ABSTRACT
PURPOSE: The detection of axillary lymph-node micrometastases in breast-cancer patients by using the reverse transcriptase-polymerase chain reaction (RT-PCR) may provide a good guide for postoperative therapy. To evaluate effectiveness of RT-PCR for the detection of micrometastasis, we have compared the results of conventional, immunohistochemical (IHC) staining with those of RT-PCR. Breast cancer, Lymph node micrometastases, MUC1, Cytokeratin 19, RT-PCR ] METHODS: We conducted RT-PCR amplifications of MUC1 and cytokeratin (CK) 19 on lymph nodes from 40 breast- cancer patients and conducted IHC staining for cytokeratin. The results of histological examination and cytokeratin IHC staining were compared with the RT-PCR results for the detection of lymph-node micrometastases. RESULTS: Nineteen of 40 cases (47.5%) were lymph-node positive and twenty-one cases (52.5%) were lymph-node negative. Using RT-PCR MUC1 and CK19 expressions were detected in all positive lymph nodes and in 4 (19.0%) and 5 (23.8%), in negative nodes, respectively. Not all positive nodes were stained by IHC (94.7%), and none of the negative lymph nodes were stained by IHC. Thus, IHC staining was ineffective in detecting micrometastases. CONCLUSION: Detection of MUC1 and CK19 by using RT- PCR can be a more accurate and useful method than IHC staining for the detection of axillary lymph-node micrometastases in breast cancer.
Subject(s)
Humans , Breast Neoplasms , Breast , Keratin-19 , Keratins , Lymph Nodes , Neoplasm Micrometastasis , Polymerase Chain ReactionABSTRACT
PURPOSE: The detection of axillary lymph-node micrometastases in breast-cancer patients by using the reverse transcriptase-polymerase chain reaction (RT-PCR) may provide a good guide for postoperative therapy. To evaluate effectiveness of RT-PCR for the detection of micrometastasis, we have compared the results of conventional, immunohistochemical (IHC) staining with those of RT-PCR. METHODS: We conducted RT-PCR amplifications of MUC1 and cytokeratin (CK) 19 on lymph nodes from 40 breast- cancer patients and conducted IHC staining for cytokeratin. The results of histological examination and cytokeratin IHC staining were compared with the RT-PCR results for the detection of lymph-node micrometastases. RESULTS: Nineteen of 40 cases (47.5%) were lymph-node positive and twenty-one cases (52.5%) were lymph-node negative. Using RT-PCR MUC1 and CK19 expressions were detected in all positive lymph nodes and in 4 (19.0%) and 5 (23.8%), in negative nodes, respectively. Not all positive nodes were stained by IHC (94.7%), and none of the negative lymph nodes were stained by IHC. Thus, IHC staining was ineffective in detecting micrometastases. CONCLUSION: Detection of MUC1 and CK19 by using RT- PCR can be a more accurate and useful method than IHC staining for the detection of axillary lymph-node micrometastases in breast cancer.
Subject(s)
Humans , Breast Neoplasms , Breast , Keratin-19 , Keratins , Lymph Nodes , Neoplasm Micrometastasis , Polymerase Chain ReactionABSTRACT
One of the most important prognostic factors in breast cancer is presence of axillary lymph node invasion. It is reported that 20-30% of node negative patients with conventional cstaining has a risk of relapse within five years after primary treatment. The status of lymph node can be determined by serial sectioning or immunohistochemical staining, the former was accurate but time consuming, troublesome method and the latter was unsatisfactory in accuracy and objectivity. RT-PCR is sensitive and accurate molecular method and has been used in detecting micrometastasis of lymph node, bone marrow and blood of the cancer patients. We conducted RT-PCR amplification of MUC1, cytokeratin (CK) 19 using total RNA samples of lymph nodes of 40 breast cancer patients and conducted immunohistochemical staining for cytokeratin. The results of histological examination and immunohistochemical staining of cytokeratin were compared with RT-PCR results for the detection of lymph node micrometastasis. Nineteen patients(47.5%) were lymph node positive and twenty one patients (52.5%) were lymph node negative. MUC1 and CK19 were expressed in all lymph node positive patients. Among the node negative patients, 4 cases and 5 cases were expressed MUC1 and CK19 with RT-PCR. But immunohistochemical staining method was ineffective in detecting micrometastasis because lymph nodes of negative node group were not stained for cytokeratin. This study could not rule out the false positivity of RT-PCR, so it should be conducted against variable tumor marker to overcome this fatal defect. We recommend that RT-PCR will be applied in sentinel lymph node for accuate prediction of whole lymph node status and that the patients revealed positive result in RT-PCR should be observed more closely than the other.
Subject(s)
Humans , Bone Marrow , Breast Neoplasms , Keratin-19 , Keratins , Lymph Nodes , Neoplasm Micrometastasis , Recurrence , RNAABSTRACT
We evaluated retrospectively the clinical characteristics of 26 adult nephrotic syndrome patients with minimal-change disease who were followed up for more than six months. Median follow up period was 23months. They consisted of 16 men and 10 women, and the mean age was 34.3 years (range 18-68 years). We administered prednisolone 1.0mg/Kg body weight to the patients for eight weeks and tapered it gradually. Complete remission was obtained in 22 (85%) patients treated with prednisolone and 54% of them reached complete remission in four weeks after beginning prednisolone treatment. Nine patients who initially responded to prednisolone therapy relapsed. Two of these nine patients showed single relapse and seven patients had frequent relapses during the study period. Cyclophosphamide or cyclosporin A was added when the patients did not respond to prednisolone and showed frequent relapse. Of the six patients treated with cyclophosphamide, four patients who were frequent relapsors and one patient who was a non-reponder to prednisolone went into complete remission. The other prednisolone non-responder did not remit. Microscopic hematuria was found in three patients and these patients showed elevated serum creatinine level at the time of diagnosis. Seven patients showed renal impairment at the time of renal biopsy. All of them recovered from renal failure after treatment. Six patients showed complete remission of nephrotic syndrome after prednisolone and/or cyclophosphamide treatment. There was no patient who showed a deterioration of renal function during the study period. In conclusion, complete remission was obtained in 85% of adult minimal change nephrotic syndrome patients and 41% of patients relapsed within one year after attaining complete remission. The serum level of creatinine and microscopic hematuria at the time of diagnosis were not associated with poor prognosis during the study period.
Subject(s)
Adult , Female , Humans , Male , Biopsy , Body Weight , Creatinine , Cyclophosphamide , Cyclosporine , Diagnosis , Follow-Up Studies , Hematuria , Nephrosis, Lipoid , Nephrotic Syndrome , Prednisolone , Prognosis , Recurrence , Renal Insufficiency , Retrospective StudiesABSTRACT
The HELLP syndrome(hemolysis, elevated liver enzymes, and low platelets) is a complication of severe preeclampsia or eclampsia and associated with increased maternal and perinatal mortality. Exact pathogenic mechanism is still unclear but the microangiopathic hemolytic anemia combined with endothelial cell damage is suspected to be closely associated with disease process. Variable degree of disseminated intravascular coagulation(DIC) may be accompanied with the HELLP syndrome. We report a case of postpartum HELLP syndrome. She is 24 year-old woman. She showed definite evidence of microangiopathic hemolytic anemia, DIC, elevated liver enzymes and acute renal failure. Liver biopsy revealed fatty change with focal fibrin like material deposition in the portal tract area. She recovered completely with conservative treatment in 2 weeks.
Subject(s)
Female , Humans , Pregnancy , Young Adult , Acute Kidney Injury , Anemia, Hemolytic , Biopsy , Dacarbazine , Eclampsia , Endothelial Cells , Fibrin , HELLP Syndrome , Liver , Perinatal Mortality , Postpartum Period , Pre-EclampsiaABSTRACT
Typhoid fever, although having undergone a progressive decline in incidence in Korea, has continued to occur sporadically in this country. Renal complications are usually noted in 2-6 percent of patients and various clinical features of renal complication have been reported. However, acute renal failure has been rarely reported. We did a renal biopsy in two patients with typhoid fever who exhibited clinical evidence of acute renal failure, such as oliguria, azotemia, and mentality change. Light microscopy showed that the glomeruli were intact and some of the tubules were dilated and lined by regenerating epithelium. There was mild interstitial edema. Immunofluorescent microscopy showed trace deposits of IgA in one case. Electron microscopy did not show eigther abnormal electron dense deposits or cellular proliferation. Fever and melena disappeared after chloramphenicol treatment, and with the cure of the typhoid fever, the renal symptoms also. Typhoid nephritis should be considered as a cause of acute renal failure when acute renal failure is developed in febrile patients.
Subject(s)
Humans , Acute Kidney Injury , Azotemia , Biopsy , Cell Proliferation , Chloramphenicol , Edema , Epithelium , Fever , Immunoglobulin A , Incidence , Korea , Melena , Microscopy , Microscopy, Electron , Nephritis , Oliguria , Typhoid FeverABSTRACT
Congenital renal arteriovenous malformation is a rare disease. Renal arteriovenous malformations have been discovered with increasing frequency since they were first described by Varela in 1923. Patients with arteriovenous malformations may have gross hematuria, flank pain, urinary obstruction or may be asymptomatic. The diagnosis of arteriovenous malformation is usually made by renal angiogram. Treatment of arteriovenous malformation can be obtained with conservative treatment, ligation of the arterial branch, selective transcatheter embolization and surgical procedures. We experienced a case of congenital arteriovenous malformation manifested by gross hematuria and intermittent right flank pain, cured by means of transcatheter arterial embolization therapy with gelfoam and alcohol. Thus, we report a case with a brief review of literatures.
Subject(s)
Humans , Arteriovenous Malformations , Diagnosis , Flank Pain , Gelatin Sponge, Absorbable , Hematuria , Ligation , Rare DiseasesABSTRACT
Scrub typhus is a zoonosis transmitted by a chigger of trombiculid mite and manifested with fever, skin rash, myalgia, and hepatitis etc. The renal involvement of the disease is prese-ted with transient microscopic hematuria and/or proteinuria. However acute renal failure or meningoencephalitis is very rare. We report a case of scrub typhus manifested with acute renal failure, meningoencephalitis, and hepatitis. The patient was treated with doxycycline and continuous arteriovenous hemofiltration (CAVH) and recovered successfully.
Subject(s)
Humans , Acute Kidney Injury , Doxycycline , Exanthema , Fever , Hematuria , Hemofiltration , Hepatitis , Meningoencephalitis , Myalgia , Proteinuria , Scrub Typhus , TrombiculidaeABSTRACT
Since 1976, several cases of acute renal failure and acute hepatitis after ingestion of raw carp bile have been reported. We experienced 1 case of acute renal failure and hepatitis after ingestion of the raw fish(Cyprinus carpio nudus) gall bladder. The patient ate raw fish gall bladder to improve the health. The size of the fish he ate was over 1 m and that of the gall bladder was about an egg size. The clinical manifestations were characterized by dizziness, headache, diffuse abdominal pain, both flank pain, nausea, vomiting and diarrhea. These symptoms were followed by gross hematuria, oliguria and jaundice. Elevation of blood urea nitrogen, creatinine, transaminases lasted for about 2 weeks. Biopsy of the kidney was performed 13 days after ingestion of raw fish gall bladder. The kidney pathology showed recovery phase of acute tubular necrosis. The patient recovered with conservative treatment.
Subject(s)
Humans , Abdominal Pain , Acute Kidney Injury , Bile , Biopsy , Blood Urea Nitrogen , Carps , Creatinine , Diarrhea , Dizziness , Eating , Flank Pain , Headache , Hematuria , Hepatitis , Jaundice , Kidney , Nausea , Necrosis , Oliguria , Ovum , Pathology , Transaminases , Urinary Bladder , VomitingABSTRACT
Thin glomerular basement membrane nephropathy, also called benign recurrent hematuria, is characterized by diffuse thinning of the glomerular basement membrane and by hematuria. The present study was based on a retrospective review of 366 native kidney biopsies performed at Chungnam National University Hospital from January 1993 to November 1996. Fifteen of these cases satisfied the criteria for definition of thin glomerular basement membrane nephropathy, placing the incidence of the disease at 4.0%. The criteria for definition of the disease are 1) normal findings by light microscopy, 2) no deposits by immunofluorescent microscopy, and 3) diffuse thinning of the glomerular basement membrane by electronmicroscopy. The studied patients had a mean age of 35.8 years (range from 14 to 59) and included 12 females and 3 males. A positive family history was present in one case. All pateints were normotensive and had hematuria (four cases showed gross hematuria). Seven patients had mild proteinuria, but two patients showed proteinuria of nephrotic range. The serum creatinine level was within normal limits except one. Abnormalities were not observed in immunoglobulins, complement component, serologic tests (RA, ASO) and HBsAg. Renal biopsy findings by light and immunofluoroscent microscopy did not reveal any abnormalities but diffuse thinning of the glomerular basement membrane (range from 154 to 279nm) was observed by electronmicroscopy. With the above results, patients with idiopathic renal hematuria with normal renal function and normal blood pressure, thin glomerular basement membrane nephropathy should be considered.
Subject(s)
Female , Humans , Male , Biopsy , Blood Pressure , Complement System Proteins , Creatinine , Glomerular Basement Membrane , Hematuria , Hepatitis B Surface Antigens , Immunoglobulins , Incidence , Kidney , Membranes , Microscopy , Proteinuria , Retrospective Studies , Serologic TestsABSTRACT
BACKGROUND: 99mTc MIBI(Methoxyisobutylisonitrile complex), a member of the isonitrile class of coordination compounds, is a lipophilic cation presently under investigation for clinical use as myocardial perfusion imaging agent and is widely used to detect myocardial infarction. Preliminary reports indicate that T1-201 accumulate in human neoplasm and several authors reported 99mTc MIBI may also localized in primary malignant tumor and metastatic deposits from lung cancer. We evaluated the uptake of 99mTc MIBI in lung cancer and localization of mediastinal and other site metastasis, and compared the benign lesion of the lung. METHOD: Thirty four patients of lung cancer and ten patients of benign lung lesion were studied with chest CT and 99mTc MIBI Lung SPECT. 99mTc MIBI uptake ratio was assessed by TR/NL(Lung lesion/ Normal area), HT/NL (Heart/ Normal area) and HT/TR(Heart/Lung lesion). RESULTS: 1) All lung cancer patients showed increased uptakes of 99mTc MIBI in malignant lung lesion and Tc-99m MIBI uptake was also increased in mediastinal and lymph node metastasis except two cases. 2) There was significant different ratio of TR/NL between malignant and benign lesion, 3.79 +/- 1.82 and 1.67+/-0.63 on planar images, respectively(p <0.001). 3) There was no significant difference of 99mTc MIBI uptake ratio between squamous cell carcinoma, small cell carcinoma and adeno carcinoma(3.64+/- 1.66, 3.57+/-0.72, 4.31 +/-2.28 respectively). CONCLUSION: 99mTc MIBI lung SPECT was useful in the localization of tumor and mediastinal or other site metastatic lesion in lung cancer and also in the differential diagnosis between benign and malignant lesion.
Subject(s)
Humans , Carcinoma, Small Cell , Carcinoma, Squamous Cell , Diagnosis, Differential , Lung Neoplasms , Lung , Lymph Nodes , Myocardial Infarction , Myocardial Perfusion Imaging , Neoplasm Metastasis , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray ComputedABSTRACT
No abstract available.
ABSTRACT
No abstract available.