The purpose of this study is compare IVF cycle outcome in poor responders between clomiphene citrate (CC) stimulated and controlled ovarian hyperstimulation (COH) protocol. A total of 94 patients responding poorly in previous IVF cycles (estradiol<600 pg/ml or less than 3 oocytes retrieved) subsequently underwent either COH (COH group: 122 cycles, 68 patients) or CC-stimulated cycles (CC group: 43 cycles, 26 patients). CC was administered for five consecutive days starting on cycle day 3 at a dose of 100 mg daily. Serial transvaginal ultrasound examination was done from cycle day 8. Urine was collected 3~4 times before hCG injection for the detection of LH surge. The hCG was administered when serum estradiol reached greater than 150 Pg/ml and mean follicle diameter>16 mm. In COH group, ovarian stimulation was done using short protocol (GnRH-a/FSH/HMG/hCG). No difference in age or number of transferred embryos was found between CC group and COH group. COH group had significantly (p<0.05) higher mean peak level of E2 (810+/-112 vs 412+/-55 pg/ml) and greater number of retrieved oocytes (3.0+/-0.2 vs 2.0+/-0.2) than CC group. CC group had significantly embryos (1.8+/-0.2) compared with (2.1+/-0.2) in COH group. However, CC group had higher pregnancy rate than COH group per retrieval [26.9% (7/26) vs 6.2% (6/97)], or per transfer [31.8% (7/22) vs 7% (6/86)]. Although cycle cancellation rate in CC group (48.8%) was higher than that of COH group (21.3%), the pregnancy rate per cycle in CC group was still higher (16.3%) than COH group (4.9%). In addition, implantation rate in CC group was 17.5% (7/40), which was significantly p<0.01) higher than 3.9% (7/180) in COH group. These data suggest that oocyte and embryo quality are lower in COH cycles of poor responders than CC cycles. We suggest that clomiphene citrate stimulated IVF cycle may be more efficient than COH IVF cycle in poor responders in terms of lower costs and higher pregnancy performance.
Clomiphene* ; Embryonic Structures ; Estradiol ; Fertilization* ; Humans ; Oocytes ; Ovulation Induction ; Pregnancy ; Pregnancy Rate ; Ultrasonography

The purpose of this study was to provide fundamental data by figuring out fatigue differences in patients on hemodialysis and peritoneal dialysis. The subjects for this study were 49 patients on hemodialysis and 54 patients on peritioneal dialysis at C university medical center in Seoul Results were as follows: 1. The average fatigue score in peritoneal dialysis patients tended to be higher in patients on peritoneal dialysis(42.22) than in patients on hemodialysis(39.41). Peritoneal dialysis patients showed higher score than hemodialysis patients in some general characteristics in groups with male, ones in 20's, 40's, 50's, married, college degree, having religion, having occupation, and not take regular nap. 2. The percents of this subjects with feel fatigue at the time of survey was higher in peritoneal dialysis patients(68.5%) than in hemodialysis patients(57.1%). The percentages of the subjects who feel fatigue in peritioneal dialysis patients was higher than hemodialysis patients, and the high tendencies in peritoneal dialysis patients in were obsemed in groups with male, ones in 30's, to have college degree, periods so of 1-2years in peritoneal dialysis, region, men without occupation, regular exercises, regular nap etc.
Academic Medical Centers ; Dialysis* ; Exercise ; Fatigue* ; Humans ; Male ; Occupations ; Peritoneal Dialysis ; Renal Dialysis ; Seoul

No abstract available.
Embryonic Structures* ; Humans*

OBJECTIVES: This study is to compare psychopathology and their perceived parental rearing pattern of the children of mothers with major depression, bipolar disorder and those of normal control group. The correlation was also assessed between behavior problem and perceived parenting style. METHODS: The subjects were 30 children (age range 12-18) of mothers who met the DSM-IV criteria of major depressive disorder or bipolar I disorder and 30 children of normal mother group. All completed self-report questionnaires containing Child, adolescent Behavior Problem Checklist (K-CBCL), Youth Self Report (YSR) and Parental Bonding Instrument (PBI). RESULTS: 1) The mean score of the subscales of somatic complaints, anxious/depressed, internalizing problems in K-CBCL was significantly higher in the control subjects compared with that of the children of mothers with affective disorders (p<0.05). 2) In YSR, there was a tendency of increased behavior problems among the children of mothers with major depression compared with the control subjects. Compared with children of mothers with bipolar disorder, children of mothers with major depression had significantly more behavior problems (p<0.05). 3) Mothers with affective disorders tended to display less caring and fathers and mothers with affective disorders tended to display more overprotective parenting style than the control subjects. 4) There was positive correlation between paternal overprotection and behavior problems in the children of mothers with affective disorders. CONCLUSION: In summary, the author identified that the children of mothers with affective disorders have more behavior problems in social adjustment than normal control subjects. Parental rearing style is thought to have more negative influence on the children of mothers with affective disorders than normal control. It is surmised that less caring and more overprotective rearing style could influence behavior problems of their children.
Adolescent ; Adolescent Behavior ; Bipolar Disorder ; Checklist ; Child ; Depression ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Fathers ; Humans ; Mood Disorders* ; Mothers* ; Parenting ; Parents ; Psychopathology ; Surveys and Questionnaires ; Self Report ; Social Adjustment

No abstract available.
Humans ; Infant* ; Parturition*

BACKGROUND: Tuberculosis continues to be a major threat to health throughout the world, with an estimated 8 to 10 million new cases and 3 million deaths annually. And control of the disease is further threatened by the emergence of drug resistance. Recent major advances have been made in unravelling the molecular basis of M. tuberculosis resistance to isoniazid, streptomycin, quinolones and rifampin. And rifampin resistance is the useful indicator for the occurance of the multi-drug resistance. Hence, the rapid detection of rifampin resistant strain of M. tuberculosis is the key to have successful anti-tuberculosis therapy. Here we present our experience using PCR and line probe assay (INNO-LiPA) for easy and rapid detection of rifampin resistance of M. tuberculosis. METHODS: Thirty rifampin resistant and twenty susceptible strains of M. tuberculosis were collected from the routine culture and analyzed with INNO-LiPA. And results were compared with conventional antibiotic susceptibility testing. After amplification of the region of the RNA polymerase(rpoB), the amplified product is hybridized with a set of 10 oligonucleotides immobilized onto a membrane strip. From the pattern obtained the presence or not of rifampin resistance M. tuberculosis can be assessed. RESULTS: Ninety three percent of patients who had rifampin resistant strain revealed the multidrug resistance while only two showed resistance to rifampin only. The INNO-LiPA test results were generally agreeable with that of the conventional susceptibility testing(90%). The mutations in codon 531 (absence of 55 probe) were most commonly observed. In 55.2% of the 31 rifampin resistance M. tuberculosis confirmed on mutation by R-probes on the INNO-LiPA strips. CONCLUSIONS: The line probe assay after polymerase chain reaction is a fast and convenient method to detect both presence of M. tuberculosis complex strains and its resistance to rifampin in clinical specimens. We have suggested that detection of rifampin resistance may play a key role in monitoring multi-drug resistance. Consequently, the INNO-LiPA test may constitute an important tool for the control of tuberculosis.
Codon ; Drug Resistance ; Drug Resistance, Multiple ; Humans ; Isoniazid ; Membranes ; Mycobacterium tuberculosis* ; Mycobacterium* ; Oligonucleotides ; Polymerase Chain Reaction ; Quinolones ; Rifampin* ; RNA ; Streptomycin ; Tuberculosis

BACKGROUND: This study aims to obtain basic data regarding the proper maintenance and potential role of humidifiers in the development of nosocomial pneumonia. We investigated into a spectrum of bacteria that grew after disinfection in humidifiers that were used in intensive care units (ICUs). The bacteria were isolated at different time points after disinfection. METHODS: We randomly selected 6 humidifiers that were used in an ICU and conducted a series of bacterial culture studies at 24 hr, 48 hr, 72 hr and 168 hr after disinfecting the six humidifiers. The fluid from the humidifider was cultured in the same manner as the dialysate. RESULTS: No bacteria were isolated in most of the 6 humidifiers 24 hr after the disinfection of the instruments. Gram-negative bacilli such as Acinetobacter baumannii, Burkholderia cepacia, and Stenotrophomonas maltophilia were cultured at 48 hr after disinfection. CONCLUSION: Regular and thorough disinfection of humidifiers is necessary to prevent possible spread of infection via humidifiers in the ICU.
Acinetobacter baumannii ; Bacteria ; Burkholderia cepacia ; Disinfection ; Critical Care ; Intensive Care Units ; Pneumonia ; Stenotrophomonas maltophilia

This study aims to find factors that affect variations in cesarean section frequency rates among OBGY clinics in Metropolitan areas. The factors include patient, medical supplier characteristics and economic factors. This study is a cross-sectional analysis using health insurance delivery claims from July to December 2000 and files of the NHIC(national health insurance corporation). Multiple regression was used to analyze the dependent variable of cesarean section frequency rate at each clinic. The results are as follows : Cesarean section frequency rate is increasing in proportion to the number of the following patients : repeated caesarean section, disproportion, obstructed labour, fetal distress, emergency caesarean section and self-employed patients. There are geographic variations as well. Cesarean section frequency rates are higher in Inchon and Gyonggi province than in Seoul. The higher number of total delivery the clinic has, the lower rate of cesarean section it has. Clinics with high frequency rates in 1999 showed higher rates the next year. Further research is required to develop evidence based delivery modes and change strategies for increasing normal delivery and activating midwife clinics.
Cesarean Section* ; Cross-Sectional Studies ; Emergencies ; Female ; Fetal Distress ; Humans ; Incheon ; Insurance, Health ; Midwifery ; Pregnancy ; Seoul ; Small-Area Analysis

The effect of androgen in the development of the normal prostate and the evolution of benign prostatic hypertrophy (BPH), and prostatic adenocarcinoma has been proven. In addition to androgen, estrogen and progesterone are also thought to play a role in the pathogenesis of BPH and carcinoma. However, their exact roles are not yet known because there is no conclusive evidence. Thirty cases of prostatic adenocarcinoma and 16 cases of BPH were studied. Immunohistochemical staining for estrogen receptor (ER) and progesterone receptor (PR) in epithelial and stromal cells, respectively was performed and the results were assessed semiquantitatively based on the number of positive cells per 100 total cells. Slides were scored as negative; less than 5% of cells, 1 ; 6~15% of cells, 2 ; 16~25% of cells, and 3 ; more than 26% of cells. The relationship between ER and PR expression and the patient's age, histologic grade, and clinical stage was evaluated in prostatic adenocarcinomas. ER was negative in epithelial and in stromal cells for all prostatic adenocarcinomas and BPH cases. The PR expression in epithelial cells and in stromal cells of BPH was noted in 15 (93.8%) and 16 (100.0%) out of 16, respectively. The PR expression of carcinoma cells and stromal cells in prostatic adenocarcinoma was found in 28 (93.3%) and 23 out of 30 (76.7%), respectively. The PR immunoreactivities of stromal cells around carcinoma were 3 in 18 cases, 2 in one case, and 1 in 4 cases, but those of epithelial and stromal cells of BPH and carcinoma cells of prostatic carcinoma were similar to each other with a value of 3 in most cases. The PR expression rate of stromal cells around carcinoma was significantly correlated with the patient's age (p=0.044), but not with histologic grade and clinical stage. In summary, estrogen does not have a direct effect on the biological behavior of BPH and prostatic adenocarcinoma, but progesterone appears to play a role in the pathogenesis of BPH and prostatic adenocarcinoma. Further studies should clarify the biological role of progesterone in the human prostate.
Adenocarcinoma* ; Epithelial Cells ; Estrogens* ; Humans ; Progesterone* ; Prostate ; Prostatic Hyperplasia* ; Receptors, Progesterone* ; Stromal Cells

Pulmonary lymphangiomyomatosis is a rare disease of haphazard overproliferation of smooth muscle from perilymphatics, peribronchial and perivascular regions of the lung that leads to chylous effusion, hemoptysis, spontaneous pneumothorax and pulmonary insufficiency. The disease only affects women of child-bearing age. There is presently no successful therapy and most of the patients die within 10 years of diagnosis. We experienced a case of pulmonary lymphangiomyomatosis in a 30-year-old woman who had suffered from three episodes of spontaneous pneumothorax for 4 years. Open lung biopsy was performed. Microscopically, abnormal excess proliferation of smooth muscle tissue was identified in the wall of perivascular lymphatic channels as well as around small bronchi, and more distal air spaces. Varying sized cytic spaces Iined by cuboidal cells were also present. Tamoxifen, given if February 1991, did not influence the course of her disease. She died of respiratory failure at age of 31 in April 1991.
Female ; Humans ; Biopsy