Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Urticaria multiforme is a cutaneous condition observed in children. This self-limited condition is characterized by well-circumscribed, annular, and erythematous wheals, which spontaneously disappear within a few days. Patients commonly present with acral edema and show a favorable response to antihistamines. It is frequently misdiagnosed as erythema multiforme or serum sickness-like reaction owing to distinctive annular wheals with an ecchymotic center observed in patients. This condition was previously known as acute annular urticaria. The term urticaria multiforme was introduced in 2007 to highlight this specific variant of urticaria. We describe 2 patients with acral edema and transient annular wheals with dusky red centers, which were diagnosed as urticaria multiforme lesions. To our knowledge, the Korean literature includes only a single case report describing acute annular urticaria. However, the report does not use the term ‘urticaria multiforme’ to describe this condition.
Child ; Edema ; Erythema Multiforme ; Histamine Antagonists ; Humans ; Pigmentation* ; Urticaria*

No abstract available.
Neck ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

No abstract available.
Brain Diseases* ; Brain Stem* ; Humans ; Hypertensive Encephalopathy ; Stroke, Lacunar*

Apicoectomy ; Busan ; Classification ; Dentigerous Cyst ; Diagnosis ; Female ; Humans ; Incidence ; Jaw ; Male ; Methods ; Observational Study ; Odontogenic Cysts ; Prevalence ; Radicular Cyst ; Retrospective Studies ; Surgery, Oral ; Tooth

BACKGROUND: Septic shock is a pathophysiologic state of circulatory failure with tissue hypoperfusion. However, it is usually defined as sepsis-induced hypotension not responding to fluid resuscitation, regardless of the objective findings of tissue hypoperfusion such as lactic acidosis or organ failures. Numerous patients with sepsis-induced hypotension present to the emergency department without hyperlactemia or severe organ failure. Hence, we investigated the clinical characteristics and outcomes of patients with septic shock according to the presence of hyperlactatemia or significant organ failure. METHODS: We conducted a retrospective observational study of adult patients presenting with septic shock in the emergency department of a tertiary care hospital between August 2008 and July 2010. Initial serum lactate was categorized low (<2.5 mmol/L) and high (> or =2.5 mmol/L). Organ failure was assessed by the Sequential Organ Failure Assessment (SOFA) score. Primary outcome measurement was in-hospital mortality. RESULTS: A total of 227 patients were enrolled. There were 88 (38.8%) patients in the low lactate group, and 139 (61.2%) patients in the high lactate group. Patients with low lactate levels showed a lower mortality rate (6.8% compared with 25.1% of those with high lactate level). The low lactate group showed less rapid heart rate, less severe organ failures and shorter length of stay in the intensive care unit. During the early goal-directed therapy, they required a smaller amount of fluid administration and a lower dose of norepinephrine although other hemodynamic variables were similarly maintained. In particular, if patients showed less severe organ dysfunction (SOFA score < 8) in the low lactate group (n = 45), in-hospital mortality was 0% (adjusted mortality was 1.3% [95% confidence interval = 0.3-5.0]). CONCLUSION: Patients with septic shock, who were enrolled according to the traditional definition, showed a very favorable outcome if they did not have hyperlactatemia or significant organ failure.
Acidosis, Lactic ; Adult ; Emergencies ; Heart Rate ; Hemodynamics ; Hospital Mortality ; Humans ; Hypotension ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Norepinephrine ; Resuscitation ; Retrospective Studies ; Sepsis ; Shock ; Shock, Septic ; Tertiary Healthcare

OBJECTIVE: The purpose of this study is to compare the pregnancy outcomes of gestational diabetes mellitus (GDM) class A1 to those of GDM A2. METHODS: We performed a retrospective analysis of 99 women who were diagnosed as GDM during prenatal care and managed until delivery from March 1996 to September 2007. Subjects were grouped into GDM class A1 and class A2. The obstetric and neonatal outcomes were compared between the two groups. RESULTS: There were 57 cases of GDM class A1 and 42 cases of GDM class A2. Hemoglobin A1c level of GDM A2 group was significantly higher than GDM A1 group. We could not find any significant difference in obstetric (body mass index, hypertensive disorder, preterm delivery, preterm labor, preterm premature rupture of membrane) and neonatal outcomes (gestational age at delivery, macrosomia, shoulder dystocia, respiratory distress syndrome, transient tachypnea of neonate, sepsis, Apgar score, congenital anomaly) between the two groups other than increased frequency of cesarean delivery and admission to neonatal intensive care unit in GDM A2 group. CONCLUSION: After proper management, overall pregnancy outcomes of women with GDM class A2 are comparable to those with GDM class A1.
Apgar Score ; Diabetes, Gestational ; Dystocia ; Female ; Hemoglobins ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome ; Prenatal Care ; Retrospective Studies ; Rupture ; Sepsis ; Shoulder ; Tachypnea

PURPOSE: We investigated the clinicopathologic information of patients with gastric cancer with multiple primary cancers (GC-MPC) of three or more sites. MATERIALS AND METHODS: Between 1995 and 2009, 105,908 patients were diagnosed with malignancy at Severance Hospital, Yonsei University Health System. Of these, 113 (0.1%) patients with MPC of three or more sites were registered, and 41 (36.3%) of these were GC-MPC. We retrospectively reviewed the clinical data and overall survival using the medical records of these 41 GC-MPC patients. We defined synchronous cancers as those occurring within 6 months of the first primary cancer, while metachronous cancers were defined as those occurring more than 6 months later. RESULTS: Patients with metachronous GC-MPC were more likely to be female (p=0.003) and young than patients with synchronous GC-MPC (p=0.013). The most common cancer sites for metachronous GC-MPC patients were the colorectum, thyroid, lung, kidney and breast, while those for synchronous GC-MPC were the head and neck, esophagus, lung, and kidney. Metachronous GC-MPC demonstrated significantly better overall survival than synchronous GC-MPC, with median overall survival durations of 4.7 and 14.8 years, respectively, and 10-year overall survival rates of 48.2% and 80.7%, respectively (p<0.001). CONCLUSION: Multiplicity of primary malignancies itself does not seem to indicate a poor prognosis. The early detection of additional primary malignancies will enable proper management with curative intent.
Breast ; Esophagus ; Female ; Head ; Humans ; Kidney ; Lung ; Medical Records ; Neck ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate ; Thyroid Gland

PURPOSE: Abdominal actinomycosis is a rare chronic suppurative infectious disease, caused by a gram-positive bands Actinomyces israelii organism. The pathogens produces a characteristic granulomatous inflammatory fibrosis and mass lesion. Actinomycosis is usually divided into three clinical types; cervicofascial, thoracic and abdominopelvic. This study was designed to investigate the clinical or radiologic variability and the meanings of the diagnostic differentiality of abdominopelvic actinomycosis when patients present with an unusual abdominal mass or abscess. METHODS: The medical records of 19 patients treated at the Departments of Surgery and Obstetrics and Gynecology, Dong-A University Hospital were reviewed. The clinical characteristics, diagnostic evaluation and surgical treatment results were retrospectively analyzed. RESULTS: Of the 19 patients, 7 cases involved the colon and 11 the uterus and ovary with one case also involving the retroperoneum and ureter. Most cases (84.2%) had predisposing factors of disease progression, including intrauterine device (IUD), abortion, previous surgery, appendicitis and diverticulitis. The common presentations of the patients were abdominal pain (57.8%) and a palpable mass (15.7%). Preoperatively, no case was diagnosed as actinomycosis, but misconceived as a pelvic abscess, ovarian or colon cancers, a mesenteric origin mass, a lymphoma, periappendiceal abscess, acute appendicitis, uterine myoma, dysfunctional uterine bleeding or endometriosis. Explorations were performed in all patients. Eighteen cases were cured following surgery with subsequent antibiotics. However, one case recurred due to incompletion of antibiotics following surgical drainage. CONCLUSION: Abdominopelvic actinomycosis should be included as a differential diagnosis when an unusual abdominal mass presents on abdominal CT or ultrasound. Appropriate antibiotics, as well as surgery, are important in the treatment of abdominopelvic actinomycosis.
Abdominal Pain ; Abortion, Induced ; Abscess ; Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Appendicitis ; Causality ; Colon ; Colonic Neoplasms ; Communicable Diseases ; Diagnosis, Differential ; Disease Progression ; Diverticulitis ; Drainage ; Endometriosis ; Female ; Fibrosis ; Gynecology ; Humans ; Intrauterine Devices ; Leiomyoma ; Lymphoma ; Medical Records ; Metrorrhagia ; Obstetrics ; Ovary ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography ; Ureter ; Uterus