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

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

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

The ultimate aim of periodontal treatment is periodontal regeneration, which necessiates the regeneration of bone tissues. This paper investigated the effect of growth factor on bone cells. Platelet-derived growth factor(PDGF) is the one of the polypeptide growth factor that has been reported as a biological mediator which regulates activities of the cell proliferation, migration and metabolism of undifferentiated mesenchymal cells. The purpose of this study is to evaluate the effects of PDGF on bone nodule formation and ALP activity of MC3T3-E1 cells. Cells were seeded at 1x10(5)cells/well in alpha-modified eagle medium containing 10% fetal bovine serum, 10ml beta-glycerophosphate and 50microgram/ml of ascorbic acid. PDGF 0, 0.1, 1, 10ng/ml were added to the cells at a confluent state and cultured for 3, 7, 14, 21, 28 days. We examined bone nodule formation and alkaline phosphatase activity. The results were as follows: There were bone nodule formation at day 21 both in control and all the experimental groups, and at day 28, all the experimental groups showed much more bone nodules than control groups. Compared to control-1 group, ALP activity was increased in PDGF 0.1ng/ml group and was decreased in 1,10ng/ml PDGF treated groups.(P< 0.05, P< 0.01) Compared to control-2, ALP activity was decreased in all the experimental groups except PDGF 0.1ng/ml in 21 day group. In the time-response effect, ALP activity was increased by the day 14 in all the experimental groups and thereafter ALP activity was decreased.(P<0.05, P< 0.01) In the dose-response effect, ALP activity was decreased as the dose of PDGF was increased, and after 21 day ALP activity was lowest in 1ng/ml group, ALP activity was highest in the day 7 in control group and 0.1ng/ml, 14 day experimental group. In conclusion, PDGF is considered more effective in the proliferation than differentiation of osteoblast-like cells, and it may be useful to study the combined effect of PDGF and other growth factors on osteoblast-like cells.
Alkaline Phosphatase ; Ascorbic Acid ; Bone and Bones ; Cell Proliferation ; Eagles ; Intercellular Signaling Peptides and Proteins ; Metabolism ; Regeneration

Polypeptide growth factors belong to a class of potent biologic mediators which regulate cell differentiation, proliferation, migration and metabolism. IGF-I is polypeptides secreted by skeletal cells and is considered as regulators of bone formation. The purpose of this study is to evaluate the effects of IGF-I on bone nodule formation and alkaline phosphatase activity of MC3T3-E1 cells. MC3T3-E1 cells were seeded at 1x10(4) cells/well, 1x10(5) cells/well in alpha-modified Eagle medium containing 10% fetal bovine serum, 10 mM beta-glycerophosphate and 50microgram/ml of ascorbic acid. Before 48 hours of indicated time, medium were changed with serum free medium. After 24 hours, 0.1, 1, 10 ng/ml IGF-I were added to the cells and cultured for 3, 7, 14, 21, 28 days. And histochemical analysis was done and ALP activity was measured and was expressed as nmol/min/mg of protein. The bone nodule formation in MC3T3-E1 cells of IGF-I was seen at 21, 28 days, but there were no difference between control group and experimental groups. The ALP activity decreased when it is compare to control 2 group except for 1 ng/ml, 10 ng/ml IGF-I of 21-day-groups and 1 ng/ml IGF-I of 28-day-groups. Dose response effects of IGF-I of ALP activity in MC3T3-E1 cells were seen the highest ALP activity at 1ng/ml until 21days and the highest ALP activity at 10 ng/ml of 28 daygroups. The peak times were seen at 7-day group, 14-day group on control group and experimental group respectively, and 1 ng/ml group was the highest ALP activity. From the above results, IGF-I was not seen notable effect on bone nodule formation and decreased ALP activity of MC3T3-E1 cells but the use of IGF-I to mediate biological stimulation of MC3T3-E1 cells shows promise for future therapeutic application.
Alkaline Phosphatase ; Ascorbic Acid ; Cell Differentiation ; Eagles ; Insulin-Like Growth Factor I* ; Intercellular Signaling Peptides and Proteins ; Metabolism ; Osteogenesis ; Peptides

ERCP may provide more definite diagnosis, preoperative guidance, and endoscopic therapy in many children with known and suspected disorders of the pancreas or biliary tract. To our knowledge, there has been rare case of ERCP in children and no reported case of ERCP performed in inf~int less than 2 years old in Korea. We report a case of KRCP performed in 26 month old girl who was admitted to evaluate jaundice. We diagnosed CBD stones and choledochal cyst, Todani type III containiaig stones by ERCP. After endoscopic sphincterotomy(EST), removal of stones, and endoscopic nasobiliary drainage(END) her bilirubin level normalized about 2 months later.
Biliary Tract ; Bilirubin ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde* ; Choledochal Cyst* ; Diagnosis ; Female ; Humans ; Infant* ; Jaundice ; Korea ; Pancreas ; Sphincterotomy, Endoscopic*

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*

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