Herpes simplex esophagitis can occur in those with normal immune function, but is more often seen in those who are immunocompromised. In one series, 5 percent of post-kidney transplant recipients had herpes esophagitis. We experienced a case of herpes simplex esophagitis, following renal transplantation in a 9 year old male. He complained of epigastric pain, nausea and blood-tinged vomiting. Endoscopic examination showed volcano ulcer, mucosal friability and multiple confluent ulcers covered by whitish exudates on elevated margin in the middle and lower esophagus. Microscopic findings revealed multinucleated giant cells, margination of chromatin, intense nonspecific inflammation and strong positive for herpes simplex virus immunohistochemical staining. Esophageal lesions and symptoms improved after acyclovir therapy.
Acyclovir ; Child* ; Chromatin ; Esophagitis ; Esophagus ; Exudates and Transudates ; Giant Cells ; Herpes Simplex* ; Humans ; Inflammation ; Kidney Transplantation ; Male ; Nausea ; Simplexvirus* ; Transplantation ; Ulcer ; Vomiting

BACKGROUND: Spa therapy is widely used in many countries for the treatment of atopic dermatitis. There have been some reports about the therapeutic efficacies and mechanisms of spa therapy for the treatment of atopic dermatitis (AD) from other countries, but there have been no such reports from Korea. OBJECTIVE: The purpose of this study was to investigate the therapeutic efficacy and the safety of Hae-Un-Dae spa therapy for adult AD patients. METHODS: A total of 15 patients with AD were recruited in this study. The patients were classified into the mild group (n=5) and severe group (n=10) according to their eczema area and severity index (EASI) score at baseline. They had a bath in a Hae-Un-Dae spa three times per week for 4 weeks. To evaluate the therapeutic efficacy, the EASI score, the physician's global assessment (PGA) and the visual analogue scale (VAS) for pruritus were assessed every week. The skin hydration, the skin pH and the transepidermal water loss (TEWL) were also measured weekly to investigate the changes of the skin barrier function during the spa therapy. RESULTS: Compared to baseline, the EASI scores of the total group and the severe group decreased at 2, 3 and 4 weeks. Furthermore, the VAS for pruritus of the total group and the severe group was also decreased. Among the factors of the skin barrier function, the skin pH decreased in the mild group and it increased in the severe group during the spa therapy. Of the 15 patients, one patient experienced exacerbation of symptoms and two patients reported a transient pickling sensation during the spa therapy. CONCLUSION: Our study suggests that Hae-Un-Dae spa therapy could be an effective and safe modality for the management of adult AD, yet more studies should be performed to determine the therapeutic mechanism.
Adult ; Baths ; Dermatitis, Atopic ; Eczema ; Humans ; Hydrogen-Ion Concentration ; Pruritus ; Sensation ; Skin

BACKGROUND: A rapid increase in the desflurane concentration induces tachycardia and hypertension and increases the plasma catecholamine concentration. This study compared the desflurane-induced hemodynamic responses in hypertensive patients with those of normotensive patients. METHODS: Sixty patients, 30 normotensive patient (group 1) and 30 hypertensive patients (group 2), were scheduled to undergo elective surgery under general anesthesia. The hypertensive patients have been taking regular antihypertensive drugs and their blood pressure and heart rate was well controlled. Thirty normotensive patients were not premedicated. The inspired concentration of desflurane through the mask was increased abruptly to 12.0 vol%. The target was to produce an end-tidal concentration of desflurane (ETdesf) of 10.0 vol% which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), blood pressure (BP), cardiac index (CI), systemic vascular resistance (SVR), ETdesf, end-tidal concentration of carbon dioxide, and peripheral oxygen saturation were measured at the baseline and every 30 seconds for 5 minutes after inhaling of desflurane and for 2 minutes after intubation. RESULTS: The HR, BP, and CI increased significantly in the two groups compared with the baseline. However, the HR, blood pressure, CI, SVR, and ETdesf were similar in both groups. In addition, there were no significant differences of hemodynamic changes between the beta-blocker and the calcium channel blocker in the hypertensive patients. CONCLUSIONS: In patients with well-controlled hypertension, the hemodynamic responses to desflurane are similar to those in normotensive patients.
Anesthesia, General ; Antihypertensive Agents ; Blood Pressure ; Calcium Channels ; Carbon Dioxide ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Inhalation ; Intubation ; Masks ; Nebulizers and Vaporizers ; Oxygen ; Plasma ; Tachycardia ; Vascular Resistance

PURPOSE: Pathologic downstaging of rectal cancer has been suggested to be associated with the time interval from chemoradiotherapy (CRT) completion to surgery. We aimed to evaluate the effect of this time interval for patients with rectal cancer on the pathologic response. METHODS: All patients with rectal cancer undergoing neoadjuvant CRT with evaluable data were selected from among the Health Insurance Review and Assessment Service data. Patients were divided into groups according to the time between CRT and surgery. CRT responses were analyzed. RESULTS: Two hundred forty-nine patients were included, of whom 86 (34.5%) were in the 5- to 7-week interval, 113 (45.4%) in the 7- to 9-week interval, 38 (15.3%) in the 9- to 11-week interval, and 12 (4.8%) in the >11-week interval. The median time interval between CRT completion and surgery was 7.4 weeks (range: 5–22.7 weeks; interquartile range, 6.7–8.7 weeks). Surgery 9–11 weeks after CRT completion resulted in the highest, but not statistically significant, pathologic complete response (pCR) rate (3 patients, 8.6%; P = 0.886), no pCR was noted in the >11-week interval group. Results for downstaging in the 9- to 11-week interval group were as follows: T downstaging, 38.2% (P = 0.735); N downstaging, 50.0% (P = 0.439); and TN downstaging, 52.9% (P = 0.087). The 3-year overall survival rates for the 5- to 7-week, 7- to 9-week, 9- to 11-week, and >11-week interval groups were 93.0%, 85.0%, 81.6%, and 91.7%, respectively (P = 0.326). CONCLUSION: Delaying surgery by 9 to 11 weeks may increase TN downstaging, but delaying for over 11 weeks may not increase additional tumor downstaging from long-course CRT.
Chemoradiotherapy* ; Humans ; Insurance, Health* ; Neoadjuvant Therapy ; Polymerase Chain Reaction ; Rectal Neoplasms* ; Survival Rate

Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptive and compensatory mechanisms already existing in the human brain. Although the evidence is sparse for improvement in subjects with central vestibular dysfunction following VRT, it improves postural stability in cerebellar diseases and reduces subjective complaints and fall risk in Parkinson disease. Possible mechanisms of recovery after central nervous system lesions may include neural sprouting, vicarious functions, functional reorganization, substitution, and plasticity. VRT regimens for patients with central causes should include balance and gait training, general strengthening and flexibility exercises, utilization of somatosensory and vision and utilization of alternate motor control strategies. VRT would be an option to relieve the symptoms of the many patients who have central dizziness.
Brain ; Central Nervous System ; Cerebellar Diseases ; Dizziness ; Exercise ; Gait ; Humans ; Parkinson Disease ; Plastics ; Pliability ; Rehabilitation

Jeollabuk-do ; Osteotomy ; Recurrence

Orthognathic Surgery ; Politics ; Prognosis ; Social Change

BACKGROUND: Accurate and rapid detection of extended-spectrum beta-lactamases (ESBLs) is important in guiding proper antimicrobial therapy for infected patients. We evaluated the performance of MicroScan NegCombo Type 44 panel (Dade Behring, USA), which was developed to confirm ESBL-producing Enterobacteriaceae using ceftazidime/clavulanate and cefotaxime/clavulanate. METHODS: From August 30 to September 20, 2007, 206 non-duplicate clinical isolates, including 106 Escherichia coli, 81 Klebsiella pneumoniae, 11 Klebsiella oxytoca, and 8 Proteus mirabilis were subcultured and tested with Type 32 and Type 44 panels. The results were compared with those of the CLSI phenotypic confirmatory test (CLSI-PCT) and disk approximation test (DAT). Isolates not susceptible to cefotetan or flagged as "Possible ESBL, unable to interpret confirm test (Possible ESBL)" on Type 44 panel were tested with boronic acid disks to confirm AmpC beta-lactamases (AmpC) production. RESULTS: Of the 206 isolates tested, 44 (21.4%) produced ESBL by CLSI-PCT or DAT, including 27 E. coli, 14 K. pneumoniae, 2 K. oxytoca, and 1 P. mirabilis. Thirty-eight isolates flagged as "Confirmed ESBL" on Type 44 panel were all confirmed as ESBL-producers. Of 14 K. pneumoniae flagged as "Possible ESBL", 6 were confirmed as ESBL and AmpC co-producers and 8 as AmpC-producers. CONCLUSIONS: Type 44 panel showed an excellent performance in detecting ESBL-producing E. coli, Klebsiella spp., and P. mirabilis. When flagged as "Confirmed ESBL", no other confirmatory test was necessary to report as ESBL; however, "Possible ESBL" required a differential test for AmpC production.
Bacterial Proteins/*biosynthesis ; Cefotetan/pharmacology ; Disk Diffusion Antimicrobial Tests ; Drug Resistance, Bacterial ; Escherichia coli/*enzymology/isolation & purification ; Humans ; Klebsiella/*enzymology/isolation & purification ; Proteus mirabilis/*enzymology/isolation & purification ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; beta-Lactamases/*biosynthesis

IgG4-related disease (IgG4-RD) is a group of fibro-inflammatory diseases affecting multiple organ systems, pathologically characterized by tissue infiltration with abundant IgG4-positive cells. We here report a case of IgG4-RD that was successfully controlled by mycophenolic acid (MPA). A 62-year-old male visited complaining of dizziness and loss of appetite. He had a clinical history of autoimmune pancreatitis treated with steroids and cyclophosphamide 5 years prior, and had also been diagnosed with Hashimoto's thyroiditis at the age of 55 years. We initially prescribed prednisolone (1 mg/kg), tapered to 5 mg/day over 8 months. However, his eosinophilia gradually deteriorated, and we added cyclophosphamide (1 mg/kg daily) for the next 7 months. His laboratory data fluctuated when he was on low-dose predinisolone and cyclophosphamide, and we thus changed his medication to prednisolone combined with MPA for the following 63 months. Currently, his laboratory findings are stable.
Appetite ; Cyclophosphamide ; Dizziness ; Eosinophilia ; Humans ; Immunoglobulin G ; Male ; Middle Aged ; Mycophenolic Acid* ; Pancreatitis ; Prednisolone ; Steroids ; Thyroid Gland ; Thyroiditis

Methotrexate (MTX) is indicated for patients with moderate to severe rheumatoid arthritis (RA), but it sometimes causes severe hematologic complications in patients with impaired renal function. We experienced three cases of pancytopenia due to low-dose MTX treatment in RA patients with impaired renal function. Two patients were dialysis patients, and the other had stage 4 chronic kidney disease. The mean cumulative MTX dose and treatment duration for the three patients was 25 mg and 10 days, respectively. All cases experienced severe stomatitis and pancytopenia and recovered with conservative care. In conclusion, MTX should be used cautiously in patients with impaired renal function.
Arthritis, Rheumatoid ; Dialysis ; Humans ; Methotrexate ; Pancytopenia ; Renal Insufficiency, Chronic ; Stomatitis