Retinoid, Ro l0-9359 is an aromatic analog of vitamin A acid or retinoic acid. The orally administrable retinoid has a therapeutic effect on the treatment of psoriasis, ichthyosis, Darier's disease, pustulosis palmoplantaris and skin cancer. However, some results have been reported previously, indicating that oral retinoid alone does not clear psoriatic lesions although some improvement may he noted. Morcover, promising results of combination treatment of psoriasis with the retinoid and local dithranol or PUVA have been reported. In the present study we report the clinical results obtained in 16 psoriatics after oral retinoid treatment, with and without the addition of topical cotricosteroid. We employed a new retinoid regimen orally in 16 adults with widcspread psoriatic lesions, Most of them bad been treated earlier with topical corticosteroids without beneficial effect. Of 16 cases 8 were treated with retinoid alone and the other 8 patients with topical corticosteroids in addition to the oral regimen, The results are summarized as follows: 1. Complete to good clearing of the lesions was seen in 5 of 8 patient with retinoid alone and in 7 of 8 patients using the combination treatment. 2. Side-effects appeared in all patients, the most prominent being dryness of the mouth or cheilitis in cases and pruritus in 10 cases. However, there were no abnormalities shown in liver function tests during or after treatment. From the above results the combination treatment with topical corticosteroids seems to be more effective than retinoid alone in the treatment of psoriasis. It is considered that the oral retinoid could be an alternative on the treatment of psoriasis.
Adrenal Cortex Hormones ; Adult ; Anthralin ; Cheilitis ; Darier Disease ; Humans ; Ichthyosis ; Liver Function Tests ; Mouth ; Pruritus ; Psoriasis* ; Skin Neoplasms ; Tretinoin

PURPOSE: Prolonged recovery time of pulmonary function after an asthma exacerbation is a significant burden on asthmatics, and management of these patients needs to be improved. The aim of this study was to evaluate factors associated with a longer recovery time of pulmonary function among asthmatic patients hospitalized due to a severe asthma exacerbation. METHODS: We retrospectively reviewed the medical records of 89 patients who were admitted for the management of acute asthma exacerbations. The recovery time of pulmonary function was defined as the time from the date each patient initially received treatment for asthma exacerbations to the date the patient reached his or her previous best FEV1% value. We investigated the influence of various clinical and laboratory factors on the recovery time. RESULTS: The median recovery time of the patients was 1.7 weeks. Multiple linear regression analysis revealed that using regular inhaled corticosteroids (ICS) before an acute exacerbation of asthma and concurrent with viral infection at admission were associated with the prolonged recovery time of pulmonary function. CONCLUSIONS: The prolonged recovery time of pulmonary function after a severe asthma exacerbation was not shown to be directly associated with poor adherence to ICS. Therefore the results indicate that an unknown subtype of asthma may be associated with the prolonged recovery of pulmonary function time after an acute exacerbation of asthma despite regular ICS use. Further prospective studies to investigate factors affecting the recovery time of pulmonary function after an asthma exacerbation are warranted.
Adrenal Cortex Hormones ; Asthma* ; Humans ; Linear Models ; Medical Records ; Phenotype ; Prospective Studies ; Respiratory Function Tests ; Retrospective Studies

Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis which is predominantly due to long-term glucocorticoid treatment or by pituitary disease. Primary adrenal failure is a rare disease that is life-threatening when overlooked whle adrenal failure secondary to hypothalamo-pituitary disease is a common clinical problem that has serious impact on the quality of life. Recent data suggests that the health-related quality of life in many patients with adrenal insufficiency is more severely impaired than previously thought and that current hormone replacement strategies are insufficient to prevent increased morbidity and mortality due to the disease. Therefore, the optimization and careful monitoring of glucocorticoid and mineralocorticoid replacement therapy remains one of the most challenging tasks in endocrinology. Leaving treatment aside, diagnosis of adrenal insufficiency is also challenging, because the main presenting symptoms such as fatigue, anorexia, and weight loss are non-specifically associated with many other common ailments, delaying a correct diagnosis. Some pitfalls in diagnostic work-up, particularly in the identification of secondary adrenal insufficiency, make the diagnosis even more difficult. Despite the difficulties, the complications associated with adrenal insufficiency make the rapid diagnosis and proper management of adrenal failure are important tasks for all physicians. We review here current standards for clinical assessment, diagnosis and treatment of adrenal insufficiency in light of recent research findings.
Addison Disease ; Adrenal Cortex Function Tests ; Adrenal Insufficiency ; Anorexia ; Endocrinology ; Fatigue ; Glucocorticoids ; Humans ; Light ; Pituitary Diseases ; Quality of Life ; Rare Diseases ; Weight Loss ; Axis, Cervical Vertebra

BACKGROUND/AIMS: This study aimed to evaluate the adverse events and efficacy of azathioprine (AZA) and 6-mercaptopurine (6-MP) in Korean patients with Crohn's disease (CD). METHODS: We retrospectively analyzed 700 patients with CD (male : female=469 : 231; median age at diagnosis, 22 years; agerange, 9-74 years) who were treated at the Asan Medical Center between January 1997 and January 2006. RESULTS: Of 700 patients, 372 (53.1%) were treated with AZA/6-MP. The cumulative rates of AZA/6-MP treatment at 1, 5, 10, and 20 years were 17.4%, 51.6%, 73.1%, and 94.5%, respectively. Of 372 patients treated with AZA/6-MP, 217 patients (58.3%) experienced 291 adverse events, requiring discontinuation of therapy in 41 patients (11%). Nausea occurred in 120 patients (32.3%) and led to discontinuation of therapy in 11 patients (3.0%). Leukopenia developed in 116 patients (31.2%), requiring dose adjustments in 100 patients (26.9%) and discontinuation of medications in 16 patients (4.3%). Other adverse events included infections (2.7%), abnormal liver function tests (2.7%), fever (0.8%), hair loss (0.8%), arthralgias (0.5%), pancreatitis (0.5%), headaches (0.5%), and skin rashes (0.3%). Complete corticosteroids withdrawal was achieved in 70.9% of the patients based on an intention-to-treat analysis. The remission rate of perianal fistulas was 32.6%. CONCLUSIONS: The risk of leukopenia by AZA/6-MP is higher in Korean patients with CD than in Western patients. Although the adverse events of AZA/6-MP are not uncommon in Korean patients with CD, the actual discontinuation rate of the treatment is low. Therefore, AZA/6-MP can be administered to most Korean patients with CD without serious adverse events.
6-Mercaptopurine ; Adrenal Cortex Hormones ; Arthralgia ; Azathioprine ; Crohn Disease ; Drug Toxicity ; Exanthema ; Fever ; Fistula ; Hair ; Headache ; Humans ; Leukopenia ; Liver Function Tests ; Nausea ; Pancreatitis ; Retrospective Studies

The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves' disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves' disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves' disease. One kind of thionamides and beta-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including beta-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves's disease that is resistant to conventional therapies.
Adrenal Cortex Hormones ; Adult ; Antithyroid Agents ; Cholestyramine Resin* ; Drug Resistance ; Female ; Glycogen Storage Disease Type VI ; Graves Disease* ; Humans ; Hypersensitivity ; Iodine ; Thyroid Function Tests ; Thyroid Gland ; Thyroidectomy* ; Thyrotoxicosis

BACKGROUND: Radiation pneumonitis(RP) is the major serious complication of thoracic irradiation treatment. In this study, we attempted to retrospectively evaluate the long-term prognosis of patients who experienced acute RP and to identify factor that might allow prediction of RP. METHODS: Of the 114 lung cancer patients who underwent thoracic radiotherapy between December 2000 and December 2002, We performed analysis using a database of 90 patients who were capable of being evaluated. RESULTS: Of the 44 patients(48.9%) who experienced clinical RP in this study, the RP was mild in 33(36.6%) and severe in 11(12.3%). All of severe RP were treated with corticosteroids. The median starting corticosteroids dose was 34 mg(30~40) and median treatment duration was 68 days(8~97). The median survival time of the 11 patients who experienced severe RP was significantly poorer than the mild RP group. (p=0.046) The higher total radiation dose(>or=60 Gy) was significantly associated with developing in RP.(p=0.001) The incidence of RP did not correlate with any of the ECOG performance, pulmonary function test, age, cell type, history of smoking, radiotherapy combined with chemotherapy, once-daily radiotherapy dose fraction. Also, serum albumin level, uric acid level at onset of RP did not influence the risk of severe RP in our study. CONCLUSION: Only the higher total radiation dose(>or=60 Gy) was a significant risk factor predictive of RP. Also severe RP was an adverse prognostic factor.
Adrenal Cortex Hormones ; Drug Therapy ; Humans ; Incidence ; Lung Neoplasms* ; Lung* ; Prognosis ; Radiation Pneumonitis* ; Radiotherapy ; Respiratory Function Tests ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Smoke ; Smoking ; Uric Acid

PURPOSE: It has been identified that eosinophilic bronchitis (EB) in adults can progress to asthma or fixed airway obstruction. In the present study, we evaluated the clinical course and prognosis of EB in children and their relationship with accompanying rhinosinusitis. METHODS: A total of 55 children with EB followed up for over than a year after the diagnosis were enrolled for the present study. We classified the subjects into two groups according to the prognosis and the presence of rhinosinusitis, respectively, and compared them with respect to clinical characteristics, eosinophil percentage in induced sputum, fractional exhaled nitric oxide (FeNO) and pulmonary function test. The poor prognostic group was defined as the children with asthma or asthma-like symptoms, or persistent or recurrent chronic cough in the long-term follow-up. RESULTS: The poor prognosis was achieved in 12 children (22%), and 3 children (5%) amongst them were diagnosed with asthma. There were no significant differences in clinical characteristics, eosinophil percentages in induced sputum, FeNO, spirometry and IOS according to the prognosis and the presence of rhinosinusitis. Additionally, the children with rhinosinusitis did not show any poorer outcome than those without rhinosinusitis. CONCLUSION: There were some limitations of this study for which the relationship between EB and rhinosinusitis in children was evaluated. However, in case of either poor short-term response to inhaled corticosteroids or elevated eosinophilic inflammation in airways or abnormal airway reversibility in impulse oscillometry, the long-term prognosis of EB in children needs to be considered, regardless of the presence of rhinosinusitis.
Adrenal Cortex Hormones ; Adult ; Airway Obstruction ; Asthma ; Bronchitis ; Child ; Cough ; Eosinophils ; Humans ; Inflammation ; Nitric Oxide ; Oscillometry ; Prognosis ; Respiratory Function Tests ; Spirometry ; Sputum

BACKGROUND: Although corticosteroid and cytotoxic agent such as cyclophosphamide have been used for the treatment of idiopathic interstitial pneumonia (IIP), efficacy of these toxic drugs are unclear because previous reports included the patients who did not undergo surgical lung biopsy and none evaluated the response according to histopathologic entities of IIP. To answer this, we retrospectively analyzed the treatment response and side effects of corticosteroids and cyclophosphamide therapy in patients with idiopathic UIP and NSIP. METHODS: Among 61 patients with UIP and 26 patients with NSIP diagnosed by surgical lung biopsy at Samsung Medical Center from July 1996 to June 2002, those who received corticosteroid or cyclophosphamide therapy for at least 6 months and were followed for at least one year after the initiation of treatment were enrolled (32 UIP, 23 NSIP). Treatment response of 55 patients was assessed by ATS response criteria (clinical symptoms, pulmonary function test and radiological findings).Adverse reactions to either agent (42 cases of cyclophosphamide+/-low-dose prednisolone, 49 cases of prednisolone alone) were also analyzed. RESULTS: Irrespective of treatment regimen, NSIP showed more favorable response than UIP (6 months: 78.3% vs. 9.4%, 12 months: 69.6% vs. 9.4%, p<0.001). Cyclophosphamide showed comparable response to corticosteroid in NSIP while its efficacy was as poor as those of corticosteroid therapy in UIP. Significant adverse reaction to drug more frequently occurred in corticosteroid group (35.7%) than cyclophosphamide group (14.3%) (p=0.017). CONCLUSION: Cyclophosphamide is effective and more tolerable than corticosteroids in the treatment of idiopathic nonspecific interstitial pneumonia.
Adrenal Cortex Hormones ; Biopsy ; Cyclophosphamide* ; Humans ; Idiopathic Interstitial Pneumonias ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases, Interstitial ; Prednisolone ; Respiratory Function Tests ; Retrospective Studies

This study was designed to investigate the therapeutic effect of dinitrochlorobenzene (DNCB) on alopecia areata. Forty patients with alopecia areata were sensitized by applying 0.1ml of 2% DNCB dissolved in aceton solution on the voiar aspect of left forearm. Patients were subsequently chaIlenged at weekly mtervals with 0. 1% DNCB solution appIied to one side of affected area for periods of 2 to 8 months. The other side of affected area was reserved as a contol site. The results were as follows. 1. In 29 out of 40 patients (72.5%), hair regrowth occurred either excIusiveIy on the treated site (18 cases) or considerably faster and denser on treated site(11 cases)(Table 1) 2. In the majority of cases, the regrowth of hair was observed, within eight weeks of the treatment. 3. The response to DNCB depended on the severity of the aIopecia. The response rate were 80.9% (17/21) in moderate degree (<25% bald area) cases, 68.7% (ll/16), in the extensive degree(>25% bald area) caes and 33% (1/3) in alopecia totalis(Tale 1) 4. The rate of response depended on the duration of the alopecia. Satisfaetory results were obtained in 19 out of 25 patients with a history of less than one year(76%), in 7 out of 10 patients with a history of one to three year(70%) and in 3 out of 5 patients with a history of more than three years (60%) (Table 2) 5. The main side reactions were burning sensation (3 cases), severe eczema (2 cases), folliculitis (2 cases) and cervical lymphadenopathy(7 cases). 6. Liver function test and complete blood cell count were in normal range during the course of treatment in 5 randomly selected patients. 7. Although the treatment of alopecia areata with DNCB still remains to be an experimental trial, this therapy could be substituted for corticosteroids in selected cases.
Adrenal Cortex Hormones ; Alopecia ; Alopecia Areata ; Blood Cell Count ; Burns ; Dinitrochlorobenzene* ; Eczema ; Folliculitis ; Forearm ; Hair ; Humans ; Liver Function Tests ; Reference Values ; Sensation

No abstract available.
Adrenal Cortex Function Tests ; *Adrenal Cortex Neoplasms/complications/diagnosis/metabolism/surgery ; *Adrenal Gland Neoplasms/complications/diagnosis/metabolism/surgery ; Adrenalectomy ; *Adrenocortical Adenoma/complications/diagnosis/metabolism/surgery ; Biopsy ; Cushing Syndrome/diagnosis/etiology ; Female ; Humans ; Immunohistochemistry ; *Incidental Findings ; Middle Aged ; *Neoplasms, Multiple Primary/complications/diagnosis/metabolism/surgery ; *Pheochromocytoma/complications/diagnosis/metabolism/surgery ; Predictive Value of Tests ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Markers, Biological/metabolism