PURPOSE: To investigate the association between necrotizing enterocolitis (NEC) and red blood cell transfusions in very low birth weight (VLBW) preterm infants. METHODS: We studied were 180 VLBW preterm infants who were admitted to the neonatal intensive care unit of CHA Gangnam Hospital from January of 2006 to December of 2009. The subjects were divided into 2 groups: an NEC group (greater than stage II on the modified Bell's criteria) and a control group (less than stage II on the modified Bell's critieria). We defined red blood cell transfusion before NEC diagnosis as the frequency of transfusion until NEC diagnosis (mean day at NEC diagnosis, day 18) in the NEC group and the frequency of transfusion until 18 days after birth in the control group. RESULTS: Of the 180 subjects, 18 (10%) belonged to the NEC group, and 14 (78%) of these 18 patients had a history of transfusion before NEC diagnosis. The NEC group received 3.1+/-2.9 transfusions, and the control group received 1.0+/-1.1 transfusions before the NEC diagnosis (P=0.005). In a multivariate logistic regression corrected for gestational age, Apgar score at 1 minute, the presence of respiratory distress syndrome, patent ductus arteriosus, premature rupture of membrane, disseminated intravascular coagulopathy and death were confounding factors. The risk of NEC increased 1.63 times (95% confidence interval, 1.145 to 2.305; P=0.007) with transfusion before the NEC diagnosis. CONCLUSION: The risk for NEC increased significantly with increased transfusion frequency before the NEC diagnosis.
Apgar Score ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Erythrocyte Transfusion ; Erythrocytes ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Logistic Models ; Membranes ; Parturition ; Rupture

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the correlation of adjacent segmental disease with tilt angles of the upper and lower instrumented vertebra after instrumented posterolateral fusion for degenerative lumbar scoliosis. SUMMARY OF LITERATURE REVIEW: There has been no study of radiologic measurement and decision of fusion level using the angle of pedicle screws inserted for treatment of degenerative lumbar scoliosis. MATERIALS AND METHODS: From 2004 to 2008, 74 patients that underwent decompression and posterolateral fusion for degenerative lumbar scoliosis were included in this study. In all cases, instrumentation and posterolateral fusion were both performed. The sex ratio was 31:43, the mean age was 68.7 years and the mean follow up duration was 37.4 months. The angle between each upper end plate of the upper vertebral body and lower end plate of the lower vertebral body of the fusion, and the line parallel to the axis of the sagittal line of vertebrae was each defined as UIV-a and LIV-b. The correlation of development of adjacent segment disease and UIV-a, and LIV-b angle was investigated. RESULTS: Sum of the absolute value of UIV-a and LIV-b had a statistically significant positive correlation with that of adjacent segment disease. Also, UIV-a alone, had a statistically positive correlation with the development of proximal adjacent segment disease. CONCLUSIONS: Since it is proven that adjacent segment disease has positive correlation with the sum of the absolute value of UIV-a and LIV-b, the extent of fusion should be adjusted to make the line parallel to the line perpendicular to the sagittal surface.
Axis, Cervical Vertebra ; Decompression ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis ; Sex Ratio ; Spine

Breast cancer is a major public health problem. 1 woman in 8 will have breast cancer develop during her lifetime in America. As in the United States, long-term increases in the incidence of breast cancer are being observed worldwide. The high incidence of breast cancer in the female population is provide the rationale for screening. The principal purpose of screening for breast cancer is to reduce mortality from the disease through early diagnosis and treatment. It is demonstrate that mortality from breast cancer can be reduced as much as 30% in a screened population. Thus the authors tried screening for breast cancer by mammography with education in breast self examination and classified mammographic parenchymal pattern of the breast in the National Medical Center. The results obtained were summarized briefly as follows:1) Between 1995-5 and 1995-7, 329 women over aged 35 in National Medical Center were invited for screening by mammography with education in breast self examination and mammographic parenchymal pattern of the breast. 2) 294(89.3 percentage) women in 329 were attended for screening and mammographic parenchymal pattern of the breast. 3) A group of 16 women(4.9 percentage) was called for further assessment. 4) 5 women(1.7 percentage) had suspicious lesions and proceeded to surgical biopsy; 4 lesions proved fibrocystic disease and 1 lesion proved fat necrosis and dystrophic calcification. 5) The mammographic parenchymal pattern of the breast showed the number of women according to classification: 20%, 23%, 50%, 7% for N1, P1, P2, DY type, respectively. 6) The malignant lesion was not detect. The results are not statistically significant. But periodic mammography screening of asymptomatic women shows that a satisfactory cancer detection can be achievable. Follow-up of women over aged 35 in the National Medical Center is continuing.
Americas ; Biopsy ; Breast Neoplasms* ; Breast Self-Examination ; Breast* ; Classification ; Early Diagnosis ; Education ; Fat Necrosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Mammography ; Mass Screening* ; Mortality ; Public Health ; United States

OBJECTIVES: Klinefelter syndrome is the most common genetic cause of male infertility and presents with 47, XXY mainly or 46, XX/47, XXY mosaicism. It is characterized by hypogonadism and azoospermia due to testicular failure, however, sporadic cases of natural pregnancies have been reported. With the development of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI), sperm can be retrieved successfully and ART is applied in these patients for pregnancy. It has been suggested that the risk of chromosome aneuploidy for both sex chromosome and autosome is increased in the sperms from 47, XXY germ cells. Considering the risk for chromosomal aneuploidy in the offspring, preimplantation genetic diagnosis (PGD) could be applied as a safe and more effective treatment option in Klinefelter syndrome. The aim of this study is to assess the outcome of PGD cycles by using FISH for sex chromosome and autosome in patients with Klinefelter syndrome. MATERIALS AND METHODS: From Jan. 2001 to Dec. 2003, PGD was attempted in 8 cases of Klinefelter syndrome but TESE was failed to retrieve sperm in the 3 cases, therefore PGD was performed in 8 cycles of 5 cases (four 47, XXY and one 46, XY/47, XXY mosaicism). In one case, ejaculated sperm was used and in 4 cases, TESE sperm was used for ICSI. After fertilization, blastomere biopsy was performed in 6~10 cell stage embryo and the chromosome aneuploidy was diagnosed by using FISH with CEP probes for chromosome X, Y and 17 or 18. RESULTS: A total of 127 oocytes were retrieved and ICSI was performed in 113 mature oocytes. The fertilization rate was 65.3+/-6.0% (mean+/-SEM) and 76 embryos were obtained. Blastomere biopsy was performed in 61 developing embryos and FISH analysis was successful in 95.1% of the biopsied blastomeres (58/61). The rate of balanced embryos for chromosome X, Y and 17 or 18 was 39.7+/-6.9%. The rate of aneuploidy for sex chromosome (X and Y) was 45.9+/-5.3% and 43.2+/-5.8% for chromosome 17 or 18, respectively. Embryo transfer was performed in all 8 cycles and mean number of transferred embryos was 2.5+/-0.5. In 2 cases, clinical pregnancies were obtained and normal 46, XX and 46, XY karyotypes were confirmed by amniocentesis, respectively. Healthy male and female babies were delivered uneventfully at term. CONCLUSION: The patients with Klinefelter syndrome can benefit from ART with TESE and ICSI. Considering the risk of aneuploidy for both sex chromosome and autosome in the sperms and embryos of Klinefelter syndrome, PGD could be offered as safe and more effective treatment option.
Amniocentesis ; Aneuploidy ; Azoospermia ; Biopsy ; Blastomeres ; Chromosomes, Human, Pair 17 ; Embryo Transfer ; Embryonic Structures ; Female ; Fertilization ; Germ Cells ; Humans ; Hypogonadism ; Infertility, Male ; Karyotype ; Klinefelter Syndrome* ; Male ; Mosaicism ; Oocytes ; Pregnancy ; Preimplantation Diagnosis* ; Prostaglandins D ; Sex Chromosomes ; Sperm Injections, Intracytoplasmic ; Spermatozoa

Ophthalmoplegic migraine is defined as recurrent unilateral headaches associated with extraocular muscle palsies. This disorder is more common in older children, but it may begin in infancy. Neuroimaging study should be performed to rule out conditions resulting in third nerve compression, such as intracranial aneurysm or mass lesions. Early treatment with corticosteroids could shorten the duration of the ophthalmoplegia and relieve the pain. We report a 8 year old boy who had severe headache with recurrent ipsilateral ophthalmoplegia that developed at the age of 2. The pediatrician should be aware that ophthalmoplegic migraine may occur in infancy and that early systemic steroid therapy is critical to prevent permanent sequelae.
Adrenal Cortex Hormones ; Child ; Headache ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Ophthalmoplegia ; Ophthalmoplegic Migraine* ; Paralysis

PURPOSE: The C677T polymorphism of the methylenetetrahydrofolate reductase(MTHFR) has been suggested as a risk factor of maternal meiotic nondisjunction for Down syndrome. Recently, a second genetic polymorphism in MTHFR at position 1298 was reported. However, a positive association between the A1298C MTHFR polymorphism and Down syndrome has not been reported. Therefore, this study was undertaken to determine which polymorphism of MTHFR gene was associated with the increased risk of a child suffering from Down syndrome(DS). METHODS: We enrolled 33 patients with Down syndrome and 100 healthy individuals and analyzed the MTHFR C677T and A1298C polymorphism by a PCR-restriction fragment length assay. RESULTS: Frequencies of MTHFR C677T genotypes(CC, CT, and TT) were 9(27%), 22(67%), and 2 (6%) in the DS patients and 24(24%), 55(55%) and 21(21%) in the control, respectively. The frequency of mutant 677TT was significantly low in the DS patients(OR : 0.14; 95% CI : 0.02-0.95; P= 0.04). For the MTHFR A1298C polymorphism, frequencies of genotypes(AA, AC, and CC) were 16(48 %), 15(45%) and 1(3%) in DS patients and 77(77%), 21(21%) and 2(2%) in the control, respectively. The frequency of mutant 1298AC was significantly increased in DS patients with an odds ratio of 3.3(95% CI : 1.39-7.82; P=0.007). CONCLUSION: Our results suggest that MTHFR mutant 677TT may have a protective effect against Down syndrome, but MTHFR mutant 1298AC may be an independent risk factor in Down syndrome.
Child ; Down Syndrome* ; Humans ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Odds Ratio ; Polymorphism, Genetic ; Risk Factors

Hydranencephaly is a condition in which cerebral hemisheres are absent and reduced to fluid-filled sacs in a normal skull. Numerous causes have been proposed, but bilateral occlusion of the internal carotid arteries during early fetal development can explain most of the pathologic abnormalities. We evaluated a case of hydranencephaly by brain CT and magnetic resonance angiography. Magnetic resonance angiography showed flow within the vertebral and basilar arteries without internal carotid intracranial flow above the supraclinoid segment. A brief review of the related literature was given on this subject.
Basilar Artery ; Brain ; Carotid Artery, Internal* ; Fetal Development ; Hydranencephaly* ; Magnetic Resonance Angiography ; Skull

OBJECTIVES: To analogize the test results through analyzing the correlation of bone mineral density (BMD) values between 2 sites (proximal femur and lumbar spine). MATERIALS AND METHODS: Among the 1557 cases that underwent BMD test on their proximal femur and lumbar spine without history of trauma or disease of the hip or lumbar region, according to their age, they were divided into 4 groups, and the T-score and Z-score of the proximal femur and lumbar spine were each investigated. RESULTS: The correlation figured out through the regression analysis was that, considering the lumbar spine value as the independent variable (L), and the proximal femur value as the dependant variable (H), the T-score was H=0.508xL-0.723 in group 1, H=0.445xL-0.649 in group 2, H=0.363xL-1.124 in group 3 and H=0.404xL-1.467 in group 4. The correlation coefficient of T-score value of the 2 sites of each group was 0.58, 0.59, 0.47, 0.54 each, and which were statistically significant. Z-score was H=0.485xL-0.514 in group 1, H=0.451xL-0.141 in group 2, H=0.390xL-0.401 in group3, L=0.897xH-0.481 in group 4. CONCLUSION: On the BMD test performed in an age group of over 40 years old, T-score and Z-score each showed significant increase and this is thought to be related to low bone mineral due to bone mineral decrease because of the old age. Also, in cases with lesion in the hip joint or spine, there is a clinical usefulness of analogizing the result of the other region with a result of a single region.
Bone Density ; Femur ; Hip ; Hip Joint ; Humans ; Lumbosacral Region ; Spine

OBJECTIVES: The risk of aneuploidies of embryos increases in advanced maternal age or parental karyotype abnormality and it results in poor reproductive outcomes such as recurrent spontaneous abortion (RSA) or repeated implantation failure (RIF). Preimplantation genetic diagnosis for aneuploidy screening (PGD-AS) can be applied for better ART outcome by selecting chromosomally normal embryos. The aim of this study is to evaluate the clinical outcome of PGD-AS and which group can get much benefit from PGD-AS among the patients expected to have poor reproductive outcome. METHODS: In 42 patients, 77 PGD cycles were performed for aneuploidy screening. Patients were allocated to 3 groups according to the indication of PGD-AS: group I-patients with old age (> or =37) and RIF more than 3 times (n=11, mean age=42.2 yrs.), group II-patients with RSA (> or = 3 times) associated with aneuploid pregnancy (n=19, mean age=38.9 yrs.), group III-parental sex chromosome abnormality or mosaicism (n=18, mean age=29.6 yrs.) including Turner syndrome, Klinefelter syndrome and 47,XYY. PGD was performed by using FISH for chromosome 13, 16, 18, 21, X and Y in group I and II, and chromosome X, Y and 18 (or 17) in group III. RESULTS: Blastomere biopsy was successful in 530 embryos and FISH efficiency was 92.3%. The proportions of transferable embryos in each group were 32.5+/-17.5%, 23.0+/-21.7% and 52.6+/-29.2% (mean +/- SD), respectively, showing higher normal rate in group III (group II vs. III, p<0.05). The numbers of transferred embryos in each group were 3.9+/-1.5, 1.9+/-1.1 and 3.1+/-1.4 (mean +/- SD), respectively. The clinical pregnancy rates per transfer was 0%, 30.0% and 20.0%, and it was significantly higher in group II (group I vs. group II, p<0.05). The overall pregnancy rate per transfer was 19.6% (10/51) and the spontaneous abortion rate was 20% (2/10) of which karyotypes were euploid. Nine healthy babies (one twin pregnancy) were born with normal karyotype confirmed on amniocentesis. CONCLUSION: Our data suggests that PGD-AS provides advantages in patients with RSA associated with aneuploidy or sex chromosome abnormality, decreasing abortion rate and increasing ongoing pregnancy rate. It is not likely to be beneficial in RIF group due to other detrimental factors involved in implantation.
Abortion, Induced ; Abortion, Spontaneous ; Amniocentesis ; Aneuploidy* ; Biopsy ; Blastomeres ; Chromosomes, Human, Pair 13 ; Embryonic Structures ; Female ; Humans ; Karyotype ; Klinefelter Syndrome ; Mass Screening* ; Maternal Age ; Mosaicism ; Parents ; Pregnancy ; Pregnancy Rate ; Preimplantation Diagnosis* ; Prostaglandins D ; Sex Chromosome Aberrations ; Turner Syndrome ; Twins

OBJECTIVE: The purpose of this study was to evaluate intrauterine fetal death and elucidate the etiology of intrauterine fetal death. METHODS: This is a clinical study of 74 cases of intrauterine fetal death (IUFD) among 5,523 deliveries at Soonchunhyang University Hospital during Jan. 1998 to Apr. 2003. RESULTS: The overall incidence of IUFD was 1.34%. And the age distribution of mother with IUFD was between 19 to 44 year old and was highest in the 25 to 29 year old age group (39.1%). The parity of mothers with IUFD was the highest in nulliparous group (78.3%) and there was a decreased tendency with high parity. There were 47 cases (63.5%) with previous history of abortion and 2 cases (2.7%) with previous history of IUFD. The highest incidence rate of IUFD was shown at 20-24 weeks of gestation (48.6%) and in the fetus weighted less than 1,000 gm (59.5%), and the sex ratio of male versus female fetus was 1:1.07. The modes of delivery were labor induction (54.1%), laparotomy (18.9%), spontaneous labor (27.0%). The indication for laparotomy was placental abruption, placenta previa, previous cesarean section state. The etiology factors of IUFD were unexplained causes (55.4%), cord complication (12.2%), placental abruption (9.4%), placenta previa (9.4%) in order. CONCLUSION: The causes of IUFD were unexplained, cord complication, placental abruption in order. So, the proper antenatal care should be taken of fetuses on the basis of risk factors of antepartum and intrapartum.
Abruptio Placentae ; Adult ; Age Distribution ; Cesarean Section ; Female ; Fetal Death* ; Fetus ; Humans ; Incidence ; Laparotomy ; Male ; Mothers ; Parity ; Placenta Previa ; Pregnancy ; Risk Factors ; Sex Ratio