Pseudomembranous Aspergillus Tracheobronchitis: Case Report of a Rare Manifestation of Airway Invasive Aspergillosis

Aspergillus tracheobronchitis, an uncommon form of invasive pulmonary aspergillosis, is characterized by the development of a pseudomembrane, ulcers, or an obstruction that is predominantly confined to the tracheobronchial tree. Pseudomembranous Aspergillus tracheobronchitis is the most severe form of Aspergillus tracheobronchitis, and only a few cases have been reported in Korea. We report the characteristic chest CT findings in a patient diagnosed with pseudomembranous Aspergillus tracheobronchitis after bronchoscopy and successfully treated by proper antifungal treatment.

Merits of and Technical Tips for Supra-Mesenteric Aortic Cross Clamping

Supra-celiac aortic cross clamping is often utilized during aortic reconstruction for aneurysmal/occlusive disease involving the pararenal aorta. However, this may be accompanied a myriad of complications related to hemodynamic disturbances, cardiopulmonary compromise and hepatic ischemia. Supra-mesenteric aortic cross clamping may be an excellent option in selected patients with suitable anatomy to minimize or avoid these complications. Herein, the merits of and technical tips for supra-mesenteric aortic cross clamping are discussed.

Effect of Placenta-Derived Mesenchymal Stem Cells in a Dementia Rat Model via Microglial Mediation: a Comparison between Stem Cell Transplant Methods

PURPOSE: Loss of cholinergic neurons in the hippocampus is a hallmark of many dementias. Administration of stem cells as a therapeutic intervention for patients is under active investigation, but the optimal stem cell type and transplantation modality has not yet been established. In this study, we studied the therapeutic effects of human placenta-derived mesenchymal stem cells (pMSCs) in dementia rat model using either intracerebroventricular (ICV) or intravenous (IV) injections and analyzed their mechanisms of therapeutic action. MATERIALS AND METHODS: Dementia modeling was established by intraventricular injection of 192 IgG-saporin, which causes lesion of cholinergic neurons. Sixty-five male Sprague-Dawley rats were divided into five groups: control, lesion, lesion+ICV injection of pMSCs, lesion+IV injection of pMSCs, and lesion+donepezil. Rats were subjected to the Morris water maze and subsequent immunostaining analyses. RESULTS: Both ICV and IV pMSC administrations allowed significant cognitive recovery compared to the lesioned rats. Acetylcholinesterase activity was significantly rescued in the hippocampus of rats injected with pMSCs post-lesion. Choline acetyltransferase did not co-localize with pMSCs, showing that pMSCs did not directly differentiate into cholinergic cells. Number of microglial cells increased in lesioned rats and significantly decreased back to normal levels with pMSC injection. CONCLUSION: Our results suggest that ICV and IV injections of pMSCs facilitate the recovery of cholinergic neuronal populations and cognitive behavior. This recovery likely occurs through paracrine effects that resemble microglia function rather than direct differentiation of injected pMSCs into cholinergic neurons.

Evaluation of Validity and Reliability of Inertial Measurement Unit-Based Gait Analysis Systems

OBJECTIVE: To replace camera-based three-dimensional motion analyzers which are widely used to analyze body movements and gait but are also costly and require a large dedicated space, this study evaluates the validity and reliability of inertial measurement unit (IMU)-based systems by analyzing their spatio-temporal and kinematic measurement parameters. METHODS: The investigation was conducted in three separate hospitals with three healthy participants. IMUs were attached to the abdomen as well as the thigh, shank, and foot of both legs of each participant. Each participant then completed a 10-m gait course 10 times. During each gait cycle, the hips, knees, and ankle joints were observed from the sagittal, frontal, and transverse planes. The experiments were conducted with both a camerabased system and an IMU-based system. The measured gait analysis data were evaluated for validity and reliability using root mean square error (RMSE) and intraclass correlation coefficient (ICC) analyses. RESULTS: The differences between the RMSE values of the two systems determined through kinematic parameters ranged from a minimum of 1.83 to a maximum of 3.98 with a tolerance close to 1%. The results of this study also confirmed the reliability of the IMU-based system, and all of the variables showed a statistically high ICC. CONCLUSION: These results confirmed that IMU-based systems can reliably replace camera-based systems for clinical body motion and gait analyses.

Dual left anterior interventricular coronary artery with a rare course in a Korean / 대한해부학회지

Dual left anterior interventricular coronary artery (also called left anterior descending artery, hereafter referred as LAD) is a rare congenital coronary artery anomaly. Notably, type IV dual LAD has never been reported in Koreans. During a routine dissection, a new variant of type IV dual LAD was found in a 57-year-old Korean male cadaver, whose cause of death was unknown. One LAD originated from the right coronary artery, coursed through the anterior interventricular sulcus, but did not reach the apex cordis. The other LAD arose from the left coronary artery, never entered the anterior interventricular sulcus through its course, but reached the apex cordis, where it met the posterior interventricular branch of the right coronary artery. This is the first report on a new variant of type IV dual LAD in Koreans, which is of clinical importance during procedures containing the coronary artery.

MR Images of Infarction of Wandering Spleen Associated with Intestinal Non-rotation

Wandering spleen is a rare clinical condition caused by lax splenic suspensory ligaments. The laxity of ligaments causes torsion of splenic vascular pedicle. CT scan of a 7-year-old girl with abdominal pain showed a non-enhancing lobular mass in lower abdomen. Small bowel loops were located at the right-sided abdomen and colonic loops at the left-sided abdomen. MRI scan showed non-enhancing heterogeneous mass with twisted vascular pedicle. To our knowledge, only a few cases have been reported about wandering spleen diagnosed on MRI.

Perilesional Steatosis in Ectopic Pancreas Mimicking Exogastric Mass : A Case Report

We report an unusual case of ectopic pancreas that appeared on radiologic images as a lobulated, submucosal mass enclosed by fat component in the gastric lower body. Although, ectopic pancreas including fat component is extremely rare, in the setting of gastric submucosal mass with containing perilesional fat, these findings should be considered in ectopic pancreas as part of the differential diagnosis.

Edematous and painful external hemorrhoids following intersphincteric resection for low rectal cancer / 대한외과학회지

Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.

Robotic-Assisted Resection of Primary Rectal Cancer: An Analysis of Consecutive 185 Cases / 대한내시경복강경외과학회지

PURPOSE: Although some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of a robotic system, few studies have reported the use of robotic surgery for rectal cancer. This study analyzed prospectively the safety, morbidity, mortality and operation time of a robotic rectal resection for rectal cancer. METHODS: The data of 185 consecutive patients, who had undergone robotic rectal resection for rectal cancer at Korea University Aanam Hospital from July 2007 to April 2011, was analyzed prospectively. The postoperative outcomes and operative times were evaluated. RESULTS: Robotic rectal resection using a da Vinci surgical system was performed on 185 patients. There were 115 low anterior resections, 5 anterior resections, 1 Hartmann's operation, 10 ultra-low anterior resections, 43 intersphincteric resections and 11 abdominoperineal resections. The median hospital stay was 9 days. The overall morbidity rate was 33.4%. There was one conversion to open surgery. The mean passage of flatus was noted on postoperative day 2.0, diet was started on postoperative day 2.3 and the mean postoperative hospital stay was 13.7 days. The mean number of retrieved lymph nodes was 16. The total operation time decreased with increasing operator experience (306 min vs 285 min vs 268 min, p=0.009). CONCLUSION: A robotic rectal resection is feasible and safe for rectal cancer patients. The data showed an acceptable morbidity and mortality rate compared to the short term results of conventional laparoscopic and open surgery reported previously. Nevertheless, the oncologic and functional benefits of robotic colorectal surgery should be evaluated through a large scale study.

Prevalence and Characteristics of Major Vascular Diseases of Elderly Men in the Incheon Area

PURPOSE: As Korea is an aging society (WHO classification) and projected to be an aged society in 10 years, peripheral vascular diseases (PVD) in the elderly population has emerged as an important social and medical issue. But their prevalence was rarely reported in Korea. The purpose of this study is to define the prevalence of carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), and peripheral arterial occlusive disease (PAOD) of lower limb in the Incheon area. METHODS: Elderly men (> or =65 years) were referred randomly from the Incheon Federation of Korean Senior Citizens' Association (from Nov 2008 to Sep 2009) to Inha Univeristy Hospital, Incheon, Korea for a PVD screening program. The subjects were screened for CAS and AAA by duplex. CAS was defined as > or =50% internal CAS and AAA as > or =3 cm aortic diameter in minor axis. PAOD of lower limb was screened by measurement of ankle brachial index (ABI); ABI of < or =0.9 was considered abnormal. RESULTS: 1150 subjects were screened including 103 octogenarians (9.0%). Mean age was 72.3+/-0.2 years. Combined conditions were hypertension (54.3%), diabetes mellitus (25.2%), coronary artery disease (15.6%), dyslipidemia (18.9%), obesity (31.1%) and smoking history (71.7%). CAS was detected in 7.7% (89/1,150) subjects. Thirty-three (2.9%) were diagnosed with AAA. PAOD was detected in 50 subjects (4.4%). CONCLUSION: Prevalence of PVD in Korea is not lower compared to that of western countries, especially the USA and the UK. A nationwide program for timely detection and treatment for PVD should be developed.

Idiopathic Fibrosing Mediastinitis Causing Pulmonary Hypertension with Improvement by Steroid Treatment / 결핵및호흡기질환

Idiopathic fibrosing mediastinitis is, an uncommon cause of pulmonary hypertension this is characterized by excessive fibrosis of the mediastinum with an unknown etiology. Steroid therapy has been suggested for individuals with progressive symptoms, bu there is littlet data demonstrating the efficacy of such therapy are lacking. We present a case of pulmonary hypertension secondary to a compression of a main pulmonary artery by fibrosing mediastinitis which was confirmed by a biopsy with a thoracotomy. The chest CT scan and 2D echocardiography performed before and after a trial of steroid therapy demonstrated improvement after steroid therapy.

Differences of Cesarean Section Rates according to San-Yin-Jiao(SP6) Acupressure for Women in Labor / 간호학회지

PURPOSE: The purpose of this study was to explain differences of cesarean section rates according to San-Yin-Jiao(SP6) acupressure for women in labor. METHOD: A noneqivalent control group pre test - post test design was used to explain differences of cesarean section rates according to SP6 acupressure. The participants were 209 women who were assigned to one of three groups SP6 acupressure(n=86), SP6 touch(n=47), and control group(n=76). For 30 minutes, the SP6 acupressure group received SP6 acupressure,and the SP6 touch group received SP6 touch for the duration of each uterine contraction. The Control group was encouraged to deep breath and relax for the duration of each uterine contraction for 30 minutes. RESULT: The rates of cesarean section were 12.8%, 29.8%, and 22.4% for the SP6 acupressure group, SP6 touch group, and control group respectively. There was a significant difference among groups (p=0.049). Cesarean section rateswere significantly different between the SP6 acupressure and non-SP6 acupressure group(p=0.035). CONCLUSION: This finding shows that 30 minutes of SP6 acupressure was effective in decreasing the cesarean section rate. Therefore, SP6 acupressure during labor could be applied as an effective nursing intervention.

Imaging Diagnosis of Fetal Abdominal Solid Tumor / 대한산부인과학회잡지

OBJECTIVE: Ultrasonography is screening modality of choice and plays an important role in prenatal diagnosis of various diseases and neoplasm of fetus. Recently, Magnetic Resonance Imaging was used as a diagnosis tool to fetal disease. We would like to evaluate efficacy of ultrasonography and magnetic resonance imaging for the diagnosis of fetal abdominal solid tumor. METHODS: Among 2,055 cases of abnormal ultrasonography findings detected by prenatal ultrasonography from January 1996 and June 2002, a comparison between the diagnosis made by prenatal ultrasonography, fetal magnetic resonance imaging (MRI), postnatal radiological studies and histopathologic studies was made in four cases with fetal abdominal solid tumor. RESULTS: The first case was diagnosed as adrenal tumor or hepatic tumor by US, hemangioedothelioma of liver by fetal MRI, and confirmed as hemangioendothelioma postnatally. The second case showed concordance with mesoblastic nephroma among the diagnosis made by US, fetal MRI, and postnatal histopathologic studies. The third case was diagnosed as extrathoracic pulmonary sequestration by US and MRI, and the same diagnosis was made by postnatal histopathologic studies. The fourth case was suspected as kidney tumor by US and was diagnosed as adrenal as adrenal neuroblastoma postoperatively. CONCLUSION: Fetal solid tumor is not a common disorder, but the location, size and orgin of tumor plays important role in the prognosis of neonatal period; additional workup by fetal MRI would improve the diagnosis of such tumors.

Prenatal Ultrasonograpy of Cystic Hygroma in Unusual Site / 대한산부인과학회잡지

Among 2,055 cases of abnormal findings detected by prenatal ultrasonography at Yonsei University College of Medicine from January 1996 to June 2002, the incidence and the site of cystic hygroma were evaluated. The clinical courses and postnatal prognosis were studied in four cases with cystic hygroma developed in unusual sites. Among 2,055 cases of abnormal ultrasonographic findings, 76 cases (3.70%) were diagnosed as cystic hygroma. Among 76 cases of cystic hygroma, 4 cases (5.3%) were detected in unusual sites; 1 case in mediastinum, 1 right axillary area, and 2 in anterolateral portion of neck. In cystic hygroma, prenatal accurate ultrasonographic findings including size and site of mass are important. Cystic hygroma developed in unusual sites are associated with perinatal complications including airway obstruction and compression of the surrounding organs. In giant cystic hygroma, cesarean section should be considered to avoid trauma and birth injury. After delivery, close observation and proper management are required.

Recommended Protocol for Antenatal Corticosteroid / 대한주산의학회잡지

No abstract available.

Fetal Growth Restriction was a Major Cause of Increased Perinatal Mortalities of Postterm Pregnancies / 대한산부인과학회잡지

OBJECTIVE: Perinatal mortality rates were higher in postdate than in term pregnancies. Previous study showed the risk to be greater in postterm newborns weighing less than 2500 grams at birth. This study is designed to examine the effect of gestational age and fetal growth restriction (FGR) on the perinatal mortalities of the postterm pregnancies. METHODS: Maternal and perinatal database of Yonsei University Medical Center from 1961 to 1990 was reviewed. After excluding pregnancies with known medical or obstetrical complications, we compared perinatal mortality rates of 39,631 singleton pregnancies delivered between 37 weeks and 44 weeks of gestational age according to the birthweight percentile. Birth weight percentile were grouped as FGR1 (10 percentile). Mortalities were compared using Chi-square statistics. RESULTS: Mean birth weight increased up to 42 weeks of gestation. Perinatal mortalities increased after 42 weeks of gestation. FGR1 group showed higher perinatal mortality rate compared with AGA group at 41 weeks of gestation (135/8, p<0.01). At 42 weeks of gestation, both FGR1 and FGR2 showed increased perinatal mortality rates (130/10 p<0.01, 56/10 p<0.01). Among AGA group, mortality increase was not obvious up to 42 weeks of gestation. CONCLUSION: Fetal growth restriction was a major cause of increased perinatal mortalities in postterm pregnancies.

Prenatal Diagnosis of Fetal Trisomy 21 from Maternal Peripheral Blood

This study was undertaken to establish a noninvasive prenatal genetic diagnostic method for trisomy 21 using the fetal nRBCs that is rarely present in maternal circulation. Peripheral venous blood samples were collected from 30 women with an advanced maternal age, abnormal triple marker test results, or abnormal ultrasound findings such as an increased nuchal translucency. The blood samples were treated with heparin. The triple density gradient centrifugation, and MACS using CD45 and CD71 were used to isolate the fetal cells. FISH analysis using probe 21 was performed with GPA-immunostaining. The study population consisted of 30 patients from 13 to 25 weeks of gestation, and nRBCs were separated in all cases. In GPA-immuno FISH analysis using probe 21, 3 cases of trisomy 21 were diagnosed and these results were confirmed by the amniocentesis. In conclusion, a prenatal diagnosis of trisomy 21 through GPA- immuno fluorescence in situ hybridization (FISH) analysis using separated fetal nRBCs is a useful, innovative, accurate, rapid and non-invasive diagnostic method.

A case of vaginal delivery in woman with congenital factor V deficiency / 대한산부인과학회잡지

Congenital factor V deficiency is a rare coagulation disorder, which is genetically autosomal recessive. In 1947, Owren first described a case of parahemophilia. During childhood, ecchymosis (bruising), epistaxis, oral hemorrhage, soft-tissue hemorrhage, and postpartum hemorrhage are noted in half of the patients. Because factor V is involved in common pathway in the coagulation scheme, prothrombin time (PT) and partial thromboplastin time (PTT) are prolonged. Definite diagnosis can be made with a specific factor V assay. Fresh frozen plasma would appear to be the treatment of choice. For the first time in Korea, we experienced a case of vaginal delivery in a patient with factor V deficiency. She delivered a male baby weighing 3120gm with median episiotomy. Six units of fresh frozen plasma were transfused during delivery. After additional transfusions of fresh frozen plasma, she was discharged on fourth postpartum day without hemorrhage or hematoma.

Clinical Usefulness of Fluorescence in Situ Hybridization (FISH) in the Diagnosis of Genetic disease / 대한산부인과학회잡지

INTRODUCTION: The traditional cytogenetic analysis requires relatively long cell culture time, intensive labour and trained personnel. But, in clinical situations, rapid diagnosis of genetic disease is very important for urgent decision for future management. So we need more rapid and precise diagnostic tools for clinical genetic counselling. The fluorescence in situ hybridization (FISH) has been studied for detecting chromosomal aneuploidies because this method can get rapid and precise results of cytogenetic studies. OBJECTIVE: To evaluate the clinical utility of fluorescence in situ hybridization technique as a diagnostic tool of chromosomal anomaly. METHODS: Peripheral blood or gonadal tissue were obtained from the patients (n=63) clinically suspicious of genetic disease. Chorionic villi (n=6), amniotic fluid (n=9), and fetal cord blood (n=2) were obtained from 15 pregnancies undergoing fetal karyotyping at 9 to 30 weeks of gestation for prenatal genetic counselling. Karyotyping was performed by both traditional cytogenetics and FISH, using commercially available kits. After the procedures, the results of FISH were compared with the results of traditional cytogenetic studies. RESULTS: In a blind series of 17 samples all, including trisomy 21 (1 case), trisomy 18 (1 case), monosomyX (1 case), 47,XYY (1 case), and 47,XXY (1 case), were correctly identified. FISH results were correspondent with conventional karyotyping results in 7 patients with intersex except one case of suspicious of mosaicism. In nine children of Turner syndrome, the results of two methods were correspondent too. There was a fluorescent signal defect in band 15 q11-q13 in one of chromosome 15 in 18 children of 29 patients, clinically suspicious of Prader-Willi syndrome, with FISH method and only four patients were diagnosed as Prader-Willi syndrome with G-banding microscope. It was impossible to identify the defect in chromosome 15 q11-q13 in 10 (34%) children by both methods. Two children of 11 patients, clinically suspicious of Angelman syndrome, were diagnosed as Angelman syndrome with both method respectively. And four children were diagnosed as Angelman syndrome only with FISH method. In 5 cases, we cannot detect the defect in chromosome 15 q11-q13 with both methods. In four cases of Williams syndrome, the results of both methods were as follows; 1 case (25%): diagnosed as Williams syndrome by both methods; 2 cases (50%): diagnosed

A New Prenatal Diagnosis of Fetal Cells Isolation from Maternal Peripheral Blood -Using Comparative Genomic Hybridization by Microdissection / 대한산부인과학회잡지

OBJECTIVE: The objective of this study was to determine the clinical use of CGH (comparative genomic hybridization) for detection of fetal aneuploidy from fetal cells (nucleated red blood cells, nRBCs) isolated from maternal peripheral blood. METHODS: Maternal peripheral venous blood sample was collected and treated by heparin. Triple density gradient centrifugation, and MACS (magnetic activated cell sorting) using CD45 and CD 71 were used to isolated the fetal nRBCs. With microdissection, DOP (degenerate oligonucleotide primed)-PCR (polymerase chain reaction), and nick translation, CGH was performed. RESULTS: Fetal nRBCs were successfully isolated from maternal peripheral blood. After microdissection of fetal nRBCs, DOP-PCR. and nick translation, DNA size was suitable for hybridization. In CGH analysis, we can confirm normal female and trisomy 21 male fetus. CONCLUSION: Prenatal diagnosis from fetal cells in maternal peripheral blood by comparative genomic hybridization shows clinical promise in terms of speed, accuracy, and non-invasiveness. To enable widespread use of this method, further studies involving many cases are warrented.