OBJECTIVE: To evaluate the perinatal prognosis of fetuses with a single umbilical artery. METHODS: From 1992 to 1998, nineteen cases with single umbilical artery(SUA) was observed in 8,704 deliveries at Chonnam University Hospital. RESULTS: Out of nineteen fetuses, thirteen fetuses with single umbilical artery were detected by antenatal ultrasonographic examination and six fetuses were detected after birth. The male to female ratio was 0.9: 1. Congenital malformations were observed in 8 babies(42.1%) and included leg deformity, esophageal atresia, imperforated anus, ventriculomegaly, meningocele, hydronephrosis, ventricular septal defect, joint contracture, cleft lip and palate, toe anomaly, imperforated anus, kyphosis, no urethra and testis, clubfoot, patent ductus arteriosus and rnild mitral regurgitation. Among 10 cases of karyotyping analysis three cases were diagnosed as trisomy 18. Fourteen fetuses(77.8%) showed growth restriction at delivery. Antenatal obstetric complications were hydramnios(n = 3), oligohydramnios(n =2), and severe preeclampsia(n = 3). CONCLUSION: Careful ultrasonographic evaluation for the identification of a SUA is necessary because of its frequent association with congenital anomaly, growth restriction and cytogenetic abnormality.
Anal Canal ; Chromosome Aberrations ; Cleft Lip ; Clubfoot ; Congenital Abnormalities ; Contracture ; Ductus Arteriosus, Patent ; Esophageal Atresia ; Female ; Fetus ; Heart Septal Defects, Ventricular ; Humans ; Hydronephrosis ; Jeollanam-do ; Joints ; Karyotyping ; Kyphosis ; Leg ; Male ; Meningocele ; Mitral Valve Insufficiency ; Palate ; Parturition ; Prognosis* ; Single Umbilical Artery* ; Testis ; Toes ; Trisomy ; Urethra

Halothane, in common use today, sensitizes the myocardium to endogenous and exogenous sympathomimetic amines arid induces cardiac arrhythmia, sometimes life threatening. Sympatbomimetic amines, however, are frequently injected subcutaneously for hemostasis or intravenously far cardiovascular stability. Therefore, this study was performed to investigate the effect of lidocaine 1 mg/kg, pro-pranolol 0.02 mg/kg, and droperidol 0.1 mg/kg pretreatment on arrhythmias(A.R.) and changes in heart ramie(H.R.), systolic bood pressure(T.B.P ) and diastolic blood pressure (D.B.P.) Induced by lV administered ephedrine 0.2 mg/kg. Patients were divided into 5 groups: 20 cases without pretreatment(Group l ), 10 cases with lidocaine prtreatment(Group ll), 10 cases with propranolol pretreatment(Group lll), 20 eases with lidocaine-propranolol pretreatment(Group lV) and 20 cases with droperidol pretreatment(Group V ). The results were as follows: 1) In Group l, ephedrine produced A.R. in 16 cases(80%) and significant increase in H.R.(d~11 bpm, p<0.001) and S.B.P. (8~22 torr, p<0.001), but D.B.P. increased insignif-icantly(2~10 torr, NS). 2) In Group ll, ephedrine produced A.R. in 5 cases(57%) and 5.B.p.(10~17 terr, p<0, 01) increased significantly, but H.R. remained unaltered. 3) In Group lll, ephedrine produced A.R. in 3 cases(30%) and H.R. (6~8 bpm, p<0.05) decreased, but S.B.P.(12~21 torr, p<0.01) and D.B.P (8~16 torr, p<0.01) increased signi-ficantle. 4) In Group lV, ephedrine produced A.R. in 2 cases(10.%) and H.R.(3~6 bpm, p<0.05) decreased, but S.B.P (4~11 torr, p<0.05) and D.B.P.(3~9 torr, p<0.01) increased signific-antly. 5) In Group V. ephedrine produced A.R. in 2 cases(10%) and H.R.(9~13 bum, p<0.001) increased siginificantly, but S.B.P. and D.B.P. remained unaltered. From the above results, it is concluded that lidocaine and propranolol mixture or droperidol protects most effectively against ventricular arrhythmias induced by ephedrine during halothane-N2O anesthesia in human volunteers.
Amines ; Anesthesia* ; Arrhythmias, Cardiac* ; Blood Pressure ; Droperidol* ; Ephedrine* ; Halothane ; Healthy Volunteers ; Heart ; Hemostasis ; Humans ; Lidocaine* ; Myocardium ; Propranolol* ; Sympathomimetics

PURPOSE:The aim of this study was to compare the perinatal outcome of preterm infants born to severe pregnancy induced hypertension (PIH) mothers according to the presence or absence of HELLP syndrome. METHODS:A retrospective analysis was done in 314 premature live infants born to 302 severe PIH mothers who admitted at Chonnam National University Hospital from January 2002 to May 2008. Maternal and neonatal characteristics and their outcome were compared between the groups. Statistical analysis was performed by SPSS program using Student's t test, Chi-square analysis, Fisher's exact test, and logistic regression test. RESULTS:Among 302 severe PIH mothers (single pregnancy 270, twin pregnancy 32), 84 (27.8%) were associated with HELLP syndrome. Among their 334 fetuses (singleton 270, twins 64), total 20 (6.0%) resulted in fetal death and the rate of fetal death was higher in HELLP syndrome group compared to the control group (12.2% vs. 3.4%, P=0.006). Among the 314 live premature infants, 86 (27.4%) were born to severe PIH with HELLP syndrome (study group) and 228 (72.6%) were born to the control group. There were no differences in maternal and neonatal characteristics, maternal death, neonatal morbidity and neonatal death between the groups. However, the duration of mechanical ventilation (12.2+/-14.5 vs. 7.6+/-9.9 days, P=0.019) and hospitalization (25.6+/-12.3 vs. 13.0+/-10.5 days, P=0.013) were longer in the study group. CONCLUSION:Most of severe PIH mothers complicated by preterm birth, and especially combined with HELLP syndrome showed higher fetal and perinatal death than without HELLP syndrome. Moreover, their live-born premature infants needed longer duration of mechanical ventilation and hospitalization. These results indicate that careful fetal monitoring and delivery with the co-operations of obstetricians and neonatologists is essential to improve the perinatal outcome.
Female ; Fetal Death ; Fetal Monitoring ; Fetus ; HELLP Syndrome ; Hospitalization ; Humans ; Hypertension, Pregnancy-Induced ; Infant ; Infant, Newborn ; Infant, Premature ; Logistic Models ; Maternal Death ; Mothers ; Pregnancy ; Pregnancy, Twin ; Premature Birth ; Respiration, Artificial ; Retrospective Studies ; Twins

In vitro fertilization (IVF) is a main option for the infertility treatment and its major concerns are the risk of multiple pregnancy, preterm delivery, intrauterine growth retardation (IUGR), and congenital malformation. Russell-Silver syndrome (RS) is a congenital disorder characterized by intrauterine and postnatal growth retardation associated with inverted triangular face, clinodactyly, and asymmetry of the body. The possibility of genomic imprinting defect has been suggested because the risk of RS syndrome is increased after IVF like other imprinting defect disorders such as Angelman or Beckwith-Wiedemann syndrome, and the major epigenetic disturbance of RS syndrome is the hypomethylation of the imprinting in 11p15. We report three cases of RS syndrome in one of IVF twins with a review of the literature.
Beckwith-Wiedemann Syndrome ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Epigenomics ; Female ; Fertilization in Vitro ; Fetal Growth Retardation ; Genomic Imprinting ; Humans ; Infertility ; Pregnancy ; Pregnancy, Multiple ; Silver-Russell Syndrome ; Twins

Penetrating trauma in a fetus is uncommon but may cause potentially life-threatening injuries. We experienced a case of preterm infant who delivered by C-section and showed two deep laceration wounds on face, facial nerve palsy, skull fracture and intracranial hemorrhage due to penetrating injury of an abdominal stab wound in a 31 weeks pregnant woman.
Craniocerebral Trauma ; Facial Nerve ; Female ; Fetus ; Head ; Humans ; Infant, Newborn ; Infant, Premature ; Intracranial Hemorrhages ; Lacerations ; Paralysis ; Pregnant Women ; Skull Fractures ; Wounds, Stab

Prematurity and low birth weight are major factors associated with neonatal morbidity and mortality, and their incidence is not decreasing despite an annual decrease in the total number of live births in Korea. The objective of this study was to establish a strategy to reduce neonatal mortality by analyzing the clinical characteristics of high-risk infant births along with their mortality and causes of death. We retrospectively surveyed the medical records of infants born at Chonnam National University Hospital and of patients admitted to the neonatal intensive care unit (NICU) for 10 years from October 1999 to December 2008. Premature and low birth weight infants were almost half of the live births, and their NICU admission rate increased with increases in the numbers of outborns and multiples. Also, their mortality decreased dramatically over the past 10 years. About 60% of deaths occurred within 1 week of life, and the causes of death were mostly related to prematurity. Perinatal asphyxia was the major cause of death in infants less than 1 week old, whereas sepsis was the major cause after 4 weeks of age. The major cause of death was sepsis in premature or low birth weight infants and perinatal asphyxia in term or normal weight infants. The major cause of death was sepsis in inborns and perinatal asphyxia in outborns. Our results suggest that medical personnel training for immediate postnatal care including neonatal resuscitation, infection control, and a systematic team approach to regionalization are all needed to reduce the mortality rate.
Asphyxia ; Cause of Death ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Low Birth Weight ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal ; Korea ; Live Birth ; Medical Records ; Parturition ; Postnatal Care ; Premature Birth ; Resuscitation ; Retrospective Studies ; Sepsis

Kasabach-Merritt syndrome is a rare thrombocytopenic consumptive coagulopathy associated with a giant hemangioma. We experienced a case of unexplained ascites with thrombocytopenia in a 32 week premature infant. An exploratory laparotomy was performed to determine the cause of the refractory ascites and thrombocytopenia. An intestinal hemangioma was found, but, surgical removal was not performed due to the extensive involvement. Hemangioma was confirmed by SPECT (single-photon emission computed tomography) and the thrombocytopenia was treated with steroid therapy. It is recommended that hemangioma of the visceral organs should be suspected when unexplained thrombocytopenia and disseminated intravascular coagulopathy persist.
Ascites ; Hemangioma ; Humans ; Infant, Newborn ; Infant, Premature ; Kasabach-Merritt Syndrome ; Laparotomy ; Thrombocytopenia ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Recently, the number of late preterm infants are increasing, and they are prone to have many clinical problems. The purpose of this study is to emphasize the importance of perinatal care for the late preterm infants and their mothers. METHODS: Total admitted numbers of late preterm infants were 547 (from 464 mothers) and of term infants were 1,514 (from 1,470 mothers) in NICU, at Chonnam National University Hospital January 2014~December 2015. Maternal and neonatal mortality rate were calculated in the total admitted numbers. Exclusion criteria were death or transfer during admission, congenital anomaly, and etc. The enrolled numbers of late preterm infants were 493 (from 418 mothers) and of term infants were 1,167 (from 1,123 mothers). Retrospective chart review was conducted. In mothers, demographics, underlying illness, and obstetric complication, and in newborns, demographics, hospital days and morbidity were compared between late preterm group and term group. RESULTS: Maternal mortality rate was not different. However, neonatal mortality rate was higher in late preterm infants. In mothers of late preterm group, there was no difference in demographic characteristics, but the rates of autoimmune disease and obstetric complication were higher. In infants of late preterm group, body size was smaller, artificial conception and C-section rate were higher, and one and five-minute Apgar scores were lower, and hospital duration was longer. And the incidence of respiratory distress, transient tachypena of newborn, intraventricular hemorrhage and metabolic abnormalities were higher, but the incidence of meconium aspiration syndrome was lower compare to the term infant group. CONCLUSIONS: Maternal mortality was not different. However, neonatal mortality was higher in late preterm infants. In late preterm group, the mothers had higher rate of autoimmune disease and obstetric complication, and the infants had higher morbidity compare to the term group. When the obstetrician decides on delivery time in high risk pregnancy, maternal medical condition and neonatal outcome should be considered.
Autoimmune Diseases ; Body Size ; Demography ; Fertilization ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; Jeollanam-do ; Maternal Mortality ; Meconium Aspiration Syndrome ; Mortality ; Mothers ; Perinatal Care ; Pregnancy, High-Risk ; Premature Birth ; Retrospective Studies

Brain metastasis from primary uterine cervical carcinoma have been described but are extremely rare and usually occur in the presence of widely disseminated diseases. The authors report a case of solitary cerebellar metastasis from uterine cervical carcinoma, which was confirmed by histopathological examination. The patient has shown no evidence of metastatic lesions elsewhere, thus far, but had undergone a radical hysterectomy under the diagnosis of uterine cervical carcinoma 52 months prior to the surgical excision of the cerebellar metastasis.
Brain ; Diagnosis ; Humans ; Hysterectomy ; Neoplasm Metastasis*

BACKGROUND: Hemodynamic derangement during off-pump coronary artery bypass surgery (OPCAB) is mainly attributed to impaired filling and diastolic dysfunction. An elevated ratio of the mitral velocity to the early-diastolic velocity of the mitral annulus (E/e' > 15) is a relatively new indicator of diastolic function, and this was reported to be associated with impaired hemodynamics during OPCAB. We investigated the efficacy of milrinone on the perioperative hemodynamics and short term outcomes of patients with an E/e' > 15 and who underwent OPCAB. METHODS: The patients were randomly allocated into either group C (control, n = 31) or group M (n = 31) and they were treated with the same amount of either normal saline or milrinone (0.5 microg/kg/min) without bolus loading after completion of internal mammary artery harvest until the end of operation. Hemodynamic measurements were recorded after the induction of anesthesia (T1), 5 min after starting each distal anastomosis of the left anterior descending artery (T2), left circumflex artery (T3) and right coronary artery (T4), and 5 min after sternum closure (T5). RESULTS: The mixed venous oxygen saturation (SvO2) was lower through T2-T4 compared to the baseline value in both groups, while the degree of the decrease was significantly less in group M than that in group C. The other hemodynamic variables, the operative data and the postoperative outcomes were similar between the two groups. CONCLUSIONS: Intraoperative infusion of milrinone did not significantly improve the perioperative hemodynamics and the subsequent short term outcomes for the patients with preexisting diastolic dysfunction as represented by an elevated E/e' value, although it reduced the degree of decrease of the SvO2 during OPCAB.
Anesthesia ; Arteries ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Hemodynamics ; Humans ; Mammary Arteries ; Milrinone ; Oxygen ; Sternum