BACKGROUND: Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients. METHODS: A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher. RESULTS: Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients' mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016). CONCLUSIONS: This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.
Emergency Service, Hospital ; Factor VIIa* ; Female ; Humans ; Maternal Death ; Maternal Mortality ; Medical Records ; Organ Dysfunction Scores ; Postpartum Hemorrhage* ; Postpartum Period* ; Prognosis ; Recombinant Proteins ; Retrospective Studies

STUDY DESIGN: External linkage type of spine motion analyzer and special programs for calculation of the relative angular motion and graphical display were developed and used to measure relative thoracic and lumbar motion patterns in healthy subjects. OBJECTIVES: To examine the dynamic relationship of thoracic and lumbar spines during various trunk motions and to measure main and coupling motions in three-dimensional spinal kinematics. SUMMARY OF LITERATURE REVIEW: Many kinds of methods, such as inclinometer, stereoradiography, electrogoniometer, cadaveric study etc., were introduced for measuring lumbar spine motion. But, there is no reliable method for measuring accurate dynamic three-dimensional motion patterns of whole thoracic and lumbar spines. MATERIALS AND METHODS: Thirty healthy men, ranging in age from 21 to 29 years, participated in the study. The developed device was tested to measure spine motion patterns in flexion, extension, lateral bending and axial rotation. RESULTS: The average range of motion for flexion was 71.30degrees/16.54degrees(lumbar/thoracic), for exten-zion 25.11degrees/12.67degrees, for one side lateral bending 27.42degrees/31.71degrees, for one side axial rotation 30.86degrees/24.38degrees. There were more coupling motions in lateral bending and axial rotation than in flexion and extension. Coupling motion pattern were found to be relatively consistent among subjects in active axial rotation, and the direction of coupling motion was flexion plus ipsilateral side bending. CONCLUSIONS: It was rather simple and reliable method thor spine motion analysis. There were similarities between motion patterns of lumbar and thoracic spine. But, range of motion in sagittal plane was much greater in lumbar spine than in thoracic
Biomechanical Phenomena ; Cadaver ; Humans ; Male ; Range of Motion, Articular ; Spine*

Many kinds of lumbar diseases cause lumbar segmental instability and/or limitation of motion. But, there is no reliable method for measuring accurate trunk motion. In order to measure relative trunk motion respect to the pelvis in vitro, external linkage type of spine motion analyzer was developed. Special programs for calculation of the relative angular motion and graphical display were also developed. The developed device was tested to compare spine motion pattern between 15 normal volunteers and 18 lumbar fusion patients in flexion, extension, lateral bending and axial rotation. It was rather simple and reliable method for spine motion analysis. And it was possible to measure not only angular displacement but also angular velocity and angular acceleration. There were more coupling motions in lateral bending and axial rotation than in flexion and extension. Compared to the normal subjects, patients showed different angular motion, especially in the angular acceleration. Optimal trajectory of the trunk motion derived from mathematical model in flexion and extension matched well with measurement for normal subjects.
Acceleration ; Healthy Volunteers ; Humans ; Models, Theoretical ; Pelvis ; Spine*

The biomechanical responses, such as nucleus pulposus pressure, facet contact force, stress distribution among ligaments in the cervical spine under static loading like flexion and extension, were examined with 3-D nonlinear finite element model. Finite element model consisted of whole cervical spines with intact discs and ligaments was developed from 1mm thick CT-cross sections of a 25-year-old healthy young man. Geometrical nonlinearity was considered for the large deformation and ABAQUS package was used for calculation. Results were verified comparing with those of existing in vivo and in vitro experiments. Results indicated that, developed cervical spine FEM was well consistent with other experiments. Nucleus pulposus pressure increased in flexion and extension more in lower cervical region. Facet contact force increased more in lower cervical spine in extension. In addition, capsular ligament was the most important one among 7 cervical ligaments surrounding cervical spine both in flexion and extension. We could better understand the biomechanics of whole cervical spine with developed finite element model and it might be applied to dynamic or postoperative study.
Adult ; Humans ; Ligaments ; Spine*

PURPOSE: To classify Avellino corneal dystrophy (ACD) into 3 groups by slit lamp photography and to evaluate the inter-group differences. METHODS: DNA analysis was performed in one member from each of 45 families who were clinically diagnosed as ACD. Corneal opacities were classified into mild (group I), moderate (group II), and severe (group III) based on slit lamp photograph. RESULTS: Six patients were confirmed as homozygous ACD and ninety-two as heterozygous ACD. One homozygous patient was revealed to have a novel phenotype. The age increased with increasing severity, and the proportion of females in group III was significantly higher than that of the other two groups (p=0.001). The prevalence of laser in situ keratomileusis (LASIK) increased in group III (p=0.001), and the incidence of pterygium increased in group I compared with the other two groups (p=0.025). CONCLUSIONS: ACD was aggravated with age, while pterygium and LASIK altered the natural course of ACD.
Classification* ; Corneal Opacity ; DNA ; Female ; Humans ; Incidence ; Keratomileusis, Laser In Situ ; Phenotype ; Photography ; Prevalence ; Pterygium

PURPOSE: To report a rare case of isolated neurogenic blepharoptosis secondary to eyelid trauma. CASE SUMMARY: A previously healthy 41-year-old male was evaluated for decreased visual acuity and blepharoptosis in the left eye after ocular trauma. On ophthalmologic examination, visual acuity in the left eye was hand motion, intraocular pressure was 29 mm Hg, hematoma and eyelid edema were minimal. The patient had complete unilateral ptosis with superficial upper eyelid laceration. Additional findings in the left eye included fracture of the medial orbital wall, hyphema, iris sphincter muscle tear, iridodialysis and conjunctival laceration. The other examinations were unremarkable with full ocular motility. Because of iris sphincter muscle tear and iridodialysis, the pupillary reaction could not be evaluated. His left upper eyelid drooped completely and levator function test (LFT) was 0 mm. He was diagnosed with an isolated neurogenic blepharoptosis and received oral prednisolone at a dose of 1 mg/kg per day for 7 days with gradual tapering. One month later, the patient had normal symmetric lid height and completely restored levator function.
Adult ; Blepharoptosis ; Edema ; Eyelids ; Hand ; Hematoma ; Humans ; Hyphema ; Intraocular Pressure ; Iris ; Lacerations ; Male ; Oculomotor Nerve ; Orbit ; Prednisolone ; Visual Acuity

No abstract available.
Brain* ; Technetium Tc 99m Exametazime*

No abstract available.
Brain* ; Technetium Tc 99m Exametazime*

BACKGROUND: Surveillance of surgical site infection is a main component of nosocomial infection surveillance. To perform a valid comparison of rates among hospitals, among surgeons, across time, surgical site infection rates must account for the variation in patient's underlying severity of illness and other important risk factors. So, a risk index was developed to predict a surgical patient's risk of acquiring a surgical site infection. The risk index score, ranging from 0 to 3, was the number of risk factors present among the following: (1) a patient with an American Society of Anesthesiologists preoperative assessment score of 3,4,5, (2) an operation classified as contaminated or dirty-infected, and (3) an operation lasting over T hours, where T depends upon the operative procedure being performed. METHOD: We performed surgical site infection surveillance according to patient risk index after cardiovascular surgery from Mar 1, 1997 to May 31, 1997. In addition, we also monitored nosocomial infection of all patients after cardiovascular surgery Data was collected prospectively, Surgical site infection rate was classified according to patient risk index and compared with NNIS (National Nosocomial Infections Surveillance) semiannual report of 1995. RESULT: Overall nosocomial infection rate was 18.9% and among all patients detected by surveillance protocols, pneumonia was the most common (6.3%) nosocomial infection after cardiovascular surgery, and the remaining infections were distributed as follows: surgical site infection 45%, urinary tract infection 3.2%, bloodstream infection 3.2%. Surgical site infection rate for patient with scores of 0, 1, 2 and 3 were 0%, 3.1%, 4.6%, 66,7%, respectively and increased according to patient risk index (P<0.05). There is no statistical difference between our surgical site infection rate and 1995 NNIS semiannual report of surgical site infection rates (P>0.05). CONCLUSION: The patient risk index is a better predictor d surgical site infection risk than the traditional wound classification system and surgical site infection surveillance with patient risk index is useful for nosocomial infection surveillance after surgery.
Classification ; Cross Infection ; Humans ; Operative Time ; Pneumonia ; Prospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Urinary Tract Infections ; Wounds and Injuries

In most of the previous studies, invasive and discrete techniques have been used to monitor the healing process of the gingival graft. However, Laser Doppler Flowmetry(LDF, floLAB, Moor Instruments Ltd., England) is a non-invasive technique for measurement of blood flow in the tissue and also allows continuous monitoring. Thus, we tested the usefulness of LDF in monitoring the healing process of free gingival graft at gingival recession. Eleven gingival graft site of 7 patients, including 5 males and 2 females, aged between 21 and 41 years (mean age 28.5) were monitored for the blood flow. The blood flow in gingival graft at coronal site, central site, apical site, mesial site and distal site was measured using LDF. Blood flow was measured at 1- week, 2- week, 3- week and 4- week after gingival graft surgery from 10 a.m. to 2 p.m. Time-course of the healing process was evaluated by statistical analysis using repeated ANOVA and Duncan test. The results were as follows : (1) Blood flow stayed increased for 2 weeks, and then, it was a tendency to decrease. (2) The blood flow at distal site had always higher than mesial site during the measuring periods. (3) The blood flow was high orderly after 1 week ; most coronal site, most apical site, central site. But that was high orderly after 2 week, 3 week, 4 week ; most coronal site, central site, most apical site. In conclusion, LDF was a useful and clinically adaptable method to monitor wound healing process. Our study suggested that it was important to protect surgical site to promote initial wound healing.
Female ; Gingival Recession ; Humans ; Laser-Doppler Flowmetry* ; Male ; Transplants* ; Wound Healing