The safety of accelerated schedules of allergen immunotherapy (ASAI) in patients with bronchial asthma (BA) has been reported but there are little data on the safety of ASAI for patients with atopic dermatitis (AD). In this study, we investigated the safety of ASAI in patients with AD. Sixty patients with AD and 18 patients with BA sensitized to house dust mites (HDM) were studied. A maximum maintenance dose of HDM extract, adsorbed to aluminum hydroxide, was administered to patients by subcutaneous injection with either a 3-day protocol (rush immunotherapy) or 1-day protocol (ultra-rush immunotherapy). Systemic reactions were observed 4 of 15 patients (26.7%) with AD during rush immunotherapy, 13 of 45 patients (28.9%) with AD during ultra-rush immunotherapy, and 4 of 18 patients (22.2%) with BA during rush immunotherapy (P > 0.05). No severe or near fatal systemic reactions occurred in 78 subjects of this study. Systemic reactions developed within 4 hr after administration of the maximum allergen dose in 20 of 21 patients (95.2%) with AD and BA who showed systemic reactions during rush or ultra-rush immunotherapy. In conclusion, ASAI was safe and well tolerated in patients with AD. ASAI can be a useful therapeutic option for AD.
Adolescent ; Adult ; Allergens/*therapeutic use ; Aluminum Hydroxide/chemistry ; Animals ; Asthma/therapy ; Dermatitis, Atopic/immunology/*therapy ; Desensitization, Immunologic/*methods ; Drug Administration Schedule ; Female ; Humans ; Infusions, Subcutaneous ; Male ; Pyroglyphidae/*immunology/metabolism

Pituitary tumor can be accompanied with various pituitary hormone abnormalities. Pituitary tumors can be divided into functioning or nonfunctioning tumors. A functioning pituitary tumor, via the oversecretion of pituitary hormones, causes diverse clinical features. A nonfunctioning pituitary tumor can be accompanied with pituitary dysfunction and this may be due to compression or destruction of normal pituitary tissue, suppression of the pituitary portal system or direct damage to the hypothalamus. Corticotropin-releasing hormone (CRH) deficiency, which is caused by defects in the synthesis or release of CRH, is a cause of secondary adrenocortical insufficiency. The clinical presentations are hypoglycemia, weight loss, anemia, weakness, nausea, vomiting and hyponatremia. Acquired CRH deficiency has also been suggested to occur based on a lack of adrenocorticotropic hormone (ACTH) response to insulin-induced hypoglycemia, but there is a normal ACTH response to exogenous CRH. We experienced a case of a woman with pituitary macroadenoma accompanied with CRH deficiency. We report here on this case with the review of the literature.
Adrenocorticotropic Hormone ; Anemia ; Corticotropin-Releasing Hormone ; Female ; Humans ; Hypoglycemia ; Hyponatremia ; Hypothalamus ; Nausea ; Pituitary Hormones ; Pituitary Neoplasms ; Portal System ; Vomiting ; Weight Loss

BACKGROUND: Serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels are known markers of growth hormone (GH) secretion. The clinical utility of serum IGF-I and IGFBP-3 testing, however, remains controversial. The aims of this study were to evaluate the usefulness of IGF-I and IGFBP-3 as indicators of GH secretion through the GH stimulation test and to investigate whether a decrease in serum IGF-I levels in children with short stature, regardless of the cause, can be used as a screening test for short stature. METHODS: A total of 262 children presented with short stature, precocious puberty, or premature thelarche and were grouped into 7 tiers based on the 2007 growth chart. Serum IGF-I and IGFBP-3 levels and GH stimulation were analyzed using an immunoradiometric assay, and the data from 68 children who were below the 3rd percentile for height were used to evaluate the usefulness of IGF-I and IGFBP-3 as markers of GH status. RESULTS: GH deficiency was confirmed by the GH stimulation test in 25 of the 68 children, and 15 (15/25, 60%) and 4 (4/25, 16%) of them showed a decrease in IGF-I and IGFBP-3 levels, respectively. The sensitivity and specificity for predicting GH secretion were 60% and 16%, respectively, for IGF-1 and 41.9% and 97.7%, respectively, for IGFBP-3. Decreased serum IGF-I levels were more frequently observed in children below the 25th percentile than in those in the 25th to 95th percentiles. CONCLUSIONS: IGF-I and IGFBP-3 levels have been used as a screening tool for GH secretion in children with short stature, but based on the results of the GH stimulation test in the current study, the levels of IGF-I and IGFBP-3 might not be useful as markers of GH secretion. Evaluating serum IGF-I levels alone is not a sufficient screening test for children with a short stature.
Child* ; Growth Charts ; Growth Hormone ; Humans ; Immunoradiometric Assay ; Insulin-Like Growth Factor Binding Protein 3* ; Insulin-Like Growth Factor I* ; Mass Screening ; Puberty, Precocious ; Sensitivity and Specificity

Cobalt is known as a hard metal used in cement and various household products. Occupational exposure occurs during the production of cobalt powder, the processing of hard metals, the polishing of diamonds, and the processing of cobalt alloys. There have been cases of cobalt induced interstitial pneumonitis, occupational asthma, and allergic dermatitis. We report a 21-year-old patient with rhinitis and asthma induced by cobalt in a factory manufacturing diamond-cutter made from hard metal. The patient complained of rhinorrhea, sneezing, and dyspnea 5 months after working in the diamond-cutting industry. Skin prick test and patch test with cobalt(CoCl2) showed negative responses. Bronchoprovocation with CoCl2 showed a early asthamtic response. In conclusion, we report a case of cobalt-induced occupational rhinitis and asthma who worked in a factory manufacturing diamond-cutter. Further studies will be needed to investigate the pathogenesis of bronchoconstriction induced by cobalt.
Alloys ; Asthma ; Asthma, Occupational* ; Bronchoconstriction ; Cobalt ; Dermatitis ; Diamond ; Dyspnea ; Household Products ; Humans ; Lung Diseases, Interstitial ; Metals ; Occupational Exposure ; Patch Tests ; Rhinitis ; Skin ; Sneezing ; Young Adult

Streptococcus mutans and Streptococcus sobrinus are major etiological agents in enamel demineralization around orthodontic appliances. This study was designed to examine the prevalence of these streptococci on orthodontic brackets in vivo using polymerase chain reaction. Four incisor brackets in the upper and lower arches were removed and collected from 80 patients at the time of debonding. The genomic DNA of adhered bacteria was extracted and each dextranase gene of S. mutans and S. sobrinus was amplified using the specific oligonucleotide primers. The results showed that the maxillary incisor brackets were colonized by both cariogenic streptococci to a somewhat higher degree than that taken from the mandible. The prevalence of S. mutans was 50.0% on the maxillary incisor brackets and 33.8% on the mandibular incisor brackets, and that of S. sobrinus was 17.5% and 15.0%, respectively. Both species were detected on the maxillary incisor brackets of 7 patients (8.8%) and the mandibular incisor brackets of 5 patients (6.3%). These results suggest that cariogenic streptococci can adhere to the incisor brackets and may be resident species on the incisor brackets.
Bacteria ; Colon ; Dental Enamel ; Dextranase ; DNA ; DNA Primers ; Humans ; Incisor ; Mandible ; Orthodontic Appliances ; Orthodontic Brackets ; Polymerase Chain Reaction* ; Prevalence ; Streptococcus mutans ; Streptococcus sobrinus

BACKGROUND: It has been reported that the results of second renal transplantation are inferior to that of first transplantation and affected by several factors. The purpose of this study is to suggest guidelines for successful retransplantion by evaluating the factors which might affect the clinical courses and graft survival rates in the second renal transplantation. METHODS: Between March 1969 and February 2005, 1476 kidneys were transplanted in Kangnam St Mary's hospital. Among these, 77 cases were retransplantation (72 cases were second transplantation, 5 cases were third transplantation). Especially for the second transplantation, we retrospectively analysed the clinical courses of grafted kidneys and sought the factors which might be related to the long term graft survival. RESULTS: Among second transplant patients, male were 52 cases, female were 20 cases. The mean age at retransplantation was 38.4+/-11 years. Living donor were 62 cases and cadaver donor were 10 cases. The mean duration between primary graft failure and second transplantation was 20.1+/-36 months. The 1 yr, 3 yr, 5 yr survival rates of the second grafts were 86.4%, 78%, 71% respectively, and it is not significantly inferior to that of total primary transplantation at our center. Multivariate analysis showed that the duration of the first graft survival and the postoperative recovery pattern significantly predicted graft survival in the second renal transplantation. CONCLUSIONS: This study suggests retransplantation can be considered for patients who lost primary graft function. And the longer the duration of the first graft survival and the earlier the postoperative graft function recovery, the prognosis of retransplanted graft would be better.
Cadaver ; Female ; Graft Survival* ; Humans ; Kidney ; Kidney Transplantation ; Living Donors ; Male ; Multivariate Analysis ; Prognosis ; Recovery of Function ; Retrospective Studies ; Risk Factors* ; Survival Rate ; Tissue Donors ; Transplants*

BACKGROUND: Postherpetic neuralgia (PHN) is a serious complication resulting from herpes zoster infections, and it can impair the quality of life. In order to relieve pain from PHN, various treatments, including pharmacological and interventional methods have been used. However, little information on the recommendations for the interventional treatment of PHN, along with a lack of nation-wide surveys on the current status of PHN treatment exists. This multicenter study is the first survey on the treatment status of PHN in Korea. METHODS: Retrospective chart reviews were conducted on the entire patients who visited the pain clinics of 11 teaching hospitals from January to December of 2011. Co-morbid disease, affected site of PHN, routes to pain clinic visits, parenteral/topical medications for treatment, drugs used for nerve block, types and frequency of nerve blocks were investigated. RESULTS: A total of 1,414 patients' medical records were reviewed. The most commonly affected site was the thoracic area. The anticonvulsants and interlaminar epidural blocks were the most frequently used pharmacological and interventional methods for PHN treatment. For the interval of epidural block, intervals of 5 or more-weeks were the most popular. The proportion of PHN patients who get information from the mass media or the internet was only 0.8%.The incidence of suspected zoster sine herpete was only 0.1%. CONCLUSIONS: The treatment methods for PHN vary among hospitals. The establishment of treatment recommendation for PHN treatment is necessary. In addition, public relations activities are required in order to inform the patients of PHN treatments by pain clinicians.
Anticonvulsants ; Health Care Surveys ; Herpes Zoster ; Hospitals, Teaching ; Humans ; Incidence ; Internet ; Mass Media ; Medical Records ; Nerve Block ; Neuralgia, Postherpetic ; Pain Clinics ; Public Relations ; Quality of Life ; Retrospective Studies ; Zoster Sine Herpete

Background/Aims: We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA). Methods: We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2–3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment. Results: The median follow-up period was 64.8 months (interquartile range, 0.1–162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396–1.232) (P=0.215) and 1.698 (1.777–2.448) (P=0.005), respectively. Conclusions SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.

BACKGROUND AND OBJECTIVES: Pathogenesis, definition, and treatment of sinonasal polyps remain uncertain. To elucidate them, many studies on polyps have been made. However, recently reported studies on polyps using animal models seldom provided comparative data on polyp formation in various conditions. The aim of this study is to develop an animal model of polyps which is more suitable for further polyp studies. We attempted a semiquantitative analysis on the effects of mechnical trauma to the sinus mucosa on formation of polyps and polypoid mucosa in duction of rabbit maxillary sinusitis by Streptococcus pneumoniae and compared the prevalences of polyps under the different conditions. MATERIALS AND METHODS: The natural ostia of both sinuses were occluded in 10 Pasturella-free New Zealand white rabbits. Both sinuses were inoculated with S. pneumoniae, without brushing the mucosa in the left maxillary sinuses (control group) and with brushing in the right sinuses (experimental group). After four weeks, all sinuses were re-opened. Macroscopic polyp and light microscopic polyps and/or polypoid mucosa were semiquantitatively analyzed and each prevalence was compared between the two groups. RESULTS: The number of macroscopic polyps per sinus was significantly larger in the experimental group (1.1 polyps) than that in the control group (0.1 polyps). Microscopic examination revealed significantly more polyps and/or polypoid mucosa in the experimental group than in the control group. CONCLUSIONS: Our results suggest that mechanically traumatizing the sinus mucosa, such as brushing, is more helpful to polyp formation when a rabbit model of polyps is to be induced by S. pneumoniae.
Maxillary Sinus* ; Maxillary Sinusitis* ; Models, Animal ; Mucous Membrane* ; Pneumonia ; Polyps* ; Prevalence ; Rabbits* ; Streptococcus pneumoniae* ; Streptococcus*