The authors reported one case of toxic epidermal necrolysis that occurred in the carbamazepine treatment in a 47-year old male patient with aggressive organic mental disorder. This case developed toxic epidermal necrolysis while taking carbamazepine with a dose of 600mg/day. Toxic epidermal necrolysis did not improve after discontiuation of carbamazepine. We reviewed incidence and the natural history of toxic epidermal necrolysis.
Alcoholism ; Carbamazepine ; Cluster Analysis ; Neurocognitive Disorders ; Humans ; Incidence ; Male ; Middle Aged ; Natural History ; Stevens-Johnson Syndrome*

Balloon dilatation has been applied in treatint of various pathologic narrowing of the hollow viscus. It is now accepted as very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 4 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other threeconservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively.
Age Distribution ; Child* ; Constriction, Pathologic* ; Dilatation* ; Emergencies ; Esophageal Achalasia ; Esophageal Atresia ; Esophageal Perforation ; Esophageal Stenosis ; Esophagitis ; Humans ; Infant* ; Methods ; Thoracotomy ; Tracheoesophageal Fistula

PURPOSE: To review the type, incidence and radiologic findings and to evaluate the clinical significance of intrahepatic duct dilatation of choledochal cysts in children. MATERIALS AND METHODS: Ultrasonography and operative cholangiography of 49 consecutive children with surgically confirmed choledochal cyst were reviewed and classified according to the Todani's classification. Patients with intrahepatic duct dilatation in preoperative evaluation were routinely followed by ultrasonography after surgery of extrahepatic bile duct. The status of bileduct was evaluated by comparing with the preoperative ultrasonography. RESULTS: According to the preoperative evaluation, there were 19 cases(39%) of type Ia, three cases(6%) of type Ib, ten cases(20%) of type Ic, 15 cases(31%) of type IVa, two cases(4%) of type V, but no case of the type II, III, IVb in Todani's classification.In twelve of 13 patients (five cases of type I and eight cases of type IVa) who had been followed up after surgery of choledochal cyst, the previously noted intrahepatic ductal dilatation were no longer seen. CONCLUSION: The incidence of the types of choledochal cysts by Todani's classification shows no significant difference between our result and the other authors'. The intrahepatic ductal dilatation seems to be reversible and mainly secondary to extrahepatic obstruction by choledochal cyst. Thus, postoperative follow up examination is more important than preoperative classification of bile duct dilatation.
Bile Ducts ; Bile Ducts, Extrahepatic ; Child* ; Cholangiography ; Choledochal Cyst* ; Classification ; Dilatation ; Follow-Up Studies ; Humans ; Incidence ; Ultrasonography

We reviewed 30 cases of superior vena cava syndrome in adult patients who were seen at the Yeungnam University Hospital from January 1985 to June 1990. The results were as follows: 1. The male-to-female ratio was 6.5:1, and the most patients were in the age group between the sixth and seventh decades. 2. The most common symptoms were dyspnea (87%) and followed by cough (63%), facial swelling (63%) and chest pain (44%) and the physical signs were dilated neck vein (97%), facial edema (93%) and facial flushing (45%) in order of frequency. 3. The simple chest x-ray findings were superior mediastinal widening (90%), right hilar mass (77%) and pleural effusion (31%). 4. Diagnosis was made by history and physical examination (100%), chest C-T scan (100%), simple chest x-ray (97%), bronchoscopy with biopsy (40%) and so on. 5. 21 cases of patients were confirmed by histology: 14 cases (46%) of bronchogenic ca, 4 cases (14%) of lymphoma, 3 cases (10%) of metastatic lung ca. Of bronchogenic ca, small cell ca was 7 cases (23%), squamous cell ca, 5 cases (17%), and unclassified cawas 2 cases (6%). 6. In response of treatment, the clinical improvement was achieved in 18 cases with radiotherapy alone, 1 case with chemotherapy only, and 6 cases with radio-chemotherapy.
Adult ; Biopsy ; Bronchoscopy ; Chest Pain ; Cough ; Diagnosis ; Drug Therapy ; Dyspnea ; Edema ; Epithelial Cells ; Flushing ; Humans ; Lung ; Lung Neoplasms ; Lymphoma ; Neck ; Physical Examination ; Pleural Effusion ; Radiotherapy ; Superior Vena Cava Syndrome* ; Thorax ; Veins ; Vena Cava, Superior*

PURPOSE: The purpose of this study was to compare the in-vivo efficiency of vascular occlusion on radiofrequency ablation (RFA) lesion size in a rabbit kidney model. MATERIALS AND METHODS: RFA lesions were created in a single kidney in 20 rabbits using an internally cooled electrode. Twenty ablation zones (1 per kidney) were created using 4 different regimens: RFA without vascular occlusion (n = 5), RFA with renal artery occlusion (n = 5), RFA with renal vein occlusion (n = 5), RFA with renal artery and vein occlusion (n = 5). Seven days later, the rabbits were sacrificed and the lesions were excised. These groups were then compared with respect to the dimensions of the ablation zones and the changes in impedance and current during RFA. RESULTS: The maximum ablation zone width was the greatest in the renal artery and vein occlusion group (21.0+/-1.4 mm), followed by the renal artery occlusion group (17.8+/-1.0 mm), the renal vein occlusion group (17.4+/-1.1 mm), and the nonocclusion group (7.8+/-2.4 mm) (p < 0.05). No significant differences were observed for impedances and currents between the 4 groups. CONCLUSION: Vascular occlusion combined with RFA effectively increased ablation zone dimensions compared with RFA alone, and the best effect was accomplished by combined renal artery and vein occlusion.
Catheter Ablation* ; Electric Impedance ; Electrodes ; Kidney* ; Open Bite ; Rabbits ; Renal Artery* ; Renal Veins ; Veins*

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.