Journal of Korean medical science
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J. Korean Med. Sci. · Aug 2006
Case ReportsDrug hypersensitivity to previously tolerated phenytoin by carbamazepine-induced DRESS syndrome.
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome associated with anticonvulsant drugs is a rare but potentially life-threatening disease that occurs in response to arene oxide producing anticonvulsant such as phenytoin and carbamazepine. There have been many reports of cross reactivity among the anticonvulsants upon first exposure to the offending drugs. However, there has been few data describing the development of DRESS syndrome after switching medication from previously well-tolerated phenytoin to carbamazepine, and the induction of hypersensitivity to phenytoin by DRESS to carbamazepine. ⋯ We stopped carbamazepine and restored phenytoin for seizure control, but his clinical manifestations progressively worsened and he recovered only when both drugs were discontinued. Patch tests with several anticonvulsants showed positive reactions to both carbamazepine and phenytoin. Our case suggests that hypersensitivity to a previously tolerated anticonvulsant can be induced by DRESS to another anticonvulsant, and that the patch test may be a useful method for detecting cross-reactive drugs in anticonvulsant-associated DRESS syndrome.
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J. Korean Med. Sci. · Aug 2006
Case ReportsIntradural disc herniation at L5-S1 mimicking an intradural extramedullary spinal tumor: a case report.
Intradural lumbar disc herniation is a rare pathological entity. The pathogenesis of intradural lumbar disc herniation is not known clearly. Intradural disc herniations usually occurred at the L4-L5 levels but have also been reported at other levels. ⋯ The patient had full recovery in 3 months. Intradural lumbar disc herniation must be considered in the differential diagnosis of mass lesions in the spinal canal. Contrast-enhanced MRI scans are useful to differentiate a herniated disc from a disc space infection or tumor.
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Polyarteritis nodosa (PAN) is a systemic vasculitis characterized by multi-organ involvement with protean manifestations. We evaluated the clinical features of PAN in Korea. Twenty-seven patients were diagnosed as PAN at Seoul National University Hospital between January 1990 and July 2003. ⋯ During a median follow-up of 55.5 months, three of the four PAN-related deaths had an initial FFS of 2. The clinical features of PAN were not significantly different from those reported previously. However, testicular pain or tenderness was more frequent and patients with a high FFS tended to have a poorer prognosis.
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J. Korean Med. Sci. · Aug 2006
Review Case ReportsMyxedema ascites: case report and literature review.
Myxedema ascites caused by hypothyroidism is rare, so its diagnosis is often delayed and patients frequently receive unnecessary procedures such as liver biopsies and exploratory laparotomies. We report a 71-yr-old man with clinical ascites that was the first manifestation of hypothyroidism, and which resolved completely in response to thyroid hormone replacement therapy. To our knowledge, this is the first report of myxedema ascites in Korea. ⋯ Analyses of ascites from patients in this condition usually show high protein (>2.5 g/dL) and low white blood cell counts, with a high proportion of lymphocytes. A consistent feature is the good response to thyroid hormone replacement therapy, which has always led to resolution of the ascites. Myxedema ascites is thus rare but easy to treat; it should be borne in mind, especially if the ascites fluid has a high protein content.
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J. Korean Med. Sci. · Jun 2006
Neonatal brain damage following prolonged latency after preterm premature rupture of membranes.
This study evaluated the risk of brain damage in neonates delivered at < 34 weeks following a prolonged latency after preterm premature rupture of membranes (pPROM). The medical records of 77 singletons delivered at < 34 weeks with pPROM and 66 singletons delivered at < 34 weeks with preterm labor and intact membranes were reviewed. Latency was divided into four intervals: < or = 24, > 24-< or = 72, > 72- < or = 168 hr, and > 1 week. ⋯ The risks of intracranial ultrasonic abnormalities, however, did not increased with prolonged latency. In the patients with preterm labor and intact membranes, the both risks did not increased with increasing latency. Therefore, this study was suggested that the risk of histologic chorioamnionitis increased with increasing latency, but there was no relationship between neonatal brain damage and latency interval after pPROM.