Erythema multiforme(EM) is an acute, self-limited eruption of the skin and mucous membrane, characterized by distinctive target lesions. Although a wide range of factors have been implicated as precipitating EM, the pathogenesis is unknown. Recently, several studies on EM have been reportecl, showing the presence of immune complexes in patient with EM, and these authors suggested that such complexes may be cf immunopathogenic significance. The atudy was undertaken to irivestigate the pathogenesis of EM. In ten patients with EM, we performed serological study and direct immunofluorescence study. The reaults obtained were as follows. 1) There was no signifir.ant abnormality in CBC, urinalysis, chest PA, stool, and serology including ASO, CH, Ig quantitation, VDRL, HBsAg, ANA, RF, and cryoglobul in. 2 In direct immunofluorescence study, 4 biopsies showed IgM deposits in the su!erficial blood vessels, 4 demonstrated C, 2 showed IgG deposition and 2 biopsies showed fibrin deposition. All biopsies were negative for lgA. Additionally 1 biopsy demonstrated IgM depnsition along the dermoepidermal junction, and 1 showed both IgG and fihrin deposition. This study supports the view that deposition of immune complexes may play a role in the pathogenesis of EM.
Biopsy

Actinomycosis is an indolent, suppurative infection caused by an anaerobic gram-positive organism (usually actinomyces israelii) which usually causes infection in the face, mediastitum, lung, and abdomen. Primary esophageal actinomycosis which is not related with pulmonary or mediastinal actinomycosis, is very rare, especially in immunocompetent host. A 58-year-old woman has been suffered from dysphagia, odynophagia, and chest pain after insertion of esophageal stent in esophageal acid stricture. She underwent a esophagectomy with esophagogastrostomy for above mentioned symptoms. Pathologic diagnosis was a esophageal actinomycosis.
Abdomen ; Actinomyces ; Actinomycosis* ; Chest Pain ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis ; Esophagectomy ; Female ; Humans ; Lung ; Middle Aged ; Stents*

No abstract available.
Congenital Hypothyroidism*

No abstract available.
Arm* ; Free Tissue Flaps*

No abstract available.
Esophageal Atresia* ; Tracheoesophageal Fistula*

Antibiotics were reported to be able to alter bacterial surface properties in subinhibitory concentrations (sub-MICs). The effects of sub-MICs of certain antibiotics on a bacterial surface property such as hemagglutination, as well as on the cell morphology were studied using Streptococcus gordonii and Staphylococcus aureus. The effect of sub-M1Cs of antibiotics on the binding of these bacteria to immobilized fibrinogen were also investigated. The MICs of antibiotics were determined by culturing S. gordonii and S. aureus in media supplemented with serially diluted drug solutions, and one-half the MIC was used as the sub-MIC of the drugs, unless stated otherwise. Sub-MICs of antibiotics did not affect bacterial agglutination of erythrocytes. Microscopic observation of S. gordonii grown at sub-MIC concentration of 0.02 ug/ml of amoxicillin revealed cell enlargement of 1.6 times those grown without the drug. When grown in the sub-MIC amount of 0.08 ug/ml of cefazolin, most S. gordonii cells were enlarged and elongated into rod-shape, resulting in 3 times the size of the cells grown without the antibiotic. The data from the fibrinogen-binding experiments showed that the binding of S. gordonii to immobilized fibrinogen was increased with all the B-lactam drugs tested; the binding of S. aureus to immobilized fibrinogen, on the other hand, was decreased with the same drugs. The results show that low concentrations of certain B-lactam antibiotics are able to cause alterations in cellular morphology of S. gordonii and affect the binding of S. gordonii and S. aureus to immobilized fibrinogen.
Agglutination ; Amoxicillin ; Anti-Bacterial Agents* ; Bacteria ; Cefazolin ; Cell Enlargement ; Erythrocytes ; Fibrinogen ; Hand ; Hemagglutination ; Staphylococcus aureus* ; Staphylococcus* ; Streptococcus gordonii* ; Streptococcus* ; Surface Properties*

We evaluated the clinical effects of Nicorandil in 27 patients (17 male and 10 female) with ischemic heart disease (17 patients of stable effort angina, 3 patients of unstable effort angina, 6 patients of spontaneous angina, 1 patient of variant angina) in terms of the effect on the anginal pain, electrocardiographic changes and side effects. The results obtained were as follows; 1. The pulse rate was not changed by the drug administration and blood pressure were decreased slightly by Nicorandil in a daily dose of 15 mg divided into 3 dose, but these decrease were not significant in statistical meaning. 2. Improvement in EKG changes was observed in 9 patients (69%) among the 13 patients who showed abnormal EKG initially. 3. Anti-anginal effect of nicorandil were excellent in 14 patients, good in 8 patients, fair in 3 patients and so the rate of global improvement was 82%. 4. Nicorandil had side effects in 7 patients, headache (4 patients), palpitation, ocular pain, edema, but these were transitory and tolerable except of one case who could not be continued because of severe headache.
Angina Pectoris* ; Blood Pressure ; Edema ; Electrocardiography ; Headache ; Heart Rate ; Humans ; Male ; Myocardial Ischemia ; Nicorandil*

BACKGROUND: The most important thing to strengthen primary care is to prove that the continuity of primary care is an essential area for good health outcomes. The purpose of this study is to analyze the effect of outpatient continuity of primary care on the hospitalization experience of diabetes mellitus in new diabetic patients. METHODS: Using the Korean National Health Insurance Service national sample cohort (NHIS-NSC 2011–2015) data, 3,391 new diabetic patients in 2012 were selected for the study. Multiple logistic regression was performed to investigate the effect of outpatient continuity of primary care on hospitalization in new diabetic patients. RESULTS: The outpatient continuity of primary care in new diabetic patients was measured by the continuity of care index, which showed that 69.4% (n=2,352) were high level and 30.6% (n=1,039) were low level. Patients who had high continuity of primary care at the early stage of diabetes diagnosis showed 3.49 times more likely to maintain high continuity of primary care in the second year (95% confidence interval [CI], 2.72–4.49). Patients with low continuity of primary care for 2 years from the initial diagnosis of diabetes were 2.56 times more likely to be hospitalized due to diabetes than those who did not (95% CI, 1.55–4.25). CONCLUSION: This study identified the need for policies to increase the continuity of primary care for new diabetic patients and could contribute to lowering the admission rate of diabetic patients if the policy for this would work effectively.
Cohort Studies ; Continuity of Patient Care ; Diabetes Mellitus ; Diagnosis ; Hospitalization ; Humans ; Logistic Models ; National Health Programs ; Outpatients ; Primary Health Care

No abstract available.
Esophageal Atresia* ; Tracheoesophageal Fistula*

BACKGROUND: Left ventricular hypertrophy is a major cardiovascular risk factor for sudden death, acute myocardial infarction and congestive heart failure. The left ventricle is generally thought to adapt to sustained arterial hypertension with increased total peripheral resistance by developing concentric hypertrophy. In recent years, the echocardiogrphy has been developed as a noninvasive method for evaluation of left ventricular geometry and left ventricular mass. However, left ventricular adaptation to hypertension has been shown to be more complex than expected. In fact, many patients with mild to moderate hypertension exhibit normal left ventricular mass and wall thickness, other hypertensive patients have eccentric ventricular hypertrophy that is not related to systolic dysfunction, but rather to increased cardiac output and preload and in some hypertensive patients absolute and relative wall thickness is increased with normal ventricular mass(concentric remodeling). There are differences in the hemodynamics, systolic function and diastolic function in each group. METHODS: From september 1992 to August 1994, in 144 patients with untreated essential hypertension and 50 age and gender matched normal adults studied by two-dimensional, M-mode and Doppler echocardiography. In the present study we used echocardiographically derived left ventricular mass and relative wall thickness to assess the patterns of ventricular geometric adaptation to systemic hypertension and their relations to systemic hemodynamics, left ventricular load and contractile performance. RESULTS: Hypertensive group was 144 cases(M:F=68:76), the mean age 56+/-13years. Normotensive group was 50 cases(M:F=22:28), the mean age 52+/-9years. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 42 cases(29%), 24 cases(17%) had increased relative wall thickness with normal ventricular mass(concentric remodelin),48 cases(33%) had both increased relative wall thickness and ventricular mass(concentric hypertrophy), 30 cases(21%) had increased left ventricular mass with normal relative wall thickness(eccentric hypertrophy). Concentric hypertrophy and normal left ventricle group are more common in untreated hypertensive patients in Korea. Systemic hemodynamics showed tendency to paralleled ventricular geomety. In groups with concentric remodeling and hypertrophy, perpheral resistance was increased. Cardiac index was midly increased in eccentric hypertrophy. Diastolic dysfunction was prominent tn concentric hypertrophy. CONCLUSION: Each patterns of left ventricular geometry had different systemic hemodynamics, ventricular pressure overload and ventricular volume overload. Therefore, appropriate selection of antihypertensive agent for the patients with each patterns of hypertrophy reduce the left ventricular hypertrophy and may improve the prognosis.
Adult ; Cardiac Output ; Death, Sudden ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular* ; Korea ; Myocardial Infarction ; Prognosis ; Risk Factors ; Vascular Resistance ; Ventricular Pressure