Three cases of human embryo of Carnegie stage 13 were described. The CR length of these embryos were 3.0-5.3mm. The authors made a reconstruction model using photograph, photocopy and computer. These embryos were characterized externally by 4 limb buds and 4 pairs of branchial arches, and internally closed otic pits, appearance of venous valves, septum primum and foramen primum in the heart, beginning of the right and left lung buds, appearance of lens disk.
Branchial Region ; Embryonic Structures* ; Heart ; Humans* ; Limb Buds ; Lung ; Venous Valves

No abstract available.

PURPOSE: Recently, time interval between onset of transmitral early inflow (E) and onset of early diastolic (Ea) velocity of the mitral annulus (TE-Ea) has been used to identify diastolic dysfunction in adults, but to date, no studies have been done in infants. The purpose of our study was to evaluate the normal values of TE-Ea in infants under 1 year of age, and to assess the influence of age, heart rate and cardiac growth on this index. METHODS: Thirty healthy children (mean+/-SD, age; 5.4+/-2.3 months) underwent echocardiography. Mitral and tricuspid inflow and tissue Doppler velocities were obtained from the leaflet tips and lateral site of the annulus, respectively, in the apical four-chamber view. The time intervals between the peak of R wave and onset of mitral and tricuspid E velocity (T(E)) and between peak of R wave and onset of Ea velocity (T(Ea)) were measured. The differences between these time intervals were calculated as T(E-Ea), which were compared with demographic and echocardiographic variables. RESULTS: Mean heart rate was 125.27+/-10.78 (bpm). Mitral T(E-Ea) was shorter than tricuspid T(E-Ea) (mean+/-SD, 24.89+/-10.33 msec versus 32.43+/-12.72 msec, P=0.016). Both mitral and tricuspid T(Ea) were significantly greater than T(E) (both: P<0.01). Age and heart rate did not show correlation with T(Ea-E). When correlated with echocardiographic variables, mitral T(E-Ea) tended to decrease as mitral ring area increased. CONCLUSION: In normal infants, T(E-Ea) values differ between both ventricles, which suggest differences in ventricular adaptation in the first year of life.
Adult ; Child ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Heart Rate ; Humans ; Infant* ; Reference Values

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.

This study attempted to assess the incidence and outcome of anthracycline cardiotoxicity and the role of dexrazoxane as a cardioprotectant in childhood solid tumors. The dexrazoxane group included 47 patients and the control group of historical cohort included 42. Dexrazoxane was given in the 10:1 ratio to doxorubicin. Fractional shortening and systolic and diastolic left ventricular diameters were used to assess the cardiac function. The median follow-ups were 54 months in the dexrazoxane group and 86 months in the control group. The mean cumulative doses of doxorubicin were 280.8+/-83.4 mg/m2 in the dexrazoxane group and 266.1+/-75.0 mg/m2 in the control group. The dexrazoxane group experienced significantly fewer cardiac events (27.7% vs. 52.4%) and less severe congestive heart failure (6.4% vs. 14.3%) than the control group. Thirteen cardiotoxicities including one cardiac death and 2 congestive heart failures occurred in the dexrazoxane group, and 22 cardiotoxicities including 2 cardiac deaths and 4 congestive heart failures, in the control group. Five year cardiac event free survival rates were 69.2% in the dexrazoxane group and 45.8% in the control group (P=0.04). Dexrazoxane reduces the incidence and severity of early and late anthracycline cardiotoxicity in childhood solid tumors.
Adolescent ; Antibiotics, Antineoplastic/*adverse effects ; Cardiomyopathies/chemically induced/prevention & control ; Cardiovascular Agents/*therapeutic use ; Child ; Child, Preschool ; Cohort Studies ; Disease-Free Survival ; Doxorubicin/*adverse effects ; Echocardiography ; Female ; Follow-Up Studies ; Heart Failure/chemically induced/prevention & control ; Humans ; Infant ; Male ; Neoplasms/*drug therapy/mortality ; Razoxane/*therapeutic use ; Ventricular Function, Left/physiology

PURPOSE: This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. METHODS: A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. RESULTS: A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9%). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6% vs. 22.0%, P=0.04). CONCLUSION: This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.
Amikacin ; Bacteremia ; Bacteria ; Cefotaxime ; Child ; Escherichia coli ; Fever ; Fungi ; Gentamicins ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Klebsiella ; Neutropenia ; Oxacillin ; Penicillins ; Retrospective Studies ; Shock ; Staphylococcus aureus ; Vancomycin

We investigated the actual status of antipsychotics maintenance therapy(AMT) for schizophrenic patients through a mail survey sent to psychiatrists practicing in Seoul and Kyonggj province who had no less than two years of psychiatric expertise and who were below fifty years of age. Out of 453 questionnaires sent, 215 completed questionnaires were returned (response rate 47%). The majority of respondents considered pharmacotherapy as the most important longterm treatment strategy for schizophrenia. Haloperidol was selected by the majority as their first choice neuroleptics. The proposed mean daily maintenance dosage was 383+/-229(75-1250)mg in chlorpromazine equivalent. The mean duration of AMT was 1.8+/-1.0(0.25-7.5)years after the first episode and 3.6+/-1.8(0.5-10)years after multi-episodes. Psychotherapy was regarded as more important by the resident psychiatrists group than by the certified psychiatrists. There were preferential differences for a particular treatment strategy, dosage and duration of AMT among the different clinics. A great number of respondents(93%) regarded long-term continuous maintenance as their major AMT policy, Only a few respondents(4.3%) were satisfied with the established guidelines for AMT in treatment of schizophrenia. The results show considerable variations in psychiatrists opinions on AMT which was influenced by grades of expertise of the clinician and the working environment of the clinic or the hospital. To decrease these variabilities and make clinically useful guidelines, it will be necessary' to do further pharmacoepidemiological studies as well as other types of related clinical research.
Antipsychotic Agents* ; Chlorpromazine ; Surveys and Questionnaires ; Drug Therapy ; Haloperidol ; Humans ; Postal Service ; Psychiatry ; Psychotherapy ; Schizophrenia ; Seoul*

OBJECTIVE: The limitations of medical management of symptomatic intracranial arterial stenosis (ICS) have prompted development of new strategies, including endovascular treatment. However, stenting of symptomatic ICS remains investigational. Here, we have reported and analyzed a series of 19 endovascular procedures involving placement of a Wingspan stent. METHODS: We conducted a retrospective review of a series of ICS in which patients were treated with percutaneous transarterial balloon angioplasty and stent placement (PTAS). Patients included in the study were diagnosed as symptomatic ICS between May 2010 and September 2011. RESULTS: Nineteen patients (median age, 65 years; 12 males, seven women) were treated with the Wingspan stent system for symptomatic ICS ranging from 50% to 99%. The technical success rate was 100%. The location of ICS included the internal carotid (n = 5; 1 petrous, 3 cavernous, and 1 clinoid segments), vertebral (n = 1; V4 segment), basilar (n = 1), and middle cerebral (n = 12; 9 M1, 3 M2) arteries. There was no occurrence of procedure-related mortality. Periprocedural morbidity occurred in two cases (10.5%), including carotid-cavernous fistula (n = 1) and subarachnoid hemorrhage (n = 1). No ipsilateral stroke was recorded beyond 30 days during a mean follow-up period of 13.2 months (range 9-19 months). Restenosis (> 50%) was observed in one patient (6.3%), who was asymptomatic, on follow-up imaging. CONCLUSION: Wingspan stent for symptomatic ICS can be performed with a high rate of technical success and acceptable periprocedural morbidity rates. Our initial experience indicates that this procedure represents a viable treatment option for this patient population.
Angioplasty ; Angioplasty, Balloon ; Arteries ; Caves ; Constriction, Pathologic ; Endovascular Procedures ; Fistula ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Stents ; Stroke ; Subarachnoid Hemorrhage

PURPOSE: Clotting factor X deficiency is one of the least common coagulation disorders. The authors describe a case of cleft palate in a patient with a congenital clotting factor X deficiency. METHODS: In pediatric patients with a cleft palate, the coagulation problem is more worrisome, because they are more sensitive to blood than adults, and because postoperative bleeding can cause blood ingestion with subsequent vomiting, aspiration, and airway obstruction. To prevent hemorrhagic complications in the described case, fresh frozen plasma (FFP) was administered every 24 hours from the day before surgery to the second postoperative day. RESULTS: Good hemostasis, normal healing, and no complications was shown postoperatively. CONCLUSION: The replacement of fresh frozen plasma was useful in the case of congenital clotting factor deficiency for bleeding prophylaxis in cleft palate operation.
Adult ; Airway Obstruction ; Cleft Palate ; Eating ; Factor X ; Factor X Deficiency ; Hemorrhage ; Hemostasis ; Humans ; Plasma ; Vomiting

PURPOSE: The purpose of this study is to compare the frequency with which pseudole-sions around the gallbladder (GB) fossa are revealed by multiphasic CT, by CT during arterial portography (CTAP), and by CT during hepatic arteriography (CTHA) and to determine their radiological characteristics. MATERIALS AND METHODS:Multiphasic CT, CTAP, and CTHA examinations of 81 patients without pathology of the GB and around the GB fossa were evaluated for pseudolesion around the GB fossa. The definition of pseudolesion was as follows: 1) hyperattenuation during the arterial phase and isoattenuation during the delayed phase of multipha-sic CT, or perfusion defect on CTAP and hyperattenuation on CTHA; 2) no Lipiodol tagging on Lipiodol CT; 3) all findings observed adjacent to the gallbladder fossa; and 4) no interval change on follow-up CTAP and CTHA. We compared the frequency of pseudolesions around the GB fossa, as seen on multiphasic CT, CTAP, and CTHA, and determined their size, location, and shape, as revealed by CTHA. RESULTS: The frequency of pseudolesion was 2.5% (2/81) on multiphasic CT, while on CTAP or CTHA, the frequency was 53.1% (43/81), and 58 pseudolesions were identi-fied. Of 58 pseudolesions, 56 were revealed by CTAP and 57 by CTHA. Forty-nine of 58 pseudolesions were larger and all pseudolesions showed more contrast to parenchyma on CTHA than on CTAP. The location of pseudolesions was segment V(32 of 58), IV (25 of 58), and VI (1 of 58), and their size ranged from 5 to 30 (mean, 17.5)mm. Pseudolesions were wedge-shaped (48 of 58), oval (6 of 58), bandlike (3 of 58), or round (1 of 58). CONCLUSION: CTAP and CTHA frequently revealed pseudolesion around the GB fossa. The radiological characteristics of these modalities help differentiate pseudolesions from true tumoral hepatic lesions.
Angiography ; Ethiodized Oil ; Follow-Up Studies ; Gallbladder* ; Humans ; Pathology ; Perfusion ; Portography