Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins

No abstract available.

PURPOSE: Effective chest compressions may improve the return of spontaneous circulation and positive neurologic outcomes in cardiac arrest victims. Out of concern for rescuer fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommend that the individual applying chest compressions should be switched every 2 minutes, but there is little evidence to support this recommendation. In this study, we investigated whether or not changing the individual who is applying chest compressions every 2 minutes during cardiopulmonary resuscitation is appropriate or not. METHODS: We recruited health personnel working at one university hospital on a volunteer basis. On a randomly assigned day, we compared the effectiveness of the use of multiple rescuers following the 2 minute guideline, versus single rescuer (rescuer-limited) in performance of CPR. The resulting data was collected by use of CPR recording technology, and chest compression quality variables including compression rate, compression depth, proportion of adequate compression depth, and proportion of incomplete recoil were recorded. RESULTS: There were statistically significant improvements in the rescuer-limited trial outcome including average compression depth (p=0.013), proportion of adequate compression depth (p=0.027), and difference in reported fatigue (0.007). CONCLUSION: In this study, we found that a rescuer-limited method is more effective than the multiple rescuer method in terms of subjective fatigue and chest compression quality metrics.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Arrest ; Humans ; Thorax

PURPOSE: A eutectic mixture of local anesthetics (EMLA(R)) cream has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 40 to 60 minutes before the painful procedure. Because of the long application period, EMLA(R) is not useful in the emergency department (ED). The purpose of this study was to determine whether a 20-minute application of 9.6% lidocaine would be useful in reducing the pain of routine peripheral intravenous cannulation in the ED. METHODS: We examined 27 male and 19 female patients ages over 18 years of age who required intravenous cannula insertion. Intravenous insertion was performed on 46 patients: 24 patients in the placebo group (mean age: 40.0 years) and 22 in the 9.6% lidocaine group (mean age: 37.6 years). The 9.6% lidocaine or placebo gel was applied and covered with an occlusive dressing for 20 minutes. Pain was scored by the patients using a 0- to 10-cm visual analogue scale. RESULTS: The patients in the 9.6% lidocaine group (mean pain score: 3.4) experienced less pain than those in the placebo group (mean: 5.3), and the difference was statistically significant (p=0.029). CONCLUSION: We concluded that a 20-minute application of 9.6% lidocaine is safe and effective for reducing pain associated with venipuncture.
Anesthesia, Local* ; Anesthetics, Local ; Catheterization ; Catheters ; Emergency Service, Hospital ; Female ; Humans ; Lidocaine* ; Male ; Occlusive Dressings ; Phlebotomy* ; Skin

OBJECTIVE: To delineate the role of antidiuretic hormone (ADH) in relation to nocturnal polyuria, and to identify the factors influencing on the diurnal antidiuretic hormone level. METHOD: The ADH was measured by radioimmuoassay at daytime (2:00 PM) and at nighttime (2:00 AM) with nocturnal polyuria group (11) and without nocturnal polyuria group (8). Urine volume, serum osmolarity, urine osmolarity, and blood pressure were also measured at the same time. RESULTS: 1) The ADH at 2:00 AM did not increase in nocturnal polyuria group, although it increased in no-symptom group. 2) There was a statistically significant correlation between wheelchair ambulation time and daytime ADH level. 3) The difference of ADH level between daytime and nighttime showed decrease in orthostatic hypotension group. CONCLUSION: There was relationship between nocturnal polyuria and diurnal variation of ADH level. The ADH concentration seems to be influenced by the postural factors and sympathetic factors.
Blood Pressure ; Hypotension, Orthostatic ; Osmolar Concentration ; Polyuria* ; Spinal Cord Injuries* ; Spinal Cord* ; Walking ; Wheelchairs

Granulomatosis with polyangiitis (GPA) is a disease characterized by a granulomatous necrotizing vasculitis of the small vessels, along with the presence of antineutrophil cytoplasmic antibody (ANCA), serologically. GPA is a multisystem disease, in which the diagnosis is frequently based on respiratory and renal manifestations, with rare breast invasion. To date, several cases of breast invasion by GPA have been published, and most cases have been positive for ANCA. However, ANCA-negative forms of breast invasion by GPA are extremely rare and have not been reported in Korea thus far. Therefore, we report a case of ANCA-negative GPA in a 70-year-old woman, who was initially presented with a localized palpable mass in the left breast.
Aged ; Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Breast* ; Cytoplasm* ; Diagnosis ; Female ; Humans ; Korea ; Vasculitis

PURPOSE: Roux-en-Y reconstruction (RY) in laparoscopic distal gastrectomy for gastric cancer is a more complicated procedure than Billroth-I (BI) or Billroth-II. Here, we offer a totally laparoscopic simple RY using linear staplers. MATERIALS AND METHODS: Each 50 consecutive patients with totally laparoscopic distal gastrectomy with RY and BI were enrolled in this study. Technical safety and surgical outcomes of RY were evaluated in comparison with BI. RESULTS: In all patients, RY gastrectomy using linear staplers was safely performed without any events during surgery. The mean operation time and anastomosis time were 177.0+/-37.6 min and 14.4+/-5.6 min for RY, respectively, which were significantly longer than those for BI (150.4+/-34.0 min and 5.9+/-2.2 min, respectively). There were no differences in amount of blood loss, time to flatus passage, diet start, length of hospital stay, and postoperative inflammatory response between the two groups. Although there was no significant difference in surgical complications between RY and BI (6.0% and 14.0%), the RY group showed no anastomosis site-related complications. CONCLUSION: The double stapling method using linear staplers in totally laparoscopic RY reconstruction is a simple and safe procedure.
Aged ; Female ; Gastrectomy/*methods ; Gastric Bypass/*methods ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Stomach Neoplasms/surgery

PURPOSE: To identify the effect of insufficient lymph node dissection (LND) on the survival of patients with pT2 gastric cancer. MATERIALS AND METHODS: A total of 340 patients (120 patients with insufficient LND and others with D2 LND) who underwent gastrectomy for pT2 gastric cancer between January 2008 and December 2010 were included. RESULTS: The incidence of preoperatively diagnosed early gastric cancer was higher and there were fewer metastatic lymph nodes (LNs) in the insufficient LND group than the D2 group, but there was no survival difference between two groups (p=0.365). Among the 89 patients with metastatic LNs after D2 LND, 13 patients (14.6%) had metastatic LNs at selected N2 stations (#10, 11, or 12a), but none of these patients were in the pN1 category. One patient had five metastatic LNs at station #11p with no metastatic LNs at any other stations. The number of metastatic LNs was identified as the only risk factor for LN metastasis at selected N2 stations by logistic regression. CONCLUSION: If a patient has pN0 or pN1 category after insufficient LND for pT2 gastric cancer, the surgery can be regarded as secure. However, for patients with pN2 or pN3 category, more careful examination is required.
Aged ; Female ; Gastrectomy ; Humans ; Lymph Node Excision/*methods ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/*surgery

Anti-Ma2-associated encephalitis is one of the paraneoplastic neurological syndromes. It has been shown to be associated with various neoplasms, mainly testicular, lung, and breast cancers. Most patients with anti-Ma2-associated encephalitis present limbic-diencephalic-brainstem dysfunctions such as seizure, mood disorder, excessive daytime sleepiness, and ophthalmoparesis. Some patients develop symptoms indicating the multifocal involvement of the limbic system, diencephalon, or brainstem. However, there are few case studies of anti-Ma2-associated encephalitis presenting as isolated hypersomnia. We report a case of anti-Ma2-associated encephalitis presenting as hypersomnia.
Brain Stem ; Breast ; Diencephalon ; Disorders of Excessive Somnolence* ; Encephalitis* ; Humans ; Limbic System ; Lung ; Mood Disorders ; Ophthalmoplegia ; Paraneoplastic Syndromes ; Seizures

PURPOSE: The C677T polymorphism of the methylenetetrahydrofolate reductase(MTHFR) has been suggested as a risk factor of maternal meiotic nondisjunction for Down syndrome. Recently, a second genetic polymorphism in MTHFR at position 1298 was reported. However, a positive association between the A1298C MTHFR polymorphism and Down syndrome has not been reported. Therefore, this study was undertaken to determine which polymorphism of MTHFR gene was associated with the increased risk of a child suffering from Down syndrome(DS). METHODS: We enrolled 33 patients with Down syndrome and 100 healthy individuals and analyzed the MTHFR C677T and A1298C polymorphism by a PCR-restriction fragment length assay. RESULTS: Frequencies of MTHFR C677T genotypes(CC, CT, and TT) were 9(27%), 22(67%), and 2 (6%) in the DS patients and 24(24%), 55(55%) and 21(21%) in the control, respectively. The frequency of mutant 677TT was significantly low in the DS patients(OR : 0.14; 95% CI : 0.02-0.95; P= 0.04). For the MTHFR A1298C polymorphism, frequencies of genotypes(AA, AC, and CC) were 16(48 %), 15(45%) and 1(3%) in DS patients and 77(77%), 21(21%) and 2(2%) in the control, respectively. The frequency of mutant 1298AC was significantly increased in DS patients with an odds ratio of 3.3(95% CI : 1.39-7.82; P=0.007). CONCLUSION: Our results suggest that MTHFR mutant 677TT may have a protective effect against Down syndrome, but MTHFR mutant 1298AC may be an independent risk factor in Down syndrome.
Child ; Down Syndrome* ; Humans ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Odds Ratio ; Polymorphism, Genetic ; Risk Factors