Nephrotic syndrome is most commonly observed in membranous lupus nephritis in patients with systemic lupus erythematosus (SLE). However, other forms of idiopathic nephrotic syndrome rarely occur in these patients. Here, we report a case of SLE complicated by minimal change disease (MCD). A 24-year-old woman with SLE visited our hospital for generalized edema and heavy proteinuria. Laboratory tests did not support immunological exacerbation of lupus, while renal biopsy revealed diffusely effaced foot processes without electron-dense deposits that were consistent with MCD. Administration of high-dose corticosteroids and 6 subsequent cycles of monthly intravenous cyclophosphamide resulted in complete remission. Although nephrotic-range proteinuria recurred 1 month after switching to maintenance therapy with mycophenolate mofetil, complete remission was reestablished after a 6-month treatment with corticosteroids and cyclosporine. Physicians should be cautious in assessment and management of such a rare renal manifestation.
Adrenal Cortex Hormones ; Biopsy ; Cyclophosphamide ; Cyclosporine ; Edema ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Mycophenolic Acid ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Proteinuria ; Young Adult

Laparoscopic sleeve gastrectomy can reduce morbidity and mortality in patients with morbid obesity, but it can cause complications such as a gastrointestinal leak. A 30-year-old morbidly obese female who had type 2 diabetes mellitus and hypertension with estimated body mass index of 40.2 kg/m2 was admitted. Laparoscopic sleeve gastrectomy was performed. On postoperative day 19, a leak was suspicious on physical examination and radiologic findings. Conservative management was performed, but the patient was hemodynamically unstable and imminently septic. After laparoscopic drainage procedure, esophagogastroduodenoscopy was performed and revealed the fistula opening at staple line just below gastroesophageal junction. Fibrin tissue adhesive was injected around the fistula and the esophageal covered stent was inserted to cover the leak. At 14th days after stent insertion, the barium study confirmed no more leak. In this case, we experienced that the esophageal stent insertion with fibrin tissue adhesive injection may reduce recovery time of the fistula developed after laparoscopic sleeve gastrectomy.
Adult ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Drainage ; Endoscopy, Digestive System ; Esophagogastric Junction ; Female ; Fibrin Tissue Adhesive ; Fistula ; Gastrectomy* ; Humans ; Hypertension ; Obesity ; Obesity, Morbid* ; Physical Examination ; Stents

Temporal triangular alopecia is a triangular or oval shaped non-scarring alopecia, occurring on the temporal side of a scalp. Although surgical excision or hair transplantation has been known to be an effective therapy for this condition, so far only a few case reports have proved their usefulness. A 27-year-old male patient presented with a history of congenital hair loss affecting left frontotemporal area which persisted after simple excision done 10 years ago. We transplanted 270 follicular units into the alopecic patch using follicular unit hair transplantation method. About 75% of alopecic patch was covered with newly grown hairs 15 months after hair transplantation and the patient was satisfied with the result. Herein, we report a case of temporal triangular alopecia which underwent both simple excision and hair transplantation, which provides information about the benefit and loss for each procedure.
Adult ; Alopecia* ; Hair* ; Humans ; Male ; Scalp ; Transplantation*

OBJECTIVES: Since the 1990s, drug-resistant bacteria have become common pathogens of hospital-acquired infections. In recent years, healthcare-associated infections have come to the fore, and it is reported that distribution rates of these bacteria are comparable to those of hospital-acquired infections. However, there have been few studies on differences in resistant bacteria depending on the size of hospitals. Thus, the authors studied differences in drug-resistant bacteria between a tertiary hospital and smaller medical institutions. METHODS: We retrospectively analyzed the clinical findings and sputum culture results of patients transferred from tertiary hospitals (group A, n=74) and those transferred from smaller medical institutions (group B, n=65). RESULTS: The number of patients with malignancy was higher in group A than in group B. The length of intensive care unit stay was longer in group A than in group B. Antibiotic therapy and mechanical ventilation were more frequently used in group A than in group B. There were no significant differences between the 2 groups in bacterial species (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) and their resistance rates to carbapenem, while there were significant differences between the 2 groups in the bacterial species (Acinetobacter baumannii) and its resistance rate to carbapenem. CONCLUSION: In this study, there were significant differences between the 2 groups in the bacterial species and resistance rates to carbapenem for A. baumannii infection unlike other bacterial infections. Further studies on risk factors and patient classification are needed to confirm our results.
Acinetobacter baumannii ; Bacteria ; Bacterial Infections ; Drug Resistance, Bacterial* ; Escherichia coli ; Humans ; Intensive Care Units ; Klebsiella pneumoniae ; Pseudomonas ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers*

OBJECTIVES: The purpose of this study was to investigate the relationship of cord blood levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) in preterm infants with maternal preeclampsia. METHODS: Thirty six preterm infants born at Ewha Womans University Mokdong Hospital from January 2006 to August 2006 were studied after prior parental consent at mid-pregnancy. sFlt-1, PlGF, and VEGF levels in the cord blood of preterm neonate, with or without maternal preeclampsia, were measured using enzyme-linked immunosorbent assay. RESULTS: There was no difference in sFlt-1 between infants with and without maternal preeclampsia. Infants with maternal preeclampsia had significantly lower PlGF levels (P=0.035) and higher sFlt-1/PlGF ratio (P=0.080) with borderline significance. Cord blood VEGF levels were not related to maternal preeclampsia. Infants with maternal preeclampsia had lower birth weight (P=0.030), lower neonatal platelet count without statistical significance (P=0.064) and more likely to be small for gestational age (P=0.057). Neonatal platelet count was significantly correlated with cord blood PlGF levels (r=0.674, P=0.032). CONCLUSION: Increased sFlt-1/PlGF ratio and decreased PlGF may not only be related to the pathophysiology of maternal preeclampsia but also affect the neonatal platelet count and birth weight.
Birth Weight ; Female ; Fetal Blood* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Parental Consent ; Platelet Count ; Pre-Eclampsia* ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factor Receptor-1*

OBJECTIVES: Radiation therapy has multiple roles in the treatment of meningioma although surgery remains the primary treatment of choice. In this retrospective study, we report the results of radiation therapy for meningioma as definitive, postoperative or salvage therapies. METHODS: Seventeen patients diagnosed with meningioma were treated with radiation therapy in our institute from May 2000 to October 2009. Radiation therapies were performed as definitive therapies in 8 patients, as postoperative therapies in 5 and as salvage therapies in 4. Nine patients received stereotactic radiosurgery (SRS), 2 patients fractionated stereotactic radiotherapy (FSRT), and 5 patients 3-dimensional conformal radiotherapy (3DCRT). Radiation dose were 12 to 20 Gy for SRS, 36 Gy in 9 fractions for FSRT and 50.4 Gy in 28 fractions for 3DCRT. Follow-up imaging study of computed tomography or magnetic resonance imaging was performed at 6 to 12 months intervals and neurologic exam was performed with an interval less than 6 months. RESULTS: The median follow-up duration was 38 months (range, 12 to 85 months). Tumor progression after radiation therapy developed in one patient. The reduction of tumor volume measured on follow-up images were more than 20% in 4 patients and minimal change of tumor volume less than 20% were observed in 12 patients. Peritumoral edema developed in 4 patients and disappeared without any treatment. One patient had radiation necrosis. CONCLUSION: Our experience is consistent with the current understanding that radiotherapy is as an effective and safe treatment modality for meningiomas when the tumor cannot be resected completely or when recurred after surgery.
Brain Edema ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Meningioma* ; Radiosurgery ; Radiotherapy* ; Radiotherapy, Conformal ; Retrospective Studies ; Salvage Therapy ; Tomography, X-Ray Computed ; Tumor Burden

Medical certificate, post-mortem examination or certificate guarantee their authenticity of the content through the article 233 of the criminal act. The article 233 of the criminal act states that if a medical or oriental medical doctor, dentist or midwife prepare false medical certificate, postmortem examination or certificate life or death, one shall be punished. To constitute the crime of issuance of falsified medical certificates, it is necessary for the contents of the certificate to be substantially contrary to the truth, as well as it is needed the subjective perception that the contents of the certificate are false. On the article 17 of the medical service act, no one may prepare a medical certificate, a report or certificate of postmortem examination to a patient or public prosecutor in a district public prosecutors' office, who conducts a medical service and has given the medical treatment or conducted the postmortem examination by him/herself: Provided that, such certificate or report may be issued for a patient without giving any medical treatment, if the patient has died within 48 hours after his/her last medical treatment, while if the medical doctor, dentist or oriental medical doctors who examined a patient or conducted a postmortem examination of the dead patient is unable to issue such certificate or report due to an inevitable cause or event, any other medical doctor, dentist or oriental medical doctor who works for the same medical institution, may issue such certificate or report based on the medical records of the patient.
Autopsy ; Crime ; Criminals ; Dentists ; Humans ; Liability, Legal* ; Medical Records ; Midwifery ; Physicians ; Social Responsibility*

Oral appliances have been considered as effective treatment modality for obstructive sleep apnea (OSA). Especially mandibular advanced device (MAD) showed more effective treatment results compared to other oral appliances. With the accurate diagnosis through polysomnography, clinical examination and radiographic examination, the appropriate application of oral appliances would show promising results for OSA and snoring. However oral appliances can raise the complications such as untoward movement of teeth and development of temporomandibular joint disorders, thus it is highly recommended that the treatment Should be undertaken by skilled dental specialists. Moreover, periodic check-up and adjustment of appliances, if needed, should be performed. Although the assertion that continuous positive airway pressure is superior to MAD physiologically, consensus is not available until now. For optimum treatment for OSA, further researches are necessary for investigation of long-term efficiency, performance, cardiovascular status and objective adaptation.
Continuous Positive Airway Pressure ; Polysomnography ; Sleep Apnea, Obstructive* ; Snoring ; Specialization ; Temporomandibular Joint Disorders ; Tooth

Obstructive sleep apnea syndrome (OSAS) is caused by repetitive upper-airway narrowing or collapse during sleep resulting in hypopneas and apneas. When a patient is diagnosed of OSAS with polysomnogram, he/she should receive upper airway evaluation to find the narrow site. The anatomic narrow site can be nasal cavity, nasopharynx, oropharynx, and/or hypopharynx. Surgical treatment for OSAS should be tailored to the anatomic narrow site. In this article, the authors describe surgical treatment options for OSAS.
Apnea ; Humans ; Hypopharynx ; Nasal Cavity ; Nasopharynx ; Oropharynx ; Polysomnography ; Sleep Apnea, Obstructive*

Insomnia is one of the most common sleep disorders, which is leading to significant clinical distress and impairment of daytime functioning and decreasing quality of life. This article reviews the current clinical treatment options of insomnia. Non-pharmacological treatment including stimulus control, sleep restriction, cognitive therapy, relaxation training, and education of sleep hygiene should be considered first for treatment of insomnia. Psychological and behavioral interventions tend to have longer-lasting treatment benefits, while drugs show immediate improvement of sleep disturbance. In pharmacotherapy, benzodiazepine receptor agonist, melatonin receptor antagonist, and 'off-label' drugs to treat insomnia are reviewed.
Behavior Therapy ; Cognitive Therapy ; Drug Therapy ; Quality of Life ; Relaxation ; Sleep Initiation and Maintenance Disorders* ; Sleep Wake Disorders