No abstract available.
Anesthesia* ; Humans ; Outpatients*

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

No abstract available.
Child* ; Humans ; Infant* ; Urinary Tract Infections* ; Urinary Tract*

Objectives: This study was aimed to assess the usefulness of the quantitative assessment of clock drawing test (CDT) combined with the Mini-Mental State Examination (MMSE) compared to that of the Montreal Cognitive Assessment (MoCA) or the MMSE alone for screening of dementia in Parkinson disease (PD) in patients with a low educational level. Methods: A representative sample of 91 PD patients was administered MMSE, MoCA and CDT. The discriminative validity of the MMSE, MoCA, and a MMSE+CDT combination for dementia screening was determined by estimating the sensitivity and specificity of each test and by testing integrated discrimination improvement (IDI). Results: The mean age and educational years were 69.0 (years) and 7.3 in the study population. The best screening cut-off points for the MMSE, MoCA, and MMSE+CDT were 25/26, 21/22 and 41/42. In a group of patients with educational years ≤6,
Dementia

Small cell neuroendocrine carcinoma is a high-grade and poorly differentiated tumor typically presenting as primary pulmonary neoplasm. Extrapulmonary small cell carcinoma is rare. Primary small cell neuroendocrine carcinoma of the breast (SCNCB) is extremely rare, with an incidence of less than 0.1% of all breast cancers. Herein, we report imaging features of SCNCB incidentally diagnosed in a 58-year-old woman along with a literature review. The tumor was observed to be a round and circumscribed mass with rim enhancement, heterogeneous intra-tumoral enhancement, and peritumoral edema on MRI. The patient underwent breast-conserving surgery with adjuvant chemotherapy and radiation therapy. No tumor recurrence was observed during the 2-year follow-up visits after surgery.

No abstract available.

Peritonitis is a common and potentially serious infection in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The most common organisms usually associated with CAPD peritonitis are Staphylococcus aureus and Staphylococcus epidermidis. Rarely, aerobic gram negative bacilli have been the causative agents of CAPD peritonitis. The treatment of CAPD peritonitis requires removal of the peritoneal catheter and treatment with parenteral antibiotics active against the causative pathogen. While hospitalized for CAPD peritonitis, a 55-year-old man on CAPD had nosocomial peritonitis secondary to infection by ESBL-producing E.coli, that was sensitive to imipenem and meropenem. He was treated successfully with a 4-week course of intraperitoneal meropenem therapy without subsequent relapse, loss of peritoneal catheter, ultrafiltration failure, or dialysis inadequacy.
Anti-Bacterial Agents ; Catheters ; Dialysis ; Escherichia coli ; Humans ; Imipenem ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Recurrence ; Staphylococcus aureus ; Staphylococcus epidermidis ; Thienamycins ; Ultrafiltration

PURPOSE: To evaluate the outcome of coronary lesions for efficacy of dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD). METHODS: Retrospective studies were performed on 438 cases of KD treated with one or two episode of high-dose IVIG and 24 cases with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD) at this hospital from June 2000 to January 2004. 2D echocardiogram was done at admission, 2 months later and every 2 or 3 months when coronary lesion had improved more than 2 months later. RESULTS: In 108(24.7%) of 438 cases with IVIG therapy only, 10(41.7%) of 24 cases with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD), coronary abnormality had been shown by initial 2D-echocardiogram examined at acute stage. In 10(2.3%) of 438 patients with IVIG therapy only, and in 3(12.5%) of 24 cases with additional IVIG retreatment, coronary lesions were still remained at follow-up echocardiogram. Even though it had tendency to increase the coronary lesions in the group with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD), there was no significant differences about the incidence of coronary lesions between two groups. There was no significant differences in age, sex, and other clinical findings between two groups. CONCLUSION: The combination therapy with high doses of IVIG and aspirin in KD is the standard treatment but not always effective. The dexamethasone therapy may be another treatment of choice after additional immunoglobulin(IVIG) retreated in IVIG- resistant Kawasaki disease(KD).
Aspirin ; Dexamethasone* ; Follow-Up Studies ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Retreatment ; Retrospective Studies

PURPOSE: The purpose of this study is to evaluate the role of plasma brain natriuretic peptide(BNP) concentraion in Kawasaki disease(KD) and to evaluate the relationship of BNP and Tissue doppler imaging(TDI) in ventricular function. METHODS: Plasma BNP concentration was obtained in the acute phases of KD(n=49) and non-KD(n=36). TDI and conventional echocardiography were performed in 49 patients in acute phase of KD. E' velocity, A' velocity at the lateral mitral annulus, interventricular septum, lateral tricuspid annulus were measured. RESULTS: The mean plasma BNP concentration in patients with KD in the acute phase was significantly higher than non-KD(61.1+/-100.9 pg/mL vs 13.2+/-9.5 pg/mL, P<0.05). There was significant negative correlation with BNP and E' velocity, E/E' ratio at lateral mitral annulus in the aucte phase of KD. CONCLUSION: The level of plasma BNP significantly increased in aucte phase of KD. But, there was no definite level of plasma BNP to diagnosis of KD. Diatolic ventricular function was decreased in acute phase of KD which BNP is elevated by TDI.
Brain* ; Diagnosis ; Echocardiography ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Natriuretic Peptide, Brain* ; Plasma* ; Ventricular Function

Clinical and bacteriologicaql studies on 133 cases of urinary tract infection who were admitted to the Dept. of Pediatrics, NMC during the period of Jan. 1974 to Jan. 1979 were subjected in this study. The resultes were as follows : 1. Among the total 133 cases, 100 cases(75.2%) were male and 33 cases(24.8%) were female with sex ratio of 3:1. 2. The highest incidence(42.1%) was in children below the age of one year. The rate then decreased with age. 3. Seasonal incidence was relatively high in summer months, but seasonal difference was not significant. 4. Edema, signs of URI, vomiting, hematuria, failure to thrive and feeding problem were common clinical features. 5. Urinalysis disclosed proteinuria in 43 cases(32.3%), hematuria in 36 cases(27.1%) and pyuria in 26 cases(19.6%). 6. Hematological findings showed low hemoglobin in 40 cases(30.0%), leucocytosis in 31 cases(23.3%) and elevated ESR in 42 cases(31.6%). 7. IVP was performed in 13 cases, and 3 cases of them showed abnormal findings. 8. Nephrotic syndrome, acute glomerulonephritis, hyperbilirubinemia and sepsis were the common concurrent illnesses. 9. E. coli predominated as the infecting organisms(36.8%). It was most sensitive to ;gentamycin(83.7%) and cefamezine(77.8%)
Child* ; Edema ; Failure to Thrive ; Female ; Glomerulonephritis ; Hematuria ; Humans ; Hyperbilirubinemia ; Incidence ; Male ; Nephrotic Syndrome ; Pediatrics ; Proteinuria ; Pyuria ; Seasons ; Sepsis ; Sex Ratio ; Urinalysis ; Urinary Tract Infections* ; Urinary Tract* ; Vomiting