PURPOSE: Here, we report a case of an infant with fetal alcohol syndrome with esotropia who was born to a mother who consumed a large quantity of alcohol during her pregnancy. METHODS: A 1-year-old female infant visited our hospital for the main symptom of the esodeviation of the eye. The medical history of the mother and the delivery history were reviewed, and a physical examination and ophthalmic examination of the infant were performed. RESULTS: At the first examination, the patient was 15 months old, her mass was 5, 600 grams, her height was 70 cm, her head circumference was 39.5 cm, and her chest circumference was 41 cm; all the measurements were below the 3rd percentile. From the gestation age of 24 weeks, the mother consumed 1-2 bottles of sojoo every day, and the infant patient was delivered at the gestation age of 42 weeks by Cesarean section. The infant's birth weight was 1, 510 grams. Upon physical examination, her philtrum was found to be shallow, and microcephaly was detected. Upon ophthalmic examination, a refractive error +1.25 Dsph. was detected. With regard to the horizontal length of the palpebral fissure, the right and the left were 1.7 cm and 1.6 cm, respectively, which is considered short; telecanthus and esotropia were also present. CONCLUSIONS: To the best of our knowledge, this is the first reported case of fetal alcohol syndrome with accompanying esotropia.
Birth Weight ; Cesarean Section ; Esotropia* ; Female ; Fetal Alcohol Spectrum Disorders* ; Head ; Humans ; Infant ; Lip ; Microcephaly ; Mothers ; Physical Examination ; Pregnancy ; Refractive Errors ; Strabismus ; Thorax

OBJECTIVE: To evaluate the clinical significance of fetal choroid plexus cysts (CPCs) in the second trimester, especially an association with trisomy 18. METHODS: From March 1998 through June 1999, second trimester screening ultrasonography was performed on 4,948 unselected single-ton pregnancies. CPCs were noted in 132 fetuses. Among them, detailed ultrasonography and follow-up was possible in 119 cases and they were recruited into the study. There were 91 cases of isolated CPCs and 28 cases of CPCs in high-risk population. "Isolated CPCs" were defined as: mother did not have any risk factors requiring amniocentesis and there were no other sonographic abnormalities on detailed ultrasound. "CPCs in high-risk population" were defined as: mother had any risk factor requiring karyotyping or there were any other sonographic abnormalities although she was general population. Amniocentesis was performed in 39 cases. We compared gestational age at time of detection, size, bilaterally, multiplicity, and complexity of CPCs in the group of isolated CPCs and CPCs in high-risk population (t-test, chi-square test; P<0.05). We evaluated the findings of detailed and follow-up ultrasonography, karyotypes, and final outcomes of pregnancy. RESULTS: Gestational age at time of detection was not different in both groups of isolated CPCs and CPCs in high-risk population (19+/-2 vs 18+/-1 wk, p>0.05). Mean size (6.4 vs 6.2 mm), bilaterality (60% vs 57%), multiplicity (66% vs 57%), and complexity (8% vs 14%) of CPCs were also similar. All CPCs were disappeared irrespective of size and mean time of disappearance was 25+/-3 and 26+/-3 week, respectively (p>0.05). All cases of isolated CPCs resulted in phenotypically-normal neonates. It was confirmed by either amniocentesis or postnatal examination by the pediatrician. Among fetuses having CPCs in high-risk population, two trisomy 18 and one trisomy 21 were detected. All of them had positive result of maternal serum marker test and/or sonographic abnormalities. Remaining cases were proved normal. CONCLUSION: The risk of chromosome abnormalities is very high when CPCs are associated with other abnormalities on detailed ultrasound, indicating a clear need to offering genetic amniocentesis. As contrast, the risk of chromosome abnormalities for a case of isolated CPCs is very low, and in this series there was no trisomy 18. Therefore isolated CPCs should be considered as the indication of detailed ultrasound examination, but not routine karyotyping.
Amniocentesis ; Biomarkers ; Choroid Plexus* ; Choroid* ; Chromosome Aberrations ; Down Syndrome ; Female ; Fetus ; Follow-Up Studies* ; Gestational Age ; Humans ; Infant, Newborn ; Karyotype ; Karyotyping ; Mass Screening ; Mothers ; Pregnancy ; Pregnancy Trimester, Second* ; Prenatal Diagnosis ; Risk Factors ; Trisomy* ; Ultrasonography

We present a case of thrombotic coronary aneurysm of the left anterior descending artery (LAD) presenting with recurrent severe orthopnea in an end stage renal disease patient. She was admitted to the hospital with progressive dyspnea, exertional chest pain, and profound orthopnea. The echocardiography revealed a well marginated mass lesion between the main pulmonary artery and the left atrium. Chest CT showed a space-occupying lesion surrounded by the main pulmonary artery, the left atrium and the appendage adjacent to the atherosclerotic calcified lesion. Coronary angiography confirmed a huge thrombotic aneurysm with total occlusion of the proximal LAD. The presentation and management of the coronary aneurysm was reviewed.
Aneurysm ; Arteries ; Atherosclerosis ; Chest Pain ; Coronary Aneurysm ; Coronary Angiography ; Coronary Vessels ; Dyspnea ; Echocardiography ; Heart Atria ; Humans ; Kidney Failure, Chronic ; Pulmonary Artery ; Renal Dialysis ; Thorax

Hemorrhagic complications in patients with end stage renal disease (ESRD) are common. These abnormal bleeding tendencies are caused by several factors including anticoagulation during hemodialysis, anemia, and uremic platelet dysfunction. The most common clinical manifestation of uremic bleeding is hemorrhage of the gastrointestinal tract from gastric ulcer disease. Mediastinal bleeding, however, is rare in ESRD patients. Here, we report a case of spontaneous mediastinal bleeding in a patient with hemodialysis. A huge periesophageal hematoma was observed on the chest CT scan and the bleeding time representing platelet function was prolonged. This case underlies the diversity of uremic bleeding.
Anemia ; Bleeding Time ; Blood Platelets ; Gastrointestinal Tract ; Hematoma ; Hemorrhage ; Humans ; Kidney Failure, Chronic ; Mediastinum ; Renal Dialysis ; Stomach Ulcer ; Thorax ; Uremia

PURPOSE: To detect the dysfunction of arteriovenous fistula (AVF) early, we have developed a new method to calculate the intra-vascular conduit flow rate based on the Bernoulli's theory. However, this method has limitation on detection of inflow stenosis. For detection of both in- and out-flow stenosis, we tried to measure intra-access static (pS) and total pressure (pT), and compared with angiographic findings. METHODS: From a total of 46 cases of native AVFs, of at least 3 months of construction, intra-access pS and pT were measured, before starting hemodialysis. deltap (pT-pS) and pT/mean arterial pressure (MAP) ratio were calculated, and compared with angiographic findings. RESULTS: Among 37 patients without outflow stenosis (Vs) in fistulogram, 10 patients with inflow stenosis (As) had significantly lower pT/MAP ratio and deltap than those without As patients (p<0.005). Among 34 patients without As, deltap was significantly lower in 7 patients with Vs than those 27 patients without Vs (p=0.001). CONCLUSION: pT/MAP ratio was correlated with As, and deltap reflects Vs in angiography. The measurement of pS and pT might be useful to predict inflow and outflow stenosis of AVFs.
Angiography ; Arterial Pressure ; Arteriovenous Fistula* ; Constriction, Pathologic ; Humans ; Renal Dialysis*

PURPOSE: To detect early arteriovenous fistula (AVF) dysfunction, we have developed a new method of intra-access total pressure (pT), and static pressure (pS) measurements. The purpose of this study is to assess the relationship between intra-access pressure and vascular stricture in order to establish the clinical validity of the method. METHODS: Total 46 of native AVFs were enrolled. They were measured intra-access pS and pT monthly. In initial angiography, 6 of 10 inflow stricture (As), 6 of 7 outflow stricture (Vs) and 2 having both lesions were taken PTA (percutaneous angioplasty) and compared pressure and ratio changes. If delta p (pT-pS) decreased more than 10% over 3 months or pT/MAP (mean arterial pressure) ratio dropped more than 10% over 3 months with below 0.8, then the patients were referred to angiography. Thirtyone patients were performed final angiography, and we compared the results with those of initial angiography. RESULTS: Although pT/MAP ratio and delta p were increased after PTA, there was no statistical significance in 6 As (+) patients (p>0.05). Six Vs (+) and 2 AS (+) and Vs (+) patients' delta p were increased significantly (p<0.05). Two As (+) and 5 Vs (+) were detected with delta p or pT/MAP ratio change. However, 2 Vs (+) were unable to be detected with delta p, but detected only by final angiography. Among 15 As (-) and Vs (-) patients in both initial and final angiography, pT and MAP were not reproducible (pI<0.4), but pS and delta p showed intermediate reproducibility (pI>0.45). CONCLUSION: Intra-access stricture could be detected with pT/MAP ratio and delta p change. However, more careful MAP and pT measurement should be recommended for accurate diagnosis.
Angiography ; Arteriovenous Fistula ; Constriction, Pathologic ; Fistula ; Humans ; Renal Dialysis

BACKGROUND: Although the frequency of respiratory viral infection in patients with pulmonary acute respiratory distress syndrome (ARDS) is not uncommon, clinical significance of the condition remains to be further elucidated. The purpose of this study was to compare characteristics and outcomes of patients with pulmonary ARDS infected with influenza and other respiratory viruses. METHODS: Clinical data of patients with pulmonary ARDS infected with respiratory viruses January 2014–June 2018 were reviewed. Respiratory viral infection was identified by multiplex reverse transcription–polymerase chain reaction (RT-PCR). RESULTS: Among 126 patients who underwent multiplex RT-PCR, respiratory viral infection was identified in 46% (58/126): 28 patients with influenza and 30 patients with other respiratory viruses. There was no significant difference in baseline and clinical characteristics between patients with influenza and those with other respiratory viruses. The use of extracorporeal membrane oxygenation (ECMO) was more frequent in patients with influenza than in those with other respiratory viruses (32.1% vs 3.3%, p=0.006). Co-bacterial pathogens were more frequently isolated from respiratory samples of patients with pulmonary ARDS infected with influenza virus than those with other respiratory viruses. (53.6% vs 26.7%, p=0.036). There were no significant differences regarding clinical outcomes. In multivariate analysis, acute physiology and chronic health evaluation II was associated with 30-mortality (odds ratio, 1.158; 95% confidence interval, 1.022–1.312; p=0.022). CONCLUSION: Respiratory viral infection was not uncommon in patients with pulmonary ARDS. Influenza virus was most commonly identified and was associated with more co-bacterial infection and ECMO therapy.
APACHE ; Extracorporeal Membrane Oxygenation ; Humans ; Influenza, Human ; Multivariate Analysis ; Orthomyxoviridae ; Respiratory Distress Syndrome, Adult

Replacement lipomatosis of the kidney is a rare disorder in which a massive fatty tissue proliferation occurs within the renal sinus, hilum and perirenal region. Clinical symptoms includes flank pain, hematuria, fever usually associated with urinary tract infection and renal stone. But deep vein thrombosis due to mass effect has not been reported to be associated with replacement lipomatosis of kidney. A 37-year-old male was referred for the initiation of hemodialysis due to chronic rejection of allograft kidney. Collateral superficial veins were observed on his anterior abdominal wall and firm mass was palpable in the right lower quadrant abdomen. Abdominal-pelvis computed tomography revealed huge fatty mass originated from allograft kidney and non-visualization of inferior vena cava with lower density thrombus at both the common femoral veins. We report a rare case of replacement lipomatosis of the kidney complicated by deep vein thrombosis after renal transplantation.
Abdomen ; Abdominal Wall ; Adipose Tissue ; Adult ; Femoral Vein ; Fever ; Flank Pain ; Hematuria ; Humans ; Kidney ; Kidney Transplantation ; Lipomatosis ; Male ; Rejection (Psychology) ; Renal Dialysis ; Thrombosis ; Transplantation, Homologous ; Urinary Tract Infections ; Veins ; Vena Cava, Inferior ; Venous Thrombosis

BACKGROUND: Although the frequency of respiratory viral infection in patients with pulmonary acute respiratory distress syndrome (ARDS) is not uncommon, clinical significance of the condition remains to be further elucidated. The purpose of this study was to compare characteristics and outcomes of patients with pulmonary ARDS infected with influenza and other respiratory viruses. METHODS: Clinical data of patients with pulmonary ARDS infected with respiratory viruses January 2014–June 2018 were reviewed. Respiratory viral infection was identified by multiplex reverse transcription–polymerase chain reaction (RT-PCR). RESULTS: Among 126 patients who underwent multiplex RT-PCR, respiratory viral infection was identified in 46% (58/126): 28 patients with influenza and 30 patients with other respiratory viruses. There was no significant difference in baseline and clinical characteristics between patients with influenza and those with other respiratory viruses. The use of extracorporeal membrane oxygenation (ECMO) was more frequent in patients with influenza than in those with other respiratory viruses (32.1% vs 3.3%, p=0.006). Co-bacterial pathogens were more frequently isolated from respiratory samples of patients with pulmonary ARDS infected with influenza virus than those with other respiratory viruses. (53.6% vs 26.7%, p=0.036). There were no significant differences regarding clinical outcomes. In multivariate analysis, acute physiology and chronic health evaluation II was associated with 30-mortality (odds ratio, 1.158; 95% confidence interval, 1.022–1.312; p=0.022). CONCLUSION Respiratory viral infection was not uncommon in patients with pulmonary ARDS. Influenza virus was most commonly identified and was associated with more co-bacterial infection and ECMO therapy.

Severe hypoglycemia induces neuroglycopenic symptoms, including mental alteration, as glucose is the exclusive fuel for the central nervous system. However, some reports have shown that non-glucose fuels, like lactates and ketones, could be utilized by the brain during severe hypoglycemia. Herein, a case of extreme hypoglycemia in a 44-year old woman, subsequently diagnosed as congestive heart failure accompanied by ischemic hepatitis and lactic acidosis, is presented. In two episodes of extreme hypoglycemia, she was fully alert without obvious neurological deficits. In this unusual case, an increased supply of lactate might have maintained the cerebral function and prevented cerebral injury during the hypoglycemia that was induced as a result of starvation and hepatic and cardiac dysfunctions
Acidosis, Lactic* ; Adult ; Brain ; Central Nervous System ; Female ; Glucose ; Heart Failure ; Hepatitis ; Humans ; Hypoglycemia* ; Ketones ; Lactates ; Lactic Acid ; Masks* ; Starvation