No abstract available.
Sympathectomy

Background: Alopecia areata is an autoimmune disease that presents as non-scarring hair loss and can affect all age groups. The clinical course of alopecia areata is unpredictable. Objective: This study aimed to analyze the characteristics, treatment response, and relapse rate of alopecia areata in patients of different ages with long-term follow-up. Methods: The medical records of 121 patients diagnosed with alopecia areata were retrospectively reviewed, and their prognosis was assessed on the basis of various indices. Results: A total of 121 patients, including 24 cases of childhood-onset, 83 adult-onset, and 14 late-onset alopecia areata, were analyzed. In the first episode, 72.7%, 14.7%, and 9.9% of patients had mild, moderate, and severe alopecia areata, respectively. A significant and complete response was observed in 66.7%, 89.2%, and 100% of childhood-onset, adult-onset, and late-onset patients, respectively. The duration of the initial episode showed a negative correlation with age. The overall frequency of relapse was 47.1%, whichc significantly declined with time, with a majority (63.3%) of relapses occurring in the first year. Younger age at initial presentation and thyroid diseases were strongly associated with poor prognosis. Conclusion Younger patients showed a tendency of poor prognosis regardless of the prognostic factors. A longer follow-up period might be required for the younger onset patients.

The occurrence of double primary cancer of the esopbagus and duodenum is considered very rare. Moreover, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency to early metastasis. We report a case of double primary cancer, which we have synchronously confirmed esophageal squamous cell carcinoma and duodenal adenocarcinoma with gastrofiberscopic biopsy, and then treated them by gastrojejunostomy and systemic chemotherapy.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Drug Therapy ; Duodenum ; Esophageal Neoplasms ; Gastric Bypass ; Neoplasm Metastasis

A 30 year-old women who had had moderately advanced pulmonary tuberculosis and taken antituberculosis regimens including rifampicin was admitted with the symptoms of petechiae on the trunk and extremities and gum bleeding. The thrombocytopenic purpura appeared 20 days after the treatment with rifampicin, and which was rapidly improved with discontinuation of the drug. The diagnosis was confirmed by relapse of thrombocytopenia after retreatment with rifampicin. The paper presents a patient with thrombocytopenia induced by rifampicin and a brief review of pertinent literature.
Adult ; Diagnosis ; Extremities ; Female ; Gingiva ; Hemorrhage ; Humans ; Purpura ; Purpura, Thrombocytopenic* ; Recurrence ; Retreatment ; Rifampin ; Thrombocytopenia ; Tuberculosis, Pulmonary

Dapsone toxicity is evidenced by varying clinical pictures ranging from deep cyanosis in an otherwise alert normal appearing individual to restlessness, dyspnea, extensive hemolytic anemia, methemoglobinemia, sulfhemoglobinemia and serious central nervous system dysfunction. We experienced a case of acute massive dapsone intoxication in 34 years old man due to voluntary ingestion of 25g of this drug as a suicide attempt. A severe methemoglobinemia developed, accompanied by nausea, vomiting, intense cyanosis, headache, and dyspnea. Subsequently moderate hemolytic anemia observed. The patient recovered completely after intensive treatment with methylene blue, activated charcoal hemoperfusion, oral charcoal ingestion, steroid, and conservative treatment. Methylene blue was given by continuous intravenous infusion in order to avoid overdosage. We herein report a case of the acute hemolytic anemia and severe methemoglobinemia induced by massive dapsone intoxication with a review of the literature.
Adult ; Anemia, Hemolytic* ; Central Nervous System ; Charcoal ; Cyanosis ; Dapsone* ; Dyspnea ; Eating ; Headache ; Hemoperfusion ; Humans ; Infusions, Intravenous ; Methemoglobinemia* ; Methylene Blue ; Nausea ; Psychomotor Agitation ; Suicide ; Sulfhemoglobinemia ; Vomiting

OBJECTIVE: To determine the relationship between the clinical outcome and the extent of surgical laminectomy for adequate decompression on the cases of cauda equina syndrome, the authors review and analyze their cases and compared with those of literatures. METHODS: The authors reviewed 655 patients retrospectively who had underwent surgery on the cases of lumbar disc herniation from January 2000 to December 2004. There were 19 patients (2.9%) who presented for clinical cauda equina syndrome. Among them, we selected and analyzed 15 patients who were treated by unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy, and they had been followed from 5 weeks to 47 months postoperatively (mean, 13.47 months). The levels of the disc herniations were L4-5 in 8 patients, following L5-S1 in 4 patients and 2 levels(L4-5 and L5-S1) in 3 patients. Motor and sensory recoveries were recorded. Postoperative urinary function recovery was defined according to Gleave and Macfarlane7). RESULTS: In 12 months postoperatively, the bladder function was obtained in 14 of 15 patients(93%) with regaining urinary continence. Thirteen of 15 patients(86%) with preoperative motor weakness of lower extremities were recovered. Sensory deficit of lower extremities, perianal and saddle anesthesia were all recovered. Patients had recovered on lumbosciatic pain and saddle hypesthesia, in turn, motor function and urinary incontinence. CONCLUSION: In treating cauda equina syndrome, the authors did less extensive surgery, such as unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy for adequate decompression. The outcome is satisfactory and comparable with those of subtotal or total laminectomy.
Anesthesia ; Cauda Equina* ; Decompression ; Diskectomy ; Humans ; Hypesthesia ; Laminectomy ; Lower Extremity ; Polyradiculopathy* ; Recovery of Function ; Retrospective Studies ; Urinary Bladder ; Urinary Incontinence

PURPOSE: The purpose of this study was to assess the clinical outcomes of hypofractionated radiotherapy (HFRT) with three-dimensional conformal technique for medically inoperable patients with early stage non-small-cell lung cancer (NSCLC) and to evaluate prognostic factors. MATERIALS AND METHODS: We performed a retrospective review of 26 patients who underwent HFRT for early stage NSCLC between September 2005 and August 2011. Only clinical stage T1-3N0 was included. The median RT dose was 70 Gy (range, 60 to 72 Gy) and the median biologically equivalent dose (BED) was 94.5 Gy (range, 78.0 to 100.8 Gy). In 84.6% of patients, 4 Gy per fraction was used. Neoadjuvant chemotherapy with paclitaxel and cisplatin was given to 2 of 26 patients. RESULTS: The median follow-up time for surviving patients was 21 months (range, 13 to 49 months). The overall response rate was 53.9%, and the initial local control rate was 100%. The median survival duration was 27.8 months. Rates of 2-year overall survival, progression-free survival (PFS), local control (LC), and locoregional-free survival (LRFS) were 54.3%, 61.1%, 74.6%, and 61.9%, respectively. Multivariate analysis showed that BED (>90 vs. < or =90 Gy) was an independent prognostic factor influencing PFS, LC, and LRFS. Severe toxicities over grade 3 were not observed. CONCLUSION: Radical HFRT can yield satisfactory disease control with acceptable rates of toxicities in medically inoperable patients with early stage NSCLC. HFRT is a viable alternative for clinics and patients ineligible for stereotactic ablative radiotherapy. BED over 90 Gy and 4 Gy per fraction might be appropriate for HFRT.
Cisplatin ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Multivariate Analysis ; Paclitaxel ; Radiotherapy, Conformal ; Retrospective Studies

Background: Facial herpes zoster can be accompanied by several complications. In particular, postherpetic neuralgia (PHN) and ocular complications (OCs) are relatively common. Both PHN and OC are of interest because they can lower the quality of life. Objective: This study aimed to evaluate the clinical features of facial herpes zoster and to assess the risk factors of OCs and PHN. Methods: We analyzed the medical records of 146 patients with facial herpes zoster from January 2014 to May 2019. We assessed the proportion of OCs and PHN in patients with facial herpes zoster according to several clinical factors, including age, sex, dermatomal distribution, delayed time to treatment, and associated systemic conditions. OCs were divided into mild and severe ocular complications (SOC) by ophthalmologic diagnosis. Results: The incidence rate of OCs (83.8%) and SOC (37.8%) were highest in patients in their 70s. Herpes zoster involving the ophthalmic and maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of OCs and SOC than those involving only the ophthalmic branch (p=0.031, p=0.025). Patients who received antiviral treatment within 4 days showed lower rates of OCs and SOC than patients who received treatment after 5 days (p＜0.001, p=0.003). The incidence of PHN was significantly higher in those over 60 years old, when both the ophthalmic and maxillary branches were involved, and for those treated more than 4 days after the onset. Conclusion To decrease the risk of OCs and PHN in facial herpes zoster, it is important to provide early antiviral treatment and appropriate ophthalmologic consultation.