BACKGROUND: Heparin salts induce negative proportional bias according to anticoagulant concentration for analysis of ionized calcium (iCa) However, D-phenylalanyl -L-prolyl- L-arginine chloromethyl ketone (PPACK), a selective thrombin inhibitor, do not bind to ionized calcium. Therefore, we evaluated PPACK as an alternative anticoagulant to lithium heparin (Li-Hep) for analysis of ira, blood gases and electrolytes. METHODS: The concentration of iCa in whole blood anticoagulated with heparin was compared with that in serum of patients admitted to Chungbuk National University Hospital (n=27). The blood gases, electrolytes and iCa according to each anticoagulant concentration (Ll-Hep or PFACK) were analyzed. The concentrations of anticoagulated whole blood (Li-Hep; 50 kIU/L, PPACK ; 75 mumol/L) were compared with those of nonanticoagulated whole blood for blood gases, electrolytes and iCa (n=17), RESULTS: The results were as follows; whole blood anticoagulated with Li-Hep demonstrated -0.28+/-0.15 mmol/L (26.6%) bias for ira compared with serum. No bias according to each anticoagulated concentrations were observed in analysis of blood gases, potassium and chloride. Negative proportional bias for iCa and sodium in serum anticoagulated with Li-HeP was observed. In comparison, no bias for ira and sodium was observed with PPACK. No bias was observed in analysis of blood gas or electrolytes with each anticoagulated whole blood except for sodium and chloride that had clinically nonsignificant bias. Whole blood anticoagulated with Li-Hep demonstrated a consistent -0.08+/-0.02 mmol/L (6.3%) bias for ira compared with nonanticoagulated whole blood. In comparison, no bias was observed with PPACK-anticoagulated whole blood for iCa. CONCLUSIONS: We concluded that PPACK is an ideal anticoagulant without bias for analysis of iCa, blood gases and electrolytes.
Arginine ; Bias (Epidemiology) ; Calcium* ; Chungcheongbuk-do ; Electrolytes* ; Gases ; Heparin* ; Humans ; Lithium ; Potassium ; Salts* ; Sodium ; Thrombin

BACKGROUND: The HBV-PCR assay seems to be potentially valuable diagnostic tool for the evaluation of variable serologic status. However, the selection of the primer for HBV-PCR test may be very important because they can influence the HBV-PCR positivity. METHODS: We compared the results of primer HBV1/2 including famous 1896 and 1899 mutation sites with those of primer PHBV1/2 at precore/core region. HBV-PCR was tested in 87 HBsAg-positive patients using two sets of primers. The results were evaluated according to the primers and also compared the results with the clinical diagnosis and the alanine aminotransferase (ALT) level. RESULTS: The positive rate of PHBV primer was higher than HBV primer including mutation sites (nucleotide 1896 and 1899) in HBeAg-negative patients. According to the clinical diagnosis, the sensitivity of PHBV primer was higher than that of HBV primer in chronic hepatitis patients. There was no significant correlation between ALT level and HBV-PCR results. CONCLUSIONS: It is important that the selection of primer in HBV-PCR is important, because the primer including mutation sites may result in false negative results. PHBV primer used in this study could be useful for the detection of HBV-DNA by HBV-PCR.
Alanine Transaminase ; Diagnosis ; Hepatitis, Chronic ; Humans ; Polymerase Chain Reaction*

Purpose: /Objectives: To determine predictors of fall events in hospitalized patients with cancer, and identification of fall risk. Methods: An analysis of medical records was conducted together with a review of standardized fall reports of 565 patients admitted between January 1 and December 31, 2020. The collected data were analyzed with the chi-squared test, Fisher exact test, independent t-test, and logistic regression analysis using STATA 17 program. Results: There was a statistically significant increased fall risk; accompanied by a guardian (OR=10.30 CI=2.66~39.94), number of attachment devices (OR=1.30, CI=0.46~0.64), medication (OR=0.17, CI=0.04~0.84), pain (OR=4.73, CI=1.59~14.0), walking problem (OR=29.85, CI=9.31~95.74), chemotherapy (OR=5.20, CI=1.81~14.89), and fall risk score (OR=1.83, CI=1.50~2.24). Conclusion These findings can serve as academic evidence to support the role of nurses in assessing the risk of fall events/accidents with regard to cancer patients and the development of individually adjusted fall assessment tools.

Idiopathic CD4+ T-lymphocytopenia is a rare immune disorder characterized by an unexplained deficit of CD4+ T cells and results in various opportunistic infections. Herein, we report a case of new onset weakness in a 10-year-old boy secondary to motor axonal neuropathy associated with idiopathic CD4+ T-lymphocytopenia. The patient was referred to rehabilitation for an evaluation of progressive weakness involving all four limbs. A subsequent nerve conduction study and needle electromyography identified motor axonal neuropathy. At that time, laboratory studies specific to the differential diagnosis of motor axonal neuropathy were performed; however, the abnormality noted was a decreased CD4+ T-lymphocyte count. Motor axonal neuropathy represents an uncommon manifestation of idiopathic CD4+ T-lymphocytopenia and is probably associated with an underlying immune process.
Axons ; Diagnosis, Differential ; Electromyography ; Extremities ; Humans ; Immune System Diseases ; Lymphopenia ; Needles ; Neural Conduction ; Opportunistic Infections ; T-Lymphocytes ; T-Lymphocytopenia, Idiopathic CD4-Positive

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.
Body Mass Index ; Cystectomy ; Female ; Follow-Up Studies ; Humans ; Laparoscopy* ; Laparotomy ; Medical Records ; Minimally Invasive Surgical Procedures ; Operative Time ; Ovary ; Postoperative Complications ; Retrospective Studies

OBJECTIVES: To compare the urodynamic characteristics between pre- and post-menopausal women with stress urinary incontinence. METHODS: Forty premenopausal women and 44 postmenopausal women with stress urinary incontinenece were enrolled. All of the patients underwent a detailed history, gynaecologic examination, urinalysis and urodynamics including cystometry and pressure-flow analysis. RESULTS: There was no difference in the body mass index between the two groups. The mean age of pre- and post-menopausal women was 40.9 +/- 6.4 years and 62.1 +/- 9.4 years, respectively. The parity in postmenopausal women was greater than premenopausal women (2.8 +/- 1.2 vs 2.2 +/- 0.8, P = 0.026). The valsalva leak point pressure (VLPP) in postmenopausal women was lower than that in premenopausal women (106.4 +/- 30.3 vs 88.2 +/- 25.1 cmH2O, P = 0.04). The maximal urethral closure pressure (MUCP) in postmenopausal women was lower than premenopausal women (44.9 +/- 21.4 vs 77.4 +/- 32.2 cmH2O, P < 0.001). The functional urethral length (FUL) in postmenopausal women was shorter than it in premenopausal women (29.0 +/- 9.7 vs 37.0 +/- 10.9 mm, P = 0.003). There were no significant statistical differences in maximal flow rate, residual urine, maximal bladder capacity and Q tip test. CONCLUSION: The VLPP and MUCP were lower, and the FUL was shorter in postmenopausal women with stress urinary incontinence than premenopausal women. The parity and number of vaginal deliveries were different between the two groups. Further investigation will be needed concerning these variables.
Body Mass Index ; Female ; Humans ; Parity ; Postmenopause ; Premenopause ; Retrospective Studies ; Urinalysis ; Urinary Bladder ; Urinary Incontinence ; Urodynamics

CONCLUSION: Vascular reconstruction is an important part of the treatment of complex intracranial aneurysms. We report our clinical experience using vascular reconstruction techniques without an extracranial arterial stump for the treatment of complex intracranial aneurysms. METHODS: We conducted a retrospective review of five patients who underwent in situ bypasses and two patients who underwent direct neck suture secondary to clip reinforcement for the treatment of complex intracranial aneurysms between January 1999 and May 2008. RESULTS: Five of the aneurysms were fusiform and the other two were blood blister-like aneurysms (BBAs). Fusiform aneurysms were located at the anterior cerebral artery (ACA) in two patients and the middle cerebral artery (MCA) in three patients. The aneurysms were treated with end-to-side anastomosis after aneurysm excision in three cases and end-to-end anastomosis after aneurysm excision in two cases. Two cases of BBA on the dorsal intracranial artery (ICA) wall were treated by direct suture secondary to the wrapping-clipping method. Follow-up angiography was performed in five patients and revealed patent bypasses in four patients. Follow-up angiography was not performed in two patients due to their poor postoperative condition, and it revealed delayed occlusion due to granuloma formation in one patient with BBA. The patient outcomes were excellent in five patients and poor in two patients whose clinical condition was Hunt- Hess grade V preoperatively. CONCLUSION: In situ bypass is an effective alternative to extracranial-intracranial bypass for distally located fusiform aneurysms. In addition, arterial suturing followed by the wrapping-clipping method is a useful technique for fragile aneurysms unamenable to direct clip or encircled clip for true ICA trunk aneurysms. Although technically challenging, this technique of vascular reconstruction without extracranial arterial graft should be considered for appropriate candidates.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Follow-Up Studies ; Granuloma ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck ; Reinforcement (Psychology) ; Retrospective Studies ; Sutures ; Transplants

A 76-year-old Korean woman visited to emergency room because of respiratory arrest and admitted to intensive care unit of the hospital. Severe hypothyroidism was diagnosed after repeated failure of weaning mechanical ventilator. Respiratory arrest and weaning failures were considered to be associated with hypoventilation due to hypothyroidism. She was recovered and weaned from mechanical ventilation after replacement of thyroid hormone. Severe hypothyroidism may be a cause of respiratory failure or weaning failure.
Aged ; Emergency Service, Hospital ; Female ; Humans ; Hypothyroidism* ; Hypoventilation ; Intensive Care Units ; Respiration, Artificial ; Respiratory Insufficiency* ; Thyroid Gland ; Ventilators, Mechanical ; Weaning

OBJECTIVE: Distal middle cerebral artery (MCA) aneurysms are the least frequent aneurysms of the MCA, and they represent about 1.1 to 5% of all MCA aneurysms. Patients with ruptured distal MCA aneurysms generally have a poor clinical outcome. The purpose of this article is to review the characteristics of distal MCA aneurysms to avoid the complications of microsurgical dissection and clipping of distal MCA aneurysms. METHODS: A total of 1187 patients with ruptured aneurysms were treated at our hospital between January 1997 and May 2008. All patients underwent surgical procedures. Computed tomography (CT) revealed rupture of distal MCA aneurysms in 15 (1.26%) patients. The location of the aneurysm were the M2 (insular) segment in seven patients, the M2-3 junction in three and the M3 (opercular) segment in five. Brain CT images revealed the presence of both subarachnoid hemorrhage (SAH) and intracranial hemorrhage (ICH) in 11 of 15 (77.3%) patients, with a mean ICH volume of 14.5 cc (range : 5 to 32 cc). Rebleeding occurred in 7 out of the 15 (46.7%) patients. RESULTS: All the patients underwent early surgical procedures, including clipping in seven, trapping in two, bypass surgery in four, Guglielmi detachable coil embolization in one and exploratory craniotomy in one patient. The aneurysm had a fusiform appearance in 9 out of 15 cases (60%), and the mean size of the aneurysm was 10.4 mm (range : 2 to 35 mm). Three patients died due to severe brain swelling (20%). CONCLUSION: In this study, distal MCA aneurysms had a relatively fusiform shape as well as high rates of rebleeding and ICH. A good clinical outcome was associated with early surgery for adequately controlling brain swelling and preventing rebleeding.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Brain Edema ; Cerebral Hemorrhage ; Craniotomy ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Middle Cerebral Artery ; Rupture ; Subarachnoid Hemorrhage

We recently experienced a case of synovial sarcoma in the posterior neck, which involved adjacent bony structures. Synovial sarcoma is rare, malignant soft tissue tumor that occur predominantly in the lower extremities. Wide surgical excision with involved tissue is the treatment of first choice, because most synovial sarcomas reveal aggressive features. We removed the tumor with involved bony structures and patient was given postoperative radiation therapy. Despite these treatment options, the patient died 1 year after surgery. We report this case with a review of the literature.
Humans ; Lower Extremity ; Neck ; Sarcoma, Synovial