BACKGROUND: The purpose of this study was to determine whether the injection rate affects the spread of spinal anesthesia in cesarean sections. METHODS: Spinal anesthesia was performed on 45 parturients in a cesaren section. Dural puncture was performed in the sitting position with a 27-gauge Whitacre needle. All patients received a mixture of 10 mg hyperbaric bupivacaine and 15 microgram fentanyl. Twenty five (Group I) patients received rapid injections (about 0.2-0.3 ml/sec) and twenty (Group II) received slow injections (about 0.1 ml/sec). Anesthetic levels, time to T4 sensory block, maximal height sensory block and incidence of hypotension were measured. RESULTS: There was significantly rapid T4 sensory block in group I but no differences in maximal height of sensory block and incidence of hypotension between the two groups. CONCLSIONS: We conclude that injection rate (about 0.1-0.3 ml/sec) has a statistically insignificant influence on the maximal height sensory block and incidence of hypotension.
Anesthesia, Spinal* ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl ; Humans ; Hypotension ; Incidence ; Needles ; Pregnancy ; Punctures

OBJECTIVE: This study was designed to detect genes specifically expressed in severe preeclamptic placentas. METHODS: Placenta tissues were collected immediately after delivery from 5 preeclamptic patients and 5 normal pregnant women. Total RNAs of each placenta were extracted and hybridized for a cDNA microarray. Of the microarray data, four up-regulated genes (DSCR4, GPA, PCDHGB1, Hemogen) and four down-regulated genes (IL1R2, MGST1, GAS1 GREB1) were selected and reverse transcriptase-polymerase chain reaction was used to confirm the results of cDNA microarray. RESULTS: The expression fold for each up-regulated gene was 2.2 times for DSCR4, 2.7 times for PCDHGB1, 3.5 times for Hemogen, 5.2 times for GPA on the cDNA microarray. The expression fold for each down-regulated gene was 3.3 times for IL1R2, 4.2 times for MGST1, 4.9 times for GAS1 and 2.3 times for GREB1 on the cDNA microarray. The expression fold for each up- regulated gene was 5.21 times for DSCR4, 3.01 times for PCDHGB1, and 4,53 times for Hemogen and 2.2 times for GPA on RT-PCR. The expression fold for each down-regulated gene was 2.7 times for IL1R2, 2.22 times for MGST1, 2.53 times for GAS1 and 1.83 times for GREB1 on the RT-PCR. CONCLUSION: DSCR4, PCDHGB1, Hemogen and GPA as the up-regulated genes and IL1R2, MGST1, GAS1 and GREB1 as the down-regulated genes, which were found and selected by the cDNA microarray, might be considered to be novel biomarkers for preeclampsia.
Biomarkers ; Chimera ; Female ; Gene Expression ; Humans ; Microarray Analysis ; Oligonucleotide Array Sequence Analysis ; Placenta ; Pre-Eclampsia ; Pregnant Women ; RNA

Otosclerosis is a localized disorder of bone metabolism involving the endochondral bone of the otic and labyrinthine capsule. Both "advanced" and "very advanced" otosclerosis refer to the state of otosclerotic involvement of the otic capsule, which has progressed to result in profound deafness with undetectable bone and air conduction thresholds. Shea et al. estimated that 1.6% of patients with otosclerosis had developed profound hearing losses, and that hearing improvements after stapes surgeries in these patients were lower than the case of "not-advanced" otosclerosis. Stapedectomy and hearing aid amplification could be tried, but cochlear implantation is an established intervention for patients with profound sensorineural hearing loss due to otosclerosis. Although the reported results of cochlear implantations in otosclerosis patients are not significantly different from those of other cochlear implantees not affected by otosclerosis, in former conditions, potential ossification of cochlea, facial nerve stimulation, and instability of the results might take place. We report a case of otosclerosis histologically diagnosed for the first time here in Korea, and for which cochlear implantation was successfully performed.
Cochlea ; Cochlear Implantation ; Cochlear Implants ; Deafness ; Facial Nerve ; Hearing ; Hearing Aids ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Hypogonadism ; Korea ; Mitochondrial Diseases ; Ophthalmoplegia ; Otosclerosis ; Stapes Surgery

OBJECTIVE:cDNA microarray technology was used to comprehensively analyze the gene expression in the placenta of term women with labor compared to without labor. METHODS:Placental tissue was obtained from patients in spontaneous labor (n=5) and those not in labor (n=5) during Cesarean section of full term pregnancy. mRNA levels were examined through cDNA microarray using Agilent GeneSpringGX 7.3 (Agilent technology, USA). SPSS 11.0 was used for statistical analysis. RESULTS:Among total 38,467 genes, 2,374 genes were detected to be up-regulated in labor samples, while 12 genes were down-regulated. 40 genes of them were identified as significantly up-regulated in levels of expression (up-regulated > or =5.0 fold, p<0.05). According to gene ontology analysis, they are associated with variable cell biologic functions including apoptosis, signal transduction, metabolic process, immune response, and transcription, etc. CONCLUSION:This study suggests that our results could provide interesting clues to understanding the initiation and the process of normal labor and might lead to further studies in a more targeted fashion.
Apoptosis ; Cesarean Section ; DNA, Complementary* ; Female ; Gene Expression Profiling ; Gene Expression* ; Gene Ontology ; Humans ; Metabolism ; Oligonucleotide Array Sequence Analysis* ; Placenta* ; Pregnancy ; Pregnant Women* ; RNA, Messenger ; Signal Transduction

OBJECTIVE: This study was performed to evaluate the diagnostic accuracy of cytology, colposcopically directed biopsy and conization and to analyze predictive factors for residual tumor after conization in patients with cervical neoplasia. METHODS: We reviewed 167 patients who had undergone cytology, colposcopically directed biopsy and conization followed by subsequent hysterectomy depending on their current disease status at the Department of Obstetrics & Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January, 1993 to August, 1998. The diagnostic accuracy of cytology, colposcopically directed biopsy and conization were investigated. Also, we investigated the significance of the margin status and the presence of HPV which were used to predict residual tumors in hysterectomy specimens after conization. RESULTS: The results of each methods were analyzed with regard to the histopathologic findings of the surgical specimen. The accuracy rates of cytology, and colposcopically directed biopsy were 59.3% (99 of 167) and 71.3% (119 of 167), respectively. After conization, residual tumors were found in 30.1% of subsequent hysterectomized specimens (51 of 167). Underestimation by conization occurred in 2.0% of cases (1 of 51) and overestimation in 7.8% (4 of 51). Residual tumors were significantly more frequent in patients with positive conization margins than in those with negative margins (P<0.001). But the presence of HPV was not significant. CONCLUSION: These results suggest that diagnostic conization seems to be essential procedure in patients showing abnormal results by cytology and colposcopically directed biopsy, especially in those with CIN III or microinvasion, for the further proper management of cervical neoplastic lesion and margin status is useful in predicting residual tumor after conization.
Biopsy* ; Conization* ; Gynecology ; Humans ; Hysterectomy ; Korea ; Neoplasm, Residual* ; Obstetrics

One of the most interesting congenital malformations is a conjoined twin. Conjoined twins are a rare occurrence in obstetric practice. More commonly known as Siamese twins, this phenomenon is shrouded in mystery and considered a curiosity by general public. Current technology is providing a basis for earlier diagnosis and a better prognosis. Frequently, the twins are born dead, but there are a few cases in which the twins survive. We present a case of thoraco-omphalophagus with omphalocele in 35 years old woman at 25weeks 5 days gestation by 3-D ultrasonography and MRI.
Adult ; Diagnosis ; Exploratory Behavior ; Female ; Hernia, Umbilical* ; Humans ; Magnetic Resonance Imaging* ; Pregnancy ; Prognosis ; Twins, Conjoined ; Ultrasonography*

OBJECTIVE: To determine the effect of magnesium sulfate (MgSO4) on the apoptosis and invasion of cytotrophoblasts in vitro under normal and hypoxic condition as assessed immunoblot analyses of Bcl-2/Bax, invasion assay and immunohistochemical staining of integrin alpha1. METHODS: Normal cytotrophoblasts were isolated from second trimester placentas and cultured in several physiologically relevant concentrations of MgSO4 under control tissue culture condition (20% O2) or hypoxic condition (1-2% O2). Apoptosis of cytotrophoblasts was estimated by immunoblotting for Bcl-2/Bax, invasiveness was estimated by invasion assay and immunohistochemical staining of Integrin alpha1. RESULTS: The expression of Bcl-2 did not change under standard condition, but it decreased under hypoxic condition with increasing of MgSO4 concentrations. The expression of Bax did not change under both standard condition and hypoxic condition with increasing MgSO4 concentrations. The invasiveness of cytotrophoblasts significantly decreased under both control and hypoxic conditions with increasing of MgSO4 concentrations. The expression of Integrin alpha1 immumohistochemical staining significantly decreased under control condition and showed decreasing tendency under hypoxic condition with increasing of MgSO4 concentrations. CONCLUSION: MgSO4 might induce cytotrophoblasts to the apoptosis and inhibit invasion of cytotrophoblasts under hypoxic condition.
Apoptosis* ; Female ; Humans ; Immunoblotting ; Integrin alpha1 ; Magnesium Sulfate* ; Magnesium* ; Placenta ; Pregnancy ; Pregnancy Trimester, Second ; Trophoblasts*

PURPOSE: We aimed to evaluate the use and safety of double dose oseltamivir for patients manifesting severe respiratory symptoms or showing no improvement of clinical symptoms after 72 hours' treatment with the usual oseltamivir dosage. METHODS: We analyzed the clinical features of 2009 influenza A H1N1 inpatients who had been admitted to a university hospital's Department of Pediatrics between August 2009 and January 2010. The Influenza A H1N1 diagnoses were confirmed by real-time reverse transcriptase polymerase chain reaction. RESULTS: The study participants numbered 157 (mean age, 5.0 years; male-to-female ratio, 1.1:1). Among them, twenty (mean age, 5.2 years) were administered double dose oseltamivir. This double dose group showed higher peak body temperatures and more abnormal radiologic results than the other, usual-dose group. The mean time duration between high fever and afebrile status after initiation of double-dose oseltamivir administration was 2.1 days, whereas that within the usual-dose group was 1.7 days. There were no adverse effects in the patients treated with double-dose oseltamivir. CONCLUSION: Double-dose oseltamivir was well tolerated in patients with severe 2009 influenza A H1N1 infection.
Body Temperature ; Diagnosis ; Fever ; Humans ; Influenza A virus ; Influenza, Human* ; Inpatients ; Oseltamivir* ; Pandemics* ; Pediatrics ; Reverse Transcriptase Polymerase Chain Reaction ; Severity of Illness Index

We report a case of ring chromosome 13 with a distal deletion of 13q32.2-->qter observed in a fetus who was referred to our institution at term due to severe growth restriction and multiple congenital malformations on ultrasonographic examination.This boy was born by vaginal delivery at 39 weeks in gestation. His weight, head circumference and height were less than the 3 percentile of gestational age. Apgar score was 7 at 1 minute and 9 at 5 minutes. He showed microcephaly, large forehead, low set ears, hypertelorism, flat nasal bridge, and micrognathia. The genitalia was ambiguous, showing severe hypoplasia of the penis. The anus was ectopic, displaced anteriorly from its normal position but with a normal opening and function. Neurologic examination was normal. Echocardiogram done at 2 weeks of life showed a persistent foramen ovale and a ventriculoseptal defect (type II) with increased pulmonary hypertension. MRI examination of the brain showed poorly demarcating corpus callosum suspecting agenesis of corpus callosum. Also, cerebellar vermis was small and hypoplastic, mimicking a variant form of Dandy-Walker malformation. MRI of the pelvis showed a tubular structure in pelvic cavity, suspicious of uterine remnant, between urinary bladder and rectum, and a inguinal hernia was noted in the left side. In the abdominal cavity enlarged adrenal glands were noted, and hormonal study showed elevated 17-alpha-OH-progesterone (168.9 ng/ml) with normal 17-KS and 17-OHCS levels. Gastrointestinal and urogenital system were otherwise normal. Cytogenetic analysis of the parents were both normal but the newborn showed 46, XY, r (13), de novo, with deletion points q32.2-->qter. Our findings are in line with previous reports about chromosome 13 deletions, in which loss of the "critical point" leads to major malformations like brain anomalies and ambiguous genitalia.
Abdominal Cavity ; Adrenal Glands ; Agenesis of Corpus Callosum ; Anal Canal ; Apgar Score ; Brain ; Chromosomes, Human, Pair 13 ; Corpus Callosum ; Cytogenetic Analysis ; Dandy-Walker Syndrome ; Disorders of Sex Development ; Ear ; Fetus ; Foramen Ovale ; Forehead ; Genitalia ; Gestational Age ; Head ; Hernia, Inguinal ; Humans ; Hypertelorism ; Hypertension, Pulmonary ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Microcephaly ; Neurologic Examination ; Parents ; Pelvis ; Penis ; Pregnancy ; Rectum ; Ring Chromosomes ; Urinary Bladder ; Urogenital System

OBJECTIVE: The aim of this study was to examine the effects of maternal age on perinatal and obstetric outcomes with respect to maternal age older than 40 years. METHODS: A retrospective review of maternal and newborn medical records of women who delivered their babies in the hospitals of the Catholic University of Korea between January 1, 2000 and July 1, 2005 was conducted to compare pregnancy complications and perinatal outcomes in three age groups; women aged 25~29 years (group A; n=214), those aged 35~39 years (group B; n=276), and those aged 40 years and older (group C; n=347). RESULTS: The incidences of GDM (gestational diabetes mellitus), preterm birth and cesarean section in group C were by far the greatest among the three groups. The incidence of postterm delivery in group A was the highest among the three groups. Previous cesarean section and elderly gravida were the most frequent causes of cesarean section in group C. The incidences of low birth weight (<2,500 g) and the NMICU(neonatal medical intensive care unit) admission rate in group C were higher than those in group B, but not significantly different from those in group A. CONCLUSION: Maternal ages of 35~39 years do not appear to be associated with adverse perinatal and obstetrical outcomes. Maternal ages of over 40 years influence the incidences of PIH (pregnancy induced hypertension), GDM, preterm birth, cesarean section, placenta previa, low birth weight and NMICU admission.
Aged ; Cesarean Section ; Female ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Critical Care ; Korea ; Maternal Age* ; Medical Records ; Placenta Previa ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Premature Birth ; Retrospective Studies