The purpose of this article was to evaluate the accuracy of predicting amnionicity using the number of yolk sacs by diagnostic ultrasound examination in monochorionic (MC) multifetal pregnancies between 7 + 0 and 9 + 6 gestational weeks. A total of 97 patients with MC multifetal pregnancies underwent early ultrasound examination from 2004 to 2014 at Cheil General Hospital and Women's Healthcare Center. All patients for whom the number of yolk sacs was reported were included in this study. We compared the number of yolk sacs with amnionicity confirmed by an intertwine membrane. Overall, there was a 9.3% (9 cases) discrepancy in number of yolk sacs and amnionicity (4.3% for monochorionic diamniotic, 36.4% for monochorionic monoamniotic, and 33% for monochorionic triamniotic). Among the 9 cases with discrepancies, 4 cases with 2 yolk sacs were confirmed as monoamniotic pregnancies and 4 MC twin pregnancies showing a single yolk sac were diagnosed as diamniotic twin pregnancies. One case with 2 yolk sacs was identified as a triamniotic triplet pregnancy. In 9.3% of MC gestations, the number of yolk sacs was not correlated with the number of amnions in our study. To determine amnionicity in MC multifetal pregnancies, we recommend careful evaluation not of the number of yolk sacs but the presence or absence of intertwine dividing membrane after 8 gestational weeks.
Amnion* ; Delivery of Health Care ; Hospitals, General ; Humans ; Membranes ; Pregnancy* ; Pregnancy, Triplet ; Pregnancy, Twin ; Twins ; Ultrasonography ; Yolk Sac*

PURPOSE: Although many strides have been made in the radiological and laboratory diagnosis, the liver biopsy is still considered an important tool for the diagnosis of liver disease. We report our experience that histologic investigation of the liver was essential searching for the etiologic diagnosis in eight children with fever of unknowm origin and hepatosplenomegaly, who's diagnosis were not documented by other diagnostic studies. METHODS: Histologic investigation of the liver including Percutanous liver biopsy, open surgical biopsy, necropsy or autopsy was taken at Seoul national university of children's hospital between 1985 and 1995 in twelve children with fever of unknown origin and hepatosplenomegaly. We performed light and electron microscopic examination, culture and PCR of the tissue obtained by liver biopsy. RESULTS: 1) The etiologic diagnoses were possible by histologic investigation of the liver in 9 of 12 Cases; Nine cases were congenital tuberculosis, cryptococcosis, hepatic capillariasis, candidiasis, amoebiasis, neonatal herpes hepatitis, Escherichia. coli abscess and two cases of cytomegalovirus hepatitis. Three cases in which organisms could not be found in tissue obtained from biopsy were suspected clinically as liver abscess and parasite infestation. 2) Three cases were males and 6 were females, ranging in age from 1 days to 6 years; mean age 23.6 months. 3) Clinical manifestations were fever of unknown origin(9 Cases), hepatomegaly(9 Cases), splenomegaly(5 Cases), skin lesions(2 Cases) and jaundice(3 Cases). 4) Laboratory findings were increased AST/ALT(7 Cases), hyperbilirubinemia(3 Cases), leukocytosis(5 Cases), eosinophilia(2 Cases), increased CRP(9 Cases) and increased ESR(5 Cases). 5) In four children, there were underlying diseases which were acute lymphoblastic leukemia, acute myeloid leukemia and two cases of prematures. CONCLUSIONS: In children with fever of unknown origin and hepatosplenomegaly, we recommend liver biopsy for early diagnosis and apropriate management.
Abscess ; Amebiasis ; Autopsy ; Biopsy* ; Candidiasis ; Child* ; Clinical Laboratory Techniques ; Cryptococcosis ; Cytomegalovirus ; Diagnosis ; Early Diagnosis ; Escherichia ; Female ; Fever of Unknown Origin* ; Fever* ; Hepatitis ; Humans ; Leukemia, Myeloid, Acute ; Liver Abscess ; Liver Diseases ; Liver* ; Male ; Parasites ; Polymerase Chain Reaction ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Seoul ; Skin ; Tuberculosis

Many risk factors for atherosclerosis have been proposed to identify high risk individuals. We conducted a retrospective study to determine the risk factors for development of carotid stenosis (CS) in Koreans. Database of 2,805 subjects who underwent a check up of carotid artery for health examination were analyzed. Stenosis (%) of common carotid artery or proximal internal carotid artery was examined with ultrasonography. Subjects were divided into 2 groups (Group I; CS <10%, Group II; CS > or =30%). We compared demographic, laboratory and clinical data between 2 groups to determine the risk factors of CS. One hundred ninety seven subjects (7.0%) were categorized as Group II. At age- and sex-adjusted multivariate analysis, diabetes mellitus, hypertension, cerebrovascular disease, ischemic heart disease, hyperlipidemia, aspirin medication, current smoking, fasting glucose, total cholesterol, low density lipoprotein-cholesterol (LDL-C) and leukocyte count were significant risk factors of CS. At stepwise logistic regression analysis, age, hypertension, hyperlipidemia, LDL-C and leukocyte count were independent risk factors. At subgroup analysis by smoking, age and leukocyte count were independent risk factors in smoker and age and hypertension in nonsmoker.
Adult ; Age Factors ; Aged ; Carotid Stenosis/blood/*epidemiology/etiology ; Cholesterol/blood ; Comparative Study ; Female ; Humans ; Korea/epidemiology ; Lipoproteins, LDL Cholesterol/blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoking/adverse effects

OBJECTIVES: The purpose of this study was to investigate demographic, clinical, behavioral and metabolic-endocrine factors related to weight gain in patients with schizophrenia treated with serotonin-dopamine antagonists(SDA). METHODS: Forty-two in-patients with DSM-IV schizophrenia were recruited from Samsung Seoul Hospital and St. Andrew Neuropsychiatric Hospital. The subjects were first-episode patients or patients who did not take any antipsychotics for the previous two months. All the patients were administered with one of the SDAs for 8 weeks. Body weights and body mass index (BMI) were measured weekly during the treatment period. The mean levels of daytime activities were evaluated at baseline and 4 weeks and 8 weeks after the treatment. To assess the clinical response to the medication, the Krawiecka Rating Scale (KRS) and Clinical Global Impression (CGI) were applied before and after the treatment. Fasting blood levels of glucose, cholesterol, triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL), and serum level of prolactin were measured before and after the treatment. RESULTS: The body weight and BMI were significantly increased through the treatment periods. There were significant increases in the blood levels of cholesterol, TG and prolactin after 8 weeks. KRS total score showed significant decrease and the mean level of daytime activities showed significant increase by the treatment. Significant negative correlations were observed between the weight gain indices and the baseline BMI. The level of clinical improvement was significantly correlated with the degree of weight gain. Gender, age, smoking, daily dosages of antipsychotics, level of daytime activity and changes in appetite did not show any association with the weight gain indices. Neither the baseline biochemical variables nor their changes after the treatment were significantly correlated with the indices of weight gain. CONCLUSION: This result implies that low baseline BMI could be a risk factor of weight gain in short-term treatment of schizophrenia with SDAs. And it is also suggested that the effects of SDAs on weight gain and the clinical improvement might be developed through the same pharmacodynamic pathway.
Antipsychotic Agents ; Appetite ; Body Mass Index ; Body Weight ; Cholesterol ; Diagnostic and Statistical Manual of Mental Disorders ; Fasting ; Glucose ; Humans ; Lipoproteins ; Prolactin ; Risk Factors ; Schizophrenia* ; Seoul ; Smoke ; Smoking ; Triglycerides ; Weight Gain*

OBJECTIVES: Primary, enduring negative symptoms have been used to define the deficit syndrome of schizophrenia, and the diagnostic validity of the deficit syndrome has been demonstrated by clinical, biological and neuropsychological studies. This study aims at evaluating the long-term stability of the diagnostic category of deficit syndrome using direct patient assessments. METHODS: The subjects were thirty-two patients with schizophrenia who were categorized into deficit or non-deficit subgroup using the Schedule for the Deficit Syndrome (SDS) in their remission or partial remission state maintained by long-term treatments with antipsychotics (mostly atypical drugs). These patients were re-assessed based on the same deficit syndrome criteria an average of 5.6 years after having been initially categorized. Lifetime presence of clinical symptoms were evaluated using the Krawiecka Scale. RESULTS: The majority (87.5%) of the patients who were classified as non-deficit at the initial assessment continued to remain non-deficit during the follow-through period. However, only 37.5% of the patients classified as deficit at the initial assessment remain classified as showing deficit syndrome. Compared to the non-deficit group, patients of the deficit group at the final assessment showed significantly higher scores of positive symptoms at their previous psychotic states. Among the individual items of SDS, 'poverty of speech' was the most predictable of the long-lasting deficit syndrome. CONCLUSION: This study showed insufficient long-term stability of the deficit syndrome categorized by SDS criteria. This could be explained by low validity of SDS criteria for the identification of the trait-dependent deficit syndrome. It might also suggest that deficit symptoms could be improved by optimal long-term treatment with atypical antipsychotics.
Antipsychotic Agents ; Appointments and Schedules ; Diagnosis* ; Follow-Up Studies* ; Humans ; Schizophrenia*

OBJECTIVES: During March-May, 2000, a measles outbreak occurred at Youngduk, Korea. This county is divided into two areas with different historical and socioeconomic background. The outbreak occurred in one of these areas. We conducted a comparative epidemiologic study on the two areas in order to evaluate the factors related to the epidemic. MATERIALS AND METHODS: We selected two groups, grades 3 and 5 in a primary schools in each area. We investigated outbreak-related factors using parent-questionnaires, the vaccination history from the students health record and the records concerning the recent measles-outbreak from the local health center. Serologic test on measles-IgG and -IgM antibody was done. RESULTS: The infection rate was 31.6% for the epidemic area and 3.7% for non-the epidemic area according to clinical or serological criteria (p<0.001). No difference was seen in the measles vaccination rate, residence at the time of vaccination or past measles infection history between the two areas. In the epidemic area, the attack rate for the 4-6 year-old MMR booster group(20.5%) was higher than the non-booster group(32.4%), but was not found significantly. Vaccine efficacy was 29.6% in the epidemic area and 87.0% in the non-epidemic area (p<0.001). The IgG level and positive rate were significantly different between the two areas (median 10727 IU/ml, 98.9% in epidemic area; median 346 IU/ml, 85.9% in the non-epidemic area, p<0.001). However, the IgG level and positive rate between the measles-cases and non-cases were not significantly different. CONCLUSIONS: This outbreak took place in mostly vaccinated children. These results suggest that a reduction of herd immunity for immunity failure after vaccination may be one of the feasible factors related to the outbreak pattern in the two areas. The results of the IgG level and positive rate suggest that re-establishment of a normal value for IgG level and of a qualitative method for IgG are needed.
Child ; Epidemiologic Studies ; Humans ; Immunity, Herd ; Immunoglobulin G ; Korea ; Measles* ; Reference Values ; Serologic Tests ; Vaccination

BACKGROUND: Compared with other chronic diseases, hearing loss is generally overlooked from the perspective of disease burden. However, hearing loss is emerging as an important issue in the current society. The objective of this study was to investigate disease burdens and marginal utilities associated with hearing loss and other chronic diseases. METHODS: This study analyzed the cross-sectional data of 32,986 participants aged 19 years and older who completed the Korea National Health and Nutrition Examination Surveys between 2009 and 2013. Additionally, this study used the pure tone audiometric test, European Quality of Life-Five Dimensions Questionnaire, and chronic disease status. The data were analyzed using a multiple linear regression method. RESULTS: The data of 23,297 people who underwent a pure tone audiogram and completed the European Quality of Life-Five Dimensions Questionnaire were used in this analysis. The marginal utility of hearing loss ranked fifth among nine chronic diseases. The estimated loss of quality-adjusted life years associated with hearing loss was −93.69 years per 100,000 people, which is similar to other chronic diseases. CONCLUSION: This study assessed the marginal utilities and public burdens of hearing loss and eight chronic diseases in a South Korean population. Although the values may vary depending on country and race, this study may provide an indispensable foundation for more detailed studies on hearing loss.
Chronic Disease* ; Continental Population Groups ; Hearing Loss* ; Hearing* ; Humans ; Korea ; Linear Models ; Methods ; Quality-Adjusted Life Years

Lipocortin 1 has been proposed as a putative mediator of anti-inflammatory actions of glucocorticoids. We investigated the role of lipocortin 1 in the effect of dexamethasone using rat splenic leukocytes. Concanavalin A(ConA; 1-microgram/ml) increased the leukocyte proliferation and nitric oxide(NO) generation, which were measured as (3H)-thymidine uptake by the cells and nitrite accumulation in the culture media, respectively. Dexamethasone suppressed CoNinduced cell proliferation, in a concentration-dependent manner with EC-50 around 50nM. The addition of anti-lipocortin 1 (Anti-LC1) reversed dexamethasone effects: 0.24, 1.2, 6 microgram/ml of Anti-LC1 reversed dexamethasone(50nM)-induced suppression of thymidine uptake by 9+/-3%, 16+/-3%, 36+/-5%, respectively; 0.24, 1.2, and 6-microgram/ml of Anti-LC1 reversed dexamethasone-induced decrease of nitrite concentration by 49 +/- 16%, 61 +/- 20%, 77 +/- 19 %, respectively. The present data indicate that lipocortin 1 mediates, at least in part, glucocorticoids-induced suppression of leukocyte proliferation and blockade of NO generation.
Animals ; Annexin A1* ; Annexins* ; Cell Proliferation ; Culture Media ; Dexamethasone* ; Glucocorticoids ; Leukocytes* ; Nitric Oxide* ; Rats* ; Thymidine

L-transposition of the great arteries (L-TGA) is a rare congenital anomaly and could cause complete atrioventricular (AV) block at relatively younger age. We present a case of 43-year-old male who complained of dizziness due to complete AV block. We confirmed L-TGA using transthoracic echocardiography and cardiac computed tomography. Permanent pacemaker was inserted without complications. No invasive treatment including corrective surgery was performed because patient's cardiac function was almost normal and the symptom was completely resolved after pacemaker insertion.
Adult ; Arteries* ; Atrioventricular Block* ; Dizziness ; Echocardiography ; Heart Defects, Congenital ; Humans ; Male

OBJECTIVES : Whether bipolar II disorder (BP-II) is simply a milder form of bipolar I disorder (BP-I) or a valid diagnostic category that could be separated from BP-I, is an issue still under consideration. Investigations exploring differential clinical and biological features of the two conditions are needed to resolve the controversies. This study aimed to obtain a comprehensive view of differences in clinical course and symptoms characteristics between BP-I and BP-II. METHODS : 44 BP-I and 26 BP-II patients were assessed using the Diagnostic Interview for Genetic Studies (DIGS), Korean version. Demographic data, age at onset, number of (hypo) manic/ depressive episodes, the duration of illness, polarity at onset, seasonality, rapid cycling, atypical depression and symptom profiles of each episode were evaluated. RESULTS : BP-II patients experienced depressive episodes more frequently than BP-I patients after illness onset (U=240.5, p=0.008). More BP-II patients showed seasonality (34.9% vs. 61.5%) and a rapid cycling course (4.5% vs. 18.2%). When comparing symptom profiles of manic/hypomanic episodes, irritable mood, decreased sleep need, inattention, reckless behavior, arrogant/provocative attitude and frequent outbursts of anger were less encountered in BP-II patients. In depressive episodes, leaden paralysis and psychomotor agitation were more frequently observed in BP-II patients. There was no significant difference between the two groups in psychotic symptoms of depressive episode. CONCLUSION : BP-I and BP-II disorders showed differences in clinical courses and symptom profiles. BP-II disorder seems to be less severe than BP-I disorder with regard to the intensity of manic symptoms, but more severe with respect to frequencies of depressive episodes. These results provide additional evidence supporting the distinction of BP-I and BP-II as separate diagnos-tic categories that might have different genetic profiles and/or biological mechanisms.
Anger ; Depression ; Humans ; Irritable Mood ; Paralysis ; Psychomotor Agitation ; Seasons