One fetal demise of twin pregnancy in the second or third trimester is an unusual and difficult problem in the managemcnt of pregnancy. It can be associated with an increased risk for mortality and morbidity in the remaining fetus and with maternal DIC. 255 twin gestations were delivered at our hospital between December 1984 and August 1998. 8 cases of twin pregnancies with one fetal demise were observed. We reviewed 8 cases of twin pregnancies with one fetal demise that had been managed conservatively. The incidence of twin pregnancies with one fetal demise was 3.14% in the study population. The incidence of preterm delivery was 87.5%. The perinatal mortality rate of surviving twins was 25%. There were no cases of maternal disseminated intravascular coagulation or infection. There were no cases of neurologic damages in the surviving twins. The main cause of neonatal death was prematurity. An expectant approach to the twin pregnancies with one fetal demise seems reasonable.
Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Fetus ; Humans ; Incidence ; Mortality ; Perinatal Mortality ; Pregnancy ; Pregnancy Trimester, Third ; Pregnancy, Twin*

Echocardiographic examination was performed before, immediately after, 4-6 months after and 10-12 months after mitral valve replacement(MVR) surgery in 46 patients with mitral valve disease(8 patients with mitral regurgitation, 24 patients with mitral stenosis and 14 patients with mitral stenosufficiency) to evaluate the effects of mitral valve replacement on dimension of left atrium and left ventricle, volume of left ventricle, ejection fraction(EF) and fractional shortening(FS) of left ventricle. The results are as follows : 1) The endsystolic dimension(ESD), enddiastolic dimension(EDD), endsystolic volume(ESV) and enddiastolic volume(EDV) decreased significantly after operation in patients with mitral stenoinsufficiency(MSR), the ESD, EDD, ESV and EDV increased significantly after the operation, but returned to preoperative value 10-12 months after the operation. 2) The EF and FS of left ventrcle after MVR were significantly lower than preoperative value throughout the postoperative period in patients with MR. However in patients with MS or MSR, there were no significant postoperative changes in EF and FS, except transient depression in the patients with MS at the immediate postoperative period. 3) In all patients with mitral valve disease, the left atrial dimension and the ratio of domension of left atrium to the dimension of aorta decreased significantly after MVR. From above results, it is suggested that surgery should be considered seriously for the patients with MR before the ESD, EDD and ESV increase maekedly, even if the EF anf FS are in normal range and the symptoms are not severe, to prevent irreversible depression of myocardial function. It seems that serial echocardiographic examination is very helpful in this respect.
Aorta ; Atrial Natriuretic Factor ; Depression ; Echocardiography* ; Heart Atria ; Heart Ventricles ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Postoperative Period ; Reference Values

PURPOSE: The skeleton is commonly affected by metastatic cancer. The purpose of this study was to evaluate the results of treating metastatic pathologic fractures in lower extremities using locking plates. MATERIALS AND METHODS: Between 2004 and 2010, we evaluated 12 patients (13 cases) of metastatic pathologic fractures in lower extremities, treated with the locking plate. Mean patient age was 62.2 years (range, 50-81 years), the locations of the fractures were; proximal femur in 2 cases, femoral mid-shaft in 3, distal femur in 3, proximal tibia in 4, and distal tibia in 1 case. The interval to wheelchair ambulation, pain relief and complications were evaluated. Additionally, we assessed operation time and postoperative blood loss. RESULTS: Mean time from operation to wheelchair ambulation was 3.2 days (range, 1-6 days). Mean VAS scores improved from a preoperative score of 8.1 points (range, 7-9 points) to a score of 2.7 points (range, 2-4 points) at 1 week postoperatively. No early complications associated with surgery were encountered. Mean operation time was 88.4 minutes (range, 70-105 minutes), and mean postoperative blood loss was 246.5 ml (range, 130-320 ml). CONCLUSION: Internal fixation of metastatic pathologic fractures using a locking plate in the lower extremity can be an effective treatment option in the meta- or diaphyseal area of long bones with massive bony destruction or poor bone stock by offering early ambulation, pain relief and low postoperative complications.
Early Ambulation ; Femur ; Fractures, Spontaneous ; Humans ; Lower Extremity ; Postoperative Complications ; Postoperative Hemorrhage ; Skeleton ; Tibia ; Walking ; Wheelchairs

No abstract available.
Posterior Cruciate Ligament*

Prenatally diagnosed neuroblastomas have been reported in increasing numbers over the past several years. The vast majority are in favorable stages of the disease (stage I, II, IV-S). The authors experienced one case of stage IV-S neuroblastoma of the adrenal gland with liver metastasis, which regressed spontaneously after removal by adrenalectomy. This patient was noticed to have an abdominal mass at prenatal ultrasonography performed at 36weeks of gestation. This tumor was a neuroblastoma of the left adrenal gland with multiple liver metastases. Left adrenalectomy and liver biopsy were performed at 3 months of age. Thirty-eight months after surgery, an MRI demonstrated that the hepatic metastatic lesions had completely regressed without chemotherapy or radiation.
Adrenal Glands ; Adrenalectomy* ; Biopsy ; Drug Therapy ; Humans ; Liver* ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Neuroblastoma* ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography, Prenatal

BACKGROUND: Angiotensin convertiong enzyme inhibitors have been shown to exert favorable effects on the left ventricular remodeling process associated with ventricular dilation after coronary occlusion. However, the effects of such therapy on global and regional left ventricular remodeling after coronart artery reperfusion have not been characterized, nor have such effects been assessed after exercise training. METHODS AND RESULTS: Female Sprague-Dawley rats(n=80) were randodmized into 4 groups at 5 days after 45 minutes of left coronary artery occlusion followed by reperfusion. Animals completion the experiment included : Untreated Sedentary group(n=20), Untreated with Swimming Exercise group(n=21), Captopril Treated Sedentary group(n=18) and Captoril Treated with Exercise group(n=21). At 3 weeks after randomization, global and regional morphologic changes of the left ventricle(LV) were examined from mid-ventricular transverse slices which were perfusion-fixed at a constant aortic pressure of 60mmHg and a left ventricular cavity pressure of 10mmHG. At rest and during exercise, compared to untreated rats, the captopril treated animals showed significantly decreased LV weight/tibial length ratio(LV/TL)(p<0.01),increased LV cavity area and dimension(both p<0.01), decreased total myocardial area and noninfarcted area(both p<30.001) and reduced wall thicknesses in the noninfarcted and infarcted regions(both p<0.001). Compared to treated and untreated dsedentary rats, exercise significantly increased LV/TL(p<0.05) and epicardial and endocardial areas in the infarcted zone(both p<0.05) and decreased transmurality(p<0.01). Exercise decreased LV cavity area in the captopril treated groups(42.3+/-10.4 vs. 40.4+/-6.0mm2),whereas exercise increased LV cavity area in the untreated groups(33.5+/-8.9 vs. 39.1+/-6.2mm2)(p<0.05). CONCLUSION: These findings provide evidence in rats for evidence in rats for exaggerated left ventricular dilation and supperssion of compensatory myocardial hypertrophy globally and in the infarct zone with 3 weeks of captopril treatment following coronary artery reperfusion with acute nontransmural myocardial infarction. In addition, the effects of captopril on LV dilation and suppression of global and regional hypertrophic response were partially reversible by swimming exercise.
Angiotensins ; Animals ; Arterial Pressure ; Arteries ; Captopril ; Coronary Occlusion ; Coronary Vessels* ; Enzyme Inhibitors ; Female ; Humans ; Hypertrophy ; Myocardial Infarction ; Myocardial Reperfusion ; Random Allocation ; Rats* ; Rats, Sprague-Dawley ; Reperfusion* ; Swimming ; Ventricular Remodeling*

No abstract available.
Anesthesia, Local* ; Arthroscopy* ; Knee*

No abstract available.

The antihypertensive effects of diltiazem was observed in 30 cases of essential hypertension, and following results were obtained. 1) Mean decrease in systolic and diastolic blood pressure by oral diltiazem was 42.0+/-2.5mmHg and 17.8+/-1.7mmHg. The results of antihypertensive therapy revealed good control in 50% fair control in 30% poor in 17% and failure in 3% of the cases. In 80% of the cases, good or fair control of Hypertension which means drop of diastolic pressure to the level of less than 100mmhg was observed. 2) Mean drop in heart rate was 21+/-2 beats/min. 3) Daily dose was 90-180mg. 4) The side effect of oral Diltiazem was mild headache and dizziness, respectively one case.
Blood Pressure ; Diltiazem* ; Dizziness ; Headache ; Heart Rate ; Hypertension

Osteoporosis is a disease characterized by excessive bone loss or osteopenia particulary in the axial skeleton at the site of fracture, such as the spine and proximal femur. Since the strength of both spine and femur is directly proportional to the bone mass, this osteoporosis always increases the risk of fracture. In this study, to evaluate whether a simple measurement of femoral geometry and BMD value are related with hip fracture, we obtained DEXA Scan (Lunar Expert-XL) of hip by retrospective study. DEXA scan was measured on 70 control people and 17 hip fracture patients aged 50 or older. The result is I. The mean Ward BMD value of hip fracture group is significantly lower than control group (Hip fracture group: 0.52g/cm2, Control group: 0.67g/cm2 P=0.0001) 2. The mean L-spine BMD value of hip fracture group is significantly lower than control group (Hip fracture group: 0.81g/cm, Control group: 0.97g/cm2 P=0.0002) 3. The mean femur axis length of hip fracture group is longer than control group (Hip fracture group: 6.77g/cm2, Control group: 6.57g/cm2 P=0.006) As a conclusion, the measurement of BMD and hip axis length in DEXA scan is an effective method for screening the hip fracture risk patient and BMD value of femur, hip axis length and L- spine BMD value are strongly associated with hip fracture.
Absorptiometry, Photon ; Axis, Cervical Vertebra* ; Bone Density* ; Bone Diseases, Metabolic ; Femur ; Hip* ; Humans ; Mass Screening ; Osteoporosis ; Retrospective Studies ; Skeleton ; Spine