Acute aortic dissection is the most common catastrophic illness of the aorta. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode, but survival may be significantly improved by the timely institution of diagnostic modalities and appropriate medical and surgical therapy. But, approximately 10-20% of patients with acute aortic dissection present with a clinical picture of acute myocardial infarction. This sometimes can not only delay the diagnosis and adequate treatment of acute aortic dissection but also inappropriately treat with thrombolytic agents and anticoagulants which result in rapid deterioration of clinical condition of patient. We report a case of acute aortic dissection with dynamic ST changes in electrocardiogram which resulted in delay of accurate diagnosis and adequate treatment of acute aortic dissection.
Anticoagulants ; Aorta ; Catastrophic Illness ; Diagnosis ; Electrocardiography* ; Fibrinolytic Agents ; Humans ; Myocardial Infarction

PURPOSE: To evaluate the clinical features of the patients with episcleritis and scleritis. METHODS: Retrospective chart review was performed for above patients that had been followed from 1986. 8. 8 to 2001. 6. 4. RESULTS: The number of patients with episcleritis was 17 (49%) and that of scleritis was 18 (51%). Ocular complication occurred in 59% of patients with episcleritis and 72% of patients with scleritis. Keratitis was the most common ocular complication. No patient with episcleritis had a decrease in visual acuity, whereas 33% of patients with scleritis did. Systemic diseases were found in 69% of episcleritis whereas 77% of patients with scleritis associated with systemic diseases. Rheumatoid arthritis was the most common one in both groups of patients. CONCLUSIONS: Ocular complications, systemic diseases, and decrease in visual acuity are associated more of commonly with scleritis than episcleritis. When scleritis is suspected, careful examinations for associated ocular complications should be performed and be followed with history taking and evaluation for associated systemic disease.
Arthritis, Rheumatoid ; Humans ; Keratitis ; Retrospective Studies ; Scleritis* ; Visual Acuity

In the last 30 years, technical improvements have directly contributed to expanding sonographic breast imaging applications into the most important adjunctive imaging modality for breast evaluation. Most of these advances have related to improvements in sonographic gray-scale image resolution and contrast, but some applications such as color Doppler imaging, elastography, optical imaging, or three-dimensional ultrasounds have resulted in sonographic information that is uniquely different from grayscale imaging. The current spectrum of new breast sonographic techniques not only offers information uniquely different from gray-scale imaging but also involves hardware advances that affect the method of image production. In this article, we discuss the current trends in breast ultrasonography focusing on the advances to further improve accuracy for breast lesion diagnosis.
Breast ; Elasticity Imaging Techniques ; Optical Imaging ; Ultrasonography, Mammary

The Rh blood group system has C, D, E, c, and e as the main antigens, but ce(f) has been reported as a compound antigen. Anti-f(ce) is an unexpected antibody (Ab) against the ce(f) compound antigen. This paper reports a case with anti-f(ce) and anti-M Abs in a patient with liver cirrhosis. A 47-year-old male patient was repeatedly admitted to hospital due to recurrent hepatic encephalopathy. He showed disorientation and was admitted. A packed red blood cells (pRBCs) transfusion was required, and Ab identification test identified anti-f(ce) and anti-M Abs. Anti-f(ce) Ab can cause fetal neonatal hemolytic disease and a clinically serious hemolytic transfusion reaction (HTR), and anti-M Ab can cause a HTR when it reacts at 37℃. RBCs with Rh haplotype of CDe and negative for M antigen were transfused to the patient. There was no HTR. The possibility of an anti-f(ce) Ab was not considered when an unexpected Ab screening/identification test was performed. It was simply reported as an ‘unknown alloantibody’. Therefore, laboratory physicians should consider Abs to the Rh compound antigen when Abs to Rh antigens are identified, and efforts should be made to identify them to gain basic knowledge about Abs against Rh compound antigens.

Platelet transfusion refractoriness (PTR), in which platelet counts do not increase after transfusion, occurs in many patients receiving platelet transfusions. PTR is a clinical condition that can harm patients. The causes of PTR can be divided into two types: immune and non-immune. Most cases of PTR are non-immune. Among immune causes, the most common is human leukocyte antigen (HLA) class I molecules. PTR caused by anti-HLA antibodies is usually managed by transfusing HLA-matched platelets. Therefore, it is important, especially for hemato-oncologists who frequently perform transfusion, to accurately diagnose whether the cause of platelet transfusion failure is alloimmune or non-immunological when determining the treatment direction for the patient. In this review, we discuss the definitions, causes, countermeasures, and prevention methods of PTR.

Background: According to the revision of the Blood Management Act in 2020, medical institutions that meet certain conditions are obliged to install a transfusion management division in Korea. Therefore, this study assessed the management status of the transfusion management division at major medical institutions. Methods: From August 7th to August 18th, 2021, a survey questionnaire was given to laboratory physicians of 10 major medical institutions in Korea, and the installation and operation of the transfusion management division were surveyed. Results: The medical institutions that participated in this survey completed a transfusion management division in the first half of the year. Doctors, nurses, and medical technologists were assigned as medical personnel, and all laboratory physicians were leading the work as the head of the transfusion management division. Regarding the tasks performed at the transfusion management division, all medical institutions conducted a transfusion appropriateness assessment, education related to transfusion, and adverse transfusion reactions. Most medical institutions had difficulties because there was an insufficient basis to calculate the workforce and budget in installing and operating the transfusion management division. Conclusion There are rarely reference materials for the practice and operation of the transfusion management division, which has no precedent in Korea, so it is often difficult for medical institutions to prepare it. This study will be a reference for medical institutions that need to install a transfusion management division in the future.Efforts should be made to legislate transfusion management fees focused on the academic community.

OBJECTIVE: To determine the potential value of distributional-phase T1-weighted ferumoxides-enhanced magnetic resonance (MR) imaging for tissue characterization of focal liver lesions. MATERIALS AND METHODS: Ferumoxides-enhanced MR imaging was performed using a 1.5-T system in 46 patients referred for evaluation of known or suspected hepatic malignancies. Seventy-three focal liver lesions (30 hepatocellular carcinomas [HCC], 12 metastases, 15 cysts, 13 hemangiomas, and three cholangiocarcinomas) were evaluated. MR imaging included T1-weighted double-echo gradient-echo (TR/TE: 150/4.2 and 2.1 msec), T2*-weighted gradient-echo (TR/TE: 180/12 msec), and T2-weighted turbo spin-echo MR imaging at 1.5 T before and after intravenous administration of ferumoxides (15 mmol/kg body weight). Postcontrast T1-weighted imaging was performed within eight minutes of infusion of the contrast medium (distributional phase). Both qualitative and quantitative analysis was performed. RESULTS: During the distributional phase after infusion of ferumoxides, unique enhancement patterns of focal liver lesions were observed for hemangiomas, metastases, and hepatocellular carcinomas. On T1-weighted GRE images obtained during the distributional phase, hemangiomas showed a typical positive enhancement pattern of increased signal; metastases showed ring enhancement; and hepatocellar carcinomas showed slight enhancement. Quantitatively, the signal-to-noise ratio of hemangiomas was much higher than that of other tumors (p < .05) and was similar to that of intrahepatic vessels. This finding permitted more effective differentiation between hemangiomas and other malignant tumors. CONCLUSION: T1-weighted double-echo FLASH images obtained soon after the infusion of ferumoxides, show characteristic enhancement patterns and improved the differentiation of focal liver lesions.

OBJECTIVE: To compare the performance of superparamagnetic iron oxide (SPIO) -enhanced magnetic resonance (MR) imaging at 1.5T and dual-phase spiral computed tomography (CT) for the depiction of small hypervascular hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Forty-three patients with 70 small nodular HCCs (5-20 mm; mean, 13.7 mm) were examined. Diagnosis was based on the results of surgical biopsy in 22 patients and by the combined assessment of MR imaging, lipiodol CT, alpha feto-protein levels, and angiographic findings in 21. MR imaging consisted of respiratory-triggered turbo spin-echo T2-weighted imaging, T1-weighted fast low-angle shot, and T2* -weighted fast imaging with steady-state precession imaging before and after SPIO enhancement. CT imaging was performed with 5-mm collimation and 1: 1.4 pitch, and began 30 and 65 secs after the injection of 150 mL of contrast medium at a rate of 3 mL/sec. Two blinded observers reviewed all images independently on a segment-by-segment basis. Diagnostic accuracy was evaluated using receiver operating characteristics (ROC) analysis. RESULT: The mean areas (Az) under the ROC curves were 0.85 for SPIOenhanced MR imaging and 0.79 for dual-phase spiral CT (p < .05). The mean sensitivity of SPIO-enhanced MR imaging was significantly higher than that of CT (p < .05), i.e. 70.6% for MR imaging and 58.1% for CT. MR imaging had higher false-positive rates than dual-phase spiral CT, but the difference was not statistically significant (3.7% vs 3.3%) (p > .05). CONCLUSION: SPIO-enhanced MR imaging is more sensitive than dual-phase spiral CT for the depiction of small hypervascular hepatocellular carcinomas.

Catastrophic antiphospholipid syndrome (APS) is defined as a rare, life-threatening autoimmune disorder leading to multiorgan failure. Probable APS, with clinical manifestations similar to APS without antiphospholipid antibodies, was suggested to be seronegative catastrophic APS. The triggering factors of catastrophic APS are various, including infection, trauma, malignancy, and surgery. In approximately 40% of patients, catastrophic APS develops from an unknown cause. We report a case of seronegative catastrophic APS due to an unknown origin. A 20-year-old man presented with cough, abdominal pain, skin lesions, tunnel vision, and watery diarrhea without fever. His symptoms and laboratory test suggested disseminated intravascular coagulation. Considering seronegative catastrophic APS, we treated with intravenous steroid and intravenous immunoglobulin, but the effects were limited. After weekly treatment with rituximab, an immune-modulating agent, his laboratory findings including thrombocytopenia and coagulation tests, returned to normal. We conclude that rituximab can be an effective treatment for seronegative catastrophic APS.
Abdominal Pain ; Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome ; Autoimmune Diseases ; Cough ; Diarrhea ; Disseminated Intravascular Coagulation* ; Fever ; Humans ; Immunoglobulins ; Skin ; Thrombocytopenia ; Young Adult ; Rituximab