A pregnancy is considered postterm if it is beyond 294 days (42 complete weeks). Several investigators have demonstrated that postterm pregnancy may be accompanied by a rise in perinatal morbidity and/or mortality. Abnormalities such as meconium staining, cringenital anomalies, intrauterine growth retardation, postmaturity syndrome, fetal asphyxia have been reported in some cases of reduced amniotic fluid volume (oligohyramnios) which is commonly observed in postterm pregnancies. Amniotic fluid volume has been shown to decrease significantly as gestational age advances beyond term. Oligohydramnios has particular relevance to postterm pregnancies. Poor perinatal outcomes of oligohydramnios on postterm pregnancy have been reported by several authors. To date, however, the relationship between oligohydramnios in pastterm pregnancy and fetal outcome is debatable. The purpose of this clinical study was to evaluate the relationship between oligohydr- amnios and perinatal outcome in 64 cases of postterm pregnancies. Amniotic fluid index(AFI) values were measured semiweekly in 64 good dated, uncomplicated singleton pregnancies. AFI values were categorized into 2 groups. The group 1; patients whose final AFI value was above 5.0 cm; Group 2, patients whose AFI value fell below 5.0 cm. Adverse fetal outcome was defined by the presence of meconium staining, fetal heart rate decelerations, cesarean delivery for fetal distress, low Apgar score at 1 and 5 minutes, neonatal intensive care unit admission, and perinatal mortality. The fetal outcome was compared group 1 with group 2 and results obtained were as follows: 1. The incidence of oligohydramnios in postterm pregnancy was 54.7 %. The average diminution of amniotic fluid index was from 8.2 1.8 cm to 5.6+2.2 cm/week. 2. The incidence of meconium-staining in amniotic fluid was 40.6 % (Group 1: 20.7 %, Group 2: 57.1 %) and showed statistically significant difference between the two groups(p= 0.003). 3. The incidence of Apgar score less than 7 was 23.4% in 1 minute (Group 1: 13.8 %, Group 2: 31.4 %) and 4.7 % in 5 minutes(Group 1: 3.4%, Group 2: 5.7 %), respectively and showed no statistically significant difference between the two groups (p=0.140, p=1.000). 4. I'he incidence of cesarean delivery due to fetal distress was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). 5. The incidence of admission to NICU was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). Adverse fetal outcome was not uniformly observed in postterm pregnancies with oligohydramnios. Amniotic fluid index in oligohydramnios group as a single independent guide was not enough to predict fetal outcomes in postterm pregnancy without specific pathologic condition of fetus.
Amniotic Fluid* ; Apgar Score ; Asphyxia ; Deceleration ; Female ; Fetal Distress ; Fetal Growth Retardation ; Fetus ; Gestational Age ; Heart Rate, Fetal ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Meconium ; Mortality ; Oligohydramnios ; Perinatal Mortality ; Pregnancy* ; Research Personnel

Prognosis and biologic behavior of malignant ovarian tumors have been assessed by clinical staging, morphological grading and many other variables. Recently DNA ploidy measured by flow cytometry has been suggested as an additional important indicator of the tumor behavior and prognosis. The author measured DNA ploidy, S-phase fraction and DNA Index in 36 patients of epithelial ovarian tumors(17 were malignant, and 19 were borderline) by flow cytometric analysis of paraffin embedded tumor blocks. Comparing with FIGO stage, tumor grade, histologic type and others, the author investigated the clinical significance of the results of flow cytometric analysis. The results obtained as follows : (continue)
DNA* ; Flow Cytometry ; Humans ; Paraffin ; Ploidies* ; Prognosis

No abstract available.
Fentanyl ; Intensive Care Units ; Miliaria*

Current concept of the pathogenesis of preeclampsia involves the generalized dysfunction of maternal vascular endothelial cells. Using ELISA (enzyme-linked immunosorbent assay) method, the fibronectin, as a marker of endothelial cell injury, was measured in the group of 35 cases of preeclampsia (mild; 15 and severe; 20 cases) and the control group of 21 cases of normal pregnancy. The clinical profiles, hematologic and renal function test results were compared and correlated with the levels of plasma fibronectin between two groups. The results obtained were as follows 1. The mean age between preeclampsia and control group was not different statistically, but gestational age, birth weight and maternal weight were different significantly between two groups. 2. Compared with normal control group, plasma levels of fibronectin were signifi- cantly elevated in preeclampsia group. As to the differential validity between two groups (control vs preeclampsia), using cutoff value of 380 mg/dl, sensitivity was 95.7 %, specificity was 90.5 %, predictive value was 93.8 %. As to the differential validity between mild and severe preeclampsia, using cutoff value of 742 mg/dl, sensitivity was 65.0 %, specificity was 73.3 %, predictive value was 76.5%. 3. As to the correlationship between plasma fibronectin levels and hematologic test results, uric acid and creatinine levels showed positive correlation in preeclampsia. Based upon these study results, plasma fibronectin could be a useful parameter for the differential diagnostic validity and grade of preeclampsia.
Birth Weight ; Creatinine ; Endothelial Cells ; Enzyme-Linked Immunosorbent Assay ; Fibronectins* ; Gestational Age ; Hematologic Tests ; Plasma* ; Pre-Eclampsia* ; Pregnancy ; Sensitivity and Specificity ; Uric Acid

No abstract available.
Edema* ; Hemoptysis* ; Lower Extremity*

In treatment of Vitamin D-resistant rickets, the authors supplemented supramalleolar stepcut osteotomy for complex deformity of tibia consisted of varus, anterior bowing and intemal torsional supramalleolar level which accompanied severe waddling gait. The results of 10 tibia operations from 5 patients were generally satisfactory in terms of appearance and function.
Congenital Abnormalities ; Gait ; Humans ; Osteotomy ; Rickets ; Rickets, Hypophosphatemic ; Tibia ; Vitamin D ; Vitamins

BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
Adult ; Blood Transfusion ; Bloodless Medical and Surgical Procedures* ; Heart Valves* ; Humans ; Jehovah's Witnesses* ; Mortality ; Perioperative Care ; Survival Rate

PURPOSE: In contracted bladder of various etiologies, if many of conservative managements fail, a surgical treatment seems to be the only therapeutic approach. We tried to evaluate the long term results of aug mentation cystoplasty including the postoperative complication and the degree of satisfaction in patients. MATERIALS AND METHODS: From 1989 to 1988, augmentation cystoplasties had been performed in 11 patients with contracted bladder of various etiologies. We reviewed the patients' medical records including the result of urodynamic examinations, retrospectively. Postoperative follow-up periods were 9 to 114months (mean:61months). Patients were interviewed by telephone. RESULTS: Urinary frequency, nocturia, dysuria and suprapubic pain were improved in all patients, but dysuria persisted in one patient with tuberculous cystitis. Clean intermittent catheterization (CIC) was done in there of 11 patients due to large volume of residual urine. The volume of residual urine was 200-300ml in one with hyperreflexic neurogenic bladder, and 100-200ml in two with interstitial cystitis. Self voiding was possible in 8 patients with residual urine volume less than 90ml. Almost all patients were very satisfied symptomatically in the telephone survey. There were no significant complications which required surgical revision. CONCLUSIONS: It is concluded that augmentation cystoplasty could be an excellent method of treatment for selective patients with contracted bladder, who have not improved symtomatically by medication or conservative management.
Cystitis ; Cystitis, Interstitial ; Dysuria ; Follow-Up Studies ; Humans ; Intermittent Urethral Catheterization ; Medical Records ; Nocturia ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Telephone ; Urinary Bladder* ; Urinary Bladder, Neurogenic ; Urodynamics

BACKGROUND: Caudal anesthesia is considered a safe and reliable anesthetic technique for many pediatric surgical procedures. It is well known that extradural clonidine produces analgesia in adult. The purpose of this study is to assess its efficacy in children. METHODS: We randomized 45 pediatric patients aged under 10 years, weighted under 25 kg presented for lower abdominal surgery with duration of operation would be shorter than 2 hours, into three groups of 15 each. After sedation with the use of intravenous thiopental sodium, caudal anesthesia was performed with the use of 1 mL/kg of 0.25% bupivacaine. We allocated randomly the patients who received no additional medication in 0.25% bupivacaine (group I), with epinephrine 1/200,000 (group II), and with 1 mcg/kg of clonidine (group III). The degree of postoperative analgesia was evaluated using the Broadman ""Objective Pain/discomfort Scale"" (OPS) at hourly intervals for 24 hours. RESULTS: Duration of sleep in the recovery room was significantly longer in group III than in group I and group II, and statistical significant difference was found between the group I and group II. Duration of analgesia was significantly longer in group III than in group I and group II. Overall hourly OPS scores were lower in group III than in group I and group II. CONCLUSION: Duration of postoperative analgesia with caudal bupivacaine was increased by addition of 1 mcg/kg of clonidine.
Adult ; Analgesia ; Anesthesia, Caudal* ; Bupivacaine ; Child ; Clonidine* ; Epinephrine ; Humans ; Recovery Room ; Thiopental

OBJECTIVE: In the development of squamous neoplasia of the uterine cervix, high risk HPV infection has been followed by CD44 variant expression and angiogenesis. The aim of this study is to evaluate the sequential changes and relatianship of CD44 variant expression, microvessel density (MVD), and VEGF expression in CIN III, microinvasive (MI) and invasive (CA) squamous cell carcinoma. METHODS: The materials were 17 cases of CIN III, 14 cases of MI and 15 cases of CA. In situ PCR for HPV 16/18 and immunohistochemical studies for CD44std, v6, v7/8, CD 31 for MVD, and VEGF were performed. RESULTS: CD44std expression was decreased in squarnous neoplasia compared to normal, and CD44v6 and v7/8 expressions were increased, however, there was no statistical significance. Accentuated staining of CD44v6 and v7/8 along the infiltrating borders was noted in 76.9% and 69.2% of MI and in 71.4% and 42.9% of CA, respectively. High MVD and VEGF 2+ expression were higher in the squamous neoplasia compared to narmal, however, there was no significant difference between the squamous neoplasia and no significant relationship between MVD and VEGF expression. The expression rates of CD44std and CD44v6 were higher in HPV 16/18 negative squamous neoplasia and that of CD44v7/8 was higher in HPV 16/18 pasitive squamous neoplasia, however, their differences were not significant. The incidences of high MVD and VEGF 2+ expression were higher in HPV 16/18 positive suqmaous neoplasia with no statistical significance. CONCLUSIONS: These results suggest that CD44 variants expression and angiogenesis are involved in the development of squamous neoplasia of the uterine cervix, however, HPV 16/18 might not be related to CD44 variant expression and angiogenesis.
Carcinoma, Squamous Cell ; Cervix Uteri* ; Female ; Incidence ; Microvessels* ; Polymerase Chain Reaction ; Vascular Endothelial Growth Factor A*