PURPOSE: To evaluate a role as over 35 years, maternal serum markers, and a false positive screen for Down syndrome were the predictor of adverse pregnancy outcome. Materials and METHODS: From Mar.1994, through Feb.1996, 5284 women were screened triple test to detect Down syndrome in the second trimester and were delivered Samsung Cheil hospital. The values of each maternal serum markers were measured with radioimmunoassay. And then, the screen positive of Down syndrome was calculated using alpha-software Version 4.0. The adverse outcome of the fetus and the mother included low birth weight(LBW) ( <2500gm), prematurity( <37 gestational weeks), placenta previa, preterm premature rupture of membranes(PPROM), pregnancy induced hypertension(PIH),abruptio placenta, and intrauterine fetal death(IUFD). The predictor markers included over 35years, elevated alpha-fetoprotein (AFP), elevated human chorionic gonadotropin(hCG), lowered unconjugated estriol (uE3), and a false positive screen for Down syndrome. RESULTS: Mean age and mean gestational weeks in the study were 30+/-4.8 years and 17.1 weeks respectively. The adverse pregnancy outcomes were 357 LBW(6.8%), 253 prematurity(4.8%), 108 placenta previa(2.0%), 68 PPROM(1.3%), 66 PIH(1.3%), 24 abruptio placenta(0.5%), and 20 IUFD(0.4%). In univariate analysis, over 35 years was significantly associated with abruptio placenta, prematurity, and placenta previa, elevated MS-AFP( >2.0 MoM) associated with IUFD, LBW, PIH, prematurity, and PPROM , elevated MS-hCG (>3.0 MoM) associated with IUFD, LBW, PIH, prematurity, and placenta previa, lowered uE3 (<0.75) associated with IUFD, abruptio placenta, LBW, and prematurity.(P <0.05). In multivariate logistic regression analysis, IUFD was significantly associated with only elevated MS-AFP, LBW associated with elevated MS-AFP, elevated MS-hCG, and lowered uE3, PIH associated with only elevated MS-AFP, PPROM only elevated MS-AFP, prematurity only elevated MS-AFP, and placenta previa over 35 years, elevated MS-hCG.(P <0.05). However, abruptio placenta was not significantly associated with predictor markers.(P >0.05) CONCLUSIONS: Some predictors such as over 35 year, elevated hCG, lowered uE3, a false positive screen for Down syndrome were significantly associated with adverse pregnancy outcome. Also in multivariate analysis, we identified especially elevated AFP to be the most reliable predictor for adverse pregnancy outcome.
alpha-Fetoproteins ; Biomarkers ; Chorion ; Down Syndrome ; Estriol ; Female ; Fetus ; Humans ; Logistic Models ; Mothers ; Multivariate Analysis* ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Trimester, Second ; Pregnancy* ; Radioimmunoassay ; Rupture

Proinflammatory cytokines and their receptors are increased in the peripheral blood of patients with heart failure. We measured cytokines and their receptors in systemic artery (SA), coronary sinus (CS) and infra-renal inferior vena cava (IVC), in order to investigate their origin and influential factors. Thirty patients with idiopathic dilated cardiomyopathy were performed echocardiography at admission, and right heart catheterization after stabilization. Blood was drawn from 3 sites for measurement of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and soluble tumor necrosis factor- receptor (sTNFR) I, II. TNF-alpha at CS (3.25+/-0.34 pg/mL) was higher than those of SA (1.81+/-0.39 pg/mL) and IVC (1.88+/-0.38 pg/mL, p<0.05). IL-6 at CS (18.3+/-3.8 pg/mL) was higher than that of SA (5.8+/-1.2 pg/mL, p<0.01). The levels of sTNFR I, II showed increasing tendency in sequence of SA, IVC and CS. TNF-alpha and sTNFR I, II from all sites were proportional to worsening of functional classes at admission (p<0.05). E/Ea by Doppler study at admission, which reflects left ventricular end-diastolic pressure (LVEDP) was positively correlated with TNF-alpha from SA (R=0.71, p<0.01), CS (R=0.52, p<0.05) and IVC (R=0.46, p<0.05). Thus, elevated LVEDP during decompensation might cause cytokine release from myocardium in patients with idiopathic dilated cardiomyopathy.
Adult ; Aged ; Cardiomyopathy, Congestive/*blood/*immunology ; Female ; Heart/anatomy & histology ; Hemodynamic Processes ; Human ; Interleukin-6/*blood ; Male ; Middle Aged ; Receptors, Tumor Necrosis Factor/*blood ; Statistics ; Tumor Necrosis Factor/*metabolism

Mirizzi syndrome is a rare complication, resulting in bile duct obstruction and jaundice that usually arise from impacted gallstone in the cystic duct or neck of the gallbladder. It is vitally important to confirm underlying cystic duct anomaly in Mirizzi syndrome since it can produce surgical difficulty and higher complications. Generally, Mirizzi syndrome is treated surgically while endoscopic treatment is limited. Herein, we present Mirizzi syndrome with low lying cystic duct and remnant cyst duct calculi treated successfully by biliary stent and administration of choleretic agent, following by balloon dilatation on cystic duct and balloon extraction of the stone.
Calculi ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholestasis ; Cystic Duct* ; Deception* ; Dilatation ; Gallbladder ; Gallstones ; Humans ; Jaundice ; Mirizzi Syndrome* ; Neck ; Stents

Mirizzi syndrome is a rare complication, resulting in bile duct obstruction and jaundice that usually arise from impacted gallstone in the cystic duct or neck of the gallbladder. It is vitally important to confirm underlying cystic duct anomaly in Mirizzi syndrome since it can produce surgical difficulty and higher complications. Generally, Mirizzi syndrome is treated surgically while endoscopic treatment is limited. Herein, we present Mirizzi syndrome with low lying cystic duct and remnant cyst duct calculi treated successfully by biliary stent and administration of choleretic agent, following by balloon dilatation on cystic duct and balloon extraction of the stone.
Calculi ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholestasis ; Cystic Duct* ; Deception* ; Dilatation ; Gallbladder ; Gallstones ; Humans ; Jaundice ; Mirizzi Syndrome* ; Neck ; Stents

Persistent Müllerian duct syndrome (PMDS) is a pseudohermaphroditism in males characterized by the presence of Müllerian duct derivatives. As PMDS dogs often lack clinical symptoms, a molecular diagnosis is essential to identify the syndrome in these animals. In this study, a new molecular method using DNA mismatch-specific Surveyor nuclease was developed. The Surveyor nuclease assay identified the AMHR2 mutation that produced PMDS in a Miniature Schnauzer as accurately as that obtained by using the conventional method based on restriction digestion. As an alternative to the current molecular diagnostic method, the new method may result in increased accuracy when detecting PMDS.
Animals ; Diagnosis ; Digestion ; Disorders of Sex Development ; DNA ; Dogs ; Humans ; Male ; Methods ; Pathology, Molecular

The association of nephrotic syndrome with a hypercoagulable state and vascular thrombosis is well recognized. In all adult series of nephrotics, venous thrombosis are much more common than arterial thrombosis, which has been mainly reported in children. Intracoronary thrombus is among the rarest arterial thromboses. We present a case of acute myocardial infarction in a 39-year-old women with nephrotic syndrome secondary to membranous glomeluronephritis, in which subsequent coronary angiography showed no evidence of atherosclerotic change and thrombotic occlusion in the left main coronary artery which was successfully treated with intracoronary stent and intravenous abciximab.
Adult ; Child ; Coronary Angiography ; Coronary Vessels ; Female ; Glomerulonephritis, Membranous* ; Humans ; Myocardial Infarction ; Nephrotic Syndrome ; Stents* ; Thrombosis* ; Venous Thrombosis

BACKGROUND AND OBJECTIVES: It has been shown that the coronary flow reserve (CFR) of an infarct related artery can predict left ventricular functional recovery following acute myocardial infarction (AMI). However, the prognostic value of CFR on the long-term clinical outcome of patients with an AMI has not been studied. SUBJECTS AND METHODS: Using a Doppler guide wire, we measured the CFR in 130 patients with an AMI following successful intervention (6+/-3 days after onset of the AMI). Two-year follow-up was conducted with regard to end points, including : cardiac death, non-fatal AMI, and severe congestive heart failure (CHF; > or = NYHA III). RESULTS: During the follow-ups, cardiac events occurred in 17 patients (5 deaths, 3 non-fatal AMIs and 9 severe CHFs). After analysis of the receiver operating characteristic curves, the best cut-off value for CFR in predicting cardiac events was 1.4 (sensitivity 76.5%, specificity 73.5%, accuracy 82.0%). With cardiac events as an end point, a 2-year Kaplan-Meier event survival analysis revealed that the patients with a CFR < or = 1.4 had a worse prognosis than those with a CFR >1.4 (Event free survival rates were 69.8% vs. 95.4%, respectively, p<0.001). Using Cox proportional hazard analyses, as an independent predictor, age, heart rate, CFR and left ventricular end systolic volume index, were also found to be significantly associated with cardiac events (hazard ratios 1.1224, 1.0404, 0.1887, and 1.0588, respectively). CONCLUSION: The coronary flow reserve, of infarct related arteries, measured during the early recovery phase can be used as an independent predictor for the prognosis of patients with an acute myocardial infarction following successful intervention.
Arteries ; Coronary Circulation ; Death ; Follow-Up Studies ; Heart Failure ; Heart Rate ; Humans ; Myocardial Infarction* ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Stroke Volume ; Survival Rate

Objective: Personal mobility vehicles (PMV) have been used widely as a means of replacing bicycles in recent yearsbecause of their convenience and high economic efficiency. On the other hand, accidents related to PMV are alsoincreasing, but there have been few studies in this area. This study examined the factors that increase the severity ofdamage and determine the characteristics of the PMV compared to the accidents on a bicycle. Methods: Retrospective observational studies were performed. The variables related to the accident were collected andanalyzed for patients who visited the emergency room due to a PMV and bicycle accident. Multivariate logistic regressionanalysis was used to determine the factors affecting the severity of the patients. The odds ratios were calculated andcompared between injuries related to PMV and bicycles. Results: A total of 1,124 patients (bicycles 1,017, PMV 107) were enrolled in this study. In multivariate regression analysis,the severity of PMV was higher (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.06-2.83) than that of a bicycle.The factors affecting the severity of the patients were age (OR, 1.02, 95% CI, 1.01-1.03), alcohol use (OR, 1,70; 95% CI,1.04-2.70), ambulance transport (OR, 2.46; 95% CI, 1.78-3.40), and wearing a helmet (OR, 2.06; 95% CI, 1.36-3.13). Conclusion PMV showed higher severity of damage than a bicycle. The PMV, which is a new transportation means, isinsufficient for the prevention of safety compared to bicycles where driving regulations and wearing protective equipmentare common. Additional studies on the precise mechanisms of injury and damage are expected to prevent accidents andreduce their severity.

Objective: No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED. Methods: This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance. Results: This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667–0.791] vs. 0.681 [0.613–0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613–0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762–0.867) and 0.806 (0.754–0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00–1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02–1.11; P=0.002). Conclusion Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/ septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.
Arm ; Arteriovenous Fistula* ; Follow-Up Studies ; Forearm* ; Humans ; Kidney Failure, Chronic ; Male ; Ocimum basilicum* ; Renal Dialysis ; Transplants ; Veins*