BACKGROUND: Although intralesional methotrexate (MTX) is an effective, nonsurgical treatment of keratoacanthoma (KA), there have not been many reports of on the MTX treatment for KA in Korea. OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of the intralesional MTX for the treatment of KA in Korean patients. METHODS: We retrospectively studied seven patients with KA who received intralesional injection of MTX in our department. The efficacy was evaluated based on the physician assessment. Our review also included the cases of KA treated with intralesional MTX in Korean patients from the previous reports. We then analyzed the therapeutic regimens in the Korean patients by comparing them with the Caucasian patients. RESULTS: We identified 11 cases of Korean KA patients treated with an intralesional MTX, including seven from our institution and four from the Korean literature. Ten of the 11 patients (91%) showed a complete resolution with an intralesional MTX. No adverse events were observed during the treatment and the follow-up periods. No recurrence was found during the follow-up. In therapeutic analysis, the Korean patients required 2 to 7 injections (mean 4.6 injections) to achieve a tumor resolution with the mean time to clearing at 7.6 weeks. CONCLUSION: Intralesional MTX can be an effective and safe non-operative treatment modality for most Koreans with KA.
Asian Continental Ancestry Group ; Follow-Up Studies ; Humans ; Injections, Intralesional ; Keratoacanthoma* ; Korea ; Methotrexate* ; Recurrence ; Retrospective Studies*

BACKGROUND: Keloids and hypertrophic scars represent excessive scarring. They require different therapeutic approaches, which can be hampered because of an apparent lack of morphologic difference between the two diseases. OBJECTIVE: This study investigated the clinical and dermoscopic features of keloids and hypertrophic scars in order to help dermatologists distinguish these lesions better. METHODS: A total of 41 keloids and hypertrophic scars in 41 patients were examined clinically and by performing dermoscopy with a digital imaging system. Lesions were evaluated for vascular structures. RESULTS: Dermoscopy revealed vascular structures in most keloid lesions (90%) but in only 27% of hypertrophic scar lesions. The most common dermoscopic vascular structures in keloids were arborizing (52%), followed by linear irregular (33%) and commashaped (15%); these features were present but less evident in hypertrophic scars (9% for all types). The distribution frequency of the vascular structures differed significantly between diseases (p<0.001). CONCLUSION: A strong association of vascular structures with keloids was observed on dermoscopic examination. The results suggest dermoscopic examination of vascular structures is a clinically useful diagnostic tool for differentiating between keloids and hypertrophic scars.
Blood Vessels ; Cicatrix ; Cicatrix, Hypertrophic* ; Dermoscopy* ; Humans ; Keloid*

Schonlein-Henoch purpura is a generalized small vessel vasculitis characterized by nonthrombocytopenic purpura, arthritis, abdominal pain and nephritis. In 1914 Osler described an allergic purpura associated with hemiplegia. After then Lewis et al. reported the cases of Schonlein-Henoch purpura associated with convulsion, coma, confusion, intracranial hemorrhage, and chorea, CNS complication has been reported in 1-8% of children and subsided spontaneously in most cases. Headache is a remarkable sympton and appears nonspecific nature. In 1991 Ostergaard and Storm reported that headache occured during the first week following skin rash and frequently showed abnormal EEG findings. We investigated prospectively the presence of a possible cerebral and renal involvement in the case of Schonlein-Henoch purpura. EEG abnormality demonstrated in 52.6% of all cases, and headache or irritability in 47.4% of all cases. A significant association was found between abnormal EEG finding and presence of headache, but was not found between EEG findings and presence of renal involvement and hypertension. Patients with abnormal EEG had no Past or famity history of febrile convulsion or ididopathic epilepsy.
Abdominal Pain ; Arthritis ; Child ; Chorea ; Coma ; Electroencephalography* ; Epilepsy ; Exanthema ; Headache ; Hemiplegia ; Humans ; Hypertension ; Intracranial Hemorrhages ; Nephritis ; Prospective Studies ; Purpura, Schoenlein-Henoch* ; Seizures ; Seizures, Febrile ; Vasculitis

Paraquat (1, 1'-dimethy-14, 4' dipyridium chloride: Gramoxon(r)) was first discovered in England in 1955. It has been widely distributed for use in Korea since 1970 as a pesticide and also often the cause of accidental intoxications. The authors would like to report the following case of paraquat intoxicatio in a 13 year old female child admitted via emergency room with complaints of epigastric pain, vomiting and hematuria of four days duration. On admission the data of laboratory evaluation were as follows: BUN/Cr 126/11.6 mg/dl; sGOT/sGPT 641/641 IU/L; total bilirubin/direct bilirubin 3.9/2.4 mg/dl; alkaline phosphatase 396.1 U/L; fecal occult blood test-positive; pH 7.428, pCO2 26.2 mmHg, pO2 131.4 mmHg, base excess -5.0 mmol/L on arterial blood gas analysis (ABGA). Gastroendoscopy revealed esophageal ulcers, and as symptoms of renal failure could not be relieved by hemodialysis, kidney biopsy was performed on the otherwise previously healthy child to establish the cause of renal failure. The result of biopsy revealed tubular necrosis with eosinophilic infiltrations. A more detailed retrograde probe of the child's past medical history evoked that the patient had ingested paraquat in a suicidal attempt. Supportive therapy and hemodialysis were continued thereafter, but the symptoms of renal failure could not be reversed, and the patient eventually died due to acute respiratory distress syndrome.
Adolescent ; Alkaline Phosphatase ; Bilirubin ; Biopsy ; Blood Gas Analysis ; Child ; Emergency Service, Hospital ; England ; Eosinophils ; Female ; Hematuria ; Humans ; Hydrogen-Ion Concentration ; Kidney ; Korea ; Necrosis* ; Occult Blood ; Paraquat* ; Renal Dialysis ; Renal Insufficiency ; Respiratory Distress Syndrome, Adult ; Ulcer ; Vomiting

PURPOSE: To report a case of complete recovery within 1 day of cortical blindness associated with electroconvulsive therapy (ECT). CASE SUMMARY: A 15-year-old girl, who had no ophthalmologic disease, complained of bilateral visual loss immediately after ECT. At the first ophthalmologic examination, best corrected visual acuity was 0.03 in both eyes. Findings of anterior segment and fundus, movement of external ocular muscles, and pupillary light reflex were normal. Visual field examination showed generalized reduction of sensitivity and increased fixation loss in both eyes. Optical coherence tomography revealed no abnormalities. Electroretinography was normal, and a slightly prolonged latency of P100 was noted in the right and left flash visual evoked potentials. Without any specific treatment, the patient's vision improved gradually after 18 hours of ECT and was recovered completely, with vision of 1.0 in both eyes the next day. There were no abnormalities in visual evoked potentials or the visual field. CONCLUSIONS: Transient visual loss can occur after ECT, because of cortical blindness by transient cerebral ischemia, and can be recovered completely without specific treatment.
Adolescent ; Blindness, Cortical ; Electroconvulsive Therapy ; Electroretinography ; Evoked Potentials, Visual ; Eye ; Humans ; Ischemic Attack, Transient ; Light ; Muscles ; Reflex ; Tomography, Optical Coherence ; Vision, Ocular ; Visual Acuity ; Visual Fields

A clinical and statistical study was performed on 213 neonates of hyperbilirubinemia who were admitted to department of pediatrics of Korea University Hospital from Jan. 1989 to Jun. 1991. and we studied the difference between ABO compatible group and incompatible group, such as, day of apperance of hyperbilirubinemia, tendency of bilirubin concentration change, reticulocyte, hemoglobin and duration of hyperbilirubinemia. The following results were obtained. 1) There were no difference of initial body weight and gestational age between compatible (3.0 +/- 0.72kg, 38.2 +/- 3.2 weeks) and incompatible groups (3.2 +/- 0.54kg, 39.1 +/- 2.8 weeks). 2) Onset of hyperbilirubinemia within 2 days in the incompatible group (40.5%) was earlier than the compatible group (23.5%) significantly (p<0.05). 3) Mean bilirubin level in the incompatible group was higher than the compatible group significantly (p<0.05). 4) Peak bilirubin level in the incompatible group(18.7+/-4.1mg/dl) was higher than the compatible group (14.8+/-3.4mg/dl) significantly (p<0.05). 5) There were no difference of hemoglobin level, reticulocyte count, coombs positive finding and the ratio of exchange transfusion between two groups.
Bilirubin ; Body Weight ; Gestational Age ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Infant, Newborn ; Korea ; Pediatrics ; Reticulocyte Count ; Reticulocytes ; Statistics as Topic

No abstract available.
Anemia, Refractory* ; Cyclosporine*

In Korea, all domestic made test systems for detecting antibodies in HIV-1 contain the antigens from human immunodeficiency type 1 (HIV-1) subtype B. However, because HIV-1 subtype O is significantly different in amino acid sequences from all other subtypes of HIV-1, there has been a need for developing a test for detecting antibodies in subtype O. For this purpose, the entire nucleotide sequence corresponding to the extracellular domain of the transmembrane glycoprotein of HIV-1 subtype O was synthesized with consideration of Escherichia coli cordon usage. Various regions of the extracellular domain were cloned into E. coli expression vectors and tested for levels of protein production. The nucleotide sequence, named ECTM, that can encode a 129 amino acid-long peptide, was found to be expressed at a high level in E. coli. The protein of approximately 17 kDa specifically reacted with sera from individuals infected with HIV-1 subtype O. The ECTM protein was purified to near homogeneity by the CM-T gel chromatography, using concentrated, denatured inclusion bodies. In Western blot analysis, the purified viral antigen reacted with sera from individuals infected with subtype O more efficiently than subtype B. The enzyme linked immunoabsorbent assay (ELISA) system was developed using the subtype O viral protein and compared with the commercially available kit lacking the antigens from subtype O. The ELISA kit containing the subtype O antigen ECTM alone efficiently reacted with sera from individuals infected with subtype O. The subtype O antigen-containing kit produced a positive absorbence even when sera were diluted 512-fold, suggesting a high sensitivity. The commercially available kit also reacted with subtype O sera, but produced a negative result at a dilution of 8-fold. Our results suggest that the currently available kit may not be able to efficiently detect subtype O sera and that the viral protein developed in this study may be added to the current system to maximize the detection of sera from individuals infected with subtype O.
Amino Acid Sequence ; Antibodies ; Base Sequence ; Blotting, Western ; Chromatography, Gel ; Clone Cells ; Enzyme-Linked Immunosorbent Assay ; Escherichia coli ; Glycoproteins ; HIV* ; HIV-1* ; Humans* ; Inclusion Bodies ; Korea ; O Antigens

We performed this study to show that it is possible to identify underlying causes of de ath not identif ied by issued death certificates by mapping and adding information from National Database(DB) such as health insurance DB or KUHDDS(Korea Uniform Hospital Discharge Data Sets) with death certificates. We collected 2,986 death certificates issued at Cheonan, Asan provinces and 458 death certificates issued at 3 general hospitals at Chenoan city. Mapping of death certificate data with health insurance DB was possible in 77.4%(Cheonan, Asan provinces) and 87.3%(3 general hospitals at Cheonan city) of cases. Rate of underlying causes of death identified from records on death certificates before mapping was 64.4% and 68.3% each. After mapping and adding information from health insurance DB, the rate increased to 79.8% and 79.2% each. This work was done by skilled medical record officers. We also selected death certificates which recorded the causes of deaths as old age, cardiopulmonary arrest, or nonspecific symptoms. The possibility was shown that old age, ca rdiopulmonary a rrest, and nonspecific symptoms can be corrected by information from mapped health insurance DB and KUHDDS. With these results, we discussed some cause of incorrect recording practices. And we suggested simple but practical method to improve the correctness of death certificates; there is a possibility that comparing death certificates with KUHDDS before it is issued, where available, can improve the quality of death certificate.
Cause of Death* ; Chungcheongnam-do ; Death Certificates* ; Heart Arrest* ; Hospitals, General ; Insurance, Health ; Medical Records

For the previous century, the humans have created an unintended and unwanted problem of endocrine disruptors as a potential threat to our public health. By the name of industrialization, endocrine disruptors are smuggling in the everyday life of people today. Although there are much debate on the reality of their emerging health threat, it is no doubt that there are certain classes of compounds that have the potential to affect hormonal status adversely, leading to abnormal development, reproductive dysfunction, and some cancers. The classes of endocrine disruptors are extensively diverse and even more increasing, such as, polychlorinated biphenyls (PCBs), dioxins, dieldrin, bisphenol A and toxaphene. Although these endocrine disruptors have been prohibited or tightly regulated, many of them are still unrecognized and still used without knowing their potential threat to the biological world. Once they are released into the environment, they usually persist without degradation and even undergo bioaccumulation and bioconcentration in food chain. Comparing with the great concern over the public health, we do not have enough information for these issues. It is now clear that we need further extensive studies for the risk assessment and the protection of human and ecological health from the potential hazards of endocrine disruptors. This article introduces a breif overview of the current status of our knowledge and research on endocrine disruptors.
Dieldrin ; Dioxins ; Endocrine Disruptors* ; Food Chain ; Humans ; Polychlorinated Biphenyls ; Public Health ; Risk Assessment ; Toxaphene