We present a case of pemphigus vulgaris developed during pregnancy. The clinical features of this patient were similar to those of hetpes gestationis. By immunofluorescence studies we found that the patient's serum contained autoantibodies to intercellular substance of epidermis. Direct immunofluorescence microscopy of a perilesional skin also demontrated immunoglobulin deposition in the intercellular areas. Additionally we did in vitro C3 staining for further confirmation of the diagnosis but it was negative in basement membrane zone. This patient was initially treated with corticosteroid and azathioprine. Several months later gold compound was given instead of azathioprine and corticosteroid with good therapeutic response.
Autoantibodies ; Azathioprine ; Basement Membrane ; Diagnosis ; Epidermis ; Fluorescent Antibody Technique ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulins ; Microscopy ; Pemphigus* ; Pregnancy* ; Skin

No abstract available.
HIV ; Humans ; Liver Abscess ; Liver Abscess, Amebic

A 45-year-old man was referred from a local clinic with persistent fever, intermittent pain in the left upper abdomen, and weight loss of 7 kg. He quit his animal husbandry 18 months ago when his cows were found to be infected with Brucella. Abdominal computed tomography (CT) scan taken on admission showed splenomegaly with a wedge-shaped hypoattenuating region in the enhanced image, which was consistent with splenic infarction. Serology for Bruculla was strongly positive with the standard tube agglutination test (1/2560). After initiation of doxycycline (100 mg every 12 hrs) and rifampin (600 mg every day), the patient's condition improved, and was discharged with oral antibiotics that were to be continued for 3 months. During the 12 months' follow up at the outpatient department, the patient had no symptoms, and the last agglutination titer for Brucella in serum had decreased to 1/40. To our knowledge, this is the first report on splenic infarction associated with brucellosis in Korea, which was treated successfully with antibiotic therapy.
Abdomen ; Agglutination ; Agglutination Tests ; Animal Husbandry ; Anti-Bacterial Agents ; Brucella ; Brucellosis ; Doxycycline ; Fever ; Follow-Up Studies ; Humans ; Korea ; Middle Aged ; Outpatients ; Rifampin ; Splenic Infarction ; Splenomegaly ; Weight Loss

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation for facial laceration in pediatric patients. The major benefits are its rapid onset of effects, relatively short half-life, and lack of respiratory depression. The known side effects of ketamine are hallucinations, dizziness, nausea, and vomiting. Seizure is not a known side effect of ketamine in patients without a seizure history. Here, we present the case of a patient in whom ketamine likely induced a generalized tonic-clonic seizure when used as a single agent in procedural sedation for facial laceration repair. The aim of this article is to report a rare and unexpected side effect of ketamine used at the regular dose for procedural sedation. This novel case should be of interest to not only emergency physicians but also plastic surgeons.

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation for facial laceration in pediatric patients. The major benefits are its rapid onset of effects, relatively short half-life, and lack of respiratory depression. The known side effects of ketamine are hallucinations, dizziness, nausea, and vomiting. Seizure is not a known side effect of ketamine in patients without a seizure history. Here, we present the case of a patient in whom ketamine likely induced a generalized tonic-clonic seizure when used as a single agent in procedural sedation for facial laceration repair. The aim of this article is to report a rare and unexpected side effect of ketamine used at the regular dose for procedural sedation. This novel case should be of interest to not only emergency physicians but also plastic surgeons.

The mainstay of diagnosing scrub typhus is through serologic testing. However, because of the delay of several days from the onset of the illness to the increase in the antibody titer, diagnosis can be difficult in the early stage of the illness. The aim of this study was to determine the clinical usefulness of adenosine deaminase activity (ADA) in diagnosing scrub typhus. A total of 104 patients were enrolled during the study period. Of these patients, 59 patients were diagnosed with scrub typhus and the mean serum ADA level was 46.7+/-11.6 U/L. High serum ADA levels strongly supported the diagnosis of scrub typhus, especially in patient without eschar. The remaining 44 patients did not have scrub typhus and 95% (42/44) of them had normal serum ADA levels. Therefore, evaluating serum ADA level could help diagnose patients with acute febrile disease such as scrub typhus, especially in its early stage of disease progression.
Adenosine ; Adenosine Deaminase ; Disease Progression ; Humans ; Orientia tsutsugamushi ; Scrub Typhus ; Serologic Tests

The mainstay of diagnosing scrub typhus is through serologic testing. However, because of the delay of several days from the onset of the illness to the increase in the antibody titer, diagnosis can be difficult in the early stage of the illness. The aim of this study was to determine the clinical usefulness of adenosine deaminase activity (ADA) in diagnosing scrub typhus. A total of 104 patients were enrolled during the study period. Of these patients, 59 patients were diagnosed with scrub typhus and the mean serum ADA level was 46.7+/-11.6 U/L. High serum ADA levels strongly supported the diagnosis of scrub typhus, especially in patient without eschar. The remaining 44 patients did not have scrub typhus and 95% (42/44) of them had normal serum ADA levels. Therefore, evaluating serum ADA level could help diagnose patients with acute febrile disease such as scrub typhus, especially in its early stage of disease progression.
Adenosine ; Adenosine Deaminase ; Disease Progression ; Humans ; Orientia tsutsugamushi ; Scrub Typhus ; Serologic Tests

OBJECTIVE: The purpose of this large prospective study is to assess the association between the disappearance of the lateral spread response (LSR) before and after microvascular decompression (MVD) and clinical long term results over two years following hemifacial spasm (HFS) treatment. METHODS: Continuous intra-operative monitoring during MVD was performed in 244 consecutive patients with HFS. Patients with persistent LSR after decompression (n=22, 9.0%), without LSR from the start of the surgery (n=4, 1.7%), and with re-operation (n=15, 6.1%) and follow-up loss (n=4, 1.7%) were excluded. For the statistical analysis, patients were categorized into two groups according to the disappearance of their LSR before or after MVD. RESULTS: Intra-operatively, the LSR was checked during facial electromyogram monitoring in 199 (81.5%) of the 244 patients. The mean follow-up duration was 40.9+/-6.9 months (range 25-51 months) in all the patients. Among them, the LSR disappeared after the decompression (Group A) in 128 (64.3%) patients; but in the remaining 71 (35.6%) patients, the LSR disappeared before the decompression (Group B). In the post-operative follow-up visits over more than one year, there were significant differences between the clinical outcomes of the two groups (p<0.05). CONCLUSION: It was observed that the long-term clinical outcomes of the intra-operative LSR disappearance before and after MVD were correlated. Thus, this factor may be considered a prognostic factor of HFS after MVD.
Decompression ; Follow-Up Studies ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Prospective Studies

PURPOSE: To evaluate the side effects, pattern of failure, and survival rate according to the sequence of postoperative adjuvant radiotherapy and chemotherapy, patients with stages II and lll rectal cancer who had undergone curative resection were randomized to early radiotherapy group (arm I) or 'late radiotherapy group (arm II)', then we intend to determine the most effective sequence of the radiotherapy and chemotherapy. MATERIALS AND METHODS: From January 1996 to March 1999, 3 13 patients with curatively resected stages II and III rectal cancer have been randomized to early' or late radiation therapy group and recei ved combined chemotherapy (5-FU 375 mg/m/day, leucovorin 20 mg/m, IV bolus daily D1-5, 8 cycles) and radiation therapy (whole pelvis with 45 Gy/25 fractions/5 weeks). Arm I received radiation therapy from day 1 with first cycle of chemotherapy and arm II received radiation therapy from day 57 with third cycle of chemotherapy after completion of first two cycles. Preliminary analysis was performed with 228 patients registered up to Jun 1998. Two out of the 228 patients were excluded because of double primary cancer. Median follow-up period was 23 months. RESULTS: Local recurrence occurred in 11 patients (9.7%) for arm I and 9 patients (8%) for arm II. There was no significant difference between both groups (p=0.64). However, distant metastasis was found in 22 patients (19.5%) for arm I and 35 patients (31.0%) for arm II and which showed statistically significant difference between the two groups (p=0.046). And neither 3-year disease-free survival (70.2% vs 59.2%, p=0.2) nor overall survival (89.4% vs 88.0%, p=0.47) showed significant differences. The incidence of leukopenia during radiation therapy and chemotherapy was 78.3% and 79.9% respectively but leukopenia more than RTOG grade 3 was only 2.1% and 6.0% respectively. The incidence of diarrhea more than 10 times per day was significantly higher in the patients for arm I than for arm II (71.2% vs 4 1.6%, p=0.02) but this complication was controlled with supportive cares. CONCLUSION: Regardless of the sequence of postoperative adjuvant radiation therapy and chemotherapy a fter curative resection for rectal cancer, local recurrence rate was low with combined chemoradiotherapy. But distant metastasis rate was lower in early radiation therapy group than in late radiation therapy group and the reason is unclear. Most patients completed these treatments without severe complication, so these were thought to be safe treatments but the treatment compliance should be improved.
Arm ; Chemoradiotherapy ; Chemotherapy, Adjuvant* ; Compliance ; Diarrhea ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Leucovorin ; Leukopenia ; Neoplasm Metastasis ; Pelvis ; Prospective Studies* ; Radiotherapy* ; Radiotherapy, Adjuvant ; Rectal Neoplasms* ; Recurrence ; Survival Rate

OBJECTIVE: The aim of this study is to investigate the clinical outcomes of surgery and coiling and analyze the predicting factors affecting the clinical outcomes of ruptured posterior inferior cerebellar artery (PICA) aneurysms. METHODS: During the last 15 years, 20 consecutive patients with ruptured PICA aneurysms were treated and these patients were included in this study. The Fisher's exact test was used for the statistical significance of Glasgow Outcome Scale (GOS) according to initial Hunt-Hess (H-H) grade, treatment modalities, and the presence of acute hydrocephalus. RESULTS: Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. CONCLUSION: In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.
Aneurysm ; Arteries ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Pica ; Subarachnoid Hemorrhage ; Surgical Instruments