BACKGROUND: Acute isovolemic hemodilution is one of the autologous transfusion which diminishes intraoperative blood loss and avoids homologous transfusion. A method of assessment of hemostatic function by whole blood is thrombelastography, which is a sensitive indicator of platelet interreaction with protein coagulation cascade. We investigated the effect of intraoperative isovolemic hemodilution on blood coagulation as measured by thrombelastography. METHODS: We studied in twenty-one patients undergoing elective total hip replacement arthroplasty. Hemodilution was done with Hartmann's solution and pentastarch and prothrombin time, activated partial thromboplastin time and native whole blood thrombelastography were performed preoperatively, immediate postoperative and days 2 postoperatively. RESULTS: The Hb, Hct and platelet count decreased significantly after hemodilution. The thrombelastographic changes included decreases in r and k with concurrent increases in alpha angle and MA in immediate postoperative time. On days 2, there were further increase in alpha angle and MA. These changes indicate enhanced procoagulant activity and progressive increase in maximum clot strength. Conclusion: Acute isovolemic hemodilution with Hartmann's solution and pentastarch induced hypercoagulable state without any serious complication in total hip replacement arthroplastic surgery.
Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Blood Coagulation ; Blood Platelets ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Thrombelastography*

Central anticholinergic syndrome (CAS) is the clinical picture of the central cholinergic blockade. Many drugs used in anesthesia may cause blockade of central cholinergic neurotransmission. Early diagnosis of CAS is very important clinically, CAS's effects are broad and life-threatening. However, it is difficult to find physostigmine in Korea, which is essential to confirm a diagnosis for CAS. An 18-year-old female who was diagnosed with hyperhydrosis underwent a thoracoscopic sympathicotomy. She received N2O-O2-Propofol anesthesia. The anesthesia was unevenful, but postoperatively, she suffered from drowsiness, fever, mydriasis, stiffness of the left upper and lower extremities, and seizures. All tests to seek the cause of CAS such as blood chemistry, brain CT, brain MRI, and CSF test, were normal. She completely recovered without any sequelae after 3 days in ICU. Though it was not confirmed with physostigmine, we report the case to be suspected CAS by all other indications.
Adolescent ; Anesthesia* ; Anticholinergic Syndrome* ; Brain ; Brain Chemistry ; Diagnosis ; Early Diagnosis ; Female ; Fever ; Humans ; Korea ; Lower Extremity ; Magnetic Resonance Imaging ; Mydriasis ; Physostigmine ; Seizures ; Sleep Stages ; Synaptic Transmission

Occupational infection is a human disease caused by work-associated exposure to microbial agents through human and environmental contact. According to the literature, occupational infection was the third leading cause of occupational disease (861 cases, 8.0%), and health care, agricultural, forestry, and fishery workers were risk groups in Korea. In addition, most high-risk groups have not been protected by workers' compensation, which could lead to underestimation of the exact spectrum and magnitude of the problem, and may also result in a lack of development and implementation of occupational infection management. Through a review of national guidelines and documentations on prevention and control of occupational infection, a management strategy would promote adherence to worker safety regulations if it is explicit with regard to the agent and mode of infection in each of the high-risk groups.
Adult ; Aged ; Aged, 80 and over ; Bacterial Infections/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Mycoses/*epidemiology ; Occupational Diseases/*epidemiology ; Occupational Exposure/adverse effects ; Occupational Health/legislation & jurisprudence ; Protozoan Infections/*epidemiology ; Republic of Korea/epidemiology ; Risk Factors ; Virus Diseases/*epidemiology ; Workers' Compensation

Angioedema is a well-demarcated localized edema involving the deeper layers of the skin, including the subcutaneous tissue. Angioedema occurs with Cl esterase inhibitor (Cl INH) deficiency that may be inborn as an autosomal dominant characteristic or may be acquired. Acquired angioedema (AAE) is a rare disorder characterized by adult onset and lack of evidence of inheritance of the disease. Two types of AAE are known today: type I in which there are lowering of functional Cl INH, an underlying disease such as a B-cell disease, and no detectable autoantibodies to Cl INH, type II with anti Cl INH autoantibodies in the circulation without detectable underlying disease and with depressed functional Cl INH levels. We experienced a case of angioedema in a 29-year old man. He had no family history of angioedema and laboratory data showed depressed Cl-INH levels. We diagnosed the case as acquired type of angioedema. Even though we could not measure anti-Cl INH auto-antibodies, we identified the case as type II because there was no evidence of underlying disease.
Adult ; Angioedema* ; Angioedemas, Hereditary* ; Autoantibodies ; B-Lymphocytes ; Complement C1 Inhibitor Protein* ; Complement C1s* ; Edema ; Humans ; Skin ; Subcutaneous Tissue ; Wills

Heparin-induced thrombocytopenia (HIT) is a heparin-dependent antibody-mediated platelet activating syndrome frequently accompanying thrombocytopenia, thromboembolism. We experienced a case of cardiopulmonary bypass using hirudin, a direct thrombin inhibitor, in a patient with HIT. The patient who showed thrombocytopenia and thrombosis after heparin re-exposure was highly suspected of having HIT. Hirudin was used in this case as an anticoagulating agent during cardiopulmonary bypass (CPB) to prevent serious complications of heparin. Hirudin 0.3 mg/kg was mixed with a priming solution of CPB and a 0.2 mg/kg IV bolus followed by a continuous infusion of hirudin 0.15 mg/kg given for anticoagulation. After CPB, forced diuresis and platelet transfusion was performed and the patient was recovered without complication.
Blood Platelets ; Cardiopulmonary Bypass* ; Diuresis ; Heparin ; Hirudins* ; Humans ; Platelet Transfusion ; Thrombin ; Thrombocytopenia* ; Thromboembolism ; Thrombosis

Endometrial osseous metaplasia is a rare condition. The etiology and pathogenesis remain controversial. In most cases, the development of this condition is observed to be related to the history of abortion, either spontaneous or therapeutic and also, frequently associated with menstrual irregularity and endometritis. Patients usually present with secondary amenorrhea, irregular menstruation, pain, and dysmenorrhea. The authors recently experienced a case of endometrial osseous metaplasia of a referred endometrial cancer patient who had no history of abortion at all. We report this case with a brief review of the literature.
Amenorrhea ; Dysmenorrhea ; Endometrial Neoplasms ; Endometritis ; Endometrium* ; Female ; Humans ; Menstruation ; Metaplasia*

Objectives: This study was conducted to identify the level of mental health and burnout of medical staff at hospitals and public health centers, which responded to the coronavirus disease 2019 (COVID-19) in South Korea and to suggest appropriate management plans. Methods: The mental health and burnout levels of medical staff responding to COVID-19 were evaluated through an online survey conducted during the period July 1–14, 2021. To analyze the mental health status of the participants according to their demographic characteristics, the chisquare test, t-test, and an analysis of variance were conducted, followed by Scheffe post-hoc tests for pairwise comparisons. Results: A total of 773 participants were included in the study. An analysis of the clinically significant symptoms of the group showed that 29.5% had posttraumatic stress symptoms, 30.6% had depression, 15.8% had anxiety, 39.8% had somatic symptoms, and 4.5% were seen to be at risk of suicide. The average scores for burnout were as follows: 3.55±1.75 for emotional exhaustion, 2.68±1.73 for depersonalization, and 3.89±1.40 for personal accomplishment. Mental health problems and burnout were found to be high in women, those in the 20–39-year age bracket, those with less than 5 years of work experience, and public health center workers. Conclusion The medical staff responding to COVID-19 were observed to experience high levels of mental health and burnout problems. Work-related characteristics, such as younger age, lower work experience, and employment at a public health center, may have a negative impact on mental health and cause burnout. Therefore, individualized and systemic support for mental health and to prevent the burnout of medical staff responding to cases of COVID-19 is needed.

Esophagea1 achalasia is a disease of unkown etiology characterized by abscenee of peristalsis in the body of the esophagus and failure of the lower esaphageal sphincter to relax in response to swallow. The cause has been suggested by the lack or abscence of ganglion cell in Auerbach's plexus. About 10% of patients with achalasis develop pulmonary complication such as aspiration pnuemonia, pulmonary fibrosis, pulmonary tuberculosis, culosis, bronchiectasis, lung abscess and bronchial asthma. Although aspiration pneumonia is the most common pulmonary complication in patients with achalasia, lung abscess is the extremely rare complication. A 48 years old female, who has experienced dysphagia and regurgitation for several years, is hospitalized because of high fever, cough and sputurn for 2 weeks. Lung abscess in apicoposterior segment of left upper lobe is observed in X-ray and chest CT. The findings of esophagogram, esophagogastroscopy and esophageal manometry are consistent with achalasia. We report a case of lung abscess associated with achalasia.
Asthma ; Bronchiectasis ; Cough ; Deglutition Disorders ; Esophageal Achalasia* ; Esophagus ; Female ; Fever ; Ganglion Cysts ; Humans ; Lung Abscess* ; Lung* ; Manometry ; Middle Aged ; Myenteric Plexus ; Peristalsis ; Pneumonia, Aspiration ; Pulmonary Fibrosis ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary

We report on a de novo centric fission of chromosome 11 in a healthy female referred for chromosome analysis due to recurrent miscarriages. Both fission products were mitotically stable. This centric fission of chromosome 11 appears to have no clinical significance for this patient other than recurrent miscarriages.
Humans ; Female ; *Chromosomes, Human, Pair 11 ; *Chromosome Aberrations ; Adult ; Abortion, Habitual/*genetics

Gastric angiodysplasia may be responsible for up to 2% to 6% of upper gastrointestinal bleeding. Moreover, gastric angiodysplasia may be particularly difficult to treat and is usually associated with a high rebleeding rate. Bleeding due to gastric angiodypsplasia is usually treated by various endoscopic approaches, including argon and Nd:YAG laser photocoagulation, monopolar or biopolar electrocoagulation, heater probe, or injection. Associated complications of these methods, however, such as perforation, acute bleeding during the procedure, or delayed massive hemorrhage have been reported. Recently a few reports have been suggested that endoscopic ligation therapy is a safe, effective treatment for gastric angiodysplasia. A 70-year-old man, who had undergone subtotal gastrectomy for perforation of a duodenal ulcer for 20 years, was admitted due to melena and dizziness persisting for 1 week. A gastroscopy revealed a single angiodysplasia with active bleeding just above the anastomotic site of the remnant stomach. Endoscopic ligation therapy was performed successfully and the bleeding stopped immediately after endoscopic ligation. Since then, no recurrence of bleeding has been reported to date.
Aged ; Angiodysplasia* ; Argon ; Dizziness ; Duodenal Ulcer ; Electrocoagulation ; Gastrectomy ; Gastric Stump ; Gastrointestinal Hemorrhage ; Gastroscopy ; Hemorrhage ; Humans ; Ligation* ; Light Coagulation ; Melena ; Recurrence