To determine the perinatal mortality and morbidity of fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery in severe pre-eclampsia and eclampsia, the outcome of 5 fetuses with AEDV was compared with that of 35 fetuses with positive end-diastolic velocities (PEDV). The study population comprised 38 cases of severe pre-eclampsia and 2 cases of eclampsia with structurally normal singletons, who had had umbilical artery Doppler velocimetry weekly from admission to delivery. The Doppler velocimetry result was not used for the clinical management. Perinatal death and neonatal morbidity from both groups were further examined in gestational age category to control the influence of preterm births. The incidence of AEDV of the umbilical artery Doppler velocimetry in severe pre-eclampsia and eclampsia was 12.5% (5/40). The AEDV group had a significantly higher incidence than the PEDV group in terms of ceasarean section due to fetal distress (60% : 17%), Apgar score < 7 at 5 minutes (60% : 14%), perinatal death (25% : 0%) and assisted mechanical ventilation (67% : 9%) both at 32-36 weeks. Time intervals from the detection of AEDV to delivery of live neonates varied from the day to 15 days. In conclusion, AEDV in the umbilical artery might be of clinical value in routine surveillance of pregnancies complicated by severe pre-eclampsia and eclampsia, and predict hypoxic fetal condition which needs operative interventions before or during labor and mechanical ventilation after birth.
Apgar Score ; Cesarean Section ; Dystocia ; Eclampsia* ; Female ; Fetal Distress ; Fetus ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Maternal Death ; Mortality ; Parturition ; Parturition* ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Premature Birth ; Respiration, Artificial ; Rheology ; Trial of Labor ; Umbilical Arteries* ; Uterine Rupture

PURPOSE: To describe the magnetic resonance (MR) findings of intracranial dural arteriovenous fistulae (DAVF) and associated venous hypertensive diseases, and to determine their diagnostic value. MATERIALS AND METHODS: MR Imagings of twelve cases of angiographically-proven intracranial DAVF were analyzed. The presence of signal voids, dilatation of involved dural sinus, the dilatation of the extra/intradural venous system, high signal intensity on T2 weighted image, cerebral edema, intracranial hemorrhage, and hydrocephalus were retrospectively analyzed. MR findings and angiographic classification were compared. RESULTS: In 11 of 12 patients (92%), MR revealed the location of DAVF. In five cases, these were cavernous, and in six, they were extracavernous; the locations of the latter were as follows: superior sagittal sinus (SSS), 4: torcula, 1; lateral sinus & SSS, 1. Except for the lateral sinus lesion, all the DAVF seen in thses 11 patients showed the presence of signal voids and dilatation of the involved dural sinus. Findings of associated venous hypertensive disease, namely dilatation of the superior ophthalmic vein and cortical venous system, cerebral edema, and high signal intensity on T2-weighted images were observed in three cavernous lesions (50%), but all extracavernous DAVF (100%) showed associated venous hypertensive disease. When the grade of angiographic classification was high and reflux of sinus blood to the cortical vein was seen on angiography, the MR findings of intracranial venous hypertension showed good correlation. CONCLUSION: The MR findings of DAVF include dilatation of the dural sinus and signal voids of feeding arteries and draining vein. Other findings which suggest intracranial venohypertensive disease are dilatation of the cortical and medullary vein, hydrocephallus, cerebral edema and intracranial hamorrhage. These and the angiographic findings correlate well and suggest that in the diagnosis of DAVF and the detection of intracanial venohypertension, MR is a non-invasivse technique which can be use be usefully employed before final diagnosis by angiography.
Angiography ; Arteries ; Arteriovenous Fistula ; Brain Edema ; Central Nervous System Vascular Malformations* ; Classification ; Diagnosis ; Dilatation ; Humans ; Hydrocephalus ; Hypertension ; Intracranial Hemorrhages ; Magnetic Resonance Imaging* ; Retrospective Studies ; Superior Sagittal Sinus ; Transverse Sinuses ; Veins

The authors reviewed 50 patients of congenital dislocation of the hip who had surgical treatment at the Department of Orthopedic Surgery, Seoul National University Children's Hospital from October, 1985 to August, 1993. We investigated the contributing factors to coxa magna after surgical treatment and it's relationship to the avascular necrosis of femoral head, and observed the influnce of coxa magna on the development of the hip joint. Coxa magna was defined as a femoral head with the greatest diameter 15% greater than the opposite side. To assess the development of the acetabulum in the hips with coxa magna, radiographical horizontal and vertical parameters were measured preoperatively, and at postoperative 1 year, 2 year, and 3 year or more. Twenty-one of fifty hips had coxa manga. The incidence of coxa magna increased in patients who had open reduction at younger age(average 30 months), compared to older age(average 44 months). Neither femoral osteotomy nor pelvic osteotomy increased statistically the incidence of coxa magna. Avascular necrosis of femoral head did not necessarily resulted in coxa magna. There were not statistically significant differences in the coverage ratios of femoral head by the acetabulum between coxa magna positive and negative groups, because lateral acetabular growth accompanied in accordance with enlargement of femoral head in the majority of cases with coxa magna. Open reduction alone caused concomitant vertical overgrowth of ipsilateral hemi-pelvis with resultant pelvic tilt and leg length inequality(IHD>5mm, upto 2cm) in 6 of 10 cases. The patients, who had coxa magna with good radiological results by Severin's classification, underwent open reduction at younger age and had lesser enlargement of the femoral head, compared to those with fair or poor results.
Acetabulum ; Classification ; Dislocations ; Head ; Hip Joint ; Hip ; Humans ; Incidence ; Leg ; Necrosis ; Orthopedics ; Osteotomy ; Seoul

PURPOSE: To demonstrate and evaluate the value of MRI findings of the TSH(Thyroid-Stimulating Hormone, TSH, Thyrotropin)-secreting pituitary adenoma. MATERIALS AND METHODS: The authors reviewed retrospectively the MR images of 4 patients with TSH-secreting pituiatary adenoma. Evaluation of the anatomical location, signal characteristics, enhancement patterns, size, shape and circunferential changes were made. RESULTS: No characteristic common MR findings in size, shape, signal intensity, and circumferential changes of TSH-secreting pituiatary adenoma waere observed among 4 cases(size; 5x7 mm to 10x11 mm, shape;ovoid to round, signal intensity;high in 1 case on T1 and T2WI, isosignal intensity in the other 3 cases, circumferential change; stalk deviation in 1 case, no stalk deviation in 3 cases). But, the tumors were centrally located at the anterior pituitary gland and showed relatively homogeneous signal intensity on MR images of all 4 patients. CONCLUSION: We conclude that centrally-located mass at the anterior pituitary gland with homogeneous signal intensity on MR image may be suggestive of the TSH-secreting pituitary adenoma, although the MR findings are not specific for the disease.
Adenoma ; Humans ; Magnetic Resonance Imaging* ; Pituitary Gland, Anterior ; Pituitary Neoplasms* ; Retrospective Studies

As B.C.G. vaccination is being given extensively to uninfected children in this country. It has become important for pediatricians, general practitioners and public health people to differentiate natural conversion of response to tubercle bacilli from B.C.G. conversion. The authors have investigated this problem by studying 993 pupils in a primary school in Seoul. In our investigation, the difference between the convesion rate with 1/2,000 O.T. and 1/10,000 O.T. at various intervals after B.C.G. vaccination in the B.C.G.- converted group is statistically significant, whereas in the naturally converted group, the difference between the two groups is not statistically significant. There also is a difference in local reaction between the naturally converted group and the B.C.G.-converted group, although it is hard to distinguish with a single reaction whether it is due to natural conversion or to B.C.G. conversion. From both the results of our study and a some of the previous articles on this matter, the authors conclude that natural conversion to tuberculosis may be differentiated from B.C.G. conversion by using both 1/2,000 O.T. and 1/10,000 O.T. at the same time rather than using 1/2,000 O.T. alone, as practiced until now in this country, in order that the reaction may not be erroneous1y read as a naturally-converted positive reaction always.
Child ; Follow-Up Studies* ; General Practitioners ; Humans ; Public Health ; Pupil ; Seoul ; Tuberculin Test* ; Tuberculin* ; Tuberculosis* ; Vaccination*

No abstract available.
Classification* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive*

BACKGROUND: Excessive iodine intake increases the occurrence of autoimmune thyroid disorders by enhancing immunogenecity of iodine-rich thyroglobulin, In Korea, most of postpartum women take a large amount of iodine-rich seaweed. Although the excessive iodine intake may affect the thyroid function, only a few reports were available concering iodine intake, especially on postpartum period. METHODS: A prospective study was undertaken in 146 of normal delivered postpartum women. Dietary intake and urinary excretion of iodine, serum T3, T4, TSH, anti-TPO Ab and anti-Tg Ab were measured before and 1, 6, 12 and 24 weeks after delivery. Iodine intake was analyzed by one-to-one interview using 24hr recall and food frequency questionnaire. RESULTS: 1. PPT was occurred in 6 (10.3%) postparturn women, It presented as hypothyroidism alone in 1 (16.7%), transient thyrotoxicosis followed by hypothyroidisrn in 3 (50.0%), and thyrotoxicosis alone in 2 (33.3%) of the follwed-up patients. 2. During pregnancy, no difference was found in age, serum T3, T4 and TSH between PPT and normal thyroid function group. 3. In PPT group, anti-TPO and anti-Tg Ab were significantly higher than those of normal thyroid function group during pregnancy, and their sensitivity for PPT was 40% and 33%, respectively. But there was no correlation between dietary iodine intake and the titer of thyroid auto-antibodies. 4. There was no correlation between pre and post-partum dietary iodine intake and occurrence of PPT. CONCLUSION: In Korea, the incidence of PPT was slightly higher than other nations. The sensitivity of thyroid auto-antibodies was too low to use for prediction of PPT. Pre and post-partum iodine intake had no effect on the occurrence of PPT and post-partum thyroid function.
Female ; Humans ; Hypothyroidism ; Incidence ; Iodine ; Korea ; Postpartum Period ; Postpartum Thyroiditis* ; Pregnancy ; Prospective Studies ; Surveys and Questionnaires ; Seaweed ; Thyroglobulin ; Thyroid Gland ; Thyrotoxicosis

BACKGROUND: This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians. METHODS: We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications. RESULTS: Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest. CONCLUSIONS: The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.
Cardiopulmonary Resuscitation ; Catheterization ; Emergencies* ; Extracorporeal Membrane Oxygenation ; Extremities ; Heart Arrest ; Humans ; Ischemia ; Myocardial Infarction ; Retrospective Studies ; Treatment Outcome

Comatose cardiac arrest patients frequently experience cardiogenic shock or recurrent arrest. Extracorporeal membrane oxygenation (ECMO) can be used to salvage patients with cardiogenic shock or cardiac arrest refractory to conventional therapies. However, in comatose cardiac arrest patients whose neurologic recovery is uncertain, the use of ECMO is restricted because it requires considerable financial and human resources. Amplitude-integrated electroencephalography is an easily applicable, real-time electroencephalography monitoring tool that has been increasingly used to monitor brain activity in comatose cardiac arrest patients. We describe our experience of using amplitude-integrated electroencephalography in decision-making to place ECMO for comatose cardiac arrest patients whose eventual neurologic recovery appeared uncertain at the time of ECMO placement.
Brain ; Coma ; Electroencephalography ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Prognosis ; Shock, Cardiogenic

A radioisotope first pass study was done on patients over a period of 1 to 15 years (average 4.6 years) after repair for ventricular septal defect or arterial septal defect with a left to right shunt. The age of the patients ranged from 6 to 32 years (average 14.2 year) at the time of the study. The total work of exercise and the right and left ventricular ejection fraction(EF) were evaluated at rest and after exercise. The results were compared with the preoperative hemodynamic findings and with the age of patient at the time of the operation. 1) When the total work of exercise was divided with the maximal exercise capacity of the normal individual corresponding to the patients' height and body surface area (the percentage of total work), it were very low with the average of 40% of normal. There was no sexual difference, but the percentage of total work of exercise had significant correlation with the patients' age at the time of operation (r = -0.52,p<0.01) and post-exercise left ventricular ejection fraction (LVEF)(r = -0.39,p<0.05). 2) LVEF at rest had some correlation with the preoperative mean pulmonary arterial pressure (r = -0.29, p = 0.05), but showed no relationship with Qp/Qs or Rp/Rs ratios. The right ventricular ejection fraction (RVEF) at rest had no relations with the preoperative hemodynamic findings with maximal workload. 3) The post-exercise RVEF showed linear correlation with the preoperative Rp/Rs ratio (r = -0.49,p<0.005), and mean pulmonary arterial pressure (r = -0.37,p<0.05). The post-exercise LVEF had no significant correlation with any preoperative hemodynamic factors. 4) When greater than 5% increase in ventricular EF after exercise is considered normal, the group with the normal right and left ventricular responses (n = 11) showed normal preoperative Rp/Rs ratio (7.6 +/- 4.1). In the group with normal left, but abnormal right ventricular response (n = 9) and the group with abnormal biventricular response (n = 11), both demonstrated incremental increase in Rp/Rs ratio (20.1 +/- 11.3, 26.3 +/- 19.8 respectively). Normal right, but abnormal left ventricular reaction (n = 2) was noted in patients with residual aortic valvular insufficiency and residual ventricular septal defect. In conclusion, post-operative ventricular response was much more sensitive and informative than that of ventricular function at rest and to detect subclinical cardiac dysfunction. Post-exercise RVEF was closely correlated with preoperative pulmonary vascular hemodynamics, while post-exercise LVEF seemed to be a majo determinant of working capacity after repair.
Adolescent ; Adult ; Child ; Child, Preschool ; Exercise Test ; *Exertion ; Female ; Heart Defects, Congenital/*physiopathology/radionuclide imaging/*surgery ; Human ; Infant ; Male ; *Stroke Volume