Cold hemagglutinin disease is a form of immune hemolytic anemia caused by cold-reactive immunoglobulins. Cold agglutinins are autoantibodies, usually of the IgM type, that cause red blood cell agglutination at reduced temperatures. When the agglutinated antibody-covered red blood cells return to the central circulation, the classical complement pathway is activated. Complement components combine with the antibody-covered red blood cells, inducing membrane changes that result in intravascular hemolysis. Clinical manifestations of cold hemagglutinin disease, which occur only on cold exposure include acrocyanosis, purpura, Raynauds phenomenon, acral gangrene, immune complex nephritis, and hemolytic anemia. We experienced a case of 66-year-old woman with cold agglutinin disease, gastric cancer and gall bladder stone. Preoperative plasmapheresis and intraoperative forced air convective warming to minimize red blood cell agglutination and hemolysis were performed. The operating room was prewarmed to 31~32degrees C. The patient had her lower body and the upper extremities covered with warming blankets. Inspired gases were humidified at 37degrees C and intravenous fluids were warmed with a blood warmer. Peripheral body temperature was maintained above 36.5degrees C throughout the procedure. Subtotal gastrectomy and cholecystectomy were done successfully without complication. It can be concluded that the maintenance of central and peripheral body temperature above the thermal aetivity of the cold agglutinin is required during the perioperative period.
Aged ; Agglutination ; Agglutinins ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Anesthesia, General* ; Antigen-Antibody Complex ; Autoantibodies ; Body Temperature ; Cholecystectomy ; Complement Pathway, Classical ; Complement System Proteins ; Erythrocytes ; Female ; Gangrene ; Gases ; Gastrectomy ; Hemagglutinins ; Hemolysis ; Humans ; Immunoglobulin M ; Immunoglobulins ; Membranes ; Nephritis ; Operating Rooms ; Perioperative Period ; Plasmapheresis ; Purpura ; Stomach Neoplasms ; Upper Extremity ; Urinary Bladder Calculi

Eales’ disease is an idiopathic disorder induced by ischemic retinal vasculitis, usually affecting the peripheral retina. We encountered a young patient diagnosed as cerebral infarction with a history of Eales’ disease. The patient’s middle cerebral artery showed multifocal stenosis with contrast enhancement, suggesting vasculitis. These findings might give clues to a rare cause of cerebral artery stenosis.

Lack of mullerian development (Mayer-Rokitansky-Kuster-Hauser Syndrome) is characterized by absence of apparent vagina and/or uterus, normal secondary sexual characteristics, normal reproductive hormonal profile, and a relatively common cause of primary amenorrhea about 1 in 4,000 female births and also cause of primary infertility. Management for these women comprise of construction of neovagina for sexual life. In 1985, the first report of a successful pregnancy through the uterine surrogacy was made. It is being possible for these women to have new opportunity of getting her own genetic offspring. Since ovarian activity is completely preserved in patients, controlled ovarian hyperstimulation is similar to any other IVF case that is with urinary or recombinant gonadotropins following GnRH agonist down regulation. Genetic offspring can be achieved by cellection of oocytes from the genetic mather, in-vitro-fertilization by the genetic father, and placement into a surrogate carrier. We have experienced a case of successful surrogate pregnancy in a patient with congenital absence of vagina and uterus.
Amenorrhea ; Down-Regulation ; Fathers ; Female ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Oocytes ; Parturition ; Pregnancy* ; Uterus ; Vagina

Objectives: ：The purpose of this study was to find out how demographic factors, suicide attempt patterns, psychiatric history and management of suicide attempters affect the completion of emergency department (ED) based case management program. Methods: ：Among the patients who attempted suicide and visited the emergency department of Chung-Ang University Hospital from June 1, 2018 to May 31, 2021, 661 patients who agreed to case management were studied. After being discharged from the emergency department, subjects were registered for an eight-week follow-up service program. Hierarchical logistic regression analysis was conducted with demographic factors, suicide attempt patterns, psychiatric history and management as independent variables, and completion of case program as dependent variables. Results: ：Suicide attempt pattern had the most significant influence on the completion of case management program, followed by demographic factors, psychiatric history and management. Those who completed the case management program were significantly more likely to have suicide plans in the future, more authentic in sui-cide attempts, and had higher proportion of past suicide attempts than those who did not complete the program. Conclusions ：To ensure that the subjects complete the follow-up project program and get connected to community services, an individualized approach with consideration of suicide attempt patterns, demographic factors, and psychiatric history is needed.

OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and management of cervical neoplasia. METHODS: Cold knife conization was performed in total 163 patients from January 1992 to December 2003. The results of PAP smear and colposcopy-directed biopsy were compared with the pathologic diagnosis of conization. And we evaluated the rate of positive margin and the presence of residual lesion. And then, we reviewed the pregnancy outcome after conization. RESULTS: The rate of agreement between PAP cytology and conization was 45.4%, and the rate of agreement between colposcopy-directed biopsy and conization was 65.6%. Hysterectomy was done in 102 patients (62.6%). The positive rate of resection margin was 19.6%. The incidence of residual lesion after conization was 31.2% in margin (+) and 1.4% in margin (-). We evaluated 7 cases of pregnancy after conization. CONCLUSION: Cervical conization as surgical treatment was effective in cervical neoplasia patients, especially young patients, with continuous follow-up.
Biopsy ; Conization* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Incidence ; Pregnancy ; Pregnancy Outcome

BACKGROUND/OBJECTIVES: This research was conducted to compare lecture-and experience-based methods of nutritional education as well as provide fundamental data for developing an effective nutritional education program in elementary schools. SUBJECTS/METHODS: A total of 110 students in three elementary schools in Jeollanam-do were recruited and randomly distributed in lecture-and experience-based groups. The effects of education on students' dietary knowledge, dietary behaviors, and dietary habits were analyzed using a pre/post-test. RESULTS: Lecture-and experience-based methods did not significantly alter total scores for dietary knowledge in any group, although lecture-based method led to improvement for some detailed questions. In the experience-based group, subjects showed significant alteration of dietary behaviors, whereas lecture-based method showed alteration of dietary habits. CONCLUSIONS: These outcomes suggest that lecture-and experience-based methods led to differential improvement of students' dietary habits, behaviors, and knowledge. To obtain better nutritional education results, both lectures and experiential activities need to be considered.
Education* ; Food Habits ; Humans ; Jeollanam-do ; Learning* ; Lectures

PURPOSE: Arachidonic acid is known to have effects on cell growth as a controller of cell proliferation and a stimulator of platelet derived growth factor. We investigated the correlations among birth weight, placental weight and free arachidonic acid level in cord blood. METHODS: Twenty full-term well babies were included in this study. Those who had sepsis, IUGR, twin that may affect the level of arachidonic acid, birth weight, and/or placental weight were excluded. Free arachidonic acid level were measured by gas chromatographic-mass spectrometry. (GC-MS) Correlation Pearson Coefficients were used for statistical analyses. RESULTS: The correlation coefficients between birth weight and placental weight, birth weight and arachidonic acid level, and placental weight and arachidonic acid level were 0.727 (P<0.001), 0.440 (P>0.05), 0.407 (P>0.05) respectively. CONCLUSION: There was statistically significant positive correlation between birth weight and placental weight. But since cord blood free arachidonic acid levels were not correlated with placental weight and birth weight, we conclude that cord blood free arachidonic acid level has no effects on fetal growth and placental growth.
Arachidonic Acid* ; Birth Weight* ; Cell Proliferation ; Fetal Blood* ; Fetal Development ; Fetal Growth Retardation ; Humans ; Parturition* ; Platelet-Derived Growth Factor ; Sepsis ; Spectrum Analysis

PURPOSE: Arachidonic acid is known to have effects on cell growth as a controller of cell proliferation and a stimulator of platelet derived growth factor. We investigated the correlations among birth weight, placental weight and free arachidonic acid level in cord blood. METHODS: Twenty full-term well babies were included in this study. Those who had sepsis, IUGR, twin that may affect the level of arachidonic acid, birth weight, and/or placental weight were excluded. Free arachidonic acid level were measured by gas chromatographic-mass spectrometry. (GC-MS) Correlation Pearson Coefficients were used for statistical analyses. RESULTS: The correlation coefficients between birth weight and placental weight, birth weight and arachidonic acid level, and placental weight and arachidonic acid level were 0.727 (P<0.001), 0.440 (P>0.05), 0.407 (P>0.05) respectively. CONCLUSION: There was statistically significant positive correlation between birth weight and placental weight. But since cord blood free arachidonic acid levels were not correlated with placental weight and birth weight, we conclude that cord blood free arachidonic acid level has no effects on fetal growth and placental growth.
Arachidonic Acid* ; Birth Weight* ; Cell Proliferation ; Fetal Blood* ; Fetal Development ; Fetal Growth Retardation ; Humans ; Parturition* ; Platelet-Derived Growth Factor ; Sepsis ; Spectrum Analysis

Primary ovarian pregnancy is rare form of ectopic pregnancy. It can be diagnosed if the only implantation occurs in the ovary. The clinical diagnosis of ovarian pregnancy is difficult. Owing to the availability of sensitive assays for human chorionic gonadotropin and the development of transvaginal ultrasonography, early diagnosis of an ectopic pregnancy has been made more feasible. But clinical and even intraoperative diagnosis of ovarian pregnancy is still difficult and only microscopic examination of tissue specimen can confirm the diagnosis. Misdiagnosis is common because it can be confused with a ruptured corpus luteum. Laparoscopic wedge resection is treatment of choice. The authors present a case of ovarian pregnancy with a brief review of the literatures.
Chorionic Gonadotropin ; Corpus Luteum ; Diagnosis ; Diagnostic Errors ; Early Diagnosis ; Female ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Ultrasonography

BACKGROUND: Paradoxical embolism through the patent foramen ovale (PFO) is a well-recognized mechanism for otherwise unexplained ischemic stroke. Although transthoracic contrast echocardiography (TCE) has been used frequently for noninvasive diagnosis of right to left shunt through PFO, its diagnostic accuracy appears limited, especially in patients with poor acoustic window. Since harmonic imaging (HI) can enhance the definition of contrast microbubbles, theoretical advantages of HI in the detection of right to left shunt through PFO using microbubbles can be considered. However, there are few data regarding the diagnostic efficacy of HI in the detection of right to left shunt through PFO. The purpose of this study was to compare the diagnostic value of transthoracic HI in the detection of right to left shunt through PFO in patients with stroke with that of fundamental imaging (FI). Methods: One hundred thirty-six consecutive patients with stroke (82 male, mean age:9) underwent TCE in both HI and FI and transesophageal echocardiography (TEE) during rest and Valsalva maneuver with intravenous administration of agitated saline. PFO was judged to be present if microbubbles appeared in the left atrium within 3 cardiac cycles of their appearance in the right atrium. TEE was regarded as the gold standard for assessing the diagnostic accuracy of TCE. Results: Right to left shunt through PFO was detected in 40 of 136 patients by TEE (29.4%). FI of TCE detected shunt through PFO in only 9 of 136 patients (6.6%). In contrast, HI detected shunt through PFO in 25 of 136 patients (18.4%). The overall sensitivity and specificity of FI and HI for detection of right to left shunt through PFO were 22.5%, 62.5% (p<0.05) and 100%, 100%, respectively. Valsalva maneuver during HI significantly increased the detection rate of shunt through PFO (during rest in 9 and during Valsalva maneuver in 25, p<0.05). CONCLUSION: HI with contrast microbubble injection significantly enhanced the detection of right to left shunt through PFO in patients with ischemic stroke compared with FI by transthoracic approach.
Acoustics ; Administration, Intravenous ; Diagnosis ; Dihydroergotamine ; Echocardiography* ; Echocardiography, Transesophageal ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Heart Atria ; Humans ; Male ; Microbubbles ; Sensitivity and Specificity ; Stroke ; Valsalva Maneuver