Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.
Anti-Bacterial Agents ; Cerclage, Cervical ; Cesarean Section ; Female ; Fetus ; Humans ; Male ; Membranes ; Obstetrics ; Placenta ; Pregnancy* ; Pregnancy, Twin ; Rupture ; Siblings ; Tocolysis ; Twins*

BACKGROUND AND OBJECTIVE: The clinical manifestation of Henoch-Schonlein purpura and existance of renal involvement may influence on its course and prognosis. To verify prevention with early administration of steroid, we studied the efficacy of corticosteroid treatment. MATERIAL AND METHOD: We analysed 65 children under 15 years of age with Henoch-Scho nlein purpura according to their age, sex, and seasonal incidence. Forty children showed typical skin lesions, arthralgia and abdominal pain. We have divided them two groups. Group A consisted of 20 children who received 1 mg/kg of prednisolone/perday for 2 weeks and group B did not. We carried out their physical examination and urinalysis monthly for a year. RESULT: The main clinical manifestations were skin rash(100% ), abdominal symptoms(41.5 %), joint symptoms (49.2%), and renal involvement(34%). As for gastrointestinal symptoms, abdominal pain(66.7% ) was most commonly observed one and others were nausea or vomiting (44.7%) and melena(25.9%). The joint involvement was observed mostly in knee(56.3%) and ankle joint(31.3% ), Hematuria was observed in all cases with renal involvement and proteinuria, in 28% of them. The improvement of renal manifestations were noted in 84.2% of them within 4 months. Mild elevation of IgA was more frequently observed in renal involvement group than non-involved group (p< 0.01). There were no significant differences in immonologic parameters such as IgG, IgM, IgE, duration of the acute phase and severity of cutaneous symptoms between two growps. None of steroid treated growp showed progression of nephropathy. Of the 20 non-steroid treated growp, 2(10%) developed nephropathy. Conclusion We may suggest that existance of renal involvement in Henoch-Schonlein purpura influences its course and prognosis.
Abdominal Pain ; Ankle ; Arthralgia ; Child ; Hematuria ; Humans ; Immunoglobulin A ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Joints ; Nausea ; Physical Examination ; Prognosis ; Proteinuria ; Purpura* ; Purpura, Schoenlein-Henoch ; Seasons ; Skin ; Urinalysis ; Vomiting

Cavernous angiomas are considered to be congenital in origin. Patients under age of 14 years usually does not require imaging because they are likely to have a benign abducens nerve palsy, unless they develop additional signs or symptoms of neurologic disease during observation. Here we report a case of an isolated abducens nerve palsy caused by overt hemorrhage from de novo formation of cavernous angioma in the pons. Cavernous angiomas of the brain stem should be considered as a possible cause of isolated abducens nerve palsy in young adult and MRI, including gradient-echo sequences should be performed.
Abducens Nerve Diseases* ; Abducens Nerve* ; Brain Stem ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Pons ; Young Adult

Cavernous angiomas are considered to be congenital in origin. Patients under age of 14 years usually does not require imaging because they are likely to have a benign abducens nerve palsy, unless they develop additional signs or symptoms of neurologic disease during observation. Here we report a case of an isolated abducens nerve palsy caused by overt hemorrhage from de novo formation of cavernous angioma in the pons. Cavernous angiomas of the brain stem should be considered as a possible cause of isolated abducens nerve palsy in young adult and MRI, including gradient-echo sequences should be performed.
Abducens Nerve Diseases* ; Abducens Nerve* ; Brain Stem ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Pons ; Young Adult

PURPOSE: Since 1997, private postnatal care facilities (San-hu-jo-ri-won in Korean) have emerged to take the role of the family. As a result, neonates are now exposed to many people and are very vulnerable to infection. However, there has been no study on the influence of postnatal care facilities on neonatal infection. The aim of this study was to determine the risk factors of neonatal infection in full-term babies in Korea. MATERIALS and METHODS: We followed up 556 pregnant women and their babies for 4 weeks after their births at 2 hospitals in Seoul and Daejeon from October 2004 to September 2005. Among 512 full-term babies, 58 had infectious diseases. To determine the risk factors for infection, 53 infected neonates at 4-28 days of life and 413 healthy neonates were compared. RESULTS: The incidence of neonatal infection at 4 to 28 days after birth was 10.5%. After adjusting the related factors, the number of siblings (OR = 2.05, 95% CI = 1.13-3.71 for 1 or more) and postnatal care facilities or home aides (OR = 1.91, 95% CI = 1.07-3.45) were significant risk factors. Formula or mixed feeding (OR = 1.66, 95% CI = 0.91-3.04) increased the risk of neonatal infection but it was not statistically significant. CONCLUSION: When the newborns had siblings, stayed at postnatal care facilities, or were cared for by home aides, the risk of neonatal infections significantly increased. Further research on the feeding effect on neonatal infection and evaluation of prevention efforts are needed.
Communicable Diseases/*epidemiology ; Female ; Humans ; Infant, Newborn ; Korea/epidemiology ; Mothers ; Risk Factors ; *Term Birth

OBJECTIVES: Ginseng has a long history of being used in insomnia treatment and there is some evidence from animal studies of its sleep-enhancing property. From this, it can be assumed that ginseng has sleep-promoting effect in humans. The purpose of this study was to investigate the effect of Korean red ginseng on change of sleep architecture in humans. METHODS: A total of 20 healthy young males with regular sleep and wake habits and without any psychiatric nor cognitive problems were selected based on review of sleep questionnaires and sleep diaries they completed followed by an interview with a board-certified psychiatrist. The subjects were randomly assigned to red ginseng or placebo for 2 weeks of trial. The total daily dose of ginseng was 4,500 mg. The polysomnographic recordings were made at baseline and at 2 weeks after. The effects of red ginseng and placebo on sleep were assessed by comparing the changes in polysomnographic variables between the two groups. RESULTS: A total of 15 subjects, 8 from red ginseng group and 7 from placebo group, were included to undergo polysomnographic procedures. The red ginseng group showed tendencies to increase stage 3 sleep (p=0.087) and to decrease stage 2 sleep (p=0.071) from the baseline compared with the placebo group. CONCLUSION: Korean red ginseng tends to increase deep sleep and decrease shallow sleep. Our result is in line, at least in part, with previous findings that Korean red ginseng increased total and NREM sleep in rats. Further studies with higher ginseng dosage, larger sample size and longer trial duration should be conducted to confirm the sleep stabilizing and balancing effects of Korean red ginseng.
Animals ; Humans ; Male ; Panax ; Polysomnography ; Psychiatry ; Surveys and Questionnaires ; Rats ; Sample Size ; Sleep Initiation and Maintenance Disorders

This study was done to present a criterion in selection of the most proper light sources and materials by measuring metamerism index(MI) of the light curing composite resins with spectrocolorimeter. Metamerism is defined when two objects appear to be the same color in one illuminant but different in another. This is due to the fact that they have different spectral curves that fail to match under the second illuminant. In this study, A1 & A3 shade of five light curing composite resins (Esthet-X, Filteck Z250, Filteck A110, Charisma, Vitalescence) were chosen based on Vita shade. Five samples were made for shade of each product with Teflon mold (diameter: 15mm, thickness: 2mm). Metamerism index of each samples on a Barium sulfate plate (L*=96.54, a*=0.19, b*=0.01) prepared for sample fixation were measured with spectrocolorimeter(Miniscan XE plus, Model 4000s, Hunter Lab, USA) by applying standard light source D65, C, Fcw, TL84 and A. Standardization was done with reference standard (X=80.8, Y=85.7, Z=90.8) and light trap. The results were as follows. 1. Different resins with same Vita shade showed recognizable color difference(DeltaE*>2). 2. All composites had MI below accepted value 0.5 between standard illuminant(D65, C, & A) and below 1.5 under fluorescent condition (Fcw & TL84). 3. MI value between D65 and A showed higher value than MI value between other source of light(p<0.01). 4. All resins except Z250 showed MI value that A3 is higher than A1 between D65 and A(p<0.05).
Barium Sulfate ; Composite Resins* ; Fungi ; Polytetrafluoroethylene

Neonatal hepatitis(NH) and congenital extrahepatic biliary atresia(BA) are two major causes of neonatal cholestasis. The method of therapeutic trials for each disease is essentially different. Nonetheless it is very difficult to differentiate these diseases histologically, since most of the hepatic changes are mutual in both of them. This study is to aimed to find out major differences between the two by scoring various histological parameters. A total of 63 consecutive liver biopsies taken from 54 patients with suggested NH and BA were examined by applying morphometric scoring system. The detailed clinical histories, laboratory data including serology for HBsAg and TORCH infection and radiologic operative findings were reviewed. Among 54 patients, 27 were diagnosed as NH and 20 as BA. In two cases, features of both diseases were coexistent. The pathological diagnosis was not compatible with the final diagnosis in 5 cases(10.7%). In all of these 5 cases, biopsy had been performed at the age of one to two months. The seropositivity for TORCH was 59.3%(16.27) in NH, but 25.0%(5/20) in BA. Serum AST, ALT and alpha-fetoprotein values were higher in NH, and total bilirubin in BA. Of various histological parameters, scores of portal fibrosis, bile duct and ductular proliferation and bile thrombi were much higher in BA, and at the age of less than 2 months, extramedullary hemopoiesis(EMH) was found much more frequently in NH. Giant cell transformation of hepatocytes(GCT) was more commonly observed in NH. The numbers of GCT and EMH were particulary plentiful when the patients' sera were positive for HBsAg or TORCH. These results indicate that portal fibrosis, biliary proliferation and bile thrombi are the three major histologic features of BA, and therefore erroneous histological diagnosis may ensue when scores of those features are low as in some early BA.
Infant, Newborn ; Humans ; Biopsy

No abstract available.
Magnetic Resonance Imaging*

The limitation so direct or indirect laryngoscopy and laryngogram in detemining the exact site and anatomiclocation of laryngeal carcinoma were well documented by many authors. As compared with laryngoscopy and laryngogram, CT study for laryngeal cancer is more exact and accurate method demonstrating anatomic sites of involvement, invasion into deep soft tissue spaces of endolarynx, destruction of laryngeal cartilages and cervical metastasis. Fourteen laryngeal cancer patients proven by laryngoscopic biopsy were further examined by computed tomography for staging. The authors compared laryngoscopic findings with those of computed tomography, and their clinical, surgical and computed tomographic findings were analysed. The results were as follows; 1. All patients were proved as squamous cell carcinoma. They were 12 males and 2 females aged over 50 yrs. 2. Common clinical symptoms were hoarseness, dysphagia and swallowing difficulty. The pirmary anatomic sites determined by CT were 8 transglottic, 2 glottic, 2 supraglottic and 1 pyriform sinus respectively. They were 2 T1. 7 T2, 1 T3, 3 T4 by TNM systems, respectivly. (One case was difficult to evaluate exactly). 3. Invasion into deep soft tissue spaces of endolarynx, cartilage destruction, and neck metastasis were relatively predominant in transglottic caracinomas. 4.CT was superior in evaluating tumor invasion, especially into deep soft tissue spaces of endolarynx, laryngeal cartilages and metastasis ot soft tissue and lymph nodes of neck. However CT had some limitation in determining primary site of laryngeal cancer.
Biopsy ; Carcinoma, Squamous Cell ; Cartilage ; Deglutition ; Deglutition Disorders ; Female ; Hoarseness ; Humans ; Laryngeal Cartilages ; Laryngeal Neoplasms ; Laryngoscopy ; Lymph Nodes ; Male ; Methods ; Neck ; Neoplasm Metastasis ; Pyriform Sinus