Febrile ulceronecrotic PLEVA is an unusually severe from of PLEVA, characterized by the sudden onset of diffuse ulceronecrotic eruption aasociated with high fever. A mild eruption precede the acute fulminating course, We observed a 13-year-old boy presenting the form of febrile ulceronecrotic PLEVA. The histologic features were those of PLEVA. He received the systemic corticosteroids with aupportive care. To recognize this disorder is important because of a possibly fatal outcome, So close attention and vigorous therapy are necessary.
Adolescent ; Adrenal Cortex Hormones ; Fatal Outcome ; Fever ; Humans ; Male ; Pityriasis Lichenoides* ; Pityriasis*

We performed analysis of 79 childhood patients diagnosed as vitiligo and nevus depigmentosus in Tediatric Dermatologie Department of Seoul National University Hospital from March 1987 to September 1987. The results were as follows : 1. Of the 79 patients, 31 patients(39.2%) were vitiligo 21 patients(26.6% )were nevus depigmentosus and 27 patients(34.2%)were uncertain by cliniral diagnostic ctriteri.. 2. Viiligo began rarely in infancy(6.4% )and most appeared evenly in all childhood over 1 year old. Nevus clepigmentosus was present at birth in 57.1% of patients and was discovered within the first 6 months after birth in 42.9% of patients. 3. In vitiligo, most lesions were multiple. The most common site of involvement was the face, and there was this tendency of periorficial predisposition. In nevus ciepigmentosus, most lesions were solitary. The most, common aites of involvement were the lowed limbs and trunk, but there was no tendency of periorfcial presposition. 4. We found focal type of vitiligo in,51,6% of patients, vulgaris type in 32. 3 % acrofacial type in 9.6% and segmerital type in 6.5%. We also found isolated pattern of nevus clepigrnento us in 76.2% of patients, ciermatomal p<:ttern in 19.0ki and whorlec1 pattern in 4.8% The contrast enhiancement between the hypopigmented skin and nomal surrounding skin by Wood's light, examinatior reflected the epiclermal melanin pig merit, i. e., the more marked loss of pigmentation, the more accentuatian of the contrast The before, Wood's light examination without I:3OPA staining could help to ciiagnose the atisculte type of vitiligo showing eidermal melanocytes and nevu c.Iepigmeritosus.
Child* ; Dihydroxyphenylalanine* ; Extremities ; Humans ; Melanins ; Melanocytes ; Nevus* ; Parturition ; Pigmentation ; Seoul ; Skin ; Vitiligo*

BACKGROUND: Anti-streptolysin O (ASO) test is usually used to diagnose group A streptococcal infection-related diseases, such as rheumatic fever, reactive arthritis, and various infectious diseases. Despite the recent declining incidence of these diseases, ASO test is still frequently performed as a screening test to diagnose rheumatic diseases. This study re-evaluated the clinical usefulness of ASO test in systemic rheumatic diseases (SRD). METHODS: ASO tests was performed in 825 patients between April and October in 2010. ASO levels were compared between SRD and non-SRD groups of patients. The results of ASO, C-reactive protein (CRP), and rheumatoid factor (RF) were compared among 6 subgroups of SRD: rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Behcet disease, Sjogren's syndrome and others. RESULTS: Positive results in ASO test (>200 IU/mL) were observed in 15.3% (126/825) of the patients tested. None of the ASO positive patients was, however, diagnosed with rheumatic fever or reactive arthritis. There were no statistically significant differences in the mean value (P=0.688) or positive rate (P=0.835) of ASO test between SRD and non-SRD groups. Positive rates of ASO test were also not statistically significant different among six subgroups of SRD patients (all P>0.05), whereas those of CRP and RF tests were significantly different. CONCLUSIONS: The usefulness of ASO test is very low for diagnosing SRD, although it is frequently carried out as a screening test. We suggest that ASO test must be performed selectively when diseases from group A streptococcal infection are suspected.
Arthritis, Reactive ; Arthritis, Rheumatoid ; Behcet Syndrome ; C-Reactive Protein ; Communicable Diseases ; Humans ; Incidence ; Lupus Erythematosus, Systemic ; Mass Screening ; Rheumatic Diseases ; Rheumatic Fever ; Rheumatoid Factor ; Sjogren's Syndrome ; Spondylitis, Ankylosing ; Streptococcal Infections

BACKGROUND: Measurements of serum anti-thyroglobulin antibody (anti-Tg) and anti-thyroid peroxidase antibody (anti-TPO) are important for the diagnosis of autoimmune thyroid diseases. Although ELISA is most commonly used for the detection of anti-thyroid autoantibodies, other methods like particle agglutination assay (PA) or radioimmunoassay (RIA) are still being used in clinical laboratories. There are few studies about the comparison between PA and ELISA, and we evaluated the validity of these assays in this study. METHODS: We have used three methods, PA (Fujirebio Inc.), ELISA-1 (Zeus Scientific Inc.), and ELISA-2 (Orgentec Diagnostika) for the measurements of titers or concentrations of anti-thyroid autoantibodies. A total of 212 patients belonging to six different disease groups were tested: 40 patients for anti-Tg only, 64 for anti-TPO (or anti-microsome) only, and 108 for both antibodies. All test results were compared with each other in six disease groups. RESULTS: Concordance of positive or negative results was obtained in 78.5-97.3% of the samples tested, and positive rates of three methods were similar in autoimmume thyroid disease group. In the comparable concentration range, the correlation coefficients were 0.328-0.820 between the two ELISAs or between ELISA and PA. CONCLUSIONS: Positive or negative decisions by three assay systems have high concordance rates, and antibody levels measured by three methods correlate well in the comparable concentration range. The ELISA-1 shows less non-specific reactions, better discrimination in low level of autoantibodies, and the highest positive rate in autoimmume thyroid disease group.
Agglutination ; Antibodies ; Autoantibodies ; Discrimination (Psychology) ; Enzyme-Linked Immunosorbent Assay ; Humans ; Peroxidase ; Radioimmunoassay ; Thyroid Diseases

Purpose: The purpose of this study was to evaluate the effects of inhaled clary sage (Salvia sclarea L.) oil or linalyl acetate on patients’ anxiety and stress levels before undergoing chemotherapy. Methods: Forty-five eligible participants were randomly assigned to inhale clary sage oil, or linalyl acetate, each at concentrations of 5% vol/vol in almond oil or pure almond oil (control). State-trait anxiety inventory (STAI), Stress rating scale, anxiety-visual analog scale (Anxiety-VAS), stress-visual analog scale (Stress-VAS), blood pressure, and heart rate were measured before and after the inhalation prior to undergoing chemotherapy. Results: Anxiety-VAS and StressVAS were significantly lower after than before inhalation of clary sage oil (p < .01 and p < .05, respectively) and linalyl acetate (p < .05 and p < .05, respectively), despite having no significant difference in the three groups compared with control group. Systolic (p < .05) and diastolic (p < .01) blood pressure before undergoing chemotherapy were significantly lower after than before inhalation of linalyl acetate, while there was no significant difference in after than before inhalation of clary sage oil, despite both reducing levels of anxiety and stress. Conclusion These findings suggest that linalyl acetate inhalation may be inappropriate in lowering anxiety and stress in patients undergoing chemotherapy, despite its anxiolytic and antistress effects, while clary sage oil inhalation may be useful in reducing anxiety and stress in patients undergoing chemotherapy, which has a risk of hypotensive side effects.

Objective: This study aimed to determine the clinical factors associated with positive brain magnetic resonance imaging (MRI) findings in patients presenting to the emergency department (ED) with acute altered mental status (AMS). Methods: Patients with acute AMS who presented to the ED were retrospectively analyzed from September 2019 to March 2020. Non-traumatic patients with abnormal alert, verbal, pain, unresponsive (AVPU) scale scores and exhibiting acute change in mental status were included in the study. We evaluated the clinical characteristics of patients with acute AMS according to the results of their brain MRI. A multivariable logistic regression model was used to determine the clinical factors associated with positive brain MRI findings. Results: During the study period, 138 patients underwent brain MRI in the ED, with 36 (26.1%) positive results. A majority of patients with positive brain MRI findings had underlying malignancies, cerebrovascular disease, higher serum total bicarbonate (TCO2) levels, TCO2≥22 mmol/L, lower blood urea nitrogen levels, abnormal findings on brain computed tomography and abnormal findings on neurologic examination. In the multivariable analysis, serum TCO2≥22 mmol/L (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.09-4.12) and the presence of cranial nerve abnormalities (OR, 3.88; 95% CI, 1.55-9.68) and extremity abnormalities (OR, 2.76; 95% CI, 1.11-6.88) were significantly associated with positive brain MRI results. Conclusion Serum TCO2 level and the presence of cranial nerve and extremity abnormalities in the neurologic examinations were significantly associated with positive brain MRI results in patients with acute AMS.

Objective: We investigated the factors that affect the time from the onset of acute stroke symptoms to arrival at the emergency department (ED). Methods: Between July 2019 and February 2020, patients with acute stroke symptoms who visited a public hospital were evaluated by retrospective analysis using a prospective survey. The data for this study was gathered from baseline interviews with patients enrolled in stroke surveys. The primary outcome was time to arrival at the ED, evaluated as a binary variable with a value of 4.5 hours. Results: Overall, 205 patients were included in the final analysis. Among them, 47% (n=96) of patients with acute stroke symptoms arrived at the ED later than 4.5 hours from the time of onset of acute stroke symptoms. After multivariable logistic regression analyses, it was found that patients with higher National Institutes of Health Stroke Scale (NIHSS) scores, patients who did not live with their family members, and patients who were found by a passerby were associated with early ED arrival post onset of acute stroke symptoms. Among patients diagnosed with acute stroke, those with higher NIHSS scores or underlying malignant diseases were found to present earlier at the ED. Conclusion Approximately half of the patients (47%) with acute stroke symptoms presented to the ED within 4.5 hours. Higher NIHSS scores and the presence of underlying malignancy were identified as the key factors that were associated with an early presentation at the ED from the time of onset of acute stroke.

Dystonia is an abnormal movement characterized by sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures. Torsion dystonia is characterized by torsion spasms of muscle contraction, which distorts the limbs and trunk into dystonic postures. We present a case of a patient with torsion dystonia who was recalcitrant to oral medication or even surgical operations. This patient was treated with motor point block using 5% phenol solution. Using electromyographical guidance, phenol was injected into the paraspinal and upper extremity muscles, respectively. He showed reduction of dystonia and improvement of functional abilities. Motor point block using phenol can be considered as a tool of the management for patients with torsion dystonia. MDVAQ@yumc.yonsei.ac.kr
Dyskinesias ; Dystonia ; Dystonia Musculorum Deformans* ; Extremities ; Humans ; Muscle Contraction ; Muscles ; Phenol* ; Posture ; Spasm ; Upper Extremity

OBJECTIVE: To assess the reliability of triple marker screening test in midtrimester pregnancy for fetal Down syndrome. METHODS: From October 1, 1996 to May 31, 1998 at Nowon Eulji Hospital, 3700 Pregnant women underwent serum tiple marker screening for Down syndrome during 15-20weeks of gestational age. The results of serum triple marker screenig tests for Down syndrome and the outcomes of pregnancies were retrospectively assesed. RESULTS: Sixty seven of 3700 cases(1.81%) were positive in screening test, and 3633(98.18%) cases were negative. Among 67 cases of positive screening test, 1 case(1.49%) was diagnosed as Down syndrome. Among 3633 cases of negative screening test, 4 cases(0.1%) were diagnosed as chromosomal abnormalies postnatally. Two of these 4 cases of chromosomal abnormalies were Down syndrome. CONCLUSION: With this results, sensitivity of triple marker screeing test for Down syndrome is very low as 33.3%. In order to increase the sensitivity, some compensatory adjustment is required in triple marker screening test.
Down Syndrome* ; Equidae ; Female ; Gestational Age ; Humans ; Mass Screening* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second* ; Pregnant Women ; Retrospective Studies

BACKGROUND: Chronic cough is a common clinical problem to which various etiologies are attributable; postnasal drip, asthma, gastroesophageal reflux (GER) and chronic bronchitis, However, in some cases, no particular etiology can be confirmed. OBJECTIVE: This study was aimed to evaluate cough sensitivity and the clinical manifestations of patients with idiopathic chronic cough. MATERIALS AND METHODS: We recruited 70 non-smoking patients who had been coughing for more than 3 weeks without any history, symptoms or signs of rhinitis, sinusitis, typical asthma, GER or recent upper respiratory infection episodes. Nineteen healthy controls were also enrolled. Bronchial provocation tests with methacholine, capsaicin and distilled water (DW) were performed. RESULTS: Thirteen patients were positive to rnethacholine test (PC20 < 25mg/ml) and defined as cough variant asthma. The others are classified into idiopathic chronic cough. By capsaicin and DW challenge tests, idiopathic cough patients could be divided into two groups, i.e., increased cough sensitivity (ICS) and normal cough sensitivity (NCS) groups. DW- induced cough counts were negatively correlated with C7 (lowest capsaicin concentration inducing continuous 7 or more coughs) (r=-0.739, p<0.001). No difference was found in clinical features such as age, sex, atopy, or peripheral eosinophil counts between these two groups but cough counts per cough burst were significantly higher in the ICS group. CONCLUSION: The heterogeneity in cough sensitivity of idiopathic chronic cough patients may refiect different pathophysiologic mechanisms. It is unclear whether patients with NCS merely have habitual or psychogenic cough or not. These suggest that different therapentic strategies should be established on idiopathic chronic cough patients according to cough sensitivity.
Asthma ; Bronchial Provocation Tests ; Bronchitis, Chronic ; Capsaicin ; Cough* ; Eosinophils ; Gastroesophageal Reflux ; Humans ; Methacholine Chloride ; Population Characteristics ; Rhinitis ; Sinusitis ; Water