The relationship between eosinophilia and serum cytokine concentrations in maintenance hemodialysis patients / 대한내과학회지

BACKGROUND: Eosinophilia in hemodialysis (HD) patients has been associated with allergic reactions to dialyzers and exaggerated activation of complement during HD. Complement activation can lead to cytokine production. The cause of the eosinophilia is controversial and maybe multifactorial. Eosinophilia is stimulated by T lymphocytes and maybe related to the immune dysfunction of uremic patients. The aim of this study is to elucidate the relationship between the eosinophilia and serum cytokine concentrations in maintenance HD patients and to reveal whether the eosinophilia in HD patients reflects HD-associated cytokine production. METHODS: We examined 40 HD patients who were stable for a minimum of 3 months at our hemodialysis unit. We measured eosinophil count and eosinophil percent on peripheral blood smear. Eosinophilia was defined as >or=350 cells/mm3 or >or=5% on smear. The serum concentrations of Interleukin-1beta (IL-1beta), Interleukin-2 (IL-2), Interleukin-5 (IL-5), Interleukin-6 (IL-6) were measured by ELISA before (pre) and after (post) dialysis. RESULTS: Thirteen patients with eosinophilia were compared 27 patients without eosinophilia. In patients with eosinophilia, serum concentrations of IL-1beta and IL-2 were significantly elevated after dialysis than before dialysis (p<0.05). Post-HD IL-6 concentrations also were elevated, but statistically insignificant. IL-5 concentrations were not elevated after dialysis. In patients without eosinophilia, serum concentrations of IL-1beta, IL-2 and IL-6 were significantly elevated after dialysis (p<0.05). IL-5 concentrations were not elevated after dialysis. The eosinophil counts were not correlated to age, gender, underlying disease, serum levels of blood urea nitrogen, creatinine, albumin, CRP and the levels of post dialysis cytokines. CONCLUSION: Independently on eosinophilia in HD, the serum concentrations of cytokines (IL-1beta, IL-2 and IL-6) were elevated after HD. IL-5 concentrations were not elevated after dialysis. But we could not reveal whether the eosinophilia in maintenance HD patients may be a surrogate marker for the reflection of exaggerated cellular cytokine production during HD or not by this study.

A Kimura's disease developing during follow up period after remission of lymphoma / 대한내과학회지

The presented case is a 43-year-old male with a painless mass in the right neck for two weeks. Excisional biopsy was performed under the clinical impression of malignant lymphoma, because he experienced lymphoma 32 months ago. Histopathologically, it shows hyperplasia of small blood vessels and lymphoid cells with eosinophilic infiltration, so it was diagnosed as Kimura's disease. This seems to be the first reported case of Kimura's disease developed during follow up period after remission of lymphoma.

A case of eosinophilic gastroenteritis with diffuse small bowel edema and ascites / 대한내과학회지

Eosinophilic gastroenteritis is an uncommon disorder of stomach, small bowel and colon characterized by peripheral blood eosinophilia, eosinophilic infiltration of the gut wall, and variable clinical symptoms. This disease was first described by Kaijser in 1937, and its cause was poorly understood. It may be related to allergy, which combines allergic rhinitis, allergic asthma, atopic dermatitis, food allergy and elevated IgE. The clinical symptoms and signs are variable according to the extents and depths of the eosinophilic infiltration. Endoscopic findings may show normal, nodular, ulcerative, or hemorrhagic mucosal changes, and biopsy findings reveal eosinophilic infiltration of mucosal and muscular layer. We diagnosed and treated a case of diffuse serosal eosinophilic gastroenteritis associated with ascites in a patient with allergic asthma who had severe abdominal pain, distention and watery diarrhea, and she dramatically responded to corticosteroid therapy.

Thrombocytopenia between Decompensated Alcoholic and Viral Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Thrombocytopenia is frequently found among patients with chronic liver disease, and its mechanism, especially among patients with decompensated liver cirrhosis had not been established. Therefore to elucidate the mechanism of thrombocytopenia, the relationship between thrombocytopenia and severity of hepatic dysfunction, splenomegaly was measured. We measured the peripheral blood components with splenic volume obtained from a computerized tomography of decompensated liver cirrhosis patients. METHODS: We studied 103 patients who had been diagnosed with decompensated liver cirrhosis with esophageal varices and ascites from January 1982 to August 1999. We checked their counts of platelets, albumin, bilirubin, splenic volume, degree of esophageal varices, hepatic encephalopathy and ascites by retrograde methods. RESULTS: In viral liver cirrhosis, thrombocytopenia and splenomegaly correlated well with disease severity but they didn't in alcoholic cirrhosis. Of special note, the platelet count was significantly lower and the splenic volume was larger in the Child C of viral cirrhosis patients group than in the alcoholic group(p<0.05). CONCLUSION: When we compared decompensated alcoholic with viral liver cirrhosis patients, the degrees of thrombocytopenia and splenomegaly were much less in the former group. The factors for this phenomena are Splenic Pooling theory, Platelet-associated IgG, Thrombopoietin and Toxic Marrow. We suggest that splenomegaly is an important factor among these, but the mechanisms involved in the pathogenesis of this hematologic phenomena are not completely understood. Especially in alcoholic liver cirrhosis, many other factors may be involved, including the direct effect of alcohol to bone marrow, so further studies will be needed to establish whether a causal relationship exists.

The Relationships between blood pressure and serum lipids in Korean adults

BACKGROUND: Since better understanding of the associations between blood pressure and blood lipids may provide insight into the mechanisms by which hypertension is associated with increased risk of coronary heart disease, this study is aimed to explore the associations of blood pressure with serum lipids, BMI, age, FBS and life style factors. METHODS AND RESULTS: In this study, 20,826 men and 10,209 women were included for the assessment of the cross-sectional relations of blood lipids, BMI, Blood pressure and Life style factors. Stratified analyses and multivariable methods were used to control for potential confounding anthropometric and lifestyle variables. Total cholesterol and Triglyceride levels increased significantly with increasing systolic or diastolic blood pressure in both sexes. Men of 20-29 years old had steeper regression slopes for blood pressure by total cholesterol level than did women of similar age. In men, the association between blood pressure and total cholesterol level decreased with age, whereas in women, no change was observed regarding age. Body mass index modified the relation, whereas smoking, exercise, and alcohol consumption had little influence on the association. HDL cholesterol level had little influence on blood pressure. In the group of age or =40, BMI accounted more. In the group of age < 40, other variables ,besides age and BMI, are suggested to influence more on male hypertension than female hypertension. CONCLUSION: These results provides evidence that there are interrelations between blood pressure, blood lipids and life style factors that may influence the mechanisms of coronary heart disease.

Effect of Pelvic Irradiation on the Bone Mineral Content of Lumbar Spine in Cervical Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate the loss of bone mineral contents(BMC) in lumbar spine within the radiation field for cervical cancer treatment, BMC in the irradiated patient group was compared with that of a normal control group. METHOD AND MATERIALS: Measurements of BMC in the trabecular bone in lumbar spines(L3-L5) were performed in the both patient and normal control groups. Investigators used dual-energy quantitative computerized tomography(DEQCT) using photon energy of 120 and 80kVp. The numbers of patient and control groups were 43 in each with age distribution of fifth to seventh decade of women. The numbers of control group were 22 in fifth, 10 in sixth, and 11 in seventh decade, those of patient group were 14 in fifth, 14 in sixth, and 15 in seventh decade of women. The radiation field was extended to L5 spine for pelvic irrdiation with 45-54Gy of external radiation dose and 30Gy of high dose rate brachytherapy in cervical cancer. RESULTS: The BMC is decreased as increasing age in both control and patient groups. BMC in lumbar spine of patient group was decreased by about 13% to 40% maximally. The BMC of L3 and L4 a region that is out of a radiation field for the patient group demonstrated 119.5+/-30.6, 117.0+/-31.7 for fifth, 83.3+/-37.8, 88.3+/-46.8 for sixth and 61.5+/-18.3, 56.2+/-26.6mg/cc for seventh. Contrasted by the normal control group has shown 148.0 +/-19.9, 153.2+/-23.2 for fifth, 96.1+/-30.2, 105.6+/-26.5 for sixth and 73.9+/-27.9, 77.2+/-27.2mg/cc for seventh decade, respectively. The BMC of patient group was decreased as near the radiation field, while the lower lumbar spine has shown more large amounts of BMC in the normal control group. In particular, the BMC of L5 within the radiation field was significantly decresed to 33%, 31%, 40% compared with the control group of the fifth, sixth and seventh decades, respectively. CONCLUSION: The pelvic irradiation in cervical cancer has much effected on the loss of bone mineral content of lumbar spine within the radiation field, as the lower lumbar spine has shown a smaller BMC in patient group with pelvic irradiation in contrast to that of the normal control groups.