Refractory status epilepticus (RSE) is defined as seizure activity that continues after treatment with conventional anticonvulsants. Mortality rates of range from 2% to 100%. RSE are associated with significant morbidity and high mortality as evidenced by older age of the patient, acute etiology for the seizure, no previous history of seizures, low initial Glasgow Coma Scale, and the significant duration of the RSE. An intravenous valproic acid (VPA) was suggested as a useful drug in controlling RSE. A continuous infusion VPA was an efficient method of rapidly achieving VPA concentrations in the upper region of the therapeutic range while minimizing adverse effects. A 10-year-old female suffered a generalized tonic clonic seizure that developed into refractory status epilepticus. Her Glasgow Coma Scale was deteriorated to 4. Status epilepticus was refractory to phenytoin, phenobarbital, midazolam, thiopental. After 4days of unsatisfactory control of seizure activity, high dose VPA was administered for 2 months. The clinical and electrolgraphic seizure improved and the patient has made an satisfactory neurologic recovery
Anticonvulsants ; Child ; Female ; Glasgow Coma Scale ; Humans ; Midazolam ; Phenobarbital ; Phenytoin ; Seizures ; Status Epilepticus ; Thiopental ; Valproic Acid

No abstract available.
Female ; Hydatidiform Mole* ; Pregnancy

No abstract available.
Female ; Gestational Age* ; Humans ; Membranes* ; Pregnant Women* ; Rupture*

OBJECTIVES: This clinical study evaluated the effect of light activation on the whitening efficacy and safety of in-office bleaching system containing 15% hydrogen peroxide gel. MATERIALS AND METHODS: Thirty-three volunteers were randomly treated with (n = 17, experimental group) or without light activation (n = 16, control group), using Zoom2 white gel (15% H2O2, Discus Dental) for a total treatment time of 45 min. Visual and instrumental color measurements were obtained using Vitapan Classical shade guide and Shadepilot (DeguDent) at screening test, after bleaching, and 1 month and 3 month after bleaching. Data were analyzed using t-test, repeated measure ANOVA, and chi-squared test. RESULTS: Zoom2 white gel produced significant shade changes in both experimental and control group when pre-treatment shade was compared with that after bleaching. However, shade difference between two groups was not statistically significant (p > 0.05). Tooth shade relapse was not detected at 3 months after bleaching. The incidence of transient tooth sensitivity was 39.4%, with being no differences between two groups. CONCLUSIONS: The application of light activation with Zoom2 white gel system neither achieved additional whitening effects nor showed more detrimental influences.
Humans ; Hydrogen ; Hydrogen Peroxide ; Hypersensitivity ; Incidence ; Light ; Mass Screening ; Recurrence ; Tooth ; Tooth Bleaching

PURPOSE: Pandemic influenza viruses have caused significant morbidity and mortality. Pandemic influenza A (H1N1) was detected in April 2009 and caused worldwide outbreak. We investigated the differences in clinical characteristics and courses between pandemic and seasonal influenzas. METHODS: We reviewed the medical records of pediatric patients, (< or =18 years) with influenza hospitalized to Gachon University Gil Medical Center from the 1 April 2009 to the 31 August 2011. RESULTS: Two hundred twenty-six patients with pandemic influenza and 118 patients with seasonal influenza were included. Age, sex, and proportion of underlying diseases were similar between the two groups. Hypoxemia, shortness of breath, and tachypnea were more common in pandemic influenza.(P<0.05) Oxygen supplementation and radiologically confirmed pneumonia were more common in pandemic influenza.(P<0.005) However, there were no significant differences in the mean duration of hospitalization, proportion of patients admitted to the intensive care unit, need for mechanical ventilation, and death. CONCLUSION: Pandemic influenza caused more frequently lower respiratory tract infection and pneumonia. However, the courses of pandemic influenza were not different from those of seasonal influenza; probably, due to the effects of several factors, including antiviral therapy.
Anoxia ; Dyspnea ; Hospitalization ; Humans ; Influenza, Human ; Intensive Care Units ; Medical Records ; Orthomyxoviridae ; Oxygen ; Pandemics ; Pediatrics ; Pneumonia ; Respiration, Artificial ; Respiratory Tract Infections ; Seasons ; Tachypnea

OBJECTIVE: The aim of this study was to evaluate the clinical experiences of patients with the primary tubal cancer diagnosed and treated in the Department of Obstetrics and Gynecology, Gacheon Medical School from January 1996 to December 2000. METHODS: Age, symptoms, Pap smear, CA-125, preoperative diagnosis, mode of surgery, stage, additional pathologic finding, mode of adjuvant therapy and survival periods of patients were reviewed retrospectively. RESULTS: The mean age of patients was 57.4 years. The symptoms were vaginal spotting, leukorrhea and pelvic mass. Three patients were treated by simple hysterectomy and both salpingoophorectomy. Staging laparotomy was done in 4 patients. Three patients were in stage I, 2 patients were in stage II and 2 patients were in stage III. Endometrial adenocarcinoma was present in 1 patient and endometrial hyperplasia was present in 1 patient. The mean follow-up period of five patients were 25.4 months and 2 patients were lost for follow-up. Conclusions: The primary tubal cancer was rare gynecologic malignancy and the preoperative diagnosis was difficult due to non-specific symptoms and signs. Staging laparotomy and adjuvant chemotherapy should be done like in ovarian cancer. More studies may be needed for the associated endometiral diseases.
Adenocarcinoma ; Chemotherapy, Adjuvant ; Diagnosis ; Endometrial Hyperplasia ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Laparotomy ; Leukorrhea ; Metrorrhagia ; Obstetrics ; Ovarian Neoplasms ; Retrospective Studies ; Schools, Medical

Expression of matrix metalloproteinase-9 (MMP-9) is associated with airway remodeling and tissue injury in asthma. However, little is known about how MMP-9 is up-regulated in airway epithelial cells. In this study, we show that phorbol myristate acetate (PMA) induces MMP-9 expression via a protein kinase Calpha(PKCalpha)-dependent signaling cascade in BEAS-2B human lung epithelial cells. Pretreatment with either GF109203X, a general PKC inhibitor, or Go6976, a PKCalpha/beta isozyme inhibitor, inhibited PMA-induced activation of the MMP-9 promoter, as did transient transfection with PKCalpha antisense oligonuclotides. PMA activated NF-kappaB by phosphorylating IkappaB in these cells and this was also inhibited by GF109203X and Go6976, suggesting that PKCalpha acts as an upstream regulator of NF-kappaB in PMA-induced MMP-9 induction. Our results indicate that a "PKCalpha-NF-kappaB"-dependent cascade is involved in the signaling leading to PMA-induced MMP-9 expression in the lung epithelium.
Up-Regulation/*drug effects ; Tetradecanoylphorbol Acetate/*pharmacology ; Protein Kinase C-alpha/*metabolism ; NF-kappa B/*metabolism ; Matrix Metalloproteinase 9/*metabolism ; Lung/drug effects/*metabolism ; Humans ; Epithelial Cells/drug effects/metabolism ; Cell Line

PURPOSE: Unplanned conversion is sometimes necessary during minimally invasive liver resection (MILR) of hepatocellular carcinoma (HCC). The aims of this study were to compare surgical outcomes of planned MILR and unplanned conversion and to investigate the risk factors after unplanned conversion. METHODS: We retrospectively analyzed 286 patients who underwent MILR with HCC from January 2006 to December 2017. All patients were divided into a MILR group and an unplanned conversion group. The clinicopathologic characteristics and outcomes were compared between the 2 groups. In addition, surgical outcomes in the conversion group were compared with the planned open surgery group (n = 505). Risk factors for unplanned conversion were analyzed. RESULTS: Of the 286 patients who underwent MILR, 18 patients (6.7%) had unplanned conversion during surgery. The unplanned conversion group showed statistically more blood loss, higher transfusion rate and postoperative complication rate, and longer hospital stay compared to the MILR group, whereas no such difference was observed in comparison with the planned open surgery group. There were no significant differences in overall and disease-free survival among 3 groups. The right-sided sectionectomy (right anterior and posterior sectionectomy), central bisectionectomy and tumor size were risk factors of unplanned conversion. CONCLUSION Unplanned conversion during MILR for HCC was associated with poor perioperative outcomes, but it did not affect long-term oncologic outcomes in our study. In addition, when planning right-sided sectionectomy or central bisectionectomy for a large tumor (more than 5 cm), we should recommend open surgery or MILR with an informed consent for unplanned open conversions.

Background: High-alert medications (HAMs) are medications that bear a heightened risk of causing significant patient harm if used in error. To facilitate safe use of HAMs, identifying specific HAM lists for clinical setting is necessary. We aimed to develop the national level HAM list for acute care setting. Methods: We used three-step process. First, we compiled the pre-existing lists referring HAMs. Second, we analyzed medication related incidents reported from national patient safety incident report data and adverse events indicating medication errors from the Korea Adverse Event Reporting System (KAERS).We also surveyed the assistant staffs to support patient safety tasks and pharmacist in charge of medication safety in acute care hospital. From findings from analysis and survey results we created additional candidate list of HAMs. Third, we derived the final list for HAMs in acute care settings through expert panel surveys. Results: From pre-existing HAM list, preliminary list consisting of 42 medication class/ingredients was derived. Eight assistant staff to support patient safety tasks and 39 pharmacists in charge of medication safety responded to the survey. Additional 44 medication were listed from national patient safety incident report data, KAERS data and common medications involved in prescribing errors and dispensing errors from survey data. A list of mandatory and optional HAMs consisting of 10 and 6 medication classes, respectively, was developed by consensus of the expert group. Conclusion We developed national level HAM list for Korean acute care setting from pre-existing lists, analyzing medication error data, survey and expert panel consensus.