BACKGROUND: Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients. METHODS: A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher. RESULTS: Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients' mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016). CONCLUSIONS: This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.
Emergency Service, Hospital ; Factor VIIa* ; Female ; Humans ; Maternal Death ; Maternal Mortality ; Medical Records ; Organ Dysfunction Scores ; Postpartum Hemorrhage* ; Postpartum Period* ; Prognosis ; Recombinant Proteins ; Retrospective Studies

Forty five patients with urinary tract infection were treated with 100mg Norfloxacin twice daily for 3 or 7 days according to the seriousness of infection. Of the 19 patients with uncomplicated urinary tract infection including 5 patients with acute bacterial prostatitis or acute epididymitis, none had bacteriuria 7 days after therapy and 1 patient was reinfected 14 days after therapy discontinuation. Of the 26 patients with complicated urinary tract infection, 17 patients(65%) were uninfected 7days after therapy and among them, 3 patients were reinfected I4 days after discontinuation of therapy. Of the 9 patients with persistent infection, 4 patients had resistant bacteriuria and 5 patients had bacteriuria different from that found before therapy. Eradication rate of E. coli, Enterobacter spp., Proteus spp., Pseudomonas spp., and Serratia spp. were 100%,, 100%,, 100%,, 80% and 40%, respectively. Further clinical envaluation seems worthwhile especially in pseudomonas infections since it offers one of the very few alternatives for oral treatment of pseudomonas infections which today may require hospitalization only for the purpose of injectible antibiotics.
Anti-Bacterial Agents ; Bacteriuria ; Enterobacter ; Epididymitis ; Hospitalization ; Humans ; Male ; Norfloxacin ; Prostatitis ; Proteus ; Pseudomonas ; Pseudomonas Infections ; Serratia ; Urinary Tract Infections* ; Urinary Tract*

Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.
Angiography ; Anoxia ; Causality ; Echocardiography ; Emergency Service, Hospital ; Female ; Humans ; Infarction* ; Intensive Care Units ; Middle Aged ; Protein C Deficiency ; Pulmonary Embolism ; Risk Factors ; Splenic Infarction ; Thrombophilia ; Venous Thromboembolism ; Venous Thrombosis

Colchicine poisoning is rare but can cause potentially life-threatening toxic complications such as hypovolemic shock, cardiovascular collapse and multiple organ failure. In this case report, we describe a case of a 20-year-old female who presented to the emergency department after suicidal ingestion of a toxic dose of colchicine. She developed thrombocytopenia, neutropenia and acute respiratory distress syndrome that required blood transfusion and administration of granulocyte colony stimulating factor for the prevention of infectious complications. With regard to the clinical manifestations of colchicine toxicity, we discussed suggested mechanisms.
Blood Transfusion ; Colchicine* ; Colony-Stimulating Factors* ; Eating ; Emergency Service, Hospital ; Female ; Granulocytes* ; Humans ; Multiple Organ Failure ; Neutropenia ; Poisoning* ; Respiratory Distress Syndrome, Adult ; Shock ; Thrombocytopenia ; Young Adult

No abstract available.
Carcinoma, Small Cell* ; Prognosis*

Thrombosis of deep cerebral veins including internal cerebral vein, great vein of Galen and straight sinus are frequently associated with thalamic and other deep cerebral infarction or hemorrhage, which lead to severe neurologic deficits or death. The pregnancy is one of the factors causing cerebral venous thrombosis in adult. We report a case of isolated deep cerebral vein thrombosis during pregnancy which was confirmed by MRI and angiogram.
Adult ; Cerebral Infarction ; Cerebral Veins* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Pregnancy* ; Thrombosis* ; Venous Thrombosis

A clinical obsevation was made on 8 patients with Corrected Transposition of the Great Arteries who visited seoul National University Hospital during the period of Feb., 1979-Sep., 1982. 1. Sex distribution was 5 male and 3 female patients. 2. Age distribution was from 16 to 39 years and the mean age was 24 years. 3. Symptoms were exertional dyspnea in all cases, cyanosis in 3 cases. Other symptoms were palpitation, chest pain, growth retardation and chest deformity. Duration of illness was from 6 to 16 years and N.Y.H.A. functional class was between II and III. 4. On physical examination, cardiac mumurs were heard in all cases. Cyanosis on the lips and nail beds were noticed in 3 cases and clubbing of fingers was seen in 1 case. 5. Situs inversus was noticed in 1 case, mesocardia in 3 cases, dextrocardia in 1 cases and right sided aortic arch in 1 case by simple Chest PA. 6. Electrocardiographic findings were Biventricular hypertrophy in 3 cases, Left ventricular hypertrophy in 2 cases, Right ventricular hypertrophy in 2 cases and Incomplete right bundle branch block in 1 case. No arrhythmias were observed. Septal Qwave was not observed on the left precordial leads in all cases. 7. CTGA were suspected or diagnosed by Echocardiography in 7 cases. 8. The diagnosis of CTGA and its associated anomalies were confirmed in all cases by cardiac catheterization and angiocardiography. There were one case of I.D.D. type CTGA and seven cases of S.L.L. type CTGA's. Associated anomalies were ventricular septal defect in 5 cases, pulmonary stenosis in 5 cases, patent foramen ovale in 3 cases, atrial septal defect in 2 cases, patent ductus arteriosus in 1 case, dextrocardia in 1 case, left sided A.V. valve regurtation in 2 cases, and right sided aortic arch in 1 case. 9. Operation was done in the case associated with patent ductus arteriosus, and corrective surgery was done in the another case associated with ASD, VSD, PS and TR with C-TGA.
Age Distribution ; Angiocardiography ; Aorta, Thoracic ; Arrhythmias, Cardiac ; Arteries ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Congenital Abnormalities ; Cyanosis ; Dextrocardia ; Diagnosis ; Ductus Arteriosus, Patent ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Fingers ; Foramen Ovale, Patent ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Hypertrophy, Right Ventricular ; Lip ; Male ; Physical Examination ; Pulmonary Valve Stenosis ; Seoul ; Sex Distribution ; Situs Inversus ; Thorax

In literatures, most of the studies of severe hyponatremia during or following its treatment has been concentrated with special references to the rate of correction and its neurologic outcomes. But, there is relatively few ones analyzing the diverse clinical manifestations of neurologic symptorns or complications during the course of treating severe hyponatremia. We experienced a catastrophic course related to hyponatremia in a 51 year woman with severe rheumatoid arthritis, who underwent knee joint replacement, and this case revealed the initial transient neurologic recovery for 3 days by the initial rapid correction of hyponatremia, then followed by delayed deterioration of osmotic demyelination syndrome leading to locked-in syndrome. Reported cases with similar clinical course (biphasic course) in the world lituratures were reviewed with special interests in the initial maximum rate of correction of hyponatremia and radiologic findings. This review suggests that clinicians treating the patients with severe symptomatic hyponatremia should be aware of the possibility of delayed neurologic sequelae despite the recovery of neurologic status as well as the degree of hyponatremia in the early treatment course of hyponatremia.
Arthritis, Rheumatoid ; Demyelinating Diseases* ; Female ; Humans ; Hyponatremia ; Knee Joint ; Quadriplegia

Lemierre syndrome is a rare syndrome caused by an acute pharyngitis with secondary septic thrombophlebitis of the internal jugular vein and metastatic infections. Although mortality from Lemierre syndrome is low, it remains a potentially life-threatening disease that requires careful consideration, as its early diagnosis and treatment is essential to prevent metastatic infection. We report a case of a 19-year-old woman who presented with a sore throat and right upper quadrant pain. Abdominal and pelvic computerized tomography (CT) showed acalculous cholecystitis with hepatosplenomegaly. The chest CT showed septic emboli in both lung fields and the neck CT revealed thrombosis in the left internal jugular vein. The patient was treated with antibiotics. After nine days, the chest CT showed a further increase in the size of the septic embolism and the patient was treated with anticoagulants. After 23 days, the size of septic emboli in the lung significantly decreased and the patient was discharged.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Anticoagulants ; Early Diagnosis ; Embolism ; Female ; Humans ; Jugular Veins ; Lemierre Syndrome ; Lung ; Neck ; Pharyngitis ; Thorax ; Thrombophlebitis ; Thrombosis

OBJECTIVES: This research was performed in order to develop the social perception scale which could detect the deficits of the social perception, composed of visual perception and contextual perception, in the patients with schizophrenia and might have the desirable reliability and discriminating power between the patients with schizophrenia and the normal controls, and so as to be appropriate to the schizophrenics' cognitive rehabilitation strategy of Brenner, et al. METHODS: We selected 10 photographs among 30 photographs which could show the variable social situations according to the consensus of the staff members of the Integrated Psychological Therapy. Then we developed the questions, composed of visual perception subscale and contextual perception subscale, which we called preliminary social perception scale. We tested the above scale to the 20 patients with schizophrenia in the chronic mental hospital. Then we tested the above scale to both the 20 patients meeting DSM-IV criteria for schizophrenia in the closed ward of the university psychiatric hospital and the 20 normal controls. We developed the final social perception scale to exclude the items of inadequate reliability. We compared the item difficulties of social perception scale between the patients in the chronic mental hospital and those in the university psychiatric hospital. finally, we compared the scores of social perception scale between the patients with schizophrenia and the normal controls. RESULTS: The final 6 items were selected to become the social perception scale according to the values of the item-total correlation, test-retest reliability, and interrater reliability. The final social perception scale showed similar rank of item difficulties between two groups with schizophrenia. The patient group differed significantly fiom the normal control group on the scores of contextual perception subscale(t=-3.09, p<.01) and the total scores of social perception scale(t= -3.33, p<.01). CONCLUSION: This study suggests that the above social perception scale which has excellent internal consistency, test-retest reliability, interrater reliability and the discriminating power. This scale can be applied to both the cognitive rehabilitation strategy in the patients with schizophrenia and the evaluation of the effectiveness of the cognitive rehabilitation.
Consensus ; Diagnostic and Statistical Manual of Mental Disorders ; Hospitals, Psychiatric ; Humans ; Rehabilitation* ; Schizophrenia* ; Social Perception* ; Visual Perception