Anesthesiologists are occasionally faced with a dilemma in managing Jehovah's witness patients who refuse transfusion of blood or blood products in life threatening situations. We report a case in which a 28-year old Jehovah's witness parturient underwent an emergency cesarean section due to complex problems of fetal distress, twin pregnancy and preeclampsia. Despite the severe anemia, she had a good postoperative recovery without any complications. We suggest that it is necessary to know the religious background, ethical issues and conflicts in caring for Jehovah's Witness patients, and be familliar with perioperative management without transfusion for these cases.
Adult ; Anemia ; Cesarean Section* ; Emergencies* ; Ethics ; Female ; Fetal Distress ; Humans ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin

No abstract available.
Giant Cell Tumors* ; Giant Cells* ; Ribs*

BACKGROUND: It is well-known that migraineurs frequently have abnormal findings on transcranial Doppler ultra-sound (TCD), but their clinical implications are not clear. We investigated the clinical significance of TCD findings in migraineurs. METHODS: One hundred thirty-seven consecutive migraineurs were prospectively gathered. The following clinical parameters were investigated : 1) age and sex, 2) time from onset of headache to visiting hospital, 3) frequency, duration, laterality, pulsating quality, and severity of headache, 4) presence of nausea, vomiting, photophobia, and phonophobia, 5) aura, and 6) aggravation of headache by routine physical activity. TCD was performed during a headache-free period to measure the mean flow velocities (MFVs) and other parameters of 13 intracranial and 2 extracranial vessels. If MFV of any artery or its side-to-side difference in each migraineur was beyond 2 standard deviations of corresponding age and sex-matched reference subgroups, the TCD result was regarded as abnormal. Correlations between abnormal TCD and clinical parameters were examined by univariate and multivariate analyses. RESULTS: Results of TCD were abnormal in 84 patients (61.3%). Pulsatility of headache and absence of aura were significantly correlated with abnormal TCD on univariate analyses (p=0.003 and 0.049 respectively). On multivariate analysis, pulsatility of headache was the only statistically significant predictor of abnormal TCD (p=0.015). Headache attacks tended to be less frequent in patients with abnormal TCD with marginal significance (p=0.050). CONCLUSIONS: Our study shows that abnormal results on TCD are more frequent in migraineurs with pulsatile headache. An association between abnormal TCD and frequency of headache attacks is suggested.
Arteries ; Epilepsy ; Headache ; Humans ; Hyperacusis ; Migraine Disorders ; Motor Activity ; Multivariate Analysis ; Nausea ; Photophobia ; Prospective Studies ; Vomiting

Ophthalmoplegia, ataxia, and areflexia are a classical triad of Miller Fisher syndrome (MFS). The experience of dizziness secondary to ophthalmoplegia is also not uncommon. However, nystagmus is rare and vertigo, a symptom of vestibulocerebellar dysfunction, has not been reported yet. A 56-year-old woman visited our hospital due to sudden vertigo. Initial examination revealed nystagmus evoked by a bilateral horizontal gaze with left side dysmetria. The next day, her symptoms rapidly aggravated to ophthalmoplegia, severe ataxia, areflexia, and quadriplegia. She was diag-nosed with MFS and was treated with intravenous immunoglobulin. On the fourth day, she developed respiratory fail-ure and a ventilator was applied. Twenty-eight days after her admission, she recovered to the point of walking without any aid and was discharged with minimal disability. There are still controversies surrounding the nosology of MFS and many investigators have reported evidence for brainstem involvement. Vertigo can be additional evidence for the involvement of the central nervous system in MFS.
Ataxia ; Brain Stem ; Central Nervous System ; Cerebellar Ataxia ; Dizziness ; Female ; Humans ; Immunoglobulins ; Middle Aged ; Miller Fisher Syndrome* ; Ophthalmoplegia ; Quadriplegia ; Research Personnel ; Ventilators, Mechanical ; Vertigo* ; Walking

Cerebrovascular complications are of the most frequent intracranial complications of bacterial meningitis. Most of the previous reports suggest that the prognosis for the pafients with cerebrovascular complications was unfavorable. We recently experienced a case of meningococcal meningitis with fulminant meningococcemia associated with multifocal non-enhancing lesions on, initial brain MRI. These lesions were hyperintense on T2weighted image and were located in left basal ganglia, both medial thalami, periventricular white matter, left cerebellar hemisphere, and right midbrain and were considered to be resulted from small vessel involvement. Gram negative diplococci were detected by Gram staining of specimens from skin lesion. After antimicrobial therapy and glucocorticoid replacement the patient was recovered without any neurologic sequelae. After one month, follow-up MRI showed resolution of all the ischemic lesions except in midbrain. Additionally there was a small focal hemtoma formation in left basal ganglia. The small hematoma was considered to be resulted from rupture of microaneurysm and disappeared on follow up MRI performed after 3 months. This case suggests that the cerebrovascular complications in meningococcal mningitis might be treated successfully.
Basal Ganglia ; Brain ; Follow-Up Studies ; Hematoma* ; Humans ; Magnetic Resonance Imaging ; Meningitis* ; Meningitis, Bacterial ; Meningitis, Meningococcal ; Mesencephalon ; Prognosis ; Rupture ; Skin

Coloring Agents ; Cytomegalovirus ; Endothelial Cells ; Humans ; Intranuclear Inclusion Bodies ; Male ; Methenamine ; Mouth ; Oral Manifestations ; Stomatitis ; Tongue ; Ulcer

BACKGROUND: THP-adriamycin ia a tetrahydropyranyl derivative of adriamycin with compatible anti-lymphoma effect but fewer side effects, especially cardiac, nausea/vomiting and alopecia. So we performed a multicenter study of 4-drug combination chemotherapy, THP-COP regimen for patients with non-Hodgkin's lymphoma to evaluate the response rate, survival time and toxicity by Malignant Lymphoma Study Group in Korea. METHODS: Between June 1996 and Feb. 1997, previously untreated stage II/III/IV intermediate and high-grade non-Hodgkin's lymphoma patients were treated with a THP-COP regimen including THP-adriamycin 40 mg/m2 on day 1, cyclophosphamide 750 mg/m2 on day 1, oncovin 1.4 mg/m2 on day 1, and prednisolone 100 mg PO on day 1-5 with 3 weeks interval. RESULTS: Twenty six patients (89.7%) were evaluable. Patient characteritics include: median age 54.8 years (16-76) and 13 patients were 60 years or old; clinical stage II in 9 patients (34.6%), stage III in 7 patients (26.9%), and stage IV in 10 patients (38.5%). Objective response were 13 CR, 7 PR, 6 PD with 76.9% response rate. Six months and 1 year survival rates and progression-free survival rates were 87.8%, 70.4%, and 85.0%, 60.5% respectively. Grade 3/4 toxicities were anemia in 7.7%, neutropenia in 53.8%, thrombocytopenia in 3.8%, vomiting in 7.7%, alopecia in 7.7% and increased SGOT in 3.8%. Prognostic significance of age and International Prognostic Index were not demonstrated. CONCLUSION: THP-COP combination chemotherapy is active in advanced stage, non-Hodgkin's lymphoma with low incidence of vomiting and alopecia.
Alopecia ; Anemia ; Aspartate Aminotransferases ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Incidence ; Korea ; Lymphoma* ; Lymphoma, Non-Hodgkin* ; Neutropenia ; Prednisolone ; Survival Rate ; Thrombocytopenia ; Vincristine ; Vomiting

An influenza pandemic due to a novel influenza A/H1N1 virus occurred after April 2009. This virus has some characteristics that differentiate it from the seasonal influenza virus. The 2009 pandemic influenza A/H1N1 virus can frequently infect the lower respiratory tract, and it might cause acute tracheobronchitis as well as pneumonia. Viral-bacterial interaction is well known as an important mechanism of the pathogenesis of respiratory complications of influenza. Herein, we report on a case that presented with pseudomembranous tracheobronchitis complicated by coinfection with 2009 pandemic influenza A/H1N1 and Staphylococcus aureus. We also review the relevent literature.
Bronchoscopes ; Coinfection ; Influenza, Human ; Orthomyxoviridae ; Pandemics ; Pneumonia ; Respiratory System ; Seasons ; Staphylococcus ; Staphylococcus aureus ; Viruses

Ulcerative colitis (UC) is one of the chronic inflammatory bowel diseases (IBD), characterized by a diffuse mucosal inflammation limited to the colon. Complications of UC include stricture, colorectal cancer, and toxic colitis. UC patients rarely present with a stenosis or fistula, and strictures develop in less than 5% of patients with UC. We present a patient with UC, accompanied by unusual complications that involved not only a stricture but also a fistula and abscess. A 49-year-old female was presented with a left flank pain and fever that had begun two weeks before admission. She had received a diagnosis of UC 20 years ago and had it treated for 2 years in a local hospital. However, she arbitrarily stopped visiting the hospital and relied on home remedies. An abdominopelvic CT scan revealed luminal narrowing and extra-peritoneal fistula formation in the descending colon. Fistula was connected with a subcutaneous abscess in the left flank. She had undergone total colectomy and ileo-anal anastomosis. On the pathologic exam, the long standing UC with severe stenosis was observed without malignant change. It cannot be emphasized enough that a correct therapeutic approach and an appropriate follow-up schedule are very important for patients with UC.
Abscess ; Appointments and Schedules ; Colectomy ; Colitis ; Colitis, Ulcerative ; Colon ; Colon, Descending ; Colorectal Neoplasms ; Constriction, Pathologic ; Female ; Fever ; Fistula ; Flank Pain ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Intestinal Fistula ; Medicine, Traditional ; Middle Aged ; Phenobarbital ; Ulcer

PURPOSE: E2F3 is important for cell cycle regulation and DNA replication. Recent studies have reported that members of the E2F family can play specific and diverse roles in the tumorigenesis of human malignancies, and the E2F3 expression appears to provide a growth advantage to tumor cells by activating cell proliferation in bladder tumors. We studied the prognostic significance of E2F3 expression in bladder cancer. MATERIALS AND METHODS: We examined the expression of E2F3 with using immunohistochemical staining in the tumor samples from 109 patients suffering with bladder cancer, and we analyzed the prognostic significance of E2F3 according to the grade, stage, recurrence and progression of bladder cancer. RESULTS: We found positive staining for E2F3 in 23 cases (21.1%). The E2F3 expression was correlated with the tumor stage (superficial vs. invasive, p<0.001) and the tumor grade (p=0.001). The E2F3 expression was not correlated with the recurrence and progression of superficial bladder cancer. CONCLUSIONS: In this study, our results showed that the E2F3 expression was observed in a portion of the bladder cancer specimens. These results suggest that E2F3 may contribute to the development of bladder cancer, but it may not play a role as a prognostic factor of bladder cancer.
Carcinogenesis ; Cell Cycle ; Cell Proliferation ; DNA Replication ; E2F3 Transcription Factor ; Humans ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*