Two Cases of Anaphylaxis After Laminaria Insertion

Anaphylaxis following laminaria insertion rarely occurs but may be a life-threatening condition. Laminaria tents, prepared from natural sea kelp, are commonly used prior to elective termination of pregnancy to achieve cervical dilatation. We report herein two cases of anaphylaxis caused by IgE-mediated hypersensitivity to laminaria. Two women, each of whom had undergone at least one previous abortion where a laminaria had been utilized, developed anaphylactic reaction following laminaria insertion. The reaction included urticaria, nausea, breathing difficulty, and hypotension. The patients subsequently underwent skin testing and measurement of serum specific IgE level to laminaria extract, and were shown to elicit positive responses to laminaria. The implication and impact of laminaria allergy on gynecologic procedures are significant and this allergy should be included in the list of differential diagnoses for hypersensitive reaction in gynecologic procedures.

Contact urticaria to bisphenol-A-Diglycidylether dental resin / 천식및알레르기

Epoxy resin based on Diglycidyl-ether-Bisphenol-A has been commonly used in dental fillings and dentures. Epoxy resin is a well known low molecular weight chemical sensitizer, but contact urticaria from epoxy resin has been infrequently reported despite it's wide use in dental practice. We report a case of a 48-year-old housewife who presented a recurrent episode of perioral erythema and angioedema associated with dental work. These symptoms, which occurred within 2 hours of having dental fillings, were aggravated with repeated dental procedures for a period of several days. Her symptoms improved after removal of dental fillings. Her contact urticaria to epoxy resin was reproduced by patch test with AH26 root canal sealer containing Bisphenol-A type epoxy resin. Delayed type reaction to epoxy resin was also noted. Her symptoms did not reoccur after use of another type of root canal sealer.

A case of anaphylactic shock induced by hydrocortisone sodium succinate in patient with wheat allergy / 천식및알레르기

Corticosteroids are widely used in treatment of allergic or idiosyncratic anaphylactic reactions, paradoxically, they can be responsible for anaphylactic reactions. Although several reports of suspected allergic reactions to corticosteroids had already appeared, Mendelson et al reported the first instance of immediate anaphylaxis ascribed to solucortef in 1974. We present a review of the literature, and report on one patient with wheat allergy suffered from anaphylactic shock after injection of hydrocortisone sodium succinate. In patients with systemic severe reactions to injectable corticosteroids, we recommend careful and comprehensive skin testing with most available corticosteroids, as well as the components of the injectables.

Effect of VCAM-1 expression in human endothelial cells by proinflammatory cytokines / 천식및알레르기

BACKGROUND: The expression of adhesion molecules contribute to development of systemic diseases. Vascular cell adhesion molecule-l(VCAM-1) is an endothelial cell membrane glycoprotein that has been implicated in leukocyte/endothelial cell interactions in inflammation. OBJECTIVE: The aim of this study was to characterize the surface expression and regulation of VCAM-1 on two different endothelial cells. METHOD: We examined the effects of the expression of VCAM-1 in two different endothelial cells, isolated from human umbilical cords and human glomerulus. Expression of VCAM-1 was measured by enzyme-linked immunosorbent assay(ELISA) and flow cytometry. RESULTS: In human umbilical cord endothelial cells(HUVECs), both interleukin-l B(IL-lB) and tumor necrosis factor-a (TNF-a) increased VCAM-1 expression. VCAM-1 expression increased by TNF-a was higher than that increased by IL-lB. In human glomerular endothelial cells(HGECs), IL-lB and TNF-a markedly increased VCAM-1 expression. Conclusion. The regulation of VCAM-1 appears to be somewhat different in HGECs compared with HUVECs. These differences between the responsiveness of the two cells may possibly indicate inherent differences in endothelial cell derived from different vascular beds.

A case of anaphylaxis to laminaria / 천식및알레르기

Anaphylaxis is a life - threatening syndrome elicited in a hypersensitive individual on subsequent exposure to a sensitizing antigen with, reactions ranging widely in severity from mild pruritus and criteria to shock and death. Anaphylaxis occurs in the United States at rates estimated to be as high as one in every 3000 inpatients and may account for more than 500 deaths annually. Preparations of kelp Laminaria digitata are used as tents in gynecologic procedures to dilate the cervix, and the kelp consists principally of a glucagon carbohydrate called laminarin. Laminarin is thought to function as the active ingredient in dilatation by changing osmotic pressure or uterine prostaglandin metabolism. The tent is inserted into the cervix several hours before the procedure. As the cervix desiccates and dilates, the tent develops an hourglass shape. Recently, we experienced one patient with anaphylaxis to laminaria diagnosed by skin test and showing good response to treatment.

The Clinical Characteristics of 16 Patients with Sphincter of Oddi Dyskinesia / 대한소화기내시경학회지

We evaluated the clinical characteristics of patients with SO dyskinesia(n=16) who were confirmed by ERCP manometry during past 5 years. They were 14 male and 2 female and mean age was 52-year-old(range, 32-75). According to the criteria suggested by Hogan and Geenen, 13 patients were classified into biliary type and 3 patients into pancreatic type. Among the patients with biliary type(n=13), 12 patients fulfilled the criteria for group II dysfunction of SO and 1 patient for group III. Among the patients with pancreatic type(n=3), all fulfilled the criteria for group II. The manometric abnormalities were increased basal pressure(n=4), tachyoddia(n=7), increased retrograde propagation(n=3), tachyoddia and increased retrograde propagation(n=l), and tachyoddia and increased basal pressure(n=l). As treatment, 12 patients received conventional endoscopic sphincterotomy and 3 patients received endoscopic pancreatic sphincterotomy in addition to conventional endoscopic sphincterotomy. Satisfactory results (complete absence or marked reduction of pain) were obtained in 13(87%) out of 15 patients by endoscopic treatment. In conclusion, SO dyskinesia is not so common disease and the detection of patients with SO dyskinesia may increase by frequent application of ERCP manometry.

A Case Arthritis After Intravesical BCG Instillation for Bladder Cancer / 대한류마티스학회지

Intravesical instillation of BCG(Calmette-Guerin Bacillus) is the most widely used treatment of superficial transitional cell carcinoma of the bladder. While the exact mechanisms are not yet known, it is assumed that the recognition of tumor antigen is enhanced by immunologic response of the urothelium of mycobacterium. Various complications have been reported after BCG treatment and arthritis is observed in 0.5 to% of treated patients. This from of arthritis may be attributed to an antigen of mycobacterium sharing a cross reactive epitope with an antigen in articular cartilage. A 40-year-old male had transurethral resection and intravesical instillation of BCG for transitional cell carcinoma of bladder. Within few days of the fourth instillation, he developed arthritis on right knee and right metatarsal joint. Laboratory findings showed nonspecific inflammatory sign, positive HLA B27, negative rheumatoid facor and negative antinuclear antibody. The joint effusion was aseptic. He was treated with nonsteroidal antiinflammatory drugs (indomethacin 200rag/day) with resolution of arthritis symptom. We report a patient who developed an inflammatory oligoarthritis following intravesica] instillation of BCG for the treatment oof bladder cancer.