Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins

PURPOSE: This study was done to explore the meaning and nature of life world for adolescents with epilepsy. The hermeneutic phenomenological method which was developed by van Manen was used. METHODS: Participants were four boys and five girls, ages 13 to 18 being seen in a neurology outpatient department. Data were collected from iterative work with in-depth interviews from during the period from February to September, 2010. Contents of the interviews were tape-recorded with participant consent. RESULTS: Essential themes that fit into the context of the 4 existential grounds of body, time, space and other people were: an illness that makes a hurt in one's heart rather than one's body, a change in the body that is not controllable, a future like thick fog, everyday life trapped in illness, a change of relationships, learning how to live with an illness. CONCLUSION: Findings reveal the life world of the adolescents is affected to varying degrees by the epilepsy. It is important for nurses to identify and address developmental issues and effects of the illness and to support reorientation in a disintegrated life situation. The result of this study will provide nurses with insights into these experiences and should help promote empathetic care.
Adolescent ; Chronic Disease ; Epilepsy ; Heart ; Humans ; Learning ; Life Change Events ; Neurology ; Outpatients ; Qualitative Research ; Weather

No abstract available.
Glomerular Basement Membrane*

PURPOSE: To investigate the effect of growth hormone(GH) secretion on serum concentration of leptin, we evaluated the differences in serum concentration of leptin between patients with growth hormone deficiency(GHD) and GH normal short stature in prepubertal male children, and the relationship between GH and serum leptin level. Also, we analyzed the correlation between serum concentrations of leptin and insulin-like growth factor-I(IGF-I), insulin-like growth factor binding protein-3(IGFBP-3), total cholesterol(TC), free fatty acid(FFA) and body mass index(BMI). METHODS: Eight cases with GHD and 10 cases with GH normal short stature were included in this study. Patients were all male, prepubertal children with mean age 10.6 years. Blood samples were collected in these patients by L-dopa GH provocation test. Statistical analysis of the comparisons of serum leptin level and correlation of multiple variables were performed using PC-SAS program. Significance was defined as P<0.05. RESULTS: The mean serum concentration of leptin in GHD(12.27+/-10.63ng/mL) was significantly higher than in GH normal short stature(5.39+/-3.21ng/mL)(P=0.0344). Serum concentration of leptin was negatively correlated to GH(y=-7.7x+43.3, r=-0.23, P=0.0109). Serum concentration of leptin was positively correlated to BMI(y=2.5x-33.3, r=0.75, P=0.0003). Serum concentration of leptin was not correlated to IGF-I, IGFBP-3, TC and FFA. CONCLUSION: Serum concentration of leptin was siginificantly increased in patients with GHD compared to GH normal short stature and was negatively correlated to GH.
Child ; Growth Hormone* ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Leptin* ; Levodopa ; Male

Heterotopic pregnancy occurs when an intrauterine pregnancy co-exists with an ectopic pregnancy. It is a potentially fatal condition, rarely occuring in natural conception cycle. But its incidence is increased since the rise in PID, pelvic surgery, IUD, and advent of assisted reproductive technology involving use of superovulatory drugs and/or in vitro-fertilization. We present a case of intrauterine twin pregnancy and right tubal pregnancy following treatment with in vitro-fertilization. The right tubal pregnancy was diagnosed after rupturing at 6th gestational weeks, and resected via laparoscopy. And healthy twin babies were delivered without complication at 38th gestational week. So we report this case with a brief review of the literatures.
Female ; Fertilization ; Humans ; Incidence ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic* ; Pregnancy, Tubal ; Pregnancy, Twin ; Reproductive Techniques, Assisted

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent abscesses, nodules, and fistulous tracts. Recently, novel staging systems, including sonographic scoring system of hidradenitis suppurativa (SOS-HS), have been widely introduced in HS. Objective: To assess the efficacy of SOS-HS compared with Hurley staging and modified sartorius scoring (MSS) system and determine the necessity of ultrasound evaluation. Methods: A radiologist performed an ultrasound evaluation, and three dermatologists reviewed the images and videos. Clinical characteristics, including staging and demographic data, were recorded by three dermatologists. The correlation of each staging system and the significance of vascularity (Doppler mode) and lesion depth on sonography were statistically analyzed. Results: Among the 46 patients, 34.8% were classified as stage 1 and 3, and 30.4% were classified as stage 2 in the SOS-HS system, which was statistically higher than the Hurley staging (p＜0.0005). MSS score increased according to the SOS-HS stages (p＜0.0005, p=0.001). Vascularity and depth of involvement also increased with SOS-HS and Hurley staging. Conclusion Sonographic examination can be applied in HS severity assessment and documentation of the clinical characteristics of each lesion in detail. Special tools, such as Doppler mode and depth assessment, can also be useful in HS evaluation.

A 78-year-old male presented with an asymptomatic pinkish multi-nodular mass on his frontal scalp. The lesion had recurred twice after incomplete surgical excision. Initial punch biopsy was diagnosed with cylindroma. He revisited after one year with exophytic enlargement of the mass, and two staged Mohs micrographic surgery identified well-differentiated malignant cylindroma. Histopathology in the lower dermis and periosteal layer showed atypical cells with mitosis and hyperchromatic nucleoli with increased Ki-67 index of 10% to 30%. The postoperative wound was successfully treated with negative wound pressure therapy (NPWT) and secondary intentional healing. We report this case showing malignant transformation of solitary cylindroma, and good result for secondary intention healing using NPWT for postoperative defect.

No abstract available.
Myxoma ; Stroke ; Thrombolytic Therapy

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent abscesses, nodules, and fistulous tracts. Recently, novel staging systems, including sonographic scoring system of hidradenitis suppurativa (SOS-HS), have been widely introduced in HS. Objective: To assess the efficacy of SOS-HS compared with Hurley staging and modified sartorius scoring (MSS) system and determine the necessity of ultrasound evaluation. Methods: A radiologist performed an ultrasound evaluation, and three dermatologists reviewed the images and videos. Clinical characteristics, including staging and demographic data, were recorded by three dermatologists. The correlation of each staging system and the significance of vascularity (Doppler mode) and lesion depth on sonography were statistically analyzed. Results: Among the 46 patients, 34.8% were classified as stage 1 and 3, and 30.4% were classified as stage 2 in the SOS-HS system, which was statistically higher than the Hurley staging (p＜0.0005). MSS score increased according to the SOS-HS stages (p＜0.0005, p=0.001). Vascularity and depth of involvement also increased with SOS-HS and Hurley staging. Conclusion Sonographic examination can be applied in HS severity assessment and documentation of the clinical characteristics of each lesion in detail. Special tools, such as Doppler mode and depth assessment, can also be useful in HS evaluation.

PURPOSE: Our examination was designed to determine the diagnostic properties of the cutoff point for the prediction of bacteremia in febrile children less than 3 years of age. Cutoff point is the value that simultaneously maximizes both sensitivity and specificity. METHODS: We conducted a retrospective study of febrile children, less than 3 years of age, who clinically have no identifiable source of fever. Peripheral blood leukocyte count(WBC), absolute neutrophil count(ANC), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured at the same time. All patients received blood culture, urine culture and/or CSF culture. Bacterial infection was defined as single pathogen isolated from the CSF or blood or a urinary tract infection (UTI). Patients were dichotomized into two groups: those with bacterial infection and no bacterial infection. We analyzed the characteristics of the children in the two groups. RESULTS: Seventy-one patients(44 males; 27 females) were enrolled in the study. Twenty patients (28%) had a serious bacterial infection(twelve urinary tract infection, five bacteremia, three meningitis) and fifty-one(72%) had no serious bacterial infection. WBC, ESR and CRP were significantly different between the two groups(P<0.05). The cutoff point of WBC, ESR and CRP were 20,000/mm3, 30 mm/hr and 3.0 mg/dL, respectively. The sensitivity and specificity of each cutoff point were WBC(75%, 75%), ESR(79%, 68%) and CRP(83%, 77%), respectively. CONCLUSION: These data show the ability of predictors to identify febrile children less than 3 years of age with bacterial infection. Febrile children who reach the cutoff point must be treated intensively and those who do not reach the cutoff point can be carefully managed without administering antimicrobial agents.
Anti-Infective Agents ; Bacteremia ; Bacterial Infections* ; Blood Sedimentation ; Child* ; Fever ; Humans ; Leukocytes ; Male ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity ; Urinary Tract Infections