Autologous Hematopoietic Stem Cell Transplantation in Patients with Refractory Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To determine the safety and efficacy of immune ablation followed by autologous hematopoietic stem cell transplantation (HSCT) in refractory systemic lupus erythematosus (SLE). METHODS: Three patients who had been refractory to steroid and one or more immunosuppressive drug were included. Peripheral blood stem cells were mobilized with cyclophosphamide (CTX, 3 g/m(2)), followed by granulocyte-colony stimulating factor (5mug/kg/day). T lymphocytes were depleted from the graft by selection of CD34 positive cells. Conditioning regimens composed of high dose CTX (total dose 200 mg/kg) and anti-thymocyte globulin (total dose 90 mg/kg) in 2 patients and BEAM (BCNU 300 mg/m(2), etoposide 200 mg/m(2), cytarabine 200 mg/m(2), melphalan 200 mg/m(2)) in 1 patient. Stored stem cells were reinfused 48 hours after conditioning. RESULTS: Among 3 patients, first patient had lupus nephritis, second patient had overlap syndrome combined with rheumatoid arthritis (rhupus) and the last patient had severe thromobocytopenia and intractable polyserositis. No life threatening complications were observed during the treatment. All patients demonstrated rapid and marked improvement in organ function and quality of life just after HSCT. Previous massive proteinuria in first patient was decreased to less than 500 mg/day with 6 months follow up. Rhupus patient satisfied American college of rheumatology 70% response criteria with 3 months follow up. But third patient improved polyserositis dramatically 1 month after HSCT and relapsed at 9 weeks. CONCLUSION: In refractory SLE patients, HSCT can be performed safely with marked improvement and sustained withdrawal of all immunosuppressive medication. A further randomized trial is needed to confirm the efficacy and durability of remission.

Detection of Malignant Cells in Pleural Fluid or Ascites by CD44v8-10/CD44v10 competitive RT-PCR

BACKGROUND: CD44 is a cell surface adhesion molecule which has been implicated in various biologic functions as lymphocyte homing and activation, cellular migration and extracellular matrix adhesion. Over-expression of CD44v8- 10 has been found in several cancers and is considered to be associated with tumor progression and metastasis. Recently, a novel molecular method, CD44v8- 10/CD44v10 competitive reverse transcription-polymerase chain reaction(RT-PCR) has been developed for detecting cancer cells over-expressing CD44v8-10. METHODS: We analyzed from benign and malignant pleural effusion and ascites by CD44 competitive RT-PCR and compared to the conventional cytology. RESULTS: The CD44 competitive RT-PCR analysis showed that all the 24 samples associated with benign disease presented a predominant expression of the CD44v10 transcript (v8-10/v10 ratio: 0.126-0.948), whereas 6 of 7 malignant pleural samples associated with cytology positive cancer expressed the CD44v8-10 transcript (v8-10/v10 ratio > 1.00). CONCLUSION: These results indicate that CD44 competitive RT-PCR assay is a useful and adjunct to cytological examination in cancer diagnosis, especially in detecting exfoliated cancer cells in pleural effusion.

A Case of Primary Intestinal T-Cell Lymphoma Involving Entire Gastrointestinal Tract: Esophagus to Rectum

Primary intestinal T-cell lymphoma is a rare disease entity, which is approximately 10% to 25% of intestinal lymphomas, and most of the lymphomas occur in the small intestine. We report here a case of a 56-year-old woman who has been suffering from chronic diarrhea and weight loss for 6 months. Abdominal CT scan and small bowel series showed diffuse wall thickening of the small bowel. Gastroscopic examination showed diffuse erythematous lesions on the esophagus and small gastric ulcerations on the antrum of the stomach, and colonoscopic examination also showed multiple punched-out ulcerations and erosions on the entire colon, including the sigmoid colon to the terminal ileum. Diffuse infiltration of CD 3 positive lymphoma cells was found on biopsy. The patient was diagnosed as primary intestinal T-cell lymphoma with diffuse involvement of the entire gastrointestinal tracts from the esophagus to the rectum. Although the patient received systemic combination chemotherapy and achieved partial response initially, the lymphoma relapsed repeatedly.

Left Ventricular Geometry in Essential Hypertensive Patients Versus Hemodialysis Patients

BACKGROUND: In end stage renal disease, left ventricular hypertrophy developed frequently due to volume and pressure overload and other unclarified precipitating factors which could not be seen in essential hypertension. It is now well established that left ventricular hypertrophy and patterns of left ventricular geometry can influence the prognosis in essential hypertension. The aim of present study was to investigate the characteristics and prognostic significance of left ventricular hypertrophy and geornetrir patterns in hemodialysis patients and to compare them with essential hypertension group. METHOD: One hundred and forty essential hyertensive patients and forty eight hemodialysis patients were enrolled and their left ventricular geometric patterns(normal, roncentric remodeling, concentric hypertrophy, eccentric hypertrophy) were compared. RESULTS: 1) Mean age was higher in essential hypertension group(57.3+/-13.5 years versus 48.8+/-11,2 years) but the left ventricular mass index was higher in hemodialysis group(126.0+/-35.3g/m versus 142.6+/-44.4g/m, p=0.01). 2) Among left ventricular geometric patterns in hemodiaysis patients, only the prevalence of concentric hypertrophy was higher statistically compared with essential hypertensive patients(p= 0.014). 3) In essential hypertension group, age(B=0.18, p=0.016), systolic blood pressure(B=0.40, p<0.01) and total peripheral resistance(B=- 0.45, p<0.01) were correlated with left ventricular mass index. On the other hand, mean blood pressure(B=0.38, p<0.01), heart rate(B=- 0.39, p=0.012) and total peripheral resistance(B= - 0.70, p<0.01) were correlated with left ventricular mass index in hemodialysis group. 4) The hemodynamic characteristics of left ventricular hypertrophy were similar in both groups. Cardiac index was lowest and total peripheral resistance was highest in concentric remodeling. Left ventricular mass index, left ventricular septal and posterior wall thickness were highest in concentric hypertrophy and left ventricular internal dimension was highest in eccentric hypertrophy. 5) Comparing the difference between pre- and post-dialysis, only norrnal pattern slightly showed decreased left ventricular internal dimension in diastole, increased relative wall thickness and increased fractional shortening. CONCLUSION: It is considered that the characterization of geometric patterns of left ventricular hypertrophy and investigation of its precipitating factors in essential hypertensive patients and hemodialysis patients mll be helpful to improve their mortality and morbidity.

Changes of Epidermal Growth Factor in Sera among the Patients with Chronic Hepatitis, Cirrhosis and Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Epidermal growth factors (EGF) is known to activate mitogen activated protein kinase (MAP kinase) in hepatocytes by the route of both Raf-dependent and Raf-indefendent pathways. And this is likely to play important role in normal liver cell growth and regeneration. EGF is also reported as a potent mitogen and one of the angiogenic factors. To elucidate the dynamic changes of the serum concentration of epidermal growth factor in chronic liver disease and its correlation with role of EGF and mechanism of tumor development, this study is intended to employ an ELISA in 38 biopsy-proven cases. METHODS: Sera taken out of 5 patients with chronic persistent hepatitis. 4 patients with chronic active hepatitis, 19 patients with liver cirrhosis, 10 patients with hepato-cellular carcinoma that pathological diagnosis was proven later were tested for EGF employing Quantikine ELISA Kits (R & D Systems Inc. Minneapolis, MN). The statistical analysis was evaluated by student's t-test. RESULTS: EGF concentration was 253.33+ 69.5pg/ml(Mean+ SE) in hepatocellular carcinoma, 246.60+ 91.19pg/ml(Mean+ SE) in chronic active hepatitis, 222.71+ 115.97pg/ml (Mean+ SE) in chronic persistent hepatitis, 141.15+ 23.12pg/ml(Mean+ SE) in liver cirrhosis in orders. Serum EGF concentration in hepatocellular carcinoma was significantly higher than that in liver cirrhosis(p value=0.021695). However, comparing to the remaining other groups, no significant difference was found. CONCLUSION: These results support that the reconstruction of the capillary networks in liver cirrhosis resplts in down-regulation of the EGF in comparison to chronic hepatitis. But it is suggested that revaluation of EGF stimulates MAP kinase activity eventually playing in tumorigenesis of the liver with neoangiogenesis.

Evaluation of Correlation between Automatic Ocillometric Sphygmomanometer and Standard Korotkoff Auscultatory Sphygmomanometer

BACKGROUND: Early diagnosis and treatment of hypertension is imperative to prevent the complications associated with this condition. The development of accurate and convenient methods of blood pressure measurement, therefore, is indispensible. At present, the JNC V has acknowledged the use of automatic sphygmomanometer that can be used without the help of someone else. We compared automatic oscillometric sphygmomanometers manufactured by Sein Electronics, korea(SE-7000 and SE-5000) with the standard Korotkoff auscultatory mercuy sphygmomanometer meter. The correlation between these two methods were calculated to determine whether these products could actually be used in clinical practice. This study was undertaken to ensure the clinical evaluation of these two products and standardization of an antomatic sphygmomanometer in korea before it is actually used. METHODS: The study included eighty-three patients, ranging in age from 14 to 81 years, who were admitted to Hanyang University Hospital in October, 1995. The blood pressure measured by the automatic oscillometric sphygmomanometer(SE-7000) in the right arm and was compared with that measured by the standard mercury sphygmomanometer(baumanometer) in the left arm. Also the blood pressure measured by the automatic oscillometric sphygmomanometer(SE-5000) at the wrist was compared by the baumanometer in the same side arm. The correlation between these methods were determined by the paired Student`s t-test and by the simple liner regression method. RESULTS: The p value of systolic blood pressure between two methods(SE-7000 and baumanometer) in the both arms was 0.896 and correlation coefficient was 0.8286. The p value of diastolic blood pressure between this two methods was 0.352 and correleation coefficient was 0.7455. The p value of systolic blood pressure between two methods(SE-5000 and baumanomter) by the arm and the wrist was 0.00018 and correlation coefficient was 0.8588, the p value of diastolic blood pressure between this two methods was 0.000048 and correlation coefficient was 0.5944. CONCLUSION: The blood pressure measured by the SE-5000 at the wrist was statistically different from that measured with the baumanometer in the arm. Further studies are necessary to use this product in clinical practice. However, the systolic and diastolic blood pressures measured with the SE-7000 in the arm were relatively similar to those measured by the baumanometer enabling this products to be effectively used in clinical practice.