BACKGROUND: Korea is an endemic area of viral hepatitis B with a rate of 5~10% carrier state. Therefore, hepatitis B vaccination is performed nationwide. But 5~15% of healthy individuals fail to respond adequately to the vaccine and an approved guideline for the nonresponders has not been developed yet. This study is designed to identify risk factors for those who lack anti-HBs after hepatitis B vaccination and to document the results of a double-dose revaccination in such nonresponders to the primary vaccination. METHODS: From Feb. 1996 to Aug, 1997, we assessed 51 healthy subjects(HBs Ag negative, anti-HBs negative, anti-HBc negative and a normal LFT). All subjects were vaccinated with Hepavax- B, 1.0ml, 24 by a rapid schedule(0, 1, and 2 months) and 27 by a standard schedule(0, 1, and 6 months). Anti-HBs titers were evaluated 3 months after the third vaccine and assessed the nonre-sponders (anti-HBs titer<2mIu/ml) and the hyporesponders(2~10mK/ml). All 13 nonresponders were revaccinated with 2ml of Hepavax-B 3 months after the primary vaccination. Anti-HBs titers were evaluated 1 month later. RESULTS: The differences in age(p<0.01) and smoking amount(p<0.05) between the responders and the hypo and the nonresponders were statistically significant. There were more males and higher body mass index in the hypo and the nonresponders but not statistically significant. The seroconversion rate after the double-dose vaccination was 92.3%(12/13) with an average titer of 5K08mlU/ ml(1-132.4mIU/ml). CONCLUSIONS: Increase in age and smoking amount were the risk factors of the nonresponders after the primary vaccination. Most of the hypo and the nonresponders to the primary vaccination responded adequately to the double-dose revaccination.
Body Mass Index ; Carrier State ; Hepatitis B* ; Hepatitis* ; Humans ; Immunization, Secondary* ; Korea ; Male ; Risk Factors* ; Smoke ; Smoking ; Vaccination

Reflex sympathetic dystrophy syndrome (RSDS) is a well-recognized disorder in adult group. But it is rarely diagnosed in the pediatric age group. RSDS is often a response to a physical or an emotional distress. Diagnosis of RSDS is made on a clinical basis whenever a patient with a painful limb presenting two or more of the following signs and symptoms : Persistent pain and swelling, vasomotor instability, trophic skin changes in the same extremity and autonomic imbalance. We report a case of RSDS in a 14- year-old girl. Her left arm was cold, edematous and blue with a limited active range of movement. Bone scan and thermography showed abnormal findings in affected arm. Prednisolone therapy, 60mg/day, was started. She also received sympathetic blocks and conservative treatment with physical therapy, transcutaneous electrical nerve stimulation, psychological therapy and anti-depressants. She showed gradual improvement in symptoms and signs.
Adult ; Arm ; Diagnosis ; Extremities ; Female ; Humans ; Prednisolone ; Prednisone ; Reflex Sympathetic Dystrophy* ; Reflex* ; Skin ; Thermography ; Transcutaneous Electric Nerve Stimulation

BACKGROUND/AIMS: Multidetector computed tomography (MDCT) is considered to be a noninvasive, alternative method for evaluating stent restenosis. However, the diagnostic accuracy of 16-channel MDCT for stent stenosis is reported to have severe limitations because of high-attenuation stent-related artifacts. 64-channel MDCT, which recently became available in clinical practice, has better spatial and temporal resolution than 16-channel MDCT. The diagnostic accuracy of 64-channel MDCT for stent restenosis (in-segment and in-stent) was assessed by comparing it with conventional coronary angiography. METHODS: In-segment and in-stent restenosis (> or =50% in diameter) were evaluated in 96 stent segments in 68 patients [61+/-12 years, 51 (75%) male] using both 64-channel MDCT and conventional coronary angiography. The in-stent analysis was confined to the portion of the artery covered by the stent and the in-segment analysis included the stent and 5 mm proximal or distal to the stent edges. RESULTS: The 64-channel MDCT could evaluate stent restenosis in 93 of 96 (97%) stent segments. Quantitative conventional coronary angiography found in-segment restenosis (> or =50% in diameter) in 16 of 68 (23%) patients and 16 of 96 (17%) segments. For the patients with interpretable stent segments, the sensitivity, specificity, positive predictive value, and negative predictive value of 64-channel MDCT for in-segment restenosis per patient were 63, 96, 83, and 89%, respectively; per segment they were 63, 97, 83, and 93%, respectively; and for in-stent restenosis per stent they were 82, 98, 82, and 98%, respectively. CONCLUSIONS: The diagnostic accuracy of 64-channel MDCT for assessing stent restenosis had high specificity and negative predictive value in the clinical setting. The 64-channel MDCT may be a promising, less-invasive imaging tool for stent restenosis, especially for the purpose of excluding stent restenosis.
Arteries ; Artifacts ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Humans ; Multidetector Computed Tomography ; Sensitivity and Specificity ; Stents