Allopurinol is a xanthine oxidase inhibitor widely used to control plasma uric acid levels. Serious and life threatening adverse effects such as the allopurinol hypersensitivity syndrome(AHS) are rare. We describe a 32-year-old female patient who was treated with allopurinol and developed fever, rash, and renal and liver dysfunction.
Adult ; Allopurinol* ; Exanthema ; Female ; Fever ; Humans ; Hypersensitivity* ; Liver Diseases ; Plasma ; Uric Acid ; Xanthine Oxidase

PURPOSE: The peak age for breast cancer in Korea is in the fifth decade, which is younger than that of Western countries. However, controversy exists about the effect of age on the prognosis. The purpose of this study was to investigate the impact of age on the prognosis in young breast cancer patients. METHODS: Nine hundred and seventeen patients, having undergone a breast cancer operation at our hospital, between January 1990 and December 2001, were included. The patients were divided into two groups: young age (under 35 years) and old age (> 35 years) groups. The factors analyzed included the tumor size, number of lymph node metastasis, stage, hormonal receptor status, c-erbB-2 status, p53 status, operation method and adjuvant therapy. These factors and the survival rates were compared between the two groups using SPSS 12.0. RESULTS: One hundred and twenty three (13.4%) and 794 (86.6%) patients were younger than and older than 35 years, respectively. There were no statistical differences in the clinicopathological factors between the two groups, with the exception of stage. The 5 year disease free survival rates in the young and old age groups were 67.0 and 77.5%, respectively (P=0.027). When adjusted for stage, the rates for the old and young age groups in stage I were 90.7 and 72.4%, respectively. Also, for stages II and III, those in the young age group had worse prognosis compared to those in the old age group. The 5 year overall survival was lower in the young age group, but with no statistical significance (P=0.108). CONCLUSION: The young aged breast cancer patients had a worse prognosis than the old age group. Therefore, aggressive adjuvant treatment should be considered to reduce the recurrence in young patient, despite the earlier occurrence of breast cancer.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Humans ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis* ; Recurrence ; Survival Rate

Solar urticaria is an uncommon disorder characterized by pruritus, erythema and whealing occurring minutes after exposure to sunlight or artificial radiation, and generally resolves in a few hours. A 46-year-old woman presented with a 2-year history of pruritus and whealing, which occurred immediately after exposure to sunlight. Phototesting elicited urticarial reactions in the UVA and visible sepectra. The results of passive and reverse passive transfer studies were all negative. The patient was treated with cetirizine, doxepin and prednisolone. After 2 months of the treatment, the symptoms did not appear.
Cetirizine ; Doxepin ; Erythema ; Female ; Humans ; Middle Aged ; Prednisolone ; Pruritus ; Sunlight ; Urticaria*

Ramsay Hunt syndrome or herpes zoster oticus is a viral disease associated with otalgia, vesicular eruption, facial paralysis, hearing disturbance, tinnitus, vertigo and other symptoms. Rarely it can be associated with involvement of IV, V, IX, X, XI, XII cranial nerves, cervical plexus, and diffuse encephalitis. We report a case of Ramsay Hunt syndrome with vocal cord paralysis which developed prior to facial nerve paralysis.
Cervical Plexus ; Cranial Nerves ; Earache ; Encephalitis ; Facial Nerve ; Facial Paralysis ; Hearing ; Herpes Zoster Oticus* ; Paralysis ; Tinnitus ; Vertigo ; Virus Diseases ; Vocal Cord Paralysis* ; Vocal Cords*

BACKGROUND & OBJECT10NS: Multiple system atrophy(MSA) is a heterogenous system disorder affecting extrapyramidal, cerebellar and autonomic nervous system. Clinical spectrum is broad, and depending on the system affected, patients are classified into striato-nigral degeneration (SND), olivo-ponto-cerebellar atrophy (OPCA) and Shy-Draper syndrome (SDS). However, evolution of symptoms during follow-up usually occurs, stirring up a debate between "lumpers" and "splitters". Recent pathological documentation of intracytoplasmic inclusions support "lumpers" that MSA is a specific disease entity with specific pathology. The study was done to analyze the natural course of MSA, and examine whether they are separate or part of the same disease. METHOD: We obtained the clinical data of patients with clinically probable MSA by the criteria of Quinn (1994). In addition to review of medical records, all patients were phone-interviewed or examined personally. RESULTS: Forty four patients were included in the study (male 23, female 21). Mean onset age 52.9 years, and mean follow-up period 19.7 months. Nine patients died during follow-up (mean disease duration 5.2 years). The initial predominant features were parkinsonism in 40% (14/35), cerebellar dysfunction in 25.7% (9/35), autonomic dysfunction in 17.1% (6/35) and others in 17.1%. At the latest follow-up, parkinsonism were noted in 77.1%, cerebellar dysfunction in 88.6% and autonomic dysfunction in 80%. With progression, all the patients showed mixed clinical manifestations, the most common being combination of all 3(60%). CONCLUS10N: The data supports that SND, OPCA and SDS are part of the same disease process.
Age of Onset ; Autonomic Nervous System ; Cerebellar Diseases ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Natural History* ; Olivopontocerebellar Atrophies ; Parkinsonian Disorders ; Pathology

BACKGROUND: Most mutations in the reverse transcriptase (RT) gene of the hepatitis B virus (HBV) are related to resistance to antiviral agents. Cross-sectional studies on the mutations of this gene are rare. Thus, we analyzed the mutation patterns of RT genes and their biochemical parameters. METHODS: From 2009 to 2012, 301 blood specimens from patients with chronic hepatitis B at Daegu Catholic University Medical Center were retrospectively analyzed for the RT gene sequence of HBV, ALT, hepatitis B e antigen (HBeAg), and HBV DNA. The mutation patterns of the RT gene were compared with the biochemical parameters. RESULTS: Of the 301 patients, 100 (33.2%) had no RT gene mutations. The remaining showed the following mutation patterns: rtM204I/V (50.2%), rtL180M (39.2%), and rtA181T/V (19.6%). Combined mutations were found in 146 cases (48.5%). Of these, the combination of amino acid changes at rt180+rt204 (49.3%) was most frequently detected, followed by rt181+rt236 (11.0%) and rt173+rt180+rt204 (9.6%). In the mutated group, HBV DNA and HBeAg positive rates were significantly higher (P<0.05 for both). Phenotypic analysis showed that lamivudine resistance was most frequently detected (34.6%), followed by adefovir resistance (15.6%). Multidrug resistance was detected in 48 cases (15.9%). The adefovir-resistant group had a higher proportion of cases with HBV loads greater than 2,000 IU/mL. CONCLUSIONS: We found correlations between the mutation status of the RT domain and biochemical parameters such as HBV DNA and HBeAg positive rate. The presence of RT gene mutations could therefore be utilized to predict clinical status.
Adenine/analogs & derivatives/therapeutic use ; Antiviral Agents/therapeutic use ; DNA, Viral/analysis ; Drug Resistance, Multiple, Viral ; Drug Resistance, Viral ; Hepatitis B e Antigens/blood ; Hepatitis B virus/*enzymology/isolation & purification ; Hepatitis B, Chronic/drug therapy ; Hospitals, University ; Humans ; Lamivudine/therapeutic use ; Mutation ; Organophosphonates/therapeutic use ; Phenotype ; RNA-Directed DNA Polymerase/*genetics ; Republic of Korea ; Retrospective Studies

Despite abundant blood supply, metastatic tumors of the penis are rare. We report herein a case of metastatic cancer of the penis from urinary bladder carcinoma in a 80-year-old man. He presented with 1 month history of erythematous tender mass on the penis which developed 16 months later after the diagnosis of carcinoma of the urinary bladder had been made. Skin biopsy from this lesion revealed variable sized atypical cells with hyperchromatic and pleomorphic nuclei similar to those of the urinary bladder. On immunohistochemical staining, infiltrating cells of both bladder and penis showed positive reaction to thrombomodulin and carcinoembryonic antigen(CEA), but negative reaction to cytokeratin20 and C-erB-2 oncogene.
Aged, 80 and over ; Biopsy ; Diagnosis ; Humans ; Male ; Neoplasm Metastasis ; Oncogenes ; Penile Neoplasms* ; Penis ; Skin ; Thrombomodulin ; Urinary Bladder*

OBJECTIVES: Recently, it was reported that microsurgical fenestration of the lamina terminalis (LT) may reduce the incidence of shunt-dependent hydrocephalus in aneurysmal SAH. The authors investigated the efficacy of the LT opening on the incidence of shunt-dependent hydrocephalus especially in the ruptured anterior communicating artery (ACoA) aneurysms. METHODS: The data of 71 ruptured ACoA aneurysm patients who underwent aneurysmal clipping in acute stage were reviewed retrospectively. The patients were divided into two groups according to the use of intraoperative microsurgical opening of the LT. Group I (n=36) included the patients with microsurgical fenestration of LT during routine pterional approach, Group II (n=35) consisted of patients in whom microsurgical fenestration of LT was not feasible. The rate of shunt-dependent hydrocephalus was compared between two groups by logistic regression to control for confounding factor. RESULTS: Ventriculo-peritoneal shunts were performed after aneurysmal obliteration in 18 (25.4%) patients. Overall conversion rates from acute hydrocephalus on admission to chronic hydrocephalus in each group were 29.6% (Group I) and 58.8% (Group II), respectively. There was no significant correlation between the microsurgical fenestration and the rate of occurrence of shunt-dependent hydrocephalus (p>0.05). CONCLUSION: Although this study cannot provide a definitive answer, the microsurgical fenestration of LT can play a negative role for reducing the incidence of chronic hydrocephalus. Surgeons should carefully decide the concomitant use of LT fenestration during surgery for the ruptured ACoA aneurysms.
Aneurysm ; Arteries ; Humans ; Hydrocephalus* ; Hypothalamus* ; Incidence ; Intracranial Aneurysm* ; Logistic Models ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Ventriculoperitoneal Shunt

Male breast cancer is a rare disease, accounting for approximately 1% of all breast cancer. We report a case of cutaneous, osteolytic, pulmonary, and hepatic metastases of male breast cancer in a 40-year-old male who presented 4x2.5 cm erythematous plaque with ulceration and bloody discharge on the areolar area of the left anterior chest. The histopathologic findings of the lesion showed nests and strands of invasive carcinoma forming ductlike structures and cellular arrangement in single-row line, referred to as Indian filing, between collagen bundles. The tumor cell showed positive reaction for estrogen receptor, but negative reaction for progesterone receptor. He was treated with tamoxifen, 5-fluouracil, adriamycin, and cyclophosphamide. Six months after initiation of the treatment, skin lesion was improved. Also, number and size of the metastatic cancer nodules decreased in the computer tomographic imaging.
Adult ; Breast Neoplasms ; Breast Neoplasms, Male* ; Collagen ; Cyclophosphamide ; Doxorubicin ; Estrogens ; Humans ; Male ; Male* ; Neoplasm Metastasis* ; Rare Diseases ; Receptors, Progesterone ; Skin ; Tamoxifen ; Thorax ; Ulcer

A review of the literature indicates that the simultaneous occurrence of two or more neoplasms in one specimen is a relatively infrequent finding. The finding of nevocellular nevi in close association with seborrheic keratosis, desmoplastic trichoepithelioma, syringoma, basal cell carcinoma, trichilemmal cyst, and epidermoid cyst raises interesting points about the histogenesis of these lesions. The combined occurrence of nevus with other epithelial neoplasms may indicate that changes in the microenvironment produced by nevus result in the induction of growth of the ectodermal origin neoplasms. We report a case of simultaneous occurrence of intradermal nevus and seborrheic keratosis.
Carcinoma, Basal Cell ; Ectoderm ; Epidermal Cyst ; Keratosis, Seborrheic* ; Neoplasms, Glandular and Epithelial ; Nevus ; Nevus, Intradermal* ; Syringoma