The incidence of vector-borne infectious diseases is increasing due to developments in diagnostic techniques, as well as due to economic, environmental, and ecological factors such as global warming, increased rainfall, globalization, and urbanization. Tick-borne infectious diseases occurring in Korea include severe fever with thrombocytopenia syndrome, Lyme disease, anaplasmosis, and Japanese spotted fever. Various skin lesions, such as erythema migrans, tick bite sites, rash, and eschar, are associated with tick-borne infectious diseases. It is necessary to remove ticks immediately to prevent transmission of these tick-borne infectious diseases. Especially for conditions such as Lyme disease, at least 24 to 48 hours of tick attachment to the host is required for transmission of the causative pathogens to the host. Tick-borne diseases are acquired after outdoor activities and have nonspecific symptoms such as fever, headache, and chills, which make them difficult to identify without a diagnostic test. Rapid diagnosis and early treatment can reduce the otherwise significant morbidity and mortality associated with these conditions; therefore, therapy should not be delayed until laboratory confirmation is received.
Anaplasmosis ; Animals ; Asian Continental Ancestry Group ; Chills ; Communicable Diseases* ; Diagnosis ; Diagnostic Tests, Routine ; Erythema ; Exanthema ; Fever ; Global Warming ; Headache ; Humans ; Incidence ; Internationality ; Korea* ; Lyme Disease ; Mortality ; Rickettsia Infections ; Scrub Typhus ; Skin ; Thrombocytopenia ; Tick Bites ; Tick-Borne Diseases ; Ticks ; Urbanization

Pernicious anemia is a macrocytic anemia that is caused by vitamin B12 deficiency, itself a result of the absence of intrinsic factors due to autoimmune destruction of parietal cells. We report here the case of a 43-year-old female with spontaneous remission of pernicious anemia. The patient presented with fatigue. Her serum vitamin B12 level was low, hemoglobin level was 7.6 g/dL, and serologic tests for anti-intrinsic factor and anti-parietal cell antibodies were positive. We diagnosed her with pernicious anemia, but did not administer vitamin B12 because her hemoglobin level increased spontaneously. Since then, the patient's hemoglobin and serum vitamin B12 levels have been within the normal range.
Adult ; Anemia, Macrocytic ; Anemia, Pernicious* ; Antibodies ; Fatigue ; Female ; Humans ; Intrinsic Factor ; Rabeprazole ; Reference Values ; Remission, Spontaneous* ; Serologic Tests ; Vitamin B 12 ; Vitamin B 12 Deficiency

BACKGROUND/AIMS: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. METHODS: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. RESULTS: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). CONCLUSIONS: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.
4-Hydroxycoumarins/*poisoning ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/adverse effects/blood ; Anticoagulants/*poisoning ; Blood Coagulation/*drug effects ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Partial Thromboplastin Time ; Prothrombin Time ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Rodenticides/*poisoning ; Serum Albumin/metabolism ; Vitamin K/*blood ; Vitamin K Deficiency Bleeding/blood/*chemically induced/diagnosis/therapy ; Young Adult

Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis. We report a case of pancreaticopleural fistula that was presented with right-sided hemothorax. A 49-year-old male with a history of chronic alcoholism was presented with a month of dyspnea. A chest radiography showed a right-sided massive pleural effusion with old-blood-colored fluids and amylase levels of 1,020 IU/L. On the chest computerized tomography (CT), there was pleural effusion and a well-defined tract from the posterior mediastinum to the pseudocyst in the tail of the pancreas. Even with conservative treatment with closed thoracostomy, octreotide and gabexate mesilate, he developed hemothorax. Abdominal CT revealed an increase of the hemorrhagic pancreatic pseudocyst. Distal pancreatectomy with splenectomy and external drainage of the pancreaticopleural fistula on the posterior mediasternum were performed. The patient had an uneventful course and was discharged on the 27th postoperative day. Management of pancreaticopleural fistula is multimodal included medication, endoscopic stenting and surgery. Surgery in pancreaticopleural fistula might be beneficial in selective cases.
Alcoholism ; Amylases ; Drainage ; Dyspnea ; Fistula ; Gabexate ; Hemothorax ; Humans ; Male ; Mediastinum ; Middle Aged ; Octreotide ; Pancreas ; Pancreatectomy ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Pleural Effusion ; Splenectomy ; Stents ; Thoracostomy ; Thorax

INTRODUCTION: Adult stem cells generate differentiated cells beyond their own tissue boundaries. To prove that stem cells derived from bone marrow is capable of therapeutic application in cerebral ischemic patients, we performed this study. MATERIAL AND METHOD: We transplanted adult stem cells derived from bone marrow of the patient's iliac bone to 5 patients with cerebral infarction. Of 5 patients, two patients had internal carotid artery occlusion, two patients had severe stenosis of the middle cerebral artery, remaining one patient had occlusion of the branch of the middle cerebral artery. At first, we performed extracranial-intracranial bypass surgery in all patients, and then implanted bone marrow stem cell in the infarcted brain and boder zone area directly under the microscopic navigator and also injected bone marrow stem cells through the grafted vessel to the infarcted area. Two weeks after bypass surgery, we confirmed the patency of bypass graft with external carotid angiography. In the same setting, mesenchymal stem cells acquired from autologous bone marrow were superselectively injected into the bypass graft via a microcatheter. Postoperative evaluation of the patients was decided to the neurological status and the degree of reduction of the high signal area on the T2 image of the postoperative MRI. RESULT: All patients who underwent bypass surgery with stem cell implantation had an uneventful postoperative course and showed some improvement of preoperative neurologic dysfunction. Postoperative significant improvement of cerebral vasoreactivity to acetazolamide was showed in all patients. On postoperative 3 months MRI, three patients showed significant reduction of the high signal area on the T2 image, and also improved neurological status on those patients. Other one patient showed moderate degree of the reduction of the high signal area on T2 image of the postoperative MRI, but neurological status of that patient slightly improved. Remaining one patient who showed poor circulation via bypass graft does neither reduction of the high signal area on T2 image of the postoperative MRI nor improvement of the neurological status of that patient. CONCLUSION: In patients of fixed cerebral infarction with major neurologic deficit, EC-IC bypass surgery is not effective, even though infarcted area filled by grafted vessel extensively. In those patients, autologous bone marrow stem cell implantation combined with bypass seems to be expect neuronal regeneration.
Acetazolamide ; Adult Stem Cells ; Angiography ; Bone Marrow* ; Brain ; Carotid Artery, Internal ; Cerebral Infarction* ; Constriction, Pathologic ; Humans ; Magnetic Resonance Imaging ; Mesenchymal Stromal Cells ; Middle Cerebral Artery ; Neurologic Manifestations ; Neurons* ; Regeneration* ; Stem Cell Transplantation* ; Stem Cells* ; Transplants

OBJECTIVE: To evaluate the relationship between gestational age, tubal ultrasonographic diameter, and serum beta-hCG levels and different stages of trophoblastic infiltration of the tubal wall in tubal pregnancy. METHODS: The 45 cases of fallopian tube containing tubal pregnancy were reviewed. Gestational age, diameter of the tubal mass, and beta-hCG level on the day of surgery were calculated by transvaginal sonography and immunoassay respectively. The tubal pregnancy was classified according to the depth of trophoblastic infiltration: trophoblast limited to the tubal mucosa (stage I), extension to the tubal muscularis (stage II), or complete tubal wall infiltration up to the serosa discontinued by trophoblastic cells (stage III). RESULTS: 14 patients (31.1%) had stage I tubal infiltration, 10 patients (22.2%) had stage II infiltration, 21 patients (46.7%) had stage III infiltration. There was no relationship between gestational age, tubal diameter and stage, but there was a predictable correlation between beta-hCG and the depth of trophoblastic invasion. The median beta-hCG level was 1,332.1 mIU/mL (range, 215-2,995 mIU/mL) for patients with stage I infiltration, 9,548.0 mIU/mL (range, 569-43,989 mIU/mL) for stage II infiltration, and 23,087.9 mIU/mL (range, 1,373-98,000 mIU/mL) for stage III infiltration. Cut off level of beta-hCG for each stage were 1,996.5 mIU/mL (stage I vs II, III) and 5,665 mIU/mL (stage I, II vs III) respectively. CONCLUSION: These findings may explain why beta-hCG is a important predicting factor for invasion of trophoblast in tubal pregnancy.
Chorionic Gonadotropin* ; Fallopian Tubes ; Female ; Gestational Age ; Humans* ; Immunoassay ; Mucous Membrane ; Pregnancy ; Pregnancy, Tubal* ; Serous Membrane ; Trophoblasts*

OBJECTIVES: Extracranial-intracranial (EC-IC)bypass procedures have proved useful in selected patients with cerebral ischemia. We have experienced EC-IC bypass procedures in 85 patients with hemodynamic cerebral ischemia, moya moya and complicated aneurysm. In this study, complications after EC-IC bypass procedures was investigated. METHODS: Authors performed EC-IC bypass surgery for augmentation of cerebral blood flow in 85 patients for recent 7 years. Of 85 patients, the pathologic lesions were artherosclerotic hemodynamic cerebral ischemia in 60, moya moya in 14, complicated aneurysm in 9, and traumatic occlusion of the carotid artery in 2. An superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 67 cases and graft bypass with saphenous vein or radial artery in 18 cases. RESULTS: Of 85 patients who underwent bypass surgery, 63 had an uneventful postoperative course. Fifteen patients had hyperperfusion syndrome that included temporary neurologic deficit in 7, reperfusion hemorrhage in 3, seizure in 3, and neusea and vomiting in 2. Five patients had wound problems. Permanant neurologic deficit and complete obstruction of the preoperative stenotic lesion occured in one respectively. All patients except three cases of reperfusion hemorrhage and one case of permanent neurologic deficit recovered completely. Two of three cases of reperfusion hemorrhage and one case of permanent neurologic deficit recovered with minor neurologic deficit, and the remaining one case of reperfusion hemorrhage died. CONCLUSION: EC-IC bypass surgery is a reliable and reasonably safe method for establishing new pathways of collateral circulation to the brain. However, this operation can have potential complications by relative hyperperfusion of chronically hypoperfused and presumably dysautoregulated region, and new flow pattern after bypass. Bypass is deferred to 8 weeks till impaired autoregulation is restored after acute cerebral infarction. And blood pressure should be controlled closely throughout the immediate postoperative period.
Aneurysm ; Blood Pressure ; Brain ; Brain Ischemia ; Carotid Arteries ; Cerebral Arteries ; Cerebral Infarction ; Collateral Circulation ; Hemodynamics ; Hemorrhage ; Homeostasis ; Humans ; Neurologic Manifestations ; Postoperative Period ; Radial Artery ; Reperfusion ; Saphenous Vein ; Seizures ; Transplants ; Vomiting ; Wounds and Injuries

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.
Female ; Humans ; Magnetic Field Therapy ; Muscle Contraction ; Pelvic Floor ; Physical Examination ; Prospective Studies ; Quality of Life ; Surveys and Questionnaire ; Spouses ; Urinary Incontinence* ; Urinary Incontinence, Urge

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.
Female ; Humans ; Magnetic Field Therapy ; Muscle Contraction ; Pelvic Floor ; Physical Examination ; Prospective Studies ; Quality of Life ; Surveys and Questionnaire ; Spouses ; Urinary Incontinence* ; Urinary Incontinence, Urge

OBJECTIVE: To evaluate the indications, advantages and complications of laparoscopically assisted vaginal hysterectomy (LAVH), retrospectively. METHODS: From Mar. 2003 to Feb. 2004, clinical trials of LAVH (n=154) were performed in the Department of Obstetrics and Gynecology, Kangbuk Samsung Medical Center, School of Medicine, University of Sungkyunkwan, Seoul, Korea. Medical records of patients who underwent LAVH were reviewed. The results were evaluated according to characteristics of patients, history of previous abdominal surgery, preoperative surgical indications, postoperative diagnosis, mean operation times, weight of uterus, change of hemoglobin, hospital stay, associated diseases, concomitant procedures and complications. RESULTS: The mean age was 46.09 +/- 6.67 years. The mean parity was 2.08 +/- 0.94. Tubal ligation, vaginal bleeding, leiomyoma was the most common previous abdominal surgery, preoperative surgical indication, and postoperative diagnosis, respectively. The mean operation time was 130.66 +/- 67.68 minutes. The mean uterine weight was 259.27 +/- 123.48 gm. The mean hemoglobin change was 1.61 +/- 1.12 g/dL. The mean hospital stay was 3.44 +/- 1.83 days. The complication rate was 3.2% (5 cases); bladder injury (3 cases) being the most common complication. CONCLUSION: LAVH appears to be beneficial in many aspects. The further development of laparoscopic instruments and skills will reduce limitations and complications of LAVH and will hopefully allow the utilization of this technique to expand to include other clinical indications and concomitant procedures.
Diagnosis ; Female ; Gynecology ; Humans ; Hysterectomy, Vaginal* ; Korea ; Leiomyoma ; Length of Stay ; Medical Records ; Obstetrics ; Parity ; Retrospective Studies ; Seoul ; Sterilization, Tubal ; Urinary Bladder ; Uterine Hemorrhage ; Uterus