BACKGROUND: Acute isovolemic hemodilution is one of the autologous transfusion which diminishes intraoperative blood loss and avoids homologous transfusion. A method of assessment of hemostatic function by whole blood is thrombelastography, which is a sensitive indicator of platelet interreaction with protein coagulation cascade. We investigated the effect of intraoperative isovolemic hemodilution on blood coagulation as measured by thrombelastography. METHODS: We studied in twenty-one patients undergoing elective total hip replacement arthroplasty. Hemodilution was done with Hartmann's solution and pentastarch and prothrombin time, activated partial thromboplastin time and native whole blood thrombelastography were performed preoperatively, immediate postoperative and days 2 postoperatively. RESULTS: The Hb, Hct and platelet count decreased significantly after hemodilution. The thrombelastographic changes included decreases in r and k with concurrent increases in alpha angle and MA in immediate postoperative time. On days 2, there were further increase in alpha angle and MA. These changes indicate enhanced procoagulant activity and progressive increase in maximum clot strength. Conclusion: Acute isovolemic hemodilution with Hartmann's solution and pentastarch induced hypercoagulable state without any serious complication in total hip replacement arthroplastic surgery.
Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Blood Coagulation ; Blood Platelets ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Thrombelastography*

PURPOSE: We evaluated the capability of MR in the diagnosis of anomalous pulmonary venous connection (APVC). MATERIALS AND METHODS: The patient group consisted of 11 total APVC and 8 partial APVC diagnosed with MR. Echocardiography was performed in all cases, cardiac angiography in 12 cases and operation in 12 cases. We compared MR findings with those of operation, echocard iography and cardiac angiography. RESULTS: In surgically proven 12 cases, diagnostic accuracy of preoperative MR, echocardiography and cardiac angiography was 100%, 67% and 63%, respectively. In the remaining cases, MR findings well correlated with those of echocardiography or cardiac angiography. Stenosis of common pulmonary vein or superior vena cava was identified in 4 cases. In one patient, MR depicted associated cor triatriatum clearly. CONCLUSION: MR is an effective modallty in depicting anomalous pulmonary venous con nections.
Angiography ; Constriction, Pathologic ; Cor Triatriatum ; Diagnosis ; Echocardiography ; Humans ; Pulmonary Veins ; Vena Cava, Superior

Benign ductal or glandular neoplasms of the esophagus unrelated to Barrett esophagus are extremely rare. Only 9 cases have been reported in the English language literature. We now report a case of esophageal gland duct adenoma incidentally found in a 73-year-old man. A 0.8 cm-sized, polypoid submucosal lesion in the distal esophagus was removed. Histologically, the lesion was well circumscribed and consisted of several ducts or cysts with focal papillary configurations. Interstitial lymphocytic infiltration with germinal centers was also observed. The lining cells of ducts or cysts were composed of two layers: an inner intensely eosinophilic luminal duct cell layer and an outer myoepithelial cell layer that was accentuated by alpha-smooth muscle actin. There was no significant nuclear atypia or mitosis. Mucin production was occasionally observed in a few goblet cells. To the best of our knowledge, this is the first case of benign ductal or glandular neoplasm of the esophagus among Koreans.
Actins ; Adenoma ; Aged ; Barrett Esophagus ; Eosinophils ; Esophagus ; Germinal Center ; Goblet Cells ; Humans ; Mitosis ; Mucins ; Muscles ; Neoplasms, Glandular and Epithelial ; Phenobarbital

OBJECTIVE: To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility. METHODS: Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling. RESULTS: Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r2=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r2=0.529) during the first phase of filling cystometry. CONCLUSION: Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.
Compliance* ; Female ; Humans ; Male ; Spinal Cord Injuries ; Urinary Bladder* ; Urinary Bladder, Neurogenic* ; Urinary Bladder, Overactive ; Urodynamics

Purpose: To evaluate the accuracy of magnetic resonance imaging (MRI)-guided breast biopsy. Methods: We retrospectively reviewed the clinical data of 111 consecutive patients referred for MRI-guided breast biopsy after mammography and breast ultrasound between May 2009 and April 2019. After excluding 37 patients without follow-up images (> 2 years), 74 patients (74 lesions) were finally included. We reviewed the histologic results of MRI-guided biopsy and subsequent surgery, post-biopsy management, and breast cancer development during followup. We investigated the false-negative rate, ductal carcinoma in situ (DCIS) underestimation, atypical ductal hyperplasia (ADH) underestimation rate, and technical failure rate of MRIguided biopsy. Results: Among 74 scheduled MRI-guided biopsies, six were canceled because biopsy was deemed unnecessary, while three failed due to technical difficulties (technical failure rate:3/68, 4.4%). MRI-guided biopsy was performed in 65 patients, of which 18 patients were diagnosed with malignant lesions, 46 with benign lesions, and one with ADH bordering on DCIS. Subsequent surgery (n = 27) showed DCIS underestimation in three cases (3/7, 43%), ADH underestimation in two cases (1/2, 50%), as well as seven concordant benign and 11 concordant malignant lesions. The overall false-negative rate was 4.3% (2/46). Thirty-eight out of 48 benign lesions were followed-up (median period, 5.8 years; interquartile range, 4.1 years) without subsequent surgery. Thirty-seven concordant benign lesions were stable (n = 27) or disappeared (n = 10); however, the size of one discordant benign lesion increased on follow-up MRI and it was diagnosed as DCIS after 1 year. Conclusion MRI-guided biopsy is an accurate method for exclusion of malignancy with a very low false-negative rate.

Purpose: To evaluate the accuracy of magnetic resonance imaging (MRI)-guided breast biopsy. Methods: We retrospectively reviewed the clinical data of 111 consecutive patients referred for MRI-guided breast biopsy after mammography and breast ultrasound between May 2009 and April 2019. After excluding 37 patients without follow-up images (> 2 years), 74 patients (74 lesions) were finally included. We reviewed the histologic results of MRI-guided biopsy and subsequent surgery, post-biopsy management, and breast cancer development during followup. We investigated the false-negative rate, ductal carcinoma in situ (DCIS) underestimation, atypical ductal hyperplasia (ADH) underestimation rate, and technical failure rate of MRIguided biopsy. Results: Among 74 scheduled MRI-guided biopsies, six were canceled because biopsy was deemed unnecessary, while three failed due to technical difficulties (technical failure rate:3/68, 4.4%). MRI-guided biopsy was performed in 65 patients, of which 18 patients were diagnosed with malignant lesions, 46 with benign lesions, and one with ADH bordering on DCIS. Subsequent surgery (n = 27) showed DCIS underestimation in three cases (3/7, 43%), ADH underestimation in two cases (1/2, 50%), as well as seven concordant benign and 11 concordant malignant lesions. The overall false-negative rate was 4.3% (2/46). Thirty-eight out of 48 benign lesions were followed-up (median period, 5.8 years; interquartile range, 4.1 years) without subsequent surgery. Thirty-seven concordant benign lesions were stable (n = 27) or disappeared (n = 10); however, the size of one discordant benign lesion increased on follow-up MRI and it was diagnosed as DCIS after 1 year. Conclusion MRI-guided biopsy is an accurate method for exclusion of malignancy with a very low false-negative rate.

This study was conducted to confirm the performance of the microRNA (miRNA) biomarker combination as a new breast cancer screening method in Korean women under the age of 50 with a high percentage of dense breasts. To determine the classification performance of a set of miRNA biomarkers (miR-1246, 202, 21, and 219B) useful for breast cancer screening, we determined whether there was a significant difference between the breast cancer and healthy control groups through box plots and the Mann– Whitney U-test, which was further examined in detail by age group. To verify the classification performance of the 4 miRNA biomarker set, 4 classification methods (logistic regression, random forest, XGBoost, and generalized linear model plus random forest) were applied, and 10-fold cross-validation was used as a validation method to improve performance stability. We confirmed that the best breast cancer detection performance was achievable in patients under 50 years of age when the set of 4 miRNAs were used. Under the age of 50, the 4 miRNA biomarkers showed the highest performance with a sensitivity of 85.29%, specificity of 93.33%, and area under the curve (AUC) of 0.961. Examining the results of 4 miRNA biomarkers was found to be an effective strategy for diagnosing breast cancer in Korean women under 50 years of age with dense breasts, and hence has the potential as a new breast cancer screening tool. Further validation in an appropriate screening population with large-scale clinical trials is required.

Neonatal lupus erythematosus (NLE) is a rare disease characterized by typical clinical features and the transplacental passage of maternal autoantibodies, particularly anti-SSA/Ro. The major clinical manifestations are cutaneous lupus lesions, congenital heart block, hematological disorders, and hepatobiliary diseases. We report a case of NLE presenting with multiple round and oval target-like erythematous skin lesions and abnormal liver function, born to a clinically asymptomatic mother whose diagnosis was made retrospectively only after her newborn's diagnosis. Both the infant and the mother were positive for the anti-SSA/Ro and anti-SSB/La antibodies.
Antibodies ; Autoantibodies ; Heart Block ; Humans ; Infant ; Liver ; Lupus Erythematosus, Systemic ; Mothers ; Rare Diseases ; Retrospective Studies ; Skin

PURPOSE: Aplasia cutis congenita (ACC) is a rare condition characterized by a localized absence of skin, and it can be associated with other congenital anomalies. This study was done to evaluate clinical course and outcome of ACC in neonates. METHODS: Based on the medical records, we retrospectively reviewed 8 neonates diagnosed with ACC at Cheil General Hospital and Women's Health Care Center, Kwandong university College of Medicine from January 2004 to December 2010. We classified ACC by Frieden's classification and analyzed the patient's demographic data, clinical course and outcome. RESULTS: Among 8 patients with ACC, 5 patients were classified to group 1; scalp ACC without anomalies and 3 patients to group 7; ACC localized to extremities without blistering. Defect size was from 0.3 cm to 1.5 cm, limited in the superficial skin or subcutaneous tissue without associated anomalies. Defects were healed under conservative treatment with mild scar formation within four months. CONCLUSION: ACC could be diagnosed easily through physical examination in neonates. All cases showed good clinical outcome without surgical treatment. However because of small numbers and small sized defects of cases, further study including lesions of large size is needed.
Blister ; Cicatrix ; Ectodermal Dysplasia ; Extremities ; Hospitals, General ; Humans ; Infant, Newborn ; Medical Records ; Physical Examination ; Prognosis ; Retrospective Studies ; Scalp ; Skin ; Subcutaneous Tissue ; Women's Health

OBJECTIVES: The aim of this study was to evaluate the risk factors of suicide attempt in patients with alcohol dependence. METHODS: A total of 68 patients admitted to the hospital for alcohol dependence were divided into two groups according to history of suicide attempt. In this study, sociodemographic variables, characteristics of alcohol drinking, and clinical scales were compared between the two groups. RESULTS: Regarding sociodemographic and clinical features, the alcoholic group with history of suicide attempt included more patients with no spouse, using medical aid in social security, and history of depressive disorder. Regarding characteristics of alcohol drinking, ages of first alcohol problems and first admission for alcohol problems were significantly younger in the attempter group. Patients in the attempter group had been drinking more and had higher frequency of delirium tremens and psychiatric admission. Regarding clinical scales, significantly higher scores for suicide ideation, depression, anxiety, and impulsiveness were observed in the attempter group. Among the scores for Temperament and character inventory, the score for persistence was significantly lower in the attempter group. After controlling for other compounding factors, depressive disorder [p=0.006, odds ratio (OR)=32.2] and suicide ideation (p=0.029, OR=1.2) were significant factors showing correlation with suicide attempt. CONCLUSION: Results of this study suggest that assessment and management of the depressive disorder and suicide ideation are necessary for suicide prevention in patients with alcohol dependence.
Alcohol Drinking ; Alcohol Withdrawal Delirium ; Alcoholics ; Alcoholism ; Anxiety ; Depression ; Depressive Disorder ; Drinking ; Humans ; Male ; Odds Ratio ; Risk Factors ; Social Security ; Spouses ; Suicide ; Temperament ; Weights and Measures