Transfer of large quantities of fetal blood across the placental barrier to the maternal circulation is a rare occurrence which results in severe anemia in the newborn infants. This phenomenon is believed to occur most often during labor and delivery and apparently, is more frequent when abnormal obstetric conditions are present. However, fetal erythrocytes have been identified in the naternal circulation throughout most of pregnancy indicating some degree of constant or intermittent transplacental transfusion. We experienced a case of stillbirth due to large amount of fetomaternal transfusion. Acid elutionl test of maternal blood was positive and direct and indirect Coombs test was negative. Ultrasonographic finding on abdomen and cranium to rule out the internal hemorrhage was normal. We report a case of stillbirth due to fetomaternal transfusion with a brief review of related literatures.
Abdomen ; Anemia ; Coombs Test ; Erythrocytes ; Female ; Fetal Blood ; Fetomaternal Transfusion* ; Hemorrhage ; Humans ; Infant, Newborn ; Pregnancy ; Skull ; Stillbirth*

Multiple extradural arachnoid cysts of the spine are extremely uncommon in children with only a few cases reported. The authors report a case of multiple extradural spinal arachnoid cysts in children with a review of the relevant literature.
Arachnoid ; Arachnoid Cysts ; Child ; Humans ; Spine

OBJECTIVE: Psychotherapeutic intervention combined with pharmacotherapy is helpful for achieving remission of depressive disorder. We developed and tested the effect of cognitive behavior therapy (CBT)-based psychotherapy applied in a forest environment on major depressive disorder. METHODS: We performed 4 sessions during 4 weeks (3 hours/session) in patients with major depressive disorder during pharmacotherapy. For the forest group, sessions were performed in the forest; for the hospital group, sessions were performed in the hospital. The control group was treated with the usual outpatient management. RESULTS: A total of 63 patients completed the study: 23 in the forest group, 19 in the hospital group, and 21 in the control group. Hamilton Rating Scales for Depression (HRSD) scores of the forest group were significantly decreased after 4 sessions compared with controls. Montgomery-Asberg Depression Rating Scales (MADRS) scores of the forest group were significantly decreased compared with both the hospital group and the controls. The remission rate (7 and below in HRSD) of the forest group was 61% (14/23), significantly higher than both the hospital group (21%, 4/19) and the controls (5%, 1/21). In heart rate variability (HRV) analysis, some measurements representing HRV and parasympathetic nerve tone were increased in the forest group after 4 sessions. The salivary cortisol levels of the forest group were significantly decreased. CONCLUSION: CBT-based psychotherapy applied in the forest environment was helpful in the achievement of depression remission, and its effect was superior to that of psychotherapy performed in the hospital and the usual outpatient management. A good environment such as a forest helps improve the effect of psychotherapeutic intervention because it includes various natural instruments and facilitators in the treatment of depression.
Achievement ; Cognitive Therapy ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Heart Rate ; Humans ; Hydrocortisone ; Outpatients ; Psychotherapy ; Weights and Measures

OBJECTIVE: Psychotherapeutic intervention combined with pharmacotherapy is helpful for achieving remission of depressive disorder. We developed and tested the effect of cognitive behavior therapy (CBT)-based psychotherapy applied in a forest environment on major depressive disorder. METHODS: We performed 4 sessions during 4 weeks (3 hours/session) in patients with major depressive disorder during pharmacotherapy. For the forest group, sessions were performed in the forest; for the hospital group, sessions were performed in the hospital. The control group was treated with the usual outpatient management. RESULTS: A total of 63 patients completed the study: 23 in the forest group, 19 in the hospital group, and 21 in the control group. Hamilton Rating Scales for Depression (HRSD) scores of the forest group were significantly decreased after 4 sessions compared with controls. Montgomery-Asberg Depression Rating Scales (MADRS) scores of the forest group were significantly decreased compared with both the hospital group and the controls. The remission rate (7 and below in HRSD) of the forest group was 61% (14/23), significantly higher than both the hospital group (21%, 4/19) and the controls (5%, 1/21). In heart rate variability (HRV) analysis, some measurements representing HRV and parasympathetic nerve tone were increased in the forest group after 4 sessions. The salivary cortisol levels of the forest group were significantly decreased. CONCLUSION: CBT-based psychotherapy applied in the forest environment was helpful in the achievement of depression remission, and its effect was superior to that of psychotherapy performed in the hospital and the usual outpatient management. A good environment such as a forest helps improve the effect of psychotherapeutic intervention because it includes various natural instruments and facilitators in the treatment of depression.
Achievement ; Cognitive Therapy ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Heart Rate ; Humans ; Hydrocortisone ; Outpatients ; Psychotherapy ; Weights and Measures

The objective of aneurysm surgery is to exclude the aneurysm from the circulation while preserving blood flow distal to the lesion. In certain situations, the aneurysm neck cannot be clipped safely or the parent vessel reconstructed, primarily in large or giant size with incorporation of parent vessels or perforating arteries, calcification at the aneurysm base, and fusiform or dissecting aneurysms. In such cases, occlusion of the parent vessel is a treatment of option. In many patients, however, sacrifice of the parent artery has an associated risk of ischemic stroke. Therefore, sacrifice of the parent vessel can be supplimented with distal revascularization to provide the necessary distal blood flow while allowing the aneurysm to be trapped. The indications, options, and surgical approaches are described with review of literatures. Finally the authors' experiences of revascularization in 7 patients with unclippable aneurysms are reported.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Humans ; Intracranial Aneurysm* ; Neck ; Parents ; Stroke

Excessive intake of sodium caused by high salt diet promotes the expression of inflammatory cytokines and differentiation of helper T cells resulting in inflammatory responses. High-glucose diet also contributes to the pathogenesis of periodontitis by inducing changes in the oral microbiome and reducing salivation. However, the effect of a high-salt and glucose diet (HSGD) on the prognosis of periodontitis remains unclear. In this study, a rat modelof experimental periodontitis was established by periodic insertion of absorbable sutures containing Porphyromonas gingivalis and Fusobacterium nucleatum strains into the right gingival sulcus to analyze the effect of HSGD on the incidence and progression of periodontitis. The alveolar bone heights (ABH) was measured with microcomputed tomography imaging of the HSGD- and general diet (GD)-treated groups. The right ABH was significantly decreased compared to the left in both groups at 4 weeks after induction of inflammation; however, no significant difference was noted between the groups. Notably, the ABH in the HSGD-treated group was significantly decreased at 8 weeks after induction of inflammation, whereas in the GD-treated group, an increase in the ABH was observed; a significant difference of the ABH was noted between the two groups (p < 0.05). At 12 weeks, recovery of the alveolar bone was observed in both groups, with no significant differences in ABH between the two groups. These findings indicate that the intake of excessive sodium attenuates the recovery rate of the alveolar bone even after the local infectant isremoved. In addition, this study demonstrates the use of HSGD in establishing a new animal model of periodontitis.

BACKGROUND: The composite summary score (range, 0-24) of abdominal aortic calcification (AAC) devised by Kauppila et al is a simple method of assessing AAC severity. However, few studies have been conducted to determine an optimal AAC cutoff score for the prediction of mortality or to investigate the relation between mineral metabolism and AAC progression using the scoring system. METHODS: The medical records of 112 patients on hemodialysis who had undergone simple lateral lumbar radiography every 6 months from August 2009 were reviewed. Patients were followed until November 2012, and the relationship between the degree of AAC at baseline and mortality was evaluated. In addition, the relationship between the progression of AAC and serum concentrations of calcium and phosphate was evaluated in the 75 patients who were successfully followed until November 2012. RESULTS: The mean AAC score at baseline was 5.5+/-4.8, and the cutoff calcification score for the prediction of mortality was 7.75 (sensitivity=61%, specificity=81%). Patients were allocated to Group A (baseline total calcification score < or =8.0, n=85) or Group B (baseline total calcification score>8.0, n=27), and multivariate analysis showed that Group B was an independent risk factor of all-cause mortality and cardiovascular events. Of the 75 patients successfully followed, 51 showed AAC progression (Group 1) and 24 showed no change or improvement (Group 2). Group 1 was found to have significantly higher mean serum corrected calcium levels during the 2nd year and 3rd year of follow-up than Group 2. Furthermore, repeated-measures analysis of variance showed higher monthly corrected calcium concentrations (P=0.099) and mean corrected calcium levels during the 1st year, 2nd year, and 3rd year of follow-up (P=0.062) in Group 1, but without statistical significance. The cutoff values of mean corrected calcium of the 2nd year and 3rd year for the prediction of AAC progression during follow-up years were 8.96mg/dL and 9.45mg/dL, respectively. Serum phosphate levels and corrected calciumxphosphate values were similar in Groups 1 and 2. CONCLUSION: Patients with an AAC score of>8 at baseline seem to be at higher risk of mortality during follow-up. Of the serum variables examined, such as corrected calcium, phosphate, and corrected calciumxphosphate, corrected calcium was found to be marginally associated with AAC progression. However, a larger-scale prospective study is required to confirm our findings.
Aorta, Abdominal ; Calcium* ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic ; Medical Records ; Metabolism ; Mortality* ; Multivariate Analysis ; Radiography ; Renal Dialysis* ; Risk Factors ; Vascular Calcification

Ischemic colitis generally develops in the elderly patients with concomitant cardiovascular condition, diabetes mellitus, and renal insufficiency. This disease predominently occurs in the left colon, particularly splenic flexure and sigmoid colon. The most frequent symptoms include abdominal pain, diarrhea, alteration in bowel functions and hematochezia. Blood loss is usually minimal in most patients. Herein, we report a case of ischemic colitis which developed on ascending colon with massive bleeding. A 48-year-old man was admitted because of massive lower gastrointestinal bleeding for 7 days. He has underwent hemodialysis for thirteen years. Colonoscopy showed a circular ulcer on the ascending colon with partial stenosis and mass-like oozing lesion distal to the stenotic area. We performed right hemi-colectomy. Grossly, colon showed shallow ulceration and congested ileocecal valve coated with hemorrhage. Microscopically, ulcer bed showed thickened and fibrotic submucosa which had nearly obliterated atherosclerotic vessels.
Abdominal Pain ; Aged ; Colitis, Ischemic* ; Colon ; Colon, Ascending ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Constriction, Pathologic ; Diabetes Mellitus ; Diarrhea ; Estrogens, Conjugated (USP) ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Ileocecal Valve ; Middle Aged ; Renal Dialysis ; Renal Insufficiency ; Ulcer

Humans ; Incisor ; Lip ; Osteotomy ; Tooth

To evaluate the effect of anabolic steroid(AS) on body composition and protein metabolism in malnourished CAPD patients, 7 CAPD patients who were proved to be malnourished by subjective global assessment received 200mg of AS, nandrolone decanoate, by intramuscular route monthly for 5 months. We analyzed the body composition, biochemical nutritional markers, plasma and dialysate amino acids(AA) before and after administration of AS. The mean age was 53.6+/-11.5 years, the sex ratio was 2:5, and the duration of CAPD was 28.5+/-18.7 months. Two patients were diabetics. Five months after AS administration, %lean body mass seemed to increase from 52.6+/-11.7 to 57.3+/-11.0%(P>0.05), but there were no significant changes in body weight and body mass index. Serum insulin-like growth factor-I (172.4+/-88.5 vs. 204.1+/-85.8ng/ml, P<0.05) and transferrin(213.6+/-55.4 vs. 239.0+/-55.3mg/dl, P<0.05) were significantly increased, and serum total CO2(31.1+/-4.5 vs. 25.9+/-2.5mM/L, P<0.05) were significantly decreased. Urea nitrogen appearance(4.0+/-2.0 vs. 3.6+/-1.6g/ day) seemed to be decreased. Both plasma essential AA(EAA) level(738.3+/-206.5 vs. 492.5+/-187.2micromol/L, P<0.05) and peritoneal EAA loss(565.0+/-186.1 vs. 377.4+/-113.9micromol/day, P<0.05) decreased significantly after administration. Plasma total and non- essential amino acids(NEAA) level tended to be increased and peritoneal total and NEAA loss seemed to be decreased without statistical significance. In conclusion, AS seems to have anabolic effect and be useful in the correction of malnutrition in CAPD patients.
Amino Acids ; Anabolic Agents ; Body Composition* ; Body Mass Index ; Body Weight ; Humans ; Malnutrition ; Metabolism* ; Nandrolone ; Nitrogen ; Peritoneal Dialysis, Continuous Ambulatory* ; Plasma ; Sex Ratio ; Urea