Hysteroscopy is a procedure that may appear minimally invasive, but may result in potentially disastrous complications. A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for the visualization of the endometrium. Fluid overload due to the absorption of distention media during hysteroscopy can cause mild to severe complications, including hyponatremia, hypoosmolarity, nausea, vomiting, headache, arrhythmia, blindness, confusion, seizure, cerebral edema, brain herniation, and death. We report a case of a 41 year-old female patient who underwent elective hysteroscopic myomectomy under general anesthesia. Approximately 4 hours after the beginning of the surgery, the patient's serum sodium concentration dropped to 109 mM. She was treated with furosemide and recovered without sequelae.
Absorption ; Anesthesia, General ; Arrhythmias, Cardiac ; Blindness ; Brain ; Brain Edema ; Endometrium ; Female ; Furosemide ; Headache ; Humans ; Hyponatremia ; Hysteroscopes ; Hysteroscopy ; Nausea ; Seizures ; Sodium ; Vomiting

Chronic pancreatitis is a rare problem in childhood and sometimes shows pancreatic calcification. The most common symptom is recurrent upper abdominal pain with or without associated nausea or vomiting. Pancreatic calcifications are virtually pathognomonic of chronic pancreatitis. In our case, however, chronic pancreatitis caused by multiple pancreatic stones in dilated pancreatic duct, which was very rare in childhood. Endoscopic retrograde cholangiopancreaticography (ERCP) is valuable in confirming the diagnosis and decision making process for further medical or surgical management of pancreatic disease. We experienced a case of chronic relapsing pancreatitis with pancreatic stones in 13-year-old girl who presented with recurrent upper abdominal pain. She was investigated with ERCP and treated by endoscopic sphincterotomy of sphincter of Oddi and by some stone removal with endoscopic basket. We report this case and review related literatures briefly.
Abdominal Pain ; Adolescent ; Cholangiopancreatography, Endoscopic Retrograde ; Decision Making ; Diagnosis ; Female ; Humans ; Nausea ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatitis* ; Pancreatitis, Chronic ; Sphincter of Oddi ; Sphincterotomy, Endoscopic ; Vomiting

Background/Aims: Besifovir dipivoxil maleate (BSV) and tenofovir alafenamide fumarate (TAF) have been recently approved in Korea as the initial antiviral agents for chronic hepatitis B (CHB).However, the real-world outcome data for these drugs remain limited. Therefore, we conducted a noninferiority analysis using real-world data to compare the clinical outcomes of the two nucleotide analogs in treatment-naïve patients with CHB. Methods: We retrospectively investigated a cohort of patients with CHB who received BSV or TAF as first-line antiviral agents. The endpoints were virological response (VR) and liver-related clinical outcomes. Results: A total of 537 patients, consisting of 202 and 335 patients administered BSV and TAF, respectively, were followed up for 42 months. No significant difference was observed between the VRs of the patients from the two groups. The rates of biochemical response, virologic breakthrough, and incidence rates of hepatocellular carcinoma did not differ between the groups. However, the hepatitis B e antigen seroclearance rate was higher and the renal function declined less in the BSV group. Multivariable analysis indicated older age, alcohol abuse, cirrhosis and ascites, and lower serum HBV DNA level to be independently associated with increased hepatocellular carcinoma risk. The 1:1 propensity score-matched analysis with 400 patients showed VR rates of 85.0% and 88.7% in the BSV and TAF group patients, respectively, at 2 years. The absolute value of the 95% confidence interval for the difference (–0.04 to 0.12) satisfied the a priori limit of a noninferiority of 0.15. Conclusions BSV is noninferior to TAF in terms of VR, and their clinical outcomes are comparable to CHB.

The current patient management system has several limitations. To develop the critical pathway (CP) as a cost-effective method via continuous patient management, we investigated the medical records of 77 patients who underwent FP chemotherapy in Seoul National University Hospital from Feb, 1 to 28, 1999. And the pilot study was done to 12 patients admitted to undergo the FP chemotherapy. 1. The vertical contents in the CP consisted of 7 items; assessment, activity, diet, IV therapy, medication, education and evaluation. The duration of the horizontal axis was 6 days from admission to discharge. 2. The medical performance according to the vertical axis in the preliminary CP, consisted of 72 , and modified to 74 items in the final form of CP. 3. The nursing record consisted of a vertical axis of 4 items; assessment, IV therapy, medication and education. The duration of the horizontal axis was 6 days from admission to discharge of hospital days.
Axis, Cervical Vertebra ; Critical Pathways* ; Diet ; Drug Therapy* ; Education ; Humans ; Medical Records ; Nursing Records* ; Nursing* ; Pilot Projects ; Seoul

BACKGROUND: During ophthalmologic surgery, various intravenous anesthetic induction agents are used to prevent an intraocular pressure (IOP) increase. This study was designed to compare the effects of vecuronium and rocuronium on IOP in patients who were intubated. METHODS: Thirty-two patients undergoing elective strabismus surgery, aged 4 to 12 years, were randomized to receive rocuronium 0.6 mg/kg (Group 1, n = 16), or vecuronium 1.0 mg/kg (Group 2, n = 16).IOP, mean arterial pressure (MAP), and heart rate (HR) were measured at the following time points: prior to induction (B); after the administration of the induction agents; before intubation (T0); and at 1, 3 and 5 mins after intubation (T1, T3 and T5). RESULTS: The IOP after T0 in Group 1 was significantly lower than B (P < 0.05) in Group 2.The IOP at T1 in the Group 1 and 2 was not different from B, respectively.The IOP, MAP, and HR at T1 in the Groups 1 and 2 were significantly higher than at T0 (P < 0.05).No significant differences were observed between the groups in term of IOP. CONCLUSIONS: We concluded that vecuronium and rocuronium are both useful as muscle relaxants for use in general anesthesia in ophthalmologic surgery, because both agents caused similar decreases in intraocular pressure.
Aged ; Androstanols ; Anesthesia, General ; Arterial Pressure ; Heart Rate ; Humans ; Intraocular Pressure ; Intubation ; Muscles ; Strabismus ; Vecuronium Bromide

An ectopic pancreas is the presence of pancreatic tissue outside of its usual location. This condition rarely causes clinical symptoms, and the most commonly reported sites of these lesions are the stomach, the duodenum and jejunum. The presence of this ectopic tissue is not a rare condition, but its unusual locations, clinical symptoms, and complications are of clinical interest. We report a case of a gastric ectopic pancreas with recurrent upper gastrointestinal bleeding in a 20-year-old man.
Choristoma ; Duodenum ; Hemorrhage* ; Humans ; Jejunum ; Pancreas* ; Stomach ; Young Adult

We report four cases of Ganoderma lucidum-induced aplastic anemia involving members of the same family. A 33-year-old man and three family members were admitted to the hospital due to fever and pancytopenia. The illness arose after ingesting herbal wine containing G. lucidum 2 weeks earlier. A bone-marrow biopsy showed hypocellularity in three of the four family members (the exception was the one who died). They were treated with supportive management, including transfusions, granulocyte colony stimulating factor, and empirical antibiotics for neutropenic fever. The pancytopenia improved 4-5 weeks after the symptoms first appeared.
Adult ; Anemia, Aplastic* ; Anti-Bacterial Agents ; Biopsy ; Colony-Stimulating Factors ; Fever ; Ganoderma ; Granulocytes ; Humans ; Pancytopenia ; Plants, Medicinal ; Reishi* ; Wine

Chalcones (1,3-diaryl-2-propen-1-ones), a subfamily of flavonoid, are widely known to possess potent anti-inflammatory and anti-oxidant properties. In this study, we investigated the effect of 3-(4-Hydroxyphenyl)-1-(thio3-(4-Hydroxyphenyl phen-2-yl)prop-2-en-1-one (TI-I-175), a synthetic chalcone derivative, on endotoxin-induced expression of monocyte chemoattractant protein-1 (MCP-1), one of the key chemokines that regulates migration and infiltration of immune cells, and its potential mechanisms. TI-I-175 potently inhibited MCP-1 mRNA expression stimulated by lipopolysaccharide (LPS) in RAW 264.7 macrophages without significant effect on cell viability. Treatment of cells with TI-I-175 markedly prevented LPS-induced transcriptional activation of activator protein-1 (AP-1) as measured by luciferase reporter assay, while nuclear factor-kappaB (NF-kappaB) activity was not inhibited by TI-I-175, implying that TI-I-175 suppressed MCP-1 expression probably via regulation of AP-1. In addition, TI-I-175 treatment significantly inhibited LPS-induced Akt phosphorylation and led to a significant decrease in reactive oxygen species (ROS) production by LPS, which act as up-stream signaling events required for AP-1 activation in RAW 264.7 macrophages. Taken together, these results indicate that TI-I-175 suppresses MCP-1 gene expression in LPS-stimulated RAW 264.7 macrophages via suppression of ROS production and Akt activation.
Cell Survival ; Chalcone* ; Chalcones ; Chemokine CCL2 ; Chemokines ; Gene Expression ; Inflammation ; Luciferases ; Macrophages* ; Phosphorylation ; Reactive Oxygen Species ; RNA, Messenger ; Transcription Factor AP-1 ; Transcriptional Activation

Transfusion-related acute lung injury (TRALI) is defined as a new episode of acute lung injury that occurs during or within 6 hours of a completed transfusion, which has been the leading cause of transfusion-related death. We present a suspected case of TRALI in a 30-year-old parturient with gestational ITP scheduled for cesarean section. The parturient developed hypoxemia and pulmonary edema after platelet concentrate transfusion during perioperative period. The parturient completely recovered after an oxygen support for 4 days. It is important to recognize TRALI as soon as possible to minimize perioperative morbidity and mortality.
Acute Lung Injury ; Adult ; Anoxia ; Blood Platelets ; Cesarean Section ; Female ; Humans ; Oxygen ; Perioperative Period ; Platelet Transfusion ; Pregnancy ; Pulmonary Edema ; Purpura, Thrombocytopenic, Idiopathic

beta-Glucosidase, which hydrolyzes cellobiose into two glucoses, plays an important role in the process of saccharification of the lignocellulosic biomass. In this study, we optimized the activity of beta-glucosidase of brown-rot fungus Fomitopsis pinicola KCTC 6208 using the response surface methodology (RSM) with various concentrations of glucose, yeast extract and ascorbic acid, which are the most significant nutrients for activity of beta-glucosidase. The highest activity of beta-glucosidase was achieved 3.02% of glucose, 4.35% of yeast extract, and 7.41% ascorbic acid where ascorbic acid was most effective. The maximum activity of beta-glucosidase predicted by the RSM was 15.34 U/mg, which was similar to the experimental value 14.90 U/mg at the 16th day of incubation. This optimized activity of beta-glucosidase was 23.6 times higher than the preliminary activity value, 0.63 U/mg, and was also much higher than previous values reported in other fungi strains. Therefore, a simplified medium supplemented with a cheap vitamin source, such as ascorbic acid, could be a cost effective mean of increasing beta-glucosidase activity.
Ascorbic Acid ; beta-Glucosidase* ; Biomass ; Cellobiose ; Coriolaceae* ; Fungi* ; Glucose ; Vitamins ; Yeasts