No abstract available.
Disabled Persons* ; Female ; Humans ; Menarche*

Primary carcinoma of the fallopian tube is an extremely rare malignancy of the female genital tract. We have experienced two cases of primary carcinoma in the fallopian tube. One case with huge mass which was diagnosed incidentally on the basis of the biopsy findings, and the other case of the 3 years follow-up. We reported the cases with a brief review of the concemed literatures.
Biopsy ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Humans

No abstract available.
Doxorubicin* ; Drug Therapy, Combination* ; Etoposide* ; Stomach Neoplasms*

OBJECTIVE: The Purpose of this study was to compare the perioperative variables in patients administered inhalation or regional anesthesia for the initial cesarean section following emergency hysterectomy under general anesthesia. METHODS: Emergency cesarean hysterectomies performed between January 1993 and December 2004 was analyzed retrospectively. There were 65 emergency cesarean hysterectomies during the period. General anesthesia for both delivery and following hysterectomy was employed 24 cases (General group) and regional anesthesia for the initial cesarean section following general anesthesia for emergency hysterectomy was employed 41 cases (Regional group). RESULTS: Most common indication of cesarean hysterectomy was placenta accreta in the both groups. Incidence of uterine atony without pathology was higher in the regional group than in the general group (34.1% vs. 4.2%). There was no difference in the intraoperative managements, estimated blood loss, and transfusions between the two groups. Total perioperative complications were found in 20 out of 65 cases (28.2%), and the incidence of disseminated intravascular coagulopathy (DIC) was higher in the regional group than in the general group (24.4% vs. 4.2%). CONCLUSION: The anesthetic method did not affect the intraoperative managements although the incidence of uterine atony without pathology was higher, and perioperative DIC was more in the regional group than in the general group.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Cesarean Section ; Dacarbazine ; Emergencies* ; Female ; Humans ; Hysterectomy* ; Incidence ; Inhalation ; Pathology ; Placenta Accreta ; Pregnancy ; Retrospective Studies ; Uterine Inertia

Hemangiopericytoma is a rare vascular tumor arising from pericytes. The tumor usually develops in the skin or subcutaneous tissue, particularly in the extremities.4 pulmonary origin of hemangiopericytoma is known to be quite rare. It has the potential to become a highly malignant lesion, so wide excision is the treatment of choice. We present a case of primary malignant hemangiopericytoma of the lung and discuss the clinical symptoms, diagnosis, therapy and prognosis within the context of a brief review.
Diagnosis ; Hemangiopericytoma* ; Lung* ; Pericytes ; Prognosis ; Skin ; Subcutaneous Tissue

Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient's family. In contrast, when health care professionals in the ED recognize ethical problems, they often don't have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.
Beneficence ; Decision Making ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Ethicists ; Ethics Committees, Clinical ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Social Justice

BACKGROUND: The toxicity of paraquat has been known to be caused by oxygen free radicals which leads to the lipid peroxidation and multiple organ failure. Although vitamin C has been known to be a potent antioxidant, recently there are numerous data which have shown that a low dose of vitamin C may act as a prooxidant due to the stimulation of the Fenton reaction with metal ions, which produces hydroxyl radicals. It has been reported that a deferoxamine in paraquat intoxication could reduce the production of the hydroxyl radicals by the inhibition of the Fenton reaction through the reduction of iron ion in tissue. The aim of this study was to evaluate the effect of the high and low dose of vitamin C and deferoxamine on lipid peroxidation and plasma TNF-alpha in paraquat intoxication. METHODS: Female Sprague-Dawley rats were divided into seven groups: control group which was not given paraquat(20mg/kg), P group which was given paraquat only, PVH group given paraquat and high dose of vitamin C(100mg/kg), PVL group given paraquat and low dose of vitamin C(10mg/kg), PVHD given paraquat, high dose of vitamine C and deferoxamine(100mg/kg), PVLD given paraquat, low dose of vitamin C and deferoxamine, and PD given paraquat and deferoxamine. Animals were killed at 6 and 24 hours after treatment. Malondialdehyde(MDA), superoxide dismutase(SOD) and glutathione(GSH) contents, catalase activity, plasma TNF-alpha, and histologic changes in the lung and liver tissue were measured. RESULTS: The lung histology in the PVH and PD or PVHD groups showed the significant decreases in the alveolar edema and interstitial thickness compared to the P group. The liver histology in the PVH and PVHD groups demonstrated marked differences in the central venous and sinusoidal dilatation compared to that of the P group. While the MDA levels of the lung and liver in the PVH and PD groups showed the significant reduction compared to that of the P group at 6 hours after treatment, all groups showed the significant changes compared to the P group at 24 hours. There was no significant change of the SOD levels of the lung and liver at 6 hours among all groups. At 24 hours, the SOD levels of the lung in PVH, PVL, and PVHD groups showed the significant increases compared to the P group. The increase of the SOD level in groups combined with deforoxamine, however, revealed a little reduction. The SOD level of the liver in PVH group only significantly increased compared to the P group at 24 hours. There was no significant change of the GSH level of the lung and liver among all groups at 6 hours. At 24 hours, the GSH level of the lung and liver were significantly increased in both PVH and PD group and PVH group, respectively, compared to the P group. Although the catalase activity of the lung was not significantly increased, that of liver was significantly increased in both PVHD and PD groups compared to the P group at 6 hours. The catalase activities of the lung and liver were significantly increased in PVH, PD, and PVHD at 24 hours. The concentrations of the Plasma TNF-alpha were slightly decreased at 6 hours and slightly increased at 24 hours compared to that of the P group, but they were not significant. CONCLUSION: This study showed that although the low dose of vitamin C had no effect, the high dose of vitamin C revealed a decrease of the MDA level and an increase of SOD, GSH, and catalase activity in the lung and lung and liver tissues, and the effect of the high dose of vitamin C increased with time. The administration of the deferoxamine with or without high dose of vitamin C, however, significantly showed the inhibition of the lipid peroxidation and antioxidant effect and low dose vitamin C decreased the effect of deferoxamine. The effects of the vitamin C and deferoxamine on plasma TNF-alpha were not clearly shown.
Animals ; Antioxidants* ; Ascorbic Acid* ; Catalase ; Deferoxamine* ; Dilatation ; Edema ; Female ; Free Radicals ; Humans ; Ions ; Iron ; Lipid Peroxidation* ; Liver ; Lung ; Multiple Organ Failure ; Oxygen ; Paraquat* ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Superoxides ; Tumor Necrosis Factor-alpha ; Vitamins*

PURPOSE: The purpose of this study was to evaluate the appropriateness of prehospital emergency care by 119 rescue services in Seoul. METHODS: We enrolled all patients who used 119 rescue services in Seoul between January and Sepember 2006 and analyzed the 119 ambulance patient care record databases. Major emergencies were defined and categorized into four groups: cardiopulmonary complaint (CP), neurologic complaint (NR), cardiorespiratory arrest (CA) and major trauma (MT). Interventions provided by emergency medical technicians were scored as 2:essential, 1:optional and 0:unnecessary in each category of major emergency. We summed scores of provided interventions per patient and graded them into four levels for conducting the appropriateness review. Multivariate logistic regression analysis was performed to determine the relationship of risk factors to the appropriateness of intervention. RESULTS: Total number of cases was 171,112 of which 36,065 were major emergencies. The proportion of "very low" level appropriate was 40.1% for CP (N=11,522). 49.3% for NR (N=15,239), 14.5% for CA (N=1,591), and 32.7% for MT (N=7,713). The proportion of "high" level was less than 3% except for CA(11.3%). Variables affecting the "moderate" or "high" level of appropriateness of prehospital emergency care, as determined by multivariate logistic regression analysis, were age > or =65(OR: 1.425, 95% CI: 1.337-1.520), female gender (OR: 0.880, 95% CI: 0.828-0.935), and type of complaint in the order CP (OR: 0.181, 95% CI: 0.161-0.204), NR (OR: 0.184, 95% CI: 0.164-0.207), and MT (OR: 0.202, 95% CI: 0.178-0.229). CONCLUSION: The prehospital emergency care of 119 rescue services in Seoul was frequently inappropriate and was influenced by patient's age, gender and chief complaints.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Female ; Humans ; Logistic Models ; Patient Care ; Regional Health Planning ; Risk Factors

BACKGROUND: Pulmonary tuberculosis is one of the diseases characterized granuloma formation which was controlled by cellular immune reactions. In the process of granulomatous changes, activated alveolar macrophages and T lymphocytes secrete many cytokines including interleukin-1 (IL-1), tumor necrosis factor-alpha(TNF-alpha), interferon-gamma (INF-gamma) which mediate inflammatory reactions. Intercelluar adhesion molecule-1(ICAM-1) also known to major role player in inflammatory processes, and increased cellular expressions when endothelial cell was stimulated by IL-1, TNF and IFN. METHOD: To evaluate relationships among cellular immune reactions and clinical stages, pulmonary tuberculosis patients were classifed into three groups according to their clinical stages including minimal, moderate and far advance tuberculosis. TNF-alpha, INF-gamma, sICAM-1 (soluble form of ICAM-1) were measured at the time of diagnosis and after 6-months anti-tuberculosis medications by radioimmuno assay or enzyme linked immunosolvent assay. RESULTS: TNF-alpha, INF-gamma, sICAM-1 were singificantly increased in moderate and far advanced pulmonary tuberculosis patients but no meaningful changes in minimal staged patients. 6-months anti-tuberculosis medications reduced serum sICAM-1 levels significantly, related to clinical improvement but no significnat changes were found in the serum levels of TNF-alpha and INF-gamma. In the point of correlations, positive ones revealed between TNF-alpha and sICAM-1, also between IFN-gamma and sICAM-1 but no correlation between TNF-alpha and IFN-gamma. CONCLUSION: Measurement of serum sICAM-1 could be usuful parameter to evaluate the severity of pulmonary tuberculosis and to monitor disease activities durig anti-tubercoulsis medications.
Cytokines ; Diagnosis ; Endothelial Cells ; Granuloma ; Humans ; Interferon-gamma* ; Interleukin-1 ; Macrophages, Alveolar ; Necrosis ; T-Lymphocytes ; Tuberculosis ; Tuberculosis, Pulmonary* ; Tumor Necrosis Factor-alpha*

Polymorphonuclear leukocytes(PMN) are the predominant inflammatory cells recruited in acute lung injury such as adult respiratory distress syndrome, pneumonia and also chronic lung disease such as idiopathic pulmonary fibrosis and pulmonary emphysema. Interleukin -8(IL-8) is an 8,000 D protein produced by many cells and has potent neutrophil chemoattractant and activating properties. The GRO, also called melanoma growth-stimulatory activity(MGSA), referring to a peptide of 73 amino acids, was reported to be mitogenic for cultured human melanoma cells. Mature GRO/MGSA has marked sequence similarity to IL-8. In view of the structural similarities to IL-8, it was of particular interest to test GRO for neutrophil activating and chemotactic properties. We found a significant release of IL-8 and GRO/MGSA from the cultured human umbilical vein endothelial cell(HUVEC) which was stimulated either with TNFalpha or IL-1beta and also found the expression of IL-8 and GRO/MGSA mRNA. Neutrophil chemotactic activity was enhanced in accordance with the increased IL-8 and GRO/MGSA. Our study also suggest that the IL-8 is more important in the increased neutrophil chemotactic activity than GRO/MGSA when endothelial cell is stimulated with TNFalpha or IL-1beta in vitro.
Acute Lung Injury ; Amino Acids ; Endothelial Cells ; Humans ; Idiopathic Pulmonary Fibrosis ; Interleukin-1* ; Interleukin-8* ; Interleukins ; Lung Diseases ; Melanoma ; Neutrophils ; Pneumonia ; Pulmonary Emphysema ; Respiratory Distress Syndrome, Adult ; RNA, Messenger ; Tumor Necrosis Factor-alpha* ; Umbilical Veins