The high incidence antigert Jr" was first identified in 1970 by Stroup and Macllroy. Anti-Jr~ was immune antibodies developed by transfusion or pregnancy and occasionally cause hemolytic disease of the newborn and transfusion reaction, but these usually mild. We are reporting the first case of anti-Jra in Korea, which was identified in pregnant woman with transfusion history. The 35 year old pregnant woman(G6P4L1D3A1) admitted to treat for incompetent internal os of cervix on department of Obstetrics and Gynecology. Prenatal irregular antibody screening was negative. One unit of RBC was transfused at 21 gestational weeks for correction of anemia. One week later, irregular antibody was detected in her serum. The antibody reacted best by indirect antiglobulin test and panagglutinated all identified cells. The titer was 1 : 8. The antibody was identified as anti-Jr by Dr. Osaka Red Cross Center. Her phenotype of Jra was Jr(a-), but there was no Jr(a-) person in her family. She might have anti-Jra in her serum with undetectable level due to multiple pregnancies. In this case, the development of anti-Jr was stimulated by one unit of RBC transfusion with anamnestic reaction. The titer of anti-Jr was gradually reduced during pregnant period. She delivered at 37 gestational weeks by cesarian section. The baby was clinically well at birth and typed as Jr(a+).
Adult ; Anemia ; Antibodies ; Blood Group Incompatibility ; Cervix Uteri ; Coombs Test ; Female ; Gynecology ; Humans ; Incidence ; Infant, Newborn ; Korea ; Mass Screening ; Obstetrics ; Parturition ; Phenotype ; Pregnancy ; Pregnancy, Multiple ; Pregnant Women* ; Red Cross

PURPOSE: In some patients with velopharyngeal insufficiency(VPI), Hypernasality can persist after surgical management. Continuous Positive Airway Pressure(CPAP) is applied to these patients for treating hypernasality. The purpose of this study is to report follow-up results of postoperative CPAP therapy. METHODS: After performing palatal lengthening, CPAP therapy was applied to three patients for eight weeks from July of 2008 to November of 2009. Perceptual evaluation, nasometry, and nasopharyngeal endoscopy were performed to evaluate hypernasality, nasalance and size of the gap at velopharyngeal port. Each evaluation was made before surgery, right after CPAP therapy and during follow- up of more than a year after CPAP therapy. RESULTS: All of the patients showed improvement in hypernasality right after CPAP therapy according to the auditory perceptual evaluation, nasometry and nasopharyngeal endoscopy. But the improvement in hypernasality in these patients did not last during follow-up. CONCLUSION: In this study, our results suggest that CPAP therapy is effective in reducing hypernasality for postoperative VPI patients immediately after the therapy, but hypernasality may be worsen in some patients during follow-up. Therefore we recommend follow-ups after CPAP therapy to see if the efficacy of CPAP therapy lasts.
Endoscopy ; Follow-Up Studies ; Humans ; Velopharyngeal Insufficiency

PURPOSE: Spontaneously ruptured hepatocellular carcinoma (srHCC) is known to be a life-threatening complication with poor prognosis. Although there are various treatment modalities, there is no definite treatment guideline. The purpose of this study was to review the surgical outcome and prognosis of srHCC treated with intraoperative radiofrequency ablation (RFA) and distilled water peritoneal lavage (DWPL). METHODS: From March 2012 to October 2018, 9 patients with srHCC who underwent emergent surgery were reviewed. After hematoma removal, intraoperative RFA and DWPL were applied to all patients. Hepatectomy was performed if necessary. Patients with multiple tumors, distant metastasis, and vascular tumor involvement in radiologic imaging were excluded. RESULTS: Six of 9 patients with diameters less than 7 cm were able to obtain hemostasis using RFA alone (RFA group). However, 3 patients with a tumor size of more than 10 cm underwent liver resection because they could not obtain hemostasis with RFA (hepatectomy only group). The RFA group had shorter operation time (148.3 ± 31.7 minutes vs. 251.7 ± 20.2 minutes, P < 0.05) and less red blood cell transfusion (5.8 ± 2.5 packs vs. 24.0 ± 11.5 packs, P < 0.05) than the hepatectomy only group. There was no peritoneal metastasis at long-term follow-up in the RFA group. Five-year recurrence-free survival rate was 0% in both groups. However, 5-year overall survival rate was better in the RFA group (83.3% vs. 0%, P < 0.05). CONCLUSION: Intraoperative RFA and DWPL are easy to perform and theoretically the best methods for managing relatively small srHCC.
Carcinoma, Hepatocellular ; Catheter Ablation ; Erythrocyte Transfusion ; Follow-Up Studies ; Hematoma ; Hemostasis ; Hepatectomy ; Humans ; Liver ; Neoplasm Metastasis ; Peritoneal Lavage ; Prognosis ; Rupture ; Survival Rate ; Water

BACKGROUND AND OBJECTIVES: Kawasaki disease (KD) is an acute systemic vasculitis in children which causes coronary arterial dilatation (CAD) and gallbladder distension (GBD). There is a dearth of investigating the relationship between the severity of KD and GBD with lipid profiles. SUBJECTS AND METHODS: A total of 80 patients with 'complete KD' who were diagnosed from January 2005 to May 2009 was enrolled in this study. Serum cholesterol {total, high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C)}, triglyceride (TG), complete blood count, inflammation markers {erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)} were measured at the time of admission during febrile period. Echocardiography and abdominal sonogram were performed in all patients to determine CAD and gallbladder size. According to GBD, patients with KD were classified as patients with GBD and patients without GBD. Between two groups, demographic and clinical data were analyzed. RESULTS: The serum level of LDL-C was significantly lower in patients with GBD (p=0.03) compared with patients without GBD or febrile control. There was no significant difference in inflammatory indices between patients with GBD and patients without GBD. GBD was not significant risk factor of CAD in this study (odds ratio=2.0, 95% confidence interval=0.82-5.3, p=0.16). CONCLUSION: This is the first study that highlights the relationship between the GBD and lipid metabolism in patients with KD. This study provides clinical insights about potential mechanism underpinning the relationship between the GBD and lipid metabolism.
Blood Cell Count ; C-Reactive Protein ; Child ; Cholesterol ; Coronary Artery Disease ; Dilatation ; Echocardiography ; Gallbladder ; Gallbladder Diseases ; Humans ; Inflammation ; Lipid Metabolism ; Mucocutaneous Lymph Node Syndrome ; Risk Factors ; Systemic Vasculitis

BACKGROUND/AIMS: The use of laparoscopic adjustable gastric banding (LAGB) is increasing proportionally with the obesity epidemic. However, some postoperative complications have been highlighted as major problems associated with LAGB. There is no consensus concerning the endoscopic management of these adverse events. The aim of this study was to retrospectively review the feasibility and effectiveness of endoscopic treatment for LAGB complications. METHODS: We retrospectively evaluated 352 patients who underwent LAGB between 2011 and 2015. LAGB-associated complications developed in 26 patients (7.4%). This study involved six patients (1.7%) who received endoscopic treatment. RESULTS: Types of LAGB-induced complications in our series included intragastric migration (n=3), gastric leaks (n=2), and gastric fistulas (n=1). The endoscopic treatment of these complications was successful in four of the six patients. Endoscopic band removal was successful in two patients. All gastric leaks were successfully closed via an endoscopic procedure. In two cases (intragastric migration and gastric fistula), endoscopic treatment was not sufficient, and surgery was performed. CONCLUSIONS: Endoscopic procedures afforded acceptable treatment of band migration and gastric leaks after LAGB. However, the results were poor in patients with gastric fistula.
Bariatric Surgery ; Consensus ; Endoscopy ; Far East* ; Gastric Fistula ; Humans ; Obesity ; Postoperative Complications ; Retrospective Studies

PURPOSE: The frequency of computerized tomography (CT) for diagnosing of atypical acute appendicitis, as ordered by emergency physicians, was noted. According to abdominal CT findings, the severity of acute appendicitis is divided into six grades that are used for diagnosis and treatment. However, whether or not the laboratory and clinical findings of atypical acute appendicitis have a relation to the grading of abdominal CT scans is unknown. This study was performed to evaluate the correlation between CT grades and symptoms, signs and operative and pathologic findings of atypical acute appendicitis. METHODS: This study included 412 patients who were admitted and underwent an appendectomy from January 2004 to June 2005. An abdominal and pelvic CT scan was performed in 114 patients who had atypical presentations in the emergency room. The abdominal and pelvic CT scales were correlated with clinical signs, laboratory findings, and pathology reports. The CT scale for appendicitis is a sixgrade scale from normal (grade 0) to periappendiceal abscess (grade 5). RESULTS: Sixty-six patients were male and 48 were female, and the mean age was 50.7+/-22.0 years old. On the abdominal CT, grade 0 (normal) was 3 patients (2.6%), grade 1 (probable appendicitis) 5 (4.4%), grade 2 (appendicitis) 17 (14.8%), grade 3 (appendicitis with periappendicitis) 47 (40.9%), grade 4 (appendicitis with rupture) 30 (26.1%), and grade 5 (complicated appendicitis) 12 (10.4%). There was no significant difference between CT grades and either local tenderness or rebound tenderness in the right lower quadrant abdomen (p>0.296). However increased body temperature correlated with higher CT grades (p=0.01). There were significant differences in the neutrophil count (p<0.001), but not the white blood cell count (p=0.493). The severity of pathology of acute appendicitis correlated with the CT grade (R=0.468, p=0.004). CONCLUSION: There was no significant correlation of local and rebound tenderness on right lower quadrant abdomen and of white blood cell count with CT grading in appendicitis, but there was a high correlation of body temperature and of neutrophil counts with the CT grades of appendicitis for patients with atypical appendicitis. The CT grades of appendicitis also correlated with the pathology.
Abdomen ; Abscess ; Appendectomy ; Appendicitis* ; Body Temperature ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Leukocyte Count ; Male ; Neutrophils ; Pathology ; Tomography, X-Ray Computed ; Weights and Measures

PURPOSE: The frequency of computerized tomography (CT) for diagnosing of atypical acute appendicitis, as ordered by emergency physicians, was noted. According to abdominal CT findings, the severity of acute appendicitis is divided into six grades that are used for diagnosis and treatment. However, whether or not the laboratory and clinical findings of atypical acute appendicitis have a relation to the grading of abdominal CT scans is unknown. This study was performed to evaluate the correlation between CT grades and symptoms, signs and operative and pathologic findings of atypical acute appendicitis. METHODS: This study included 412 patients who were admitted and underwent an appendectomy from January 2004 to June 2005. An abdominal and pelvic CT scan was performed in 114 patients who had atypical presentations in the emergency room. The abdominal and pelvic CT scales were correlated with clinical signs, laboratory findings, and pathology reports. The CT scale for appendicitis is a sixgrade scale from normal (grade 0) to periappendiceal abscess (grade 5). RESULTS: Sixty-six patients were male and 48 were female, and the mean age was 50.7+/-22.0 years old. On the abdominal CT, grade 0 (normal) was 3 patients (2.6%), grade 1 (probable appendicitis) 5 (4.4%), grade 2 (appendicitis) 17 (14.8%), grade 3 (appendicitis with periappendicitis) 47 (40.9%), grade 4 (appendicitis with rupture) 30 (26.1%), and grade 5 (complicated appendicitis) 12 (10.4%). There was no significant difference between CT grades and either local tenderness or rebound tenderness in the right lower quadrant abdomen (p>0.296). However increased body temperature correlated with higher CT grades (p=0.01). There were significant differences in the neutrophil count (p<0.001), but not the white blood cell count (p=0.493). The severity of pathology of acute appendicitis correlated with the CT grade (R=0.468, p=0.004). CONCLUSION: There was no significant correlation of local and rebound tenderness on right lower quadrant abdomen and of white blood cell count with CT grading in appendicitis, but there was a high correlation of body temperature and of neutrophil counts with the CT grades of appendicitis for patients with atypical appendicitis. The CT grades of appendicitis also correlated with the pathology.
Abdomen ; Abscess ; Appendectomy ; Appendicitis* ; Body Temperature ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Leukocyte Count ; Male ; Neutrophils ; Pathology ; Tomography, X-Ray Computed ; Weights and Measures

No abstract available.
Female ; Humans ; Lipoproteins*

We experienced one case of anesthesia for liver transplantation in 32-year-old male patient with liver cirrhosis. The liver donor was 27-year-old male patient who was diagnosed brain death due to car accident. The operation was finished successfuly for 12 hours with intensive monitoring and treatrnent with using TEG and RIS. Patient was transfered to ICU after operation with intubated state. Extubation was done 2 days after operation and patient discharged without complication about 2 months later.
Adult ; Anesthesia* ; Brain Death ; Humans ; Liver Cirrhosis ; Liver Transplantation* ; Liver* ; Male ; Tissue Donors

The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has become of great concern in both hospital and community settings. To evaluate the prevalence and risk factors for methicillin resistance among Staphylococcus aureus, blood isolates in our Emergency Department (ED) were collected. All patients with S. aureus bacteremia (SAB) who presented to the ED from January 2000 to August 2005 were included, and a retrospective study was performed. A total of 231 patients with SAB were enrolled (median age, 59 yr; M:F, 125:106). Among these patients, methicillin-resistant strains accounted for 27.3% (63 patients). Catheter-related infection was the most frequent primary site of SAB (39.0%), followed by skin and soft tissue infection (16.5%). In multivariate analysis, recent surgery (OR, 3.41; 95% CI, 1.48-7.85), recent hospitalization (2.17; 1.06-4.62), and older age (> or =61 yr) (2.39; 1.25-4.57) were independently associated with the acquisition of methicillin-resistant strains. When antimicrobial therapy is considered for the treatment of a patient with suspected SAB, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage for patients with risk factors: older age, recent hospitalization, and recent surgery.
Adult ; Age Factors ; Aged ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Cross Infection/blood/drug therapy/microbiology ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Methicillin/pharmacology/*therapeutic use ; *Methicillin Resistance ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections/blood/drug therapy/*microbiology ; Staphylococcus aureus/*drug effects/isolation & purification