Takotsubo cardiomyopathy, also called stress-induced cardiomyopathy, usually occurs in patients with severe emotional or physiologic stress. The prognosis is favorable, and the wall motion abnormlities normalize within weeks. However, stress-induced cardiomyopathy is rarely assosicated with left ventricular thrombus and thromboembolic complications. Here, we report a case of stress-induced cardiomyopathy with left ventricular thrombus that embolized to cause cerebral infarction.
Cardiomyopathies ; Cerebral Infarction ; Humans ; Prognosis ; Takotsubo Cardiomyopathy ; Thrombosis

Necrotizing fasciitis is a relatively uncommon infectious disorder where a bacterial organism penetrates the subcutaneous tissues and superficial fascia, ultimately causing necrosis of vast areas of soft tissue. Although invasive Streptococcus spp., most commonly group-A streptococci, is the most frequent cause of this disorder, in a single organism-infection, necrotizing fasciits caused by Klebseilla pneumoniae is becoming more frequently reported, perhaps due to the recent increase in the frequency of diabetes and liver diseases. Necrotizing fasciitis caused by K. pneumoniae is usually secondary to hematogenous dissemination, most commonly caused by trauma or liver abscess and usually results in multiple organ failure. The progression of the disease is so rapid that the mortality rate is high despite aggressive surgical intervention and extensive use of antibiotics at an early disease stage. Here we report a case of necrotizing fasciitis caused by hematogenously spread K. pneumoniae from incompletely treated chronic otitis media in a patient with alcoholic liver cirrhosis and diabetes.
Anti-Bacterial Agents ; Fasciitis, Necrotizing* ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Cirrhosis, Alcoholic ; Liver Diseases ; Liver Diseases, Alcoholic ; Mortality ; Multiple Organ Failure ; Necrosis ; Otitis Media* ; Otitis* ; Pneumonia ; Streptococcus ; Subcutaneous Tissue

Maternal serum alpha-fetoprotein(MSAFP) has been a world wide screening test for open neural the tube defect. But elevation of MSAFP is related to not only neural tube defect, but also incorrect gestational age, congenital anomalies such as congenital nephrosis, esophageal and intestinal obstruction, low birth weight, oligohydroamnios, fetal death and chromosomal anomalies. If MSAFP is elevated, gestational age, congenital anomalies such as neural tube defect, multiple pregnancy and fetal death must be evaluated by ultrasound. When the ultrasound is nondiagnostic, amniotic fluid AFP(AFAFP) levels are measured and if AFAFP is elevated, presence or absence of aetylchoineststarase(AChE) is determined to rule out the false positive of amniotic AFP. Amniotic AChE test yielded detection rate of open spina bifida of 99%, 98% for anecephaly and a false-positive rate of 0.34%. We report a case with elevated AFAFP and positive amniotic AChE result in one fetus of the twin pregnancy conceived by ICSI and ZIFT, but in which targeted ultrasound findings were normal, maintained the pregnancy to term and normal twin was delivered by elective cesarean section.
Acetylcholinesterase ; alpha-Fetoproteins ; Amniotic Fluid* ; Cesarean Section ; Female ; Fetal Death ; Fetus* ; Gestational Age ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Intestinal Obstruction ; Mass Screening ; Nephrosis ; Neural Tube Defects ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Sperm Injections, Intracytoplasmic* ; Spina Bifida Cystica ; Ultrasonography ; Zygote Intrafallopian Transfer ; Zygote*

OBJECTIVE: To evaluate the efficacy of new protocol (Modified luteal long; MLL protocol) to improve the clinical outcomes in IVF-ET. METHODS: New protocol was applied to repeated ART failure group for 7 months (GroupI, n=106) after informed consent. Outcomes of new protocol group were evaluated and compared to conventional long protocol group (Group II, n=315) prospectively and compared to same indication group with GroupI (Group III, n=144) historical prospectively. RESULTS: There were no differences in the clinical characteristics except patient's age between GroupI and II (35.16+/-4.35 vs. 33.22+/-4.14, p<0.05). Outcomes of IVF-ET, such as numbers of retrieved oocytes, numbers of transferred embryos, numbers of 2 PN, rates of ICSI, rates of blastocyst ET, rates of fertilization, ampules of gonadotropin between GroupI & II, and GroupI & III, respectively. But the embryo quality score of GroupII was significantly higher than GroupI. There was significant increase of implantation rate (25.2 vs. 17.1%, p=0.02) in GroupII compared to GroupI, especially in 31-35 years old group. Implantation rate of less than 35 years old group and clinical pregnancy rate of 31-35 years old group in GroupII tubal factor patients were significantly higher than GroupI tubal factor patients. Clinical pregnancy rate (47.2 vs. 12.8%, p=0.001) and implantation rate (15.2 vs. 5.5%, p=0.009) of GroupI was significantly higher than GroupIII, especially in 36-40 years old group. Implantation rates of ES factor patients (especially in 36-40 years old) and unknown factor patients (especially less than 35 years old), and clinical pregnancy rate of ES factor patients (especially in 36-40 years old) were significantly higher in GroupI than III. CONCLUSION: These results suggest that new protocol may play some role in the increase of endometrial receptivity. Further investigation, including molecular research work will be needed to clarify the factors concerned in the increase of implantation rate.
Adult ; Blastocyst ; Embryo Transfer* ; Embryonic Structures* ; Fertilization ; Fertilization in Vitro* ; Gonadotropins ; Humans ; Informed Consent ; Oocytes ; Pregnancy Rate ; Prospective Studies ; Sperm Injections, Intracytoplasmic

We report a case of mucinous adenocarcinoma in the ascending colon. A 55-year-old woman was admitted to Asan Medical Center due to right lower quadrant abdominal pain. On physical examination, an approximately 5X5 cm sized tender mass was palpated in the right lower quadrant. Colonoscopy revealed a fungating mass covered with gelatinous, yellow-whitish mucoid material in the ascending colon. Abdominal computed tomography showed irregular wall thickening from ileocecal valve to mid ascending colon with pericolic fat thickening. She underwent right hemicolectomy and surgical specimen revealed well differentiated tubulopapillary adenocarcinoma with mucinous background consistent with mucinous adenocarcinoma.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Chungcheongnam-do ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Female ; Gelatin ; Humans ; Ileocecal Valve ; Middle Aged ; Mucins* ; Physical Examination

Distal renal tubular acidosis is a condition characterized by an inability of the distal nephron to acidify urine, causing hyperchloremic metabolic acidosis. Distal renal tubular acidosis is classified as proton secretory defect, permeability defect and voltage defect based on its pathophysiology. In the former two, serum level of potassium decreases due to increased excretion of potassium. But in the latter (voltage defect), hyperkalemia is characteristic by impaired the generation of an optimal electrical gradient for hydrogen ion and potassium secretion. We experienced a case of Sj gren's syndrome associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus. The patient was a 58- year-old woman who complained of general weakness, nausea and xerostomia. Laboratory analysis showed metabolic acidosis with alkaline urine and hyperkalemia. Anti-nuclear antibody and anti-ds DNA antibody were positive. She presented with polyuria, low urine osmolarity and inadequate response to DDAVP. The response to Shirmer test was decreased. Salivary scintigraphy showed decrease of uptake in the parotid and submandibular salivary glands. We believe this is the first case report in which Sj gren's syndrome is associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus.
Acidosis ; Acidosis, Renal Tubular* ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Nephrogenic* ; DNA ; Female ; Humans ; Hyperkalemia ; Nausea ; Nephrons ; Osmolar Concentration ; Permeability ; Polyuria ; Potassium ; Protons ; Radionuclide Imaging ; Salivary Glands ; Xerostomia

Distal renal tubular acidosis is a condition characterized by an inability of the distal nephron to acidify urine, causing hyperchloremic metabolic acidosis. Distal renal tubular acidosis is classified as proton secretory defect, permeability defect and voltage defect based on its pathophysiology. In the former two, serum level of potassium decreases due to increased excretion of potassium. But in the latter (voltage defect), hyperkalemia is characteristic by impaired the generation of an optimal electrical gradient for hydrogen ion and potassium secretion. We experienced a case of Sj gren's syndrome associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus. The patient was a 58- year-old woman who complained of general weakness, nausea and xerostomia. Laboratory analysis showed metabolic acidosis with alkaline urine and hyperkalemia. Anti-nuclear antibody and anti-ds DNA antibody were positive. She presented with polyuria, low urine osmolarity and inadequate response to DDAVP. The response to Shirmer test was decreased. Salivary scintigraphy showed decrease of uptake in the parotid and submandibular salivary glands. We believe this is the first case report in which Sj gren's syndrome is associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus.
Acidosis ; Acidosis, Renal Tubular* ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Nephrogenic* ; DNA ; Female ; Humans ; Hyperkalemia ; Nausea ; Nephrons ; Osmolar Concentration ; Permeability ; Polyuria ; Potassium ; Protons ; Radionuclide Imaging ; Salivary Glands ; Xerostomia

Anomalies of the lumbosacral nerve roots, in which conjoined nerve roots are most common, are occasionally accompanied by herniated nucleus pulposus. Most of these anomalies were incidental findings from operations, and recent advances in diagnostic imaging techniques have increased the number of cases of lumbosacral root anomalies reported. All these anomalies are congenital, unilateral and almost exclusively situated at the L5-S1 segment. Diagnostic techniques, such as myelography, CT and MRI detect conjoined nerve root. Conjoined nerve root may be confused with a dumbbell tumor or extruded free disc fragment on CT scans. Surrounded by high-signal intensity epidural fat, a conjoined nerve root is more clearly depicted on MR images than on CT scans. Although the size of disc herniation was small, the symptom was magnified by a relatively fixed conjoined root. At surgery, it is necessary for a larger surgical exposure by means of hemi-laminectomy because of the fixation of the nerve roots, and difficulty in retraction. Recently, we experienced two cases of conjoined nerve root and presented them with a review of the literature.
Diagnostic Imaging ; Incidental Findings ; Magnetic Resonance Imaging ; Myelography ; Tomography, X-Ray Computed

OBJECTIVES: Protein-calorie malnutrition is a common problem in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Serum albumin(SA) concentration has been used as a marker for assessing nutritional status. Hypoalbuminemia has been linked to an increased risk of morbidity and mortality and more numerous, prolonged hospitalization for peritoneal dialysis patients. The aim of this study was to determine factors affecting SA value in CAPD patients. METHODS: We performed a cross-sectional study which included patients' demographics, anthropometric data, biochemical parameters, urea kinetic data and comorbidity in 106 stable CAPD patients. RESULTS: 1) There were 50 men and 56 women with a mean CAPD duration of 43 months and mean age of 49 years. The mean concentration of SA was 3.9+/-0.5 (range 2.5-5.3) g/dl and weekly Kt/Vurea 2.0+/-0.4 (range 1.32-3.79) 2) Twenty-one patients(20%) were classified as group I(SA<3.5g/dl)and the remaining patients(80%) as group II(SA 3.5g/dl) 3) Group I patients were significantly older(55+/-11 vs 47+/-11 years, p<0.05) and had significantly higher comorbidity score(1.5+/-0.8 vs 0.7+/-0.9, p<0.05), C-reactive protein (4.5+/-0.9 vs 0.5+/-0.1 mg/dl, p<0.05), 24-hr dialysate-toplasma creatinine(D/PCr) ratio(0.84+/-0.1 vs 0.76+/-0.1, p<0.05), 24-hr dialysate protein (7167+/-2031 vs 5471+/-1515 mg, p<0.05) and had significantly lower residual renal function(RRF)(0.2+/-0.3 vs 0.7+/-1.2 ml/min, p<0.05), BUN(48+/-14.8 vs 55.6+/-14.9 mg/dl, p<0.05), serum creatinine(10.4+/-2.8 vs 12.6+/-3.5 mg/dl, p<0.05), IGF-1(186+/-99 vs 260+/-131 ng/ml, p<0.05), serum phosphorus(4.1+/-1.2 vs 5.0+/-1.3 mg /dl, p<0.05) than group II.4) SA showed positive correlation with anion gap (r=0.43, p value=0.001), transferrin(r=0.41, p value= 0.001) phosphorus(r=0.31, p value=0.001) and negative correlation with 24-hr dialysate protein loss(r=-0.51, p value=0.001), 24-hr D/PCr ratio(r=-0.49, p value=0.001), comorbidity score(r=-0.36, p vluue=0.001). NPCR(r=0.22, p value=0.023), IGF-1(r=0.30, p value=0.002), BUN(r=0.23, p value=0.016) weakly correlated with SA.5) By stepwise multiple logistic regression analysis, age, CRP, 24-hr D/PCr ratio and RRF independently influenced SA level. CONCLUSION: SA level seems to be affected by non-nutritional factors such as age, peritoneal membrane transport characteristics, residual renal function and presence of acute phase protein response manifested by CRP elevation, in addition to nutritional factors.
Acid-Base Equilibrium ; Acute-Phase Proteins ; C-Reactive Protein ; Comorbidity ; Cross-Sectional Studies ; Demography ; Female ; Hospitalization ; Humans ; Hypoalbuminemia ; Logistic Models ; Male ; Membranes ; Mortality ; Nutritional Status ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Protein-Energy Malnutrition ; Serum Albumin* ; Urea

The purpose of this study was to evaluate the usefulness of retinal nerve fiber layer [RNFL] photography and Heidelberg Retina Tomograph [HRT, Heidelberg, Germany] in early detection of glaucoma. Among 2802 people who underwent routine health checkup at. Seoul National University Hospital from July I to Decernber 31, 1996, forty-nine persons were included whose IOP was above 21mmHg or cup/disc ratio was 0.5 or greater. RNFL photography, HRT and automated perimetry [Humphrey Field Analyzer, program C30-2] were performed. Twelve eyes were diagnosed as glaucoma and one sye as glaucoma suspect. Four eyes with glaucoma had RNFL defect with normal visual field and 7 eyes with glaucoma had both RNFL defect and glaucomatous visual field defect. Of 26 eyes suggested as glaucoma by FSM classification of HRT, only 8 eyes met the diagnostic cri-teria of glaucoma of this study. Among 21 eyes with decreased hump height in HRT only 7 eyes were diagnosed as glaucoma. RNFL photography increased the detection rate for glaucoma by 50% over that with visual field test. only. RNFL photography will be a valuable method for early detection of glaucorna while HRT may play a suppleinentary role.
Classification ; Glaucoma* ; Humans ; Nerve Fibers* ; Photography ; Retina ; Retinaldehyde* ; Seoul ; Visual Field Tests ; Visual Fields