OBJECTIVE: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. METHODS: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. RESULTS: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. CONCLUSION: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.
Body Mass Index* ; Cesarean Section* ; Emergencies* ; Female ; Humans ; Hypertension ; Institute of Medicine (U.S.)* ; Odds Ratio ; Overweight ; Parturition ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Retrospective Studies ; Weight Gain*

Hypoxia-ischemia leads to serious neuronal damage in some brain regions and is a strong risk factor for stroke. The aim of this study was to investigate the neuroprotective effect of tanshinone I (TsI) derived from Danshen (Radix Salvia miltiorrhiza root extract) against neuronal damage using a mouse model of cerebral hypoxia-ischemia. Brain infarction and neuronal damage were examined using 2,3,5-triphenyltetrazolium chloride (TTC) staining, hematoxylin and eosin histochemistry, and Fluoro-Jade B histofluorescence. Pre-treatment with TsI (10 mg/kg) was associated with a significant reduction in infarct volume 1 day after hypoxia-ischemia was induced. In addition, TsI protected against hypoxia-ischemia-induced neuronal death in the ipsilateral region. Our present findings suggest that TsI has strong potential for neuroprotection against hypoxic-ischemic damage. These results may be used in research into new anti-stroke medications.
Animals ; Brain ; Brain Infarction ; Diterpenes, Abietane ; Drugs, Chinese Herbal ; Eosine Yellowish-(YS) ; Fluoresceins ; Hematoxylin ; Hypoxia-Ischemia, Brain ; Mice ; Neurons ; Neuroprotective Agents ; Risk Factors ; Salvia miltiorrhiza ; Stroke ; Tetrazolium Salts

An umbilical vein aneurysm is rare, but appears to be associated with fetal morbidity and mortality. There are no specific guidelines for pregnancy with umbilical vein aneurysm and the management is substantially up to the clinician. We report a case of intra-amniotic umbilical vein aneurysm diagnosed at 35 gestational weeks by ultrasound. Because the aneurysm was growing rapidly, prompt cesarean delivery was conducted. After delivery, a huge fusiform umbilical cord was noted, which was confirmed to be umbilical vein aneurysm by pathological examination. We also reviewed previous reported cases and summarized the management strategies of prenatally detected umbilical vein aneurysms. In addition, the umbilical vein in this case report had the largest size ever reported.
Aneurysm* ; Karyotyping ; Mortality ; Pregnancy ; Ultrasonography ; Umbilical Cord ; Umbilical Veins* ; Varicose Veins

Tissue genotyping is more useful approach than using blood genomic DNA, which can reflect the effects of the somatic mutations in cancer. Although polymorphisms in glutathione S-transferase (GST) have been associated with the risk of bladder cancer (BC) development, few reports provide information about the prognosis of BC. We investigated glutathione S-transferase mu (GSTM1) and glutathione S-transferase theta (GSTT1) genotypes using genomic DNA from primary 165 BC tissue samples to assess the association with disease prognosis. DNA samples from tumor were analyzed by multiplex polymerase chain reaction (PCR). The results were compared with clinicopathological parameters. The prognostic significance of the GSTs was evaluated by Kaplan-Meier and multivariate Cox regression model. Kaplan-Meier estimates revealed significant differences in time to tumor recurrence according to the GSTM1 tissue genotype (P = 0.038) in non-muscle invasive bladder cancer (NMIBC). Multivariate Cox regression analysis also revealed that the tissue GSTM1 genotype (hazards ratio [HR]: 0.377, P = 0.031) was an independent predictor of bladder tumor recurrence in NMIBC. This identification of GSTM1 tissue genotype as a prognosticator for determining recurrence in NMIBC should prove highly useful in a clinical setting.
Aged ; *Genotype ; Glutathione Transferase/*genetics ; Humans ; Isoenzymes/*genetics ; Kaplan-Meier Estimate ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Recurrence ; Tumor Markers, Biological/metabolism ; Urinary Bladder Neoplasms/diagnosis/*genetics/pathology/*prevention & control

Estrogens are commonly used in gynecologic area, such as oral contraception, hormone replacement therapy, and in vitro fertilization-embryo transfer. Although estrogen is a common cause of acute drug-induced pancreatitis, there has been paucity of report in Korea. Clinical course of estrogen-induced acute pancreatitis is usually mild to moderate, but fetal case can occur. In addition, there can be a latency from the first administration to the symptom. Therefore, physicians should consider the possibility of the disease when a woman taking estrogen or previous history of taking estrogen presents with acute abdominal pain. Here, we report a case of estrogen-induced acute pancreatitis that occurred during the preparation for embryo transfer.
Abdominal Pain ; Contraception ; Embryo Transfer ; Estrogens ; Female ; Hormone Replacement Therapy ; Humans ; In Vitro Techniques ; Korea ; Pancreatitis*

Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.
Cyanoacrylates/therapeutic use ; Duodenal Diseases/diagnosis/etiology/*therapy ; Duodenum/*blood supply ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; Male ; Middle Aged ; Portal Vein ; Rupture ; Sclerosing Solutions/therapeutic use ; *Sclerotherapy ; Tomography, X-Ray Computed ; Varicose Veins/complications/*therapy

OBJECTIVE: Authors investigated magnetic resonance imaging (MRI) and histological characteristics of photothrombotic infraction rat model (PIRM) on long term basis to provide a basis for further research. METHOD: Photothrombotic ischemia was induced in male Sprague-Dawley rats using Rose-bengal dye (20 mg/kg) and cold light. MRI was performed 1, 6, 12, 24 hours, 3, 7 days, 2, 3, 4, 6, and 8 weeks after photothrombosis and obtained T1- & T2-weighted and contrast-enhanced images. Also, T2* images were obtained after superparamagnetic iron oxide injection. After MRI, animals were sacrificed and the brain sections were stained for routine immunohistopathology. RESULTS: MRI and histological analysis revealed well induced lesion in the cortex and showed biological course of infarction. However, PIRM showed rapid development of infarction lacking collateral circulation. Infarction size reached maximum 12 hours after induction, progressively decreasing over 4 weeks. Interstitial and cytotoxic edema were evident at 6, 12, 24 hours, but decreasing afterwards. Neurogenic inflammation appeared on 3rd day and reached maximum on 5~7th day. Arachnoid membrane was characteristically invaded with inflammatory cells and later thickened with fibrosis. CONCLUSION: This study showed PIRM is ideal model to study subacute and chronic stages of cerebral infarction.
Animals ; Arachnoid ; Brain ; Cerebral Infarction* ; Collateral Circulation ; Edema ; Fibrosis ; Humans ; Infarction ; Iron ; Ischemia ; Magnetic Resonance Imaging* ; Male ; Membranes ; Models, Animal ; Neurogenic Inflammation ; Rats, Sprague-Dawley ; Thrombosis*

Longitudinal standards for height and height velocity are essential to monitor for appropriate linear growth. We aimed to construct standards in Korean children and adolescents through the population-based longitudinal Kangwha study. Our study was a part of a community-based prospective cohort study from 1986 to 1999 with 800 school children. Height and height velocity were recorded annually from age 6 until final height. Results were compared with cross-sectional data from the 2007 Korean National Growth Charts. Final height was 173.5 cm in boys and 160.5 cm in girls. Although final height was similar between longitudinal and cross-sectional standards, the mean height for age was higher in the longitudinal standard by 1-4 cm from age 6 until the completion of puberty. Using the longitudinal standard, age at peak height velocity (PHV) was 12 in boys and 10 in girls; height velocity at PHV was 8.62 cm/yr in boys and 7.07 cm/yr in girls. The mean height velocity was less than 1 cm/yr at age 17 in boys and 15 in girls. Thus, we have presented the first report of longitudinal standards for height and height velocity in Korean children and adolescents by analyzing longitudinal data from the Kangwha cohort.
Adolescent ; Asian Continental Ancestry Group ; *Body Height ; Child ; Cohort Studies ; Cross-Sectional Studies ; Female ; *Growth Charts ; Humans ; Longitudinal Studies ; Male ; Prospective Studies ; Republic of Korea ; Young Adult

We found an title error in our published article.

PURPOSE: The aim of this study was to evaluate serum and urinary nephrin levels of normal pregnancy to establish a standard reference value and to compare them with patients who subsequently developed preeclampsia (PE). MATERIALS AND METHODS: In this prospective study, 117 healthy singleton pregnancies were enrolled between 6 to 20 weeks of gestation at 2 participating medical centers during October 2010 to March 2012. Urine and serum samples were collected at the time of enrollment, each trimester, and at 4 to 6 weeks postpartum. Enzyme-linked immunosorbent assay for nephrin was performed and samples from patients who subsequently developed PE were compared to the normal patients. RESULTS: Of 117 patients initially enrolled, 99 patients delivered at the study centers and of those patients, 12 (12.1%) developed PE at a median gestational age of 34⁺⁴ weeks (range 29⁺⁵–36⁺⁶). In the normal patients (n=68), serum nephrin level decreased and urinary nephrin level increased during the latter of pregnancy. In 12 patients who subsequently developed PE, a significant rise in the 3rd trimester serum and urinary nephrin levels, compared to the controls, was observed (p<0.001), and this increase occurred 9 days prior to the onset of clinical disease. CONCLUSION: As the onset of PE was preceded by the rise in the serum and urinary nephrin in comparison to normal pregnancy, serum and urinary nephrin may be a useful predictive marker of PE.
Enzyme-Linked Immunosorbent Assay ; Gestational Age ; Humans ; Postpartum Period ; Pre-Eclampsia* ; Pregnancy* ; Prospective Studies ; Reference Values