Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe drug-induced hypersensitivity syndrome characterized by hematological abnormalities and multiorgan involvement. Liver involvement is the most common visceral manifestation. However, renal failure has been rarely described. The common culprit drugs are anticonvulsants and allopurinol. We experienced a patient with DRESS syndrome with acute interstitial nephritis caused by concomitant administration of quinolone and non-steroidal anti-inflammatory drugs (NSAIDs). A 41-year-old man presented with a diffuse erythematous rash and fever which developed after administration of quinolone and NSAIDs for a month due to prostatitis. He was diagnosed with DRESS syndrome. Skin rash, fever, eosinophilia, and elevations of liver enzymes improved with conservative treatment and discontinuation of the causative drugs. However, deterioration of his renal function occurred on day 8 of admission. The levels of blood urea nitrogen and serum creatinine increased and oliguria, proteinuria and urinary eosinophils were observed. Ultrasonography showed diffuse renal enlargement. The clinical features were compatible with acute interstitial nephritis. Despite intravenous rehydration and diuretics, renal function did not improve. After hemodialysis, his renal function recovered completely within 2 weeks without administration of systemic corticosteroid.
Adult ; Allopurinol ; Anti-Inflammatory Agents, Non-Steroidal ; Anticonvulsants ; Blood Urea Nitrogen ; Creatinine ; Diuretics ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome* ; Eosinophilia ; Eosinophils ; Exanthema ; Fever ; Fluid Therapy ; Humans ; Hypersensitivity ; Liver ; Nephritis, Interstitial* ; Oliguria ; Prostatitis ; Proteinuria ; Renal Dialysis ; Renal Insufficiency ; Ultrasonography

BACKGROUND/AIMS: Following sustained virological response (SVR) for chronic hepatitis C (CHC) infection, patients with advanced fibrosis require regular monitoring for hepatocellular carcinoma (HCC). The aspartate aminotransferase to platelet ratio index (APRI) is a simple noninvasive surrogate marker known to reflect fibrosis. METHODS: We retrospectively analyzed 598 patients who achieved SVR with interferon-based therapy for CHC. RESULTS: Over a median of 5.1 years of follow-up, there were eight patients diagnosed with HCC and a 5-year cumulative incidence rate of 1.3%. The median pretreatment APRI was 0.83, which decreased to 0.29 after achieving SVR (p<0.001). Both the pre- and posttreatment indices were associated with HCC development. The 5-year cumulative HCC incidence rates were 0% and 2.8% for patients with pretreatment APRI <1.0 and ≥1.0, respectively (p=0.001) and 0.8% and 12.8% for patients with posttreatment APRI <1.0 and ≥1.0, respectively (p<0.001). Pretreatment APRI at a cutoff of 1.0 had a 100% negative predictive value until 10 years after SVR. CONCLUSIONS: HCC development was observed among CHC patients who achieved SVR. The pre- and post-treatment APRI could stratify HCC risk, indicating that the APRI could be a useful marker to classify HCC risk in CHC patients who achieved SVR. However, given the small number of HCC patients, this finding warrants further validation.
Aspartate Aminotransferases* ; Aspartic Acid* ; Biomarkers ; Blood Platelets* ; Carcinoma, Hepatocellular* ; Fibrosis ; Follow-Up Studies ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Incidence ; Retrospective Studies

Cefotetan is a commonly prescribed second-generation cephalosporin that acts against a wide range of bacteria. However, cefotetan-induced hypersensitivity has rarely been reported. We report 2 cases of cefotetan-induced anaphylaxis with immunologic evaluation. The first case was a 70-year-old asthmatic woman who had dyspnea and hypotension during administration of cefotetan, in which high serum-specific IgE to cefotetan-human serum albumin (HSA) conjugate was detected by enzyme-linked immunosorbent assay. The second case was a 63-year-old asthmatic woman who complained of chest tightness and dyspnea during cefotetan infusion, in which high serum-specific IgG1 and IgG4 with no serum specific IgE to cefotetan-HSA conjugate was detected. The basophil activation test using basophils from the patient showed a significant up-regulation of CD63 with the addition of anti-IgG4 antibody compared with that in non-atopic healthy controls. In conclusion, cefotetan can induce anaphylaxis, which may involve both IgE- and IgG4-mediated responses in the pathogenic mechanism.
Aged ; Anaphylaxis* ; Bacteria ; Basophils ; Cefotetan ; Dyspnea ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hypersensitivity ; Hypotension ; Immunoglobulin E ; Immunoglobulin G ; Middle Aged ; Serum Albumin ; Thorax ; Up-Regulation

BACKGROUND/AIMS: Endoscopic classification of chronic gastritis has not been standardized yet. Patterns of endoscopic classification in the real clinical practice are not defined. MATERIALS AND METHODS: From July 2013 to September 2013, a questionnaire consisting of eight questions on endoscopic gastritis was surveyed. The correct answer for endoscopic diagnosis of chronic gastritis was defined by an advisory group, including professors of gastroenterology. A total of 189 physicians, most of them primary care physicians, participated in the survey. RESULTS: The overall agreement with standard endoscopic diagnoses was 56 percent. The correct answer for each question was 56 percent for erosive gastritis, 58 percent for hypertrophic gastritis, 60 percent for atrophic gastritis, 52 percent for metaplastic gastritis, respectively. In the superficial gastritis case, the ratio of correct answer was 24 percent, which was lowest among all the questions. Forty-four percent of all participants answered superficial gastritis as hemorrhagic gastritis. These results reveal that hemorrhagic gastritis is diagnosed inappropriately and needs further attention to prevent patients from unnecessary worries and misunderstandings. The correct answer for nodular gastritis was 42 percent, which is relatively low as well. Considering the significance of nodular gastritis as a risk factor for gastric cancer, education for endoscopist to detect nodular gastritis is indispensable. CONCLUSIONS: There was significant discrepancy on the endoscopic diagnosis of chronic gastritis. Further studies to develop a new standardized guideline for diagnosis of gastritis should be accompanied.
Classification ; Diagnosis* ; Education ; Endoscopy ; Gastritis* ; Gastritis, Atrophic ; Gastritis, Hypertrophic ; Gastroenterology ; Humans ; Physicians, Primary Care ; Risk Factors ; Stomach Neoplasms ; Surveys and Questionnaires

No abstract available.

BACKGROUND: A diagnosis of malignant pleural effusion is clinically important, as the prognosis of lung cancer patients with malignant pleural effusion is poor. The diagnosis will be difficult if a cytological test is negative. This study was performed to investigate whether the detection of hypermethylation of the p16 (CDKN2A) and retinoic acid receptor b2 (RARB2) genes in pleural fluid is useful for a diagnosis of malignant pleural effusion. METHODS: Pleural effusion was collected from 43 patients and was investigated for the aberrant promoter methylation of the RARB2 and CDKN2A genes by use of methylation-specific PCR. Results were compared with findings from a pleural biopsy and from pleural fluid cytology. RESULTS: Of 43 cases, 17 cases of pleural effusion were due to benign diseases, and 26 cases were from lung cancer patients with malignant pleural effusion. Hypermethylation of the RARB2 and CDKN2A genes was not detected in the case of benign diseases, independent of whether or not the patients had ever smoked. In 26 cases of malignant pleural effusion, hypermethylation of RARB2, CDKN2A or either of these genes was detected in 14, 5 and 15 cases, respectively. The sensitivities of a pleural biopsy, pleural fluid cytology, hypermethylation of RARB2, hypermethylation of CDKN2A, or hypermethylation of either of the genes were 73.1%, 53.8%, 53.8%, 19.2%, and 57.7%, respectively; negative predictive values were 70.8%, 58.6%, 58.6%, 44.7%, and 60.7%, respectively. If both genes are considered together, the sensitivity and negative predictive value was lower than that for a pleural biopsy, but higher than that for pleural fluid cytology. The sensitivity of hypermethylation of the RARB2 gene for malignant pleural effusion was lower in small cell lung cancers than in non-small cell lung cancers. CONCLUSION: These results demonstrate that detection of hypermethylation of the RARB2 and CDKN2A genes showed a high specificity, and sensitivity was higher than for pleural fluid cytology. With a better understanding of the pathogenesis of lung cancer according to histological types at the molecular level, and if appropriate genes are selected for hypermethylation testing, more precise results may be obtained.
Biopsy ; Genes, p16 ; Humans ; Lung Neoplasms ; Methylation ; Pleural Effusion ; Pleural Effusion, Malignant ; Polymerase Chain Reaction ; Prognosis ; Receptors, Retinoic Acid ; Smoke

BACKGROUND AND OBJECTIVES: Metal allergy has been reported to be related to stent restenosis. Therefore, we sought to investigate the incidence of metal allergy with new carbon stent with ion implantation technique and its relationship to restenosis. SUBJECTS AND METHODS: Between April 2002 and June 2004, 128 patients (100 male, mean age 60+/-10 years) were included in this study. The clinical diagnoses of the study patients included 64 acute myocardial infarction, 24 unstable angina and 40 stable angina patients. Patients were randomly assigned to receive either an Arthos Inert Stent (the study group) or an Arthos stent (the control group), with follow-up angiography scheduled 6 months later. Three months after stent implantation, skin patch tests, for the detection of metal allergies, were performed with manganese, molybdenum, nickel and chromium. RESULTS: There were no differences between the age, genders, risk factors and multi-vessel involvement between the two groups, as well as no differences in the angiographic parameters and restenosis (p>0.05). There were no differences in the positive rates of the skin tests between the Arthos stent and Arthos Inert stent groups or between the restenosis and no-restenosis groups (p>0.05). CONSLUSION: The new carbon stent, with ion implantation, did not reduce coronary restenosis. An allergic reaction was not related to the stent technology or stent restenosis.
Angina, Stable ; Angina, Unstable ; Angiography ; Carbon* ; Chromium ; Coronary Artery Disease ; Coronary Restenosis ; Diagnosis ; Follow-Up Studies ; Humans ; Hypersensitivity* ; Incidence ; Male ; Manganese ; Molybdenum ; Myocardial Infarction ; Nickel ; Patch Tests ; Risk Factors ; Skin ; Skin Tests ; Stents*

Minoxidil induces hair growth in male pattern baldness and prolongs the anagen phase. All-trans retinoic acid (ATRA) has been reported to act synergistically with minoxidil in vivo: they can enhance more dense hair regrowth than either compound alone. We evaluated the effect of minoxidil combined with ATRA on hair growth in vitro. The effect of co-treatment of minoxidil and ATRA on hair growth was studied in hair follicle organ culture. In cultured human dermal papilla cells (DPCs) and normal human epidermal keratinocytes, the expressions of Erk, Akt, Bcl-2, Bax, P53 and P21 were evaluated by immunoblot analysis. Minoxidil plus ATRA additively promoted hair growth in vitro, compared with minoxidil alone. In addition, minoxidil plus ATRA elevated phosphorylated Erk, phosphorylated Akt and the ratio of Bcl-2/Bax, but decreased the expressions of P53 and P21 more effectively than by minoxidil alone. Our results suggest that minoxidil plus ATRA would additively enhance hair growth by mediating dual functions: 1) the prolongation of cell survival by activating the Erk and Akt signaling pathways, and 2) the prevention of apoptosis of DPCs and epithelial cells by increasing the ratio of Bcl-2/Bax and downregulating the expressions of P53 and P21.
Tretinoin/*administration & dosage ; Minoxidil/*administration & dosage ; Keratolytic Agents/administration & dosage ; Humans ; Hair/cytology/*drug effects/*growth & development ; Drug Combinations ; Dose-Response Relationship, Drug ; Cells, Cultured ; Cell Proliferation/drug effects

BACKGROUND: Many epidemiological studies have reported that hyperuricemia was related to cardiovascular diseases, insulin resistance and the metabolic syndrome. However, there are few studies on the relationship between serum uric acid concentration and the metabolic syndrome among Korean adults. We performed this study to assess the relationship between serum uric acid level and the factors of the metabolic syndrome among healthy Korean men. METHODS: We consecutively selected 206 male subjects who underwent health screening examination from February 2005 to April 2005 at the Health Promotion Center of Seoul Paik Hospital. Insulin resistance measured by HOMA-IR and the metabolic syndrome factors were assessed by the quartiles of serum uric acid level. RESULTS: Body mass index (P<0.001), systolic blood pressure (P=0.015), diastolic blood pressure (P=0.015), fasting insulin (P=0.038), and triglyceride (P=0.005) level increased and high density lipoprotein cholesterol (P=0.008) decreased significantly from the lowest quartile to the highest quartile of seum uric acid level. The proportions of the metabolic syndrome in each quartile were 13.7%, 15.7%, 18.9%, and 36.0%, respectively (P=0.007). However, insulin resistance measured by HOMA-IR was not associated with serum uric acid. When compared with the lowest quartile group, the odds ratio for the metabolic syndrome of the second, the third, and the highest quartile groups were 1.42 (0.39-5.14), 1.14 (0.33-3.92), and 4.00 (1.15-13.89), respectively. CONCLUSION: We found that high uric acid level was significantly related to the factors of the metabolic syndrome and increased the risk of the metabolic syndrome. Further prospective studies with large sample size are necessary to establish whether uric acid level can pose as a risk factor for the development of the metabolic syndrome.
Adult ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol, HDL ; Fasting ; Health Promotion ; Humans ; Hyperuricemia ; Insulin ; Insulin Resistance ; Male ; Mass Screening ; Odds Ratio ; Risk Factors ; Sample Size ; Seoul ; Triglycerides ; Uric Acid*

Japanese hop (Hop J) pollen has been considered as one of the major causative pollen allergens in the autumn season. We developed a new Hop J immunotherapy extract in collaboration with Allergopharma (Reinbeck, Germany) and investigated immunologic mechanisms during 3 yr immunotherapy. Twenty patients (13 asthma with rhinitis and 7 hay fever) were enrolled from Ajou University Hospital. Sera were collected before, 1 yr, and 3 yr after the immunotherapy. Changes of serum specific IgE, IgG1 , and IgG4 levels to Hop J pollen extracts and serum IL-10, IL-12, TGF-beta1 and soluble CD23 levels were monitored by ELISA. Skin reactivity and airway hyper-responsiveness to methacholine were improved during the study period. Specific IgG1 increased at 1 yr then decreased again at 3 yr, and specific IgG4 levels increased progressively (p<0.05, respectively), whereas total and specific IgE levels showed variable responses with no statistical significance. IL-10, TGF-beta1 and soluble CD23 level began to decrease during first year and then further decreased during next two years with statistical significances. (p<0.05, respectively). In con-clusion, these findings suggested the favorable effect of long term immunotherapy with Hop J pollen extracts can be explained by lowered IgE affinity and generation of specific IgG4 , which may be mediated by IL-10 and TGF-beta1.
Transforming Growth Factor beta/blood ; Receptors, IgE/blood ; Pollen/*immunology ; Poaceae/*immunology ; Interleukin-10/blood ; Immunoglobulin G/blood ; Immunoglobulin E/blood ; Humans ; *Desensitization, Immunologic ; Cytokines/*blood ; Bronchial Hyperreactivity/etiology