Correct discrimination of the first and the second twin is important. Case: (1) The first fetus, whose amnionic cavity was closest to the cervix at 19 weeks, even though its body was higher than the second fetus, was found to be closer to the cervix by 23 gestational weeks than its twin. (2) The result of the chromosomal study of dichorionic twins at 17 gestational weeks was male with 9 inversion of the presumed first, and female with trisomy 21 of the presumed second. AT 19 gestational weeks, the sex and order of the two were found to be reversed at sonography for selective termination. In diamnionic twins, the fetus in the amnionic sac closest to the cervix is nominated as the first.
Amnion ; Cervix Uteri ; Diagnosis* ; Discrimination (Psychology) ; Down Syndrome ; Female ; Fetus* ; Humans ; Male ; Pregnancy, Twin* ; Twins*

No abstract available.
Tretinoin*

No abstract available.
Alopecia* ; Hair* ; Humans ; Male* ; Tissue Expansion*

Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.
Anti-Bacterial Agents ; Cerclage, Cervical ; Cesarean Section ; Female ; Fetus ; Humans ; Male ; Membranes ; Obstetrics ; Placenta ; Pregnancy* ; Pregnancy, Twin ; Rupture ; Siblings ; Tocolysis ; Twins*

PURPOSE: The purpose of this study was to identify effects of an obesity control program including rhythmical dance exercise, on body composition, knowledge about obesity, life habits and self-esteem among obese elementary school children. This program included obesity related health education and counseling based on behavior modification once a week, 1 hour-rhythmical dance class once a week and 40-minute jump rope classes twice a week for 8 weeks. METHOD: There were 29 students with obesity in the experimental and 28 in the control group. Participated was voluntary. The data were collected from April 16 to July 6 2007. chi-square-test, Fisher's exact test, paired t-test and t-test were used to analyze the data. RESULTS: Students in the experimental group showed significantly lower fat mass (t=-2.16, p=.036) and percent body fat (t=-2.93, p=.005) and significantly higher muscle mass (t=2.05, p=.045) and lean body mass (t=2.71, p=.009) than those in the control group. Knowledge of obesity increased significantly and eating habits changed significantly. But difference in exercise habits and self-esteem were not significant. CONCLUSION: This study provides evidence that an 8 week-obesity control program including rhythmical dance exercise is effective in decreasing body fat, increasing muscle mass and increasing knowledge of obesity in children who are obese.
Adipose Tissue ; Behavior Therapy ; Body Composition ; Child ; Counseling ; Eating ; Health Education ; Humans ; Muscles ; Obesity

No abstract available.
Glaucoma* ; Manometry* ; Mass Screening*

A 33-year-old-woman with twin pregnancy underwent genetic amniocentesis in our hospital at 16 weeks of gestation. Fetal chromosomal analysis showed 46,XY,inv(9) and 47,XX,+21. The affected twin was terminated by ultrasonographically guided intracardiac injection of 3 ml potassium chloride solution at 19 weeks of gestation. A healthy 2570 g male infant was born by cesarean section with Apgar scores of 8 and 9 at one and five minutes, respectively.
Amniocentesis ; Cesarean Section ; Down Syndrome* ; Female ; Humans ; Infant ; Male ; Potassium Chloride ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnancy, Twin ; Twins, Dizygotic*

We report an unusual case of primary extranodal non-Hodgkin's lymphoma combined with sinusitis in an AIDS patient. A 39-year-old male presented with sinusitis as initial manifestation. A nasal endoscopy revealed nasal polyposis with mucopurulent discharge in both middle meatus and paranasal sinus (PNS) CT scans demonstrated pansinusitis without lamina papyracea or skull base defect. He received antiretroviral and antibiotics therapy due to low CD4 count representing immunocompromised state. The patient was not followed up for observation and he returned with reduced right visual acuity and diplopia, and proptosis after 6 months. A PNS CT scan showed bilateral sinonasal polyposis with pansinusitis and soft tissue density in the right orbit and frontal lobe through bone defect of lamina papyracea and skull base. Endoscopic sinus surgery for orbital decompression and biopsy of intraorbital mass was performed under general anesthesia. The mass was infiltrated into orbital contents and was confirmed as an diffused large B-cell lymphoma with anaplastic variant. The patient received radiotherapy because his general condition was poor. Proptosis and ocular pain were decreased; however, he complained of a persistent headache. Brain CT and MRI showed diffused parenchymal edema around brain abscess in the right frontal lobe. Stereotactic evacuation of the right brain abscess was performed. He has no specific complaints for the last 14 months and antiretroviral therapy is concluded at the present.
Acquired Immunodeficiency Syndrome ; Adult ; Anesthesia, General ; Anti-Bacterial Agents ; B-Lymphocytes* ; Biopsy ; Brain ; Brain Abscess ; CD4 Lymphocyte Count ; Decompression ; Diplopia ; Edema ; Endoscopy ; Exophthalmos ; Frontal Lobe ; Headache ; Humans ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin ; Magnetic Resonance Imaging ; Male ; Orbit ; Radiotherapy ; Sinusitis* ; Skull Base ; Tomography, X-Ray Computed ; Visual Acuity

BACKGROUND AND PURPOSE: The optic nerve sheath diameter (ONSD) is an indirect marker of the intracranial pressure, but the normal range of ONSD as measured using magnetic resonance imaging (MRI) and its associations with clinical parameters and the eyeball transverse diameter (ETD) remain unclear. METHODS: We included 314 healthy adults who underwent brain MRI examinations for health screening between June 2014 and September 2017. The ONSD and ETD of each eye were calculated using time-of-flight magnetic resonance angiography. Linear regression analyses were performed to assess the relationships between ONSD and variables including age, sex, height, weight, body mass index (BMI), mean arterial blood pressure (MABP), intraocular pressure (IOP), and ETD. We further investigated a normative value for the ONSD/ETD ratio and its associated factors. RESULTS: The mean ONSD and ETD were 4.71 mm [95% confidence interval (CI), 4.66–4.75 mm] and 21.24 mm (95% CI, 21.13–21.35 mm), respectively. Multiple linear regression analysis showed that ONSD was only associated with ETD (p < 0.001), with it being independent of age, sex, height, weight, BMI, MABP, and IOP. The ONSD/ETD ratio had a mean value of 0.22 (95% CI, 0.22–0.22), and was not correlated with age, sex, height, weight, BMI, MABP, or IOP. CONCLUSIONS: This study determined the normative value of MRI-based ONSD in healthy Korean adults. There was a strong correlation between the ETD and ONSD, which can be presented as the ONSD/ETD ratio. This parameter needs to be investigated further in disease populations.
Adult* ; Arterial Pressure ; Body Weight ; Brain ; Humans ; Intracranial Pressure ; Intraocular Pressure ; Linear Models ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging* ; Mass Screening ; Optic Nerve* ; Reference Values

PURPOSE: Percutaneous Kirschner wire fixation is common method for hand fracture. It is simple but has risk of ascending infection through the pin and bony injury by multiple drilling. Ascending infection through pin tract is mostly superficial and can be treated with antibiotics and aseptic dressing. This is a case review of subacute osteomyelitis on phalangeal bones after Kirschner wire fixation with literature review. METHODS: A 40-years-old man with distal phalangeal fracture on right second finger is presented. He went to a local clinic and had percutaneous Kirschner wire fixation under local anesthesia. He was transferred to our hospital for ulcerative wound on DIP joint at 4 weeks after operation. Radiography showed osteolytic change around medulla of middle and distal phalanges, leading to diagnosis of a subacute osteomyelitis. We treated it with amputation at the level of shaft of middle phalanx. RESULTS: The postoperative course was uneventful. We thought several possible reasons for osteomyelitis in our case. First, it could resulted from ascending infection through the wire. Second, it could be resulted from a bony burn by repeated drilling. And bony necrosis could be a consequence of arterial insufficiency caused by 2 pin insertion. CONCLUSION: We suggest that a precise pinning based on accurate anatomical understanding is required for a percutaneous Kirschner wire fixation. The fre-quency of drilling should be minimized. Careful observation and patient education for pin site care are essential.
Amputation ; Anesthesia, Local ; Anti-Bacterial Agents ; Bandages ; Burns ; Diagnosis ; Fingers ; Hand ; Joints ; Necrosis ; Osteomyelitis* ; Patient Education as Topic ; Radiography ; Ulcer ; Wounds and Injuries