Although a higher incidence of ectopic pregnancy has been reported after in vitro fertilization(IVF) and embryo transfer(ET), five ectopic pregnancies in one patient is very rare. We experienced a case of combined interstitial and intrauterine pregnancy as fifth ectopic pregnancies after in vitro fertilization and embryo transfer in one patient with history of bilateral salpingectomy due to previous four tubal pregnancies. Repeated transvaginal ultrasound examinations confirmed heterotopic pregnancy. In IVF-ET, bilateral salpingectomy does not remove the risk of interstitial or cornual pregnancy.
Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Humans ; Incidence ; Pregnancy* ; Pregnancy, Ectopic* ; Pregnancy, Heterotopic ; Pregnancy, Tubal ; Salpingectomy* ; Ultrasonography

OBJECTIVE: The implantation failure after embryo-transfer (ET) is a major continuing problem in in vitro fertilization (IVF). This study was undertaken to determine the effectiveness of intravenous immunoglobulin for treatment of individuals experiencing repeated unexplained in vitro fertilization-embryo transfer (IVF-ET) failure. METHODS: A total of nine consecutive infertile patients who failed to become pregnant after previous IVF-ET replacing at least three or more normal developed embryos each were included in our study. During the subsequent new IVF-ET cycle, each women received intravenous immunoglobulin 500mg/kg before the embryo transfer. RESULTS: Only one implantation occurred. There were no remarkable side effects. A specific effect of intravenous immunoglobulin for patients with repeated IVF-ET failure could not be demonstrated. CONCLUSION: High-dose intravenous immunoglobulin may not be useful for patients with repeated failure of embryo transfer.
Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Humans ; Immunoglobulins*

Infertility is a disease that exists when a couple has tried to conceive for 12 months during which time they have had intercourse without the use of contraception. The fecundability of a normal couple in one cycle has been estimated at 20% to 25%. On the basis of this estimate, about 85% of couples should conceive after 12 months of unprotected intercourse. Infertility affects about 13.5% of reproductive couples in Korea. Earlier evaluation and treatment is required in women with age over 35 years and some medical conditions. Both partners should be evaluated at the same time. The use of a standard infertility treatment algorithm results in a higher pregnancy rate and lower cost and therefore should be the preferred treatment approach. IVF-ET and tubal surgery must be considered to be complementary rather than competitive procedures. Adequate selection of patients is crucial to find the best therapeutic approach.
Contraception ; Family Characteristics ; Female ; Female* ; Fertility ; Humans ; Infertility ; Infertility, Female* ; Korea ; Pregnancy Rate

No abstract available.
Coxiella burnetii* ; Coxiella* ; Korea* ; Milk*

PURPOSE: This study was designed to review the clinical outcome of infants who underwent tracheostomy in the neonatal intensive care unit (NICU) of a single center in Korea during 16 years. METHODS: We retrospectively reviewed medical records of 33 patients who underwent tracheostomy in NICU of Samsung Medical Center between January, 1997 and December, 2013. We collected data on timing, indications, clinical outcomes, and complications of tracheostomy in the study patients. We also compared these variables with those in another single center study (study A) recently showing the outcome of infants who underwent tracheostomy in a NICU of USA during 10 years. RESULTS: The median gestational age and birth weight of the study patients were 35 weeks, and 3,200 g, respectively. Gestational age of the study patients was greater than that of study A (35 weeks vs. 27 weeks). The most common indication for tracheostomy was airway disease (69.7%) in our study. Bronchopulmonary dysplasia (9%) was less frequent indication for tracheostomy in our study when compared with in the study A (41%). Granuloma formation was the most common complication of tracheostomy (48%) and decannulation was accomplished in nine patients (27.3%). Although the mortality rate was 12.1%, no patient died from tracheostomy-related complications. CONCLUSION: Main causes of tracheostomy in our NICU are airway problems and neuromuscular diseases rather than bronchopulmonary dysplasia itself. For better clarification of clinical courses and outcomes related to tracheostomy performed in NICU in Korea, further study in a larger population will be needed.
Birth Weight ; Bronchopulmonary Dysplasia ; Gestational Age ; Granuloma ; Humans ; Infant* ; Infant, Newborn ; Intensive Care, Neonatal* ; Korea ; Medical Records ; Mortality ; Neuromuscular Diseases ; Retrospective Studies ; Tracheostomy*

OBJECTIVE: This study was designed to evaluate the survival benefit of laparoscopic surgical staging (LSS)-guided tailored radiation therapy (RT) in locally advanced cervical cancer (LACC). METHODS: We retrospectively reviewed 89 LACC patients' medical records who primarily received non-surgical treatment, of which pretreatment LSS was performed in 20 (LSS group) and primary chemoradiation therapy (CCRT) without LSS (CCRT group) was carried out in 69 from January 2000 to January 2006. We analyzed clinical characteristics, pretreatment imaging study results and survival outcomes including disease free survival (DFS) and overall survival (OS) to compare them between the two groups. RESULTS: There were as many as eight cases (40%) of LSS related complications. The mean time interval between LSS and RT or CCRT was 26.6 days (+/-18.8 days). Six out of twenty (30%) in LSS group and 10 out of 69 (14.5%) in CCRT group received extended field RT when paraaortic lymph nodes (LNs) were positive based on the pathologic findings after LSS and the results of imaging studies, respectively. Three-year DFS and OS were both better in 33 imaging-negative CCRT group patients than those in 4 imaging-negative/pathology-positive (false negative) patients after LSS (3-year DFS, 50% vs. 87%, p=0.022; 3-year OS, 50% vs. 84%, p=0.033). The 5-year DFS rates were 52% and 55% in LSS group and in CCRT group, respectively (p=0.28). The 5-year OS rates were 68% in LSS group and 62% in CCRT group without significant difference between the two groups (p=0.79). CONCLUSION: We found that LSS-based RT tailoring did not show survival benefit in LACC despite inaccuracy of imaging-based RT tailoring. Further studies are required to find new method to overcome this inaccuracy and improve survival outcomes.
Disease-Free Survival ; Humans ; Laparoscopy ; Lymph Nodes ; Medical Records ; Retrospective Studies ; Uterine Cervical Neoplasms

PURPOSE: Tuberculosis (TB) is a major infectious disease and is responsible for two million deaths annually. For the identification and quantitation of Mycobacterium tuberculosis (M. tuberculosis), a causative agent of TB, a sandwich enzyme-linked immunosorbent assay (ELISA) against the MPT64 protein of M. tuberculosis, an antigen marker of the M. tuberculosis complex, was developed. MATERIALS AND METHODS: The MPT64 protein was expressed, and anti-MPT64 monoclonal antibodies were prepared. A sandwich ELISA was established using recombinant MPT64 protein and anti-MPT64 monoclonal antibodies. The sandwich MPT64 ELISA was evaluated using reference and clinical mycobacterial strains. RESULTS: The sandwich MPT64 ELISA detected MPT64 protein from 2.1 ng/mL to 250 ng/mL (equivalent to 1.7x10(4) CFU/mL and 2.0x10(6) CFU/mL). All 389 clinical M. tuberculosis isolates tested positive in the sandwich MPT64 ELISA (sensitivity, 100%), and the assay showed no cross reactivity to any tested nontuberculous mycobacterial strain (specificity, 100%). CONCLUSION: The sandwich MPT64 ELISA is a highly sensitive and quantitative test for MPT64 protein, which can identify M. tuberculosis.
Antigens, Bacterial/*analysis/immunology ; Enzyme-Linked Immunosorbent Assay/*methods ; Mycobacterium tuberculosis/*immunology

BACKGROUND AND OBJECTIVES: B-type natriuretic peptide (BNP) is released from the cardiac ventricles in response to increased wall tension. Early diagnosis of congestive heart failure (CHF) and assessment of the left ventricular end diastolic pressure (LVEDP) are thought to be important in the diagnosis, treatment and follow up of patients with CHF. SUBJECTS AND METHODS: Between March, 2002 and November, 2002, 50 patients, who were admitted for treatment and hemodynamic monitoring, were studied. For the BNP measurement, 3 to 5ml blood samples were collected into tubes containing EDTA. The BNP was measured with a fluorescence immunoassay kit (Triage, Biosite, San Diego, U.S.A.). Cardiac Catheterization was performed for the assessment of the LVEDP. RESULTS: Of the 50 subjects, 34 with CHF had a mean BNP level of 483.1+/-77.8 pg/mL, whereas those without CHF had a level of 79.2+/-24.0 pg/mL. The difference between the groups was statistically significant (p=0.005). A significant positive correlation was seen between the BNP and the LVEDP (r=0.53, p=0.001). The correlation between the BNP and the left ventricular ejection fraction (LVEF) was not statistically significant (r=-0.226, p=0.198). CONCLUSION: The plasma BNP was significantly increased in CHF, and might reflect the LVEDP. Further study will be required to see whether the BNP is a useful parameter for the staging and treatment of CHF.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Early Diagnosis ; Edetic Acid ; Estrogens, Conjugated (USP)* ; Fluorescence ; Follow-Up Studies ; Heart Failure* ; Heart Ventricles ; Hemodynamics ; Humans ; Immunoassay ; Natriuretic Peptide, Brain* ; Plasma ; Stroke Volume ; Ventricular Pressure

BACKGROUND: Ethambutol(EMB) is one of the first-line drugs included in short-course anti-tuberculosis therapy. The point mutations in embB gene have been speculated to be associated EMB resistance. However, detection of embB mutations at these positions have been observed in both EMB-susceptible isolates; thus, it remains controversial whether these mutations are associated with EMB resistance METHODS: The 36 M. tuberculosis isolates were selected from clinical isolates which tested susceptible to EMB and resistant to at least one drug. DNA extracted from the isolates was analyzed by amplifying embB gene. The PCR products were purified and directly sequenced. We reviewed the history of past drug susceptibility test results. RESULTS: Out of 36 EMB-susceptible strains, 3 strains (8.3%) had a mutation in codon 306 or 406 of the embB gene. These three strains had at least isoniazid resistance. They grew at 1.0 mcg/ml of EMB in Lowenstein-Jensen media. The patients of the strains were continuously smear-positive for over 3 years despite taking TB therapy. One strain had been EMB-resistant in past drug susceptibility tests. CONCLUSION: EMB-susceptible strains containing embB mutation may be caused by decreased viability in vitro test not by itself.
Codon ; DNA ; Drug Resistance ; Ethambutol ; Humans ; Isoniazid ; Korea ; Mycobacterium tuberculosis* ; Mycobacterium* ; Point Mutation ; Polymerase Chain Reaction ; Tuberculosis

BACKGROUND: Fluoroquinolone drugs are an important anti-tuberculous agent for the treatment of multi-drug resistant tuberculosis. However, many drugs belonging to the fluoroquinolones have different cross resistance to each other. METHODS: Sixty-three ofloxacin (OFX) resistant and 10 pan-susceptible M. tuberculosis isolates were selected, and compared for their cross resistance using a proportion method on Lowenstein-Jensen media, containing ofloxacin (OFX), ciprofloxacin (CIP), levofloxacin (LVX), moxifloxacin (MXF), gatifloxacin (GAT) and sparfloxacin (SPX), at concentrations ranging from 0.5 to 3microgram/ml. DNA extracted from the isolates was directly sequenced after amplifying from the gyrA and gyrB genes. RESULTS: The 63 OFX resistant M. tuberculosis isolates showed complete cross resistance to CIP, but only 90.5, 44.4, 36.5 and 46.0% to LVX, MXF, GAT, and to SPX, respectively. Fifty-one of the isolates (81.0%) had point mutations in codons 88, 90, 91 and 94 in gyrA, which are known to be correlated with OFX resistance. The Gly88Ala, Ala90Valand Asp94Ala mutations in gyrA showed a tendency to be susceptible to MXF, GAT and SPX. Only 4 isolates had mutations in the gyrB gene, which did not affect the OFX resistance. CONCLUSION: About 60% of the OFX resistant M. tuberculosis isolates were susceptible to GAT, SPX and MXF. These fluoroquinolones may be useful in the treatment of TB patients showing OFX resistance.
Ciprofloxacin ; Codon ; DNA ; Fluoroquinolones ; Genotype ; Humans ; Levofloxacin ; Mycobacterium tuberculosis* ; Mycobacterium* ; Ofloxacin ; Point Mutation ; Tuberculosis ; Tuberculosis, Multidrug-Resistant