The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multiple-trauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and anti-thrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.
Abdominal Pain ; Aged ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Brain ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Drainage ; Emergencies ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Iliac Artery ; Multiple Trauma ; Shock ; Sleep Stages ; Subarachnoid Hemorrhage, Traumatic* ; Tomography, X-Ray Computed ; Vital Signs

Heterotopic pregnancy is defined as simultaneous intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancies, but it has been increased. This increased incidence is explained by the rise in PID, pelvic surgery, IUD and assisted reproductive technologies-in vitro fertilization/gamate intrafallopian insemination/intrauterine insemination. Thus careful pelvic examination combined with serial beta-hCG determinations and transvaginal sonography to evaluate the adnexal region are necessary prerequisites for early diagnosis. We report a case of heterotopic pregnancy following in ovulation induction and intrauterine insemination with a brief review of literature.
Early Diagnosis ; Female ; Gynecological Examination ; Incidence ; Insemination* ; Ovulation Induction* ; Ovulation* ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic*

OBJECTIVE: This study analyzed the relationship between prognosis and multiple clinical factors of ruptured middle cerebral artery (MCA) aneurysm with intracerebral hemorrhage (ICH), to aid in predicting the results of surgical treatment. METHODS: Enrolled subjects were 41 patients with ruptured MCA aneurysm with ICH who were treated with surgical clipping. Clinical factors such as gender, age, and initial Glasgow coma scale were assessed while radiological factors such as the volume and location of hematoma, the degree of a midline shift, and aneurysm size were considered retrospectively. Prognosis was evaluated postoperatively by Glasgow outcome scale. RESULTS: Age and prognosis were correlated only in the groups with ICH over 31 mL or ICH at the frontal lobe or sylvian fissure. When initial mental status was good, only patients with ICH on the temporal lobe had a better prognosis. If the midline shift was less than 4.5 mm, the probability of better prognosis was 95.5% (21 of 22). If the midline shift was more than 4.5 mm, the probability of poor prognosis was 42.1% (8 of 19). Patients with ICH less than 31 mL had higher survival rates, whereas if the ICH was more than 31 mL, 41.2% (7 of 17) had a poor clinical pathway. CONCLUSION: Even if the initial clinical condition of the patient was not promising, by carefully examining and taking into account all factors, neurosurgeons can confidently recommend surgical treatment for these patients.
Aneurysm ; Cerebral Hemorrhage ; Frontal Lobe ; Glasgow Coma Scale ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Prognosis ; Retrospective Studies ; Surgical Instruments ; Survival Rate ; Temporal Lobe

Ovarian remnant syndrome is a rare condition which develops when functional ovarian tissue is left in situ after intended bilateral oophorectomy. It produces clinically significant syndrome, namely chronic pelvic pain and dysmenorrhea. Although the true incidence of this syndrome is unknown, an apprant increase in incidence has been reported. We have experienced a case of ovarian remnant syndrome showing chronic pelvic pain and palpable abdominal mass after difficult gynecologic operation. So, we report this case with a brief review of literatures.
Dysmenorrhea ; Female ; Incidence ; Ovariectomy ; Pelvic Pain

"Pseudomyxoma peritonei is a clinical entity in which the peritoneal surface and omentum are involved with gelatinous, mucinous implants, and often massive gelatinous ascites. Most cases originate from ruptured ovarian mucinous cysts or appendiceal mucoceles, and involve only the intraperitoneal cavity. But there is much confusion about its etiology, clinical manifestation, treatment, and prognosis. We experienced a case of pseudomyxoma peritonei originating from the mucinous cystic tumor of borderline malignancy in unilateral ovary with rupture. A case of pseudomyxoma peritonei is reported with a brief review of the literature."
Female ; Gelatin ; Mucins ; Mucocele ; Omentum ; Ovary ; Prognosis ; Pseudomyxoma Peritonei* ; Rupture

PURPOSE: This study investigates the COX-2 expression in human primary breast carcinomas and its relationship with both angiogenesis and the expression of estrogen receptor. MATERIALS AND METHODS: COX-2 expression, angiogenesis, and estrogen receptor expression were examined by immunohistochemical methods in 167 human breast carcinomas by using monoclonal antibodies against COX-2, CD34, and estrogen receptor protein. RESULTS: Although COX-2 was expressed in 77.8% of the breast carcinomas (130/167) regardless of histological types, it was not detected at all in benign epithelial cells. Interestingly, COX-2 expression was found to be significantly correlated with tumor angiogenesis (p=0.004), but not with estrogen receptor and other histopathologic parameters. CONCLUSION: The results suggest that COX-2 expression occurs frequently in breast tissue during transformation of benign epithelial cells to malignant cells regardless of the estrogen receptor status. COX-2 expression may play a role in tumor angiogenesis that is responsible for tumor growth and metastasis.
Antibodies, Monoclonal ; Breast Neoplasms* ; Breast* ; Cyclooxygenase 2* ; Epithelial Cells ; Estrogens* ; Humans* ; Neoplasm Metastasis

Adenomyomas of the stomach are rare tumors characterised by duct/gland-like structures embedded within a smooth muscle stroma. A 5-year-old female patient was admitted to the department of Pediatrics, Ewha Womans University MokDong Hospital with the history of severe epigastric pain and vomiting for 1 day. Esophagogastroduodenoscopy showed bridging fold with central dimpling on posterior wall of prepyloric antrum. Endoscopic biopsy was nondiagnostic. The patient complained epigastric pain continuously and underwent wedge resection. Pathologic examination showed an adenomyoma of the prepyloric antrum. After wedge resection, the patient did not complain epigastric pain during the postoperative follow-up. We report an unusual case of an adenomyoma of stomach.
Adenomyoma* ; Biopsy ; Child* ; Child, Preschool ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Humans ; Muscle, Smooth ; Pediatrics ; Stomach* ; Vomiting

BACKGROUND: Procalcitonin (PCT) has been suggested as a marker of bacterial infection with systemic manifestation. The purpose of this study was to determine whether PCT level can be used to discriminate between the sepsis or septic shock and localized infection or non-infection. MATERIALS AND METHODS: This was a prospective study involving 71 patients who presented with fever. The final diagnosis was inflammation without infection in 16, localized infection in 25, sepsis in 15, and septic shock in 15. We compared the different parameters of infection- erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), interleukin-6 (IL-6), and PCT - by comparing the area under the receiver operating characteristic curves (AUCs) of sepsis/or septic shock and localized infection/or non-infection. We also determined the predictive power of PCT in detecting sepsis. RESULTS: The median PCT concentrations were 0.85 (range, 0.747-1.57) ng/mL for non-infection, 1.28 (0.73- 2.33) ng/mL for localized infection, 2.59 (1.87-9.0) ng/ mL for sepsis, and 23.9 (23.1-126.1) ng/mL for septic shock. PCT exhibited the highest discriminative value, with an AUC of 0.889 (95% CI, 0.81-0.97), followed by IL-6 (0.779; CI, 0.65-0.90), CRP (0.642; CI, 0.51-0.78), and ESR (0.412; CI, 0.28-0.56). At a cutoff value of 1.73 ng/mL, PCT showed sensitivity of 86.5%, specificity of 75.6%, positive predictive value of 72.2%, and negative predictive value of 88.6%. CONCLUSION: The PCT concentrations could be used to help discriminate sepsis in newly admitted febrile patients.
Area Under Curve ; Bacterial Infections ; Blood Sedimentation ; Diagnosis* ; Fever* ; Humans ; Inflammation ; Interleukin-6 ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Sepsis ; Shock, Septic

BACKGROUND: Procalcitonin (PCT) has been suggested as a marker of bacterial infection with systemic manifestation. The purpose of this study was to determine whether PCT level can be used to discriminate between the sepsis or septic shock and localized infection or non-infection. MATERIALS AND METHODS: This was a prospective study involving 71 patients who presented with fever. The final diagnosis was inflammation without infection in 16, localized infection in 25, sepsis in 15, and septic shock in 15. We compared the different parameters of infection- erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), interleukin-6 (IL-6), and PCT - by comparing the area under the receiver operating characteristic curves (AUCs) of sepsis/or septic shock and localized infection/or non-infection. We also determined the predictive power of PCT in detecting sepsis. RESULTS: The median PCT concentrations were 0.85 (range, 0.747-1.57) ng/mL for non-infection, 1.28 (0.73- 2.33) ng/mL for localized infection, 2.59 (1.87-9.0) ng/ mL for sepsis, and 23.9 (23.1-126.1) ng/mL for septic shock. PCT exhibited the highest discriminative value, with an AUC of 0.889 (95% CI, 0.81-0.97), followed by IL-6 (0.779; CI, 0.65-0.90), CRP (0.642; CI, 0.51-0.78), and ESR (0.412; CI, 0.28-0.56). At a cutoff value of 1.73 ng/mL, PCT showed sensitivity of 86.5%, specificity of 75.6%, positive predictive value of 72.2%, and negative predictive value of 88.6%. CONCLUSION: The PCT concentrations could be used to help discriminate sepsis in newly admitted febrile patients.
Area Under Curve ; Bacterial Infections ; Blood Sedimentation ; Diagnosis* ; Fever* ; Humans ; Inflammation ; Interleukin-6 ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Sepsis ; Shock, Septic

Prune-belly syndrome is a rare compound fetal anomaly, characterized by absence or hypoplasia of abdominal wall musculature associated with urinary tract abnormalities and cryptorchidism. The prenatal ultrasound diagnosis was based on the findings of a lower abdominal cystic echo caused by abnormal dilatation of the bladder, upward compression of small intestines and decreased amniotic fluid volume. We experienced a case of Prune-belly syndrome diagnosed by ultrasound in a 12 weeks fetus following to IVF-ET pregnancy. Termination was performed at 12 weeks and autopsy confirmed the distended bladder, absence of abdominal muscles and urethra. So, we reported this case with a brief review of literature.
Abdominal Muscles ; Abdominal Wall ; Amniotic Fluid ; Autopsy ; Cryptorchidism ; Diagnosis ; Dilatation ; Female ; Fetus ; Intestine, Small ; Male ; Pregnancy ; Prenatal Diagnosis ; Prune Belly Syndrome* ; Ultrasonography* ; Urethra ; Urinary Bladder ; Urinary Tract