No abstract available.
Cell Proliferation* ; Female ; Humans ; Trophoblasts*

Intramural pregnancy is one of the rarest form of ectopic pregnancy that only 20 cases have been reported in the world so far. Pathologically, the location of the gestational sac is completely isolated from the uterine cavity and entirely surrounded by myometrium without any contact of endometrium. Many reports noted that there would be possible relationship between the intramural pregnancy and prior uterine traumatic factor- curettage, cesarean section, myomectomy, salpingectomy, and manual removal of the placenta and so on. We have recently experienced a case of intramural pregnancy following curettage, managed completely by the laparoscopic excision and additive single dose intramuscular MTX treatment. So, we report this case with a brief review of the literature.
Animals ; Cesarean Section ; Curettage ; Endometrium ; Female ; Gestational Sac ; Mice ; Myometrium ; Placenta ; Pregnancy* ; Pregnancy, Ectopic ; Salpingectomy

OBJECTIVE: To compare the abortion time, success rate and efficiency of application of intravaginal misoprostol versus intracervical laminaria insertion and intravenous sulprostone administration for mid-trimester pregnancy termination. MATERIAL: Patients requesting termination of second trimester pregnancy were randomized into two groups. In Group I, the women were given 200 microg tablet of misoprostol placed in the posterior vaginal fornix. In Group II, the women were given laminaria insertion in cervical canal with intravenous sulprostone administration. Altogether 50 subjects were recruited with 25 women in each group. RESULTS: The mean interval from start of induction to vaginal delivery was 1480.84+/-37.73 minutes in Group I and 1236.16+/-77.59 minutes in Group II(p=0.232). The success rate of termination within 48 hours in Group I and Group II were 84%, 92%(p=0.384). There were no significant differences in the mean interval time and success rates. Measurement of blood loss(differs in hemoglobin between the admission and postabortive 24 hours) shows in Group I(1.0352+/-0.5774) and in Group II(1.5640+/-0.8976). Mean changes in hemoglobin level were significantly lesser in the misoprostol group(p=0.017). No serious complication occurred. CONCLUSION: Intravaginal misoprostol appears to be acceptably safe and effective agents for second trimester pregnancy termination.
Female ; Humans ; Laminaria* ; Misoprostol* ; Pregnancy Trimester, Second ; Pregnancy*

No abstract available.
Hysterectomy*

BACKGROUND: Thirty children ranging from 3 to 15 years of age underwent cardiac valve replacement at Dongsan Medical Center from 1982 to 1997. MATERIAL AND METHOD: There were 16 boys and 14 girls. The mean age was 12.1. The underlying pathological cause for valve replacement was congenital heart disease in 17 children and acquired heart disease in 13. The valve replaced was mitral in 15 children, aortic in 11, tricuspid in 3, and combined aortic and mitral in 1. Twenty-one mechanical and 10 tissue valves were placed: primary mechanical valve have been utilized since 1985. Eight of ten patients with tissue valves have had successful second valve replacements 4 to 11 years after the initial operation. RESULT: The operative mortality was 6.7%, but mortality was higher among patients less than 5 years of age and patients who had previous cardiac operations. Of the 28 operative survivors, 4 patients were lost to follow-up: the remaining patients were observed for a total of 2091 patient/months(mean 74.7 months, maximum 187 months). There was one late death from dilated cardiomyopathy after mitral valve replacement in 7 year-old patient with atrioventricular septal defect. After the operation, all patients with mechanical valves were placed on a strict anticoagulant regimen with Coumadin. The actuarial survival rate was 96% at the end of the follow-up. No instance of thromboembolism or major bleeding were observed in the survivors. CONCLUSION: These results indicate that valve replacement can be performed with low mortality in children, and with satisfactory long-term survival.
Cardiomyopathy, Dilated ; Child* ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Diseases ; Heart Valves ; Hemorrhage ; Humans ; Lost to Follow-Up ; Mitral Valve ; Mortality ; Survival Rate ; Survivors ; Thromboembolism ; Warfarin

OBJECTIVES: The nickel and cobalt present in many industrial working environments and consumer products. They are two of the leading causes of allergic contact dermatitis, which is a typical delayed(type IV) hypersensitivity reaction. However, the mechanism by which nickel and cobalt causes this pathology is not well known. The nickel and cobalt induced contact dermatitis is mediated primarily through macrophages. This mechanism is similar to the autotoxicity procedure for NO. Therefore, this study was designed to examine whether the metals could modulate NO production and how the metals may affect ATP production and cell viability. In summary, the purpose of this study was to elucidate the role of NO in the nickel and cobalt induced cytotoxicity. METHODS: This study is based on observations of cultures of RAW 264.7 cells which are originated from a tumor of Balb/c mouse that was induced by Abelson murine leukemia virus. RAW 264.7 cells were treated with either Ni, Co, Ni plus Co, or Nmonomethyl-L- arginine(NMLA) for 24-72 h. The cytotoxicity of the nickel and cobalt was measured by cell viability and NO2-, and mitochondrial function was evaluated by adenosine triphosphate(ATP) production in RAW 264.7 cells. In addition, the morphology of cells was observed using an inverted microsope. RESULTS: The NO2- synthesis of RAW 264.7 cells increased with increasing concentrations of Ni and Co up to 50 microM after 24 and 48 h of exposure to Ni and Co but then decreased if the concentration was greater than 50 microM and the time period was greater than 48 h. However, the viability of cells was decreased by Ni and Co exposure in a dose and time dependent manner. Therefore, 50 microM Ni or Co and 48 h of treatment were used in this study. A complete inhibition of NO2- synthesis by Ni or/and Co occurred when iNOS inhibitor, NMLA, were pretreated prior to addition of Ni or/and Co, whereas Ni or/and Co induced decrease of synthesis of ATP and viability completely recovered when NMLA were pretreated prior to addition of Ni or/and Co. Ni or/and Co(50 microM) induced the characteristic morphological features of cytotoxicity which is characterized by a shrinkage of cytoplasm and irregular shape of the cells, but the pretreatment of NMLA resulted in a recovered morphological change of the cells to their normal appearance. CONCLUSIONS: These results suggest that NO plays an important role in the pathogenesis of the cytotoxicity of nickel and cobalt, and nickel and cobalt may exert their toxicities by means of modulation of NO production. The results from this study may facilitate further understanding the role of NO on nickel and cobalt induced immune and inflammatory processes.
Abelson murine leukemia virus ; Adenosine ; Adenosine Triphosphate ; Animals ; Cell Survival ; Cobalt* ; Cytoplasm ; Dermatitis, Allergic Contact ; Dermatitis, Contact ; Hypersensitivity ; Macrophages ; Metals ; Mice ; Nickel* ; Nitric Oxide* ; Pathology

Systolic coronary arterial narrowing, secondary to myocardial bridging which is capable of producing chest pain, myocardial infarction and ventricular fibrillation is a known but an uncommon entity. A supra-arterial myotomy in a case of myocardial bridge causing medication-refractory angina is described. Under the partial sternotomy incision, we performed a supra-arterial myotomy in the left anterior descending coronary artery without cardiopulmonary bypass. The postoperative course was uneventful.
Cardiopulmonary Bypass* ; Chest Pain ; Coronary Vessels ; Myocardial Bridging* ; Myocardial Infarction ; Sternotomy ; Ventricular Fibrillation

BACKGROUND: All currently available mechanical and bioprosthetic valves are associated with various types of deterioration leading to dysfunction and/or valvular complications. Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. This review was conducted to determine the factors affecting the risk of reoperation for prosthetic valve replacement. MATERIAL AND METHOD: From January 1985 to July 1996, 124 patients underwent reoperation on prosthetic heart valves, and 3 patients had a second valve reoperation. The causes of reoperation were prosthetic valve failure (96 cases, 77.4%), prosthetic valve thrombosis (16 cases, 12.9%), prosthetic valve endocarditis (7 cases, 5.6%) and paravalvular leak (5 cases, 4.1%). This article is based on the analysis of the experience with particular emphasis on the preoperative risks affecting the outcome of the reoperation. RESULT: Overall hospital mortality rate was 8.9% (11/124). Low cardiac output was the most common cause of death (70.6%). Left ventricular systolic dimension (p=0.001), New York Heart Association functional class IV (p=0.003) and serum creatinine level (p=0.007) were the independent risk factors, but age, sex and cardiothoracic ratio did not have any influence on the operative mortality. Follow-up period was ranged from 3 to 141 months (mean, 50.6 months). A late mortality rate was 1.8%. CONCLUSION: The surgical risk of reoperation on heart valve prostheses in the advanced NYHA class patients is higher, therefore reoperation is recommended before the hemodynamic impairment become severe.
Cardiac Output, Low ; Cause of Death ; Creatinine ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis* ; Heart Valves* ; Heart* ; Hemodynamics ; Hospital Mortality ; Humans ; Mortality ; Reoperation ; Risk Factors ; Thrombosis

The purpose of this study was to determine the meaning of the pain and experiences of elderly women with osteoarthritis, by adopting Colaizzi's phenomenological method. The participants were 7 elderly women over the age of 65. They were selected using a theoretical sampling technique. The Data was collected by in-depth and open-ended interviews from Dec. 1. 1999. to Feb, 28. 2000. The length of the interviews varied from 120 minutes to 180 minutes. Data was recorded and analyzed by a constant comparative method. From the data, significant statements were extracted and then organized into 48 themes, which resulted in 15 clusters of themes and 6 categories. The final descriptions turned out to be valid through the interviewee' validation process. Essential themes of the pain experiences emerged : "physical discomfortness(disturbances)", "negative state of mind", "influence of the death", "positive change in life", "Cause of pain perceived", and "change of their personal relationships". From these results, it was found that elderly women need nursing care based on a deep understanding of pain, and a reflection on their past is imperative to overcome their given situations. In conclusion, it is suggested that the care givers provide more support to solve the problems experienced by the elderly. Thus the researchers expect to provide understanding of older people and give basic data of holistic care for them.
Aged* ; Arthritis ; Caregivers ; Female ; Humans ; Nursing Care ; Osteoarthritis*

PURPOSE: The increasing prevalence and global spread of carbapenem-resistant Acinetobacter baumannii (A. baumannii) has become a serious problem. The aim of this study was to investigate molecular and epidemiological characteristics of carbapenem-resistant A. baumannii isolates collected from Korean non-tertiary hospitals. MATERIALS AND METHODS: Thirty six non-duplicated carbapenem-resistant A. baumannii isolates were collected from 17 non-tertiary hospitals in Korea between 2004 and 2006. Isolates were typed by multilocus sequence typing and repetitive-sequence-based PCR (rep-PCR). Detection of genes encoding OXA carbapenemase and their relationship with ISAba1 was performed by PCR. RESULTS: Two clones were prevalent among 36 isolates: ST69 (17 isolates, 47.2%) and ST92 (19 isolates, 52.8%). Rep-PCR patterns were diverse and revealed that all isolates were clustered into eight band patterns. The ISAba1-activated blaOXA-23-like and ISAba1-activated blaOXA-51-like genes were prevalent among the carbapenem-resistant A. baumannii isolates. CONCLUSION: The class D beta-lactamase genes of A. baumannii were distributed nationwide in non-tertiary Korean hospitals.
Acinetobacter Infections/epidemiology/*microbiology ; Acinetobacter baumannii/classification/*genetics ; Anti-Bacterial Agents/therapeutic use ; Bacterial Typing Techniques ; Carbapenems/*therapeutic use ; DNA, Bacterial/analysis ; *Drug Resistance, Bacterial ; Hospitals ; Humans ; Microbial Sensitivity Tests ; Molecular Epidemiology ; Multilocus Sequence Typing ; Polymerase Chain Reaction ; Prevalence ; Republic of Korea ; beta-Lactamases/genetics