BACKGROUND: The hypereosinophilic syndrome(HES) represents a leukoproliferative process likely caused by a number of disorders, all of which are marked by sustained over-production of eosinophils. OBJECTIVES: The purposes of this study were aimed at evaluating the clinical and histopathological characteristics of HES. METHODS: The medical records and hist opathological slides of patients with HES who had skin biopsies performed in our department were reviewed. Criteria for the diagnosis of HES include (1) peripheral blood eosinophilia with eosinophil counts greater than 1,500/L for at least 6 months; (2) no evidence of parasitic, allergic, or other known causes of eosinophilia; and (3) presumptive signs and symptoms of multiple organ involvement. RESULTS: Four male and three female patients were included. HES developed in adulthood or old age (mean, 43.4 years). Because only the patients with cutaneous involvement were included, all the patients showed skin lesions. Heart, liver, stomach, nervous system, lymph nodes, and lung were involved organs in decreasing order of frequency. At the onset of HES, 40 to 80% of white blood cells were eosinophils in peripheral blood. White blood cell count and serum IgE level were elevated in all the tested patients. In six patients (85.7%), the level of serum erythrocyte sedimentation rate was elevated. Persistent hypereosinophilia (>1,500/L) was present for longer than 6 months in all patients. Stool examination and skin test for parasitic infestation all gave negative results. All the patients were not taking any medication. Histopathological examinations revealed perivascular mixed inflammatory cell infiltration; predominantly eosinophils in the stomach, liver, and nerve as well as in the skin. Interestingly, two patients who were presented with skin lesions showed the findings of eosinophilic vasculitis. In these patients, the skin lesions were consisted of Raynaud's phenomenon, digital gangrene, and several erythematous plaques. The most common cutaneous manifestations were papules and nodules on the extremities. The main treatment modality was systemic steroid. Except for one patient presented with central nervous system involvement of HES, all the patients were in a well-controlled state. In one patient with the typical clinical and hematologic features of HES, Hodgkin's disease followed. After the complete remission of Hodgkin's disease with chemotherapy, HES subsided. CONCLUSIONS: HES is a heterogenous collection of disorders marked by hypereosinophilia and organ damage. Most common cutaneous manifestations were papules and nodules on the extremities. Raynaud's phenomenon and digital gangrene can be the primary manifestation of HES in which cases cutaneous lesions showed eosinophilic vasculitis. Five patients (71%) responded well to systemic steroids. HES may be a herald of malignancy such as Hodgkin's disease. Further investigation will be mandatory ro elucidate the etiology and pathogenesis of HES.
Biopsy ; Blood Sedimentation ; Central Nervous System ; Diagnosis ; Drug Therapy ; Eosinophilia ; Eosinophils ; Extremities ; Female ; Gangrene ; Heart ; Hodgkin Disease ; Humans ; Hypereosinophilic Syndrome* ; Immunoglobulin E ; Leukocyte Count ; Leukocytes ; Liver ; Lung ; Lymph Nodes ; Male ; Medical Records ; Nervous System ; Skin ; Skin Tests ; Steroids ; Stomach ; Vasculitis

No abstract available.
Antibody Formation* ; Immunoglobulin A* ; T-Lymphocytes*

The clinicopathologic features and the comparative analysis of diagnostic methods in 42 patients having intestinal tuberculosis were studied. In all the cases, clinical and colonoscopic diagnosis was confirmed by histological examination. Abdominal pain was the most common symptom (54%). Twenty nine patients had active pulmonary tuberculosis which was confirmed by a chest X-ray, or an AFB smear and a culture of sputum. A transverse ulcer with surrounding hypertrophic mucosa and multiple erosion was the usual colonoscopic findings. The granulomas were usually located in the just upper and lower portion of muscularis mucosa. The direct smear and culture of the fresh biopsy material showed AFB in 11 (32.4%) and 12 cases (36.4%) respectively. Ziehl-Neelsen staining in serially sectioned slides from formalin-fixed, paraffin- embedded tissue revealed AFB in 15 cases (35.7%). An immunohistochemical stain for Mycobacterium bovis was done in all cases and 13 cases were positive (31%). A polymerase chain reaction (PCR) was done and showed positivity in 4 out of 20 cases of fresh biospy material and 12 out of 40 cases in paraffin embedded tissue. For the conclusive diagnosis of intestinal tuberculosis, a Ziehl-Neelsen stain is the most sensitive, fast, and cost-effective method. The diagnostic accuracy will be increased when other diagnostic methods such as tissue culture and PCR are coupled with this simple staining method.
Abdominal Pain ; Biopsy ; Diagnosis* ; Granuloma ; Humans ; Intestines ; Mucous Membrane ; Mycobacterium bovis ; Paraffin ; Polymerase Chain Reaction ; Sputum ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

PURPOSE: In this study, we analyzed clinical manifestations of and ways to manage malaria. METHODS: The medical records of the patients confirmed as malaria by using peripheral blood smear at Ui jungbu St. Mary's hospital from April 1997 to November 2001 were reviewed retrospectively. RESULTS: Of the 170 patients, there were 111 males and 59 females, and their mean ages were 32.3+/-14.5, 34.9+/-18.1 years, respectively. Malaria occurred throughout the year and peaked during the sixth to ninth months (84.1%). All cases were vivax malaria. All 170 patients had fever, but tertian fever was seen in only 81 (48%) patients. Laboratory abnormalities were hemoglobin below 12 g/dL in 70 (41.2%) patients, WBC below 4000/mm3 in 49 (28.9%), platelet count below 120,000/mm3 in 142(83.5%). Of the 92 patients who underwent ultrasonography of the abdomen, splenomegaly was seen in 81 (89%)patients. The time from onset of symptoms to admission ranged from 2 to 30 days with a mean 8.1+/-5.5 days. All patients responded promptly to drug therapy. One patient developed recurrent malaria 120 days after the first attack. Another patient experienced multifocal splenic infarction. CONCLUSION: All patients with malaria had fever and chills. The most common laboratory findings were thrombocytopenia and anemia. All patients responded promptly to drug therapy. As cases of malaria in Korea are increasing, early diagnosis and treatment, as well as prevention, are important.
Abdomen ; Anemia ; Chills ; Drug Therapy ; Early Diagnosis ; Female ; Fever ; Humans ; Korea ; Malaria ; Malaria, Vivax* ; Male ; Medical Records ; Platelet Count ; Retrospective Studies ; Splenic Infarction ; Splenomegaly ; Thrombocytopenia ; Ultrasonography

There are many factors which cause postoperative hepatic dysfunction or necrosis: chronic liver disease, viral infection, septicemia, severe burn, nutritional deficiency, previous or concommitant drug therapy, hypoxia, hypercarbia, hypotension and surgical procedures. Anesthetic agents are not the most common cause of postoperative hepatic dysfunction. But too frequently halothane is blamed for postoperative hepatic dysfunction, while other more likely causes are ignord. So, in order to in vestigate the effects of halothane, enflurane and thalamonal anesthesia on hepatic function, we compared with serum GOT, GPT level at preoperatively and postoperatively in 60 patients who had no liver disease previously and had no experience of general anesthesia. We divided them randomly in 3 groups: halothane administered group, enflurane administered group and thalamonal administered group. And serum GOT, GPT were checked preoperatively, postop, 24 hrs, and on postop, 6th day. Blood transfusion were not performed during this study. The result of this study reveals that there is no statistically significant difference in changes of SGOT, SGPT between halothane, enflurane and thalamonal group during postoperative period(p>0.05). This result show that the effect of halothane on hepatic function was not significantly different from those of enflurane and thalamonal.
Alanine Transaminase* ; Anesthesia* ; Anesthesia, General ; Anesthetics ; Anoxia ; Aspartate Aminotransferases* ; Blood Transfusion ; Burns ; Drug Therapy ; Enflurane* ; Halothane* ; Humans ; Hypotension ; Liver Diseases ; Malnutrition ; Necrosis ; Sepsis

BACKGROUND: Tumor necrosis factor-alpha(TNF-alpha) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-alpha was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. METHODS: Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and damping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-alpha, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. RESULTS: 1. TNF-alpha level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min- and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1+/-1.2% vs 1.2+/-0.9%, p<0.05). CONCLUSION: The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-alpha level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-alpha level during the early reperfusion period(<2h) is related to delayed neuronal damage.
Animals ; Brain Ischemia ; Brain* ; Heart Arrest* ; Heart Arrest, Induced ; Necrosis ; Neurologic Manifestations ; Neurons ; Plasma ; Rats* ; Reperfusion ; Reperfusion Injury* ; Resuscitation ; Thorax ; Tumor Necrosis Factor-alpha*

Our study surveded 418 obese first grade elementary school children(279 male and 139 female), in seoul, and measured levels of serum total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride were measured in addition to the measurement of body weight and height. The following results were obtained. 1) Obesity index was catergorized into mild, moderate, and severe, and the percentage of mild was 6.8%, moderate 48%, severe 45.7% respectively in surveyed children. 2) The average level of total cholesterol was 1.66.60 27.63mg/dl, HDL cholesterol 50.22+/-0.68mg/dl, LDL cholesterol 82.23+/-1.26mg/dl. 3) Atherogenic index was calculated, and obtained value was 2.45+/-0.48. It showed higher statstical significance in boys than in girls(p<0.05). 4) There was no significant difference in average level of total cholesterol, LDL cholesterol, and triglyceride in accordance of the severity of obesity. 5) Statistical significance was found in different average ievels of HDL cholesterol and atherogenic index according to obesity index (p<0.05). 6) There was a statistical significance in the average values of Kaup index and Rohrer index in accordance with obesity index (p<0.000). 7) There was no correlation between abnormal levels of total cholesterol, HDL cholesterol, and LDL cholesterol and the severity of obesity. 8) Abnormal levels of triglyceride, atherogenic index, Rohrer index and Kaup index had a statistical significance since their levels. 9) There was a correlation between atherogenic index and body measurement. Total cholesterol level showed correlation with obesity index, and HDL cholesterol with Kaup index and arm circum ference.
Arm ; Body Weight ; Child ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Humans ; Male ; Obesity ; Seoul* ; Triglycerides

BACKGROUND: The association of Kaposi's sarcoma-associated human herpesvirus, or human herpesvirus 8 (HHV8) with various skin diseases has been described in many reports. However, only 3 human diseases: Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman disease were proved to be associated with HHV8. In addition to Karposi's sarcoma, sarcoidosis and Kikuchi's disease were also described to be associated with HHV8. OBJECTIVE: The purpose of this study was aimed at the association of HHV8 with various skin diseases, such as Kaposi's sarcoma, sarcoidosis, and Kikuchi's disease. METHODS: We performed PCR to examine whether the 233-bp segment of the viral DNA of HHV8 was detected in Korean patients with Kaposi's sarcoma, sarcoidosis, Kikuchi's disease, angiosarcoma, and angiolymphoid hyperplasia with eosinophilia. The medical records and histopathological specimens of patients diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: HHV8 DNA sequences were identified in 9 (69%) of sarcoid tissues from 12 patients with sarcoidosis and in all (100%) of from 8 patients with Kaposi's sarcoma but not in 2 tissues from 2 patients with Kikuchi's disease, in 3 tissues from 2 patients with angiosarcoma and 2 tissues from 2 patients with angiolymphoid hyperplasia with eosinophilia. CONCLUSION: HHV8 may be strongly associated with the pathogenesis of Kaposi's sarcoma and sarcoidosis. However, the association with Kikuchi's disease, angiosarcoma, and angiolymphoid hyperplasia with eosinophilia was denied in this study. Further extensive study will be needed.
Angiolymphoid Hyperplasia with Eosinophilia ; Base Sequence ; Chungcheongnam-do ; DNA, Viral ; Giant Lymph Node Hyperplasia ; Hemangiosarcoma ; Herpesvirus 8, Human* ; Histiocytic Necrotizing Lymphadenitis ; Humans* ; Lymphoma, Primary Effusion ; Medical Records ; Polymerase Chain Reaction* ; Sarcoidosis ; Sarcoma ; Sarcoma, Kaposi ; Skin Diseases

BACKGROUND: Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northern territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. METHODS: We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from aug 5 to Aug 14, 1998. RESULTS: There were total 102 patients, male were 52%and women were 48% Most of patients were between 30's and 60's. Most of them were minor, and less than 3%of them needed critical care. The diagnosis were laceration(39.2%, contusion(22.5%, fracture(13.7%, infectious disease(7.8%, ligament rupture(7.8%, aggravation of chronic illness(5.9%, dermatitis(2.0% and traumatic hyphema(1.0%. The laceration occurred in the foot(37.9%, lower leg(27.0%, thigh(16.2%, hand(10.8% and head(8.1%. The location of ligament injury were achilless tendon(62.5%, hand(25% and knee(12.5%. The 67.5%of flood-related laceration patients progressed cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). CONCLUSION: During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.
Cellulitis ; Critical Care ; Depression ; Diagnosis ; Disasters ; Female ; Gyeonggi-do ; Humans ; Immunization ; Lacerations ; Ligaments ; Male ; Medical Records ; Mental Health ; Northern Territory ; Shoes ; Stress Disorders, Post-Traumatic ; Tetanus ; Wounds and Injuries

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.
Ataxia ; Barbiturates ; Benzodiazepines ; Brain ; Cardiopulmonary Resuscitation ; Depression ; Eating ; Epilepsy ; Ethanol ; Female ; Heart Arrest* ; Hemoperfusion ; Humans ; Hypotension ; Lethargy ; Neurons ; Phenobarbital* ; Phenytoin ; Pulmonary Edema* ; Shock ; Status Epilepticus ; Suicide ; Young Adult