No abstract available.

PURPOSE: To provide accurate information on induced labor and find strategies to enhance women's childbirth satisfaction. METHODS: Participants were pregnant women expected to have normal vaginal delivery. A total of 113 women with induced labor and 61 women with spontaneous labor were surveyed. Data were collected using a questionnaire and electronic medical records. RESULTS: The following variables related to labor progress showed significant differences between the induced labor group and the spontaneous labor group: length of the first stage of labor in primigravidas, use of analgesic, incidence of uterine hyperstimulation, incidence of fetal distress, and medical treatment for the expectant mother. Delivery type and the incidence of postpartum complications showed significant difference between the two groups. Induced labor women's childbirth satisfaction was mainly affected by the process of labor whereas spontaneous labor women's childbirth satisfaction was affected by the outcome of childbirth. CONCLUSION: Medical staff should have accurate information on the risk of induced labor and the benefits of a natural delivery. Moreover, medical staff should provide necessary information and environment for women to participate in the decision-making process.
Electronic Health Records ; Female ; Fetal Distress ; Humans ; Incidence ; Labor, Induced ; Medical Staff ; Mothers ; Parturition* ; Postpartum Period ; Pregnancy ; Pregnant Women

Over the last decades, the onset of puberty in girls has occurred earlier, but the tempo of pubertal progression has been relatively slower, resulting in a younger age at puberty onset without a change in age at menarche. Sufficient energy availability and adiposity contribute to early pubertal development, and environmental factors, such as endocrine-disrupting chemicals (EDCs), may affect not only the control of energy balance, but also puberty and reproduction. EDCs are hormonally active substances that can perturb puberty by acting both peripherally on target organs, such as adipose tissue or adrenal glands, and/or centrally on the hypothalamic-pituitary-gonadal (HPG) axis. Depending on whether the exposure takes place earlier during fetal and neonatal life or later during early childhood, EDCs can lead to different outcomes through different mechanisms. Evidence of associations between exposures to EDCs and altered pubertal timing makes it reasonable to support their relationship. However, human epidemiologic data are limited or inconsistent and cannot provide sufficient evidence for a causal relationship between EDC exposure and changes in pubertal timing. Further investigation is warranted to determine the overall or different effects of EDCs exposure during prenatal or childhood windows on pubertal milestones and to reveal the underlying mechanisms, including epigenetic marks, whereby early-life exposure to EDCs affect the HPG-peripheral tissue axis.
Adipose Tissue ; Adiposity ; Adolescent ; Adrenal Glands ; Endocrine Disruptors ; Epigenomics ; Female ; Humans ; Menarche ; Puberty ; Reproduction

Purpose: The effects of circadian blood pressure (BP) alterations on the development and progression of microvascular complications in type 1 diabetes mellitus (T1DM) patients are unknown. We evaluated the effects of circadian BP alterations with development of microvascular complications during follow-up with patients with childhood-onset T1DM. Methods: We investigated the medical records of 81 pediatric patients with T1DM who underwent 24-hour ambulatory BP monitoring (ABPM) between January 2009 and February 2010. Results: Mean age at diagnosis and ABPM evaluation was 8.0±3.9 and 15.6±2.4 years, respectively. Hypertension (daytime, nighttime, and 24-hour mean hypertension) data were available in 42 patients. During the 8 years of follow-up after ABPM, microvascular complications occurred in 8 patients (diabetic retinopathy [DR] alone in 5, microalbuminuria alone in 2, and both in 1), of whom 7 had nondipper BP. Nighttime diastolic BP, nighttime mean arterial pressure, and glycated hemoglobin A (HbA1c) level were higher in patients with DR than in those without DR (P<0.05 for all). Daytime or nighttime BP and presence of dipper BP were not related to microvascular complications, but diabetic microvascular complications were more likely to occur in patients with an older age at diagnosis and higher HbA1c level. The proportion of patients with DR was higher in those with nondipper hypertension (83.3%) compared with dipper and nondipper normotension (0% and 16.7%, respectively; P=0.021). Conclusion As a predictor of microvascular complications, nondipper hypertension was not significant. Glycemic control rather than nondipper hypertension is the predominant factor determining DR in T1DM patients.

BACKGROUND: In subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown. METHODS: Thirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively. Patients were treated with glucocorticoid after adrenalectomy and were reevaluated every 1 to 6 months using a rapid adrenocorticotropic hormone (ACTH) stimulation test. RESULTS: Levels of basal 24-hour urine free cortisol (UFC), serum cortisol after an overnight dexamethasone suppression test (DST), and serum cortisol and 24-hour UFC after low-dose DST and high-dose DST were all significantly lower in patients with SC compared with OC. Basal ACTH levels showed significantly higher in patients with SC compared with OC. The probability of recovering adrenal function during follow-up differed significantly between patients with OC and SC (P=0.001), with significant correlations with the degree of preoperative cortisol excess. Patients with OC required a longer duration of glucocorticoid replacement to recover a normal ACTH stimulation test compared with patients with SC (median 17.0 months vs. 4.0 months, P<0.001). CONCLUSION: The HPA axis recovery time after adrenalectomy in patients with SC is rapid and is dependent on the degree of cortisol excess. More precise definition of SC is necessary to achieve a better management of patients and to avoid the risk of under- or over-treatment of SC patients.
Adrenalectomy ; Adrenocorticotropic Hormone ; Cushing Syndrome* ; Dexamethasone ; Follow-Up Studies ; Humans ; Hydrocortisone ; Retrospective Studies

PURPOSE: The purpose of this study is to examine the frequency of posterior element injury in patients with traumatic thoraco-lumbar burst fractures and to evaluate the correlation between the MR imaging and CT findings. MATERIALS AND METHODS: The MR images of 38 patients with 39 thoraco-lumbar burst fractures and the results of the CT examinations of 28 patients with 29 fractures were retrospectively analyzed. Both procedures were performed within two weeks of injury. Twenty-one males and 17 females were included ; their average age was 51.3 (range, 11-75) years. MR images were evaluated for injury to the posterior ligamentous complex, comprising the supraspinous ligament(SSL), the interspinous ligament(ISL), the flaval ligament(FL), and the capsule of facets. Analysis of the CT findings focused on the posterior bony elements of the lamina, pedicle, spinous process, and facet joint. RESULTS: MR imaging revealed posterior ligamentous injuries in 18(46.2%) of 39 burst fractures ; there was tearing of the ISL in 15 cases(38.5%), of the SSL in 11(28.2%), of the capsule of facets in 11(28.2%), and of the FL in nine(23.1%). Among the 29 burst fracture cases examined by CT, posterior bony injuries were detected in 13(44.8%). Lamina and facet joint fractures were detected in six cases(20.7%), facet separation or dislocation in six(20.7%), and spinous process and pedicle fracture in one(3.4%). In 29 burst fracture cases, both MRI and CT were performed. Among the 18 cases in which MR imaging revealed posterior ligamentous injuries, CT failed to demonstrate posterior element fractures in seven. On the other hand, among the 13 cases in which CT indicated posterior bony fractures, MR failed to reveal posterior ligamentous injuries in two. CONCLUSION: Posterior element injury is frequently found in patients with traumatic thoraco-lumbar burst fractures demonstrated by MR imaging(46.2%) and CT(44.8%). Both MRI and CT are useful tools for the evaluation of posterior element injury, which determines the degree of instability of traumatic burst fracture.
Dislocations ; Female ; Hand ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Zygapophyseal Joint

BACKGROUND: It is generally known that the principle treatment of obesity is life-style modification and behavior therapy for weight reduction. This study was carried out to investigate the effect of office-based education for weight control and behavior modification in overweight patients. METHODS: We selected 119 patients among the overweight or obese (BMI >or=23 kg/m2) patients who visited the Department of Family Medicine at Asan Medical Center. Life styles such as diet, exercise, smoking, and alcohol drinking were evaluated by self-questionnaire. Weight, height, body mass index, waist circumference, waist to hip ratio, and body fat were measured. The patients were divided randomly into two groups, the intervention (n=60) and the control (n=59) group. We educated the intervention group about the importance of weight reduction, life-style modification and provided specific guidelines. Two months later, we measured anthropometric variables and evaluated changes of behavior modification. RESULTS: After two months, 28 patients of the intervention group and 22 patients of the control group were followed up. At the follow-up time, the body weight and waist circumference decreased significantly in the intervention group compared with those of the control group. The exercise time increased significantly in the intervention group compared to the control group. The frequency of fatty meal ingestion decreased significantly in the intervention group. CONCLUSIONS: The office-based education for weight reduction in overweight or obese patients has contributed substantially in changing their life-style and reducing their waist circumference. As a result, we have found that patient education for behavior modification was essential part of comprehensive approach for weight control in overweight patients.
Adipose Tissue ; Alcohol Drinking ; Behavior Therapy* ; Body Height ; Body Weight ; Chungcheongnam-do ; Diet ; Eating ; Education ; Follow-Up Studies ; Humans ; Life Style ; Meals ; Obesity ; Overweight* ; Patient Education as Topic* ; Smoke ; Smoking ; Waist Circumference ; Waist-Hip Ratio ; Weight Loss

BACKGROUND: beta-lactam antibiotics are one of the most frequently used antimicrobial agents. However, with the increase of beta-lactamase-producing bacteria, penicillins arid 1 st generation cephalosporins have become less useful. Cefatrizine and clavulanic acid combination (CTCA) was developed to restore the activity. The aim of this study was to determine the activities of CTCA against major recent clinical isolates. METHODS: Aerobic and anaerobic bacteria tested were isolated from clinical specimens in Severance Hospital during 1996 to 1999. Antimicrobial susceptibility was determined by the NCCLS agar dilution methods. RESULTS: MICs of cefatrizine (CT) and CTCA were similar for methicillin-susceptible Staphylococcus aureus, Streptococcus pyogenes and S. pneumoniae. For Moraxella (Branhamella) catarrhalis, MIC90 CTCA was 1 microgram/mL, which was 1/8-fold lower than that of cefatrizine. MIC90S of CTCA for Escherichia coli and Klebsiella pneumoniae were 4 microgram/mL and 8 microgram/mL, respectively, which were 1/4- to 1/16-fold lower than those of CT. However, it was less active against Citrobacter freundii, Enterobacter cloacae and Serratia marcescens. Against Bacteroides fragilis group organisms, it showed good activities similar to those of other beta-lactam and beta-lactamase inhibitor combinations. CONCLUSIONS: CTCA showed good antimicrobial activities against M. (B.) catarrhalis, Haemophilus influenzae, Neisseria gonorrhoeae, extended spectrum beta-lactamase-producing E. coli and K. pneumoniae, Proteus vulgaris and B. fragilis. In conclusion, it would be useful for the treatment of infections due to those organisms, and for the empirical treatment of respiratory and urinary tract infections.
Agar ; Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteria* ; Bacteria, Anaerobic ; Bacteroides fragilis ; beta-Lactamases ; Cefatrizine ; Cephalosporins ; Citrobacter freundii ; Clavulanic Acid ; Enterobacter cloacae ; Escherichia coli ; Haemophilus influenzae ; Klebsiella pneumoniae ; Moraxella (Branhamella) catarrhalis ; Neisseria gonorrhoeae ; Penicillins ; Pneumonia ; Proteus vulgaris ; Serratia marcescens ; Staphylococcus aureus ; Streptococcus pyogenes ; Urinary Tract Infections

We report a man who exhibited pure agraphia after suffering a left subcortical infarction involving part of the thalamus and the basal ganglia. His writing difficulty was characterized by stopping, letter omission, and substitution in spontaneous writing and writing to dictation, but he was able to copy normally. Decreased perfusion in the left frontal lobe and temporal cortex was noted on brain single-photon-emission computed tomography . This patient's agraphia persisted at follow-up 52 days later. We suggest that the subcortical lesion in this patient caused pure agraphia secondary to diaschisis of the interconnected cortical area.
Agraphia ; Basal Ganglia ; Brain ; Cerebral Infarction ; Coat Protein Complex I ; Follow-Up Studies ; Frontal Lobe ; Humans ; Infarction ; Perfusion ; Stress, Psychological ; Thalamus ; Writing