No abstract available.
Fetus* ; Humans*

No abstract available.
Enterococcus*

No abstract available.
Enterococcus*

The central venous catheter(Quinton) was replaced in the right atrium for chemotherapy and blood sampling to a eight-year old girl with acute lymphoblastic leukemia. The catheter was flushed with heparin two times daily and the chemotherapeutic drug regimens by CCSG-105 protocol were vincristine, prednisone, L-asparaginase, daunomycin, methotrexate, cyclophosphamide, cytosine arabinoside, 6-mercaptopurine and adriamycin. On day 31 of catheterization, the lumen for blood sampling was blocked. From day 60 of catheterization, anorexia, nausea, vomiting, abdominal distension and tachypnea were developed. Echocardiogram, lung scan, pulmonary function test(PFT), arterial blood gas analysis (ABGA) were done. Two cemtimeters in diameter of thrombosis was found in the right atrium on echocardiogram. The lung scan showed slight decrease in uptake of Tc-99m on the whole lung fields. Restrictive ventratory impairment on PFT and decreased PaO2(48 mmHg) on ABGA were found. To lysis of thromboembolism, urokinase(4,400 IU/kg for initial 10 minutes and the 4,400 IU/kg for 12 hours) was injected intravenously and aspirin(30 mg/kg/d, po) was given. The thrombosis was disappeared from the atrium on echocardiogram and PaO2 was increased up to 97 mmHg temporary. The catheter was removed but total haziness on the right middle and lower lobes were developed after 5 days. The same dose of urokinase was injected just infront of the embolism through Pitfall catheter for 8 days intermittently as results of pulmonary angiography. Symptoms and PaO2 were alleviated and the lung was expanded with mild atelectasis on day 55 of the first fibrinolytic enzyme therapy. Although the frequent complications of central venous catheter are catheter occlusion and infection, we have to check the development of thromboembolism with echocardiogram periodically or in case of unexplained respiratory symptoms.
6-Mercaptopurine ; Angiography ; Anorexia ; Blood Gas Analysis ; Catheterization ; Catheters ; Central Venous Catheters* ; Cyclophosphamide ; Cytarabine ; Daunorubicin ; Doxorubicin ; Drug Therapy ; Embolism ; Enzyme Therapy ; Female ; Heart Atria ; Heparin ; Humans ; Lung ; Methotrexate ; Nausea ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisone ; Pulmonary Atelectasis ; Tachypnea ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Vincristine ; Vomiting

No abstract available.
Dermatitis, Seborrheic* ; Humans

Five cases of cerebral arteriovenous malformation(AVM) are presented, which underwent total extirpation using the operating microscope. The following are considerations which favor the total extirpation of AVM and the advantages of using the operating microscope, including the rationale for non-use of hypotensive anesthesia or mannitolization which is commonly used in intracranial aneurysm surgery: 1) Relatively small sized AVMs are found to show a high rate of large intracerebral hematoma, including that the degree of bleeding from the malformed vessels is not related to the size of the AVM. 2) The operating microscope facilitates the following procedures: a) determination of the extent of the malformed vessels. b) clipping feeders. c) identification of red vein and laminar flow. d) preservation of normal brain tissue.
Anesthesia ; Brain ; Hematoma ; Hemorrhage ; Intracranial Aneurysm ; Intracranial Arteriovenous Malformations* ; Mannitol ; Veins

BACKGROUND: Interleukin-4(IL-4) from the Th2 subset of lymphocytes has been known to have a key role in the pathogenesis of atopic dermatitis. Blood levels of IgE, often reflecting the severity of allergic diseases, are not always elevated in patients with atopic dermatitis due to its homocytotrophic characteristics. OBJECTIVE: We propose that IL-4 can substitute or at least complement the role of IgE as an index of disease severity of atopic dermatitis. METHODS: Eleven patients with atopic dermatitis and five normal controls were included in this study. Before treatment, we evaluated the clinical severity of atopic dermatitis by the method described elsewhere with some modification which employed extent, duration, and intensity of skin lesions. Based on this criteria, we divided patients into 'severe and mild groups. With blood samples drawn from patients and normal controls, we measured IL-4 and IgE values. After a treatment period of I to 2 months, when all of the patients became free of symptoms and signs of atopic dermatitis, patients in each group were re-evaluated for ehanges of IL-4 and IgE values. IL-4 values were determined with a Predicata human interleukin-4 kit from Genzyme diagnostics (Predicta IL-4 kit) and ELISA reader (CRES UV900, Biotek). IgE values were measured .with IMx total IgE assay system from Abott laboratories (model 8389-0). RESULTS: l. Of eleven patients, six were mild and five were severe in clinical severity. 2. IL-4 levels were decreased from the pre-treatment average value of 57.149+/- 40.079 pg/ml to a post-treatment average value of 32.072+/- 16.912 pg/ml (p<0.05) which was similar to average normal control value, 36.690+/- 24.451 pg/ml. 3. IgE levels were similarly decreased from an average value of 230.2 86.4 IU/ml before treatment to one of 171.S+/-79.4 IU/ml after treatment (p<0.05). 4. This tendency of post-treatment lowering of values became more apparent in severe groups (p<0.05) but less obvious in mild groups both in terms of IL-4 and IgE (p>0.1). CONCLUSION: We conclude that IL-4 is not only involved in the pathogenesis but can also be used as a main index of disease severity in atopic dermatitis especially when the clinical severity is more than mild.
Complement System Proteins ; Dermatitis, Atopic* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin E ; Interleukin-4* ; Lymphocytes ; Skin

Cryptococcosis is a disease caused by the Cryptococcus neoformans, occcuring most frequently in immunocompromised hosts. Cutaneous involvement is seen in 10-15 % of disseminated cases and its manifestation is variable. A 52 year old man presented with a subcutaneous neck mass and severe headache which had lasted for 2 months and 1 month respectively. Initially cutaneous involvement was monomorphic and localized and a CSF study failed to reveal any organisms. After several weeks of herb medication, however, multiple skin lesions occurred with varied morphology and a CSF study confirmed cryptococcosis by culture. The Urine cortisol was markedly elevated, suggesting an exogenous intake of steroid.
Cryptococcosis* ; Cryptococcus neoformans ; Headache ; Humans ; Hydrocortisone ; Immunocompromised Host ; Middle Aged ; Neck ; Skin

Specific cutaneous infiltrates in chronic lymphocytic leukemia(CLL) presenting as tumor and large nodule on face, scalp and upper trunk and involvement of oral mucsa is extremly rare. In 7% of cases, leukemic infiltrates of the skin precede the diagnosis of Leuke. We report herein leukemic macrocheilia which occured 3 years before a diagnosis of CLL.
Diagnosis ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Scalp ; Skin

BACKGROUND: Pustular eruptions due to drugs are uncommonly reported. We studied the characteristics of clinical and histopathologic findings of pustular drug eruption. OBJECTIVE: We observed th.e causative agents, clinical featurs and histopathologic findings of pustular drug eruption and identified differential points of generlized pustular eruption. METHODS: We evaluated t,he clinical and histopathologic findings of 8 patients with pustular drug eruption and reviewed the literatures reported cases of pustular drug eruption. RESULTS: All patients diagnosed pustular drug eruption suffered from generalized pustular eruption associated with systemic symptoms such as fever, headachened myagia one to three days after treatment with causative agents. The causative agents of putular drug eruption are antibiotics such as ceftriaxone, analgesics and antipyretics. The pustule resolved after a few days of treatment with systemic corticosteroids and antihistamines. Laboratory findings revealed leukocytosis, neutrophilia, and analevated erythrocyte sedimentation rate, On histopatologic findings, we observed subcorneal pustuls containing neutrophils, eosinophils and some lymphocytes and spongiosis, exocytosis of acute iiflammatory cells. Perivascular infiltration of lymphocyte ancl edema of papillary dermis was also bserved in the dermis. CONCLUSION: Pustular drug eruption is characterized by generalized pustular eruption associated with systemic symptoms and histopathologic findings of that are sterile subcorneal pustules. Therefore differential diagnosis of other generalized pustular erupticns are relatively easy by careful history of medication, clinical and histopathologic findings.
Adrenal Cortex Hormones ; Analgesics ; Anti-Bacterial Agents ; Antipyretics ; Blood Sedimentation ; Ceftriaxone ; Dermis ; Diagnosis, Differential ; Drug Eruptions* ; Edema ; Eosinophils ; Exocytosis ; Fever ; Histamine Antagonists ; Humans ; Leprosy ; Leukocytosis ; Lymphocytes ; Neutrophils