To evaluate the clinical efficacy of emergency cervical cerclage in the treatment of advanced cervical incompetence, a prospective clinical trial was performed in 18 patients with advanced cervical incompetence at 20 to 25 weeks gestation. Modified McDonalds operation with or without transabdominal amniocentesis was used for cervical cerclage. Pregnancy was prolonged for a sufficient time to deliver viable fetuses in 56.3% of patients. The median procedure-to-delivery interval was 8.6 (range 0.1 to 20.5) weeks for the entire group, and 13.9 (range 6.5 to 20.5) weeks for 9 patients who achieved live birth. The median gestational age at delivery was 38.6 (range 28.3 to 41.0) weeks for the live infants. The median birthweight of the live infants was 3062 g (range 1050 to 3620 g). The lack of significant matemal morbidity combined with the results for the fetus-infant supports further efforts in this area.
Amniocentesis ; Cerclage, Cervical ; Emergencies* ; Fetus ; Gestational Age ; Humans ; Infant ; Live Birth ; Pregnancy ; Prospective Studies

OBJECTIVES: To study the distributions of pH and gas values in umbilical arterial(UA) blood of normal newborns following uncomplicated pregnancies and vaginal births. Methods: In 457 consecutive normal term infants who were born between March 1995 and June 1998, we examined the UA pH and blood gas values obtained immediately following delivery. Maternal inclusion criteria were defined as an uncomplicated singleton pregnancy and a normal full term spontaneous vaginal delivery. And also neonatal inclusion criteria were defined as a normal intrauterine growth appropriate for gestational age without any malformations and Apgar score of 7 or more at both one and five minutes after birth. Umbilical artery blood samples were collected at each birth and were evaluated for pH, carbon dioxide pressure (PaCO2), oxygen pressure (PaO2) and actual bicarbonate. RESULTS: Histogram of UA pH value resemble normal distribution curve. The lowest UA pH was 7.04 and the 10th percentile value was 7.23. The median UA pH was 7.31 and 5% was below 7.20. The lowest UA PaO2 was 4.6mmHg and the 10th percentile value was 11.5mmHg. The highest UA PaCO2 was 67.2mmHg and the 90th percentile value was 56.5mmHg. The lowest bicarbonate value was 13.2mmol/L and the 10th percentile value was 18.4mmol/L. CONCLUSION: The distributions of the UA pH and gas values of the collective of normal newborns were illustrated. None of the UA pH was below 7.0.
Apgar Score ; Blood Gas Analysis* ; Carbon Dioxide ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Newborn* ; Oxygen ; Parturition ; Pregnancy ; Umbilical Arteries*

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

OBJECTIVE: This study was performed to evaluate the feasibility, safety, and tolerance of early postoperative oral feeding in gynecologic patients who have underwent intra-abdominal surgery. Thus, we investigated the clinical efficacy of early postoperative oral feeding in gynecologic patients, prospectively. METHODS: From September 1998 to March 1999, we studied 80 gynecologic patients undergoing laparotomy at Department of Obstetrics and Gynecology, Yonsei University College of Medicine, prospectively. After surgery, the patients were grouped into two arms; the first early oral feeding group began a clear liquid diet on the first postoperative day and advanced to regular diet as tolerated. the second control group received nothing by mouth until return of bowel function. RESULTS: Although more patients in the study group developed nausea, the incidence of vomiting and abdominal distension were comparable in both groups. Time to development of bowel sound and flatus were significantly shorter in study group. Postoperative complications including pneumonia, atelectasis, wound complications, and febrile morbidity occurred insignificantly in both group. Postoperative changes in hematologic indices and electrolytes were comparable in both group. CONCLUSION: Early postoperative oral feeding in gynecologic patients undergoing intra-abdominal surgery is safe, well tolerated. We believe that re-evaluation of postoperative surgical care may increase our knowledge and better serve our patients.
Arm ; Diet ; Electrolytes ; Flatulence ; Gynecology ; Humans ; Incidence ; Laparotomy ; Mouth ; Nausea ; Obstetrics ; Pneumonia ; Postoperative Complications ; Prospective Studies ; Pulmonary Atelectasis ; Vomiting ; Wounds and Injuries

The association of major fetal malformations with amniotic bands has been known for many years. However, we are apt to ignore the possibility of amniotic band syndrome. In this case, fetal anencephaly was diagnosed at 17 weeks, menstrual age on the basis of sonographic findings. Following pregnancy termination, examination of the abortus rev- ealed the cerebral remnant which is similar to that found in dysraphic anencephaly, but collateral evidence of amniotic band was found. Therefore, when confronted with severe cranial or cerebral malformation amniotic band syndrome should be in the differential dia- gnosis.
Amniotic Band Syndrome* ; Anencephaly* ; Infant, Newborn ; Pregnancy ; Skin* ; Ultrasonography

Most proximal humeral fractures respond satisfactorily to conservative treatment. It is only the occasional displaced fracture or fracture-dislocation that demaads special treatment. The purpose of this study is to analysis the results of closed and open reduction of displaced proximal humeral fractures according to Neers classification. Fifty-two cases of these fractures, followed up more than five months, are presented. 1. The average age of patients was 40. I years. 2. The fractures were classified according to Neers method. Nearly half (48.1%) of the cases were one-part fractures. Next, two-part fractures rated 42.3%, while three-part fractures, only one (l.9%). 3. Among the total 52 patients, 42 cases(80.8%) were treated conservatively and 10 were operated. We performed surgical operations in seven cases among 22 two-part fractures, aix were reduced with Kirschner wires and one treated with Kirschner wire and staple. The average age of these seven cases was 26. 6 years and the resulta were good except one. 4. The results of these patients were evaluated by the Neers criteria. Of 52 caaes, 40 had good results, five, fair, and the remaining seven poor results. Twenty-three cases (92%) in 25(100%) one-part fractures were good and 17 cases (77.3%) in 22 (100%) two-part fractures were also good. In three-part and four-part fractures the results were all poor.
Bone Wires ; Classification ; Humans ; Methods ; Shoulder Fractures

Dislocation of the hemate bone is very rare. There is no reported case in Korea. The mechanism of injury may be attributed to direct trauma. We have experiened a case of dislocation of the hamate bone, treated it by open reduction and internal fixation using two Kirschner wires. The result was satisfactory. A case of dislocation of the hamte bone is reported with brief review of literature.
Bone Wires ; Dislocations ; Hamate Bone ; Korea

A clinical analysis was done on 129 patients (131 cases) of the ankle fractures that were admitted and treated in Orthopedic Department, Inchon Christian Hospital from January 1973 to December 1980. The following results were obtained: l. Of the 129 patients, male was 104 patients and female 25 patients, the average age of the patients was 37. 2. The main cause of the injuries was traffic accident (38.2%), and the remain causes were industrial accident (28.2%), fall down (18.3%), slip down (11.5%), and sports injury (3.8%) in order. 3. The most common type by Lauge-Hansen classification was supination-external rotation type (37.4%). 4. In method of treatment, operative treatment was done in 72 cases and nonoperative in 59 cases. 5 The average duration of the cast immobilization in nonoperative treatment was 8 weeks and operative 7 weeks. 6. The better result was obtained by operative treatment than nonoperative one. 7. The most poor result was noticed in pronation-external rotation type according to Lauge-Hansen classification. 8. We agree that the accurate reduction of the lateral malleolus make the talus in good anatomic position in ankle joint. 9. We agree that Lauge-Hansen classification is useful in diagnosis and treatment of ankle fracture.
Accidents, Occupational ; Accidents, Traffic ; Ankle Fractures ; Ankle Joint ; Ankle ; Athletic Injuries ; Classification ; Clinical Study ; Diagnosis ; Female ; Humans ; Immobilization ; Incheon ; Male ; Methods ; Orthopedics ; Talus

One hundred and seventy-two cases of tuberculosis of the bones and joints were treated at the department of orthopedic surgery, Inchon Christian Hospital during the 3 years and 10 months from March, 1979, to December, 1982. The results obtained were as followings: 1. The incidence was decreased progressively 1.92% in 1980 to 1.18 in 1982. 2. Tuberculous lesions involved spine(50.58%), knee(16.28%), hip(13.37%), ankle(2.33%) and greater trochanter(2.33%) in order. 3. Age and sex distribution were not remarkable. 4. The main associated tuberculous lesions were pulmonary tuberculosis and tuberculous pleurisy (20.65%). Therefore, pulmonary problems should be always carefully investigated in every case of skeletal tuberculosis. 5. Average duration of disease was one year and 3.5 months, average hospital days was one month. 6. Initial miss diagnosis of lesions ultimately proved to be tuberculosis. Rheumatoid arthritis:13 cases, Osteoarthritis : 3 cases, Herniated lumbar disc: 3 cases, Cellulitis :2 cases, Neoplasm :2 cases. Early diagnosis is essential since proper therapy is available and far advanced destruction, long suffering and disability can be avoided. 7. Post operative complication was mainly due to failure of bone graft in tuberculous spondylitis and was draining sinus formation and wound disruption in other skeletal tuberculosis. 8. The result of treatment of skeletal tuberculosis from conservative methods were relatively poor. The corroboratory care of skeletal tuberculosis can be obtained by extensive surgery.
Cellulitis ; Diagnosis ; Early Diagnosis ; Incheon ; Incidence ; Joints ; Orthopedics ; Osteoarthritis ; Sex Distribution ; Spondylitis ; Transplants ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary ; Wounds and Injuries

In the review of a series of 71 clavicle shaft fracture that were treated with open reduction and internal fixation, we tried a direct comparison between two fixation modes, that is, the fixation with plate and screws (54 cases) and the intramedullary nailing with Knowles pin (17 cases). The average time to healing was not significantly different between the two group; 10.8 weeks after the plating and 11.7 weeks with Knowles pinning. The rate of successful healing within four months after the surgery were also high in both groups: one delayed union and one nonunion in the plate group, and one delayed union in the Knowles pin group. There was one loosening in the Knowles pin group, which needed reoperation. Intramedullary fixation has several advantages compared with fixation with a plate and screws. It can be performed through a shorter incision: less dissection of soft tissue is needed: and, after healing, the pin is easily removed through a small incision under local anesthesia.
Anesthesia, Local ; Clavicle ; Fracture Fixation, Intramedullary ; Reoperation