Implantation of a blastocyst within the endocervical canal is termed a"cervical pregn-ancy", which is one of the most dangerous forms of ectopic pregnancy. It is even less common, but the incidence appear to be increasing, in part due to newer forms of assisted reproduction. Proper management is indicated as soon as the diagnosis is suspected. Hemorrhage may be massive and sometimes fatal. In the past, hysterectomy was often the only choice available because of profuse hemorrhage that accompanied attempts at removal of the cerv- ical pregnancy. We report two cases of cervical pregnancy treated conservatively without hysterect- omy. Hemorrhage from the implantation site was controlled by intracervical placement of a Foley catheter balloon without hemostatic cervical sutures at 3 and 9 o clock. Immediate insertion of a Foley catheter into the cervical canal and inflation of the catheter bulb after endocervical suction curettage appears to be a simple and effective technique of managing cervical pregnancy in a patient who wishes to maintain childbearing capacity.
Blastocyst ; Catheters ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Inflation, Economic ; Pregnancy* ; Pregnancy, Ectopic ; Reproduction ; Sutures ; Vacuum Curettage

Acute fatty liver is rare but life threatening complication and usually manifests late in pregnancy. The mean gestational age onset of symptoms has been reported 35-37 weeks of gestation. Recently, several reports revealed acute fatty liver can develops in the second trimester of pregnancy. Recent reports suggest that early diagnosis and delivery decreased the mortality of fetus and mother. We have experienced a case of the second trimester onset acute fatty liver, in pregnancy so we report the case with brief review.
Early Diagnosis ; Fatty Liver* ; Female ; Fetus ; Gestational Age ; Humans ; Mortality ; Mothers ; Pregnancy ; Pregnancy Trimester, Second*

The clinical and pathological features of a paraganglioma arising in the cauda equina is described and compared with previous reports. The right microscopic fetures were similar to those of paragangliomas from other sites, with a 'Zellballen' pattern of cells containing arzyrophil granules. Immunohistocytochemical stains for neurone specific enolase, S-100 protein, cytokeratin were positive, but stains for glial fibrillary acidic protein were negative. Electron microscopy showed densely staining membrane-bound granules, cilia like structures and fibros bodies in the cytoplasm. The last two features only occur in paragangliomas from this site. The pathological findings suggest that paragangliomas in this site arise from pre-existing paraganglia, possibly of the visceral autonomic group.

Anterior exposure to the upper two thoracic vertebrae is technically difficult with transcervical approach. The authors used a transstermal biclavicular approach to the T1 metastatic adenocarcinome in a 47 year old patient. The advantages of this approach are that : 1) it levels the insertion of the sternocleidomastoid muscles intact and prevents the complication of respiratory problem, 2) it gives most wide surgical field among the other similar approaches, and 3) this procedure is not transpleural but transmediastinal approach.
Humans ; Middle Aged ; Muscles ; Spine* ; Thoracic Vertebrae

No abstract available.
DNA Topoisomerases* ; DNA*

BACKGROUND: In 2026, the elderly population (age> or =65 years) in Korea is projected to be 20.8% of the total population. Along with this rise will be the rise in need for medical care in geriatric hospitals. Geriatric inpatients are vulnerable to infections because of functional disabilities and comorbidities. We investigated the clinical features of pneumonia in the elderly at these facilities. METHODS: We performed a retrospective study based on medical records looking at pneumonia, which was identified in 63 inpatients >65 years admitted to a geriatric hospital from October 2013 to December 2014. RESULTS: In-hospital mortality was 31.7%(20/63) and the 30-day mortality was 17.5%(11/63) of the total number of patients. Median age was 83 years (range, 67-94 years). Univariate analysis showed that the following factors were significantly different between survivors and nonsurvivors, number of comorbidities, history of antibiotics therapy in preceding 90 days, clinical improvement in 72 hours, alteration of mentality, respiration rate, serum albumin level, and peripheral blood leukocyte count. Multivariate analysis showed that the independent factors for predicting increased mortality were number of comorbidities > or =4 (odds ratio [OR], 9.803; p=0.030), failure to improve clinically in 72 hours (OR, 6.150; p=0.046), respiration rate> or =30/min (OR, 9.370; p=0.021), and serum albumin level< or =3.0 g/dL (OR, 32.022; p=0.010). CONCLUSION: When elderly inpatients with pneumonia have factors such as comorbidities greater than 4, failure to improvement clincally in 72 hours, tachypnea (> or =30/min), and hypoalbuminemia (< or =3.0 g/dL), escalation of empiric antibiotics or transfer to an acute care setting is necessary to reduce mortality.
Aged ; Anti-Bacterial Agents ; Comorbidity ; Geriatrics ; Hospital Mortality ; Humans ; Hypoalbuminemia ; Inpatients ; Korea ; Leukocyte Count ; Medical Records ; Mortality ; Multivariate Analysis ; Pneumonia* ; Respiration ; Respiratory Rate ; Retrospective Studies ; Serum Albumin ; Survivors ; Tachypnea

No abstract available.
Family Practice* ; Hospitals, Community* ; Humans

Paroxymal ventricular tachycardia occurs most frequently during the first several months following myocardial infarction, although the risk of arrhythmia development continues for many years. Underlying disease was coronary artery disease, dilated or hypertrophic cardiomyopathy, valvular heart disease, myocarditis, and idiopathic. Idiopathic ventricular tachycardia may be the most common type in Korea and usually originates from either right ventricular outflow tract or left ventricular septum. For the emergency treatment of sustained, hemodynamically stable ventricular tachycardia, antiarrhythmic drugs are the therapy of choice(choice of therapy). Mostly class I antiarrhythmic drugs, such as lidocaine, are preferred. In hemodynamically unstable ventricular tachycardia, electrical defibrillation should be applied, in case of recurrences, followed by pharmacological treatment with class I antiarrhythmic drugs or amiodarone. We report a case of paroxymal ventricular tachycardia improved due to(by) electrical defibrillation was done repeaedly in patient with cerebral infarction.
Amiodarone ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Cardiomyopathy, Hypertrophic ; Cerebral Infarction ; Coronary Artery Disease ; Emergency Treatment ; Heart Valve Diseases ; Humans ; Infarction* ; Korea ; Lidocaine ; Myocardial Infarction ; Myocarditis ; Recurrence ; Tachycardia, Ventricular* ; Ventricular Septum

PURPOSE: To clarify the effects of missing values due to behavioral and psychological symptoms in dementia (BPSD) in Alzheimer's disease (AD) patients on the neuropsychological tests, this study describes the pattern of missing values due to BPSD, and its influence on tests. MATERIALS AND METHODS: Drug-naive probable AD patients (n=127) with BPSD and without BPSD (n=32) were assessed with Seoul Neuropsychological Screening Battery including measures of memory, intelligence, and executive functioning. Moreover, patients were rated on Korean Neuropsychiatry Inventory (K-NPI). RESULTS: The more severe the K-NPI score, the less neuropsychological tests were assessable, leading to many missing values. Patients with BPSD were more severely demented than those without BPSD. K-NPI scores were significantly correlated with the number of missing values. The effect of BPSD was largest for tests measuring frontal functions. The replacement of the missing values due to BPSD by the lowest observed score also showed the largest effect on tests of frontal function. CONCLUSION: The global cognitive and behavior scales are related with missing values. Among K-NPI sub-domains, delusion, depressing, apathy, and aberrant motor behavior are significantly correlated for missing values. Data imputation of missing values due to BPSD provides a more differentiated picture of cognitive deficits in AD with BPSD.
Aged ; Alzheimer Disease/*psychology ; Behavioral Symptoms ; Cognition ; Delusions ; Dementia/psychology ; Female ; Humans ; Male ; Neuropsychological Tests ; Regression Analysis

OBJECTIVES: Donepezil is a widely used drug for the treatment of patients with Alzheimer's disease(AD). The aim of the present study was to clarify the efficacy and the characteristics of responders to donepezil. METHODS: Patients with probable AD(n=80 ; 75.7 years) and small vessel dementia(SVD)(n=18 ; 77.8 years) who received donepezil were retrospectively analyzed using Alzheimer's registry, and three questions were asked: 1) Does donepezil therapy improves cognitive symptoms in patients with dementia? 2) If donepezil improves cognitive symptoms, which items of the K-MMSE are improved? 3) What are the characteristics of responder to donepezil medication? RESULTS: 1) After donepezil medication, cognitive function measured by the K-MMSE was significantly improved in both types of dementia(AD and SVD), However, statistical differences were not found between these groups. 2) In a clinical trial of donepezil, the patients performed better than before mediation on K-MMSE items assessing orientation, recall, construction, concentration, calculation. 3) In AD, the K-MMSE score before medication was closely related with response of donepezil. CONCLUSION: This study suggests that donepezil improves various cognitive functions in both types of dementia, and the responsive group had significantly lower K-MMSE scores than the non-responsive group before medication.
Alzheimer Disease* ; Dementia* ; Humans ; Negotiating ; Neurobehavioral Manifestations ; Retrospective Studies