No abstract available.
Uterine Prolapse*

Although occasional patients with chronic myeloid leukemia (CML) have chromosomal changes other than Philadelphia chromosome early in the disease, in typical cases the 9;22 translocation remains the sole abnormality throughout the disease course in chronic phase. When disease progression occurs, however, 75-80% develop additional chromosome aberrations. These secondary changes sometimes precede the more aggressive manifestations hematologically and clinically and thus may serve as valuable prognostic indicators. ider (9) (q10)t (9;22) (q34;q11.2) is very rare and a recurrent chromosomal abnormality associated with acute lymphoblastic leukemias (ALL) and lymphoblastic crisis of CML. And ider (9) (q10)t (9;22) (q34;q11.2) is a lymphoid-specific rearrangement and the patients with this abnormality are of older age on average. They commonly show pre-B cell lineage immunophenotype and L2 morphology. We report a case of ider (9) (q10)t (9;22) (q34;q11.2) as secondary aberration in a patient with lymphoblastic crisis of CML.
Blast Crisis ; Chromosome Aberrations ; Disease Progression ; Humans ; Leukemia* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Philadelphia Chromosome ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Precursor Cells, B-Lymphoid

Using 3D ultrasound, bilateral chylothorax was diagnosed antenatally in the second trimester. Apparently stable, bilateral pleural effusion progressed rapidly to severe hydrops with facial edema during observation, and then we decided bilateral pleural-amniotic shunt operation. Here we present a case where drainage of pleural effusion by a double reverse pig tail stent made by ourself was achieved, although placement of the thoracoamniotic shunt resulted in near complete drainage of bilateral pleural effusion with normalization of intrathoracic anatomic relationships, subsequent resolution of fetal hydrops, but the ultimate outcome was unsuccessful due to the internalization of one catheter and unknown sudden death. We think that ongoing research is required to further evaluation about complications associated with this procedure, specifically failure of function due to obstruction, migration of the catheter,
Catheters ; Chylothorax* ; Death, Sudden ; Drainage ; Edema ; Female ; Humans ; Hydrops Fetalis ; Pleural Effusion ; Pregnancy ; Pregnancy Trimester, Second ; Stents ; Tail ; Ultrasonography

The diagnosis of acute undifferentiated leukemia is made when the leukemic cells cannot be classified using morphologic and cytochemical analyses, and do not express myeloid or lymphoid antigens. Trisomy 13 is a rare primary chromosomal abnormality in acute leukemia and associated with lineage inconsistency and poor prognosis. We report a rare case of acute undifferentiated leukemia showing negativity in periodic acid-Schiff (PAS) and myeloperoxidase (MPO) without any lineage-specific cell surface marker expression and having trisomy 13. The patient was a 72- year-old male who visited our hospital because of anemia and general weakness. On examination, leukocytosis with proliferated blasts (76%) in peripheral blood was noted. Bone marrow aspirate showed blast proliferation (74%) with morphologically hand-mirror type. The blast expressed CD34 (96%) and HLA-DR (76%) in immunophenotyping. Cytogenetic study of bone marrow cells showed 46,XY,+13,-21[15]/46,XY[5]. Induction chemotherapy was failed and differentiation to monocytic series was noted.
Anemia ; Bone Marrow ; Bone Marrow Cells ; Chromosome Aberrations ; Cytogenetics ; Diagnosis ; HLA-DR Antigens ; Humans ; Immunophenotyping ; Induction Chemotherapy ; Leukemia* ; Leukocytosis ; Male ; Peroxidase ; Prognosis ; Trisomy*

PURPOSE: To evaluate the usefulness of percutaneous management and prognosis in venous rupture during angioplasty of hemodialytic arteriovenous fistulas. MATERIALS AND METHODS: Among 814 patients who underwent angioplasty on account of inadequate hemodialysis, 63[39 women and 24 men aged 20-78 (mean, 55.8) years] were included in this study. All 63 had peripheral venous stenosis. Venous rupture was diagnosed when contrast leakage was seen at venography after percutaneous angioplasty (PTA). In order to manage venous rupture, the sites at which this occurred were compressed manually for 3-5 minutes or blood flow was blocked with a balloon catheter for the same period. In one case, a stent was inserted at the rupture site. Using the Kaplan-Meier method, we investigated the patency rate of arteriovenous fistula (AVF) in cases of successful PTA. We also compared PTA patency rates in cases with and without peripheral venous rupture. RESULTS: Venous rupture occurred in 38 cephalic, 16 brachial, and 9 basilic veins. In 63 patients, bleeding stopped and in 54 (85.7%) of these, PTA was successful. Among the nine failed cases, dilatation was incomplete in five, though bleeding had stopped. In patients with brachial and cephalic vein rupture, the venous tract at the rupture site was not located. Two patients underwent surgery: one of these experienced brachial venous rupture, with incontrollable bleeding, and the other had nerve compression symptoms due to hematoma. Among 54 patients in whom PTA was successful, the primary and secondary six-month rates for angioaccess were 47.9% and 81.2%, and the mean patency period was 6.1 and 15.8 months, respectively. In cases of non-venous rupture, the mean patency period was 9.6 months, significantly longer than in cases involving venous rupture (p=0.02). CONCLUSION: Venous rupture occurring during the PTA of hemodialytic AVF can be managed percutaneously.
Angioplasty* ; Arteriovenous Fistula ; Catheters ; Constriction, Pathologic ; Dilatation ; Female ; Hematoma ; Hemorrhage ; Humans ; Male ; Ocimum basilicum ; Phlebography ; Prognosis ; Renal Dialysis* ; Rupture* ; Stents ; Veins

PURPOSE: The purpose of this study is to compare the clinical characteristics and predisposing factors of necrotizing enterocolitis (NEC), primarily a disease of the premature, in between term and preterm groups. METHODS: We retrospectively reviewed the medical records of 36 neonates with NEC (> or =modified Bell's staging criteria IIa) who were admitted to the NICU of Seoul National University Children's Hospital from January 1, 2000 through December 31, 2004. 20 full and 16 preterm neonates were compared in regard to demographics, clinical characteristics and predisposing factors. RESULTS: 29/36 neonates(80.6%) were outborn. Mean gestational age and birth weight were 38.5+/-0.9 weeks and 3, 010+/-490 g, term and 31.4+/-3.4 weeks and 1, 460+/-750 g, in preterm respectively group. Mean age at diagnosis was 17.3+/-13.5 days in term versus 20.8+/-19.6 days in preterm group. Abdominal distension was the most common finding in both groups and diarrhea was significantly more common in term group. Congenital heart disease, intrauterine growth retardation, bacterial infection were found in 75.0% of term group. The rates of surgical intervention and complication were higher in preterms, however, mortality rate was higher in term group. Congenital heart disease, especially the presence of complex heart disease with poor systemic perfusion or heart failure, was associated with higher mortality. CONCLUSION: Diarrhea was more common in term group. Neonates with predisposing factors for NEC, especially in term neonates with congenital heart disease, should be followed closely for early diagnosis and proper treatment.
Bacterial Infections ; Birth Weight ; Causality* ; Demography ; Diagnosis ; Diarrhea ; Early Diagnosis ; Enterocolitis, Necrotizing* ; Fetal Growth Retardation ; Gestational Age ; Heart Defects, Congenital ; Heart Diseases ; Heart Failure ; Humans ; Infant, Newborn* ; Medical Records ; Mortality ; Perfusion ; Retrospective Studies ; Seoul

The purpose of this study was to demonstrate survival rate changes after the introduction of inhaled nitric oxide (iNO) therapy, and to identify the factors that influence these changes in neonates with a congenital diaphragmatic hernia (CDH) at a single center. A total of 48 neonates were divided into two groups based on the time of admission, i.e., into period I (P1; n=17; before the introduction of iNO therapy) and period II (P2; n=31; after the introduction of iNO therapy). Survival rates of the 48 neonates showed a tendency to increase from 53% during P1 to 77% during P2, but without a statistical significance, but a significant difference was found between survival rates during the two periods after adjusting for initial clinical characteristics, when the postoperative survival rate increased significantly from 69% for P1 to 100% for P2. The mean duration of preoperative respiratory management was significantly longer for P2 than for P1. Seven of 12 patients who received preoperative iNO therapy due to persistent pulmonary hypertension or refractory preductal hypoxemia in P2 survived after operation. We speculate that a management strategy based on iNO therapy and delayed operation, rather than differences between the initial clinical characteristics of the two study groups, might partially contribute to the observed improvements in postoperative and overall survival rates in neonates with CDH.
Administration, Inhalation ; Female ; Hernia, Diaphragmatic/congenital/mortality/*therapy ; Humans ; Infant, Newborn ; Male ; Nitric Oxide/administration & dosage/*therapeutic use ; Postoperative Care/methods ; Preoperative Care/methods ; Respiratory Therapy/methods ; Survival Rate ; Time Factors ; Treatment Outcome

PURPOSE: Total thyroidectomy with central lymph node dissection (CLND) is a treatment modality of choice for thyroid cancer. Hypocalcemia is the most common complication after total thyroidectomy. The aim of the current study was to determine the association between surgery-related clinical factors and postoperative hypocalcemia. METHODS: A prospective analysis was performed for 101 patients who underwent total thyroidectomy with CLND for papillary cancer from June 2013 to June 2014. Correlation between clinicopathologic factors and postoperative hypocalcemia was analyzed. RESULTS: Based on the postoperative day-2 calcium, 56 patients (55%) developed hypocalcemia and 45 patients (45%) were normal. No significant differences in histopathologic (tumor size, tumor focality, histologic type, number of retrieved lymph nodes, metastatic lymph node, thyroiditis, retrieved parathyroid gland) findings were observed between the hypocalcemia group and normal calcium group. Mean value of the postoperative day-0 parathyroid hormone (PTH) was significantly lower in the hypocalcemia group (hypoca1cemia group: 14.3+/-9.4 pg/mL; normal group: 25.0+/-16.4 pg/mL; P<0.001). In logistic regression analysis, postoperative PTH was a factor significantly affecting postoperative hypocalcemia (OR 0.93; CI: 0.90-0.97; P<0.001). In ROC analysis, the cut-off value of PTH was 19.965 (sensitivity 79%, specificity 58%), and area under the curve (AUC) was 0.709 (95% CI: 0.607-0.811). CONCLUSION: Postoperative PTH was a factor predicting hypocalcemia after total thyroidectomy with CLND. Use of postoperative PTH as a screening tool for prediction of postoperative hypocalcemia would be useful in management of patients with hypocalcemia.
Calcium ; Humans ; Hypocalcemia* ; Logistic Models ; Lymph Node Excision* ; Lymph Nodes* ; Mass Screening ; Parathyroid Hormone ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Thyroiditis