A Case of Incidentaloma Compromising of Pheochromocytoma and Adrenocortical Adenoma in an Infant / 대한소아혈액종양학회지

Pheochromacytoma, although occasionally present with adrenal cortical hyperfunction, is rarely associated with nonfunctioning adrenal cortical tumor. To our knowledge, eight cases of phemchromocytoma associated with adrenocortical adenoma have been reported in the literature, including a case in a Korean adult female. An adrenal mass is considered an incidentaloma when there is no history or physical findings suggesting an adrenal functional disorder or tumor. The majority of adrenal masses are nonfunctioning adrenocortical adenomas. In our case, left adrenal mass was found incidentally by ultrasonography after birth, done because of mother's oligohydroamnios. Abdomial CT study revealed an adrenal tumor, and a surgical resection was performed. The specimen showed a coincident pheochromocytoma and adrenocortical adenoma. The patient seems to be the first case of coexistence of nonfunctioning pheochromocytoma and adrenocortical adenoma in one adrenal tumor. We report this case with the review of literatures.

The Positive Rate of Serum Rheumatoid Factor in Health Screening Subjects and Related Factors

BACKGROUND: This study was done to estimate the prevalence of Rheumatoid Factor (RF) positive rate in adult Korean population and to investigate the association between rheumatoid factor positive rate and related factors. METHODS: The database from 4,678 subjects, who visited a general health screening center of an university hospital during 1 year period were surveyed. RF was tested using a commercial latex test kit, HBsAg by RIA of 3rd generation, anti-HCV by EIA of 3rd generation and serum AST, ALT by enzyme kinetic method. Syphilis was checked using RPR test and TPHA. Lung diseases (tuberculosis, IPF) were screened using chest X-ray. Flukes was checked by sedimentation method and cestodes was by direct method in stool tests. Smokers were based on history on health screening. RESULTS: 1) The positive rate of RF was 4.4%, HBsAg was 5.9%, anti-HCV was 1.5% and ALT>35 IU/L was 18.4%. The number of syphilis subjects was 19, lung diseases was 119, parasitic diseases was 43, and smokers was 1,299. 2) RF positive rate of males was 4.0%, females was 5.3%. Therefore, the positivity of females was higher than males and RF positivite rate was increased in the higher age groups. 3) RF positive rate in HBsAg (+) subjects was 18.1% and HBsAg (-) was 3.6% and in anti-HCV (+) subjects was 10.3% and anti-HCV (-) was 4.3%. 4) RF positive rate of subjection both positive reactions of RPR test and TPHA, namely, syphilis tests was 21.1%. 5) RF positive rate of parasitic diseases was 4.7%, lung diseases was 2.5% and smokers was 4.2%. 6) RF positive rate was highly associated with HBsAg, syphilis, anti-HCV, female sex, age in order of sequence. CONCLUSION: The positive rate of RF in healthy Korean adults can be estimated to be 4.5% and shows high association with hepatitis B and C virus infection in addition to syphilis, age and sex.

Production and Expression of Gro-alpha and RANTES by Peripheral Blood Mononuclear Cells Isolated from Patients with Kawasaki Disease and Measles

We investigated whether the production and gene expression of Gro-alpha and RANTES in Kawasaki disease differ in measles. Forty-two samples from 14 patients in different clinical stages of Kawasaki disease, eight samples from 8 patients in the acute stage of measles and seven samples from 7 healthy children were collected. The present study was performed using ELISA and RT-PCR for the productions and gene expression of the chemokines. The production of Gro-alpha was markedly elevated during the acute stage of measles compared with Kawasaki disease. Moreover, the expression of Gro-alpha was increased in every case of measles, but not in Kawasaki disease. The production of RANTES was elevated in the acute stage of both diseases when compared to the healthy control. However, the plasma RANTES level did not change significantly according to the clinical stages of Kawasaki disease. A correlation between the production and gene expression of RANTES and Gro-alpha was not found in Kawasaki disease. These results suggest that Kawasaki disease differs from measles with regard to Gro-alpha production and expression, but not RANTES. Gro-alpha might play an important role in the acute stage of measles, however not in Kawasaki disease. Further studies are needed to clarify the efficacy of Gro-alpha as a marker in measles.

Factors Influencing on Perceived Stigma of Parents with Epileptic Children / 대한소아신경학회지

PURPOSE: Epilepsy, a typical chronic disease, may cause severe of psychosocial difficulties for all family members, including stigmatization. The present study focused on how children with epilepsy affect their parents' perceived stigma. METHODS: Participants were 87 parents(21 fathers and 66 mothers) whose children were diagnosed as and treated for epilepsy at the pediatric epilepsy clinic in Dongguk University Hospital. To obtain data, the parental perceived stigma scales with 3 questionnaires were developed by modifying Jacoby's stigma scales. Data were analyzed with the SPSS 10.0 program using oneway ANOVA and multiple regression. RESULTS: The results of the analysis showed that 22 parents(25.3%) have perceived stigma. Oneway ANOVA showed significant differences of the parental perceived stigma level according to the parental academic background, the number of antiepileptic drugs, the combined disabilities, the educational institution of epileptic children, and the desire for support. Multiple regression showed that the parental academic background and the existence of combined disabilities are the factors which influence significantly on the parental perceived stigma level. CONCLUSION: These results suggest that the parents of epileptic children who have low academic background and who care for the epilepsy-plus children may have more perceived stigma. These findings may help healthcare providers prepare for the epilepsy family programs in terms of relieving their social stigma.

Effect of CpG Oligodeoxynucleotides on Airways of Mice with Established Airways Inflammation

PURPOSE: Airways eosinophilia and increased IgE, characteristic features of asthma, result from a predominant Th2 response. In this study, we investigated the effect of CpG oligodeoxynucleotides (ODNs) on the inhibition of airways eosinophilia in mice with established airway inflammation. We also investigated the immunological mechanisms involved. METHODS: Groups of BALB/c mice were sensitized intradermally with ovalbumin(OVA). At week 10, airway inflammation was induced by intranasal challenge of the mice with OVA. At week 14, the mice were challenged intranasally again with OVA in the presence and without the presence of CpG ODNs. Mice with saline administration served as negative controls. Bronchoalveolar lavage fluids(BALF) were obtained and eosinophils were counted. Th1 and Th2 cytokines in the spleen cell cultures were measured by ELISA. Serum OVA-specific IgE and IgG2a antibodies were also measured by ELISA. RESULTS: BALF eosinophils were significantly inhibited in the CpG ODNs-treated mice(P<0.01). IgE and IgG2a levels increased significantly in both CpG ODNs-treated and untreated groups as compared to the negative control group; there was, however, no significant difference between the two groups four days after intranasal administration of CpG ODNs. Cytokine analysis revealed decreased production of IL-4, IL-5, and IL-13 and increased production of IL-12 in the CpG ODNs-treated group as compared to the untreated group. Interestingly, IFN-gamma levels were not upregulated in the CpG ODNs-treated group. CONCLUSION: CpG ODNs vaccination is a potentially useful approach for reversing airways eosinophilia in mice with established airways inflammation.

Production of Plasma Leptin and Expression of Interferon-gamma Inducible Protein-10 (IP-10), Monokine Induced by Interferon-gamma (Mig) and Interleukin-8 (IL-8) mRNA in Kawasaki Disease

BACKGROUND: Kawasaki disease is an acute febrile illness with systemic vasculitis which primarily affects children, We examined the production of leptin in plasma and gene expressions of CXC chemokines in peripheral blood mononuclear cells from patients with Kawasaki disease. METHODS: Consecutive 39 samples from 13 patients according to the different clinical stages (acute, subacute, convalescent) of Kawasaki disease were collected. The plasma leptin levels according to clinical stages of Kawasaki disease were examined by ELISA and the expression of IP-10, Mig and IL-8 mRNAs in 39 samples (13 samples of each stage) from 13 cases were examined by RT-PCR. RESULTS: There were not significant changes of plasma leptin levels according to the clinical stages of Kawasaki disease. The mean values of plasma leptin concentrations during each of the stages (n=13, p>0.05, pg/ml) were 335.8+/-549.0 in acute, 358+/- 347.6 in subacute, and 443.6+/-645.9 in convalescent stage. The mRNAs of IP-10, Mig, and IL-8 were expressed in 13/13 (100%), 2/13 (15%), 9/13 (69%) during acute stage, 13/13 (100%), 6/13 (46%), 13/13 (100%) during subacute stage, and 13/13 (100%), 4/13 (31%), 10/13 (77%) during the convalescent stage, respectively. In three patients, the production of leptin and expression of IP-10 mRNA were dramatically decreased according to the process of the clinical stages. In five patients with prominent cervical lymphadenopathy, the expression of IL-8 mRNA during the subacute stage was more elevated than the acute and convalescent stages. CONCLUSION: This data suggests that the production of leptin and the gene expressions of IP-10, Mig and IL-8 seem to have no significant correlation to the clinical stages of Kawasaki disease. However, expression patterns of IP-10, Mig and IL-8 mRNA may be related to the specific clinical manifestations, and the expression of IP-10 may also be correlated to leptin levels with pericardial involvement.