Spinal epidural abscesses were evaluated using Gadolinium-enhanced magnetic resonance imaging (MRI) in 19 surgically and clinically confirmed cases, including 13 with tuberculous spondylitis and 6 with pyogenic spondylitis. We observed rim enhancement patterns in 10 patients and diffuse enhancement patterns in 9 patients. The spread patterns were localized to ventral or dorsal epidural space and encircled entire epidural space. We conclude that rim enhancement indicates abscess and diffuse enhancement indicates granulation tissue and fibrosis. Tuberculous epidural abscess spreads to ventral epidural space and pyogenic epidural abscess encircles entire epidural space.
Abscess ; Epidural Abscess* ; Epidural Space ; Fibrosis ; Granulation Tissue ; Humans ; Magnetic Resonance Imaging* ; Spondylitis

BACKGROUND/AIMS: Chronic hepatitis C virus (HCV) infection is often associated with extrahepatic autoimmune disease, and autoantibodies such as anti-nuclear antibody (ANA) or anti-smooth muscle antibody (ASA). The presence of autoantibodies may make discrimination between chronic hepatitis C with autoimmune features and type 1 autoimmune hepatitis difficult. We studied the prevalence of autoantibodies in patients with chronic HCV infection and their clinical significance. MATERIALS AND METHODS: ANA, ASA, anti-mitochondrial antibody (AMA), anti-microsomal antibody (AmA), rheumatoid factor (RF), anti-cardiolipin antibody (aCL) and lupus anti-coagulant (LA) were tested in 116 patients (80 chronic hepatitis C, 36 liver cirrhosis). Genotypes of HCV were determined in 25 patients by INNO LiPA. RESULTS: The overall prevalence of autoantibody was 65.5%. The most common autoantibody was aCL (34.5%), followed by ANA (25%), RF (18%), LA (15.5%), ASA (6.9%), anti-microsomal antibody (6%) and AMA (1%). The positive rate of either ANA or ASA was 30.2%, but both were positive in 1.7% only. There was no difference in the demographic features, biochemistry, HCV genotypes and disease status between autoantibody-positive and autoantibody-negative patients. CONCLUSIONS: Autoantibodies were commonly found in patients with chronic HCV infection. But, the presence of autoantibodies may be a non-specific finding in chronic hepatitis C infection without clinical significance.
Autoantibodies* ; Autoimmune Diseases ; Biochemistry ; Discrimination (Psychology) ; Genotype ; Hepacivirus ; Hepatitis C, Chronic* ; Hepatitis, Autoimmune ; Hepatitis, Chronic* ; Humans ; Liver ; Prevalence* ; Rheumatoid Factor

PURPOSE: It is known that single umbilical artery is frequently associated with gastrointestinal or urogenital anomaly, however, routine renal sonography has been debated in healthy neonate with isolated single umbilical artery. This study is designed to determine the usefulness of routine renal sonography in apparently healthy infants with an isolated single umbilical artery. METHODS: Thirty healthy neonates with a single umbilical artery without a major anomaly from January 1995 to July 2002 were enrolled. The authors investigated the clinical background of babies and their mothers after renal sonography after 72 hours of age. When the abnormalities were found at the first renal sonography, the severity of hydronephrosis and degree of obstruction and renal function were analyzed by follow up renal sonography, voiding cystourethrography(VCUG) and technetium-99m-dimercaptosuccinic acid(DMSA) scan or technetium-99m-mercaptoacetyl-triglycerine (MAG3) scan. RESULTS: Among the 30 healthy patients with isolated single umbilical artery, five patients(16.7%) showed abnormalities on first renal sonography with one major(3.3%) and four(13.4%) minor renal anomaly(minimal or mild hydroneohrosis). One major renal anomaly(severe hydronephrosis) showed severe decreased renal function on MAG3 scan without reflux, and the other four minor regressed spontaneously on follow up study. CONCLUSION: The value of routine early renal sonograpy for detecting renal anomaly in healthy infants with an isolated single umbilical artery remained unclear because most of the anomalies would regress spontaneously in the follow up study.
Follow-Up Studies ; Humans ; Hydronephrosis ; Infant* ; Infant, Newborn ; Mass Screening* ; Mothers ; Single Umbilical Artery*

In vitro fertilization (IVF) is a main option for the infertility treatment and its major concerns are the risk of multiple pregnancy, preterm delivery, intrauterine growth retardation (IUGR), and congenital malformation. Russell-Silver syndrome (RS) is a congenital disorder characterized by intrauterine and postnatal growth retardation associated with inverted triangular face, clinodactyly, and asymmetry of the body. The possibility of genomic imprinting defect has been suggested because the risk of RS syndrome is increased after IVF like other imprinting defect disorders such as Angelman or Beckwith-Wiedemann syndrome, and the major epigenetic disturbance of RS syndrome is the hypomethylation of the imprinting in 11p15. We report three cases of RS syndrome in one of IVF twins with a review of the literature.
Beckwith-Wiedemann Syndrome ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Epigenomics ; Female ; Fertilization in Vitro ; Fetal Growth Retardation ; Genomic Imprinting ; Humans ; Infertility ; Pregnancy ; Pregnancy, Multiple ; Silver-Russell Syndrome ; Twins

No abstract available.
Bone Diseases, Developmental/diagnosis/drug therapy/*genetics ; Child ; Fibrillin-1/*genetics ; Hand/diagnostic imaging ; Heterozygote ; Human Growth Hormone/therapeutic use ; Humans ; Limb Deformities, Congenital/diagnosis/drug therapy/*genetics ; Male ; Pelvis/diagnostic imaging

No abstract available.
Chorionic Gonadotropin* ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans* ; Progesterone* ; Superovulation*

Plasmapheresis has been used for some conditions during pregnancy and puerperium, such as hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. We present one case of the HELLP syndrome which was treated with plasmapheresis and also review the indications, complications and guidelines for repetitive plasma exchange.
Blood Platelets ; Female ; HELLP Syndrome* ; Hemolysis ; Liver ; Plasma Exchange ; Plasmapheresis* ; Postpartum Period* ; Pregnancy

PURPOSE: Prolonged stay in the emergency department (ED) have been associated with high mortality, but this association remains controversial. We examined the relationship between emergency department length of stay (EDLOS) and the mortality in critically ill patients undergoing traumatic emergency surgery. METHODS: A retrospective cohort study was conducted at an academic medical center with 257 critically ill patients undergoing traumatic emergency surgery from 2003 to 2004. Patients were classified into two groups those spending less than 4 hours in the emergency department and those spending over 4 hours. The groups were compared for hospital-mortality, and the data were entered into multinominal logistic regression, ROC curve, and life table using 12.0 version of SSPS. RESULTS: The overall mortality rate was 16.0%. Average length of stay was 220.1+/-138.5 minutes and 191.3+/-112.9 minutes in the survivors and non-survivor groups, respectively (p=0.212). Hospital-mortality and cumulative survival rate were similar in the group spending less than 4 hours to those in the group spending over 4 hours. The mortality was mainly related to the severity of the patients' condition (SAPS II). CONCLUSION: EDLOS did not affect hospital mortality, and EDLOS of more than 4 hours was not associated with worse prognosis.
Academic Medical Centers ; Cohort Studies ; Critical Illness* ; Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Length of Stay* ; Life Tables ; Logistic Models ; Mortality ; Prognosis* ; Retrospective Studies ; ROC Curve ; Survival Rate ; Survivors

PURPOSE: Violence in the Emergency Department is a common concern but it is an ill-defined and underreported problem because no organization or administrative guidelines exist to adequately address it. The aim of this effort was to gather demographic information on the persons responsible for the violence and on the causes of the violence, so we would have basic data for the prevention of such violence. METHODS: The answers of Emergency Department doctors and nurses working in tertiary, university hospitals in South Korea to questions on a prospective questionaires during the period from December 2002 through February 2003 were analyzed. The survey used 10 questions to elicit demographic information on the persons responsible for the violence, the degree of violence, the severity of the patient' s disease and the reason for the violence. RESULTS: Two hundred twenty-five (225) cases of violence in the emergency department were reported from 6 tertiary hospitals during the 2-month duration. Total respondents to the questionaires were 225 (6 staffs, 131 nurses, and 88 residents). Verbal insults and threats were the most common form of violence. Almost all of the violence was due to the male gender, and 74.5% of violence was done by patient's guardians. More than half of those responsible for the violence were in an alcohol-drunken state. The causes of violence were long waiting time and poor patient-practitioner relationship and were not related with the severity of disease. CONCLUSION: If violence in the emergency department is to be managed and/or prevented, more administrative and financial efforts, a regular format for documentation of incidents, regular preventive education, and further study, if possible, with the Korean Society of Emergency Medicine are necessary.
Surveys and Questionnaires ; Education ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Hospitals, University ; Humans ; Korea ; Male ; Prospective Studies ; Tertiary Care Centers ; Violence*

No abstract available.
Epidermal Cyst