, Yi Kyung Kim, Ji Eun Ban, Sejung Sohn, Young Mi Hong Adenovirus infection, which has been known to mimic Kawasaki disease (KD), is one of the most frequent conditions observed during differential diagnosis when considering KD. Accordingly, it is essential to being able to differentiate between these two diseases. Therefore, we performed multiplex reverse transcriptase- polymerase chain reaction and tissue-Doppler echocardiography to distinguish between adenovirus patients and KD patients.
A total of 113 adenoviral infection patients (female 48, male 65) diagnosed from January 2010 to June 2016 were evaluated. We divided adenoviral infection patients into two groups: group 1, which consisted of individuals diagnosed with KD according to the KD American Heart Association criteria (n=62, KD with adenovirus infection); and group 2, which comprised individuals only diagnosed with adenovirus infection (n=51). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide. Echocardiographic measurements were compared between two groups. In addition, reverse transcriptase-polymerase chain reaction was performed using nasopharyngeal secretions to diagnose adenoviral infection.
Conjunctival injection, cervical lymphadenopathy, polymorphous skin rash, abnormalities of the lip or oral mucosa and abnormalities of extremities were significantly higher in group 1 than group 2. Moreover, group 1 had significantly higher C-reactive protein and alanine aminotransferase levels, as well as lower platelet counts and albumin levels than group 2. Coronary artery diameter was significantly greater in group 1 than group 2.
In patients with adenoviral infection with unexplained prolonged fever, echocardiography and C-reactive protein can be used to differentiate KD with adenoviral infection from adenoviral infection alone.
, Yoon Suk Lee, Sang Won Lee, Sejung Sohn, Young Mi Hong Kawasaki disease (KD) is the self-limited and multisystem vasculitis which accompanies many complications. Ophthalmic findings in KD are bilateral conjunctival injection, iridocyclitis, superficial keratitis, vitreous opacities and subconjunctival hemorrhage. Optic disc swelling is a rare ophthalmic complication in KD. We describe a 3-year-old boy who presented with 7 days of fever, both conjunctival injection without discharge, and right cervical lymph node enlargement of more than 1.5 cm. He was diagnosed as incomplete KD. He had no ocular symptom except bilateral conjunctival injection. On ophthalmic examination, he was diagnosed by anterior uveitis with optic disc swelling. The brain magnetic resonance imaging was performed and revealed no evidence of increased intracranial pressure. Echocardiography revealed the dilated right coronary artery up to 3.4 mm. Fever subsided and optic disc swelling was completely improved after intravenous immunoglobulin (2 g/kg) treatment. Optic disc swelling is a rare ophthalmic complication in KD.
Citations
, Sung Jin Kim, Ji Hei Cha, Seung Joo Lee, Sejung Sohn Influenza virus infection is a common respiratory disease in children. Renal complications of influenza infection were not commonly encountered until the 2009 H1N1 influenza pandemic, when acute kidney injury (AKI) frequently developed in severely ill patients. Kawasaki disease (KD) is another rare association in pandemic influenza virus infections. There are some reports about KD coincident with influenza A H1N1/09 infection. However, simultaneous AKI and KD in influenza A or B virus infections have never been reported. Herein, we report the first case of influenza B virus infection that initially presented as AKI but was subsequently diagnosed as atypical KD.
, Hyun Joo Kim, Seung Lee Seo, Young Sook Kim, Mi Ae Lee, Jeong Hee Hahm Levofloxacin, an oral fluroquinolone antibacterial agent, is the optical S-(-) isomer of ofloxacin. In vitro it is generally twice as potent as ofloxacin and active against most aerobic gram positive and gram negative organisms, but only moderate activities against anaerobics.
Our purpose was to investigate the therapeutic efficacy and tolerability of levofloxacin in patients with several kinds of cutaneous infections.
Levofloxacin(CRAVIT®; Korea Daiich Parm. Co.) 300-600mg/day for 5-14days was administrated to eighteen patients with cutaneous and subcutaneous infections. The Bacterial culture and laboratory tests were performed prior to and after treatments. Clinical effects and adverse events were evaluated on laboratory indics.
1) Nine of thrteen cases(70%) were useful, four cases(30%) were slightly useful.
2) Clinically twelve of eighteen cases were cured and eight cases were partial response to the drug.
3) There were no laboratory abnormalities after levofloxacin treatment
4) Side effects were not significant except dizziness and sleep disturbance.
Levofloxacin was evaluated as a highly effective antibacterial agent against dermatologic infections.
Citations
, Hae Young Choi, Ki Bum Myung, Eun Ae Park Subcutaneous fat necrosis of the newborn is a spontaneously regressing disorder of healthy fullterm of postterm infants, characterized by symmetric, firm, erythematous to violaceous sub-cutaneous nodules and plaques. Histopathologically, subcutaneous fat necrosis with granu-lomatous panniculitis and needle-shaped clefts in the cytoplasm of foamy and multinucleated histiocytic giant cells are diagnostic.
We report an uncomplicated case of subcutaneous fat necrosis in a 21-day-old, normally delivered male infant, which developed on the fourth day of life and spontaneously regressed in 4 months.
, Gil Ja Shin Percutaneous mitral balloon valvuloplasty was introduced by Dr. Inoue in 1984 and it is now widely used in the treatment of mitral stenosis due to its simple design to use.
From September 1993 to January 1996, 11 cases of percutaneous mitral balloon valvuloplasty were performed at the Ewha Womans University Hospital.
Following the percutaneous mitral balloon valvuloplasty, the mitral valve opening area was increased from 1.18±0.34cm2 to 1.91±0.62cm2(p<0.001). The mean mitral valve diastolic pressure gradient was decreased from 14.35±6.00mmHg to 5.41±4.03mmHg.(p<0.001) The NYHA functional class was improved significantly. Among 11 cases, 1 case(9%) was failed to expand mitral valve opening area and another 1 case developed grade 2 of mitral regurgitation. But there was no life threatening complication such as cardiac tamponade.
It is concluded that percutaneous mitral balloon valvuloplasty with Inoue alloon is an effective and simple method for most patient with mitral stenosis who do not have thrombi.
The patient of herniated intervatebral disc of lumbar spine was treated as conservatively and did respond well in majority. But in patient who had not responded to conservative therapy, opeative method was performed such as open discectomy, chemonucleolysis, or automated percutaneous lumbar discectomy.
Open discectomy is useful for most patients but still carries the risk of general anesthesia and risk to sofi tissues. joints. nerves, and the invariable production of epidural fibrosis. Chemonucleolysis was introduced by Smith in 1964 as an alternative method but, it carries many complications such as anaphylaxis, subarachnoid hemorrhage, transverse myelitis, and severe back pain. Because of reducing this complications automated percutaneous lumbar discectomy has been advocated as an alternative treatment of herniated intervertebral disc in selected patients.
Twenty patients with symptomatic lumbar disc herniation were treated with automated percutaneous lumbar discectomy from August 1989 to October 1991 in Ewha Women University Hospital. They were followed up for more than 12 months. Changes in the objective and subjective signs and aymptoms of patients were examined preoperatively and postoperatively.
The results were as follows :
1) Age was ranged from 14 to 54 years with average 30 years, and 12 males and 8 females.
2) LA-5 was the most commonly involved level(80%).
3) In MRI classification subannular herniation was 11 cases and subligamentous herniationwas 4 cases.
4) Average duration of procedure was 31 minutes. and average amount of tissue aspirated was 3.9cc and average hospitalization period was 5 days.
5) Clinical results were satisfactory in 85% and unsatifactory in 15% of patients.
6) Unsatisfactory results were combined stenosis, insufficient removal of disc material, or recurred herniation of interverebral disc.
7) There was no significant complications postoperatively.
From this results, automated percutaneous lumbar discectomy is a good treatment method for selected cases of lumbar dsic herniation.
, Jin Young Choi, Ho Jun Kang, Ji Hee Sung, Sang Jong Park, Sun Hong Yoo, Young Min Park Vitamin A deficiency can occur as a result of malnutrition, malabsorption, or poor vitamin metabolism due to liver disease and night blindness might develop as the first symptom. Although there have been foreign reports about night blindness due to vitamin A deficiency which was derived from liver cirrhosis, primary biliary cirrhosis, intestinal bypass surgery or bariatric operation, it is hard to find reports about night blindness after percutaneous transhepatic biliary drainage for external bile drainage. We report a case of night blindness derived from fat-soluble vitamin A deficiency developed after long-term (18 months) external bile drainage for benign biliary stricture occurred after left hepatic lobectomy and hepaticojejunostomy due to the Klatskin tumor (IIIb). Her night blindness and low serum retinol level (0.02 mg/L) was dramatically improved after vitamin A supplementation. We recommend lipid-soluble vitamin supplementation on the case of long-term external bile drainage.
Drug eruptions are common problems in hospital inpatients and outpatients. Cutaneous drug reactions range from mild to severe and from those localized only to skin to those associated with systemic disease. Cutaneous drug reactions are also a challenging diagnostic problem since they can mimic a large variety of skin diseases, including viral exanthem, collagen vascular disease, neoplasia, bacterial infection, psoriasis, and autoimmune blistering disease, among others. Furthermore, determining a particular medication which caused an eruption is often difficult when the patient is taking multiple drugs. In this review, clinical manifestations of adverse cutaneous drug reactions are described. A morphologic approach to drug eruption includes those that are classified as exanthematous eruption, urticaria, pustular eruption, bullous eruption, fixed drug eruption, photosensitive eruption, skin necrosis, lichenoid eruption, cutaneous pseudolymphoma, lupus erythematosus, and hand-foot syndrome. And also, recently reported cutaneous adverse reactions associated with newly developed drugs, such as epidermal growth factor receptor inhibitors, low molecular weight tyrosine kinase inhibitors, tumor necrosis factor-alpha antagonists, sirolimus and granulocyte colony-stimulating factor, are discussed.
Citations
, Ha Suk Bae, Tae Sik Yoon Post stroke dysphagia is a common disorder presented in 30-65% of stroke patients. It can result in severe complication such as aspiration pneumonia. Thus nutritional support with nasogastric(NG) feeding tube is needed in these patients. But this method is not recommended more than 4 weeks. In the patients with severe dysphagia, the percutaneous endoscopic gastrostomy(PEG) is recommended in respective with the complication and prognosis.
We experienced a case of 46 year-old-male with esophagogastric ulcer because of remnant NG feeding tube on stomach. He had not a special past history until admission. He was bedridden and quadriplegic state due to spontaneous intracranial hemorrhage on both fronto-parietal lobe and subdural hemorrhage. NG feeding tube(polyvinyl chloride, 16 French) was inserted because of severe dysphagia and the clinicians attempted the PEG tube insertion but removed the PEG tube due to the sepsis with wound infection and reinserted NG feeding tube. After transfer into our hospital, a sudden blood clot from NG feeding tube was drained. We performed gastrofibroscopic examination and found NG feeding tube remnant (23cm) on stomach. It was removed and multiple esophagogastric linear ulcer with hemorrhage due to exposed vessel was observed. He obtained nutrition by total parenteral nutrition for 4 weeks after that. On follow up gastrofibroscopic examination, esophagogastric ulcers were being healing. So we tried PEG tube insertion again but failed because of granulation tissue on previous PEG tube insertion site and inserted NG feeding tube. After 3 months, he was inserted PEG tube and being supported sufficient nutrition.
Many complications are associated with the prolonged NG feeding tube insertion. So recent studies showed alternative method in case of prolonged dysphagia. We report a case with esophagogastric ulcer associated with remnant NG feeding tube on stomach.
, Hong-Keun Cho, Seong-Hoon Park, Si-Hoon Park Percutaneous mitral valvuloplasty(PMV) became a treatment modality or mitral stenosis because of its low morbidity, short hospital stay, and low cost. We reviewed clinical and hemodynamic results after PMV for the patients with mitral stenosis in Ewha Womans University Mokdong hospital.
We compared the results of echocardiographic, hemodynamic, and clinical parameters before and after PMV. PMV was performed under fluoroscopic guidance in 21 patients(M:4, F:17, mean age 43±12 years) with mitral stenosis from October 1993 to April 1999. Transesophageal echocardiography(TEE) and Transthoracic echocardiography(TTE) were performed for the evaluation of mitral valve, chamber size, and the presence of left atrial thrombus before procedures. TIE was also used for follow-up evaluation. On presentation, all patients showed at least NYHA class II. Five patients had atrial fibrillation. Two patients with thrombus in the left atrium were included to study group after thrombolytic treatment with coumadin. Echo-score of our patients was not greater than 8.
Mean mitral valve area(MVA) by 2 dimensional or Doppler echocardiography was increased from 1.16±0.36cm2 before PMV to 2.06±0.33cm2 after PMV. There were marked improvements in transmitral gradients(11.60±5.54mmHg before PMV vs 4.93±2.53mmHg after PMV, p<0.001), left atrial dimension(46.41±14.66mm vs 42.03±15.01mm, p=0.042), and cardiac output(4.21±1.25L/min vs 6.88±9.57L/min, p<0.0001) following PMV, Severe(≥GIII) mitral insufficiency or severe postprocedural complications were not noted. This suggested that all procedure was successful.
The Procedural success rate of PMV in Ewha Womans University Mokdong hospital was 100%. Low echo score of our patients might explain this high procedural success rate. Long-term-follow-up is warranted in the near future.
, Jin Han Cha For coverage of sacral pressure sore, the gluteus maximus musculocutaneous flap had been used commonly. We covered these sacral defect with the gluteus maximus fasciocutaneous flap. Forty three parients with relatively large(average 8×8cm) sacral grade IVpressure sores underwent bilateral gluteus maximus fasciocutaneous flap and donor site was closed as a V-Y advancement. The mean postoperative follow up was 32 months, with a range of 4 to 53months. Using this technique, we achieved uniformly good results and minimal complication. There is no recurrance in our cases. We believe that the V-Y advancement technique using the fasciocutaneous unit has some major advantages for repair of large sacral defects. It is a safe, simple, and less invasive method. The purpose of this presentation is to demonstrate our encouraging experience with this surgical modality.
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