Allopurinol is widely used for chronic tophaceous gout as a uric acid lowering agent. Hypersensitivity to allopurinol occurrs in about 10% of patients, which limits the usage of allopurinol. The successful oral and intravenous desensitization of allopurinol has been reported worldwide since 1976. We recently experienced a 51-year-old male patient with gouty arthritis and hyperuricemia, who had previously experienced skin rash after allopurinol treatment. When allopurinol was retried, erythematous and foliative skin rash developed on entire body. Because allopurinol was essential in controlling hyperuricemia, the oral desensitization of allopurinol was tried. We report successful rapid oral allopurinol desensitization in the patient with chronic tophaceous gout, who exhibited exfoliative dermatitis as allopurinol hypersensitivity.
Allopurinol* ; Arthritis, Gouty ; Dermatitis, Exfoliative* ; Exanthema ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Male ; Middle Aged ; Uric Acid

PURPOSE: To report a rare case of endophthalmitis caused by Shewanella algae after trauma. CASE SUMMARY: A 27-year-old man was referred for trauma caused by a fishing sinker in his right eye. On initial examination at another hospital, his visual acuity was light perception, and intraocular pressure was 50 mm Hg. On slit lamp examination, corneal edema and severe anterior chamber inflammation were observed. Consequently, the next day total pars plana vitrectomy, lensectomy, intravitreal silicone oil injection, and antibiotics injection were performed. After the operation, intraocular pressure was 15 mm Hg and the patient's pain was temporarily decreased. The presence of Shewanella algae in the vitreous culture was determined but antibiotic sensitivity was not proven. The patient received postoperative topical fortified vancomycin, ceftazidime, and tobramycin hourly and underwent intravenous antibiotic therapy. On postoperative day 25, the patient transferred to our hospital and ocular pain presented continuously. Intraocular inflammation was not severe but visual acuity was light perception because of retinal necrosis in the posterior pole. Therefore, the patient received topical fortified antibiotics and intravenous antibiotics therapy. On postoperative month 2, visual acuity was light perception and the patient's right eye progressed to pthisis bulbi. CONCLUSIONS: Here in the first case reported in Korea or other conturies of primary endophthalmitis by Shewanella algae after traumas. Shewanella algae endophthalmitis has a rapid progression and poor visual prognosis in spite of aggressive therapy.
Anterior Chamber ; Anti-Bacterial Agents ; Ceftazidime ; Corneal Edema ; Endophthalmitis ; Eye ; Humans ; Inflammation ; Intraocular Pressure ; Korea ; Light ; Necrosis ; Patient Rights ; Prognosis ; Retinaldehyde ; Shewanella ; Silicone Oils ; Tobramycin ; Vancomycin ; Visual Acuity ; Vitrectomy

PURPOSE: To report the effect and visual improvement of internal limiting membrane (ILM) peeling, and epiretinal membrane (ERM) peeling in symptomatic ERM with pseudolamellar macular hole. METHODS: This study included 27 eyes in 26 consecutive patients with ERM including pseudolamellar macular hole that underwent vitrectomy, ERM peeling, intravitreal gas tamponade, and maintained a face-down position for 7 days. ILM peeling was performed only in 13 eyes of 13 patients. The patients were divided into 2 groups: eyes with or without ILM peeling (14 eyes and 13 eyes, respectively) and the follow-up period was 12 months or more in all cases. The postoperative anatomic results based on optical coherence tomography (OCT) and improvement of best corrected visual acuity (BCVA) were retrospectively compared between the 2 groups. RESULTS: Anatomic closure after surgery was achieved in 11 eyes (78.6%) in the ILM without peeling group and in 12 eyes (92.3%) in the ILM with peeling group (p = 0.596). The BCVA improved from 0.41 +/- 0.31 (log MAR) to 0.33 +/- 0.21 in the ILM without peeling group (p = 0.479) and from 0.46 +/- 0.41 (log MAR) to 0.28 +/- 0.25 in the ILM with peeling group (p = 0.001). CONCLUSIONS: ILM peeling with the addition of ERM peeling is an effective technique for BCVA improvement in the ERM with pseudolamellar macular hole. Vitrectomy, ERM peeling, gas tamponade, and ILM peeling are important for anatomic and functional success in the ERM with pseudolamellar macular hole.
Epiretinal Membrane ; Eye ; Follow-Up Studies ; Humans ; Membranes ; Retinal Perforations ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

Cervical pregnancy is a rare form of ectopic gestation in which the blastocyst implants in the cervical mucosa below the histologic cervical os. Because of the serious vaginal bleeding, hysterectomy was usually done in the management of cervical pregnancy. Howerver, conservative treatment is desirable for women who want to be pregnancy in the future. Methotrexate has been utilized recently for conservative management of cervical pregnancy. We report a case of cervical pregnancy which was treated succesfully with intramuscular methotrexate injection.
Blastocyst ; Female ; Humans ; Hysterectomy ; Methotrexate* ; Mucous Membrane ; Pregnancy* ; Uterine Hemorrhage

Leber's hereditary optic neuropathy(LHON) is an optic nerve disease that causes blindness and is associated with maternally inherited mitochondrial DNA(mt DNA) mutations. The most common mitochondrial DNA mutation among LHON patients is a point mutation at the nucleotide 11778 in the subunit 4 of complex I. In one 45-year old male LHON patient with bilateral optic neuropathy, we investigated the presence of a point mutation of mitochondrial DNA and identified a single guanine to adenine transition mutation in the mitochondrial DNA at nucleotide point 11778.
Adenine ; Blindness ; DNA, Mitochondrial* ; Guanine ; Humans ; Male ; Middle Aged ; Optic Atrophy, Hereditary, Leber ; Optic Nerve Diseases ; Point Mutation*

PURPOSE: Laparoscopic gastrectomy in obese patients has been investigated in several studies, but its feasibility has rarely been examined in morbidly obese patients, such as in those with a body mass index (BMI) of > or =30 kg/m2. The present study aimed to evaluate the technical feasibility and safety of laparoscopic gastrectomy in morbidly obese patients with gastric cancer. MATERIALS AND METHODS: A total of 1,512 gastric cancer patients who underwent laparoscopic distal gastrectomy (LDG) were divided into three groups: normal (BMI<25 kg/m2, n=996), obese (BMI 25~30 kg/m2, n=471), and morbidly obese (BMI> or =30 kg/m2, n=45). Short-term surgical outcomes, including the course of hospitalization and postoperative complications, were compared between the three groups. RESULTS: The morbidly obese group had a significantly longer operating time (240 minutes vs. 204 minutes, P=0.010) than the normal group, but no significant differences were found between the groups with respect to intraoperative blood loss or other complications. In the morbidly obese group, the postoperative morbidity and mortality rates were 13.3% and 0%, respectively, and the mean length of hospital stay was 8.2 days, which were not significantly different from those in the normal group. Subgroup analysis showed that postoperative complication rates were not high in morbidly obese patients, independent of the type of anastomosis technique used and level of lymph node dissection. CONCLUSIONS: LDG is technically feasible and safe in morbidly obese patients with a BMI of > or =30 kg/m2 and early gastric carcinoma. Except for a longer operating time, LDG might represent a reasonable treatment option in these patients.
Body Mass Index ; Gastrectomy* ; Hospitalization ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Mortality ; Obesity, Morbid ; Postoperative Complications ; Stomach Neoplasms*

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Background/Aims: Helicobacter pylori infection is presumably associated with iron deficiency and iron deficiency anemia (IDA). This study aimed to evaluate the relationship between H. pylori infection and the decline in iron stores in non-elderly adults during their health check-ups. Methods: We identified a total of 1,069 subjects who were tested for iron, ferritin, and total iron-binding capacity during their health check-ups, from January 2016 to May 2017. Of these, subjects who underwent endoscopy via rapid urease test and those aged 65 years or below were finally enrolled. Results: Overall, 281 subjects were enrolled, and 187 patients (66.5%) tested positive for H. pylori. The mean age was 36.1 years (range, 22 to 65), and 176 subjects (62.6%) were male. The mean levels of hemoglobin (14.1 ± 1.7 g/dL vs. 14.6 ± 1.4 g/dL, p = 0.019) and ferritin (121.7 ± 106.9 ng/mL vs. 151.8 ± 107.8 ng/mL, p = 0.027) in the H. pylori-positive group were significantly lower than those in the H. pylori-negative group. Iron deficiency (ferritin < 30 ng/mL) was more common in patients with H. pylori infection (p = 0.002). There was no significant difference in anemia (hemoglobin < 13 g/dL in men, < 12 g/dL in women) or IDA (anemia, ferritin < 10 ng/mL, and transferrin saturation < 16%) with H. pylori. Logistic regression analysis demonstrated that female sex (odds ratio, 197.559; 95% confidence interval, 26.461 to 1,475.015) and H. pylori infection (odds ratio, 3.033; 95% confidence interval, 1.216 to 7.567) were factors associated with iron deficiency. Conclusions H. pylori infection is associated with iron deficiency, suggesting a decline in iron stores among infected non-elderly adults.

BACKGROUND: The anaphase promoting complex (APC) promotes the degradation of mitotic cyclins as well as other substrates involved in sister chromatid adhesion. This study was carried out to examine the relationship between the APC expression and the clinicopathological variables, in an attempt to determine the role of the APC in the proliferation of lung cancer and to evaluate the possibility of an aberrant APC function in surgically resected squamous cell carcinomas and adenocarcinomas of the lung. METHODS: Immunohistochemical staining was performed for APC, Ki-67, cyclin B1, Cdc2, MMP-2 and VEGF in 55 cases of squamous cell carcinoma and 34 cases of adenocarcinoma of the lung, using the avidin-biotin-peroxidase method. RESULTS: The immunohistochemical stains for APC revealed a positive reaction in 49 cases (55.1%). The APC expression level was higher in the cyclin B1-positive group (p= 0.01), the Cdc2-positive group (p=0.001), the MMP-2-positive group (p=0.03), the group with lymph node metastasis (61.4% vs 48.9%), and the group with stage II/III cancer (60.7%) compared with those with stage I (42.9%). CONCLUSIONS: The APC may have an aberrant function, such as a change in its role in controlling the cell cycle, and might be associated with the invasiveness and proliferation of tumor cells.
Adenocarcinoma* ; Anaphase* ; Anaphase-Promoting Complex-Cyclosome* ; Carcinoma, Squamous Cell* ; Cell Cycle ; Chromatids ; Coloring Agents ; Cyclin B1 ; Cyclins ; Humans ; Lung Neoplasms ; Lung* ; Lymph Nodes ; Neoplasm Metastasis ; Siblings ; Vascular Endothelial Growth Factor A

PURPOSE: The aim of this study was to evaluate the surgical outcomes of abdominal total gastrectomy, without mediastinal lymph node dissection for type II and III gastroesophageal junction (GEJ) cancers. MATERIALS AND METHODS: We retrospectively reviewed surgical outcomes in 67 consecutive patients with type II and III GEJ cancers that were treated by the surgical resection between 2004 and 2008. RESULTS: Thirty (45%) patients had type II and 37 (55%) had type III tumor. Among the 65 (97%) patients with curative surgery, 21 (31%) patients underwent the extended total gastrectomy with trans-hiatal distal esophageal resection, and in 44 (66%) patients, abdominal total gastrectomy alone was done. Palliative gastrectomy was performed in two patients due to the accompanying peritoneal metastasis. The postoperative morbidity and mortality rates were 21.4% and 1.5%, respectively. After a median follow up of 36 months, the overall 3-years was 68%, without any differences between the Siewert types or the operative approaches (transhiatal approach vs. abdominal approach alone). On the univariate analysis, the T stage, N stage and R0 resection were found to be associated with the survival, and multivariate analysis revealed that the N stage was a poor independent prognostic factor for survival. CONCLUSIONS: Type II and III GEJ cancers may successfully be treated with the abdominal total gastrectomy, without mediastinal lymph node dissection in the Korean population.
Esophagogastric Junction ; Follow-Up Studies ; Gastrectomy ; Humans ; Korea ; Lymph Node Excision ; Multivariate Analysis ; Neoplasm Metastasis ; Retrospective Studies ; Stomach Neoplasms