To evaluate the clinical efficacy of emergency cervical cerclage in the treatment of advanced cervical incompetence, a prospective clinical trial was performed in 18 patients with advanced cervical incompetence at 20 to 25 weeks gestation. Modified McDonalds operation with or without transabdominal amniocentesis was used for cervical cerclage. Pregnancy was prolonged for a sufficient time to deliver viable fetuses in 56.3% of patients. The median procedure-to-delivery interval was 8.6 (range 0.1 to 20.5) weeks for the entire group, and 13.9 (range 6.5 to 20.5) weeks for 9 patients who achieved live birth. The median gestational age at delivery was 38.6 (range 28.3 to 41.0) weeks for the live infants. The median birthweight of the live infants was 3062 g (range 1050 to 3620 g). The lack of significant matemal morbidity combined with the results for the fetus-infant supports further efforts in this area.
Amniocentesis ; Cerclage, Cervical ; Emergencies* ; Fetus ; Gestational Age ; Humans ; Infant ; Live Birth ; Pregnancy ; Prospective Studies

OBJECTIVE: The involvement of IGF system in hyperandrogenism and abnormal follicular development is controversial. This study is to assess whether IGF system contribute to it in the women with polycystic ovary(PCO). METHODS: Baseline serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), testosterone (T), androstenedione (ADD), prolactin, thyroid stimulating hormone (TSH), free insulin-like growth factor(IGF)-I, free IGF-II, insulin-like growth factor binding protein(IGFBP)-1, and IGFBP-3 were measured in twelve healthy regularly cycling volunteers and forty-two women with PCO then, the changes of baseline serum levels were evaluated after laparoscopic ovarian electrocauterization in nine PCO patients. In addition, the expression pattern of IGF-I and IGF-II was examined in the ovary of control and PCO group. RESULTS: Baseline levels of LH, ADD, free IGF-II, and IGFBP-3 were significantly higher in PCO group. However, there were no significant differences in the levels of free IGF-I and IGFBP-1, although free IGF-I showed decreasing tendency in PCO group. And there was a significant positive correlation between the LH and free IGF-II level in the PCO(P=0.011, r2=0.3899), but not in the control. After ovarian electrocauterization, LH, T, and ADD levels decreased, and free IGF-I and IGFBP-3 level increased. While free IGF-II and IGFBP-1 level showed no significant changes. In the ovary, expression of both IGFs showed similar pattern in normal and PCO ovaries. CONCLUSIONS: The elevated IGFBP-3 level may alter the bioavailability of IGF(s) in the PCO. The change in IGF-I level and resumption of ovulation after electrocauterization, suggest a possible role of IGF system in the impairment of follicular development in the PCO.
Androstenedione ; Biological Availability ; Carrier Proteins* ; Estradiol ; Female ; Follicle Stimulating Hormone ; Humans ; Hyperandrogenism ; Insulin-Like Growth Factor Binding Protein 1 ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Luteinizing Hormone ; Ovary* ; Ovulation ; Prolactin ; Somatomedins* ; Testosterone ; Thyrotropin ; Volunteers

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

The association of major fetal malformations with amniotic bands has been known for many years. However, we are apt to ignore the possibility of amniotic band syndrome. In this case, fetal anencephaly was diagnosed at 17 weeks, menstrual age on the basis of sonographic findings. Following pregnancy termination, examination of the abortus rev- ealed the cerebral remnant which is similar to that found in dysraphic anencephaly, but collateral evidence of amniotic band was found. Therefore, when confronted with severe cranial or cerebral malformation amniotic band syndrome should be in the differential dia- gnosis.
Amniotic Band Syndrome* ; Anencephaly* ; Infant, Newborn ; Pregnancy ; Skin* ; Ultrasonography

OBJECTIVES: To study the distributions of pH and gas values in umbilical arterial(UA) blood of normal newborns following uncomplicated pregnancies and vaginal births. Methods: In 457 consecutive normal term infants who were born between March 1995 and June 1998, we examined the UA pH and blood gas values obtained immediately following delivery. Maternal inclusion criteria were defined as an uncomplicated singleton pregnancy and a normal full term spontaneous vaginal delivery. And also neonatal inclusion criteria were defined as a normal intrauterine growth appropriate for gestational age without any malformations and Apgar score of 7 or more at both one and five minutes after birth. Umbilical artery blood samples were collected at each birth and were evaluated for pH, carbon dioxide pressure (PaCO2), oxygen pressure (PaO2) and actual bicarbonate. RESULTS: Histogram of UA pH value resemble normal distribution curve. The lowest UA pH was 7.04 and the 10th percentile value was 7.23. The median UA pH was 7.31 and 5% was below 7.20. The lowest UA PaO2 was 4.6mmHg and the 10th percentile value was 11.5mmHg. The highest UA PaCO2 was 67.2mmHg and the 90th percentile value was 56.5mmHg. The lowest bicarbonate value was 13.2mmol/L and the 10th percentile value was 18.4mmol/L. CONCLUSION: The distributions of the UA pH and gas values of the collective of normal newborns were illustrated. None of the UA pH was below 7.0.
Apgar Score ; Blood Gas Analysis* ; Carbon Dioxide ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Newborn* ; Oxygen ; Parturition ; Pregnancy ; Umbilical Arteries*

OBJECTIVE: The ovarian cycle is characterized by repeating patterns of cellular proliferation and differentiation that accompany follicular development and the formation and regression of the corpus luteum (CL). That angiogenesis may play an important role in this process. Angiogenesis is supposed to be regulated by vascular endothelial growth factor (VEGF). The goal of the present investigation, therefore, was to determine whether the expression of VEGF was changed in the normally cycling human ovary. We also investigated VEGF expression in the regressed CL (ie, nonfunctiong CL) of normal term pregnancy to define the association with steroidogenic activity. To our knowledge there is no report available on VEGF expression in the CL of term pregnancy. METHODS: We assessed VEGF expression in ovaries obtained from, 26-42 yr of age, and from patients undergoing hysterectomy and salpingo-oophorectomy for nonendocrinological or nonovarian disorders. Tissue samples from premenopausal women included specimens from follicular (n=4) and luteal (n 4) phases. In addition, we studied ovarian specimens from pregnant women (n=3). Immunohistochemical analysis for VEGF was performed using a rabbit polyclonal antibody directed against human VEGF. RESULTS: These data demonstrate a development-related VEGF expression in the follicle and indirectly show that VEGF expression may be up to the existence of LH-receptor. And also, VEGF was overexpressed in the regressed CL of pregnant women compared with the functioning CL of nonpregnant cycles CONCLUSION: This study suggests that the intensity of VEGF expression is not correlated with steroidogenic activity, although both of them are stimulated by LH.
Cell Proliferation ; Corpus Luteum ; Female ; Humans* ; Hysterectomy ; Menstrual Cycle ; Ovarian Follicle ; Ovary* ; Pregnancy ; Pregnant Women ; Vascular Endothelial Growth Factor A*

A 67-year-old man, with a history of pontine hemorrhage, was admitted because of ocular tremors. Also, tremors in the right upper limb and palates were detected. Oculopalatine tremors showed synchronous vertical oscillations and the limb showed midbrain tremor. Brain MRI revealed high signal intensities of both inferior olivary nuclei and right superior cerebellar peduncle. Electromyogram showed different tremor frequencies in the oculopalate and limb. Clinical, MRI and electromyographic findings indicate that the origins of oculopalatine and limb tremors are different.
Aged ; Brain ; Extremities ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Mesencephalon* ; Palate ; Tremor* ; Upper Extremity*

Pregnancy maintenance is dependent on the presence of a functional corpusluteum (CL) for a few weeks after implantation. However, the factors responsible for the rescue of the CL during earlypregnancy have not been fully clarified. This study was designed to evaluate whether the change in size of the CL ofearly pregnancy, serum concentration of progesterone, 17alpha-hydroxyprogesterone,or beta-hCG correlated with the gestational age or were predictive of pregnancyoutcome. We retrospectively analysed thirty-six women between 4~9 weeks' gestation. All women underwent transvaginal ultrasound measurement of the CL size andgestational sac(or crown-rump length). Blood was drawn from each patient on the day of the ultrasound examinationto measure hormone concentration. Fifteen women experienced vaginal bleeding and abdominal pain.Among them, four women were aborted. There was no significant positive correlation between CL size and serumprogesterone, 17alpha-hydroxyprogesterone or beta-hCG both in normal and abnormal pregnancy. A positive correlation was observed between the gestational age and progesterone orbeta-hCG in normal pregnancy, but not in abnormal pregnancy(threatened or spontanousabortion). In conclusion, close correlation between the gestational age and serum concentrationof progesterone or beta-hCG may reflect the normal function of CL. Therefore, abnormal response of CL or abnormal production of beta-hCG cause a disturbancein progesterone secretion leading to the abnormal pregnancy.
Corpus Luteum* ; Female ; Gestational Age ; Humans ; Pregnancy Maintenance ; Pregnancy* ; Progesterone* ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage

Pregnancy maintenance is dependent on the presence of a functional corpusluteum (CL) for a few weeks after implantation. However, the factors responsible for the rescue of the CL during earlypregnancy have not been fully clarified. This study was designed to evaluate whether the change in size of the CL ofearly pregnancy, serum concentration of progesterone, 17alpha-hydroxyprogesterone,or beta-hCG correlated with the gestational age or were predictive of pregnancyoutcome. We retrospectively analysed thirty-six women between 4~9 weeks' gestation. All women underwent transvaginal ultrasound measurement of the CL size andgestational sac(or crown-rump length). Blood was drawn from each patient on the day of the ultrasound examinationto measure hormone concentration. Fifteen women experienced vaginal bleeding and abdominal pain.Among them, four women were aborted. There was no significant positive correlation between CL size and serumprogesterone, 17alpha-hydroxyprogesterone or beta-hCG both in normal and abnormal pregnancy. A positive correlation was observed between the gestational age and progesterone orbeta-hCG in normal pregnancy, but not in abnormal pregnancy(threatened or spontanousabortion). In conclusion, close correlation between the gestational age and serum concentrationof progesterone or beta-hCG may reflect the normal function of CL. Therefore, abnormal response of CL or abnormal production of beta-hCG cause a disturbancein progesterone secretion leading to the abnormal pregnancy.
Corpus Luteum* ; Female ; Gestational Age ; Humans ; Pregnancy Maintenance ; Pregnancy* ; Progesterone* ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage

A 39-year-old woman has had several episodes of transient right hemiplegia. On neurological examination during the ictal period she had alert consciousness with aphasia, head and eyeball deviation to the right side, and right hemiplegia. Brain MRI was normal. EEG-video monitoring of ictal period showed continuous ictal discharge in the midline frontocentral area coincided with right hemiplegia. After injection of diazepam, the ictal discharge and right hemiplegia disappeared. We report a case of status epilepticus characterized by ictal hemiplegia.
Adult ; Aphasia ; Brain ; Consciousness ; Diazepam ; Female ; Head ; Hemiplegia* ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Status Epilepticus*