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Red blood cell distribution width is useful in discriminating adult onset Still's disease and sepsis within 24 hours after hospitalization

  • Park, Hee-Jin;Song, Jungsik;Park, Yong-Beom;Lee, Soo-Kon;Lee, Sang-Won
    • The Korean journal of internal medicine
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    • v.33 no.6
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    • pp.1234-1240
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    • 2018
  • Background/Aims: Red blood cell distribution width (RDW) is a value representing the heterogeneity in the size of red blood cell, and it is usually used in distinguishing types of anaemia. Recently, it was reported that it could reflect the burden of inflammation in diverse diseases and their prognosis. Hence, in this study, we investigated whether RDW may contribute to discriminating adult onset Still's disease (AOSD) from sepsis in serious febrile patients within 24 hours after hospitalization. Methods: We reviewed the medical records and enrolled 21 AOSD patients, 27 sepsis patients and 30 matched healthy controls. We collected at least two laboratory results of variables including RDW within 24 hours after hospitalization, and we calculated their mean values. Results: Sepsis patients showed the significantly increased median white blood cell count, compared to AOSD patients ($14,390.0/mm^3$ vs. $12,390.0/mm^3$, p = 0.010). The median RDW in sepsis patients was higher than that in AOSD patients (15.0% vs. 13.3%, p = 0.001), and furthermore, the median RDW in both patient-groups was significantly higher than that in healthy controls. In contrast, the median ferritin level in sepsis patients was lower than that in AOSD patients (544.0 mg/dL vs. 3,756.6 mg/dL, p = 0.001). In multivariate analysis, RDW ${\geq}14.8%$ (odds ratio, 17.549) and ferritin < 2,251.0 mg/dL (odds ratio, 32.414) independently suggested sepsis more than AOSD in patients initially presenting with fever requiring hospitalization. Conclusions: RDW might be a rapid and helpful marker for a differential diagnosis between AOSD from sepsis at an early phase.

Therapeutic Effects of Probiotics in Patients with Atopic Dermatitis

  • Yim, Jun-Hee;Kim, Duk-Han;Ku, Ja-Kyung;Kang, Yoon-Sung;Kim, Mi-Yeon;Kim, Hyung-Ok;Chung, Myung-Jun;Park, Young-Min
    • Journal of Microbiology and Biotechnology
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    • v.16 no.11
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    • pp.1699-1705
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    • 2006
  • Recent studies have suggested that oral bacteriotherapy with probiotics might be useful for preventing and managing childhood atopic dermatitis (AD). The purpose of this investigation was to evaluate the efficacy and safety of oral treatment with probiotics for adolescent and adult AD patients as well as for childhood AD patients. Sixty-four patients with mild to moderate AD were recruited for treatment with a mixture of four probiotic strains (Lactobacillus rhamnosus, Lactobacillus plantarum, Lactobacillus casei, and Biftdobacterium lactis) twice daily for 8 weeks. The degree of pruritus was determined by a 10-point visual analog scale every other week, and the patients' global assessments of their clinical responses (i.e., better, unchanged, or worse) was done at the end of intervention. The clinical severity of the eczema was evaluated by eczema area and severity index (EASI) score every other week. As laboratory markers, total immunoglobulin E (IgE), eosinophil cationic protein (ECP) in the serum, and cytokine production [interleukin-4 (IL-4), interleukin-10 (IL-10), and $interferon-{\gamma}\;(IFN-{\gamma})$ by the peripheral blood mononuclear cells (PBMCs) were measured at the beginning and at the end of intervention. Of the 64 enrolled AD patients, only 50 patients finally completed the 8-week study. After 8-week treatment with probiotics, the EASI score was significantly improved (p<0.0001), 50% of the patients experienced improvement of their eczema, and significant improvement of the pruritus was also observed (p=0.0002). The effect was more pronounced for the patients with very high IgE levels (>1,000 ku/l) or for the patients with moderate disease severity. There was no significant difference in the therapeutic effects between the childhood AD and adolescent and adult AD patients. There were no significant changes of cytokines, as well as the total IgE and ECP levels, in the patients' serum. Treatment with the mixture of four probiotic strains was generally well tolerated. Our results suggest that the treatment with the mixture of four probiotic strains is beneficial for the management of the adolescent and adult AD patients, as well as for the childhood AD patients.

Three Cases of Chronic Adult Atopic Dermatitis (만성 성인형 아토피 피부염의 한방 치험 3례)

  • Ku, Young-Hui;Choi, In-Hwa
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.15 no.1
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    • pp.140-150
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    • 2002
  • Introduction: Atopic dermatitis is chronic eczematous dermatosis which is related strongly to a family history of atopic disease and hereditary disposition. Its threshold of itching is low so that severe itching occurs and causes secondary eczema. Adult atopic dermatitis has mostly severe symptoms and progresses to chronic relapsing. Objective: The purpose of this study was to estimate the efficacy of oriental medical treatment and management on chronic adult atopic dermatitis. Subject: We studied 3 patients who visited Dongguk University Gangnam Oriental Hospital Dept. of Dermatol. with chronic adult atopic dermatitis from August 2001 to April 2002 and were observed for over 4 months. Methods: We treated them with herb-medication, acupuncture, negative therapy, aroma therapy, full spectrum visible ray therapy(by carbon arc) and external application(Jaun-go). We used the SCORAD index to assess the severity of atopic dermatitis. Results: There were 3 patients with chronic adult atopic dermatitis we could check for over 4 months by clinical scoring using the SCORAD system. 1. The grades of the severity of atopic dermatitis were lower only by the oriental medical treatments and management. 2. Intensities of relapse cases were lower then before the oriental medical treatments. 3. The secondary treatment term for relapse cases was shorter then the first treatment term after oriental remedies were used. Conclusion: Considering the above results, more study is needed on the chronic relapse cases with adult atopic dermatitis, the factors of increasing seventy of adult atopic dermatitis, the prognostic factors of adult atopic dermatitis, and the clinical interchange of chronic adult atopic dermatitis between oriental medicine and western medicine.

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Two Polymorphisms of Interleukin-4 Gene in Korean Adult Periodontitis

  • Kang, Byung-Yong;Choi, Young-Kyu;Choi, Wook-Hwan;Kim, Ki-Tae;Choi, Sung-Sook;Kim, Kyungjae;Ha, Nam-Joo
    • Archives of Pharmacal Research
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    • v.26 no.6
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    • pp.482-486
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    • 2003
  • Adult periodontitis is a multifactorial disease characterized by multple genetic and environmental factors. In view of the importance of interleukin-4 (IL-4) gene as a genetic factor for adult periodontitis, we investigated the relationship between two polymorphisms (-590 C $\rightarrow$ T polymorphism and 70 bp repeat polymorphism) of the human IL-4 gene and adult periodontitis in the Korean population. Genomic DNA was extracted from white blood cells of 32 adult periodontitis patients and 150 normal controls, respectively. There were no significant differences in the allele, genotype and haplotype distributions of two polymorph isms between normal controls and adult periodontitis group. Therefore, our results suggest that IL-4 gene locus contributes little to the interindividual susceptibility for adult periodontitis in Korean population.

Surgical treatment of patent ductus arteriosus in adult (성인에 있어서 동맥관개존증의 외과적 치료)

  • Mun, Byeong-Tak;Kim, Sang-Hyeong;Lee, Dong-Jun
    • Journal of Chest Surgery
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    • v.17 no.1
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    • pp.32-40
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    • 1984
  • During the past six years from July 1977 to June 1983, fifteen adult patients of patent ductus arteriosus were surgically treated. The results were as follows: 1. Of the 15 patients, their age range was 17 to 34 years with a mean of 24 years, and sexual predominance was women [9. cf. 6 men]. 2. The most common symptom showed exertional dyspnea, and 10 patients were classed in NYHA class II, the rest were all class III. 3. On physical examination, all patients were auscultated continuous murmur, but concomitantly diastolic murmur was noted apical region in 2 patients. 4. On roentgenogram of chest, normal finding was 3 patients, and the other patients were revealed the evidence of pulmonary congestion. 5. The electrocardiogram was normal in 6 patients, but LVH was seen in 5, and 2 patients were LVH+ LAH. 6. Cardiac catheterization was performed in 12, and mean value of SO2[LPA-RV] was 6.3%, Q/Q 2.09, peak systolic pulmonary arterial pressure 45.3 mmHg, and Rp/Rs 0.365. 7. All operations were carried out by posterolateral thoracotomy. In 6 patients, division and suture of ductus were possible, the other patients were treated by division and ligation with heavy silk or Dacron patch. 8. Postoperative complications were hoarseness, persistent murmur, reoperation for bleeding, and atelectasis. Early and late mortality was 20% [3 patients], and cause of death was mainly aneurysmal rupture of previous operative site.

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Comparison of Spiritual Well-being and Quality of Life between Hospice Patients and Nonhospice Patients (호스피스 환자와 비호스피스 환자의 영적 안녕과 삶의 질)

  • Lee, Hae-Sook;Doh, Bok-Num
    • Korean Journal of Adult Nursing
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    • v.15 no.3
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    • pp.364-372
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    • 2003
  • Purpose: This study was conducted to find out the effects of hospice care by evaluating the spiritual well-being and quality of life in the hospice and nonhospice patients. Method: The research design was composed of descriptive study. The data were collected using the questionnaire with interview from 30 hospice patients at three hospice institutes and 30 nonhospice patients at two general hospitals. The tools used for this study were 14-item questionnaire regarding general characteristics, a revised Spiritual Well-being Survey(Paloutzion and Ellision, 1982) and 22-item of revised Mcgill Quality of Life questionnaire. Result: The spiritual well-being of the hospice patients was higher than that of nonhospice patients(F=5.52, p=0.023). The global quality of life of the hospice patients was higher than that of nonhospice patients(F=8.84, p=0.004). There was a significant positive correlation between spiritual well-being and quality of life of the hospice patients and non hospice patients. Conclusion: The hospice care effects on spiritual well-being and quality of life of the terminal cancer patients.

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Symptom Experience and Quality of Life in Patients with Chronic Lung Disease - With a Special Reference to Bronchial Asthma and Bronchiectasis - (만성폐질환자의 증상 경험과 삶의 질 - 기관지천식과 기관지확장증 환자를 중심으로 -)

  • Park, Soon-Joo
    • Korean Journal of Adult Nursing
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    • v.14 no.3
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    • pp.470-478
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    • 2002
  • Purpose: In this study, symptom experience and quality of life(QoL) in patients with Bronchial asthma(BA) and Bronchiectasis(BRC) were examined to develop nursing strategies. Method: Data collection was done with 61 outpatients with BA and 43 outpatients with BRC in January and February, 2001. Data analyses were performed using SPSS Win 8.0. Result: The mean scores of symptom experience were 11.3 and 10.8 in patients with BA and BRC, respectively. The mean score of QoL was 18.0 in patients with BA and 19.2 in patients with BRC. There were statistically significant differences in the score of the symptom experience according to sex and occupation in patients with BA, and to the religion and occupation in patients with BRC. The mean score of QoL had significant difference according to the income in patients with BA, but had no significant differences in patients with BRC. The score of QoL had significantly correlated with the degree of symptom experience in patients with BA(p=.000) and with BRC(p=.022). Conclusion: The degree of symptom experience negatively correlated with QoL. Therefore, symptoms experienced by patients should be considered in development of nursing strategies for patients with BA and BRC.

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Clinical Impact of Overexpression of FOXP3 and WT1 on Disease Outcome in Egyptian Acute Myeloid Leukemia Patients

  • Assem, Magda M;Osman, Ahmed;Kandeel, Eman Z;Elshimy, Reham AA;Nassar, Hanan R;Ali, Radwa E
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.10
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    • pp.4699-4711
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    • 2016
  • Background: In the last decade, it has become clear that change of gene expression may alter the hematopoietic cell quiescent state and consequently play a major role in leukemogenesis. WT1 is known to be a player in acute myeloid leukemia (AML) and FOXP3 has a crucial role in regulating the immune response. Objectives: To evaluate the impact of overexpression of WT1and FOXP3 genes on clinical course in adult and pediatric AML patients in Egypt. Patients and methods: Bone marrow and peripheral blood samples were obtained from 97 de novo non M3 AML patients (63 adult and 34 pediatric). Real-time quantitative PCR was used to detect overexpression WT1 and FOXP3 genes. Patient follow up ranged from 0.2 to 39.0 months with a median of 5 months. Results: In the pediatric group; WT1 was significantly expressed with a high total leukocyte count median 50X109/L (p=0.018). In the adult group, WT1 had an adverse impact on complete remission induction, disease-free survival and overall survival (p=0.02, p=0.035, p=0.019 respectively). FOXP3 overexpression was associated with FAB subtypes AML M0 +M1 vs. M2, M4+M5 (p =0.039) and the presence of hepatomegaly (p=0.005). Conclusions: WT1 and FOXP3 overexpression has an adverse impact on clinical presentation, treatment response and survival of pediatric and adult Egyptian AML patients.

Emergency Cranial Irradiation Effects in Adult Leukemia with Extremely High Leukocytosis (극심한 백혈구 증다증이 동반된 성인 백혈병에 있어서 응급 두개부 방사선 조사의 효과)

  • Park Seoung-Ho;Cho Moon-June;Kim Samyong
    • Radiation Oncology Journal
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    • v.10 no.2
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    • pp.255-259
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    • 1992
  • We have treated adult acute leukemia 64 patients between January 1990 and October 1991 at the Chungnam National University Hospital. They were examined for the impact of presenting WBC count on the initial course and from them we have chosen twenty patients whose leukocyte count is over one hundred thousands per cubic milimeter, We divided the twenty patients into 4 groups on the base of treatment modalities: conservative therapy only, chemotherapy only, cranial irradiation only, and chemotherapy with cranial irradiation. Early sudden death rate is lower in cranial irradiation with/without chemotherapy groups than the conservative only or chemotherapy only patients. Also the remission rate is high in cranial irradiation with chemotherapy patients. Therefore we suggest that the rapid intervention of cranial irradiation in adult acute leukemia could be helpful in reducing the early sudden death rate and perhaps in increasing the remission rate.

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Efficacy of Isoproterenol as a Marker of Epidural Test Dose in Patients Anesthetized with Enflurane (Enflurane 전신마취중 경막외 시험용량의 표식자로서 Isoproterenol의 효율성)

  • Kim, Keon-Sik;Kang, Wha-Ja;Lee, Doo-Ik
    • The Korean Journal of Pain
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    • v.14 no.2
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    • pp.186-192
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    • 2001
  • Background: Epidural test doses containing epinephrine are an incomplete marker for the detection of inadvertent intravascular injection. Therefore, many investigators have attempted to find a more reliable marker as an alternative to epinephrine in adult patients anesthetized with enflurane. The present study was designed to test whether two different simulated intravenous test doses of isoproterenol could be used as a reliable marker for the detection of inadvertent intravascular injection in adult patients anesthetized with $O_2-N_2O$-enflurane. Methods: Forty healthy adult patients were anesthetized with 1% end-tidal enflurane and nitrous oxide after endotracheal intubation and were randomized to one of two groups according to the dose of isoproterenol. Group 1 and 2 (n = 20 each) received 3 ml of 1.5% lidocaine with 3 and 5 g isoproterenol intravenously, respectively, to simulate an intravascularly administered test dose. Heart rate (HR) and systolic blood pressure (SBP) were measured at 20-second intervals for 4 min after injection. Results: Mean maximal HR increases were $24{\pm}17$, $35{\pm}11$ bpm (P < 0.05), mean maximal SBP increases were $14{\pm}8$, $13{\pm}9$ mmHg and mean maximal SBP decreases $20{\pm}11$, $22{\pm}9$ mmHg following the IV injection of 3, $5{\mu}g$ isoproterenol, respectively. The incidence of hypotension was similar in both groups. Isoproterenol 3 and $5{\mu}g$ produced 75%, 100% sensitivity in the HR criteria ($\geq$ 20 bpm increase) and 60%, 70% sensitivity in the SBP criteria ($\geq$ 15 mmHg), respectively. Conclusions: These results indicate that based on the HR response, the epidural test dose containing $5{\mu}g$ isoproterenol to simulate an intravascular administration is a more reliable marker than $3{\mu}g$ isoproterenol in adult healthy patients during enflurane anesthesia.

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