OBJECTIVE: To determine if birth weight greater than 4000gm can be predicted by ultrasound measurement of abdominal circumference(AC) and if shoulder dystocia in macrosomic infants can be predicted by ultrasound measurement of the difference between the abdominal diameter(AD) and biparietal diameter(BPD). METHODS: A Retrospective study was performed of births occuring from March, 1998 to August, 1999 at department of Obstetrics and Gynecology, College of Medicine, Chung-Ang University. Among neonates of birth weight greater than 4000 gm, 50 cases in that ultrasound examination was done within 2 weeks before delivery were selected for macrosomic group and 50 cases were selected for control group during the same period, among neonate of birth weight from 3100gm to 3900gm. RESULTS: 1) Normal spontaneous vaginal delivery(NSVD) was 41 cases in control group and 30 cases in macrosomic group. Among NSVD, shoulder dystocia was 1 case in 41 cases of control group and was 7 cases in 30 cases of macrosomic group. 2) On ultrasound measurement, 6 cases had AC greater than 35 cm in control group and 45 cases in macrosomic group. Among 30 cases in NSVD was done in macrosomic group, difference between AD and BPD was 2.9 0.271 cm when shoulder dystocia was existed and was 2.1 0.409 cm when shoulder dystocia was not existed. Between the two groups, statistically significant difference was detected. 3) When AC(cutoff value of 35cm) was used for screening of macrosomia, sensitivity for macrosomia was 88.2% and specificity was 89.8% and when AD-BPD difference(cutoff value of 2.6cm) was used for prediction of shoulder dystocia, sensitivity for shoulder dystocia was 66.6% and specificity was 95.2%. CONCLUSIONS: In prenatal ultrasound measurement, AC measurement at third trimester of pregnancy will be a valuable indicator for macrosomia screening. The AD-BPD difference of shoulder dystocia group was greater than uncomplicated group in macrosomia and the AD-BPD difference cutoff value of 2.6cm was significant value statistically.
Birth Weight ; Dystocia* ; Female ; Gynecology ; Humans ; Infant ; Infant, Newborn ; Mass Screening ; Obstetrics ; Parturition ; Pregnancy ; Pregnancy Trimester, Third ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder* ; Ultrasonography*

Background: More comprehensive healthcare services should be provided to patients with complex chronic diseases to better manage their complex care needs. This study examined the effectiveness of comprehensive primary care in patients with complex chronic diseases. Methods: We obtained 2002–2019 data from the National Health Insurance Sample Cohort Database. Participants were individuals aged ≥ 30 years with at least two of the following diseases: hypertension, diabetes mellitus, and hyperlipidemia. Doctors’ offices were classified into specialized, functional, and gray-zone based on patient composition and major diagnostic categories. The Cox proportional hazard model was used to examine the association between office type and hospital admission due to all-causes, severe cardiovascular or cerebrovascular diseases (CVDs), hypertension, diabetes mellitus, or hyperlipidemia. Results: The mean patient age was 60.3 years; 55.8% were females. Among the 24,906 patients, 12.8%, 38.3%, and 49.0% visited specialized, functional, and gray-zone offices, respectively. Patients visiting functional offices had a lower risk of all-cause admission (hazard ratio [HR], 0.935; 95% confidence interval [CI], 0.895–0.976) and CVD-related admission (HR, 0.908; 95% CI, 0.844–0.977) than those visiting specialized offices.However, the admission risks for hypertension, diabetes mellitus, and hyperlipidemia were not significantly different among office types. Conclusion This study provides evidence of the effectiveness of primary care in functional doctors’ offices for patients with complex chronic diseases beyond a single chronic disease and suggests the need for policies to strengthen functional offices providing comprehensive care.

PURPOSE: Lymph-node metastasis is one of the most important prognostic factors in gastric cancer. However, it can be missed with conventional histologic examination with hematoxylin-eosin staining. Several methods have been introduced to improve the detection rate of micrometastasis. Among them, immunohistochemical staining with the anti-cytokeratin antibody is known to be an easy and useful method. METHODS: We used immunohistochemical staining with the anti-cytokeratin antibody to evaluate the incidence of micrometastasis in 48 patients with advanced gastric cancer who had been diagnosed as lymph-node negative by H&E, and its relationship to various clinicopathologic factors. RESULTS: Lymph-node micrometastasis (anti-cytokeratin antibody positive) was found in 15 (31.3%) of the 48 patients and in 33 (1.75%) of 1884 lymph nodes. Among the clinicopathologic variables, only lymphatic invasion was significantly associated with micrometastasis status. The gender, the age, the tumor size, the location of the tumor, the histologic type, and the depth of invasion were not significantly associated with micrometastasis status. During the average follow-up period of 21 months, 6 patients suffered a recurrence, and 2 of these patients died of the cancer recurrence. The recurrence and mortality rates were not significantly associated with micrometastasis status. CONCLUSION: Micrometastasis in stomach cancer was frequent when the primary tumor had invaded the lymphatic vessels.
Follow-Up Studies ; Humans ; Incidence ; Keratins ; Lymph Nodes* ; Lymphatic Vessels ; Mortality ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Recurrence ; Stomach Neoplasms*

PURPOSE: An increased incidence of gallstones has been widely reported in patients who had undergone a gastrectomy. But, there has been little information about the pathophysiologic mechanism for the occurrence of gallstones after gastric surgery. Many investigators have considered the cause to be decreased gallbladder motility due to vagal denervation. We observed higher increase in the incidence of gallbladder stones in patients who underwent a Billroth II gastrojejunostomy than in those who underwent a Billroth I gastrojejunostomy after radical subtotal gastrectomy. METHODS: We prospectively studied the change in the motility of the gallbladder after a gastrectomy. The gallbladder ejection fraction (EF) was compared pre- and postoperatively by using gallbladder scintigraphy with 2,6-diisopropyl-iminodiacetic acid (DISIDA). RESULTS: Twenty patients underwent a Billroth(B) I anastomosis and twelve patients underwent a B-II anastmosis after the gastrectomy. The means of the EF of the B-I group were 75.9%, 46.4%, 68.1% at the preoperative period, at 1 month and 6 months after the gastrectomy respectively. Those of B-II group were 78.2%, 45.3%, 56.3%, respectively. There was no statistically significant difference of EF between the two groups at postoperative 1 month, but the difference at postoperative 6months was statistically significant. The differences of EF between preoperative period and postoperative 1 month, 6 months were significant in the B-I group andthe B-II group. CONCLUSION: At 6 months postoperative period, there was more recovered gallbladder motility after a gastrectomy with B-I anastomosis than with B-II anastomosis.
Denervation ; Gallbladder* ; Gallstones ; Gastrectomy* ; Gastric Bypass ; Gastroenterostomy ; Humans ; Incidence ; Postoperative Period ; Preoperative Period ; Prospective Studies ; Radionuclide Imaging ; Research Personnel

BACKGOUND: Gram negative bacterial lipopolysaccharide (LPS) induces increase in the production of nitric oxide (NO), or a related substance derived from L-arginine in the animal tissue. Recent evidence indicates that airway epithelium may secrete NO or a related compound. It has multiple regulatory roles in the airways. In vitro, the effects of lipopolysaccharide (LPS) on the reactivity of rat' tracheal wall with or without epithelium were examined. METHODS: Tracheas were removed from Sprague Dawley rats. Preparations were mounted for isometric recording in 20ml organ baths at 37degrees C containing Tis-buffered Tyrode solution continuously gassed with 100% O2. Tensions were measured with force displacement transducers and responses were recorded on a polygraph. Cummulative concentration-response curves were constructed for acetylcholine (Ach) in the tracheal strips with or without preincubation of Escherichia coli LPS (100 mcg/ml, 5hrs). And then effects of NO synthase inhibitors and removal of epithelium were examined. RESULTS: In isolated perfused tracheas preincubated by LPS, both removed epithelium and intact epithelium of rat tracheal rings showed decreased Ach-induced contraction. In intact epithelium group, 10 (-5)M L-NAME (N-nitro-L-arginine methyl ester), 10 (-5)M L-arginine or dexamethasone pretreatment was restored in Ach-induced contraction response. But in the removed epithelium group, Ach-induced contraction was potentiated by L-arginine pretreatment and was not restored by the pretreatment of L-NAME and dexamethasone. CONCLUSIONS: The results suggest that nitric oxide synthase is induced by endotoxin in the tracheal epithelium, resulting in inhibition of the contractile response.
Acetylcholine ; Animals ; Arginine ; Baths ; Dexamethasone ; Epithelium* ; Escherichia coli ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Rats* ; Rats, Sprague-Dawley ; Trachea* ; Transducers

The spontaneous rupture of the ureter is a rare condition. Two cases are reported with a spontaneous rupture caused by ureteral calculi. The diagnosis was suspected by delayed post-CT KUB and confirmed by ureteroscopy. On the basis of the clinical evolution the authors discuss the diagnosis and pathogenesis of the observed ureteral rupture. Rupture of ureter must be considered as differential diagnosis of acute flank pain, especially when there is change of pain character or severity.
Diagnosis ; Diagnosis, Differential ; Flank Pain ; Rupture* ; Rupture, Spontaneous ; Ureter* ; Ureteral Calculi ; Ureteroscopy ; Urinary Calculi

We report a case of a 72-year-old woman with Churg-Strauss syndrome, who presented with intestinal perforation. She has had bronchial asthma with peripheral blood eosinophilia for 30 years. Gross findings of a resected colon showed multiple ulcers with perforation. Histologic findings demonstrated transmural inflammation infiltrated with large numbers of eosionophils, neutrophils and lymphoplasma cells, and characteristic extravascular granuloma in the subserosa. There were multifocally-distributed transmural vasculitis showing all stages of activity in medium and small-sized arteries and veins located in the submucosa, and proper muscle and subserosal layers of the colon, some of which revealed granulomatous inflammation. Histologic finding of liver showed chronic viral hepatitis B with mild inflammatory activity and macronodular cirrhosis. Immunohistochemical findings, acid fuschin orange G staining and electromicroscope found no evidence of hepatitis B virus infection contributing to the pathogenesis of this lesion.
Aged ; Case Report ; Churg-Strauss Syndrome/virology ; Churg-Strauss Syndrome/pathology ; Churg-Strauss Syndrome/complications* ; Colon/virology ; Colon/pathology* ; Colonic Diseases/virology ; Colonic Diseases/pathology ; Colonic Diseases/etiology* ; Female ; Hepatitis B/pathology ; Hepatitis B Antigens/analysis ; Human ; Immunohistochemistry ; Intestinal Perforation/virology ; Intestinal Perforation/pathology ; Intestinal Perforation/etiology*