We reported a case of hemolytic transfusion reaction that was related to multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea after serial RBC transfusions. A forty-nine year old female visited the emergency room (ER) with hematochezia. She had previously received 16 units of packed RBCs from 2003 to Jan 2007 for her intermittent esophageal varix bleeding. No specific antibodies were identified before this visiting. At the ER, under the request for packed RBCs, we identified anti-E antibody within her serum. Her blood type was AB, RhD+ with the phenotype of CcDe. She received 5 units of E antigen negative RBCs. However, she showed hemolytic transfusion reactions such as mild fever with a decrease of hemoglobin from 11.4 g/dL to 6.8 g/dL after the transfusion. From the 8th to the 10th hospital day, another 3 units of E-antigen negative with the least incompatible RBCs were transfused to the patient, but the level of hemoglobin was not definitely increased. At the 14th hospital day, she received a final 2 units of leuko-reduced RBCs without E, M and Jkb antigens. Her hemoglobin was increased right after the final transfusion. We found that the patient's serum reacted with multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea antibodies. She finally recovered from acute varix bleeding and was discharged on the 26th hospital day with the level of hemoglobin being 8.3 g/dL.
Antibodies ; Blood Group Incompatibility ; Emergencies ; Esophageal and Gastric Varices ; Female ; Fever ; Gastrointestinal Hemorrhage ; Hemoglobins ; Hemorrhage ; Humans ; Phenotype ; Varicose Veins

BACKGROUND AND OBJECTIVES: he patients with atrial septal defect generally have no symptoms in the childhood, and have nonspecific symptoms such as dyspnea on exertion, fatigue, and palpitation even in the late period of adult. Thus delayed diagnosis for whom surgical correction was undoubtedly needed remains to be resolved. Accordingly, the simple and noninvasive method such as electrocardiography in patients with atrial septal defect having the nonspecific symptoms or having no symptoms warrants to be developed. This study was performed to see whether the crochetage pattern on R wave in inferior limb leads is effective for the electrocardiographic diagnosis of atrial septal defect and relates to the magnitude of left to right shunt. METHODS: Our subjects were 129 patients diagnosed as the atrial septal defect by the echocardiography and cardiac catheterization from January 1992 to June 1998. We selected 57 persons, as control group, who showed the normal findings under the echocardiography and also showed the incomplete right bundle branch block on the electrocardiography. We compared the frequency of the crochetage pattern in inferior limb leads between the two groups. Also we compared the frequency of the crochetage pattern before operation and after operation according to the quantity of the left to right shunt in the operated 40 patients with atrial septal defect. RESULTS: ) The crochetage pattern was observed in 61.2% in patients with atrial septal defect and its frequency was greater than that of the control group (38.6%, p=0.005). 2) The crochetage pattern was disappeared by the operation in 16/29 patients (55.2%, p=0.001). 3) The frequency of disappearance of the crochetage pattern after operation differed significantly according to shunt severity: 72.2% for a Qp/Qs> or =3.0 group, 18.2% for a Qp/Qs<3.0 group (p=0.015). CONCLUSION: The crochetage pattern on R wave in inferior limb leads was helpful to the electrocardiographic diagnosis of the atrial septal defect. The disappearance of the crochetage pattern after operation was correlated with shunt severity.
Adult ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography* ; Extremities* ; Fatigue ; Heart Septal Defects, Atrial* ; Humans

DA-8159, a selective inhibitor of phosphodiesterase type 5, was developed as a new drug for erectile dysfunction. The effect of DA-8159 on the electroretinogram (ERG) and the retinal histopathology were evaluated in rabbits. The ERG was performed prior to, and 1 and 5 hr after DA-8159 (5 to 30 mg/kg) administration. The plasma concentration of DA-8159 was determined at each time point, and retinal microscopic examination was also performed. There was no statistically significant ERG change at any dose or at any time. Though the 30 Hz flicker showed a prolongation of the implicit time at 5 hr after the administration of either DA-8159 15 mg or 30 mg/kg (p<0.05), but concurrent amplitude decreases were not statistically significant. At a dose of 5 mg/kg, no test drug was detected in the blood after either 1 or 5 hr. At either 15 mg/kg or 30 mg/kg, there was a dose-dependent increase in the blood concentration after 1 hr of drug administration, which decreased with time. In light and electron microscopic examinations of the retina, there was no remarkable change at any dose. These results suggest DA-8159 has a low risk potential to the retina, but further evaluation on the visual functions in human is needed.
3',5'-Cyclic-GMP Phosphodiesterase/*antagonists & inhibitors ; Animals ; Dose-Response Relationship, Drug ; Electroretinography/*drug effects ; Humans ; Male ; Phosphodiesterase Inhibitors/blood/*pharmacology ; Pyrimidines/blood/*pharmacology ; Rabbits ; Retina/*cytology/*drug effects

BACKGROUND: The patients with mitral stenosis are generally accompanied with impaired pulmonary function. The aim of this study was to evaluate the changes of pulmonary function after percutaneous mitral balloon valvuloplasty (PMV) in that patients. METHODS: PMV was performed in 36 patients with mitral stenosis in Pusan National University Hospital and hemodynamic, echocardiographic and pulmonary function test data before and after PMV were analyzed. RESULT: After PMV, NYHA functional class was improved from 2.2+/-0.6 to 1.2+/-0.4 (p<0.001). The mean left atrial pressure and mean pulmonary arterial pressure significantly decreased from 14.5+/-6.2 mmHg to 5.7+/-4.4 mmHg(p<0.001) and from 25.3+/-10.9 mmHg to 15.5+/-7.4 mmHg (p<0.001), respectively. Cardiac output was slightly decreased from 5.34+/-1.31 L/min to 5.28+/-1.25 L/min (p=0.50). Mean mitral pressure gradient decreased from 13.5+/-5.8 mmHg to 4.4+/-2.1 mmHg (p<0.001) and mitral valvular area significantly increased from 0.86+/-0.19 cm2 to 1.71+/-0.28 cm2 (p<0.001). In pulmonary function test, only MVV and PEF was significantly improved from 77.2+/-23.8% to 88.4+/-27.9% (p<0.01) and 87.1+/-26.8% to 97.5+/-26.4% (p<0.01), respectively. But, VC, FEV1, FEF25-75% and FVC were not changed significantly. In exercise treadmil test, exercise duration was significantly improved from 482.0+/-266.2 sec to 718.0+/-287.5 sec (p<0.001). CONCLUSION: We observed the results of better hemodynamic changes and exercise capacity after PMV. But, there was no significant improvement in pulmonary function after PMV. In our opinion, irreversible pulmonary changes and hemodynamic effect on pulmonary function should be considered.
Arterial Pressure ; Atrial Pressure ; Balloon Valvuloplasty* ; Busan ; Cardiac Output ; Echocardiography ; Exercise Test ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Respiratory Function Tests

No abstract available.
Adult* ; Disseminated Intravascular Coagulation* ; Humans ; Kasabach-Merritt Syndrome*

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.
Cardiology ; Coronary Angiography ; Electrocardiography ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Myocardial Infarction* ; Necrosis

PURPOSE: This study was designed to compare Transilluminated Powered Phlebectomy (TIPP) with conventional surgical treatment (high ligation of the greater saphenous vein and above knee stripping with varicosectomy). METHODS: 428 cases of varicose veins, managed surgically at our hospital, were reviewed. A retrospective review of clinical records, between November 2000 an March 2003, was performed. The patients were divided into one of two groups: TIPP or a conventional operation. All the patients had at least a C2 CEAP disease. RESULTS: The demographics, hospital stays and operating times for the two groups were similar. However, a TIPP was associated with significantly fewer incisions (4.4+/-1.5 vs 8.2+/-3.9; P<0.001) and recurrence (n=14, 6% vs n=24, 12%; P=0.003). The incidence of a postoperative hematoma developing was more common with TIPP (n=20, 9% vs n=1, 0.5%; P=0.023). The problem of a hematoma formation in TIPP was solved by the insertion of a small closed suction drain. Skin perforation and wrinkling, and dermatosclerosis, were only complicated in the TIPP. The mean pain scores (out of 10) for the TIPP and conventional operation groups, at 2 and 7 days and 4 weeks, were 4.8, 1.4 and zero, and 4.8, 2.8 and zero, respectively. The cosmetic satisfaction score was higher in the TIPP group (8.7 vs 5.7; P<0.001). CONCLUSION: With respect to pain, cosmetic satisfaction and residual varicose, the outcomes in the TIPP group were significantly better than those in the conventional operation group.
Demography ; Hematoma ; Humans ; Incidence ; Knee ; Length of Stay ; Ligation ; Lower Extremity* ; Recurrence ; Retrospective Studies ; Saphenous Vein ; Scleroderma, Localized ; Skin ; Suction ; Varicose Veins*

PURPOSE: There has been considerable controversy about whether acid reduction surgery is a definitive surgical treatment for perforated duodenal ulcer with numerous methods having been described. The controversy has increased with the development of the Proton Pump inhibitor and the discovery of Helicobacter Pylori (HP), because the recurrence and morbidity have been shown to decrease with simple closure followed by a good medical therapy against HP and the ulcer. This study is an evaluation of simple closure as an alternative treatment of perforated duodenal ulcer. METHODS: This retrospective study reviewed the records of 288 patients with surgically-treated ulcer perforation. After 62 patients were excluded, 128 patients treated with simple closure were compared with 98 patients treated with definitive surgery. In the simple closure group, we compared 50 patients treated with Proton Pump inhibitor and 78 patients treated with H2 blocker. Also, the influence of various factors such as age, delayed operation, size of ulcer perforation, operative methods, associated diseases, and complications were analyzed to evaluate recurrence, morbidity and mortality. RESULTS: After mean follow up for 53.7 months, 56.6% of patients treated with simple closure had fewer post operative complications and a lower recurrence rate compared with definitive surgery. The infection rate by HP of 81.6% in our study was similar to that of other studies. Some factors as age (>60), duration of symptoms (>24 hours), size of ulcer perforation (>10 mm), associated disease and operative time showed an influence on the mortality. CONCLUSION: Recent advances in the treatment of perforated peptic ulcer such as the development of the Proton Pump inhibitor and the discovery of HP have shown that after simple closure, an adequate medical treatment of ulcer can effectively decrease the recurrence rate, morbidity and mortality.
Duodenal Ulcer* ; Follow-Up Studies ; Helicobacter pylori ; Humans ; Mortality ; Operative Time ; Peptic Ulcer ; Proton Pumps ; Recurrence ; Retrospective Studies ; Ulcer

The hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Microvascular thromboses in HUS may involve intestine, pancreas, skeletal muscle, and heart. Microinfarcts in the pancreas may cause acute pancreatitis and rarely insulin-dependent diabetes mellitus. Acute pancreatitis is a relatively common complication of HUS in children, but rare (2%) in adults. We have experienced a 43 year-old woman with HUS complicating acute pancreatitis. She presented with hemolytic anemia, thrombocytopenia and acute renal failure. During hemodialysis, she complained of left side abdominal and back pain. On laboratory study, levels of serum amylase and lipase were elavated. The size and shape of pancreas was normal on abdominal ultrasonography and computed tomography. We present this case with a review of literature.
Acute Kidney Injury ; Adult ; Amylases ; Anemia, Hemolytic ; Back Pain ; Child ; Diabetes Mellitus, Type 1 ; Female ; Heart ; Hemolytic-Uremic Syndrome* ; Humans ; Intestines ; Lipase ; Muscle, Skeletal ; Pancreas ; Pancreatitis* ; Renal Dialysis ; Thrombocytopenia ; Thrombosis ; Ultrasonography

BACKGROUND: The aims of this study were to assess the etiologies, survival and prognositic factors of patients with chronic cor pulmonale visited Pusan National University Hospital. METHODS: This study included 103 patients with chronic cor pulmonale. There were 67 men and 36 women. The diagnosis of chronic cor pulmonale was primarily based on the presence of underlying lung disorder and echocardiographic finding of enlarged or hypertrophied right ventricle. Other clinical data including patients' symptoms and signs, findings of arterial blood gas analysis, hematologic and biochemical laboratory and pulmonary function test were assessed. RESULTS: The most common underlying lung disorder was pulmonary tuberculosis (59.2%) and chronic obstructive pulmonary disease was the next (28.2%). The survival rate was 57% in one year, 45% in two years, and 34% in three years. The prognostic factors were maximal voluntary ventilation(MVV), forced vital capacity(FVC), FEV1, serum Na, vital capacity(VC), serum albumin and peak expiratory flow(PEF) in univariate analysis. And in multivariate analysis, serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant. CONCLUSION: Pulmonary tuberculosis was the most important underlying lung disorder in chronic cor pulmonale. The survival rate was 57% in one year, 45% in two years, and 34% in three years. Serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant prognostic factors.
Blood Gas Analysis ; Busan ; Diagnosis ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Lung ; Male ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Heart Disease* ; Respiratory Function Tests ; Serum Albumin ; Survival Rate ; Tuberculosis, Pulmonary