PURPOSE: Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) to antiepileptic drug (AED), are rare, but result in significant morbidity and mortality. We investigated the major culprit drugs, clinical characteristics, and clinical course and outcomes of AED-induced SCARs using a nationwide registry in Korea. METHODS: A total of 161 patients with AED-induced SCARs from 28 referral hospitals were analyzed. The causative AEDs, clinical characteristics, organ involvements, details of treatment, and outcomes were evaluated. We compared the clinical and laboratory parameters between SJS/TEN and DRESS according to the leading causative drugs. We further determined risk factors for prolonged hospitalization in AED-induced SCARs. RESULTS: Carbamazepine and lamotrigine were the most common culprit drugs causing SCARs. Valproic acid and levetiracetam also emerged as the major causative agents. The disease duration and hospital stay in carbamazepine-induced SJS/TEN were shorter than those in other AEDs (P< 0.05, respectively). In younger patients, lamotrigine caused higher incidences of DRESS than other drugs (P= 0.045). Carbamazepine, the most common culprit drug for SCARs, was associated with a favorable outcome related with prolonged hospitalization in SJS (odds ratio, 0.12; 95% confidence interval, 0.02-0.63, P= 0.12), and thrombocytopenia was found to be a risk factor for prolonged hospitalization in DRESS. CONCLUSION: This was the first large-scale epidemiological study of AED-induced SCARs in Korea. Valproic acid and levetiracetam were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as carbamazepine and lamotrigine. Carbamazepine was associated with reduced hospitalization, but thrombocytopenia was a risk factor for prolonged hospitalization. Our results suggest that the clinical characteristics and clinical courses of AED-induced SCARs might vary according to the individual AEDs.
Anticonvulsants ; Carbamazepine ; Cicatrix ; Drug Hypersensitivity Syndrome ; Epidemiologic Studies ; Hospitalization ; Humans ; Incidence ; Korea ; Length of Stay ; Mortality ; Referral and Consultation ; Risk Factors ; Stevens-Johnson Syndrome ; Thrombocytopenia ; Valproic Acid

Hepatic portal venous gas is a very rare radiologic sign which is characterized by gas accumulation in the portal venous circulation. Pneumatosis intestinalis is also very rare and is characterized by multiple air cysts in the serosal or submucosal layers of the gastrointestinal tract walls. These two findings are caused by various pathological conditions and can develop individually or simultaneously. The latter is clinically more significant because it is frequently related to bowel ischemia or necrosis, and represents a poor prognosis. However, prognosis is more influenced by the severity of underlying disease rather than hepatic portal venous gas or pneumatosis intestinalis itself. If bowel ischemia or necrosis is the primary cause, emergency operation is very important to improve patient's prognosis. Herein, we report a case of necrotizing colitis presenting as hepatic portal venous gas and pneumatosis intestinalis which was successfully managed by early surgery.
Colitis/complications/*diagnosis/surgery ; Humans ; Intestinal Perforation ; Male ; Middle Aged ; Necrosis ; Pneumatosis Cystoides Intestinalis/complications/*diagnosis ; Portal Vein ; Radiography, Abdominal ; Tomography, X-Ray Computed

BACKGROUND: Thyroid incidentalomas detected by 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUVmax) in 18F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy. METHODS: A total of 2,584 subjects underwent 18F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects. RESULTS: Of the 2,584 subjects who underwent 18F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUVmax was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001). CONCLUSION: Thyroid incidentalomas found on 18F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUVmax tended to be malignant.
Biopsy, Fine-Needle ; Diagnosis ; Early Detection of Cancer ; Electrons ; Fluorodeoxyglucose F18 ; Humans ; Incidental Findings ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Prevalence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms

Ewing's sarcoma is an uncommon malignancy that usually occurs in children. It most commonly involves the lower extremity, with the pelvis being the next most common site. Primary Ewing's sarcoma that arises in the head and neck region is extremely rare, representing only 1-4% of all Ewing's sarcoma cases. We report a case of primary Ewing's sarcoma in the nasal cavity in a 10-year old patient with a non-specific past medical history, in which the patient received 3 trials of neoadjuvant chemotherapy, endoscopic wide excision, followed by 2 more trials of adjuvant chemotherapy. Currently, it has been 5 years since treatment and the patient did not exhibit any signs or symptoms of recurrence of the disease.
Chemotherapy, Adjuvant ; Child ; Head ; Humans ; Lower Extremity ; Nasal Cavity ; Neck ; Pelvis ; Recurrence ; Sarcoma, Ewing

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world and is the only major disease that is continuing to increase in both prevalence and mortality. The second Korean National Health and Nutrition Survey revealed that the prevalence of COPD in Korean subjects aged > or =45 years was 17.2% in 2001. Further surveys on the prevalence of COPD were not available until 2007. Here, we report the prevalence of spirometrically detected COPD in Korea, using data from the fourth Korean National Health and Nutrition Survey (KNHANES IV) which was conducted in 2007~2009. METHODS: Based on the Korean Statistical Office census that used nationwide stratified random sampling, 10,523 subjects aged > or =40 years underwent spirometry. Place of residence, levels of education, income, and smoking status, as well as other results from a COPD survey questionnaire were also assessed. RESULTS: The prevalence of COPD (defined as forced expiratory volume in 1 sec/forced vital capacity <0.7 in subjects aged > or =40 years) was 12.9% (men, 18.7%; women, 7.5%). In total, 96.5% of patients with COPD had mild-to-moderate disease; only 2.5% had been diagnosed by physicians, and only 1.7% had been treated. The independent risk factors for COPD were smoking, advanced age, and male gender. CONCLUSION: The prevalence of COPD was 12.9% in the KNHANES IV data. Most patients with COPD were undiagnosed and untreated. Based on these results, a strategy for early COPD intervention is warranted in high risk subjects.
Aged ; Censuses ; Female ; Forced Expiratory Volume ; Humans ; Hypogonadism ; Korea ; Male ; Mitochondrial Diseases ; Nutrition Surveys ; Ophthalmoplegia ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Surveys and Questionnaires ; Risk Factors ; Smoke ; Smoking ; Spirometry ; Vital Capacity

Actinomycosis infection can involve most part of the human body including mouth, cervicoface, chest, abdomen and pelvis. Cardiac involvement occurs in less than 2 percent of the infection of actinomyces israelii and pericardial involvement is rare. 34 year male was admitted because of chest pain and general weakness for several months. Echocardiography revealed akinesia of apex suggesting myocardial infarction and large pericardial effusion. Under the impression of pericardial effusion from tuberculosis infection, the patient was started on anti-tuberculosis medicine. Pericardial window operation with pericardial biopsy was performed 7 days later when the patient failed to show a significant improvement. Pericardial biopsy confirmed actinomycosis infection. During admission, the patient had a cerebral infarction with left hemiparesis. The patient was treated with high dose penicillin and improved symptomatically. Echocardiography showed resolution of pericardial effusion.
Abdomen ; Actinomyces ; Actinomycosis* ; Biopsy ; Cerebral Infarction* ; Chest Pain ; Echocardiography ; Human Body ; Humans ; Male ; Mouth ; Myocardial Infarction* ; Paresis ; Pelvis ; Penicillins ; Pericardial Effusion ; Thorax ; Tuberculosis*

BACKGROUNDS/AIMS: This study was performed prospectively to evaluate the short - term effect of cisapride tartrate on the frequency and the degree of symptoms in patients with functional dyspepsia and functional constipation. METHODS: One-hundred thirty-two patients with a mean age of 44.7 years in men and 43.1 years in women, who presented with symptoms of both functional dyspepsia and functional constipation were recruited, and the frequency and the degree of symptoms corresponding to functional dyspepsia and functional constipation were assessed by an interview in 10 hospitals respectively. In an open, multicenter trial, 132 patients received 10 mg of cisapride tartrate three times a day (TID) for 8 weeks. Patients wrote a defecation diary for 8 weeks and checked symptom scores, which represented the degree of symptoms of dyspepsia and constipation, at the 4th and 8th week. RESULTS: The frequently reported symptoms of functional dyspepsia were epigastric fullness (2.34+/-0.80), bloating (2.05+/-0.82), early satiety (1.67+/-0.99), anorexia (1.04+/-0.95) and nausea (0.94+/-0.93). The mean defecation frequency per week was 3.07+/-2.35 and patients showed subjective symptom scores as follows; 97.0+/-25.26 % in the rate of sense of incomplete evacuation, 1.85+/-0.73 in the hardness of stool and 1.62+/-0.57 in difficulty to pass stool. After adminstration of cisapride tartrate in the case of functional dyspepsia, 66.1% of patients at the 4th week and 81.5 % of patients at the 8th week showed good or excellent improvements. In the case of functional constipation, 82.7% of patients also showed good or excellent improvements. Overall improvements of symptoms in both functional dyspepsia and functional constipation were 78.2% at the 8th week. CONCLUSION: Cisapride tartrate reduced the frequency and the degree of symptoms in functional dyspepsia and functional constipation without significant adverse effects. Functional dyspepsia and functional constipation without significant adverse effects.
Anorexia ; Cisapride* ; Constipation* ; Defecation ; Dyspepsia* ; Female ; Hardness ; Humans ; Male ; Nausea ; Prospective Studies

Cushing's syndrome is produced by the hypersecretion of adrenal glucocorticoids and is characterized by moon face, central obesity, disappearance of diurnal variation of plasma cortisol and unsuppressibility of plasma cortisol by low-dose dexamethasone. On the other hand, hyperaldosteronism is produced by the hypersecretion of aldosterone and is characterized by hypertension and hypokalemia. We report a rare case of adrenal adenoma with concurrent hypercortisolism and hyperaldosteronism manifestated with hypertension, cushingoid appearance, left adrenal mass with low-normal plasma potassium. Laparoscopic unilateral tumor excision was performed and hypertension disappeared after the operation.
Adenoma* ; Aldosterone ; Cushing Syndrome* ; Dexamethasone ; Glucocorticoids ; Hand ; Hydrocortisone ; Hyperaldosteronism* ; Hypertension ; Hypokalemia ; Obesity, Abdominal ; Plasma ; Potassium

We report a case with low-grade MALT lymphoma of the rectum in a 32-year-old man. Primary lymphoma of thecolon is rare and comprises less than 1 % of large bowel malignancies. Recently, large part of colonic lymphomahave been shown to be MALT lymphoma, which is a distinct type of B-cell lymphoma. The radiologic findings of thiscase are mucosal nodularity with shallow ulcers in the rectum, as seen on bar-ium enema, and rectal wallthickening, as seen on CT. There was no evidence of intra-abdominal lym-phadenopathy nor hepatosplenomegaly. Suchradiologic findings are rather similar to the findings in cases of inflammatory bowel disease, rending thedifferential diagnosis difficult.
Adult ; Colon ; Diagnosis ; Enema ; Humans ; Inflammatory Bowel Diseases ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone* ; Rectum* ; Ulcer

Twin pregnancies have a higher rate of premature delivery than singleton pregnancies and a substantially higher perinatal mortality. Twin gestation complicted by a single anomalous fetus diffculties in obstetric management. Options available to patients include continuing the entire pregnancy, selective termination of the anomalous fetus, or termination of the entire pregnancy. The incidence of one anomalous fetus in twin pregnancy is rare. Gastroschisis is intestinal herniation through a defect in the anterior abdominal wall usually to the right of umblicus. There is no sac and the intestines are covered with a thickened inflammatory exudate. Most case of gastroschisis occur sporadically and chromosomal anomaly are less common. A case of one gastroschisis in twin pregnancies diagnosed by ultrasonography is reported with a brief review of the literature.
Abdominal Wall ; Exudates and Transudates ; Fetus ; Gastroschisis ; Humans ; Incidence ; Intestines ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin* ; Twins* ; Ultrasonography