No abstract available.
Cefazolin* ; Erythromycin* ; Latency Period (Psychology)* ; Membranes* ; Rupture*

A 24-year-old pregnant woman started to have severe hyperemesis gravidarum at 6 weeks' gestation. Six weeks later, dizziness, ataxia, visual disturbance, diplopia and confusion were developed. On admission, she presented ophthalmoplegia, nystagmus, deaeased tendon reflex, intention tremor, ataxia, confusion and memory disturbance. She was diagnosed to Wernicke-Korsakoff syndrome and 100mg of thiamine was administered intravenously daily till 28 weeks gestation and then intramuscularly. Her ocular symptns, together with neurological signs, were gradually improved. Memory disturbance slightly improved but remained at the time of delivery. The case will be presented in more details with a brief revie of literatures.
Ataxia ; Diplopia ; Dizziness ; Female ; Humans ; Hyperemesis Gravidarum* ; Korsakoff Syndrome* ; Memory ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Reflex, Stretch ; Thiamine ; Tremor ; Young Adult

OBJECTIVES: The purposes of this study were to determine the usefulness of transvaginal ultrasonographic assessment of the uterine cervix and to compare the diagnostic performance of ultrasonographic and digital examination of the cervix in predicting a successful induction of labor. STUDY DESIGN: One hundred-one singleton term pregnancies without ruptured membranes admitted for the labor induction were included in this study. Digital examination and transvaginal ultrasonography of the uterine cervix were performed at the time of admission. Cervical parameters evaluated included cervical length, presence of funneling, funnel length, and funnel width. Labor induction was underwent by prostaglandin E2 (PGE2) vaginal suppository and/or pitocin intravenous infusion. Outcome variable was a successful labor induction within 48 hours after beginning of the induction. RESULTS: The prevalence of induction failure was 10.9% (11/101). Receiver-operator characteristic (ROC) curve and multiple logistic regression analysis indicated a significant relationship between the successful induction of labor and cervical length <3.1 cm. The diagnositic indices of endocervical length was superior to those of Bishop's cervical score in predicting a successful induction of labor. In patients with cervical length <3.1 cm, the labor was induced successfully with fewer tablets of PGE2, less use of pitocin infusion, and shorter induction-delivery interval. CONCLUSION: Transvaginal ultrasonographical examination of the uterine cervix is more accurate than digital examination of the cervix in the prediction of a successful induction of labor in term gestation.
Cervix Uteri* ; Dinoprostone ; Female ; Humans ; Infusions, Intravenous ; Logistic Models ; Membranes ; Oxytocin ; Pregnancy* ; Prevalence ; Suppositories ; Tablets ; Ultrasonography

OBJECTIVES: The purpose of this study was to determine the clinical significance of residual amniotic fluid volume, as measured by the amniotic fluid index(AFI), on the prediction of latency period and perinatal outcomes in patients with preterm premature rupture of the membranes(PPROM). METHODS: Study population consisted of 103 singleton pregnancies with PPROM between 24 and 34 weeks' gestation. Amniotic fluid index was determined using transabdominal ultrasound at admission. Latency period was defined as time interval in hours between admission and delivery. All medical records of mothers and neonates were reviewed. Spearman's rho rank correlation, receiver-operator characteristic(ROC) curve analysis, survival analysis and Cox's proportional hazard model were used for statistical analysis. RESULTS: There was a statistically significant correlation between latency period and AFI at admission. ROC curve analysis showed that AFI at admission had a significant predictive value in the prediction of latency period < 48 hours. Survival analysis demonstrated that AFI < 5.0 was strongly associated with the likelihood of shorter latency period, Cox's proportional hazard model indicated that AFI < 5.0 was a significant independent predictor for the occurrence of latency period < 48 hours even after adjustment of other independent variables. The patients with AFI <5.0 had a higher rate of cesarean section due to fetal distress than those with AFI > 5.0 but the incidence of chorioamnionitis was not significantly different between two groups. Comparing the perinatal mortality and neonatal morbidity including infectious morbidity between the neonates born to mothers with AFI <5.0 and those with AFI > 5.0, there was no significance after adjustment of gestational age at birth. CONCLUSION: AFI at admission has a significant correlation with latency period and predictive value in prediction of latency period in the patients with PPROM. AFI <5.0 is a independent predictor for the shorter latency period.
Amniotic Fluid* ; Cesarean Section ; Chorioamnionitis ; Female ; Fetal Distress ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Latency Period (Psychology)* ; Medical Records ; Membranes* ; Mothers ; Parturition ; Perinatal Mortality ; Pregnancy ; Proportional Hazards Models ; ROC Curve ; Rupture* ; Ultrasonography

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is one of the most frequent and clinically significant complications of prematurity and it has been widely accepted that immaturity, barotrauma, and oxygen toxicity are major factors in the etiology of BPD. However, recent studies showed that infection may also play a role in the pathogenesis of BPD and exposure to a prenatal inflammatory process may lead to lung injury and predispose to the subsequent development of BPD. The purpose of this study was to test the hypothesis that neonates with BPD had higher incidence of histologic chorioamnionitis than those in whom BPD does not develop. METHODS: A retrospective study was conducted to examine the relationship between histologic chorioamnionitis and the occurrence of BPD in neonate. We reviewed the hospital charts of 363 women and their neonates whose gestational age at birth were between 24 weeks and 35 weeks and recorded their pregnancy outcomes, the results of placental Biopsy, perinatal outcomes including the occurrence of BPD. RESULTS: 1. Neonates who developed BPD showed higher incidence of acute histologic chorioamnionitis. The relationship remained significant even after the adjustment for gestational age (odds ratio, 3.2: 95% confidence interval, 1.6-11.3: P<0.05). 2. Higher maternal serum CRP was also associated with increased incidence of histologic chorioamnionitis and BPD (P<0.05). 3. Neonates who developed BPD also had higher incidence of infectious morbidity such as early neonatal pneumonia and sepsis (P<0.05). CONCLUSION: These results suggest that histologic chorioamnionitis is closely related to the occurrence of BPD. This support the hypothesis that intrauterine infection may cause fetal lung injury and subsequent development of BPD.
Barotrauma ; Biopsy ; Bronchopulmonary Dysplasia* ; Chorioamnionitis* ; Female ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Lung Injury ; Oxygen ; Parturition ; Pneumonia ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Sepsis

OBJECTIVE: o determine the correlation between birth weight and the level of insulin-like growth factor(IGF)-I, -II and insulin-like growth factor binding protein(IGFBP)-3 in amniotic fluid at second trimester and to evaluate possibility whether the levels of IGF-I, II and IGFBP-3 could predict birth weight. METHODS: Sixty-seven samples of amniotic fluid in second trimester were analyzed for IGF-I, IGF-II, and IGFBP-3 by radioimmunoassay. Newborn birth weights were stratified arbitrarily as <25th percentile, 25-75th percentile, and >75th percentile. Linear regression analysis and Kruskal-Wallis test were used in well appropriately for statistical analysis. RESULTS: The level of IGF-I showed positive correlation with birth weight. However, the levels of IGF-II and IGFBP-3 showed no significant correlation with birth weight. The level of IGF-I were signifi cantly different among these groups. However, the levels of IGF-II and IGFBP-3 were not significantly different among these groups divided by the birth weight percentile. CONCLUSION: The levels of IGF-I in amniotic fluid at second trimester may be useful marker in predicting birth weight.
Amniotic Fluid* ; Birth Weight* ; Female ; Humans ; Infant, Newborn ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Linear Models ; Parturition* ; Pregnancy ; Pregnancy Trimester, Second* ; Radioimmunoassay

Emergency endoacopy was performed in 315 patients for recent four years The source of upper GI bleeding in these 315 caaes were as follows: Esophageal varix(93), gastric ca(39), Mallory-weiss syndrome(14), gastric ca(38), Duodenal ulces(21), Erosive gastritis(14), Marginal ulcer(2), Combined case(24) Unknown cases(10), Essentiall Tx was not performed in 4 died case because of poor general conditions, After check up BP, Heart, Pluae rate, that examination was performed during drip infusion to be 'safety of cireulatary system. No compication were encountered. To confirm the source of bleeding at earlier stage, was useful to decid which way, that is conservative of surgical therapy in which better for the Management. The results are as follows: 1) The sex incidence of upper GI bleeding showed Male predominance c a ratio 4. 6: 1 and peak age groups were 4th & 5th decade. 2) Endoscopic diagnosis of npper GI bleeding in the studied case were in the order of Esophageal varix bleeding(29%), Gastric ulcer (23. 5%), Mallory weiss syndrome(12. 4%) Duodenal ulcer(6.7%) Erosive gastritis(4.4%) We could not find the bleedi site in 3.2% of the studied case. 3) The cause of emergeney endoseopy are Melena(19%), Hemstenesis(22.0%) and ccenbined (58. 4%) 4) Among the 315 cases of upper GI bleeding, 70. 1% of the cases revealed moderste degree of bleeding. 5) Among the 315 cases of apper BI bleeding, 28. 1% of the cases were confirmed of inducing factor. 6) Among the 315 cases of upper BI bleeding, 69% of the cases received an endcrscopic examination within 72 hr after initial episode of bleeding. (continue...)
Diagnosis ; Emergencies* ; Endoscopy* ; Esophageal and Gastric Varices ; Heart ; Hemorrhage* ; Humans ; Incidence ; Infusions, Intravenous ; Male ; Stomach Ulcer

OBJECTIVE: In this study, there was an investigation as to whether there is a functional difference in essential tremor (ET), according to responses to beta-blockers, by evaluating regional changes in cerebral glucose metabolism. MATERIALS AND METHODS: Seventeen male patients with ET were recruited and categorized into two groups: 8 that responded to medical therapy (group A); and 9 that did not respond to medical therapy (group B). Eleven age-sex matched healthy control male subjects were also included in this study. All subjects underwent F-18 fluorodeoxyglucose (FDG)-PET, and evaluated for their severity of tremor symptoms, which were measured as a score on the Fahn-Tolosa-Marin tremor rating scale (FTM). The FDG-PET images were analyzed using a statistical parametric mapping program. RESULTS: The mean FTM score 6 months after the initiation of propranolol therapy was significantly lower in group A (18.13 > 8.13), compared with group B (14.67 = 14.67). The glucose metabolism in group A in the left basal ganglia was seen to be decreased, compared with group B. The ET showed a more significantly decreased glucose metabolism in both the fronto-temporo-occipital lobes, precuneus of right parietal lobe, and both cerebellums compared with the healthy controls. CONCLUSION: Essential tremor is caused by electrophysiological disturbances within the cortical-cerebellar networks and degenerative process of the cerebellum. Furthermore, ET may have different pathophysiologies in terms of the origin of disease according to the response to first-line therapy.
Adrenergic beta-Antagonists/*pharmacology/therapeutic use ; Aged ; Brain/*drug effects/metabolism/radiography ; Brain Mapping ; Essential Tremor/*diagnosis/drug therapy/radiography ; Fluorodeoxyglucose F18/*chemistry ; Glucose/*metabolism ; Humans ; Male ; Middle Aged ; *Positron-Emission Tomography ; Propranolol/pharmacology/therapeutic use ; Radiopharmaceuticals/*chemistry

OBJECTIVE: The objectives of this study were to determine whether NF-kappa B-mediated pro-inflammatory cytokines signaling leads to COX-2 expression and PGE2 synthesis in human myometrial cells at term, and to compare cytokines-induced NF-kappa B activity and subsequent COX-2 expression and PGE2 synthesis between prelabor and in-labor myometrial cells. METHODS: Ten samples of human myometrium were obtained from 5 pregnant women with no labor and 5 in labor at term during cesarean section. Myometrial smooth muscle cells were harvested by cell culture and stimulated with TNF-alpha. PGE2 production and COX-2 expression were determined by ELISA and Western blotting analysis, respectively. NF-kappa B transcriptional activity was assessed by luciferase assay and by nuclear shifting using EMSA. RESULTS: Before the treatment of TNF-alpha, the levels of PGE2 production, COX-2 expression, and activity and nuclear shift of NF-kB in in-labor cells were higher than those in prelabor cells. By the stimulation of TNF-alpha, PGE2 output, COX-2 expression, and activity and nuclear shift of NF-kappa B increased in both of prelabor and in-labor cells. The increases of PGE2 production, COX-2 expression, and NF-kappa B activity were significantly greater in in-labor cells. CONCLUSION: Pro-inflammatory cytokines-induced COX-2 expression and subsequent PG synthesis, mediated by NF-kappa B, appears one of the important mechanisms of labor in term gestation.
Animals ; Blotting, Western ; Cell Culture Techniques ; Cesarean Section ; Cyclooxygenase 2 ; Cytokines ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Luciferases ; Mice ; Myocytes, Smooth Muscle ; Myometrium ; NF-kappa B ; Pregnancy* ; Pregnant Women ; Tumor Necrosis Factor-alpha

Myotonic dystrophy is an autosomal-dominantly inherited neuromuscular disorder characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, heart, lung and intestine. During pregnancy and delivery, serious maternal and obstetrical complications may occur. The myotonia is often aggravated during pregnancy and it leads to obstetrical complications such as fetal loss, preterm premature delivery, hydrops, in-utero fetal death, difficulties in fetal expulsion, postpartum hemorrhage and/or anesthetic accidents. The affected neonate may display severe hypotonia, facial displegia and respiratory distress. This report presents a woman with myotonic dystrophy complicated with congestive heart failure and preterm delivery during pregnancy.
Cataract ; Edema ; Estrogens, Conjugated (USP)* ; Female ; Fetal Death ; Heart Failure* ; Humans ; Infant, Newborn ; Intestines ; Lung ; Muscle Hypotonia ; Muscle Weakness ; Muscular Dystrophies ; Myocardium ; Myotonia ; Myotonic Dystrophy* ; Obstetric Labor, Premature* ; Postpartum Hemorrhage ; Pregnancy*