Trichloroethylene (TCE) is currently used as a degreasing agent in the jewelry manufacturing industry. The characteristic sign arising after the exposure of TCE are hepatitis and contact dermatitis. The incidence of toxicity is relatively rare, therefore, the mechanism of occurrence is considered as hypersensitivity. A previously healthy 21-year-old male began to work at jewelry industry. The solvent used in that place was TCE. Over the next month, he experienced symptoms of weakness, fever, dry skin, red rash and bumps, peeling face, and jaundice. At that time, he had marked liver enzyme elevation with evidence of cholestasis. After two weeks of avoidance of TCE exposure, his liver enzymes showed a marked reduction in ALT from a peak of 1132 to 131 IU/L. The total bilirubin reduced from 9.3 to 4.6 mg/dL. Tests for hepatitis A, B, and C, CMV, HIV were all negative. The patch test showed primary irritant reaction to TCE and its metabolite, trichloroethanol. This is the second report of TCE induced hepatotoxicity in Korea. We consider this case as a TCE induced hepatotoxicity due to possibly hypersensitivity mechanism.
Bilirubin ; Cholestasis ; Dermatitis, Contact ; Exanthema ; Fever ; Hepatitis A ; Hepatitis* ; HIV ; Humans ; Hypersensitivity ; Incidence ; Jaundice ; Jewelry ; Korea ; Liver ; Male ; Occupational Exposure* ; Patch Tests ; Skin ; Trichloroethylene ; Young Adult

No abstract available.
Blood Flow Velocity* ; Fetus* ; Gases*

OBJECTIVE: To evaluate the usefulness of percutaneous umbilical blood sampling (PUBS) and prevalence of fetal infection in the pregnant women with suspicious fetal rubella infection. METHODS: Between June 1996 and May 2002 in Chonnam National University Hospital, the rubella specific IgG, IgM antibody and RT-PCR were checked in fetal blood obtained from 31 pregnant women with high risk of rubella infection. Eighteen women (58.1%) had rubella specific IgM, 11 women (35.5%) high titer of rubella specific IgG, and 2 women had a history of recent rubella vaccination within 3 months. RESULTS: PUBS was performed in all cases, successful in 27 cases (87.1%) and failed in 4 cases (12.9%). Cardiocentesis was performed in failed cases. Performing the PUBS, fetal bradycardia was observed in 7 cases (25.9%), fetal tachycardia in 1 case (14.8%), and preterm labor in 2 cases (7.4%). Performing cardiocentesis, fetal bradycardia was observed in 1 case (25.0%), fetal tachycardia in 2 cases (50.0%), and preterm labor in 1 case (25.0%). There was no fetal death. All samples of fetal blood were positive for rubella specific IgG but rubella specific IgM was detected in only 1 case. RT-PCR was negative in all cases. CONCLUSION: Fetal blood sampling is relatively safe and a great precaution is necessary before termination of pregnancy with suspicious fetal rubella infection and without typical maternal rash to reduce unnecessary termination of pregnancy. Several tests such as rubella specific IgM and PCR from placental villi, amniotic fluid, and fetal blood should be considered before termination of pregnancy.
Amniotic Fluid ; Bradycardia ; Chorionic Villi ; Cordocentesis* ; Exanthema ; Female ; Fetal Blood ; Fetal Death ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Jeollanam-do ; Obstetric Labor, Premature ; Polymerase Chain Reaction ; Pregnancy ; Pregnant Women* ; Prenatal Diagnosis* ; Prevalence ; Rubella* ; Tachycardia ; Vaccination

Cowden syndrome is very rare clinical condition with characteristic mucocutaneous lesions associated with abnormalities of the breast, thyroid, and gastrointestinal tract. Here, the case of a 16-year-old girl with diverse gastrointestinal polyposis with breast and thyroid lesions is reported as a definite case of Cowden syndrome. During follow up for 4 years, changes in the characteristic lesions were observed; Esophageal acanthosis and oropharyngeal polyps were newly developed. Gastric, duodenal, rectal and ileal polyps were noted at the first visit when she was 12 years of age and revealed histologically hyperplastic polyps. Mucocutaneous lesions, the pathognomonic finding of Cowden syndrome, were not noted at the first visit or during the follow up period. Breast and thyroid masses were noted at the first visit. Breast aspiration showed highly cellular ductal epithelial fragments and fibroblastic stromal cell fragments, and a thyroid biopsy shows proliferation of irregular sized follicles, with variable colloid contents. Macrocephaly was also noted at the first visit. The characteristic lesions of Cowden syndrome change with the patient's age, and the long-term follow up is recommended in cases suspected with this syndrome.
Adolescent ; Biopsy ; Breast ; Colloids ; Female ; Fibroblasts ; Follow-Up Studies* ; Gastrointestinal Tract ; Hamartoma Syndrome, Multiple* ; Humans ; Macrocephaly ; Polyps ; Stromal Cells ; Thyroid Gland

No abstract available.
Pregnancy*

Lymphedema refers to inflammation that occurs in a part of the body owing to impaired lymphatic transport. Lymphedema arises as a consequence of a malformation or malfunction of the lymphatic system. It commonly occurs on the face, vulva, and penis and can cause superficial lesions known as lymphangiectasia. Common presenting symptoms include pain, pruritus, oozing of lymphatic fluid, sexual dysfunction, and infection. Prolonged lymphedema can lead to fibrosis and epidermal hyperplasia with verrucous hyperkeratosis. In rare cases, the lymphedema may mimic a skin tumor. We report the case of a 69-year-old woman who presented with erythematous oozing papules and hard nodules on the vulva, which mimicked a fibrous tumor.

Arginine vasopressin (AVP) is a neuropeptide with vasoconstrictive, antidiuretic, cardiovascular regulative and hepatic glycogenolysis effects, that also affects other behaviors including modulating learning. A number of studies on AVP regulation have been conducted in various metabolic diseases (disorders). In this study, the immunoreactivities of AVP in the paraventricular nucleus (PVN) and supraoptic nucleus (SON) and mRNA expressions in the hypothalamus were investigated by immunohistochemistry and quantitative real-time PCR (RT-qPCR) in stroke-prone spontaneously hypertensive rats at different ages (i.e., at postnatal months [PM] 1, 8, and 12). Blood glucose levels in the PM 8 group were higher than in the other groups. However, cresyl violet positive neurons were detected in the PVN and SON of all animals, and numbers of cresyl violet positive neurons were similar in all aged groups. In addition, AVP immunoreactivity was detected in the PVN and SON of all age groups, and AVP immunoreactivity and mRNA expression levels were found to be increased in proportion to age by immunohistochemistry and RT-qPCR. These results suggest that the diabetic condition is temporally generated after hypertension has developed. Furthermore, our findings suggest that increased AVP expressions in the hypothalamic PVN and SON are associated with hypertension by age.
Aged ; Animals ; Arginine ; Arginine Vasopressin ; Benzoxazines ; Blood Glucose ; Glycogenolysis ; Humans ; Hypertension ; Hypothalamus ; Immunohistochemistry ; Learning ; Metabolic Diseases ; Molybdenum ; Neurons ; Neuropeptides ; Oxides ; Paraventricular Hypothalamic Nucleus ; Rats, Inbred SHR ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Supraoptic Nucleus ; Viola

OBJECTIVE: This study was conducted to compare the efficacy and safety of oral nicardipine in acute therapy for preterm labor with those of parenteral ritodrine hydrochloride. METHODS: Patients between 24 and 34 weeks' gestation with documented preterm labor were randomly assigned to receive oral nicardipine (n=31) or intravenous ritodrine (n=32) as initial tocolytic therapy. Patients in the nicardipine group received a 40-mg loading dose and then 20 mg every 2 hours as needed to stop contractions (total 80 mg). Patients in the ritodrine group received a 0.05 mg/min as initial dose. The dose was increased at 15-minute intervals until uterine contractions were inhibited or side effects became intolerable. The maximum recommended dose was 0.35 mg/min. Patients could be switched to another tocolytic regimen if they continued to have contractions after 6 hours of therapy. The main outcome variables examined were failure of tocolysis, time to uterine contractions equal or less than 5 times per hour, time to uterine quiescence, time gained in utero, and frequency of adverse medication effects. RESULTS: There were no significant differences in maternal demographic characteristics between the groups. Successful tocolysis, defined as cessation of uterine contractons less than 6 hours from initial dose, was observed in 58.1% in the nicardipine group and 65.6% in the ritodrine group (P=.544). Among patients with successful tocolysis who responded with uterine quiescence within 6 hours, there was no significant difference in the time to uterine quiescence in the ritodrine group (P=.087). Time to uterine contractions equal or less than 5 times per hour from initial treatment showed no significant difference between the two groups with successful tocolysis (P=.097). The patients in the ritodrine hydrochloride group had more adverse side effects, mainly maternal tachycardia (P=.013) and nausea and/or vomiting (P=.006). CONCLUSION: Oral nicardipine was effective, safe, and well-tolerated tocolytic agent. Patients who received ritodrine hydrochloride were more likely to have adverse medication effects.
Female ; Humans ; Nausea ; Nicardipine* ; Obstetric Labor, Premature* ; Pregnancy ; Ritodrine* ; Tachycardia ; Tocolysis ; Uterine Contraction ; Vomiting

BACKGROUND/AIMS: Endoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II. METHODS: Thirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications. RESULTS: Afferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management. CONCLUSIONS: Patients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.
Abdominal Pain ; Anoxia ; Bile Ducts ; Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Endoscopes* ; Gastrectomy* ; Gastroenterostomy* ; Humans ; Intubation ; Pancreatitis ; Peritonitis

Appendiceal intussusception is a rare disease with variable clinical findings, ranging from acute appendicitis to chronic recurrent abdominal pain or rectal bleeding. Occasionally, it is incidentally discovered with no symptoms. Because a preoperative diagnosis is difficult, it can be diagnosed either after surgery, in the case of acute appendicitis, or after a polypectomy, based on being mistaken for a polyp. During a colonoscopy, an appendiceal intussusception should be suspected if the appendiceal orifice is not observed at the cecum and there is a polypoid lesion at the location where the appendiceal orifice is expected. Treatments are usually determined according to preceding diseases. It is important that the colonoscopist avoid careless endoscopic removal by mistaking the intussusception for a polyp.
Abdominal Pain ; Appendicitis ; Cecum ; Colonoscopy ; Hemorrhage ; Intussusception ; Polyps ; Rare Diseases