No abstract available.
Diaphragm*

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

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

No abstract available.
Head and Neck Neoplasms* ; Head* ; Neck Dissection* ; Neck*

No abstract available.
Laryngectomy*

BACKGROUND: Acute lung injury (ALI) is a commonly encountered respiratory disease and its prognosis is poor when the treatment is not provided promptly and properly. However no specific pharmacologic treatment is currently available for ALI, although recently several supportive drugs have been under scrutiny. We studied anti-inflammatory effects of pentoxifylline (PF), a methylated xanthine, and ONO-5046, a synthetic neutrophil elastase inhibitor on lipopolysaccharide (LPS)-induced ALI in vitro. METHODS: To establish an in vitro model of LPS-induced ALI, primary rat alveolar macrophages and peripheral neutrophils in various ratios (1:0, 5:1,1:1,1:5,0:1) were co-cultured with transformed rat alveolar epithelial cells (L2 cell line) or vascular endothelial cells (IP2-E4 cell line) under LPS stimulation. Each experiment was divided into five groups-control, LPS, LPS+PF, LPS+ONO, and LPS+PF+ONO. We compared LPS-induced superoxide anion productions from primary rat alveolar macrophages and peripheral neutrophils in various ratios, and the resultant cytotoxxicity on L2 cells or IP2-E4 cells between groups. In addition we also compared the productions of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, monocyte chemotactic protein(MCP)-1, IL-6, and IL-10 as will as mRNA expressions of TNF-α, inducible nitric oxide synthetase(iNOS), and MCP-1 from LPS-stimulated primary rat alveolar macrophages between groups. RESULTS: (1) PF and ONO-5046 in each or both showed a trend to suppress LPS-induced superoxide anion productions from primary rat alveolar macrophages and peripheral neutrophils regardless of their ratio, except for the LPS+PF+ONO group with the 1:5 ratio, although statistical significance was limited to a few selected experimental conditions. (2) PF and ONO-5046 in each or both showed a trend to prevent IP2-E4 cells from LPS-induced cytotoxicity by primary rat alveolar macrophages and peripheral neutrophils regardless their ratio, although statistical significance was limited to a few selected experimental conditions. The effects of PF and/or ONO-5046 on LPS-induced L2 cell cytotoxicity varied according to expaerimental conditions. (3) PF showed a trend to inhibit LPS-induced productions of TNF-α, MCP-1, and IL-10 from primary rat alveolar macrophages. ONO-5046 alone didnot affect the LPS-induced productions of proinflammatory cytokines from primary rat alveolar macrophages but the combination of PF and ONO-5046 showed a trend to suppress LPS-induced productions of TNF-αand IL-10 PF and ONO-5046 in each or both showed a trend to increase LPS-induced IL-β and IL-6 productions from primary rat alveolar macrophages. (4) PF and ONO-5046 in each or both showed atrend to attenuate LPS-induced mRNA expressions of TNF-α and MCP-1 from primary rat alveolar macrophages but at the same time showed a trend increase iNOS mRNA expression. CONCLUSION: These results suggest that PF and ONO-5046 may play a role in attenuating inflammation in LPS-induced ALI and that further study is needed to use these drugs as a new supportive therapeutic strategy for ALI.
Acute Lung Injury* ; Animals ; Cytokines ; Endothelial Cells ; Epithelial Cells ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Interleukins ; Leukocyte Elastase* ; Macrophages, Alveolar ; Monocytes ; Neutrophils* ; Nitric Oxide ; Pentoxifylline* ; Prognosis ; Rats ; RNA, Messenger ; Superoxides ; Tumor Necrosis Factor-alpha ; Xanthine

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

Retrospective analysis of survival rates was undertaken in the patients of 58 cases treated with conventional radiation therapy for malignant salivary gland tumors between January 1975 and December 1984 in Korea Cancer Center Hospital (KCCH). They were patients whose long-term follow-up was possible and who had refused surgery or had had recurrences postoperatively. Out of 58 patients, 25 patients (43.1%) had mucoepidermoid carcinomas and 24 patients (41.3%) adenoid cystic carcinoma. Total actuarial survival rates at 5 years and 10 years were 68.2% and 31.8% respectively, but disease-free survival rates, 43.2% and 13.0%, respectively. According to TNM stage, the survival rates at 5 years were 86.5% in T1, 40.0% in T2 + T3, and 0% in T4. In terms of histologic types, 5 years disease-free survival rate of adenoid cystic carcinomas (40.1%) was lower than that of mucoepidermoid carcinomas (49.8%) but overall survival rate (77.3%) was much higher than that of mucoepidermoid carcinomas (51.5%). Therefore, we concluded that the patients, who had had disease after failure of treatment, could survive during a certain period of time and their alive times were 2 years on the average. There was a difference in survival rates in the mucoepidermoid carcinomas in terms of histological grade of differentiation and it was a arbiter in prognosis: 5 YSR of low-grade was 78.8% and higher 2 times than that of high-grade. There was no difference in survival rates according to location and sex. The number of patients having minor salivary gland tumors was 6 cases and their actuarial 5 YSR was 32.3%. Consequently, prognostic factors which influence the survival rates of patients with malignant salivary gland tumors are thought to be 1) histological ubtypes 2) T and N staging (AJCC) 3) histological grade, especially in mucoepidermoids.
Carcinoma, Adenoid Cystic ; Carcinoma, Mucoepidermoid ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Korea* ; Prognosis ; Recurrence ; Retrospective Studies ; Salivary Glands* ; Salivary Glands, Minor ; Survival Rate

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