Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a type of severe adverse drug-induced reaction. Dermatologists should make a quick diagnosis and provide appropriate treatment for DRESS syndrome to reduce mortality rates, which can be as high as 10%. We present the case of a 47-year-old man with schizoaffective disorder treated with lamotrigine who developed DRESS syndrome to emphasize the importance of close observation of patients with drug eruption. He was consulted for erythematous maculopapular rashes on the trunk that developed 3 weeks after starting lamotrigine. A few days later, he developed generalized influenza-like symptoms. The skin rashes spread over his entire body, and the sense of itching was rapidly aggravated within a few days. Increased liver enzyme levels and significant eosinophilia were found on laboratory test results. His condition was diagnosed as DRESS syndrome, and he was treated with systemic and topical corticosteroids for 2 weeks.
Adrenal Cortex Hormones ; Anticonvulsants ; Diagnosis ; Drug Eruptions ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Exanthema ; Humans ; Liver ; Middle Aged ; Mortality ; Pruritus ; Psychotic Disorders

Cutaneous pili migrans is a rare condition in which a hair shaft migrates under the superficial skin. We report a case in which a 2-year-old boy presented with an unusually shaped long hair strand that had penetrated the epidermis of the sole. We discuss the structure and fragility of skin in children, which may predispose their skin to invasion by a foreign body, viz., a long hair strand.
Child ; Child, Preschool ; Dermoscopy ; Epidermis ; Foreign Bodies ; Hair ; Humans ; Male ; Skin

BACKGROUND: The phenotypic heterogeneity of psoriasis could be explained by the alternate activation of either T-helper (Th)-1- or Th-17-related cytokines. However, evidence directly supporting this hypothesis is scarce. OBJECTIVE: To characterize the expression of Th-1- and Th-17-related cytokines according to the morphological psoriasis phenotype: guttate vs. plaque. METHODS: In this study, we enrolled 68 patients exhibiting either guttate or plaque psoriasis, and 10 healthy controls. To avoid age-related bias, age matching was performed for each group. Circulating levels of interferon (IFN)-gamma, interleukin (IL)-1RA, IL-2, IL-12p40, IL-17A, IL-22, and IL-23 were measured with an enzyme-linked immunosorbent assay (ELISA). Psoriasis-affected tissue was obtained through biopsy sampling from the eight patients who exhibited the most typical morphology. Levels of IL-1RA, IL-12p40, IL-17, IL-22, and IL-23 in the psoriasis tissue samples were measured with western blot analysis. RESULTS: ELISAs of the serum samples showed higher levels of inflammatory cytokines such as IL-1RA, IL-2, IL-23, and IFN-gamma in patients with psoriasis than in healthy controls. However, the inflammatory cytokine levels did not differ significantly between guttate and plaque psoriasis patients. Western blot analysis of psoriatic tissue revealed higher protein levels of Th-1- and Th-17-related cytokines in patients than in healthy controls. The levels of IL-12p40 and IL-23 were unexpectedly higher in plaque tissue than in guttate tissue. CONCLUSION: The morphological phenotype of psoriasis does not appear to be determined by a specific activation of either the Th-1 or Th-17 pathway. Rather, the cytokine profile influences disease activity and is altered according to the status of the lesion (early or chronic).
Bias (Epidemiology) ; Biopsy ; Blotting, Western ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interferons ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-12 Subunit p40 ; Interleukin-17 ; Interleukin-2 ; Interleukin-23 ; Interleukins ; Phenotype ; Population Characteristics ; Psoriasis*

No abstract available.
Neurofibromatoses* ; Neurofibromatosis 1* ; Neurofibromin 1 ; Vitiligo*

BACKGROUND: Staphylococcus aureus is a major bacteremia-causing pathogen in hemodialysis patients, frequently colonizing patient skin and mucosa. Active infection control is necessary to prevent methicillin-resistant S. aureus (MRSA) infection in hospitals; however, the spread of community-associated MRSA has recently become a concern for MRSA infection control. We evaluated the nasal colonization of MRSA among hemodialysis patients and the molecular characterization of the MRSA isolates. METHODS: Nasal swabs were obtained from 482 hemodialysis patients in 7 nationwide hospitals in November 2009, and cultured for MRSA colonization. Swabs were inoculated and cultured in 6.5% NaCl tryptic soy broth, then subcultured on MRSASelect medium (Bio-Rad, Hercules, CA) for 20-24 h. Multiplex PCR was performed to analyze staphylococcal cassette chromosome mec (SCCmec) types of MRSA isolates. RESULTS: Of 482 hemodialysis patients, 57 (11.8%) carried MRSA, ranging from 6.7% to 19.0%. Among the 57 MRSA isolates, we identified 3 (5.3%) SCCmec II, 1 (1.8%) SCCmec IIA, 30 (52.6%) SCCmec IIB, 1 (1.8%) SCCmec III, 6 (10.5%) SCCmec IV, and 16 (28.1%) SCCmec IVA subtypes. CONCLUSION: The MRSA carriage rate (11.8%) of hemodialysis patients in this study was high. The SCCmec IIB subtype, a healthcare-associated strain, was the predominant strain, although SCCmec IV isolates, typically found in community-associated MRSA infections, were also frequently observed. To prevent healthcare-associated MRSA infections in hemodialysis patients, standardized infection control measures should be performed, and efforts to reduce MRSA carriage rates should be considered.
Colon* ; Humans ; Infection Control ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Mucous Membrane ; Multiplex Polymerase Chain Reaction ; Renal Dialysis* ; Skin ; Staphylococcus aureus

PURPOSE: This study evaluated the prevalence of cystic disease in the intra-abdominal organs in a normal population and a group of patients with vascular disease. METHODS: We reviewed the medical records and computed tomography scans of the vascular disease group and the control group. Vascular disease group (n=586) were patients who suffered with abdominal aortic aneurysm (AAA), aorto-iliac occlusive disease (AOD) and peripheral arterial occlusive disease (PAOD) and who were treated in our institute. The control group (n=424) were patients who visited the health promotion center in our institute during the same period. RESULTS: The prevalence of abdominal cysts in the control group and the vascular disease group was 41.7% and 65.2%, respectively. The vascular disease group showed a higher prevalence of abdominal cystic lesion for all the specific vascular diseases. However, when the two groups were stratified according to age, the vascular disease group displayed no significant difference in the prevalence of abdominal cyst compared to that of the control group. CONCLUSION: Abdominal cystic lesions are common in patients with vascular disease, including AAA, AOD, and PAOD. But this high prevalence of abdominal cystic lesions seems to be associated with the advanced age of vascular disease patients. Further molecular-based research is needed to clarify the pathogenetic relationship between vascular disease and abdominal cystic lesions.
Aortic Aneurysm, Abdominal ; Arterial Occlusive Diseases ; Health Promotion ; Humans ; Medical Records ; Prevalence ; Vascular Diseases

A hemodialysis room is the healthcare facility utmost demanding an infection control because dialysis patients have chronic serious underlying conditions and high risks of bloodborne infection due to a indwelling intravascular catheter, a frequent exposure to bloods or body fluids, and a blood transfusion as well as a hemodialysis room can be a mixing vessel to encounter both hospital-acquired pathogens and community-acquird pathogens. Therefore the Korean Society for Nosocomial Infection Control (KOSNIC) purposed to develop a guideline for the infection control in a hemodialysis room with support of Korean Center for Disease Control (KCDC). This guideline was composed of 11 chapters including vascular access control, dialysis water, microbiological and chemical monitoring of dialysis water and dialysates, components and passage of dialysates, maintenance of dialysis machines, disinfection, waste management, infection surveillance, aseptic techniques and standard precaution, environmental control, prevention of bloodborne infections and 5 appendices composing basic infection control techniques. This is the first official guideline approved by KOSNIC and KCDC of the infection control in a hemodialysis room in Korea. Here the guideline was published except appendices and entire guideline including those can be downloaded on hompages of KOSNIC (http://www.kosnic.org/) and KCDC (http//www.cdc.go.kr/).
Blood Transfusion ; Body Fluids ; Catheters ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Delivery of Health Care ; Dialysis ; Dialysis Solutions ; Disinfection ; Glycosaminoglycans ; Humans ; Infection Control ; Korea ; Renal Dialysis ; Waste Management ; Water

Squamous cell carcinoma of the rectum is extremely rare. Herein we report two cases of rectal squamous cell carcinoma. Case 1 was a 44-year-old Korean female presenting with abdominal pain and rectal bleeding for 3 months before her hospital visit. A colonoscopic examination revealed an ulcerated rectal mass 8 cm proximal to the anal verge. Chemoradiotherapy was administered following Hartmann's procedure in case 1. The patient remained alive during 19 months of follow up. Case 2 was a 43-year-old Korean female who had severe constipation for 2 months. A barium enema and computed tomography of the pelvis showed a rectal mass adherent to the sacrum. Based on the results of a colonoscopic biopsy, a diverting colostomy was performed in case 2, with no further treatment. The pathologic findings showed that both tumors were composed of oval-shaped cells with abundant eosinophilic cytoplasm and intercellular bridges with keratin pearls, and thus were diagnosed as well-differentiated squamous cell carcinoma. Neither of the cases showed evidence of HPV infection. The pathogenesis of rectal squamous cell carcinoma has not been clarified. Herein we report two cases of rectal squamous cell carcinoma and briefly discuss the possible histogenesis.
Abdominal Pain ; Adult ; Barium ; Biopsy ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Colostomy ; Constipation ; Cytoplasm ; Enema ; Eosinophils ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Keratins ; Pelvis ; Rectum ; Sacrum ; Ulcer

PURPOSE: To describe the use of an emergency department (ED)-based, in-depth injury surveillance system to determine the incidence and mechanism of preschool children injury. METHODS: We prospectively studied and registered injured children under 7 years old, (n=5,921) whose injuries resulted in ED treatment from August 2006 to July 2008. We upgraded the checklist surveillance items, included place, accident mechanism, and agent factors. The ED physicians recorded the injury data on checklists in real time as they gave the ED orders. The recorded data were stored in computer networks and automatically coded, which enabled access to the raw data sources. The statistical data were calculated in detail by using relative frequency distribution from the raw data. RESULTS: A total of 29,548 injured patients visited the ED from August 2006 to July 2008. Preschool children injuries, except those from traffic accidents, were 5,921(20.0%). The most common sources of injuries were from blunt trauma (37%), slips(17%), and falls(16%). Among those admitted to our hospital, fall injuries and inhalation of foreign body accidents accounted for 7.6% and 7.5%, respectively. The larger proportion of fall injuries occurred from a height of less than 1 meter(82.2%). The frequency of injury mechanism differed according to age: fall(35%), blunt(19%), and burn(14%) were noted under 1 year old, compared to blunt(34%), fall(14%), and slip(13%) from between 1 to under 3 years of age, and blunt(37%), slip(19%), and fall (11%) between 3 to under 7 years of age. CONCLUSION: The ED-based preschool children injury surveillance system could provide a useful and efficient method to determine injury incidence and injury-related factors.
Accidents, Traffic ; Checklist ; Child ; Child, Preschool ; Information Storage and Retrieval ; Emergencies ; Foreign Bodies ; Humans ; Hypogonadism ; Incidence ; Inhalation ; Mitochondrial Diseases ; Ophthalmoplegia ; Population Surveillance ; Prospective Studies

PURPOSE: To evaluate the developmental patterns of the sutures and synchondroses in the central skull base. MATERIALS AND METHODS: We evaluated the CT scans of 109 children(age range, 29 days to 15 years) with no skull base abnormality who had undergone axial CT of the skull base with 1-mm collimation. Using a five-tier scheme, we analyzed the developmental patterns of the 18 sutures and synchondroses related to the sphenoid and occipital bones. RESULTS: Fusion of the sutures and synchondroses related to the sphenoid bone progressed rapidly during the first two years. Thereafter, changes in the sphenoid bone were dominated by pneumatization of the sphenoid sinus. Fusion of the synchondroses within the sphenoid body, including intersphenoidal, intrapresphenoidal, and intrapostsphenoidal synchondrosis occurred early and in most cases was graded <=4. Fusion of the sphenosquamosal, sphenoethmoidal, and frontosphenoidal sutures was delayed, and residual sclerosis was a common finding. Except for Kerckring-supraoccipital synchondrosis, fusion of the six sutures and synchon-droses related to the occipital bone occurred more gradually than that of those related to the sphenoid bone. Among these, fusion of the occipitomastoidal suture and petro-occipital synchondrosis was the last to occur. CONCLUSION: A knowledge of the developmental patterns of sutures and synchondroses can help differentiate normal conditions from those such as fracture, osseous dysplasia, or congenital malformation, which are abnormal. Our results provide certain basic informations about skull base maturity in children.
Child ; Humans ; Occipital Bone ; Sclerosis ; Skull Base* ; Skull* ; Sphenoid Bone ; Sphenoid Sinus ; Sutures* ; Tomography, X-Ray Computed