Correct discrimination of the first and the second twin is important. Case: (1) The first fetus, whose amnionic cavity was closest to the cervix at 19 weeks, even though its body was higher than the second fetus, was found to be closer to the cervix by 23 gestational weeks than its twin. (2) The result of the chromosomal study of dichorionic twins at 17 gestational weeks was male with 9 inversion of the presumed first, and female with trisomy 21 of the presumed second. AT 19 gestational weeks, the sex and order of the two were found to be reversed at sonography for selective termination. In diamnionic twins, the fetus in the amnionic sac closest to the cervix is nominated as the first.
Amnion ; Cervix Uteri ; Diagnosis* ; Discrimination (Psychology) ; Down Syndrome ; Female ; Fetus* ; Humans ; Male ; Pregnancy, Twin* ; Twins*

The endoscopic variceal ligation(EVL) has been adopted as a new treatment for acute hemorrhage from esophageal varices that ranks the highest mortality rate in upper gastrointestinal tract bleedings. This treatment method has good effects for the urgent treatment and eradication of varices from acute variceal bleeding in repeated sessions. We enrolled 34 patients with an acute or chronic variceal bleeding episode at the time of admission in this study from Apr. 8, 1992 to June. 2, 1994. Among 34 patients, there were 31 males and 3 females, at ages between 45-66(mean: 52 years). The incidence of symptoms on admission was 10 in tarry stool, 9 in hematemesis 8 in ascites, 4 in hepatic encephalopathy and 3 in nonspecific symptoms. Varices were eradicated or reduced to grade I in 30(88.2%) of the 34 patients by 4-25 bands (mean: 10.8 bands) in 1-7 EVL sessions(mean: 3.1 sessions). After EVL, there are complicated by active bleeding in 3 patients, dysphagia in 3 patienta and transient chest discomfort in 5 patients but subsided during 24 hours. These results indicated that EVL is a safe method for treatment of bleeding from esophageal varices.
Ascites ; Deglutition Disorders ; Esophageal and Gastric Varices* ; Female ; Hematemesis ; Hemorrhage* ; Hepatic Encephalopathy ; Humans ; Incidence ; Ligation* ; Male ; Mortality ; Thorax ; Upper Gastrointestinal Tract ; Varicose Veins

Neurofibromatosis(NF) is a disorder characterized by its relative commonness, variability, and heterogeneity. It is usually expressed as a generalized form, but is rarely localized in a limited part of the body as a segmental form. In 1981, Riccardi classified NF into 8 types and a segmental form (type V) was defined by limitation of cafe-au-lait spots and/or neurofibroma on a given unilateral segment of the body. Recently we came across two cases of typical segmental neurofibromatosis. The First case was a 53-year-old woman with localized neurofibromatosis on the right T8,9 dermatome. The Second case was a 34-year-old man with localized neurofibromatosis on the right T5,6 dermatome. There were no cafe-au-lait spots, axillary frecklings, Lisch nodules or a family history in both cases. We report these rare cases with a literature review.
Adult ; Cafe-au-Lait Spots ; Female ; Humans ; Middle Aged ; Neurofibroma ; Neurofibromatoses* ; Population Characteristics

A umbilical omphalomesenteric duct polyp is the result of incomplete closure of the omphalomesenteric duct, which connects the midgut with the yolk sac of the embryo. It may be associated with underlying embryologic anomalies such as Meckels diverticulum and umbilical enteric fistula, the complications of which may at times be fatal. This rare malformation should be clinically discerned from persistent granulation tissue or pyogenic granuloma. Histologically, it shows a polypoid lesion consisting of ectopic gastrointestinal epithelium with the appearance of gastric, intestinal, or colonic mucosa. We report a case of an umbilical omphalomesenteric duct polyp in an 8-year-old male patient, who had had a bright-red polyp on the umbilicus from the age of 1 month and had not had any other types of underlying abnormalities.
Child ; Colon ; Diverticulum ; Embryonic Structures ; Epithelium ; Fistula ; Granulation Tissue ; Granuloma, Pyogenic ; Humans ; Male ; Mucous Membrane ; Polyps* ; Umbilicus ; Vitelline Duct* ; Yolk Sac

PCR implication using the primers for gag, pol and rev genes in BLV (bovine leukemia virus) proviral DNA and syncytium assay were carried out for the Korean native goats experimentally infected with bovine leukemia virus to investigate pathogenesis of BLV in the goats, and to establish a model animal for BLV infection. The oligonucleotide primers used in PCR revealed very high specificity, The minimal amount of FLK-BLV cellular chromosomal DNA to detect the integrated BLV proviral DNA was 10 ng. The peripheral blood lymphocytes from the goat infected with BLV were examined at regular intervals by PCR amplification and syncytium assay. Pol or gag genes were detected in none of three infected goats at the 1st week post-infection (p.i.). At the 4th week p.i., one of three goats showed the amplified gag gene. Thereafter detection rates for the genes were increased, indicating that the BLV proviral genes were integrated in all of the lymphocytes from three goats, at the 16th weeks p.i., when it was evident in syncytium assay that the lymphocytes from all of three goats were infested with infective BLV. Investigating the tissues from the necropsied goats at the 8th month p.i., the amplified BLV proviral genes and infective BLV were detected in all of the peripheral lymphocytes from three infected-goats. Among various tissues examined, the amplified BLV proviral genes were observed in spleen and superficial cervical, mandibular and retropharyngeal lymph nodes, and the infective BLV, in superficial cervical and mandibular lymph nodes. It was assumed that the Korean native goat was quite susceptible to BLV infection, indicating that the goat could be a good model animal for BLV.
Animals ; Cattle ; Deltaretrovirus Infections ; DNA Primers ; DNA* ; Enzootic Bovine Leukosis* ; Genes, gag ; Genes, rev ; Giant Cells ; Goats* ; Leukemia ; Leukemia Virus, Bovine* ; Lymph Nodes ; Lymphocytes ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Spleen

No abstract available.
Candida* ; Fluconazole*

PURPOSE: Because there are no significant differences of the clinical findings between the appendicitis and cecal diverticulitis, it is very difficult to make a correct diagnosis preoperatively and to choose a appropriate management intraoperatively. The purpose of this study is to investigate the clinical charateristics of right diveticulitis and to evaluate the appropriateness of surgical management. METHODS: We reviewed 45 cases of right colonic diverticulitis which underwent emergency operation under the impression of acute appendicitis during 10 years from January 1988 to December 1997. RESULTS: Of them, 38 cases were treated by diverticulectomy with appendectomy (Group I), and 7 cases were treated by resection (ileocecal resection or right hemicolectomy) (Group II). The male to female ratio was 4:1, and the mean age was 38.2 years. In Group I, all cases had a solitary inflamed cecal diverticulum. In group II, two cases had a solitary cecal diverticulitis, whereas five cases had multiple ones. Postoperative complications were found in 14 cases, but all of them were not significant. Postoperative Barium enema was performed in 22 cases of Group I, in two cases of Group II. In Group I, 8 cases had a residual diverticulum at postoperative Barium enema. In Group II, no residual diverticulum was shown. Follow-up study by Telephone was done at 16 cases, there were no symptomatic recurrences. CONCLUSIONS: In conclusion, when right colonic diverticulitis is found at the time of operation, surgical management is a safe treatment with low morbidity and low recurrence rate. Diverticulectomy with appendectomy is a safe surgical procedure for the uncomplicated diverticulitis. If diverticulitis is complicating, multiple or undistinguishable with malignancy, resection (ileocecal resection, right hemicolectomy) should be considered as a primary surgical treatment. Postoperative colon study is helpful, due to high incidence of residual diverticulum.
Appendectomy ; Appendicitis* ; Barium ; Colon* ; Diagnosis ; Diverticulitis ; Diverticulitis, Colonic* ; Diverticulum ; Emergencies ; Enema ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Postoperative Complications ; Recurrence ; Telephone

BACKGROUND: Recent studies have suggested associations between cardiovascular diseases (CVD) and osteoporosis and between serum lipids and osteoporosis. However, there are only a few studies about the relationship between bone mineral density (BMD) and serum lipids in Koreans. The aim of this study was to evaluate the correlation of serum lipid levels with osteoporosis in postmenopausal women in Korea. METHODS: This cross-sectional study consisted of 1,093 Korean postmenopausal women who visited a university hospital for medical checkup from March 2007 to March 2009. Anthropometric measurements and blood tests were done for body mass index (BMI), plasma lipids, and fasting glucose. BMD was measured using a dual energy X-ray absorptiometry. Blood pressure was taken. After the subjects were classified into three groups (osteoporosis, osteopenia, or normal) by lumbar or femur BMD, the correlation between serum lipids and BMD was analyzed. RESULTS: Serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the osteoporosis group (52.74+/-13.94 mg/dL) than in the other two groups (osteopenia, 56.22+/-13.40 mg/dL; normal, 56.54+/-13.22 mg/dL; p=0.007) when participants were grouped by lumbar BMD. In addition, serum triglyceride in the osteoporosis group was higher than in the other two groups. The results were statistically significant after adjusting for confounding factors including age, BMI and blood pressure. However, there was no significant difference when grouped by femur BMD. CONCLUSION: With decreasing lumbar BMD, we saw lower HDL-C levels and higher triglyceride levels. Osteoporosis may play a role as a risk factor for CVD through its relationships with lumbar BMD and serum lipids.
Absorptiometry, Photon ; Blood Pressure ; Body Mass Index ; Bone Density ; Bone Diseases, Metabolic ; Cardiovascular Diseases ; Cholesterol ; Cross-Sectional Studies ; Fasting ; Female ; Femur ; Glucose ; Hematologic Tests ; Humans ; Lipoproteins ; Osteoporosis ; Plasma ; Risk Factors ; Triglycerides

BACKGROUND: Preoperative identification of systemic and pulmonary venous return is essential for surgical design in situs ambiguus. This study was carried out to evaluate anatomy of systemic and pulmonary venous return and to assess clinical efficacy of magnetic resonance imagine(MR) by comparing with results of cardiac catheterization(Cath) and echocardiography(Echo). MATERIALS AND METHODS: MR performed on 22 patients with cardiac situs ambiguus(right isomerism ; 13, left isomerism ; 9). MR findings were compared with the findings of Cath and Echo for the assessment of diagnostic accuracy of MR in 19 patients. RESULTS: 1) Interruptions of IVC with azygous continuation were found in all patients of left isomerism. But IVC was drained to right of left sided atria in right isomerism. 2) Brlateral SVC were found in 12 of 22 situs ambiguus(left isomersm ; 5, right isomerism ; 8). 3) Total anomalous pulmonary venous returns(TAPVR) were found in 7 of 12 right isomerism. Location of vertical veins were as follows ; prearterial(n=1), retroarterial-prebronchial(n=3), retrobronchial(n=3). In 5 patients of remained 6 right isomerism, pulmonary venous returns(PAPVR) in which right and left pulmonary veins entered to right and left atrium respectively, were found in 5 of 9 left isomerism. 4) Compared with Cath and Echo findings(n=19) in which MR, Cath and Echo were performed simultaneously, TAPVR were found in 6 cases on MR but 2 cases on Cath and Echo. The cases that were not detected by Cath showed severe decrement of pulmonary flow due to hypoplasia of pulmonary artery or obstruction of pulmonary vein. On MR, accurate anatomy of PAPVR were found only in 4 cases. CONCLUSIONS: MR can provide accurate and complete imaging of systemic and pulmonary venous return in sitrs ambiguus. Especially, MR is superior to Cath or Echo in depiction of TAPVR with severe decrement of pulmonary flow of obstruction of pulmonary vein, PAPVR and bilateral SVC.
Heart ; Heart Atria ; Heterotaxy Syndrome* ; Humans ; Isomerism ; Pulmonary Artery ; Pulmonary Veins ; Scimitar Syndrome ; Veins

Pancreatic pseudocyst is a common complication of acute pancreatitis. Pseudocysts are commonly observed in the lesser sac and retroperitoneum; they are rarely seen in the liver. Herein, we report a case of intrahepatic pseudocyst, complicated by asymptomatic groove pancreatitis, that has successfully been treated with hepatic resection. A 70-year-old woman was referred to our hospital with severe upper abdominal pain. Abdominal computed tomography scan showed 11×10 cm sized cystic lesion in the left lateral section of the liver. Appearance of the pancreas was relatively normal. Endoscopic aspiration revealed a high level of amylase in the cystic fluid. After endoscopy, signs of peritonitis were observed; then, a left hemihepatectomy was performed. Pathologic examination revealed an intrahepatic pancreatic pseudocyst. The presence of intrahepatic cystic lesion in patients with suspected pancreatitis should raise the suspicion of intrahepatic pseudocyst. Intrahepatic pancreatic pseudocysts may be the only clinical manifestation even without an episode of acute pancreatitis.
Abdominal Pain ; Aged ; Amylases ; Endoscopy ; Female ; Hepatectomy ; Humans ; Liver ; Pancreas ; Pancreatic Pseudocyst* ; Pancreatitis* ; Peritoneal Cavity ; Peritonitis