Down syndrome is the most common autosomal chromosomal abnormality characterized by mental and growth retardation, and by various typical features including prominent epicanthal fold, oblique palpebral fissure, flat nasal bridge, short and broad hand, wide toe interspace, etc. The overall incidence has been shown to be 1:800 deliveries, increasing with advancing maternal age. However, twin cases are extremely rare, and thus far only 500 cases were reported worldwide. We have recently observed 10-day-old male monozygotic twins with Down syndrome, born to a mother of 30 years of age with one normal child. Both have VSD confirmed by 2D-echocardiography, in addition to various typical features. Cytogenetic examination revealed that both have karyotypes of 47, XY, +21. This is the first report in Korea as the authors are aware of.
Child ; Chromosome Aberrations ; Cytogenetics ; Down Syndrome ; Hand ; Humans ; Incidence ; Incontinentia Pigmenti* ; Karyotype ; Korea ; Male ; Maternal Age ; Mothers ; Toes ; Twins, Monozygotic

Gastric cancer is the most prevalent gastrointestinal tract malignancy in Korea. By the time the patient hassymptoms, these tumors are usually advanced in stage. In high risk populations,screening such as double contrastUGI or gastric endoscopy is needed and patient with vague symptoms should be studied. However, these screeningshave high diagnostic accuracy rate, only CT scan can identify accurately abnormal stomach wall thickening andintraabdominal tumor extension. And CT is important for palnning of treatment, assessing surgical resectability,postoperative evaluation and prognostic implications. Author reviewed CT scan of 67 cases of confirmed gastriccancer by double contrast UGI or endoscopic biopsy, for 29 months from March 1983 to August 1985 at Department ofRadiology, Pusan National University Hospital. The results were as follows: 1. The most frequent site ofinvolvement of gastric cancer was gastric antrum in 49.9%(33/67). 2. By CT staging, stage 3 was 40.2%(27/67) andstage 4 was 38.8%(26/67). 3. In CT scan analysis, the structures involved by diect invasion were regional lymphnodes, pancrease, and gastrocolic ligament in order of frequency. The structures involved by distant metastaseswere liver, systemic lymph nodes, and mesentery in order of requency. 4. The diagnostic accuracy of CT staging was73.9%(17/23) by correlation of surgical and pathological findings. 5. In determination of stage by CT, the rate ofin accuracy of stage 2 was highest as 33%(2/6), and that of stage 3 was 29.2%(3/11). 6. Of all misdiagnoses,83.3%(5/6) was owing to failure to differentiate lymph node invasion from reactive hyperplasia of lymph node.
Biopsy ; Busan ; Endoscopy ; Gastrointestinal Tract ; Humans ; Hyperplasia ; Korea ; Ligaments ; Liver ; Lymph Nodes ; Mesentery ; Pancreas ; Pancrelipase ; Pyloric Antrum ; Stomach ; Stomach Neoplasms ; Tomography, X-Ray Computed

BACKGROUND: To decrease the risk of pulmonary aspiration of gastric contents, patients are routinely asked not to eat or drink anything for at least 6 to 8 hours before surgery. We studied to evaluate whether the volume and pH of gastric fluid immediately after induction of anesthesia is correlated with water ingestion. METHODS: Fifty patients, scheduled for elective surgery, were randomly divided into two groups. Control group(n=25) were fasted overnight and received no water. Experimental group(n=25) were fasted overnight and received 150 ml water approximately 2 hours before the induction of anesthesia. Gastric fluid was obtained via multiorifice gastric tube with the patient in three different positions. The volume of gastric fluid was recorded and its pH was measured. RESULTS: The gastric volumes were no differences between the two groups. The gastric pH values were significant differences. The incidence of patients with the high risk factors of gastric volume greater than 25 ml and pH less than 2.5 was decreased in experimental group. CONCLUSIONS: We concluded that surgical patients could be permitted to ingest 150 ml water approximately 2 hours before the induction of anesthesia.
Adult* ; Anesthesia ; Eating* ; Humans ; Hydrogen-Ion Concentration* ; Incidence ; Risk Factors ; Water*

Essential thrombocytosis (ET) is a clonal myeloproliferative disorder, characterized predominantly by a markedly elevated platelet count without known cause. We report a case of essential thrombocytosis, the only clinical manifestation of which consisted of neurologic symptoms, including headache, dysarthria, right hemiparesis with a relatively benign and slowly progressive clinical course. Neuroradiologic examination (Brain CT and MRI) disclosed a multiple infarction in the both basal ganglia and left parietal region. These findings are discussed in relation to the possible pathogenetic mechanisms of the vascular occlusion due to abnormal platelet function in ET.
Basal Ganglia ; Blood Platelets ; Cerebral Infarction* ; Dysarthria ; Headache ; Infarction ; Myeloproliferative Disorders ; Neurologic Manifestations ; Paresis ; Platelet Count ; Rabeprazole ; Thrombocytosis*

PURPOSE: The most serious complication related to cataract surgery is endophthalmitis. Although its incidence is decreasing, it remains the great threat to the outcome of visual acuity in patients who received cataract surgery. METHODS: Retrospective analysis was performed on 18 patients who were diagnosed with endophthalmitis. The following factors were investigated: method of cataract extraction, performance of anterior vitrectomy, presence of posterior capsule rupture, results of bacterial culture, existence of systemic disease, and the duration of time from initial cataract surgery to diagnosis of endophthalmitis and then to subsequent posterior vitrectomy. In addition, the differences in final visual acuity due to variations in these factors were analyzed. RESULTS: Patients who were diagnosed with endophthalmitis and had been commenced on systemic antibiotics within a week of the cataract operation, showed better outcomes in final visual acuity (P=0.043). CONCLUSION: Occurrence of endophthalmitis and subsequent usage of systemic antibiotics within a one-week time frame of cataract surgery, led to statistically significant improvement in final visual acuity compared to cases in which these events occurred one week later.
Anti-Bacterial Agents ; Cataract Extraction ; Cataract* ; Diagnosis ; Endophthalmitis* ; Humans ; Incidence ; Retrospective Studies ; Rupture ; Visual Acuity ; Vitrectomy

PURPOSE: The most serious complication related to cataract surgery is endophthalmitis. Although its incidence is decreasing, it remains the great threat to the outcome of visual acuity in patients who received cataract surgery. METHODS: Retrospective analysis was performed on 18 patients who were diagnosed with endophthalmitis. The following factors were investigated: method of cataract extraction, performance of anterior vitrectomy, presence of posterior capsule rupture, results of bacterial culture, existence of systemic disease, and the duration of time from initial cataract surgery to diagnosis of endophthalmitis and then to subsequent posterior vitrectomy. In addition, the differences in final visual acuity due to variations in these factors were analyzed. RESULTS: Patients who were diagnosed with endophthalmitis and had been commenced on systemic antibiotics within a week of the cataract operation, showed better outcomes in final visual acuity (P=0.043). CONCLUSION: Occurrence of endophthalmitis and subsequent usage of systemic antibiotics within a one-week time frame of cataract surgery, led to statistically significant improvement in final visual acuity compared to cases in which these events occurred one week later.
Anti-Bacterial Agents ; Cataract Extraction ; Cataract* ; Diagnosis ; Endophthalmitis* ; Humans ; Incidence ; Retrospective Studies ; Rupture ; Visual Acuity ; Vitrectomy

PURPOSE: To report three cases in which herpes simplex keratitis developed after initiation of latanoprost. METHODS: We experienced three patients with herpes simplex keratitis after latanoprost instillation, two patients with open angle glaucoma and one is congenital glaucoma. We preformed herpes simplex virus culture for two cases. RESULTS: One patient with history of herpes simplex keratitis, resolution when latanoprost was stopped; antiviral therapy could not eradicate herpes simplex keratitis until latanoprost was discontinued. The second patient with latanoprost associated herpes simplex keratitis cleared with discontinuation of latanoprost and start of antiviral therapy. The third patient had resolution, only when latanoprost was stopped. The result of viral cultures for two cases was negative. CONCLUSIONS: Clinicians should be aware of development or recurrence of herpes simplex keratitis when laranoprost is used for intraocular pressure control.
Glaucoma ; Glaucoma, Open-Angle ; Herpes Simplex* ; Humans ; Intraocular Pressure ; Keratitis, Herpetic* ; Recurrence ; Simplexvirus

PURPOSE: To describe the CT findings of primary liposarcoma of the mediastinum, and to correlate these with the pathologic findings. MATERIALS AND METHODS: We retrospectively reviewed the medical records, chest radiographs and CT scans of four male patients with histopathologically proven primary liposarcoma of the mediastinum treated between September 1996 and April 2002. The CT scans were analyzed by two radiologists, and final decisions were reached by consensus. They were analysed in terms of tumor size and location, enhancement pattern, the pattern of the fat component, calcification, mass effect, pleural effusion, lymph node enlargement, pericardial effusion, tumor extension to the costophrenic junction, and adjacent organ invasion. RESULTS: All patients presented with dyspnea and chest pain. Pathologic subtypes, which were well-differentiated and pleomorphic, were myxoid (n=2) and mixed (n=2). The transverse diameter of the mass ranged from 10.5 to 21 cm. All tumors were located in the anterior mediastinum, and all had lobulated margins. Soft-tissue attenuation predominance (n=2) occurred in the myxoid type, and roughly equal amounts of fat and soft-tissue attenuation (n=2) were present in the mixed type. A small area at calcification was seen in the mixed type (n=1). Mass effect on mediastinal structures was demonstrated in all patients. In three patients, the tumor draped around and conformed to the shape of the costophrenic junction. Chest wall invasion occurred in one patient. CONCLUSION: Findings of an anterior mediastinal location, fat attenuation, mass effect, the invasion of adjacent organs, and a lobulated margin strongly suggested mediastinal liposarcoma. CT attenuation of the lesions correlated closely with the degree of histologic differentiation.
Chest Pain ; Consensus ; Dyspnea ; Humans ; Liposarcoma* ; Lymph Nodes ; Male ; Mediastinum* ; Medical Records ; Pericardial Effusion ; Pleural Effusion ; Radiography, Thoracic ; Retrospective Studies ; Thoracic Wall ; Tomography, X-Ray Computed

To study the histopathologic effects and possible collagen fiber alterations in corneal opacification after repeated photorefractive keratectomy(PRK) in human. PRK had been performed five times for 2 and 2/3 years using excimer laser. One year and ten months after last PRK, partial penetrating keratoplasty was performed. The cornea was stained with PAS, Alcian blue, Masson`s trichrome, Congo red. Oil red. O and stained immunohistochemically for collagens type III, IV, VI, VII. It was observed under light microscope(LM) and transmission electron microscope(TEM). LM findings showed thickening of epithelial layers, proliferation of subepithelial fibroblasts and absence of Bowman`s membrane. By TEM, disarray of collagen lamellae and electron dense deposits to adjacent keratocyte were observed. Histochemically, positive staining in Alcian blue, while negative in others. In immunohistochemistry, positive staining for type IV and VI collagens were noted. Corneal opacity after repeated PRK is due to deposits of type IV and VI collagens and acidic mucoprotein in extracelluar matrix, which is positive in Alcian blue stain.
Alcian Blue ; Collagen ; Congo Red ; Cornea ; Corneal Opacity* ; Fibroblasts ; Humans ; Immunohistochemistry ; Keratoplasty, Penetrating ; Lasers, Excimer ; Membranes ; Photorefractive Keratectomy*

PURPOSE: To evaluate the effectiveness of the minus diopter posterior chamber intraocular lens(PC IOL) implantation in highly myopic patients undergoing cataract extraction. METHODS: We have evaluated the outcome of 27 highly myopic patients(32 eyes) who had undergone extracapsular cataract extraction with minus diopter PC IOL implantation during the period from July 1995 to December 2000. RESULTS: At the time of the operation examined average axial length in the operated eyes was 31.8 mm and the average of calculated diopter of PC IOL was -2.45 diopter(D). There was no statistically significant difference between the preoperative and postoperative best corrected visual acuity in each inserted IOL diopter(p>0.05). The preoperative refraction ranged from -17D to 29D(-22.45D in average), and visual acuity improved by over 0.5 in 15 eyes(49.5%). After cataracts developed in 4 eyes(12.5%), requiring Nd-YAG laser posterior capsulotomy. There were no serious complications such as retinal detachment. CONCLUSION: It is suggested that PC IOL implantation after extracapsular cataract extraction in highly myopic eyes can improve the visual acuity, without in increased risk of after cataracts and complications such as retinal detachment.
Cataract ; Cataract Extraction ; Humans ; Lasers, Solid-State ; Posterior Capsulotomy ; Retinal Detachment ; Visual Acuity