Many patients with Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome(TTP-HUS) satisfactorily respond to plasma exchange. Some patients, however, respond either not at all or only transiently and incompletely. In the refractory case, endothelial cell-derived unusually large von Willebrand factor multimers(ULvWFM) have an important role in the formation of microthrombi. As the ULvWFM may be removed in the cryoprecipitate, we reason the plasma depleted of cryoprecipitate(the plasma cryosupernatant) should be considered for effectiveness in the treatment of refractory TTP- HUS. We experienced a 48 year old woman presented with diarrhea, jaundice and oliguria. She had microangiopathic hemolytic anemia, renal impairment, platelets of 21,000/mm3 and LDH 3,258U/L. She had not improved after plasma exchange with fresh frozen plasma(FFP)(1.5 plasma volumeX7 days). On hospital day 8, her HUS had not responded, platelets of 37,000/mm3 and LDH 1,588U/L. Substitution of cryosupernatant for FFP was associated with prompt increased in the platelet count to normal and complete resolution of HUS. Therefore. the cryosupernatant fraction of plasma should be considered as an alternative to whole FFP for plasma exchange if there is continuing platelet consumption and microvascular thrombosis in spite of intensive conventional plasma therapy.
Anemia, Hemolytic ; Blood Platelets ; Diarrhea ; Female ; Hemolytic-Uremic Syndrome* ; Humans ; Jaundice ; Middle Aged ; Oliguria ; Plasma Exchange* ; Plasma* ; Platelet Count ; Thrombosis ; von Willebrand Factor

No abstract available.
Animals ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats* ; Spermatic Cord Torsion* ; Testis*

Although hemodialysis using heparin bound Hemophan(HBH-HD) has been reported to be a possible modality that can be used in patients at high risk of bleeding, the efficiency of HBH-HD is not certain. To investigate the efficiency of HBH- HD, we compared the total blood compartment volume(TBCV), Kt/V and urea clearance of dialyzer(K) of HBH-HD with those of routine hemodialysis with systemic heparinization(R-HD) in the same patients. HBH-HD was switched to R-HD as soon as the bleeding risk had ceased. Before each HBH-HD, heparin solution(1liter, 20IU/ml saline) was recirculated through the Hemophan(Gambro dialyzer, GFS Plus 11) for 1 hour while removing saline solution(700ml/hr) by applying transmembrane pressure gradient, followed by a single pass rinse with 1 liter of saline solution. Then we performed 10 HBH-HD on 10 patients at risk of bleeding. The dilayzer had to be changed due to severe clotting in one patient during HBH-HD so the comparison of above parameters was possible in 9 patients. The duration of each dialysis was possible in 9 patients. The duration of each dialysis was standardized to 4 hours at blood flow of 200 to 250ml/min. During HBH-HD, there was a slight increase in activated partial thromboplastin time(aPTT)(45.02.6 sec) at 15 min after initiation of dialysis from predialysis level (35.81.3 sec), but no increase in aPTT was observed at 60min, 120min, and the end of dialyses. The loss of TBCV(%) of dialyzers was greater in HBH-HD (174%) than in R-HD(51%). The Kt/V and K of HBH-HD, however, were 1.25+/-0.10 and 143+/-3ml/ min, respectively, which did not differ from those of R-HD which were 1.28+/-0.07 and 145+/-4ml/min, respectively. We conclude that the use of heparin bound Hemophan can be an efficient hemodialysis technique in patients at high risk of bleeding, but clotting of the dialyzer should be observed carefully during hemodialysis(values are mean+/-SE).
Dialysis* ; Hemorrhage ; Heparin* ; Humans ; Renal Dialysis* ; Sodium Chloride ; Thromboplastin ; Urea

PURPOSE: The aim of this study was to evaluate the reliability of the chief complaint addressing seizure in 119 run-sheets and to estimate the frequency of recommended administration of prehospital anti-convulsants. METHODS: A retrospective medical review of the period from 1 January, 2007 to 1 December, 2012 at one university hospital was conducted. Patients who were transported by 119 ambulance and whose chief complaint addressing seizure were enrolled. Medical records were independently reviewed by two emergency physicians. The reliability was analyzed according to the level of prehospital providers. prehospital providers. The operational definition of prehospital status epilepticus was cases with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures and seizure witnessed by 119 providers or persistent seizure at the time of arrival at the hospital. RESULTS: Among 239 medical records, 188(78.7%) cases with seizure were identified. The reliability was increased when level I emergency medical technicians were staffed(90.6% vs 74.3%). Psychiatric disorders(4.6%) and hyperventilation syndrome(3.8%) were frequently confused with seizure. Prehospital anti-convulsants were recommended in 15 cases(6.3%). CONCLUSION: Chief complaints addressing seizure by 119 prehospital providers were reliable. Not only rarity of prehospital status epilepticus but also other medical and legal barriers should be considered in regard to the possibility of prehospital anti-convulsant administration.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Humans ; Hyperventilation ; Medical Records ; Retrospective Studies ; Seizures ; Status Epilepticus

PURPOSE: The aim of this study was to evaluate the reliability of the chief complaint addressing seizure in 119 run-sheets and to estimate the frequency of recommended administration of prehospital anti-convulsants. METHODS: A retrospective medical review of the period from 1 January, 2007 to 1 December, 2012 at one university hospital was conducted. Patients who were transported by 119 ambulance and whose chief complaint addressing seizure were enrolled. Medical records were independently reviewed by two emergency physicians. The reliability was analyzed according to the level of prehospital providers. prehospital providers. The operational definition of prehospital status epilepticus was cases with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures and seizure witnessed by 119 providers or persistent seizure at the time of arrival at the hospital. RESULTS: Among 239 medical records, 188(78.7%) cases with seizure were identified. The reliability was increased when level I emergency medical technicians were staffed(90.6% vs 74.3%). Psychiatric disorders(4.6%) and hyperventilation syndrome(3.8%) were frequently confused with seizure. Prehospital anti-convulsants were recommended in 15 cases(6.3%). CONCLUSION: Chief complaints addressing seizure by 119 prehospital providers were reliable. Not only rarity of prehospital status epilepticus but also other medical and legal barriers should be considered in regard to the possibility of prehospital anti-convulsant administration.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Humans ; Hyperventilation ; Medical Records ; Retrospective Studies ; Seizures ; Status Epilepticus

No Abstract Available.
Animals ; Base Sequence* ; Cattle* ; Serotyping*

PURPOSE: Human metapneumovirus(hMPV) is a respiratory viral pathogen that causes a wide spectrum of illnesses, ranging from asymptomatic infection to severe bronchiolitis. The virus has been identified world widely, but so far it has not been published in Korea. METHODS: We obtained clinical samples by nasopharyngeal aspiration from 218 children hospitalized due to acute lower respiratory tract infections at Soonchunhyang University Hospital in Cheonan from October, 2004 to April, 2005. We designed specific primers from conserved region of fusion glycoprotein of hMPV. Total RNA was extracted and RT-PCR was performed, and single specific 423 bp product was obtained. The PCR product was confirmed to be fusion glycoprotein RNA by sequencing. RESULTS: We detected hMPV in 15(6.9 percent) of the 218 hospitalized children. The infected children comprised nine boys and six girls; their mean age was 2.8 years(5 mo-12 yrs) and they were diagnosed with pneumonia(60 percent), bronchiolitis(33.3 percent), croup(6.6 percent). The number of cases of detected hMPV in Korea increased dramatically during the period from March to May 2005. CONCLUSION: hMPV is circulating in Korean children and is associated with respiratory tract infection. Additional studies are required to define the epidemiology and the extent of diseases in the general population caused by hMPV.
Asymptomatic Infections ; Bronchiolitis ; Child* ; Child, Hospitalized ; Chungcheongnam-do ; Epidemiology ; Female ; Glycoproteins ; Humans* ; Korea ; Metapneumovirus* ; Polymerase Chain Reaction ; Respiratory Tract Infections ; RNA