Peripartum cardiomyopathy is a myocardial disease associated with pregnancy and leading to heart failure. A twenty-eight years old primipara was scheduled for a cesarean section due to a twin pregnancy. She had no previous cardiac or other systemic illness. But periodic episode of sudden hypertension, tachycardia, hypoxemia(PaO2/FiO2=58) and pulmonary edema were developed in the perioperative period. After being transferred to the intensive care unit, mechanical ventilation with positive end expiratory pressure was applied for six days and pulmonary infiltration subsided. However, two days after extubation, acute pulmonary edema redeveloped in both lung fields in spite of fluid restriction. In echocardiogram demonstrated global hypokinesia of the left ventricle with an ejection fraction of 31%. Dobutamine infusion was started and one day after infusion the pulmonary edema subsided. In conclusion echocardiogram would be helpful for diagnosis of peripartum cardiomyopathy and adequate cardiac support with assisted ventilation will improve prognosis.
Cardiomyopathies* ; Cesarean Section ; Diagnosis ; Dobutamine ; Edema ; Female ; Heart Failure ; Heart Ventricles ; Hypertension ; Hypokinesia ; Intensive Care Units ; Lung ; Perioperative Period ; Peripartum Period* ; Positive-Pressure Respiration ; Pregnancy ; Pregnancy, Twin ; Prognosis ; Pulmonary Edema* ; Respiration, Artificial ; Tachycardia ; Ventilation

Chondroid syringoma, also known as `mixed tumor of the skin', is a kind of acquired hamartoma of folliculosebaceous-apocrine lineage. Histologically, it is characterized by the biphasic pattern, with epithelial structures enveloped by abundant stroma. We report a case of chondroid syringoma, as an asymptomatic nodule, on the upper lip of a 55-year-old male. Histologically, the tumor had both epithelial components with follicular differentiation and myxochondroid stroma.
Adenoma, Pleomorphic* ; Hamartoma ; Humans ; Lip ; Male ; Middle Aged

Much attention has been paid to the insertion of central venous catheter(CVC) but their removal is a subject discussed rarely. After removal of a central venous catheter, rare but potentially life-threatening, transient cardiopulmonary collapse or neurological dysfunction had developed. The failure to appreciate these complications may be a significant factor in their high mortality. Early recognition and treatment may be made possible by a high index of suspicion. In this report, the clinical courses of two patients with central venous catheter removal distress syndrome are reviewed. Also guidelines for safe removal of CVC are formulated. An awareness of potential CVC removal complications is most important for their prevention and timely treatment. CVCs should be removed with the same degree of meticulous attention to detail that accompanies their insertion. Medical personnel should be reminded that removal of the catheter is an integral component of CVC management.
Catheters ; Central Venous Catheters* ; Humans ; Mortality

Laryngeal edema developed in 10.1% of studied patients with congenital heart disease after cardiac surgery. The 181 patients were divided into two groups; those with laryngeal edema (group 1) and those without laryngeal edema (group 2). The mean ages in group 1 and 2 were 10 and 22.9 months. Group 1 patients were younger on average than those of group 2 (p< 0.05). The differences in the cardiopulmonary bypass time and anesthesia time between the two groups were not statistically significant. The duration of intubations and ventilatory support before and after the onset of laryngeal edema and the period of the ICU stay were longer in group 1 than in group 2 (p< 0.05). A predictor of postextubation laryngeal edema was not found in our patients from above mentioned parameters. We conclude that the higher incidence of laryngeal edema may be due to young age (most were under 1 year of age), and duration of intubation and ventilatory support.
Adolescent ; Child ; Child, Preschool ; Heart Defects, Congenital/*surgery ; Human ; Incidence ; Infant ; Infant, Newborn ; Intubation, Intratracheal/*adverse effects ; Laryngeal Edema/epidemiology/*etiology ; Postoperative Care ; Postoperative Complications ; Risk Factors

BACKGROUND: The hemodynamic status of critically ill patients is poorly predicted from clinical examination and chest x-ray findings, so equipments such as pulmonary artery catheter are needed for monitoring of hemodynamics. The authors undertook this study to evaluate physician's accuracy in predicting hemodynamic profiles, rates of therapeutic change resulting from catheterization and to compare the outcomes with or without therapeutic changes. METHODS: Pulmonary artery catheters were inserted in 19 critically ill patients. The physicians accuracy of predicting the hemodynamic profile, the rate of therapeutic changes by monitoring actual hemodynamic profiles were calculated and compared to the outcome between the patients with and without therapeutic change, RESULTS: Hemodynamic profiles were correctly predicted in 63% of all cases. Hemodynamic data from pulmonary artery catheter made the therapeutic plan changed in 53% of all cases. The cardiac index and left ventricular stroke work index were improved and the mortality rate was lower in patients with therapeutic changes, but there were no significant statistical differences between the patients with and without therapeutic changes. Complications occurred in 6 cases but had no effect on patient' s outcome. CONCLUSIONS: Hemodynamic data from a pulmonary artery catheter could lead to a more accurate diagnosis and therapeutic changes.
Catheterization ; Catheterization, Swan-Ganz* ; Catheters ; Critical Illness* ; Diagnosis ; Hemodynamics* ; Humans ; Mortality ; Pulmonary Artery* ; Stroke ; Thorax

Multicentric reticulohistiocytosis(MR) is a rare systemic disease of unknown etiology, characterized by destructive polyarthritis and mucocutaneous eruptions in various locations. In most cases rapidly progressive destructive polyarthritis is the presenting symptom, followed by typical skin eruptions. Skin lesions are characterized clinically by erythematous to brownish nodular lesions on the face, periungual areas and the trunk. The biopsy demonstrating the characteristic granulomatous infiltration of multinucleated giant cells and histiocytes with a ground-glass appearance is diagnostic. We report a case of multicentric reticulohistiocytosis in a 57-year-old female patient, who had skin lesions with polyarthritis and cardiac problem. To our knowledge, this is the first case report in Korea.
Arthritis ; Biopsy ; Female ; Giant Cells ; Histiocytes ; Humans ; Korea ; Middle Aged ; Skin

BACKGROUND: Increased intra-abdominal pressure (IAP) leads to adverse effects on most organ systems and is associated with significant morbidity and mortality in surgical and trauma patients. The purpose of this study was to determine the effect of positive end expiratory pressure (PEEP) on IAP and abdominal perfusion pressure (APP, mean arterial pressure, MAP minus IAP) at normal and increased intra-abdominal pressures. METHODS: 15 patients requiring a laparoscopic cholecystectomy were included. IAP was measured indirectly using a transurethral catheter, and APP was calculated for each patient at 0, 5, 10, 15, and 20 cmH2O of PEEP, while the insufflator pressure was maintained at either 0 or 15 mmHg. RESULTS: At each insufflator pressure, IAP increased with higher PEEP levels (P < 0.05). At 0 mmHg insufflator pressure state, MAP substantially decreased according to increasing PEEP levels, however, at 15 mmHg insufflator pressure state, MAP substantially increased despite increasing PEEP levels. Meanwhile, APP decreased with increasing PEEP levels at an insufflator pressure of zero while remaining constant at a 15 mmHg insufflator pressure. CONCLUSIONS: We found that IAP increases in response to higher PEEP levels (10, 15, and 20 cmH2O) at insufflator pressures of both zero and 15 mmHg in patients anesthetized for laparoscopic cholecystectomy. However, APP did not decrease with increasing PEEP levels at a higher intraadominal pressure (15 mmHg).
Arterial Pressure ; Catheters ; Cholecystectomy, Laparoscopic ; Humans ; Mortality ; Perfusion* ; Positive-Pressure Respiration*

BACKGROUND: The use of mouse bone marrow mesenchymal stem cells (mBMSCs) represents a promising strategy for performing preclinical studies in the field of cell-based regenerative medicine; however, mBMSCs obtained via conventional isolation methods have two drawbacks, i.e., (i) they are heterogeneous due to frequent macrophage contamination, and (ii) they require long-term culturing for expansion. METHODS: In the present study, we report a novel strategy to generate highly pure mBMSCs using liposomal clodronate.This approach is based on the properties of the two cell populations, i.e., BMSCs (to adhere to the plasticware in culture dishes) and macrophages (to phagocytose liposomes). RESULTS: Liposomal clodronate added during the first passage of whole bone marrow culture was selectively engulfed by macrophages in the heterogeneous cell population, resulting in their effective elimination without affecting the MSCs.This method allowed the generation of numerous high-purity Sca-1 ＋ CD44 ＋ F4/80 - mBMSCs ([ 95%) with just one passaging. Comparative studies with mBMSCs obtained using conventional methods revealed that the mBMSCs obtained in the present study had remarkably improved experimental utilities, as demonstrated by in vitro multilineage differentiation and in vivo ectopic bone formation assays. CONCLUSION Our newly developed method, which enables the isolation of mBMSCs using simple and convenient protocol, will aid preclinical studies based on the use of MSCs.

The incidence of acute leukemia during pregnancy is extremely rare, and often it is not easy to differentiate it from other diseases associated with pregnancy such as sepsis or hemorrhage. Pregnancy itself is not known to affect the natural course of leukemia; however, complications of leukemia like anemia, infections, and coagulopathy can adversely influence both the fetus and the mother. In this case, a pregnant patient misdiagnosed with septic shock and severe leukocytosis was correctly diagnosed with acute myeloid leukemia after surgical delivery.
Anemia ; Cesarean Section* ; Female ; Fetus ; Hemorrhage ; Humans ; Incidence ; Intensive Care Units ; Leukemia ; Leukemia, Myeloid, Acute* ; Leukocytosis ; Mothers ; Pregnancy ; Sepsis* ; Shock, Septic

The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: (1) definition and diagnosis of overweight and obesity in children and adolescents; (2) principles of treatment of pediatric obesity; (3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; (4) pharmacotherapy; and (5) bariatric surgery.
Adolescent ; Bariatric Surgery ; Child ; Diagnosis* ; Diet ; Drug Therapy ; Gastroenterology* ; Humans ; Korea ; Life Style ; Mental Health ; Obesity ; Overweight ; Pediatric Obesity*