No abstract available.
Stevens-Johnson Syndrome*

Coxiella burnetii is the etiological agent of Q fever, that may occur either acutely or the chronically. To understand the seroepidemiological patterns of C. burnetii infection in Korea, we examined a total of 3,178 sera from patients with acute febrile episodes by using indirect immunofluorescence assay (IFA) for detectable antibodies to C. burnetii and other eight rickettsial antigens. The IFA seropositivity>or=1:20 for C. burnetii phase II was 11.5% (368 out of 3,178 sera). The co-existence of antibodies to other rickettsial antigens was found in 216 out of the 368 positive sera. Thirty-seven point five percent (n=138) had antibodies to R. tsutsugamushi (cutoff>or=1:20), 16% (n=59) to Ehrlichia sennetsu, 14.9% (n=55) to Rickettsia typhi, 13.5% (n=50) to R. akari, 11.4% (n=42) to R. japonica, 8.9% (n=33) to R. prowazekii, 7.6% (n=28) to R. sibirica, and 6.7% (n=25) to R. conorii by IFA, respectively. These results are consistent with previous reports documenting diverse serum cross-reactivity in chronic Q fever. Therefore we excluded the samples that reacted to other rickettsial antigens at same or higher titers than to C. burnetii, resulting in the seropositive rate of 4.1%. The serological prevalence was 2% (n=64) when the conventional cut-off titer of 1:80 was used. Our results suggest that infections with C. burnetii are more prevalent than expected previously and should be differentially diagnosised for febrile illness occurring after exposure to ticks or other vectors.
Antibodies ; Coxiella burnetii* ; Coxiella* ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Korea ; Neorickettsia sennetsu ; Prevalence ; Q Fever ; Rickettsia ; Rickettsia typhi ; Seroepidemiologic Studies* ; Ticks

Drug-induced hepatotoxicity is injury to the liver as a result of drug exposure. Due to their unpredictable nature, drug-induced liver injuries pose a serious problem for clinicians, health agencies, and pharmaceutical firms. Albendazole is a benzimidazole with wide spectrum coverage as an antiparasitic drug. Very few cases of high-dose albendazole-induced hepatotoxicity have been reported so far, and no case in response to a single dose. A 25-year-old man presented to our hospital with dark urine. Twenty days prior to presentation, he took a tablet of albendazole (400 mg) as a prophylactic treatment for lumbricosis. Upon laboratory analysis, aspartate aminotransferase (AST) was 748 IU/L, alanine transaminase (ALT) was 939 IU/L, and total/direct bilirubin was 9.3/7.3 mg/dL. The patient was negative for viral markers (HAV, HBV, and HCV) and autoantibodies. Abdominal ultrasonography revealed no evidence of chronic liver damage. The pathology was compatible with drug-induced hepatotoxicity. The patient improved with conservative management only.
Adult ; Alanine Transaminase ; Albendazole ; Aspartate Aminotransferases ; Autoantibodies ; Benzimidazoles ; Bilirubin ; Biomarkers ; Drug-Induced Liver Injury ; Humans ; Liver

Background/Aims: Recent data indicate the presence of liver enzyme abnormalities in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the clinical features and treatment outcomes of COVID-19 patients with abnormal liver enzymes. Methods: We performed a retrospective, multicenter study of 874 COVID-19 patients admitted to five tertiary hospitals from February 20 to April 14, 2020. Data on clinical features, laboratory parameters, medications, and treatment outcomes were collected until April 30, 2020, and compared between patients with normal and abnormal aminotransferases. Results: Abnormal aminotransferase levels were observed in 362 patients (41.1%), of which 94 out of 130 (72.3%) and 268 out of 744 (36.0%) belonged to the severe and non-severe COVID-19 categories, respectively. The odds ratios (95% confidence interval) for male patients, patients with a higher body mass index, patients with severe COVID-19 status, and patients with lower platelet counts were 1.500 (1.029 to 2.184, p=0.035), 1.097 (1.012 to 1.189, p=0.024), 2.377 (1.458 to 3.875, p=0.001), and 0.995 (0.993 to 0.998, p>0.001), respectively, indicating an independent association of these variables with elevated aminotransferase levels. Lopinavir/ ritonavir and antibiotic use increased the odds ratio of abnormal aminotransferase levels after admission (1.832 and 2.646, respectively, both p<0.05). The median time to release from quarantine was longer (22 days vs 26 days, p=0.001) and the mortality rate was higher (13.0% vs 2.9%, p<0.001) in patients with abnormal aminotransferase levels. Conclusions Abnormal aminotransferase levels are common in COVID-19 patients and are associated with poor clinical outcomes. Multivariate analysis of patients with normal aminotransferase levels on admission showed that the use of lopinavir/ritonavir and antibiotics was associated with abnormal aminotransferase levels; thus, careful monitoring is needed.

Background/Aims: Recent data indicate the presence of liver enzyme abnormalities in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the clinical features and treatment outcomes of COVID-19 patients with abnormal liver enzymes. Methods: We performed a retrospective, multicenter study of 874 COVID-19 patients admitted to five tertiary hospitals from February 20 to April 14, 2020. Data on clinical features, laboratory parameters, medications, and treatment outcomes were collected until April 30, 2020, and compared between patients with normal and abnormal aminotransferases. Results: Abnormal aminotransferase levels were observed in 362 patients (41.1%), of which 94 out of 130 (72.3%) and 268 out of 744 (36.0%) belonged to the severe and non-severe COVID-19 categories, respectively. The odds ratios (95% confidence interval) for male patients, patients with a higher body mass index, patients with severe COVID-19 status, and patients with lower platelet counts were 1.500 (1.029 to 2.184, p=0.035), 1.097 (1.012 to 1.189, p=0.024), 2.377 (1.458 to 3.875, p=0.001), and 0.995 (0.993 to 0.998, p>0.001), respectively, indicating an independent association of these variables with elevated aminotransferase levels. Lopinavir/ ritonavir and antibiotic use increased the odds ratio of abnormal aminotransferase levels after admission (1.832 and 2.646, respectively, both p<0.05). The median time to release from quarantine was longer (22 days vs 26 days, p=0.001) and the mortality rate was higher (13.0% vs 2.9%, p<0.001) in patients with abnormal aminotransferase levels. Conclusions Abnormal aminotransferase levels are common in COVID-19 patients and are associated with poor clinical outcomes. Multivariate analysis of patients with normal aminotransferase levels on admission showed that the use of lopinavir/ritonavir and antibiotics was associated with abnormal aminotransferase levels; thus, careful monitoring is needed.

The purpose of this study was to investigate clinical and radiological outcomes of multiple drilling in case of failed conservative treatment of juvenile osteochondritis dissecans in athletes. We treated 37 lesions from 30 athletic patients who failed conservative treatment for juvenile osteochondritis dissecans. Multiple drillings were done for 32 lesions and multiple drilling and bioabsorbable pin fixations were done for 5 lesions. Lysholm score, Hughston clinical scale were used for clinical evaluation before and last follow up of treatment. For radiologic evaluation we used magnetic resonance imaging at 3 months and 12 months after operation. Of all 37 lesions, 11 lesions were located on medial femoral condyle, 2 lesions on lateral femoral condyle and 24 lesions on trochlear groove. There were clinical and radiological improvement from Hughston scale after operative treatment. Twenty-five patients among 30 returned to the sports activity. There were no specific complications after operation. Multiple drilling and bio-absorbable pin fixation of juvenile athletic osteochondritis dissecans patients after failure of conservative treatment showed good clinical and radiologic results. So it would be helpful for juvenile athletic patients to return to sports activities.
Arthroplasty, Subchondral ; Athletes* ; Follow-Up Studies ; Humans ; Knee* ; Magnetic Resonance Imaging ; Osteochondritis Dissecans* ; Osteochondritis* ; Sports

BACKGROUND: To assess the utility of HRCT in the evaluation of visceral pleural invasion and to determine whether visceral pleural invasion and bronchovascular bundle thickening on the same lobe could be related to the recurrence and survival in non-small cell lung cancer (NSCLC). METHOD: Eighty one patients, which were fulfilled long-term follow-up at least 18 months (maximum 103 months) among which 434 patients had underwent curative surgical resection for NSCLC from 1986 to 1995, were studied. They were analyzed to evaluate whether the prognostic factors such as the recurrence and survival depend on visceral pleural invasion and bronchovascular bundle thickening to the same lobe. Thirty two patients adjacent to a chest wall or a fissure were evaluated for visceral pleural invasion by HRCT. CT criteria included abutting pleura along the chest wall, abutting and/or compressing fissure, crossing fissure, and pleural tail. RESULTS: The positive predictive value and the negative predictive value of crossing fissure were 100% and 100%, respectively. Two patients showing spiculated interface between a mass and abutting fissure were confirmed to have visceral pleural invasion at surgery. Visceral pleural invasion confirmed at surgery was significant to local recurrence and survival (p<.05, p<.05, respectively). Brochovascular bundle thickening to the same lobe on CT scan was significant to survival (p<.05) but was not significant to local and distant recurrence (p>.05). CONCLUSION: Visceral pleural invasion and bronchovascular bundle thickening to the same lobe have a role in predicting prognosis such as recurrence and survival in NSCLC. Therefore, the analysis of visceral pleural invasion on CT scan and the pathological analysis of bronchovascular bundle thickening to the same lobe may be necessary to predict the prognosis in NSCLC.
Carcinoma, Non-Small-Cell Lung ; Follow-Up Studies ; Humans ; Pleura ; Prognosis ; Recurrence ; Thoracic Wall ; Tomography, X-Ray Computed

Ehrlichia sennetsu is the causative agent of human Sennetsu ehrlichiosis. Ehrlichiosis is an acute and occasionally chronic infectious disease caused by obligate intracellular bacteria in the family Rickettsiaceae. To understand the seroepidemiological patterns of ehrlichiosis in Korea, a total of 2,625 patients with acute febrile episode reported from 1990 to 1992 were surveyed using an indirect fluorescent antibody assay (IFA). The result was as follows. Seropositivity for ehrlichiosis was 3.23% by excluding highly cross-reacted sera with other rickettsial antigens. Sera reacted to E. sennetsu showed the cross reaction with other rickettsia as in the order of R. typhi 49.6%, R. conorii 31.6%, R. japonica 28.1%, C. burnetii 26.4%, R. sibirica 25.8%, O. tsutsugamushi 25.8%, R. akari 25.4%, and R. prowazekii 25.4%. Sexual difference in the seropositivity was not noted. The age groups of fifties and under the tenth showed higher prevalence than others. Seropositivity was most prevalent in July and August. As for regional distribution, Chonbuk (10.5%) showed the highest seropositive rate. Geographical distribution of the seropositivity covered most area except Cheju province in Korea.
Bacteria ; Communicable Diseases ; Cross Reactions ; Ehrlichiosis* ; Humans ; Jeju-do ; Jeollabuk-do ; Korea ; Neorickettsia sennetsu ; Prevalence ; Rickettsia ; Rickettsiaceae

BACKGROUND: Vasoconstrictor-induced reduction in arterial graft diameter can cause significant flow deprivation. The aim of this study was to evaluate the effect of vasodilator pretreatment on vasoconstrictor-induced blood vessel spasm in vitro. MATERIAL AND METHOD: Rabbit brachial arteries (BA) and celiac arteries (CA) were cut into rings (3~4 mm) and suspended with a force displacement transducer (TSD 125C(R), Biopac Inc. USA) in a tissue bath filled with 5 mL modified Krebs solution bubbled with 5% CO2 and 95% O2 at 38degrees C. The rings were contracted with vasoconstrictors, and the developed tension changes were considered control values. The rings were then pretreated with 30micrometer nitroglycerin, nicardipine, verapamil, and papaverine, respectively, for 40 minutes and rinsed with the physiologic buffered salt solution three times every 15 min. The vasoconstrictor-induced tension changes after the previous procedure were considered experimental values. Data are expressed as the percentage tension induced by vasoconstrictors before and after pretreatment with vasodilators. RESULT: Nicardipine depressed vasoconstriction induced by norepinephrine, angiotensin II (AII), and U46619 in both the BA and the CA more significantly than did nitroglycerin (p<0.01) and verapamil (p<0.05). Verapamil depressed vasoconstriction induced by 5-hydroxytryptamine (5HT), AII, and U46619 in the BA and by 5HT in the CA more significantly than did nitroglycerin (p<0.01). CONCLUSION: These findings suggest that both nicardipine and verapamil effectively depressed vasoconstrictor action. Nicardipine is thought to be more effective than verapamil for the prevention of vasoconstrictor action.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid ; Angiotensin II ; Baths ; Blood Vessels ; Brachial Artery ; Celiac Artery ; Contracts ; Displacement (Psychology) ; Glycosaminoglycans ; Isotonic Solutions ; Nicardipine ; Nitroglycerin ; Norepinephrine ; Papaverine ; Serotonin ; Spasm ; Transducers ; Transplants ; Vasoconstriction ; Vasoconstrictor Agents ; Vasodilator Agents ; Verapamil

BACKGROUND: It is still unclear how self-measured home blood pressure (BP) evolves over time in treated hypertensive patients, and the usefulness of home BP based treatment is under debate. METHODS: The patients whose anti-hypertensive medications had not been changed at least 6 months were enrolled. They measured home BP at enrollment and at study end. The patients were classified into controlled hypertension (CH), hypertension with white coat effect (WCH), hypertension with reverse white coat effect (RWCH), and uncontrolled hypertension (UH), based on their clinic and home BP. Their home BP profiles were reflected in the patients' treatments, instead of relying solely on clinic BP. RESULTS: Ninety patients (mean age, 56.5 +/- 9.9; male, 57.8%) were analyzed and mean follow-up duration was 34.1 +/- 3.6 months. CH, WCH, RWCH, and UH patients were 33.3% (30 patients), 37.8% (34 patients), 5.6% (5 patients), and 23.3% (21 patients), respectively at enrollment. Almost all CH and WCH patients remained in normal range of home BP whereas about half of RWCH and UH patients moved to CH or WCH. As a result, the proportion of RWCH and UH decreased at the end of follow-up. Overall clinic and home BP reduced significantly in all groups. Clinic BP declined significantly in WCH and UH, whereas home BP declined significantly in RWCH and UH. That means the BP profiles shifted toward more reasonable states. CONCLUSIONS: BP profiles shifted toward more reasonable states after home BP based adjustment of anti-hypertensive medication. Measurement of home BP might be beneficial in anti-hypertensive treatment.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; European Continental Ancestry Group ; Follow-Up Studies ; Humans ; Hypertension ; Male ; Reference Values