Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution.
To evaluate the safety and efficacy of pelvic arterial embolization (PAE) for the treatment of primary postpartum hemorrhage (PPH) and to determine the factors associated with clinical outcomes.



This retrospective single-center study was institutional review board approved, and informed consent was waived. Outcomes were analyzed in 251 patients who underwent PAE for primary PPH between January 2000 and February 2011. Mode of delivery, causes of bleeding, detailed laboratory and treatment records, and clinical outcomes were recorded. Clinical success was defined as cessation of bleeding after initial session of PAE without the need for additional PAE or surgery. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes.



The clinical success rate was 86.5% (217 of 251). Among the 34 failed cases, 12 underwent repeat PAE, 16 underwent additional surgery, and three recovered with conservative management. Overall bleeding control was achieved in 98.0% (246 of 251) of the patients. Overall mortality was 2% (five of 251) after the first (n = 3) or second (n = 1) session of PAE or additional surgery (n = 1). Among the 113 patients with long-term follow-up, 110 (97.3%) maintained a regular menstrual cycle and 11 had successful pregnancies. Univariate analysis showed that cesarean section delivery, disseminated intravascular coagulation (DIC), and massive transfusion of more than 10 red blood cell units were related to failed PAE. Multivariate analysis showed that DIC (odds ratio, 0.36; P = .04) and massive transfusion (odds ratio, 0.10; P < .001) were significantly related to clinical failure.



PAE is safe and effective for managing primary PPH. Patients with DIC and massive transfusion were likely to have poor results after PAE.

title: Z-Shaped Microcatheter Tip Shaping for Embolization of Aneurysms at the Proximal A1 Segment of the Anterior Cerebral Artery: A Technical Note
abstract: Embolization of an aneurysm at the proximal A1 segment of the anterior cerebral artery (ACA) is technically challenging. We treated four consecutive patients with unruptured aneurysms at the proximal portion of the A1 segment of the ACA. We tested various microcatheter tip shapes before we successfully embolized a lesion with a zigzag-shaped microcatheter tip, which was made by steam shaping. The shape of this microcatheter tip resembled the letter "Z", had a relatively long distal straight segment and was helpful in prompt catheterization of the aneurysm sac and stable placement of the catheter and delivery of coils.

title: Atypical Imaging Features of Epstein-Barr Virus–Positive Primary Central Nervous System Lymphomas in Patients without AIDS
abstract: Recent clinical experience with EBV-positive PCNSL in patients without acquired immune deficiency syndrome showed that they tended to have atypical features seen on conventional MR imaging. The purpose of our study was to evaluate the MR imaging features of EBV-positive PCNSL in patients without AIDS and to compare these imaging findings with those of EBV-negative PCNSL.  MR images were obtained in 55 consecutive patients with pathologically proved EBV-positive (n = 10) or EBV-negative (n = 45) PCNSL. We statistically analyzed the differences between the patient groups regarding the occurrence of tumor necrosis or hemorrhage and ADC, rCBVmax, rCBVr, and the Cho/NAA ratio in the tumor area.  Tumor necrosis and hemorrhage were observed in 9 (90%) and 7 (70%), respectively, of the patients with EBV-positive PCNSL; necrosis was observed in 8 (18%), and hemorrhage, in 3 (7%) patients with EBV-negative PCNSL (P < .0001 each). The necrotic core was hyperintense relative to contralateral white matter, as seen on DWI in 4 patients with EBV-positive PCNSL, though the ADC between the 2 patient groups did not differ significantly. rCBVmax, rCBVr, and the Cho/NAA ratios did not differ significantly between the 2 groups. The sensitivity and specificity of necrosis and hemorrhage for differentiating the 2 groups were 89.2% and 81.7% and 78.5% and 94.1%, respectively.  Our initial clinical experience with a small number of patients suggests that EBV-positive PCNSL in patients without AIDS tends to present with atypical MR imaging features.

title: Fibrosarcoma of the ovary arising in a fibrothecomatous tumor with minor sex cord elements. A Case report and review of the literature.
abstract: We report the case of a 69-year-old woman who presented with postmenopausal bleeding. Endometrial curettings showed complex atypical hyperplasia with focal well-differentiated adenocarcinoma. A computed tomographic scan of the abdomen revealed a right ovarian mass. Histologically, the right ovarian tumor was a fibrothecoma with minor sex cord elements showing focal fibrosarcomatous change. Fibrosarcoma of the ovary is a rare tumor that is considered to arise de novo or secondary to benign fibromatous tumors. Fibrothecoma of the ovary with minor sex cord elements is also a rare entity. To the best of our knowledge, this is the first reported case of a fibrosarcoma arising in a fibrothecoma with minor sex cord elements.

title: Interaction of pitch and duration processing by non-musicians in reading musical notation.
abstract: To study the relation of pitch and duration processing in reading musical notation, a Stroop-like task was used by 20 non-musicians. A probe display was presented before each target note. Participants were required to process the tonal and metric information of the probe and then to make a match or mismatch decision between probe and target. The target's color informed participants which dimension (pitch or duration) required analysis. The congruity of the irrelevant dimension of the target was manipulated to examine the effect on the relevant dimension. The interference effect of the irrelevant dimension on the relevant dimension was obvious for number of errors and reaction times. This result is consistent with pitch and duration being processed interdependently and reconciles with the theory of dynamic attention.

title: Effects of interscalene brachial plexus block to intra-operative hemodynamics and postoperative pain for arthroscopic shoulder surgery
abstract: Although arthroscopic shoulder surgery is less invasive and painful than open shoulder surgery, it can often cause intra-operative hemodynamic instability and severe post-operative pain. This study was conducted to investigate the efficacy of the interscalene brachial plexus block (IBPB) on intra-operative hemodynamic changes and post-operative pain during arthroscopic shoulder surgery.  After institutional review board approval, 50 consecutive patients that had undergone arthroscopic shoulder surgery under general anesthesia were randomly assigned to one of two groups to evaluate intra-operative hemodynamic changes and post-operative pain control. Group 1 patients received an IBPB with 10 ml of normal saline guided by a nerve stimulator before induction, and Group 2 patients received 10 ml of 0.5% ropivacaine hydrochloride with the same technique. The heart rate and systolic and diastolic blood pressures were recorded before the incision and 1, 3, 5, 10, and 20 minutes after the incision. Pre-operative and post-operative pain was evaluated with a visual analog scale 1, 3, 6, 12, and 24 hours after surgery. The patients were given tramadol as a rescue medication option. The total volume of tramadol that was injected was also evaluated over the same intervals.  Group 2 showed significantly lower systolic and diastolic blood pressures and heart rates intra-operatively compared to Group 1 (P < 0.05). The visual analog scale pain scores, except at 24 hours after surgery, were significantly lower in Group 2 (P < 0.05). The total tramadol consumption significantly reduced in Group 2 (P < 0.05).  IBPB effectively controlled the hemodynamic changes that occurred during arthroscopic shoulder surgery as well as post-operative pain.

title: Changing prescribing practice in CAPD patients in Korea: increased utilization of low GDP solutions improves patient outcome.
abstract: Novel, biocompatible peritoneal dialysis (PD) solutions have become available in recent years. In 2001, low glucose degradation products (GDP), neutral pH solutions became commercially available in Korea. To date, there are no reports regarding the large scale adoption of these solutions in clinical practice and regarding what, if any, impact these solutions have on patient outcomes.



Using a database of almost 4000 patients treated by PD in Korea, we conducted a prospective, longitudinal observational study documenting the patterns of use of one novel low GDP solution (balance, Fresenius Medical Care, St Wendel, Germany) in 1909 PD incident patients between 1 January 2002 and midyear 2005. Outcomes including patient and technique survival and peritonitis rates were analysed using univariate and multivariate analysis.



Prescription of low GDP solutions reached between 70 and 80% by the year 2003 and persisted at this level. Patients prescribed low GDP PD solution tended to be younger and were more likely to be treated in centres with larger enrollment in the database. Survival of diabetic patients treated with the new PD solution was identical to that of the non-diabetic patients treated with standard PD fluids (PDF) and treatment with low GDP PDF independently reduced the relative risk (RR) of death (RR = 0.613; CI 0.50-0.74; P < 0.00001) in a proportional hazards model which included age, diabetes and centre experience. In a univariate analysis, low GDP PD solution was associated with a longer technique survival (P = 0.049) but this effect was not significant in multivariate analysis. No significant differences in peritonitis-free interval or peritonitis rate could be attributed to the prescribed PDF.



Prescription of low GDP, pH-neutral PD solutions has rapidly increased in Korea. This change has resulted in a significant improvement in patient and technique survival without any measurable change in peritonitis incidence or rate. Reasons for the improved patient survival cannot be determined from this analysis and require further study.

title: Angularly fused triquinanes from linear substrates through trimethylenemethane diyl [2 + 3] cycloaddition reaction.
abstract: Angularly fused triquinanes were synthesized from linear dienes and phenyl(propynyl)iodonium salt through trimethylenemethane (TMM) diyl mediated [2 + 3] cycloaddition reaction. TMM diyl intermediates were obtained from alkylidene carbenes generated from reactions of alkynyliodonium salts with nucleophiles.