BACKGROUND: House dust mites have been reported to play an aportant role in the pathogenesis of atopic dermatitis(AD). In fact a high positive rate for house dust mites in the skin prick test was observed in patients of AD. However, it is quite difficult to determine the clinical relevance of positive immediate hypersensitivity to mite antigen by clarical history alone because AD patients are nearly always exposed to these antigens in their daily lives. OBJECTIVE: The aim of this study was to elucidate the clinical. singficance of a positive immediate hypersensitivity reaction by observing the proliferative respons of peripheral blood mononuclear cells(PBMC) to mite antigen in the AD. METHODS: The proliferative response of PBMC separated from Dermatopkagoides farinae(Df) positive AD patients to Df antigen was compared with that from Df negative normal controls, Df positive normal controls and Df negative AD patients. RESULTS: PBMC from Df positive AD patients showed signinc not proliferation in response to Df antigen evaluated by comparing stimulation indices(SI) among different experiment groups. CONCLUSION: Significant correlation between responses of PBMC and immediate hypersensitivity of skin to Df antigen in AD was found, and it was suggested the Df may be a real aggravating factor in the Df positiv AD patients. SI may be used as ar objective criteria to select patients for hyposensitization therapy after doing a skin test.
Dermatitis, Atopic* ; Desensitization, Immunologic ; Humans ; Hypersensitivity, Immediate* ; Mites* ; Pyroglyphidae ; Skin Tests ; Skin*

BACKGROUND: As the pleural inflammation progresses, exudative pleural fluid becomes loculated rapidly with pleural thickening. Complete drainage is important 13 prevent pleural fibrosis, entrapment and depression of lung function Intrapleural urokinase instillation therapy has been advocated as a method to facilitate drainage of gelatinous pleural fluid and to allow enzymatic debriment of pleural surface. This study was designed to investigate the Predictors of effeotiveness of intrapleural urokinase in treatment of loculated pleural effusion METHOD: Thirty-five patients received a single radiographically guided pig-tail catheter ranging in size from 10 to 12 French Twenty-two patients had tuberculous pleural effusions, and 13 had non-tuberculous postpneumonic empyemas. A total of 240,000 units of urokinase was dissolved in 240 ml of normal saline and the aliquots of 80mL was instilled into the pleura1 cavity via pig-tail catheter per every 8hr. Effectiveness of intrapleural urokinase instillation therapy was assessed by biochemical markers, ultrasonography, and technical details. A greater than 50% improvement on follow-up chest radiographs was defined as success group. RESULT: Twenty-seven of 35 (77.1%) patients had successful outcome to urokinase instillation therapy. Duration of symptoms before admission was shorter in sucess group (11.8α6.9day) than in failure group (26.62α16.5day) (P<0.05). Amount of drained fluid during urokinsse therapy was larger in success group (917.1α392.7ml) than in failure group (613.8α259.7ml) (P<0.05). Pleural fluid glucose was higher in success group (89.7 α35.9mg/dl) than in failure group (41.2α47.1mg/dl) (P<0.05). Pleural fluid LDH was lower in success group (878.4α654.31U/L) than in failure group (2711.1α973.1IU/L) (P<0.05). Honeycomb septated pattern on chest ultrasonography was observed in six of eight failure group, but none of success group(P<0.05). CONCLUSION: Longer duration of symptoms before admission smaller amount of drained fluid during urokinase therapy, lower glucose value, higher LDH value in pleural fluid examination and honeycomb septation pattern on chest ultrasonography were predictors for failure group of intrapleural urokinase instillation therapy.
Biomarkers ; Catheters ; Depression ; Drainage ; Empyema ; Fibrosis ; Follow-Up Studies ; Gelatin ; Glucose ; Humans ; Inflammation ; Lung ; Pleural Effusion* ; Radiography, Thoracic ; Thorax ; Ultrasonography ; Urokinase-Type Plasminogen Activator*

A Case of disseminated cryptococcosis in a 5-year old girl is reported. Although twenty four pediatric cases of cryptococcosis were reported in Korea for the past 15years, this case's clinical picture is interesting and make diagnostic difficulties from miliary tuberculosis. She was transferred from a local clinic under the impression of miliary tuberculosis with chest X-ray showing miliary shadows. Mantoux test showed strong positive. She was not vaccinated BCG and had a history of contact with tuberculous patient for a month. Cough, fever and abdominal pain were persisted in spite of antituberculous medications(INH & RMP). CSF examination revealed cryptococcus cyst. Facial skin lesions which looked like Moluscum contagiosum at first became to be umbilicated and disseminated. It was diagtococcal lesions with little inflammatory response. In spite of treatment with 5-FC and Amphotericin B, her general condition became worse and died of respiratory failure. A brief review of the literature was done.
Abdominal Pain ; Amphotericin B ; Child, Preschool ; Cough ; Cryptococcosis* ; Cryptococcus ; Female ; Fever ; Humans ; Korea ; Lung* ; Mycobacterium bovis ; Respiratory Insufficiency ; Skin* ; Thorax ; Tuberculosis, Miliary

PURPOSE: To assess the usefulness of T2-weighted oblique coronal MR imaging (T2OCI) in the differential diagnosis of complete and partial tears of the anterior cruciate ligament (ACL) of the knee. MATERIALS AND METHODS: Thirty-three patients with ACL tear (16 complete and 17 partial tears), comfirmed by arthroscopy, were included in this study. Conventional MR imaging and T2OCI were performed, and the findings were retrospectively reviewed by two radiologists in terms of continuity, shape, axis and internal signal intensity of the ligament. Each finding was tested if there were stastistically significant differences in its prevalence between partial and complete tears. The diagnostic accuracy of T2OCI and conventional MR imaging in the detection of partial and complete tears of the ACL were compared. RESULTS: Conventional MR imaging revealed no statistically significant finding for differential diagnosis of complete and partial ACL tears. The reliable and statistically significant (p<0.001) findings of T2OCI were complete discontinuity of the ligament in cases involving complete ACL tears (14 of 16 complete tears and 2 of 17 partial tears) and the preservation of the band form for partial ACL tears (2 of 16 complete tears and 15 of 17 partial tears). The accuracy of T2OCI and conventional MR imaging was 88% and 70%, respectively. CONCLUSION: When ACL injury is vague on conventional MR images, a modality which is more useful in the differential diagnosis of partial and complete tears of the ACL, and in predicting the site of a tear, is T2-weighted oblique coronal imaging.
Anterior Cruciate Ligament* ; Arthroscopy ; Axis, Cervical Vertebra ; Diagnosis, Differential* ; Humans ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Prevalence ; Retrospective Studies

PURPOSE: To evaluate usefulness of volume rendering technique using 3D visualization software on PC in patients with suspected intracranial aneurysm on brain MRA. MATERIALS AND METHODS: We analyzed prospectively 21 patients with suspected aneurysms on the routine MIP images which were obtained 15 degree increment along axial and sagittal plane, among 135 patients in whom brain MRA was done due to stroke symptoms for recent 5 months. The locations were the anterior communicating artery (A-com) in 8 patients, the posterior communicating artery (P-com) in 3, the ICA bifurcation in 5, the MCA bifurcation in 4, and the basilar tip in one. Male to female ratio was 14:7 and mean age was 62 years. MRA source images were sent to PC through LAN, and the existence of aneurysm was evaluated with volume rendering technique using 3D visualization software on PC. The presence or absence of aneurysm on MIP and volume rendering images was decided by the consensus of two radiologists. RESULTS: We found the aneurysms with volume rendering technique, from 1 patient among 8 patients with suspected aneurysm at A-com and also 1 patient among 3 patients with suspected aneurysm at P-com on routine MIP images. Confirmative angiography and interventional procedures were done in these 2 patients. The causes for mimicking the aneurysm on MIP were flow displacement artifact in 9, normal P-com infundibulum in 2, and overlapped or narrowed vessels in 8 patients, and among them confirmative angiography was done in 2 patients. CONCLUSION: Volume rendering technique using visualization software on PC is useful to scrutinize the suspected aneurysm on routine MIP images and to avoid further invasive angiography.
Aneurysm* ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Artifacts ; Brain* ; Consensus ; Female ; Humans ; Intracranial Aneurysm ; Local Area Networks ; Male ; Prospective Studies ; Stroke

Infantile myofibromatosis is a rare benign tumor of childhood characterized by a myofibroblastic tumor in the skin, subcutaneous tissues, bones, and, occasionally, the viscera. The tumor may be solitary or multicentric. A solitary skeletal lesion most commonly occurs in the craniofacial region. We report a case of solitary infantile myofibromatosis of the skull, confirmed by excisional biopsy.
Biopsy ; Myofibroblasts ; Myofibromatosis* ; Skin ; Skull* ; Subcutaneous Tissue ; Viscera

PURPOSE: To evaluate the findings and role of contrast-enhanced fat suppression MR imaging in avascular necrosis(AVN) of the femoral head. MATERIALS AND METHODS: In 15 patients with AVN of the femoral head, MR T1-weighted and T2-weighted images and contrast-enhanced fat-suppression T1-weighted images were obtained, and the findings were re-viewed. Early and advanced groups were classified on the basis of clinical findings and imaging, and the en-hancement pattern was classified as either type I, rim enhancement; type II, surrounding diffuse enhance-ment; type III, intralesional enhancement; or type IV, II + III. RESULTS: Twenty-four cases of AVN of the femoral head were detected; in nine patients, lesions were bilateral. Eight cases occurred in the early group and 16 in the advanced. All eight in the early group showed the "double line sign" on T2-weighted images, with a type-I enhancement pattern. In the advanced goup, type II(8/16) and type IV(8/16) enhancement patterns were seen. Among the cases showing the type-IV pattern, the intrale-sional enhancing area showed low signal intensity on T1-weighted images and isosignal intensity on T2 weighted in one case, and low signal intensity on T1-weighted images and high signal intensity on T2-weight-ed in the other cases. There was no difference in the extent of the disease before and after enhancement. CONCLUSION: Contrast-enhanced fat-suppression MR images may be helpful in evaluating the extent of AVN of the femoral head and predicting the histopathologic findings of the disease
Head* ; Humans ; Magnetic Resonance Imaging* ; Necrosis*

Although ascending aortic aneurysm is a uncommon disease, it has fatal complications such as aortic rupture, dissection, or death. So, experts recommend a preemptive aortic operation. A 77-year-old man with hypertension visited for slow progressive exertional dyspnea and general weakness. Chest X-ray showed deviation of trachea to right, mediastinal widening, cardiomegaly, and bulging of right heart border to right. Transthoracic echocardiography(TTE) and transesophageal echocardiography(TEE) showed marked dilated ascending aorta with wall calcification associated with severe aortic regurgitation and pericardial effusion. Measured diameter of ascending aorta was 12 x 11 cm on Chest Computed Tomography (CT) scan, 8.35 cm on TTE, and 10.2 cm on TEE. Our exam found out the obstructive pneumonia and aortic regurgitation as consequences of complications of huge aneurysm. We report a case of huge ascending aortic aneurysm without any previous aortic operation, aortic complications, trauma, or other etiologic factors.
Aged ; Aneurysm ; Aorta ; Aortic Aneurysm* ; Aortic Rupture ; Aortic Valve Insufficiency ; Cardiomegaly ; Dyspnea ; Heart ; Humans ; Hypertension ; Pericardial Effusion ; Pneumonia ; Thorax ; Trachea

BACKGROUND: Psoriasis is belived to be a disorder of keratinocyte hyperproliferation mediated by T helper cells. Cyclosproine is one of the immunosuppressants and there have been several studies showing the benefcial effects of cyclosporine on psoriasis. OBJECTIVE: To evaluate the clinical efficacy, tolerability, and adverse effects of cyclosporine, a randomized open uncontrolled multicenter study was conducted in 15 university hospitals in Korea. METHOD: There were 68 total trial cases and among them 16 patients dropped out from the study. The reported reasons for stopping the use of the medication under study prematurely were lack of cooperation(seven cases), adverse effects(six cases), the ineffectiveness of the medication(two cases), and another(one case). The drug was administered for 18 weeks to 52 patients. The initial dosage of the drug was 2.5mg/kg/day which was maintained or increased to 4mg/kg/day or 5mg/kg/day according to the PASI score reduction rate at the 6th and 12th week. The PASI score was measured and Iaboratory tests and observation of adverse events were done. RESULTS: At the end of therapy PASI score reduction rate of more than 66% occured in 40 patients (76.9%). The PASI score was significantly reduced from 20.0 to 5.4 after treatment for 18 weeks. The social disability score was significantly decreased. Pruritus and nail involvement were also significantly decreased. The change of systolic and diastolic blood pressure were statistically not significant. The 30% increase of serum creatinine level compared to the baseline was observed in six patients(11.5%) at the 6th week, three patients(5.8%) at the 12th week, five patients(9.6%) at the 18th week, but no patients showed an increase above the normal range.The increase of serum total bilirubin and SGOT was observed in six patients(11.5%) and one patient(1.9%0, respectively. The clinical adverse events reported during the study were gastrointestinal trouble(seven cases, 13.5%), hypertrichosis(two cases, 3.8%), generalized weakness(two cases, 3.8%0, paresthesia(one case, 1.9%), hypertension(one case, 1.9%), disturbance of erection(one case, 1.9%). The overall assessment of efficacy and tolerability by investigator and patients were mostly good or very good. CONCLUSION: Generally cyclosporine was well accepted and tolerated and low dose cyclosporine therapy-2.5mg/kg/day to 5mg/kg/day-is an effective therapeutic modality for the treatment of psoriasis.
Aspartate Aminotransferases ; Bilirubin ; Blood Pressure ; Creatinine ; Cyclosporine* ; Hospitals, University ; Humans ; Immunosuppressive Agents ; Keratinocytes ; Korea ; Pruritus ; Psoriasis* ; Research Personnel ; T-Lymphocytes, Helper-Inducer

Fusobacteria are anaerobic gram-negative, non-spore forming bacilli found in normal flora of the oral cavity, urogenital tract, and gastrointestinal tract. Fusobacterium nucleatum has been seldom reported as a cause of liver abscess, particularly in immunocompetent hosts. A 55-year-old man with frequent periodontal disease visited our hospital with intermittent fever and headache for 2 months. Abdominal CT scan revealed an 8.2x6 cm mass in the right hepatic lobe with central low density. Abscess culture revealed F. nucleatum as the causative organism. Percutaneous abscess drainage and intravenous administration of antibiotics for 4 weeks improved symptoms and decreased the abscess size. We report a rare case of liver abscess due to F. nucleatum in an immunocompetent man with periodontal disease.
Ampicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Fusobacterium Infections/complications/*diagnosis/drug therapy ; Fusobacterium nucleatum/*isolation & purification ; Humans ; Injections, Intravenous ; Liver Abscess/*diagnosis/etiology/microbiology ; Male ; Middle Aged ; Periodontal Diseases/*diagnosis ; Sulbactam/therapeutic use