A 46-year-old male patient had recurrent episodes of generalized pruritic wheals during hemodialysis. He has experienced urticaria during hemodialysis whenever he used a capillary dialyser sterilized by ethylene oxide(EO, Polysulfone-) gas which is used to sterilize hemodialysers and other medical equipment. On the other hand, capillary dialyser sterilized by Gamma ray (Hemophad) has not evoked urticaria. Although the presence of EO-specific antibodies was not detected, urticarial rash never developed when the equipment was switched to a gamma-sterilized one. We herein report a case referred to ethylene oxide induced cutaneous hypersensitivity during hemodialysis.
Antibodies ; Capillaries ; Ethylene Oxide ; Exanthema ; Gamma Rays ; Hand ; Humans ; Hypersensitivity* ; Kidneys, Artificial ; Male ; Middle Aged ; Renal Dialysis* ; Urticaria

No abstract available.
Zygapophyseal Joint*

The increase in size of lymph node on Ct scan is the single most important finding of lymphadenopathy. The purpose of this study was to evaluate the size of mediastinal lymph nodes in patients with idiopathic pulmonary fibrosis with no evidence of malignancy or current infection. CT scans of 70 patients (16 with conventional CT and 54 with high-resolution CT) were assessed for lymph node size and locations. The duration of symptoms, and the extent and patterns of the parenchymal lung disease on CT scans were correlated with lymph node enlargement. In 54 of 70 patients, more than one lymph nodes were larger than 1-1.5cm. The prevalence of mnode enlargement increased significantly with a longer duration of symptom (p=0.001), larger extent of the disease (p=0.043), and with a greater proportion of honeycomb pattern (p=0.0344). Right paratracheal, subcarinal, right tracheobronchial, and paraesophageal nodes were the most common sites of nodes enlargement. In conclusion, mediastinal lymph node enlargement is common in patients with idiopathic pulmonary fibrosis and is more frequently seen in patients with a longer duration of clinical symptoms, greater extent of the disease, and with a larger proportion of honeycomb pattern.
Humans ; Idiopathic Pulmonary Fibrosis* ; Lung Diseases ; Lymph Nodes* ; Lymphatic Diseases ; Prevalence ; Tomography, X-Ray Computed*

No abstract available.
Lichens* ; Mucinosis, Follicular*

Purpose: To investigate the outcomes of patients who underwent surgical correction of congenital superior oblique muscle paralysis in adulthood. Methods: We retrospectively analyzed the medical records of 35 patients who underwent surgical correction of congenital superior oblique muscle paralysis after the age of 18 years. At the final follow-up, success was defined as residual hypertropia < 4 prism diopters (PD), whereas failure was defined as residual hypertropia ≥ 5 PD or overcorrection. Clinical features were compared between the success and failure groups to identify factors affecting the surgical outcome. At the final follow-up, the resolution of symptoms, such as head tilt and diplopia, was also recorded. Results: Of the 35 patients, 24 (68.6%) and 11 (31.4%) were classified into the success and failure groups, respectively. Preoperative vertical deviation was larger in the failure group compared to the success group (23.1 vs. 15.2 PD, respectively; p < 0.05). Of the 31 patients with preoperative head tilt, head tilt resolved in 29 (93.5%). Of the 19 patients with diplopia, it resolved in all except 1 who was overcorrected. Conclusions The preoperative vertical angle of the superior oblique muscle may affect the outcome of surgery performed in adulthood for correcting congenital superior oblique paralysis. Head tilt, diplopia, and subjective symptoms are typically resolved postoperatively.

Undifferentiated embryonal sarcoma(UES) is an uncommon malignant hepatic tumor that occurs in older children and young adults. Six cases of UES were reviewed to determine their characterisfic findings on sonography (US) (n=5), computed tomography (CT) (n=6), and angiography (n=2) US demonstrated a single large, echogenic mass with some anechoic spaces in each case. CT revealed a well demarcated hypodense mass with hyperdense septa of variable shape and thickness. Four cases showed enhancing peripheral rim and some solid portions at the periphery or adjacent to the septa. Follow-up CT scan in one case who had not been treated showed enhancing solid portion changed to hypodense areas. Angiography showed hypovascular or avascular mass. Familiarity with these radiological findings of UES of liver will be helpful in differential diagnosis of primary hepatic tumors of childhood.
Angiography ; Child* ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Liver ; Recognition (Psychology) ; Sarcoma* ; Tomography, X-Ray Computed ; Young Adult

Gastric dilatation is a rare life-threatening condition and consists of massive distention of the stomach by gas and fluid. Its etiology is unclear but predisposing factors include recent surgery, diabetic gastroparesis, fundoplication and gastric outlet obstruction. As the distended stomach grows larger, it hangs down across the duodenum, producing a mechanical gastric outlet obstruction, venous obstruction of the mucosa, ischemic necrosis and perforation. The distended stomach pushes the diaphragm upward, causing collapse of the left lung, rotation of the heart, and obstruction of the inferior vena cava. Hypochloremia, hypokalemia, and alkalosis may result from fluid and electrolyte losses and may precipitate cardiac arrhythmias. If acute gastric dilatation is not treated promptly, cardiovascular and pulmonary compromise may compound an increasing intravascular volume deficit leading to hypotension, which may be a cause of death.
Alkalosis ; Arrhythmias, Cardiac ; Causality ; Cause of Death ; Diaphragm ; Duodenum ; Fundoplication ; Gastric Dilatation* ; Gastric Outlet Obstruction ; Gastroparesis ; Heart ; Hypokalemia ; Hypotension ; Lung ; Mucous Membrane ; Necrosis ; Stomach ; Vena Cava, Inferior

Gastric dilatation is a rare life-threatening condition and consists of massive distention of the stomach by gas and fluid. Its etiology is unclear but predisposing factors include recent surgery, diabetic gastroparesis, fundoplication and gastric outlet obstruction. As the distended stomach grows larger, it hangs down across the duodenum, producing a mechanical gastric outlet obstruction, venous obstruction of the mucosa, ischemic necrosis and perforation. The distended stomach pushes the diaphragm upward, causing collapse of the left lung, rotation of the heart, and obstruction of the inferior vena cava. Hypochloremia, hypokalemia, and alkalosis may result from fluid and electrolyte losses and may precipitate cardiac arrhythmias. If acute gastric dilatation is not treated promptly, cardiovascular and pulmonary compromise may compound an increasing intravascular volume deficit leading to hypotension, which may be a cause of death.
Alkalosis ; Arrhythmias, Cardiac ; Causality ; Cause of Death ; Diaphragm ; Duodenum ; Fundoplication ; Gastric Dilatation* ; Gastric Outlet Obstruction ; Gastroparesis ; Heart ; Hypokalemia ; Hypotension ; Lung ; Mucous Membrane ; Necrosis ; Stomach ; Vena Cava, Inferior

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of defective apoptosis, a disruption of the regulatory pathway that terminates immune and inflammatory responses.Fever, cytopenia, splenomegaly, and/or hemophagocytosis are typical findings of this syndrome. HLH can be induced by genetic disorders (familial) or secondary causes.Familial HLH is rare, while secondary causes in adults include infection, autoimmunity, and malignancy. HLH in adults tends to be confused with or misdiagnosed as sepsis, mainly due to similar clinical manifestations and laboratory findings, which make it difficult to diagnose HLH rapidly and adopt immunosuppressive agents and/or chemotherapy adequately. Treatment of pediatric HLH using HLH-2004 or multi-agent chemotherapy can be applied in adult patients, although the dose and type of drug need to be adjusted.It is highly recommended that allogenic hematopoietic stem cell transplantation should be used in patients who become reactivated or are refractory to the initial treatment as soon as possible to improve survival. Future clinical trials are warranted to determine more suitable treatments for adult patients with HLH.

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of defective apoptosis, a disruption of the regulatory pathway that terminates immune and inflammatory responses.Fever, cytopenia, splenomegaly, and/or hemophagocytosis are typical findings of this syndrome. HLH can be induced by genetic disorders (familial) or secondary causes.Familial HLH is rare, while secondary causes in adults include infection, autoimmunity, and malignancy. HLH in adults tends to be confused with or misdiagnosed as sepsis, mainly due to similar clinical manifestations and laboratory findings, which make it difficult to diagnose HLH rapidly and adopt immunosuppressive agents and/or chemotherapy adequately. Treatment of pediatric HLH using HLH-2004 or multi-agent chemotherapy can be applied in adult patients, although the dose and type of drug need to be adjusted.It is highly recommended that allogenic hematopoietic stem cell transplantation should be used in patients who become reactivated or are refractory to the initial treatment as soon as possible to improve survival. Future clinical trials are warranted to determine more suitable treatments for adult patients with HLH.