By means of hospital-based data over 8 years we sought to evaluate the clinical indications and incidence of emergency peripartum hysterectomy by demographic characteristic and reproduction history. From the obstetric record of all deliveries at Chung Goo Hospital between Jan. 1, 1990, and Nov. 31, 1997, we identified all women undergoing emergency cesarean hysterectomy, calculated incidence rates, conducted statistical tests of linear trends and heterogenety, and observed the clinical indicatons preceding the onset of this procedure. There were 16731 deliveries during this period, Cesarean hysterectomy was performed in 24 of 5993 cesarean sections(0.40%) and in 10 of 10738 vaginal deleveries(0.09%), so more frequently after cesarean section than vaginal delivery. The age of patients varied from 22 to 40 years old. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(52.94%) followed by placental disorders(41.18%), uterine myoma with pregnancy(2.9%) and uterine rupture (2.9%). All patients who had hysterectomy received transfusion from 1 pint to 57 pints. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coaguolopathy and wound disruption. There were three maternal deaths, the cause was disseminated intravascular coaguolopathy and amniotic embolism. The data identifiy uterine atony as the primary cause for gravid hysterctomy. The data also illustrated how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidity remained high.
Adult ; Cesarean Section ; Embolism ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period* ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Reproduction ; Urinary Bladder ; Uterine Inertia ; Uterine Rupture ; Wounds and Injuries

No abstract available.
Apoptosis* ; Cell Line* ; Colon* ; Colonic Neoplasms* ; Etoposide*

PURPOSE: We evaluated the usefulness of quantitative spiral CT to predict postoperative lung function in patients undergoing pulmonary resection. MATERIALS AND METHODS: Fourteen patients in whom pneumonectomy or segmentectomy were performed underwent preoperative chest spiral CT and pulmonary function test(PFT). Six patients underwent postoperative follow-up PFT. Ten patients underwent preoperative radioisotope(RI) lung perfusion scan. Preoperative CT data were postprocessed with contiguous pixel method ranged from -9107HU to -500HU to quantify total functional lung volume(TFLV) and regional volume to be resected(RFLV). Postoperative lung function was predicted by following formula;Predicted postoperative PFT value=preoperative PFT x 1-RFLV/TFLV). CT predicted value was compared with postoperative measured PFT value and those value of RI perfusion scan. RESULTS: CT predicted values were very close to postoperative measured value and RI predicted value, and were correlated well with postoperative measured values (FVC: r=0.988, P<0.001 ;FEV1: r=0.994, P<0.001) and RI predicted values (FVC :r=0.976, P<0.001 ;FEVl: r=0.974, p<0.001). CONCLUSION: Quantitative spiral CT was useful to predict postoperative lung function and could be an effective alternative to RI perfusion scan.
Follow-Up Studies ; Humans ; Lung* ; Mastectomy, Segmental ; Perfusion ; Pneumonectomy ; Thorax ; Tomography, Spiral Computed*

PURPOSE: We applied spiral CT to evaluate the dynamic changes of regional ventilation of the lung in normal subjects and abnormal patients. MATERIALS AND METHODS: This study includes normal subjects (n:5) and patients with chronic obstructive pulmonary disease (n=4), small air-way disease (n=3), diffuse panbronchiolitis (n=4), and tracheobronchial tuberculosis (n=2). Time-continuous scan data at a fixed level during forced vital capacity maneuver (10--12 seconds) were obtained and images were reconstructed retrospectively by using 0.67 second scan data per image. The reconstructed images were displayed in a cine mode. Time-density curves were plotted and were correlated with clinical diagnosis. RESULTS: In normal subjects, mean attenuation difference between full inspiration and full expiration was 145. 8HU and mean time interval between 20% expiration and 80% expiration was 2.04 seconds. In chronic obstructive lung disease, mean attenuation difference between full inspiration and full expiration was 21.2HU and mean time interval between 20% expiration and 80% expiration was 3.63 seconds. In small air-way disease, mosaic-pattern hyperlucency and normal portion of lung showed mean attenuation differences between 20% expiration and 80% expiration to be 49.8HU and 167.0HU, respectively. In diffuse panbronchiolitis, centrilobular region and normal portion of lung showed mean attenuation differences between 20% expiration and 80% expiration to be 35.4HU and 79.3HU, respectively. CONCLUSION: Respiratory dynamic CT is an updated technique which enable imaging of the functional status of the lung parenchyma. It may be useful in differentiation and quantitation of variable obstructive lung diseases.
Diagnosis ; Humans ; Lung Diseases, Obstructive ; Lung* ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Tomography, Spiral Computed ; Tuberculosis ; Ventilation ; Vital Capacity

Purpose: Children have few small alveoli, which reduce lung compliance; in contrast, their cartilaginous rib cage makes their chest wall highly compliant. This combination promotes lung collapse. Prolonged inspiratory to expiratory (I:E) ratio ventilation is used to optimize gas exchange and respiratory mechanics in surgery. However, the optimal ratio is unclear in children. We hypothesized that, compared to a 1:2 I:E ratio, a 1:1 I:E ratio would improve dynamic compliance and oxygenation, and affect the peak airway pressure in pediatric patients undergoing surgery. Materials and Methods: Forty-eight patients aged ≤6 years who were scheduled to undergo surgery under general anesthesia with an arterial line were randomly allocated to receive 1:1 (group 1:1) or 1:2 (group 1:2) I:E ratio ventilation. Airway pressure, respiratory system compliance, and arterial blood gas analyses were compared between groups immediately after induction (T0), 30 min after induction (T1), 60 min after induction (T2), immediately after surgery (T3), and on arrival at the post-anesthesia care unit (T4). Results: Peak and plateau airway pressures were significantly lower in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.048, respectively). The dynamic and static compliances were significantly higher in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.045, respectively). However, the partial pressure of oxygen did not significantly differ between groups. Conclusion Compared to a 1:2 I:E ratio, a 1:1 I:E ratio improved dynamic compliance and lowered the peak airway pressure without complications in pediatric patients. Nevertheless, our results do not support its use solely for improving oxygenation.

Purpose: Children have few small alveoli, which reduce lung compliance; in contrast, their cartilaginous rib cage makes their chest wall highly compliant. This combination promotes lung collapse. Prolonged inspiratory to expiratory (I:E) ratio ventilation is used to optimize gas exchange and respiratory mechanics in surgery. However, the optimal ratio is unclear in children. We hypothesized that, compared to a 1:2 I:E ratio, a 1:1 I:E ratio would improve dynamic compliance and oxygenation, and affect the peak airway pressure in pediatric patients undergoing surgery. Materials and Methods: Forty-eight patients aged ≤6 years who were scheduled to undergo surgery under general anesthesia with an arterial line were randomly allocated to receive 1:1 (group 1:1) or 1:2 (group 1:2) I:E ratio ventilation. Airway pressure, respiratory system compliance, and arterial blood gas analyses were compared between groups immediately after induction (T0), 30 min after induction (T1), 60 min after induction (T2), immediately after surgery (T3), and on arrival at the post-anesthesia care unit (T4). Results: Peak and plateau airway pressures were significantly lower in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.048, respectively). The dynamic and static compliances were significantly higher in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.045, respectively). However, the partial pressure of oxygen did not significantly differ between groups. Conclusion Compared to a 1:2 I:E ratio, a 1:1 I:E ratio improved dynamic compliance and lowered the peak airway pressure without complications in pediatric patients. Nevertheless, our results do not support its use solely for improving oxygenation.

No abstract available.
Meningitis, Aseptic*

PURPOSE: In children on anticancer chemotherapy, bloodstream infections (BSIs) are a major cause of morbidity and mortality. We investigated febrile episodes and bloodstream infections in pediatric cancer patients to guide proper selection of empiric antibiotics for febrile pediatric hemato-oncologic patients. METHODS: All febrile episodes treated in the division of hematology-oncology, the department of pediatrics, Hanyang University Hospital, between July 2005 and June 2008 were reviewed. Episodes with and without bloodstream infections were compared. RESULTS: Forty cases (18.9%, 25 patients) of BSI occurred in 212 febrile episodes (63 patients). Thirty-seven cases (23.6%, 22 patients) of BSI occurred in 157 febrile episodes with neutropenia (54 patients). Microorganisms identified in BSI corresponded to 23 gram-positive bacteria (51.2%), 20 gram-negative bacteria (44.5%), and 2 fungi (4.4%). Rates of BSI between those who had received umbilical cord blood transplantation and those who had received transplantation from other source were significantly different (55.0% vs. 7.7%, P=0.001). No differences in mortality rate were observed among organisms in BSI patients. For febrile episodes the rate of BSI was higher among those with Chemoport than those with Hickman catheter (P=0.029) and gram-positive pathogens were more likely to be associated with Chemoport (P=0.001). CONCLUSION: The study showed the rate of BSI, distribution of pathogens with regard to neutropenia, transplantation, central venous catheters, and antimicrobial susceptibility of pathogens in order to help guide in the choice of optimal empiric antibiotics in pediatric febrile neutropenic hemato-oncologic patients.
Anti-Bacterial Agents ; Bacteremia ; Catheters ; Central Venous Catheters ; Child ; Fetal Blood ; Fever ; Fungi ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Neutropenia ; Pediatrics ; Transplants

Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. Because heterotopic pregnancy is difficult to diagnose and it has high morbidity and mortality rate, one should always take this into consideration and should conduct careful and thorough gynecologic evaluation. We have experienced a case of heterotopic pregnancy in a 29-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.
Abdominal Pain ; Adult ; Female ; Humans ; Incidence ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Reproduction

BACKGROUND: Single or multiple episodes of brief period of ischemia and reperfusion(ischemic preconditioning, IP) have been shown to limit infarct size after a subsequent longer period of ischemia. A considerable number of possible mechanisms has been proposed, however, controversies still remain. Accordingly, we evaluated the effect of four cycles of 5 minutes ischemia and 5 minutes reperfusion(IP) followed by subsequent 30 minutes ischemia(ISCH) and 60 minutes reperfusion using isolated Langendorff-Perfused rabbit hearts. Methods and RESULTS: After a 50-minute recovery phase, parameters of the left ventricular function(LVF) including left ventricular developed pressure(LVDP), contractility and the heart rate were recorded, and ultrastructure was examined. Myosin ATPase activity was determined by measurement of inorganic phosphorus and isozymes of the myosin heavy chain were examined by polyacrylamide gel electrophoresis containing pyrophosphate buffer. The ISCH hearts showed severe to irreversible change of the cardiac myocytes homogenously in contrast to the IP hearts in which changes were not homogenous and irreversible injury was only focal. However, parameters of the LVF were not significantly different between the IP and the ISHC hearts during reperfusion. Myosin ATPase activities were also not significantly different(0.67+/-0.123 micromol/mg protein/h in the IP hearts, 0.56+/-0.172 micromol/mg protein/h in the ISCH hearts, and 0.76+/-0.239 micromol/mg protein/h in the control hearts). Band patterns of the myofibrillar proteins, separated by sodium ddodecyl sulfate-polyacrylamide gel electrophoresis, revealed no differences between the IP, ISCH and the control hearts. Myosin heavy chains in the IP and the ISCH hearts were separated into 3 isozymes, V1,V2and V3in pyrophosphate gel electrophoresis in contrast that the control hearts revealed two isozymes, V1and V2. However, there were no differences in the protein composition and electrophoretic motility between the IP and the ISCH hearts. CONCLUSION: These results indicate that IP could not attenuate the changes in LVF, myosin ATPase activity and myosin isozymes on reperfusion, however, it could attenuate the ultrastructural changes of the cardiac myocytes.
Adenosine Triphosphatases* ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Heart Rate ; Heart* ; Ischemia ; Ischemic Preconditioning* ; Isoenzymes ; Myocytes, Cardiac ; Myosin Heavy Chains ; Myosins* ; Phosphorus ; Reperfusion ; Sodium ; Ventricular Function, Left*