Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. This condition is characterized by the absence or rudimentary development of fetal heart, and associated with various anomaly. The presence of an acardiac twin requires the normal (or "pump") twin to provide circulation for itself, as well as the acardiac sibling. The acardiac malformations are uniformly fatal in the affected twin, and mortality in the co-twin is as high as 55%. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We recently experienced a case of acardius anceps associated with a normal male infant, so present with a brief review of the literature.
Fetal Heart ; Heart Failure ; Humans ; Infant ; Male ; Mortality ; Polyhydramnios ; Pregnancy ; Siblings ; Twins, Monozygotic

OBJECTIVE: The purpose of this study was to evaluate the outcome and safety of vaginal delivery after previous cesarean birth. METHODS: This study was based on 303 cases of delivery with previous cesarean birth at Masan, Fatima Hospital from May, 1997 to April, 1998. Among them, 62 cases had performed trial of labor. We had made a comparison between elective repeat section group and trial of labor group by analizing the frequency, successful rate, maternal morbidity, perinatal morbidity and mortality. RESULTS: Among 303 cases with previous cesarean birth, trial of labor was done in 62 cases(20.5%). Among trial of labor group, vaginal delivery was done in 54 cases (87.1%) and repeat section was done in 8 cases(12.9%). Indications for elective repea section before the onset of labor were refuse trial of labor(51.9%), request for tubal ligation(17.4%), and previous section > or =2(7.5%), etc. The successful rate of vaginal delivery according to indication for previous cesarean birth was 85.0%(17/20) in the cases of dystocia and 88.1%(37/42) in the cases except dystocia. The successful rate was not influenced by the indication for previous cesarean birth(P>0.05). There were no maternal death or uterine rupture in the cases of trial of labor. There were no significant difference between elective repeat section group and trial of labor group in maternal morbidity, perinatal morbidity and mortality(P>0.05). CONCLUSION: Under strict indications, vaginal delivery subsequent to cesarean birth may be safe, and can reduce the rate of cesarean section that was increased constantly.
Apgar Score ; Cesarean Section ; Dystocia ; Eclampsia* ; Female ; Fetal Distress ; Fetus ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Maternal Death ; Mortality ; Parturition ; Parturition* ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Premature Birth ; Respiration, Artificial ; Rheology ; Trial of Labor ; Umbilical Arteries* ; Uterine Rupture

The number of HIV-infected individuals susceptible to Hepatitis A virus (HAV) infection is increasing in Korea; however, it has proven difficult to devise a vaccination policy therefore because limited seroepidemiologic data exists for them. Accordingly, anti-HAV IgG was measured in 188 HIV-infected adults between July 2008 and July 2010. The nadir CD4+ T lymphocyte counts were not different between the HAV-positive and -negative groups (197 +/- 138 vs 202 +/- 129, P = 0.821). The only factor independently associated with seropositive status was age under 40 yr old (OR 0.017, P < 0.001). Our findings suggest that HAV vaccination in HIV-infected adults should be targeted at persons under the age of 40 yr.
Adult ; Age Factors ; CD4 Lymphocyte Count ; Female ; HIV Infections/*complications ; Hepatitis A/complications/*epidemiology ; Hepatitis A Antibodies/blood ; Hepatitis A virus/immunology ; Humans ; Male ; Middle Aged ; Odds Ratio ; Republic of Korea/epidemiology ; Seroepidemiologic Studies

PURPOSE: Fluoroquinolones, rapidly gaining prominence in treatment of Stenotrophomonas maltophilia (SMP), are noted for their potency and tolerability. However, SMP may rapidly acquire resistance to fluoroquinolones. We evaluated associations of clinical factors with acquisition of levofloxacin resistance (LFr) in SMP. MATERIALS AND METHODS: Our retrospective cohort study was based on patient data collected between January 2008 and June 2010. Through screening of 1275 patients, we identified 122 patients with data for SMP antibiotic susceptibility testing in > or =3 serial SMP isolates. RESULTS: We assigned the 122 patients to either the SS group (n=54) in which levofloxacin susceptibility was maintained or the SR group (n=31) in which susceptible SMP acquired resistance. In multivariate regression analysis, exposure to levofloxacin for more than 3 weeks [odds ratio (OR) 15.39, 95% confidential interval (CI) 3.08-76.93, p=0.001] and co-infection or co-colonization with Klebsiella pneumoniae resistant to levofloxacin (OR 4.85, 95% CI 1.16-20.24, p=0.030) were independently associated with LFr acquisition in SMP. CONCLUSION: Acquisition of LFr during serial sampling of SMP was related to the levofloxacin exposure.
Aged ; Anti-Bacterial Agents/*pharmacology/*therapeutic use ; Fluoroquinolones/pharmacology/therapeutic use ; Gram-Negative Bacterial Infections/drug therapy ; Humans ; Levofloxacin/*pharmacology/*therapeutic use ; Microbial Sensitivity Tests ; Middle Aged ; Retrospective Studies ; Stenotrophomonas maltophilia/drug effects/*pathogenicity

Dyslipidemia, one of the major disadvantages of use of protease inhibitor (PI), is a risk factor for cardiovascular disease in HIV-infected patients receiving antiretroviral treatment. Little is known about the effect of a switch from another PI to unboosted atazanavir (ATV) on the lipid profile. The aim of this study was to evaluate changes in the lipid profile after switching from another PI to either unboosted or boosted ATV in HIV-infected Koreans. We retrospectively collected data on the serum lipid profile at the time of the switch (week 0), and weeks 12 and 24 after the switch, as well as clinical characteristics at week 0 in a total of 27 patients. Triglyceride (TG) showed a significant decrease at weeks 12 and 24 in all patients (196 vs. 174 mg/dL, P=0.048 and 196 vs. 150 mg/dL, P=0.021, respectively). However, these effects were only observed in the unboosted ATV group (N=14; 239 vs. 125 mg/dL, P=0.017 and 239 vs. 87 mg/dL, P=0.021, respectively). For total cholesterol, only the unboosted ATV group at 24 weeks showed a significant decrease (184 vs. 158 mg/dL, P=0.031). No significant changes were observed in LDL- and HDL-cholesterol at weeks 12 and 24 in both the unboosted and boosted ATV groups. These results suggest that changing to unboosted ATV from another PI may ameliorate high TG and total cholesterol in HIV-infected Koreans.
Antiretroviral Therapy, Highly Active ; Atazanavir Sulfate ; Cardiovascular Diseases ; Cholesterol ; Dyslipidemias ; HIV ; Humans ; Oligopeptides ; Protease Inhibitors ; Pyridines ; Retrospective Studies ; Risk Factors

Metabolic syndrome is an important long term complication in chronic asymptomatic HIV-infected subjects under highly active antiretroviral therapy (HAART), because it can contribute to morbidity and mortality via cardiovascular disease (CVD). Therefore, a predictive marker for early detection of metabolic syndrome may be necessary to prevent CVD in HIV-infected subjects. Retinol-binding protein-4 (RBP-4) has been shown to be associated with metabolic syndrome in various non-HIV-infected populations. We performed a cross-sectional study to evaluate whether serum RBP-4 levels are correlated with metabolic syndrome in HIV-infected subjects receiving HAART. In total, 98 HIV-infected Koreans who had been receiving HAART for at least 6 months were prospectively enrolled. Metabolic syndrome was diagnosed according to the Adult Treatment Panel III criteria, and serum RBP-4 concentrations were measured using human RBP-4 sandwich enzyme-linked immunosorbent assay. Serum RBP-4 levels were significantly higher in HIV-infected subjects receiving HAART with metabolic syndrome (n=33, 33.9+/-7.7 microg/mL) than in those without it (n=65, 29.9+/-7.2 microg/mL) (p=0.012). In multivariate linear regression analysis, the number of components of metabolic syndrome presented and waist circumference were independently, significantly correlated with RBP-4 (p=0.018 and 0.030, respectively). In conclusion, we revealed a strong correlation between RBP-4 and the number of components of metabolic syndrome in HIV-infected subjects receiving HAART.
Adult ; *Antiretroviral Therapy, Highly Active ; Enzyme-Linked Immunosorbent Assay ; Female ; HIV Infections/*blood/*drug therapy ; Humans ; Male ; Metabolic Syndrome X/*blood/*drug therapy ; Middle Aged ; Retinol-Binding Proteins, Plasma/*metabolism

BACKGROUND/AIMS: Endoscopic resection (ER) of superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ER for SEN to determine its feasibility and effectiveness. METHODS: Subjects who underwent ER for SEN at Asan Medical Center between December 1996 and December 2010 were eligible. The clinical features of patients and tumors, histopathological characteristics, adverse events, ER results and survival were investigated. RESULTS: A total of 129 patients underwent ER for 147 SENs. En bloc resection (EnR) was performed in 118 lesions (80.3%). Complete resection (CR) was accomplished in 128 lesions (86.5%), and curative resection (CuR) was performed in 118 lesions (79.7%). The EnR, CR, and CuR rates were significantly greater in the endoscopic submucosal dissection group when compared to those in the endoscopic resection group. Adverse events occurred in 22 patients (17.1%), including bleeding (n=2, 1.6%), perforation (n=12, 9.3%), and stricture (n=8, 6.2%). Local tumor recurrence occurred in 2.0% of patients during a median follow-up of 34.8 months. The 5-year overall and disease-specific survival rates were 94.0% and 97.5%, respectively. CONCLUSIONS: ER is a feasible and effective method for the treatment of SEN as indicated by favorable clinical outcomes.
Aged ; Aged, 80 and over ; Disease-Free Survival ; Dissection/*adverse effects/methods ; Esophageal Neoplasms/pathology/*surgery ; Esophageal Perforation/epidemiology/etiology ; Esophageal Stenosis/epidemiology/etiology ; Esophagoscopy/*adverse effects/methods ; Female ; Gastric Mucosa/surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Postoperative Hemorrhage/epidemiology/etiology ; Retrospective Studies ; Treatment Outcome

From April 2008 to November 2008, many cases of hepatitis A were reported in Seoul and Gyeonggi Province in Korea. Furthermore, the rate of severe or fulminant hepatitis have significantly increased during the latest epidemic (13.4% vs. 5.2%, p=0.044). Therefore, widespread use of vaccine is warranted to reduce the burden of hepatitis A in Korea.
Adolescent ; Adult ; Child ; Epidemics ; Female ; Hepatitis A/diagnosis/*epidemiology/prevention & control ; Humans ; Immunoenzyme Techniques ; Male ; Republic of Korea/epidemiology ; Retrospective Studies

PURPOSE: To identify the clinical features and outcomes of endogenous endophthalmitis in Korea. MATERIALS AND METHODS: We reviewed 18 patients with endogenous endophthalmitis at 2 Korean hospitals, treated over a 14 year period between January 1993 and December 2006. RESULTS: The comorbidities observed in these cases were diabetes mellitus and liver cirrhosis. The most common pathogens, which were found in 7 patients each (38.9%), were Klebsiella pneumonia and Pseudomonas aeruginosa. All patients were treated with systemic antibiotics and fortified topical antibiotics. A surgical approach including vitrectomy was performed in 9 cases (50.0%). The prognosis was generally poor, and visual acuity improved slightly in 6 patients (33.3%). CONCLUSION: In this study, diabetes mellitus and Klebsiella pneumonia showed a close relationship with endogenous endophthalmitis, respectively. Endogenous endophthalmitis is a serious risk to sight and careful attention to establishing the diagnosis and management may decrease the ocular morbidity.
Aged ; Diabetes Complications/*epidemiology/microbiology ; Endophthalmitis/complications/*epidemiology/microbiology ; Female ; Humans ; Incidence ; Klebsiella pneumoniae/isolation & purification ; Liver Cirrhosis/*complications/epidemiology/microbiology ; Male ; Middle Aged ; Pseudomonas aeruginosa/isolation & purification ; Republic of Korea/epidemiology ; Retrospective Studies

Coccidioidomycosis is a fungal infection that results from inhaling the airborne arthroconidia of the Coccidioides species. It is an endemic disease in the southwest part of North America and rarely diagnosed in Korea. As tourism to endemic areas and the number of immunocompromised patients have been increasing, the incidence of this infection has increased in non-endemic areas. Treatment is usually successful with antifungal agents; however, recurrence is common. It is difficult to decide when to discontinue the antifungal treatment especially in non-endemic areas where doctors are not familiar with the disease. We report a case of recurrent coccidioidomycosis manifesting as osteomyelitis after the treatment of the patient for disseminated coccidioidal infection. The complement fixation test was a useful tool for the assessment of patient response and to evaluate suspected recurrence.
Coccidioides ; Coccidioidomycosis ; Complement Fixation Tests ; Endemic Diseases ; Humans ; Immunocompromised Host ; Incidence ; Inhalation ; Korea ; North America ; Osteomyelitis ; Recurrence