• Archives of Plastic Surgery
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• v.34 no.1
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• pp.77-80
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• 2007

Purpose: Purpura fulminans is a rare but rapidly progressive, serious, often life-threatening disorder in childhood, which is complicated with septic shock or disseminated intravascular coagulopathy during acute infection. It occurs first as acute-onset petechial rash, and spreads rapidly into full thickness skin and soft tissue necrosis. In the past, it had high mortality rate, up to 80%, but recently, survival rate has increased due to early diagnosis, and rapid advancement of critical care and antibiotics. From our experiences of PF management, we would like to review the pathophysiology and suggest the surgical treatment guideline about meningococcal induced purpura fulminans. Methods: Two cases of purpura fulminans over the last 3 years were reviewed retrospectively about reconstructive management. After they were treated resuscitative management initially by the critical intensive care, reconstructive surgery was performed by plastic surgeon as soon as the patients were vitally and mentally stable. Results: There were 6 procedures in case 1, and 3 procedures in case 2. The mean delayed period from admission with sepsis to the first surgical debridement was 24 days and 42 days, respectively. Total hospitalization period was 103 days and 69 days, respectively. All of them were treated with debridement and split thickness skin graft, but delayed debridement was superior to early one in the point of preserving much more tissues. Conclusion: From our experience, we suggest that conservative therapy to the wounds appears to be the best tool in the initial vitally unstable period in order to preserve as much tissues and functions as possible if no active inflammation and compartment syndrome are detective.

• Tuberculosis and Respiratory Diseases
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• v.52 no.4
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• pp.367-375
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• 2002

Background : Murine typhus is a flea-borne, worldwide Rickettsial disease caused by Rickettsia typhi. Its symptoms are typically mild but sometimes can be fatal. The major clinical features include fever, rash, and headache. Recently, we experienced 6 cases of ARDS associated with a Rickettsia typhi infection. This study was aimed to analyze the attributing factors for fatal murine typhus and to review the characteristics of the patients who showed acute respiratory distress syndrome as the initial presentation. Methods : The medical records of 15 patients diagnosed as murine typhus were reviewed. The diagnosis was made by single titers of 1:512 or higher, or a 4-fold rise with compatible clinical features. Acute Respiratory Distress Syndrome (ARDS) was defined according to the American-European Consensus Conference. The Characteristics between the ARDS group and the non-ARDS group of murine typhus were compared. Results : Six patients developed ARDS as their initial presentation. Two of them were women and three of them had lived urban area. None of Them a showed skin rash. One of them expired during treatment. The time lapse until the commencement of the specific treatment, the lower serum albumin level, the higher serum total bilirubin level, the higher APACHE III score and the higher MOD score were significantly associated with the ARDS group compared to the non-ARDS group. Conclusion : Murine typhus should be considered as one of the etiologies for the ARDS of unknown cause, particularly in an endemic regions. ARDS caused by Murine typhus generally has a good prognosis.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.213-221
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• 2001

Propose : Tsutsugamushi fever is a acute febrile disease, which is caused by O. tsutsugamushi. Recently, this disease is increasingly reported in children. This study was undertaken to investigate clinical features of tsutsugamushi fever in children. Methods : This study involved 17 children with tsutsugamushi fever who were admitted to Masan Samsung hospital between September 1997 and December 2000. We investigated the age, sex ratio, clinical manifestations, laboratory findings, response of therapy and prognosis. Results : The age of patients was $6.9{\pm}3.6$ years, ranging from 6 months to 12 years and male predilection(58.8%) was noted and all cases of patients occured in October or November. The most common symptoms were fever in all cases and headache in 8(47.1%). The most common signs were skin rash in all cases, eschar in 14(82.4%) and lymphadenopathy 8(47.1%). Locations of the eschars were back and inguinal area in each 3 cases, neck and chest in each 2, popliteal area in 2, scalp and thigh in each 1. Laboratory findings included anemia in 1 case, leukopenia and thrombocytopenia in each 5, hematuria and proteinuria in each 1, ESR elevation in 2 and positive CRP in 12, AST elevation in 9 and ALT elevation in 7. Serologic diagnosis was made by passive hemagglutination assay(PHA) in 8 cases(47%) on admission, 4 cases in initial negative group were performed follow-up test at 2nd or 3rd weeks of illness and then all cases of 4 were converted to positive reaction. Clinical improvement was noticed in all cases after treatment to chloramhenicol or doxycycline. Mean duration for defervescence after treatment was $1.4{\pm}0.8$ days. Complications were interstitial pneumonia in 1 case and aseptic meningitis in 3, but all cases of patients were recovered without sequelae or recurrence. Conclusions : Tsutsugamushi fever in children was similiar to adult in the clinical features except male predilection. Early diagnosis and empirical treatment based on clinical manifestations such as fever, skin rash, eschar, lymphadenopathy is important and serologic diagnosis need to perform follow-up test at 2nd or 3rd weeks of illness.

• KSBB Journal
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• v.25 no.4
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• pp.387-394
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• 2010

This study was conducted to investigate effect of complex extract of various mushrooms and sharp toothed eel on the skin conditions with atopic dermatitis and acne symptoms. The total phenol concentration was increased in order of hot water> ethanol> ethyl acetate> petroleum ether> chloroform extract. Especially, when the hot water extract was used, it was about 2-3 fold higher than that of ethyl acetate, petroleumether, and chloroform extract. When the complex extract concentration was increased from 1.0 to 50 mg/L, the DPPH scavenging rate increased from 10.1 to 81.4%. The reduction power was sharply increased from 0.05 to 0.27 (700 nm) when the complex extract concentration was increased from 25 to 75 mg/L. However, above 100 mg/L, it was not decreased. In the case of SOD-like activity, it was 45.7% at 100 mg/L. Total numbers of patients with atopic dermatitis were 15 and 5 patients with severe acne symptoms. According to photos taken before and after the treatment and questionnaire results, considerable improvements in skin conditions are observed in the patients with atopic dermatitis and acne. For atopic patients, erythema and edema have been improved but the degree of effect was dependent on the individual's constitution. Concerning acne, the effect of coating of the extracts was prominent for first week and the degree decreased with time till 4 weeks. The complex extracts wereefficient in soothing rash and maturation. Side effects such as a scar were not detected during the application and treatment.

• Journal of Acupuncture Research
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• v.17 no.1
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• pp.1-12
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• 2000

Ge-Fu(歌賦) means prose and poetry individually, and they both have a meaning of all the rhythmical poetrical compositions making it ease for people to remember the content. All the Ge-Fus used in oriental medicine are made in Yuan(元), Mine(明)and Qing(靑)dynasty, and they have been largely used in most of all the fields of medicine such as Ben-Cao(本草), Tang-Ye(湯液), Zhen-Jiu(鍼灸), Zhen-Duan(診斷). Zhen-Jiu-Ge-Fu(鍼灸歌賦) has about 90 poetries and 10 proses and they contain the names of meridian; courses of meridian streams; accurate positions of acupuncture points; functions; effects; meanings of the name of acupuncture points; usages and effects of special points; manipulations of reinforcing and reducing method; contraindications of acupuncturing; principles of selections and orders of acupuncture points in therapy; and eight diadgoses. Zhen-Jiu-Ge-Fu is subdivided into Jing-Xue(經穴歌), Zhi-Jiu-Ge(刺灸歌), Shu-Xue-Ge(輸穴歌), Zhi-Liao-Ge(治療歌). And In Zhi-Liao-Ge, the most brief and essential Ge-Fu-Si-Zong-Sue-Ge- contains theraputic designs using far apart acpuncture points from the right painful areas in the body. In this study, the author opinionated the Si-Zong-Sue-Ge can be the prototype of the distant needling; the research on this can open the importance of Ge-Fus. On conclusion, 1. "Upper and lower Abdomen - Zu-San-Li($S_{36}$) (肚腹三里留)" means when there are problems and disorders in upper and lower abdomen, distinctively, such as gastric pain, maldigestion, flatulence, abdominal pain, constipation, diarrhea, vomiting, menstrual disorer, knee pain and tonic functioning, 족삼리 can be a right choice for distant needling point for treating. 2. "Face and Eye-He-Gu($Li_4$) (面目合谷收)" means when there are problems and disorders in facial, eye, ear, nose, throat, mouth regions, distinctively, such as facial edema, toothache, headache, sore throat, rhinorrhea, frontal headache, abdominal pain, dizziness, He-Gu can be a right choice for distant needling point for treating. 3. "Upper and lower back - Wei-Zhong($B_{40}$) (腰背委中求)" means when there are problems and disorders in upper and lower back, distinctively, such as upper back pain, lumbargo, hamstring muscle pain, popliteal region pain, lower extremity compartment syndrom, Inguinal region pain, muscle twitch, vomiting and diarrhea, hemorrhoidal bleeding, skin rash, Wei-Zhong can be a right choice for distant needling point for treating. 4. "Head and neck - Lie-Que($L_7$) (頭項審列缺)" means when there are problems and disorders in capital and nuchal area, distinctively, such as migraine, frontal headache, rhinorrhea, asthmatic dyspnea, aphasia, coughing, neck stiffness, occipital headache, upper extremity pain, Lie-Que can be a right choice for distant needling point for treating.

• Pediatric Infection and Vaccine
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• v.21 no.1
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• pp.65-70
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• 2014

Although congenital syphilis can be prevented with prenatal screening, the disease remains problematic. Currently, there are no cases that describe hematuria and pneumonia related to congenital syphilis. We report a case of congenital syphilis that involved nephrotic syndrome and pneumonia alba in a 22-day-old male infant whose mother did not receive adequate prenatal care. The congenital syphilis diagnosis was confirmed with a serologic test and the patient recovered with penicillin treatment. Clinical findings may be subtle in neonates and delayed recognition occurs frequently, thus complete prenatal screening is critical for congenital syphilis prevention. Immediate serologic testing should be performed to obtain a differential diagnosis if an infant is delivered by a mother that has not received appropriate prenatal examinations.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.485-489
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• 2016

Objective: to investigate the effect and side effects of recombinant human interleukin - 11 (rhIL - 11, in Chinese Juheli, produced by Qi Lu Biotechnology CO., LTD) in the second prevention of chemotherapy induced thrombocytopenia (CIT). Methods: Cancer patients with CIT were recruited and were treated with rhIL - 11 (treatment phase, TP), and in the following cycle, all these patients administered with rhIL - 11 24 hours immediately after chemotherapy (preventive treatment phase, PTP). Duration and severity of thrombocytopenia between two phases were compared. Results: for patients in TP or PTP, nadir values of platelet were ($29.28{\pm}20.08){\times}10^9/L$ and ($45.24{\pm}19.66){\times}10^9/L$, duration of thrombocytopenia in TP and PTP was ($11.52{\pm}4.33$) and ($8.20{\pm}+2.77$)days, recovery time was ($19.40{\pm}3.89$)and ($13.44{\pm}3.02$)days, duration of rhIL - 11 administration was ($10.68{\pm}2.46$)and ($6.28{\pm}1.77$)days, number of patients needing platelet infusion was 16and4 respectively, all differences were statistically significant (p value were 0.007, 0.002, 0.000, 0.000, 0.034 respectively). For TP and PTP, number of patients with hemorrhage was 8 and 4, duration of bleeding was ($5.00{\pm}0.82$) and ($4.50{\pm}0.71$) days respectively, with no statistically significant difference. Adverse reactions mainly included fever, edema, arrhythmia, joint pain, fatigue, skin rash, headache, dizziness, etc., all were not statistically significant between TP and PTP. Conclusion: rhIL - 11 could be well tolerated and is effective that could reduce the duration, severity of CIT, platelet transfusion, and incidence of bleeding, as well as shorten the recovery time, duration of rhIL - 11 administration. Thus, rhIL - 11 could be commended in the second prevention of CIT for patients with cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.3
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• pp.2019-2022
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• 2013

Purpose: To investigate the safety and efficacy of pemetrexed combined with chemotherapy as second or third line in patients with stage IV colorectal cancer (CRC). Patients and Methods: This trial was conducted to evaluate the effectiveness and safety of pemetrexed given to patients with recurrent or metastatic colorectal carcinoma who previously received 5-FU-based chemotherapy. All patients were required to have a histological diagnosis of colorectal adenocarcinoma with measurable metastatic disease and prior chemotherapy. Patients received pemetrexed at a dose of 500 $mg/m^2$ by 10 minute infusion on day 1, repeated every 21 days. Doses were modified depending on nadir counts. Combined chemotherapy included Oxaliplatin, Irinotecan and cis-platinum. Results: Thirty patients were enrolled and twenty-nine were evaluable for response. One patient did not have repeat radiological testing to determine response because he went off study after only one cycle of treatment for economic reasons. For 29 evaluable patients, 1 partial response, 6 stable disease and 22 progressive disease were recorded. Response rate was 3.45% (1/29). All responses occurred in patients receiving a starting dose of pemetrexed 500 $mg/m^2$. Median time to progression for all eligible patients was 2.5 months. The most common toxicities experienced were mild to moderate fever, hepatic damage, myelosuppression, nausea, vomiting, constipation, abdominal pain, diarrhea, and skin rash. Conclusion: Pemetrexed at 500 $mg/m^2$ given every three weeks combined with chemotherapy is associated with moderate response and good tolerability in patients with stage IV CRC.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.2
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• pp.93-97
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• 2012

Background: Some disabled patients show insufficient cooperation during dental treatment, and general anesthesia in an outpatient setting can be successfully administered. To minimize post-anesthetic complications is an essential issue, and strict discharge protocols are required for the safety of the patients. Post-anesthetic follow-ups using telephone calls can be applied to improve the quality of the outpatient care system. The authors evaluated the post-operative condition of patients after dental treatment under general anesthesia. Methods: Total 143 patients and their caregivers included in this study. The patients received general anesthesia for dental treatment in Seoul National University Dental Hospital, Clinic for Persons with Disabilities from July, 2011 to April, 2012. Telephone calls were given to the patients or their caregivers to collect information about the patients' systemic condition and anesthesia-related complications. Results: Among 131 patients with responses of telephone calls, 87 patients (66.4%) reported no discomfort, while 44 patients (33.6%) presented post-anesthetic complications. A total of 20 patients reported mild fever, 10 patients had vomiting, and 7 patients had sore throat. Other complications included nausea, fatigue, nasal bleeding, skin sore, and body rash. Among the patients with the history of epilepsy, 63.6% showed post-anesthetic discomfort or complication (P = 0.027, ${\chi}^2$ test). Conclusions: One third of dental patients who received general anesthesia due to insufficientcooperation complained discomfort after discharged from outpatient anesthetic care.

• Pediatric Infection and Vaccine
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• v.15 no.2
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• pp.188-194
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• 2008

Purpose : The purpose of this study is to investigate the clinical characteristics of recurrent Kawasaki disease (KD). Methods : From January 2004 to December 2007, the medical records of 20 children with recurrent KD in Severance Children's Hospital were retrospectively reviewed. The clinical characteristics, laboratory findings, treatment and complications of these patients were compared between the initial episode and the second episode. Results : At the initial episode of the recurrent KD group, the gender ratio was 1.2:1 (male:female) and the mean age was $37.2{\pm}19.9$ months. The interval between the two episodes in the recurrent KD group was 3.3 months. The febrile period before admission was shorter for the second episode (P=0.034). The skin rash was less developed in the second episode. But there were no differences in the laboratory results and complications between the initial episode and the second episode. Three patients (15%) among those with a second episode failed to respond to the initial intravenous immunoglubulin treatment. On comparison between the initial episodes of the recurrent group and the nonrecurrent group, the erythrocyte sedimentation rate was higher in the first episode of the recurrent KD group. Conclusions : For recurrent KD, it tends to present more atypical features than the KD that occurs for the first time. Physicians should consider these characteristics when making the diagnosis and treating recurrent KD.