Aquagenic Urticaria Treated with Omalizumab / 대한내과학회지

Aquagenic urticaria is a rare form of physical urticaria in which a 1-2 mm wheal is produced by contact with water. Treatment options include antihistamines, ultraviolet monotherapy, topical barrier creams, and acetylcholine antagonists. Despite these pharmacologic measures, the symptoms are frequently refractory to therapy. Aquagenic urticaria lowers the patient’s quality of life and causes daily discomfort. Recently, a patient with aquagenic urticaria treated with omalizumab was reported. Here, we describe a 22-year-old man with a 3-year history of aquagenic urticaria confirmed by a water immersion test. Because he showed no improvement with antihistamines, the patient began omalizumab treatment and demonstrated an excellent response. This case provides new information for clinicians.

Factors affecting incorrect interpretation of abdominal computed tomography in non-traumatic patients by novice emergency physicians

Objective@#Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans. @*Methods@#This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists’ reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis. @*Results@#Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0–16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85–14.78). @*Conclusion@#Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents’ training should focus on these two areas to improve abdominal CT interpretation accuracy.

Aquagenic Urticaria Treated with Omalizumab / 대한내과학회지

Aquagenic urticaria is a rare form of physical urticaria in which a 1-2 mm wheal is produced by contact with water. Treatment options include antihistamines, ultraviolet monotherapy, topical barrier creams, and acetylcholine antagonists. Despite these pharmacologic measures, the symptoms are frequently refractory to therapy. Aquagenic urticaria lowers the patient’s quality of life and causes daily discomfort. Recently, a patient with aquagenic urticaria treated with omalizumab was reported. Here, we describe a 22-year-old man with a 3-year history of aquagenic urticaria confirmed by a water immersion test. Because he showed no improvement with antihistamines, the patient began omalizumab treatment and demonstrated an excellent response. This case provides new information for clinicians.

Factors affecting incorrect interpretation of abdominal computed tomography in non-traumatic patients by novice emergency physicians

Objective@#Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans. @*Methods@#This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists’ reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis. @*Results@#Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0–16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85–14.78). @*Conclusion@#Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents’ training should focus on these two areas to improve abdominal CT interpretation accuracy.

Stability of unilateral sagittal split ramus osteotomy for correction of facial asymmetry: long-term case series and literature review

Bilateral sagittal split ramus osteotomy is considered a standard technique in mandibular orthognathic surgeries to reduce unexpected bilateral stress in the temporomandibular joints. Unilateral sagittal split ramus osteotomy (USSO) was recently introduced to correct facial asymmetry caused by asymmetric mandibular prognathism and has shown favorable outcomes. If unilateral surgery could guarantee long-term postoperative stability as well as favorable results, operation time and the incidence of postoperative complications could be reduced compared to those in bilateral surgery. This report highlights three consecutive cases with long-term follow-up in which USSO was used to correct asymmetric mandibular prognathism. Long-term postoperative changes in the condylar contour and ramus and condylar head length were analyzed using routine radiography and computed tomography. In addition, prior USSO studies were reviewed to outline clear criteria for applying this technique. In conclusion, patients showing functional-type asymmetry with predicted unilateral mandibular movement of less than 7 mm can be considered suitable candidates for USSO-based correction of asymmetric mandibular prognathism with or without maxillary arch surgeries.

A Case of Castleman's Disease Accompanied with Systemic Lupus Erythematosus

Castleman's disease is a rare atypical lymphoproliferative disorder. Although HHV-8 has been reported to be a cause of Castleman's disease, the etiology and pathogenesis of the disease remains mostly unknown. We experienced a 51-year-old female patient who was concurrently diagnosed with Castleman's disease and systemic lupus erythematosus. Castleman's disease has been rarely reported in patients with systemic lupus erythematosus. Thus, we report the case and briefly discuss relevant articles.

A Case of Pediatric-onset Mixed Connective Tissue Disease Presenting Raynaud's Phenomenon Affecting Tongue, Hands, and Feet

Mixed connective tissue disease (MCTD) was first described by Sharp and coworkers in 1972, characterized by symptoms of Raynaud's phenomenon or swollen hands, overlapping clinical features of systemic lupus erythematosus, systemic sclerosis, or polymyositis/dermatomyositis, and the presence of anti-U1 RNP antibody. MCTD is rare in children and constitutes 0.3~0.6% of all rheumatologic patients in pediatric rheumatology database of the United States. Here, we report the first Korean case of a 10-year-old female patient with MCTD, presenting Raynaud's phenomenon in the hands, feet, and tongue.

Analysis of the acid-base disorders of critically ill patients in the medical intensive care unit / 대한내과학회지

BACKGROUND: Acid-base imbalances are common in critically ill patients; however, the incidence of acid-base imbalances in the medical intensive care units has not been fully determined. In this study, we investigated the incidence and the type of acid-base imbalances in critically ill patients and we assessed which variables were associated with the patients' outcome. METHODS: One hundred eighty-seven patients (122 men, age: 61.2+/-12.8 years) were enrolled. All the patients were admitted to the medical intensive care unit between January 2005 and December 2005. All the data sets included simultaneous measurements of an arterial blood gas with base excess, the serum electrolytes, the anion gap and the APACHE II scores. RESULTS: The mortality rate was 56.7%. The incidence of acid-base imbalances was as follows: 25.1% were single disorders that existed with only a single primary acid-base imbalance, 48.7% were double disorders, 13.4% were triple disorders and 12.8% were normal (no disorders). The incidence of metabolic acidosis was 57.8% and the mortality rate was not different according to the type of acid-base imbalances. There were significant differences between the nonsurvivors and survivors according to the pH (7.34 vs. 7.41, respectively), HCO(-)3 (20.68 mmol/L vs. 25.90 mmol/L, respectively), ECF base excess (-5.19 vs. 1.19, respectively), the anion gap (18.57 mmol/L vs. 13.77 mmol/L, respectively), the corrected anion gap (23.63 mmol/L vs. 17.96 mmol/L, respectively), the serum albumin (2.37 g/dL vs. 2.74 g/dL, respectively), and the APACHE II scores (20.7 vs 17.2, respectively). However, on the Cox proportional hazard regression analysis, only the APAHCE II scores affected the patients' outcome. CONCLUSIONS: There were diverse acid-base imbalances in the critically ill patients and the incidence of metabolic acidosis was highest among the acid-base imbalances. The best predictor of the patients' outcome was the APACHE II scores.

A Case of Aplastic Anemia Associated with Systemic Lupus Erythematosus: Successful Treatement with Cyclosporine / 대한류마티스학회지

Systemic lupus erythematosus(SLE) is autoimmune disease in which involves systemic organs. Hematological manifestations are common in patients with SLE but aplastic anemia is very rare and, although various immunosuppressants have been tried, there is no established treatment in aplastic anemia associated with SLE. Furthermore, disease course and prognosis may be different from other aplastic anemia. A 42-year-old woman presented with fever, chilling, myalgia, general weakness, pancytopenia. Her bone marrow aspirate and biopsy revealed almost acellular bone marrow with rare foci of hematopoietic elements and she was diagnosed with SLE simultaneously. High-dose methyprednisolone, prednisolone and cyclophosphamide therapies had been unsuccessful in controlling pancytopenia. Cyclosproine was started and the aplastic anemia was responded. Now she was free of transfusion with more than 10 g/dL of hemoglobin.

Implant-supported prosthesis placed in the distraction-augmented alveolar bones: review of 2 cases

Production Of Gm-Csf And Tgf-beta 1 In Irradiated Human Gingival Fibroblasts Cultured With Lipopolysaccharide

PURPOSE: Irradiation in the oral cancer patients causes early and late complications such as intraoral mucositis and fibrosis, with a various expression of GM-CSF and TGF-beta. The purpose of this study was to investigate the production of GM-CSF and TGF-beta1 by the irradiated human gingival fibroblasts cultivated with lipopolysaccharide. MATERIALS AND METHODS: Irradiated (total dose, 60 Gy) human gingival fibroblasts were incubated with LPS. Culture supernatants that were collected at 24, 48, and 72 hours were assessed for GM-CSF and TGF-beta1 by enzyme-linked immunosorbent assay. RESULTS: 1. GM-CSF production in nomal gingival fibroblasts was increased with incubation time, but decreased with incubation time in irradiated gingival fibroblasts. GM-CSF production in both normal and irradiated gingival fibroblasts induced with LPS was higher than the control. 2. TGF-beta1 production in normal gingival fibroblasts was decreased after 24 hours, but, it was increased until 48 hours in irradiated gingival fibroblasts. TGF-beta1 production in normal gingival fibroblasts exposed with LPS was higher than the control. Conversely, It was lower than the control in irradiated gingival fibroblasts exposed with LPS. CONCLUSION: This indicates that irradiation in gingival fibroblasts may play an important role in radiation-induced intraoral mucositis and fibrosis. However, LPS decreases the production of TGF-beta1 in the irradiated gingival fibroblasts.

Spatial changes of the maxillofacial complex following maxillary protraction of human dry skull / 대한치과교정학회지

The purpose of this investigation was to study the spatial changes of the maxillofacial complex following maxillary protraction transmitted to the center of resistance of a dry juvenile human skull by a modified maxillary protraction appliance. Four dry juvenile human skulls (without mandible) with well aligned upper deciduous dentition and early mixed dentition were used as experimental samples. A modified protraction headgear was fabricated from a Delare's facemask, and following an alginate impression, an orthodontic resin maxillary splint was made for each dry skull. Protraction force level was maintained at approximately 1000gm per side for 6 hours. Cephalometric radiographs were taken pre- and post-protraction, and nine reference markers with 1.5 mm length of .017 x .025 TMA wire were placed on the right side of the skull for an accurate superimposition of serial cephalometric radiographs. The present investigation demonstrated that vertical changes associated with an anterior displacement of the maxillary complex was observed, and the most prominent effect of protraction headgear was a counterclockwise rotation of the maxilla, that is, a forward and downward tipping around the palatomaxillary region.

Osteoblastoma-like Osteosarcoma occurred in the Mandible: Report of A Case

Quantitative Analysis of Transforming Growth Factor-beta1 in Human Fibroblasts Induced with Staphylococcus enterotoxin B and Lipopolysaccharide

Reconstruction of midfacial defects utilizing rectus abdominis free flap: report of 2 cases

The Usefulness of Panoramic Radiography using a Lead Ruler for Dental Implant Planning

PURPOSE: If damage to the neurovascular bundle of the mandibular canal during dental implant surgery of the mandible is to be prevented, accurate measurement of the distance between the alveolar crest and the mandibular canal, as seen on panoramic radiographs, is important. The purpose of this study was to compare the accuracy of panoramic radiography using a lead ruler with that of computed tomography for the measurement of the distance between the alveolar crest and superior border of the mandibular canal and to evaluate the usefulness of panoramic radiography using a lead ruler. MATERIALS AND METHODS: For control study, panoramic radiography of the dry mandible was undertaken using a lead ruler, and computed tomography was added. The distances between the alveolar crest and the superior border of the mandibular canal and between the alveolar crest and the lowest border of the body of the mandible were measured at the level of the 2nd premolar to the 3rd molar. These measurements were compared with actual measurements of the dry mandible in the same areas. The cases of 87 patients[49 men, 38 women; age range, 20 -84 (mean, 42) years] who had undergone panoramic radiography using a lead ruler were reviewed. They were catergorized according to sex, the presence of teeth, and whether under or over 50 years of age. All measurements were compared and analyzed using the Student t-test. RESULTS: Measured values obtained from a panoramic radiograph using a lead ruler(magnification:100.32%+/-5.92) and from a computed tomograph(magnification:100.22%+/-5.55) deviated less from actual measurements on the dry mandible (p > 0.05). The distance from the 2nd premolar to the 3rd molar was greater in male adults (19.62 mm +/-3.95) than in female (17.54 mm +/-4.04) (p 0.05), except 2nd pre molar and 1st molar in the female. CONCLUSION: Panoramic radiography using a lead ruler is a simple and accurate modality for the presurgical planning of dental implant surgery. It is suggested that the successful long-term rate of dental implantation may be higher in dentulous male than in edentulous female molars.

Production of Transforming Growth Factor-beta1 in Human Fibroblasts Induced with Bacterial Toxins

TGF-beta1 is a potent chemotactic factor for inflammatory cells and fibroblasts. It also stimulates the celluar source and components of extracellular matrix and the production of proteinase inhibitors. Collectively, these biologic activities lead to the accumulation and stabilization of the nascent matrix, which is vital to wound healing. The objective of this study is to investigate production of TGF-beta1 in vitro fibroblast culture in the presence of Staphylococcus enterotoxin B(SEB) and/or lipopolysaccharide(LPS) and to elucidate the role of TGF-beta1 which may be responsible for wound healing The fibroblasts were originated from facial dermis and hypertrophic scar in 26 year-old male patient. In the presence of LPS(0.0l microgram, 0.1 microgram, 1.0 microgram), SEB(0.0l microgram, 0.1 microgram, 1.0 microgram) respectively, cells(5x103ml) were cultivated in vitro. At 1, 3, and 5 days after incubation, cells were counted. Also, cells(2.5x105ml) were cultivated in EMEM with LPS(0.01, 0.1 and 1.0 microgram), SEB(0.01, 0.1 and 1.0 microgram) respectively and LPS(0.1 microgram) and SEB(0.1 microgram) in combination for 24, 48, and 72 hours respectively. Culture supernatants were harvested at 1, 2, and 3 days after incubation period and triplicate culture supernatants were pooled and TGF-beta1 was assayed in duplicate. The results were as follows. 1. In facial dermal fibroblast induced with SEB and LPS respectively or in combination, the suppression of cell proliferation occurred very significantly at 1 day after incubation, compared with the control. In SEB exposure, the production of TGF-beta1 was decreased very significantly at 1 day after incubation, compared with the control. However, in LPS, SEB and LPS exposure, the production of TGF-beta1 was increased very significantly at 1 day after incubation, compared with the control. 2. In hypertrophic scar fibroblast induced with SEB and LPS respectively or in combination, the suppression of cell proliferation did not occur at 1 day after incubation, compared with the control. In SEB and LPS exposure in combination, the production of TGF-beta1 was increased very significantly at 1 day after incubation, compared with the control. However, the production of TGF-beta1 did not occur in SEB and LPS exposure respectively. In conclusion, the concentration of bacterial toxins and the incubation period correlated with cell proliferation and production of TGF-beta1 very significantly and both fibroblasts have different phenotype each other in this regard. This data suggest that the significant production of TGF-beta1 may develope abnormal wound healing associated with tissue fibroproliferative disorder, such as hypertrophic scar and keloid formation.

Production of IL-6 and IL-8 in human fibroblasts stimulated with bacterial toxins

The cervical island flap for intraoral reconstruction following excision of oral cancer: report of 3 cases