No abstract available.
Adenoma* ; Hyperaldosteronism*

OBJECTIVE: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. METHODS: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. RESULTS: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. CONCLUSION: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.
Body Mass Index* ; Cesarean Section* ; Emergencies* ; Female ; Humans ; Hypertension ; Institute of Medicine (U.S.)* ; Odds Ratio ; Overweight ; Parturition ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Retrospective Studies ; Weight Gain*

PURPOSE: Fast MRI has provided detailed and reproducible fetal anatomy. This study was performed to evaluate the usefulness of fetal MRI for prenatal diagnosis. MATERIALS AND METHODS: Fifty-six fetuses with congenital abnormalities on ultrasonography were evaluated by fetal MRI from 2001 to 2004 in Severance Hospital. Final diagnosis was made by postnatal pathology, postnatal MRI, and other modalities (such as ultrasound, retrograde pyelogram). A 1.5-Tesla superconductive MR imaging unit was used to obtain half-Fourier acquisition single-shot turbo spin images. RESULTS: Of the 56 fetuses, intracranial abnormalities were found in 26 fetuses, intraabdominal abnormalities in 17 fetuses, intrathoracic in 6 fetuses, head and neck in 5 fetuses, and other sites in 2 fetuses. There were six cases in which the diagnoses of fetal MRI and ultrasonography differed. In such cases, fetal MRI provided more exact diagnosis than ultrasonography (5 vs. 0). Three fetuses with intracranial abnormalities on ultrasonography were diagnosed as normal by fetal MRI and in postnatal diagnosis. CONCLUSION: Although ultrasonography is known as a screening modality of choice in the evaluation of fetus because of the cost-effectiveness and safety, the sonographic findings are occasionally inconclusive or insufficient for choosing the proper management. Thus, in this study, we suggest that fetal MRI is more useful than ultrasonography for the evaluation of intracranial abnormalities in some instances. For prenatal counseling and postnatal treatment planning, fetal MRI can be informative when prenatal ultrasonography is inadequate and doubtful.
Female ; Fetal Diseases/*diagnosis/ultrasonography ; Humans ; *Magnetic Resonance Imaging ; Pregnancy ; Prenatal Diagnosis/*methods ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography, Prenatal

The incidence of acute leukemia in pregnancy is estimated to be about 1 per 75000 pregnancies, and the incidence of lymphocytic leukemia is known to be lower than myelocytic leukemia. Pregnancy dose not affect the course of acute leukemia, but thrombocytopenia, anemia and leukopenia resulting from leukemia may lead to hemorrhage, infection, and insufficient supply of oxygen and nutrition to fetus. The most important factor for chemotherapy is gestational age. Since no evidence on adverse effect of chemotherapeutic agents on fetus when given after the first trimester, aggressive chemotherapy is recommended during pregnancy. However, during chemotherapy, caution regarding risk of spontaneous abortion, intrauterine fetal growth retardation, teratogenicity, intrauterine fetal death, fetal immunosupression and preterm labor should be taken. Acute leukemia in pregnancy is extremely rare, so treatment and management of the pregnant mother bearing viable fetus in her 3rd trimester is not established clearly. We experienced a patient with acute lymphocytic leukemia who was first diagnosed at 27 gestational weeks and immediately started with chemotherapy. But due to preterm labor and impending fetal distress, emergency cesarean section was performed at 28 gestational weeks. We present this patient along with past experiences of acute leukemia in pregnancy.
Abortion, Spontaneous ; Anemia ; Cesarean Section ; Drug Therapy ; Emergencies ; Female ; Fetal Death ; Fetal Distress ; Fetal Growth Retardation ; Fetus ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Leukemia ; Leukemia, Lymphoid ; Leukemia, Myeloid ; Leukopenia ; Mothers ; Obstetric Labor, Premature ; Oxygen ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pregnancy Trimester, First ; Pregnancy* ; Thrombocytopenia

OBJECTIVE: To investigate the differential expression of junctional proteins in the normal and preeclamptic human placenta and the effect of ginsenoside Rk1 in junctional proteins. METHODS: Placental tissues from 10 women with severe preeclampsia and 5 normal women were collected at the time of their cesarean section. Five of 10 preeclamptic women were complicated with intrauterine growth restriction (IUGR). Immunohistochemistry and Western blotting was employed to localize junctional proteins (zo-1, occludin and plakoglobin) positive cells. The placental explant culture was performed to investigate if Rk1 can attenuate the expression of junctional proteins (zo-1, occluding and plakoglobin) induced by deferoxamine-induced hypoxia. Rk1 was treated at the day 3 and Western blot analysis was performed for protein quantification. RESULTS: There was no different expression of zo-1 and plakoglobin among all the study groups. Occludin showed negative at the endothelial cells of the terminal villi in both normal and preeclampsia groups. At the endothelial cells of the stem villi, occludin was detected in both normal and severe preeclamptic placenta with normal fetal growth. However, severe preeclampsia with IUGR were decreased expression of occludin at the endothelial cells of the stem villi. When we administered Rk1 to the placenta treated with DFO, expression of occludin was not different. CONCLUSION: The placental expression of zo-1 and plakoglobin were not different among the study groups, while that of occludin was significantly decreased at the endothelium of stem villi in severe preeclampsia with IUGR. Rk-1 showed no effect on the placental junctional proteins. These results suggest that occludin may play a role in pathophysiology of fetal growth restriction in utero.
Anoxia ; Blotting, Western ; Cesarean Section ; Endothelial Cells ; Endothelium ; Female ; Fetal Development ; Fetal Growth Retardation ; gamma Catenin ; Ginsenosides ; Humans ; Immunohistochemistry ; Occludin ; Placenta ; Pre-Eclampsia ; Pregnancy ; Proteins

OBJECTIVE: We studied relationship between average amount of fish consumption and blood mercury level in pregnant women, in addition we would like to know the blood mercury level in pregnant women in Korea and we compared the initial blood mercury level in pregnant women and followed up how much blood mercury level decreased after counseling and prenatal education. METHODS: Pregnant women who received prenatal care at the Yonsei medical center from March 2004 to September 2004, were targeted. They were divided into two groups. One was the study group who was educated to restrict the intake of fish, the other was the control group who was not given any prenatal education. We measured their blood mercury level and followed up until 2nd and 3rd trimester, to find out the differences between two groups. RESULTS: Out of the 63 pregnant women who participated in our study, we followed up 11 pregnant women in the study group and 13 pregnant women of control group. The initial mean blood mercury level of both groups was 2.94 (0.14-10.75) microgram/L. Blood mercury level in fish eating group of more than 4 times a month was higher than the others, which was statistically significant (p=0.02). Followed up blood mercury levels were increased in both groups, but there was not statistically significant between two groups. CONCLUSION: Pregnant women who consume a large amount of fish may have high blood mercury level. As fish intake seems to influence blood mercury level, to lower their blood mercury level, periconceptional education to decrease fish consumption might be necessary.
Counseling ; Eating ; Education ; Female ; Fishes ; Humans ; Korea ; Pregnancy ; Pregnant Women* ; Prenatal Care ; Prenatal Education

Fetal chylothorax is a rare congenital manifestation that shows variable clinical outcome ranging from complete spontaneous resolution to progression into hydrops or lung hypoplasia. There is no consensus in the literature as to the optimal antenatal management despite several complications such as preterm delivery, pulmonary hypoplasia, and perinatal death. Pleuroamniotic shunting has been the treatment of choice in fetal chylothorax. Recently, new fetal therapy such as OK-432 (Picibanil) pleurodesis is being introduced. Herein, we present two cases of women referred at early 2nd trimester because of fetal hydrothorax by routine ultrasonography. Cytology obtained by thoracocentesis revealed abundant lymphocytes, suggesting chylothorax. Effusion was aspirated and OK-432 (Picibanil) was injected into the pleural space of fetus. On follow up ultrasonography, the pleural effusion was nearly resolved by adhesion of the intrathoracic space and resulted in the delivery of a healthy neonate. Intrapleural OK-432 injection may be feasible therapeutic option for selected cases in early 2nd trimester with persistent chylothorax for effective control of pleural effusion with no adverse effects.
Chylothorax ; Consensus ; Edema ; Female ; Fetal Therapies ; Fetus ; Follow-Up Studies ; Humans ; Hydrothorax ; Infant, Newborn ; Lung ; Lymphocytes ; Picibanil ; Pleural Effusion ; Pleurodesis

Inflammatory pseudotumor is an uncommon nonneoplastic lesion of unknown etiology that occurs most commonly in the lung. However, it also occurs in diverse extrapulmonary locations: abdomen, retroperitoneum, pelvis, heart, head and neck, upper respiratory tract, trunk, bladder, and extremities. The extrapulmonary inflammatory pseudotumor is often larger, less-well circumscribed and multinodular. Proximity of the tumor to vital structures or involvement of vital organs compromises the opportunity for complete resection; thus higher recurrence rates are often reported even after surgical treatment. The authors report a case of inflammatory pseudotumor originating from common carotid artery in a 42-year-old female patient with a rapidly growing neck mass, treated by en bloc resection of inflammatory pseudotumor and a long segment of common carotid artery followed by polytetrafluoroethylene(PTFE) graft interposition.
Abdomen ; Adult ; Carotid Arteries* ; Carotid Artery, Common ; Extremities ; Female ; Granuloma, Plasma Cell* ; Head ; Heart ; Humans ; Lung ; Neck ; Pelvis ; Recurrence ; Respiratory System ; Transplants ; Urinary Bladder

BACKGROUND AND OBJECTIVES: Rhinovirus enters into airway epithelial cells via the membrane bound receptor ICAM-1. Infected epithelial cells secrete the cytokines such as IL-6 and IL-8, which induce neutrophil migration into the epithelium. Clarithromycin has been found to inhibit ICAM-1 production and secretion of IL-6 and IL-8. We hypothesized that these properties of clarithromycin may be applicable in treating rhinovirus infection. MATERIALS AND METHOD: We assayed the effects of clarithromycin on rhinovirus infected A549 cells. ICAM-1 expression was assessed by flow cytometry, and cytokine secretion was assayed by ELISA. The level of viral replication was expressed as viral titer, which was determined through viral culture on MRC-5 cells. RESULTS: The mean fluorescence intensity of ICAM-1 in rhinovirus infected cells decreased from 12.4+/-0.59 to 9.2+/-0.72 after treatment with clarithromycin. The production of IL-1beta, IL-6, and IL-8 was decreased after rhinovirus infected cells were treated with clarithromycin. In the absence of rhinovirus infection, clarithromycin had no effect on ICAM-1 expression or cytokine secretion. The rhinovirus titer in infected cells was 10(3.71) TCID 50 U/ml, which was reduced following clarithromycin treatment to 10(2.14) TCID 50 U/ml. CONCLUSION: These findings suggest that clarithromycin treatment of rhinovirus infected A549 cells inhibited rhinovirus induction of increased ICAM-1 expression, cytokine elaboration, and viral replication.
Clarithromycin* ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Epithelium ; Flow Cytometry ; Fluorescence ; Intercellular Adhesion Molecule-1 ; Interleukin-6 ; Interleukin-8 ; Macrolides ; Membranes ; Neutrophils ; Rhinovirus

BACKGROUND: Recently introduced plateletpheresis systems (AmicusTM software version 2.41 and MCS + LDP Rev. C) were evaluated for their performance. METHOD: Single-needle procedure was used for all donors, 127 with the AmicusTM and 85 with the MCS +. The targeted platelet yield was 3.2x1011. Components were evaluated for component yields, collection time, collection efficiency and incidence of donor reactions due to citrate. RESULTS: The collection time was significantly shorter with the AmicusTM (mean 57 min vs. 71 min, p< 0.05), and in 9 donors with a mean preapheresis platelet count of 325x103 /microliter the whole procedure could be completed within 40 minutes. However, the total processing time, including preprocessing and postprocessing time, between AmicusTM (78.0 min) and MCS + (74.3 min) was not statistically different. Mean platelet yield for AmicusTM and MCS + were 3.6x1011 and 3.4x1011, respectively. With 82.4% of SDPs collected with the MCS + having a platelet count of 3.0~3.9x1011, compared to 65.4% with the AmicusTM, the MCS + was more accurate in predicting the platelet yield of the final products. All components showed a residual WBC count of 5.0x106, and in 99.2% and 97.6% of components collected with the AmicusTM and MCS +, respectively, had a residual WBC count of less than 1.0x106. Mild donor reactions due to citrate tended to be more common on the MCS + (14.1%), which also used significantly more ACD (mean 342.5 mL vs. 268.0 mL, p< 0.05), than on the AmicusTM (5.5%). CONCLUSION: The plateletpheresis systems evaluated in this study allow the collection of leukoreduced SDPs of high quality within a reasonable time.
Blood Platelets ; Citric Acid ; Humans ; Incidence ; Platelet Count ; Plateletpheresis* ; Tissue Donors