Purpose: The diagnostic usefulness of fetal echocardiography in congenital heart disease is well known. One of the indications for fetal echocardiography is presence of extracardiac anomalies and such coexistent congenital heart disease may have important implications for obstetric and neonatal management. MATERIALS AND METHODS: 496 women with singleton pegnancies with amgenital anomalies that underwent penatal care and follow-up in Severance Hospital for 5 years from 1991 to 1995 were evaluated for the incidence of congenital heart disease. RESULTS: The incidence of congenital heart disease in fetuses with the associated extracardiac anomalies were as follows; central nervous system 6.9%(11/160), gastro-intestinal system 10.7%(8/75), genito-urinary sysem 4.7%(4/85), others 5.6%(4/72). Thirty-one of eighty-ane fetuses with congenital heart disease were found to have the associated extracardidac anomalies and ten of them chenoscenal abnormalities. CONCLUSION: We recommend that fetuses with congenital extracardiac anomalies sbould be checked for the presence of congenital heart disease and chmmosomal abnormalities, if needed.
Central Nervous System ; Echocardiography ; Female ; Fetus ; Follow-Up Studies ; Heart Defects, Congenital* ; Humans ; Incidence

This study was carried out to investigate the development rates of human embryos co-cultured with cumulus cells to each blastocyst stage. Human zygotes were co-cultured on cumulus cell monolayer in YS medium supplemented with 20% hFF. On day 2, if patient had four or more 'good' embryos(regular blastomeres without fragmentation), embryos were further cultured for 72hrs. Blastocysts on day 5 were classified into early blastocyst (ErB), early expanding blastocyst (EEB), middle expanding Blastocyst (MEB), and expanded blastocyst (EdB) on the basis of their morphological aspects of trophectoderm cells and blastocoele. Subsequently, maximum 3 of best blastocysts were transferred in 486 cycles. The results in this study were as follows: Patients who had four or more 'good' embryos on day 2 were 498 persons, but patients whose embryos could not be transferred due to failure in development to the blastocyst stage on day 5 were 12 persons (2.4%). The development rate of embryos to the blastocyst stage was 58.2% (2,885/4,957) on day 5, and the rates that developed to the ErB, EEB, MEB, and EdB stage were 15.0% (743/4,957), 14.9% (739/4,957), 14.4% (714/4,957), and 13.9% (689/4,957), respectively. Total 1366 blastocysts were transferred in 486 cycles (mean number=2.81). The implantation rate and the ongoing implantation rate obtained by observing the number of G-sac and FHB were 29.9% (409/1,366) and 22.5% (308/1,366), respectively. The clinical pregnancy rate was 51.2% (249/486), and the ongoing pregnancy rate was 39.1% (190/486). Among women showing ongoing pregnancy, women with singleton were 50% (95/190), women with twin were 37.9% (72/190), and women with triplet were 12.1% (23/190). Although triplet pregnancy rate in this study was high such as 12.1%, because many blastocysts with high viability were produced in our co-culture system using cumulus cells on day 5, we really believe that a multiple pregnancy except twin should not occur by selecting good embryos for maximum two blastocyst transfer. These results demonstrate that autologous cumulus cells may be used for the production of blastocysts with high developmental competence, and the use of autologous cumulus cells to be collected easily, and to be treated conveniently at OPU must be an effective means for obtaining high implantation and pregnancy rate.
Blastocyst* ; Blastomeres ; Coculture Techniques* ; Cumulus Cells* ; Embryo Transfer ; Embryonic Structures* ; Female ; Humans* ; Mental Competency ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Pregnancy, Triplet ; Triplets ; Zygote

Purpose: The purpose of this study is three-fold: 1) to evaluate factors influencing hearing aid (HA) satisfaction; 2) to provide a profile of HA satisfaction in daily life; and 3) to examine the reasons why people gave up using HAs. Materials and Methods: Data for 1148 respondents were statistically analyzed and reported. Results: In the study, age (β=-0.03, p<0.01), level of education (β=1.21, p<0.01), HA purchase price (β=1.50, p<0.01), bilateral amplification (β=1.23, p<0.01), wearing time (β=0.28, p<0.01), and HA fitting and fine tuning on a regular basis (β=1.71, p<0.01) significantly influenced HA satisfaction. In addition, the authors observed that the most satisfactory factors were clarity of sound (53.5%), people’s trust in their HA (61.7%), and listening from a quiet environment (72.8%) in the domains of sound quality, HA features, and listening environments, respectively. Finally, with multiple choices being possible, 65% of the 40 respondents who no longer used HAs answered that their HAs ended up in a drawer since the background noise was annoying and distracting. Conclusion This study is significant in that it is a large-scale multi-center research to comprehensively examine the factors influencing HA satisfaction in South Korea. This data will provide helpful information that could lead to the successful rehabilitation of hearing loss with HAs.

Background: To estimate the prevalence of Sjögren's syndrome (SS) in patients with rheumatoid arthritis (RA) and to compare the clinical features of RA patients with and without SS. Methods: We conducted a retrospective study of RA patients who visited a rheumatology clinic in a tertiary referral hospital in Korea between May 20 and July 22, 2016. All patients fulfilled the classification criteria for RA, and the diagnosis of SS was made clinically by rheumatologists and according to the 2002 American-European Consensus Group (AECG), 2012 American College of Rheumatology (ACR), and 2016 ACR/European League Against Rheumatism (EULAR) classification criteria. The prevalence was estimated as the number of SS patients within the total number of RA patients. The disease activity and treatment pattern of RA were compared between patients with and without SS. Results: Among 827 RA patients, 72 patients (8.7%) were diagnosed with SS by a rheumatologist, though only 60 patients (7.3%) satisfied the 2002 AECG classification criteria for SS. Fifty-two patients (6.3%) and 56 patients (6.8%) fulfilled the 2012 ACR and 2016 ACR/EULAR classification criteria, respectively. The prevalence of SS in RA patients was 10.5%, 17.0%, and 67.6% in rheumatoid factor, antinuclear antibody (≥ 1:80), and anti-Ro antibody positive patients, respectively. Conclusion The prevalence of SS among RA patients was 8.7% according to rheumatologists' diagnosis. The presence of SS did not affect the treatment patterns of RA patients. However, the autoantibody profiles and demographics of RA patients with SS differed from those of patients without SS.

PURPOSE: L-asparaginase is a crucial chemotherapeutic agent for the treatment of acute lymphoblastic leukemia. However, hypersensitivity to L-asparaginase is common which limits its clinical use. METHODS: We performed 44 cases of premedication and 3 cases of desensitization in 16 patients with hypersensitivity to L-asparaginase. RESULTS: With premedication, 33 cases completed L-asparaginase injection with no hypersensitivity reactions. Eleven cases showed mild hypersensitivity reactions, such as urticaria. Desensitization was performed in 3 cases: in 2 cases, desensitization was successful, and in 1 case the medication was switched to Erwinia asparaginase. CONCLUSION: Premedication and desensitization appear to be useful in helping patients receive desired doses of L-asparaginase in pediatric patients with acute lymphoblastic leukemia.
Asparaginase ; Desensitization, Immunologic ; Drug Hypersensitivity ; Erwinia ; Humans ; Hypersensitivity* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Premedication* ; Urticaria

Pseudo-Meigs' syndrome is a syndrome that includes hydrothorax and ascites secondary to ovarian tumors other than solid benign fibroma. In this report, we present the case of a 29-years-old female who complained of abdominal distension with peripheral edema during her third trimester. Two solid masses of 15 cm dimension in the left abdomen and 7 cm dimension in the right abdomen were detected by ultrasound and chest X-ray revealed right pleural effusion. Magnetic resonance imaging (MRI) confirmed the ovarian masses and ascites. As the patient had regular uterine contractions, we decided to perform emergency cesarean section because of previous cesarean section history. A laparotomy was performed and pathologists confirmed the presence of a metastatic adenocarcinoma. Four days following the surgery, gastroduodenoscopy revealed a huge ulcerofungating mass was visible in greater curvature of stomach. The final diagnosis was metastatic adenocarcinoma from gastric cancer. Although pseudo-Meigs' syndrome is very rare, it should be carefully considered when evaluating female complaining with ascites in ovarian tumor.
Abdomen ; Adenocarcinoma ; Ascites ; Cesarean Section ; Edema ; Emergencies ; Female ; Fibroma ; Humans ; Hydrothorax ; Laparotomy ; Magnetic Resonance Imaging ; Pleural Effusion ; Pregnancy ; Pregnancy Trimester, Third ; Stomach ; Stomach Neoplasms ; Thorax ; Uterine Contraction

OBJECTIVE: To determine the clinical significance of persistent left superior vena cava (PLSVC) in a fetus with and without cardiac and extra-cardiac anomalies. METHODS: This was a retrospective review of all cases of PLSVC detected prenatally at our institution between May 2001 and May 2008. This retrospective study included 85 fetuses with PLSVC who were diagnosed based on the presence of an additional vessel identified to the left of the pulmonary artery in the three-vessel view of the heart. Patient charts and recorded images were reviewed in order to identify associated conditions and outcomes. Telephone interviews were conducted to check patients' conditions in cases of isolated PLSVC. RESULTS: Eighty-five cases of PLSVC were detected prenatally during this study period. Of these 85 fetuses, 11 were aborted due to associated, prenatally proven, severe congenital heart anomalies or chromosomal anomalies, and 52 fetuses were delivered. The cases for other 22 fetuses were lost to follow-up. Postnatal echocardiography was performed in the 33, surviving patients, and PLSVC was confirmed in 32 of these patients. The most common associated congenital cardiac anomalies were seen included VSD, AVSD, and DORV (54.1%, 17.6% and 17.6%, respectively) (Table 3). PLSVC was also seen in seven cases (8.2%) of right isomerism and in four cases (4.7%) of left isomerism. In only two cases was the coexistence of PLSVC and extra-cardiac anomalies noted in this study. Fifteen cases were prenatally diagnosed as isolated PLSVC and all of them had live births. The follow-up period in our isolated PLSVC patients ranged from 0.5 to 84 months (Mean 24.5 months). Thirteen of these infants were doing well at the time of preparing this document and one case was diagnosed as TAPVR on postnatal echocardiography and one case was lost to follow-up. CONCLUSION: We strongly suggest that PLSVC is a benign vascular malformation and does not affect to the patient after birth. However, PLSVC is frequently associated with heterotaxy syndromes as well as other cardiac malformations and can be misdiagnosed as TAPVR. So if we find PLSVC in prenatal ultrasonography, meticulous inspection of the fetal anatomy must be performed.
Echocardiography ; Female ; Fetus ; Follow-Up Studies ; Glycosaminoglycans ; Heart ; Heterotaxy Syndrome ; Humans ; Infant ; Interviews as Topic ; Isomerism ; Live Birth ; Lost to Follow-Up ; Parturition ; Pregnancy ; Pregnancy Outcome ; Prenatal Diagnosis ; Pulmonary Artery ; Retrospective Studies ; Scimitar Syndrome ; Ultrasonography, Prenatal ; Vascular Malformations ; Vena Cava, Superior

BACKGROUND AND OBJECTIVES: Cardiovascular complications are the leading cause of morbidity and mortality in childhood cancer survivors. Hematopoietic stem cell transplantation (HSCT) is a curable therapy for pediatric cancer. However, changes in cardiac function in children after HSCT are not well known. We assessed left ventricular (LV) function in children after HSCT using speckle tracking echocardiography (STE). SUBJECTS AND METHODS: Forty consecutive patients with median age of 11.9 years (range, 1.5-16 years) who received HSCT for acute leukemia and had comprehensive echocardiography before and after (median 9.2 month) HSCT were included in this study. The LV function parameters including conventional tissue Doppler imaging (TDI) and STE data were collected from pre- and post-HSCT echocardiography. These data were compared to those of 39 age-matched normal controls. RESULTS: Compared to normal controls, post HSCT patients had similar (p=0.06) LV ejection fraction. However, the following three LV function parameters were significantly decreased in post HSCT patients: rate-corrected velocity of circumferential fiber shortening (p=0.04), mitral inflow E velocity (p<0.001), and mitral septal annular E' velocity (p=0.03). The following four STE parameters were also significantly decreased in post HSCT patients: LV global circumferential systolic strain (p<0.01), strain rate (SR, p=0.01), circumferential diastolic SR (p<0.01), and longitudinal diastolic SR (p<0.001). There was no significant change in TDI or STE parameters after HSCT compared to pre-HSCT. Patients with anthracycline cumulative dose >400 mg/m2 showed significantly (p<0.05) lower circumferential systolic strain and circumferential diastolic SR. CONCLUSION: Subclinical cardiac dysfunction is evident in children after HSCT. It might be associated with pre-HSCT anthracycline exposure with little effect of conditioning regimens. Serial monitoring of cardiac function is mandatory for all children following HSCT.
Case-Control Studies* ; Child* ; Echocardiography* ; Hematopoietic Stem Cell Transplantation* ; Humans ; Leukemia* ; Mortality ; Stem Cell Transplantation ; Survivors ; Ventricular Dysfunction, Left*

OBJECTIVES: The aim of this study is to develop guidelines for psychosocial treatment of alcohol use disorder. METHODS: According to the ADAPTE manual, the Korean alcohol use disorder treatment guidelines were developed by the guideline development committee. Recommendations from foreign guidelines were evaluated regarding the applicability and acceptability to domestic circumstances. In addition, a survey from experts was conducted, along with a review of Korean literature. By these means, recommendations of psychosocial treatment for alcohol use disorder were established. RESULTS: The main findings of the survey were as follows : 1) Although Group therapy was not recommended by foreign clinical guidelines, it was considered as a first-line treatment by Korean experts. 2) Among many psychosocial treatment programs, cognitive behavior therapy (CBT), coping skills training, 12-step facilitation, and Group therapy were commonly used programs in Korea. Finally, the following treatment methods were selected for recommendations : Group therapy, motivational enhancement treatment, CBT, behavioral self-management, alcoholic anonymous, 12-step facilitation, psychodynamic psychotherapy, psychoeducational intervention, continuous case management, and community residential rehabilitation program. CONCLUSION: Just as in treatment of chronic diseases such as hypertension, continuity is important for management of alcohol use disorder. Therefore, not only pharmacological treatment but also psychosocial treatment should be provided comprehensively after treatment of acute withdrawal symptoms.
Adaptation, Psychological ; Alcoholics ; Anonyms and Pseudonyms ; Case Management ; Chronic Disease ; Cognitive Therapy ; Humans ; Hypertension ; Korea ; Psychotherapy, Group ; Psychotherapy, Psychodynamic ; Rehabilitation ; Self Care ; Substance Withdrawal Syndrome

PURPOSE: The use of cyclosporine and mini-dose methotrexate (MTX) is a common strategy for graft-versus-host disease (GVHD) prophylaxis in allogeneic transplants. We investigated whether patients who receive fewer than the planned MTX doses are at increased risk for GVHD. METHODS: The study cohort included 103 patients who received allogeneic transplants at the Department of Pediatrics of The Catholic University of Korea College of Medicine, from January 2010 to December 2011. MTX was administered on days 1, 3, 6, and 11 after transplant at a dose of 5 mg/m2 each. Within the cohort, 76 patients (74%) received all 4 doses of MTX [MTX(4) group], while 27 patients (26%) received 0-3 doses [MTX(0-3) group]. RESULTS: Although there was no difference in neutrophil engraftment between the 2 groups, platelet engraftment was significantly faster in the MTX(4) group (median, 15 days), compared to the MTX(0-3) group (median, 25 days; P=0.034). The incidence of grades II-IV acute GVHD was not different between the MTX(4) and MTX(0-3) groups (P=0.417). In the multivariate study, human leukocyte antigen mismatch was the most significant factor causing grades II-IV acute GVHD (P=0.002), followed by female donor to male recipient transplant (P=0.034). No difference was found between the MTX(4) and MTX (0-3) groups regarding grades III-IV acute GVHD, chronic GVHD, and disease-free survival. CONCLUSION: Our results indicate that deviations from the full dose schedule of MTX for GVHD prophylaxis do not lead to increased incidence of either acute or chronic GVHD.
Appointments and Schedules ; Blood Platelets ; Child* ; Cohort Studies ; Cyclosporine ; Female ; Graft vs Host Disease* ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Korea ; Leukocytes ; Male ; Methotrexate* ; Neutrophils ; Pediatrics ; Tissue Donors