Traditionally umbilical vein has been used for exchange transfusion in neonates. This method is relatively safe and effective but with a few complications. So via percutaneous femoral vein catheters we tried exchange transfusions in 30 patients with neonatal hyperbilirubinemia admitted to GNUH from September 1990 to August 1992. Femoral vein catheterization succeeded in 2~3 trials, In all cases high bilirubin level was lowered by half at the end of exchange transfusion. Transient microscopic hematuria by bladder puncture occurred in one neonate. Exchange transfusion via femoral vein catheter is a sage, easy and effective method.
Bilirubin ; Catheterization* ; Catheters* ; Femoral Vein* ; Hematuria ; Humans ; Hyperbilirubinemia, Neonatal ; Infant, Newborn* ; Punctures ; Umbilical Veins* ; Urinary Bladder

The second survey which was composed of questionnaires on a variety of ophthalmic topics was made up and sent to members of the Korean Society of Cataract and Refractive Surgery(KSCRS) in March, 1997. The second survey was composed of 80 items, including 8 additional items compare to the first survey in 1996. Forty-three percent(65/150) responded and the results were compared to these of the first survey.Over half of the respondents(64%) were in their forties. Catarct operation accounted for over 60% of the total operations in 75% of KSCRS members which was increased compared to previous survey(45%). The 0-2 days of admission in the cataract surgery was 56% of respondents that was increased than previous survey(36%). Increased preference to 3.5mm incision and 5.5mm incision in cataract operation and increased use of 5.5mm optic size IOL(47%) in phacoemulsification surgery compare to previous survey in that 6.0mm optic size IOL was mostly used were shown which indicate increase of small incision cataract surgery.For radial keratotomy as a means of correcting myopia, 97% of the respondents were not performing the procedure. Fortu-six percent of the respondents have been doing excimer laser photorefractive keratectomy which was decreased than previous survey(54%).For use of foldable IOL. which was one of new question items, 50% of respondents answered they use it in less than 20% of cataract surgery which indicates foldable IOL is not popularly used.These results reflect the present trends of cataract and refractive surgeries in Korea.
Cataract* ; Surveys and Questionnaires ; Keratotomy, Radial ; Korea ; Lasers, Excimer ; Myopia ; Phacoemulsification ; Photorefractive Keratectomy ; Refractive Surgical Procedures*

BACKGROUND AND OBJECT: Immunostimulatory CpG-oligodeoxynucleotides (ISS CpG-ODN) up-regulate the TH1-type immune response and down-regulate the TH2-type response. This study was performed to investigate the immune response changes resulting from ISS CpG-ODN on bronchial hyperrestponsiveness, eosinophilic inflammation and mucus hypersecretion in rat asthma. MATERIALS AND METHODS: 10 normal controls(NC) and 26 asthmatic rats, which were generated by ovallbumin(OVA) sensitization and challenge, were studied. The asthmatic rats were randomized into 11 asthma controls(AC) and 15 in the asthma-CpG treatment group(CpG). The CpG group was administered ISS CpG-ODN intramuscularly and the AC group was administered a placebo(0.9% NaCl)on day 15 and 20. After CpG-ODN or placebo administration, we measured the IFN-(TH1-type cytokine) and IL-4(TH2-type cytokine) levels in the bronchoalveolar lavage fluid(BALF), the specific airway resistance(sRaw), eosinophilic fraction in BALF, eosinophilic infiltration, goblet cell dysplasia and MUC5AC gene expression in the lung tissue. RESULTS: In the BALF of the CpG group, the IFN-γ concentration was significantly high and the IL-4 concentration was significantly low when compared with the AC group. Both the sRaw and eosinophilic fraction, and infiltration into the BALF and lung tissue significantly lower in the CpG group when compared with the AC group. However, little difference in goblet cell dysplasia and MUC5Ac gene expression was observed between the CpG group and the Ac group. CONCLUSION: ISS CpG-ODN decreases bronchial hyperresponsiveness and eosinophilic inflammation in the rat asthma model through the up-regulation of the TH1-type immune response with the down-regulation of the TH2-type response. However, the effect of these immune response changes on mucus hypersecretion was is not remarkable in this study.
Animals ; Asthma* ; Bronchoalveolar Lavage ; Down-Regulation ; Eosinophils ; Gene Expression ; Goblet Cells ; Inflammation ; Interleukin-4 ; Lung ; Mucus ; Rats* ; Up-Regulation

OBJECTIVE: To determine whether cyclooxygenase (COX)-1 and COX-2 are expressed differentially during the whole gestational period in the pregnant human uterine cervix and if they are involved in the process of labor. METHODS: Nine patients were matched for obstetrical history and maternal age were divided into an abortion group who aborted between 13 and 16 weeks(n=3), a preterm group who delivered between 20 and 37 weeks(n=3), and a term group who delivered between 37 and 42 weeks of gestation(n=3). Immediately after vaginal delivery cervical biopsy samples were obtained and immunohistochemically stained for COX-1 and COX-2 and the degree of staining was evaluated by H-scoring system. RESULTS: Expression of COX-1 and COX-2 was found in epithelial and stromal cells of uterine cervical tissues of preterm and term group. The immunohistochemical expression of COX-1 and COX-2 was strongest in the term group compared to the preterm group in stromal cells(HSCORE : 2.0 vs. 4.0 ; 2.0 vs. 3.0), and in epithelial cells(HSCORE : 1.0 vs. 3.0 ; 1.0 vs. 3.0). CONCLUSION: Although small amount of the groups were investigated, in the pregnant human uterine cervix, COX-1 and COX-2 are found to be expressed, and both shows the strongest expression in term cervical tissue. It is suggested that the uterine cervix, under the control of prostaglandins, is actively involved in the process of labor, and it is thought that the role of COX-1 and COX-2 is more important in parturition process with advancing gestational age.
Biopsy ; Cervix Uteri* ; Cyclooxygenase 1* ; Cyclooxygenase 2 ; Female ; Gestational Age ; Humans* ; Maternal Age ; Parturition ; Pregnancy ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Stromal Cells

Uterine artery embolization for the treatment of uterine leiomyomas is gaining acceptance as an effective alternative to surgical treatment in preserving uterus and reducing symptoms. Vaginal expulsion of leiomyomas after UAE is uncommon, and has been regarded as a side effect of the procedure, as well as a natural phenomenon of treatment response. A-28-year-old unmarried woman who has been suffered from menorrhagia underwent UAE. MRI revealed the remnant leiomyomas were reduced in size and volume and also symptoms of leiomyomas were much improved. After 6 month, We've made sure about non-visualization of leiomyoma on follow-up pelvic dynamic MRI. We report this rare case of vaginal expusion of intramural leoimyoma with a brief literature.
Female ; Follow-Up Studies ; Humans ; Leiomyoma* ; Magnetic Resonance Imaging ; Menorrhagia ; Single Person ; Uterine Artery Embolization* ; Uterine Artery* ; Uterus

Actinomycosis is an indolent infectious disease characterized by pyogenic response and necrosis, followed by intense fibrosis. The main forms of human actinomycosis are cervicofacial, pulmonary, and abdominopelvic type. Pulmonary actinomycosis accounts for 15% to 20% of total cases and unfortunately, clinical manifestations and radiologic findings are nonspecific. Small pleural effusion or empyema may develop in advanced disease but massive empyema is infrequent and rarely reported. We report a case of huge empyema caused by pulmonary actinomycosis in a 55 year-old man, presented with one-month history of productive cough and fever. The CT scan revealed a huge cavity with air-fluid level occupying the left hemithorax. Empyema caused by actinomycosis was confirmed microscopically by demonstration of sulfur granules in empyema sac through thracotomy. Decortication and surgical resection of empyema sac and destructed lung was accomplished and followed by intravenous infusion of penicillin G.
Actinomycosis* ; Communicable Diseases ; Cough ; Empyema* ; Fever ; Fibrosis ; Humans ; Infusions, Intravenous ; Lung ; Middle Aged ; Necrosis ; Penicillin G ; Pleural Effusion ; Sulfur ; Tomography, X-Ray Computed

Incidence of nontuberculous mycobacterium (NTM) pulmonary disease is increasing with the wider recognition and development of diagnostic technology. Mycobacterium kansasii is the second most common pathogen of NTM pulmonary disease in human immunodeficiency virus (HIV)-infected patients. However in Korea, the incidence of M. kansasii pulmonary disease is relatively low, and there has been no report of M. kansasii pulmonary disease with bronchial involvement in HIV patients, to the best of our knowledge. We report a case of M. kansasii pulmonary disease presenting with endobronchial lesions in an HIV-infected patient complaining of chronic cough with bilateral enlargements of hilar lymph nodes on chest X-ray.
Bronchial Diseases ; Cough ; HIV ; Humans ; Incidence ; Korea ; Lung Diseases* ; Lymph Nodes ; Mycobacterium kansasii* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Thorax

BACKGROUND: Eltrombopag is a thrombopoietin receptor agonist with excellent treatment outcomes in immune thrombocytopenia (ITP). Here, we analyzed the dose of eltrombopag required to achieve and maintain safe platelet counts in Korean ITP patients. METHODS: Adult refractory ITP patients (<30,000 platelets/microL) were enrolled. Eltrombopag doses were increased to achieve a target platelet count (> or =50,000 cells/microL). After achieving the target platelet count, the dose of concomitant ITP medications and eltrombopag was reduced to identify the lowest effective dose required to maintain the platelet count. RESULTS: Among 18 patients, 66.7% achieved complete response, 5.6% achieved platelet counts between 50,000 and 100,000 cells/microL, and 27.8% failed to achieve the target platelet count. The median ITP duration was significantly shorter in patients who achieved the target platelet count. The initial dose required to achieve the target platelet count was 25 mg/d. The adjusted maintenance doses were 25 mg twice per week or 25 mg/d. After discontinuation, 83.3% relapsed, and the median relapse-free survival was 15 days. Two relapsed and 1 failed patient switched to romiplostim. The response to romiplostim was similar to eltrombopag. During eltrombopag treatment, 38.9% showed hepatobiliary laboratory anomalies. Among 9 follow-up bone marrow examinations, 1 revealed fibrosis after 1 year of treatment. CONCLUSION: Eltrombopag was well tolerated with excellent treatment outcomes in refractory adult ITP patients. Low-dose eltrombopag effectively maintained the target platelet count. However, some patients required longer or higher-dose treatment to maintain the target platelet count, especially in heavily pretreated or longer ITP cases.
Adult* ; Bone Marrow Examination ; Fibrosis ; Follow-Up Studies ; Humans ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Receptors, Thrombopoietin ; Thrombocytopenia*

Cryptococcosis is an invasive fungal infection, which is more common in immunocompromised patients. However, pulmonary cryptococcosis can occur in immunocompetent patients and should be considered on a differential diagnosis for nodular or mass-like lesions in chest radiograph. Recently, we experienced a patient with pulmonary cryptococcosis, successfully treated with oral fluconazole therapy. A 74-year-old female patient was referred for an evaluation of abnormal images, a large consolidative mass with multiple nodular consolidations and small nodules that mimics primary lung cancer with multiple lung to lung metastases. Computed tomography-guided lung biopsy confirmed the diagnosis of pulmonary cryptococcosis. The follow-up image taken after 4 months with oral fluconazole treatment showed marked improvement.
Aged ; Biopsy ; Cryptococcosis ; Diagnosis, Differential ; Female ; Fluconazole ; Follow-Up Studies ; Humans ; Immunocompromised Host ; Lung ; Lung Neoplasms ; Multiple Pulmonary Nodules ; Neoplasm Metastasis ; Thorax

OBJECTIVE: The purpose of this study was to determine the effectiveness of intra-amniotic methotrexate instillation for the treatment of viable cervical pregnancy. MATERIALS AND METHODS: Four patients were enrolled in this study after confirmation of cervical pregnancy by ultrasonography. Viable cervical pregnancy was determined by ultrasonographic findings with the entire chorionic sac containing a live fetus below the internal os, empty uterine cavity, and significantly dilated or barrel shaped cervical canal. Under the transvaginal ultrasonographic guidence, 50 mg of methotrexate was injected directly into the amniotic sac after complete aspiration of amniotic fluid. Serial serum beta-human chorionic gonadotropin (beta-hCG) was evaluated weekly until normalized. RESULTS: All the patients were successfully treated with conservative method and one patient received hysterectomy due to arterio-venous malformation diagnosed during follow up. Initial serum beta-hCG concentration was 22,484-93,803 mIU/ml and decreased by log scale after treatment. CONCLUSION: Intra-amniotic methotrexate instillation without concomitant feticide injection or feticidal procedure can be used for the initial treatment in viable cervical pregnancy. Initial titer or falling rate pattern of serum beta-hCG did not seem to be related with the prognosis.
Amniotic Fluid ; Chorion ; Chorionic Gonadotropin ; Female ; Fetus ; Follow-Up Studies ; Humans ; Hysterectomy ; Methotrexate* ; Pregnancy* ; Prognosis ; Ultrasonography