Increased Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 Levels in the Cerebrospinal Fluid from Children with Aseptic Meningitis

PURPOSE: Matrix metalloproteinase(MMP)-9 is known to breakdown the blood-brain barrier by degrading the extracellular matrix of the subendothelial basement membrane in meningitis. Tissue inhibitor of metalloproteinase(TIMP)-1, a known inhibitor of MMP-9, has been postulated to inhibit the proteolytic activity of MMP-9 by bindng to MMP-9, but their interaction has not been fully understood yet. So far, there have been some reports on the relationship of MMP-9 and TIMP-1 in bacterial meningitis, but few reports in viral meningitis. Furthermore, there has been no report on this in Korea. We investigated the concentrations of MMP-9 and TIMP-1 in cerebrospinal fluid (CSF) and serum of patients with viral meningitis and control subjects, and evaluated their relationship with other clinical parameters of meningitis. METHODS: CSF and blood were obtained from 25 subjects with viral meningitis and 14 control subjects. After centrifugation, supernatants were stored at -20 degrees C and we assayed concentrations of MMP-9 and TIMP-1 by the sandwich ELISA method. RESULTS: Concentrations of CSF MMP-9 and TIMP-1 were significantly elevated in patients with viral meningitis, when compared with those in control subjects. Their serum levels showed no differences between the two groups. MMP-9 levels were closely correlated with TIMP-1 levels in the CSF(rs=0.42, P<0.05). CSF MMP-9/TIMP-1 ratios were significantly higher in patients with viral meningitis than those in the control subjects(P<0.05). Both CSF MMP-9 and TIMP-1 levels positively correlated with CSF total leukocyte counts(rs=0.43, P<0.05, rs=0.48, P<0.05). TIMP-1 levels positively correlated with total protein concentrations in the CSF(rs=0.43, P<0.05). CONCLUSION: MMP-9 and TIMP-1 may play an important role in the breakdown and maintenance of BBB in viral meningitis, respectively.

Hydroxyurea Therapy in Hemoglobin Madrid Patients / 대한혈액학회지

Unstable hemoglobins (Hb) are variants of adult Hb that tend to precipitate and form insoluble inclusions (Heinz bodies) within red blood cells (RBC) and RBC precursors. More than 100 structurally different unstable Hb variants showing broad spectrum of manifestations from asymptomatic to severe hemolytic anemia and dyserythropoiesis have been discovered. Hydroxyurea is a potent ribonucleotide reductase inhibitor and have been proposed as a new therapy for beta chain hemoglobinopathies through activation of gamma chain synthesis. We treated two patients (A : son, B : father) with highly unstable Hb diagnosed as Hb Madrid [Beta 115(G17)Ala->Pro] by direct DNA sequencing and restriction enzyme analysis. Our patients received hydroxyurea in dosages varying from 0.75g to 1.3g daily for 89 weeks. We could not show the clinical and hematological improvements after hydroxyurea therapy in thses patients. Optimization of dosage and long term side effects of hydroxyurea should be studied further.

An Analysis of MCV, RDW, HDW and EPO Concentration in Anemia of Acute Infection / 대한소아혈액종양학회지

PURPOSE: The purpose of this study was to assess the usefulness of mean corpuscular volume (MCV), red cell distribution width (RDW) and hemoglobin distribution width (HDW), which can be measured easily with automatic blood cell counter, in differentiating anemia of acute infection from iron deficiency anemia (IDA) in the early phase of infection. We also wanted to determine whether decreased erythropoietin (EPO) production contribute to the pathogenesis of anemia of acute infection. METHODS: 39 anemic children who were admitted to Kangbuk Samsung Hospital due to acute infectious disease between June 1997 and September 1998 were studied. We measured serum ferritin level by radioimmunoassay and divided the patients into two groups according to the serum ferritin level. The children with serum ferritin level above 30 ng/mL were included in anemia of infection group, and the children with serum ferritin level under 10 ng/mL were included in IDA group. Anemic children whose ferritin level were between 10 ng/mL and 30 ng/mL were excluded. We measured MCV, RDW and HDW by automatic blood cell counter and compared them between two groups. We also measured EPO concentration in anemia of acute infection group and compared with that of the control group. RESULTS: 1) Most common acute infectious disease accompanied by anemia of acute infection were acute gastroenteritis, acute pharyngitis, and pneumonia. 2) Complete blood count (CBC) revealed normocytic normochromia in anemia of acute infection and microcytic hypochromia in IDA. MCV of IDA group was significantly lower than that of anemia of acute infection group (65.2+/-8.7 fL vs 82.4+/-5.5 fL, P<0.005). RDW in IDA group was significantly higher than that of anemia of acute infection group (17.1+/-2.5% vs 15.0+/-1.0%, P<0.005). HDW in IDA group was significantly higher than that of anemia of acute infection group (3.2+/-0.5 g/dL vs 2.4+/-0.2 g/dL, P<0.005). 3) The mean EPO concentration in anemia of acute infection group was significantly higher than that of control group (27.1+/-14.5 mU/mL vs 18.4+/-8.7 mU/mL, P<0.05). CONCLUSION: 1) We concluded that MCV, RDW and HDW are effective parameters to differentiate anemia of acute infection from IDA. 2) Decreased EPO production may have less significant role in the pathogenesis of anemia of acute infection compared to anemia of chronic disease. 3) Our results suggested that other factors such as accelerated erythrocyte destruction or hypoferremia may contribute to the development of anemia of acute infection. Further studies will be required to identify the pathophysiology of anemia of acute infection.

A Case of Disseminated Pagetoid Reticulodsis

No abstract available.

The Role of Urinary Sodium at Transient Renal Acidification Defect during Acute Infantile Acute Gastroenteritis

The pupose of this study is to verify the role of urinary sodium in transient renal acidification defect which frequently combine acute infantile gastroenteritis. We studied on twenty-five infants, 2month to 36 month of age, during the 4 month period, from August, 1991 to December, 1991. The patients had acidosis for a mean of 3 days and sixty urine samples were collected during this period. The mean pH of 23 rine samples with sodium concentration<10 mmol/L was significantly higher than pH of 37 samples with sodium concentration<10 mmol/L, We separately analyzed 15 urine samples collected during metabolic acidosis after completion. of rehydration. The result was that a urinary acidification defent was observed in the urine samples with low sodium concentration but not in the sodium rich samples. We concluded that impaired urinary acidification defect is frequently during metabolic acidosis in infants with acute gastroenteritis and results from a sodium deficit rather than from transient distal renal tublur acidosis.

The significance of nucleated red blood cell counts in low birth weight neonates

We studied to assess the relationship between intrauterine growth retardation and theincreased nucleated red blood cell counts (NRBC) in small for gestational age (SGA) and appropriatefor gestational age (AGA) neonates with low birth weight. We also evaluated the nucleated red blood cell counts in low birth weight neonates who had either perinatal asphyzia or hyaline membrane disease (HMD) or died within 7 days after birth. The results were as follows: 1) In low birth weight neonates, the mean value for NRBC counts was 9.02/100 WBCs and the mean absolute value for NRBC counts was 0.9210E9/L. 2) The mean values for NRBC counts were 13.4/100 WBCs in SGA and 6.4/100WBCs in AGA. The mean absolute values for NRBC were 1.32x10E9/L in AGA neonates 3) In SGA neonates with low birth weight, the mean NRBC counts wers 19.6/100WBCs in asphyxiated group and 4.5/100WBCs in control group. The mean absolute NRBC counts were 1.9810E9/L in control group. 4) In AGA neonates with low birth weight, the mean NRBC countswere 9.1/100WBCs in asphyxiated group and 2.4/100WBCs in control group. The meanabsolute NRBC counts were 0.98x10E9/L in asphyxiated group and o.23x10E9/L in controlroup. 5) The mean NRBC counts were 13.8/100WBCs in neonates with HMD and 7.1/100WBCs in control group. The mean absolute NRBC counts were 1.50x10E9/L in neonates withHMD and 0.70x10E9/L in control group. 6) The mean NRBC counts were 19.9/100 WBCs in expired group and 6.8/100WBCs in suvived group. The mean absolute NRBC counts were 2.1810E9/L in expired group and 0.66x10E9/L in survived group. 7) The NRBC counts of SGA neonates were significantly higher than that of AGA neonates with low birth weight. 8) The NRBC counts of asphyxiated neonates were significantly higher than that of the control group. 9) The NABC counts of expired neonates were significantly higher than that of the control group. 10) The NRBC counts of expired neonates were significantly higher than that of the survived neonates.

The Heart in Acute Glomerulonephritis: An Echocardiographic Study

Patients with acute glomerulonephritis often are seen with signs suggesting heart failure. Whether these signs are due to fluid overload secondary to kidney damage only, or whether there is associated myocardial damage has not been elucidated. Twenty-two children with acute glomerulonephritis were studied by echocardiography during edematous phase of disease. Left ventricular function was normal in all childrem. The most consistent finding was enlargement of left atrium and left ventricle during the edematous phase. There was no correlation between blood pressure and the echocardiographic findings. This study suggest that signs of heart failure in acute glomerulonephritis are not due to myocardial damage but probably reflect fluid overload.