To compare the efficiency, success rate and abortion time of applications of intravaginal misoprostol versus intravenous Sulprostone(Nalador) for mid-trimester pregnancy termination. Eighty three patients between 17-29 weeks of gestation with medical, obstetric, or genetic reasons for termination of pregnancy were randomized to receive either 50 ug tablets of misoprostol placed in the posterior vaginal fomix or 1,000ug sulprostone intravenously diluted I L of isotonic saline solution given as a 12-h infusion. Among eighty three patients recruited, fourty five patients received misoprostol and thirty eight patients received sulprostone intravenously. The average interval from start of induction to vaginal delivery was 13.35+/-3.34 hours in misoprostol group and 21.14+/-6.64 hours in the sulprostone group. The success rate of complete termination within 12 and 24 hours in misoprostol group were 57.7%, 93.3%, respectively, while in sulprostone group were 15.8%, 92.1% respectively. Oxytocin augumentation was 6.7% in misoprostol group and 7.9% in the sulprostone group. No serious complication occurred. Intravaginal misoprostol appears to be acceptably safe and effective agents for second trimester pregnancy termination. Misoprostol has the advantage of being inexpensive, easily stored and readily available. The regimen of 100 ug misoprostol inserted intracervicovaginally every 8 hours is the optimal method for pregnancy termination.
Female ; Humans ; Misoprostol* ; Oxytocin ; Pregnancy ; Pregnancy Trimester, Second* ; Sodium Chloride ; Tablets

No abstract available.
Female ; Humans ; Insulin* ; Lipoproteins* ; Pregnant Women* ; Triglycerides*

OBJECTIVE: We performed the transvaginal ultrasonographic evaluation of uterine cervix and fetal fibronectin in cervicovaginal secretions in women after 37 complete weeks of gestation to predict the onset of labor. METHODS: Total 80 primiparous or multiparous women were divided into two groups on the duration between evaluation and onset of labor. The biometric analysis of uterine cervix(cervical index, endocervical length, funneling, funnel length and width) was done by transvaginal ultrasonography. The cervicovaginal fetal fibronectin was measured by fetal fibronectin immunoassay (ELISA kit, Adeza Biochemical, USA). The efficacy of these method was analyzed with Pearson chi-square test, receiver-operator characteristic curves, and multiple logistic regression test. RESULTS: 1) There were no significant differences in clinical characteristics between two groups. 2) Group 1(onset of labor within 7 days after evaluation) showed significantly shorter endocervical length(Group 1: 2.33+/-0.75cm,Group 2: 2.93+/- 0.42cm, p=0.013), higher value of cervical index(Group 1: 1.27+/-0.67, Group 2: 0.62+/-0.34, p=0.008) and higher level of fetal fibronectin(Group 1: 98.65+/-11.34ng/ml, Group 2: 13.37+/- 2.7ng/ml, p=0.004). 3) The ROC curve analysis showed that a level of endocervical length <2.64mm, cervical index> 0.7, fetal fibronectin> 60ng/ml had the diagnostic performance in predicting group 1. Fetal fibronectin level in cervicovaginal secretion> 60ng/ml showed the highest diagnostic index in predicting the onset of labor within 7 days(p<0,001, odds ratio=21.3). CONCLUSION: Cervicovaginal fetal fibronectin predicts delivery within 7 days more accurately than cervical index, endocervical length. Combine use of these tests improve the diagnostic efficiency and allowed prediction of onset of labor, identifying a subgroup of patients who may require aggressive treatment.
Cervix Uteri ; Chi-Square Distribution ; Female ; Fibronectins* ; Humans ; Immunoassay ; Logistic Models ; Pregnancy* ; ROC Curve ; Ultrasonography*

OBJECTIVE: To compare the efficiency, success rate and abortion time between the live and the dead fetus in second trimester pregnancy termination with intravag-inal misoprostol. SUBJECTS AND METHODS: A total of 45 pregnant women between 18-29 weeks of gestation with medical, obstetric, or genetic reasons for termination were recruited to receive 50 ug misoprostol inserted intravaginally (posterior fornix) every 4 hours. RESULTS: The success rate of complete termination(abortion) within 12 and 24 hours in dead fetuses were 78.2% and 95.6%, respectively, while in live fetuses were 36.3% and 90.9%, respectively. The mean abortion time of the dead fetus group (10.31+/-3.43 hours) was significantly less than that of the live fetus group (14.20+/-3.31 hours). No serious complications occurred in terms of hemorrhage, diarrhea, nausea and vomiting. CONELUSION: Intracervicovaginal misoprostol is a safe and effective method for second trimester pregnancy termination. The abortion time is less in dead fetus pregnancy than that in the live fetus pregnancy.We used 50 ug tablets of misoprastol every four hours. But, we suspect that the regimen of 100ug misoprostol inserted intracervicovaginally every eight hours will beis the proper and optimal method for pregnancy termination.
Diarrhea ; Female ; Fetus* ; Hemorrhage ; Humans ; Misoprostol* ; Nausea ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women ; Tablets ; Vomiting

Continued improvements in treatments of the thoracolumber spine have occured in the last several years. The operative treatment of choice currently is short segment fusion(instrumentation one level above to one level below the injury). The development of pedicle screw systems has brought short segment fusion into clinical reality from the posterior approach. We analysed the clinical results of 20 patients with unstable fracture and fracture-dislocation of thoracolumbar spine who were treated with the posterior transpedicular screw system. The mean fol- low-up was 18 month. Ll was the most common injury level and the bursting fracture was the most common fracure type by Denis classification. The mean preoperative sagital index was 21.5。 and improved 8.1。 postoperatively. The mean preoperative anterior and posterior height of the vertebral height were 56.9% and 88.8% and improved postoperatively 94.7 and 88.8 respectively. The mean preoperative neural canal impingement in neural defici: patient was 47.2% and was improved 30.65% postoperatively. The mean prooperative ASIA motor was 34.1 and improved 41.7 postoperatively. There was no metal failure. These data suggested that the posterior transpedicular screw fixation, transpedicle bone graft, decompression and posterolateral bone graft was able to porvide sufficient stability and to achieve the neurologic improvement.
Asia ; Classification ; Decompression ; Humans ; Neural Tube ; Pedicle Screws ; Spine ; Transplants

This report is a review of experience with 45 patients plication methods of redundant rectal mucosa by longitudinal over and over suture who were admitted in department of surgery at Dongsan sacred Heart Hospital during 1997. This new technique was indicated by incomplete rectal prolapse, first degree complete rectal prolapse (internal rectal intussusception), 3rd degree hemorrhoids, redundant rectal mucosa in operation field, anal prolapse and severe external anal skin tag. At first, entire hemorrhoid-bearing area was dissected by excision and ligation methods. Within upward 1cm from ligationpoint, No.3 chromic catgut suture was done including rectal submucosa. Starting from this, linear continueous overlapping locking suture was done until redundant mucosa was tented by Chromic suture traction in range of 1 to 1.5 cm widths. If there is wide redundant mucosa not corrected one time, another linear continuous overlapping locking suture especially not circular may be done. This method is very easy and few complication-bleeding, pain, infection, mucosa loss, etc. The patients who have incomplete defecation sensation, rectocele and skin tag were satisfied with operation. This method may be an easy, effective new technique in patients who have anal prolapse, skin tag, rectocele and constipation etc.
Catgut ; Constipation ; Defecation ; Heart ; Hemorrhoids ; Humans ; Ligation ; Mucous Membrane* ; Prolapse ; Rectal Prolapse ; Rectocele ; Sensation ; Skin ; Sutures* ; Traction

PURPOSE: To correlate the CT findings of renal cell carcinomas with nuclear grading in histopathology. MATERIALS AND METHODS: Preoperative CT scans and pathologic nuclear grading of 60 surgically resected renal cell carcinomas in 55 patients were retrospectively and independently reviewed. RESULTS: As nuclear grade increased, renal cell carcinomas were more likely to be of higher stage(92% of nuclear grade III renal cell carcinomas was of stage Ill, all Grade IV tumors were of stage IIIb or higher) and greater size(84% of grade III tumors and 100% of grade IV tumors>5cm in size) at presentation, and appeared more heterogeneous(84% of grade III tumors and 88% of grade IV tumors showed moderate or severe heterogeneity) and less well marginated(84% of grade Ill tumors and 100% of grade IV tumors had irregular or imperceptible margins). CONCLUSION: Small well-marginated homogeneous renal cell carcinomas were either nuclear grade I or II, and were distinguishable from the more aggressive nuclear grade III or IV lesions, which generally displayed irregular margins and greater inhomogeneity.
Carcinoma, Renal Cell* ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: Mycobacterial culture is a confirmatory test to detect M.tuberculosis, but it takes at least 6 weeks to diagnose. PCR is a rapid and sensitive method, but it is known that PCR has a high false positive rate due to contamination, and a high false negative rate due to inhibitors. It is also known that LCR and PCR-Hybridization, recently developed methods, are more specific methods than PCR in terms of detection M.tuberculosis. In this study, we estimated the clinical utility of in house PCR, LCR and PCR-Hybridization for the detection of M.tuberculosis. METHODS: We evaluated 75 specimens, upon which M.tuberculosis culture based testing was requested, by PCR LCR, and PCR-Hybridization and compared results. Mycobacterial culture was performed on 3% Ogawa media for 8 weeks, and an in house PCR, LCx Mycobacterium tuberculosis assay kit(Abbott Laboratories, North Chicago, III) and the AMPLICOR M.tuberculosis test kit(Roche Molecular Systems, Inc. Branchburg, NJ, USA). RESULTS: In the view of the culture results, the sensitivities of the three tests were 40%, 80%, and 100% and their specificities were 98.6%, 94.3%, and 94.3%. CONCLUSION: LCR and PCR-Hybridization and rapid and sensitive methods for detecting M.tuberculosis in clinical laboratories.
Mycobacterium tuberculosis ; Polymerase Chain Reaction* ; Tuberculosis*

Epidermolysis bullosa dystrophica is rare, chronic non-inflammtory mechanobullous disease of hereditary trait, which easily produces bullae by minor trauma or sponta neosly. A 1-day old male neonate presented wide spread vesicobullous minor, eruptions since birth. On examination, tense bullse were noted on the dorsa of the feet and right knei: area Which is usually serous but may be hemarrhagic tendeney. This was healed by the dropping of oxoline and wet betadine auze application along with the administration of vitamin E and phenytoin. We present a case of epidermolysis bullosa dystrophica that seems be a dominant type considering the presence of family history with histopathologic and electron microscopic findings.
Epidermolysis Bullosa Dystrophica* ; Epidermolysis Bullosa* ; Foot ; Humans ; Infant, Newborn ; Male ; Parturition ; Phenytoin ; Povidone-Iodine ; Transcutaneous Electric Nerve Stimulation ; Vitamin E ; Vitamins

The acardius occurs with an incidence of one in 35,000 births and is presumed to result hom vascular anastomosis between the arterial circulation of the hemodynamically larger ""pump"" twin and that of the recipient ""perfused"" twin. The perfused twin displays severe anomalies, typically referred to as acardia, that are incompatible with life. The pump twin, because of its expanded cardiac demand, may also deveolp cardiac failure, with a mortality risk of 50-70%. We experienced one case of acardiac-acephalus twin gestation diagnosed by antenatal ultrasonography, and presented this.
Heart Failure ; Humans ; Incidence ; Mortality ; Parturition ; Pregnancy ; Twins* ; Ultrasonography*