Granuloma annulare is a common, benign, inflamatory, usually self-limited dermatosis. Disseminated perforating granuloma annulare is a rare variant of granuloma annulare. A 23-month-old female patient had asymptomatic, multiple umbilicated papules on the face, limbs including palms and soles, buttock and trunk for about 5 months. The new lesions have developed with mild fever or symptoms of upper respiratory infection. Histopathological examination revealed transepidermal elimination of mucinous degenerated collagen fibers and surrounding palisading lymphohistiocytic granuloma. After she was treated with prednisolone and antibiotics, the lesions slightly resolved, but thereafter, new lesions have developed frequently with mild fever. We herein reported a rare case of disseminated perforating granuloma annulare in the youngest patient yet reported.
Anti-Bacterial Agents ; Buttocks ; Child* ; Collagen ; Extremities ; Female ; Fever ; Granuloma Annulare* ; Granuloma* ; Humans ; Infant ; Mucins ; Prednisolone ; Skin Diseases

BACKGROUND: The aim of this study was to compare the efficacy of ketorolac, paracetamol, and paracetamol plus morphine on pain relief after thyroidectomy. METHODS: Eighty patients were randomly allocated to one of the 4 groups: normal saline (group C), ketorolac 30 mg (group K), paracetamol 1 g (group P), and paracetamol 700 mg plus morphine 3 mg (group PM). Each regimen was administered intravenously (IV) 30 min. before the end of surgery. If pain was not relieved, patients received an IV bolus of pethidine hydrochloride 25 mg. Pain intensity using a visual analogue scale (VAS) was recorded at 0.5, 1, 2, 4, and 6 hr after the end of surgery. RESULTS: VAS at 0.5 and 1 hr after the end of surgery were significantly lower in group K, group P, and group PM than in group C (P < 0.05). The number of patients receiving pethidine hydrochloride at 0.5 and 1 hr after the end of surgery was significantly lower in group K, group P, and group PM than in group C (P < 0.05). There was no significant difference among the groups in the incidences of adverse events associated with study medications and patient satisfaction (P > 0.05). CONCLUSIONS: Paracetamol 1 g IV possesses a similar analgesic efficacy to ketorolac 30 mg IV after thyroidectomy. Paracetamol may represent an alternative to ketorolac for pain prevention after mildly to moderately painful surgery in situations where the use of NSAIDs is unsuitable.
Acetaminophen ; Analgesics ; Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Incidence ; Ketorolac ; Meperidine ; Morphine ; Patient Satisfaction ; Thyroidectomy

Kawasaki disease is an acute vasculitis of infancy and early childhood characterized by high fever, rash, mucositis, lymphadenopathy and coronary artery damage. The failure to indentify a causative organism using convetional culture and serological techniques, and the lack of response to antibiotics indicate that the disorder is probably not due to any known bacterial or viral pathogens. During the acute phase of the disease, the alterations of T and B cell functions, changes of cytokine and immunoglobulin levels have been reported. This study was performed to investigate the changes of immunoglobulins levels in patients with Kawasaki disease. IgG, IgA, IgM and IgG subclasses were measured using immunoprecipitation and EIA in the sera of patients with Kawasaki disease. The results were as follows: 1) Acute phase reactants such as CRP and ESR were significantly increased in Kawasaki patients compared to those in control patients(p<0.01). 2) Serum IgG levels in Kawasaki disease were markedly increased than those in control patients, while serum IgA and IgM levels showed no significant changes (P: No Significance). 3) IgG1 and IgG4 were predominantly increased increased in the sera of Kawasaki patients, while IgG2 and IgG3 were not significantly increased (P: No Significance). With these results, unidentified infectious organism with abnormal immune response could be suggested as an etiologic factor of Kawasaki disease.
Acute-Phase Proteins ; Anti-Bacterial Agents ; Child* ; Coronary Vessels ; Exanthema ; Fever ; Humans ; Immunoglobulin A ; Immunoglobulin G* ; Immunoglobulin M ; Immunoglobulins ; Immunoprecipitation ; Lymphatic Diseases ; Mucocutaneous Lymph Node Syndrome* ; Mucositis ; Vasculitis

BACKGROUND: Adolesoents experience many physical, psychological and social stresses. It is well known that there is a strong relationship between stress and illness. It has been told that good health goes with good health habits. We examine the relationship between several health habits and stress in adolescents. METHODS: We surveyed adolescents and their parents who visited an adolescent clinic in a general hospital for 8 manths. Structured questionnaires about status of several health habits and BEPSI(The Brief Encounterr Psychosocial Instrument) score were used. BEPSI is a quick stress measure that is composed of several items. RESULTS: This study included 486 adolescents and their 486 parents. Average number of good health habits was 3.2+/-1.7 and average BEPSI score was 2.1+/-0.6. The group that had more good health habits tended to mark lower BEPSI scores(p<0.05). There was a significant relationship between stress and each habit except sleep time of more than 7hrs, regular exercise and hobby. Smoker group and alcohol drinker group showed higher BEPSI scores, respectively. The conversation time between parents and adolescents had a significant relationship with BEPSI scores. CONCLUSIONS: Several health habits were significantly connected with stress in adolescents. We can assume that good health habits and conversation with their parents are important in the management of stress in adolescents.
Adolescent* ; Hobbies ; Hospitals, General ; Humans ; Parents ; Surveys and Questionnaires

This study was performed to evaluate the changes of serum IgG4 level in children with allergic diseases. Serum Ige, IgG and IgG4 level were measured using enyzme immunoassay (IgE) and radial immunodiffusion method (IgG and IgG4) in 21 children with bronchial asthma, allergic rhinitis or urticaria Eosinophil counts in peripheral blood and the values of serum IgE were significantly increased in allergic patients. The values of IgG4 in allergic patients were also increased compare to those in controls (24.23mg/dl versus 20.33mg/dl). But the values of IgG4 were not significantly correlated to either IgG or IgE levels. Further studies will be needed for measuring allergen specifie IgE and IgG4 levels considering the onset of diseases, methods and duration of treatment.
Asthma ; Child ; Eosinophils ; Humans ; Hypersensitivity ; Immunoassay ; Immunodiffusion ; Immunoglobulin E ; Immunoglobulin G* ; Rhinitis ; Urticaria

The purine antimetabolite 6-Mercaptopurine (6-MP) has been in clinical use for over 30 years and is still a widely used agent in the treatment of childhood acute lymphoblastic leukemia. The bioavailibility, clinical efficacy and toxicity of 6-MP administered orally for maintenance therapy of children with acute lymphoblastic leukemia are highly variable in many studies, as well as at differnt times in same patient. there are many factors affecting the bioavailibility of 6-MP. The most notably factor being that concomitantly administered drugs and foods might contribute to a decrease in the bioavailibity of this drug. In our sociocultural environment milk is a major constituent of child's foods. Cow's milk contains a high concentration of xanthine oxidase, which could potentially transform 6-TM into 6-thioxanthine (6-TX) and 6-thiouric acid (6-TUA) which have no more therapeutic effects. In this study, we evaluated the effect of various milk products on the bioavailability of 6-MP. Incubation at 37degrees C for 30 min raw or pasteurized milk resulted in transformation of a large quantity of clinically relevant concentration of 6-MP into 6-TUA. The concomitant adminstration of folic acid and allopurinol has markedly inhibitory effect on the 6-MP destroying activity of milk at clinically relevant concentrations. These observations may help to optimize modalities of administration of 6-MP for the treartment of patients with childhood leukemia.
6-Mercaptopurine* ; Allopurinol ; Biological Availability* ; Child ; Complement Factor B ; Folic Acid ; Humans ; Leukemia ; Milk* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Xanthine Oxidase

No abstract available.
Humans ; Sexual Behavior* ; Uterine Cervical Neoplasms*

Topical immunotherapy with diphenylcyclopropenone(DPCP) has been used for the treatment of alopecia areata. Due to the therapeutic principle of producing a contact eczema, itching, erythema and scaling are inevitable or even desired side effects. However, erythema multiforme-like reactions following topical DPCP treatment have been rarely reported with an estimated incidence of 1.2%. We present herein a case of Stevens-Johnson syndrome, the severe form of erythema multiforme as a side effect of topical DPCP. A 57-year old male patient visited us for the treatment of alopecia totalis. After sensitization with 0.2% DPCP in acetone, we applied DPCP on the scalp once a week for three weeks. Following the 3rd challenge of DPCP, iris-shaped lesions, erosions, vesicles, and bullae developed with fever. Also, he had vesicles and erosions in the oral cavity. The patient was treated with systemic antibiotics, steroids, and antihistamines. The cutaneous lesions were cleared with hyperpigmentation, and pronounced hair regrowth was observed.
Acetone ; Alopecia ; Alopecia Areata ; Anti-Bacterial Agents ; Dermatitis, Contact ; Erythema ; Erythema Multiforme ; Fever ; Hair ; Histamine Antagonists ; Humans ; Hyperpigmentation ; Immunotherapy* ; Incidence ; Male ; Middle Aged ; Mouth ; Pruritus ; Scalp ; Steroids ; Stevens-Johnson Syndrome*

Multidirectional shoulder instability is often difficult to diagnose and treat and can be cause of significant disability. Nonoperative rehabilitations and life tyle modifications are the primary treatments. Hiwever, the inferior capsular shift procedure, performed either from an anterior or posterior approach, as described by Neer and Foster, is recommended for symptomatic multidirectional instability that is unresponsive to nonoperative therapy. Twenty-seven shoulders in twenty-seven patients with inferior and multidirectional instability were managed with Neer s inferior capsular shift, through anterior or posterior approach depending on the direction in which the shoulder is most unstable. All of the patients were followed up for an average of 3 years (range one to seven years). The postoperative range of motion of the shoulders was well maintained except 1 patient. Three patients had recurrence of symptomatic and disabling multidirectional instability, but twenty-four (89%) of the shoulders continued to function well with no instability, no pain, no recurrence and no remarkable limitation of motion.
Humans ; Range of Motion, Articular ; Recurrence ; Shoulder*

Over 26 kinds of tablets and capsules, such as Tetracycline, Quinidine and Potassium preparations were reported to cause esopbageal ulcerations, eharacterized in various size, shape and number, ind sually in mid-esophagus, Recently authors experienced 10 cases of drug-induced esophageal ulcerations due to antibiotics and antiinflammatory agents such as Tetracycline, Aspirin, etc. Four cases were men and six were women. Four cases were in third dades, three in fourth cleeades, two in fifth decades and one in sixth decades. Presenting symptoras were odynophagia(4/10), dysphagia(3/10), substernal pain(7/10) and epigastric pain(3/10). Endoscopic examination of the esophgus showed single or multiple, small and shallow ulcers on the mid-esophgeal mucosa at the level of 30cm from the ineisor in eight cases, one Iarge and deep ulcer at the level of 40cm from incisor in one patient and one amall, shallow and one large, deep ulcers at the same time. in one patient The shape of alcers were various from a round to a large horseshoe shaped one. The clinical course was mild without complications. It was suggested that drug-induced esophsgeal ulcers with antibiotics and antiinflammatory agents could be found frequently and they had benign and mild clinicalc ourse,
Anti-Bacterial Agents ; Anti-Inflammatory Agents ; Aspirin ; Capsules ; Female ; Humans ; Incisor ; Male ; Mucous Membrane ; Potassium ; Quinidine ; Tablets ; Tetracycline ; Ulcer*