Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartments, including abdominal ascites, pleural effusions, pericardial effusions, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was hystorically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. We have experienced a case of nonimmune hydrops fetalis at 32 weeks of gestation in a 27-year-old woman and reported that with brief review of related literatures.
Adult ; Ascites ; Edema ; Female ; Fetus ; Humans ; Hydrops Fetalis* ; Immunoglobulins ; Pericardial Effusion ; Pleural Effusion ; Pregnancy ; Skin

Ectopia cordis is defined as a congenital malposition of the heart partially or completely outside the thorax and often associated with sternal and congenital heart defects:surgical repair is generally unsuccessful because of the magnitude of the deformity and the associat-ed intracardiac anormalies. Four types of ectopia cordis are described : cervical, thoracic, abdominal and thoracoa- bdominal. Cervical and thoracic type are often fatal within days, because the heart is expo- sed and malformed. Abdominal type carries a better prognosis because cardiac abnormalities are less often found. The prognosis of thoraco-abdominal type mainly depends on the pre- sence of intracardiac abnormalities. We have experienced a case of thoracic ectopia cordis at 25 weeks' gestation by ultra- sonography, so present the case and the review with literature briefly.
Congenital Abnormalities ; Ectopia Cordis* ; Heart ; Pregnancy ; Prenatal Diagnosis* ; Prognosis ; Thorax

PURPOSE: Although subintimal angioplasty (SIA) has been advocated to treat chronic lower extremity arterial occlusions, numerous reports have described differences in its results. We evaluated the effect of SIA in a group of patients with severe lower extremity arterial occlusive disease. METHOD: During a 5-month period, 6 limbs in 4 patients with arterial occlusions (mean length, 17.7 cm; range, 9 to 27 cm) were treated with SIA. Three limbs had gangrene, and all patients had resting pain. There were two external iliac-superficial femoral, two superficial femoral-popliteal and two femoral-popliteal-tibial artery lesions. With fluoroscopic guidance, via an antegrade common femoral artery puncture, a subintimal dissection plane was created across the occlusion with standard hydrophilic guidewire and catheter. The arterial lumen was reentered distal to the occlusion, and the recanalized segment was balloon (3 to 6 mm) dilated. RESULT: SIA was technically successful in all 6 limbs (100%). Pain was completely resolved and all areas of gangrene were healed. The mean increase in ankle-brachial index after SIA was 0.51 (range, 0.25 to 0.71). There was no significant complication related with SIA and all arteries were patent during 3.6-months mean follow-up period. CONCLUSION: SIA for long occlusions of the crural arteries is safe and effective and can be an excellent alternative to reconstructive surgery in elderly and frail patients.
Aged ; Angioplasty* ; Ankle Brachial Index ; Arterial Occlusive Diseases ; Arteries ; Catheters ; Extremities ; Femoral Artery ; Follow-Up Studies ; Gangrene ; Humans ; Lower Extremity* ; Punctures

BACKGROUND: There are some previous reports about partial D in Korea. However, the frequency of the partial D in Korea is still unknown. In this study, subtypes of partial D were analyzed by the use of various commercially available anti-D reagents. METHODS: We collected 273 cases determined as RhD negative by RhD typing using the tube method with monoclonal IgM/IgG anti-D reagent (Bioscot. Livingston, UK) from 80,062 cases that were screened between January 2004 and August 2007. The cases were divided into three periods (I, II, III), according to the manufacturers and numbers of anti-D reagents used. A weak D test was performed by using the tube method with various anti-D reagents. The cases with different reactivity between anti-D reagents were determined as partial D, and further analyzed the subtypes by reactivity patterns according to the target epitope of anti-D reagents. An additional test using the ID-Partial D Typing Card (DiaMed, Cressier, Switzerland) was conducted during period III. RESULTS: Five cases showed reactivity patterns of weak D and 16 cases showed reactivity patterns of partial D. Ten cases of partial D were typed as DVI and three cases were typed as DFR. During period III, five cases were typed as DVI and one case was typed as DFR. These results were different from the results obtained with the use of the ID-Partial D Typing Card. CONCLUSION: DVI, which is the most common subtype of partial D, is also common in Korea. Therefore, RhD typing and a weak D test should be performed using combined anti-D reagents that enable the differentiation of DVI from other subtypes.
Indicators and Reagents* ; Korea

Aberrant right subclavian artery (ARSA) is a rare congenital anomaly but is the most common of the congenital vascular anomalies of the aortic arch. We report the case of a 68-year-old female undergoing chemotherapy for multiple myeloma who had a large thoracic aortic aneurysm (7.4 cm) with ARSA. She was treated with a hybrid procedure that combined a left common carotid-to-subclavian artery bypass with a "thoracic endovascular aortic repair (TEVAR)" because of the risk associated with a thoracotomy. A stent graft was deployed in the proximal part of the descending aorta to cover the thoracic aortic aneurysm after a left common carotid-to-subclavian bypass was made to restore blood flow in the left arm. There was no endoleak on digital subtraction angiography. Hybrid therapy can be performed successfully for the treatment of thoracic aortic aneurysm with ARSA.
Aged ; Aneurysm* ; Angiography, Digital Subtraction ; Aorta ; Aorta, Thoracic* ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Arm ; Arteries ; Blood Vessel Prosthesis ; Drug Therapy ; Endoleak ; Female ; Humans ; Methods ; Multiple Myeloma ; Stents ; Subclavian Artery* ; Thoracotomy

Ael is a rare blood type which has the least amount of A antigen among A subgroups. It can be detected by special tests performed to resolve the discrepancy between red cell and serum typing in routine serological typing. The presence of A antigen on Ael red cell is demonstrable only by adsorption and elution tests. An Ael individual does not secret A substance in the saliva and may have anti-A antibody in the serum which is usually less reactive with the reagent red cells than anti-B antibody. In Korea, Ael02 has been reported more frequently than other Ael alleles. We report a case of Ael02/O04 who presented as typical phenotype O with strong anti-A and anti-B antibodies and no A antigen detected even by adsorption and elution tests. The case has been proved to be Ael02/O04 by direct sequencing analysis. In individuals with history of discrepancies in the results of ABO phenotyping, ABO genotyping is needed for an accurate evaluation of their blood type.
ABO Blood-Group System/classification/*genetics ; Alleles ; Child ; Genotype ; Heterozygote ; Humans ; Male ; Pedigree ; Phenotype ; Sequence Analysis, DNA

BACKGROUND: Hepatitis B Virus (HBV) is a major risk factor for hepatocellular carcinoma, and about five to six percents of people are infected with HBV in Korea. Lamivudine is a first-line drug having good control against HBV replication, but long-term treatment by lamivudine induces drug resistance. We analyzed the rate of HBV resistance mutation for lamivudine by direct sequencing and CLIP sequencing. METHODS: HBV DNA was isolated from 371 patients who were in treatment, or were planning to be treated with lamivudine. The direct sequencing for lamivudine resistance mutation was performed in 371 patients and CLIP sequencing in 138 patients. We analyzed the mutation rate and the type of mutations for lamivudine resistance. RESULTS: The mutation was detected in 203 patients (54.7%) and (CTG) L180M (ATG) was most common (36.1%) followed by (ATG) M204I (ATT) (29.9%) and (ATG) M204V (GTG) (18.6%). According to the duration of treatment, mutation rates were as follows: 45.3% for less than one year, 71.7% for one to two years, 66.7% for two to three years, and 87.9% for more than three years. The results of the direct sequencing and CLIP sequencing agreed in 134 out of 138 patients, in whom both tests were performed. CONCLUSIONS: We confirmed that HBV mutation rates for lamivudine resistance increased as the lamivudine treatment period increased. The lamivudine resistance mutations detected were similar to the previous studies. CLIP sequencing showed good correlation with the direct sequencing and gave additional mutation information. CLIP sequencing is a promising tool for the detection of lamivudine resistance mutation in HBV that can assist treatment plans.
Carcinoma, Hepatocellular ; DNA ; Drug Resistance ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Lamivudine ; Mutation Rate ; Risk Factors

Nitric acid is an oxidizing agent used in metal refining and cleaning, electroplating, and other industrial applications. Its accidental spillage generates oxides of nitrogen, including nitric oxide (NO) and nitrogen dioxide (NO2), which cause chemical pneumonitis when inhaled. The clinical presentation of a nitric acid inhalation injury depends on the duration and intensity of exposure. In mild cases, there may be no symptoms during the first few hours after exposure, or the typical symptoms of pulmonary edema can appear within 3-24 hours. However, in cases of prolonged exposure, progressive pulmonary edema develops instantaneously and patients may not survive for more than 24 hours. We report a case of a 44-year-old male who was presented with acute respiratory distress syndrome after nitric acid inhalation. He complained of cough and dyspnea of a sudden onset after inhaling nitric acid fumes at his workplace over a four-hour period. He required endotracheal intubation and mechanical ventilation due to fulminant respiratory failure. He was managed successfully with mechanical ventilation using positive end expiratory pressure and systemic corticosteroids, and recovered fully without any deterioration in his pulmonary function.
Adrenal Cortex Hormones ; Adult ; Cough ; Dyspnea ; Electroplating ; Humans ; Inhalation* ; Intubation, Intratracheal ; Male ; Nitric Acid* ; Nitric Oxide ; Nitrogen ; Nitrogen Dioxide ; Oxides ; Pneumonia ; Positive-Pressure Respiration ; Pulmonary Edema ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency

Clinical criteria have been established for idiopathic hypereosinophilic syndrome (HES): persistent eosinophilia of 1500 eosinophils/mm3 for at least 6 months or death even within 6 months with signs and symptoms of HES; no evidence for parasitic, allergic, or other recognized causes of eosinophilia despite careful evaluation; and signs and symptoms of organ system involvement or dysfunction, such as congestive heart failure, hepatosplenomegaly, central nerveous system disease. Because cerebral hemorrhage in HES has not been reported yet in Korea, we report a case of hypereosinophilic syndrome with peripheral blood eosinophilia, with biopsies of skin and duodenum showing diffuse eosinophilic infiltration, and multiple organ dysfunction in a 49 year old man died of cerebral hemorrhage three months after the occurrence of the disease.
Biopsy ; Cerebral Hemorrhage ; Duodenum ; Eosinophilia ; Eosinophils ; Heart Failure ; Humans ; Hypereosinophilic Syndrome* ; Intracranial Hemorrhages* ; Korea ; Middle Aged ; Polyradiculoneuropathy* ; Skin

PURPOSE: Respiratory syncytial virus (RSV) is one of the main pathogens causing lower respiratory infections (LRI) in young children, usually of limited severity. However, in congenital heart disease (CHD) patients, one of the high-risk groups for RSV infection, RSV can cause serious illnesses and fatal results. To elucidate the effects of RSV infection in CHD patients, we observed RSV infection cases among CHD patients and non-CHD patients. METHODS: On admission of 343 LRI patients over 3 years, 77 cases of RSV infection were detected by the RSV antigen rapid test of nasopharyngeal secretion. We compared RSV infection cases among groups of CHD and non-CHD patients. RESULTS: During the winter season, RSV caused 20-50% of LRI admissions in children. In patients with completely repaired simple left to right (L-R) shunt diseases such as ventricular septal defect, atrial septal defect, and patent ductus arteriosus, RSV infections required short admission days similar to non-CHD patients. In patients with repaired CHD other than simple L-R shunt CHD, for whom some significant hemodynamic problems remained, RSV infection required long admission days with severe clinical course. In children with unrepaired CHD, RSV infection mostly occurred in early infant age, with long admission days. RSV infections within a month after cardiac surgery also required long admission days and severe clinical course. CONCLUSION: To avoid the tragedic outcome of severe RSV infection in the CHD patients, efforts to find the subgroups of CHD patients at high risk to RSV infection are needed, and effective preventive treatment should be applied.
Antibodies, Monoclonal, Humanized ; Bronchiolitis ; Child ; Ductus Arteriosus, Patent ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Infant ; Pneumonia ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Seasons ; Thoracic Surgery ; Palivizumab