Monitoring fetal movement serves as an indirect rneasure of fetal well-being, especially for central nervous system integrity and function. Methods to monitor fetal movement vary from the simple approach of having the mother chart perceived movement to highly specialized methods. However there were no reliable objective monitoring methods in Korea. For development of objective method for evaluating fetal movement, during pregnancy, one-hundred and two pregnant patients were entered to this study. All patients were divided into following 3 groups and each type of monitoring methods were applied. Group 1(N=20): Type I using portable FHR Doppler unit(IFD-100 model, Intermed, Korea). Group 2(N=20): Type II using FHR Microphone(Prenatal Listening Kit, Model FS002, Unisar Inc., US). Group 3(N=62): Type III using conventional ultrasound transducer(Corometric 115 Model, US). In this study, accurate counting of the fetal movementutus were best performed using Type III, because of monitoring fetal movements has its greatest efficiency when using conventional ultrasound transducer of fetal monitor. It was also attractive to doctors and nurses as a convenient methods because it needed only single transducer when compared to Type I and II. Although monitoring fetal body movement permits a general assessment of well-being, no perfect technique is still reliable. Futher techniques would be developed using the results of this study for improvement of several factors such as accuracy and objectiveness
Central Nervous System ; Fetal Monitoring ; Fetal Movement* ; Humans ; Korea ; Mothers ; Pregnancy* ; Transducers ; Ultrasonography

Corynebacterium species are non-fermentous Gram-positive bacilli that are normal flora of human skin and mucous membranes and are commonly isolated in clinical specimens. Non-diphtheriae Corynebacterium are regarded as contaminants when found in blood culture. Currently, Corynebacterium striatum is considered one of the emerging nosocomial agents implicated in endocarditis and serious infections. We report a case of native-valve infective endocarditis caused by C. striatum, which was misidentified by automated identification system but identified accurately by 16S ribosomal RNA sequencing, in a 55-year-old male patient. The patient had two mobile vegetations on his mitral valve, both of which had high embolic risk. Through surgical valve replacement and an antibiotic regimen, the patient recovered completely. In unusual clinical scenarios, C. striatum should not be simply dismissed as a contaminant when isolated from clinical specimens. The possibility of C. striatum infection should be considered even in an immunocompetent patient, and we suggest a genotypic assay, such as 16S rRNA sequencing, to confirm species identity.
Corynebacterium* ; Endocarditis* ; Humans ; Male ; Middle Aged ; Mitral Valve ; Mucous Membrane ; RNA, Ribosomal, 16S* ; Skin ; Surgical Instruments

The 15 year-old female patient was admitted with the complaints of moon face, obesity and short stature. She has received steroid therapy since 11 years ago at home to control joint pain due to rheumatoid arthritis. The diagnosis was confirmed by history of long-term steroid therapy, characteristic clinical features, biochemical studies and radiological studies. In radiological studies, superior mediastinal widening, aseptic necrosis of both hip an diffuse osteoporosis in various skeleton were revealed. Brief review of literature was presented.
Adolescent ; Arthralgia ; Arthritis, Rheumatoid ; Diagnosis ; Female ; Hip Joint* ; Hip* ; Humans ; Lipomatosis* ; Necrosis* ; Obesity ; Osteoporosis ; Skeleton

PURPOSE: It has been reported that deep neck abscesses are recently increasing again. We analyzed pediatric cases with deep neck abscesses during the last several years to contribute to the treatment of the disease. METHODS: The clinical data of 30 children under 16 years of age with deep neck abscess from February 2001 to July 2006 were analysed retrospectively. RESULTS: The mean age was 9 years (2-16 years), and the male/female ratio was 19/11. Abscesses in the peritonsillar space were most common (57%), followed by the retropharyngeal (30%) and parapharyngeal (13%) spaces. Upper respiratory infection in 10 cases (33%), dental infection in four case (14%), cervical lymphadenitis in three case (10%) and sinusitis in two case (6%) contributed to the development of deep neck infections. The frequent symptoms were fever in 16 case (53%), sore throat in 15 case (50%), poor oral intake in 10 (33%), odynophagia in eight (27%), and neck pain in eight (27%). Unilateral tonsillar hypertrophy and displacement in 15 case (50%) were most common. Neck mass in 13 patients (43%), neck stiffness in three (10%) and trismus in three (10%) were also found. Bacteria were isolated in 8 among 10 pus cultures; Streptococcus species 7 and Micrococcus luteus 1. All of those bacteria except Micrococcus luteus were sensitive to penicillin G. Surgical intervention was applied to 12 cases (40%), and the remaining 18 patients (60%) were treated with antibiotics only. There were no differences between the two groups in the duration of admission and antibiotic treatment. No complicated cases were observed. CONCLUSIONS: Peritonsillar abscesses were most frequent. Upper respiratory infection was the most common predisposing factor, followed by dental infection and sinusitis. Symptoms of respiratory tract obstruction were not found. The most common pathogens were Streptococcus species. Deep neck abscesses in children, if diagnosed at the early stage, possibly can be treated by antibiotics only, without surgical intervention.
Abscess* ; Anti-Bacterial Agents ; Bacteria ; Causality ; Child* ; Fever ; Humans ; Hypertrophy ; Lymphadenitis ; Micrococcus luteus ; Neck Pain ; Neck* ; Penicillin G ; Peritonsillar Abscess ; Pharyngitis ; Respiratory System ; Retrospective Studies ; Sinusitis ; Streptococcus ; Suppuration ; Trismus

PURPOSE: Obesity-related leptin and leptin receptor (OBR) have a relation to the development of cancer and metastasis and also the low survival rate for breast cancer patients. Leptin has been associated with increased aromatase activity and it displays functional cross-talk with estrogen. This study was designed to determine the relationship between the expression of leptin and OBR in breast cancer tissue and the prognosis of early-stage breast cancer patients, and especially for the tamoxifen-treated patients. MATERIALS AND METHODS: Ninety-five patients with early-stage breast cancer and who had undergone surgical treatment at Kyung Hee University Hospital between January 1994 and June 2004 were analyzed. The surgical specimens underwent immunohistochemical analysis for leptin and OBR. The patients' survival and clinical characteristics were obtained from the medical records. RESULTS: Of the 95 patients, 79 (83%) and 32 (33.7%) showed the expression of leptin and OBR in breast cancer tissue, respectively. The expression of leptin and OBR in breast cancer tissue was not significantly related to the clinicopathological characteristics, including obesity, the expression of hormonal receptor, the HER-2/neu expression, menopause, stage and the nuclear grade. The expression of leptin and OBR was not significantly related to the overall disease-free survival (DFS). For the tamoxifen-treated postmenopausal obese patients, the DFS of the leptin-positive group was higher than that of the leptin-negative group (p=0.017). CONCLUSION: The expression of leptin and OBR in breast cancer tissue may be not a prognostic factor for disease-free survival of breast cancer patients. In the future, further studies are needed to determine whether leptin expression could be a predictive factor for tamoxifen therapy in the postmenopausal obese subgroup among the early breast cancer patients.
Aromatase ; Breast Neoplasms ; Breast* ; Disease-Free Survival ; Estrogens ; Female ; Humans ; Leptin* ; Medical Records ; Menopause ; Neoplasm Metastasis ; Obesity ; Postmenopause ; Prognosis* ; Receptors, Leptin* ; Survival Rate ; Tamoxifen

Pseudoaneurysm is a rare life-threatening complication of chronic pancreatitis. It can be diagnosed by various imaging modalities including computerized tomography (CT), ultrasound, and angiography. Early diagnosis and radiologic or surgical treatment can promise better outcomes. However, pseudoaneurysm is not easily diagnosed. It can be misdiagnosed as a pseudocyst with secondary infection. Rarely, the correct diagnosis is made by an inadvertent trial with percutaneous drainage. The endoscopically identified hemosuccus pancreaticus is also a rare finding. Recently, we experienced two cases of pseudoaneurysm in patients with chronic pancreatitis. They did not have any evidence of bleeding in the initial endoscopy or evidence of pseudoaneurysms in the initial ultrasound and CT scan. In one case, the pseudoaneurysm was identified during a percutaneous drainage procedure, performed to diagnose and manage a cystic lesion which appeared to be an infected cyst. In the other case, the pseudoaneurysm was suspected after the hemosuccus pancreaticus was found during endoscopy performed due to recurrent hematemesis. Both cases were successfully treated with arterial embolization of the pseudoaneurysms.
Aneurysm, False* ; Angiography ; Coinfection ; Diagnosis ; Drainage* ; Early Diagnosis ; Endoscopy ; Hematemesis ; Hemorrhage ; Humans ; Pancreatitis, Chronic* ; Tomography, X-Ray Computed ; Ultrasonography

Upon review, it is noted that recurrent painful ophthalmoplegic neuropathy (RPON) is a rare neurological syndrome characterized by recurrent unilateral headaches and painful ophthalmoplegia of the ipsilateral oculomotor nerve. As seen on brain MRI, thickening and enhancement of the oculomotor cranial nerve can be observed in these cases. We experienced a case of RPON in an adult patient who showed thickening and enhancement of the oculomotor nerve on gadolinium-enhanced 3D-FLAIR image. The authors report a case of RPON with a review of the literature.
Adult ; Brain ; Cranial Nerves ; Headache ; Humans ; Magnetic Resonance Imaging ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Ophthalmoplegia ; Paralysis

OBJECTIVE: To investigate the effect of intravenous infusion of peripheral blood mononuclear cells (mPBMC) mobilized by granulocyte-colony stimulating factor (G-CSF) on upper extremity function in children with cerebral palsy (CP). METHODS: Fifty-seven children with CP were enrolled. Ten patients were excluded due to follow-up loss. In total, 47 patients (30 males and 17 females) were analyzed. All patients' parents provided signed consent before the start of the study. After administration of G-CSF for 5 days, mPBMC was collected and cryopreserved. Patients were randomized into two groups 1 month later. Twenty-two patients were administered mPBMC and 25 patients received normal saline as placebo. Six months later, the two groups were switched, and administered mPBMC and placebo, respectively. Quality of Upper Extremity Skills Test (QUEST) and the Manual Ability Classification System (MACS) were used to evaluate upper motor function. RESULTS: All subdomain and total scores of QUEST were significantly improved after mPBMC and placebo infusion, without significant differences between mPBMC and placebo groups. A month after G-CSF, all subdomain and total scores of QUEST were improved. The level of MACS remained unchanged in both mPBMC and placebo groups. CONCLUSION: In this study, intravenously infused mPBMC showed no significant effect on upper extremity function in children with CP, as compared to placebo. The effect of mPBMC was likely masked by the effect of G-CSF, which was used in both groups and/or G-CSF itself might have other neurotrophic potentials in children with CP.
Cerebral Palsy* ; Child* ; Classification ; Follow-Up Studies ; Granulocyte Colony-Stimulating Factor ; Humans ; Infusions, Intravenous* ; Male ; Masks ; Parents ; Peripheral Blood Stem Cell Transplantation ; Upper Extremity*

PURPOSE: Although follicular thyroid cancer (FTC) has a relatively fair prognosis, distant metastasis sometimes results in poor prognosis and survival. There is little understanding of the mechanisms contributing to the aggressiveness potential of thyroid cancer. We showed that hypoxia inducible factor-1alpha (HIF-1alpha) induced aggressiveness in FTC cells and identified the underlying mechanism of the HIF-1alpha-induced invasive characteristics. MATERIALS AND METHODS: Cells were cultured under controlled hypoxic environments (1% O2) or normoxic conditions. The effect of hypoxia on HIF-1alpha, and epithelial-to-mesenchymal transition (EMT) related markers were evaluated by quantitative real-time PCR, Western blot analysis and immunocytochemistry. Invasion and wound healing assay were conducted to identify functional character of EMT. The involvement of HIF-1alpha and Twist in EMT were studied using gene overexpression or silencing. After orthotopic nude mouse model was established using the cells transfected with lentiviral shHIF-1alpha, tissue analysis was done. RESULTS: Hypoxia induces HIF-1alpha expression and EMT, including typical morphologic changes, cadherin shift, and increased vimentin expression. We showed that overexpression of HIF-1alpha via transfection resulted in the aforementioned changes without hypoxia, and repression of HIF-1alpha with RNA interference suppressed hypoxia-induced HIF-1alpha and EMT. Furthermore, we also observed that Twist expression was regulated by HIF-1alpha. These were confirmed in the orthotopic FTC model. CONCLUSION: Hypoxia induced HIF-1alpha, which in turn induced EMT, resulting in the increased capacity for invasion and migration of cells via regulation of the Twist signal pathway in FTC cells. These findings provide insight into a possible therapeutic strategy to prevent invasive and metastatic FTC.
Adenocarcinoma, Follicular/*genetics/metabolism ; Animals ; Anoxia/*genetics ; Cadherins/genetics ; Epithelial-Mesenchymal Transition/*genetics ; Gene Expression Regulation, Neoplastic ; Hypoxia-Inducible Factor 1, alpha Subunit/*genetics/metabolism ; Lymphokines ; Mice ; Neoplasm Invasiveness ; Phenotype ; Real-Time Polymerase Chain Reaction ; Signal Transduction/drug effects ; Thyroid Neoplasms/*genetics/metabolism ; Transcriptional Activation ; Twist Transcription Factor/*genetics/metabolism ; Vimentin/metabolism

BACKGROUND/AIMS: This study compared the clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent (SEMS) in patients with malignant colorectal obstruction. METHODS: In total, 111 patients were retrospectively enrolled in this study between January 2003 and June 2011 at Seoul National University Boramae Hospital. Technical and clinical success rates, complication rates, and stent patency were compared between using an endoscopic (n=73) or radiologic (n=38) method during the SEMS placement procedure. RESULTS: The technical success rate was higher in the endoscopic method than in the radiologic method (100% [73/73] vs. 92.1% [35/38], respectively; p=0.038). In addition, in 3 of the remaining 35 patients in the radiologic-method group, adjuvant endoscopic assistance was required. In the six patients (including the three aforementioned patients), the causes of technical failure were the inability to pass the guidewire into an obstructive lesion due to a tortuous, curved angulation of the sigmoid or descending colon (n=4), and a difficult approach to a lesion located at the descending or transverse colon (n=2). The clinical success rate, complication rate, and stent patency did not differ significantly between the two methods (p=0.424, 0.303, and 0.423, respectively). CONCLUSIONS: When the colorectal obstruction had a tortuous, curved angulation of the colon or was located at or proximal to the descending colon, the endoscopic method of SEMS placement appears to be more useful than the radiologic method. However, once SEMS placement was technically successful, the clinical success rate, complication rate, and stent patency did not differ with the method of insertion.
Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Colorectal Neoplasms/complications/*diagnosis ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction/*diagnosis/etiology/therapy ; Male ; Metals/chemistry ; Middle Aged ; Palliative Care/*methods ; Retrospective Studies ; *Stents ; Treatment Outcome