BACKGROUND: The objective of this study was to assess the risk of emergency cesarean deliveries (CDs) and adverse neonatal/maternal outcomes according to the planned gestational age at delivery (GAD) for elective CD. METHODS: The study population consisted of term singleton pregnant women who were booked for elective CD and were subsequently delivered at term by CD, after excluding cases with a trial of labor. The relationship between the planned GAD, risk of emergency CD prior to planned date, and adverse neonatal/maternal outcomes were determined. RESULTS: The frequency of emergency CD, adverse neonatal and maternal outcomes were 9.5%, 4.5%, and 5.9%, respectively. The risk of emergency CD prior to the planned delivery date increased significantly according to the planned GAD (5.8% at 37 weeks, 8.2% at 38 weeks, 13.6% at 39 weeks, and 26.7% at 40 weeks or more of planned GAD, P = 0.005). Emergency CD was associated with an increased risk of adverse maternal outcomes, whereas the risk of adverse neonatal outcomes did not differ. In the total study population including both cases with elective and emergency CD, the risk of adverse maternal outcomes did not increase according to the planned GAD, and the risk of adverse neonatal outcomes decreased significantly according to the planned GAD. CONCLUSION: The risk of emergency CD increased as the planned GAD increased, but the risk of adverse maternal outcomes did not increase and the risk of adverse neonatal outcomes decreased significantly according to the planned GAD in the total study population including elective/emergency CD.
Emergencies ; Female ; Gestational Age ; Humans ; Pregnant Women ; Trial of Labor

OBJECTIVE: To investigate the promoter methylation status in the p16 gene in primary cervical cancer and to analyze the relationships between the clinicopathologic parameters and the methylation status of p16 gene. METHODS: Promoter methylation was evaluated by using a methylation-specific polymerase chain reaction in 78 cervical cancer tissues and 24 control non-neoplastic cervical tissues. Clinicopathologic parameters were obtained from medical records and the relationships between the discrete variables and the methylation status were evaluated. RESULTS: The frequency of the promoter methylation of p16 in cervical cancer was 57.0% (45/78). Primary cervical cancer had a significantly higher methylation frequency for p16 gene as compared to a control non-neoplastic cervix (p<0.0001). Higher stage cancers exhibited an increased promoter methylation frequency for p16 (45.6% in stage Ib, 58.3% in stage IIa, 88.2% in stage IIb, and 66.7% in stage IIIb, p=0.0125). CONCLUSION: Our results suggest that promoter methylation of p16 is a frequent event in cervical carcinogenesis and has a potential clinical application as markers for cancer progression and prediction of prognosis.
Carcinogenesis ; Cervix Uteri ; Female ; Genes, p16* ; Medical Records ; Methylation* ; Polymerase Chain Reaction ; Prognosis ; Uterine Cervical Neoplasms*

PURPOSE: QTc dispersion is a quantitative measure of myocardial repolarization and is a new important prognostic factor for many diseases. We have analyzed the admission ECGs of 53 patients with spontaneous intracerebral hemorrhage (ICH) for QTc dispersion. This study was performed to investigate the value of QTc dispersion as a prognostic factor in ICH patients. METHODS: ECGs done within 24 hours from attack onset were analyzed for abnormalities and QTc. The QTc dispersion is the QT duration of the longest minus the shortest rate-corrected QT interval. We studied the differences in QTc dispersions on the initial ECGs in the ED between a favorable group and an unfavorable group. RESULTS: We found that patients had less chance for a good recovery if they had a lower Glasgow Coma Scale (GCS) score on admission, a larger volume hematoma, a prolonged QTc dispersion, or a longer maximal QTc interval of the 53 patients with ICH, 16 (30.2%) patients demonstrated ECG abnormalities. The QTc dispersion was extremely prolonged in both groups. The favorable group included patients with a mean QTc dispersion=70.6 ms, whereas the unfavorable group included patients with a QTc dispersion= 117.6 ms. CONCLUSION: A prolonged QTc dispersion and a lower GCS score were significant predictors of a poor prognosis for spontaneous ICH patients. An increased QTc dispersion on the initial ECG is an important prognostic factor for ICH patients. More attention should be given to the disposition and intensive care of such patients.
Cerebral Hemorrhage* ; Electrocardiography ; Glasgow Coma Scale ; Hematoma ; Humans ; Critical Care ; Prognosis

PURPOSE: This study intended to identify prognostic factors influencing recovery, progressing chronic renal failure (CRF) and mortality in acute renal failure (ARF) patients at the emergency department. METHODS: We retrospectively analyzed 104 patients with ARF and with serum creatinine (Cr) level above 2 mg/dL and glomerular filtration rate (GFR) < 62.5 mL/min/ 1.73m2 (< 50%), who were treated at the emergency department fome Jan. 1998 to Aug. 2003. RESULT: Among the 104 patients, 71 patients were male and 33 patients were female. The overall mortality was 16.3%. Based on a univariate analysis, sex, age > 60 years, underlying disease, cause of ARF, urine volume, existence of oliguria, duration of oliguria, proteinuria, GFR, serum BUN, serum Cr, BUN/Cr ratio, arterial pH, PaO2, S a O2, serum Na+, serum K+, serum albumin, serum total bilirubin, serum osmolarity, serum AST, serum ALT, serum creatine kinase, and serum myoglobin were all significant factors discriminating between recovery patients and nonrecovery patients (progressing CRF, mortality). Based on a multivariate analysis, sex, existence of oliguria, duration of oliguria, GFR, BUN/Cr ratio, PaO2, serum K+, SaO2, serum bilirubin, and serum osmolarity were useful factors which might affected non-recovery. CONCLUSION: In ARF, the prognostic factors were serum K+, S a O2, duration of oliguria, and BUN/Cr ratio. The higher serum K+, the lower SaO2, the longer the duration of oliguria, and the lower the BUN/Cr ratio are for ARF patients at the emergency department, the more the intensive care emergency physician must perform.
Acute Kidney Injury* ; Bilirubin ; Coriolaceae ; Creatine Kinase ; Creatinine ; Emergencies* ; Emergency Service, Hospital* ; Female ; Glomerular Filtration Rate ; Humans ; Hydrogen-Ion Concentration ; Critical Care ; Kidney Failure, Chronic ; Male ; Mortality ; Multivariate Analysis ; Myoglobin ; Oliguria ; Osmolar Concentration ; Proteinuria ; Retrospective Studies ; Serum Albumin

PURPOSE: Since 1960 pediatric advanced life support (PALS) has been studied and applied to clinical situations, ILCOR guidelines 2000 for CPR and ECC was achieved. Pediatric cardiopulmonary arrest differs from adult arrest in etiologies, mechanisms, and managements. This study was performed to identify the clinical manifestations and real picutre of CPR to recognize the need of standard CPR method that increases the survival in infants with out-of hospital arrest. METHODS: This study was planned by retrospectively reviewed the records of all children who arrived without spontaneous respiration and palpable pulse at the emergency room of the three Hospitals from January 1996 to July 2003. RESULTS: During that period, 45 infants presented with out of-hospital cardiopulmonary arrest. Overall, there was a return of vital signs in 15 of the 45 patients; 6 survived to discharge from hospital. 1. Out-of-hospital arrest in infants demonstrated that 60% were male, mean age was 133.4 days. Of these, 71.1% of the arrests occurred in the home with family members presents, those family members didn't perform basic CPR in only 1 case. 2. In any ROSC group, the interval between the arrest and arrival at the hospital was 14.4 minutes. In ROSC never achieved group, the interval was 32.0 minutes. 3. Two of the 15 patients with SIDS(13.3%) and four of the 13 patients with respiratory arrest(30.8%) survived to hospital discharge. CONCLUSION: Factors that predicted survival to discharged alive included a death caused by respiratory disease, a short interval between the arrest and arrival at the hospital, and a short duration of resuscitation efforts in the ER. We found that need of standard guideline and commonly applied CPR techniques.
Adult ; Cardiopulmonary Resuscitation* ; Child ; Emergency Service, Hospital ; Heart Arrest* ; Humans ; Infant* ; Male ; Respiration ; Resuscitation ; Retrospective Studies ; Vital Signs