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.

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

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

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

BACKGROUND: Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). METHODS: This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. RESULTS: The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. CONCLUSIONS: LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.
Anoxia ; Critical Care* ; Critical Illness ; Diagnosis ; Diaphragm ; Fever ; Humans ; Lung* ; Medical Records ; Pneumonia ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Ultrasonography* ; Weaning

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

PURPOSE: To compare the effects of anti-inflammatory agents, specifically bromfenac, loteprednol, and prednisolone, on the permeability of cultured human trabecular meshwork cell (HTMC) monolayers. METHODS: HTMCs were cultured until confluency in the inner chamber of Transwell, then exposed to 1/1,000 or 1/500 diluted commercial 0.1% bromfenac, 0.5% loteprednol, and 1% prednisolone for 24 hours. The permeabilities of carboxyfluorescein through the HTMC monolayer were measured with a spectrofluorometer after 2 hours in the outer chamber. Cellular viabilities were assessed with an 3-[4,5–dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay. RESULTS: Bromfenac and loteprednol diluted at 1/1,000 or 1/500 did not significantly affect the cellular survival (p > 0.05). Bromfenac did not affect the permeability via the HTMC monolayer (p > 0.05) and loteprednol decreased the permeability (p < 0.05). In addition, 1/2,000 prednisolone also decreased the permeability (p < 0.05). CONCLUSIONS: Among the anti-inflammatory agents, the non-steroidal anti-inflammatory agent bromfenac did not affect the permeability, while loteprednol and prednisolone decreased the permeability through the HTMC monolayer. Thus, loteprednol and prednisolone may decrease the trabecular outflow.
Anti-Inflammatory Agents* ; Humans ; Loteprednol Etabonate ; Permeability* ; Prednisolone ; Trabecular Meshwork*