The effectiveness of intrauterine insemination (IUI) combined with controlled ovarian hyperstimulation (COH) in the treatment of infertility with various etiologies was compared in a total of 152 cycles. Patients received a maximum of three IUI cycles for the treatment. Severe male (<2 x 10(6)motile sperm) or age facto. (> 39 y) patients were excluded in this study. Pregnancy was classified as clinical if a gestational sac was seen on ultrasound. The overall clinical pregnancy rate was 7.9% per cycle (12/152) and 9.7% per patient (12/124). The pregnancy rates were 0% in unstimulated natural (0/l8), 7.5% in CC (3/40), 8.2% in CC+hMG (4/49), 5.9% in GnRH-a ultrashort (1/17), 5.9% in GnRH-a long (1/17) and 27.3% in dual suppression cycles (3/11), respectively. The pregnancy rate was higher in dual suppression cycle than other stimulated cycles, but this was not significant. The multiple pregnancy rates were 25.0% (2 twins and 1 triplet). No patient developed ovarian hyperstimulation. Abortion rates were 66.7% in CC (2/3) and 100% in ultrashort cycles (1/1). The livebirth rate was 5.9% per cycle (9/152) and 7.3% per patient (9/124). There were no differences in age, duration of infertility, follicle size, total ampules of gonadotropins and days of stimulation between pregnant and non-pregnant groups. However, significant(P<0.05) differences were observed in the level of estradiol (E2) on the day of hCG injection (3,266.6+/-214.2 vs 2,202.7+/-139.4 pg/ml) and total motile sperm count (212.1+/-63.4 vs 105.1+/-9.9 x 10(6)) between pregnant group and non-pregnant group. These results suggest that lUl combined with successful ovarian stimulation tends to improve the chance of pregnancy as compared to lUl without COH and a total motile sperm count may be considered predictive of the success for pregnancy.
Abortion, Induced ; Estradiol ; Female ; Gestational Sac ; Gonadotropins ; Humans ; Infertility ; Insemination* ; Male ; Ovulation Induction ; Pregnancy Rate* ; Pregnancy* ; Pregnancy, Multiple ; Sperm Count ; Twins ; Ultrasonography

Emergency medicine(EM) is the specialty of evaluating, stabilizing and initiating treatment for patients with life or limb-threatening illnesses or injuries. Techniques unique to the specialty of EM are the triage systems, quick stabilization methods, and emergency surgery procedures. The field of EM encompasses areas such as emergency department management, disaster planning and management, the management of emergency medical service(EMS) systems, research into such areas as brain and heart resuscitation, trauma and disaster management, survival medicine, and environmental emergencies(cold and heat injuries, poisioning, decompression sickness and barotrauma). Today, in addition to providing emergency care, the emergency specialists have moral and legal obligations to assess and report probable cases of child and spouse abuse, sexual assault, and alcohol and drug abuse. Future, the EM should provide surveillance, identification, intervention, and evaluation of injury and disease, therefore EM will remain as a key component of evolving community health care system.
Brain ; Child ; Community Health Services ; Decompression Sickness ; Disaster Planning ; Disasters ; Emergencies* ; Emergency Medical Services ; Emergency Medicine* ; Emergency Service, Hospital ; Heart ; Hot Temperature ; Humans ; Jurisprudence ; Resuscitation ; Specialization ; Spouse Abuse ; Substance-Related Disorders ; Triage

To evaluate the effectiveness of intrauterine insemination (IUI) in the treatment of infertility, timed-intercourse and intrauterine insemination by husband in stimulated cycles with clomiphene citrate and gonadotropins were compared in a total of 105 cycles. Patients received 100 mg of clomiphene citrate daily for 5 days starting on day 3 of the menstrual cycle followed by hMG or FSH. Doses of exogenous gonadotropins were adjusted by the follicular development and concentrations of serum estradiol (E2). More than 3 follicles reaching >16 mm were present in the ovary, 5,000 IU of hCG was administered intramusculary. Patients received a maximum of three intercourse or IUI cycles for the treatment. Severe male (<10x106 motile sperm) or age factor (>39 y) patients were excluded in this study. Pregnancy was classified as clinical if a gestational sac or fetal cardiac activity was seen on ultrasound. The overall clinical pregnancy rates were 17.1% per cycle (18/105) and 21.2% per patient (18/85). The pregnancy rates (per cycle) were 17.5% (l1/63) in intercourse and 16.7% (7/42) in IUI groups, respectively. IUI had no significant improvement in pregnancy rate compared with timed-intercourse. The multiple pregnancy rates were 11.1% (1 twin and 1 triplet). No patient developed ovarian hyperstimulation. Abortion rate was 28.6% (2/7) in IUI group only. The delivery and ongoing pregnancy rates were 15.2% per cycle (16/105) and 18.8% per patient (16/85). There were no differences in age, duration of infertility, follicle size and level of estradiol (E2) on the day of hCG injection in pregnant and non-pregnant groups. However, total doses of gonadotropins were higher in pregnant group than in non-pregnant group (p<0.01). Pregnancy rate was not affected by ovulatory status at the time of insemination. These results indicate that well timed-intercourse in stimulated cycles is as effective as IUI for infertile couples.
Abortion, Induced ; Age Factors ; Clomiphene* ; Estradiol ; Family Characteristics ; Female ; Gestational Sac ; Gonadotropins* ; Humans ; Infertility ; Insemination* ; Male ; Menstrual Cycle ; Ovary ; Pregnancy Rate* ; Pregnancy* ; Pregnancy, Multiple ; Spouses ; Ultrasonography

No abstract available.
Female ; Fetal Heart* ; Fetal Movement* ; Heart Rate, Fetal* ; Music* ; Pregnancy

BACKGROUND: The medicolegal problems can be occurred in all medical field, Especially ED can be more exposed to the legal claims due to the very nature of ED business and characteristics of ED patient (or their family member). All emergency physicians, as a ED manager, should be concerned about the law associated with emergency cairo for handling the medicolegal problem. So they can deal with and prevent the legally risky situations that may be occurred in ED practice. Ultimately we can reduce the risk of a malpractice lawsuit and provide good emergency care services. SUGGESTION: The authors would like to suggest several items that we have thought the ED physicians and managers always have to remember to manage the medicolegally risky situations. 1. Every member of ED health care team must be trained in understanding the patients' wants and desires. 2. The emergency physicians and nurses must realize that they are the best risk management tools in the hospital. 3. ED physician should have the knowledge of the law associated with emergency health care. 4. Develop the system that can share the informations about the medicolegal events which were experienced by each ED health care providers of every health care institutes. 5. We should never forget the time honored sentences, 'Good medicine is good law'.
Academies and Institutes ; Commerce ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Empathy* ; Health Personnel ; Humans ; Jurisprudence ; Malpractice ; Patient Care Team ; Risk Management

BACKGROUND: Plasmodium vivax malaria was recently re-presenting infectious disease in Korea since was being controlled for about 10 years age, but has been increasing years by year in the soldiers or farmers working at the near Demilitarized Zone(DMZ). So we analyzed the Characteristics of the patients diagnosed as malaria since 1997 in Yeungnam university hospital. METHODS: From January 1997 to August 1999, the 23 patients complainted of the febrile and chilly sense were diagnosed as Plasmodium vivax malaria in Yeungnam university hospital. We analyzed the patient's records for clinical findings(i.e. clinical symptoms and signs), occupation and regions of working or visiting, laboratory findings, treatment and its results, etc. RESULTS: Male patients were 21 and female patients were 2 among the total 23 patients, the 19 of 21 male patients were soldiers discharged from military services. All patients had been visited or worked near the DMZ, as the northern part of Kyungki-do(21 cases) or Kangwon-do(2 cases). And all patients complainted of delayed onset(means 6 months) of fever and chills after working or visiting at this zones. On physical examination, liver or spleen were palpated initially at least 1 finger breadth in 9 cases(39.1%), and peripheral blood smears showed the infected RBCs(i.e. gametocyte, ring form, schizont, trophozoite) in all cases, and 21 cases(91.3%) showed thrombocytopenia. All patients were treated by the combined regimen of 2-days hydroxychloroquine and 14-days primaquine. All cases showed clinical and laboratory improvement initially, but 5 cases were recurred after 2 months and showed re-improvement. And none of 23 cases showed the significant complications and deaths after medical treatment. CONCLUSION: Plasmodium vivax malarial infection is currently re-presenting disease near the DMZ. So we should consider the active prevention and management of malaria.
Chills ; Communicable Diseases ; Female ; Fever ; Fingers ; Humans ; Hydroxychloroquine ; Korea ; Liver ; Malaria ; Malaria, Vivax* ; Male ; Military Personnel ; Occupations ; Physical Examination ; Plasmodium vivax* ; Plasmodium* ; Primaquine ; Schizonts ; Spleen ; Thrombocytopenia

No abstract available.
Animals ; Enalapril* ; Nicardipine* ; Nitroprusside* ; Rats* ; Skin*

No abstract available.

No abstract available.
Blepharoptosis*

No abstract available.
Axilla* ; Female* ; Humans ; Neck*