Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Embolization, Therapeutic ; Hemobilia* ; Hemorrhage ; Humans ; Plastics* ; Stents*

We performed 24-hr monitoring of pulse oximetric saturation (SpO2) with ECG and six-minute walk test (6MWT) in 19 patients with fibrotic interstitial lung diseases (ILD) to investigate; 1) The frequency and severity of hypoxemia and dysrhythmia during daily activities and 6MWT, 2) safety of 6MWT, and 3) the parameters of 6MWT which can replace 24-hr continuous monitoring of SpO2 to predict hypoxemia during daily activities. All patients experienced waking hour hypoxemia, and eight of nineteen patients spent > 10% of waking hours in hypoxemic state. Most patients experienced frequent arrhythmia, mostly atrial premature contractions (APCs) and ventricular premature contractions (VPCs). There were significant correlation between the variables of 6MWT and hypoxemia during daily activities. All of the patients who desaturated below 80% before 300 meters spent more than 10% of waking hour in hypoxemia (P = 0.018). In contrast to waking hour hypoxemia, SpO2 did not drop significantly during sleep except in the patients whose daytime resting SpO2 was already low. In conclusion, patients with fibrotic ILD showed significant period of hypoxemia during daily activities and frequent VPCs and APCs. Six-minute walk test is a useful surrogate marker of waking hour hypoxemia and seems to be safe without continuous monitoring of SpO2.
*Activities of Daily Living ; Aged ; Anoxia/*physiopathology ; Arrhythmias, Cardiac/*physiopathology ; Dyspnea/physiopathology ; Electrocardiography, Ambulatory ; Exercise Test ; Exercise Tolerance ; Female ; Humans ; Lung Diseases, Interstitial/*physiopathology ; Male ; Middle Aged ; Motor Activity/*physiology ; Oximetry ; Respiratory Function Tests ; Sleep ; Walking

PURPOSE: Doxylamine is antihistamine drug that is used as a hypnotic. It is also used for suicidal attempts because it can be easily purchased at the pharmacy without a prescription. There were many articles about the complications after doxylamine intoxication such as a rhabdomyolysis, but only a few articles have reported on seizure. We reviewed the cases of doxylamine intoxication with seizure that were treated in the emergency department. METHODS: We reviewed the medical records of the patients who were over 15 years old and who were intoxicated by doxylamine at 3 emergency medical centers from January 2006 to June 2010. We reviewed the patients' age, gender, the dose of doxylamine ingested, if gastrointestinal decontamination was done, the time from intoxication to hospital arrival, the seizure history, treatment of seizure, the electroencephalography (EEG) results, the brain computed tomography (CT) results and the blood test results. RESULTS: There were 168 patients who were intoxicated by doxylamine during the study period. Twelve patients had a seizure episode. The differences between the patients who developed seizure and the patients who did not were the dose and the serum levels of sodium and creatinine. The only clinically meaningful difference was the amount of doxylamine. The amount of doxylamine ingested (>29 mg/kg) predicted the development of seizure with a sensitivity of 75% and a specificity of 92% on the ROC curve. One patient among the seizure patients expired in the emergency department. CONCLUSION: In case of doxylamine intoxicated patients, there is close relationship between seizure and ingested amount, so close observation needs to be done for the patients who ingest too much because doxylamine can cause death. Further prospective studies are needed for doxylamine intoxicated patients with a seizure episode.
Brain ; Creatinine ; Decontamination ; Doxylamine ; Electroencephalography ; Emergencies ; Hematologic Tests ; Humans ; Medical Records ; Pharmacy ; Prescriptions ; Rhabdomyolysis ; Risk Factors ; ROC Curve ; Seizures ; Sensitivity and Specificity ; Sodium

PURPOSE: To determine the means, medians and reference intervals for TSH (thyroid-stimulating hormone) and fT4 (free thyroxine) for each month of gestation and for three trimesters in Korean pregnant women. METHODS: Serum samples were collected from 265 pregnant women with singleton gestation. Levels of TSH, fT4 were measured by immunoassay. After exclusion of subjects with positive antimicrosomal autoantibodies, the means, medians and reference intervals based on 2.5th and 97.5th percentiles for TSH, fT4 were determined. RESULTS: The study population consisted of 94 women in first trimester, 49 women in second trimester, and 122 women in third trimester. The trimester-specific reference intervals were: TSH (1st trimester: 0.03~2.72, 2nd: 0.27~2.29, and 3rd: 0.03~2.88 mIU/L), fT4 (1st trimester 4.50~19.75, 2nd: 4.70~12.98 and 3rd: 5.07~11.84 pg/mL). fT4 levels were significantly lower in the second and third trimesters. TSH levels were lower in the first trimester than second and third trimester, with gradual elevation in the second and third trimester. CONCLUSION: Levels of TSH, fT4 during pregnancy differ from those in non-pregnant women. Gestational age specific reference intervals will play a cental role in screening and diagnosis of thyroid disorders. Further studies for normal reference ranges during pregnancy are needed to create reference intervals in Korean pregnant women.
Autoantibodies ; Female ; Gestational Age ; Humans ; Immunoassay ; Mass Screening ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnant Women ; Reference Values ; Thyroid Function Tests ; Thyroid Gland ; Thyrotropin

Malignant neoplasm of the fallopian tube is the rarest of the gynecologic cancers. Vaginal bleeding, vaginal discharge, and pelvic pain are the most common symptoms. Because of these non-specific symptoms, the diagnosis of this least common neoplasm is rarely made before laparotomy. The tumor is typically unilateral and has histologic subtypes, endometrioid and serous adenocarcinoma being the most common subtypes. Surgery, clearly the mainstay of treatment, is also the first approach to diagnosis. The procedure of choice is total abdominal hysterectomy with bilateral salpingo-oopho-rectomy. We had experienced one patient with primary tubal cancer, successfully evaluated with laparoscopy. And then we intend to report the case of the above patient and have a brief discussion about that.
Adenocarcinoma ; Diagnosis ; Fallopian Tube Neoplasms ; Fallopian Tubes ; Female ; Humans ; Hysterectomy ; Laparoscopy* ; Laparotomy ; Pelvic Pain ; Uterine Hemorrhage ; Vaginal Discharge

OBJECTIVE: Placental abruption is one of the obstetric hemorrhage diseases that needs emergent treatment. But there is no predictable tool for placental abruption at present, we clinically analyzed its incidence, etiological factors, signs and symptom and neonatal outcome for reducing complications of this disease. METHODS: The data presented here were based on 80 cases of placental abruption among 20,483 deliveries during 13 years of period from January, 1991 to December, 2003. RESULTS: The incidence of placental abruption was 0.4%. Most of cases (97.5%) occurred over 28 weeks of gestational age. The incidence of unknown etiological factor was 67.5% and pregnancy-induced hypertension was related in 22.5% of cases. The most common signs and symptom was vaginal bleeding (46.3%). Lower abdominal pain (33.8%), fetal distress (10%), premature labor (5%) were also noted. The half of the patients was diagnosed before delivery and the mode of delivery was cesarean section in 93.8%. The survival rate of newborns in severe degree group (14.3%) of placental abruption was lower than that of mild degree group (94.1%) or moderate degree group (84.6%). Additionally, Apgar scores at 1min and 5min of newborns in severe degree group (1.3+/-2.4/1.3+/-3.0) were significantly lower than that of mild degree group (5.9+/-2.5/7.5+/-2.2) or moderate degree group (5.5+/-2.7/7+/-2.8) (p<0.01). There was no maternal death in our study. CONCLUSION: Because the etiological factor of this disease was uncertain in two thirds of cases, comprehension of etiological factor such as pregnancy-induced hypertension and signs and symptom is emphasized. Bleeding and uteroplacental insufficiency caused by placental abruption affect fetal jeopardy in severe cases. Accurate diagnosis and adequate treatment including management of premature baby should be conducted in suspicious case of placental abruption for prevention of progression of this disease.
Abdominal Pain ; Abruptio Placentae* ; Cesarean Section ; Comprehension ; Diagnosis ; Female ; Fetal Distress ; Gestational Age ; Hemorrhage ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant, Newborn ; Maternal Death ; Obstetric Labor, Premature ; Pregnancy ; Survival Rate ; Uterine Hemorrhage

The incidence of all malignant tumor in pregnancy is 0.07-0.1%. The most frequent tumors in pregnancy are breast cancer, gynecologic tumors (cervical cancer, ovarian cancer), melanoma and lymphomas. Any malignant tumor in pregnancy has a diagnostic and therapeutic problem. Melanoma is 8% of all malignancies in pregnancy. Surgery is a definitive therapy for early-stage disease. Melanoma in pregnancy metastasize early and rapidly. So we have difficulty in making therapeutic plan. Most frequent metastatic lesions are liver and lung. We experienced melanoma of liver in pregnancy. This report represents melanoma in pregnancy with a review of literature.
Breast Neoplasms ; Incidence ; Liver* ; Lung ; Lymphoma ; Melanoma* ; Ovarian Neoplasms ; Pregnancy* ; Rupture, Spontaneous*

Thrombotic thrombocytopenic purpura (TTP) is a clinical syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, fever, renal disorder and neurologic signs. Its clinical course is rapid and its mortality rate is very high. However, the prognosis has much improved after plasma exchange was introduced as a therapeutic modality. We report a 31-year-old multipara pregnant woman with refractory TTP, who achieved complete remission after 54 plasma exchanges.
Pregnancy ; Female ; Humans ; Mortality

Two cases of an anomalous systemic arterial supply to the basal segments of the left lower lobe without pulmonary wequestration are presented. In the first case, a preoperative diagnosis was made by chest CT, and confirmed by angiograpy, in a 22-year old man who had a recurrent hemoptysis. There was systemic arterial supply that originated from the thoracic descending aorta and no pulmonary arterial supply to the basilar segment of the left lower lobe. However, the pulmonary parenchyma was normal without sequestration. Ligation of the abnormal artery and a left lower lobectomy were performed without complication. In the second case, there were characteristic features of this anomaly on chest CT and the angiogram in a 31-year-old man with symptoms of hemoptysis. The patient refused surgery.
Adult ; Aorta, Thoracic ; Arteries ; Bronchopulmonary Sequestration ; Diagnosis ; Hemoptysis ; Humans ; Ligation ; Tomography, X-Ray Computed

PURPOSE: Zinc ion is critical for the functional and structural integrity of eukaryotic cells and participate in the regulation of apoptosis. In general, zinc inhibits a nuclear endonuclease, thereby causing inhibition of apoptosis. Recent studies have pointed to a role for a family of caspase proteases that act upstream of endonuclease. The widely used chemotherapeutic agents exert effects by inducing of apoptosis in sensitive tumor cells. In this study, we investigated the effects of zinc ion and other divalent cation on the idarubicin (IDA)-induced apoptosis of HL-60 cells. In addition, to determine whether Zn inhibits an event upstream of endonuclease activation, we analysed the activity of caspase-3, 9 and proteolytic cleavage of procaspase-3 and PARP [poly (ADP-ribose) polymerase]. METHODS: HL-60 cells were cultured in RPMI 1640 and treated with various doses and time periods of IDA with or without pretreatment of ZnCl2, CaCl2 and MgCl2. Cell viability was measured by trypan blue staining. For detection of apoptotic death, cells were stained with Hoechst dye and observed under fluorescence microscopy. The activities of caspase-3 and caspase-9 were measured by the proteolytic cleavages of Ac- DEVD-AMC and Ac-LEHD-AFC as flurogenic substrates, respectively. The proteolytic cleavages of procaspase-3 and PARP were analyzed by Western blotting using anti- caspase-3 and anti-PARP antibody, respectively. RESULTS: IDA induced the apoptotic death of HL-60 cells in a dose and time dependent manner, which was characterized by increasing chromatin condensation and DNA fragmentation. Pretreatment of HL-60 cells with ZnCl2 caused potent inhibition of IDA-induced apoptosis. Consistent with apoptotic death of HL-60 cells, IDA induced the catalytic activation of caspase-3 and caspase-9. After pretreatment of ZnCl2, the activation of caspase- 3 and the proteolysis of PARP induced by IDA were potently inhibited. But, after pretreatment of CaCl2 and MgCl2, there were no significant changes of IDA-induced apoptosis and proteases activity. CONCLUSION: Zinc ion suppressed the IDA-induced apoptosis via the inhibitions of caspase-9 and caspase-3. But calcium and magnesium ions didn't affect the IDA-induced apoptosis.
Apoptosis* ; Blotting, Western ; Calcium ; Caspase 3 ; Caspase 9 ; Cell Survival ; Chromatin ; DNA Fragmentation ; Eukaryotic Cells ; HL-60 Cells ; Humans ; Idarubicin ; Ions ; Magnesium ; Magnesium Chloride ; Microscopy, Fluorescence ; Peptide Hydrolases ; Proteolysis ; Trypan Blue ; Zinc