BACKGROUND: Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients. METHODS: A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher. RESULTS: Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients' mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016). CONCLUSIONS: This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.
Emergency Service, Hospital ; Factor VIIa* ; Female ; Humans ; Maternal Death ; Maternal Mortality ; Medical Records ; Organ Dysfunction Scores ; Postpartum Hemorrhage* ; Postpartum Period* ; Prognosis ; Recombinant Proteins ; Retrospective Studies

Duodenal diverticulitis is a rare complication of the duodenal diverticulum. Its rarity is due to the relatively large diameter of the duodenum, which makes the intraluminal flow of sterile liquid duodenal contents fluent. Additionally, nonspecific signs and symptoms of duodenal diverticulitis make it very difficult to diagnose properly. We describe a patient presenting with abdominal pain, nausea, and leukocytosis, with diverticulitis of the third portion of the duodenum caused by the impaction of a foreign body, who was diagnosed and treated with enteroscopy.
Abdominal Pain ; Diverticulitis ; Diverticulum ; Double-Balloon Enteroscopy ; Duodenum ; Foreign Bodies ; Humans ; Leukocytosis ; Nausea

Thymic carcinoid tumor is a rare mediastinal tumor, which was firstly described by Rosai and Higa in 1972. A carcinoid tumor of the thymus has recently been regarded as a distinct tumor from thymoma, and is probably Kultschizky cell origin. The pathologic diagnosis of thymic carcinoid is made from findings from light microscopy, immunohistochemical studies and electron microscopy. About 50% of thymic carcinoids were seen with endocrinopathies. Recurrences and extrathoracic metastasis are characteristics of thymic carcinoids. Surgical removal of the intial and tumor recurred are considered to be the most effective treatment today. However, the role of the adjuvant radiotherapy and the chemotherapy is still uncertain. Herein we report a case of thymic carcinoid tumor, which was confirmed by operation and pathologic study.
Carcinoid Tumor* ; Diagnosis ; Drug Therapy ; Mediastinal Neoplasms ; Microscopy ; Microscopy, Electron ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence ; Thymoma ; Thymus Gland ; Thymus Neoplasms

Extramedullary plasmacytoma (EMP) is a plasma cell tumor located outside of the bone marrow. It most often occurs in the upper respiratory tract (85%), as well as the head and neck, and very rarely occurs in the retroperitoneum. Here we report the case of a 57-year-old woman with retroperitoneal EMP.
Bone Marrow ; Female ; Head ; Humans ; Middle Aged ; Multiple Myeloma ; Neck ; Plasmacytoma* ; Respiratory System ; Retroperitoneal Fibrosis ; Retroperitoneal Space

Transcatheter arterial embolization (TAE) is widely used in the treatment of unresectable hepatocellular carcinoma. Its common complications are right upper quadrant pain, nausea, vomiting, and rare complications include focal pancreatic necrosis, gastric ulcer, renal failure, DIC, biliary tree necrosis and splenic infarction and so on. It has been reported that hepatobronchial fistula could develop as a pleuropulmonary complication of liver abscess. We report a case of hepatobronchial fistula caused by complicating liver abscess in a patient with hepatocellular carcinoma who was treated with TAE.
Biliary Tract ; Carcinoma, Hepatocellular* ; Dacarbazine ; Fistula* ; Humans ; Liver Abscess ; Nausea ; Necrosis ; Renal Insufficiency ; Splenic Infarction ; Stomach Ulcer ; Vomiting

BACKGROUND: Laser therapy for various skin conditions is one of the most common procedures in dermatology. Recently, several articles described the use of 1064 nm Q-switched Nd:YAG lasers for the treatment of benign skin lesions. Such treatment is known to trigger its therapeutic effect through a photoacoustic effect and selective photothermolysis effect. However, only a limited number of articles have dealt with the theoretical base of the photoacoustic effect of the 1064 nm Q-switched Nd:YAG laser. OBJECTIVE: To compare the wound repair process and nonselective tissue heat damage induced by three different laser modalities: the CO2 laser, Er:YAG laser, and 1064 nm Q-switched Nd:YAG laser. METHODS: We irradiated the skin of an albino rat (Sprague Dawley(R), 200~250 g) with CO2, Er:YAG, and 1064 nm Q-switched Nd:YAG lasers. Skin biopsy specimens of the irradiated areas were collected on the first, fifth, and tenth day after laser exposure. For histologic analysis, the specimens were stained with the H&E, Verhoff-Van Gieson, and Masson's trichrome protocols. RESULTS: Compared with other laser modalities, rat skin irradiated by the 1064 nm Q-switched Nd:YAG laser showed the least amount of heat damage and the quickest tissue repair response to the damage. CONCLUSION: A 1064 nm Q-switched Nd:YAG laser with a photoacoustic effect capable of ablating the epidermis and dermis can be a proper treatment modality for the removal of benign skin lesions. The 1064 nm Q-switched Nd:YAG laser may be considered as an alternative treatment option for the treatment of benign skin lesions.
Animals ; Biopsy ; Dermatology ; Dermis ; Epidermis ; Hot Temperature ; Laser Therapy ; Lasers, Gas ; Rats* ; Skin* ; Wounds and Injuries*

Capsule endoscopy (CE) provides a minimally invasive examination of the entire small intestine, and is the preferred procedure for evaluation of patients with GI bleeding of unknown origin. Even though the FDA approved its use for pediatric patients between 10 and 18 years old in January 2004, little information is available regarding the effectiveness of CE in the younger pediatric population (below 6 years old) because of safety issues. A 42-month child with recurrent melena was referred to evaluate the cause of gastrointestinal bleeding. Despite extensive evaluation, including EGD, colonoscopy, a small bowel series, and Meckel's scan, the bleeding source was not identified. Finally, wireless CE demonstrated angiodysplasia on the mucosa of proximal jejunum. This is the first pediatric case of endoscopy-assisted CE under intravenous sedation without endotracheal intubation in Korea.
Angiodysplasia ; Capsule Endoscopy ; Child ; Colonoscopy ; Hemorrhage ; Humans ; Intestine, Small ; Intubation, Intratracheal ; Jejunum ; Korea ; Melena ; Mucous Membrane ; Preschool Child

No abstract available.
Classification* ; Female ; Hydatidiform Mole* ; Pregnancy

Methotrexate (MTX) has been widely used in the treatment of psoriasis and rheumatoid arthritis. But prolonged use of MTX can induce hepatic fibrosis and even cirrhosis. To date, in Korea, there have been very few reports on hepatotoxicity due to MTX, and no report on biopsy-proven chronic active hapatitis. We report one patient who developed chronic acitve hepatitis while taking long-term daily dose of MTX(10mg per day) for psoriasis for a prolonged period.
Arthritis, Rheumatoid ; Fibrosis ; Hepatitis ; Hepatitis, Chronic* ; Humans ; Korea ; Methotrexate* ; Psoriasis*

Acute eosinophilic pneumonia (AEP) has been described as an idiopathic febrile illness with a duration of less than seven days with severe hypoxemia, pulmonary infiltrates, and no history of asthma. It has been reported that AEP is associated with smoking. Although the pathogenesis of smoking induced AEP is being actively studied, there is no direct histological evidence that smoking actually induces AEP. Recently, we encountered a case of AEP that may have been caused by smoking. We performed a cigarette smoking challenge test to verify that smoking was indeed the cause of AEP in this patient. Smoking induced an increase the proportion of eosinophils in the bronchoalveolar lavage fluid without any respiratory symptoms or abnormal radiological findings. This result suggests that smoking was the cause of AEP in this patient.
Anoxia ; Asthma ; Bronchoalveolar Lavage Fluid ; Eosinophils* ; Humans ; Pulmonary Eosinophilia* ; Smoke* ; Smoking*