Heterogeneity in clinical features and pathogenesis of non-steroidal anti-inflammatory agent (NSAIDs) hypersensitivity have been reported. NSAIDs can cause bronchial constriction in asthmatics or hives and angioedema in patients with chronic urticaria, in which case causative drugs show cross-reactivity with other NSAIDs. Normal subjects without allergic diseases may develop urticaria angioedema or anaphylaxis after ingestion of a specific NSAID. In this type of reaction, cross-reactivity between causative drugs and other NSAIDs does not occur. We experienced a case of acetaminophen anaphylaxis without aspirin sensitivity in a 38-year-old male, which was confirmed by oral provocation test. An oral challenge with 150mg of acetaminophen induced urticaria in lower legs, and erythema, with febrile sensation in ears. With a dose of 600mg acetaminophen, urticaria developed in trunk and extremities with facial angioedema. An oral provocation test with 650mg of aspirin was well tolerated without any adverse reactions. We report acase of acetaminophen anaphylaxis, which occurred in a normal individual at a small dose(150mg) without cross-reactivity with aspirin. This type of reaction supports heterogenei~ty of NSAIDs hypersensitivity and it may be caused by an other mechanism, not by cyclooxygenase inhibition.
Acetaminophen* ; Adult ; Anaphylaxis* ; Angioedema ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin* ; Bronchoconstriction ; Ear ; Eating ; Erythema ; Extremities ; Humans ; Hypersensitivity ; Leg ; Male ; Population Characteristics ; Prostaglandin-Endoperoxide Synthases ; Sensation ; Urticaria

OBJECTIVE: The aim of this study was to investigate the usefulness of serum ECP as a marker of the severity of asthma and extent of airway inflammation. METHOD: We investigated 108 patients suffering from bronchial asthma, who were classified as mild intermittent(n=19), mild persistent(n=27), moderate persistent(n=42), and severe persistent(n=20) and 10 healthy controls. Atopy was defined as those who showed >2+ responses on skin prick test. Serum ECP, peripheral blood eosinophil, sputum eosinophil, and PEFR were measured on the same date and meth~acholine PC20 were determined within 2 weeks. RESULTS: Serum ECP levels were 10.1+- 2.0 ug/L in controls, and 29.1+- 23.6 ug/L in asthmatic patients. According to symptom severity, serum ECP levels were 22.9 +- 15.6 ug/L, 28. 6 +- 24.1 ug/L, 29.5 +- 22.2 ug/L, and 34.6 +- 31.2 ug/L in mild intermittent, mild persistent, moderate persistent and severe persistent asthmatic patients, respectively and there were no significant differences among four groups(p>0.05). Serum ECP levels correlated with peripheral blood eosinophil counts(r=0.48, p<0.01), but not with sputum eosinophil, PEFR, and methacholine PC20 levels. There was no significant difference in serum ECP level between atopic and non-atopic asthma(p>0.05). CONCLUSION: Single measurevment of ECP level at clinic could not represent the severity of asthma.
Asthma* ; Eosinophil Cationic Protein* ; Eosinophils* ; Humans ; Inflammation ; Methacholine Chloride ; Peak Expiratory Flow Rate ; Skin ; Sputum

No abstract available.
Humans ; Infant, Newborn ; Meningitis, Bacterial*

No abstract available.
Heart Septal Defects, Ventricular* ; Oximetry*

From January to December 1984, 191 patients with associated ventricular septal defect(VSD) were studied in the cardiac cathetherization laboratory. Among theses 191 cases, 58 cases(30.4%) of subpulmonic VSD were identified by angiocardiography. Among the 59 cases of subpulmonic VSD, 12 cases(20.6%) were complicated with aortic infficiency(AI). The relative frequency of subpulmonic VSD increased with the increase of age and the frequency of complication of AI with the subpulmonic VSD also increased with the increase of age. The amount of left to right shunt in the patients with subpulmonic VSD and AI was small and Qp/Qs ratio was less than 2.0 in all of the 12 cases. Among the 12 patients 4 cases had a pressure gradient greater than 20 mmHg across the infundibular region of the right ventricle.
Angiocardiography ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans

No abstract available.
Humans ; Infant, Newborn* ; Respiration, Artificial ; Survival Rate ; Ventilators, Mechanical*

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

BACKGROUND/AIMS: Ultrasonography is the easiest, fastest procedure for the diagnosis of choledocholithiasis, but the diagnostic failure are mostly because of the intrapancreatic level of this condition and the absence of bile duct dillatation. Endoscopic ultrasonography is a promising procedure for the diagnosis of extrahepatic cholestasis due to noninvasiveness and accuracy in the digestive gas interposition. The aim of this study was to prospectively compare the diagnostic accuracy of endoscopie ultrasonography with abdominal ultrasonography and endoscopic retrograde cholangiography in 66 patients with suspected choledocholithiasis. METHODS: All of the patients had abdominal ultrasonography, endoscopic ultrasonography ~and endoscopie retrograde cholangiography within 72 hours and final diagnosis was determined by endoseopic retrograde cholangiography with sphincterotomy. RESULTS: (l) Choledocholithiasis was confirmed in 45 patients: Thirteen patients had nondilated common bile ducts and 20 patients had stones with diamerer < 1 cm. (2) Endoscopic ultrasonography was more sensitive(95.5%) than abdominal ultrasonography (44.4%: P<0.0001) and similar to endoscopic retrograde cholangiography (97.8%). Specificity was same as 100% in 3 diagnostic tools. (3) Endoscopic ultrasonography was superior to abdommal ultrasonography for the diagnosis of choledocholithiasis with nondilated common bile duct(100% vs 15.3%, P<0.0001) and with less than 1cm sized small stone(100% vs 10.0%, P<0.0001). Endoscopic ultrasonography results did not depend on stone diameter or common bile duct dilatation. CONCLUSIONS: Endoscopic ultrasonography could be an accurate and safe diagnostic tool for the diagnosis of choledocholithiasis and could be promising especially in the cases with difficult cannulation of bile duct and gal1 stone pancreatitis.
Bile ; Bile Ducts ; Biliary Tract* ; Catheterization ; Cholangiography ; Choledocholithiasis* ; Cholestasis, Extrahepatic ; Common Bile Duct ; Diagnosis ; Dilatation ; Endosonography* ; Humans ; Pancreas* ; Pancreatitis ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography

The purpose of this study was to investigate the effects of transcutaneous electrical nerve stimulation (TENS) and cold therapy on cyclooxygenase-2 (COX-2) expression in lumbar spinal cord and on secondary hyperalgesia produced by muscle pain. Muscle pain was experimentally induced by injection of 2% carrageenan into gastrocnemius muscle of Sprague-Dawley rats. For assessment of secondary hyperalgesia, the rats were tested for paw withdrawal latency (PWL) and tail flick latency (TFL) to heat stimulus. COX-2 expression in lumbar cord was examined using RT-PCR and immunohistochemistry. Secondary hyperalgesia to heat stimulus was significantly reduced in the both TENS- and cold-treatment groups, compared to the control group. The COX-2 mRNA levels were down-regulated in the lumbar spinal cord in the both TENS- and cold-treatment groups. In addition, COX-2 immunoreactivity was decreased in the dorsal horn of the lumbar spinal cord in the both TENS- and cold-treatment groups. These results suggested that decreased COX-2 expression in the lumbar spinal cord of the subjects receiving TENS treatment and cold therapy might be an important factor for reducing secondary hyperalgesia produced by muscle pain.
Animals ; Carrageenan ; Cryotherapy* ; Cyclooxygenase 2* ; Horns ; Hot Temperature ; Hyperalgesia ; Immunohistochemistry ; Muscle, Skeletal ; Myalgia* ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Spinal Cord ; Transcutaneous Electric Nerve Stimulation*

Viru-Merz® ointment,1% tromantadine hydrochloride, is a topical antiviral agent used for recurrent herpes simplex. There are many reported cases of contact dermatitis by tromantadine.But erythema multiforme-like eruptions in association with Viru-Merz® Ointment has not been reported. A 31-year-old woman, who applied Viru-Merz® ointment for a recurrent herpes simplex labialis, developed an allergic contact dermatitis. Erythema multiforme like eruptions with typical target feature followed around the eczematous lesions on the face, and spread progressively on the neck and trunk. A patch test revealed positive reaction to Viru-Merz® ointment.
Adult ; Dermatitis, Allergic Contact ; Dermatitis, Contact ; Erythema Multiforme* ; Erythema* ; Female ; Herpes Simplex ; Humans ; Neck ; Patch Tests