Juvenile pemphigus vulgaris (JPV) is a rare variant of pemphigus vulgaris (PV) occurring in childhood and adolescence that has similar symptoms and the same histological and immunopathological features as classic adult PV. Although rare, advanced cases of JPV can be fatal due to secondary sepsis. Many patients with JPV are misdiagnosed and therefore not properly treated in the early stages of the disease. Although systemic corticosteroids are the therapeutic mainstay, long-term corticosteroid use has various adverse effects. Intravenous immunoglobulin (IVIG) was recently reported to reduce the side effects of corticosteroids. Here, we report a case of JPV in a 14-year-old boy treated with IVIG.
Adolescent ; Adrenal Cortex Hormones ; Adult ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Male ; Pemphigus* ; Sepsis

PURPOSE: It has been reported recently that peritoneal protein clearance (Pcl) is a marker of endothelial dysfunction and cardiovascular disease in peritoneal dialysis patients. We evaluated whether baseline or longitudinal follow-up Pcl is a factor to consider in predicting the outcome in peritoneal dialysis patients for the follow-up period. METHODS: Patients who initiated continuous ambulatory peritoneal dialysis at our center from September 1994 to January 2006 and had a baseline peritoneal equilibration test, measurement of dialysis adequacy, and 24-h dialysate Pcl (24hr dialysate protein loss/ [serum albumin/0.4783]) were included. Demography, comorbidities, and biochemical data were retrospectively collected. Follow-up was until death or the end of the period studied (November 2009). RESULTS: A total of 203 patients (56% men, mean age 55.0+/-12.5; 55.2% with diabetes; 22.2% with cardiovascular disease) were included. The mean follow up period was 38 months (3-170 months). Baseline Pcl was 128.2 ml/day. Follow up data of Pcl were not changed from baseline period. Cox's analysis revealed the predictors of mortality (and technical failure) were age and diabetes mellitus but not dialysate/plasma creatinine ratio (D/Pcr) and Pcl. On multivariate analysis, Pcl was negatively correlated with serum albumin and triglyceride and positively correlated with D/Pcr and peritoneal creatinine clearance. CONCLUSION: Our study showed that the changes in Pcl over time were not significant from baseline up to 53 months. Neither baseline nor mean Pcl during the follow-up period were independent predictors for technical or patient survival.
Ascitic Fluid ; Cardiovascular Diseases ; Comorbidity ; Creatinine ; Demography ; Diabetes Mellitus ; Dialysis ; Follow-Up Studies ; Humans ; Male ; Multivariate Analysis ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Retrospective Studies ; Serum Albumin ; Treatment Outcome

Carbol fuchsin is a mixture of phenol and basics fuchsin, used in bacterial staining procedures. It is a component of Ziehl-Neelsen stain. Phenol in Carbol fuchsin is a toxic agent which can lead to various gastrointestinal, ocular, skin, neurologic and renal side effects. We hereby report a case of Carbol fuchsin poisoned patient. Acute renal failure with metabolic acidosis was rapidly progressed. However, she was treated successfully by continuous veno-venous hemodiafiltration.
Acidosis ; Acute Kidney Injury ; Dialysis ; Hemodiafiltration ; Hemoperfusion ; Humans ; Phenol ; Rosaniline Dyes ; Skin

BACKGROUND AND OBJECTIVES: Recent studies have reported that vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF)-1alpha are up-regulated in BRAF(V600E)-positive papillary thyroid carcinoma (PTC). We investigated whether papillary thyroid microcarcinomas (PTMCs) also exhibited increased expression of VEGF and HIF-1alpha. In addition, we analyzed the relationship between BRAF(V600E) mutation and clinicopathological parameters, as well as HIF-1alpha expression in PTMC. MATERIALS AND METHODS: We retrospectively selected 225 patients with PTMC. Immunohistochemical staining for HIF-1alpha and VEGF was performed using paraffinembedded PTMC tissue microarrays. BRAF(V600E) mutation status was analyzed by dideoxy sequencing. RESULTS: PTMCs larger than 0.5 cm tend to be related to aggressive clinicopathological features such as thyroid capsular invasion (p=0.023) and bilaterality (p=0.047). Immunoreactivity to HIF-1alpha (20.7%) and VEGF (30.2%) was more prominent in PTMCs as compared to normal follicular cells. However, HIF-1alpha and VEGF expression was not correlated with clinicopathological features. BRAF(V600E) mutation was found in 70.7% (159/225) of the PTMC cases. PTMCs harboring the BRAF(V600E) mutation exhibited larger tumor sizes as compared to PTMCs without the BRAF(V600E) mutation (p=0.038). However, BRAF(V600E) mutation status did not correlate with the expression of HIF-1alpha (p=0.623) or VEGF (p=0.990). CONCLUSION: HIF-1alpha and VEGF were more frequently detected in PTMCs as compared to normal thyroid tissues. However, BRAF(V600E) mutation status was not correlated with the expression of HIF-1alpha or VEGF in PTMCs.
Carcinoma ; Carcinoma, Papillary ; Humans ; Hypoxia-Inducible Factor 1 ; Proto-Oncogene Proteins B-raf ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Vascular Endothelial Growth Factor A

PURPOSE: A CXCR4/stroma derived factor-1alpha (SDF-1alpha, CXCL12) interaction is involved in many metastatic cancer mechanisms, including breast cancer. The primary objectives of this study were to investigate the correlation between CXCR4 and axillary lymph node metastasis and to clarify the interaction between CXCR4 in primary tumor cells and SDF-1alpha in metastatic lymph nodes. An analysis of the correlation between CXCR4, SDF-1alpha and clinicopathologic features was also performed. METHODS: Representative areas from 44 invasive ductal carcinomas were selected for construction of tissue microarrays using a 5 mm punch. Breast cancers (n=44), metastatic axillary lymph nodes (n=18) and non-metastatic axillary lymph nodes (n=26) were immunohistochemically stained for CXCR4, SDF-1alpha, estrogen receptor (ER), progesterone receptor (PR) and HER2. The parameters of age, tumor size, nuclear grade, histologic grade, lymph node status and pathologic node (pN) stage pN0 to pN3 were evaluated. RESULTS: CXCR4 expression was negatively correlated with increased age (p=0.005) and positively correlated with a large tumor size (p=0.043) and PR expression (p=0.027). CXCR4 expression was not correlated with metastatic lymph nodes (p=0.079) and SDF-1alpha expression in metastatic lymph nodes (p=0.062). However, CXCR4 nuclear positivity is correlated with lymph node metastasis (p=0.044). SDF-1alpha was not correlated with any clinicopathologic feature in a statistically significant manner. CONCLUSION: An evaluation of young age, large tumor size and PR expression helps predict lymph node metastasis and poor prognosis. Expression of CXCR4 nuclear positivity is correlated with a poor prognosis.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Chemokine CXCL12 ; Estrogens ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Receptors, Progesterone

BACKGROUND: This study was carried out to compare the effect of intravenous anesthesia with fentanyl or alfentanil on the hemodynamic profile, sedation, recovery and side effect in the patients undergoing oocyte retrieval. METHODS: The patients were designed to receive alfentanil (group A, n = 70) or fentanyl (group F, n = 70) intravenous anesthesia. The patients were given midazolam 0.6 mg/kg and alfentanil 15 microgram/kg in group A or fentanyl 1.5 microgram/kg in group F. Propofol 0.7 mg/kg was given if patient was awaken during procedure. Hemodynamic changes, propofol used dosage and initial propofol injecting time, Ramsay Sedation Scales, cough reflex on opioid injection, recovery time, duration of apnea and postoperative nausea, vomiting at the recovery room were recorded. RESULTS: Group A had rapid onset, deep sedation, less amount of propofol used, more frequent apnea than group F. There were no significant differences in postoperative nausea, vomiting and recovery time between the two groups. CONCLUSIONS: The intravenous anesthesia with fentanyl or alfentanil are suitable for oocyte retreival but apnea happened more frequent in alfentanil group, so the use of alfentanil needs to monitor ventilation and hemodynamic changes carefully.
Alfentanil ; Anesthesia, Intravenous ; Apnea ; Cough ; Deep Sedation ; Fentanyl ; Fertilization in Vitro ; Hemodynamics ; Humans ; Midazolam ; Oocyte Retrieval ; Oocytes ; Organothiophosphorus Compounds ; Postoperative Nausea and Vomiting ; Propofol ; Recovery Room ; Reflex ; Ventilation ; Vomiting ; Weights and Measures

BACKGROUND: This study was carried out to compare the effect of intravenous anesthesia with fentanyl or alfentanil on the hemodynamic profile, sedation, recovery and side effect in the patients undergoing oocyte retrieval. METHODS: The patients were designed to receive alfentanil (group A, n = 70) or fentanyl (group F, n = 70) intravenous anesthesia. The patients were given midazolam 0.6 mg/kg and alfentanil 15 microgram/kg in group A or fentanyl 1.5 microgram/kg in group F. Propofol 0.7 mg/kg was given if patient was awaken during procedure. Hemodynamic changes, propofol used dosage and initial propofol injecting time, Ramsay Sedation Scales, cough reflex on opioid injection, recovery time, duration of apnea and postoperative nausea, vomiting at the recovery room were recorded. RESULTS: Group A had rapid onset, deep sedation, less amount of propofol used, more frequent apnea than group F. There were no significant differences in postoperative nausea, vomiting and recovery time between the two groups. CONCLUSIONS: The intravenous anesthesia with fentanyl or alfentanil are suitable for oocyte retreival but apnea happened more frequent in alfentanil group, so the use of alfentanil needs to monitor ventilation and hemodynamic changes carefully.
Alfentanil ; Anesthesia, Intravenous ; Apnea ; Cough ; Deep Sedation ; Fentanyl ; Fertilization in Vitro ; Hemodynamics ; Humans ; Midazolam ; Oocyte Retrieval ; Oocytes ; Organothiophosphorus Compounds ; Postoperative Nausea and Vomiting ; Propofol ; Recovery Room ; Reflex ; Ventilation ; Vomiting ; Weights and Measures

Purpose: Evaluate the clinical results of humerus neck nonunion treated with Polarus intramedullary nail. Materials and Methods: 8 patients who underwent surgery for nonunion of humerus surgical neck fracture were included. All patients were female, the average age was 65 years. 5 out the total 8 cases initially received surgery, open reduction and internal fixation with metal plate in 1 case, Ender nail insertion in 2 cases, external fixator in 1 case and closed reduction and percutaneous pinning in 1 case. The other 3 non union cases initial received conservative managemnent. The average period of nonunion was 9 months in the operated group and 6.2 months in the conservative group. All 8 cases received closed reduction with intrameedullary Polarus nail and auto iliac bone graft. Union was confirmed radiologically, and functional evaluation was done with the UCLA functional criteria. Results: All 8 cases showed union on radiologic evaluation. Average time to union was 3.5 months, average follow up period was 27 months. Average UCLA shoulder evaluation score was 7.6 points preoperatively which improved to 26.3 points after surgery. Active shoulder flexion was 40.7 degrees preoperatiely which increased to 104 degrees after surgery. Shoulder abduction improved from 32.9 degrees preoperatively to 96.3 degrees after surgery. UCLA functional criteria was good in 5 cases and fair in 3 cases, which no poor cases. Conclusion: Polarus IM nailing and AIBG is a useful method for treating nonunion of humerus neck fracture with improvement in union and function.
External Fixators ; Female ; Follow-Up Studies ; Humans ; Humerus* ; Neck* ; Shoulder ; Transplants

BACKGROUND: Liquid-based cytology is currently known as an effective method, and cervical cytology has been shown to be especially effective from of malignancy detection. In our study, the cytological detection rates of the Thinprep (Liquid-based cytology) and conventional cytology (bronchial washing & brushing) for endobronchial lesions were compared. METHODS: Between July 2005 and September 2005, the data from 30 patients with respiration symptom, who had shown abnormal lesion on bronchoscopy, were collected. RESULTS: The bronchoscopic biopsy group was consisted of 30 cytodiagnosis specimens, 24 of which were confirmed to be malignant. The others were tuberculosis (4), bronchiectasis and bronchopulmonary fistula (1 each). Of the 24 malignant case, cancer or atypical cells were detected in 19, 17 and 12 of the Thinprep, brushing cytology and washing cytology cases, respectively. None one of the methods detected cancer cells in the non-malignant specimens. Washing cytology has shown sensitivity, specificity, and positive and negative predictive values of 50, 100, 100 and 33.3% respectively. Brushing cytology has shown sensitivity, specificity, and positive and negative predictive values of 70.8, 100, 100 and 46.2%, respectively. Thinprep has shown sensitivity, specificity, and positive and negative predictive values of 79.2, 100, 100 and 54%, respectively. CONCLUSIONS: Thinprep (liquid-based cytology) showed better sensitivity and negative predictive values for the evaluation of lung cancer than conventional cytology. However a large-scale study will be needed in the future.
Biopsy ; Bronchiectasis ; Bronchoscopy* ; Cytodiagnosis ; Fistula ; Humans ; Lung Neoplasms ; Respiration ; Tuberculosis

To elucidate the effect of soy isoflavone supplementation and exercise on serum lipids in normolipidemic and mildly hyperlipidemic postmenopausal period, 54 women residing in Seoul area were recruited. The subjects were divided into 4 groups: control group (n = 13), isoflavone group (n = 14), exercise group (n = 14), isoflavone + exercise group (n = 13). The control group was given placebo capsules, isoflavone group was given soy isoflavone supplements (90 mg/day), exercise group was given placebo capsules and exercised 3 times/week, over 30 min/time, and isoflavone + exercise group took soy isoflavone supplement and exercised. The duration of study were 8 weeks. The average age of the subjects was 57.0 years, 56.0 years, 54.4 years, and 55.2 years, respectively. There were no significant differences among the four groups in terms of height, weight, and body mass index. There were no significant differences among the four groups in terms of serum, total cholesterol, HDL-cholesterol. But the subjects indicated a significant difference in serum LDL-cholesterol (110.5 mg/day in before versus 74.6 mg/day in after) in the isoflavone + exercise group at the levels of p < 0.05. In conclusion, the isoflavone supplementation and exercise may be helpful to decrease serum lipids of normolipidemic and mildly hyperlipidemic postmenopausal women.
Body Mass Index ; Capsules ; Cholesterol ; Female ; Humans ; Postmenopause ; Seoul