A Case of Green Nail Syndrome in a Dress Designer with a Chronic Use of Thimble / 대한피부과학회지

Green nail syndrome is a chronic nail infection by Pseudomonas aeurginosa. Infected lesions can involve both finger and toe nails and cause greenish discoloration and onycholysis. Environmental factors such as frequent hydration and external trauma are predisposing factors. A 37-year-old patient was diagnosed with green nail syndrome on the right thumb. She used a thimble for a long time as a dress designer. Herein, we describe an uncommon case of green nail syndrome by chronic thimble use as a rare and an educational report.

A case of de novo B - cell prolymphocytic leukemia associated with false - positive direct antiglobulin test / 대한내과학회지

De novo B-cell prolymphocytic leukemia (B-PLL) is a distinct clinicopathologic entity that was first described in 1974 by Galton et al. B-PLL is characterized by marked lymphocytosis with predominance of prolymphocytes, often massive splenomegaly, minimal lymphadenopathy, often aggressive clinical course and frequently poor prognosis.We experienced a case of B-PLL associated with false-positive direct antiglobulin test. The patient was 52 year-old man who presented with marked leukocytosis (160.2x103/(mu)L) and 60% of characteristic prolymphocytes in the peripheral blood. The bone marrow aspirate showed dry tap and the PAS stain of peripheral blood smear showed positivity of prolymphocytes. The immunophenotyping of the leukemic prolymphocytes revealed the positivity of surface immunoglobulin (IgM, lambda type), HLA-DR, CD19 and CD5.

Two Cases of Antisynthetase Syndrome Combined with Mechanic's Hand / 대한류마티스학회지

The antisynthetase syndrome is characterized by inflammatory myositis associated with intersititial lung disease (ILD), polyarthritis, mechanic's hand, and Raynaud's phenomenon, and usually with fever. The patients with these conditions have autoantibodies to aminoacy1-tRNA synthetases (histidy1-, threony1-, alany1-, isoleucy1-, and glycy1-tRNA synthetase) ; the most common is anti-histidy1-tRNA sythetase (anti Jo-1), present in 20% of myositis patients in Western countries. However, the mechanisms of production of autoantibodies to aminoacy1-tRNA synthetases are not understood. Several hypotheses about the relationship of anti-aminoacy1-tRNA synthetases with inflammatory myositis have been reported. The poor prognostic outcome for the antisynthetase patients are related to ILD. We experienced two cases of antisynthetase syndrome which have characterized by the clinical manifestations, and report these cases with a review of the literatures.

A Case of Intractable Diarrhea Associated with Early Onset Secondary Amyloidosis in Rheumatoid Arthritis / 대한류마티스학회지

Amyloidosis is a disease that characterized by accumulation of an amorphous, proteinaceous materials in the various tissues and organs, but its origin is unknown. Recent clinical study showed that incidence of amyloidosis in rheumatoid arthritis was near 10% to 21%. Secondary amyloidosis is caused by accumulation of serum amyloid. A which is doing the acute phase behavior faster than C reactive protein. Symptoms of amyloidosis are various according to the involved organ. Gastrointestinal symptoms are obstruction, ulcer, malabsorption, and bleeding. Diarrhea is very intractable with the conventional antidiarrheal agent, the mechanism of that is infiltration of amyloid material in the intestinal myenteric plexus, sympathetic nerve and ganglion. We report a case of 65 years old woman with rheumatoid arthritis presented with abdominal pain, intractable diarrhea which was not controlled by antidiarrheal agents. Duration of arthritis is only 2 years. Immunohistochemical stain showed AA type which meant secondary form. We treated with Octreotide analogue and total parenteral nutrition for chronic diarrhea.

Synovial Fluid Adenosine Deaminse Activity in the Patients of Rheumatoid Arthritis, Osteoarthritis, Ankylosing Spondylitis, and Gouty Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate whether synovial fluid adenosine deaminase activity is useful in the differential diagnosis of joint swelling and in estimating the disease activity. METHOD: Adenosine deaminase activity was determined in the synovial fluid taken from patients with rheumatoid arthritis (n=21), osteoarthritis (n=ll), ankylosing spondylitis (n=3), and gouty arthritis (n=2). This enzyme activity was compared with the laboratory indices (ESR, CRP) in the blood and the other parameters in the synovial fluid. RESULT: More increased adenosine deaminase activity was found in the synovial fluid taken from patients with rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis, as compared with that of osteoarthritis patients. Synovial fluid ADA activity was significantly corelated with the WBC count in the synovial fluid, but there was no statistical corelation between other synovial parameters and adenosine deaminase activity. CONCLUSION: Adenosine deaminase activity is useful in the differential diagnosis of joint swelling between inflammatory joint disease and osteoarthritis, but not useful in estimating the disease activity.

The Effect of Halofantrine in the Treatment of 14 Cases of Chloroquine Resistant Imported Malaria / 대한내과학회지

OBJECTIVES: The prevalence of malaria is increasing in recent years and also multidrug resistant malaria is increasing around the world and there is an increasing concern about imported malaria in nonendemic areas. Now many drugs are tried to find out effect on multidrug resistant malaria. We performed this study to investigate the thrapeutic effect of halofantrine in the treatment of chloroquine resistant imported malaria. METHODS: From Feb. 1992 to May 1995, we experienced 35 patients infected with malaria and treated 14 patients among 35 patients with halofantrine. RESULTS: 1) All 14 patients were sailor with a mean age of 39.4 years and infected with malaria. 2) The majority of patients were infected with malaria at Africa. 3) 10 patients were infected with Plasmodium falciparum and the remainder were undetermined. 4) In the 11 cases of chloroquine resistant malaria treated with quinine plus tetracycline combination therapy or Fansidar, 4 cases could not be tolerable due to side effects and resistance to the therapy, we substituted halofantrine for above regimens. 5) In the 10 cases, treated after May 1994, halofantrine was the first choice of treatment because they were the cases of malaria infected in the mid-Africa where the prevalence of chloroquine resistant malaria is high. 6) With halofantrine, all 14 cases were treated with minimal side effects suc4 as nausea, vomiting, anorexia, abdominal pain and fatigue. CONCLUSION: We think halofantrine is a simple and effective regimen against chloroquine resistant malaria and consider this agent as an alternative therapeutic regimen on chloroquine resistant malaria.