Although cerebrospinal fluid leakage is suggested as one of the causes of spontaneous intracranial hypotension, on]y a few cases with direct evidence of cerebrospinal fluid leakage on radionuclide cisternography have been reported in the literature Indirect evidences of cerebrospinal fluid leakage such as early visualization of the soft tissue and bladder or delayed migration of radiotracer have been observed in most patients with spontaneous intracranial hypotension. We report a case of spontaneous intracranial hypotension in which cerebrospinal fluid leakage was directly demonstrated by early dynamic imaging of spine on radionuclide cisternography. We suggest that early dynamic imaging of spine is an important adjunctive procedure in detecting cerebrospinal fluid leakage in patients with spontaneous intracranial hypotension.
Cerebrospinal Fluid* ; Humans ; Intracranial Hypotension* ; Spine ; Urinary Bladder

No abstract available.
Free Tissue Flaps* ; Upper Extremity*

OBJECTIVE: To evaluate the pregnancy outcome, designate the predicting factor of neonatal thrombocytopenia, and reevaluate the treatment scheme of idiopathic thrombocytopenic purpura (ITP) in pregnancy. METHODS: Medical records of 83 patients(98 deliveries) who were diagnosed as having ITP and delivered at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine from January 1990 to May 1999 were reviewed. For statistical analysis Chi-square test and Fisher's exact test were used. RESULTS: Among various maternal characteristics, inability to raise platelet counts more than 100,000/mm3 by any means of treatment, categorized as ""poor response to treatment"", could be designated as the predicting factor of neonatal thrombocytopenia (p<0.05). Pregnant women treated with prednisolone had significantly greater chance of having preterm delivery (p<0.001). The occurrence of postpartum anemia requiring transfusion was higher in the group undertaking cesarean section (p<0.05). Although a control group was missing, the pregnancy outcome was poor in the category of pregnancy induced hypertension(PIH) and preterm labor being 17.3% and 33.7%, respectively. CONCLUSION: The ITP patient should be carefully monitored during the antenatal care visits because of the increased incidence in adverse pregnancy outcome such as PIH and preterm labor. Neonatal thrombocytopenia could be predicted in the presence of inability to raise platelet counts to more than 100,000/mm3 by any means of treatment. Cesarean section should not be performed routinely under the indication of ITP due to the accompanynig morbidity and low incidence of bleeding sequalae in the neonate. The accompanying complications of prednisolone treatment raises questions and warnings about its usage, therefore a prospective study is warranted to evaluate the effect and complications of prednisolone treatment.
Anemia ; Cesarean Section ; Female ; Gynecology ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn ; Medical Records ; Mortuary Practice ; Obstetric Labor, Premature ; Obstetrics ; Platelet Count ; Postpartum Period ; Prednisolone ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Purpura, Thrombocytopenic, Idiopathic ; Thrombocytopenia* ; Thrombocytopenia, Neonatal Alloimmune

No abstract available.
Polyps*

BACKGROUND: Aprotinin, which is a nonspecific serine protease inhibitor, has an antiinflammatory and thrombogenic effect. However, it has an antithrombogenic effect during the cardiopulmonary bypass. This study was performed to evaluated the effects of aprotinin on the activated clotting time(ACT) and the total amount of the heparin used during the cardiopulmonary bypass. MATERIAL AND METHOD: From December 1998 to November 1999, 82 consecutive patients electively underwent open heart surgery at Gachon medical school. The patients were older than 18 years. Eighty two patients were classified into a control group(group C, n=36) and a aprotinin-treated group(group A, n=46). Body weight, height, body surface area(BSA), pump time(PT), aortic cross clamping time(ACCT), and body temperature(BT) were determined. Total amount of heparin and protamine during the CPB were also measured. ACT was determined before heparin administration, at 20, 40 and 60 minutes after heparin administration, and after protamine administration. RESULT: No significant differences were noted in either group in body weight, height, BSA, BT, and the total amoun of heparin and protamine. Group A demonstrated a significant(p<0.05) increase in age, PT, ACCT, and ACT at 20, 40, and 60 minutes after heparin administration. CONCLUSION: In summary, the use of aprotinin prime resulted in an increase in ACT. The total amount of heparin in aproinin-treated patient was similar to that of the control group in spite of having the prolonged pump time. Therefore aprotinin may reduce the requirement of heparin.
Aprotinin* ; Body Height ; Body Weight ; Cardiopulmonary Bypass ; Constriction ; Heart* ; Heparin* ; Humans ; Schools, Medical ; Serine Proteases ; Thoracic Surgery*

The blue rubber bleb nevus syndrome(CRBNS) is a rare disorder characterized by distinctive vascular malformations of the skin and gastrointestinal tract. The syndrome is associated commonly with iron deficiency anemia due to gastrointestinal bleeding. Most cases are sporadic, although a few have been reported with autosomal dominant inheritance. We report a case with clinical characteristics of the blue rubber bleb nevus syndrome. The patient had typical skin manifestations of the BRBNS and chronic iron deficiency anemia. However, we could not find any gastrointestinal vascular malformations radiologically.
Anemia, Iron-Deficiency ; Blister* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Nevus* ; Rubber* ; Skin ; Skin Manifestations ; Vascular Malformations ; Wills

No abstract available.
Genitalia* ; Humans ; Male*

Primary tumors of the heart are rare, three quarter of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, however, only 3 to 4 percent of myxoma are detected in the left ventricle. We report on a 32 years old woman with left ventricular myxoma who presented with shortness of breath, chest tightness, and general weakness. Acute pulmonary embolism and left ventricular myxoma were found on a perfusion lung scan and echocadiogram. A mass located on septal wall of left ventricle was excised en bloc. The patient recovered uneventfully and careful follow up has be performed periodically.
Adult ; Dyspnea ; Female ; Follow-Up Studies ; Heart ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Lung ; Myxoma* ; Perfusion ; Pulmonary Embolism* ; Thorax

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects
Adult ; Anemia ; Ascites ; Blood Pressure ; Cardiac Output ; Electrocardiography ; Fibrosis ; Hemodynamics* ; Humans ; Liver Cirrhosis* ; Liver* ; Stroke Volume ; Systole ; Vascular Resistance