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Outcomes of ‘one-day trial of vaginal delivery of twins’ at 36–37 weeks’ gestation in Japan
Yuria Haruna,Shunji Suzuki 대한산부인과학회 2019 Obstetrics & Gynecology Science Vol.62 No.6
ObjectiveThe lack of obstetricians in Japan has prevented the implementation of a 24–hour delivery monitoring system forhigh-risk deliveries such as twin vaginal delivery at many obstetric facilities. To examine the outcomes of a 1-day trialof the vaginal delivery of twins at 36–37 weeks’ gestation. MethodsWe induced the vaginal delivery of twins at 36–37 weeks’ gestation of 256 women who provided consent betweenJanuary 2007 and December 2016 using the following protocol: 1) administration of 0.5 mg oral prostaglandin E2every 1 hour (maximum: 1.5 mg) in the morning; 2) intravenous administration of oxytocin and amniotomy in theafternoon; and 3) selection of caesarean delivery when vaginal delivery was not expected by evening. We examinedtheir perinatal outcomes in a chart review. ResultsThe completion rates of vaginal delivery in total, nulliparous, and multiparous women were 79%, 72%, and 84%,respectively. There were no cases of neonatal asphyxia. The total incidence of neonatal respiratory disorders was2.1%, but there were no cases of persistent pulmonary hypertension. The total incidence of postpartum hemorrhagerequiring transfusion was 2.7%. ConclusionThe 1-day planned vaginal delivery of twins at 36–37 weeks’ gestation appears valid and safe, and our findingssuggest that it can be an option for the delivery of twins.
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소아에서 발생한 연쇄구균 감염 후 사구체 신염에 의한 가역성 후두부 뇌병증 증후군 1례
윤봉식(Bong Sic Yun),이수진(Su Jin Lee),김유리아(Yuria Kim),김기혁(Ki Hyuk Kim),정희정(Hee Jung Jung) 대한소아신경학회 2008 대한소아신경학회지 Vol.16 No.2
저자들은 10세 남아에서 발생한 연쇄구균 감염 후 사구체 신염에서 일시적인 혈압상승 후 나타난 가역성 후두부 뇌병증 증후군 1례를 경험하였다. 갑작스런 의식장애와 시력장애 및 경련이 동반된 혈압상승시 고혈압성 뇌병증 및 혈압 상승이 동반된 중추신경감염성 질환이나 두개강내 종양과 경련성 질환을 감별해야 하며 가역성 후두부 뇌병증 증후군을 고려하여 MRI를 시행하는 것이 중요하다. Posterior Reversible Encephalopathy Syndrome(PRES) mainly develops in patients under immunosuppressive therapy after transplantation, or patients who suffer hemato-oncologic diseases, eclampsia, acute hypertensive encephalopathy related with nephrotic disease. Sudden headache, nausea, mental derangement, convulsion, vision problems are the main symptoms shown in PRES. It typically shows edema of occipito-parietal area of cortex or subcortex in Magnetic Resonance Imaging(MRI). A 10-year-old male was hospitalized with the chief complaint of headache, vomiting and dizziness for 3 days. He was treated for upper respiratory infection for 1 week before the hospitalization. Initial blood pressure was 145/95 mmHg, which was high for his age. Uninalysis showed microscopic hematuria(3+). The hypertension persisted even after the hospitalization, and re-checked blood pressure was 175/115 mmHg. The patient complained of headache, and after that, he suffered from alteration of mental status with dysarthria and generalized type of seizure events. The MRI showed lesions suggestive of PRES. He recovered to alertmental status after the blood pressure was controlled. Antistreptolysin-O(ASO) titer was increased and complement 3(C3) titer was decreased. The follow up MRI taken 1 month after the event became normal. We report a case of PRES related with contemporary hypertensive event in Acute Post-Streptococcal Glomerulonephritis(APSGN).
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최은나,김정태,김유리아,유병원,최덕영,최재영,설준희,이승규,김동수,박영환,Choi, Eun Na,Kim, Jeoung Tae,Kim, Yuria,Yoo, Byung Won,Choi, Deok Young,Choi, Jae Young,Sul, Jun Hee,Lee, Sung Kye,Kim, Dong Soo,Park, Young Hwan The Korean Pediatric Society 2005 Clinical and Experimental Pediatrics (CEP) Vol.48 No.3
가와사끼병은 주로 소아연령에서 발생하는 급성 열성 혈관염으로 관상동맥의 확장이 치명적 합병증으로 나타날 수 있다. 저자들은 3개월된 영아에서 반복적인 정맥용 면역글로불린, 스테로이드, 경구용 methotrexate의 치료에도 불구하고 진행되는 관상동맥 병변으로 다발성 거대 관상류, 협착 및 관상동맥 내 혈전을 보이며 심전도상 심근 허혈 소견과 함께 심장 자기공명영상에서 좌심실의 확장과 전벽 및 중격의 심한 운동저하를 나타낸 증례를 보고한다. 환아는 보존적 요법에 반응하지 않는 관상동맥병변으로 내원 88일째 수술적으로 우측 거대관상동맥류를 절개하고 Gore-tex tube를 삽입하여 각각의 측부순환과 연결하였으며, 좌측 관상동맥 협착부위는 세로로 절개한 후 심장막 반(pericardial patch)을 삽입, 확장하였으나, 수술 후 심폐부전으로 사망하였다. Kawasaki disease is an acute systemic vasculitis of unknown origin. Giant coronary aneurysm is one of the most serious complications, although peripheral artery vasculitis can produce life-threatening events. Myocardial ischemia and infarction can be caused by coronary artery stenosis, aneurysm, and stagnation of blood flow in coronary arteries which triggers thromboembolism. Atypical presentation in young infants often interferes with prompt diagnosis and timely treatment, resulting in poor outcomes. We describe a 3-month-old infant with multiple giant coronary aneurysms with flow stagnation, stenosis and large mural thrombus due to Kawasaki disease. He presented with a prolonged course of severe coronary involvement in spite of all measures to reduce coronary complications. Finally, surgical intervention was tried because of the worsening coronary artery abnormalities. The patient died of acute cardiorespiratory failure shortly after weaning from cardiopulmonary bypass.
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