PURPOSE: Differences in definitions of the condition, relevant triggers, and the geographical locations of study centers, cause estimates of the prevalence of anaphylaxis to vary. Recent epidemiological data indicate that the incidence of anaphylaxis is rising. METHODS: To investigate the causes and clinical features of anaphylaxis in Korean adults, factors associated with the severity of the condition, and serious outcomes, a retrospective medical record review was performed on adult patients diagnosed with anaphylaxis between 2007 and 2011 in 15 University Hospitals of South Korea. RESULTS: A total of 1,806 cases (52% male, age 16-86 years) were reported. Cutaneous symptoms (84.0%), combined with respiratory (53.9%) and/or cardiovascular (55.4%) symptoms, were the most frequent presentations. Using a recognized grading system, 1,776 cases could be classified as either mild, 340; moderate, 690; or severe, 746. Although eliciting factors varied significantly by age, gender, and regional and seasonal factors, drugs (46.5%; including nonsteroidal anti-inflammatory drugs, antibiotics, and radiocontrast media) were the most common cause of anaphylaxis, followed by foods (24.2%), insect stings (16.4%), exercise (5.9%), and unknown etiology (7.0%). All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. Epinephrine auto-injectors were prescribed for 7.4% of reported cases. CONCLUSIONS: The principal causes of anaphylaxis in Korean adults were drugs, food, and insect stings. Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes.
Adult* ; Anaphylaxis* ; Anti-Bacterial Agents ; Epidemiology ; Epinephrine ; Hospitals, University ; Humans ; Incidence ; Insect Bites and Stings ; Korea ; Length of Stay ; Male ; Medical Records ; Prevalence ; Retrospective Studies* ; Seasons

PURPOSE: To investigate whether causes of anaphylaxis vary according to regions and seasons in Korean adults. METHODS: Based on previous retrospective studies of anaphylaxis between 2007 and 2011 at the 15 university hospitals. Regions were classified into 4 groups: region I, Seoul; region II, Gyeonggi; region III, Chungcheong; and region IV, Chonnam and Busan. The cases induced by 5 major allergens including drugs, food, bee sting, radiocontrast media, and exercise, were analyzed in the present study. RESULTS: Among a total of 1,661 cases reported (53% male, 45.9+/-16.0 years), 367 (22.2%), 706 (42.5%), 319 (19.2%), and 269 cases (16.2%) were enrolled in regions I, II, III, and IV, respectively. Of the 5 major allergens, drugs (37.3%) were the most frequently reported, followed by food (25.7%), bee sting (17.9%), radiocontrast media (12.9%), and exercise (6.2%). There was no significant difference in the total occurrence of anaphylaxis in 4 seasons (374 in spring, 460 in summer, 460 in autumn, and 367 in winter). Multiple logistic regression analysis revealed that drug-induced anaphylaxis was significantly associated with the winter season (odds ratio [OR] 1.0 vs. OR 0.597, P<0.05 for spring; OR 1.0 vs. OR 0.481, P<0.01 for summer; OR 1.0 vs. OR 0.653, P<0.05 for autumn). Food-associated anaphylaxis was mainly reported in region I, whereas the frequency of insect sting was relatively higher in regions II, III, and IV than in region I. Older age and female gender were significantly associated with drug-induced anaphylaxis. CONCLUSION: Specific causative allergens of anaphylaxis in adults may vary according to age, gender, region, and season in Korea.
Adult* ; Allergens ; Anaphylaxis* ; Bees ; Bites and Stings ; Busan ; Contrast Media ; Female ; Geographic Locations ; Gyeonggi-do ; Hospitals, University ; Humans ; Insect Bites and Stings ; Jeollanam-do ; Korea ; Logistic Models ; Male ; Retrospective Studies ; Seasons* ; Seoul

Depression is an important comorbidity of asthma. However, little information is available about depression and its potential impact on asthma control in Korean adult asthma patients. We aimed to estimate the prevalence and risk factors for depression in Korean adults with persistent asthma. The 127 non-elderly (20-64 yr) and 75 elderly (> or =65 yr) patients with asthma were recruited. Demographic and clinical data were extracted, and the patients completed the Asthma Specific Quality of Life (AQOL) questionnaire and asthma control test (ACT). Depression status was defined using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Depression was more prevalent in non-elderly (18.9%) than in elderly patients with asthma (13.3%). Patients with depression were significantly younger, had lower economic status, shorter disease duration, poorer asthma control, and worse AQOL scores (P<0.05). Within the non-elderly group, younger age and shorter disease duration were significantly associated with depression (P<0.05). Within the elderly group, a higher body mass index and current smoking status were significantly associated with depression (P<0.05). The PHQ-9 score was significantly correlated with worse ACT and AQOL scores in both groups. In conclusion, depression is strongly associated with poor asthma control and quality of life in Korean adult asthma patients. Our results provide important clues that used to target modifiable factors which contribute to development of depression in asthma patients.
Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Asthma/diagnosis/*epidemiology/*psychology ; Causality ; Comorbidity ; Depression/diagnosis/*epidemiology/*psychology ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Quality of Life/*psychology ; Republic of Korea/epidemiology ; Risk Factors ; Sex Distribution ; Young Adult

PURPOSE:Many patients with atopic dermatitis have shown different responses to treatment or different prognosis dependenting on the kinds of offending allergens. We attempted to evaluate the difference of mechanism in allergic inflammation between food allergens and aeroallergens by measuring chemokines, including TARC (Thymus and activation regulated chemokine), MDC (Marcrophage-derived chemokine), IL-18, CCL-28 (Chemokine receptor ligand-28) and ECP (Eosinophil cationic protein), and to investigate the correlation between the clinical severity and chemokine levels induced by food allergens and aeroallergens in atopic dermatitis. METHODS:Sixty-seven children with atopic dermatitis (39 males and 28 females) were recruited. Thirteen nonatopic children without atopic dermatitis (6 males and 7 females) were selected as controls. RESULTS:We obtained SCORAD index cut-off points that were similar to those established by clinical criteria. Comparisons between the groups of mild, moderate and severe atopic dermatitis revealed significant differences in serum total IgE and ECP levels. SCORAD index significantly correlated with total IgE, TARC, MDC and ECP levels. Serum IgE levels correlated with TARC and ECP. SCORAD index and total IgE strongly correlated to HDM. While IL-18, TARC, MDC and ECP levels strongly correlated to egg white and milk. In soybean, IgE and TARC and ECP levels significantly correlated with specific IgE levels. CONCLUSION:TARC, MDC and ECP might play a crucial role in the chronic inflammatory process of food-specific atopic dermatitis. In contrast, IgE-mediated mechanisms might have implications for HDM, when compared with food specific atopic dermatitis. These results suggest that pathogenic mechanisms of atopic dermatitis might be different according to relevant allergens.
Allergens* ; Chemokine CCL17 ; Chemokines* ; Child ; Dermatitis, Atopic* ; Egg White ; Eosinophil Cationic Protein ; Humans ; Immunoglobulin E ; Inflammation ; Interleukin-18 ; Male ; Milk ; Prognosis ; Soybeans

Pilomatrixoma, calcifying epithelioma, is a benign neoplasm that arises from hair follicle matrix cells and a common skin neoplasm that is often misdiagnosed as other skin condition. Our study is to examine the clinical & histopathological presentation, and management of pilomatrixoma. We conducted a 4 year retrospective study of 102 patients who had a confirmed histopathologic diagnosis of pilomatrixoma. The symptom was a slowly growing, rock-hard, solitary, superficial mass in the head(64.5%), neck(14.0%) and upper extremities(12.2%). Male-to-female ratio was 1:1.3 and the mean age of patients was 13.2 years. The mean tumor size in greatest dimension was 1.3cm and the overlying skin was slightly reddish or bluish and slightly elevated than surrounding normal skin. The excised mass was relatively well encapsulated and showed multiple nodularity and calcification. The preoperative diagnosis was accurate and consistent with the pathological diagnosis of pilomatrixoma only in 38 cases (35.5%), and the most often preoperative diagnosis were unidentified mass(43%) with inclusion of 8 other possible diagnoses. All masses were treated with surgical excision without recurrence. This entity should be considered with other neoplasm in the clinical differential diagnosis of solitary firm skin nodules, especially those on head, neck, or upper extremities in young children. The results of our study was in accordance with previously published literatures and we agree that surgical excision is the treatment of choice and the recurrence rate is low.
Carcinoma ; Child ; Diagnosis ; Diagnosis, Differential ; Hair Follicle ; Head ; Humans ; Neck ; Pilomatrixoma* ; Recurrence ; Retrospective Studies ; Skin ; Skin Neoplasms ; Upper Extremity

Double eyelid operation is the most common cosmetic surgery in Asian. There are two procedures for the double eyelid operation: one is an incision method and the other is a suture(non- incision) method. The latter is classified into two categories: stitch method and buried suture method. The popular indications for the non-incision method are listed below (1) A dislike is shown for a procedure that may possibly leave conspicuous scars. (2) The relaxation of the skin and orbicular oculi muscle is not strong, and they retain some tension. (3) The deposition of subcutaneous fat is not very heavy. (4) A wide double eyelid line is not desired. (5) A weak double eyelid line is already present. So the plastic surgeon generally offer the incision method when the patient is older than the age of 35. But rarely aged woman wants the double eyelid operation by non-incision method because of short recovery time and less scar. From December 1999 to June 2003, we performed the double eyelid operation by non-incision method in 22 patients who are older than the age of 40 with selective indications. 16 patients (72.73%) were satisfied with their aesthetic results.
Asian Continental Ancestry Group ; Cicatrix ; Eyelids* ; Female ; Humans ; Relaxation ; Skin ; Subcutaneous Fat ; Surgery, Plastic ; Sutures*

The reduction mandibular angleplasty is one of the most common aesthetic facial bone contouring surgery in the Oriental and the intraoral approach has been used commonly. However this method has some disadvantages because of anatomical restriction of operation field. We performed therefore the reduction of mandibular angle with endoscopic assistance in 15 patients of mandibular angle protrusion. Thirty patients of mandibular angle protrusion were randomly divided into control group (n=15) who received classic ostectomy and study group (n=15) who received endoscopically assisted ostectomy. We compared two groups in operative times, size of incision, duration of postoperative accommodation and satisfactory rate of doctors and patients. Size of incision was assessed as smaller in study group who received endoscopically assisted ostectomy than that of control group who received classic ostectomy on student t-test (5.50 + /-0.65 versus 4.70+/- 0.56, p< or= 0.01). Duration of postoperative accommodation was also assessed as shorter in study group on student t-test (5.07+/- 0.80 versus 4.00+/-1.00, p< or =0.01). There was no specific difference between 2 groups for operative time on x(2)-test (97.33+/- 12.22 versus 97.33+/-12.80, p=1.00). Satisfactory rate of cosmetic appearances were similar according to patients and surgeons. The postoperative course was satisfactory with smaller size of incision, shorter duration of postoperative accommodation and similar operative time and satisfactory rate of cosmetic appearances according to both patients and surgeons.
Endoscopy ; Facial Bones ; Humans ; Operative Time

There have been many difficult cases in direct closure of soft tissue defect of frontal area because of its tension, so that for reconstruction of this area skin graft, local flap and free flap has been used traditionally. Although local flap represent best result in concern of its color, touchness and compatability of function, it is not always available in case that the defect size is wide. we must consider skin graft in such case but it also can not be used if there is exposure of bone with loss of periosteum. Recently there are many reports about the use of collagen dermal substitude (Terudermis(R)) and the use of Hydrogel(R) which provide moist wound environment to facilitate epithelization is increased. The authors report the experience of combination treatment with Terudermis(R) and Hydrogel(R) to take rapid soft tissue regeneration in case of wide soft tissue defect in frontal area with bone exposure.
Collagen ; Free Tissue Flaps ; Periosteum ; Regeneration ; Skin ; Transplants ; Wounds and Injuries

Implants are used in operative reconstruction of bony defect in case of blow-out fracture. If there is a large bony defect, the thin and flexible implants can not sustain intraorbital pressure, so it may be displaced. To prevent postoperative displacement of the implant, we tried reinforcing the center of the implant, where the intraorbital pressure was focused, piling up two pieces of porous polyethylene Implants(Medpor(R)) cross- shaped. 190 patients of large blow out fracture were divided into control group(n=95) who received classic orbital wall reconstruction and study group(n=95) to whom we inserted two small pieces of Medpor(R) one by one and covered a large defect cross shaped. We compared two groups in operative time, duration of postoperative accommodation and re-operation number. Operative time was assessed as shorter in study group(16.73+/-4.24min vs 21.40+/-5.32min, p> or =0.01). Duaration of postoperative accommodation also assessed as shorter in study group (2.05+/-0.70 weeks vs 3.00+/-1.00 weeks, p> or =0.01). There was no specific difference between two groups for re- operation number (3 vs 3, p=1.00). The method to insert two small pieces of Medpor(R) one by one and covered a large defect cross shaped shows shorter operative time and duration of postoperative accommodation than the classic method inserting large one piece of Medpor(R).
Humans ; Operative Time ; Orbit ; Orbital Fractures ; Polyethylene*

The incidence of facial bone fracture in children is relatively uncommon compared with that in adults. Nasal bone fracture in children may cause cosmetic or functional disabilities, so the patients should be properly treated. The diagnosis of nasal bone fracture in children is difficult because the pediatric patient does not permit the most gentle examination and x-ray examination. Failure to confirm a suspected fracture on radiography should not always deter treatment. Clinical judgment should overrule other consideration. The advent of computerized tomographic (CT) scanning has improved the radiologic diagnosis of facial fractures. But the facial bone CT is unable to image the nasal structures in detail. So the authors have performed thin section computed tomography in such children, and compares the accuracy of child`s nasal bone fractures of thin section CT scan with traditional CT scan.
Adult ; Child ; Diagnosis ; Facial Bones ; Humans ; Incidence ; Judgment ; Nasal Bone* ; Radiography ; Tomography, X-Ray Computed