OBJECTIVE: To examine the relationship of the amniotic, and maternal infiammatory responses and decreased amniotic fluid in patients with preterm PROM. METHODS: Fifty three patients with preterm PROM in singleton pregnancy who delivered preterm neonates (gestational age<35 weeks) within 3 days of amniocentesis were included. Amniotic fluid index(AFI) was measured by transabdominal ultrasonography at amniocentesis. Amniotic fluid was cultured far aerobic and anaerobic bacteria and mycoplasma. The intensity of the inflammatory response was evaluated by clinical and histologic chorioamnionitis. The intensity of fetal hypoxia was evaluated by 1 min Apgar score, 5 min Apgar score, and pH of cord blood at birth. RESULTS: The prevalence of oligohydramnios, which was defined when measured AFI was equal or less than 5.0, was 34% (18/53). The prevalence of positive amniotic fluid culture was 45% (24/53) and that of patients with was significantly higher than that of patients without oligohydramnios (78% [14/l8] vs 29% [10/35], p<0.01). Intrauterine inflammatory response was significantly stronger in patients with oligohydratnnios than in patients with adequate amniotic fluid (pathologic chorioamnionitis 100% [l6/16] vs 63% [19/30], clinical chorioamnionitis 39% [7/18] vs 6% [2/35]; p<0.01 for each). However, no significant difference was found in the intensity of fetal hypoxia (I min Apgar score <7 67% [12/18] vs 66% [23/35], 5 min Apgar score <7 39% [7/l8] vs 26% [9/35], pH of cord artery blood at birth 7.27+0.13 vs 7.22+0.13; p>O.I, for each). CONCLUSION: Oligohydramnios in patients with preterm PROM is strongly pedictive for positive amniotic fluid culture, and is associated with a robust host response in amniotic, and maternal cornpartments, but not with fetal hypoxia.
Amniocentesis ; Amniotic Fluid ; Apgar Score ; Arteries ; Bacteria, Anaerobic ; Chorioamnionitis ; Female ; Fetal Blood ; Fetal Hypoxia* ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn ; Mycoplasma ; Oligohydramnios* ; Parturition ; Pregnancy ; Prevalence ; Ultrasonography

Enterobacter cloacae is isolated from 10 newborns in the neonatal Intensive care unit(NICU) of Seoul Red Cross Hospital from April, 1997 to June, 1997. Their gestational age is from 195-299 days(mean 244.3 days), and their birth weight was from 980-4,100g(mean 2,287g). We obtained 16 E, cloacae strains form their blood, urine, endotracheal tube, umbilical catheter and 4 of them were isolated from the same patient at different culture sites. We also obtained another 3 strains of E. cloacae from 14 persons who worked in NICU and 26 places of NICU. We analysed the molecular types of 19 isolates by using rep-PCR method. We get 6 different types of PCR-products from the patients and NICU workers, and NICU environments. We observed that the incidence of E. cloacae was decreased by handwashing and wearing personal plastic gloves during the care of NICU patients.
Birth Weight ; Catheters ; Cloaca ; Cross Infection ; Enterobacter cloacae* ; Enterobacter* ; Epidemiologic Studies* ; Gestational Age ; Hand Disinfection ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal* ; Plastics ; Red Cross ; Seoul

OBJECTIVE: Neonatal blood pressure is one of the vital signs used to assess the general health of a newborn infant. But, it is difficult to measure and varies according to the model of sphygmomanometer, the used method, the postconceptional age, birth weight, asphyxia, postnatal age and activity. We have assessed the rnean value of blood pressure(BP) according to postconceptional age. Variations caused by the postconceptional age, birth weight, body surface area(BSA), postnatal age, and sex were analyzed to determine the rnost important factor influencing the neonatal BP. METHODS: This study included 448 normal fullterm infants and healthy preterm infants born from Jan. 1995 to Aug. 1997 at Ewha Dongdaemoon and Mokdong Hospital. The BP was taken on day 1, 3, 5 with the oscillometric device(Dinamap 1846 critikon Inc.), for premature infants BP was followed up every week afterward. RESULTS: The neonatal BP was related to the postconceptional age(R=0.204, P<0.05), BSA(R =0.191, P<0.05), birth weight(R=0.183, P<0.05) and the postnatal age in fullterm infants(R=0.022, P<0.05) but not with the sex of the infant. The postconceptional age was the most significant variable among those influencing the BP. The normal value of the systolic and the diastolic BP was expressed as mean+/-2SD according to the postconceptional age, less than 28 weeks(n=27) systolic/diastolic pressure 50.4+/-23.1mmHg/26.2+/-12.8mmHg, 28-32weeks(n= 63) 60.1+/- 30.6mmHg/33.6+/-16.7mmHg, 32-36weeks(n = 139) 63.2+/- 20.4mmHg/37.7+/- 19.8 mmHg, 36- 40weeks(n=543) 65.6+/-18.5mmHg/38.6+/-17.3mmHg, more than 40weeks(n= 136) 67.7+/-16,9mmHg/39.3+/- 15.8mmHg. The increase in blood prssure with the postconceptional age was statistically significant. CONCLUSION: The normal range of neonatal BP, especially preterm infants, was presented, and it would be much valuable for the evaluation of BP in neonate if standardized by postconceptional age.
Asphyxia ; Birth Weight ; Blood Pressure* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Parturition ; Reference Values* ; Sphygmomanometers ; Vital Signs

Neuroblastoma stage IV-S patients have frequent spontaneous remission and high survival rate. Many investigators have recommended minimal or no therapeutic intervention ; however, some patient do experience progressive disease and ultimately die of neuroblastoma. We experienced a case of stage IVS neuroblastoma with N-myc amplification and coagulopathy. This patient has treated with combination chemotherapy and radiation therapy, then remained disease free for 1 year on the follow up till March, 1997.
Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Neuroblastoma* ; Remission, Spontaneous ; Research Personnel ; Survival Rate

OBJECTIVES: Subacute thyroiditis is a nonsuppurative inflammation of thyroid gland and is probably caused by a cytopathic virus. Typical clinical symptoms and features of subacute thyroiditis vary widely during the course of illness. It has a clinical course, evolving from hyperthyroidism through a temporary hypothyroidism to recovery. However, the final outcome of this disease remains unpredictive in some patients. Permanet hypothyroidism occurs infrequently. METHODS: Thirty-three patients proven to have subacute thyroiditis at the Ewha Womans University Hospital from September 1993 to November 1995 were studied. We analyzed their clinical features, laboratory findings, and duration of recovery to cha- racterize the course of the disease. RESULTS: 1) Total 33 patients were studied: 31 patients were female and 2 patients were male. Their mean age was 42.6+/-8.3 years old. The peak months were August through October in this study. 2) Initial mean ESR was 73.0+/-35.2mm/hr, mean T3 was 217.3+/-73.9ng/dl, mean T4 was 15.2+/-8.5microgram/ dl, and TSH was 0.06+/-0.09microIU/ml. The positive rates of antithyroglobulin and anitmicrosomal antibodies were 31% and 6% respectively, and TSH receptor antibody was elevated in one patient. 3) In the thyroid scan, 91% showed both lobes nonvisualisation, and 9% showed one lobe nonvisualization. Radioactive iodine uptake(RAIU) at 24 hour was 2.4+/-3.3%. 4) With the predisolone therapy, 90% of patients completely recovered, 57% of these patients had no hypothyroid phase and remaining 33% of them had hypothyroid phase during course of the disease. Three of the patients had permanent hypothyroidim. 5) The average duration of recovery was 3.2+/-1.4 months and it has no correlation with initial thyroid hormone levels, antithyroid antibodies and duration of steroid administration. CONCLUSION: There was no historical, physical, laboratory findings that help us predict those patients likely to have an exacerbation of the disease.
Antibodies ; Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Inflammation ; Iodine ; Male ; Prednisolone ; Receptors, Thyrotropin ; Thyroid Gland ; Thyroiditis, Subacute

Background: Postpartum thyroiditis is a painless, destructive lymphocytic inflammation of the thyroid gland that occurs during the postpartum period and is associated with a high prevalence of serum thyroid autoantibodies. Clinical symptoms and laboratory fi#ndings of postpartum thyroiditis vary widely during the course of illness and the final outcome of this disease remains unpredictive in some patients. The purpose of this study is to investigate the clinical course and the predictors of the outcome of the disease. Methods: Thirty-eight patients proven to have postpartum thyroiditis at the Ewha Womans University Hospital were studied. We analyzed their clinical features, laboratory findings and duration of recovery to characterize the course of the disease. Results: Their mean age was 29.0±3.3 years and the time of diagnosis was 4.9±1.9 months after delivery. The prevailed months of delivery were November through January in this study. Twenty six patients were hypothyroid and 12 were thyrotoxic at initial thyroid function. The positive rates of antithyroglobulin and anitmicrosomal antibodies were 92%, 67% in the hypothyroid group and 75%, 67% in th thyrotoxic group respectively. TSH receptor antibodies were negative in all patients. In the hypothyroid group the titers of antimicrosomal antibodies were significantly higer than the thyrotoxic group. The titers of antimicrosomal antibodies were positively correlated with serum TSH and negatively correlated with serum T4. In all patients, the titers in thyroid function tests returned to the normal range without long-term hypothyroidism. Conclusion: The titers of antimicrosomal antibodies were significantly higher in the hypothyroid group than the thyrotoxic group. Thus the titers of antimicrosomal antibodies can help guide the physician in the care of patients with postpartum thyroiditis who will probably be hypothyroid. In this study, we were surprised that all patients became euthyroid without permanent hypothyroidism.
Antibodies ; Autoantibodies ; Clinical Study ; Diagnosis ; Female ; Humans ; Hypothyroidism ; Inflammation ; Postpartum Period ; Postpartum Thyroiditis ; Prevalence ; Receptors, Thyrotropin ; Reference Values ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis

PURPOSE: In most emergency department (ED), sedation is required before carrying out an invasive procedure on a pediatric patient. In the ED setting, it is essential to determine the optimal dose and administration route of CH for successful sedation. The aim of this study was to determine the optimal dose of CH for an invasive procedure and to examine the effectiveness of the drug's different administration routes. Furthermore, in this study, we performed simple survey using questionnaire which composed of Likert-scale to evaluate satisfaction of medical staffs in ED with administration routes. METHODS: This study was conducted prospectively. The study participants were pediatric patients under 8 years old who visited the ED in two tertiary hospitals in South Korea within a period of 12 months. RESULTS: Overall, 300 patients were included in this study. The age, sex, and weight of the patients were not shown to influence the sedation time. Chloral hydrate dosage is the independent factor to influence the both sedation and discharge time (p<0.01). In the comparison of the groups, groups 1, 2, and 5 showed no significant difference. On the other hand, groups 3 and 4 were shown to be statistically significantly different from group 1. CONCLUSION: Up to 100 mg/kg CH is safe to use in the emergency department for pediatric patients, but the initial dose of 50 mg/kg for oral administration should be considered in advance because it can provide safe and effective sedation with a lower possibility of causing an adverse effect.
Administration, Oral ; Chloral Hydrate* ; Deep Sedation ; Emergency Service, Hospital ; Hand ; Humans ; Korea ; Medical Staff ; Prospective Studies ; Tertiary Care Centers

BACKGROUND: Many women have experienced artificial abortion, but artificial abortion itself may take a life away from a fetus and also influence serious effect on operated womens health condition. So this study was attempted to offer basic information for improving maternity health condition by knowing womens artificial abortion performance status and recognition about its complication. METHODS: The 215 married women who visited in OPD of certain hospital in Pusan from november 1994 to January 1995, answered the question about experience of artifial abortion the recognition about its complication, and artificial abortioned group answered the reason of artificial abortion and the experience of complication. RESULTS: The number of women who experienced artificial abortion was 107 persons(49.8%). More educated women have experienced less artificial abortion. The causes of artificial abortion were birth control as of 40.6%, continuation of occupation or study as of 20.6%, for preserving health condition as of 14.2%, impossible marriage as of 14.2%. 115 persons out of 215 persons (53.4% ) answered they heard about, its complicatons. In relation to health, 66 persons(30.7% ) answered that the abortion had no relation with health condition or they answered they have no idea about the issue, 68 persons(31.6%) answered that the abortion had relation with but its complication would be soon recovered. Higher understanding was obtained in higher educated group(P<0.05). If unwanted pregnancy occur to them in the future, 32 persons(27.8%) in recognized group and 38 persons(38%) in unrecognized group answered they would perform artificial abortion. So understanding about complicaton of artificial abortion has little effect on their artificial abortion rate. CONCLUSIONS: Recognition of complications of married women is low, and recognition degree doesnt affect artificial abortion. So, not only education about complications of artificial abortion and contraception but also social performance of sharing womens responsibility for birth control or bringing up infants is necessary.
Abortion, Induced ; Busan ; Contraception ; Education ; Female ; Fetus ; Humans ; Infant ; Marriage ; Occupations ; Pregnancy ; Pregnancy, Unwanted ; Women's Health

No abstract available.
Humans ; Infant* ; Infant, Very Low Birth Weight*

The purpose of this study was to investigate the dietary intake, obesity index and psychosocial factors influencing obesity among 200 high school girls in Seoul. The Social Cognitive Theory provided the Conceptual basis for this study. A cross-sectional survey was conducted to examine factors related to obesity, including self-efficacy for controlling overeating, social support for eating behavior, perception of body image and weight control, nutrition knowledge, and attitudes toward obesity. The data were analyzed using t-test and multiple logistic regression. The results of this study are as follows : 1) The mean age of the girls was 16.4 years, and the rate of overweight and obesity(measured by obesity index) was 27.0%. 2) The mean energy intake of subjects was 1832.3+/-384.0kcal. The energy derived from carbohydrates, proteins and fats was 62.7%, 13.8%, and 23.5%, respectively. There was no significant difference between the obese and the comparison group in energy intake. 3) The result of multivariate analysis indicated that obesity had a significant relation to the perception of ideal body image, social support for eating behavior, and self-efficacy for controlling overeating(p<0.01). As subjects preferred thinner body images(OR=0.39) and received less social support(OR=0.93), the odds of being classified as obese increased. The odds of being obese were also associated with self-efficacy, however, the relation was not strong(OR=1.04). 4) Specific social support was related to obesity among adolescent girls. As subjects received more support from family member, the odds of being obese decreased. The emotional support as well as family member's positive nutrition behavior plays a significant role. In addition, instrumental support from friends was associated with obesity. With repect to self-efficacy, the odds of being obese were increased as subjects felt less confident in controlling overeating when tempting food was placed in front of them or after an argument. In contrast, the obese group felt more confident in controlling overeating for the rest of the specific situations examined. These findings suggest that educational interventions for weight control should incorporate strategies to help participants realize their degree of obesity, to reduce the discrepancy between current and ideal body image, to elicit and maintain social support from friends and family, and to increase the self-efficacy for changing eating behaviors.
Adolescent* ; Body Image ; Carbohydrates ; Cross-Sectional Studies ; Energy Intake ; Fats ; Feeding Behavior ; Female* ; Friends ; Humans ; Hyperphagia ; Logistic Models ; Multivariate Analysis ; Obesity* ; Overweight ; Psychology* ; Seoul