Intraventricular hemorrhage (IVH) is common in the premature infants and occurs mainly in subependymal germinal matrix. In contrast, IVH in the term infants is rare and different in pathogenesis and bleeding sites from those of the premature infants. Most studies of IVH in term infants have been studied by computerized tomography and postmortem examination. Brain ultrasonography which has become a frequently used diagnostic tool of IVH in the premature infants is reported to be also effective in diagnosis in the term infants. The study population comprised 11 term neonates admitted to the Neonatal Intensive Care Unit of Seoul National University Children's Hospital between July 1989 and June 1991, in whom IVH was diagnosed by ultrasonography. We analysed severity of birth asphyxia. ultrasonographic findings and clinical manifestations to investigate severity, timing, risk factors, and pathogenesis of IVH in the term neonates. 1) Apgar scores were available in 7 cases with severe asphyxia (Apgar at 1 min: less than 3), 1 cases with mild asphyxia (Apgar at 1 min: between 5~7), and 2 cases without asphyxia. 2) Clinically, 4 cases had fetal distress, and 3 cases had meconium aspiration pneumonia. 3) Bleeding sites by ultrasonography were subependymal germinal matrix in all 11 cases. IVH of choroid plexus was combined in 2 cases. Severity of IVH were grade I in 9 cases, grade II in 2 cases by Papile's classification. 4) There were no correlations between the grade of IVH and severity of perinatal asphyxia. In conclusion, ultrasonography is very useful in diagnosis and follow-up of IVH in term neonates. Subependymal germinal matrix could be common site of IVH in term neonates because germinal matrix still remains in term neonates despite of its regression. Also this can explain why IVH in our cases is not severe.
Asphyxia ; Autopsy ; Brain ; Choroid Plexus ; Classification ; Diagnosis ; Fetal Distress ; Follow-Up Studies ; Hemorrhage* ; Humans ; Infant* ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Meconium Aspiration Syndrome ; Parturition ; Pneumonia ; Risk Factors ; Seoul ; Ultrasonography

PURPOSE: We performed this study to evaluate the usefulness and the limitation of magnetic resonance angiography in imaging portal vein and hepatic vein. MATERIALS AND METHODS: Magnetic resonance portography was performed in five normal subjects and seven patients with hepatomas, two patients with Budd-Chiari syndromes, one patient with liver cirrhosis and one patient with hepatic metastasis from stomach cancer. Magnetic resonance angiography was done with a 1.5-T Scanner. Breath-hold two-dimensional time-of flight images with spoiled gradient echo technique were acquired. Scan parameters were 34/8/40degrees(TR ms/TE ms/flip angle). The portal vein and the hepatic vein were selectively imaged by applying two presaturation bands. These images were then postprocessed by a maximum intensity projection algorithm. MRA findings were compared with ultrasonography in all cases of the hepatic disease, and conventional angiography (SMA portography) in four cases. RESULTS: In normal subjects, the splenic vein, intrahepatic and extrahepatic portions of the portal vein, and the hepatic veins were well visualized. In the patients with hepatic diseases, the varices (4 cases), the splenorenal shunts (2 cases), and the recanalized umbilical vein (1 case) were demonstrated. There were portal vein thrombosis in the cases of hepatomas and hepatic metastasis. In the cases of Budd-Chiari syndrome, the hepatic veins were not visualized and there were inferior vena cava obstructions with multiple collateral vessels. CONCLUSION: Compared with ultrasonography, MRP may be useful in evaluation of varices, splenorenal shunts, and other collaterals, though less accurate than conventional angiography. MRP can be useful as a noninvasive screening alternative in the evaluation of portal vein and hepatic veins.
Angiography ; Budd-Chiari Syndrome ; Carcinoma, Hepatocellular ; Hepatic Veins ; Humans ; Liver Cirrhosis ; Magnetic Resonance Angiography ; Mass Screening ; Neoplasm Metastasis ; Portal Vein ; Portography* ; Splenic Vein ; Splenorenal Shunt, Surgical ; Stomach Neoplasms ; Ultrasonography ; Umbilical Veins ; Varicose Veins ; Vena Cava, Inferior ; Venous Thrombosis

Pedicled omentoplasty is effective in thoracic surgery, but it is associated with several postoperative complications. A case of diaphragmatic hernia as a complication of pedicled omentoplasty in a 65-year-old male is reported. Because aortoesophageal fistula occurred three months after the patch aortoplasty for mycotic aneurysm of descending thoracic aorta, he underwent ascending thoracic aorta to abdominal aorta bypass surgery with resection of thoracic aortic aneurysm and esophagorrhaphy with wrapping of the esophageal suture line and the stumps of aorta with pedicled omental flap. Three years after the operation, herniation of the stomach developed. The pedicled omental flap was ligated and divided, and the diaphragm defect was repaired.
Aged ; Aneurysm, Infected ; Aorta ; Aorta, Abdominal ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Diaphragm ; Fistula ; Hernia, Diaphragmatic* ; Humans ; Male ; Postoperative Complications ; Stomach ; Surgical Flaps ; Sutures ; Thoracic Surgery

Aortoesophageal fistula is an uncommon and fatal complication after surgery of aortic aneurysm. A case of aortoesophageal fistula as a complication of synthetis patch aortoplasty for mycotic aneurysm of descending thoracic aorta is described. After 3 months since patch aortoplasty for mycotic aneurysm of descending thoracic aorta this patient visited the emergency room due to melena and hematemesis. After gastrofiberoscopy and computed tomography the patient was taken ot the operating room. The surgical intervention was performed in two steps. Median sternotomy and midline laparotomy were made. Hemashield's Dacron(16mm) bypass between ascending thoracic aorta and infra-renal abdominal aorta was established first. Through the posterolateral thoracotomy false aneurysm and previous Hemashield's Dacron patch of descending aorta were resected. The two ends of the aorta were sutured and esophageal fistula was repaired. The esophageal suture line and the stumps were covered with omental graft. Thirty months later the patient has had no difficulty referable to the aortic surgery.
Aneurysm, False ; Aneurysm, Infected* ; Aorta ; Aorta, Abdominal ; Aorta, Thoracic* ; Aortic Aneurysm ; Emergency Service, Hospital ; Esophageal Fistula ; Fistula* ; Hematemesis ; Humans ; Laparotomy ; Melena ; Operating Rooms ; Polyethylene Terephthalates ; Sternotomy ; Sutures ; Thoracotomy ; Transplants

Endometriosis is a rare cause of an ureteral obstruction. We report a case of intrinsic ureteral endometriosis resulting in severe hydroureteronephrosis. The diagnosis of ureteral endometriosis may be considered in women with flank pain and ureteric obstruction within true pelvis.
Diagnosis ; Endometriosis* ; Female ; Flank Pain ; Humans ; Lesser Pelvis ; Ureter* ; Ureteral Obstruction

No abstract available.
Cytomegalovirus Infections* ; Cytomegalovirus* ; Humans ; Infant, Newborn ; Infant, Premature*

Purpose: With changing fungal epidemiology and azole resistance in Aspergillus species, identifying fungal species and susceptibility patterns is crucial to the management of aspergillosis and mucormycosis. The objectives of this study were to evaluate performance of panfungal polymerase chain reaction (PCR) assays on formalin-fixed paraffin embedded (FFPE) samples in the identification of fungal species and in the detection of azole-resistance mutations in the Aspergillus fumigatus cyp51A gene at a South Korean hospital. Materials and Methods: A total of 75 FFPE specimens with a histopathological diagnosis of aspergillosis or mucormycosis were identified during the 10-year study period (2006–2015). After deparaffinization and DNA extraction, panfungal PCR assays were conducted on FFPE samples for fungal species identification. The identified fungal species were compared with histopathological diagnosis. On samples identified as A. fumigatus, sequencing to identify frequent mutations in the cyp51A gene [tandem repeat 46 (TR46), L98H, and M220 alterations] that confer azole resistance was performed. Results: Specific fungal DNA was identified in 31 (41.3%) FFPE samples, and of these, 16 samples of specific fungal DNA were in accord with a histopathological diagnosis of aspergillosis or mucormycosis; 15 samples had discordant histopathology and PCR results. No azole-mediating cyp51A gene mutation was noted among nine cases of aspergillosis. Moreover, no cyp51A mutations were identified among three cases with history of prior azole use. Conclusion Panfungal PCR assay with FFPE samples may provide additional information of use to fungal species identification. No azole-resistance mediating mutations in the A. fumigatus cyp51A gene were identified among FFPE samples during study period.

BACKGROUND: Typhoid fever is diagnosed by culture or serological study. The confirmative diagnosis of typhoid fever is made by culture of the causative orga-nism usually from body fluids. Serological test is a supportive diagnostic tool, which is useful for early dia-gnosis. In Severance Hospital, Vi-indirect fluorescent antibody test(Vi-IFAT) using the Vi-antigen of Salmo-nella typhi has been used in the diagnosis of typhoid fever since 1989. We investigated the test results from the past 7 years, in order to clarify the sensitivity and specificity of Vi-IFAT. METHODS: A retrospective study was done on pa-tients whose chief complaint was fever and who were tested using Vi-IFAT in the Severance Hospital from 1989 to 1996. The positive value for Vi-IFAT was de- fined as 1:64 or higher. RESULTS: The sensitivity and specificity of Vi-IFAT for typhoid fever was 94.4% and 95.1%, respectively. The positive and negative predictive values were 85.7% and 98.2% respectively. Positive rates of Vi-IFAT after fever onset increased with time and 68% were positive before the first week. From the first to the second week, 89.5% were positive and after the second week, 100% were positive. CONCLUSION: Vi-IFAT is not only a valuable sero-logic test for the diagnosis of typhoid fever, but also useful in the early diagnosis of the disease.
Body Fluids ; Diagnosis* ; Early Diagnosis ; Fever ; Retrospective Studies ; Sensitivity and Specificity* ; Serologic Tests ; Typhoid Fever*

BACKGROUND: There are three basic types of fungal sinusitis: noninvasive, invasive, and allergic. Both noninvasive and invasive fungal sinusitis necessarily require surgery with or without antifungal treatment. This study was performed to evaluate the efficacy of treatment modalities and clinical characteristics between pathologically proven noninvasive and invasive fungal sinusitis. METHODS: 40 patients pathologically proven to have fungal sinusitis from July, 1990 to January, 2000 were enrolled in this study. This retrospective study was performed in Severance Hospital, Yong-Dong Severance Hostpital and Ah-Joo University Hospital. The efficacy of treatment modalities and prognosis between pathologically proven noninvasive group (group A) and invasive group (group B) were evaluated. RESULTS: Of the total 40 patients, 13 were male and 27 were female, and the mean age was 51.6+/-14.2 years. 32 patients belonged to noninvasive group and 8 patients belonged to invasive group. Of the total 40 patients, 20 (50%) patients had underlying diseases, such as 8 cases of Diabetes Mellitus, 3 cases of hematologic malignancy, 2 cases of solid cancer, 1 case of steroid overuse, and the others 6 cases. In group A, only 12 patients (37.5%) had underlying diseases, however, all 8 patients (100%) in group B had underlying diseases. All 32 patients of group A went chronic course but in group B, all 8 patients appeard to be acute in course. The pathogens were classified to 36 cases of Aspergillus spp. (69.2%), 3 cases of Rhizopus spp. (5.8%), and 1 case of Candida spp. (1.9%). As for the treatment modalities, in group A, 30 cases had surgery only and 2 cases performed surgery and antifungal treatment. Both showed 100% of treatment efficacy. In group B, 5 cases were treated with antifungal therapy only and 2 cases performed surgery and antifungal treatment. The former showed 20% and the latter, 33% of treatment efficacy. Noninvasive fungal sinusitis revealed good results even in surgery only therapy, but invasive fungal sinusitis tended to reveal better results in both surgery and antifungal treatment. CONCLUSION: The pathologic type of fungal sinusitis is now thought to be very important for the choice of treatment modalities and efficacy of treatment. Also the type of pathogens, immunologic state of patients, and early diagnosis of fungal sinusitis attribute to the treatment efficacy of fungal sinusitis.
Aspergillus ; Candida ; Diabetes Mellitus ; Early Diagnosis ; Female ; Hematologic Neoplasms ; Humans ; Male ; Prognosis ; Retrospective Studies ; Rhizopus ; Sinusitis* ; Treatment Outcome

Background: The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis. Materials and Methods: Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively. Results: A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%).The most frequently identified microorganisms were Staphylococcus aureus (51.1%), followed by Streptococci sp. (21.1%), Enterobacteriaceae (8.4%), and coagulase-negative-Staphylococci (CNS;8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant S. aureus (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections. Conclusion Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered.