BACKGROUND: Leprosy is an infectious disease with two polar forms, tuberculoid leprosy (TT) and lepromatous leprosy (LL), that are characterized by strong cell-mediated immunity (CMI) and CMI anergy, respectively. Transforming growth factor-beta (TGF-beta) is a family of growth factors involved in essential physiological processes, including development, differentiation, tissue repair, cell growth control and inflammation. Cellular signaling by TGF-beta family members is initiated by the assembly of specific cell surface receptors that activate transcription factors of the Smad family. Deregulation of the TGF-beta-Smad signaling pathway has been implicated in developmental disorders and several human diseases. Recently, ELISA & immunohistochemistry revealed high expression of TGF-beta isoforms in LL. OBJECTIVE: The purpose of this study was to investigate TGF-beta-Smad signaling in various forms of leprosy. METHODS: We investigated the involvement of TGF-beta by immunohistochemical staining for Smad 2 and 3 in skin biopsies from six patients of BL and four patients of TT. RESULTS: The inflammatory cells, keratinocytes and fibroblasts in BL showed strong positivity for both Smad 2 and 3, whereas those in TT showed little positivity. CONCLUSION: The high expression of Smad 2/3 in BL could represent high expression of TGF-beta, which possibly contributes to local CMI anergy and other clinical characteristic features of leprosy.
Biopsy ; Communicable Diseases ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Humans ; Immunity, Cellular ; Immunohistochemistry ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Tuberculoid ; Physiological Processes ; Protein Isoforms ; Receptors, Cell Surface ; Skin ; Transcription Factors ; Transforming Growth Factor beta

PURPOSE: The manner of rectal bleeding of auto-amputated polyps (AP) is similar to juvenile polyps (JP) or Meckel's diverticula (MD). We conducted this study to characterize the clinical spectrum of AP. METHODS: Fourteen patients were enrolled this study who were diagnosed AP due to painless rectal bleeding. The clinical data of AP was assessed and then compared with the clinical data of JP and MD retrospectively. RESULTS: The prevalence of AP was 10.4% (14/135) and high in younger patients compared with that of JP (p=0.042 below 2 years). Whereas JP was more common in patients aged 2 to 5 years (p=0.005). Male was predominant in AP (p=0.008 AP vs JP). The manner of rectal bleeding in AP group was sudden and transient. There was no significant difference in time interval between onset of rectal bleeding and diagnosis between the 3 groups. However AP was diagnosed in 9 patients (64.3%) within 7 days after onset of rectal bleeding, but JP was diagnosed in 5 patients (4.1%) in the same period (p<0.001). All of AP were located in the rectum and the sigmoid colon. The mean hemoglobin was 11.3+/-1.5 g/dL in AP, 11.8+/-1.3 g/dL in JP, and 8.4+/-1.2 g/dL in MD (p<0.001, only significant in MD). CONCLUSION: AP may be considered in male older than 1 year with transient and sudden onset or increase of painless rectal bleeding without drop of hemoglobin level.
Aged ; Colon, Sigmoid ; Diverticulum ; Hemoglobins ; Hemorrhage ; Humans ; Male ; Meckel Diverticulum ; Polyps ; Prevalence ; Rectum

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.
Anesthesia ; Anesthesia, Local ; Mandibular Nerve* ; Methods ; Needles* ; Nerve Block

PURPOSE: The proper diagnosis of Meckel's diverticulum (MD) is difficult and delayed because of the variety of clinical manifestations. We reviewed clinical characteristics of symptomatic MD to facilitate early detection. METHODS: We analyzed retrospectively the clinical manifestations, diagnostic tools, histopathological findings, and operative findings in 58 patients with symptomatic MD. RESULTS: The male to female ratio was 2.8 : 1. The most common symptom of MD was bleeding. Others symptoms included: vomiting, abdominal pain, irritability, abdominal distension and fever in the order of frequency. The clinical manifestations of symptomatic MD were lower gastrointestinal bleeding, intestinal obstruction, perforation, diverticulitis and hemoperitoneum, in the order of frequency. The causes of intestinal obstruction were intussusception, internal hernia, band, volvulus, invagination, in the order of frequency. Seventy five percent of patient with MD were diagnosed prior to 5 years of age. The most frequently used diagnostic tool was the Meckel's scan. The diverticulum was located 2 cm to 120 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 1 cm to 10 cm and 94% were less than 5 cm. The most common ectopic tissue found in the MD was gastric mucosa. Ileal resection was more frequently performed than diverticulectomy. CONCLUSION: In cases of unexplained gastrointestinal bleeding, obstruction and repeated intussusception, the meckel's scan, ultrasound and computed tomography shoud be considered to rule out MD, and if clinically necessary, an exploratory laparotomy when needed.
Abdominal Pain ; Choristoma ; Diagnosis ; Diverticulitis ; Diverticulum ; Female ; Fever ; Gastric Mucosa ; Hemoperitoneum ; Hemorrhage ; Hernia ; Humans ; Ileocecal Valve ; Intestinal Obstruction ; Intestinal Volvulus ; Intussusception ; Laparotomy ; Male ; Meckel Diverticulum* ; Retrospective Studies ; Ultrasonography ; Vomiting

Actinomycosis is an indolent, slowly progressive infection caused by actinomyces species that normally colonize the mouth, colon, and vagina, characterized by sulfur granule formation. Actinomycosis can affect multiple organs, with local or systemic manifestations. The abdomen is involved in less than 20% of the cases with the ileocecal area being the site most frequently affected. The anorectal region is less frequently involved. We report a case of anorectal actinomycosis, which was diagnosed by histologic study of sigmoidoscopic biopsy. The patient was a 40-year-old man who took immunosuppressive agents after kidney transplantation. Adequate surgical excision was done, being followed by administration of massive dose of a penicillin.
Abdomen ; Actinomyces ; Actinomycosis* ; Adult ; Biopsy ; Colon ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Mouth ; Penicillins ; Sigmoidoscopy ; Sulfur ; Vagina

Chronic urticaria (CU) is defined by the presence of urticaria that has been continuously or intermittently for a period of 6 weeks or longer. The prevalence of CU in the general population has been estimated to range from 0.5% to 5%. Correct diagnosis and proper management for CU is essential to improve the quality of care. To date, several practical guidelines have been available for practitioners. In this article, we reviewed and summarized the epidemiology, pathogenesis, diagnosis, and management based on case reports and studies of CU from Korea and the other part of world, and recently published guidelines. Although there are many controversies, this report for CU would provide a clinical guidance for healthcare professionals in Korea.
Delivery of Health Care ; Diagnosis ; Epidemiology ; Korea ; Prevalence ; Urticaria*

BACKGROUND AND PURPOSE: Cholinesterase inhibitors (ChEIs) are effective in Alzheimer's disease (AD) treatment. The aim of this study is 1) to find neuropsychological factors that affect the functional response to ChEI therapy and 2) to determine whether regional cerebral blood flow (rCBF) pretreatment predicts a cognitive change in response to ChEI. METHODS: We prospectively recruited 32 patients diagnosed with probable AD and treated them with donepezil, a ChEI, over one year. The patients were divided into stable (s-AD) and declined (d-AD) AD groups, based on changes in Korean version of Mini-Mental State Examination (K-MMSE) scores. Patients were assessed using the Alzheimer's Disease Co-operative Study-Activities of Daily Living (ADCS-ADL) and Seoul Neuropsychologic Screening Battery, as well as brain single photon emission computerized tomography (SPECT) at baseline and last medical evaluations. The predictors of therapeutic responses were analyzed using general linear models. RESULTS: Based on their cognitive function changes, AD patients were classified into two groups: s-AD (n=14, annual change in K-MMSE score <0.9), or d-AD (n=18, annual change in K-MMSE score > or =0.9). The s-AD at baseline showed significantly better ADCS-ADL function (p=0.04) and had a tendency to preserve frontal function compared to the d-AD group. Global Statistical Parametric Mapping analysis revealed no significant decrease of rCBF between baseline and follow-up SPECT, in either the s-AD or the d-AD groups. However, on regional perfusion analysis of baseline SPECT, the d-AD group demonstrated perfusion deficits in the supramarginal gyrus, inferior occipital gyrus, and rolandic operculum compared with the s-AD group. CONCLUSIONS: Highly preserved ADCS-ADLs predicted a better improvement in MMSE scores in response to ChEI therapy and a more positive functional response in the group with preserved frontal function. rCBF provided hints to the variable response to donepezil therapy with ChEI treatment.
Alzheimer Disease* ; Brain ; Cholinesterase Inhibitors ; Follow-Up Studies ; Humans ; Linear Models ; Mass Screening ; Neuropsychological Tests* ; Perfusion ; Prospective Studies ; Seoul ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To investigate the causes, clinical features and characteristics of food-dependent exercise-induced anaphylaxis (FDEIA) in Korea. METHODS: A retrospective medical chart review was performed on the patients diagnosed with anaphylaxis between 2007 and 2011 in 14 hospitals in Korea. Cases with FDEIA were subsequently identified among anaphylaxis patients, and subgroup analyses were done to assess clinical characteristics of FDEIA. RESULTS: A total of 62 subjects with FDEIA (male, 72.6%; aged 16 to 70 years) were enrolled in 10 hospitals. Wheat (69.3%) was the most common cause of FDEIA, followed by meat (8.1%), seafood (6.5%), and vegetables (6.5%). The clinical manifestations were cutaneous (100%), respiratory (64.5%), cardiovascular (61.3%), and gastrointestinal (9.7%), respectively. In severity assessment, approximately 40% of FDEIA were classified as severe anaphylaxis. Portable epinephrine auto-injector was prescribed to 17.2% of patients, and about one fifth of the patients experienced redevelopment of anaphylactic symptoms during follow-up period. There was no significant difference of age, gender, latent period, total immunoglobulin E, and past history of allergic disease between patients with severe anaphylaxis group and patients with mild-to-moderate group. CONCLUSION: Wheat is the most common cause of FDEIA in Korea. Because significant number of patients with FDEIA experienced anaphylactic symptoms after diagnosis of FDEIA, more comprehensive therapeutic and educational approaches will be required to prevent recurrent development of anaphylaxis.
Aged ; Anaphylaxis ; Epinephrine ; Follow-Up Studies ; Food Hypersensitivity ; Humans ; Immunoglobulin E ; Immunoglobulins ; Korea ; Meat ; Retrospective Studies ; Seafood ; Triticum ; Vegetables

Anaphylaxis is a medical emergency and all healthcare professionals need to be familiar with its diagnosis, acute management, long-term management including prevention of future episodes, and plan for patient education. Correct diagnosis and management for anaphylaxis is critical, but it is not easy in clinical setting. Up to the present, several practical guidelines for anaphylaxis are available for the practitioners. Among them, World Allergy Organization guideline for the assessment and management has recently been released and widely used. In this article, we reviewed and summarized the epidemiology, risk factors, diagnosis, management, prevention, and education based on case reports and studies of anaphylaxis in Korean and other countries. Although there are many controversies, this practical overview for anaphylaxis would provide a clinical guidance for Korean healthcare professionals.
Anaphylaxis ; Delivery of Health Care ; Emergencies ; Hypersensitivity ; Patient Education as Topic ; Risk Factors

PURPOSE: We investigated the causes, clinical features, and risk factors of bee venom anaphylaxis in Korea. METHODS: The medical records of the diagnosis of anaphylaxis during a 5-year period from the 14 hospitals in Korea have been retrospectively reviewed. Cases of bee venom anaphylaxis were identified among anaphylaxis patients, and subgroup analyses were done. RESULTS: A total of 291 patients were included. The common cause of bee species was vespid (24.6%) in bee venom anaphylaxis, followed by honeybee and vespid (8.8%), apitherapy (7.7%), and honeybee (2.0%), although the causative bee species were commonly unknown (56.9%). The severity of anaphylaxis was mostly mild-moderate (72.9%), and common clinical manifestations included cutaneous (80.6%), cardiovascular (39.2%), respiratory (38.1%), and gastrointestinal (13.1%) symptoms. Portable epinephrine auto-injectors were prescribed to 12.1% of the patients. Subject positive to both vespid and honeybee showed more severe symptoms and higher epinephrine use (P<0.05). The severity was significantly associated with older age, but not with gender, underlying allergic disease, or family history. Apitherapy-induced anaphylaxis showed a higher rate of hospitalization and epinephrine use than bee sting anaphylaxis (P<0.05). CONCLUSION: Vespid is the most common cause of bee venom anaphylaxis in Korea. It is suggested that positivity to honeybee and vespid may be associated with more severe symptoms.
Adult* ; Anaphylaxis* ; Apitherapy ; Bee Venoms ; Bees ; Bites and Stings ; Diagnosis ; Epinephrine ; Hospitalization ; Humans ; Hymenoptera* ; Korea ; Medical Records ; Retrospective Studies* ; Risk Factors ; Venoms*