Twin Pregnancies are increasing these days due to recent development of the technology in treating infertility. twin pregnancies tend to cause more congenital anomalies than singleton pregnancies do. Especially when twin pregnancies are affected with one anomalous fetus combined to a normal one, the proper management and counseling are difficult. We experienced a twin pregnancy in which one anencephalic fetus was combined to a normal one, after close counseling we decided to continue the pregnancy. At 35 weeks 6 days of gestation, an anencephalic fetus was dead, so we delivered by cesarean section due to breech-cephalic presentation. The birth weight of the normal and anencephalic fetuses were 2160 gm and 600 gm, respectively. The anencephalic fetus was combined with scoliosis, absent left upper limb, and nuchal skin defect, but the healthy one showed good crying and movement and its Apgar score was 8 in 1 minute and 9 in 5 minute. Although the infant needed intensive care for 21days in the nursery room, she was finally discharged in good condition. We present this case with a brief review of the literature.
Anencephaly ; Apgar Score ; Birth Weight ; Cesarean Section ; Counseling ; Crying ; Female ; Fetus* ; Humans ; Infant ; Infertility ; Critical Care ; Nurseries ; Pregnancy ; Pregnancy, Twin* ; Scoliosis ; Skin ; Twins* ; Upper Extremity

Educational evironment and condition strongly influence the quality of graduate medical education. However, in Korea educational environment of in-hospital graduate medical education and training has not been explored in details. To evaluate current situation, we investigated 1,859 graduate trainees(residents) by self-administered questionnaire from May to July in 1996. Major findings of the survey were as follows; 1. Major providers of education were senior trainees(46.7%), compared with other sources of training such as self-study(22.9%) and staff trainers(14.5%). 2. At hospitals with less than or equal to 500 beds, formal educational programs for training were more poorly developed than hospitals with more than 500 beds. Among them, weakness in programs of case conference, staff lecture and training in affiliated hospitals was more remarkable. 3. At small hospitals with less than or equal to 500 beds, satisfaction level of trainees on their training were lower than that of trained at hospitals with more than 500beds. Research, conference, discussion with senior residents, and outpatient care were more dissatisfactory in particular. 4. Significant barriers to ideal training were work overload(57.2%) and shortage of educational programs(19.0%). Most of trainees are not satisfied with environment and condition of their training programs. To improve the quality of graduate medical education which is closely related with health care quality in the near future, general environment of education such as work load and educational programs has to be reoriented.
Ambulatory Care ; Education ; Education, Medical, Graduate* ; Korea ; Quality of Health Care ; Surveys and Questionnaires

BACKGROUND/AIMS: Kidney transplantation (KT) reportedly provides a significant survival advantage over dialysis in diabetic patients. However, KT outcome in diabetic patients compared with that in non-diabetic patients remains controversial. In addition, owing to recent improvements in the outcomes of KT and management of cardiovascular diseases, it is necessary to analyze outcomes of recently performed KT in diabetic patients. METHODS: We reviewed all diabetic patients who received living donor KT between January 2008 and December 2011. Each patient was age- and sex-matched with two non-diabetic patients who received living donor KT during the same period. The outcomes of living donor KT were compared between diabetic and non-diabetic patients. RESULTS: Among 887 patients, 89 diabetic patients were compared with 178 non-diabetic patients. The incidence of acute rejection was not different between the diabetic and non-diabetic patients. Urinary tract infection and other infections as well as cardiovascular events occurred more frequently in diabetic patients. However, diabetes, cardiovascular disease, and infection were not significant risk factors of graft failure. Late rejection (acute rejection after 1 year of transplantation) was the most important risk factor for graft failure after adjusting for diabetes mellitus (DM), human leukocyte antigen mismatch, rejection and infection (hazard ratio, 56.082; 95% confidence interval, 7.169 to 438.702; p < 0.001). Mortality was not significantly different between diabetic and non-diabetic patients (0 vs. 2, p = 0.344 by log-rank test). CONCLUSIONS: End-stage renal disease patients with DM had favorable outcomes with living donor kidney transplantation.
Cardiovascular Diseases ; Diabetes Mellitus ; Dialysis ; Humans ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Leukocytes ; Living Donors* ; Mortality ; Risk Factors ; Transplants ; Urinary Tract Infections

Necrotizing fasciitis (NF) is an uncommon, life-threatening infection of the subcutaneous tissue and superficial fascia. The clinical course of NF is rapid and progressive, and it is often fatal despite the appropriate therapy. The prognosis of NF depends on a timely diagnosis and then proper treatment. At onset it may not be possible to clearly distinguish NF from minor soft-tissue infections. Although infection are common due to the use of steroids and immunosuppressive agents in patients with systemic lupus erythematous (SLE), it is interesting that NF has rarely been reported with SLE. Here, we present two cases of NF with SLE.
Fasciitis, Necrotizing ; Humans ; Immunosuppressive Agents ; Prognosis ; Steroids ; Subcutaneous Tissue

PURPOSE: To report the anatomic and visual results of triple surgery in patients with cataract and rhegmatogenous retinal detachment. METHODS: This retrospective study examined 11 cases of phakic detachment. All 11 eyes had both rhegmatogenous retinal detachment and cataract. For these, a triple procedure involving pars plana vitrectomy, cataract surgery and posterior chamber intraocular lens (PCL) insertion was performed. Intraocular lens (IOL) power calculation was performed in the diseased or both eyes. RESULTS: A clear intraoperative view of the fundus was obtained in all cases. The retina was reattached by triple surgery in 9 eyes. In one failed case, there had been extensive detachment with preoperative proliferative vitreoretinopathy grade C type 1. In the other case, retinal detachment recurred due to a new break. The two failed eyes obtained anatomic success by reoperation. Preoperative visual acuity (hand movement/10cm to 0.2) was improved (finger count/20cm to 0.8). There were 2 visual imbalances of -8.0 diopter and -10.0 diopter due to miscalculation of IOL power. CONCLUSIONS: In selective cases, combined triple surgery spares the patient repeat surgery and can offer a more rapid visual rehabilitation by clearly identifying the breaks and avoiding delays in detachment repair. To avoid miscalculation, IOL power must be calculated in both eyes, especially in cases of macular detachment.
Cataract Extraction* ; Cataract* ; Humans ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Rehabilitation ; Reoperation ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity ; Vitrectomy* ; Vitreoretinopathy, Proliferative

Purpose: Liver transplantation (LT) is now considered as a standard treatment modality for patients with end-stage liver disease. The number of patients waiting for liver graft is continuosly increasing as there is a shortage of brain-dead donors, living donor liver transplantation has been regarded as an alternative. Furthermore, China where donors are more readily available is quickly growing as a place to travel for transplantation. Methods: Twenty-eight patients who were on follow up after LT in China were enrolled. Pre-transplantation state of donors and recipients, surgical problems at the time of arrival, and complications that were detected on follow up were evaluated and analyzed. Results: All patients did not have the information of donors and knowledge of their transplanted state. All patients were received conventional deceased donor LT and the type of duct anastomosis was duct to duct technique. Hepatitis B virus (HBV) recurrence was detected in two patients, various prophylaxes were used, and inappropriate modalities were detected. Biliary complications occurred in 6 patients, who were treated with percutanous or endoscopic method. There were 5 patients mortalities: 3 patient-hepatocellular carcinoma recurrence, 1- post-transplant lymphoproliferative disease, 1-cardiac arrhythmia after retransplantation. Conclusion: The shortage of deceased donor resulted in more and more travel to China for liver transplantation. However, we have problems to solve: lack of donor information, insufficient techniques of transplantation, inappropriate post-transplantation care, and lack of education for immunosuppression and prophylaxis of HBV recurrence. In addition, the efforts to increase donations should be continued.
Arrhythmias, Cardiac ; China* ; Education ; Follow-Up Studies ; Hepatitis B virus ; Humans ; Immunosuppression ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality ; Recurrence ; Tissue Donors ; Transplants

BACKGROUND: Although degree of motor blockade during high thoracic spinal anesthesia is difficult to determine, pulmonary function may reflect the level of motor blockade. So we checked pulmonary function during spinal anesthesia with two different local anesthetic agents. METHODS: 50 patients, ASA PS 1-2, were randomly divided into two groups. After basal pulmonary function test (FVC: forced vital capacity, FEV1: forced expiratory volume in one second, PEFR: peak expiratory flow rate, PEP: peak expiratory pressure, PIP: peak inspiratory pressure.), the patients received spinal anesthesia with either 0.5% hyperbaric bupivacaine or 0.5% hyperbaric tetracaine. Thirty minutes after injection, level of sensory blockade was checked by pinprick test and pulmonary function test was performed. RESULTS: Almost all the values of pulmonary function reduced after spinal anesthesia, but the degrees of reduction were not differ in two groups except PEP, which reduced more profoundly in tetracaine group than bupivacaine group. CONCLUSIONS: It is more desirable that we use bupivacaine rather than tetracaine as spinal anesthetic agent in the patient with poor pulmonary function.
Anesthesia, Spinal* ; Anesthetics ; Bupivacaine* ; Forced Expiratory Volume ; Humans ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Tetracaine* ; Vital Capacity

No abstract available.
Leukemia, Myelomonocytic, Acute* ; Skin*

No abstract available.
Leukemia, Myelomonocytic, Acute* ; Skin*

Mucosal melanoma is a very rare disease. Most cases of mucosal melanoma have their origins in the head and neck region. To date, only three cases of melanoma originating from the eustachian tube have been reported. We present a case of mucosal melanoma of eustachian tube origin in which a complete excision was performed. The treatment of mucosal melanoma is not well established, but surgical excision is considered to be the treatment of choice. Radiotherapy is controversial but given consideration in the present case because of the anatomic complexity and difficulty in performing a complete excision. In this case, the patient underwent adjuvant radiotherapy and the mass size was greatly decreased which aided the subsequent surgical excision. Systemic chemotherapy was not utilized in this case. However, it is often used for palliative purposes. A literature review was conducted in the presentation of this case.
Drug Therapy ; Eustachian Tube* ; Head ; Humans ; Melanoma* ; Neck ; Radiotherapy ; Radiotherapy, Adjuvant ; Rare Diseases