Vulvar hematomas are uncommon outside of the obstetric population and may be the result of trauma to the perineum. Vulvar hematomas most often present with low abdominal pain and urologic and neurologic symptoms. The vulva has rich vascularization that is supplied by the pudendal artery, a branch of the anterior division of the internal iliac artery. We describe a rare case of a 15-cm-sized vulvar hematoma with the suggested rupture of a pseudoaneurysm of the left pudendal artery without trauma injury. A 14-year-old girl presented with sudden pain and swelling in her left labium and was successfully treated with selective arterial embolization and surgical evacuation. We provide a literature review and discuss patient treatment and management strategies.
Abdominal Pain ; Adolescent ; Aneurysm, False* ; Arteries* ; Female ; Hematoma* ; Humans ; Iliac Artery ; Neurologic Manifestations ; Perineum ; Rupture* ; Vulva

BACKGROUND AND OBJECTIVES: Statin prevents atherosclerotic progression and helps to stabilize the plaque. According to a recent study, statin reduces inflammation in blood vessels. However, it has not been demonstrated to have any anti-inflammation reaction in patients who have been diagnosed as having a triple-vessel coronary artery disease (CAD). SUBJECTS AND METHODS: This study included a total of thirty (30) patients who had been diagnosed by coronary angiogram as having a triple-vessel CAD. Patients who already had been taking statin were given doubled dosage. An interview, physical examination and blood test were performed at the beginning of this study and three months later. RESULTS: After doubling the dose of statin, there was no statistically significant decrease in total cholesterol, low density lipoprotein-cholesterol, (increase in) high density lipoprotein-cholesterol and triglyceride in the blood test. C-reactive protein (CRP), an acute phase reactant, significantly decreased from 0.34 mg/dL at the beginning of the study to 0.12 mg/dL at the end of study (p<0.01). The interleukin-6 concentration also significantly decreased from 8.55 pg/dL to 4.81 pg/dL (p<0.001). No major cardiovascular events occurred and the dosage regimen was not modified during the close observation period. There was no difference in the symptoms of angina pectoris, established by World Health Organization Angina Questionnaires, before and after the dose increase. Liver enzymes remained within normal range with no significant increase before and after conducting this study. CONCLUSION: Doubling the dose of statin alone significantly lowers pro-inflammatory cytokine concentration, which is closely related to the potential acute coronary syndrome, and CRP, a marker of vascular inflammation.
Acute Coronary Syndrome ; Angina Pectoris ; Blood Vessels ; C-Reactive Protein ; Cholesterol ; Coronary Artery Disease ; Coronary Vessels ; Hematologic Tests ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Interleukin-6 ; Liver ; Physical Examination ; Reference Values ; World Health Organization ; Surveys and Questionnaires

PURPOSE: This study tries to identify experience of verbal abuse, emotional response, and ways to deal with verbal abuse against nurses in hospitals. METHODS: This study was a descriptive research and conducted from April to July 2011. One hundred and seventeen nurses with over one-year experience in general wards were selected and evaluated. The data were analyzed using descriptive analysis, independent t-tests, and one-way ANOVA. RESULTS: The nurses' experience rate of verbal abuse during the entire period of work in hospitals was 98.3%. The majority of the nurses were verbally abused by patients (70.9%), followed by patients' relatives (65.8%), physicians (61.5%), and coworkers (58.1%). Overall negative emotional response score of nurses after verbal abuse was 38.82+/-8.28. Ways to deal with verbal abuse were as follows: suppression was 74.4%, complaining of an injustice to close people, 67.5%, and ignoring, 43.6%. CONCLUSION: Nurses have significantly been exposed to verbal abuse while working in hospitals. Therefore, hospital managers and nurse managers are required to inform other staff and visitors in hospitals the real condition of verbal abuse against nurses and provide a safe work environment by developing the report and disposal system of verbal abuse.
Humans ; Nurse Administrators ; Patients' Rooms

BACKGROUND: Cord blood (CB) is a useful source of hematopoietic stem cells. In public CB banks, only CB units with good hematopoietic potential are processed and stored because the processing and storage of CB are cost-consuming and labor-intensive procedures. Presently, we sought to determine factors correlated with, and influential to, hematopoietic parameters of CB units donated from Korean neonates and their mothers. METHODS: A total of 1,696 CB units that were donated and processed from August 1 - December 31, 2007 were enrolled. Donated CB volume, total nucleated cells (TNC), total mononucleated cells (MNC), CD34+ cells after processing, and cell viability before and after processing were analyzed according to sex and delivery method. We also determined whether maternal age, neonatal factors (gestational age, birth weight, sex, delivery method), CB volume, and processing time were correlated with hematopoietic parameters of CB. RESULTS: CB of female neonates had significantly higher mean TNC and CB obtained from vaginal delivery had significantly higher mean TNC, MNC, and CD34+ cells. The counts of TNC, MNC, and CD34+ cells were significantly positively correlated with CB volume, gestational age, and birth weight. Counts of TNC, MNC, and CD34+ cells, and pre- and post-viability of CB were significantly negatively correlated with processing time. CONCLUSION: The present data provide a baseline for standard methods of collection, processing, and storage in cord blood banking.
Birth Weight ; Cell Survival ; Female ; Fetal Blood ; Gestational Age ; Hematopoietic Stem Cells ; Humans ; Infant, Newborn ; Maternal Age

OBJECTIVE: To validate the efficacy of Seeplex HPV4A ACE for the detection of high-risk (HR) human papillomavirus (HPV) and HPV 16 and/or HPV 18 genotypes as compared to the PCR method and the Cervista HPV assays in cervical swab samples. METHODS: Besides liquid-based cytology, additional 97 cervical swab samples were collected for HPV genotyping by HPV4A ACE, Cervista HPV assays, and PCR method. To check the statistical differences, we also conducted the paired proportion test, Cohen's kappa statistic, and a receiver operating characteristic curve. RESULTS: Seeplex HPV4A ACE and the Cervista HPV HR showed substantial agreement with PCR for detection of HR HPVs (88.3%, kappa=0.767 and 81.7%, kappa=0.636, respectively). Seeplex HPV4A ACE also showed substantial agreement with the Cervista HPV 16/18 test (89.5%, kappa=0.628). Additionally, the sensitivity and specificity of Seeplex HPV4A ACE and Cervista HPV HR were 91.4% vs. 84.5% and 73.4%, vs. 72.7%, respectively, when those higher than low-grade squamous intraepithelial lesions were regarded as abnormalities. HPV genotyping for HPV 16/18 detected cervical intraepithelial neoplasias (CINs) better than HR HPV tests (66.7% vs. 24.6% by HPV4A ACE, 52.6% vs. 25.9% by Cervista HPV assays in CIN II or more, relatively). CONCLUSION: Seeplex HPV4A ACE is an effective method as the PCR and the Cervista HPV assays for the detection of HR HPVs and for genotyping of HPV 16 and 18.
Cervical Intraepithelial Neoplasia ; Chimera ; Genotype ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans ; Polymerase Chain Reaction ; ROC Curve ; Sensitivity and Specificity

Objective: To develop an evidence-based guideline for the diagnosis and treatment of antipsychotic-induced hyperprolactinemia by adapting existing high-quality clinical guidelines with a view to improve the clinical symptoms and long-term quality of life of patients by providing appropriate management. Methods: This guideline was developed according to the ADAPTE methodology. The adaptation process included determining key health questions, systematically searching and screening guidelines, evaluating the quality and contents of these guidelines, deriving recommendations for key questions, and performing a peer review. The selection criteria for the guideline search were (1) evidence-based guidelines, (2) published within the last 5 years, and (3) written in English or Korean. Results: After evaluating the quality and content, we finally selected three guidelines for adaptation. The final output of the development process was 25 recommendations for 10 key questions. We adopted the Agency for Health Research Quality methodology and presented the level of evidence from levels I to IV. In addition, we defined the recommendation grades from grade A (strongly recommended) to D (no recommendation) based on the level of evidence and clinical significance of the recommendation. Conclusion The development and dissemination of the adapted guideline is expected to increase the certainty of medical decision making and improve the quality of medical care. Further studies on the effectiveness and applicability of the developed guideline are necessary.

Esophageal carcinosarcoma is a rare malignant esophageal neoplasm consisting of both carcinomatous and sarcomatous elements, with an incidence of 0.5%. There have been only a few case reports of carcinosarcoma and squamous cell carcinoma coexisting in the esophagus. However, all of these are cases of synchronous or metachronous development of carcinosarcoma after chemoradiotherapy in patients of esophageal squamous cell carcinoma. A 53-year-old man underwent esophagogastroduodenoscopy because of chest pain for several months. Endoscopic examination revealed a huge pedunculated esophageal polypoid mass. Endoscopic submucosal dissection (ESD) was performed and histopathologic examination confirmed spindle cell carcinoma (carcinosarcoma). He refused additional esophagectomy. After 21 months, third follow-up endoscopy showed poorly-demarcated flat, faint discolored lesions at different location from the previous ESD site and endoscopic biopsies confirmed squamous cell carcinoma. To the best of our knowledge, this is the first case of metachronous development of esophageal squamous cell carcinoma in a patient with esophageal carcinosarcoma.
Antineoplastic Agents/therapeutic use ; Carcinoma, Squamous Cell/*diagnosis/drug therapy/pathology ; Carcinosarcoma/*diagnosis/drug therapy/pathology ; Cisplatin/therapeutic use ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Esophageal Neoplasms/*diagnosis/drug therapy/pathology ; Fluorouracil/therapeutic use ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; S100 Proteins/metabolism ; Tomography, X-Ray Computed ; Tumor Suppressor Protein p53/metabolism

OBJECTIVE: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. METHODS: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. RESULTS: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. CONCLUSION: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.
Hemoglobins ; Hemorrhage ; Humans ; Korea ; Medical Records ; Placenta ; Placentation ; Postpartum Hemorrhage ; Postpartum Period

OBJECTIVES: The Behavioral Activation of Depression Scale (BADS) has been reported to be a valid tool for assessing the different behavioral aspects of depression, such as activation, rumination or avoidance, and functional impairment. The aim of this study was to assess the reliability and validity of the Korean version of BADS (K-BADS). METHODS: A sample of 196 outpatients completed the K-BADS and the data were analyzed for internal consistency and factor structures. An additional 51 outpatients re-filled the K-BADS after two weeks for the test-retest reliability. To test for the validity, the Hospital Anxiety and Depression Scale (HADS), Working Alliance Inventory (WAI), Drug Attitude Inventory-10 (DAI-10), and Mindfulness Attention Awareness Scale (MAAS) were administered. RESULTS: Internal consistency of K-BADS was good (Cronbach's alpha=0.843) and principal component factor analysis revealed the four-factor structure. The K-BADS showed a reasonable test-retest reliability (r=0.863, p<0.001). The total score of K-BADS correlated significantly with the total scores of the HADS depression (r=−0.694) and HADS anxiety (r=−0.681). No correlations were found between the K-BADS and the K-WAI (r=0.170) and between the K-BADS and the K-DAI-10 (r=0.311). CONCLUSION: The K-BADS is a reliable and valid instrument for measuring the behavioral activation for depression in Korean patients with depressive symptoms.
Anxiety ; Depression* ; Humans ; Mindfulness ; Outpatients ; Reproducibility of Results*

BACKGROUND: The term solitary fibrous tumor (SFT) is preferred over meningeal hemangiopericytoma (HPC), because NAB2-STAT6 gene fusion has been observed in both intracranial and extracranial HPCs. HPCs are now considered cellular variants of SFTs. METHODS: This study analyzes 19 patients with STAT6-confirmed SFTs, who were followed for over 11 years in a single institution. Ten patients (10/19, 56.2%) had extracranial metastases (metastatic group), while the remainder (9/19) did not (non-metastatic group). These two groups were compared clinicopathologically. RESULTS: In the metastatic group, the primary metastatic sites were the lungs (n = 6), bone (n = 4), and liver (n = 3). There was a mean lag time of 14.2 years between the diagnosis of the initial meningeal tumor to that of systemic metastasis. The median age at initial tumor onset was 37.1 years in the metastatic group and 52.5 in the non-metastatic group. The 10-year survival rates of the metastatic- and non-metastatic groups were 100% and 33%, respectively. The significant prognostic factors for poor outcomes on univariate analysis included advanced age (≥45 years) and large initial tumor size (≥5 cm). In contrast, the patients with higher tumor grade, high mitotic rate (≥5/10 high-power fields), high Ki-67 index (≥5%), and the presence of necrosis or CD34 positivity showed tendency of poor prognosis but these parameters were not statistically significant poor prognostic markers. CONCLUSIONS: Among patients with SFTs, younger patients (<45 years) experienced longer survival times and paradoxically had more frequent extracranial metastases after long latent periods than did older patients. Therefore, young patients with SFTs require careful surveillance and follow-up for early detection of systemic metastases.
Central Nervous System ; Diagnosis ; Follow-Up Studies ; Gene Fusion ; Hemangiopericytoma ; Humans ; Liver ; Lung ; Meningeal Neoplasms ; Necrosis ; Neoplasm Metastasis* ; Prognosis ; Solitary Fibrous Tumors* ; Survival Rate