OBJECTIVE: The objective of the present study was to evaluate incidence, parirty, gestational age, cause, termination method, and maternal complication of fetal death in utero(IUFD) clinically. METHODS: A retrospective analysis was made of the birth register and hospital records of 384 cases of the fetal death in utero among 23,703 deliveries at Dongsan Medical Center, Keimyung University during 5 years from January 1993 to December, 1997. RESULTS: The incidence of the fetal death in utero was 1.62%. The parity of mother in the fetal death in utero was the most highest in the nulliparous group(26.0%). The most common gestational week when the fetal death in utero was detected was 25-28 weeks gestational period(29.4%). The sex ratio of male vs female fetus was 1.32:1, and the cases of the fetal death in utero weighting less than 2500 gm were 332 cases(86.3%). The mode of the delivery for the fetal death in utero showed that the induction of labor was most common 71.6%, the spontaneous delivery 27.8%, and the laparotomy was 0.2%. The causes of the fetal death in utero showed unexplained causes(34.l%), congenital anomaly(I6.9%), maternal disease(14.3%), pregnancy-induced hypertension(9.6%), abruptio placenta(8.8%), cord complication(5%), and placenta previa(4%). There were 38 cases(9.8%) of maternal complication. CONCLUSION: The cause in about one third of the IUFD could not be determined by this clinical studies, so further studies with autopsy and chromosomal study must be made on stillborn infants, placenta, cord and fetal membranes in cases where the causes is unknown for the purpose of good outcome in next pregnancy.
Autopsy ; Extraembryonic Membranes ; Female ; Fetal Death* ; Fetus ; Gestational Age ; Hospital Records ; Humans ; Incidence ; Infant ; Laparotomy ; Male ; Mothers ; Parity ; Parturition ; Placenta ; Pregnancy ; Retrospective Studies ; Sex Ratio

The objective is to evaluate the rate and indications of cesarean delivery. All live birth>27weeks at the Dongsan Medical Center, Keimyung University from 1993 to 1997(n=24,227) were respectively analyzed of delivery route, indication of cesarean birth, gestational age, and matemal age. The most common maternal age was between 26-30 years(49.6%). The most common gestational age was over 36 weeks(91.2%). Total cesarean rate was 22.3%(5,396/24,227), and primary rate was 13.6%(3,296/24,227). The annual primary cesarean birth rate and number increased gradually. Abnormal presentation was the most common indication(24.3%, 801/3,296) at primary cesarean deliveries. The second common indication was CPD(18.87%, 622/3,296). We experienced four cases of cesarean hysterectomy due to uterine atony and placenta previa. Further evaluation will be needed about the relationship between cesarean deliveries and long term fetal outcome, and the effort for VBAC will be needed.
Birth Rate ; Gestational Age ; Hysterectomy ; Maternal Age ; Parturition ; Placenta Previa ; Uterine Inertia

No abstract available.
Erectile Dysfunction* ; Male

In order to investigate a hemodynamic complication associated with the resection of a large arteriovenous malformation, we planed the following experiment. We divided the left common caroted artery and the internal jugular vein for microsurgical anastomsis between the rostral carotid and caudal jugular vessel ends : the 2 remaining wessel stumps were ligated. This created an arteriovenous shunt with afferent flow from the contralateral caroted and the basilar artery and retrograde down to the carotid-jugular anastomosis. And then, we occluded the shunt vessels at the each stage of the first and fourth week after anteriovenous shunt. Forty adult cats weighing from 2.2 to 2.4kg were used in this study The animals were devided into 4 groups : group 1(acute occlusion-1 week after shunt, n=10), group 2(staged occlusion-1 week after shunt, n=10), group 3(acute occlusion-4 week after shunt, n=10), group 4(staged occlusion-4 week after shunt, n=10) respectively. The regional cerebral blood flow(rCBF), cardiopulmonary function were measured in each animal group and also observed the response of the cerebral blood flow on induced changes of the blood pressure and the arterial bicarbonate. The arteriovenous shunt patency was evaluated by serial angiography. The results were as follows ; 1) Considerable increases in the mean arterial blood pressure(mABP) as well as bradycardia were observed in acute occlusion groups(group 1, 3). After induced hyercarbia, the increments of mABP in acute occlusion groups were less than staged occlusion groups, considerbly. 2) Significant decreases in the mean pulse rate were observed in acute occlusion groups. the mean pulse rate were the highest decrease in group 3. 3) The values of rCBF of left frontal cortex in acute occlusion groups were more greater increase than those of staged occlusion groups considerably. 4) After induced hypercarbia, considerable increases of the rCBF were demonstrated in all groups and increases of the rCBF were lowest in group 3 compared with the other groups. After induced hypercarbia, considerable increases of the rCBF were demonstrated in all groups and reductions of the rCBF were lowest in group 3 compared with the other groups. 5) After induced hypercarbia, considerable increases of the rCBF were demonstrated in all groups. The rCBFs were the highest increase in group3 and lowest increase in group 2 compared with the other groups. After induced hypotension, considerable reductions of the rCBF were demonstrated in all groups. The rCBFs were the highest reduction in group 3 and lowest reduction in group 2 compared with the other groups. It might be infered from these results that patients with large arteriovenous malformations, particulary those with cerebral steal symptoms, are at risk to develp neurologic defictis related to perfusion breakthrough if their malformed vessels are abruptly removed, and staged or gradual occlusion of feeding arteries may prevent this potentially devastating complication.
Adult ; Angiography ; Animals ; Arteries ; Arteriovenous Malformations ; Basilar Artery ; Blood Pressure ; Bradycardia ; Cats ; Heart Rate ; Hemodynamics ; Homeostasis* ; Humans ; Hypotension ; Jugular Veins ; Perfusion

Although alpha2-adrenoceptor agonists are widely used as postoperative sedatives in adults, the postoperative effects in pediatric patients with secondary pulmonary arterial hypertension (PAH) due to congenital heart disease are not well known. We experienced a case of successful ventilator weaning with continuous intravenous administration of dexmedetomidine (DEX) after surgical correction in a 46-month-old child with congenital ventricular septal defect (VSD) with severe PAH. She underwent VSD closure on cardiopulmonary bypass (CPB). After successful weaning from the CPB, hemodynamics and oxygenation were stabilized on DEX and nitroglycerin in the intensive care unit. The patient was successfully weaned from the ventilator 46 hours after surgery. The transthoracic echocardiogram two weeks after surgery showed a closed VSD with no residual shunt and trivial tricuspid regurgitation (Vmax = 2.5 m/sec) without PAH.
Administration, Intravenous ; Adult ; Cardiopulmonary Bypass ; Child* ; Child, Preschool ; Dexmedetomidine* ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Hemodynamics ; Humans ; Hypertension* ; Hypnotics and Sedatives ; Intensive Care Units ; Nitroglycerin ; Oxygen ; Tricuspid Valve Insufficiency ; Ventilator Weaning ; Ventilators, Mechanical ; Weaning

No abstract available.
Humans

No abstract available.
Telemedicine*

BACKGROUND: Medical emergency teams (METs) have shown their merit in preventing unexpected cardiac arrest. However, it might be impractical for small- or medium-sized hospitals to operate an MET due to limited manpower and resources. In this study, we sought to evaluate the feasibility of a medical alert system (MAS) that alerts all doctors involved in patient care of patient deterioration via text message using smart-phones. METHODS: The MAS was test-operated from July 2015 to September 2015, in five general wards with a high incidence of cardiac arrest. The number of cardiac arrests was compared to that of 2014. The indication for activation of MAS was decided by the intensive care unit committee of the institution, which examined previous reports on MET. RESULTS: During the three-month study period, 2,322 patients were admitted to the participating wards. In all, MAS activation occurred in 9 patients (0.39%). After activation, 7 patients were admitted to the intensive care unit. Two patients (0.09%) experienced cardiac arrest. Of 13,129 patients admitted to the ward in 2014, there were 50 cases (0.38%) of cardiac arrest (p = 0.009). CONCLUSIONS: It is feasible to use MAS to prevent unexpected cardiac arrest in a general ward.
Emergencies ; Heart Arrest ; Hospital Rapid Response Team ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Patient Care ; Patients' Rooms ; Pilot Projects* ; Text Messaging

PURPOSE: This study tried to evaluate the effectiveness of combined treatment using radiation therapy and concurrent cisplatin as a radiosensitizer in the management of locally advanced head and neck cancer. MATERIALS AND METHODS: From January 1995 to August 1998, 29 evaluable patients with locally advanced head & neck cancers (AJCC stage II-IV) were received curative radiation therapy (total 70-75.6 Gy/35 -42 fractions , 1.8-2 Gy/fraction) and concurrent cisplatin chemotherapy (100 mg/m2, D1, D22, D43). The neck dissections were performed for residual lymphadenopathy. Follow- up ranged from 5 to 55 months (median 24 months). RESULTS: Twenty- one (72.4%) patients achieved clinical complete responses. The partial response and minimal response rates were 17.2% and 10.4%, respectively. Locoregional failure rate was 27.6%, and included 6 patients with local failures , 4 patients with regional failures, and 2 patients with combined local and regional failures. Four of 29 patients (13.8%) developed distant metastasis. The disease free survival rate at 3 years was 60%. Nasopharyngeal primary tumors or complete responders showed significantly higher disease free survival rate. The grade 3 mucositis and nausea/vomiting was noted in 34.5%, respectively. Major prolongation of radiation therapy duration was inevitable in three patients. Twenty- one patients (72.4%) completed 3 courses of cisplatin and 5 patients received 2 courses of cisplatin. Three patients received only one course of cisplatin due to nephrotoxicity and neurotoxicity, and then changed to 5- FU regimen. CONCLUSIONS: Concurrent cisplatin- radiation therapy in locally advanced head and neck cancer showed high response rate, reasonable locoregional control, and survival rate. As expected, acute toxicities were increased, but compliance to treatment was acceptable. Assess ment of the effect of the combination in this setting requires further accrual and follow- up.
Cisplatin* ; Compliance ; Disease-Free Survival ; Drug Therapy ; Head and Neck Neoplasms ; Head* ; Humans ; Lymphatic Diseases ; Mucositis ; Neck Dissection ; Neck* ; Neoplasm Metastasis ; Survival Rate

No abstract available.