Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal drug-induced systemic hypersensitivity response characterized by erythematous eruption, fever, leukocytosis with eosinophilia, and internal organ involvement. Antitubercular agents are potential causative agents for DRESS syndrome but difficult to verify as a culprit drug, since antitubercular agents are coadministered as a combination regimen. A 42-year-old female with endobronchial tuberculosis was diagnosed with DRESS syndrome after 4-week treatment of isoniazid, rifampicin, ethambutol, and pyrazinamide with prednisolone 50 mg. All the antitubercular agents were stopped and replaced with levofloxacin, cycloserine, p-aminosalicylic acid, and kanamycin. However, severe exacerbation of DRESS syndrome compelled the patient to discontinue the administration of the second-line antitubercular agents. Two months later, the patient underwent a patch test for all the antitubercular agents which had been used, and the results showed positivity to isoniazid and cycloserine. We report a rare case of DRESS syndrome that reacted to cycloserine as well as isoniazid. Development of coreactivity to other drugs should be differentiated with a flare-up reaction in the management of DRESS syndrome.
Adult ; Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Ethambutol ; Female ; Fever ; Humans ; Hypersensitivity ; Isoniazid ; Kanamycin ; Leukocytosis ; Levofloxacin ; Patch Tests ; Prednisolone ; Pyrazinamide ; Rifampin ; Tuberculosis

In this paper, some parts of Fig. 1 and dose information of methylprednisolone on page 113 were misprinted.

No abstract available.
Cleft Lip* ; Diagnosis* ; Ultrasonography*

A wide range of denomination has been used for inflammatory myofibroblastic tumor (IMT). IMT is not entirely homogeneous, even though it shows some overlapping histologic features such as haphazard proliferation of spindle cell and polymorphic chronic inflammatory cell infiltraion. The spindle cell is considered to be of myofibroblastic origin but follicular dendritic cell origin was reported recently. IMT is known as nonneoplastic, aberrant inflammatory response. However, IMT could show local invasion, recurrence, vascular invasion, and malignant transformation, and clonal characteristics and aneuploidy of IMT support the hypothesis that IMT may be a neoplastic process. In order to define the nature of spindle cell of IMT, immunohistochemical stains for smooth muscle actin (SMA), vimentin (VMT), lysozyme, S-100 protein, cytokeratin, CD21 were done. Additional immunohistochemical stains for MIB-1 for proliferating activity and LMP (latent membrane protein) for Epstein-Barr virus (EBV) were done. IMTs were composed of each 2 cases from lung, liver and lymph node and one case from common bile duct, maxillary sinus, bladder and thigh, and were histologically subclassified according to Coffin et al. Nine cases (90%) were positive for SMA and VMT, but no correlation between SMA and VMT immunoreactivity and histologic types was identified. Five cases (50%) were positive for lysozyme and S-100 protein, and histologic type III was negative for lysozyme and S-100 protein, and immunoreactivity for S-100 protein was different according to the histologic subtypes. All 11 cases were negative for CD21 and EBV LMP. MIB-1 labelling index was less than 1% in all cases. In summary, the spindle cell is regarded as myofibroblastic origin rather than follicular dendritic cell origin. Relationship with EBV is not clear, and negligible MIB-1 reaction suggests that IMT might have a good prognosis.
Actins ; Aneuploidy ; Coloring Agents ; Common Bile Duct ; Dendritic Cells, Follicular ; Herpesvirus 4, Human ; Immunohistochemistry ; Keratins ; Liver ; Lung ; Lymph Nodes ; Maxillary Sinus ; Membranes ; Muramidase ; Muscle, Smooth ; Myofibroblasts* ; Prognosis ; Recurrence ; S100 Proteins ; Thigh ; Urinary Bladder ; Vimentin

Ectopic pregnancy is a common medical problem that is difficult to diagnose and potentially may lead to significant mortality or morbidity. The incidence of ectopic pregnancy is definitely increasing due to the rise in pelvic inflammatory disease (PID), pelvic surgery, intrauterine device (IUD), and assisted reproductive technologies, such as in vitro fertilization and embryo transfer (IVF-ET). Combined ectopic gestations are much rare and their true incidence is unknown. Multiple ectopic gestations may occur in a variety of locations. The majority involve one or both fallopian tubes. We report a case of combined tubal and cervical pregnancies, and discuss their management.
Embryo Transfer ; Fallopian Tubes ; Female ; Fertilization in Vitro ; Incidence ; Intrauterine Devices ; Mortality ; Pelvic Inflammatory Disease ; Pregnancy* ; Pregnancy, Ectopic ; Reproductive Techniques, Assisted

Young radish (Raphanus sativus L), a member of the mustard family (Cruciferae), is a common ingredient of Kimchi. Although few reports have described anaphylaxis to cruciferous vegetables, we report the case of anaphylaxis induced by contact with young radish. A 46-year-old female with a history of contact allergy to metal presented to our emergency room (ER) with dizziness, generalized eruption and gastrointestinal upset. Her symptoms developed after re-exposure to young radish while chopping it. Hypotensive blood pressures were noted. Three days prior, the patient had experienced generalized urticaria with pruritus immediately after chopping the fresh young radish, which resolved spontaneously. In the ER, her symptoms improved by the administration of epinephrine (0.3 mL), antihistamine (chlorpheniramine) and isotonic saline hydration. A skin prick test with young radish extract showed positive reactivity. The same skin test was negative in five adult controls. IgE-mediated hypersensitivity could be an important immunologic mechanism in the development of young radish-induced anaphylaxis.
Adult ; Anaphylaxis* ; Dizziness ; Emergency Service, Hospital ; Epinephrine ; Female ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Middle Aged ; Mustard Plant ; Pruritus ; Raphanus* ; Skin ; Skin Tests ; Urticaria ; Vegetables

We performed immunohistochemical staining against Hepatocyte (Hep) and CD10 antibodies in 75 hepatocellular carcinoma (HCC), 50 cholangiocarcinomas, 49 colorectal adenocarcinomas, and 308 gastric adenocarcinomas by tissue array method. We also evaluated the various non-neoplastic adult tissues and fetal digestive organs. Hep was expressed in 80% of HCCs, and HCCs without Hep expression were more likely to have a higher Edmondson & Steiner grade than HCCs with Hep expression (p=0.004). In non-HCCs, 16% of cholangiocarcinomas, 8.2% of colorectal carcinomas, and 44.2% of gastric carcinomas expressed Hep. Gastric carcinomas with Hep expression were significantly associated with early gastric carcinomas (p<0.001). In non-neoplastic tissues, Hep was found expressed in normal hepatocytes, small intestinal mucosa, and intestinal metaplasia of the stomach. Fetal hepatocytes expressed Hep after 19 weeks of gestation. CD10 was detected in 46.7% (35/75) of HCCs, and canalicular staining pattern was predominant in HCCs. In conclusion, the expression of Hep and CD10 may help to distinguish HCCs from non-HCCs.
Adult ; Antibodies, Monoclonal/metabolism ; Carcinoma, Hepatocellular/*metabolism/pathology ; Diagnosis, Differential ; Epitopes ; Gastric Mucosa/cytology/*metabolism ; Gastrointestinal Neoplasms/*metabolism/pathology ; Hepatocytes/cytology/*metabolism ; Human ; Immunohistochemistry ; Intestinal Mucosa/cytology/*metabolism ; Liver Neoplasms/*metabolism/pathology ; Neprilysin/metabolism ; Support, Non-U.S. Gov't ; Tumor Markers, Biological

To check expert opinion about the investigation system of medicine-related death, model for "Death Investigation Center" was suggested and related questionnaire were requested. Between 15 December 2009 and 5 April 2010, we sent e-mails of the questionnaire which asked the opinion for the new postmortem investigation system. We sent the questionnaire to 3,289 lawyers and 4,523 doctors (total 7812), and received 100 replies out of the total. All the lawyers and doctors interviewed knew the importance of the postmortem investigation system. Most of them (87%) agreed to the introduction of the new postmortem investigation system. Some of them thought that protector's agreement was necessary for the postmortem investigation (21%), and more doctors were likely to participate with legal protocol (23%). If the postmortem investigation could not be performed due to the protector's disagreement, another specialized medical investigation should be needed to figure out the cause of death (85%). The new postmortem investigation system should be performed by the specific institution, and supported by the government (44%). In many expert's opinion, nonmedical experts such as lawyers and priests should be included for the institution of investigation for objectivity and neutrality (72%). This sample study finds that the postmortem investigation performed by specialized institution is necessary to determine the cause of death in the hospital. For the operation of the system, neutrality and the operating core would be the most important.
Cause of Death ; Electronic Mail ; Expert Testimony ; Humans ; Lawyers ; Surveys and Questionnaires

No abstract available.
DNA* ; Nucleolus Organizer Region*

PURPOSE: To prevent permanent neurologic deficit and/or spinal deformity in pyogenic spondylitis earlydiagnosis and prompt treatment are essential. The purpose of this study is to determine the MR imaging findings ofpyogenic spondylitis. MATERIALS AND METHODS: In 31 patients with pathologically or clinically proven pyogenicspondylitis, MR images(31, T1-weighted ; 30, T2-weighted ; 31, Gd-enhanced T1-weighted) were retrospectivelyanalyzed. Analysis focused on the signal intensity and enhancement pattern of involved vertebral bodies andintervertebral discs, as well as paravertebral soft tissue abnormality. RESULTS: A total of 77 vertebral bodies(mean, 2.5 per patient) were involved. Signal intensity was low in 58 of 77 T1-weighted images, high in 63 of 75T2-weighted images and in 72 of 77 contrast-enhanced T1-weighted images, enhancement was diffuse. A total of 47intervertebral discs were involved. Signal intensity was low or intermediate in all 47 T1-weighted images, andhigh or intermediate in 38/46 T2-weighted images ; in 24 of 38 contrast-enhanced T1-weighted images, signalintensity was peripheral, and in 14, enhancement was diffuse. Twenty-six patients showed diffusely enhancedparavertebral soft tissue abnormality and in 14, the largest diameter was less than 1cm. CONCLUSION: With regardto vertebral bodies, MR imaging findings of pyogenic spondylitis are low signal intensity on T1-weighted images,and high or intermediate signal intensity on T2-weighted images, together with diffuse enhancement. Forintervertebral discs, signal intensity was low on T1-weighted images, high on T2-weighted images, and peripheralor diffuse enhancement was seen. Diffusely enhanced small paravertebral soft tissue abnormality was also present.
Congenital Abnormalities ; Humans ; Magnetic Resonance Imaging* ; Neurologic Manifestations ; Spondylitis*