High dose intravenous gammaglobuline (IVLG) therapy is effective in some of the autoimmune diseases. Although the exact mechanism of action of IVIG is uncertain, the action as a neutralizing antibody against unknown etiologic agents, the action of blocking of Fc receptors of effector cells, or the action as a antiidiotypic antibody are suggested. We report a case of 12 year old girl with systemic juvenile rheumatoid arthritis who was treated with high dose IVIG and got a remission. In August 1990 she was admitted to our hospital. because of intermittent fever, transient rash and multiple arthralgia. Under the diagnosis of systemic juvenile rheumatoid arthritis, aspirin (4.0g/day) had been given with symptom improvement. She was readmitted in October 1990 because of aspirin intoxication and acute fulminant hepatitis. She was discharged after recovery and any medicine was not prescribed. In November 1990 she was admitted because of epigastric pain, vomiting, intermittent fever, multiple arthritis, and mild hepatomegaly. Total parenteral alimentation had been given under the diagnosis of superior mesenteric artery syndrome and gold sodium thiomalate (Myochrysine, 5 and 10 mg, two weekly IM injection) was given in conjunction with prednisolone (30 mg/day) and naproxen (375 mg/day). She was admitted again in February 1991 due to the fever, coughing, rash, and hepatosplenomegaly. Pneumonia and leukopenia (2100/mm(3)) were found and gold sodium thiomalate injection was discontinued. Gammaglobulin 1 g/kg/day was given intravenously for 2 consecutive days with dramatic symptom improvement. Five more monthly IV gammaglobulin had been given and the side reaction of injection were nausia, fever, and headache which were controlled by the decrease of infusion rate. Four months after the last IVIG injection she had no symtom of arthritis and the hepatosplenomegaly was decreased. Hemoglobin level was increase to 12.2 mg/dL form 6.2mg/dL and ESR was decrease to 15mm/h. The oral prednisolne and ibuprofen were stopped one year after th last IVIG injection. All the laboratory parameters of arthritis and physical examinations had been normal for more than two year after the stop of all the medications until March of 1994. We suggest that high dose intravenous gammaglobulin can be one of treatments for severe systemic juvenile rheumatoid arthritis.
Antibodies, Neutralizing ; Arthralgia ; Arthritis ; Arthritis, Juvenile ; Aspirin ; Autoimmune Diseases ; Child ; Cough ; Diagnosis ; Exanthema ; Female ; Fever ; Gold Sodium Thiomalate ; Headache ; Hepatitis ; Hepatomegaly ; Humans ; Ibuprofen ; Immunoglobulins, Intravenous ; Leukopenia ; Naproxen ; Physical Examination ; Pneumonia ; Prednisolone ; Receptors, Fc ; Superior Mesenteric Artery Syndrome ; Vomiting

Three cases of human embryo of Carnegie stage 13 were described. The CR length of these embryos were 3.0-5.3mm. The authors made a reconstruction model using photograph, photocopy and computer. These embryos were characterized externally by 4 limb buds and 4 pairs of branchial arches, and internally closed otic pits, appearance of venous valves, septum primum and foramen primum in the heart, beginning of the right and left lung buds, appearance of lens disk.
Branchial Region ; Embryonic Structures* ; Heart ; Humans* ; Limb Buds ; Lung ; Venous Valves

Clinical electrophysiological studies(EPS) were done in seven patients with chronic recurrent sustained ventricular tachycardia(VT) in an attempt to delineate the reproducibility and to select the effective antiarrhythmic drugs for the prevention of the recurrence of VT. We could induce and terminate the sustained VT, and could select the effective antiarrhythmic drugs in all patient in the cardiac catheterization laboratory with EPS. With these effective antiarrhythmic drugs VT did not recur for the follow up period of 15 to 20 months. In view of the serious nature of the VT and the demonstrated benefits of EPS, we could conclude that patients with chronic recurrent sustained VT should undergo EPS.
Anti-Arrhythmia Agents ; Cardiac Catheterization ; Cardiac Catheters ; Follow-Up Studies ; Humans ; Recurrence ; Tachycardia, Ventricular*

The antihypertensive action of Lasix(R) retard 30 was evaluated in 20 cases of essential hypertension on an outpatient basis. The following results were obtained. 1. The patient population comprised 11 males and 9 females, aged 32 to 67 years, with mild to moderate essential hypertension. mean age was 50 years, with 75% between 40 and 59 years of age. 2. The daily effective doses ranged from 1 to 3 capsules with an average of 1.7 capsules. The total duration of medication ranged from 4 to 12 weeks with an average of 6.5 weeks. 3. In 60% of the cases, good or fair control of blood pressure was resulted. Most of the poor results were in the cases of moderate hypertension, but the results could be improved with continuous treatment or combination with other antihypertensive drugs. 4. Transient dizziness and drowsiness were complained by 2 patients, but subsided spontaneously with continuous treatment. 5. In view of these results, Lasix retard 30 appears to be effective and well tolerated agent for the treatment of mild to moderate hypertension, either used alone or combined with other antihypertensive drugs.
Antihypertensive Agents ; Blood Pressure ; Capsules ; Dizziness ; Female ; Furosemide ; Humans ; Hypertension ; Male ; Outpatients ; Sleep Stages

The toxic effect of carp bile is well documented since earlier times but its exact mechanism of toxicity is unclear till now. Recently we have experienced a case of acute renal failure with toxic hepatitis in a 32-year-old man who ingested raw carp bile. He suffered from abdominal pain, nausea, vomiting and diarrhea, which occurred 3 hours after the ingestion of raw carp bile juice. Hematuria, proteinuria, oliguria and jaundice developed subsequently. 9 times of hemodialyses was performed and hepatitis was treated by conservative measure. The patient was discharged after 17 days of hospitalization. About 1 month after carp bile ingestion, no sequelae was detected. The authors report a case of acute renal failure due to carp bile juice ingestion with review of literature. Further study in needed as to the toxic substances of carp bile and pathogenesis.
Abdominal Pain ; Acute Kidney Injury* ; Adult ; Bile* ; Carps* ; Diarrhea ; Drug-Induced Liver Injury* ; Eating ; Hematuria ; Hepatitis ; Hospitalization ; Humans ; Jaundice ; Nausea ; Oliguria ; Proteinuria ; Renal Dialysis ; Vomiting

No abstract available.

Dermatologic treatment was greatly advanced when topical corticasteroids were introduced for the management of many inflammatory and pruritic dermatoses. Their use reduced or diminished mnst of the undiserable side effects which accompanied the systemic administration of these compounds. The good effects of topical application of hydrocortisone had been demonstration in the treatment of variaus dermatoses eg., atopic dermatitis, seborrheic dermatitis, contact dermatitis etc. The halogenated derivatives followed and led to the trend to most of analogs now in use. Especially, fluocinolone acetonide cream greatly enhanced its therapeutic effectiveness in psoriasis, chronic discoid lupus erythematosus, pustular bacterid, granuloma and neurodermatitis circumscripta. But many side effects of topical corticosteroids such as steroid acne. Stria were developed and also fluorinated topical corticosteroids resulted in telangiectasia, purpura, atrophy in skin. Weber reported that strong topical corticosteroids eg.. Betamethasone valerate and fluocinolone acetonide were resulted in rosacealikc dermatitis and it was steadily increased. These adverse side effcts of topical corticosteroids, especially steroid acne, were indisputable argument in dermatologic field, for the view that this topical corticosterodis is used for cosmetics and treatment of acne vulgaris in our country. Since the strong corticosteroid tnpical preparation, the peculiar form acne, so called steroid acne, was steadily increased in our clinic. Behrman and goodman reported that acneform eruption induced by hormone was not associated with oiliness and there were but few comedone. Sullivan and Zeligman reported that the the acneform eruption due to adrenal corticaa 1 hormone was uniform in size, small papule and few pustule, usualIy erythematous base. There were also differential histologic feature. The most important difference is the normal apperance of sebaceous glands in acneform eruption due to corticosteroids contrast with hyperplasia in acne vulgaris. Abscess formation was more frequent and more extensive in acne vulgaris. Sutton Jr and Van Scott & MacCardle described that histologically, the major component in lesion of steroid acne was excessive keratinization of follicle. Castor and Baker demonstrated that topical application of corticosteroids resulted in decrease of sebaceous gIands, decrease of mitosis and increased cornification in epidermis. The present study investigated clinical case of the steroid acne, which are induced by topical application and systemic administration of corticosteroids and experimentally induced the steroid acne with the topical application of corticosteroid. And also clinical cases and experimentally induced steroid acne were compared with acne vulgaris. Material and method Subjects are 13 Patients of steroid acne induced by strong topical corticosteroid eg., fluocinolone acetonide, fluocortolone, dexamethaone, betamethasone valerate and 4 patients of steroid acne induced by systemic administration of corticosteroid eg., prednisolone and also 10 patients of acne vulgaris. Biopsy was performed from 13 patients of topical steroid acne, 3 patients of steroid acne induced by systemic administration of steroid and one patient of acne vulgaris. In order to induce steroid acne, experimentally, strong topical corticosteroid such as beta methasone valerate, fluocinolone acetonide and fluocortolone were applied on back. Comment and conclusion In Clinical feature, the steroid acne by topical application and systemic administration of corticosteroid and experimentally induced steroid acne had unique clinicall features, that showed absence of comedone and uniform sized follicular papule on deep seated erythematous scaly base. The topical steroid acne was distributed the region where were applied. But the eruption of the steroid acne induced by systemic administration of corticosteroids was distributed to face, neck, and scalp. Above findings are quite different form acne vulgaris. Histopathologically, the steroid acne induced by topical application and systemic administration of corticosterojds showed hypoplasia of sebaceous glands and excessive follicular keratinization. Occlusion of pilosebaceous opening by keratotic plug in severe case by long term application showed atrophy of epidermis and sparsity of sebaceous glands with hypokeratosis and parakeratosis. In experimentally induced steroid acne, it was definitely specific features which were absolutely identcall with above cinical steroid acne.
Abscess ; Acne Vulgaris* ; Adrenal Cortex Hormones ; Atrophy ; Betamethasone Valerate ; Biopsy ; Dermatitis ; Dermatitis, Atopic ; Dermatitis, Contact ; Dermatitis, Seborrheic ; Epidermis ; Fluocinolone Acetonide ; Fluocortolone ; Granuloma ; Humans ; Hydrocortisone ; Hyperplasia ; Lupus Erythematosus, Discoid ; Mitosis ; Neck ; Neurodermatitis ; Parakeratosis ; Prednisolone ; Psoriasis ; Purpura ; Scalp ; Sebaceous Glands ; Skin ; Skin Diseases ; Telangiectasis

No abstract available.
Osteoma, Osteoid* ; Spine*

Secondary localized amyloidosis of the skin is occasionaly associated with keratoma, epithelioma, seborrheic keratosis, chronic dermatitis, etc. It was generally known that amyloidosis, especially lichen amyloidosis, is frequently seen in atopic disorders. But the exact mechanism and relationship of atopic disorders to the development of the amyloidosis is obscure still nowadays. This 72 years old male patient was suffered from itching sensation on the whole body which is suggested to be atopic dermatitis since about 35 years ago and pruritic lichenoicl papulonodular eruptions developed on the extensor surface of the lower extremity first since about 10 years ago and then occured gradually on the thigh and extensor surface of the arm and forearm in both side. The charateristic lesions seems to be lichen amyloidosis. But we suggest thc case is secondary localized amyloidosis of the skin probably due to atopic dermatitis in according to past history, physical examination and eosinophilia without other definitive diseases, The therapeutic results were not promissing, however itching and lichenoid papules were much disappeared during the treatment with steroid cream for occlusivc dressing therapy and oral use of steroid.
Aged ; Amyloidosis* ; Arm ; Bandages ; Carcinoma ; Dermatitis ; Dermatitis, Atopic* ; Dronabinol ; Eosinophilia ; Forearm ; Humans ; Keratosis ; Keratosis, Seborrheic ; Lichens ; Lower Extremity ; Male ; Physical Examination ; Pruritus ; Sensation ; Skin ; Thigh

No abstract available.
Aloe*