Immunocytochemical Study for Lactalbumin in Alveolar Macrophage of Human Milk Aspirated Mouse

PURPOSE: Aspiration of foreign material into the lungs can cause acute or chronic pulmonary diseases. It is difficult to detect small amounts of aspiration due to the lack of safe, sensitive and specific diagnostic tests. Recently, in animal or human studies, it has been reported that immunochemistry for lactalbumin can be used to detect the minimal aspiration. So, the authors' investigation was designed to determine whether human milk phagocytized alveolar macrophages can be detected in human milk aspirated mice. METHODS: Sixty four male mice, 6-8 weeks old and 30-40 gm weighing, were used for this study. About 0.05 mL of human milk or normal saline were given intranasally once per day for 1 day or 3 days. Under anesthesia with ketamine and xylazine, the trachea of each mouse was cannulated with an 18G Jelco needle and then, each mouse's lungs were lavaged three times with 0.5 mL of phosphate buffer solution at 2, 8, 24, and 48 hours after the last milk or normal saline instillation. Cells in bronchoalveolar lavage fluid were stained with Oil Red O and immunocytochemistry for alpha-lactalbumin. RESULTS: Immunocytochemical reactivity for alpha-lactalbumin or lipid-laden alveolar macrophages were not observed in the normal saline aspirated groups. Immunocytochemical reactivity for alpha- lactalbumin were observed in the human milk aspirated groups. They showed a peak at 8 hours and decreased markedly at 24 hours but persisted even at 48 hours after aspiration. Immunocytochemical stain positive alveolar macrophages were noted similarly in number between single and multiple aspiration groups. CONCLUSION: These observations suggested that alveolar macrophages for lactalbumin could be more easily detected on immunocytochemistry than Oil Red O stain, and immunocytochemistry could be used as a sensitive and specific diagnostic test for the detection of human milk aspiration.

A Study on Clinical Application of Harada's Scoring Method to Kawasaki Disease: Suggesting the revision of the criteria for IVGG treatment of KD in Korea

PURPOSE: We performed a study on clinical benefits of Harada's scoring method, problems of present criteria and requirement of the revision of that criteria for intrvenos gamma-globulin (IVGG) treatment of Kawasaki disease (KD) in Korea. METHODS: The patients of 104 cases who visited to Department of Pediatrics of Chungnam National University Hospital and diagnosed as KD were objective group. We classified the patients to high and low risk groups as two methods of Harada's scoring method and present criteria for IVGG treatment of KD in Korea, and analyzed the results after treatment by means of echocardiogram. RESULTS: 1. Characteristics of the patients 1) Duration to diagnosis: Mean duration was 6.0 3.5days after onset of fever. 2) Age of onset and male to female ratio: the patients of 84.6% were the age of 4 years or less, and male to female ratio was 1.8 to 1. 2. Coronary aitery lesion (CAL) abnormalities according to items of Harada's scoring method and classification of risk groups 1) The age of less than 12 months and CRP of 3+ or more were significant predictive factors 2) Classification of risk groups was significantly predictive in CAL development. 3. Classification of total cases The patients reserved to administration for IVGG according to Harada's scoring method and present criteria for IVGG treatment of KD in Korea were 63.5% and 50% respectively. If so in present criteria for IVGG treatment of KD in Korea, 50% of the KD patients were excluded for that application. 4. Outcome after treatment according to selective IVGG use by two methods 1) Selective IVGG use by Harada's scoring method: There was no significant difference in development of CAL between low risk group and high risk group, resulting in 1 case (14.3%) of 7 cases and 5 cases (9.4%) of 53 cases respectively. 2) Selective IVGG use by present criteria for IVGG treatment of KD in Korea: There were more significant cases at low risk group than those at high risk group in development of CAL, resulting in 3 cases (42.9%) of 7 cases and 5 cases (12.2%) of 41 cases respectively. 3) Outcome after treatment in patients not administered IVGG as low risk groups according to two methods: There were more significant cases in low risk group at present criteria for IVGG treatment of KD in Korea than those at Harada's scoring method in the development of CAL, resulting in 3 cases (42.9%) of 7 cases and 1 case (14.3%) of 7 ases respectively. 4) Outcome after treatment in patients administered IVGG as high risk groups according to two methods: There was no significant difference between high risk groups at both methods in the CAL development, resulting in 5 cases (12.2%) of 41 cases at present criteria for IVGG treatment of KD in Korea and 5 cases (9.4%) of 53 cases at Harada's scoring method. CONCLUSIONS: Harada's scoring method had more benefits in clinical application, selection of risk group, and outcome after treatment, So we propose the revision of present criteria for IVGG treatment of KD in Korea, suggesting another method as indication for selective IVGG treatment.