OBJECTIVE:The purpose of this study was to identify the prevalence of risk factors related to Gestational Diabetes Mellitus (GDM). METHODS:We retrospectively analyzed medical records of 1,091 pregnant women who had a 50 g oral glucose tolerance test (OGTT) at performed at the department of Obstetrics and Gynecology, Chungbuk National University Hospital from June, 1999 to March, 2006. The 1-hour plasma glucose level higher than 140 mg/dL was considered as a positive screening result. Patients with positive results underwent a 100 g OGTT as the diagnostic test for GDM, and more than 2 positive results were diagnosed as GDM, according to the American National Diabetes Data Group (NDDG) guideline. We investigated age, prevalence of obesity, weight gain, history of fetal anomaly, fetal death in uterus (FDIU), macrosomia, preeclampsia, GDM and familial history of diabetes mellitus, as the risk factors of GDM. RESULTS:Elderly gravida, history of FDIU, perinatal death, preeclampsia, and GDM, familial history of diabetes mellitus were the risk factors of GDM and macrosomia to a statistically significant degree. We found out that BMI and 50 g OGTT results were increased in GDM group. However, there was a pregnant woman with no risk factors who had been diagnosed with GDM. CONCLUSION : Although the pregnant women with risk factors should be managed carefully to detect GDM, we also suggest all pregnant women to take screening test even if they have no risk factors, to improve pregnancy outcomes by detecting and treating unexpected GDM early in pregnancy.
Blood Glucose ; Chungcheongbuk-do ; Diabetes Mellitus ; Diabetes, Gestational* ; Diagnostic Tests, Routine ; Female ; Fetal Death ; Glucose Tolerance Test ; Gynecology ; Humans ; Mass Screening ; Medical Records ; Obesity ; Obstetrics ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Prevalence ; Retrospective Studies ; Risk Factors* ; Uterus ; Weight Gain

OBJECTIVE: Easy triggering of trauma-related episodic memory fragments caused by perceptual cues is tied to strong perceptual priming in the implicit memory system. And among benzodiazepines, only lorazepam has been consistently reported to have an atypical suppression effect on perceptual priming processes. The aim of this study was to investigate the effects of single doses of lorazepam, diazepam, and a placebo on intrusive memories after exposure to a distressing videotape and to explore whether the anti-intrusive effect of lorazepam is acquired as a result of the suppression of perceptual but not conceptual priming processes. METHODS: Under prospective, randomized, and double-blind conditions, we compared the anti-intrusion effect of a single dose of lorazepam (n=22) with that of diazepam (n=22) and a placebo (n=21) in young healthy Korean college students following exposure to a traumatic videotape. RESULTS: We present the first finding for an anti-intrusion effect of lorazepam. One day after the medication, lorazepam, rather than diazepam or the placebo, significantly reduced the extent of intrusion and data-driven processing of the traumatic information. There were no differences among the three conditions in state anxiety, depression, and an arousal scale throughout the experiment. CONCLUSION: Results from this study suggest the possibility of lorazepam as a candidate anti-intrusion drug, as well as the cautious use of diazepam in the treatment of PTSD patients. The anti-intrusive effect of lorazepam is directly related to its atypical inhibitory effect on implicit perceptual priming processes. The present study provides support for the enhanced perceptual priming hypothesis of PTSD.
Benzodiazepines ; Cues ; Diazepam ; Humans ; Lorazepam* ; Memory ; Memory, Episodic ; Prospective Studies ; Stress Disorders, Post-Traumatic ; Videotape Recording

PURPOSE: Recently, it was reported that apoptosis in hypoxic ischemic cerebral injury is involved in neuronal injury while nitric oxide synthase(NOS) is involved in neuronal apoptosis. The aim of the present study is to investigate the relationship between the expression pattern of NOS and the apoptosis in hypoxic ischemic cerebral injury of rats. METHODS: To investigate the expression pattern of nitric oxide synthase and the relationship between apoptosis and activity of NOS, immunoelectron microscopic examination and in situ apoptosis detection(TUNEL) were performed in male Sprague Dawley rats. Ischemic injury was induced by permanent ligation of left common carotid artery and hypoxic injury by exposure of a mixture of 10% oxygen+90% nitrogen gas. Unicryl embedding method was used for immunoelectron microscopy and Apoptag kit for apoptosis. RESULTS: The number of apoptotic cells reached the highest at 24 hr, decreased after 72 hr and maintained the expression level until 168 hr. nNOS was expressed in neurons of the cortex, peaked at 24 hr and decreased after 72 hr. However, nNOS was not detected in the hippocampus. eNOS was expressed at 12 hr and at 24 hr in the hippocampus and the cortex, respectively, and persisted at each time point. iNOS was expressed after 72 hr in the cerebral cortex and the hippocampus. CONCLUSION: The expression of three isoforms of NOS in hypoxic ischemic cerebral injury was different in time. nNOS seems to be involved in cortical damage in the early phase of hypoxic ischemic cerebral injury and iNOS is related to apoptotic cell deaths in the late phase, but further study on their mechanisms will be needed.
Animals ; Anoxia ; Apoptosis* ; Carotid Artery, Common ; Cell Death ; Cerebral Cortex ; Hippocampus ; Humans ; Ischemia ; Ligation ; Male ; Microscopy, Immunoelectron ; Neurons ; Nitric Oxide Synthase* ; Nitric Oxide* ; Nitrogen ; Protein Isoforms ; Rats* ; Rats, Sprague-Dawley

PURPOSE: Recently, it was reported that apoptosis in hypoxic ischemic cerebral injury is involved in neuronal injury while nitric oxide synthase(NOS) is involved in neuronal apoptosis. The aim of the present study is to investigate the relationship between the expression pattern of NOS and the apoptosis in hypoxic ischemic cerebral injury of rats. METHODS: To investigate the expression pattern of nitric oxide synthase and the relationship between apoptosis and activity of NOS, immunoelectron microscopic examination and in situ apoptosis detection(TUNEL) were performed in male Sprague Dawley rats. Ischemic injury was induced by permanent ligation of left common carotid artery and hypoxic injury by exposure of a mixture of 10% oxygen+90% nitrogen gas. Unicryl embedding method was used for immunoelectron microscopy and Apoptag kit for apoptosis. RESULTS: The number of apoptotic cells reached the highest at 24 hr, decreased after 72 hr and maintained the expression level until 168 hr. nNOS was expressed in neurons of the cortex, peaked at 24 hr and decreased after 72 hr. However, nNOS was not detected in the hippocampus. eNOS was expressed at 12 hr and at 24 hr in the hippocampus and the cortex, respectively, and persisted at each time point. iNOS was expressed after 72 hr in the cerebral cortex and the hippocampus. CONCLUSION: The expression of three isoforms of NOS in hypoxic ischemic cerebral injury was different in time. nNOS seems to be involved in cortical damage in the early phase of hypoxic ischemic cerebral injury and iNOS is related to apoptotic cell deaths in the late phase, but further study on their mechanisms will be needed.
Animals ; Anoxia ; Apoptosis* ; Carotid Artery, Common ; Cell Death ; Cerebral Cortex ; Hippocampus ; Humans ; Ischemia ; Ligation ; Male ; Microscopy, Immunoelectron ; Neurons ; Nitric Oxide Synthase* ; Nitric Oxide* ; Nitrogen ; Protein Isoforms ; Rats* ; Rats, Sprague-Dawley

PURPOSE: To assess the tumor response, sphincter preservation, acute toxicity and survival with preoperative concurrent chemoradiation in locally advanced rectal cancer. MATERIALS AND METHODS: Fifty-four patients were treated with preoperative chemoradiaton for tumor downstaging and sphincter preservation. Radiation was delivered to whole pelvis to 45 Gy followed by a boost 5.4 Gy to primary tumor site. Chemotherapy consists of concurrent 2 cycles of 5-fluorouracil (500 mg/m2/day) and leucovorin (20 mg/m2/day). Surgery was performed approximately 6 weeks after treatment. RESULTS: Median follow-up period and rate were 48 months and 98%, respectively. The downstaging including primary tumor and lymph node occurred in 64%. Three of 53 patients (6%) had pathologic complete response. The resectability of tumor was 98%. A sphincter preservation was possible in 61%. Three patients developed grade 4 hematologic toxicity. Grade 3 skin erythema and diarrhea were 24% and 18%, respectively. The 5-year survival and local disease-free survival were 62% and 89%, respectively. Local failure and distant metastasis rate were 9% and 35%, respectively. CONCLUSION: Preoperative chemoradiation affords considerable downstaging with acceptable acute toxicity and postoperative morbidity. Also sphincter preservation is feasible by improved downstaging of tumor. This treatment could be improved local control of tumor, and may have a potential for long-term survival.
Diarrhea ; Disease-Free Survival ; Drug Therapy ; Erythema ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Lymph Nodes ; Neoplasm Metastasis ; Pelvis ; Rectal Neoplasms* ; Skin

BACKGROUND: The investigations of personality traits have been the issue of many studies on patients with tension-type headache. However, there was few comparison study of personality traits between the patients with episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) using Minnesota Multiphasic Personality Inventory (MMPI). METHODS: The study was consecutively made of the personality profiles of two groups with ETTH (137 patients) and CTTH (115 patients) in accordance with the International Headache Society (IHS) criteria, employing the MMPI. RESULTS: The two groups could be classified into three clusters by a multivariate cluster analysis, which are relatively normal profile (cluster I), somatic profile (cluster II, elevated Hs-D-Hy scales), and psychosomatic profile (cluster III, elevated Pa-Pt-Sc-Si and Hs-D-Hy scales). The proportion of the patients with CTTH in the psychosomatic profile group was stastically more significant (59.6%) than that of the patients with ETTH (40.4%) by a chi-square test. CONCLUSIONS: This study shows that the psychosomatic profile might be more common in the CTTH patients than in the ETTH patients.
Headache ; Humans ; MMPI* ; Tension-Type Headache*

Cauda equina syndrome is a well-known but rare complication of spinal anesthesia. An 80-year-old man was scheduled for both herniorrhaphy. Spinal anesthesia was performed at the L3-4 interspinous space with 0.5% hyperbaric bupivacaine 12 mg. Eight hours after anesthesia, the patient complained bilateral sensorimotor deficits of the lower extremities and peroneal region. Urinary and fecal incontinence were also observed. MRI and myelography showed severe central spinal stenosis at L3-4 and L4-5. EMG showed cauda equina syndrome. Seven weeks after the procedure, left decompressive subtotal laminectomy L2-L5 was done. The patient still complains the neuropathic pain in the both lower extremities and ambulates using a walker. The local anesthetic was injected into thecal sac between maximum stenoses, and it is likely that there was poor upward spread leading to maldistribution of local anesthetic and resultant local anesthetic toxicity.
Aged, 80 and over ; Anesthesia ; Anesthesia, Spinal ; Bupivacaine ; Cauda Equina ; Constriction, Pathologic ; Fecal Incontinence ; Herniorrhaphy ; Humans ; Laminectomy ; Lower Extremity ; Myelography ; Neuralgia ; Polyradiculopathy ; Spinal Stenosis ; Walkers

BACKGROUND: The aim of this study was to investigate the effect of butorphanol on the Bispectral Index (BIS) during the administration of intravenous anesthesia with propofol and remifentanil. METHODS: Forty adult patients, ASA I-II, scheduled for an emergency laparoscopic appendectomy were studied. The doses for the anesthetics were adjusted to keep the BIS value between 40 and 50. After 20 minutes of stable anesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or 0.02 mg/kg butorphanol (butorphanol group). The BIS values, mean arterial pressure, and heart ratewere recorded every five minutes for a period of 20 minutes. RESULTS: The mean BIS values after butorphanol administration were not significantly different from the values following the administration of saline, throughout the observation period. No patients were able to recall explicitly any events under anesthesia. No significant changes in mean arterial pressure and heart rate were noted after butorphanol administration. CONCLUSIONS: Butorphanol given to prevent postoperative pain does not modify the BIS value during anesthesia maintained with remifentanil and propofol.
Adult ; Anesthesia ; Anesthesia, Intravenous* ; Anesthetics ; Appendectomy ; Arterial Pressure ; Butorphanol* ; Emergencies ; Heart ; Heart Rate ; Humans ; Pain, Postoperative ; Propofol*

Herpes zoster in childhood is uncommon, but it is more common in association with immunosuppression. Maternal varicella infection during pregnancy and varicella occurring in the newborn represent risk for childhood herpes zoster. However, some controversies persist on risk factors, diagnosis, and the natural history of childhood disease. We report a 10-year-old healthy boy with shingles and review the risk factors, prognosis, and treatment of pediatric zoster.
Chickenpox ; Child ; Herpes Zoster ; Humans ; Immunosuppression ; Infant, Newborn ; Natural History ; Pregnancy ; Prognosis ; Risk Factors

OBJECTIVES: An in vitro biomechanical study of posterior lumbar interbody fusion(PLIF) with threaded cage using two different approaches was performed on eighteen functional spinal units of bovine lumbar spines. The purpose of this study was to compare the segmental stiffnesses among PLIF with one long posterolateral cage, PLIF with one long posterolateral cage and simultaneous facet joint fixation, and PLIF with two posterior cages. METHODS: Eighteen bovine lumbar functional spinal units were divided into three groups. All specimens were tested intact and with cage insertion. Group 1(n=12) had a long threaded cage(15x36mm) inserted posterolaterally and oriented counter anterolaterally on the left side by posterior approach with left unilateral facetectomy. Group 2(n=6) had two regular length cages(15x24mm) inserted posteriorly with bilateral facetectomy. Six specimens from group 1 were then retested after unilateral facet joint screw fixation in neutral(group 3). Likewise, the other six specimens from group 1 were retested after fixation with a facet joint screw in an extended position(group 4). Nondestructive tests were performed in pure compression, flexion, extension, lateral bending, and torsion. RESULTS: PLIF with a single cage, group 1, had a significantly higher stiffnesses than PLIF with two cages, group 2, in left and right torsion(p<0.05). Group 1 showed higher stiffness values than group 2 in pure compression, flexion, left and right bending but were not significantly different. Group 3 showed a significant increase in stiffness in comparison to group 1 for pure compression, extension, left bending and right torsion(p<0.05). For group 4, the stiffness significantly increased in comparison to group 1 for extension, flexion and right torsion(p<0.05). Although there was no significant difference between groups 3 and 4, group 4 had increased stiffness in extension, flexion, right bending and torsion. CONCLUSION: Posterior lumbar interbody fusion with a single long threaded cage inserted posterolaterally with unilateral facetectomy enables sufficient decompression while maintaining a majority of the posterior elements. In combination with a facet joint screw fixation, adequate postoperative stability can be achieved. We suggest that posterolateral insertion of a long threaded cage is biomechanically an ideal alternative to PLIF.
Decompression ; Spine ; Zygapophyseal Joint