OBJECTIVES: The objectives of this study is to compare the differences of fetal heart rate (FHR) variables between preterm and term pregnancies after acoustic stimulation using computerized analysis of fetal heart rate. METHODS: Eighty-two normal pre-term and term pregnancies entered to this study after conventional 20-minutes nonstress test(NST) and 10-minutes acoustic stimulation test (AST). Acoustic stimulations were performed using Fetal Acoustic Stimulator (Model 146, Corometrics, US). We analyzed the FHR response after acoustic stimulation using our on-line computerized FHR analysis system, HYFM-I & II software. The changes of loss of signal, baseline FHR, variability, number of fetal movements, and number of FHR accelerations were analyzed numerically. RESULT: The mean baseline FHR was increased in term pregnancies from 141+/-7.0bpm to 152.7+/-9.7bpm, and in preterm pregnancies from 144.6+/-6.8bpm to 156.8+/-10.2bpm, respectively. The mean baseline FHR was significantly increased in both term and preterm pregnancies (p<0.01. paired t-test). The variability of FHR was increased in term pregnancies from 18.2+/-6.4bpm to 22.6+/-5.0bpm and in preterm pregnancies from 17.8+/-5.5bpm to 22.7+/-5.9bpm, respectively. The variability of FHR was also significantly increased in both term and preterm pregnancies. (p<0.01. paired t-test) CONCLUSION: The mean baseline FHR and the variability of FHR was significantly increased both preterm and term pregnancies. But the difference of each FHR variables between preterm pregnancies and term pregnancies was not statistically significant in this study.
Acceleration ; Acoustic Stimulation* ; Acoustics* ; Female ; Fetal Heart* ; Fetal Movement ; Heart Rate, Fetal* ; Pregnancy

No abstract available.
Adenocarcinoma* ; Fallopian Tubes* ; Female

Relapsing polychondritis (RP) is rare, chronic, relapsing, and multisystemic inflammatory disease targeting the cartilaginous structures. Respiratory track involvement occurs in approximately half of the cases. Subglottic stenosis is a rare manifestation of RP. Here, we report a case of RP with a subglottic stenosis, resulting in acute respiratory failure. A 63-year old man was admitted complaining of multiple joint pain, general weakness, weight loss, throat pain, hoarseness, exertional dyspnea, and hearing difficulties. A laryngoscopy and neck CT revealed a subglottic stenosis. Four days after admission, he complained severe dyspnea resulting in acute respiratory failure. Immediately, a tracheostomy was done for airway preservation. After high dose steroid therapy, the general symptoms were improved. However, the subglottic stenosis was sustained. Thus, a laryngotracheal augumentation and stent insertion was performed. The speech valve was then replaced. The subglottic stenosis was managed with low dose steroid and monthly cyclophosphamide pulse therapy, and the patients has been followed up regularly.
Arthralgia ; Constriction, Pathologic* ; Cyclophosphamide ; Dyspnea ; Hearing ; Hoarseness ; Humans ; Laryngoscopy ; Neck ; Pharynx ; Polychondritis, Relapsing* ; Respiratory Insufficiency* ; Stents ; Tracheostomy ; Weight Loss

OBJECTIVES: The trial was performed to obtain an unbiased comparison of the relative merits of endocervical and vaginal prostaglandin E2(PGE2) in the case of parous and nulliparous woman with favorable and unfavorable cervical features. This study was performed to determine the clinical usefullness of endocervical PGE2 comparing with the vaginal PGE2 in cervical ripening and induction of labor. METHOD: The randomized trial with 65 Participants was performed with sealed envelopes for parity and Bishop score (from March to september, 1998). PGE2 tablet(3mg Dinoprostone) was administrated intravaginally to the 32 pregnant women and endocervically to the 33 pregnant women every eight hours with maximum three times until the regular labor develped. RESULT: Outcomes of labor and delivery were clearly related to cervical score at trial entry. endocerval PGE2 had a more marked effect on cervical ripeness than did vaginal PGE2. There were no significant differences on age distribution, gestatioanal period, primiparity, cervical status, initial B-score in each group. There were no significant differences in cesarian section rate, fetal distress, uterine hyperstimulation, side effect and poor infant outcome between the groups The mean induction time was statistically shorter in cervical group with multiparous women than other group(p=0.0195). In the induction-active labor time, cervical with primi group was statistically shorter than other group(p=0.0245). Statistically significant differences were noted between the nulliparous woman and multiparous women in mean induction time, induction-active labor time, time to B-score 8. In the factor that effects induction-active labor, route was significantly better than other factor.(p=0.0001) CONCLUSION: edocervical PGE2 is more effctive than vaginal PGE2 in cervical ripening and induction of active labor. the endocervical PGE2 resulted in a significantly shorter induction to active labor time compared with vaginal PGE2 and has almost no side effect. Because differences in effectiveness between endocervical and vaginal PGE2 are marginal, preference of woman and clinicians can the choice between them.
Age Distribution ; Cervical Ripening ; Dinoprostone ; Female ; Fetal Distress ; Humans ; Infant ; Parity ; Pregnancy ; Pregnant Women

Aneurysms of the posterior inferior cerebellar artery (PICA) are rarely encountered. In particular, due to frequent anatomic complexity and the presence of nearby critical structures, PICA origin aneurysms are difficult to treat. However, recent reports of anecdotal cases using advanced endovascular instruments and skills have made the results of endovascular treatment rather outstanding. PICA preservation is the key to a successful endovascular treatment, based on the premise that a PICA origin aneurysm is well occluded. To secure PICA flow, stenting into the PICA would be the best method, however, it is nearly impossible technically via the ipsilateral vertebral artery (VA) if the PICA arose at an acute angle from the sac. In such a case, a bilateral approach for stent-assisted coiling can be a creative method for achievement of two goals of both aneurysm occlusion and PICA preservation: ipsilateral approach for coil delivery and contralateral cross-over approach for stent delivery via a retrograde smooth path into the PICA.
Achievement ; Aneurysm ; Arteries ; Intracranial Aneurysm ; Pica ; Stents ; Vertebral Artery

BACKGROUND: Acinetobacter baumannii is a glucose-nonfermenting gram-negative rod and is a well-recognized nosocomial pathogen. In recent years, A. baumannii strains showing resistance to carbapenems by producing metallo-beta-lactamases or OXA-type beta-lactamases have increased, and it is considered to be a serious clinical problem. But genotypes of carbapenemases produced by A. baumannii isolates in Korea have been rarely reported. The purpose of this study was to investigate the prevalence of imipenem-resistant A. baumannii and to determine the mechanism of resistance. METHODS: During the period of January through September, 2003, susceptibilities to imipenem of A. baumannii isolates from patients admitted in Kosin University Gospel Hospital in Busan, Korea were investigated. The modified Hodge and EDTA-disk synergy tests were performed for screening of carbapenemase and metallo-beta-lactamase-production. Minimal inhibitory concentrations (MICs) were determined by the agar dilution method. For detection of IMP, VIM and OXA-type beta-lactamases genes, polymerase chain reactions (PCR) were performed, and the DNA sequences of OXA-type beta-lactamases genes were determined by using the dideoxy-chain termination method. The isoelectric points of beta-lactamases were determined by isoelectric focusing. Pulsed-field gel electrophresis (PFGE) of the SmaI-digested genomic DNA was performed. RESULTS: A total of 193 strains of A. baumannii were collected from patients during the surveillance period. Twenty-seven percents (52/193) of A. baumannii isolates were resistant to imipenem. Among the 52 imipenem-resistant isolates, 41 isolates (78.8%) showed positive results in the modified Hodge test, but none of the isolates showed positive results in the EDTA-disk synergy test. Thirty-eight modified Hodge test-positive isolates harbored blaOXA-23 gene, but none of the isolates harbored IMP- or VIM-type metallo-beta-lactamases genes. Analytical isoelectric focusing revealed that all the 38 isolates had a nitrocefin-positive band at pI of 6.65. Thirty-five OXA-23-producing isolatesshowed a similar PFGE pattern when digested by SmaI endonuclease. CONCLUSION: Thirty-eight clinical isolates of A. baumannii acquired resistance to imipenem by producing OXA-23 beta-lactamase. Among them were 35 isolates thought to be originated from the same source, because they contained a similar chromosomal type. To the best of our knowledge, this is the first time that OXA-23 beta-lactamase has been detected in Korea.
Acinetobacter baumannii* ; Acinetobacter* ; Agar ; Base Sequence ; beta-Lactamases ; Busan* ; Carbapenems ; DNA ; Genotype ; Humans ; Imipenem ; Isoelectric Focusing ; Isoelectric Point ; Korea* ; Mass Screening ; Polymerase Chain Reaction ; Prevalence*

Although tourniquet application is a widely accepted adjuvant technique in the field of extremity surgery, its complication may be neglected. A 37-year-old healthy male underwent arthroscopic surgery for left posterior cruciate ligament reconstruction under a combination of spinal and epidural anesthesia. During the eleven hour operation, a tourniquet was applied four times in nine hours on the left thigh. The pressure reached 450 millimeters of mercury. Compartment syndrome developed with muscle ischemia and edema postoperatively. On the first day of the operation, a fasciotomy was performed to prevent the development of crush syndrome. However, bleeding due to vascular injury during the fasciotomy continued and crush syndrome including myoglobinemic renal failure, hyperkalemia, hypovolemic shock, and cardiac arrhythmia developed. On the second day, sudden cardiac arrest occurred during artery ligation. The patient was immediately resuscitated; he recovered, but his mental state was stuporous. Thereafter, the patient was cared intensively for eight days with fluid and electrolyte therapy, ventilatory care, hemodialysis, antibiotics for crush syndrome and renal failure, but the result was unsuccessful.
Adult ; Anesthesia, Epidural ; Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Arteries ; Arthroscopy ; Compartment Syndromes ; Crush Syndrome* ; Death, Sudden, Cardiac ; Edema ; Extremities ; Hemorrhage ; Humans ; Hyperkalemia ; Ischemia ; Ligation ; Male ; Posterior Cruciate Ligament ; Renal Dialysis ; Renal Insufficiency ; Shock ; Stupor ; Thigh ; Tourniquets* ; Vascular System Injuries

We compare the safety and efficacy of locked and non-locked plating systems with retrospective review of 51 consecutive acute cervical injury patients who underwent anterior cervical plating procedures. The two groups were comparable in demographic details, mean age(locked 40.8, non-locked 37.9), average fusion level(locked 1.53, non-locked 1.67) and fusion rate(locked 100%, non-locked 86.7%). Hardware related complication in locked plate group was seen in one patient(2.78%), but did not required the reoperation. In the non-locked plate group, 4 patients developed screw loosening and, in 1 patient, the inferior screw was found to be 2mm posterior to posterior cortex. Reoperation was needed for this case due to symptomatic myelopathy. In the non-locked plate group instrument related reoperations was done in 5 patients(33.4%) and longer operation time was required than locked system. In this study, anterior cervical fusion with plating was nessessory for stabilizing of acute cervical instability and improving neurological outcome and fusion rate. For this purpose, locked system was theoratically safter and technically easier than non-locked system.
Humans ; Reoperation ; Retrospective Studies ; Spinal Cord Diseases

Clinically, the infarction of posterior spinal arteries is rarely recognized due to rich anastomosis. As a result, there have been few clinical reports of posterior spinal artery infarction. A 38-year-old man experienced severe transitory neck and occipital pain after his friend had struck him on the cervical area. A few days later, he developed dysmetria, dysdiadochokinesia, and decreased vibration and position senses on the right side of his body. Routine laboratory find-ings, an echocardiogram, a work-up for connective tissue diseases, and CSF studies were all found to be normal. A MRI showed increased signals in the right posterior and posterolateral part of the lower medulla and some portion of the first cervical cord on T2- and proton-weighted images without significant enhancements. A cerebral angiogram showed a long narrow thread-like segment in the distal portion of the right vertebral artery, which was indicative of a dissection. The right posterior inferior cerebellar artery was not visualized.
Adult ; Arteries* ; Cerebellar Ataxia ; Connective Tissue Diseases ; Friends ; Humans ; Infarction* ; Lateral Medullary Syndrome ; Magnetic Resonance Imaging ; Neck ; Proprioception ; Spinal Cord ; Vertebral Artery ; Vibration

One to three percent of childhood brain tumors are choroid plexus tumors. Of these, 30-40% are considered to be choroid plexus carcinoma. We report one case of choroid plexus carcinoma without parenchymal invasion, which showed rapid dissemination along whole CSF pathway and developed postoperative hydrocephalus in spite of gross total resection.
Brain Neoplasms ; Choroid Plexus Neoplasms ; Choroid Plexus* ; Choroid* ; Hydrocephalus