Obstetrical hemorrhage is one of the deadly triad, along with hypertensive disorder in pregnancy and infection. Postpartum hemorrhage is the major cause of obstetrical hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage, and resulted from poor uterine contraction after delivery of the fetus and placenta. Initial management to control postpartum uterine atonic bleeding is based on the use of uterotonics such as well known oxytocin and ergot preparations together with uterine massage. Prostaglandin E2 analogue, sulprostone can be used next when these agents are failed to produce uterine contraction. The woman unresponsive to non-surgical managements requires surgical interventions including emergency hysterectomy. Recently prostaglandin E1 analogue, misoprostol, has been known to elicit potent uterine contraction and cervical ripening after oral, vaginal or rectal administration. We have experienced two cases of postpartum uterine atonic bleedings which were unresponsive to oxytocin, ergot, or prostaglandin E2, but were successfully controlled by rectal administration of misoprostols.
Administration, Rectal ; Alprostadil ; Cervical Ripening ; Dinoprostone ; Emergencies ; Female ; Fetus ; Hemorrhage* ; Humans ; Hysterectomy ; Massage ; Misoprostol* ; Oxytocin ; Placenta ; Postpartum Hemorrhage ; Postpartum Period* ; Pregnancy ; Uterine Contraction ; Uterine Inertia

PURPOSE: To report a rare case of recurrent alveolar soft-part sarcoma (ASPS) with concurrent involvement of the orbit and multiple sites of the body that was removed successfully by surgery. CASE SUMMARY: A 37-year-old woman presented with diplopia at the left lateral gaze and proptosis of the left eye. Two years earlier, the patient had a mass excision of the right gluteus maximus and the left orbit, and ASPS was histopathologically diagnosed at that time. In addition, the patient had been treated with chemotherapy and radiation therapy. On radiologic examination, recurrent tumor of the left orbit was found and surgically removed. The histopathologic examination showed that tumor cells were arranged in an alveolar pattern divided by fibrous septa and contained abundant granules in the cytoplasm, typically consistent with ASPS. Postoperatively, the symptoms of diplopia and proptosis improved. CONCLUSIONS: ASPS can occur and recur in the orbit as well as systemically. In addition, at the time of surgical removal of ASPS in the orbit, the surgeon should be particularly cautious of massive bleeding.
Adult ; Cytoplasm ; Diplopia ; Exophthalmos ; Eye ; Female ; Hemorrhage ; Humans ; Orbit ; Sarcoma, Alveolar Soft Part ; Viperidae

Endogenous endophthalmitis is rare, but when it occurs, there is high probability of visual loss in spite of early diagnosis and treatment. But in many patients, it is difficult to find exact primary site, and even if there is a presumed site, it is difficult to disclose causative organisms. As a result, proper antibiotic treatmaent may not be carried out in some cases. In a 55 year old man who suffered from liver abscess, we experienced a case of endogenous endophthalmitis accompanied by severe orbital cellulitis caused by klebsiella pneumoniae from liver abscess, and ocular symptom improved after identification of pathogen and antibiotic administration. However visual loss could not be prevented. So, we first report this case with a review of available literatures and remind seriousness of this disease at the same time.
Early Diagnosis ; Endophthalmitis* ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver* ; Middle Aged ; Orbit* ; Orbital Cellulitis*

Preoperarive measurement of strabismic angle is most important procedure in determining the amount of surgery.But measured angles are not always the same at each examination, which is quite a steress to both the operator and the patient because additional examination has to be done for accurate determination of surgical amount and also because the confidence for planned amount of surgery may be reduced.Therefore we investigated the variance of preoperative measurements and evaluated the necessity of repeated examinations. We compared the variance of measurement and investigated the bias and reliability of repeated examinations, from 104 patients who were examined initially by a resident at first visit and examined repeatedly at least 3 times before operation by a specialist.Also, the degree of variance in measurement and its relation with postoperative result were evaluated. The differences in measurement between resident and specialist was average 2.37 prism diopters, which was not significant on reliability analysis.Also, there were no significant differneces among 3 measurements by specialist. The degree of variance decreased with increasing age and the larger the degree of variance in measurement, the larger the deviation which may be remained postoperatively. The results suggest that the angle of deviation measured by resident is reliable and repeated measurements do not differ significantly[p>0.05], and also confirms that the variation of these measurements is an important factor which can influence postoperative results.
Bias (Epidemiology) ; Exotropia* ; Humans ; Specialization

OBJECTIVES: To evaluate the mechanical properties and metallurgical characteristics of the M3 Rotary and M3 Pro Gold files (United Dental). MATERIALS AND METHODS: One hundred and sixty new M3 Rotary and M3 Pro Gold files (sizes 20/0.04 and 25/0.04) were used. Torque and angle of rotation at failure (n = 20) were measured according to ISO 3630-1. Cyclic fatigue resistance was tested by measuring the number of cycles to failure in an artificial stainless steel canal (60° angle of curvature and a 5-mm radius). The metallurgical characteristics were investigated by differential scanning calorimetry. Data were analyzed using analysis of variance and the Student-Newman-Keuls test. RESULTS: Comparing the same size of the 2 different instruments, cyclic fatigue resistance was significantly higher in the M3 Pro Gold files than in the M3 Rotary files (p < 0.001). No significant difference was observed between the files in the maximum torque load, while a significantly higher angular rotation to fracture was observed for M3 Pro Gold (p < 0.05). In the DSC analysis, the M3 Pro Gold files showed one prominent peak on the heating curve and 2 prominent peaks on the cooling curve. In contrast, the M3 Rotary files showed 1 small peak on the heating curve and 1 small peak on the cooling curve. CONCLUSIONS: The M3 Pro Gold files showed greater flexibility and angular rotation than the M3 Rotary files, without decrement of their torque resistance. The superior flexibility of M3 Pro Gold files can be attributed to their martensite phase.
Calorimetry, Differential Scanning ; Fatigue* ; Heating ; Hot Temperature ; Pliability ; Stainless Steel ; Torque

An extraordinary eye movement was seen in a vegetative patient. His eyeballs were exotropic in the primary position and showed dissociated nystagmus which appeared alternately in each eye every few seconds. He also had palatal myoclonus quite asynchronous with the nystagmus. To our knowledge, there has been no such nystagmus documented in the literature. We report the new nystagmus with his EOG and brain MRI.
Electrooculography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myoclonus/*complications/diagnosis ; Nystagmus, Pathologic/*complications/diagnosis ; Palatal Muscles

No abstract available.

Myeloid-related protein (MRP)8/MRP14 is an endogenous Toll-like receptor 4 (TLR4) ligand and is abundant in synovial fluid (SF) of rheumatoid arthritis (RA) patients. Belonging to damage-associated molecular patterns, it amplifies proinflammatory mediators and facilitates a wide range of inflammatory and autoimmune diseases. Interleukin (IL)-17-producing T-helper (Th)17 cells have a crucial role in RA pathogenesis, and IL-6 is the key factor promoting Th17 differentiation. We investigated whether the level of MRP8/MRP14 is positively associated with IL-6 and IL-17 levels in RA SF and found that MRP8/MRP14 level had a significant correlation with IL-6 and IL-17 levels in RA SF. We also observed that MRP8-induced IL-17 production by peripheral blood mononuclear cells but MRP14 did not. Upon stimulation with MRP8, IL-6 production was enhanced by RA fibroblast-like synoviocytes (FLS) and was further elevated by coculturing RA FLS with activated CD4+ T cells. Moreover, we demonstrated that MRP8-activated IL-6 production by RA FLS promoted differentiation of Th17 cells using the coculture system consisting of CD4+ T cells and RA FLS. In addition, IL-6 blockade attenuated Th17 polarization of CD4+ T cells in the cocultures. Inhibitor studies revealed that MRP8 increased IL-6 production in RA FLS via TLR4/phosphoinositide 3-kinase/nuclear factor-kappaB and mitogen-activated protein kinase signaling pathways. Our results show that MRP8 has a crucial role in stimulating IL-6 expression by RA FLS, and subsequently promotes Th17 differentiation in RA, suggesting that neutralizing MRP8 level in RA synovium may be an effective therapeutic strategy in RA treatment.
ATP-Binding Cassette Transporters/*metabolism ; Adult ; Aged ; Arthritis, Rheumatoid/*pathology ; CD4-Positive T-Lymphocytes/metabolism ; Calgranulin B/metabolism ; Cell Differentiation/*immunology ; Fibroblasts/*metabolism/pathology ; Humans ; Inflammation Mediators/metabolism ; Interleukin-17/metabolism ; Interleukin-6/*biosynthesis ; Middle Aged ; Signal Transduction/immunology ; Synovial Fluid/cytology ; Synovial Membrane/metabolism/pathology ; Th17 Cells/*pathology ; Toll-Like Receptor 4/metabolism ; *Up-Regulation

Tuberous sclerosis is a inherited systemic disorder which is well known as classic triad of epilepsy, adenoma sebaceum and mental retardation. Fifty to eighty-seven percent of patients with this disorder manifest retinal hamartoma in eyeball, but this tumor is known to be never malignant and rarely cause blindness. This is a very unusual case that retinal hamartoma of 5-year old boy with tuberous sclerosis was complicated with neovascular glaucoma, vitreous hemorrhage, and cataract, and that very severe ocular pain and visual loss developed. We resected the tumor through pars plana vitrectomy but the tumor recurred in 3 weeks, and the affected eye was finally enucleated. However, there were no malignant findings and only benign findings of hamartoma which is composed of astrocyte with long process, oval nuclei and eosinophilic cytoplasm on histologic examination. So we report this unusual case with review of available literature.
Astrocytes ; Blindness* ; Cataract ; Child, Preschool ; Cytoplasm ; Eosinophils ; Epilepsy ; Glaucoma, Neovascular ; Hamartoma* ; Humans ; Intellectual Disability ; Male ; Retinaldehyde* ; Tuberous Sclerosis* ; Vitrectomy ; Vitreous Hemorrhage

No abstract available.