Immunohistochemical Study of Immune Cells, with a Special Emphasis on Macrophage Subpopulations in the Rat Thymus after Cyclophosphamide Treatment / 대한해부학회지

This study was undertaken to investigate the in vivo effects of cyclophosphamide (CY) on immune cells, with a special emphasis on macrophage subpopulations in the thymus of rats. After a single dose of CY (150 mg/kg) was administered to Sprague-Dawley rats by intraperitoneal injection, the rats were sacrificed at days 1, 3, 7, 14 and 28. The immunohistochemical characterization of the tissues were carried out using various monoclonal antibodies in cryostat-cut sections. CD4(+/-) and CD8(+/-) T cells were greatly decreased in number after CY treatment. However, macrophages, including the ED1(+/-) ED2(+/-) and ED3(+/-) macrophages exhibited signs of cellular activation such as an increase in number and size of cell, and an upregulation of the ED1, ED2 and ED3 reactive surface molecule expression. Contrarily, CY elicited a decrease in number of thymic dendritic cells (DCs). CY induced a conspicuous upregulation of ICAM-1 expression in the thymic cortex. Most of these features began to detectable from the first day and reached the maximun on the third and seventh days, but two weeks after CY administration, these phenomena began to disap. In conclusion, the results of the present study shed more light on the effects of CY on various subpopulations of macrophages and other types of immune cells and on ICAM-1 expression in the rat thymus.

Hepatic Safety of Methotrexate in Rheumatoid Arthritis Patients with Hepatitis B Surface Antigen / 대한류마티스학회지

OBJECTIVE: To investigate the hepatic safety of methotrexate (MTX)and useful parameters to assess the risk of hepatotoxicity in rheumatoid arthritis (RA) patients with hepatitis B surface antigen (HBsAg). METHODS:19 HBsAg positive (B group)and 54 HBsAg negative (non-B group)RA patients taking MTX were prospectively followed up for 2 years. Aspartate aminotransferase (AST)and alanine aminotransferase (ALT)were checked at 2-month interval.In B group,HBeAg,HBeAb and levels of hepatitis B virus DNA (HBV DNA)were additionally checked,and liver biopsy was performed in seventeen of 19 patients.Change of AST or ALT to more than 1.5 times the upper limit of normal were considered as a hepatic event.The data were analyzed by stepwise linear and logistic regression method. RESULTS:The findings of liver biopsy in B group were classified as grade I (n=8),II (n=6),and IIIA (n=3)according to the Roenigk Classification Scale. Mean cumulative dose of MTX in B group was 2054mg in cases with hepatic event and 1780mg in cases who stopped taking MTX.The frequency of hepatic event (47.4%vs 7.4%,p=0.0001)and MTX withdrawal (26.3%vs 1.9%, p=0.0008)was higher in B group than in non-B group.HBV DNA (+)group (n=9)showed the increased tendency of hepatic event and MTX withdrawal compared with HBV DNA (-)group (n=10).Baseline HBV DNA was negative in all HBeAg (-)patients (n=14),but HBV DNA was positive during MTX therapy in 7 of 14 HBeAg (-)patients.Serum levels of AST and ALT returned to normal range within 2 months after MTX withdrawal in twelve of 13 patients with hepatic event. CONCLUSION:The use of MTX in HBsAg positive RA patients requires close monitoring of AST and ALT.HBV DNA seems to be a useful marker to predict hepatic event and viral replication,especially in HBeAg (-)patients.

A Case of Successful Treatment with High Dose Intravenous Immunoglobulin in Systemic Lupus Erythematosus Patient with Salmonella Group D Bacteremia and Myelofibrosis / 대한류마티스학회지

A 22-year-old woman presented with fever and pancytopenia. One year ago, she was diagnosed as Salmonella group D bacteremia and myelofibrosis associated with SLE at another hospital. She was placed on high dose steroid, however, there was no improvement. Two months ago, she was diagnosed as recurrent Salmonella group D bacteremia. After admission to our hospital, she was placed on intravenous antibiotics and high dose intravenous immunoglobulin. A significant improvement in laboratory and clinical condition occurred and bone marrow biopsy showed complete resolution of fibrosis. We report a case of SLE with myelofibrosis and recurrent Salmonella group D bacteremia.

A Case of Uric Acid Nephropathy as first presentation of Acute Lymphoblastic Leukemia / 대한내과학회지

Acute uric acid nephropathy is a kind of acute renal failure and results from uric acid crystal deposition within the collecting ducts and the distal tubules due to rapid increase of serum uric acid concentration. Hyperuricemia can be, in the relation to the underlying physiology, clas sified into the three categories. i.e., increased urate pro duction, decreased uric acid excretion, or a combination of the two. It is most commonly presented in the lympho proliferative or myeloproliferative disorders after effective cytolytic chemotherapy in the form of tumor lysis syn drome. But we have recently experienced a case of a 73 year-old female patient with acute lymphoblastic leuke mia whose first presentation was acute uric acid nephrop athy, spontaneously developed without chemotherapy and so report it with review of related literatures.

A Case of Primary Systemic Amyloidosis Predominantly Presenting Nephrotic Syndrome and Peripheral Neuropathy / 대한신장학회잡지

Primary systemic amyloidosis is a progressive disease that is frequently fatal. Nephrotic syndrome is present in almost one-third, congestive heart failure in one-quarter, and peripheral neuropathy in one-sixth of patients at the time of diagnosis. If heart or renal failure are presented, survival rate is poor. We experienced a case of a 66 year-old female patient who had complained lower leg edema and paresthesia of extremities for about 5 months. The laboratory findings were consistent with nephrotic syndrome, but the lower leg edema was non-pitting and the cause of paresthesia was unknown. We performed kidney and nerve biopsy and confirmed a case of primary systemic amyloidosis. In this case, presence of postural hypotension, probable cardiac involvement and relatively long spikes along the outside of the glomerular capillary loops on methenamine silver stain is suggestive of poor prognosis. We can predict chronic renal failure and congestive heart failure in the course of this case. We report a case of primary systemic amyloidosis predominantly presenting nephrotic syndrome and peripheral neuropathy with review of related literatures.