No abstract available.
Creatinine* ; Glomerular Filtration Rate* ; Humans ; Infant, Newborn* ; Plasma*

No abstract available.
Humans ; Infant* ; Infant, Very Low Birth Weight*

PURPOSE: This study was performed to examine if CT classification of renal blunt injury could aid in expectation of hemodynamic stability and clinical decision of whether to intervene surgically. MATERIALS AND METHODS: Over a 80-month period between July 1987 and March 1994, 41 patients were admitted to our hospital with the diagnosis of renal blunt injury. The renal blunt injuries were classified on Fedede's three-point scale CT classification methods :grade I, contusion, intrarenal hematoma, segmental infarction, and small subcapsular hematoma;grade II, complete or incomplete laceration, large subcapsular hematoma, and renal fracture;grade Ill, shattered kidney and renal pedicle injury. Hemodynamic stability, treatment method and clinical outcome of the patients with different CT grade were analyzed retrospectively. RESULTS: All 34 patients with grade I or II CT findings were hemodynamically stable and were successfully managed with conservative method. Among 7 patients with grade III CT findings, 6 patients were hemodynamically unstable. Out of the 6, One patient with grade IIIb or renal pedicle injury was expired before surgical intervention due to ischemic shock. Four patients were intervened surgically with one failure to thrive. The remaining one patient refused to be intervened surgically, and was discharged against medical advice. Only one out of 7 patients was hemodynamically stable and was managed conservatively. CONCLUSION: The patients with grade I or II CT findings are prone to be hemodynamically stable and to be managed with conservative method. But the patients with grade III CT findings are more likely to be hemodynamically unstable. Therefore patients with grade III CT findings should be closely monitored and be pre- pared for the possibility of immediate surgical intervention
Classification* ; Contusions ; Diagnosis ; Failure to Thrive ; Hematoma ; Hemodynamics ; Humans ; Infarction ; Kidney ; Lacerations ; Retrospective Studies ; Shock ; Wounds, Nonpenetrating

PURPOSE: This study was undertaken to provide the framework for development of a genetic counseling training program, and an accreditation and certification process suitable for non-M.D. genetic counselors in Korea. MATERIALS AND METHODS: Global standards of genetic counseling curriculums, training program accreditation (TPA), and the certification process for genetic counselors (CPGC) in the U.S.A and Japan were reviewed, and a questionnaire survey was performed to elicit opinions among health-care providers including physicians, nurses, technicians, researchers, and educators. In addition, input from professional communities, including the Korean Society of Medical Genetics (KSMG) and Institute for Genetic Testing Evaluation, was sought in formulating the framework of this study. RESULTS: Comparison of U.S.A. and Japan educational systems showed similarities in curriculum, accreditation, and certification programs. Analysis of 117 respondents opinions showed a high level of agreement in the area of global standards; 88% indicated that KSMG should be in charge of TPA and CPGC, while 77% favored a certification exam composed of both written exam and interview components. CONCLUSION: Based upon this study we propose that the KSMG should be in charge of providing the TPA and CPGC for non-MD genetic counselors. Requirements for the entrance to a Master's degree genetic counseling program should be open to successful four year undergraduate students in all areas, provided the candidates demonstrate the abilities to master the graduate level of study in human genetics, clinical genetics, statistics, psychology, and other required subjects. Eligibility for certification should include qualified candidates of genetic counseling with no formally approved education, but a sufficient amount of clinical experience, in addition to accredited program graduates. Certification examinations should be carried out every two years and the certification should be good for five years, as is the case in Japan.
Accreditation ; Certification ; Counseling ; Curriculum ; Surveys and Questionnaires ; Fees and Charges ; Genetic Counseling ; Genetic Testing ; Genetics, Medical ; Humans ; Japan ; Korea

The classic type of Kaposi's sarcoma, or multifocal hemorrhagic sarcoma histologically characterized by proliferating fibroblastic and microvascular elements was described by Kaposi as a relatively rare neoplasm. During the past nine years, we experienced three cases of sporadic, classic Kaposi's sarcomas. They were presented as multiple papules, macules and nodules on the skin of the hands, lower logs and feet without systemic involvement. Histologically, Kaposi's sarcoma is divided into three stages, early patch, plaque and nodular stages. The nodular lesions(case 1, 2 and 3) showed extensive proliferatiion of spindle shaped, somewhat pleomorphic cells having dark prominent nuclei, proliferation of small vessels with solid aggregates of endothelial cells, and extravasation of erythrocytes. In early patch stage(case 3), widely dilated, anastomosing, thin-walled vascular spaces are noted in the upper half of the dermis. In plaque stage(case I and 3), there are proliferation of spindle shaped cells with extravasated erythrocytes and aggregates of blood vessels lined by prominent endothelial cells.

Proliferating trichilemmal tumor is relatively rare, and is generally considered to be a benign tumor that can be histologically mistaken for well-differentiated squamous cell carcinoma. The proliferating trichilemmal tumor is thought to be a tumor with differentiation toward the hair structure because the characteristic trichilemmal keratinization in this tumor is analogous to that of the outer root sheath of anagen hair or the trichilemmal sac surrounding catagen hair. We report four cases of proliferating trichilemmal tumor removed by surgical excision.

Diaschisis is classically defined as a sudden inhibition of function, produced by an acute focal disturbance in a remote area which is anatomically connected through fiber tracts. Transhemispheric diaschisis can underlie some diffuse symptoms of acute supratentorial stroke such as agitation, confusion, and coma. We experienced a patient with right middle cerebral artery infarction, presenting a quadriparesis and hypoesthesia at sensory level. This case suggests the diaschisis exacerbate the initial focal deficit such as weakness and sensory loss.
Coma ; Dihydroergotamine ; Humans ; Hypesthesia ; Infarction, Middle Cerebral Artery* ; Quadriplegia* ; Stroke

Clinical observations and recent experimental studies have suggested that the longer status epilepticus (SE) persists, the more difficult it is to control SE pharmacologically. These findings imply that there are fundamental pathophysiologic processes, which make more resistant to intervene in the refractory SE. Recently, it has been recognized that ketamine, N-methyl-D-aspartate receptor antagonists, are effective agents in the treatment of the late stages of SE in the animal model. However, only one clinical experience has been reported. Here, we report two cases with refractory SE, responsive to ketamine.
Ketamine* ; Models, Animal ; N-Methylaspartate ; Status Epilepticus*

OBJECTIVE: To compare the pregnancy-related complications after laparoscopic and laparotomic uterine myomectomy. METHODS: A retrospective study of 415 women who received laparoscopic (n = 340) or laparotomic (n = 75) resection of uterine leiomyomas in one center. The mean follow-up period was 26.5 months in laparoscopic group and 23.9 months in laparotomic group. RESULTS: Fifty-four and 12 pregnancies occurred in laparoscopic and laparotomic myomectomy group, respectively. The major obstetric outcomes were similar between two groups. There was no ectopic pregnancy or preterm birth. There were two cases of obstetric complication in laparoscopic group only; one experienced neonatal death and postpartum hemorrhage due to placental abruption and the other underwent subtotal hysterectomy due to uterine dehiscence identified during Cesarean section. CONCLUSION: Uterine rupture or dehiscence after laparoscopic myomectomy occurred in 3.7% (2/54) which lead to unfavorable outcome. Appropriate selection of patients and secure suture techniques appears to be important for laparotomic myomectomy in reproductive-aged women.
Abruptio Placentae ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Laparoscopy* ; Leiomyoma ; Postpartum Hemorrhage ; Pregnancy ; Retrospective Studies ; Suture Techniques ; Uterine Myomectomy* ; Uterine Rupture

OBJECTIVE: To evaluate the vertical distance between umbilicus to aortic bifurcation on coronal view in Korean women and their relation with body mass index (BMI) and woman's age. METHODS: This retrospective study included 257 women who visited emergency center at university-based hospital from January to December 2011. All women underwent abdomino-pelvic computerized tomography (CT) due to various symptoms in a supine position. By using the electronic coronal CT images, the vertical distance between umbilicus and aortic bifurcation was measured. If aortic bifurcation was located below umbilicus, the distance was expressed as minus value (i.e., caudal to umbilicus). Age of woman, body weight, height and calculated BMI (kg/m2) were also recorded. RESULTS: Aortic bifurcation was located caudal to umbilicus in 52.9% and cephalad to umbilicus in 37.4%. The vertical distance had a negative relationship with BMI (r=.0.180, P=0.004), as well as woman's age (r=-0.382, P<0.001). However, a multivariate analysis revealed that the vertical distance had a significant negative relationship with woman's age (P<0.001) but not with BMI (P=0.510). An equation could be drawn to estimate the vertical distance by using woman's age and BMI: vertical distance (mm)=12.6-0.3x(age)-0.2x(BMI). CONCLUSION: The vertical distance from umbilicus to aortic bifurcation on coronal view showed a significant inverse correlation with woman's age, however, the distances varied widely. Most older or obese Korean women had aortic bifurcation caudal to umbilicus.
Body Mass Index ; Body Weight ; Emergencies ; Female ; Humans ; Multivariate Analysis ; Retrospective Studies ; Supine Position ; Umbilicus*