No abstract available.
Hair*

BACKGROUND AND OBJECTIVES: High-dose intravenous immunoglobulin (IVIG) (2 g/kg) is usually given in the treatment of Kawasaki disease (KD). According to the authors' experience, however, medium-dose immunoglobulin (1 g/kg) was also effective in the majority of patients. We performed a retrospective clinical study to validate effectiveness of the medium-dose regimen in treatment of KD. SUBJECTS AND METHODS: A total of 274 patients with KD who were treated with medium-dose immunoglobulin at Bundang Jesaeng General Hospital from July 1998 to October 2007 were enrolled. RESULTS: Medium-dose immunoglobulin was given once in 220 patients (group A; 80.3%) and twice or more in 54 patients (group B; 19.7%). Age and gender distributions, duration of fever before treatment, hemoglobin concentrations, and white blood cell and platelet counts did not differ significantly between the two groups (p>0.05). Concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase, and bilirubin were significantly higher in group B (p<0.005). Coronary arterial lesions (CAL) were found in 51 patients (23.2%) in group A and in 26 patients (48.1%) in group B during the acute stage, and in 14 patients (6.4%) in group A and in 11 patients (20.4%) in group B during the convalescent stage (p<0.005, respectively). A giant aneurysm was found in one patient in each group (0.5% in group A and 1.9% in group B; p<0.005) during the follow-up period. CONCLUSION: A single infusion of medium-dose immunoglobulin was effective in 80% of patients with KD. About 20% of patients required two or more infusions of medium-dose immunoglobulin, who had higher concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase and bilirubin. The authors think that the medium-dose regimen proffers an advantage over the high-dose regimen in view of cost-effectiveness.
Alanine Transaminase ; Aneurysm ; Aspartate Aminotransferases ; Bilirubin ; C-Reactive Protein ; Fever ; Follow-Up Studies ; Hemoglobins ; Hospitals, General ; Humans ; Imidazoles ; Immunoglobulins ; Infusions, Intravenous ; Leukocytes ; Mucocutaneous Lymph Node Syndrome ; Nitro Compounds ; Platelet Count ; Retrospective Studies

BACKGROUND: Simvastatin belongs to the statin family, whose members have immunomodulatory activities. Ezetimibe have synergetic effects when co-administered with simvastatin. In several case reports, alopecia totalis and alopecia universalis were successfully treated with simvastatin/ezetimibe, suggesting that this combination could be a new efficient therapy for recalcitrant alopecia areata (AA). OBJECTIVE: To verify the efficacy of the simvastatin/ezetimibe combination therapy for recalcitrant AA and investigate the relationship between various treatment responses and prognostic factors. METHODS: This prospective open study was performed in patients with recalcitrant AA with the bald surface exceeding 75%. All patients took simvastatin (40 mg) and ezetimibe (10 mg) daily. The extent of hair regrowth expressed as percentage of the bald area was used to evaluate the effectiveness of the therapy. RESULTS: Of 14 enrolled patients, 4 patients (28.6%) were judged as responders showing regrowth of 30% to 80% after 3 months of treatment. The mean age of onset in non-responders was significantly lower than in responders. The total score of prognostic factors, calculated as a sum of factors related to poor prognosis, was much lower in responders than in non-responders. CONCLUSION: The remission rate in this study was unsatisfactory. However, since the recruited patients had not responded to any other treatments for AA, simvastatin/ezetimibe can still be considered as an alternative treatment for recalcitrant AA. The total scores of the prognostic factors were statistically different between responders and non-responders. These results can be used to predict the outcome of treatment with simvastatin/ezetimibe and anticipate prognosis.
Age of Onset ; Alopecia Areata* ; Alopecia* ; Ezetimibe ; Hair ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Prognosis ; Prospective Studies* ; Simvastatin

Background: Although alopecia areata (AA) is usually diagnosed based on the patient’s clinical manifestations, histologic features are the key to establishing the correct diagnosis. Moreover, it is possible to know about the progression of AA through understanding the various histologic characteristics of AA. Many studies have reported a lot of literatures related to AA, but studies investigating the correlation between histologic features and prognosis have not yet been reported. Objective: This study aimed to establish the histologic features of AA in scalp biopsy specimens and sought to correlate between histopathologic features and clinical prognosis. Methods: The pathology archives of Kyung Hee University Hospital at Gang-dong were searched for AA in the diagnostic field from the period of 2006 to 2016. The biopsy specimens were sectioned by Tyler technique. A total of 464 patients were included in the analysis. Results: There were reduction of anagen hair count according to the severity of AA, and a higher percentage of telogen ratio and vellus hair counts were observed in the alopecia totalis and alopecia universalis. Total hair counts (9.9) including miniaturized hairs were decreased prominently at more than 5 years of current duration. There was a high ratio of peribulge lymphocytic infiltration (45%) in patients with ophiasis and acute diffuse type and those with total alopecia showed prominent small portions of follicular miniaturization (27%). Conclusion These histopathologic features mentioned above may shed light on the understanding of disease progression of AA, which have various clinical aspects. Using these histologic features, we will be able to predict the efficacy for therapy and prognosis of AA.

No abstract available.
Angiomyoma ; Ear

BACKGROUND: Management of atopic dermatitis (AD) involves the regular use of emollients together with topical steroids or calcineurin inhibitors for acute flares. However, the long-term use of oral medications in young children may have certain limitations. Wet wrap dressing (WWD) is an interesting alternative therapy for the short-term control of severe or refractory flares, thus avoiding the use of systemic treatments. OBJECTIVE: This study aimed to compare the efficacy between WWD and topical steroid agents and to control and estimate the utility of WWD in pediatric AD. METHODS: A total of 40 patients with mild-to-severe AD (eczema area and severity index of ≥3) aged <13 years were included in this study. Twenty patients were treated with WWD using two layers of cotton bandages or garments (Tubifast™), and the remaining were applied with topical steroid agents without cotton bandages. Improvement in severity of atopic dermatitis was evaluated using the eczema area and severity index (EASI). Improvement in skin barrier dysfunction was evaluated by measuring the transepidermal water loss (TEWL). We compared the two groups after 1 week of treatment using analysis of covariance and t-test. Furthermore, we surveyed the study groups using a questionnaire to estimate the utility of WWD and its adverse effects as well as to evaluate subjective outcomes of WWD. RESULTS: There were significant reductions in the mean EASI (−6.3, 95% confidence interval [CI]: −7.5 to −5.1, p=0.013) and TEWL (−26.7, 95% CI: −31.2 to −22.3, p=0.002) after 1 week of WWD treatment compared with the mean EASI (−4.0, 95% CI: −5.2 to −2.9) and TEWL (−15.4, 95% CI: −19.8 to −10.9) of the control group. Results of patient self-assessment and scores in the visual analogue scale (VAS) for pruritus were improved in both groups, but the differences were not statistically significant. Usefulness of WWD as an alternative therapy for the conventional therapy was satisfactory. CONCLUSION: This study is meaningful in that it estimates both the subjective and objective efficacy of WWD. In view of these findings, WWD showed superior therapeutic effects than conventional steroid application in the treatment of AD in children, with good compliance of patients and parent-caregivers.
Bandages ; Calcineurin Inhibitors ; Child ; Clothing ; Compliance ; Dermatitis, Atopic ; Eczema ; Emollients ; Humans ; Pruritus ; Self-Assessment ; Skin ; Steroids ; Therapeutic Uses ; Water

BACKGROUND: Clinic-based blood pressure measurements may lead to untoward results in the management of hypertension. Masked hypertension (MH) has been shown to be related to a poor prognosis due to its hidden nature. The purpose of this study is to present the clinical predictors of MH in elderly patients over 65 years with well-controlled clinic blood pressure (CBP) and to evaluate the gap, the 'mask effect' (negative white-coat effect), between CBP and home blood pressure (HBP). METHODS: The BPs of 1,019 treated hypertensive patients were measured by a doctor at an out-patient clinic and by patients themselves at home. Clinical parameters for MH were analyzed in 511 patients with well-controlled CBP (45.6% men, mean age 57.1+/-9.0 years). RESULTS: Among the patients over 65 years (n=113, 46.8% men, mean age 68.4+/-7.3 years) and with well-controlled CBP, the prevalence of MH was 26.5% (30 patients). In multivariate-adjusted analysis, the risk of MH increased with physical inactivity (odds ratio [OR], 2.942; 95% confidence interval [CI], 1.039-8.329; p=0.042), use of beta-blocker (OR, 4.242; 95% CI, 1.528-11.785; p=0.06) and systolic clinic BP (OR, 1.083; 95% CI, 0.017-1.154; p=0.013). Furthermore, HBP correlated well with CBP (r=0.329; p<0.001) and further with degree of ME (r=0.723; p<0.001). CONCLUSION: In looking for MH, it would be useful to carefully assess patients taking beta-blockers, having higher CBP, and who are physically inactive by using self-monitoring home or ambulatory BP monitoring.
Aged ; Blood Pressure ; Humans ; Hypertension ; Male ; Masked Hypertension ; Masks ; Outpatients ; Prevalence ; Prognosis

BACKGROUND/AIMS: The aim of this study was to evaluate the diagnostic accuracy of 64-multidetector CT (MDCT) cholangiography for determining the causes of distal common bile duct (CBD) obstruction. METHODS: Two hundred fifty consecutive patients underwent 64-MDCT for diagnosing the clinical and biochemical signs of bile duct obstruction. The causes of bile duct obstruction were assessed by the pre- and post-enhanced axial and coronal multiplanar reformation images of 64-MDCT. The results were compared with ERCP, biopsy and surgery. RESULTS: The sensitivity and specificity of MDCT for CBD stones were 96.1% and 84.9%, respectively. In seven patients, The CBD stones in 7 patients could not be detected on MDCT. Eleven patients with stones in the distal CBD, as detected on MDCT, had no stones seen on ERCP. For malignant obstruction, the sensitivity and specificity of MDCT were 97.0% and 98.6%, respectively. Three patients who were diagnosed with periampullary cancers on MDCT were disclosed to have severe papillitis on ERCP. One patient who was diagnosed with CBD stone by MDCT was disclosed to have ampullary cancer. The overall accuracy of MDCT for determining the causes of biliary obstruction was 90.5%. CONCLUSIONS: MDCT cholangiography is a non-invasive method with relatively high sensitivity and high specificity for diagnosing the causes of distal CBD obstruction.
Biopsy ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Common Bile Duct ; Humans ; Papilledema ; Sensitivity and Specificity

Foreign bodies in the stomach are usually ingested by children under 5 years of age, persons with dentures, alcoholics, mentally disturbed individuals or prisoners with a purpose of secondary gain. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metals, fish bones and etc. A needle or a toothpick in the stomach has been rarely reported in an adult.. We present two cases of patients: one case of patient with needle stuck in the stomach, who swallowed for the purpose of secondary gain, and the other case of patient with toothpick stuck in the stomach, who did not realize having swallowed it. A 23-year-old man, prisoner, was admitted to hospital due to epigastric pain after ingestion of a needle. Endoscopy showed a black needle, 1.2cm long stuck at the prepyloric antrum. It was removed by the endoscopic biopsy forceps through the overtube used in endoscopic variceal ligation and proved to be a needle with a length of 4.9 cm and a diameter of 0.1 cm. A 58-year-old woman developed an acute onset of hematemesis and epigastralgia, and presented to the emergency room. On admission, her blood pressure was 60/40 mmHg. An emergency endoscopy showed a yellowish, thin, stiff material 3.5cm long stuck at the greater curvature of the antrum with meat materials. It was removed by the above method and proved to an wooden tooth pick with a length of 6.5 cm and a diameter of 0.2 cm. No active bleeding was noted from the removed site. She did not realized she had swallowed the toothpick. She was discharged without complication.
Adult ; Alcoholics ; Biopsy ; Blood Pressure ; Child ; Dentures ; Eating ; Emergencies ; Emergency Service, Hospital ; Endoscopy ; Female ; Foreign Bodies ; Hematemesis ; Hemorrhage ; Humans ; Ligation ; Meat ; Metals ; Middle Aged ; Needles* ; Numismatics ; Parents ; Prisoners ; Prisons ; Stomach* ; Surgical Instruments ; Tooth ; Young Adult

BACKGROUND: Aortic intramural hemorrhage (IMH), which presents clinical manifestations identical to acute aortic dissection, is suggested to have different pathology and pathophysiology. The purposes of this study were to diagnose IMH by transesophageal echocardiography (TEE) prospectively and to compare clinical and echocardiographic outcome of IMH with those of aortic dissection. METHODS: Between August 1991 and November 1996, 27 IMH and 73 acute aortic dissection were diagnosed using TEE in 202 consecutive patients with suspected aortic dissection. TEE diagnoses of IMH and aortic dissection were initially compared with computed tomography and magnetic resonance imaging and later confirmed by operative findings (n=39) or follow-up changes (n=12). RESULTS: In the 49 patients whose diagnosis was confirmed by operation or follow-up changes, the sensitivity and specificity for the diagnosis of IMH were 27 of 27 (100%) and 20 of 22 (91%), respectively. There were 11 deaths (15%) in acute aortic dissection and 1 death (4%) in IMH during follow-up of 1.7+/-1.5 years (p=NS). Stanford classification and types of treatment were not related to death in both groups. Complications were less frequently noted in IMH (3/27) than in acute aortic dissection (24/73) (p<0.001) and no death occurred in uncomplicated IMH who were medically treated. Follow-up study of 12 IMH patients showed 8 complete resolution, 3 regression, 1 progression. CONCLUSION: TEE is very useful in diagnosis of IMH and IMH has better outcome than the aortic dissection due to absence of communication and intimal tear.
Classification ; Diagnosis ; Echocardiography* ; Echocardiography, Transesophageal ; Follow-Up Studies ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Pathology ; Prospective Studies ; Sensitivity and Specificity