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*

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

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

Typically, patients afflicted with syndrome X complained of stress induced angina pectoris, and their electrocardiograms show corresponding ST-segment depressions during exercise. However, angiography is unable to demonstrate significant coronary artery luminal narrowing and significant coronary artery spasm to provocation test. And left ventricular performance at rest remains remarkably unimpaired. Syndrome X is characterized by reduction of coronary vascular reserve but without depression of left ventricular performance or negative effect on survival. The reduction of coronary vascular response is supposed to be resulted from reduced coronary vasodilator reponse due to abnormal contraction of coronary prearteriolar vessels. This case is a 43-year-old female who has had exertional chest pain since 5 months ago. The chest pain was relieved by rest and subligual nitroglycerin administration. The exercise electrocardiography showed significant ST segment depressions on lead II, III aVF and V4-V6 at stage 1, when she experienced chest pain. On 24 hour ambulatory electrocardiogram, significant ST segment depression was recorded at the time when the patient had chest pain. But coronary arteriography demonstrated normal coronary artery and no significant coronary artery spasm to provocation test with ergonovine maleate. On exercise thallium-201 scintigraphy, perfusion decrease was suspected on anterolateral wall of left ventricle. The patient was diagnosed as a syndrome X and was managed with isosorbide and nifedipine and her exercise tolerance increased significantly on follow up exercise test performed 1 month later. But she has complained of a few of attack of chest pain until now.
Adult ; Angina Pectoris ; Angiography ; Chest Pain ; Coronary Vessels ; Depression ; Electrocardiography ; Ergonovine ; Exercise Test ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart Ventricles ; Humans ; Isosorbide ; Nifedipine ; Nitroglycerin ; Perfusion Imaging ; Phenobarbital ; Spasm

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