; Inflammation ; Obstetric Labor, Premature ; Pathology ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Rabbits ; Survival Rate

BACKGROUND AND OBJECTIVES: beta-catenin has an essential role in intercellular adhesion and signal transduction. The Adenomatous poliposis coli (APC) protein interacts with beta-catenin in a multi-protein complex to regulate the level of expression of beta-catenin. Mutations in beta-catenin or APC gene can lead to the accumulation of beta-catenin in the cytosol and the nucleus. This study was designed to investigate the expression of APC and beta-catenin in laryngeal cancer. SUBJECTS AND METHOD: Immunohistochemical methods were used to determine the beta-catenin and APC protein expression in 15 laryngeal cancers. Results were correlated with clinicopathological parameters. RESULTS: beta-catenin expression to the plasma membrane was reduced or absent in 11 of 15 cases (73%) of the laryngeal cancers. Cytoplasmic expression of the beta-catenin was seen in 6 out of 15 cases (40%). APC immunoactivity was negative in 5 of 15 (33%) of the laryngeal cancers. One of the six cytoplasmic expressions of the beta-catenin was negative for APC immunoactivity, and one of the five negative for APC immunoactivity was cytoplasmic expression of the beta-catenin. CONCLUSION: There was no correlation between beta-catenin and APC protein in the analysis. This finding suggests that cytoplasmic expression of the beta-catenin resulted not from the APC mutation but from the beta-catenin mutation and abnormal Wnt signal. Only the expression of the beta-catenin in cytoplasm was associated with lymph node metastasis.
beta Catenin* ; Carcinoma, Squamous Cell* ; Cell Membrane ; Cytoplasm ; Cytosol ; Genes, APC ; Laryngeal Neoplasms* ; Lymph Nodes ; Neoplasm Metastasis ; Signal Transduction

No abstract available.
Brugada Syndrome* ; Bundle-Branch Block* ; Death, Sudden, Cardiac*

In cases of unstable cervical traumatic lesions, the biomechanical superiority of the cervical pedicle screw (CPS) allows the lesion to be stabilized effectively. In this study, we review and summarize the indications, technical guidelines, and potential neurovascular complications and their prevention of the use of the CPS for trauma. For patients with fractured lamina or lateral mass, a CPS is reliable for stabilization. In addition, the CPS can penetrate through a linear cervical spinal pedicle fracture gap and could stabilize three-column injury. CPS reduce the range of surgical approach and preserve the motion segment using short-segment fixation. Fluoroscopy-guided CPS insertion is popular and cost-effective. Image-guided navigation systems improve accuracy. Three-dimensional template-guided CPS placement is simple to use. Most spine surgeons can perform laminoforaminotomy easily. Freehand technique that can be performed quickly without heavy equipment is suitable for emergency situation. Possible complications due to screw misplacement are vertebral artery injury owing to a laterally misplaced screw, dural sac or spinal cord injury from a medially misplaced screw, and nerve root injury caused by a superiorly or inferiorly misplaced screw. To prevent neurovascular complications, meticulous preoperative anatomical evaluation and following the five steps are most important.

OBJECTIVE: Cystoscopy has been included as diagnostic procedure for pretreatment evaluation of cervical cancer by FIGO. However, its invasiveness brings up a question regarding the necessity of inclusion in staging work up of cervical cancer. We performed this study to evaluate the clinical implication of cystoscopy in cervical cancer staging. METHODS: 128 patients with invasive cervical cancer patients who were histologically diagnosed from Jan 1995 to Dec 1999 were retrospectively reviewed. Physical examination, computed tomography (CT), cystoscopy were performed in all patients. The distribution of FIGO stage was Ib 48.4%, II 35.2%, III 8.6%, and IV 7.8%. Bladder invasion was evaluated in CT and histopathologic examination was performed on cystoscopy when invasion was suspected. McNemar test was used to compare the finding in CT and cystoscopy for matched patients. P-value of 0.05 was regarded as statistically significant. RESULTS: Among seven patients whose bladder was suspected to be invaded by cervical cancer in CT scan, three patients had actual bladder invasion confirmed by cystoscopy (positive predictive rate = 42.9%). CT was statistically comparable to cystoscopy (P = 0.375, McNemar test; contingency coefficient = 0.481). CONCLUSION: Cystoscopy, which is an invasive procedure, may not be necessary and might be substituted by CT scan for pretreatment evaluation in some subset of cervical cancer patients.
Cystoscopy* ; Humans ; Physical Examination ; Retrospective Studies ; Tomography, X-Ray Computed ; Urinary Bladder ; Uterine Cervical Neoplasms*

OBJECTIVE: The objective of this study was to compare perinatal outcomes of pregnancy-induced hypertensive and normotensive women experiencing abruptio placentae, Our hypothesis is that pregnancy-induced hypertensive women have a less favorable perinatal outcome than do normotensive women. METHODS: Women with the diagnosis of abruptio placentae delivered between August 1, 1989 and December 1, 1996, composed the study group (n=92) in this case-control study. The women with abruptio placentae were divided according to their hypertensive (n=37) or normotensive (n=55) status. Maternal and neonatal medical records were reviewed and abstracted for demographic variables, antepartum complications, delivery route, abruptio placentae grade, neonatal gender, birth weight, Apgar score and perinatal mortality. We compared these perinatal outcome variables between the pregnancy-induced hypertensive and normotensive pregnant women. RESULTS: The incidence of abruptio placentae was 0.35%. The two groups of woman wne similar with regard to age and parity. Abruptio placentae grades 2 occurred more often in hypertensive women (P=0.0053). Pregnancy-inducedhypertensive women were similar to normotensive women with regard to antenatal complications. The mean gestational age of delivery, delivery route, neonatal weight and sex were similar between two groups of women. Neonates from pregnancy-induced hypertensive women were no more likely to have low 1 and 5-minute Apgar score or to die than those from normotensive women. Statistical analysis was performed with two-tailed independent t-test and Kruskal-Wallis analysis. CONCLUSION: Although pregnancy-induced hypertensive women experiencing abruptio placentae are more likely to have grade 2 abruptio placentae with fetal distress, the overall perinatal outcome was not significantly different from that of normotensive women experiencing abruptio placentae.
Abruptio Placentae ; Apgar Score ; Birth Weight ; Case-Control Studies ; Diagnosis ; Female ; Fetal Distress ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant, Newborn ; Medical Records ; Parity ; Perinatal Mortality ; Placenta* ; Pregnancy ; Pregnant Women*

BACKGROUND: In acute myocardial infarction, left ventricular remodeling, which was influenced by infarct size, location, and patency of infarct related artery(IRA), is a important prognostic factor for chronic heart failure and survival. Recently, several reports suggested that patent IRA does not always mean true myocardial reperfusion, and myocardial contrast echocardiography(MCE) may be a useful tool for assessing infarct size and viability of infarcted myocardium. So, we investigated the association between the degree of myocardial reperfusion assessed by MCE and long term change of left ventricular volume in acute anterior wall myocardial infarction patients who had patent IRA. METHODS: The study population was consisted of 17 patients with first acute anterior wall myocardial infarction patients who had patent left anterior descending artery by thrombolytic therapy or rescue PTCA. MCE was done immediately after coronary angiography within two weeks of myocardial infarction onset and analyzed by semiquantitative method to get opacification index. For analysis of left ventricular ejection fraction, wall motion abnormality and left ventricular volume, echocardiogram was taken within 2 weeks of myocardial infarction oneset and 9 months later in each case. Wall motion abnormality was quantified as wall motion index. According to serial changes of left ventricular volume, patients were divided into two groups ; group 1(less than 10% increase of LV volume at follow-up compared to intial echocardiographic exam) and group 2(more than 10% increase of left ventricular volume). We compared the opacification index of infarcted myocardium, wall motion abnormality, and ejection fraction between the two groups. RESULTS: Initial left ventricular volume and ejection fraction were not different between group 1 and group 2, but the opacification index was lower and initial wall motion index higher in group 2 than group 1. Opacification index, wall motion index, ejection fraction and left ventricular volume were closely correlated in the whole cases. By multivariate ananlysis, opacification index was the only significant factor predicting left ventricular volume increment. CONCLUSION: Myocardial reperfusion, which is closely correlated with ejection fraction and wall motion abnormality, acts as a independent predictor of left ventricular dilatation after acute anterior wall myocardial infarction. This result suggests that assessment of microvascular integrity with myocardial contrast echocardiography may be a valuable indicator to predict long-term change of left ventricular volume, although this is suggestive result in a limited number of patients.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Angiography ; Dilatation ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Myocardial Reperfusion* ; Myocardium ; Stroke Volume ; Thrombolytic Therapy ; Ventricular Remodeling

BACKGROUND AND OBJECTIVES: ovastatin, a HMG-CoA reductase inhibitor, is known to show antiproliferative effects on VSMC after vessel injury, but a large amount of the drug is needed orally for this purpose. This study investigated the effects of lovastatin given locally to injured carotid arteries of rats on reducing neointimal hyperplasia. MATERIALS AND METHOD: Lovastatin was given perivascularly to balloon-injured carotid arteries of 21 rats in 1 microM to the low-dose group, and 30 microM to the high-dose group. The control group was treated with pluronic gel only. Two weeks later, the lumen area, neointimal areas and the number of actively proliferating cells were obtained and compared. RESULTS: eointimal area was 0.113+/-0.032 mm2, 0.065+/-0.017 mm2, 0.072+/-0.017 mm2 in the control, low-dose and high-dose groups respectively. The area was significantly smaller in the treatment groups (p<0.05), but no significant difference was observed between the treatment groups. The number of actively proliferating cells per mm2 of neointimal area were 714.5+/-227.4, 688.4+/-333.7, and 1526.3+/-744.0 in the groups respectively, and the number was significantly high in the high-dose group (p<0.05). CONCLUSION: Local administration of lovastatin is effective in reducing neointimal hyperplasia after vascular injury, but extremely high doses are not needed locally for this purpose.
Animals ; Carotid Arteries* ; Carotid Artery Injuries* ; Hyperplasia* ; Lovastatin* ; Oxidoreductases ; Rats* ; Vascular System Injuries

BACKGROUND: Plasmid-mediated AmpC beta-lactamases (PABL) are cephalosporinases that confer resistance to a wide variety of beta-lactam drugs and that may thereby create serious therapeutic problems. The PABL-producing organisms are a major concern in nosocomial infections and should there-fore be monitored in surveillance studies. Although reported with increasing frequency in Korea, the occurrence and genotypic distributions of PABL in Escherichia coli and Klebsiella pneumoniae remain unknown. METHODS: We tested a total of 911 consecutive, nonduplicate isolates of E. coli and K. pneumoniae at 12 university hospitals and a commercial laboratory in Korea. Antimicrobial susceptibilities were tested using the disk diffusion method. PABL production was determined by the modified Hodge test and multiplex PCR. The PCR differentiated the six PABL-specific families in E. coli and K. pneumoniae. RESULTS: Overall, 110 (12.1%) yielded cefoxitin non-susceptible isolates and that 28 (3.1%) demonstrated PABL producers by multiplex PCR. Based on the species, of 544 E. coli and 367 K. pneumoniae isolates tested, 8 (1.5%) and 20 (5.4%), respectively, demonstrated PABL producers. The genotypes of PCR amplification showed that the MOX, DHA, and CIT family were harbored by 4, 2, and 2 of 8 PABL-producing E. coli, and the DHA, MOX, and EBC family were harbored by 13, 6, and 1 of 20 PABL-producing K. pneumoniae isolates, respectively. CONCLUSIONS: These data confirm that the occurrence of PABL-producing E. coli and K. pneumoniae is relatively high and the kinds of genotypes are variously distributed in Korea.
beta-Lactamases ; Cefoxitin ; Cross Infection ; Diffusion ; Escherichia coli* ; Escherichia* ; Genotype ; Hospitals, University ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Korea* ; Multiplex Polymerase Chain Reaction ; Pneumonia ; Polymerase Chain Reaction

Although narcotic analgesics are potent releasers of histamine, IgE-mediated allergic reactions to these drugs are rare. Here we report the case of a 56-year-old male who suffered from chronic urticarial and analgesics-induced skin rashes. He visited our allergy clinic to determine alternative analgesics before undergoing surgery. A drug provocation test showed a positive reaction to aspirin, but negative reactions to acetaminophen and celecoxib. Despite careful attention to his drug regimen, during surgery he developed generalized urticaria and flushing. Skin tests of allergy to latex, lidocaine, propofol, rocuronium, flomoxef, meperidine, palonosetron, pyridostigmine, and fentanyl yielded negative results, except for the prick and intradermal tests with meperidine. Thus, this patient had both an aspirin/non-steroidal anti-inflammatory drugs idiosyncrasy and an IgE-mediated hypersensitivity to meperidine.
Acetaminophen ; Analgesics ; Aspirin* ; Exanthema ; Fentanyl ; Flushing ; Histamine ; Humans ; Hypersensitivity* ; Hypersensitivity, Immediate ; Intradermal Tests ; Latex ; Lidocaine ; Male ; Meperidine* ; Middle Aged ; Narcotics ; Propofol ; Pyridostigmine Bromide ; Skin Tests ; Urticaria ; Celecoxib