Twin reversed arterial perfusion (TRAP) sequence is a rare specific anomaly of twin gestation with fused placenta and umbilical anastomosis. This syndrome occurs once in about 34,600 births and reported first by Beneditti in 1533. We report on prenatal diagnosis of a case of TRAP sequence with color Doppler sonography, this case is presented with a brief review of the literature.
Humans ; Parturition ; Perfusion ; Placenta ; Pregnancy ; Prenatal Diagnosis*

PURPOSE: We compared prophylactic effects and complications of intravesical instillation of the Connaught and Tice strains bacillus Calmette-Guerin (BCG) in patients with stage pT1 bladder cancer. MATERIALS AND METHODS: A total of 98 patients with stage pT1 bladder cancer were treated with transurethral resection (TUR) between January 1992 and April 1998. Of the 98 patients, 51 received the Connaught strain BCG (81mg), 27 the Tice strain BCG (12.7mg) and 20 patients underwent TUR alone. The patients were followed-up for 18-78 months (mean 42.5months). The recurrence and progression rates, mean months to tumor recurrence, recurrence free survival rate, using Kaplan-Meier curve, and complications, were compared between the two BCG strain groups. RESULTS: The overall recurrence rate was 27.5% in the Connaught strain BCG group, 29.6% in Tice strain BCG group and 65% in TUR alone group. The mean months to tumor recurrence, and the recurrence free survival rate, showed that both BCG strain drugs were superior to TUR alone. Although the prophylactic efficacy of the Connaught strain BCG was a little higher than that of the Tice strain BCG, there were no significant differences in the recurrence rates and recurrence free survival rates between the two drugs. The incidences of complications were 94.1 and 85.2% in the Connaught strain BCG and Tice strain BCG groups, respectively. CONCLUSIONS: Both the Connaught and Tice BCG strains were superior to TUR alone in the prophylaxis of the recurrence in stage pT1 bladder cancer. There was no significant difference in the complication rates between the two groups. Therefore, both the Connaught and Tice BCG strains may be regarded as alternative treatments.
Administration, Intravesical ; Bacillus* ; BCG Vaccine ; Humans ; Incidence ; Mycobacterium bovis ; Recurrence ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

A 46-year-old female with abnormal radiologic finding was diagnosed with pancreatic neuroendocrine tumor and multiple hepatic metastasis. Molecular targeted therapy (everolimus) and two times of transarterial chemoembolizations (TACE) were performed before pylorus-preserving pancreaticoduodenectomy (PPPD). After 2nd TACE and PPPD, grade 2 pancreatic neuroendocrine tumor was pathologically confirmed. Four times of additional TACE was done. After size increase of several probable hepatic metastasis in the both lobes of liver, laparoscopic left lateral sectionectomy of liver was performed. After two and half years of left lateral sectionectomy, 7th TACE was performed and the patients have survived without further disease progression. This case suggests that patients with pancreatic neuroendocrine tumor and hepatic metastasis can be treated by TACE, primary tumor resection, surgery for liver metastasis and molecular targeted therapy. Therefore, aggressive multidisciplinary approaches need to be considered for long term survival of patients with pancreatic neuroendocrine tumor with hepatic metastasis.
Disease Progression ; Female ; Humans ; Liver ; Middle Aged ; Molecular Targeted Therapy ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Pancreas ; Pancreaticoduodenectomy

It is well known that newborns and pregnant women typically show higher rates of Streptococcus agalactiae infection. However, the incidence of group B streptococcal (GBS) disease in nonpregnant adults is increasing, particularly in elderly persons and those with significant underlying diseases, such as diabetes, neurologic impairment, and cirrhosis. Skin infections, osteoarticular infections, and pneumonia are commonly associated with GBS, while meningitis and endocarditis are less common. S. agalactiae endocarditis is an uncommon but important condition with a high mortality rate. Several cases of endocarditis due to S. agalactiae have been reported in the literature, but there have been no reports of S. agalactiae meningitis associated with endocarditis in Korea. Here, we describe a case of S. agalactiae meningitis and endocarditis in a 50-year-old man who was successfully treated with intravenous antibiotics and cardiac surgery.
Adult ; Aged ; Anti-Bacterial Agents ; Endocarditis ; Female ; Fibrosis ; Humans ; Incidence ; Infant, Newborn ; Korea ; Meningitis ; Middle Aged ; Pneumonia ; Pregnant Women ; Skin ; Streptococcus ; Streptococcus agalactiae ; Thoracic Surgery

Phenylpropanolamine is a sympathomimetic amine used widely as a decongestant or appetite suppressant. Reports of the myocardial injury from the use of phenylpropanolamine are rare and the mechanism of the myocardial injury is not known clearly. We experienced a case of myocardial injury after ingestion of phenyl-propanolamine. A 46-year-old woman was admitted because of chest pain and dyspnea after ingestion of 5 tablets of anorectic pill containing phenylpropanolamine 75 mg per tablet. The serum creatine kinase MB isoenzyme levels were elevated and electrocardiographic abnormalities suggesting myocardial infarction were seen in the precordial lead. In echocardiograpy, left ventricular anteroseptal wall motion was nearly akinetic but coronary angiography showed normal coronary arteries except sluggish blood flow in left anterior descending artery.
Appetite ; Arteries ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Creatine Kinase ; Dyspnea ; Eating* ; Electrocardiography ; Female ; Humans ; Middle Aged ; Myocardial Infarction ; Phenylpropanolamine* ; Tablets

OBJECTIVE: To evaluate the diagnosis and treatment of hysteroscopy and its complications. METHODS: Reviewed 415 cases treated by hysteroscopy during 1994.9-2003.2 at Ajou University Hospital. RESULTS: Major indications were infertility (321 cases, 77.3%) and gynecologic indications such as myoma, polyps etc (94 cases, 22.7%). Hysteroscopic findings were polyp (192 cases, 46.3%), synechiae (72 cases, 17.3%), submucosal myoma (21 cases, 5.1%) and uterine anomaly (13 cases, 3.1%). Complications were 2 cases of uterine perforations and one case of bowel injury. CONCLUSION: Hysteroscopy is a safe, minimally invasive procedure with a low rate of complications.
Diagnosis* ; Hysteroscopy* ; Infertility ; Myoma ; Polyps ; Uterine Perforation

Background/Aims: Acute eosinophilic pneumonia (AEP) is common among military smokers; however, bronchoscopy is required for the diagnosis. We aimed to derive and validate a scoring system to diagnose AEP without bronchoscopy. Methods: We conducted a retrospective study including patients diagnosed with AEP or any other pneumonia among military smokers hospitalized in the Armed Forces Capital Hospital from 15 November 2016 through 25 December 2019. The patients were divided into derivation and validation groups according to their admission day. Patient symptoms, laboratory findings, and computed tomography findings were candidate variables. Least absolute shrinkage and selection operator (LASSO) regression was used to calculate the scores for each variable. Results: Among 414 patients, AEP was confirmed in 54 of 279 patients (19.4%) in the derivation group and in 18 of 135 patients (13.3%) in the validation group. Ten variables were selected using LASSO regression: new-onset or a recently increased smoking (≤ 4 weeks) (8 points), interlobular septal thickening (5 points), absence of sputum (3 points), ground glass opacity (3 points), acute onset (≤ 3 days) (2 points), dyspnea (2 points), chest pain (2 points), leukocytosis (2 points), bronchovascular bundle thickening (2 points), and bilateral involvement (2 points). The area under the receiver-operating characteristic curve of the score to diagnose AEP was 0.997 (95% confidence interval, 0.992 to 1.000) in the derivation group and 0.985 (95% confidence interval, 0.965 to 1.000) in the validation group. Conclusions We introduce a scoring system that can distinguish AEP from other types of pneumonia in military smokers without the need for bronchoscopy.

Purpose: Granular corneal dystrophy type 2 (GCD2) is a hereditary disease that features granular and lattice stromal deposits in the cornea. There are homozygotes and heterozygotes and the opacities are exacerbated by corneal trauma or surgery, such as laser in situ keratomileusis (LASIK). As there is individual variability in GCD2 phenotypes, we investigated various corneal features of GCD2 patients in their twenties, the main age group for refractive surgery. Methods: From genetically confirmed GCD2 patients who had an R124H mutation of the transforming growth factor β induced (TGFBI) gene at age 20 to 29 years, we chose representative patients: one homozygote; one compound heterozygote; one simple heterozygote with a severe phenotype with many granular deposits; one common heterozygote; and four heterozygotes with normal corneas. The corneas of all patients were subject to slit-lamp examination and photographed. Results: The homozygote had confluent granular deposits covering the cornea. The compound heterozygote had granular and lattice deposits covering the center of the cornea. The patient with a severe phenotype had more than 30 granular deposits in one eye, but was a simple GCD2 heterozygote, verified by full-sequencing of the TGFBI gene. In the four patients with normal corneas, a single small lesion was subsequently detected during follow-up in two, at 3 weeks and 6 months, respectively. Both corneas were judged clear at chance examinations. Conclusions Among Koreans in their twenties, GCD2 patients have various phenotypes, from clear corneas to severe confluent opacities. There are GCD2 heterozygotes with nearly clear corneas, so caution must be taken when choosing patients for refractive surgery.

Esophageal abscess caused by acute phlegmonous esophagitis is rare but life-threatening. Rapid abscess drainage is an important part of the treatment, and endoscope-assisted intra-luminal abscess drainage is frequently performed. Although endoscopic drainage is less invasive than surgery, it has the potential to cause esophageal stricture as a complication. We present a rare case of esophageal stricture as a complication of intra-luminal drainage and evaluate a method to minimize the incidence of esophageal stricture complications.

Background: An increasing number of blood banks use an automated analyzer in ABO blood typing to reduce the high workload and impact of human error. On the other hand, the automated system often causes ABO discrepancies, where cell and serum typing do not match. Hence, the manual method is used for confirmation.This study evaluated the appropriateness of retesting with the manual method. In addition, the causes of ABO discrepancies were analyzed. Methods: A total of 77,590 blood samples were tested with the AutoVue Innova for ABO typing. Among them, 1280 samples were retested manually due to ABO discrepancies. The causes of the discrepancies were analyzed further through additional tests. The serum reaction grades in both methods were compared. Results: ABO typing of 76,906 samples (99.12%), which included 596 manually confirmed samples could be confirmed by the AutoVue system, while 403 samples (0.52%) continued to yield discrepant results. Weak serum reactions in the AutoVue system were observed, as previously reported. One hundred and thirty samples (66.7%), which were graded 0.5+ in the automated analyzer, yielded a negative serum reaction in the manual method, showing a greater serum reaction with the AutoVue system than with the manual method. Conclusion The AutoVue Innova performs reliably for blood typing. On the other hand, the manual method is still useful as retesting to address the ABO discrepancies and weak or strong serum reactions. In particular, it is important to confirm samples with 0.5+ grade serum reactions manually.