OBJECTIVE: To determine the effect of lowering the cutoff values of 3-hour oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM). METHODS: Patients with an abnormal 50 gm glucose challenge test (GCT) of more than 130 mg/dL at 24-28 weeks of gestation underwent a 3-hour OGTT at 28-32 weeks of gestation. Patients were divided into four groups according to the criteria recommended by Carpenter-Coustan or National Diabetes Data Group (NDDG) (Control: 50 gm GCT negative [n=268], Borderline: 2 or more abnormal values met or exceeded Carpenter-Coustan criteria but not the NDDG criteria [n=100], NDDG I: 2 or more abnormal values met or exceeded NDDG criteria, [treated, n=70], NDDG II: [not treated, n=42]). Obstetric and perinatal outcomes were analyzed retrospectively. RESULTS: Of 5,827 pregnant women screened for GDM, 112 (1.9%) met the NDDG criteria, whereas 212 (3.6%) met the Carpenter-Coustan criteria. The incidences of poor maternal outcomes were 20.1%, 28.0%, 47.1%, 21.4%, and the incidences of poor neonatal outcomes were 3.7%, 6.0%, 14.3%, 16.7% in the four groups (p<0.05). Multivariable logistic regression analysis showed that 1) NDDG I showed an independent risk factor for poor maternal outcome (OR, 3.37), but the borderline group did not, 2) NDDG I showed an independent risk factor for poor neonatal outcome (OR, 3.87), but the borderline group did not, 3) the borderline group showed an independent risk factor for preterm delivery (OR, 2.67). CONCLUSION: Lowering the cutoff values would increase the number of pregnant women with GDM, while only minimally affecting the perinatal outcomes. Further large-scale prospective studies for Korean pregnant women may be needed.
Diabetes, Gestational* ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Incidence ; Logistic Models ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Risk Factors

Clear cell chondrosarcoma, first described by Unni in 1976, is distinguished from classical chondrosarcoma by a typical histological picture, mostly an epiphyseal site of origin, and relatively a benign clinical course. We present a case of clear cell chondrosarcoma arising from hyoid bone in a 70-year-old male. Histologically, large areas of closely packed cells with characteristic clear cytoplasm were seen in addition to the usual elements of a conventional chondrosarcoma. Our search and review of the literature did not reveal any reported case of clear cell chondrosarcoma arising from hyoid bone.
Aged ; Chondrosarcoma* ; Cytoplasm ; Humans ; Hyoid Bone* ; Male

PURPOSE: The purpose of this study was to identify nurse's role through job analysis of nursing duties for nurses working on East Asia traditional medicine wards. METHODS: Major steps in the study included a literature review, description of job activities of nurses on oriental medicine wards, comparative description of the literature, expert tests of validity of derived duties and tasks, and investigation of importance, difficulty and frequency of duties on job list. RESULTS: The job of nurses on oriental medicine wards was classified into 12 duties, 59 tasks, and 295 task elements. The 12 duties were nursing assessment, nursing diagnosis, nursing planning, nursing implementation, nursing evaluation, supplies management, management of human resources, management of environment, management of documents, formation of cooperative relationships, self-development, and nursing activity in oriental medicine. 'Formation of cooperative relationships' was the duty ranked highest for importance (4.34), 'self-development' was ranked highest for difficulty (3.47), and 'Formation of cooperative relationships' was ranked highest for frequency (4.21). CONCLUSION: Basic education for nurses on an oriental medicine unit is necessary for the performance of oriental nursing to be considered as a specialized field. This study contributes to human resource management in the oriental medical hospital.
Education ; Equipment and Supplies ; Far East ; Humans ; Job Description ; Medicine, East Asian Traditional* ; Medicine, Traditional ; Nurse's Role ; Nursing ; Nursing Assessment ; Nursing Diagnosis ; Task Performance and Analysis

Background and Objectives: Localization of a sound source in the horizontal plane depends on the listener’s interaural comparison of arrival time and level. Hearing loss (HL) can reduce access to these binaural cues, possibly disrupting the localization and memory of spatial information. Thus, this study aimed to investigate the horizontal sound localization performance and the spatial short-term memory in listeners with actual and simulated HL. Subjects and Methods: Seventeen listeners with bilateral symmetric HL and 17 listeners with normal hearing (NH) participated in the study. The hearing thresholds of NH listeners were elevated by a spectrally shaped masking noise for the simulations of unilateral hearing loss (UHL) and bilateral hearing loss (BHL). The localization accuracy and errors as well as the spatial short-term memory span were measured in the free field using a set of 11 loudspeakers arrayed over a 150° arc. Results: The localization abilities and spatial short-term memory span did not significantly differ between actual BHL listeners and BHL-simulated NH listeners. Overall, the localization performance with the UHL simulation was approximately twofold worse than that with the BHL simulation, and the hearing asymmetry led to a detrimental effect on spatial memory. The mean localization score as a function of stimulus location in the UHL simulation was less than 30% even for the front (0° azimuth) stimuli and much worse on the side closer to the simulated ear. In the UHL simulation, the localization responses were biased toward the side of the intact ear even when sounds were coming from the front. Conclusions Hearing asymmetry induced by the UHL simulation substantially disrupted the localization performance and recall abilities of spatial positions encoded and stored in the memory, due to fewer chances to learn strategies to improve localization. The marked effect of hearing asymmetry on sound localization highlights the need for clinical assessments of spatial hearing in addition to conventional hearing tests.

Background and Objectives: Localization of a sound source in the horizontal plane depends on the listener’s interaural comparison of arrival time and level. Hearing loss (HL) can reduce access to these binaural cues, possibly disrupting the localization and memory of spatial information. Thus, this study aimed to investigate the horizontal sound localization performance and the spatial short-term memory in listeners with actual and simulated HL. Subjects and Methods: Seventeen listeners with bilateral symmetric HL and 17 listeners with normal hearing (NH) participated in the study. The hearing thresholds of NH listeners were elevated by a spectrally shaped masking noise for the simulations of unilateral hearing loss (UHL) and bilateral hearing loss (BHL). The localization accuracy and errors as well as the spatial short-term memory span were measured in the free field using a set of 11 loudspeakers arrayed over a 150° arc. Results: The localization abilities and spatial short-term memory span did not significantly differ between actual BHL listeners and BHL-simulated NH listeners. Overall, the localization performance with the UHL simulation was approximately twofold worse than that with the BHL simulation, and the hearing asymmetry led to a detrimental effect on spatial memory. The mean localization score as a function of stimulus location in the UHL simulation was less than 30% even for the front (0° azimuth) stimuli and much worse on the side closer to the simulated ear. In the UHL simulation, the localization responses were biased toward the side of the intact ear even when sounds were coming from the front. Conclusions Hearing asymmetry induced by the UHL simulation substantially disrupted the localization performance and recall abilities of spatial positions encoded and stored in the memory, due to fewer chances to learn strategies to improve localization. The marked effect of hearing asymmetry on sound localization highlights the need for clinical assessments of spatial hearing in addition to conventional hearing tests.

Background and Objectives: Localization of a sound source in the horizontal plane depends on the listener’s interaural comparison of arrival time and level. Hearing loss (HL) can reduce access to these binaural cues, possibly disrupting the localization and memory of spatial information. Thus, this study aimed to investigate the horizontal sound localization performance and the spatial short-term memory in listeners with actual and simulated HL. Subjects and Methods: Seventeen listeners with bilateral symmetric HL and 17 listeners with normal hearing (NH) participated in the study. The hearing thresholds of NH listeners were elevated by a spectrally shaped masking noise for the simulations of unilateral hearing loss (UHL) and bilateral hearing loss (BHL). The localization accuracy and errors as well as the spatial short-term memory span were measured in the free field using a set of 11 loudspeakers arrayed over a 150° arc. Results: The localization abilities and spatial short-term memory span did not significantly differ between actual BHL listeners and BHL-simulated NH listeners. Overall, the localization performance with the UHL simulation was approximately twofold worse than that with the BHL simulation, and the hearing asymmetry led to a detrimental effect on spatial memory. The mean localization score as a function of stimulus location in the UHL simulation was less than 30% even for the front (0° azimuth) stimuli and much worse on the side closer to the simulated ear. In the UHL simulation, the localization responses were biased toward the side of the intact ear even when sounds were coming from the front. Conclusions Hearing asymmetry induced by the UHL simulation substantially disrupted the localization performance and recall abilities of spatial positions encoded and stored in the memory, due to fewer chances to learn strategies to improve localization. The marked effect of hearing asymmetry on sound localization highlights the need for clinical assessments of spatial hearing in addition to conventional hearing tests.

OBJECTIVE: To determine whether hydramnios occurring in pregnant women complicated with gestational diabetes mellitus (GDM) affects maternal and neonatal outcomes. METHODS: We evaluated 277 pregnant women with singleton pregnancies and GDM diagnosed by the National Diabetes Data Group (NDDG) criteria. The study group was consisted of 23 pregnant women diagnosed as hydramnios (Amniotic fluid index; AFI>24 cm) by ultrasonography, and the control group was consisted of 254 pregnant women with normal AFI (10-24 cm). Retrospective review of maternal and neonatal outcomes in these women was performed. Student t-test, chi-square test, Fisher's exact test, and logistic regression analysis were used for statistics. RESULTS: There were no significant differences in the maternal age and parity between the two groups. The frequency of preterm labor was higher in the study group compared to the control group (4.3% vs. 34.8%, p<0.001). The frequencies of cesarean delivery due to cephalopelvic disproportion or failure to progress, preeclampsia, and placental abruption were not significantly different between the two groups. The study group showed significantly shorter gestational age (38.2+/-1.4 weeks vs. 36.7+/-2.5 weeks, p<0.05) and heavier neonatal birth weight at delivery (3,405.0+/-595.2 gm vs. 3,701.3+/-757.9 gm, p=0.026). The frequencies of preterm birth (5.1% vs. 39.1%, p<0.001), macrosomia (13.0% vs. 34.8%, p<0.001), admission to neonatal intensive care unit (7.1% vs. 34.8%, p=0.050), neonatal respiratory complications (3.9% vs. 21.7%, p<0.001), and hyperbilirubinemia (11.0% vs. 47.8%, p<0.001) were higher in the study group even after logistic regression analysis for controlling gestational age. CONCLUSION: Hydramnios occurring in pregnant women with GDM may be associated with increased risk of preterm birth and neonatal respiratory complications, but not associated with adverse maternal outcomes, except preterm labor.
Abruptio Placentae ; Birth Weight ; Cephalopelvic Disproportion ; Diabetes, Gestational* ; Female ; Gestational Age ; Humans ; Hyperbilirubinemia ; Infant, Newborn ; Intensive Care, Neonatal ; Logistic Models ; Maternal Age ; Obstetric Labor, Premature ; Parity ; Polyhydramnios* ; Pre-Eclampsia ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Premature Birth ; Retrospective Studies ; Ultrasonography

OBJECTIVE: To investigate whether there was any correlation between sonographic parameters and perinatal course of fetal ovarian cysts. METHODS: This was a retrospective analysis of cases from July, 1994 through February, 2003. The pre- and postnatal data of 10 fetuses who prenatally diagnosed to have an ovarian cyst, delivered and followed up in our obstetric center were analyzed. Maternal age, gestational age of diagnosis, ovarian cyst location, size, combined anomaly, mode of delivery, changes of ultrasonographic parameters, management of ovarian cysts and pathologic findings were reviewed. RESULTS: A total of 10 fetal ovarian cysts were all purely cystic, with well defined margins. Three of 10 cases (30%) showed antenatal sonographic patterns of complicated cysts (2 septa, 1 intraluminal echo) which spontaneously resolved during serial sonographic monitoring. In 2 cases the sonographic findings became complicated postnatally and were operated on revealing dermoid cyst with torsion. Five uncomplicated cysts of 10 cases were spontaneously resolved during perinatal follow-up. In eight cases of ovarian cysts larger than 4 cm, there was only one case which required postnatal surgery. CONCLUSION: There was no single ultrasonographic parameter (internal echoes, septum, character, size) to predict perinatal course of ovarian cysts including spontaneous resolution, torsion and need of operation.
Dermoid Cyst ; Diagnosis ; Female ; Fetus ; Follow-Up Studies ; Gestational Age ; Maternal Age ; Ovarian Cysts* ; Prenatal Diagnosis ; Retrospective Studies ; Ultrasonography

OBJECTIVE: The elevated plasma homocysteine concentrations is a independent risk factor of atherosclerosis. We investigated the level of plasma homocysteine is associated with severe preeclampsia. METHODS: 28 pregnant women with severe preeclampsia (study group) and 26 normotensive, healthy pregnant women (control group), matched by maternal age, gestational age, pre-pregnant body mass index and parity were enrolled into this study. Blood samples were collected within 24 hours before delivery and just 24 hours after delivery. The level of plasma homocysteine was measured by fluorescent polarization immunoassay. Statistical analysis was performed using Student t test. RESULTS: Plasma homocysteine levels in the women with severe preeclampsia were significantly elevated than those of control group in antepartum and postpartum 24 hours [7.17 2.71 vs 5.37 1.49 g/mL (mean SD); p<0.05 in antepartum, 6.38 2.03 vs 4.48 +/- 0.40 g/mL (mean SD); p<0.05 in postpartum]. CONCLUSION: In the present study the increase of plasma homocysteine in pregnant women with severe preeclampsia is related the pathogenesis of preeclampsia as like in atherosclerosis and may be used as a marker of preeclampsia by further research.
Atherosclerosis ; Body Mass Index ; Female ; Gestational Age ; Homocysteine* ; Humans ; Immunoassay ; Maternal Age ; Parity ; Plasma* ; Postpartum Period ; Pre-Eclampsia* ; Pregnant Women* ; Risk Factors

OBJECTIVE: To determine the usefulness of neonatal nucleated red blood cell counts (nRBC) as an independent predictor of fetal hypoxia and perinatal outcome in severe preeclampsia. METHODS: One hundred thirty eight patients with severe preeclampsia were studied. Umbilical artery Dopppler velocimetry was performed in all patients, and were divided into two groups, the control group with present umbilical artery end diastolic velocity, and the case group with absent or reversed velocity. The patients were also separately grouped as another control (n=58), acute (n=19), and chronic hypoxia (n=55) according to abnormal Doppler findings, presence of oligohydramnios, intrauterine growth restriction (IUGR), and pattern of fetal heart rate tracings during labor. At delivery, the umbilical cord blood was collected and the levels of nRBC per 100 WBC were measured from the samples along with blood gas analysis. The results were compared between the control and acute groups, and chronic hypoxic fetus. Correlation with perinatal outcomes was also evaluated. Student's t-test, ANOVA, and regression analysis were performed for statistical analysis. RESULTS: Those with absent or reversed end diastolic velocity did not have significantly greater nRBC counts, but had lower platelet counts (p=0.02), lower pO2 (p=0.005), and higher pCO2 saturation levels (p=0.01). There were no significant differences with regard to nRBC counts among the control, acute, and chronic hypoxia groups. Elevated nRBC counts were significantly associated with neonatal intensive care unit stay of more than 28 days (p=0.013), respiratory distress syndrome (p=0.003), disseminated intravascular coagulopathy, or sepsis (p=0.041). CONCLUSION: nRBC counts did not show significant difference according to umbilical artery Doppler velocity. Also we could not find any difference between the control, acute, and chronic hypoxic group, suggesting that nRBC counts does not correlate with both hypoxic status, or duration of hypoxia. Correlation with elevated nRBC counts and neonatal intensive care unit stay of more than 28 days, respiratory distress syndrome, disseminated intravascular coagulopathy, and sepsis was observed. However, the overlapping results and the wide range of nRBC counts according to the complications limits its role as a predictor of poor perinatal outcome.
Anoxia ; Blood Gas Analysis ; Erythrocyte Count ; Female ; Fetal Blood ; Fetal Hypoxia* ; Fetus ; Heart Rate, Fetal ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Oligohydramnios ; Platelet Count ; Pre-Eclampsia* ; Pregnancy ; Rheology ; Sepsis ; Umbilical Arteries