Ninety two cases of culture proved neonatal sepsis who had been admitted to pediatric department, National medical Center, during 7 years from Jan. 1984 to Dec. 1990 were reviewed clinically and the following results were obtained. 1) The frequency of neonatal sepsis was 3.1% and male to female sex ratio was 1.9:1, Sepsis was more prevalent in premature infants (9.9%) than in full term infants (1.9%). 2) The seasonal incidence was more prevalent in summer (32.6%). 3) The weight distribution showed 50 cases with the weight less than 2500 gram and 42 cases more than 2500 gram. 4) In 76 cases the onset was before 7 days old and in 16 cases were developed after 7 days old. 5) The major associated perinatal conditions in neonatal sepsis were institutional baby (23.9%), premature rupture of membranes (11.9%) and placenta previa (4.3%) in the order of frequency. The clinical manifestations on admission were jaundice (50.0%), poor activity (46.7%), respiratory difficulty (35.9%), poor feeding (22.8%), cyanosis (22.7%), gastrointestional symptoms (21.5%), fever (15.2%) and convulsion (13.0%) in the order of frequency. 6) The associated diseases were urinary tract infection (31.5%), hyaline membrane disease (19.6%), congenital disorder (18.5%), pneumonia (15.2%), anemia (13.0%), meningitis (9.8%), omphalitis (7.6%), DIC (6.5%), necrotizing enterocolitis (5.4%) and intracranial hemorrhage (5.4%) in the order of frequency. 7) Causative organisms were gram positive organisms in 27 cases (25.7%) and gram negative organisms in 79 cases (74.3%). The main organisms were Serratia marcescens (18.5%). Enterobacter spp (17.4%), Klebsiella pneumoniae (12.0%), Staphylococcus aureus (10.9%), Acinetobactor calcoaceticus (8.7%), Coagulase (-) staphylococcus (8.7%), E. coli (8.7%), Enterococcus (6.5%), Group B beta-hemolytic streptococcus (5.4%) and Pseudomonas (5.4%) in the order of frequency. The sensitivity to antibiotics were: Serratia marcescens: 70.6% sensitive to Amikacin 58. 9% sensitive to Cefotaxime 59. Enterobacter spp: 87.5% sensitive to Amikacin 68.8% sensitive to Cefotaxime Klebsiella pneumoniae: 100% sensitive to Amikacin 91. 0% sensitive to Cefotaxime Staphylococcus aureus: 100% sensitive to Cefazolin 90. 0% sensitive to Cefotaxime Acinetobacter calcoaceticus: 88.9% sensitive to Amikacin Coagulase (-) Staphylococcus: 100% sensitive to Amikacin 87. 5% sensitive to Cefotaxime E. coli: 100% sensitive to Amikacin, Cefotaxime Enterococcus: 50% sensitive to Gentamicin, Ampicillin, Amikacin Group B beta-hemolytie Streptococcus: 100% sensitive to Ampicillin, Penicillin Pseudomonas: 100% sensitive to Amikacin, Gentamicin, Tobarmycin 8) Mortality cases were 32 cases (34.8%).
Acinetobacter calcoaceticus ; Amikacin ; Ampicillin ; Anemia ; Anti-Bacterial Agents ; Cefazolin ; Cefotaxime ; Coagulase ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Cyanosis ; Dacarbazine ; Enterobacter ; Enterococcus ; Enterocolitis, Necrotizing ; Female ; Fever ; Gentamicins ; Humans ; Hyaline Membrane Disease ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Intracranial Hemorrhages ; Jaundice ; Klebsiella pneumoniae ; Male ; Membranes ; Meningitis ; Mortality ; Penicillins ; Placenta Previa ; Pneumonia ; Pseudomonas ; Rupture ; Seasons ; Seizures ; Sepsis* ; Serratia marcescens ; Sex Ratio ; Staphylococcus ; Staphylococcus aureus ; Streptococcus ; Urinary Tract Infections

OBJECTIVE: The exact position of the lesion during the pallidotomy is critical to obtain the clinical improvement of parkinson's disease without damage to surrounding structure. Ventriculogrphy, CT(computed tomograpy) or MRI(magnetic resonance imaging) have been used to determine the initial coordinates of stereotactic target for pallidotomy. The goal of this study was to determine whether microelectrode recording significantly improves the neurophysiologic localization of the target obtained from MRI. METHODS: Twenty patients were studied. They underwent a unilateral pallidotomy. Leksell frame was applied and T1 axial images parallel to the AC-PC(anterior commissure-posterior commissure) plane using a 1.5 Tesla MRI with 3mm slice thickness were obtained. Anteroposterior coordinate of target was chosen at 2mm in front of the midcommissural point and lateral coordinate between 19 and 22mm from the midline. The vertical coordinate was calculated on coronal slice using a fast spin echo inversion recovery sequence(FSEIR) related to the position of the choroidal fissure and ranged over 4-5mm below the AC-PC plane. Confirmation of the anatomical target was done on axial slices using the same FSEIR sequence. Microrecording was done at the pallidum contralateral to the symptomatic side using an electrode with a tip diameter of 1nm diameter tip and 1.1-1.4 mOhm impedance at 1000Hz. Electrophysiologic localization of the target was also confirmed intraoperatively by macrostimulation. RESULTS: Microrecording techniques were reliable to define the transition from the base of the pallidum which was characterized by the disappearance of spike activity and by the change of the audible background activity. Signals from high amplitude neurons firing at 200-400Hz were recorded in the pallidal base. X, Y and Z coordinates of target obtained from the MRI were within 1mm from the X, Y, Z coordinates obtained with microrecording in 16 patients (80%), 15 patients(75%), 10 patients(50%) respectively. The difference of Y coordinate between on MRI and on microrecording was 4mm in only one patient. CONCLUSION: The MRI was accurate to localize the target within 1mm of the error from microrecording target in 70% of the patients. 4mm discrepancy was observed only once. We conclude that MRI alone can be used to determine the target for pallidotomy in most patients. However, microrecording technique can still be extremely valuable in patents with aberrant anatomy or unusual MRI coordinates. We also consider physiologic confirmation of the target using macrostimulation to be mandatory in all cases.
Choroid ; Electric Impedance ; Electrodes ; Fires ; Humans ; Magnetic Resonance Imaging* ; Microelectrodes ; Neurons ; Pallidotomy* ; Parkinson Disease*

OBJECTIVE: We compared the results of two surgical techniques by retrospective study of 60 elderly patients (65 years or older) who underwent either decompression alone or fusion for the treatment of two-level or more lumbar spinal stenosis. METHODS: During the period of 2003 and 2008, two-level or more decompression alone or fusion was performed for lumbar spinal stenosis by three surgeons at our institution. Patients were allocated to two groups by surgical modality, namely, to a decompression group (31 patients) or a fusion group (29 patients). Overall mean age was 71.1 years (range, 65-84) and mean follow-up was 5.5 years (range, 3-9). A retrospective review of clinical, radiological, and surgical data was conducted. RESULTS: No significant difference between the two groups was found with respect to age, follow-up period, surgical levels, or preoperative condition. At the last follow-up, correction of lumbar lordotic angle (determined radiologically) was better in the fusion group. However, clinical outcomes including visual analogue scale, Oswestry Disability Index, and the Odom's criteria were not significantly different in the two groups. On the other hand, surgical outcomes, such as, operation time, estimated blood loss, and surgical complications were significantly better in the decompression alone group. CONCLUSION: Our findings suggest that decompressive laminectomy alone achieves good outcomes in patients with two-level or more lumbar spinal stenosis, associated with an advanced age, poor general condition, or osteoporosis.
Aged ; Decompression ; Follow-Up Studies ; Hand ; Humans ; Laminectomy ; Osteoporosis ; Retrospective Studies ; Spinal Fusion ; Spinal Stenosis

Fractures of C1 are not uncommon, constituting only 10% of all cervical spine injuries. There is a high prevalence of concomitant fractures of the second and first cervical vertebral complex. Surgical treatment is controversal. Mainstay of treatment is various combination of traction and cervical orthosis according to degree of displacement and location of fracture. We experienced unusual type of fracture, anterior arch fracture of C1 who had a history of total laminectomy of C1,2 due to cervical cord tumor(neurilemmoma arising from C2 root). We performed C1,2 lateral mass screw fixation with posterior fusion with good postoperative outcome.
Laminectomy ; Orthotic Devices ; Prevalence ; Spine ; Traction

Rathke's cleft cysts are believed to be derived from remnants of Rathke's pouch, a dorsal invagination of the stomodeum. Although these cysts are characteristically small, asymptomatic and intrasellar in location, they occasionally provoke symtoms with enlargement to compress surrounding structures. It is characteristically lined by stratified squamous epithelium with keratinization on a layer of connective tissue. The cells of the anterior pituitary lobe, from which pituitary adenomas develop, are also formed by the proliferation of the anterior wall of Rathke's pouch. Thus, Rathke's cleft cyst and pituitary adenomas are considered to have a common ancestry. We report a rare case in which the preoperative diagnosis was pituitary adenoma, but the pathologic diagnosis was a combination of a Rathke's cleft cyst and a coincidental pituitary adenoma.
Adenoma* ; Central Nervous System Cysts ; Connective Tissue ; Diagnosis ; Epithelium ; Pituitary Neoplasms*

Uterine anomalies have been reported in 4% of women with infertility and in up to 15% of those with recurrent abortion. One of the major intrauterine disorder associated with infertility and recurrent abortions is intrauterine septum, The reproductive outcome of 41 patients of intrauterine septum (7 complete, 34 incomplete) with repeated abortions or infertility was assessed after the uterine septotomy. 5 of 7 patients with comlete uterine septum undergone uterine septotomy (3; hysteroscopic metroplasty, 2; abdominal metroplasty) had total 6 pregnancies and all of them had live biths. 28 patients with incomplete uterine septum got the hysteroscopic intrauterine septotomy and the viable pregnancy rate was 62% (3 ongoing pregnancies, 13 live biths of total 26 pregnancies). 6 patients with incomplete uterine septum had not the operation and 5 patients had 5 live births after total 6 pregnancies with 1 spontaneus abortion. Even though, the number of cases were small, the live birth rate in the group of septotomy of the patients of complete uterine septum (100%, 6/6) was higher than that in the group of not-done (50%, 1/2). The live birth rate in the group of not-done of the patients with incomplete uterine septum (83%, 5/6) was higher than that in the group of hysteroscopic uterine septotomy (62%, 16/26), but 5 of 6 had short uterine septal length (<1 cm), 1 had 1.5 cm septal length in the group of not-done. All the patients with successful pregnancy outcome had no other co-factors at the diagnostic laparoscopy, but the 5 primary infertility patients with no live birth even after treatment (all were with incomplete septum; 3 undergone hysteroscopic septotomy, 2 not-done with one abortion) had other co-factors such as endometriosis, peritoneal or tubal facor. In conclusion, hysteroscopic uterine septotomy would be useful for the patients with habitutal abortion or infertility and more advanced managemnet protocols should be applied to the patients having other co-factors if there was no pregnancy even after the uterine septotomy.
Abortion, Habitual* ; Endometriosis ; Female ; Humans ; Hysteroscopy* ; Infertility* ; Laparoscopy ; Live Birth ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate

No abstract available.
Animals ; Apomorphine* ; Dopamine* ; Parkinsonian Disorders* ; Rats* ; Receptors, Dopamine D2*

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is one of the well known complication of conttolled ovarian hyperstimulation. Though there have been numerous protocols for the prevention of OHSS, it has not been completely preventable until now. This study was performed to identify clinical predictors for early and late OHSS. METHODS: A retrospective analysis of all IVF cycles in 1993 up to June 1996 was performed. OHSS was diagnosed using the criteria of Rabau modified by Schenker. All cases of OHSS reported in this study presented with marked ovarian enlargement, ascites, oliguria, hemoconcentration and electrolyte disturbance. Ovarian stimulation was carried out using a combination of gonadotrophin releasing hormone-agonist, follicle-stimulation hormone and human menopausal gonadotrophin. 27 patients has moderate or severe OHSS presenting 3-7 days post-human chorionic gonadotrophin (hCG), and 21 patients had severe OHSS presenting 12-17 days post-hCG. RESULTS: No patient with early OHSS went onto develop late OHSS, and no patient with late OHSS had demonstrated early OHSS. Logistic regression showed that early OHSS was predicted by the number of oocytes retrieved and the estradiol concentration on the day hCG injection (P<0.05). Late OHSS was predicted by the transferred embryos, B-hCG on 14 day after hCG injection (P<0.05). CONCLUSION: Early OHSS was an acute effect of the hCG administered prior to egg retrieval in women with high estradiol and large number of retrieved oocytes. Our analysis of the risk factors for early OHSS indicates that cryopreservation of all embryos will not alter the risk of early OHSS even though it should prevent late OHSS. Late OHSS was induced by the rising serum concentration of hCG produced by the early pregnancy, the number of transferred embryos must be adjusted carefully, since it was associated with multiple gestation.
Ascites ; Chorion ; Cryopreservation ; Embryonic Structures ; Estradiol ; Female ; Humans ; Logistic Models ; Oliguria ; Oocytes ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction ; Ovum ; Pregnancy ; Retrospective Studies ; Risk Factors

A non-carious cervical lesion(NCCL) is the loss of tooth structure at the cementoenamel junction level that is unrelated to dental caries. This study was to evaluate the occlusal and periodontal status of teeth with non-carious cervical lesions. We evaluated 105 teeth with non-carious cervical lesions in 35 subjects aged 38-75 years and characterized them based on the shape and dimension, plaque retention, bleeding on probing(BOP), probing pocket depth(PPD), occlusal status, brushing type, hypersensitivity and wear facet. The results of this study were as follows 1. No significant association was observed between cervical lesions and occlusal contact in lateral excursions. 2. No significant difference occurred in plaque retention, PPD, BOP between teeth with and without cervical lesions. 3. Test teeth had a significantly higher percentage of hypersensitivity and occlusal wear facet than teeth without cervical lesions. 4. Wedge shaped lesions had a significantly higher percentage of plaque than saucer shaped lesions. 5. Teeth with plaque were found to have significantly deeper PPD than teeth without plaque retention in cervical regions. 6. Teeth with occlusal contacts were found to have significantly deeper PPD than teeth without occlusal contacts. 7. No significant association was observed between cervical lesions and PPD independent of plaque retention and occlusal contacts Although more knowledge is necessary, our results suggest that occlusal contact and bacterial plaque may influence on periodontal tissue, but NCCL is not directly associated with periodontal health
Dental Caries ; Hemorrhage ; Hypersensitivity ; Tooth Attrition ; Tooth Cervix ; Tooth*

OBJECTIVE: This study was conducted to compare radiologic changes and clinical outcomes in adjacent level of percutaneous pedicle screws with those of conventional (open) pedicle screws. METHODS: From January 2007 to December 2009, 51 patients underwent L3-5 decompression and spinal fusion. Percutaneous pedicle screws were used in 22 patients, and open pedicle screws were used in the remaining patients. For estimation of instability, we performed measurements of change in the lordotic and adjacent segment angles. A retrospective evaluation of the patients' data and several assessment scales was conducted for determination of clinical outcomes. RESULTS: The radiological examinations revealed no significant differences, except the L2-3 sagittal angle change. The upper adjacent level angle change in the open group was larger than that in the percutaneous group. In the percutaneous group, the sagittal angle changed from 9.7+/-3.0degrees to 11.25+/-3.6degrees during the follow-up periods, and in the open group, the sagittal angle changed from 10.8+/-4.1degrees to 13.6+/-4.5degrees. Radiological instability was observed in 5 patients (17%) in the open group and in 2 patients (9%) in the percutaneous group. Both groups showed similar clinical outcomes. CONCLUSION: We suggest that open screws have a greater tendency to cause degenerative change in the upper segment than percutaneous screws. This may be because percutaneous screw fixation causes minimal injury to supporting structures and preserves adjacent facet joints.
Decompression ; Follow-Up Studies ; Humans ; Postoperative Complications ; Retrospective Studies ; Spinal Fusion ; Weights and Measures ; Zygapophyseal Joint