Snake bite during pregnancy is rare condition, and when it occurs there are two patients, mother and fetus. Timing is particularly important for pregnant women bitten by a snake. The earlier in the pregnancy the bite occurs, the more hazard to the fetus there is, and there are case reports of snake-bite-induced abortion and malformation of the fetus. The usefulness of antivenin during pregnancy is debatable. We report a case of snake bite during thirdtrimester pregnancy in a patient with general symptoms of envenomation and progressing edema in the bitten leg who was successfully treated with an emergency Caesarian section following the administration of antivenin.
Antivenins ; Bites and Stings ; Edema ; Emergencies ; Female ; Fetus ; Humans ; Leg ; Mothers ; Pregnancy ; Pregnant Women ; Snake Bites ; Snakes

In 1932, Loffler described a syndrome of self-limiting, transient pulmonary infiltrates associated with peripheral blood eosinophilia and mild pulmonary symptoms. A number of conditions are related to pulmonary eosinophilia or pulmonary infiltration with eosinophilia. Especially, parasitic infestations are often related to pulmonary eosinophilia, but only two cases associated with Clonorchis sinensis have been anecdotally reported in English literature. Here we report a case of migrating pulmonary eosniophilic infiltrations associated with Clonorchis sinensis that was successfully treated with praziquantel. Clonorchiasis should be considered in patients with marked eosinophilia and pulmonary infiltrations.
Animals ; Biopsy ; Clonorchiasis/*complications/*diagnosis ; Clonorchis sinensis/*isolation & purification ; Human ; Male ; Middle Aged ; Pulmonary Eosinophilia/*etiology/pathology/radiography ; Syndrome

BACKGROUND: In Korea, a screening panel of cells from abroad without Di(a) positive cells has been commonly used when a patient has an unexpected antibody screening test. It has been reported that Di(a) occurs with a frequency of 6.14 to 14.5% among Koreans. However, the current popular antibody screening panels contain no Di(a) positive cells. In this study, we evaluate the clinical usefulness of the Di(a) Cell Panel (Diagnostic Grifols, Barcelona, Spain) for Koreans. METHODS: A total of 3,372 pretransfusion samples were employed for unexpected antibody screening testing using panels of cells by the DG Gel microtube column agglutination system, including additional Di(a) cells (Diagnostic Grifols, Barcelona, Spain). The positive cases in this system were confirmed again with DiaMed Di(a) antigen positive panel cells (DiaMed Ag, Cresssier, Morat, Switzerland) and this was followed by sequence- based Diego genotyping. RESULTS: The positive detection rate of an unexpected antibody screening test using SeraScan Diana I and II was 1.07% (36/3372), and seven samples were reactive (1+~2+) with the SeraScan Di(a) panel cells (0.21%). However, among the 5 available genotyped samples, two cases were typed as Di(a-b+). CONCLUSION: Even though there is discrepancy between the genotype and the two antibody screening kits, the addition of Di(a) positive cells as unexpected antibody screening panel cells is recommended.
Agglutination ; Genotype ; Humans ; Korea ; Mass Screening

An endobronchial metastasis is defined as a subsegmental or a more proximal central bronchial metastasis of a nonpulmonary neoplasm in the bronchoscopically visible range. However, the frequencies of endobronchial metastasis range from 2 to 50% of pulmonary metastases from extrathoracic neoplasms by a different difinition of an endobronchial metastasis. Primary neoplasms of an endobronchial metastasis including breast cancer, colon cancer, renal cell carcinoma, and ovarian cancer are relatively common. However, an endobronchial metastasis arising from thyroid cancer, parotid gland tumor, bone tumor, bladder cancer, and stomach cancer has only rarely been reported in the literature. Here we report a case of an endobrochial metastases from a hepatocellular carcinoma
Breast Neoplasms ; Carcinoma, Hepatocellular* ; Carcinoma, Renal Cell ; Colonic Neoplasms ; Neoplasm Metastasis* ; Ovarian Neoplasms ; Parotid Gland ; Stomach Neoplasms ; Thyroid Neoplasms ; Urinary Bladder Neoplasms

The content of meconium in amniotic fluid(AF) is important for assessing the risk of several perinatal problems such as asphyxia, meconium aspiration syndrome and various perinatal infections. This estimate is usually performed subjectively by visual inspection. The purpose of this study is to develop the objective method for quantitative measurement of meconium content in AF. Absorption spectra and meconium-crit of the solutions with various concentrations of meconium were measured. EfFects of filtration and blood contamination on the measurement of meconium content were also estimated by the same methods. Optical densities(OD) were correlated with concentrations of meconium in the whole range of scanned wavelengths. A specific peak of meconium was not available but the highest OD around 410 nm was shown. OD were linearly related to the concentrations of meconium. Meconium-crits were also well-correlated with the concentrations of meconium. Filtration of AF as well as blood contamination in AF severely affected the measurement of meconium content in AF. From the results of this study, both the spectrophotometric method and meconium-crit couid be objective methods for measuring meconium content. Both methods had merits and shortcomings. Filtration and blood contamination should be avoided for the measurement of meconium content in AF. We hope that both or either one of the two methods will be clinically used.
Absorption ; Amniotic Fluid* ; Asphyxia ; Female ; Filtration ; Hope ; Infant, Newborn ; Meconium Aspiration Syndrome ; Meconium*

PURPOSE: We investigated current dispatcher education requirements and proposed how to further improve and develop the EMD education curriculum in Korea. METHODS: The contents of EMD training programs from the US were used in the development of the questionnaire used to investigate the status of EMD education in Korea. The Delphi method was used to obtain expert consensus on which specific training objectives to include, how many hours would be required, who was qualified to receive the training, and how to confirm their successful qualification. RESULTS: A consensus of the experts was made for core educational objectives, the appropriate number of education hours, qualifications for trainers, passing marks for the exams, and the format of re-education as follows: The didactic education time requirement was 18 hours and the experiential education time requirement was 10 hours. The target qualification requirement for trainees was EMT level 1, and they were required to have an experience of firstaid as a prerequisite. The minimum annual re-education time was 8 hours (61.1%). The passing mark for examinations was 70.0 (median, IQR: 65.0 - 70.0) for the didactic test and 70.0 (median, Interguatile range [IQR]: 60.0 - 80.0) for the experiential test. The format of the required re-education included both comprehensive and individual forms. CONCLUSION: We propose the core contents of EMD education should be based on the results of the expert consensus.
Consensus ; Curriculum ; Emergencies ; Emergency Medical Services ; Korea ; Surveys and Questionnaires

PURPOSE: We investigated current dispatcher education requirements and proposed how to further improve and develop the EMD education curriculum in Korea. METHODS: The contents of EMD training programs from the US were used in the development of the questionnaire used to investigate the status of EMD education in Korea. The Delphi method was used to obtain expert consensus on which specific training objectives to include, how many hours would be required, who was qualified to receive the training, and how to confirm their successful qualification. RESULTS: A consensus of the experts was made for core educational objectives, the appropriate number of education hours, qualifications for trainers, passing marks for the exams, and the format of re-education as follows: The didactic education time requirement was 18 hours and the experiential education time requirement was 10 hours. The target qualification requirement for trainees was EMT level 1, and they were required to have an experience of firstaid as a prerequisite. The minimum annual re-education time was 8 hours (61.1%). The passing mark for examinations was 70.0 (median, IQR: 65.0 - 70.0) for the didactic test and 70.0 (median, Interguatile range [IQR]: 60.0 - 80.0) for the experiential test. The format of the required re-education included both comprehensive and individual forms. CONCLUSION: We propose the core contents of EMD education should be based on the results of the expert consensus.
Consensus ; Curriculum ; Emergencies ; Emergency Medical Services ; Korea ; Surveys and Questionnaires

BACKGROUND: Vacuum tubes are widely used in the clinical laboratory for routine tests. We compared a newly developed Green Vac-Tube (SPM, Gimje, Korea) with Vacutainer (BD, Franklin Lakes, NJ, USA) and Vacuette (Greiner Bio-One, Frickenhausen, Germany) in routine chemistry and hematology tests. METHODS: A total of 101 volunteers, 81 patients and 20 healthy volunteer, were recruited and we had collected blood samples with three kinds of EDTA tubes and those of serum separating tubes. The samples were evaluated for chemistry and hematology tests using TOSHIBA 200FR (Toshiba, Tokyo, Japan) and ADVIA (Siemens, Deerfield, IL, USA) respectively. Their results were statistically analyzed by paired t-test and Bland-Altman plot. RESULTS: Their clinical utilities were examined by CLIA'88 programs. Paired t-test analysis revealed that the results of ALP, AST, total bilirubin, CO2, Hct and MCV showed statistically significant differences between Green Vac-Tube and previously used two vacuum tubes. Similar significant differences were also observed between previous two vacuum tubes. And 194 (4.37%) cases among 5,151 cases were in the critical region by Bland-Altman plot. All different cases, except Na+, K+ however, were clinically acceptable by CLIA'88 programs. CONCLUSIONS: Green Vac-tube has good analytical performance compared to previously-used tubes.
Bilirubin ; Edetic Acid ; Hematology ; Humans ; Lakes ; Tokyo ; Vacuum

BOOP(Bronchiolitis Obliterans Organizing Pneumonia) is an inflammatory reaction that follows damage to the bronchiolar epithelium of the small conducting airways. BOOP is characterized by the pathologic finding of excessive proliferation of granulation tissue within the respiratory bronchioles, alveolar duct and spaces, accompanied by organizing pneumonia. BOOP may result from diverse causes such as toxic fumes, connective tissue disorders, infections, organ transplantation and drugs or appear idiopathically. Drug induced BOOP has been described in association with acebutolol, amiodarone, cephalosporin, bleomycine, tryptophan, gold salts, barbiturates, sulfasalazine, and carbamazepine. Carbamazepine is an iminostilbene derivative that is used as both and anticonvulasnt and pain reliever for pains associated with trigeminal neuralgia. It is structually related to the tricyclic antidepressants. To our knowledge, there have been no previously reported case that has described development of BOOP during carbamazepine treatment in Korea, and only two cases have been reported in the world. We report a case of carbamazepine-induce BOOP with a brief review of literature.
Acebutolol ; Amiodarone ; Antidepressive Agents, Tricyclic ; Barbiturates ; Bleomycin ; Bronchioles ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Carbamazepine* ; Connective Tissue ; Cryptogenic Organizing Pneumonia* ; Epithelium ; Granulation Tissue ; Korea ; Organ Transplantation ; Pneumonia ; Salts ; Sulfasalazine ; Transplants ; Trigeminal Neuralgia ; Tryptophan

OBJECTIVE: Previous epidemiological studies have suggested that hyperfibrinogenemia is an independent risk factor for cerebrovascular atherosclerosis. Fibrinogen is a key factor in the coagulation cascade, and it is suggested to play in a significant role in atherosclerosis. However, there have been relatively few studies regarding the relationship between the level of fibrinogen and prognostic influence in stroke subtypes. We prospectively evaluated that whether plasma fibrinogen levels in the acute stage were related to clinical outcome in each subtype of acute ischemic stroke. METHODS: Acute ischemic stroke was classified by the Trial of Org 10172 in the Acute Stroke Treatment (TOAST) classification. Large atrery atherosclerosis (LAA), and small vessel occlusion (SVO) were included in the classification; cardioembolic (CE) occlusion, and other causes and undetermined causes were excluded from the classficiation. The level of fibrinogen was determined within 24 hours after stroke. Stroke severity and outcome was assessed using the National Institutes of Health Stroke Scale (NIHSS) score at admission (baseline) and follow-up (4 weeks later). The NIHSS changes were compared from baseline to follow-up. Patients with NIHSS changes were divided into two groups: the good group (NIHSS had improved) and poor group (NIHSS had no change or had worsened). Patients were placed into two groups based on the plasma fibrinogen level: the normal group (plasma fibrinogen level of 200~400mg/dl) and high group (plasma fibrinogen level >400mg/dl). The level of plasma fibrinogen and changes of NIHSS were analyzed by the Chi-squared tests and multiple logistic regression. RESULTS: A total of 619 patients with acute ischemic stroke were studied. Among the 619 patients, there were 251 patients with LAA and 229 patients with SVO. Multiple logistic regression analysis indicated that a high level of plasma fibrinogen (p < 0.001), a high level of C-reactive protein (p < 0.001) and the presence of diabetes mellitus (p = 0.026) were related to poor prognosis with acute stage ischemic stroke. Partial correlation analysis showed that the plasma fibrinogen levels were related to LAA (p = 0.05) and NIHSS at admission (p = 0.007) in patients with a high plasma fibrinogen level. However, there was no statistical significance of ischemic stroke subtype and NIHSS in patients with a normal level of plasma fibrinogen. CONCLUSION: An elevated level of plasma fibrinogen seemed to be associated with LAA in acute ischemic stroke and with a poor clinical outcome.
Atherosclerosis ; C-Reactive Protein ; Classification ; Diabetes Mellitus ; Epidemiologic Studies ; Fibrinogen* ; Follow-Up Studies ; Humans ; Logistic Models ; National Institutes of Health (U.S.) ; Plasma* ; Prognosis ; Prospective Studies ; Risk Factors ; Stroke*