Impetigo herpetiformis is a form of pustular psoriasis that occurs during pregnancy and may be life-threatening. The pathogenesis and etiology of impetigo herpetiformis is not clear, but several reports have associated onset of this disorder with hypocalcemia, hypoparathyroidism, and the use of oral contraceptives. The typical lesions are erythematous patches that are studded with tiny superficial pustules particularly coalescing at their margins causing pain, and a burning sensation. Laboratory findings include an elevated erythrocyte sedimentation rate, increased peripheral blood leukocyte counts, hypoalbuminemia, and in severe cases, hypocalcemia. The histopathology is the same as that of pustula psoriasis. Our patient, a 31 year-old female (Intra Uterine Pregnancy 28 weeks), was admitted to our hospital due to generalized skin eruption and severe constitutional symptoms. Her clinical features, laboratory and histopathologic findings were compatible with that of impetigo herpetiformis. In spite of our all efforts, intrauterine fetal death was noted at her 33rd week of pregnancy. We report a case of impetigo herpetiformis terminating in fetal death with the review of literature.
Adult ; Blood Sedimentation ; Burns ; Contraceptives, Oral ; Female ; Fetal Death* ; Humans ; Hypoalbuminemia ; Hypocalcemia ; Hypoparathyroidism ; Impetigo* ; Leukocyte Count ; Pregnancy ; Psoriasis ; Sensation ; Skin

BACKGROUND: Little data is available regarding hospitalized patients with nursing home-acquired pneumonia (NHAP). This is unfortunate because there is an increasing number of elderly persons who are living in nursing homes in Korea. The aim of this study was to compare clinical characteristics and treatment responses of NHAP with community-acquired pneumonia (CAP). METHODS: Patients with pneumonia who were admitted from eight nursing homes or from their own homes were enrolled between May 2007 and April 2009. Their clinical characteristics and treatment responses were reviewed retrospectively, and differences between the two groups were analyzed. RESULTS: Of 110 Patients with pneumonia, 66 (60%) were from nursing homes and their median age was 84. In the NHAP group, functional performance status was significantly poorer, classical symptoms of pneumonia were less severe, and multi-lobe involvement (on chest radiographs) was more frequent than in the CAP group. Patients with NHAP more frequently showed lymphocytopenia, anemia, hypoalbuminemia, hypoxemia, and elevated blood urea nitrogen on admission. The mean CURB-65 score was 2.2 in the NHAP group, higher than 1.7 in the CAP group (p=0.004), and multi-drug resistant pathogens were also highly identified in NHAP group (39% vs. 10%, p=0.036). The mean duration of antibiotic therapy was greater for the NHAP (12.6 days) than for the CAP group (6.6 days) (p<0.001). The mortality rate was 23% in NHAP group, which was significantly higher than 5% in the CAP group (p=0.014). CONCLUSION: NHAP should be more intensively investigated because of the higher frequency of multi-drug resistant pathogens and mortality than the CAP.
Aged ; Anemia ; Anoxia ; Blood Urea Nitrogen ; Humans ; Hypoalbuminemia ; Korea ; Lymphopenia ; Nursing Homes ; Pneumonia ; Pyrenes ; Retrospective Studies ; Thorax

BACKGROUND/AIMS: To determine the incidence and risk factors associated with rebleeding after upper gastrointestinal bleeding (UGIB) in critically ill patients. METHODS: This study retrospectively reviewed the medical records of 60 patients undergoing bedside esophagogastroduodenoscopy between April 2000 and February 2004 for UGIB that developed whilst in the intensive care unit (ICU). RESULTS: Eight out of 60 patients died within 7 days, and an additional 7 patients died within 30 days after the initial bleeding. Two of these 15 patients (13.3%), died from GI bleeding. The 7-day and 30-day rebleeding rates were 34.6% (18/52 patients), and 51.1% (23/45 patients), respectively. Multiple logistic regression using the significant variables revealed, anemia (Hb<9.0 g/dL) and hypoalbuminemia (<3.0 g/dL) to be significant factor for 7-day rebleeding, and hypoxia (<80 mmHg), anemia (Hb<9.0 g/dL), blood transfusion (> or =3 units) to be significant independent risk factor for 30-day rebleeding. CONCLUSIONS: The rebleeding rates in the ICU setting were as high as 34.6% at 7 days and 51.1% at 30 days. This suggests that the underlying conditions of the critically ill patients affect the rebleeding rate more than the endoscopic features. Therefore, adequate general ICU care including the prevention and correction of hypoxia, anemia, and hypoalbuminemia, and minimizing blood loss can reduce the risk of rebleeding after UGIB in an ICU setting.
Anemia ; Anoxia ; Blood Transfusion ; Critical Illness* ; Endoscopy, Digestive System ; Hemorrhage ; Humans ; Hypoalbuminemia ; Incidence ; Intensive Care Units ; Logistic Models ; Medical Records ; Retrospective Studies ; Risk Factors*

Metabolic acid-base disorders are comnom clinical problems in ICU patients. Arterial blood gas analysis and anion gap (AG) are important laboratory data in approaching acid-base interpretation. When measuring the AG, several factors such as albumin have influence on unmeasured anions and unmeasured cations. If a patient has hypoalbuminemia, the AG should be adjusted according to the albumin level. High AG metabolic acidoses including lactic acidosis, ketoacidosis, and ingestion of toxic alcohols are common in ICU patients. The treatment target of lactic acidosis and ketoacidosis is not the acidosis, but the underlying condition causing acidosis. Gastric acid loss, diuretics, volume depletion, renal compensation for respiratory acidosis, hypokalemia, and mineralocorticoid excess are common causes of metaboic alkalosis. In chloride responsive metaboic alkalosis, volume and potassium repletion are mandatory.
Acid-Base Equilibrium ; Acidosis ; Acidosis, Lactic ; Acidosis, Respiratory ; Alcohols ; Alkalosis ; Anions ; Blood Gas Analysis ; Cations ; Compensation and Redress ; Diuretics ; Eating ; Gastric Acid ; Humans ; Hypoalbuminemia ; Hypokalemia ; Ketosis ; Potassium

Castleman's disease is an atypical lymphoproliferative disorder of unknown origin. It has three histologic variants(hyaline vascular, plasma-cell, and mixed) and two clinical types(localized and multicentric). Some sufferers have constitutional symptoms and laboratory abnormalities such as anemia, hypoalbuminemia, hypergammaglobulinemia, and elevated erythrocyte sedimentation rate. The localized form is cured by complete surgical excision whereas the multicentric form is managed by prednisone and other immunosuppressor drugs. The prognosis of the multicentric form is worse than the localized form since malignancies and severe infections may lead to a rapidly fatal outcome. Castleman's disease has been rarely reported at pediatric age in Korea. We experienced two cases of Castleman's disease detected at 3 and 5 years of age. They were presented with painless enlargement of submandibulars and axillary lymph nodes but had no associated symptoms. The lesions were excised and diagnosed as Castleman's disease, and no recurrence was noted during follow-up periods.
Anemia ; Blood Sedimentation ; Fatal Outcome ; Follow-Up Studies ; Giant Lymph Node Hyperplasia ; Hypergammaglobulinemia ; Hypoalbuminemia ; Korea ; Lymph Nodes ; Lymphoproliferative Disorders ; Prednisone ; Prognosis ; Recurrence

PURPOSE: Peripheral artery disease (PAD) is thought one of the most serious complications caused by atherosclerosis, and the principal cause of death and disability in persons age 50 years or older. But, there is very little information on the prevalence of PAD in diabetic patients and relationship between risk factors and PAD in Korea. Thus, the authors conducted this study to find the risk factors for PAD in diabetic patients and help to improve patients' health. METHOD: A total of 149 Korean NIDDM patients were enrolled. All subject's systolic blood pressures in arm and ankle were measured with a Doppler ultrasonic instrument, from which ankle-brachial pressure index (ABPI) was derived. We also examined clinical and biochemical parameters in all patients. RESULT: Systolic pressure, total cholesterol, TG, LDL were higher and albumin were lower in diabetic patients with PAD than in diabetic patients without PAD (p value < 0.01). Logistic regression analysis showed that hypoalbuminemia and hypertriglyceridemia were independent risk factor of PAD. CONCLUSION: In the light of these results, it seems reasonable to suggest that hypoalbuminemia and hypertriglyceridemia in diabetic patients may play a role in the pathogenesis of PAD.
Ankle ; Arm ; Arteries ; Atherosclerosis ; Blood Pressure ; Cause of Death ; Cholesterol ; Diabetes Mellitus, Type 2 ; Humans ; Hypertriglyceridemia ; Hypoalbuminemia ; Korea ; Logistic Models ; Peripheral Arterial Disease* ; Prevalence ; Risk Factors* ; Ultrasonics

BACKGROUND: Hypertension is very common in chronic hemodialysis patients. But impact of predialysis systolic blood pressure on cardiovascular mortality is not clear and it's investigation is not thoroughgoing enough in Korea. METHODS: We assessed the prevalence and control rate of hypertension in a cross sectional study of 81 clinically stable hemodialysis patients who had been treated with regular hemodialysis sessions in the Hanyang University Guri Hospital. To investigate the impact of predialysis systolic blood pressure on cardiovascular mortality, we retrospectively reviewed in May 2001 predialysis blood pressure and covariable factors of 115 hemodialysis patients who were monitored from the start of hemodialysis for more than 2 months between May 2001 and May 2004 in the Hanyang University Guri Hospital and local dialysis centers. Exclusion criteria were as follows: change to CAPD, transplantation, transfer to another dialysis center, non compliant, death due to accident and self withdrawal and hemodialysis for less than 2 months. RESULTS: The majority of hemodialysis patients (83%) take antihypertensive medications. Pre and post dialysis mean blood pressure was 153.2+/-14.5/86.9+/-4.7 mmHg, 145.5+/-17.1/84.2+/-5.2 mmHg respectively. Predialysis systolic blood pressure that was higher than 140 mmHg documented in 83% of patients. On the other side, predialysis diastolic blood pressure that was higher than 90 mmHg was only seen in 23 % of patients. Predialysis systolic hypertension was not associated with an increase in short term cardiovascular mortality. On the other hand, hypoalbuminemia and diabetes mellitus were associated with an increase in short term cardiovascular mortality. CONCLUSION: The present study suggests that control of hypertension, particularly systolic hypertension, in chronic hemodialysis patients, is insufficient, despite the use of antihypertensive drugs. The overall impact of predialysis systolic hypertension on cardiovascular mortality tends to be increased, but it was not associated with short term cardiovascular mortality.
Antihypertensive Agents ; Blood Pressure* ; Cardiovascular Diseases ; Diabetes Mellitus ; Dialysis ; Hand ; Humans ; Hypertension* ; Hypoalbuminemia ; Korea ; Mortality* ; Peritoneal Dialysis, Continuous Ambulatory ; Prevalence* ; Renal Dialysis* ; Retrospective Studies

Pseudomembranous colitis can be induced by the therapeutic or prophylactic use of antibiotics, and antibiotics- induced colitis has become a severe clinical problem. Protein?loosing enteropathy is associated with an abnormal, excessive loss of serum proteins into the gastrointestinal tract, and this leads to hypoproteinemia, including hypoalbuminemia, edema and diarrhea. We present here a case of protein?loosing enteropathy that was induced by pseudomembranous colitis, and this was induced by the use of antibiotics. Patients with chronic renal disease and peritonitis show hypoalbuminemia and edema. We experienced a patient who displayed edema, hypoalbuminemia, diarrhea and a fever for several days after the use for antibiotics for treating his peritonitis. We made the diagnosis of protein-loosing enteropathy complicated by psuedomembranous colitis. In a patient with peritonitis, uncontrolled edema and diarrhea, and the patient's hypoalbuminemia is continued, we must consider the possibility that the patient has protein-loosing enteropathy, and we should examine the total protein level and the alpha 1-antitrypsin clearance.
alpha 1-Antitrypsin ; Anti-Bacterial Agents ; Blood Proteins ; Colitis ; Diarrhea ; Edema ; Enterocolitis, Pseudomembranous ; Fever ; Gastrointestinal Tract ; Humans ; Hypoalbuminemia ; Hypoproteinemia ; Peritonitis ; Renal Insufficiency, Chronic

Hypoalbuminemia frequently occurs in Hemorrhagic Fever with Renal Syndrome (HFRS), but clinical significance of hypoalbuminemia is not well known. This study was designed to evaluate hypoalbuminemia as a marker of severity of disease in patients with HFRS. We evaluated the relationship between the level of serum albumin and clinical parameters representing the severity of disease in 144 patients with HFRS. The patients were divided into three groups based on the level of serum albumin; Group I (normal serum albumin), Group II (serum albumin <3.5 g/dL and > or =3.0 g/dL), and Group III (serum albumin <3.0 g/dL). Of the total of 144 patients, 42 patients (29.2%) were categorized as Group I, 39 patients (27.1%) as Group II, and 63 patients (43.8%) as Group III. Group III had a higher rate of incidence in episode of hypotension, pulmonary edema than did Group I and Group II. The lowest level of serum albumin was positively correlated with platelet count (r=0.505, p<0.001) and was negatively correlated with leukocyte count (r=-0.329, p<0.001), BUN (r=-0.484, p<0.001), serum creatinine (r=-0.394, p<0.001), and AST (r=-0.251, p=0.002). Our data suggest that hypoalbuminemia frequently occurs in the acute stage of HFRS, and level of serum albumin is associated with the disease severity of HFRS.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Fluorescent Antibody Technique, Indirect ; Hemorrhagic Fevers, Viral/*blood/mortality ; Human ; Hypoalbuminemia/blood ; Kidney Diseases/*blood/mortality ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin/*biosynthesis ; Treatment Outcome

OBJECTIVES: Ulcerative colitis is a chronic inflammatory disease of colon, which is common in western countries but rare in Korea. But the detection rate has been increasing in our hospital recently. The purpose of this study is to review the clinical features and trends of newly diagnosed cases in Korea each year. METHODS: We reviewed 126 cases, of which medical records were available and diagnosed by clinical finding, laboratory examinations, barium enema or colonoscopic examination, histologic and microbial tests at the hospitals in Pusan from Jan. 1986 to Dec. 1995. RESULTS: Recently, newly diagnosed cases tend to increase each year and the peak incidence of age groups was the fourth decade(27.4%) and the male to female ratio was 1:1.07. The common symptomes were hematochezia, diarrhea, abdominal pain, loss of weight, in the order of frequency. The laboratory findings were non-specific, including positive occult blood, increased erythrocyte sedimentation rate, anemia, hypoalbuminemia, and abnormal liver function test. According to the severity of disease, these was 50.8% in mild, 30.6% in moderate and 18.6% in severe disease. The difference of severity according to the extent of disease was not found. According to the extent of disease, these was 23.8% in proctitis, 25.4% in distal, 23.8% in left and 25.4% in extensive colitis. The incidence of proctitis was not more increased after 1991, compared with the previous records. 119 cases were treated medically and most cases showed exellent sort-term response(95.7%). According to the severity, the symptomatic remission rates of milder disease were significantly higher. Surgical treatment was performed in 4 cases(5 times); its indications were perforation in 2 cases, bleeding in 2 cases, and one case had failed to medical treatment. CONCLUSION: These results suggest that the trends of newly diagnosed cases each year have been increased recently. To evaluate the statistically significant clinical features, progress of disease and prognosis of ulcerative colitis in Korea, the nationwide collection of data is necessary.
Abdominal Pain ; Anemia ; Barium ; Blood Sedimentation ; Busan ; Colitis ; Colitis, Ulcerative* ; Colon ; Diarrhea ; Enema ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Hypoalbuminemia ; Incidence ; Korea ; Liver Function Tests ; Male ; Medical Records ; Occult Blood ; Proctitis ; Prognosis ; Ulcer*