OBJECTIVE: The objective of this study is to compare the effectiveness and safety in the labor induction between the high dose oxytocin method and the new low dose oxytocin method. STUDY DESIGN: Firstly, we selected 125 pregnant women hospitalized, having the indication of labor induction from March, 1995 to August, 1996. Of them, we selected 61 pregnant women tothem the high dose oxytocin method was used, as the control group, and in- creased the quantity of 2.5 mU/min every 20 minutes with the start dose of 2.5 mU/min to them. On the other hand, with the start dose of 1.25 mU/min, we increased the quantity of 1.25 mU/min every 20 minutes to the study group of low dose oxytocin method, 64 pregnant women. RESULTS: No statistical significance was found in the time from the effective uterine contraction to the delivery in the study group, in contrast to that of the control group to them the labor induction was conducted by using the high dose oxytocin. Maximum amount used to the high dose oxytocin was significantly more than that of the low dose oxytacin, but in the total given dose, there was no significant difference between two groups. Maxi- mum uterine contraction of the control group did not show any significant. difference from that of the study group, and there was also no significant difference in the frequency of generating the complications such as fetal distress. CONCLUSION: There was no difference in the labor.induction -to delivery time, and the complications of fetus, between the existing high dose oxytocin method and the new low dose oxytocin method. Therefore it is thought the low dose oxytocin method may reduce the possibility of a complieation compared with the high dose oxytocin method. However, it is considered this matter must be investigated further in the futrre.
Female ; Fetal Distress ; Fetus ; Hand ; Humans ; Oxytocin* ; Pregnant Women ; Uterine Contraction

No abstract available.
Stroke Volume*

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.
Anesthesia, Spinal ; Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Interviews as Topic ; Length of Stay ; Pain, Postoperative ; Prolapse ; Surveys and Questionnaires ; Urinary Retention ; Wounds and Injuries

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.
Anesthesia, Spinal ; Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Interviews as Topic ; Length of Stay ; Pain, Postoperative ; Prolapse ; Surveys and Questionnaires ; Urinary Retention ; Wounds and Injuries

Cushings syndrome in pregnancy is rare. This is explained by the syndromes association with amencerhea, infertility and abortions. Matemal and fetal risks increase markedly when pregnancy does occur in woman with hypercortisolism. Since pregnant women without Cushings syndrome develop some features of Cushings syndrome, such as hypertension, hyperglycemia and striae, a high index of clinical suspician must be maintained to prevent delay in diagnosis. The physiologic changes in adrenocorticostemid metabolism during pregnancy further complieate the diagnosis. We describe a case of Cushings syndmme in pregnancy secondary to an adrenal cortical adenoma which was diagnosed immediately after a preterm delivery in 24-year-old woman with preeclampsia.
Adenoma* ; Adrenocortical Adenoma ; Cushing Syndrome* ; Diagnosis ; Female ; Humans ; Hyperglycemia ; Hypertension ; Infertility ; Metabolism ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women ; Young Adult

BACKGROUND: Diabetic ketoacidosis (DKA) is usually thought of as a condition of young, insulin-requiring diabetic patients. The clinical characteristics of older adults with DKA have not been well characterized. To characterize the elderly patients with DKA, we described how DKA in the elderly differs from that in the young adults. METHODS: We analyzed the clinical data of 112 patients who were diagnosed DKA for the first time from July, 1987 to June, 1997 at Hallym Univ. Sacred Heart Hospitals. We divided our patients into 3 groups according to the age at the first DKA and compared the clinical characteristics of DKA patients aged 65 or over with those of under 30 of age. RESULTS: Forty-four patients were under 30 of age and 8 patients were 65 or over of age. The duration of DM prior to DKA was 11.9+/-3.0 years in the elderly gouty and 1.6+/-0.4 years in the young group, and the debut DKA's were 12.5% and 47.7%, respectively. The elderly patients were less likely to have been using insulin before DKA (12.5% vs. 74%). The most frequent precipitating factor of DKA was 'infection' in the elderly group (50%) and 'unidentifiable' in the young group (46%). The elderly group showed the higher arterial pH (7.22+/-0.03 vs. 7.09+/-0.02), bicarbonate (10.9+/-1.5 vs. 5.1+/-0.7 mEq/L), and serum fasting C-peptide (0.37+/-0.08 vs. 0.19+/-0.04 nmol/L) levels, and the higher mortality rate (25% vs. 2.3%) compared with the young group. CONCLUSION: The elderly patients with DKA showed the longer duration of DM and less debut DKA's, the less previous history of insulin-treatment, the higher proportion of infection as precipitating (actors, the higher arterial pH, bicarbonate, and serum fasting C-peptide levels, and the higher mortality rate compared with the young patients with DKA.
Adult ; Aged* ; C-Peptide ; Diabetes Mellitus ; Diabetic Ketoacidosis* ; Fasting ; Heart ; Humans ; Hydrogen-Ion Concentration ; Insulin ; Mortality ; Precipitating Factors ; Young Adult

PURPOSE: The aim of this study was to examine the effects of silk fibroin film on wound healing of cutaneous burn in hairless mice by using microscopic findings and stem cell markers (nestin, cytokeratin 15) and ki-67 proliferation marker. METHODS: Each mouse received two burns at the dorsal area by applying a metal rod heated with boiling water. Burn wound sites were dressed with Silk Fibroin Film and duoderm (SF group), Aquacel hydrofiber and duoderm (AC group) and duoderm only (Control group). All groups were covered externally with duodermas adhesive bands. Those mice were sacrificed at zero, two, seven, fourteen and twenty one days after burn. Histological findings and immunohistochemical staining for stem cell markers were observed. RESULTS: In SF group, inflammatory cell infiltration, formation of granulation tissue and inflammatory foci are greater than in AC and control group. Those factors appear to enhance mesenchymal stem cell markers such as nestin. Finally mesenchymal tissue regeneration was enhanced. In addition, the length of ki-67 expressed re-generating epithelium, which appeared to be associated with epithelial regeneration, was the longest in SF group. CONCLUSION: The results show that the wound healing effect of SF is the best among other treatment materials including AC in the experimental group and duoderm in the control group through mesenchymal regeneration and epithelial regeneration which are essential factors for wound healing.
Adhesives ; Animals ; Bandages, Hydrocolloid ; Burns ; Carboxymethylcellulose Sodium ; Epithelium ; Fibroins ; Granulation Tissue ; Hot Temperature ; Intermediate Filament Proteins ; Keratins ; Mesenchymal Stromal Cells ; Mice ; Mice, Hairless ; Nerve Tissue Proteins ; Regeneration ; Silk ; Stem Cells ; Water ; Wound Healing

OBJECTIVE: To evaluate the increased value of using coronal reformation of a transverse computed tomography (CT) scan for detecting adnexal torsion. MATERIALS AND METHODS: This study included 106 woman suspected of having adnexal torsion who underwent CT with coronal reformations and subsequent surgical exploration. Two readers independently recorded the CT findings, such as the thickening of a fallopian tube, twisting of the adnexal pedicle, eccentric smooth wall thickening of the torsed adnexal mass, eccentric septal thickening of the torsed adnexal mass, eccentric poor enhancement of the torsed adnexal mass, uterine deviation to the twisted side, ascites or infiltration of pelvic fat, and the overall impression of adnexal torsion with a transverse scan alone or combined with coronal reformation and a transverse scan. The areas under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and positive predictive value were used to compare diagnostic performance. RESULTS: Fifty-two patients were confirmed to have adnexal torsion. The addition of coronal reformations to the transverse scan improved AUCs for readers 1 and 2 from 0.74 and 0.75 to 0.92 and 0.87, respectively, for detecting adnexal torsion (p < 0.001 and p = 0.004, respectively). Sensitivity of CT for detecting twisting of the adnexal pedicle increased significantly for readers 1 and 2 from 0.27 and 0.29 with a transverse scan alone to 0.79 and 0.77 with a combined coronal reformation and a transverse scan, respectively (p < 0.001 and p < 0.001, respectively). CONCLUSION: Use of a coronal reformation with transverse CT images improves detection of adnexal torsion.
Acute Pain/diagnosis/radiography ; Adnexa Uteri/pathology/*radiography ; Adnexal Diseases/*radiography ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Child ; Female ; Humans ; Middle Aged ; Pelvis/radiography ; ROC Curve ; Retrospective Studies ; Tomography, X-Ray Computed/*methods ; Torsion Abnormality/*diagnosis/*radiography ; Young Adult

Hypertrophic neuropathy is a non-specific consequence of repeated demyelination and remyelination, encountered in a wide range of inherited and acquired disorders. We report an 11-year-old boy with HMSN III, a kind of hypertrophic neuropathy, with clinical, electrophysiologic and pathologic data. The electrophysiologic studies show complete conduction block in the upper and lower extremities with severe abnormal spontaneous activities. The pathologic findings of sural nerve reveal prominent hypomyelination, onion bulb formation, and severe endoneurial collagenization. Complete conduction block with the preservation of fair to good grade muscle strength is an unusual finding in hypertrophic neuropathy and other peripheral neuropathies, in general.
Case Report ; Child ; Hereditary Motor and Sensory Neuropathies/pathology/*physiopathology ; Human ; Hypertrophy ; Male ; *Neural Conduction

OBJECTIVE: Transcutaneous immunization (TCI) is a novel vaccination based on the application onto bare skin. We compared the immune response after TCI with the model DNA (OVALBUMIN) to HPV E7 and various adjuvant with intramuscular injection. We investigated the efficacy of immunization with new construct driven by K6hf promoter and compared with CMV promoter. METHODS: First, we make new construct ligated with OVA to Hair-follicle Specific pK6hf Promoter and evaluated the expression. Mouse skin was transfected with pCMV-OVA, pK6hf-OVA, pCMV-beta gal and pK6hf-beta gal and expression was determined by RT-PCR and X-Gal staining. OVA protein expression was analyzed by Western blot. Second, we immunized C57/ BL6 mice with pCMV-OVA or pK6hf-OVA DNA and cholera toxin (CT) and/or CpG. CTL was measured by ELISPOT assay of the splenocytes from the mmunized mice with the DNA vaccine. RESULTS: The beta-Galactosidase activity by X-Gal staining was detected in the epithelium of the mice skin after pK6hf-beta gal application. The mRNA and protein expression from pK6hf-OVA were evident following transcutaneous methods. Those were weaker than pCMV-OVA. TCI with pCMV-OVA and LipofectAMINE 2000 trigered an speicific CTL and Th2 response. CpG was the adjuvant for CTL after pCMV-OVA. CT and CpG did increase the CTL after pK6hf-OVA. CONCLUSION: Our data demonstrate that TCI of DNA is possible methods of CTL. CpG and CT were useful in the adjuvant for CTL. The pK6hf-OVA can induce specific CTL. This result is of potential relevance for the development of therapeutic HPV- specific DNA vaccines with TCI and pK6hf promoter can be used safely.
Animals ; beta-Galactosidase ; Blotting, Western ; Cholera Toxin ; DNA* ; Enzyme-Linked Immunospot Assay ; Epithelium ; Immunization ; Injections, Intramuscular ; Mice ; Ovum ; RNA, Messenger ; Skin ; Vaccination* ; Vaccines, DNA