Antiepileptic drugs (AEDs) can induce severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. We performed HLA genotyping and lymphocyte activation tests (LATs) for five AED-induced SCAR patients (three males and two females; aged 40–66 years old). Three patients were treated with carbamazepine (CBZ) for pain control, one was treated with phenytoin (PHT) for seizure prevention, and one was treated with valproic acid (VPA) for seizure prevention. One patient was diagnosed with CBZ-induced DRESS syndrome and the remaining patients were diagnosed with SJS. All patients recovered from SCARs after stopping suspicious drugs and supportive care. LATs were conducted to confirm the culprit drug responsible for inducing SCARs; and LAT results were positive for the suspected culprit drugs, in all except in one case. HLA-A,
Alleles ; Anticonvulsants ; Carbamazepine ; Cicatrix ; Drug Hypersensitivity Syndrome ; Female ; HLA-A Antigens ; Humans ; Long-Acting Thyroid Stimulator ; Lymphocyte Activation ; Lymphocytes ; Male ; Methods ; Phenytoin ; Seizures ; Stevens-Johnson Syndrome ; Valproic Acid

Allopurinol-induced severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome are reportedly associated with the HLA-B*58:01 genotype. Three patients who developed SCARs after allopurinol administration were subjected to HLA-B genotyping and lymphocyte activation test (LAT) to evaluate genetic risk and to detect the causative agent, respectively. All three patients given allopurinol to treat gout were diagnosed with DRESS syndrome. Symptom onset commenced 7-24 days after drug exposure; the patients took allopurinol (100–200 mg/d) for 2-30 days. HLA-B genotyping was performed using a polymerase chain reaction (PCR)-sequence-based typing (SBT) method. All patients had a single HLA-B*58:01 allele: HLA-B*13:02/*58:01 (a 63-year-old male), HLA-B*48:01/*58:01 (a 71-year-old female), and HLA-B*44:03/*58:01 (a 22-year-old male). Only the last patient yielded a positive LAT result, confirming that allopurinol was the causative agent. These findings suggest that patients with HLA-B*58:01 may develop SCARs upon allopurinol administration. Therefore, HLA-B genotyping could be helpful in preventing serious problems attributable to allopurinol treatment, although PCR-SBT HLA-B genotyping is time consuming. A simple genotyping test is required in practice. LAT may help to identify a causative agent.
Aged ; Alleles* ; Allopurinol ; Cicatrix ; Drug Hypersensitivity Syndrome ; Genotype ; Gout ; HLA-B Antigens ; Humans ; Lymphocyte Activation* ; Lymphocytes* ; Methods ; Middle Aged ; Polymerase Chain Reaction ; Stevens-Johnson Syndrome ; Young Adult

OBJECTIVES: Hyperhomocysteinemia is known to be related with the early onset of osteoporosis. This study was to examine the association between serem homocysteine levels and bone mineral density (BMD) in middle aged women. METHODS: The study included 409 women who underwent bone density tests in the health screening centers from January 2009 to october 2010. Serum homocysteine levels and BMD were measured. RESULTS: Postmenopause group (n = 109) showed significantly lower BMD score in lumbar spine and femoral neck and significantly higher serum homocysteine concentration compared to premenopause group (n = 300). However, after adjusting for age, body mass index, and the menopausal condition in total 409 women, there were no significant correlations between serum homocysteine levels and BMD. CONCLUSION: Measurement of serum homocysteine levels may not be useful, but adjunctive for the risk assessment of osteoporosis in middle aged women.
Body Mass Index ; Bone Density ; Female ; Femur Neck ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Mass Screening ; Middle Aged ; Osteoporosis ; Postmenopause ; Premenopause ; Risk Assessment ; Spine

Early esophageal cancer is defined as a tumor invading the mucosa with or without lymph node or distant organ metastasis. In the current guidelines for early esophageal cancer, absolute indication for endoscopic resection include lesions limited to the epithelium or lamina propria mucosa not exceeding two-thirds of the circumference, and relative indications include lesions limited to the muscularis mucosa or the upper third of the submucosal layer and not accompanied by clinical evidence of lymph node metastasis. After endoscopic submucosal dissection for early esophageal cancer, locally recurrent cancer can occur, especially in the case of incomplete resection. Here, we report a rare case of a submucosal tumor-like recurrence after endoscopic resection of early esophageal cancer.
Endosonography ; Epithelium ; Esophageal Neoplasms ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Recurrence

OBJECTIVE: We observed patients in whom the fluid collection in the right lateral portion of the superior aortic recess on computed tomography (CT) scans mimicked a right anterior mediastinal mass on chest PA radiographs. The purpose of this study was to assess chest PA and CT features of these patients. MATERIALS AND METHODS: All chest PA radiographs and CT scans in 9 patients were reviewed by two radiologists on a consensus basis; for the presence of pleural effusion, pulmonary edema and heart size on chest PA radiographs. For the portion of the fluid collection in the superior aortic recess (SAR), a connection between the right lateral portion of the SAR (rSAR) and posterior portion of the SAR (pSAR) on CT scans, and the distance between the right lateral margin of the rSAR and the right lateral margin of the superior vena cava. RESULTS: Fluid collection in the rSAR on CT scans caused a right anterior mediastinal mass or a bulging contour on chest PA radiographs in all women patients. All patients showed cardiomegaly, five patients had pleural effusion, and two patients had mild pulmonary edema. Further, eight patients showed a connection between the rSAR and the pSAR. CONCLUSION: The characteristic features of these patients are the right anterior mediastinal mass-like opacity due to fluid collection in the rSAR, are bulging contour with a smooth margin and cardiomegaly regardless of pulmonary edema on the chest PA radiographs, and fluid connection between the rSAR and the pSAR on CT scans.
Aged ; Aged, 80 and over ; Aorta, Thoracic/*radiography ; Cardiomegaly/radiography ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Female ; Humans ; Mediastinal Diseases/*radiography ; Middle Aged ; Pleural Effusion/*radiography ; Pulmonary Edema/*radiography ; Radiography, Thoracic/*methods ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

OBJECTIVES: This study was designed to observe the clinical and audiologic characteristics of patients diagnosed as low tone hearing loss (LHL) and to evaluate the treatment response and prognosis. SUBJECTS AND METHODS: A retrospective chart review of 61 patients who were diagnosed with LHL was performed. Result of various audiologic studies and therapeutic responses of medication have been evaluated. Data were statistically analyzed with variables such as age, sex, interval between onset and treatment, initial hearing levels, findings of electrocochleargraphy, and initial concomitant symptoms according to their treatment response. RESULTS: Frequent chief complaints of LHL were tinnitus and earfullness. Tinnitus was usually matched at lower frequencies. Treatment with low-dose steroids, diuretics, and betahistine produced a high response rate of 79.4%. Complete response occurred in 49 of the 68 ears (72.1%) and partial response occurred in five of the 68 ears (7.4%). Fourteen of the 68 ears (20.6%) were in the non-responder group. Patients treated within 7 days after the onset of symptoms all showed complete response. Statistically significant prognostic factors affecting treatment response were age and intervals between onset and treatment (p<0.05). CONCLUSION: Patients with acutely onset tinnitus or ear fullness should be carefully evaluated and promptly treated under the diagnosis of LHL.
Betahistine ; Diuretics ; Ear ; Hearing ; Hearing Loss ; Humans ; Prognosis ; Retrospective Studies ; Steroids ; Tinnitus

BACKGROUND/AIMS: The detection of iatrogenic Mallory-Weiss syndrome during the course of upper GI endoscopy is apparently rare. The aim of this study was identify the clinical features of the disease and associated medical conditions. METHODS: We retrospectively analyzed 46 cases (0.08%) of iatrogenic Mallory- Weiss syndrome identified from 54,188 consecutive upper GI endoscopies performed at our institution during a period of 85 months. RESULTS: A total of 36 patients (78.2%) had retching or belching during the procedure. Hiatal hernias were noted in 20 patients (43.5%). We identified a difference of the attack rate by sex and age for iatrogenic Mallory-Weiss syndrome; the disorder developed predominantly in men. All of the patients had a mucosal tear and oozing and 16 patients underwent endoscopic hemostasis. After being diagnosed with iatrogenic Mallory-Weiss syndrome, 17 patients underwent follow- up endoscopy and all of the patients showed good results without rebleeding. No patient showed a complicated clinical course. CONCLUSIONS: A small number of patients had iatrogenic Mallory-Weiss syndrome and most of the patients showed a good prognosis. If there is a predictable risk factor identified during an upper GI endoscopy or an associated medical condition, special care needs to be taken to minimize belching or retching.
Endoscopy ; Eructation ; Hemostasis, Endoscopic ; Hernia, Hiatal ; Humans ; Male ; Mallory-Weiss Syndrome ; Prognosis ; Retrospective Studies ; Risk Factors

Calcifying aponeurotic fibroma is a rare soft tissue tumor that occurs in the distal extremities of children and adolescents. We report ultrasound and X-ray findings of a calcifying aponeurotic fibroma in the finger of a 36-year-old woman, associated with distal phalangeal bone involvement.
Adult ; Bone Neoplasms/*radiography/surgery/*ultrasonography ; Calcinosis/*radiography/surgery/*ultrasonography ; Female ; Fibroma/*radiography/surgery/*ultrasonography ; *Fingers ; Humans ; Soft Tissue Neoplasms/*radiography/surgery/*ultrasonography ; Ultrasonography, Doppler, Color

We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.
Aged, 80 and over ; Contrast Media/administration & dosage ; Embolization, Therapeutic/*methods ; Female ; Fibrin Foam/therapeutic use ; Follow-Up Studies ; Hemoglobins ; Hemoperitoneum/*etiology/therapy ; Hemorrhage/etiology/therapy ; Hepatic Artery/radiography ; Humans ; Korea ; Liver/*injuries/pathology/radiography ; Massive Hepatic Necrosis/complications/*etiology/therapy ; Radiographic Image Enhancement/methods ; Rupture, Spontaneous ; Snake Bites/*complications ; Tomography, X-Ray Computed/*methods ; Treatment Outcome ; Viper Venoms/adverse effects

BACKGROUND: The most commonly used regimen for the eradication of Helicobacter pylori is combination of a proton pump inhibitor, clarithromycin, and two other antibiotics, metronidazole and amoxicillin. The increase in resistance to antibiotics seems to result in a decrease in eradication efficacy for H.pylori. We investigated the prevalence of antibiotic resistance in H.pylori isolated in Daejeon area. METHODS: A total of 31 clinical isolates of H.pylori were collected from the patients who underwent upper gastrointestinal endoscopy in Keonyang University Hospital during the period from March to July 2004. Antibiotic susceptibility tests for metronidazole, amoxicillin, and clarithromycin were performed by the E test (AB Biodisk, Sweden) on an egg yolk medium containing triphenyltetrazolium. The resistance break points for amoxicillin, metronidazole, and clarithromycin were defined as 0.5 microgram/mL, 8 microgram/mL, 1 microgram/mL, respectively. RESULTS: Resistance to amoxicillin, metronidazole, and clarithromycin was detected in 7.4% (2/27), 25.8% (8/31), 3.6% (1/28), respectively. CONCLUSION: The resistance to amoxicillin and clarithromycin was uncommon in Daejeon area.
Amoxicillin ; Anti-Bacterial Agents ; Clarithromycin ; Drug Resistance, Microbial ; Egg Yolk ; Endoscopy, Gastrointestinal ; Helicobacter pylori* ; Helicobacter* ; Humans ; Metronidazole ; Prevalence* ; Proton Pumps