Fetal bilateral renal agenesis is a lethal congenital anomaly characterized by bilateral pulmonary hypoplasia, deformities and death due to severe oligohydramnios. This syndrome is associated with malformations of genitourinary tract, cardiovascular system, vertebral bodies or imperforated anus in more than half of the affected individuals. An early and reliable prenatal diagnosis is extremely important because it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, empty renal fossae. But poor sonographic resolution of severe oligohydramnios makes it difficult to diagnose the disease. We present a case of bilateral renal agenesis diagnosed at the 32nd weeks gestation by using color doppler and "lying down" adrenal sign.
Anal Canal ; Cardiovascular System ; Congenital Abnormalities ; Diagnosis ; Female ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography ; Urinary Bladder

PURPOSE: This study evaluated the safety and feasibility of gasless laparoscopic assisted transumbilical appendectomy (GLATUA). METHODS: Data for 62 GLATUA and 84 laparoscopic appendectomies (LA) for uncomplicated appendicitis, which had been performed over a 12 month period in a single institution, were compared retrospectively. The GLATUAs were carried out through an umbilical incision. The abdominal wall was retracted upward using an "L"-shaped retractor and the inflamed appendix was found by gasless laparoscopic vision. A transumbilical extracorporeal appendectomy was then performed. The LAs were performed using a three-port system. RESULTS: The GLATUA group had a shorter mean operative time (44.1+/-22.1 vs. 51.5+/-24.7 min, p=0.06), mean time for resuming a soft diet (29.0+/-9.2 vs. 41.3+/-20.7 hrs, p<0.01) and hospital stay (3.0+/-0.9 vs. 3.6+/-1.7, p<0.01) than the LA group. There was no significant difference in complication rates (6.5% vs. 3.6%, p=0.44). The mean medical costs of the GLATUA group were 66.7% of the LA group. CONCLUSION: GLATUA is a safe, feasible and more cost-effective alternative technique for surgery in uncomplicated acute appendicitis than LA.
Abdominal Wall ; Appendectomy ; Appendicitis ; Appendix ; Diet ; Length of Stay ; Operative Time ; Retrospective Studies ; Vision, Ocular

In previous studies, we found that the consumption of legumes decreased bone turnover in ovariectomized rats. The purpose of the present study is to determine whether the protective effects on bone mineral density (BMD) and the microarchitecture of a diet containing legumes are comparable. In addition, we aim to determine their protective actions in bones by studying bone specific gene expression. Forty-two Sprague-Dawley rats are being divided into six groups during the 12 week study: 1) rats that underwent sham operations (Sham), 2) ovariectomized rats fed an AIN-93M diet (OVX), 3) ovariectomized rats fed an AIN-93M diet with soybeans (OVX-S), 4) ovariectomized rats fed an AIN-93M diet with mung beans (OVX-M), 5) ovariectomized rats fed an AIN-93M diet with cowpeas (OVX-C), and 6) ovariectomized rats fed an AIN-93M diet with azuki beans (OVX-A). Consumption of legumes significantly increased BMD of the spine and femur and bone volume of the femur compared to the OVX. Serum calcium and phosphate ratio, osteocalcin, expression of osteoprotegerin (OPG), and the receptor activator of nuclear factor kappaB ligand (RANKL) ratio increased significantly, while urinary excretion of calcium and deoxypyridinoline and expression of TNF-alpha and IL-6 were significantly reduced in OVX rats fed legumes, compared to OVX rats that were not fed legumes. This study demonstrates that consumption of legumes has a beneficial effect on bone through modulation of OPG and RANKL expression in ovariectomized rats and that legume consumption can help compensate for an estrogen-deficiency by preventing bone loss induced by ovarian hormone deficiency.
Amino Acids ; Animals ; Bone Density ; Calcium ; Cytokines ; Diet ; Fabaceae ; Femur ; Gene Expression ; Interleukin-6 ; Osteocalcin ; Osteoprotegerin ; RANK Ligand ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Soybeans ; Spine ; Tumor Necrosis Factor-alpha

PURPOSE: The present study was undertaken to compare the function of the urinary bladder, reflex changes of the urinary bladder, and bladder outlet, during micturition between mature male and female rats. MATERIALS AND METHODS: Mature male(n=6) and female(n=6) Sprague-Dawley rats weighing 250 to 300gm were used. After each rat was anesthetized with urethane(1g/kga simultaneous recording of the intravesical pressure and voided urinary volume during micturition were recorded. And then, the urethra was ligated placing 4-0 silk tie just distal to the bladder neck. Isovolumetric bladder contractions and urethral pressure were recorded independently. RESULTS: The voided volume and intravesical pressure during micturltion showed no significant differences between mature fema1e and male rats. During reflex bladder contraction, isovolumetric bladder contractions and urethral pressure also showed no significant differences between mature female and male rats. Administration of N-nitro-L-arginine(L-NOARG, 15mg/kg), a nitric oxide synthase inhibitor, intravenously in female rats, reversibly decreased the magnitude(42.5%, p<0.05) and duration(35.4%, p<0.05) of reflex urethral relaxation. There was no effect on reflex urethral relaxation in male rats. Administration of L-NOARG 20mg/kgintravenously in male rats reversibly decreased the magnitude(49.8%, p<0.05) and duration(38.7%, p<0.05) of reflex urethral relaxation. CONCLUSIONS: From the results, it appears that the function of the urinary bladder and the reflex change of the urinary bladder and bladder outlet during micturition showed no significant difference between male and female rats of similar weight. Howerever, the dosage of L-NOARG showed difference of the decreasing level of the magnitude and duration of the urethral relaxation.
Animals ; Female* ; Humans ; Male* ; Neck ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats* ; Rats, Sprague-Dawley ; Reflex ; Relaxation ; Silk ; Urethra ; Urinary Bladder* ; Urination

Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease that frequently involves the joints at some stage during the disease course. Although lupus arthritis is usually non-erosive, approximately 5% of patients develop erosions. This paper reports a patient with SLE combined with erosive arthritis, who was treated successfully with tocilizumab. A 20-year-old female, who was first diagnosed with SLE at the age of 13 years, had been admitted frequently to hospital with disease flare-ups during the previous 3 years. Despite aggressive treatment, her arthritis became aggravated, particularly in both wrists and the right knee. Radiologically, erosive arthritis was noted in the wrists.The serum interleukin (IL)-6 level was elevated significantly along with the other inflammatory markers. After the tocilizumab treatment, the arthritis subsided with a normalization of the IL-6 level, suggesting that tocilizumab may be a suitable treatment for lupus erosive arthritis if the IL-6 level is high.
Arthritis* ; Female ; Humans ; Interleukin-6 ; Interleukins ; Joints ; Knee ; Lupus Erythematosus, Systemic* ; Wrist ; Young Adult

BACKGROUND/AIMS: The standard treatment for chronic hepatitis C infected with hepatitis C virus (HCV) genotype 1 is a combination of pegylated interferon alfa and ribavirin over a 48 weeks period. It is unclear if 24 weeks treatment is possible for patients showing a rapid virological response (RVR) without compromising the sustained virological response (SVR) in Korea. METHODS: Between June 2005 and September 2008, among patients chronically infected with the HCV genotype 1 who were treated with pegylated interferon alfa subcutaneously once weekly plus ribavirin based on body weight, 55 patients who had low pretreatment viral load (<600,000 IU/mL) and RVR were enrolled. A total of 55 patients were divided into 24 weeks treatment group (n=29) and the standard treatment group (n=26). The HCV RNA was quantitatively assessed before treatment, and after 12 weeks of treatment, and also qualitatively assessed after 4 weeks of treatment, at end of treatment (24 weeks), and 24 weeks after end of treatment. RVR was defined as undetectable HCV RNA at the 4 weeks of treatment. RESULTS: Among the 55 patients, SVR was achieved in 100% (29/29) of the patients in 24 weeks treatment and 96.2% (25/26) of the patients in the standard treatment (p=0.473). CONCLUSIONS: HCV genotype 1 infected patients with a low baseline HCV RNA concentration who become HCV RNA negative at week 4 may be treated for 24 weeks without compromising sustained virlolgical response. However, an additional trial will be needed to optimize the treatment duration.
Adult ; Aged ; Antiviral Agents/*administration & dosage ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Genotype ; Hepacivirus/*genetics ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon Alfa-2a/*administration & dosage ; Interferon Alfa-2b/*administration & dosage ; Male ; Middle Aged ; Polyethylene Glycols/*administration & dosage ; RNA, Viral/blood ; Ribavirin/*administration & dosage ; Viral Load ; Viremia/diagnosis

PURPOSE: Pathophysiological causes of the development and progression of diabetic nephropathy are not well known, but the angiotensin-converting enzyme (ACE) gene polymorphism has been proposed to be involved in its development. To clarify risk factors for the development of microalbuminuria in Korean type 2 diabetes patients, a retrospective study on the last 10 years was conducted on outpatients with type 2 diabetes. METHODS: The impact of insertion/deletion (I/D) genotypes on the progression of diabetic nephropathy in 105 Korean type 2 diabetes patients with normoalbuminuria at diagnosis was investigated by retrospective review of clinical data. Polymorphisms of the ACE gene were examined. RESULTS: During the follow up over the last 10 years, 23 of 105 patients developed Microalbuminuria (21.9%). ACE genotypes were D/D 19.5%, D/I 41.5%, I/I 39% in microalbuminuria group, as compared with D/D 17.4%, I/D 26.1%, I/I 56.5% in normoalbuminuria group. Higher levels of mean HbA1c and mean triglyceride were noted in microalbuminuira group, as compared with those in normoalbuminuria group. Kaplan-Meier survival curve showed that higher HbA1c and higher triglyceride level were significant predictors to the development of Microalbuminuria, but I/D genotype of ACE gene did not affect. Cox regression model also showed that higher HbA1c and triglyceride were independent variables. CONCLUSION: The control of blood glucose or lipid, rather than the genetic factors such as ACE polymorphism, was considered to be more influential factor on the development of microalbuminuria in Korean patients with type 2 diabetes mellitus.
Blood Glucose ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Follow-Up Studies ; Genotype ; Humans ; Outpatients ; Peptidyl-Dipeptidase A ; Polymorphism, Genetic ; Retrospective Studies ; Risk Factors

BACKGROUND: Once daily dose of aminoglycoside has been used recently in the gram-negative infection for the purpose of improving efficacy. The clinical efficacy and side effects of once daily versus divided doses of gentamicin were compared in acute pyelonephritis. METHOD: Gentamicin (3-5mg/kg/day) was administered into 3 divided doses intravenously in 15 patients of the divided dose group, and the same dose was administered at a time in 19 patients of the once daily dose group. The duration of treatment was 6-14 days. RESULTS: The clinical outcome of all patients was favorable, and nephrotoxicity or ototoxicity was not detected in any patients. E. coli were isolated from 12 patients in the divided dose group, and 15 patients in the once daily dose group. They were all eradicated after treatment. The mean peak serum concentrations of gentamicin were 5.33+/-1.99;g/mL in the divided dose group, and 14.79+/-5.71g/mL in the once daily dose group. The trough concentrations were not different significantly between two groups(0.69+/-0.58;g/mL in the divided dose group vs. 0.35+/-0.45g/mL in the once daily dose group). The number of patients with peak concentration over 5.0g/mL was 8 out of 15 in the divided dose group. CONCLUSION: The once daily dose of gentamicin was as effective as the divided dose, and the nephrotoxicity or ototoxicity was not observed in both groups.
Gentamicins* ; Humans ; Pyelonephritis*

Primary non-Hodgkin's lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is extremely rare. A 60-year-old man was admitted due to suddenly developed jaundice. Computerized tomography and endoscopic retrograde cholangiopancreatography showed a tumor at the proximal common hepatic duct. These clinical and radiologic findings resembled those of Klatskin tumor. The resection of the common hepatic duct tumor, lymph node dissection, and Roux-en-Y hepaticojejunostomy were carried out. There was no regional lymph node metastasis and no residual tumor at the resection margins. Histology and immunohistochemistry of the resected specimen confirmed a diffuse large B-cell malignant lymphoma involving the common hepatic duct. The patient is scheduled to receive adjuvant chemotherapy. In summary, primary non-Hodgkin's lymphoma of the extrahepatic bile duct, despite its rarity, should be considered in the differential diagnosis of causes for obstructive jaundice. An accurate histopathologic diagnosis and surgical resection combined with chemotherapy may be the approach to offer a chance for cure.
Antigens, CD20/metabolism ; Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Cholangiopancreatography, Magnetic Resonance ; Diagnosis, Differential ; Humans ; Klatskin's Tumor/diagnosis ; Lymphoma, Large B-Cell, Diffuse/*diagnosis/pathology/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

Fibrous dysplasia (FD) is an uncommon skeletal disorder in which normal bone is replaced by abnormal fibro-osseous tissue. Mainly, FD is found in children, and by adulthood it usually becomes quiescent. Our case showed FD of more than 14-year duration in the left maxilla. Our evaluation was that growth ceased in adulthood and had achieved the static stage. Because FD cases in elderly patients are rarely reported, we hereby present a monostotic FD case in a 65-year-old female. We presented sequential radiographic images and scintigraphic images of this case, and combined them with a literature review that emphasized the progression of the disease.
Aged* ; Child ; Female* ; Fibrous Dysplasia, Monostotic ; Humans ; Maxilla* ; Radiography