Intramural implantation is among the rarest forms of ectopic pregnancy.Since the first description by Perli, 21 cases were reported in worldwide literatures.The pathologic criteria required for intramural pregnancy is that the product of conception is completely surrounded by uterine musculature and is separated from the uterine cavity and the fallopian tube or round ligament.The previous history of uterine injury or adenomyosis is known as possible etiology of intramural implantation. Because the early diagnosis is very difficult, most cases is found after onset of complication such as a uterine rupture or hemoperitoneum. We have recently experienced a case of intramural pregnancy diagnosed and treated by laparoscopy in a 9 weeks gestation nulliparous woman without previous history of uterine injury or disease, and report with a brief review of literatures.
Adenomyosis ; Early Diagnosis ; Fallopian Tubes ; Female ; Fertilization ; Hemoperitoneum ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Uterine Rupture ; Round Ligaments

PURPOSE: Conventional indomethacin therapy(0.2mg/kg every 12 hours for three doses) has been used for closure of PDA. The effect of prolonged low dose of indomethacin therapy(0.1mg/kg daily for six days)had been reported in foreign country but, nothing had been reported in our country. So we attempted this study to examine effects of these two methods. METHODS: Forty one infants with PDA of prematurity from January 1992 to July 1995 who were admitted in NICU of Il Sin Christian Hospital were included. 27 of these infants received conventional dose of indomethacin therapy and 14 received prolonged low dose of indomethacin therapy, and we examined with closure rate and complication etc. RESULTS: 1) Closure of PDA was observed in 15(55.6%) and relapse was 3(11.1%) in conventional dose therapy group. In prolonged low dose therapy group, closure was 8(57.1%) and relapse was none. 2) Intraventricular hemorrhage was observed in 20(74.1%), 6(42.9%) and gastrointestinal tract bleeding was 6(22.2%), 13(92.2%) in each group. There was statistically significant between the two groups(p<0.05). 3) The rise of serum BUN, creatinine was observed in 9(33.3%), 6(46.2%), bleeding tendency was 9(33.3%), 8(57.1%), necrotizing enterocolitis was 2(7.4%), 0 and retinopathy of prematurity was 8(29.6%), 3(21.4%) in each group.But there was not statistically significant correlation between the two groups. 4) The development of sepsis and broncopulmonary dysplasia was slightly more in prolonged low dose therapy group. 5) The reduction of urine output was observed in 11(40.7%), 2(14.3%) in each group but, absolute oliguria was not observed in both groups. CONCLUSIONS: Though the closure rate of PDA was similar in both groups, prolonged low dose indomethacin therapy can be recommanded with its effectiveness on preventing the relapse of PDA and the accurrence of necrotizing enterocolitis.
Creatinine ; Enterocolitis, Necrotizing ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Indomethacin* ; Infant ; Oliguria ; Recurrence ; Retinopathy of Prematurity ; Sepsis

The purpose of this study was to evaluate the effects of magnetic field on cellular activity of MC3T3-El cells. The celular activity was monitored by alkaline phosphatase and DNA synthetic activity in control, static magnetic field and pulsed electromagnetic field groups. A static magnetic field was applied to the cell by placing one, two, three, four, and five samarium-cobalt magnets above and below each cell plate for 24hours per day. A pulsed electromagnetic field with a frequency of 100 herz was applied for 10 hours per day. After 10 days of magnetic field exposure, there were increase of alkaline phosphatase activity in static magnetic field groups consisted of one, two and three magnetic groups, Alkaline phosphatase activities were not significantly increased in four and five magnetic groups, Application of pulsed electromagnetic field did not result in significant increase in alkaline phosphatase activity compared to control. DNA synthetic activity in both static and pulsed electromagnetic field group were not significantly different from that in control group, The result of this study suggest that magnetic field could have effect on the metabolism of bone cells related to the cellular metabolic process,
Alkaline Phosphatase* ; DNA* ; Electromagnetic Fields* ; Magnetic Fields* ; Magnets* ; Metabolism

No abstract available.
Acidosis, Renal Tubular*

There are few reports analyzing the results of intensive care for children in Korea. A total of 40 critically ill pediatric patients were evaluated in terms of Therapeutic Intervention Scoring System (TISS), The group was composed of patients from 4 services: cardiothoracic surgery, pediatric surgery, pediatrics and other surgeries. We evaluated duration of stay and cost in pediatric intensive care unit (PICU), Seoul National University Hospital, and TISS related to departments. The patients with higher TISS showed longer duration of stay and higher cost in PICU than those with lower TISS. The duration of stay of the patients with high TISS more than 50 was 5.0 days, but it was 2.8 days in 40-49, 2.4 days in 30-39, 2.1 days in 20-29 and 1.9 days in 10-19 of TISS's, respectively. The postoperative first day cost of intensive care was approximately 2,210,000 Won in the patients with high TISS more than 50, but it was 1,060,000 Won in 40-49, 220,000 Won in 30-39, 460,000 Won in 20-29, 120,000 Won in 10-19 of TISS's, respectively. The patients in cardiothoracic surgery showed higher values in maximum, minimum and discharge TISS than other services. Maximum, minimum and discharge TISS of the patients in cardiothoracic surgery were 41, 28 and 23, respectively. TISS's of patients in pediatric surgery and neurosurgery were similar, but durations of stay in PICU were 3.5 days in pediatric surgery and 1.2 days in neurosurgery. In this study, we conclude that duration of stay in PICU and cost of intensive care might be proportional to TISS.
Child ; Critical Illness* ; Humans ; Critical Care ; Intensive Care Units ; Korea ; Neurosurgery ; Pediatrics ; Seoul

Primary renal lymphoma is a controversial entity and extremely rare disease, possibly due to the fact that the kidney is one of the extranodal organs usually not containing lymphoid tissue. It is unclear if this conditions can be diagnosed preoperatively with imaging studies. In most cases the diagnosis is made after removal or biopsy of a kidney for suspected primary renal tumor or at autopsy. Treatment usually consists of surgery and chemotherapy with or without radiation therapy and the prognosis is poor. We report a case of primary renal lymphoma presenting with fever in a 13-month- old boy who was treated with surgical intervention and combination chemotherapy.
Autopsy ; Biopsy ; Child* ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Fever ; Humans ; Kidney ; Lymphoid Tissue ; Lymphoma* ; Male ; Prognosis ; Rare Diseases

BACKGROUND: The detection of collapsible airways has important therapeutic implications in chronic airway disease and bronchial asthma. The distinction of a purely collapsible airways disease from that of asthma is important because the treatment of the former may include the use of pursed lip breathing or nasal positive pressure ventilation whereas in the latter, pharmacologic approaches are used. One form of irreversible airflow limitation is collapsible airways, which has been shown to be a component of asthma or to emphysema, it can be assessed by the volume difference between what exits the lung as determined by a spirometer and the volume compressed as measured by the plethysmography. METHOD: To investigate whether volume difference between slow and forced vital capacity(SVC-FVC) by spirometry may be used as a surrogate index of airway collapse, we examined pulmonary function parameters before and after bronchodilator agent inhalation by spirometry and body plethysmography in 20 cases of patients with evidence of airflow limitation(chronic obstructive pulmonary disease 12 cases, stable bronchial asthma 7 cases, combined chronic obstructive pulmonary disease with asthma 1 case) and 20 cases of normal subjects without evidence of airflow limitation referred to the Pusan National University Hospital pulmonary function laboratory from January 1995 to July 1995 prospectively. RESULTS: 1) Average and standard deviation of age, height, weight of patients with airflow limitation was 58.3+/-7.24(yr), 166+/-8.0(cm), 59.0+/-9.9(kg) and those of normal subjects was 56.3+/-12.47(yr), 165.9+/-6.9(cm), 64.4+/-10.4(kg), respectively. The differences of physical characteristics of both group were not significant statistically and male to female ratio was 14:6 in both groups. 2) The difference between slow vital capacity and forced vital capacity was 395+/-317ml in patients group and 154+/-176ml in normal group and there was statistically significance between two groups(p<0.05). Sensitivity and specificity were most higher when the cut-off value was 208ml. 3) After bronchodilator inhalation, reversible airway obstructions were shown in 16 cases of patients group, 7 cases of control group(p<0.05) by spirometry or body plethysmography and the differences of slow vital capacity and forced vital capacity in bronchodilator response group and nonresponse group were 300.4+/-306ml, 144.7+/- 180ml and this difference was statistically significant. 4) The difference between slow vital capacity and forced vital capacity before bronchodilator inhalation was correlated with airway resistance before bronchodilator(r=0.307 p=0.05), and the difference between slow vital capacity and forced vital capacity after bronchodilator was correlated with difference between slow vital capacity and forced vital capacity(r=0.559 p=0.0002), thracic gas volume(r=0.488 p=0.002) before bronchodilator and airway resistance(r=0.583 p=0.0001), thoracic gas volume(r=0.375 p=0.0170) after bronchodilator, respectively. 5) The difference between slow vital capacity and forced vital capacity in smokers and nonsmokers was 267.5+/-303ml, 277.5+/-276ml, respectively and this difference did not reach statistical significance(p>0.05). CONCLUSION: The difference between slow vital capacity and forced vital capacity by spirometry may be useful for the detection of collapsible airway and may help decision making of therapeutic plans.
Airway Obstruction ; Airway Resistance ; Asthma ; Bronchodilator Agents ; Busan ; Decision Making ; Emphysema ; Female ; Humans ; Inhalation ; Lip ; Lung ; Lung Diseases, Obstructive ; Male ; Plethysmography ; Positive-Pressure Respiration ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; Respiration ; Sensitivity and Specificity ; Spirometry ; Vital Capacity

BACKGROUND/AIMS: Our aim was to assess whether short-term treatment with soluble tumor necrosis factor (TNF) receptor affects circulating markers of bone metabolism in rheumatoid arthritis (RA) patients. METHODS: Thirty-three active RA patients, treated with oral disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids for > 6 months, were administered etanercept for 12 weeks. Serum levels of bone metabolism markers were compared among patients treated with DMARDs at baseline and after etanercept treatment, normal controls and naive RA patients not previously treated with DMARDs (both age- and gender-matched). RESULTS: Bone-specific alkaline phosphatase (BSALP) and serum c-telopeptide (CTX)-1 levels were lower in RA patients treated with DMARDs than in DMARD-naive RA patients. After 12 weeks of etanercept treatment, serum CTX-1 and sclerostin levels increased. In patients whose DAS28 improved, the sclerostin level increased from 1.67 +/- 2.12 pg/mL at baseline to 2.51 +/- 3.03 pg/mL, which was statistically significant (p = 0.021). Increases in sclerostin levels after etanercept treatment were positively correlated with those of serum CTX-1 (r = 0.775), as were those of BSALP (r = 0.755). CONCLUSIONS: RA patients treated with DMARDs showed depressed bone metabolism compared to naive RA patients. Increases in serum CTX-1 and sclerostin levels after short-term etanercept treatment suggest reconstitution of bone metabolism homeostasis.
Adult ; Alkaline Phosphatase/blood ; Arthritis, Rheumatoid/blood/diagnosis/*drug therapy ; Biological Markers/blood ; Bone Morphogenetic Proteins/blood ; Bone Remodeling/*drug effects ; Collagen Type I/blood ; Female ; Genetic Markers ; Homeostasis ; Humans ; Immunoglobulin G/*administration & dosage ; Immunosuppressive Agents/*administration & dosage ; Inflammation Mediators/blood ; Male ; Middle Aged ; Peptides/blood ; Receptors, Tumor Necrosis Factor/*administration & dosage ; Time Factors ; Treatment Outcome ; Tumor Necrosis Factor-alpha/antagonists & inhibitors

PURPOSE: M. pneumoniae is knwon as a common causative agents of respiratory infection in school children. But, it tends to occur in infants and younger children recently. This study was performed to evaluate the incidence and clinical manifestations of M. pneumoniae pneumonia in infants. METHOD: A total of 142 children(33 infants{Group I : Infants group; 0-2 years} and 109 children{Group II : Children group; 3-6 years}) was admitted with M. pneumoniae pneumonia from January through December 1998. We reviewed medical records and evaluated the incidence, clinical manifestations and laboratory findings. RESULT: Number of patients with M. pneumoniae pneumonia in 0 to 2 years of age(infants group) comprised 23.2% of the total in contrast to 57.1% in 3 to 6 years of age group and 19.7% in 7 to 12 years of age group. Seasonal distribution showed the highest frequency in autumn in infant and children groups(45.5% and 39.4% respectively). The most frequent symptom was cough(90.9% and 96.3%, respectively), followed by sputum(81.8% and 90.8%, respectively), fever(72.7% and 66.0%, respectively) and rhinorrhea(72.7% and 64.0%, respectively). The common physical findings on admission were crackle(84.8% and 80.7%, respectively), wheezing(30.3% and 18.3%, respectively) and throat injection(39.4% and 35.8%, respectively). WBC count was within normal range in both groups(90.9% and 89%, respectively) and CRP was lower than 0.8 mg/dL in 63.6% of infant group and 54.1% of children group. The most common radiologic finding was bronchopneumonia in both groups (47% and 38%, respectively). CONCLUSION: Number of the patients with Mycoplasma pneumoniae pneumonia in infants age from 0 to 2 years comprised 23.2% of the total. Clinical manifestations of Mycoplasma pneumonia in infants were similar to those of older children. We recommened Mycoplasma pneumoniae should be considerd as a causative agent even in infant with respiratory infection.
Bronchopneumonia ; Child ; Humans ; Incidence ; Infant* ; Medical Records ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Reference Values ; Seasons

BACKGROUND: Dosage influences distribution of a local anesthetic solution in cerebrospinal fluid. The dose of intrathecal local anesthetic was investigated, taking into account the patient's weight and height, to see whether this would stabilize the hemodynamics and provide adequate spinal anesthesia for Cesarean section. METHODS: In this double-blind prospective study, 60 patients undergoing elective Caesarean delivery were randomized to receive either fentanyl 25microgram in hyperbaric 0.5% bupivacaine 2.5 ml (Group 1) or fentanyl 25microgram and 0.9% normal saline in a volume of hyperbaric 0.5% bupivacaine, taking into account the patient's weight and height (Group 2). The patient's hemodynamics, time to sugical incision, supplementary analgesia and conversion to general anesthesia, etc were recorded. RESULTS: The incidence of hypotension and use of ephedrine were decreased, and the administration of fluid and the duration of motor blockade were significantly shorter in Group 2. The time to surgical incision was faster and the peak sensory level was higher in Group 1. Others effects were similar in both groups. CONCLUSIONS: The dose of intrathecal local anesthetic, taking into account the patient's weight and height stabilized the hemodynamics and provided adequate spinal anesthesia for elective Cesarean section.
Analgesia ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cerebrospinal Fluid ; Cesarean Section* ; Ephedrine ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypotension ; Incidence ; Pregnancy ; Prospective Studies