OBJECTIVE: To compare pregnancy and delivery complications in first births between women 35 years or older and those who are younger. METHODS: Matemal and newborn records for first births at Chonnam university hospital from January 1, 1988 to December 31, 1996 were studied. The study group included 123 women who were 35 years or older. A control group consisting of 120 younger women was used for comparison. The X2 test was used to identify trends in individual variables and outcomes. RESULTS: Premature rupture of membrane, uterine myoma, and malpresentation were much mare prevalent in the older nullipara. However, there were no significant differences in incidences of preeclampsia, placenta previa, and pyelonephritis between the older nullipara and younger nullipara groups. Older nullipara had a significantly higher incidence of Cesarean delivery than younger women, Elective cesarean section was performed only in the older nullipara and it was the most common indication for Cesarean delivery in older nullipara. Fetal distress and breech presentation as indications for Cesarean delivery were significantly more common in the older study group. There were no noticeable differences in postpartal complication between the groups. Pretam birth and low birth weight were much more common in the older nullipara. but there were no significant differences in small for gestational age, low Apgar score, perinatal morbidity and deaths between the groups. CONCLUSION: From the results, it was difficult to conclude that women 35 or older are pmne to higher risk pregnancies, compared to their younger counterparts. Although more incidences of premature rupture of membrane, preterm delivery, and Cesarean delivery were observed, there were no significant differences in other pregnancy and delivery complications. With appropriate obstetric care, it is most probable that first time pregnancies in older women will result in similar outcome as those in younger women.
Apgar Score ; Birth Order ; Breech Presentation ; Cesarean Section ; Female ; Fetal Distress ; Gestational Age ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Jeollanam-do ; Leiomyoma ; Membranes ; Parturition ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Pyelonephritis ; Rupture

Acute hemorrhagic edema of infancy is an unusual form of leukocytoclastic vasculitis occuring in children from the age 4 months to 2 years. The etiology remains unknown. Numerous studies, however, suggest acute hemorrhagic edema of infancy as an immune-mediated vasculitis in response to a variety of antigenic stimuli. We report a case of an acute hemorrhagic edema of infancy; 11-month-old boy with a history of fever for 3 days and a history of purpuric rash on the extremities, trunk, buttock and oral mucosa for 2 days.
Acute Disease ; Biopsy ; Edema/immunology/*pathology ; Exanthema/immunology/pathology ; Hemorrhage/immunology/*pathology ; Human ; Infant ; Male ; Vasculitis, Hypersensitivity/immunology/*pathology

BACKGROUND: A number of reports have been published regarding the use of imiquimod for the treatment of melanoma in situ and metastatic melanoma. Essential steps in the process of melanoma invasion and metastasis include degradation of basement membranes and remodeling of the extracellular matrix by proteolytic enzymes, including matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). OBJECTIVE: To evaluate the antiinvasive effect of imiquimod in human malignant melanoma cell lines, SK-MEL-2 and SK-MEL-24, in vitro, and to investigate imiquimod-induced changes in the expression of MMPs and TIMPs. METHODS: Invasiveness of melanoma cell lines following imiquimod treatment was evaluated by invasion assays. In order to investigate the mechanism of the anti-invasive effect of imiquimod, mRNA and protein levels of MMP-2, -9, membrane type 1 (MT1)-MMP, TIMP-1, and -2 were assessed by real-time reverse transcription-polymerase chain reaction, gelatin zymography, and western blotting. RESULTS: Imiquimod treatment decreased in vitro viability of melanoma cells in a concentration-dependent manner. Imiquimod also elicited a concentration-dependent suppression of invasion in both melanoma cell lines. A concentration-dependent decrease in MMP-2 and MT1-MMP protein levels and a concentration-dependent increase in TIMP-1 and -2 protein levels by imiquimod was observed in both melanoma cell lines. However, expression of MMP-9 protein was increased in SK-MEL-2 but decreased in SK-MEL-24 with increasing imiquimod concentrations. Imiquimod elicited alterations in MMPs and TIMPs mRNA levels that parallel the observed changes in protein levels. CONCLUSION: Imiquimod may elicit an anti-invasive effect on human melanoma cells by regulating MMPs and TIMPs.
Basement Membrane ; Blotting, Western ; Cell Line ; Extracellular Matrix ; Gelatin ; Humans ; Matrix Metalloproteinase 14 ; Matrix Metalloproteinases* ; Melanoma* ; Membranes ; Metalloproteases* ; Neoplasm Metastasis ; Peptide Hydrolases ; RNA, Messenger ; Tissue Inhibitor of Metalloproteinase-1

OBJECTIVE: This study was performed to investigate the effects of metformin in PCOS patients undergoing IVF-ET. METHODS: From January 2002 to December 2004, 87 cycles in 32 PCOS patients undergoing IVF-ET at the Infertility clinic of Grace Women's Hospital were randomly divided into two groups and enrolled in this study. The diagnosis of PCOS was made by the criteria from 2003 Rotterdam Consensus. Metformin group (19 patients, 45 cycles) received metformin (Daewoong Pharma Co., Korea; 500 mg three times or two times a day from one or two months before and during IVF cycle) and control group (13 patients, 42 cycles) did not receive metformin. All patients received controlled ovarian hyperstimulation (COH) using gonadotropins (Fostimon, IBSA, Switzerland) with GnRH antagonist (Cetrotide, Serono, Germany). When leading follilces reached 18 mm in diameter, recombinant hCG 250 ?g (OVIDREL, Serono, Italy) was injected. Oocytes were retrieved transvaginally 35 hours later. The luteal phase was supported everyday by progesterone 50 mg IM (Progest, Samil, Korea) with micronized progesterone 200 mg vaginal insertion (Utrogestan, Besins, France). RESULTS: There was no statistical difference in the patients age (34.1+/-3.0 vs 33.5+/-2.9 years), the duration of infertility (4.3+/-1.3 vs 4.5.+/-1.3 years) and BMI (23.5+/-2.4 vs 24.01+/-2.7 kg/m2) among two groups (p> or =0.05 for each). There was also no statistical difference in the indications of IVF among two groups; ovulation factor (27 cycles vs 23 cycles), tubal factor (7 vs 8), male factor (8 vs 7) and other factor (3 vs 4) (p> or =0.05). The duration of ovulation induction in metformin group was significantly shorter when compared with control group (10.1+/-2.3 vs 13.8+/-2.2 days, p<0.05). Total doses of FSH-HP in metformin group were significantly less than that in control group (30.3+/-11.5 vs 39.9+/-11.7 ampules, p<0.05). There was no difference in the number of aspirated oocytes (10.5+/-4.7 vs 9.6+/-3.6), the fertilization rate (65.9+/-17.4% vs 63.2+/-25.9%), implantation rate (30.3+/-11.5% vs 38.1+/-17.3%) and the number of good quality embryo (5.0+/-1.8 vs 4.7+/-2.5, p< or =0.05). Clinical pregnancy rate was higher in metfomin group (33.3% vs. 23.8%), although statistically not significant. CONCLUSION: Although more randomized study is needed, metformin therapy in PCOS patients undergoing IVF has possibility of reducing the duration of COH and the gonadotropin doses.
Consensus ; Diagnosis ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization ; Fertilization in Vitro* ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Korea ; Luteal Phase ; Male ; Metformin* ; Oocytes ; Ovulation ; Ovulation Induction ; Polycystic Ovary Syndrome* ; Pregnancy Rate ; Progesterone

OBJECTIVE: To evaluate the efficacy of clinical use of a intrauterine Sengstaken-Blakemore tube (S-B tube) in postpartum hemorrhage not controlled with medication and conservative treatment. METHODS: Retrospective review was done in 18 women with insertion of S-B tube into intrauterine cavity who did not controlled with medication and conservative treatment for postpartum hemorrhage. After third stage of labor, women were treated with prophylactic intramuscular Methylergonovine 0.2 mg and intravenous infusions of oxytocin routinely. If the postpartum bleeding continued, Misoprostol 800 microgram (per rectal) and intravenous infusions of Dinoprost 2 mg mixed with 5% D/S 500 cc were employed. And then women were examined for retained placenta and laceration of birth canal. Where necessary, retained placenta was removed and lacerations were sutured. If the postpartum bleeding did not controlled despite all of procedures, we decided use of intrauterine S-B tube. RESULTS: The mean age of the patients was 30.9+/-4.4 (27-39) years, their mean body weights and parities were 67.8+/-8.2 (56.2-85.7) kg, 1.8+/-0.8 (1-4) and mean gestational age was 38.5+/-2.9 (37-42) weeks respectively. The mean time from delivery to insertion of S-B tube was 107.6+/-94.0 (24-360) minutes. The mean filled normal saline amount was 190.5+/-35.2 (120-230) cc. Of 18 who was inserted of S B tube, 15 cases needed not additional surgical therapy. So success rate was 83.3%. CONCLUSION: Insertion of intrauterine S-B tube appears as a simple and effective means of treating postpartum hemorrhage not controlled with medication and conservative treatment.
Body Weight ; Dinoprost ; Female ; Gestational Age ; Hemorrhage ; Humans ; Infusions, Intravenous ; Lacerations ; Methylergonovine ; Misoprostol ; Oxytocin ; Parturition ; Placenta, Retained ; Postpartum Hemorrhage* ; Postpartum Period* ; Retrospective Studies

Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML) is a benign, idiopathic histiocytic proliferative disorder affecting lymph nodes as well as extranodal sites. It is accompanied by fever, leukocytosis, elevated erythrocyte sedimentation rate, and polyclonal hypergammaglobulinemia. Although cutaneous involvement in RDD is common, a purely cutaneous disease is very rare. Histologic findings show characteristic large, pale, histiocytic cells exhibiting cytophagocytosis (emperipolesis). Immunohistochemically, these histiocytes are positive for S-100 protein and CD68, but negative for CD1a. The etiology is unknown, although it is thought to be a reactive disorder rather than neoplastic. We report two cases of Rosai-Dorfman disease showing involvement limited to the skin.
Adjustment Disorders ; Blood Sedimentation ; Cytophagocytosis ; Fever ; Histiocytes ; Histiocytosis, Sinus* ; Hypergammaglobulinemia ; Leukocytosis ; Lymph Nodes ; S100 Proteins ; Skin

Churg-Strauss syndrome (CSS) is a multisystem granulomatous vasculitis that is characterized by peripheral eosinophilia and the infiltration of eosinophils into systemic organs. The skin lesions of CSS consist mainly of palpable purpura and nodules. Wells' syndrome (WS) is a rare inflammatory dermatosis that is associated with recurrent granulomatous dermatitis and eosinophilia. Since these two diseases are rare, any overlap between them is very unusual. Herein, we report a patient with CSS, who initially presented a skin eruption of erythematous urticarial-plaques, vesicles, and blisters. Upon biopsy, the histology of these plaques indicated eosinophilic infiltration and "flame figures" within the dermis, which was consistent with a diagnosis of WS. Although the association between WS and CSS that was observed in our patient may be purely coincidental, it could also suggest a common pathogenetic background of these two distinct diseases, as both share several many common features.
Biopsy ; Blister ; Cellulitis ; Churg-Strauss Syndrome ; Dermatitis ; Dermis ; Eosinophilia ; Eosinophils ; Humans ; Purpura ; Skin ; Skin Diseases ; Vasculitis

Dermatofibroma is a common benign fibrohistiocytic tumor that occurs anywhere on the body surface, with a propensity for the extremities, usually the lower legs. A 31-year-old male presented with a skin-colored nodule measured 0.5 cm in diameter on the sole of hisfoot. A biopsy specimen revealed a poorly defined, nonencapsulated, nodular tumor composed of collagen bundles, fibroblasts and histiocytes, which were consistent with dermatofibroma. Herein we report a case of dermatofibroma on the sole.
Adult ; Biopsy ; Collagen ; Extremities ; Fibroblasts ; Histiocytes ; Histiocytoma, Benign Fibrous* ; Humans ; Leg ; Male

BACKGROUND: The aesthetic implications of ear keloids, which affect people of all races, are serious and the treatment of earlobe keloids is known to be difficult. The high rate of recurrence following excision alone has led to investigating various types of adjuvant therapy, including intralesional corticosteroid injection. OBJECTIVE: We evaluated the efficacy of excision combined with perioperative intralesional triamcinolone acetonide injection for treating earlobe keloids of Korean patients. METHODS: From 1997 to 2006, eighteen keloids on the earlobes of fifteen Korean patients were treated. The patient age ranged from 15 to 32 years (mean age: 24 years). All the patients were female and the keloids occurred after ear piercing. Preoperative intralesional triamcinolone acetonide (TA) injection was administered twice at a 1-month interval. Postoperative intralesional TA injections were given every 1 month for several months, depending on the patient's clinical progress. RESULTS: The follow-up period ranged from 4 to 42 months (mean: 18.5 months). After the surgery, TA intralesional injections were given 2 to 13 times (mean: 5.2 times). Of the treated keloids, eleven showed good results (61.1%) and three recurred (16.6%). No complications from the TA intralesional injection were observed. CONCLUSION: Among the various treatments for earlobe keloids, we suggest that excision with corticosteroid intralesional injection can be used as the first line therapy when considering its effect and economic advantage.
Body Piercing ; Continental Population Groups ; Ear ; Female ; Follow-Up Studies ; Humans ; Imidazoles ; Injections, Intralesional ; Keloid ; Nitro Compounds ; Recurrence ; Triamcinolone Acetonide

PURPOSE: We evaluated the diagnostic implications and therapeutic efficacy of antithrombin III(AT III) in the disseminated intravascular coagulation(DIC) of premature infants. METHODS: Ninety-two premature infants diagnosed with DIC and treated with AT III from March, 2000 to May, 2003 were retrospectively reviewed. Clinical manifestations, complete blood counts, coagulation tests, and AT III levels were compared between the two groups:definite DIC if clinical signs of DIC and AT III <70% with more than two abnormal laboratory parameters were present, and suspected DIC if not more than two abnormal laboratory parameters were present. RESULTS: AT III was given for an average of 3.2 days and no side effects related to the treatment were reported. The AT III levels increased significantly more than four fold with treatment in both groups. The clinical signs and laboratory values improved significantly after treatment. CONCLUSION: AT III level is a sensitive parameter in the diagnosis of DIC in premature infants, and it is useful as a treatment modality since it improves the clinical symptoms and the laboratory parameters without significant side effects.
Antithrombin III* ; Blood Cell Count ; Dacarbazine ; Diagnosis* ; Disseminated Intravascular Coagulation* ; Humans ; Infant, Newborn ; Infant, Premature* ; Retrospective Studies