Reactions from stinging insects are significant to dermatologists because of the wide variety of clinical presentations from mild local reaction to severe anaphylactic reaction. Although ant sting commonly occurs, it has been rarely reported in the literatures. We experienced a unique case with allergic reactions by the ant of the Cremawgaster iw6w urai vagala, subfamily Myrmicinae, family Formicidea, order Hymenoptera that has not been previously reported.
Anaphylaxis ; Ants* ; Bites and Stings* ; Humans ; Hymenoptera ; Hypersensitivity ; Insects

PURPOSE: The purpose of this study was to evaluate the effectiveness of case management for patients with hypertension on their health status and medical service utilization. METHODS: This study was a secondary analysis of data collected for a larger study of chronic disease management in 2008 using the National Health Insurance Corporation database. A total of 12,944 patients who received case management for hypertension were included in this analysis. The subjects of case management were classified into subgroups, namely, over-use, under-use, and non-use groups according to the amount of medical service utilization. To compare the medical service utilization, a control group was selected randomly. The data were analyzed through descriptive statistics, McNemar test, and ANOVA. RESULTS: All the subgroups displayed significant differences in blood pressure, self-management, social support, and their characteristics of medical service utilization. The total medical expense of the under-use and non-use groups increased after case management. However, there was no decrease in the medical expense of the over-use group. CONCLUSION: This finding suggests that there is a need to re-examine why patients overuse medical services and to supplement specific strategies for encouraging appropriate medical service utilization, and enhancing case management efforts for the over-use group.
Blood Pressure ; Case Management* ; Chronic Disease ; Delivery of Health Care ; Health Care Costs ; Humans ; Hypertension* ; National Health Programs ; Self Care

Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.
Chemoradiotherapy ; Female ; Hemorrhoids ; Humans ; Middle Aged ; Rectal Neoplasms ; Skin

The purpose of this study is to evaluate the ventricular conduction abnormalities, especially RBBB, observed electrocardiographically after surgical closure of VSD. The present study population consists of 92 patients with VSD who were surgically corrected at the Hanyang University Hospital during 6 years period from Jan. 1985 to Dec. 1990. We reviewed their clinical records including surgical notes and EKG findings before and after operations. The results of the study were as follows: 1) Male to female ratio was 1.1:1 (48:44) 2) Out of a total of 92 cases of VSD, 65cases(70.7%)were perimembranous type and 27 cases (29.3%)were subarterial type. 3) The normal preoperative EKG findings were seen in 22 patients, LVH in 21 patients, BUH in 47patients, and RVH in 3 patiens. 4) A transatrial approach was performed in 55 cases, right ventriculotomy with or without resection of muscles in right ventricle in 13 cases, and pulmonary arteriotomy alone in 24 cases. 5) The right bundle branch block after operation developed in 33 patients out of the 65 patinets with perimembranous defect and 5 patients out of the 27 patients with subarterial defects. Postoperative RBBB developed more frequently in perimembranous defect than in subarterial defect. 6) Postoperative RBBB occured in 31.8% of the patients with normal preoperative EKG findings, 23.8% with preoperative LVH, 52.1% with BVH and 66.7% with RVH. Postoperative RBBB was more frequently observed in the patients group with preoperative BVH or RVH than the patients with normal or LVH. 7) Postoperative RBBB was observed in 84.6% after right wentriculotomy, in 43.6% after right atriotomy and in 12.5% with pulmonary arteriotomy alone.
Bundle-Branch Block* ; Electrocardiography ; Female ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Male ; Muscles

PURPOSE: To assess whether pretreatment IGF-I SDS and pretreatmental bone age are useful indicators in the response of rhGH therapy in children with GH deficiency (GHD), the relationship between pretreatment IGF-I SDS, delay in bone age and the growth response during the first year of rhGH treatment was analyzed. METHODS: This study included 12 children with GHD. We measured IGF-I levels by RIA after acid-ethanol extraction at pretreatment and then calculated IGF-I SDS as follow: SDS = (IGF-I- mean IGF-I for normal subjects of the same age and sex)/SD of IGF-I for normal subjects of the same age and sex. GH levels were measured by immunoradiometric assay. All patients were treated with rhGH, 0.1IU/kg daily, 6 times a week for 1 year. RESULTS: Twelve patients (6 males and 6 females), age distribution from 4 to 16 years, were studed. The data is reported as the mean +/- SD. Height SDS for chronologic age of the group as a whole as -3.6 +/- 1.0 and bone age was 8.2 +/- 3.4 years. Pretreatment height velocity (HV) was 4.0 +/- 1.7cm/yr and the HV during each 3 months of therapy were 10.1 +/- 4.5cm/yr, 9.6 +/- 4.5cm/yr, 8.5 +/- 4.3cm/yr and 7.8 +/- 1.3cm/yr, respectively and therefore the HV during the first year of rhGH therapy increased to 9.3 +/- 2.9cm/yr (P=0.002). Pretreatmental IGF-I SDS was -2.2 +/- 0.9 (-0.4~-3.6). A significant negative correlation between pretreatmental IGF-I SDS and incremental height gain was obtained (r=-0.40, P<0.05). The height velocity of the group whose pretreatmental IGF-I SDS was below -2 (n= 8) as a whole increased significantly from 3.5 +/- 1.8cm/yr to 10.3 +/- 2.9cm/yr (P=0.001). Pretreatmental bone age delay was 3.1 +/- 1.9 (0.5-7.8) years. The height velocity of the group whose pretreatmental bone age delay above 2 years (n=9) increased significantly from 4.1 +/- 1.1cm/yr to 9.7 +/- 2.9cm/yr (P=0.001). CONCLUSION: The height velocity of GH deficient children whose pretreatmental IGF-I SDS below -2 or pretreatmental bone age delay above 2 years increased significantly after rhGH therapy. It suggests that the pretreatmental IGF-I SDS and pretreatmental bone age may be significant indicatiors in the response of GH therapy in children with GHD.
Age Distribution ; Child* ; Growth Hormone* ; Human Growth Hormone* ; Humans* ; Immunoradiometric Assay ; Insulin-Like Growth Factor I* ; Male

BACKGROUND: Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis was discovered less than 10 years ago. Its symptoms and characteristics are not well-defined yet. We experienced a case of anti-NMDA receptor encephalitis with phonemic paraphasia and acalculia that were not classical characteristics. CASE REPORT: A 44-year-old woman started to show dyslexia, phonemic paraphasia, and dyscalculia. These symptoms were gradually worsening for over 30 days. Various brain images were not helpful for primary diagnosis. Anti-NMDA receptor encephalitis was confirmed in two different laboratories. The patient started to recover with various immunosuppressive therapies. CONCLUSIONS: Anti-NMDA receptor encephalitis can have various symptoms, including phonemic paraphasia and acalculia.
Adult ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis* ; Brain ; Diagnosis ; Dyscalculia ; Dyslexia* ; Encephalitis ; Female ; Humans

Cutaneous extramedullary plasmacytomas are rare in patients with multiple myeloma, they usually indicate a large tumor cell burden and fatal outcome. A 55-year-old man presented with multiple cutaneous tender nodules or masses on whole body. A biopsy specimen of cutaneous nodule showed dermal infiltration by well differentiated plasma cells. Many atypical and immature plasma cells were found in a bone marrow smear and biopsy. A serum protein electrophoresis revealed elevated quantities of Ig G-globulin with type lambda light chain. The patient was treated with VAD(vincristine, adriamycin, dexamethasone) chemotherapy, but died with pulmonary edema and acute respiratory distress syndrome. We report a fatal case of multiple myeloma first presenting as multiple extramedullary cutaneous plasmacytomas.
Biopsy ; Bone Marrow ; Doxorubicin ; Drug Therapy ; Electrophoresis ; Fatal Outcome ; Humans ; Middle Aged ; Multiple Myeloma* ; Plasma Cells ; Plasmacytoma* ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult

PURPOSE: Recent guidelines for sepsis treatment emphasizes the need for early recognition of disease, leading to the development of the MEDS scoring system. However, there has been no prospective validation or comparison against other scoring systems. Therefore, we prospectively validated the MEDS scoring system and compared it withMultiple Organ Dysfunction Score (MODS) and Sepsisrelated Organ Failure Assessment (SOFA) scoring systems. METHODS: MEDS, MODS, and SOFA scores of 288 patients who were suspected to have systemic infection were calculated at the times of their emergency department visits, and clinical data of the patients were reviewed after six months. Results: MEDS, MODS, and SOFA scoring systems were all valid in the prediction of mortality according to logistic regression analysis. The results of probit analysis revealed significant and direct relationships between the scores and the mortality rate and demonstrated the parallelism of the mortality prediction of the three scoring systems. The cut-off values for the MEDS scoring system successfully divided subjects into five groups according to their risk for death. And the MEDS score well predicted the admission to ward or intensive care unit in survived patients. CONCLUSION: MEDS, MODS, and SOFA scor all were good predictors of outcome for patients with suspected sepsis and showed the same degree of predictive power. The MEDS scoring system, however, featured ease of calculation and definite clinical cut-off values which were useful in guiding decisions about treatment options. It also was well correlated with the prognosis of survived patients. We believe it to be the most useful and appropriate clinical prediction tool in cases of suspected sepsis in the emergency department.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Logistic Models ; Mortality* ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Prospective Studies ; Research Design ; Sepsis*

BACKGROUND/AIMS: We compared the long-term outcomes of balloon dilation versus botulinum toxin injection in Korean patients with primary achalasia and identified factors predicting remission. METHODS: We included 73 patients with achalasia newly diagnosed between January 1988 and January 2011. We ultimately enrolled 37 of 55 patients with primary achalasia through telephone interviews, who were observed for over 1 year. Short-term outcomes were evaluated from the medical records based on symptom relief after 1 month of treatment. Long-term outcomes were evaluated in a telephone interview using a questionnaire. RESULTS: Twenty-five patients were administered a botulinum toxin injection and 12 underwent balloon dilation. One month after the botulinum toxin injection, improvements were seen in chest pain (14 [56.0%] to 4 patients [16.0%]), regurgitation (16 [64.0%] to 4 [16.0%]), and dysphagia (25 [100.0%] to 5 [20.0%]). In the balloon dilation group, chest pain (8 [66.7%] to 1 [8.3%]), regurgitation (11 [91.7%] to 1 [8.3%]), and dysphagia (12 [100.0%] to 1 [8.3%]) had improved. A significant difference was observed in the mean remission duration between the botulinum toxin injection and balloon dilation groups (13 months [range, 1 to 70] vs. 29 months [range, 6 to 72], respectively; p = 0.036). Independent factors predicting long-term remission included treatment type (odds ratio [OR], 6.982; p = 0.036) and the difference in the lower esophageal sphincter pressure (OR, 7.198; p = 0.012). CONCLUSIONS: Balloon dilation may be more efficacious than botulinum toxin for providing long-term remission in Korean patients with achalasia. Follow-up manometry may predict the long-term outcome.
Adult ; Aged ; Aged, 80 and over ; Botulinum Toxins/*administration & dosage/adverse effects ; Dilatation/adverse effects/*methods ; Esophageal Achalasia/diagnosis/epidemiology/*therapy ; Female ; Humans ; Injections ; Kaplan-Meier Estimate ; Male ; Medical Records ; Middle Aged ; Neuromuscular Agents/*administration & dosage/adverse effects ; Odds Ratio ; Proportional Hazards Models ; Questionnaires ; Remission Induction ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Telephone ; Time Factors ; Treatment Outcome ; Young Adult

Secondary amyloidosis is characterized by accumulation of insoluble, fibrous amyloid proteins in various tissues and organs, accompanied by infectious or inflammatory diseases. Amyloidosis may involve the thyroid, gastrointestinal tract, kidneys, liver, or bone marrow. Amyloidosis as a complication of Crohn's disease is rare but serious, and may worsen the prognosis. We have experienced a case of amyloid goiter and gastrointestinal amyloidosis secondary to Crohn's disease. A 74-year-old female patient with Crohn's disease was admitted to Soonchunhyang University Hospital with general weakness and poor oral intake. Anterior-neck diffuse goiter and tenderness around the navel were found. Amyloid goiter and gastrointestinal amyloidosis diagnosed by sonoguided needle biopsy of the thyroid and endoscopic biopsies of the stomach and duodenum.
Aged ; Amyloid ; Amyloidogenic Proteins ; Amyloidosis* ; Biopsy ; Biopsy, Needle ; Bone Marrow ; Congo Red ; Crohn Disease* ; Duodenum ; Female ; Gastrointestinal Tract ; Goiter* ; Humans ; Kidney ; Liver ; Prognosis ; Stomach ; Thyroid Gland