The changing life pattern for women in current society is after a postponement of childbearing. Thus, the impact of older maternal age on pregnancy outcome becomes increasingly important.

The obstetric outcomes of women 35 years of age older are widely considered to be less favorable than those of younger women.

124 elderly primiparas at Department of Obstetrics and Gynecology. Ewha Womans University Hospital from January. 1980. to December 30. 1990 were studied.

The results were as follows:

1) There were 124 cases of elderly primiparas among total 24,432 deliveries and the incidence of the elderly primipara was 0.4%.

2) 79.8% of elderly primipara was distributed from 35 to 38 years.

3) One parity of pregnannt women over 35 years was 163 cases(31.6%).

4) 109 cases(87.9%) of total cases were vertex presentation and 14 cases(11.2%) were breech and 1 cases(0.8%) was face presentation.

5) As regards antepartum complication, the incidence of hypertensive disorder was 17.7% and PROM was 11.2% respectively.

6) 51 cases(41.1%) were delivered vaginally and 73 cases(58.8%) were delivered abdominally.

7) Among the indication of cesarean section, the highest incidence was elderly primipara (33.1%) and other indications were CPD, breech, placenta previa and fefal distress in order.

8) The perinatal mortality rate was 96.8(9.7%) in elderly primipara and 81.8(8.2%) in elderly multipara.

9) There was no congenital malformation.

10) The mean gestational age was 38⁸weeks and preterm pregnancy(before 36 weeks) was 19 cases(15.3%).

11) The mean birth weight of the infant was 3100gm and premature baby less than 2500gm was 12.1%.

The subcellular distribution of glucose transporter in rat hepatocytes was studied in the absence and presence of insulin by measuring glucose-sensitive cytochalasin B binding sites and immunoreactivities to antibodies specific to hepatocyte glucose transporter. Total hepatocyte membranes bound cytochalasin B at a class of glucose-sensitive sites with a K_d of l.6×l0^-6M. and a B_t of 6.8 pmol/mg protein. The glucose-sensitive cytochalasin B binding sites were found in various subcellular membrane fractions with a relative abundance of 47% in a plasma membrane-nuclei-mitochondria-enriched fraction(PM/NM). 29% in a lysosome-enriched fraction(LYSO). 16% in a Golgi-enriched. high density microsomal fraction(HDM) and 8% in the low density microsome fraction(LDM). Relative abundances of two well known plasma membrane markers. 5'-nucleotidase and cell surface carbohydrate label, on the other hand, were found to he 48~50% in PM/NM. 41~43% in LYSO. 6~8% in HDM and l~2% in LDM.

Insulin treatment of intact hepatocytes did not induce any significant changes in the subcellular distributions of the glucose-sensitive. cytochalasin B binding activities, the immunoreactivities to the transporter specific antibodies, or the two cell surface membrane markers. These findings indicate that as much as 15% of the total hepatocyte glucose transporters occur in organelle(s) other than the pasma membrane, most likely representing an intracellular storage pool. which is not decreased by insulin. It is concluded that the rat hepatocyte lacks the insulin-mediated, glucose transporter translocation mechanism, thus would be a valuable experimental system in which one can study the celluar and molecular basis of this deficiency.

A study on white blood cells(WBC) in BALB/c mice infected with Toxocara canis larvae was carried out. Mice were divided into 4 groups ; group I and group II was given a single dose of 30 and 100 infective eggs, respectively,and group III and group IV was given 100 eggs weekly for 2 weeks and 50 egg for 4 weeks from I week after an inital administration of 30 eggs. respectively. Total WBC and differential count of WBC were examined at 2 week intervals up to the 20th week.

An immediate leucocytosis took place; slight in group I, mild in group II, moderate in group III and marked in group IV.

In differential count, neutrophils in group I and group II reached the lowest level in the 2nd week, then returned to within normal limits, while in group III and gruop IV showed a rise, respectively. Eosinophils in group I and group II respectively reached a maximum peak in the 2nd week and in group III and group IV respectively showed a quiker and more intense rise in the earlier stage, and decreased rapidly for the next several weeks, then fell gradually. Lymphocytes in group I decreased gradually up to the 6th week, then returned to within normal limits, but in groups II, III and IV showed a more or less rapid decrease in the earlier stage and persisted up to the end of observation without remarkable variation, Monocytes in groups I and II were within normal limits, and in groups III and IV showed some monocytoses. No alterations were noted in the basophile count.

In order to find out status of household medicine usage in a rural community, a study was carried out, through analyzing the survey data regarding to household medicine usage of 188 household sampled from the 19 towns with 1. 186 families and farm house of 80% in a rural community. Su Dong-Myun, Nam Yang Zu-Gun. Kyung Gi-Do. Korea.

The following results were drawn:

1) The 80.9% of 152 respondents answered that they prepared household medicine. Only the 5.3% of them answered that they did not. The rest, 13.8% answered that they were not sure.

2) The preparation rates of oral medicine are as follows drugs for indigestion 80.3% of the highest rate, drugs for headache : 57.9%, drugs for common cold 46.7%, antibiotics: 44.1%, drugs for gastrointestinal pain and drugs for nutrition each 43.4%. and drugs for back and joint pain : 22.4% of the lowest rate.

3) The preparation rates by effect-specific kind including sanitary materials were as follows external ointment: 83.6% of the highest rate, drugs for indigestion 80.3%, antiseptic solution : 73.0%, adhesive plaster : 61.2%, drugs for headache : 57.9%, and guez and thermometer each : 15.8% of the lowest rate.

4) The preparation rates by the number of effect-specific kind of oral household medicine were as follows; three kinds 21.0% of the highest rate, five kinds : 16.4%. four kinds and two kinds : 14.5% each and seven kinds and over: 6.6% respectively.

5) The purchase-routes of household medicine were answered as follows : drug-stores : 85.5% almost all, medical facilities, shops and market each : 4.6% and peddlers : 2.0% respectively.

6) The sources of information about the household medicine were answered as follows : personnel of drug store or pharmacy : 49.3% of the highest rate. T.V. or radio: 27.0%. medical personnel : 15.8%, paper and magazine : 3.0% respectively.

7) The reasons for preparing the household medicine were answered as follows : for preventing disease and promotion of health : 37.5% of the highest rate, for convenience of home care: 26.3% for relief from preparation itself: 20.4%, and for emergent care before special treatment : 15.1% of the lowest rate.

8) The opinions about the necessity of drugs are distributed as follows ; necessary : 86.8% of the majority, not necessary : 1.3%, and not sure : 11.9% respectively.

Most of the progress in the diagnosis and treatment of biliary tract disease has been made in the last century. but the gallstones and their sequelae which cause most of the clinical problems. are not malady of modern times.

Alternatives to traditional cholecystectomy were developed during the 1980s and are currently undue evaluation. They include oral chemolysis. extracorporeal shock wave lithotripsy. percutaneous dissolution and extaction, and laparoscopic cholecystectomy.

One of the goals of interventional surgery is to simplify patient care by performing surgical techniques percutaneously. Cholecysrectomy is one technique that, lends itself to interventioal approach. one acan envision replacing surgery with a four step procedure. 1) percutaneous cholecystostomy 2) percutaneous stone removal 3) sclerosis and fibrosis of the gall bladder 4) cystic duct occlusion.

Both percutaneous cholecystostomy and stone removal have been performed frequently and are in the interventional repertoire. Sclerosis of biliary system may be derived from experience with chemical agents. The aim of this study is a preliminary clinical application of chemical fibrosis of gallbladder with 95% Ethanol and 5% Phenol for treatment of gallbladder diseases.

The following results were obtained:

1) The values of liver function test were normnal on postoperative 1 day. 1 week and 4 weeks in cystic duct ligated control group.

2) AST, ALT and ALP were increased markedly on postoperative 1 day after 10, 30 and 60 minutes injection groups into gallbladder with both 95% ethanol and 5% phenol.

3) The edema, congestion and inflammatory changes of gallbladder were mildly developed on postoperaive 1 day. 1 week and 4 weeks in 10, 30, and 60 minutes cystic duct ligated control group.

4) The fibrosis of gallbladder was moderately to severely developed on postoperative 4 weeks after 10, 30 and 60 minutes injection group into gallbladder with 95% ethanol.

5) The fibrosis of gallbladder was moderately developed on postoperative 4 weeks after 10, 30 and 60 minutes injection group into gallbladder with 5% phenol.

Inspite of a limited number of observation, the chemical sclerosing agents may be useful treatmental method for gallstone patient if applied in selected cases and it should he opened for further study in lager experimental group.

A series of 96 cases with intraventricular hemorrhage diagnosed by computed tomography (CT scan) is described. The early conscious level, the causes, the site of ventricular hemorrhage and the final outcome are analyzed. Intraventricular hemorrhage is generally considered to be of grave prognostic significance. Hypertension and arterial aneurysm accounted for 73.9% of the cases. The overall mortality rate was 68.8%. All cases were admitted on Day 0 or 1, and more than half were classified neurologically as grade IV or V. CT scan reliably demonstrated the presence and distribution of blood within the ventricular system including the third and fourth ventricles. Surgical treatment was beneficial in only a small number of cases.

The search for a superior absorbable surgical suture has been underway for years. The synthetic materials have been shown to have certain advantages over the use of the familiar natural absorbable gut sutures. Specially, since synthtic absorbable sutures are degraded by simple hydrosis rather than by phagocytosis. they elicit a minimal tissue reaction.

A newly-developed absorbable monofilament, poly-dioxanone(PDS, Ethicon) has certain adventages : it passes easily through tissues retains its tensile strength for a long time, and produces minimal tissue reaction.

9-0 absorbable polydioxanone(PDS) has been compared to 9-0 nonabsorbable Ethilon in order to evaluate any advantages of either suture in microvascular surgery. In each of 45 rats, one femoral artery was anastomosed end-to-end with PDS and the other with Ethilon. Specimen were harvested 48hr. 14day and two months post operatively. Histologic analysis of inflammation, fibrosis, and medial necrosis of the anastomoses revealed no significant differences between the two materials. There was no difference as regards stenosis and aneurysm formation, when evaluated independently by the two methods.

It can be concluded that the amount of inflammation and fibrosis leading to stenosis is related to the amount of trauma at the time of surgery and not to the type of suturing material used.

This study examines the extent of endothelial damage following a period of irrigation with various crystalloid irrigation fluds. Both arteries and veins were evaluated after irrigation with normal saline, lactated Ringer's. balanced salt solution (BSS), and balanced salt solution plus(BSS⁺). The arterial and venous endothelia were examined with the scanning electron microscope. Using a randomized blind observer scoring system. micrographs were evaluated for changes in nuclear shape, cell junction integrity, cytoplasm changes, and sloughing of the endothelial cell layer. BSS⁺ and BSS produced stastically significant(p<.001) improvement over the other two irrigation fluids in the arteries. BSS⁺ and BSS were stastically superior(P<.00l) in the venous vessels. The compositions of BSS and BSS⁺ tend to maintain a physiologic environment in the presence of ischemia. These maintained a morphologic appearance closer to that of perfusion-fixed controls The data suggest a protective effect of such physiologic preparations on the endothelium. The preservation of intact endothelium may play a role in decreased platelet activation. continued production of prostacyclin, and maintenance of and intact barrier between the intra-cellular and extracellular spaces. This could enhance the survival of transplanted or transferred tissue, by helping to maintain nearly normal endothelium during surgery.

Seventeen subjects with ectopic pregnancies were treated with five doses of intramuscular methotrexate(25mg) injection follow by five doses of Citovorum factor(3mg).

Seventeen subjects were 11 tubal. 4 cornual. and 2 cervical pregnancies.

The diagnosis was established in tubal and cornual pregnancies by laparoscopy following sonography and radioimmunoassay for serum β-subunit of human chorionic gonadotropin. Subjects were followed with every 3 days quantitative serum HCG and sonography.

Fifteen of the seveteen subjects experienced resolution of the ectopic mass and was subjected underwent one cornual resection and one salpingectomy.

The duration of disappearance of β-HCG to normal after treatment were 2~6 weeks.

The most of all subjects were 2~3 weeks(60%). This experience suggests the methotrexate may be an effective alternative for the treatment of early ectopic pregnancy and useful the treatment of cornual. cervical pregnancy.

Stroboscopy is very useful for clinical evaluation of abnormality in the mode of vocal cord vibration. With good trained eyes. one can detect changes in physical parameters of histological changes in the vocal cord to a certain extent.

Stroboscopic examination was performed on 149 cases who complained of voice disorders at the Department. of Otolarynglogy of Ewha Womans university hospital recently and the following results were obtained.

1) The underlying diseases in order frequency were vocal nodule and polyp 67cases(45%). acute and chronic laryngitis 32cases(22%), benign tumor l6cases(l1%), vocal cord paralysis 15cases(10%), sulcus vocalis 8cases(5%), laryngeal cancer 6cases(4%), epithelial hyperplasia 5cases(3%).

2) Glottic closure in pathological cases were as that follows ; Among l49cases, incomplete closure were 112cases(75%) and complete closure were 37cases(25%).

3) Regularity of vibration in pathological cases were as that follows ; Among l49cases. irregular were 82cases(55%) and regular were 67cases(45%).

4) Symmetry of vibratory movements of vocal cords in pathological cases were as that follows ; Among l49cases. asymmety were 69cases(46%) and symmetry were 80cases(45%).

5) Amplitude of vibration in pathological cases were as that follows ; Among l49cases. normal were 62cases(42%), great were 8cases(5%), small were 74cases(50%) and zero were 5cases(3%).

6) Wave on the mucosa in pathological cases were as that follows ; Among l49cases. normal were 62cases(42%), great were 62cases(1%), small were 2cases(42%) and zero were 23cases(15%).

Anionic sites are thought to act as anionic barriers regulating passage of proteins across Bruch's membrane of the eye. The cationic electron microscope tracer. polyethyleneimine (PEI), was used to study the distribution of the anionic sites in the Bruch's membrane of the control rabbit eyes and sodium iodate injected eyes. In Bruch's membrane of the control eyes, electron dense particles are present along the both sides of the basal lamina of the RPE and choriocapillaris and along collagen and elastic fibers. In the sodium iodate treated eyes, the RPE cells are severely degenerated and anionic sites are significantly decreased in the Bruch's membrane. These changes suggest that RPE cells play an important role in maintaining the anionic sites in the Bruch's membrane.

The response of the rat bladder to single dose of Cis-dichlorodiammineplatinum(II)(Cis-DDP). radiation(6-10 Gy). or combination of radiation and Cis-DDP was assessed from the histopathologic changes. For the combined treatment, a single dose of Cis-DDP(2.5mg/kg) was given 30 min before or immediately after radiation. Cis-DDP alone, show inflammatory cells infiltrations in the submucosa, soft tissue and muscle layer of the bladder. A single fraction of 6 Gy of X-ray irradiation produced congestion and edema in the submucosa and its degree was increased by increasing radiation dose. The vacuolization in the mucosa and degeneration and edema in the muscle layer was developed after 8 Gy X-ray irradiation. In combination of Cis-DDP and radiation, the edema and congestion of the mucosa and degeneration and edema of muscle layer were developed in 6 Gy X-ray irradiation group and its degree was more than radiation alone group. There was no significant difference in the change of the bladder according to the timing of Cis-DDP administration before or after the radiation. In combined group of Cis-DDP and radiation, enhancement ratio was 1.33 in normal bladder as the endpoint was the degeneration of the muscle layer.

Feeding gastrostomy is a popular alternative in patients with swallowing difficulty. Many of theses patients are high anesthetic risk. Nonoperative percutaneous gastrostomy is a simple and safe precedure, and appear promising as alternatives for enteric alimentation.

The auther performed 26 cases of percutaneous gastrostomy from June 1987 to April 1991 at Ewha Womans University Hospital.

The underlying diseases of the patients were esophageal cancer(14 cases). CNS disease(10 cases) and lung cancer(2 case).

Seldinger method was used in all cases.

The general condition improved in all patients, and there were no serious complications. Gastrostomy tubes were patent in all patients during their survival period, and easily changeable to a larger bore tubes.

Incomplete antagonism of competitive neuromuscular blockade is a potentially lethal complication in postoperative period.

Assessment of recovery from nondepolarizing neuromuscular block has been based on clinical criteria such as; head lift, hand grip strength, adequate tidal volume, vital capscity and inspiratory force which mostly require a cooperative patient. Other criteria, indepent of patient cooperation have been the interpretation of evoked muscle responses to single twich, tetanic and train-of-four stimulation.

The present prospective investigation compare the incidence of residual neuromuscular blockade using train-of-four responses following administration and reversal of pancuronium and vecuronium in obstetric patients.

The results were as follows:

1) The mean TOF ratio(T₄/T₁) in pancuronium group was 0.75±0.05.

2) The mean TOF ratio(T₄/T₁) in vecuronium group was 0.85±0.04.

3) 50% of patients(10/20) in the pancuronium group evidenced a ratio below 0.7, 20% of patients(4/20) in the vecuronium group was evidenced a TOF ratio below 0.7.

In conclusion, the present study emphasizes the potential for residual neuromuscular blockade in patients who received pancuronium. In contrast, patients administered vecuronium appear to have a grater margin of safty postoperatively.

Postoperative hypoxemia in elderly patients caused to suffer tissue hypoxia and injury to vital organs.

Thirty-two elderly patients over 65 years age with normal or abnormal findings in pulmonary function test were at random either epidural analgesia with 2% lidocaine and 0.5% bupivacaine or general anesthesia with diazepam, pethidine, pancuronium or vecuronium. N₂0 / 0₂ for lower abdominal or lower extremity surgery. The arterial blood gas analysis was performed at preanesthetic, 30min after extubation(or 30min after the end of surgery in epidural analgesia groups) and postoperative lday.

The results were as follows:

1) In general anesthesia group with normal findings in pulmonary function test(PET). the PH decreased, and PaCO₂ increased on 30min after extubation compared to preanesthetic values, but the PH increased, and base excess decreased significantly on the postoperative lday.

2) In epidural analgesia group with normal findings in PFT, the values of arterial blood gas analysis were no changed on 30min after the end of surgery and postoperative lday compared to preanesthetic values.

3) In general anesthesia group with abnormal findings in PFT, the PaCO₂ increased, and Pa0₂ and oxygen saturation decreased significantly on 30min after extubation, but the PH increased, Pa0₂ remained reduced on the postoperative lday compared to preanesthetic values.

4) In epidural analgesia group with abnormal findings in PFT, the values of arterial blood gas analysis were no changed on 30min after the end of surgery, but the PH increased, PaCO₂ decreased significantly on the postoperative lday compared to preanesthetic values.

It appears from these findings that epidural analgesia is preferable to general anesthesia in lower abdominal or low extremity surgery for elderly patients with abnormal findings in PFT.

Forty one cases(37 patients) of mandibular reconstruction using AO-plates were reviewed. The patients aged from 27 to 83 years o1d(52.3±18.1 years) were followed for 5 to 42 months (mean 12.7±8.3 months). Cases were grouped by the location of reconstruction; Anterior mandible crossing midline as Group A(12 cases), body segment of the mandible as Group B(l6 cases). condyle & ramus of the mandible as Group C(13 cases). The incidence of revision as a measure of outcome was calculated by actuarial methods accounting for loss or death.

Revision or plate removal occurred in 22.2% (9 of 41 cases) with an incidence of 52.2% (6 of 12 cases) in Group A, 12.5%(2 of 16 cases) in Group B, and 7.7%(l of 13 cases) in Group C. Combined use of AO-plate and bone graft had a revision rate of 33.3% (4 of 12 cases), while the reconstructions with plate only had a rate of 17.2%(5 of 29 cases). The difference between the immediate reconstructions(19.2% ; 5 of 26 cases) and delayed reconstructions(26.7% ; 4 of 15 cases) was not significent. but the delayed reconstruction of the anterior mandible resulted in highest failure rate of 57.1% (4 of 7 cases).

The revision incidence was significantly high when the area had been radiated. 33.3% of 24 radiated cases, while 5.7% of not radiated cases required revision. Particularly, the radiated Group A resulted in remarkable higher failure rate(63.2% of 10 cases) Mouth opening over 30min was obtained in 92.3% of Group C, in 63.8% of Group B. but only in 52.2% of Group A. Joint pain which was mild and tolerable was noted in 3 of 13 Group C patients.

The author report a patient with an vertebral aneurysm that was clipped sucessfully by the far lateral inferior suboccipital approach. The frequence of this approach to the vertebral aneurysm was discussed.