Takayasu's arteritis is a nonspecific stenosing inflammatory arteritis of unknown etiology, which most commonly affects the aortic arch and its large branches, thoracic aorta, pulmonary artery, and renal artery. This disease is more common in Asian females' and characterized by cicatrization of all layers of involved arteries and dense bands of inflammatory cells in media, often combined with ocular complications, cerebral complications, and cardiovascular occlusive symptoms. It is associated with four main complications, which is Takayasu's retinopathy, secondary hypertension, aortic regurgitation and aortic or arterial aneurysms. The authors have experienced one case of Takayasu's arteritis which is associated with Takayasu's retinopathy, complicated cataract, and rubeosis iridis in a 33 year old female.
Adult ; Aneurysm ; Aorta, Thoracic ; Aortic Valve Insufficiency ; Arteries ; Arteritis ; Asian Continental Ancestry Group ; Cataract ; Cicatrix ; Female ; Humans ; Hypertension ; Pulmonary Artery ; Renal Artery ; Takayasu Arteritis*

BACKGROUND: An epidemiologic study was performed after the outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit (MICU) from December 2006 to May 2007. METHODS: A retrospective case-control study was performed using the medical records of the patients. The case and control patients were compared for age, gender, total length of stay in MICU, prior carbapenem use, Acute Physiology and Chronic Health Evaluation II (APACH II) score, presence of central line, effect of mechanical ventilation, and sputum suction. Environmental and hand-washing studies were performed during the outbreak. RESULTS: Ten CRAB-affected patients and 29 controls were enrolled in this study. Univariate analysis showed that the age, total length of stay in MICU, presence of central line, and prior carbapenem use were associated with the CRAB outbreak. However, multivariate analysis showed that only prior carbapenem use was associated with the CRAB outbreak (odd ratio: 8.67, P=0.01). The outbreak disappeared after implementing a combined infection control strategy, including the sequential disinfection of MICU and strict compliance with cross-transmission prevention protocols. CONCLUSION: The use of carbapenem was associated with an increased risk of CRAB infection. This study suggests that the MICU contamination and infection transmission by health-care workers played a major role in the CRAB outbreak. Novel strategies such as restricted use of broad-spectrum antibiotics, strict hand hygiene, strict isolation of the patients, and MICU disinfection may be required to prevent the CRAB outbreak.
Acinetobacter ; Acinetobacter baumannii ; Anti-Bacterial Agents ; APACHE ; Case-Control Studies ; Compliance ; Disease Transmission, Infectious ; Disinfection ; Epidemiologic Studies ; Hand Hygiene ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Length of Stay ; Medical Records ; Multivariate Analysis ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Sputum ; Suction

Obstetrical hemorrhage is one of the deadly triad, along with hypertensive disorder in pregnancy and infection. Postpartum hemorrhage is the major cause of obstetrical hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage, and resulted from poor uterine contraction after delivery of the fetus and placenta. Initial management to control postpartum uterine atonic bleeding is based on the use of uterotonics such as well known oxytocin and ergot preparations together with uterine massage. Prostaglandin E2 analogue, sulprostone can be used next when these agents are failed to produce uterine contraction. The woman unresponsive to non-surgical managements requires surgical interventions including emergency hysterectomy. Recently prostaglandin E1 analogue, misoprostol, has been known to elicit potent uterine contraction and cervical ripening after oral, vaginal or rectal administration. We have experienced two cases of postpartum uterine atonic bleedings which were unresponsive to oxytocin, ergot, or prostaglandin E2, but were successfully controlled by rectal administration of misoprostols.
Administration, Rectal ; Alprostadil ; Cervical Ripening ; Dinoprostone ; Emergencies ; Female ; Fetus ; Hemorrhage* ; Humans ; Hysterectomy ; Massage ; Misoprostol* ; Oxytocin ; Placenta ; Postpartum Hemorrhage ; Postpartum Period* ; Pregnancy ; Uterine Contraction ; Uterine Inertia

Selective labeling of small populations of neurons of a given phenotype for conventional neuronal tracing is difficult because tracers can be taken up by all neurons at the injection site, resulting in nonspecific labeling of unrelated pathways. To overcome these problems, genetic approaches have been developed that introduce tracer proteins as transgenes under the control of cell-type-specific promoter elements for visualization of specific neuronal pathways. The aim of this study was to explore the use of tracer gene expression for neuroanatomical tracing to chart the complex interconnections of the central nervous system. Genetic tracing methods allow for expression of tracer molecules using cell-type-specific promoters to facilitate neuronal tracing. In this study, the rat tyrosine hydroxylase (TH) promoter and an adenoviral delivery system were used to express tracers specifically in dopaminergic and noradrenergic neurons. Region-specific expression of the transgenes was then analyzed. Initially, we characterized cell-type-specific expression of GFP or RFP in cultured cell lines. We then injected an adenovirus carrying the tracer transgene into several brain regions using a stereotaxic apparatus. Three days after injection, strong GFP expression was observed in the injected site of the brain. RFP and WGA were expressed in a cell-type-specific manner in the cerebellum, locus coeruleus, and ventral tegmental regions. Our results demonstrate that selective tracing of catecholaminergic neuronal circuits is possible in the rat brain using the TH promoter and adenoviral expression.
Adenoviridae ; Adrenergic Neurons ; Animals ; Brain ; Cells, Cultured ; Central Nervous System ; Cerebellum ; Gene Expression ; Lifting ; Locus Coeruleus ; Neurons ; Phenotype ; Proteins ; Rats ; Transgenes ; Tyrosine 3-Monooxygenase

BACKGROUND: For effective blood usage and reduction of unnecessary workload at blood banks, we established the maximum surgical blood order schedule (MSBOS) for major elective surgeries and evaluated indicators, including the rate of returned red blood cells (RBCs). METHODS: During August 2016 and May 2017, MSBOS for neurosurgery, thoracic surgery, orthopedic surgery, and general surgery was established using two formulas: the mean units of transfusion per procedure (MSBOS 1) and the mean units of transfusion in transfused patients per procedure (MSBOS 2). The crossmatch to transfusion (C/T) ratio, transfusion probability, and rate of returned RBCs were calculated and analyzed. RESULTS: Based on MSBOS 1, type and screen can be applied to all elective surgeries of the general surgery department. MSBOS 2 was higher than MSBOS 1 in most surgeries ranging from 1 to 3 units. The C/T ratio and transfusion probability of surgery exhibited similar tendencies, and the general surgery department was over-prescribed compared to the actual transfusion requirement. The rate of returned RBCs was the highest in thoracic surgery (32/101, 32%), and the total number of returned RBC unit was the highest in orthopedic surgery (276 of 1131 units). CONCLUSION: MSBOS 1 was the formula corresponding to the purpose of the maximum blood application protocol. Application of an appropriate MSBOS protocol and concurrent utilization of C/T ratio, probability of transfusion, and rate and number of returned units of RBCs will further aid the efficiency of blood bank resources.
Appointments and Schedules* ; Blood Banks ; Erythrocytes ; Humans ; Neurosurgery ; Orthopedics ; Thoracic Surgery

BACKGROUND: The ABO blood group typing test (ABO test) is an initial pre-transfusion test based on hemagglutination. Although various factors affect hemagglutination strength, few studies have examined how these factors can be applied in clinical laboratories and their effects on hemagglutination. This study was conducted to analyze the factors affecting hemagglutination strength in the ABO test using a tube method applied in many laboratories. METHODS: We conducted a detailed questionnaire survey of 51 laboratories which use the ABO test with a tube method. We also analyzed the results of the ABO test (cell and serum typing) with 40 specimens using factors affecting hemagglutination at a tube method and applied differently in each laboratory. RESULTS: Each laboratory used various methods to prepare red cell suspensions as specimens or reagents and used different reagent to sample ratios, centrifugation protocols, and shaking test tubes before evaluating hemagglutination strength. By testing various combinations of these factors, direct sampling from the red cell layer of the original specimen was found to have the largest effect on lowering hemagglutination strength in cell typing tests. In serum typing tests, various factors influenced hemagglutination strength, including shaking the tube before analysis and the concentration of a home-made red cell suspension used as a reagent. CONCLUSIONS: To achieve accurate results in the ABO test by the tube method, detailed guidelines that include the factors affecting hemagglutination strength determined in this study should be established.
Centrifugation ; Hemagglutination* ; Indicators and Reagents ; Methods* ; Suspensions

PURPOSE: A variety of biodegradable polymers have been utilized to fabricate matrices for engineering genitourinary tissues, Chitosan is a biosynthetic polysaccharide that is the deacetylated derivative of chitin. The aims were to investigate the characteristics of the newly developed porous chitosan-based biodegradable scaffolds and to reconstruct cavernosal smooth muscle structure in vivo. MATERIALS AND METHODS: To study the cytotoxicity of the newly developed scaffolds, cultured L929 murine fibroblasts were stained with PKH-26 and then cultured on culture plate or loaded in chitosan/hyaluronic acid polymers. For in vivo study, human corpus cavernosal smooth muscle cells were seeded on the scaffolds at concentration of 20*106 cells per cm3 .A total of 24 polymer scaffolds were implanted subcutaneously with cells in one side and without cells in the other side, respectively, in 12 athymic mice, Mice were scarificed 7, 14, 28 days after implantation, respectively. H-E stain and monoclonal anti-alpha smooth muscle actin stain were performed. RESULTS: Scanning electron micrographs of chitosan and 0.03% hyaluronic acid based scaffolds showed sheet-like porous structure. The cell division numbers of L929 murine fibroblasts sere significantly increased in scaffolds by chitosan/hyaluronic acid compared with chitosan alone, Histologically the retrieved polymers seeded with cavernosal smooth muscle cells showed organized smooth muscle structure 28 days after implantation. immunohistochemical analysis confirmed the smooth muscle phenotype. CONCLUSION: These results show that porous chitosan-based biodegradable scaffolds are new biomaterials for the reconstruction of cavernosal smooth muscle structure. However, further studies are needed to make cavernosal sinusoidal structure using this new scaffolds.
Actins ; Animals ; Biocompatible Materials ; Cell Division ; Chitin ; Chitosan ; Fibroblasts ; Humans ; Hyaluronic Acid ; Male ; Mice ; Mice, Nude ; Muscle, Smooth* ; Myocytes, Smooth Muscle ; Penis ; Phenotype ; Polymers ; Tissue Engineering

Fibrous hamartoma of infancy is an uncommon, benign fibroproliferative tumor arising from sub. cutaneous tissue during the First 2 years of life. We report a case of fibrous hamartoma of infancy in the scrotum. The clinical characteristics and management of this neoplasm are discussed with references.
Hamartoma* ; Scrotum*

Alport's syndrome, first described by Alport in 1927, is a clinical entity which consists of lens abnormalities, hereditary hemorrhagic nephritis and nerve deafness. Anterior lenticonus is a rare structual anomaly of lens in which there is a conicalor spherical protrusion of the anterior lens surface into the anterior chamber as a characteristic finding of Alport's syndrome. The authers experienced a case of Alport's syndrome in a 22-year-old man associated with bilateral anterior and posterior lenticonus, hematuria, proteinuria, renal failur earld nerve deafness(complete form).
Anterior Chamber ; Deafness ; Hematuria ; Humans ; Nephritis ; Nephritis, Hereditary* ; Proteinuria ; Young Adult

No abstract available.