No abstract available.
Female ; Humans ; Necrosis*

Replacement of cardiac valves in the pediatric patients is infrequent compared with in adult for the treatment of diseased heart valve. Furthermore, uncertainties regarding the long term fate of prosthetic value and effects of a fixed-orifice walve in the growing children are the main concern in pedriatric patients. Between January 1974 and October 1979, in 10 children, 15years or younger, cardiac valves were replaced becasuse of congenital or acquired valvular heart diseases in the Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital. There were 8 mitral valves, one aortic valve and one mitral and aortic valve replaced. Indications for valve replacement were intractable congestive heart failure or apperently progressing cardiac symptoms and signs. Early postoperative death was noticed in one due to arrythmia, and late postoperative death in one due to cerebral thromboembolism after 9 months of double valve replacement. All Survlvors showed clinical improvement and good cardiac condition during postoperative and follow-up period till now.
Child ; Adult ; Male ; Female ; Humans

OBJECTIVE: Our purpose was to assess the efficacy of routine ultrasonographic prediction of macrosomic fetal weight, to determine its influences on subsequent delivery type and to assess perinatal outcome by delivery type. METHODS: The hospital records of 177 patients delivered infants weighing > or =4000gm between January 1997 and December 1998 were reviewed. Statistical comparisons were made between patients in whom fetal macrosomia was predicted before delivery(n=71) and those in whom it was not(n=106) and between the perinatal outcomes for macrosomic fetuses delivered vaginally and by cesarean section. The statistical analysis was performed by student-t test, and Chi-square test and Fisher's exact test. RESULTS: The fetuses were consecutive singleton fetuses in vertex presentation delivered at a single institute. The sensitivity for identifying macrosomic fetus(birth weight >4000gm) with an estimated weight of > or =4000gm was 40%, Overall 60% of the infants had birth weights within 10% of the ultrasonographic estimates and 29% had birth weights within 5% of the ultrasonographic estimates. Cesarean sections were performed in 69% of the 'predicted' group and in 35% of the 'not predicted' group(69% vs 35%, p<0.0001, Fisher's exact test). Predicated group were more likely to be performed by elective cesarean section(48% vs 19%, p<0.0001, Fisher's exact test) and more like due to failed progress at<4cm cervical dilatation(27% vs 7%, p<0.05, Fisher's exact test). The proportion of patients delivered by cesarean section for failed progress at > or =4cm cervical dilatation was similar in the predicted and not predicted groups(19% vs 12%, NS). There was no significant difference in the incidences of the occurrence of birth trauma. CONCLUSION: There appears to be a limitation to obtain estimation of fetal weight by ultrasonography. The antenatal prediction of fetal macrosomia is associated with a marked increase in cesarean deliveries without a significant reduction in the incidence of fetal injury
Birth Weight ; Cesarean Section ; Female ; Fetal Macrosomia ; Fetal Weight* ; Fetus ; Hospital Records ; Humans ; Incidence ; Infant ; Labor Stage, First ; Parturition ; Pregnancy ; Ultrasonography*

OBJECTIVE: Our purpose was to evaluate the effect of epidural anesthesia on labor course. METHODS: Between January 1998 and December 1998, we evaluated pregnant women at term with singleton fetus in vertex presentation and with spontaneous onset of labor at our hospital. Comparison of 120 women (100 cases of primiparous women, 20 cases of multiparous women) who received epidural anesthesia in labor with 120 women (100 cases of primiparous women, 20 cases of multiparous women) who did not receive epidural anesthesia was performed. Adverse pregnancy outcomes were obtained from hospital delivery records and neonatal records. Statistical analysis were performed by Student's t-test and Chi square test. RESULTS: The results of this study were as followings; 1. There was no significant difference in mean age, body weight, height, and gestational age between epidural anesthesia group and control group (P>0.05). 2. The frequency of oxytocin augmentation was significantly greater in the primiparous epidural anesthetic group than in primiparous control group (p<0.05). 3. The effect of epidural anesthesia on the first stage of labor revealed no significant difference in both group. 4. Prolongation of second stage of labor was noticed in nullipara of epidural anesthesia group compared to control group (p<0.05). 5. The incidence of instrumental delivery was significantly increased in the primiparous epidural group than in the primiparous control group(p<0.05). 6. The meconium-stained amnionic fluid, Apgar score and birth weight were similar in both groups. 7. The maternal blood loss was similar in both groups. CONCLUSION: Epidural anesthesia, significantly prolongs second stage of labor in induced patients. While instrumental delivery was more prevalent in these parturients, C-section rate and intra-partum complications were not increased in these patients.
Amnion ; Anesthesia, Epidural* ; Apgar Score ; Birth Weight ; Body Weight ; Female ; Fetus ; Gestational Age ; Humans ; Incidence ; Oxytocin ; Pregnancy ; Pregnancy Outcome ; Pregnant Women

OBJECTIVE: To determine whether there is correlation between serum concentrations of lipoproteins (VLDL, HDL, LDL) and development of preedampsia. METHODS: The authors measured serum concentrations of lipoproteins(VLDL, HDL, LDL) and lipids(which are major components of lipoproteins) in 12 preeclamptic women admitted to Sanggye Paik Hospital, Inje University from March 1999 to August 1999 and 12 normal pregnant women matched in age, weight, parity and gestational age. RESULTS: The first, the values of median and range of VLDL are higher in preeclamptic women than in normal pregnant women(preeclamptic women : 244mg/dL & 124-521mg/dL, normal pregnant women : 149mg/dL & 68-308mg/dL, p=0.0005). But there are no difierences in serum concentrations of HDL(high-density lipoprotein) and LDL(low-density lipoprotein) between two groups. The second, the values of median and range of triglyceride and free fatty acids are higher in preedamptic women than in normal pregnant women(preeclamptic women : triglycerides : 305.5mg/dL & 231-545mg/dL, free fatty acids : 1,333mmol/L & 842- 1523mmol/L, normal pregnant women,: triglycerides : 239mg/dL & 151-414mg/dL, free fatty acids : 806.5mmol/L & 314-1517mmol/L, p=0.019 in triglycerides and p=0.033 in free Fatty acids). But the serum concentrations of cholesterol are similar in two groups. CONCLUSIONS: Overall, the results of this study showed the serum concentrations of VLDL, triglycerides and free fatty acids are significantly higher in preeclamptic women than in normal pregnant women. So, the high serum concentration of VLDL is thought to be important in the pathogenesis of preeclampsia. In the next study, the prospective analysis will be necessary to identify whether serum concentration of VLDL is abnormaUy high in early gestational pregnant women who are destined to preeclamsia. Also, the measurement of pI 5.6 isoelectric form of albumin which is suggested to prevent VLDL toxicity will be necessary.
Cholesterol ; Fatty Acids, Nonesterified ; Female ; Gestational Age ; Humans ; Lipoproteins* ; Parity ; Pre-Eclampsia* ; Pregnant Women ; Triglycerides

The authors experienced a case of anterior uneitis associated with secondary glaucoma caused by a cycitsercosis cellulosae in the anterior chamber of the left eye of a 39-year-old Korean male. The cyst appeared from the posterior surface of the iris through the pupillary margin of 10-o'clock position and grew larger and larger with automatic active movements, filling finally the nasal upper one third of the anterior chamber, but the cyst did not change the position to the 6-o'clock chamber angle. The cysticercus grown for almost four months was extracted successfully with a teethless, serrated, curved forceps with some resistance after opening the anterior chamber from 7~11-o'clock position without iris prolapse and any damage to the anterior lens capsule. The extracted cyst with the size of 8 mm X 6 mm X 3 mm was confirmed as a cysticercus cellulosae by parasitological examinations (Fig. 2,3). After the extraction of the cysticercus the uveitis and the increased intraocular tension subsided completely, remaining some brownish fine keratic precipitates, pigment masses on the anterior surface of the lens and irregularly somewhat dilated pupil due to partial posterior synechia. The naked vision O.S., however, was 20/25 using pin hole, and the eye has been still quiet during last 3 and half years following surgical extraction. In addition the authors have recently seen three cases of subconjunctival cystiticercosis cellulosae. In the first case the cysticercus with the size of 8 mm X 7 mm X 4 mm appeared at the nasal superior part of the bulbar conjunctiva O.D. of a three-year-old Korean male. In the second case the cyst with the size of 7 mm X 5 mm X 3 mm was seen at the nasal inferior part of the bulbar conjunctiva O.S. of a 12-year old Korean female. In the last case the cyst with the size of 10 mm X 8 mm X 5 mm was located beneath the plica semilunaris of 3-o'clock position O.D. of a 58-year-old Korean female. All the cysts were extracted successfully without any rupture, and they were confirmed as the cysticercus cellulosae histologically.
Adult ; Anterior Chamber* ; Child ; Conjunctiva ; Cysticercosis* ; Cysticercus* ; Female ; Glaucoma ; Humans ; Iris ; Male ; Middle Aged ; Prolapse ; Pupil ; Rupture ; Surgical Instruments ; Uveitis

OBJECTIVE: Unexplained elevations of midtrimester human chorionic gonadotrophin(hCG) or alpha fetoprotein(AFP) have known to be at increased risk for a variety of third trimester pregnancy complication, such as preeclampsia. The causes of these were thought to be made by impaired placental function, as a reflection of impaired uteroplacental circulation. Our purpose was to determine if amniotic fluid total -hCG and AFP levels are elevated in women with severe preeclampsia and if these levels correlated with other laboratory features of disease severity. METHODS: Seventeen women with severe preeclampsia were matched with 16 women with the diagnosis of either preterm labor and intact membranes(n=10) or preterm premature rupture of membranes(n=6) who met the following criteria: 1) singleton gestation 2) absence of congenital anomaly 3) absence of active labor 4) confirmed getational age by ultrasonography 5) transabdominal amniocentesis performed to obtain amniotic fluid to assess fetal lung maturity. Amniotic fluid total -hCG and AFP were measured by double antibody radioimmunoassay(RADIM, Italy). Mann-Whitney U test and multiple linear regression analysis were used. RESULTS: 1) Concentrations of amniotic fluid total -hCG but not amniotic fluid AFP, maternal blood total -hCG and AFP were significantly higher in severely preeclamptic women than in their matched controls(amniotic fluid total -hCG; median 28.5, range 4.3-120.3 IU/ml vs. median 9.4, range 2.7-99 IU/ml, p < 0.01). 2) Amniotic fluid total -hCG levels correlated positively with maternal blood BUN(blood urea nitrogen) levels(r= 0.66, regression coefficients 5.57, standard error 2.4021, p< 0.05, multiple linear regression) after correction for known confounding variables(i.e., maternal weight, gestational age at sampling, hematocrit). CONCLUSION: Amniotic fluid total -hCG levels are elevated in women with severe preeclampsia and correlate closely with maternal blood BUN levels. These observation suggest that the pathologic changes of preeclampsia might occur in the placenta and involve in change of a significantly secretory reaction of the placenta.
alpha-Fetoproteins* ; Amniocentesis ; Amniotic Fluid* ; Chorion ; Chorionic Gonadotropin* ; Diagnosis ; Female ; Gestational Age ; Humans* ; Linear Models ; Lung ; Obstetric Labor, Premature ; Placenta ; Placental Circulation ; Pre-Eclampsia* ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Rupture ; Ultrasonography ; Urea

OBJECTIVE: To assess whether there is correlation between serum concentrations of vascular endothelial growth factor(VEGF) and development of preeclampsia. METHODS: The authors measured serum concentrations of VEGF in 18 preeclamptic women admitted to Sanggye Paik Hospital, Inje University from February 1999 to September 1999 and in 18 normotensive pregnant women matched in maternal age, maternal body weight, parity and gestational age. VEGF was measured with a sensitive and specific enzyme immunoassays. RESULTS: VEGF was detected in all pregnant women. The results of this study showed that the serum concentrations of VEGF are significantly higher in the preeclamptic women than in the normotensive pregnant women. The values of median and range of VEGF are 7.74 ng/ml and 0.5-35.94 ng/ml in the preeclamptic women, and 0.5 ng/ml and 0.5-2.16 ng/ml in the normotensive pregnant women, respectively. There is significant difference in serum concentrations of VEGF between two groups(p<0.001, Mann-Whitney U test). Positive correlations were noted between VEGF concentraions and the systolic and diastolic blood pressure(Systolic BP: r2=0.688, Diastolic BP: r2=0.722, Spearman rank test). CONCLUSION: The high serum concentration of VEGF is thought to be important in the development or pathophysiologic mechanism of preeclampsia. In the next study, the prospective analysis will be necessary to identify whether serum concentration of VEGF is abnormally high in early gestational pregnant women who are destined to preeclampsia.
Body Weight ; Female ; Gestational Age ; Humans ; Immunoenzyme Techniques ; Maternal Age ; Parity ; Pre-Eclampsia ; Pregnant Women ; Vascular Endothelial Growth Factor A*

OBJECTIVE: Preeclampsia is primarily a disorder of the maternal endothelium. The objective of this study was to assess the effect of VEGF on human umbilical vein endothelial cells (HUVEC) in vitro. METHODS: The serum concentrations of VEGF in women with preeclampsia and normotensive pregnant women were measured with a sensitive and specific enzyme immunoassays. After HUVEC were isolated and cultured in vitro, these HUVEC were stimulated with VEGF, sera from women with preeclampsia and normotensive pregnant women for 24 hours. And then prostacyclin levels were measured. RESULTS: The serum concentrations of VEGF were significantly higher in women with preeclampsia than in normotensive pregnant women. Vascular endothelial growth factor induced a significant concentration- dependent increase in prostacyclin production. HUVEC stimulated with sera from women with preeclampsia showed an increase in production of prostacyclin. VEGF concentration in serum was correlated with prostacyclin production by the stimulated cells. CONCLUSION: VEGF may be one of the circulating factors that cause the alteration in endothelial function and the high serum concentration of VEGF is thought to be important in the pathogenesis of preeclampsia.
Endothelial Cells* ; Endothelium ; Epoprostenol ; Female ; Human Umbilical Vein Endothelial Cells ; Humans ; Immunoenzyme Techniques ; Pre-Eclampsia* ; Pregnant Women ; Vascular Endothelial Growth Factor A*

OBJECTIVE: Preeclampsia is primarily a disorder of the maternal endothelium. The objective of this study was to assess the effect of VEGF on human umbilical vein endothelial cells (HUVEC) in vitro. METHODS: The serum concentrations of VEGF in women with preeclampsia and normotensive pregnant women were measured with a sensitive and specific enzyme immunoassays. After HUVEC were isolated and cultured in vitro, these HUVEC were stimulated with VEGF, sera from women with preeclampsia and normotensive pregnant women for 24 hours. And then prostacyclin levels were measured. RESULTS: The serum concentrations of VEGF were significantly higher in women with preeclampsia than in normotensive pregnant women. Vascular endothelial growth factor induced a significant concentration- dependent increase in prostacyclin production. HUVEC stimulated with sera from women with preeclampsia showed an increase in production of prostacyclin. VEGF concentration in serum was correlated with prostacyclin production by the stimulated cells. CONCLUSION: VEGF may be one of the circulating factors that cause the alteration in endothelial function and the high serum concentration of VEGF is thought to be important in the pathogenesis of preeclampsia.
Endothelial Cells* ; Endothelium ; Epoprostenol ; Female ; Human Umbilical Vein Endothelial Cells ; Humans ; Immunoenzyme Techniques ; Pre-Eclampsia* ; Pregnant Women ; Vascular Endothelial Growth Factor A*