Patient Outcomes according to Blood Glucose Level in Neonates with Cardiovascular Surgery

PURPOSE: The purpose of this study was to provide basic data for suitable neonate blood glucose maintenance by investigating and analyzing the blood glucose level of post cardiovascular surgery neonates in the ICU for the effect of blood glucose levels on the following outcomes; ICU stay, hospital stay, mechanical ventilation time, morbidity, and mortality. METHODS: The participants were 143 neonates in the ICU after having had cardiovascular surgery. The design for this study was an investigation of the blood glucose levels of the neonates and retrospective analysis of patient outcomes according to blood glucose level. RESULTS: The results for the neonate groups showed that the factors of hospital stay, ICU stay, mechanical ventilation time and mortality, for the group with a blood glucose level over 140 mg/dL were longer and higher than for the group with blood glucose of less than 100 mg/dL or the group between 100-139 mg/dL. CONCLUSION: The results of this study indicate that when caring for neonates after cardiovascular surgery, it is important to recognize the influence of blood glucose levels on patient outcomes like hospital days, ICU stay, length of time on mechanical ventilation and mortality. Further, care guidelines for neonates' glucose level management need to be developed.

Meta Analysis of Clinical Studies of Pregnancy and Delivery in Elderly Gravida / 대한산부인과학회지

OBJECTIVE: Our purpose was to identify the age-related inceased risks of the elderly gravida over 35 or 40 years at delivery by clarifying the effects of age and parity, their combination, and their interaction and the relationships of other complications. METHODS: We have made meta analysis about general and clinical characteristics of elderly gravida over the aged 35 or 40 years, based on the 7 domestic theses since 1996 year at the department of Obstetrics and Gynecology. RESULTS: The results were obtained as follows; In elderly gravida over the aged 35 or 40 years at delivery, maternal and neonatal outcomes were generally good, but in study group, there were a high incidence of gestational (preterm delivery, fetal presentation, pregnancy-induced hypertension, gestational diadetes, placenta previa, premature rupture of membranes) complications, uterine myoma during pregnancy and low birth weight in neonate after delivery. CONCLUSION: The increased risks of the elderly gravida over the aged 35 or 40 years at delivery may have been overshadowed by the previous focus on the elderly nullipara. In spite of high incidence of maternal morbidity, the overall maternal and neonatal outcomes were generally good. It is important to recognize what is more important in age-related pregnant-risks of the elderly gravida over the aged 35 or 40 years at delivery to appropriate counsel and manage this group of patients. This informations may be helpful for counsel in elderly gravida over the aged 35 or 40 years who are considering pregnancy.

Malignant lymphoma originated from uterine cervix and extended to endometrium: A case report / 부인종양

Primary malignant lymphoma arising from the female genital tract is extremely rare. Most genital lymphomas arise in the Corpus and cervix of uterus and vagina. Patients usually present with bleeding, abdominal or pelvic discomfort but very infrequently the tumors are discovered as a result of a routine examination. We present a case of non-Hodgkin's malignant lymphoma originated from uterine cervix and extended to endometrium, and review the relevant literature.

The Clinical Significance of Abnormal 50 gm Oral Glucose Tolerance Test for Gestational Diabetes Screening / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the clinical significance of pregnant women who had abnormal 50 g oral glucose tolerance test (GTT) but normal 100 g oral GTT with those who had normal 50 g oral GTT. MATERIALS AND METHODS: Between March 1999 and Feb 2001, 812 pregnant women underwent 50 g oral GTT in the department of Ob/Gyn, Hanyang Univ. Hospital and these women were entered for this study. Among these women, those who showed abnormal 50 g oral GTT but normal 100 g oral GTT were entered for study group and those who showed normal 50 g oral GTT were entered for control group. For the perinatal outcome, average birth weight, frequency of macrosomia, intrauterine growth restriction (IUGR), premature birth, preeclampsia, cesarean section rate were compared for both groups. RESULTS: Of 812 patients, 93 patients were entered for study group and 703 patients were entered for control group. The average birth weight of the fetus in the study group at 3359.3 grams was higher than the control group at 3243.6 grams (p<0.05). The frequency of macrosomia was 11.8% in the study group and 3.3% in the control group (p=0.0001). Premature birth occurred more frequently in the study group at 10.8% as compared to the control group at 4.8% (p<0.05). Other factors did not show any significant differences. But, although a higher rate of a macrosomia was seen in the study group than in the control group, the abnormal 50 g oral GTT was not risk factor after controlling for confounding risk factors by logistic regression modeling (OR 1.53). On the other hand, the maternal BMI and the increase in body weight during pregnancy were the risk factors of macrosomnia after controlling for confounding risk factors by logistic regression modeling (OR 6.27 and 5.58). CONCLUSION: Abnormal 50 g oral GTT but normal 100 g oral GTT was not found to be a risk factor for macrosomia or pre-eclampsia. There needs to be personalized assessment of other risk factors in correlation with macrosomia, especially in obese women with a BMI greater than 26 before pregnancy, and in those with increase in body weight greater than 16 kg during pregnancy.

Anterior Displacement of Humeral Head in Hemiplegic Shoulder Subluxation

OBJECTIVE: To measure anterior displacement of the humeral head and to observe its relationship with clinical findings in the subluxed hemiplegic shoulders. METHOD: Seventeen hemiplegic patients, having the subluxed shoulder over one finger breadth were subjected. We measured shoulder pain, muscle power of the shoulder abductors, Brunnstrom stage and spasticity in the affected upper extremity. To measure the humeral displacement of the shoulder subluxation, the AP and transthoracic lateral views of simple radiologic picture were taken on both affected and unaffected shoulders, and repeated after donning three kinds of arm slings. RESULTS: Its anterior displacement as well as the inferior displacement occured in all subjects, and was significantly related with the value of shoulder pain and spasticity, and the inferior displacement with Brunnstrom stage and muscle power of the shoulder abductors in the subluxed hemiplegic shoulder (p<0.05). Correction of the humeral displacement occured significantly in anterior direction as well as inferior by use of all tested arm slings. CONCLUSION: Clinical implications of the shoulder subluxation were different according to direction of the humeral displacement, and anterior displacement will be considered for its symptom in hemiplegic shoulder.

Swallowing Difficulties in Polio Survivors

OBJECTIVE: In patients with a history of acute paralytic poliomyelitis, late progressive muscle weakness, fatigue, pain may arise, a symptom complex of known as post-poliomyelitis syndrome (PPS). Dysphagia may also develop in some PPS patients. The purpose of this study was to assess the presence of is swallowing difficulty in polio survivors and to describe the nature of the swallowing difficulty. METHOD: Polio survivors answered the questionnaire pertaining to swallowing function and received a videofluroscopic evaluation of the oral and pharyngeal phases using 3 consistencies of material: liquid barium; semisolid barium paste; boiled yolk of an egg coated with barium. RESULTS: Of the 16 subjects, 8 had subjective symptoms of swallowing difficulties. All of the 6 PPS patients, regardless of whether they had symptoms of swallowing difficulties, had some abnormal oropharyngeal function through video fluoroscopic swallowing study. CONCLUSION: In patients with post-polio syndrome, there is progressive deterioration of swallowing functions similar to that in the muscles of the limbs. This swallowing dysfunction is not related with their subjective symptoms.

The Significance of Brainstem Auditory Evoked Potential in High-Risk Neonates

OBJECTIVE: To observe the prognostic value of brainstem auditory evoked potentials (BAEP) for prediction of cerebral palsy (CP) in the high-risk neonates. METHOD: Eighty-one high-risk neonates were subjected to take the history of illness, neurological examination, developmental assessment, BAEP study within one month after birth. They had been checked for detection and management of the CP in period of 12 to 56 months after birth. Associating factors were observed about their gestational age at birth, 1-minute Apgar score, history of asphyxia and/or intubation, and hyperbilirubinemia and/or exchange transfusion. RESULTS: Abnormal BAEP findings were seen in 38 of 81 (46.9%) high-risk neonates and 6 of 81 (7.4%) were diagnosed as a CP. Five of 6 CPs and 42 of 75 non-CPs had been abnormal in BAEP study. Neonatal BAEP study showed 83.3% sensitivity, 44% specificity, 98.4% false positive and 2.9% false negative in predicting CP. Asphyxia showed high correlation with abnormality of BAEP and CP (p<0.01). Gestational age, low birth weight, toxemia, germinal matrix hemorrhage (GMH) grade II and intubation were correlated with CP (p<0.05) but not with the abnormality of BAEP. CONCLUSION: It is suggested that BAEP study of high-risk neonate is useful in prediction of CP because of low false negative and high sensitivity.

Significance of Mento-Blink Reflex Study in Lesion of Inferior Alveolar Nerve

OBJECTIVE: This study was designed to observe how the mento-blink reflex (MBR) study is valuable in evaluating the inferior alveolar nerve injury. METHOD: Eleven patients, suffering from the sensory discomfort after extraction of the third molar, and a control group consisting of 20 healthy individuals participated in the clinical neurosensory test (CNST) and the MBR study. The score of CNST was from 0 (normal) to 5 (worst) according to sensory deficit, and the results of MBR were divided into 3 groups: normal; prolongation of R2 latency; no response. RESULTS: In the control group, R2 latencies of right and left were 31.9+/-6.1 msec and 31.5+/-5.9 msec, respectively with the difference of 1.3+/-0.9 msec. The abnormality in the MBR study in patients was correlated with the subjective sensory symptoms (p=0.017) and the abnormality of MBR response was proportional to the score of the CNST. CONCLUSION: We concluded that the MBR study is a useful diagnostic tool in reflecting the inferior alveolar nerve lesion.

A Clinical Review of the Burn Amputee Patients

Burn patients with associated limb amputations present demanding rehabilitation problems, many of which might lead them to chronic issues. The authors studied 77 male and 9 female burn patients with amputations. Most amputations occurred with high voltage electrical burns. The fingers were the most frequent target for amputations. The most frequent site of amputation was the entrance at the right side and multiple amputation in nature. The prosthetic fittings were delayed because of burn wounds and grafts and fragile skin at the stump. Also, limited range of motion, decreased strength, hypertrophic scar contracture, heterotopic ossification and bony overgrowth were additional limiting factors. We conclude that early rehabilitation intervention would be critical to prevent complications and to improve rehabilitation outcome of burn amputee patients.

The Factors Associated with Fall in the Stroke Patients

Fall is a major threat to the stroke patients. The purpose of this study is to find out the potential risk factors for recurrent falls in the stroke patients. The subjects were sampled 20 hemiplegic fallers who experienced at least one fall at the stroke center of Hangkang Sacred Heart hospital. Balance subscale and gait scale of Tinetti was used as a screening test for referral to mobility fuction. The potential contributing factors for fall were social activity, impulsivity, congnition, motivation. These factors were correlated with falls. The authors also surveyed the places, postures of activities, and injurires from falls. The falls occurred 2.5 times average in studied subjects and is most of subjects the first fall occurred in their first month of standing and gait training. 58.3% of falls occurred indoor(33.3% in room), 29.2% at hospital, 12.5% outdoor. The activities related to fall were walking 36.8%, rising from a chair 36.8%, sitting 10.5%. Although, most(75%) of injuries were soft tissue contusions or strains, the other 25.1% of falls accompanied fractures. The femur fracture was 18.8%, and compressed spine fracture was 6.3%. The social activity was most strongly correlated with falls with high correlation coefficent of 0.72. The other factors were not significant with lower coefficient values, balance scale of 0.35, gait scale of 0.24, motivation of 0.40, congnition of 0.26, impulsivity of ?0.19. It was suggested that activity plays an important mediating risk factor for falls in the stroke patients. These data support the concept of preventive strategy for falls in the stroke patients who are at risk.