Pure ovarian choriocarcinoma of germ cell origin is exceedingly rare neoplasm, and even the presence of choriocarcinomatous elements admixed with other neoplastic germ cell elements is rare. In the most cases, the tumor is admixed with other neoplastic germ cell elemeats, and their presence is diagnostic of noagsatational choriocarcinoma, except for the remote of the tumor being a geatational choriocarcinoma metasttic to an ovarian germ cell tumor. We have experienced a case of nongestational ovarian choriocarcinoma in 10 year dld woman. So we report this case with a brief review of its literatures.
Choriocarcinoma* ; Female ; Germ Cells ; Humans ; Neoplasms, Germ Cell and Embryonal ; Pregnancy

BACKGROUND:Metronome guidance is a feasible and effective feedback technique to improve the quality of cardiopulmonary resuscitation (CPR). The rate of the metronome should be set between 100 to 120 ticks/minute and the speed of ventilation may have crucial effect on the quality of ventilation. We compared three different metronome rates (100, 110, 120 ticks/minute) to investigate its effect on the quality of ventilation during metronome-guided 30:2 CPR. METHODS:This is a prospective, randomized, crossover observational study using a RespiTrainer?r. To simulate 30 chest compressions, one investigator counted from 1 to 30 in cadence with the metronome rate (1 count for every 1 tick), and the participant performed 2 consecutive ventilations immediately following the counting of 30. Thirty physicians performed 5 sets of 2 consecutive (total 10) bag-mask ventilations for each metronome rate. Participants were instructed to squeeze the bag over 2 ticks (1.0 to 1.2 seconds depending on the rate of metronome) and deflate the bag over 2 ticks. The sequence of three different metronome rates was randomized. RESULTS:Mean tidal volume significantly decreased as the metronome rate was increased from 110 ticks/minute to 120 ticks/minute (343±84 mL vs. 294±90 mL, P=0.004). Peak airway pressure significantly increased as metronome rate increased from 100 ticks/minute to 110 ticks/minute (18.7 vs. 21.6 mmHg, P=0.006). CONCLUSION:In metronome-guided 30:2 CPR, a higher metronome rate may adversely affect the quality of bag-mask ventilations. In cases of cardiac arrest where adequate ventilation support is necessary, 100 ticks/minute may be better than 110 or 120 ticks/minute to deliver adequate tidal volume during audio tone guided 30:2 CPR.

PURPOSE: The purpose of this study is to correlate the MR findings with clinical stage and clinical outcome, and to describe the evolutional changes of abnormal MR findings of transverse myelitis. MATERIALS AND METHODS: Medical records and spinal MR images of 23 patients with both clinical and radiological diagnosis of transverse myelitis were retrospectively reviewed. MR findings were correlated with clinical stages including interval between MR imaging and full development of clinical symptoms, and compared with the clinical outcome. RESULTS: Diffuse high signal intensity of the spinal cord on T2-weighted image with mild cord bulging (67%) and focal contrast enhancement of the cord (75%) were observed within the first four weeks after full development of clinical symptoms. The findings decreased in extent or vanished later than four weeks on either initial or follow-up MR images. Most patients with either cord atrophy or focal hemorrhagewithin the cord lesion had poor clinical outcome. CONCLUSION: The MR findings of transverse myelitis are nonspecific, which may be seen in a variety of diseases. Serial MRIs, especially follow up examination over at least one month after full development of clinical symptoms are useful in the diagnosis of transverse myelitis and predicting its prognosis.
Atrophy ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Myelitis, Transverse* ; Prognosis ; Retrospective Studies ; Spinal Cord

Background: Fecal microbiota transplantation against gut colonization using a multidrugresistant organism is a technique used to treat infections through normalizing the gut microbiota via fecal microbiota transplantation in patients with confirmed colonization by carbapenem-resistant Enterobacteriaceae (CRE) or vancomycin-resistant enterococci (VRE) based on a fecal culture test within the past one week. In this study, we aimed to determinethe safety and effectiveness of this technique. Methods: The safety and effectiveness were assessed via a systematic review. A literature search was conducted using five Korean databases, such as KoreaMed, and international databases, including Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library. Results: Main results are described here. From the studies retrieved using the aforementioned search strategy, the remaining 581 studies were screened using the inclusion and exclusion criteria, resulting in the selection of nine studies for further consideration. In terms of safety, many studies reported deaths and adverse reactions associated with different causes. Fewer studies reported the rate of colonization; however, the effect of colony rate was inconsistent when compared to no treatment group. Additionally, none of the studies assessed the recurrence rate, a decrease in the prevalence of diseases related to infection by multidrugresistant bacteria, and the quality of life. Conclusion Fecal bacterial colonization for the decolonization of intestinal multidrugresistant bacteria was evaluated using a technique that requires further research as there is insufficient literature evidence to validate its safety and efficacy in treating infections through normalizing the intestinal flora of patients with confirmed colonization by CRE or VRE.

Background: Fecal microbiota transplantation against gut colonization using a multidrugresistant organism is a technique used to treat infections through normalizing the gut microbiota via fecal microbiota transplantation in patients with confirmed colonization by carbapenem-resistant Enterobacteriaceae (CRE) or vancomycin-resistant enterococci (VRE) based on a fecal culture test within the past one week. In this study, we aimed to determinethe safety and effectiveness of this technique. Methods: The safety and effectiveness were assessed via a systematic review. A literature search was conducted using five Korean databases, such as KoreaMed, and international databases, including Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library. Results: Main results are described here. From the studies retrieved using the aforementioned search strategy, the remaining 581 studies were screened using the inclusion and exclusion criteria, resulting in the selection of nine studies for further consideration. In terms of safety, many studies reported deaths and adverse reactions associated with different causes. Fewer studies reported the rate of colonization; however, the effect of colony rate was inconsistent when compared to no treatment group. Additionally, none of the studies assessed the recurrence rate, a decrease in the prevalence of diseases related to infection by multidrugresistant bacteria, and the quality of life. Conclusion Fecal bacterial colonization for the decolonization of intestinal multidrugresistant bacteria was evaluated using a technique that requires further research as there is insufficient literature evidence to validate its safety and efficacy in treating infections through normalizing the intestinal flora of patients with confirmed colonization by CRE or VRE.

BACKGROUND: The oculocardiac reflex (OCR) can be elicited during manipulation of the orbital structures in the strabismus correction surgery. A sinus bradycardia is the most common manifestation of OCR; and cardiac dysrhythmia and asystole may also occur. Various efforts to reduce OCR have been attempted, but without coherent outcome results. METHODS: Sixty one children, undergoing elective strabismus surgery, were randomly allocated into 2 groups: Group K received ketamine 1.0 mg/kg; and Group M received midazolam 0.15 mg/kg for induction of anesthesia. Anesthesia was maintained with 1-1.3 MAC of sevoflurane with 50% N2O in O2. Heart rate and blood pressure were measured 30 seconds before extraocular muscle (EOM) traction and immediately after traction. The OCR was defined as a decrease in heart rate more than 20% of the baseline heart rate, following manipulating EOM. Postoperative nausea and vomiting (PONV) and emergence agitation (EA) were assessed in postanesthetic care unit (PACU). RESULTS: Blood pressure before tightening EOM in Group K was higher than that in Group M (P < 0.05). However Delta HR (2.7 +/- 15% vs. - 0.9 +/- 16%) and incidence of OCR (10.0% vs. 19.4%) after traction an EOM were not different between the two groups. The occurrence of PONV (6.7 vs. 9.7%) and EA (30.0% vs. 22.6%) were similar. CONCLUSIONS: Ketamine does not reduce the incidence of OCR compared with midazolam in pediatric strabismus surgery. In addition, ketamine does not increase the incidence of PONV and EA. In conclusion, it is reliable to use ketamine in pediatric strabismus surgery.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Bradycardia ; Child ; Dihydroergotamine ; Heart Arrest ; Heart Rate ; Humans ; Incidence ; Ketamine ; Methyl Ethers ; Midazolam ; Muscles ; Orbit ; Postoperative Nausea and Vomiting ; Reflex, Oculocardiac ; Strabismus ; Traction

Pulmonary alveolar proteinosis (PAP) is characterized by the progressive accumulation of phospholipids and proteins within the alveolar sacs without producing an inflammatory response. Whole-lung lavage (WLL) is performed as the standard therapy for this disease because it serves to wash out the proteinaceous material from the alveoli. In this case, we performed sequential WLL using propofol-remifentanil, which is not related to hypoxic pulmonary vasoconstriction during one-lung ventilation. The patient's symptoms and radiologic findings showed improvement without the occurrence of any specific complications. Therefore, we report a case of anesthetic management of WLL performed repeatedly for a patient with recurrent PAP.
Humans ; One-Lung Ventilation ; Phospholipids ; Proteins ; Pulmonary Alveolar Proteinosis ; Therapeutic Irrigation ; Vasoconstriction

BACKGROUND:Accurate and timely diagnosis of acute surgical disease in pregnant patient is chal enging. Although magnetic resonance imaging (MRI) is the most accurate modality to diagnose acute appendicitis in pregnant patients, it is often used as a last resort because of high cost and long scan time. We performed this study to analyze differential diagnoses of appendix MRI and to investigate if there are any blood tests that can predict surgical condition in pregnant patients. METHODS:A retrospective, cross-sectional study was conducted on 46 pregnant patients who underwent non-enhanced appendix MRI in suspicion of acute appendicitis from 2010 to 2016. Differential diagnoses of appendix MRI were analyzed and blood tests were compared between those who had surgical and non-surgical disease. RESULTS:Appendix MRI differentiated two surgical disease; acute appendicitis and ovarian torsion; and various non-surgical conditions such as uterine myoma, hydronephrosis, ureterolithiasis and diverticulitis among clinically suspected acute appendicitis in pregnancy. The diagnostic accuracy of MRI for acute appendicitis in this study was 93.5％. Patients who had surgical disease showed significantly higher WBC count (≥11,000/mm3), proportion of neutrophils in the WBC (≥79.9％), neutrophil-to-lymphocyte ratio (NLR≥6.4), levels of C-reactive protein (CRP≥1.82 mg/dL) and bilirubin (≥0.66 mg/dL ) than those who had non-surgical disease. CONCLUSION:MRI can reliably differentiate surgical conditions and several blood tests (WBC, proportion of neutrophils in the WBC, NLR, CRP, bilirubin) can help anticipate acute surgical condition among pregnant patients suspected to have acute appendicitis.

Background: Spontaneous pneumopericardium is a very rare condition. Spontaneous pneumothorax and pneumomediastinum have been reported to be associated with an idiopathic pulmonary fibrosis (IPF). However, spontaneous pneumopericardium has not yet been reported in association with IPF. Here we report a case of spontaneous pneumomediastinum and pneumopericardium in a patient with acute exacerbation of IPF with a review of the relevant literature.
Humans ; Idiopathic Pulmonary Fibrosis* ; Mediastinal Emphysema* ; Pneumopericardium* ; Pneumothorax

Steroid cell tumors of the ovary are extremely rare, accounting for only 0.1% of all ovarian tumors. Of these, steroid cell tumors, not otherwise specified (NOS) constitute about 56% of all steroid cell tumors. Most steroid cell tumors secrete steroid hormones, and only about 10% to 15% of patients are asymptomatic. The morphology of steroid cell tumors, NOS is predominantly reported to be solid, and a review of case reports from 1979 until now revealed only 5 cases that were mainly cystic tumors. The present case, in a patient who had undergone a previous hysterectomy and surgery for a peritoneal inclusion cyst, is reported due to its rarity and its unusual presentation, together with a brief review of the literature. The tumor showed no clinical signs and symptoms typical of a steroid hormone secreting tumor and had an atypical morphology, being primarily multi-septate cystic with a minor solid portion.
Accounting ; Female ; Humans ; Hysterectomy ; Ovary