Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a type of autoimmune encephalitis that causes characteristic symptoms through the formation of antibodies against NMDA receptors. If ovarian teratomas are detected, surgical removal under general anesthesia is often considered. Many general anesthetic agents inhibit NMDA receptors. As such, anesthetic agents may have unexpected effects on disease progression. For anesthesiologists, providing general anesthesia for these patients is challenging and there are few studies on which anesthetic is most appropriate Case: Two female patients were diagnosed with anti-NMDA receptor encephalitis and ovarian teratomas. Successful teratoma resection was performed under general anesthesia using remimazolam and remifentanil. After the surgery, one patient showed some improvement but died a month later. The other patient progressively improved over time. Conclusions Remimazolam and remifentanil are useful general anesthetic agents for patients with anti-NMDA receptor encephalitis. Further studies are warranted.

PURPOSE: There are many cases of paroxysmal supraventricular tachycardia (PSVT) presenting to the emergency department (ED) with palpitation as the presenting symptom. Adenosine is usually administered for conversion to normal sinus rhythm, with a possible second dose in the case of no response. As adenosine has a short acting time, administration of the drug at a vessel as close to the heart as possible is recommended, followed by an extra normal saline bolus infusion. In this study, we hypothesized a better outcome when adenosine was administered after proper injection method instruction was given to the medical staff. METHODS: We retrospectively studied the population of PSVT patients treated with adenosine. The cases were divided into two groups: one group consisted of cases a year before instruction for adenosine use became routine practice, and the second was comprised of cases a year after instruction protocols had been put into place. We further analyzed the proportion of patients who converted to normal sinus rhythm after a single dose of adenosine. RESULTS: All 306 patients were included. Before instruction, 46 patients (40.0% of 115) converted to normal sinus rhythm after the first dose. After instruction, 108 patients (56.5% of 191) converted to normal sinus rhythm after the first dose, which was statistically significant (p<0.05). CONCLUSION: After receiving proper education, more patients converted to normal sinus rhythm after the first dose. Instruction for proper adenosine injection technique for PSVT cases can increase the success rate of rhythm conversion on the first attempt.
Adenosine* ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Heart ; Humans ; Medical Staff ; Retrospective Studies ; Tachycardia, Supraventricular*

PURPOSE: We conducted the immunoassay of pertussis according to ages, in order to evaluate protective immunity against pertussis in Korean populations. METHODS: Healthy subjects were enrolled at four university hospitals in Korea. The subjects were grouped as seven age groups (every 10 years). Antibodies against pertussis toxin (PT) in sera were measured by enzyme linked immunosorbent assay (ELISA) kits. Geometric mean concentrations (GMC) of antibodies and the ratios of the subjects with seroprotective antibody levels were determined. The subjects with antibody titers > or =24.0 EU/mL were considered to seroprotective as the manufacturer's protocol. RESULTS: Total 1,605 subjects (age: 2 months-65 years) participated in this study, and their GMC was 56.16+/-50.54 EU/mL. Among seven age groups, age group <11 year showed the highest GMC (64.78+/-53.24 EU/mL) (P<0.001). In the analysis of the ratios of the subjects with seroprotective antibody titers, 68.2% of the subjects were proven to seroprotective, and age group <11 year also showed the highest ratio (76.5%) (P<0.001). CONCLUSIONS: We found that adolescences or adults (age group > or =11 year) showed lower levels of antibody against pertussis and lower ratio of the subjects with seroprotective antibody titers than children (age group <11 year).
Adult ; Antibodies ; Child ; Enzyme-Linked Immunosorbent Assay ; Hospitals, University ; Humans ; Immunization ; Immunoassay ; Korea ; Pertussis Toxin ; Whooping Cough

No abstract available.
Adenocarcinoma* ; Cervix Uteri* ; Female

BACKGROUND/AIMS: The aim of this study was to evaluate the ability of Helicobacter pylori eradication treatment to increase platelet counts in Korean patients with chronic idiopathic thrombocytopenic purpura (ITP). METHODS: A total of 102 patients were evaluated against two criteria. First, those diagnosed with H. pylori infections in whom eradication was successful were assigned to the H. pylori-positive and -eradicated group (n=39), whereas those diagnosed with H. pylori infections in whom eradication failed were assigned to the H. pylori-positive and -non-eradicated group (n=3), and those without H. pylori infections were assigned to the H. pylori-negative group (n=60). Second, patients with complete remission in whom the platelet recovery effect was maintained over the average follow-up period of 6 months after eradication therapy were defined as the responder group (n=58), whereas those with partial or no response were defined as the nonresponder group (n=44). RESULTS: The platelet counts of the H. pylori-positive and -eradicated group were significantly increased 6 months after eradication therapy compared to those of the H. pylori-positive and -non-eradicated group and the H. pylori-negative group (43.2±29.1 to 155.3±68.7×10(3)/μL vs 42.5±28.1 to 79.8±59.7×10(3)/μL vs 43.1±28.9 to 81.2±62.2×10(3)/μL; p=0.041). The eradication therapy success rate in the responder group was 100.0% (39/39), in contrast to the nonresponder group (0%, 0/3) (p<0.001). CONCLUSIONS: H. pylori eradication therapy was related to increased platelet count, and successful eradication affected the increased platelet count in Korean patients with chronic ITP.
Blood Platelets ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic*

Waardenburg syndrome (WS) is a rare, autosomal dominant disorder characterized by sensorineural hearing loss, pigmentary disturbances of the skin, hair, and iris, and other developmental defects such as lateral displacement of both medial canthi and lacrimal puncta called dystopia canthorum. While mutations of the PAX3 (paired box) gene have been identified in about 99% of WS type 1 cases, WS type 2 is a heterogeneous group, with about 15% of cases caused by mutations in microphthalmia associated transcription factor (MITF). We have experienced three cases of typical WS type 2 in a Korean family, for whom full ocular examination and genetic studies were performed. The genetic studies revealed no mutation in either PAX3 or MITF genes. The genetic basis, as yet unknown for most cases of WS type 2, might be found with further investigation.
Child ; DNA Mutational Analysis ; DNA-Binding Proteins/genetics ; Female ; Humans ; Korea ; Male ; Middle Aged ; Mutation ; Pedigree ; Transcription Factors/genetics ; Waardenburg's Syndrome/*genetics

Hypereosinophilic syndrome, the disease with continuous over production of eosinophil from bone marrow without any identifiable underlying disorder, causes various symptoms or signs by infiltrating organs. As many as 28,780/mm3 eosinophils in peripheral blood, the eosinophilic hyperplasia in bone marrow and features of hepatic involvement -revealed elevated serum AST, ALT and ultrasonogram of abdomen showed the multiple nodules scattered throughout the liver, we have reached to make a diagnosis of the rare hyper eosinophilic syndrome carrying the eosinophil-rich exudate in pleural effusion. The patient showed improvement of clinical symptoms with oral administration of predinisolone, and we report this case with literature consideration.
Abdomen ; Administration, Oral ; Bone Marrow ; Diagnosis ; Eosinophils ; Exudates and Transudates ; Humans ; Hypereosinophilic Syndrome ; Hyperplasia ; Liver ; Pleural Effusion* ; Ultrasonography

Atrial flutter occurs most often in patients with organic heart disease. It appears that chronic atrial flutter is associated with a remarkably high risk of clinically apparent thromboembolism and effective anticoagulation appears to reduce this risk, but acute or recent onset, postoperative atrial flutter may have a lower risk of thromboembolism than those with chronic atrial flutter. In chronic atrial flutter or fibrillation with organic heart disease, anticoagulation is generally justified but there is some debate about anticoagulation in paroxysmal atrial flutter. The spontaneous echo contrast is generally accepted one of the major risk factor of thromboembolism and usually occurred in mitral stenosis, dilated cardiomyopathy, and enlarged left atrium, but rarely observed in apical hypertrophic cardiomyopathy. We experienced a patient with apical hypertrophic cardiomyopathy, who visited to emergency medical center due to dizziness and suffered from cerebral thromboembolism after restoration of sinus rhythm. In transesophageal echocardiography, there was moderate to severe spontaneous echo contrast in left atrium. This patient showed that transesophageal echocardiography evaluation of left atrium might be mandatory in patients with paroxysmal atrial flutter and organic heart disease.
Atrial Flutter* ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Dizziness ; Echocardiography, Transesophageal ; Emergencies ; Heart Atria ; Heart Diseases ; Humans ; Mitral Valve Stenosis ; Risk Factors ; Thromboembolism*

A sixty-eight year old female patient was transferred to our department for the resection of a solitary pulmonary nodule on the right lower lobe. An intraoperative frozen-section revealed a bronchioloalveolar carcinoma. Therefore, a right lower lobectomy and mediastinal lymph node dissection were performed. The permanent pathologic diagnosis of this patient was a sclerosing hemangioma. Herein, our experience of the treatment of a sclerosing hemagioma presenting with a solitary pulmonary nodule by a lobectomy is reported with a review of the literature
Adenocarcinoma, Bronchiolo-Alveolar ; Diagnosis ; Female ; Histiocytoma, Benign Fibrous* ; Humans ; Lymph Node Excision ; Solitary Pulmonary Nodule

PURPOSE: To determine the incidence of pseudolesions seen in the posterior aspect of segment IV of the liveron CT arterial portography(CTAP), and to evaluate the findings of CT hepatic arteriorgraphy(CTHA) and celiacangiography. MATERIALS AND METHODS: We retrospectively analysed 450 cases of patients who had undergone CTHA,CTAP and celiac arteriorgraphy for the diagnosis and treatment of hepatic lesion, and evaluated the incidence andimaging findings of pseudolesions in segment IV of the liver, as seen on CTAP, CTHA and celiac arteriography. RESULT: In 28 of 450 patients(6.2%), pseudolesions of focal perfusion defect were seen in segment IV on CTarterial portography. Pseudolesions were seen on CTAP on 39 different section slices ; these were wedge-shaped in41% of cases(16/39), rectangular in 30.8%(12/39), ovoid-shaped in 23.1%(9/39), and half moon-shaped in 5.1%(2/39); they were from 1 to 3cm(average, 1.5cm) in anteroposterior diameter, from 1 to 3cm(average, 1.9cm) in width, andfrom 1 to 4cm(average, 1.9cm) in craniocaudal diameter. Twenty-seven patients underwent CTHAs ; hyperattenuationwas seen in 13(48.2%), isoattenuation in 12(44.4%), and hypoattenuation in two(7.4%). In 19 of 28 celiacangiograms(67.9%), the right gastric artery was seen to arise from the hepatic artery, and aberrant right gastricveins directly draining into the left lobe of the liver were seen in three(10.7%). CONCLUSION: The incidence ofpseudolesion seen in segment IV of the liver on CTAP was 6.2% (28/450), and in 3 of 28 cases(10.7%), celiacangiography showed aberrant right gastric venous drainage. For pseudolesions, CTHA showed variable attenuation,and this modality is less sensitive than CTAP for the detection of pseudolesion.
Angiography ; Arteries ; Diagnosis ; Drainage ; Hepatic Artery ; Humans ; Incidence ; Liver* ; Perfusion ; Portography* ; Retrospective Studies