Usefulness of Ultrasound Examination in Evaluation of Breast Cancer-Related Lymphedema

OBJECTIVE: To evaluate the usefulness of ultrasound examination as an adjunctive measurement tool in breast cancer-related lymphedema. METHOD: Twenty healthy volunteers and 20 women who had been treated for unilateral breast cancer and had subsequently developed lymphedema were recruited. Examiners measured the volume of both arm with volumeter and the circumference of both forearm and upper arm with tape measure. Then the thickness of the skin and subcutis on the ventral aspect of forearm and upper arm were measured by ultrasonography. These results were compared with each other. RESULTS: The ICCs for interrater reliability of ultrasound examination was high (mostly>0.98). The volume of the swollen arm (2,308 ml) was larger than contralateral arm (1,873 ml). The circumference of swollen forearm (24.50 cm) and upper arm (30.81 cm) were larger than contralateral forearm (21.54 cm) and upper arm (27.60 cm). In the swollen side, average thickness of the forearm skin, forearm subcutis, upper arm skin and upper arm subcutis were 0.23 mm, 1.03 mm, 0.19 mm and 0.95 mm respectively. In the contralateral side, average thickness of the forearm skin, forearm subcutis, upper arm skin and upper arm subcutis were 0.12 mm, 0.69 mm, 0.13 mm, 0.73 mm respectively. The degree of increase in mid-forearm skin thickness were correlated with the degree of swelling calculated with volumeter (r=0.651, p=0.002). CONCLUSION: Ultrasonography is able to give valuable information on the extent of edema and fibrosis of skin and subcutis. It will be a useful tool to follow the results of lymphedema treatment and its progression over time.

Intravitreal Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration with a Predominantly Hemorrhagic Lesion

PURPOSE: To report the efficacy and safety of intravitreal ranibizumab monotherapy in patients with age-related macular degeneration with a predominantly hemorrhagic lesion. METHODS: Nineteen eyes of 19 patients with submacular hemorrhage involving the fovea were treated with intravitreal ranibizumab (0.5 mg/0.05 ml) injections as needed. All patients completed at least 4 months of follow-up. Ophthalmologic examinations, fluorescence angiographic evaluations, optical coherence tomography (OCT) examination, and hemorrhage size were analyzed before the injections, and at 1,2,4,6, and 12 months follow-up. RESULTS: The average VA and mean central retinal thickness (CRT) before ranibizumab treatment were 0.62 +/- 0.39 log MAR and 335.76 +/- 111.22 microm, respectively. Additionally, the VA and CRT four months after the initial injections were 0.54 +/- 0.43 log MAR and 241.42 +/- 107.55 microm, respectively. The mean size of the hemorrhage was significantly reduced from 2.87 +/- 2.44 DA (disk areas) at baseline to 0.9 +/- 1.28 DA at four month follow up. CONCLUSIONS: Intravitreal injection of ranibizumab is an effective treatment option for patients with age-related macular degeneration with a predominantly hemorrhagic lesion.

A Case of Modified Photodynamic Therapy in the Management of Choroidal Metastasis of Breast Cancer

PURPOSE: To report a case of choroidal metastasis of breast cancer that was treated with modified photodynamic therapy. CASE SUMMARY: A 45-year-old woman visited our clinic with blurred vision of the right eye, which began 1 month before. The patient previously suffered from a low back pain for 1 year. The best corrected visual acuity was 20/20 in both eyes. Fundus examination revealed an elevated yellowish mass-like lesion at the superonasal area in the right eye. Ultrasonography of the right eye showed a highly echogenic choroidal mass with moderate to high internal reflectivity. Fluorescein angiography showed hypofluorescence during the prearterial and arteriovenous phase, and well circumscribed hyperfluorescence during the venous phase. Radiologic examination was performed upon suspicion of metastasis. The examination revealed breast cancer with lung, spine and ovary metastasis. Subsequently, biopsy of the breast mass revealed an invasive ductal carcinoma. Based on these results, the patient was diagnosed with choroidal metastasis from breast carcinoma. The patient received systemic chemotherapy, and modified photodynamic therapy (PDT) was performed on the metastatic choroidal mass. Six days after modified PDT, the mass size was unchanged, and serous retinal detachment developed at the macula and inferior retina. However, 22days after treatment, the mass size markedly decreased and the serous retinal detachment was improved.

The Frequency of Unexpected Antibodies by Using Two Micro-column Agglutination Systems: DiaMed-ID and Ortho BioVue Systems / 대한수혈학회지

BACKGROUND: Unexpected antibody screening and identification tests are very important for safe blood transfusion. The micro-column agglutination test (MCAT) is widely used due to its simplicity and efficiency for detecting alloantibodies. We analyzed the frequency of unexpected antibodies at three university hospital blood banks, which use two different MCAT systems. METHODS: From February 2002 to December 2009, a total of 295,876 unexpected antibody screening tests were performed at three university hospital blood banks. Two hospital blood banks (Anam and Ansan Hospitals) used the DiaMed-ID system (DiaMed Ag, Switzerland) and the other (Guro Hospital) used the Ortho BioVue system (Ortho-Clinical Diagnostics, USA) for antibody screening and identification tests. RESULTS: The rates of detecting unexpected antibodies on screening test based on the 'tests performed' and the 'persons tested' were 1.16% per test and 0.96% per person in Korea University Guro Hospital, 0.65% and 0.41% in Korea University Anam Hospital and 0.76% and 0.57% in Korea University Ansan hospital, respectively. There were significant differences in the frequencies based on the two different systems (P<0.001). Among the warm antibodies, Rh antibodies were more frequently detected by the DiaMed-ID system, and Lewis antibodies were most frequently detected by the Ortho BioVue System. CONCLUSION: We should carefully interpretate the frequency of unexpected antibodies in the Korean population because the frequencies of unexpected antibodies are different according to different employed micro-column agglutination systems.

A Case of Isolated Choroidal Cystic Lesion With Good Visual Acuity

PURPOSE: To report a case of isolated choroidal cystic lesion in the macula with no interval change for two years. CASE SUMMARY: A 29-year-old woman who had suspicious maculopathy was referred to our clinic. Her best corrected visual acuity was 20/20 in the affected right eye, which showed a choroidal cystic lesion on a fundus exam, fluorescein angiography, USG and OCT. The multifocal ERG showed reduced amplitudes of the cystic area in the right eye, and SLO microperimetry revealed reduced retinal sensitivity in the cystic lesion as well as a stable fixation and spared foveal function. There was no evidence of underlying ocular disease in clinical assessment, and the lesion had not undergone interval change for the past two years.

Development and Evaluation of a School-based Anger Management Program (SAMP) for Adolescents

PURPOSE: This study was done to develop a school-based anger management program (SAMP) of 4 sessions and examine its effects on the anger, anger expression, psychosomatic responses, psychosocial responses, and immunologic responses in adolescents. METHODS: A quasi-experimental study using a nonequivalent control group, pre-post design with repeated measures was used. Chi-square test, t-test, paired t-test, and Fisher's exact test were used to analyze the data. RESULTS: There were no differences between the experimental and control groups in outcome variables except for lymphocytes. However, following additional analyses, statistically significant differences by time point were observed for pain sensitivity, T cell, Helper T (Th) cell, Suppressor (Ts) cell and Natural Killer (NK) cell post-treatment, entrapment and psychosomatic symptoms at the 4-week follow-up, and resilience at the 10-week follow-up for the experimental group. CONCLUSION: Although some modifications in contents and administration will be required to increase the effectiveness of the program for anger management, SAMP can be used to promote anger management ability in adolescents.

Evaluation of Green Vac-Tube in Clinical Laboratory Tests / 임상검사와정도관리

BACKGROUND: Vacuum tubes are widely used in the clinical laboratory for routine tests. We compared a newly developed Green Vac-Tube (SPM, Gimje, Korea) with Vacutainer (BD, Franklin Lakes, NJ, USA) and Vacuette (Greiner Bio-One, Frickenhausen, Germany) in routine chemistry and hematology tests. METHODS: A total of 101 volunteers, 81 patients and 20 healthy volunteer, were recruited and we had collected blood samples with three kinds of EDTA tubes and those of serum separating tubes. The samples were evaluated for chemistry and hematology tests using TOSHIBA 200FR (Toshiba, Tokyo, Japan) and ADVIA (Siemens, Deerfield, IL, USA) respectively. Their results were statistically analyzed by paired t-test and Bland-Altman plot. RESULTS: Their clinical utilities were examined by CLIA'88 programs. Paired t-test analysis revealed that the results of ALP, AST, total bilirubin, CO2, Hct and MCV showed statistically significant differences between Green Vac-Tube and previously used two vacuum tubes. Similar significant differences were also observed between previous two vacuum tubes. And 194 (4.37%) cases among 5,151 cases were in the critical region by Bland-Altman plot. All different cases, except Na+, K+ however, were clinically acceptable by CLIA'88 programs. CONCLUSIONS: Green Vac-tube has good analytical performance compared to previously-used tubes.

Clinical Manifestation and Associated Cardiac Anomalies of Dextrocardia

PURPOSE: The purpose of this study is to ascertain the clinical manifestations and associated cardiac anomalies of dextrocardia. METHODS: Twenty-four pediatric patients, who were admitted to, or visited, Dongsan Medical Center Keimyung University and were diagnosed with dextrocardia between January 1996 and July 2001, were enrolled in this study. All patients received echocardiogram and abdominal ultrasonogram to identify structural cardiac anomalies and visceral position. RESULTS:Among 24 patients, 7 cases were situs solitus(29.2%), 10 cases(41.6%) were situs inversus and 7 cases(29.2%) were situs ambiguous. Most were diagnosed within a week of life(87.5%). They were most commonly cyanotic(45.8%), but eleven cases(45.8%) had no specific symptoms or signs. Nineteen cases(79.2%) had accompanied cardiac anomalies, and pulmonary stenosis or atresia were the most common among them. All the cases of situs solitus and ambiguous had associated cardiac anomalies, but half of the situs inversus had that. Eleven cases were dead by cardiac or extracardiac anomalies during follow up and the mortality rate was higher in situs solitus or ambiguous group than situs inversus group. CONCLUSION: Dextrocardia accompanies different cardiac and extracardiac anomalies. It's very important to diagnose dextrocardia and associated cardiac or extracardiac anomalies in the early stages of life to improve prognosis.

Perinatal Factors Influencing to the Response of Surfactant Replacement Therapy for the Neonatal Respiratory Distress Syndrome Patients / 대한주산의학회잡지

No abstract available.

A Neonatal Case of Symptomatic Congenital Cytomegalovirus Infection with Hearing Defect

Cytomegalovirus(CMV) is one of the leading cause of intrauterine infections of man with an incidence ranging from 0.48% to 2.2% of all live births. Although the majority of CMV-infected newborns are clinically asymptomatic at birth, some will have signs of congenital infection : Intrauterine growth retardation, petechial or purpuric rash, microcephaly, anemia, thrombocytopenia, jaundice, hepatosplenomegaly and intracranial calcification. We experienced a case of symptomatic congenital CMV infection in a 1-day-old male who presented generalized petechiae, hepatosplenomegaly, anemia, thrombocytopenia. Urine PCR and viral culture for CMV were positive, and a brain CT revealed ventriculomegaly and periventricular calcification. And auditory evoked potential revealed left sensorineural hearing loss. He received ganciclovir treatment for 6 weeks, was discharged in good health, and continued conunder follow-up at the outpatient department.

Neonatal Systemic Candidiasis : Comparison of Clinical Manifestations between Fullterm and Preterm Infants / 대한주산의학회잡지

No abstract available.

A Case of Cri-du-chat Syndrome with Genitourinary Anomaly / 대한주산의학회잡지

No abstract available.

Clinical Features of Spontaneous Neonatal Gastric Perforation

PURPOSE: Spontaneous neonatal gastric perforation is a rare neonatal event which is associated with high mortality. The aim of this retrospective study is to investigate the diagnosis and the treatment of neonatal spontaneous gastric perforation. METHODS: From January 1991 to December 2000, eight cases of neonatal gastric perforation were presented at Keimyung University Dongsan Medical Center. RESULTS: Among 8 neonates (7 males and 1 females), 2 were premature infants. 7 cases (87.5%) had symptoms onset in first 4 days of life. The most presenting signs were abdominal distension, vomiting, and respiratory difficulty. The most common X-ray finding was pneumoperitoneum (87.5%) and the most common site of perforation was greater curvature (75%). The combined congenital anomalies were malrotation of small intestine, teratoma, and partial duodenal obstruction. The predisposing causes may be associated with congenital intestinal anomaly, necrotizing enterocolitis, and too fast increased formula. All the cases underwent surgical repairs. The mortality rate was 37.5%, and the surgical procedure performed 24 hours after presumed disease onset represented poor outcome (mortality rate 67%). CONCLUSION: This report suggests that early diagnosis and early management before clinical deterioration of metabolic status may improve the prognosis for neonatal spontaneous gastric perforation patient.

Infectious Manifestations in Childhood Leukemia

PURPOSE: Infection is one of the major causes of morbidity and mortality in children during chemotherapy for leukemia and the development of fever in neutropenic cancer patients frequently indicates infection. The purpose of the present study is to evaluate infectious manifestations during the course of leukemia. METHODS: Seventy eight leukemic children who had one or more occasions of infection during hospitalization from January 1993 to December 1999 at Dong San Hospital, Keimyung University were analyzed. Infection was defined clinically as a single oral temperature of 38.5degrees C or higher or as three consequent oral temperature 38degrees C in a day. RESULTS: Two-hundred and four febrile episodes were studied. The cause of infection was detected in 136 episodes while in 68 episodes the cause was not detected. The causes of infection were : 31 pneumonia, 24 sepsis, 16 urinary tract infections, 15 mucositis, and 14 wound infections. The etiologic pathogens were identified in 53 episodes. Sixty percent of the pathogens were gram negative organisms such as Escherichia coli, Enterobacter, Pseudomonas aeruginosa and Klebsiella. Both gram positive and fungal infections were 17.0%. Most sensitive antibiotics were vancomycin for gram positive organisms and ceftazidime and amikacin for gram negative organisms. Twenty-one patients died due to FUOs, sepsis, pneumonia and severe mucositis. CONCLUSION: Infection was the most frequent cause of death in leukemic patients and fungal infections have increased recently. The risk of infection was higher in patients with severe and prolonged neutropenia. Therefore immediate application of antibiotics and antifungal agents will be needed in the leukemic patient with neutropenia.

Thrombopoietin Level and Bone Marrow Megakaryocyte Colony Formation in Various Diseases with Thrombocytopenia / 대한소아혈액종양학회지

PURPOSE: Thrombocytopenia is a serious life threatening consequence in patients with bone marrow failure syndrome. Thrombopoietin (TPO), recently cloned by several groups has been shown to be a key regulation of megakaryopoiesis and thrombopoiesis. Recent studies have demonstrated a positive or negative relationship between TPO levels and platelet counts due to underlying disease states. To clarify the role of TPO in thrombocytopenic condition we determined plasma TPO levels and megakaryocyte colony assay. METHPDS: TPO levels were measured in thrombocytopenic patient with aplastic anemia, chemotherapy induced bone marrow failure, idiopathic thrombocytopenic purpura (ITP) and in newborn by ELISA (QuantikineTM, R&D System, USA). Controls were short statured normal children with normal platelet counts. Plasma was preserved in 20oC until test. CFU-mega was determined by MegaCultTM (Stem Cell Tech. Inc., Canada). Ficoll separated mononuclear cells were cultured for 10~12 days with TPO or stem cell factor (SCF) in 37degrees C 5% CO2 atmosphere, colonies were fixed, stained and examined with inverted microscope. Results were analysed by Student-t test. RESULTS: TPO levels were markedly increased in aplastic anemia and chemotherapy induced thrombocytopenia compared to those of normal controls. Patients with ITP had decreased level of plasma TPO. There was inverse relationship between platelet count and TPO levels for patients with aplastic anemia and chemotherapy induced thrombocytopenia. There was no definite relationship between platelet counts and TPO levels but inverse relationship between platelet counts and PDW levels in neonates was noted. The levels of TPO were increased after improvement of platelet in thrombocytopenic neonate. Megakaryocyte colonies were increased in the mononuclear cells of the patients with ITP and chemotherapy induced thrombocytopenia. There was little colony formation in aplastic anemia. TPO had no definite effect in megakaryocyte colony formation but SCF increased colony formation. CONCLUSION: TPO levels were increased in aplastic anemia and chemotherapy induced thrombocytopenia but decreased in ITP. There was inverse relationship between platelet count and TPO levels in aplastic anemia and chemotherapy induced thrombocytopenia. Thus TPO could be useful for differentiate the etiology of thrombocytopenia. Megakaryocyte colony was increased in ITP and chemotherapy induced thrombocytopenia, but decreased in aplastic anemia. SCF was effective in megakaryocyte colony formation. TPO and SCF will be helpful to increase platelet in thrombocytopenic patients. However, further study will be needed.

Candidal Sepsis in Very Low-Bith-Weight Infants: Clinical Manifestations and Epidemiology

PURPOSE: With a dramatic improvement in the survival rate of the very low-birth-weight (VLBW) infants, systemic fungal infections, especially candida sepsis, appear to represent an increasing problem among high risk neonatal patients. So, we evaluated epidemiological and clinical features of candidal sepsis in VLBW infants. METHODS: Among the VLBW infants who were admitted to NICU of the Dongsan Medical Center, Keimyung University between January 1996 and December 1999. Patients with candidal sepsis, which was proven by cultures, were evaluated for prediposing factors, clinical manifestations, and treatment and sequelae. RESULTS: 1) A total of 22 infants, representing 9.6% of the total admissions of infants with birth weight < 1,500 gram were diagnosed with candidal sepsis during hospitelizations. The mean gestational age was 29.5 weeks (27-36.3 weeks) and the mean birth weight was 1,260 gram (860-1,480 g). 2) The predisposing factors were long-term use of antibiotics, prolonged parenteral hyperalimentation with lipid, indwelling catheter, steroid treatment and mechanical ventilation. 3) The mean age of onset infection was 48 days. The most common presenting clinical manifestations were temperature instability (46.2%), apnea and/or bradycardia (42.3%), feeding intolerance (42.3%), and decreased activity (38.5%). The most common hematologic change was thrombocytopenia (53.9%). 4) The most frequent organism was Candida albicans (65.4%), following by species were C. tropicalis (11.5%), C. lusitaniae (7.7%) and C. parasilosis (7.7%). 5) After treatment of intravenous amphotericin B with or without diflucan, the mortality rate was 13.6% and significant complications were not noted. CONCLUSION: We reviewed the clinical spectrum of candidal sepsis in the VLBW infants in NICU, and concluded that early diagnosis and treatment may be important in improving the mortality and morbidity of VLBWI with candidal sepsis.

A Case of Acute Respiratory Distress Syndrome Occurred after Pulmonary Edema in a Fullterm Newborn

Acute respiratory distress syndrome (ARDS) is a syndrome identified as acute respiratory failure and is characterized by wide spread infiltrates on chest radiograph, impaired oxygenation, and noncardiogenic pulmonary edema. This syndrome is identified very uncommonly during neonatal period. We experienced a case of ARDS in a 3-day old fullterm neonate who had had the sign of pulmonary edema. He was improved with the treatment of mechanical ventilation, but pulmonary interstitial emphysema and periventricular leukomalacia were complicated.

Serum Epeidermal Growth Factor Receptor (EGFR) in Cervical Cancer / 대한부인종양콜포스코피학회잡지

Epidermal growth factor receptor (EGFR) is overexpressed in various malignancies including carcinoma of the breast, lung, esophagus, cervix, and stomach. In patients with cervical carcinoma, its overexpression may be associated with advanced stage and poor prognosis. So, we evaluated the levels of serum EGFR in patients with cervical carcinoma. The level of EGFR extracellular domain was determined in serum from 57 cervical carcinoma patients(adenocarcinoma: 2, squamous cell carcinoma: 39, carcinoma in situ(CIS): 16) and 28 cases of healthy control using enzyme-linked immunosorbent assay(Calbiochem). In invasive carcinoma, serum EGFR level was measured in 11 cases of Stage Ia, 9 cases of Stage Ib, 4 cases of Stage IIa, 15 cases of Stage IIb, 2 cases of stage III patients. The mean ages of the healthy controls, of the wome with carcinoma in situ(CIS), and with invasive cervical carcinoma were not different(49.3, 44,4, 49.5, respectively, p 0.241). The mean serum level of EGFR in healthy control(n 28), carcinoma in situ(CIS)(n 16), and invasive carcinoma patients(n=41) were not significantly different(71.4+/-12.8fmol/ml, 79.2+/-26.8fmol/ml, 61.8+/- 18.4 fmol/ml, respectively, p=0.071). In conclusion, the expression of EGFR was not increased in patients with cervical cancer compared with normal women. And no significant differences were found depending on the clinical stage.

The Effects of Type 1 diabetes on the Metabolism and Density of Bone in Children / 대한내분비학회지

BACKGROUND: The effects of type 1 diabetes mellitus on the metabolism and density of bone in children are still controversial. The aim of this study was to evaluate the effects of type 1 diabetes on markers of bone metaboism and BMD in children by analyzing BMI, HbA1c, biochemical markers, sex hormones, bone metabolism and BMD related factors. MRTHODS: We compared 36 patients (15 males, 21 females) with type 1 diabetes mellitus to 167 healthy children (84 males, 83 females) who lived in Taegu. We measured FBS, serum calcium, phosphorus, HbA1c, osteocalcin, testosterone and estradiol for analyzing the factors which influence on bone metabolism and BMD. BMD was measured at lumbar spine, femur and total body by DEXA. RESULTS: The BMI and serum level of osteocalcin were not different in both groups. Serum calcium level was significantly lower in the diabetic group than that of control group. BMD had no difference in both groups. There was no correlation between BMD and glycemic control (HbA1c) or duration of diabetes. There was good correlation (r=0.78, p<0.01) between serum testosterone level and BMD in male patient group. There was negative correlation (r=-0.4) between serum osteocalcin level and BMD. There was significant correlation (male: r=0.76, female: r=0.66) between lean body mass and BMD in both group. CONCLUSION: The BMD was not decreased significantly and bone turn-over was normal in children with noncomplicated type 1 diabetes mellitus, and BMD was not influenced by the duration or degree of metabolic control of diabetes. But, we need further study including other risk factors that have influences on BMD and bone metabolism in type 1 diabetes mellitu.

Anticancer Effect of Arsenic Trioxide in Acute Promyelocytic Leukemia

PURPOSE: Acute promyelocytic leukemia (APL or AML, M3) represents an unique model for cancer research in terms of biological and clinical features. Since 1988, it has been widely confirmed that all-trans retinoic acid (ATRA) can induce complete clinical remission in over 85% of APL patients by a differentiation process, with PML-RARalpha protein possibly being the direct target of ATRA. However, ATRA treatment has two clinical limitations, namely, retinoic acid syndrome and retinoic resistance. Recently, it has been shown that arsenic trioxide used in some traditional Chinese remedy is very effective in retinoic resistant APL treatment. We tried to observe arsenic effect on cell lines and APL patient cells. MEHTODS: We investigated arsenic trioxide-induced apoptosis on APL, HL60, K562, KPH1 cell lines through MTT assay, DNA fragmentation assay and morphologic features. RESULTS: In MTT assay, cell survival rate decreased as the concentration of arsenic trioxide increased. In DNA fragmentation assay with HL60 cell line, DNA fragmentation was more frequent in high concentrations of arsenic trioxide than in low concentrations. During arsenic trioxide treatment, the morphologic change in bone marrow cells of APL patient, included nuclear differentiation and dark cytoplasmic granule during arsenic trioxide treatment. Serum arsenic reached peak level at 4hr after injection. We experienced a case of a 9-year-old male with APL who had relapsed after cessation of retinoic acid treatment. The patient successfully achieved remission following arsenic trioxide treatment without bone marrow depression and exacerbating bleeding diathesis. CONCLUSION: Arsenic trioxide can be used effectively to treat APL patients by inducing apoptosis and partial differentiation in tumor cells. The precise cellular and molecular mechanisms of its therapeutic effects remain to be determined.