Otocephaly is a rare malformations comprising hypoplasia or absence of the mandible (agnathia), ventromedial displacement and often fusion of external ears (synotia or otocephaly), and hypoplasia of the oral cavity (microstomia) and tongue (hypoglassia). This developmental complex represents a malformation of the first and second branchial arches and occurs sometimes with holoprosencephaly. We present the ultrasound detection of otocephaly and holoprosencephaly with cyclopia in a fetus of 27 gestational weeks 6 days. The use of three-dimensional (3-D) ultrasound made additional diagnostic ultrasound tomograms possible, and the volume reconstructions improved the imaging and the understanding of the condition.
Branchial Region ; Diagnosis* ; Ear, External ; Fetus ; Holoprosencephaly ; Mandible ; Mouth ; Tongue ; Ultrasonography

Risk factors for infective endocarditis include injection drug abusers and patients with structural heart defects undergoing dental procedures. Infective endocarditis is clinically important because it is hard to diagnose it in its early stage owing to its various clinical manifestations, and because its morbidity and mortality increase when neurologic complications occur. This is a case of infective endocarditis in the course of treatment of which complicating cerebral hemorrhage and infarction progressed rapidly and prompted death.
Cerebral Hemorrhage ; Cerebral Infarction* ; Drug Users ; Endocarditis* ; Heart ; Hemorrhage* ; Humans ; Infarction ; Mortality ; Risk Factors

Massive hemoptysis represents a major medical emergency that is associated with high mortality. The causes of hemoptysis are various and include pulmonary and cardiovascular disorders and trauma. The causes of pulmonary disorder are tuberculosis, bronchiectasis, abscess, malignancy, bronchitis, and fungal infection. The causes of cardiovascular disorder are mitral stenosis, pulmonary embolism, and congestive heart failure. A fistula between an aortic aneurysm and the pulmonary parenchyma is one of the causes of hemoptysis, but it is a rare. However, if undiagnosed, it is a uniformly fatal cause of massive hemoptysis. This is a case of bleeding from a fistula between an aortic arch aneurysm and a lung parenchyma in a patient with an aortic arch aneurysm who presented with massive hemoptysis. He had suffered intermittent hemoptysis since he was diagnosed with an aortic arch aneurysm three years before. A high clinical suspicion must be maintained when a history of intermittent hemoptysis is obtained in patients with an aortic aneurysm or prior aortic graft surgery.
Abscess ; Aneurysm* ; Aorta, Thoracic* ; Aortic Aneurysm ; Bronchiectasis ; Bronchitis ; Emergencies ; Fistula* ; Heart Failure ; Hemoptysis ; Hemorrhage ; Humans ; Lung ; Mitral Valve Stenosis ; Mortality ; Pulmonary Embolism ; Transplants ; Tuberculosis

PURPOSE: Although eosinophilia is a common laboratory finding in many neonatal intensive care units (ICUs), its causative mechanisms remain obscure. We aimed to determine the causes of eosinophilia in the neonatal ICU environment. METHODS: Serial eosinophil counts were determined weekly for 288 hospitalized, appropriately grown neonates. Infants were divided into four groups according to gestational age, and the incidence and etiologic factors of eosinophilia were retrospectively studied. RESULTS: Absolute eosinophilia (>700/mm3) was documented in 18% (52/288) of neonates. Twenty-two infants (42.3%) exhibited mild eosinophilia (700-999 cells/mm3), 27 (51.9%) exhibited moderate eosinophilia (1,000-2,999 cells/mm3), and 3 (5.8%) exhibited severe eosinophilia (>3,000 cells/mm3). Of the 288 infants studied, 54 suffered sepsis. Thirty of these 54 infants (55.6%) showed eosinophilia, and 22 out of the remaining 234 infants (9%) without sepsis showed eosinophilia, indicating that eosinophilia was more prevalent in the sepsis group (P <0.05). All 5 infants suffering from bronchopulmonary dysplasia showed eosinophilia, and 47 out of the remaining 283 infants (16.7%) without bronchopulmonary dysplasia showed eosinophilia. Thus, eosinophilia was more prevalent in the bronchopulmonary dysplasia group (P <0.05). Furthermore, increased prevalence of eosinophilia was associated with respiratory distress syndrome, ventilator use, blood transfusion, and total parenteral nutrition (P <0.05). CONCLUSION: Our results suggest that eosinophilia is influenced by sepsis and bronchopulmonary dysplasia, although it can also occur idiopathically at birth. Moreover, the potential role of eosinophils in conditions such as wound healing and fibrosis in sepsis or chronic lung disease may be a cause of eosinophilia.
Blood Transfusion ; Bronchopulmonary Dysplasia ; Eosinophilia ; Eosinophils ; Fibrosis ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Lung Diseases ; Parenteral Nutrition, Total ; Parturition ; Prevalence ; Retrospective Studies ; Sepsis ; Stress, Psychological ; Ventilators, Mechanical ; Wound Healing

PURPOSE: In the treatment of breast cancer, neoadjuvant chemotherapy (NAC) is useful to reduce breast cancer size before surgical intervention. Patients who achieve a pathologic complete response (pCR) to NAC have improved overall survival (OS). However, the relationship between prognosis and partial response is yet unclear. In this study, we evaluated prognostic factors and the tumor response ratio (TRR) method among patients who received NAC. METHODS: Clinicopathologic factors were evaluated to predict OS. The TRR was calculated by dividing pathologic tumor size by clinical tumor size. TRRs were then categorized into four groups, and the survival times for the different TRR groups were compared using statistical evaluation. RESULTS: Clinical N stage (p=0.02), overall stage (p=0.04), pathologic N stage (p=0.03), hormone receptor status (p=0.01), and lymphovascular invasion (p=0.02) were significantly associated with OS. Pathologic overall stage and TRR did not correlate with OS. Patients with a pCR exhibited the best survival rates using the current staging system and the TRR method. CONCLUSION: Clinicopathologic factors can be easily applied to predict OS, and clinicians could use these parameters until an accurate, simple, and highly discriminatory methods is developed to assess breast cancer patients with a partial.

Sequential lymphoma is defined as two different types of lymphoma that occur in the same patient at different anatomic sites and times. In most cases, the two distinct histologies belong to the same lineage (B- or T-cell lymphoma), though cases with both have been observed. A few cases of Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphomas arising in patients with angioimmunoblastic T cell lymphoma (AITL) have been reported. Immune deficits inherent in AITL, combined with the immunosuppressive effects of the therapy, may have allowed unchecked EBV-induced proliferation of latently or newly EBV-infected B cells with eventual clonal selection and progression to aggressive B-cell lymphoma. Here, we report a case of AITL in which EBV-positive diffuse large B-cell lymphoma (DLBCL) arose 9 months after the initial diagnosis of AITL.
B-Lymphocytes ; Herpesvirus 4, Human ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, T-Cell ; T-Lymphocytes

Hemolytic uremic syndrome is characterized by the symptoms of microangiopathic hemolytic anemia, thrombocytopenia and renal failure. The incidence of hemolytic uremic syndrome associated with pregnancy is 10 to 25 percent. Hemolytic uremic syndrome is treated with adjunctive therapies, such as anti-platelet agents, glucocorticoid and plasma exchange. However, many patients experience a residual impairment in renal function and some of them progress to end-stage renal disease requiring dialysis or renal transplantation. Immunosuppression with cyclosporine has been implicated as a significant risk factor for post- transplant hemolytic uremic syndrome. A number of reports on transplant recipients have recognized cyclosporine-induced hemolytic uremic syndrome as a distinct entity and a potentially serious complication of cyclosporine administration.We report a case of a patient with successful renal transplantation using cyclosporine who had a severe case of post-partum hemolytic uremic syndrome that progressed to end-stage renal disease. After cadaver-donor renal transplantation using cyclosporine, mycophenolate mofetil and prednisolone her graft function at two years is normal with serum creatinine 1.0 mg/dl.
Anemia, Hemolytic ; Creatinine ; Cyclosporine* ; Dialysis ; Hemolytic-Uremic Syndrome* ; Humans ; Immunosuppression* ; Incidence ; Kidney Failure, Chronic* ; Kidney Transplantation* ; Plasma Exchange ; Postpartum Period* ; Prednisolone ; Pregnancy ; Renal Insufficiency ; Risk Factors ; Thrombocytopenia ; Transplantation ; Transplants

PURPOSE: Current diagnostic modalities frequently carry false negative evaluations, especially in micro-metastasis. Some metastases are identified incidentally during the operation for primary colorectal cancer. Our study was performed to assess the clinicopathological characteristics of intraoperatively diagnosed liver metastases, to analyze the survival and the prognosis, to compare the results with those for preoperatively diagnosed liver metastases. METHODS: Between July 1989 and December 2001, the cases of 78 patients who underwent treatment for intraoperatively diagnosed liver metastasis at our hospital were analyzed retrospectively. There were 375 patients who were diagnosed with liver metastasis preoperatively during the same period. Metachronous liver metastases were excluded. RESULTS: Intraoperatively diagnosed liver metastases mostly showed clinicopathological characteristics of primary colorectal cancer similar to those for preoperatively diagnosed liver metastases. On the other hand, the preoperative serum CEA level was significantly lower in the intraoperatively diagnosed group than it was in the preoperatively diagnosed group (P<0.001). For the metastatic lesion, the size of the metastasis was smaller in the intraoperatively diagnosed group than it was in the preoperatively diagnosed group (P=0.03). The two-year survival rate of the intraoperatively diagnosed group was significantly better than that of the preoperatively diagnosed group (71.6% vs. 58.4%; P=0.031). Prognostic factors of the intraoperatively diagnosed group were the number of liver metastases, a curative operation for the primary cancer, and an operation for the metastatic lesion. CONCLUSIONS: Intraoperatively diagnosed liver metastases had biologic features similar to those of preoperatively diagnosed liver metastases. The survival rate of the intraoperatively diagnosed group was better than that of the preoperatively diagnosed group, possibly due to the curative resection for the hepatic metastases. Therefore, aggressive treatment for primary and metastatic lesions is the therapeutic choice to improve patient's survival for intraoperatively diagnosed synchronous liver metastases.
Colorectal Neoplasms* ; Hand ; Humans ; Liver* ; Neoplasm Metastasis* ; Prognosis ; Retrospective Studies ; Survival Rate

Glycoprotein (GP) IIb/IIIa inhibitors, such as abciximab, are used as adjunctive therapy for percutaneous coronary intervention (PCI) in high-risk non-ST-elevation myocardial infarction (NSTEMI) and in ST-elevation myocardial infarction (STEMI), although their effects when used for STEMI are less clear. As the use of GP IIb/IIIa inhibitors becomes more widespread, determining the risks associated with them becomes more important. The major risks associated with the use of GP IIb/IIIa inhibitors are the potential for major bleeding and thrombocytopenia. This is the first reported case in Korea of hemorrhagic pericarditis resulting in cardiac tamponade associated with the use of abciximab, a commonly used GP Ilb/IIa inhibitor, following PCI.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary/*adverse effects ; Antibodies, Monoclonal/*adverse effects ; Anticoagulants/*adverse effects ; Cardiac Tamponade/*etiology/therapy ; Emergency Medical Services ; Hemorrhage/*etiology/therapy ; Humans ; Immunoglobulin Fab Fragments/*adverse effects ; Korea ; Male ; Pericardiocentesis ; Pericarditis/*etiology/therapy ; Platelet Aggregation Inhibitors/*adverse effects ; Risk Factors

PURPOSE: Hyponatremia is the most common electrolyte imbalance encountered in the hospital, there have been few studies about the clinical characteristics of hyponatremia in emergency patients. This study was performed to evaluate the causes and the initial symptoms of hyponatremia in emergency patients, the relationship between their ages and their initial symptoms and the relationship between the causes and the recovery time. METHODS: A total of 42 patients with hyponatremia, who were treated in the Emergency Department of Chonnam National University Hospital from 2000 to 2001, were studied by chart review. RESULTS: The initial symptoms were generalized weakness (33.3%), seizure (28.6%), mental change (21.6%), confusion (9.5%), dizziness (4.8%), and non-specific (2.4%). There was a significant difference in the initial symptoms between children and older. The initial symptom for younger patients was usually seizure. The most common causes of hyponatremia were dehydration and sodium loss (52.4%), other causes were hypothyroidism (11.9%), SIADH (7.1%), heart failure (7.1%), adrenal insufficiency (4.8%), polydypsia (4.8%), CRF (2.4%), nephrotic syndrome (2.4%) and unidentified causes (7.1%). There were significant differences in the recovery times among the causes of hyponatremia. CONCLUSION: The initial symptoms of hyponatremia in emergency patients were usually generalized weakness in older patients and seizure in the young. There were significant differences in the recovery times among the causes of hyponatremia. There were many more incidences of hypovolemic hyponatremia of emergency patients than normovolemic hyponatremia.
Adrenal Insufficiency ; Child ; Dehydration ; Dizziness ; Emergencies* ; Emergency Service, Hospital ; Heart Failure ; Humans ; Hyponatremia* ; Hypothyroidism ; Hypovolemia ; Inappropriate ADH Syndrome ; Incidence ; Jeollanam-do ; Nephrotic Syndrome ; Seizures ; Sodium