Recurrent aphthous stomatits (RAS) is also known as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. RAS has been the subject of active investigation along multiple lines of research including epidemiology, immunology, clinical correlations and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MIAU, MJAU, HU) and severity (simple versus complex). In order to properly diagnose and treat a patient with lesions of RAS, the clinician must exclude other causes of acute oral ulcers. Complex aphthosis and complex aphthosis variants associated with systemic disorders should be considered. The aphthous-like oral ulcerations of patients with HIV disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause" which, with appropriate treatment, can result in a remission or substantial lessening of disease activity. Finally, when all of these factors are considered, the evaluation of the patient for Behcet's disease can be continued on firm grounds that one of the major criteria for the diagnosis of Behcet's disease has been met.
Behcet's Syndrome/diagnosis* ; Diagnosis, Differential ; Human ; Recurrence ; Stomatitis, Aphthous/etiology ; Stomatitis, Aphthous/diagnosis* ; Stomatitis, Aphthous/classification

Humans ; Stomatitis, Aphthous ; diagnosis ; etiology ; therapy

Consensus ; Diagnosis, Differential ; Glucocorticoids ; therapeutic use ; Humans ; Practice Guidelines as Topic ; Recurrence ; Stomatitis, Aphthous ; diagnosis ; therapy

Herpes simplex virus infection of the hand in children occurs after auto-inoculation from herpetic gingivostomatitis or herpes labialis. Herpetic whitlow should be suspected based on clinical signs. Diagnosis can be made by PCR or virus culture. Many misdiagnosed cases suggests that this disease is not sufficiently known. Surgical interventions may be harmful and should be avoided. We report a case of herpetic whitlow with bacterial superinfection in a three-year-old girl.
Child ; Diagnosis ; Female ; Hand ; Herpes Labialis ; Humans ; Polymerase Chain Reaction ; Simplexvirus ; Stomatitis, Herpetic ; Superinfection*

PURPOSE: We investigated serum levels of MTX and accompanying organic toxicities after administration of High-Dose Methotrexate (HDMTX). METHODS: We reviewed a total of 42 courses of HDMTX administration in 6 patients who were diagnosed with osteosarcoma in Hanyang University Hospital from 1993 to 1997. The HDMTX was infused at the doses of 8~12 g/m2, and serum levels were assessed. Leucovorin administration was started 20 hours from the beginning of MTX infusion, and continued until the serum MTX level is below 1x10-7 mol/L and toxicities are not detectable. RESULTS: Of 6 patients (4 males and 2 females), mean age at diagnosis was 11.6 years (8.5~15.6 years). Sites of origin included distal femur in 3, proximal tibia in 1, proximal fibula in 1 and proximal humerus in 1. Serum MTX levels were 1.87+/-0.69x10-4 mol/L at 12~23 hours, and 5.10+/-3.22x10-8 mol/L at 120 hrs after HDMTX infusion. Of 42 courses, hematologic toxicity greater than grade III was observed in 19(45.2%) resulting reduction of dose in 2 patients, and hepatic toxicity greater than grade III in 28(67%). The mean ALT levels was 680+/-563 U in 1st day, and mostly normalized in 10th day. Stomatitis was generally mild, except 1 patient with grade III toxicity. No renal or neurologic toxicity was observed, except 1 seizure episode due to SIADH. CONCLUSION: HDMTX with leucovorin in osteosarcoma was well tolerated, and in majority of courses, serum MTX levels returned to non-toxic level after 120 hours and leucovorin will be desirable to administer during at least 5 days.
Child* ; Diagnosis ; Femur ; Fibula ; Humans ; Humerus ; Inappropriate ADH Syndrome ; Leucovorin ; Male ; Methotrexate* ; Osteosarcoma* ; Seizures ; Stomatitis ; Tibia

PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis) syndrome is one of the causes of periodic fever in pediatrics with unknown etiology. It is characterized by abrupt onset of fever, malaise, aphthous stomatitis, pharyngitis and cervical adenitis without long-term sequelae. Laboratory findings of this sporadic and nonhereditary syndrome are so non-specific that the diagnosis is based on clinical findings. Oral prednisolone is quite effective in controlling the symptoms. We report a case of a 6-year-old girl who was diagnosed as having PFAPA syndrome after 2 years of episodes, by excluding other disease entities with similar clinical features. The patient was treated with oral prednisolone and her symptoms improved dramatically.
Child ; Diagnosis ; Female ; Fever* ; Humans ; Lymphadenitis ; Pediatrics ; Pharyngitis* ; Prednisolone ; Stomatitis, Aphthous* ; Yemen

Behcet's disease is a systemic vasculitis that is characterized mainly by recurrent oral and genital aphthous ulcers, uveitis, and skin findings. Its neurological manifestations are well recognized. Recurrent meningitis in Behcet's disease is exceptional. We describe herein the case of a 31-year-old man who presented with recurrent aseptic meningitis without any specific cause. A few years later he developed oral and genital ulcers, and uveitis. Behcet's disease should always be considered in a differential diagnosis of recurrent aseptic meningitis without viral infection, particularly in the context of multisystem manifestations.
Adult ; Diagnosis, Differential ; Humans ; Meningitis ; Meningitis, Aseptic ; Neurologic Manifestations ; Skin ; Stomatitis, Aphthous ; Systemic Vasculitis ; Ulcer ; Uveitis

PURPOSE: This study was designed to investigate the difference of oral mucositis in hospitalized cancer patients receiving chemotherapy according to characteristics. METHODS: Data were collected from March 1 to April 25 2012 using questionnaires, and the participants were 177. The Oral Assessment Guide (OAG) by observation and The Oral Mucositis Daily Questionnaire (OMDQ) by self-report were used to measure oral mucositis. The data were analyzed using SPSS 18.0. RESULTS: Moderate to severe oral mucositis measured by OAG observation were 94.9% in hospitalized cancer patients receiving chemotherapy, frequently complaints of mouth and throat soreness measured by OMDQ was 42.4%, and intensity of mouth and throat soreness measured by OMDQ was 0.65 out of 10. There were statistically significant differences in the prevalence of oral mucositis according to nutrition state, frequency of chemotherapy, experience of oral examination, combination treatment, and number of chemotherapeutic agents. CONCLUSION: Many hospitalized cancer patients receiving chemotherapy experienced oral mucositis. Cancer patients receiving chemotherapy with poor nutritional status, more frequent chemotherapy and combination treatments should have a more meticulous oral care. So there needs to be an appropriate assessment tool and prevention protocol for oral mucositis that considers related factors.
Diagnosis, Oral ; Humans ; Mouth ; Nutritional Status ; Pharynx ; Prevalence ; Stomatitis ; Surveys and Questionnaires

PURPOSE: Crohn's disease (CD) is a chronic inflammatory disease that is difficult to treat due to various complications and frequent recurrences. There have been many studies on the clinical aspects of CD in Western countries; however, there have been few studies in Korea. We performed this study to evaluate the clinical features of CD in Korea and to assess the stability over the course of the disease according to the Vienna classification. METHODS: We reviewed the medical records of 85 patients diagnosed as having CD in Kyung Hee University Hospital from March 1986 to July 2004. RESULTS: The male-to-female ratio was 1.9:1, and the mean age at diagnosis was 27.5 years. The most common symptom was abdominal pain (82%). Perianal lesions were observed in 29 cases (34%). Fistula was the most common (26%) lesion. Extraintestinal manifestations were observed in 13 cases (15%). Stomatitis was the most common (7%) lesion. According to the Vienna classification, the group with ages at diagnosis below 40 years (A1) was 88%, and that with ages equal to or above 40 years (A2) was 12%. The location of the disease was classified as terminal ileum (L1)(15%), colon (L2)(32%), ileocolon (L3)(33%), and upper gastrointestinal (L4)(20%). The behavior of disease was classified as nonstricturing nonpenetrating (B1)(41%), stricturing (B2)(14%), and penetrating (B3)(45%). Empirical anti-tuberculous medications were administered in 23 cases (27%) before the CD had been diagnosed. CONCLUSIONS: There are differences in the locations and behaviors of Crohn's disease between Korea and Western patients. The cause of the difference is uncertain.
Abdominal Pain ; Classification* ; Colon ; Crohn Disease* ; Diagnosis ; Fistula ; Humans ; Ileum ; Korea* ; Medical Records ; Recurrence ; Stomatitis

BACKGROUND: Most patients with gastric cancer have metastatic disease at first diagnosis and need palliative chemotherapy. Unfortunately, the response duration of the first line chemotherapy is usually short and most patients need the second line therapy during their disease process. The action mechanism of continuous infusion of 5-FU is different from bolus 5-FU and we can expect that among patients who failed on bolus 5-FU, some patients will achieve response to infusional 5-FU. So, we planned to evaluate the efficacy and safety of leucovorin and infusional 5-FU as a second line regimen for the metastatic gastric cancer refractory to regimen containing bolus 5-FU. METHODS: Patients with recurred or metastatic gastric cancer unresponsive to regimen containing bolus 5-FU were entered into this study. The mixture of 5-FU 1,000 mg/m2/day and leucovorin 50 mg/m2/day was infused continuously for four days and this treatment was repeated by every three weeks. RESULTS: From March, 1996 to July 2001, 25 patients were enrolled in this study. One patient showed a partial remission, 9 stable disease and 15 progressive disease. The overall response rate was 4%. The median time to progression was 73 days and the median duration of overall survival was 140 days. Among total of 92 cycle chemotherapy, leukopenia, granulocytopenia and thrombocytopena of WHO grade 3 or 4 were observed in 7.6%, 12.0% and 14.1%, respectively. Stomatitis, nausea or vomiting of WHO grade 3 or 4 were 13.1%, 5.4%, respectively. Neutropenic infection occurred in two patients. CONCLUSION: The LF regimen was well tolerated with minimal toxicities and showed low effect as the second line chemotherapy for the patients with gastric cancer.
Agranulocytosis ; Diagnosis ; Drug Therapy ; Fluorouracil* ; Humans ; Leucovorin* ; Leukopenia ; Nausea ; Stomach ; Stomach Neoplasms* ; Stomatitis ; Vomiting