OBJECTIVE: To evaluate the results of second-trimester maternal serum triple-marker screening test for Down syndrome and open neural tube defects in singleton pregnancies conceived from in vitro fertilization, the screen positive rates and triple-marker level of patients conceiving singleton pregnancies by IVF were compared to those of pregnancies conceived naturally. METHODS: Two hundred singleton pregnancies conceived by IVF and naturally conceived pregnancies who had done maternal serum screening test during the second trimester were analyzed from January 1995 to April 1998. RESULTS: One (0.5%) of the 200 cases of IVF singleton pregnancies had a positive result for Down syndrome compared with 1% of screen positive rate in the 200 cases of naturally conceived pregnancies. The median level of the triple markers were 0.92 multiples of the median(MoM) for alpha-fetoprotein(AFP), 1.44 MoM for unconjugated estriol(E3) and 0.87 MoM for human chorionic gonadotropin(hCG) respectively. CONCLUSION: The positive rate of triple test for Down syndrome and open neural tube defect in the two groups were significantly not different. As additional data are collected, corrected standards should be determined.
Chorion ; Down Syndrome ; Female ; Fertilization in Vitro* ; Humans ; Mass Screening* ; Neural Tube Defects ; Pregnancy Trimester, Second ; Pregnancy*

BACKGROUND: The epidermal permeability barrier necessary for terrestrial life resides in the intercellular spaces of the stratum corneum and is composed of lipids. OBJECTIVE: Since strrtum corneum lipid may be important for the permeability barrier, we studied the differences and effects of experimentally altered barrier function using acetone and tape-stripping technique. METHODS: The permeability barrier of hairless mouse was disrupted by tape-stripping and acetone treatment and the recovery rate was assessed by histochemical staining, electron microscopic examination and lipid analysis. RESULTS: Although the transepidermal water loss recovered completely by 48 hours in both of the acute models, acetone treated samples seem to have on over-all better recovery rate than tape-stripped samples. The return of barrier function to normal in both tape-stripped and acetone-treated skin was accompanied by a comparable return of normal nile red and ruthenium tetroxide staining. The amount of lipid in stratum corneum paralleled both the return of barrier function towards normal and the extent of prior damage to the barrier in acetone treated skin, yet, the lipid synthesis in tape-stripped skin showed a slower return of lipid content. CONCLUSION: The difference in the recovery rate of the two acute models may be due to the fact that acetone mainly extracts intercellular lipids, whereas, tape-stripping has a prolonged effect by removal of comeocyte in addition to the intercellular lipids. This shows the importance of comeocytes as well as the intercellular lipid bilayer in the recovery of normal barrier function.
Acetone* ; Animals ; Extracellular Space ; Lipid Bilayers ; Mice ; Mice, Hairless ; Permeability ; Ruthenium ; Skin ; Water

Coccidioidomycosis is a common infectious disease in southwestern North America, which is caused by the soil fungus, Coccidioides immitis. Due to the mobility of the modern population, increasing numbers of cases are being diagnosed outside the endemic areas. Moreover, diagnosis in non-endenmic areas may be delayed or confused due to its rarity. Here we report a case of pulmonary coccidioidomycisis in an immigrant. The patient presented with unexplained pulmonary symptoms. A history of recent travel to or immigration from an endemic area may suggest coccidioidomycosis. In addition an early tissue biopsy is helpful in establishing this diagnosis.
Bacterial Infections and Mycoses ; Biopsy ; Coccidioides ; Coccidioidomycosis* ; Communicable Diseases ; Diagnosis ; Emigrants and Immigrants* ; Emigration and Immigration ; Fungi ; Humans ; Mycoses ; North America ; Soil

A 25-year-old woman developed generalized urticaria and an anaphylactic syndrome of sudden onset while she was being treated for her decubitus ulcer with chlorhexidine antiseptic solution. Prick test with 0.5% chlorhexidine produced a wheal in a few minutes. A passive intradermal transfer test (PK test) to her mother was positive. These enabled us diagnose her as having an immunologic contact urticaria to chlorhexidine.
Adult ; Chlorhexidine* ; Female ; Humans ; Mothers ; Pressure Ulcer ; Urticaria*

Successful percutaneous transluminal angioplasty (PTA) of an internal mammary artery graft was performed in a 40 year old male patient who had recurrent angina soon after bypass surgery. Coronary angiography showed total occlusion of proximal portion of the left anterior descending artery and normal right coronary artery. Angiography of the left internal mammary artery graft revealed a tight stenosis (90% diameter narrowing) in the mammary artery at its insection into the left anterior descending artery.Angiography after the angioplasty demonstrated a widely patent graft (residual stenosis 10%) and translesional pressure gradient was 10 mmHg.
Adult ; Angiography ; Angioplasty* ; Arteries ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Vessels ; Humans ; Insects ; Male ; Mammary Arteries* ; Transplants*

OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol versus intracervical dinoprostone (prostaglandin E2 gel) for cervical ripening and labor induction. METHODS: 60 patients with indication for labor induction and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone. 50 microgram tablets of misoprostol were placed in the posterior vaginal fornix every 4 hours for a maximum of 3 doses or dinoprostone 0.5mg was placed into the endocervix every 6 hours for a maximum of 2doses. No more medication was given after either spontaneous rupture of membranes or beginning of active labor. RESULTS: Among 60 patients enrolled, 30 received misoprostol and 30 received dinoprostone. The average interval from start of induction to active labor was shorter in misoprostol group (6.5+/-3.2 hours) than in the dinoprostone group (10.7+/-7.3 hours) (p<0.05). Oxytocin augmentation of labor occurred more often in the dinoprostone group (36.7%) than in the misoprostol group (10.0%) (p<0.05). There was a higher prevalence of fetal distress (23.3% versus 3.3%) and tachysystole (16.6% versus 6.6%) in the misorprostol group than in the dinoprostone group(p<0.05). CONCLUSIONS: Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor. Furthermore, the cost of misoprostol ( 360/200microgram) is much less than that of dinoprostone ( 42,000/0.5mg). Cost benefits from administration of misoprostol are evident, especially in clinics under system of diagnosis-related group (DRG) : however when given at this dosage, it is associated with a higher prevalence of fetal distress and tachysystole than dinoprostone. Further studies to compare the safety of misoprostole to that of dinoprostone and to delineate an optimal dosing regimen for misoprostol are needed.
Cervical Ripening* ; Cost-Benefit Analysis ; Diagnosis-Related Groups ; Dinoprostone* ; Female ; Fetal Distress ; Humans ; Membranes ; Misoprostol* ; Oxytocin ; Pregnancy ; Prevalence ; Prospective Studies* ; Rupture, Spontaneous ; Tablets

Generalized lipodyst,rophy is characterized by generalized loss of body fat, and is asociated vith metabolic ahnormalities, including insulin resistance, hyperglycemia., and hypertriglyceridemia. like acanthosis nigricans, generalized lipodystrophy is a cutaneous marker of insulin re.istant diabetes. We report. herein a twenty year old female witti both classic generalized lipodystripin and acanthosis nigricans, in association with insulin resistant diabetes.
Acanthosis Nigricans ; Adipose Tissue ; Female ; Humans ; Hyperglycemia ; Hypertriglyceridemia ; Insulin ; Insulin Resistance ; Lipodystrophy, Congenital Generalized*

This study was undertaken to elucidate any quantitative abnormalities of Tlymphocyte subsets (helper/inducer T cell; T cell and suppressor/cytotoxic T cell: T cell) and IgE levels in the peripheraI blood in atopic dermatitis patients by using monoclonal antibodies and enzyme immunoassay, respectively. In addition we have tried to ascertain whether there are any correlations betveen such immuiiologic abnormalities and the severity of the disease. The results showed that there were significant decrease in the mean percentage of T Cells and increase in the mean value of T/T cell ratios in patients with atopic dermatitis. These changes seem to relate to the severity of the disease when evaluated as groups. A significant increase in the mean value of serum IgE was found in atopic dermatitis patients and the change was related to the severity of the disease. But increase of serum IgE level did not correlated closely with the T cell abnormalities in each patients.
Antibodies, Monoclonal ; Dermatitis, Atopic* ; Humans ; Immunoenzyme Techniques ; Immunoglobulin E* ; T-Lymphocyte Subsets* ; T-Lymphocytes

No abstract available.
Bone Diseases* ; Diagnosis, Differential* ; Humans ; Low Back Pain* ; Spine* ; Tomography, Emission-Computed, Single-Photon*

Stratum corneum lipids, which are enriched in sphingolipids, free fatty acids, and cholesterol, are required for epidermal barrier function. When the epidermal permeability barrier is perturbed, the transepidermal water loss returns to normal by 24-48 hours in parallel with the reappearance of stratum corneum lipids, derived from secreted lamellar bodis and accelerated lipid synthesis. Recent evidence shows that topical application of individual lipids interferes with barrier recovery while complete mixtures of cholesterol, fatty acids, and ceramides facilitate recovery after barrier disrupton. Metabolic imbalances and perturbed barrier function can be either the cause or the consequences of the pathobiology of scaling disease. Many skin diseases relating cornification and dryness are indeed related to abnormality of one or several combinations of lipids. Recently the cytokines which have changed during barrier recovery seem to be important in understanding of epidermal lipid homeostasis as well as barrier recovery.
Ceramides ; Cholesterol ; Cytokines ; Fatty Acids ; Fatty Acids, Nonesterified ; Homeostasis* ; Permeability ; Skin Diseases ; Sphingolipids ; Water