Atrial septal defect is one of the most common congenital heart diseases in adult, of which absolute causes is not confirmed, but explained by multifactorial inheritance. In Korea, there has been no case report of atrial septal defect in identical twins in spite of some reports of atrial septal defect in relatives and twins in other countries. We present a first case of atrial septal defect in identical twins whose mother had no infection or medication history during pregnancy.
Adult ; Heart Diseases ; Heart Septal Defects, Atrial* ; Humans ; Korea ; Mothers ; Multifactorial Inheritance ; Pregnancy ; Twins ; Twins, Monozygotic*

Carbamylated hemoglobin (CarHb) is formed by the reaction of hemoglobin with cyanate derived from the spontaneous dissociation of in vivo urea. Previous studies have shown that formation of CarHb depends upon both the severity and the duration of renal failure. To study the clinical significances of CarHb in Korean patients with chronic renal failure, we measured CarHb levels by high-performance liquid chromatography in 159 CRF patients and 46 normal controls. Patients with CRF had a higher CarHb concentration than normal controls (107.9+/-58.8 vs 35.1+/-14.2 microgramVH/gHb; P<0.001). In patients with CRF, nondialysis group had a higher value than dialysis group (129.8+/-77.9 vs 98.7+/-46.1 microgramVH/gHb; P<0.05). There were no siginificant difference in CarHb levels between hemodialysis (92.0+/-35.8microgramVH/gHb) and peritoneal dialysis (106.7+/-55.3microgramVH/gHb) groups. CarHb levels were not different between diabetic and nondiabetic patients in predialysis and hemodialysis groups. Although there was a significant difference in peritoneal dialysis group, the BUN levels were also lower in diabetic patients than nondiabetic patients. There were no correlation between CarHb and HbA1c percentage in patients with diabetes. CarHb levels were positively correlated with BUN (r=0.489; P<0.001) and creatinine (r=0.458; P<0.01) concentrations. There were negative correlations between CarHb and both Kt/V (r=-0.358; P<0.05) and URR (r=-0.415; P<0.05) in hemodialysis patients. In conclusion, CarHb may be a useful index of uremic control in patients with chronic renal failure, and are independent of the mode of dialysis and the presence of diabetes.
Chromatography, Liquid ; Creatinine ; Dialysis ; Humans ; Kidney Failure, Chronic* ; Peritoneal Dialysis ; Renal Dialysis ; Renal Insufficiency ; Urea

Clonorchiasis is known to be closely related with the development of recurrent pyogenic cholangitis and carcinoma of the bile ducts. In order to ascertain the cholangiographic signs for recurrent pyogenic cholangitis or carcinoma of the bile ducts arising in patients with clonorchiasis. we reviewed cholangiograms in 42 patients with proven clonorchiasis. The population consisted of 29 patients with clonorchiasis alone, six patients with clonorchiasis and recurrent pyogenic cholangitis, and seven patients with clonorchiasis and carcinoma of the bile ducts. Cholangiographic abnormalities in 29 patients with clonorchiasis alone, six patients with clonorchiasis and recurrent pyogenic cholangitis, and seven patients with clonorchiasis and carcinoma of the bile ducts. Cholangiographic abnormalities in 29 patients with clonorchiasis alone were intrahepatic multiple, oval, or elliptic filling defects measuring 2-10 mm in size, representing adult flukes (n=24). The peripheral bile duct were obstructed (n=18), and the margins were ragged (n=20) and hazy (n=12) the intrahepatic bile ducts were dilated diffusely (n=27), and the dilated peripheral small tributaries gave the impression of "too many ducts appearance" (n=7) and dilatation was mid (n=17) In six patients with clonorchiasis and recurrent pyogenic cholangitis, there were filling defects of stones, and the extrahepatic ducts and larger intrahepatic ducts were predominantly dilated. In seven patients with clonorchiasis and cholangiocarcinoma all the biliary tree proximal to the tumor was markedly and diffusely dilated In the latter two groups, filling defects of flukes and associated findings were less prominent, but there was disproportionately severe dilatation of too many intrahepatic ducts. In patients with recurrent pyogenic cholangitis or cholangiocarcinoma, clonorchiasis should be considered as a underlying cause when cholangiogram shows "disproportionately" severe dilatation of too many intrahepatic ducts. intrahepatic ducts.
Adult ; Bile Ducts ; Bile Ducts, Intrahepatic ; Biliary Tract ; Cholangiocarcinoma ; Cholangitis ; Clonorchiasis* ; Dilatation ; Humans ; Trematoda

OBJECTIVE: To evaluate the surgical outcomes of ventral interbody grafting and anterior or posterior spinal instrumentation for the treatment of advanced spondylodiscitis in patients who had failed medical management. METHODS: A total of 28 patients were evaluated for associated medical illness, detected pathogen, level of involved spine, and perioperative complications. Radiological evaluation including the rate of bony union, segmental Cobb angle, graft- and instrumentation-related complications, and clinical outcomes by mean Frankel scale and VAS score were performed. RESULTS: There are 14 pyogenic spondylodiscitis, 6 postoperative spondylodiscitis, and 8 tuberculous spondylodiscitis. There were 21 males and 7 females. Mean age was 51 years, with a range from 18 to 77. Mean follow-up period was 10.9 months. Associated medical illnesses were 6 diabetes, 3 pulmonary tuberculosis, and 4 chronic liver diseases. Staphylococcus was the most common pathogen isolated (25%), and Mycobacterium tuberculosis was found in 18% of the patients. Operative approaches, either anterior or posterior spinal instrumentation, were done simultaneously or delayed after anterior aggressive debridement, neural decompression, and structural interbody bone grafting. All patients with neurological deficits improved after operation, except only one who died from aggravation as military tuberculosis. Mean Frankel scale was changed from 3.78+/-0.78 preoperatively to 4.78+/-0.35 at final follow up and mean VAS score was improved from 7.43+/-0.54 to 2.07+/-1.12. Solid bone fusion was obtained in all patients except only one patient who died. There was no need for prolongation of duration of antibiotics and no evidence of secondary infection owing to spinal instrumentations. CONCLUSION: According to these results, debridement and anterior column reconstruction with ventral interbody grafting and instrumentation is effective and safe in patients who had failed medical management and neurological deficits in advanced spondylodiscitis.
Anti-Bacterial Agents ; Bone Transplantation ; Coinfection ; Debridement ; Decompression ; Discitis ; Female ; Follow-Up Studies ; Humans ; Liver Diseases ; Male ; Military Personnel ; Mycobacterium tuberculosis ; Spine ; Staphylococcus ; Transplants ; Tuberculosis ; Tuberculosis, Pulmonary

Peritoneal tuberculosis is a disease rarely seen nowadays. Its symptoms are easy fatigue, abdominal distension, intermittent abdominal pain and ascites. Its onset is insidious, which si-mulates symptoms of peritonitis or carcinomatosis. Peritoneal tuberculosis should be considered in the differential diagnosis when a Patient's symptoms and signs are ascites, ovarian tumor, vague abdominal pain and abdominal distension with high serum level of CA 125, an antigenic determinant of epithelial ovarian cancers. We have recently experienced a case of peritoneal tuberculosis with markedly elevated serum level of CA 125 in 54 year-old woman and report our case with a brief review of the literature.
Abdominal Pain ; Ascites ; Carcinoma ; Diagnosis, Differential ; Fatigue ; Female ; Humans ; Middle Aged ; Ovarian Neoplasms ; Peritonitis ; Peritonitis, Tuberculous*

The fulminant malignant hyperthermia (MH) is now encountered less frequently because of increased awareness of the condition by anesthesiologist and better use of mornitoring facilities. Thus there is also an increase in the number of aborted cases, in which anesthesia is stopped and treatment instituted as soon as MH is thought to be likely. We presented a case of an abortive MH in 18 years old male patient during the discectomy on the third and fourth lumbar intervertebral spaces. Anesthesia was induced with thiopental sodium and succinylcholine and then maintained with nitrous oxide, oxygen and enflurane. After induction, there were persistent tachycardia, elavation of end-tidal CO2 tension on capnography, spontaneous tachypnea, body temperature elevation up to 38.2oC, respiratory acidosis and highly level of CPK, myoglobulin in serum and urine. Under the suspicion of MH, all anesthetics were discontinued and vigorous emergency treatment was attempted including ventilation with high flow of 100% oxygen (8 l/min), changing all anesthetic circuits, and cooling measurements such as chilled intravenous solution infusion, gastric lavage with cold saline, alcohol and ice water pack over the body. Fourtunately, he recovered well and discharged without complications.
Acidosis, Respiratory ; Adolescent ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Body Temperature ; Capnography ; Diskectomy ; Emergency Treatment ; Enflurane ; Fever* ; Gastric Lavage ; Humans ; Ice ; Male ; Malignant Hyperthermia ; Nitrous Oxide ; Oxygen ; Succinylcholine ; Tachycardia ; Tachypnea ; Thiopental ; Ventilation ; Water

OBJECTIVE: Uterine sarcomas are rare and characterized by rapid clinical progression and poor prognosis. The manegement of uterine sarcoma has been challenged. The purpose of this study was to investigate the clinicopathologic findings and outcome of patients with uterine sarcoma METHODS: From Sep. 1990 to July. 1999, 8 patients with histologically proven uterine sarcoma at department of obstetrics and gynecology of Chonbuk University Hospital were evaluated for their clinical profiles and survival retrospectively RESULTS: The age of patients with uterine sarcoma ranged 31 to 60, and the mean age was 46 years. The most common pathologic type of uterine sarcoma was leiomyosarcoma. The common presenting symptom were irregular uterine bleeding, hypermenorrhea and lower abdominal palpable mass. The patients with uterine sarcoma were treated by surgery, post-operative radiotherapy and adjuvant chemotherapy. The mean follow up duration was 34.1 months. The 2 year survival rate was 50%. Distant metastasis were reveled at two patients, and the sites are lung and brain. CONCLUSIONS: Uterine sarcomas are aggressive tumor with a poor prognosis. The Major treatment is surgery and the effect of chemotherapy and radiotherapy were undetermined.
Brain ; Chemotherapy, Adjuvant ; Drug Therapy ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Jeollabuk-do ; Leiomyosarcoma ; Lung ; Menorrhagia ; Neoplasm Metastasis ; Obstetrics ; Prognosis ; Radiotherapy ; Retrospective Studies ; Sarcoma* ; Survival Rate ; Uterine Hemorrhage

Purpose: The impacts of growth restriction and programming in the fetal stage on metabolic and bone health in children and adolescents are poorly understood. Moreover, there is insufficient evidence for the relationship between current growth status and metabolic components. Herein, we compared the growth status, metabolic and body compositions, and bone mineral density in Korean children and adolescents based on birth weight at gestational age. Methods: We studied 1,748 subjects (272 small for gestational age [SGA], 1,286 appropriate for gestational age [AGA], and 190 large for gestational age [LGA]; 931 men and 817 women) aged 10–18 years from the Korean National Health and Nutrition Examination Survey (KNHANES) V (2010–2011). Anthropometric measurements, fasting blood biochemistry, and body composition data were analyzed according to birth weight and gestational age. Results: The prevalence of low birth weight (14.7% vs. 1.2% in AGA and 3.2% in LGA, p<0.001) and current short stature (2.237 [1.296–3.861] compared to AGA, p=0.004) in SGA subjects was greater than that in other groups; however, the prevalence of overweight and obesity risks, metabolic syndrome (MetS), and MetS component abnormalities was not. Moreover, no significant differences were found in age- and sex-adjusted lean mass ratio, fat mass ratio, truncal fat ratio, bone mineral content, or bone density among the SGA, AGA, and LGA groups in Korean children and adolescents. Conclusion Our data demonstrate that birth weight alone may not be a determining factor for body composition and bone mass in Korean children and adolescents. Further prospective and longitudinal studies in adults are necessary to confirm the impact of SGA on metabolic components and bone health.

PURPOSE: To evaluate regional differences in relative metabolite ratios in the normal human brain by 1H MRspectroscopy (MRS), and compare the spectral quality obtained by the automated prescan method (PROBE) and themanual method. MATERIALS AND METHODS: Localized 1H MRS was performed on a GE 1.5T SIGNA MRI/MRS system (version5.5) with active shielded gradients. For 20 normal volunteers aged 8-47 years, spectral parameters were adjustedby the auto-prescan routine provided by a PROBE package(N=34)and manually (N=33). Five regions of the human brainwere examined (N=PROBE,manual): frontal white matter(N=6,10), parietal white matter(N=8,9), basal ganglia(N=6,5),thalamus(N=4,5), and cerebellum(N=4,4). For all spectra, a STEAM localization sequence with three-pulse CHESS H2Osuppression was used, with the following acquisition parameters: TR=3.0 sec, TE=30 msec, TM=13,7 msec, SW=2500Hz,SI=2048 pts, AVG=48, and NEX=2. RESULTS: A total of 61 reliable spectra were obtained by PROBE (28/34=82%success) and by the manual method (33/33=100% success). Regional differences in the spectral patterns of the fiveregions were clearly demonstrated by both PROBE and the manual methods. For prescanning, the manual method tookslightly longer than PROBE (3-5 mins and 2 mins,respectively). There were no significant differences in spectralpatterns and relative metabolic ratios between the two methods. However, auto-prescan by PROBE seemed to be veryvulnerable to slight movement by patients, and in three cases, an acceptable spectrum was thus not obtained. CONCLUSION: PROBE is a highly practical and reliable method for single voxel 1H MRS of the human brain; the twomethods of prescanning do not result in significantly different spectral patterns and the relative metaboliteratios. PROBE, however, is vulnerable to slight movement by patients, and if the success rate for obtainingquality spectra is to be increased, regardless of the patient's condition and the region of the brain, it must beused in conjunction with the manual method.
Brain* ; Healthy Volunteers ; Humans* ; Magnetic Resonance Spectroscopy* ; Rabeprazole ; Steam

Anti-glomerular basement membrane antibody mediated rapidly progressive glomerulonephritis is a rare autoimmune disease. It is characterized by acuterenal failure and crescentic glomeruli with linear immune deposits along glomerular basement membrane mediated by anti-GBM antibodies. We report a case of a sixty-years-old man with generalized edema and hematuria. On admission, BUN/Creatinine was 118/19.6 mg/dL, Hb was 10.2 g/dL. On urinalysis, protein was 3+, and many RBCs were found. Renal biopsy specimen which contained 8 glomeruli showed active cellular crescent formation in all glomeruli. On immunofluorescent staining specimen, there were 4 glomeruli which showed strong IgG linear staining along the glomerular basement membrane and mild C3 & C1q deposit along the capillary walls. The titer of anti-GBM antibody was 123 EU by ELISA (normal: <10 EU). We treated with high dose of corticosteroid and plasmapheresis, but renal function was not recovered even after 3 months of hemodialysis.
Antibodies ; Autoimmune Diseases ; Basement Membrane* ; Biopsy ; Capillaries ; Edema ; Enzyme-Linked Immunosorbent Assay ; Glomerular Basement Membrane ; Glomerulonephritis ; Hematuria ; Hemorrhage* ; Immunoglobulin G ; Plasmapheresis ; Renal Dialysis ; Urinalysis