OBJECTIVE: The changes of the production of nitric oxide in preeclampsia are still controversial. To determine the changes of nitric oxide production in preeclamptic pregnancies, NOS activity and eNOS and iNOS expression in preeclamptic placentae were compared with those in normal placentae, and to determine the changes of nitirc oxide production according to the sites of placenta, NOS activity and eNOS expression in preeclamptic placentae were also compared with those in normal placentae. METHODS: Human placentae were obtained from 15 normal and 15 preeclamptic pregnant women at the time of cesarean section. NOS activity was assessed by measuring the conversion of [3H]-arginine into [3H]-citrulline. The eNOS and iNOS expression were assessed by using western blot analysis. Data were analyzed by Student t-test and paired t-test where appropriate. RESULTS: The NOS activity(judged by measurement of [3H]-citrulline production) was significantly increased in preeclamptic placentae compared to normal(P<0.05). In normal and preeclamptic pregnant placentae, the NOS activity in main stem villi was increased compared to that in terminal villi. However, the difference of NOS activity between main stem villi and terminal villi was not significant(P>0.05). Quantification of the autoradiographic images demonstrated that the integrated optical density of the immunoreactive bands of eNOS were significantly lower in preeclamptic placentae compared to normal(p<0.05). Conversely, the integrated optical densities of the bands of iNOS were significantly higher in preeclamptic placentae compared to normal(p<0.05). CONCLUSIONS: Although the eNOS expression in preeclamptic placentae was lower than that in normal placentae, the NOS activity was significantly higher in preeclamptic placentae than that in normal in this study. These are result from increased production of iNOS in the compensatory mechanisms for the decreased nitric oxide production in pre-eclamptic placentae.
Blotting, Western ; Cesarean Section ; Female ; Humans* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Placenta* ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women

PURPOSE: To evaluate the characteristics of the bronchiectasis in diffuse panbronchiolitis using HRCT. MATERIALS AND METHODS: We retrospectively studied 12 HRCT scans and two bronchography of 12 patients with diffuse panbronchiolitis(DPB). According to Akira et al., DPB was classified into four types: small nodules around the end of bronchovascular branchings(CT type I), small nodules in the centrilobular area connected with small branching linear opacities(CT type II), nodules accompanied by ring-shaped or small ductal opacities connected to proximal bronchovascular bundles(CT type III), large cystic opacities accompanied by dilated proximal bronchi(CT type IV). We compared the type and the extent of bronchiectasis, CTtypes of DPB, and pulmonary function test. RESULTS: Bronchiectasis was defined in 12 cases with the tubular type predominantly involving small and medium-sized bronchi. These bronchiectasis involved the proximal bronchi of the centrilobular lesions of DPB. Among eight cases of advanced DPB(CT type III & IV) which extended to both upper lobes, seven showed tubular bronchiectasis at the same area. Cystic bronchiectasis was shown in eight cases predominantly involving right middle lobe(n=7). There was no linear correlation between the values of pulmonary function test and CTtypes of DPB. CONCLUSION: Characteristic feature of the bronchiectasis in DPB is the tubular ectasis predominantly involving the small and medium-sized bronchi. DPB with associated tubular bronchiectasis can involve whole lung field in advanced cases. HRCT is useful not only to depict the findings of DPB but also to demonstrate the extent of lesion.
Bronchi ; Bronchiectasis* ; Bronchography ; Humans ; Lung ; Respiratory Function Tests ; Retrospective Studies

OBJECTIVE: To determine the changes of nitric oxide production in preeclampsia, the concentration of nitric oxide metabolite, nitrite, was measured in umbilical vein after perfusing plasma from normal pregnant women and preeclamptic pregnant women. MATERIAL AND METHOD: 15 normal and 15 preeclamptic umbilical cords were obtained at the time of cesarean section. Two pieces of umbilical cord in equal length(20 cm in length) were prepared from each umbilical cord. Two pieces of umbilical cord were connected in parallel in a perfusion chamber. One piece of umbilical cord was perfused sequentially for 20-minutes' interval with the perfusates in the order of cord buffer, cord buffer including 15% normal pregnant serum, 15% normal pregnant serum with histamine(10-5mol/L), 15% normal pregnant serum with calcium ionophore A23187(5 mol/L) and the other one was perfused exactly same way using 15% preeclamptic serum instead of 15% normal pregnant serum. All the perfusates used were gassed with 95% O2 and 5% CO2 and warmed to 37degree C. Perfusates were collected in eppendorf tube and freezed at -70degree C until assayed. NO was measured by means of Greiss reaction. one way ANOVA and paired t-test were used where appropriate and p-value < 0.05 was considered significant. RESULTS: NO production in normal umbilical cords was not different regardless of perfusate. Although adding histamine and calcium ionophore, the NO production was slightly increased but statistically not significant in both groups. NO production in preeclamtic umbilical cords was significantly increased with 15% preclamptic serum(15% normal serum vs. 15% preeclamptic serum; 0.060+/-0.016microgram/ml/min vs 0.075+/-0.014microgram/ml/min, p<0.05). CONCLUSION: The preeclamptic sera may not affect the production of NO in the human umbilical vein endothelial cells. The biologic significance of increased NO production in preeclamptic umbilical cord with perfusing preeclamptic serum is unknown, but it might be compensation for the vasoconstriction of preeclampsia.
Calcium ; Cesarean Section ; Compensation and Redress ; Female ; Histamine ; Human Umbilical Vein Endothelial Cells ; Humans ; Nitric Oxide* ; Perfusion ; Plasma ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Umbilical Cord ; Umbilical Veins ; Vasoconstriction

OBJECTIVES: To determine the effectiveness and clinical utility of antenatal corticosteroids in the reduction of neonatal morbidity and mortality on preterm birth Material and method: Neonatal outcomes of 312 preterm babies were evaluated retrospectively. One hundred and two preterm babies(study group) were given dexamethasone more than 1 dose antenatally and 210 preterm babies(control group) were not given dexamethasone antenatally. Antenatal steroids were administered in the form of four 5mg intramuscular doses of dexamethasone 12 hours apart. Maternal and neonatal outcomes of study group were compared with those of control group. Student t- test, x2 test, Fisher's exact test, and logistic regression analysis were used where appropriate. p-value< 0.05 was considered significant. RESULTS: Antentenatal corticosteroid significantly decreased the incidence of RDS(OR:0.47, 95% CI:0.25-0.86), IVH/PVL(OR : 0.32, 95% CI : 0.12-0.86), necrotizing enterocolitis(OR : 0.49, 95% CI : 0.25-0.98), and neonatal death(OR: 0.30, 95% CI: 0.10 - 0.89) in preterm delivery. In the presence of PROM, antenatal corticosteoid seemed to have no protective effect on the neonatal complications such as RDS, IVH/PVL, NEC, PDA, and neonatal death. CONCLUSIONS: Antenatal administration of corticosteroids was effective to decrease the incidence of neonatal morbidity and neonatal mortality in the preterm neonates with no apparent maternal complications.
Adrenal Cortex Hormones ; Dexamethasone ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Logistic Models ; Mortality ; Premature Birth* ; Retrospective Studies ; Steroids

OBJECTIVE: To determine the dincal significance of placenta previa totalis. METHODS: Maternal and neonatal medical rerords were reviewed retrospectively. Between March 1990 and June 1997, sixty-nine pregnant women with placenta previa totalis delivered at Asan Medical Center. Diagnosis of placenta previa totalis was confirmed during cesarean section. RESULTS: Mean maternal age at diagnosis was 31.7+ 3.9 years and 3 patients(4.3%) were nullipara. Fifty two patients(75%) had the history of vaginal bleeding during their index pregnancy and seventeen of 52 patients were admitted more than once. Median gestational age at the time of initial bleeding episode was 33.2 weeks(range 23.5-41. 1) and median interval from the first admission to delivery was 11 days(range 1-63), Major placental implantation site was posterior uterine wall(64%, 44/69). Six cases(8%) were complicated with placenta accreta or increta and no case was combined with abruptio placentae. Estimated blood loss at the time of cesarean section was 1,510+/-952ml(mean+/-SD) and 43 patients(62%) were transfused. No case was complicated with disseminated intravascular coagulation. Eight patients(11.6%, 8/69) underwent cesarean hysterectomy because of uncontrollable bleeding. Thirty four patients(49.3%) delivered their babies before 37 weeks of gestation. The mean gestational age at delivery was 36.4+/-3.0 weeks(mean+/-SD). Major neonatal morbidity was respiratory distress syndrome(20.3%, 14/69). Perinatal death rate was 4.3%(3/70). CONCLUSION: Because pregnant women complicated with placenta previa totalis have high probability for transfusion and cesarean hysterectomy, these patients should be managed cautiously and thoroughly. The most frequent neonatal morbidity was respiratory distress syndrome due to preterm delivery.
Abruptio Placentae ; Cesarean Section ; Chungcheongnam-do ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hysterectomy ; Maternal Age ; Mortality ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy* ; Pregnant Women ; Retrospective Studies ; Uterine Hemorrhage

OBJECTIVE: To evaluate whether twin discordancy is a risk factor for adverse perinatal and neonatal outcomes. METHODS: Three hundred and seventy-five twin gestations over 28 weeks of gestation were included in this retrospective study. Medical records of mothers and infants were reviewed. Pregnancies were divided into 2 groups according to the birth weight discordancy(%) between twin neonates(group I;less than 25%, group II;25% or more). Birth weight discordancy was calculated from following formula; (birth weight of larger twin-birth weight of smaller twin)/birth weight of larger twin x 100. Perinatal and neonatal outcomes in group I and II were compared with each other. Also, difference in the outcomes between the smaller and larger twins of group II was evaluated. To evaluate whether birth weight discordancy is an independent variable in predicting poor perinatal and neonatal outcomes, multiple logistic regression analysis was used. RESULTS: Thirty-seven gestations(9.9%) were documented to belong to group II. Group II showed significantly higher incidence of preeclampsia, placenta previa, and small for gestational age infants(p<0.01, p<0.05 and p<0.001, respectively). The group also showed higher incidence of adverse neonatal outcomes(admission to neonatal intensive care unit, respiratory distress syndrome, pneumonia, bronchopulmonary dysplasia, patent ductus arteriosus, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, sepsis, congenital anomaly, neonatal death, p<0.01). Outcomes of the larger and smaller twins of group II were not significantly different with each other except small for gestational age infants(p<0.005). However, birth weight discordancy was not an independent variable in predicting adverse perinatal and neonatal outcomes. CONCLUSION: Fetal growth discordancy of 25% or more should be regarded as a risk factor for adverse perinatal and neonatal outcomes in twin gestations. However it is not an independent factor in predicting adverse perinatal and neonatal outcomes.
Birth Weight ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Fetal Development* ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Logistic Models ; Medical Records ; Mothers ; Placenta Previa ; Pneumonia ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors* ; Sepsis

OBJECTIVE: To assess the pre-pregnancy and pregnancy factors influencing pregnancy outcome in renal transplanted women Materials and METHODS: This retrospective study included all pregnancies in renal transplanted women in Asan Medical Center between June 1996 and February 1998. We collected data from the medical records of allograft recipients. Pre-pregnant status and pregnancy outcome were described. RESULTS: Seventeen pregnancies in 13 allograft recipients resulted in 7 term deliveries, 4 preterm births, 2 spontaneous abortions, and 4 therapeutic abortions. All but one patient received immunosuppressive therapy with cyclosporin A, azathioprine, and prednisolone during pregnancy. The mean interval from the time of transplantation to conception was 28.8+/-14.3 months(range 6-60 months). In live birth group, the mean gestational age at delivery was 37.7+/-1.2 weeks and the mean birth weight of their offspring was 2.85+/-0.37 kilogram. Apgar scores at 5 minutes were 8 or more in all of them. The obstetric complications were distributed as follows: pregnancy induced hypertension in 6 cases(55%), pregnancy aggravated hypertension in 2 cases(18%), fetal growth restriction in 1 case(9%), prematurity in 4 cases(36%). Cesarean sections were done in 4 cases(36%) because of previous Cesarean section(3 cases) and uncontrolled hypertension(1 case). Neonatal complication, transient tachypnea of the newborn, was found in one case. Graft rejection after transplantation occurred in 4 cases: 3 cases in preterm births and 1 case in therapeutic abortions. Maternal renal functions were normal during pregnancy and postpartum period whose pre-pregnant renal functions had been normal. No patient experienced any rejection episode or graft loss during pregnancy. CONCLUSION: Successful pregnancy can be expected in women with a renal transplant, although there was high incidence of pregnancy-related complications, especially hypertensive disorders. Pregnancy can be encouraged to these allograft recipients if they have good renal function.
Abortion, Spontaneous ; Abortion, Therapeutic ; Allografts* ; Azathioprine ; Birth Weight ; Cesarean Section ; Chungcheongnam-do ; Cyclosporine ; Female ; Fertilization ; Fetal Development ; Gestational Age ; Graft Rejection ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Incidence ; Kidney Transplantation ; Live Birth ; Medical Records ; Postpartum Period ; Prednisolone ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Premature Birth ; Retrospective Studies ; Transient Tachypnea of the Newborn ; Transplants

Several tests have been used for assessing color vision but most of them are nonspecific, expensive, complicated or too time consuming to perform. We have developed a new computerized color vision test named Seohan computerized 85-hue test[SCHT/85]that has many advantages compared to Farnsworth Munsell[FM]100-hue test.SCHT/85 has 85 color caps which can be displayed based on a model of FM 100-hue test using Multimedia toolbook 4.0.Selected color caps in the lower random area can be moved and inserted to the upper result area by a mouse.At the end of the test, error scores and ring graph can be displayed in monitor and can be also printed out. Total 15 subjects performed with SCHT/85 and FM 100-hue test twice who have been showed 10 normal and 5 abnormal color vision reported with other color vision tests and the results of two tests were analysed to compare the total error scores[TES]and reproducibility. All ten normal subjects showed lower TES in SCHT/85 than FM 100-hue test and the mean TES were 31.5 and 43.6 with SCHT/85 and FM 100-hue test.The coefficients of variation [CV]were 4.3%and 22.7%with SCHT/85 and FM 100-hue test.The two tests were highly correlated[r=0.92].Five abnormal subjects showed higher TES in SCHT/85 than FM 100-hue test and the mean TES were 169.8 and 157.3 with SCHT/85 and FM 100-hue test.The coefficients of variation were 9.1%and 21.2%with SCHT/85 and FM 100-hue test.These two tests were also highly correlated[r=0.965]. In conclusion, SCHT/85 which was newly developed by authors is a highly useful test for color vision.
Color Vision* ; Multimedia ; Pilot Projects*

The objective visual acuity test is mandatory in certain cases, such as infants, nonverbal subjects and subjects who need legal judgements. To produce more reliable objective method, we made a new objective system for visual acuity test which is called Seohan visual acuity test(SVT). The SVT system has three elements such as stimuli, display and evaluation. For the visual stimuli, the computer program for optokinetic nystagmus(OKN)test was set up in personal computer to control the size, speed and direction of the stimuli easily. The visual stimuli are presented on HeadMounted-Display(HMD)to separate the stimuli from the environment to keep the uniform size and distance of screen to the eye of subjects and project the stimulus in full central field of patient. Electrooculography(EOG) was used to assess the visual acuity more objectively. To evaluate the usefulness of SVT, the smallest size of the stimulus to elicit OKN(objective visual acuity)with SVT was obtained in 10 eyes in each twelve grade of subjective visual acuity(decimal V). Objective visual acuity(VA)were distributed from 8.3+/-1.87 to 21.4+/-3.1 and showed high correlation(p<0.00 ). The relationship between the objective VA obtained from SVT and subjective VA make a regression line(y=-12.874X+21.303).Subjective VA could be obtained from conversion of objective VA with 95%confidence belt. In conclusion, the objective visual acuity with SVT is highly correlated with subjective visual acuity and SVT using the OKN response to stimuli presented on HMD by the computer program can be useful in assessing visual function objectively.
Electrooculography ; Humans ; Infant ; Microcomputers ; Nystagmus, Optokinetic* ; Visual Acuity*

PURPOSE: Actinomycosis is an uncommon chronic granulomatous disease that presents as a slowly progressive, indolent, indurated infiltration with multiple abscesses, fistulas, and sinuses. The purpose of this article is to report on a case of actinomycosis with clinical findings similar to periodontitis. METHODS: A 46-year-old female presented with recurrent throbbing pain on the right first and second molar of the mandible three weeks after root planing. Exploratory flap surgery was performed, and the bluish-gray tissue fragment found in the interproximal area between the two molars was sent for histopathology. RESULTS: The diagnosis from the biopsy was actinomycosis. The clinical and radiographic manifestations of this case were clinically indistinguishable from periodontitis. The patient did not report any symptoms, and she is scheduled for a follow-up visit. CONCLUSIONS: The present study has identified periodontitis-mimicking actinomycosis. Actinomycosis should be included in the differential diagnosis in cases with periodontal pain and inflammation that do not respond to nonsurgical treatment for periodontitis. More routine submissions of tissue removed from the oral cavity for biopsies may be beneficial for differential diagnosis.
Abscess ; Actinomycosis ; Anti-Bacterial Agents ; Biopsy ; Debridement ; Diagnosis, Differential ; Female ; Fistula ; Follow-Up Studies ; Granulomatous Disease, Chronic ; Humans ; Inflammation ; Mandible ; Molar ; Mouth ; Periodontitis ; Root Planing