The Change of Brain MRI and Pathology According to the Administered Dose of Manganese in Rats / 대한산업의학회지

OBJECTIVES: This study was carried out to investigate the effect of manganese on the brains of rats, and chronic exposure to manganese is known to induce Parkinsonism in human. METHODS: The rats were divided into three groups: the first group was a control group that was administrated normal saline, and the second group was subdivided into the low dose group (10 mg/kg) and the high dose group (40 mg/kg) according to the administered dose of manganese. The rats of each group received an injection of normal saline and manganese via a tail vein once a week for 4 weeks. The rats were sacraficed at 4 weeks after the first adminstration of manganese. Brain MR imaging was performed before the rats were killed. After the rats were killed, the concentration of blood manganese was measured, and pathologic examination of the brain was performed in all the groups. RESULTS: The concentration of blood manganese was increased proportionally to the administered dose. The signal intensity of the basal ganglia on the T1-weighted imaging of brain MRI was increased in accordance with the administered dose. The ratio of neuron/glial cells in the basal ganglia was decreased in the experiment group as compared to that of the control group. CONCLUSIONS: This study showed that the signal intensity and the damage of neurons in basal ganglia were increased according to the administered dose of manganese in rats.

The Change of Brain MRI and Pathology According to the Administered Dose of Manganese in Rats / 대한산업의학회지

OBJECTIVES: This study was carried out to investigate the effect of manganese on the brains of rats, and chronic exposure to manganese is known to induce Parkinsonism in human. METHODS: The rats were divided into three groups: the first group was a control group that was administrated normal saline, and the second group was subdivided into the low dose group (10 mg/kg) and the high dose group (40 mg/kg) according to the administered dose of manganese. The rats of each group received an injection of normal saline and manganese via a tail vein once a week for 4 weeks. The rats were sacraficed at 4 weeks after the first adminstration of manganese. Brain MR imaging was performed before the rats were killed. After the rats were killed, the concentration of blood manganese was measured, and pathologic examination of the brain was performed in all the groups. RESULTS: The concentration of blood manganese was increased proportionally to the administered dose. The signal intensity of the basal ganglia on the T1-weighted imaging of brain MRI was increased in accordance with the administered dose. The ratio of neuron/glial cells in the basal ganglia was decreased in the experiment group as compared to that of the control group. CONCLUSIONS: This study showed that the signal intensity and the damage of neurons in basal ganglia were increased according to the administered dose of manganese in rats.

Comparison of the Effects between Growth Hormone and Hyaluronic Acid on Degenerative Cartilage of Knee in Rabbit

OBJECTIVE: To explore whether the growth hormone is effective in the treatment of degenerative cartilage of knee in rabbits. METHOD: Thirty New Zealand white rabbits were administered intra-articular injection with monosodium iodoacetate (Sigma, St. Louis, USA) 2.5 mg and divided into 3 groups. Each group was administered with hyaluronic acid (Hyruan plus(R), LG life science, Seoul, Korea)(group A) 0.6 ml, growth hormone (Declage(R), LG life science, Seoul, Korea) (group B) or saline (group C) 0.6 ml intra-articulary once a week for 4 weeks, beginning 4 weeks after the degeneration induction. All rabbits were killed 9 weeks after degeneration induction. The histologic morphology was observed by optical microscope with knee cartilage. RESULTS: Mankin score was 2.4+/-1.3 in group A, 3.9+/-1.7 in group B, 7.4+/-0.8 in group C. Yoshimi score was 1.5+/-0.7 in group A, 2.2+/-0.9 in group B, 4.4+/-0.6 in group C. Gross and microscopic morphologic findings showed that group C represented the more severe than group A & B (p<0.01), also group A was better than group B (p<0.05). CONCLUSION: Growth hormone is effective on degenerative knee cartilage in rabbit model, but less than the hyaluronic acid.

Primary Cerebellar Hodgkin's Lymphoma

Authors report a very rare case of primary Hodgkin's lymphoma limited to the cerebellum. A 64-year-old female patient presented with headache, nausea, and vomiting. Magnetic resonance imaging of the brain revealed a nodular enhancing mass in the left cerebellar hemisphere. Tumor was removed totally with retromastoid suboccipital approach. Diagnosis was Hodgkin's lymphoma of mixed cellularity type, consisting of a dense mixed inflammatory infiltrate containing scattered large atypical mononuclear Hodgkin cells and multinucleated Reed-Sternberg cells. Systemic work-up for the Hodgkin's lymphoma was followed with negative result. Postoperative radiation therapy was given and the patient is disease-free at 16 months after the operation.

Silent Adenomas of Pituitary Gland: It's Immunohistochemical Features and Clinical Characteristics

OBJECTIVE: The aim of the study was to review the clinical and radiological findings of those non-functioning adenomas(NFAs) with positive immnoreactivity for anterior pituitary hormones. METHODS: Sixty patients with pituitary adenoma were treated at the author's institution between January 2000 and July 2005. All consecutive patients were underwent transsphenoidal surgery by same operator. In addition to the routine histopathological examination, surgical specimen was examined by immunohistochemical staining against adenohypophyseal cells. And clinical analysis was performed by retrospective review of medical records, neuroimaging examinations and immunohistochemical technique. We classified these pituitary adenomas into functioning adenomas (group F), immunopositive NFAs (group S, so-called silent adenoma) and immuno-negative NFAs (group N), and compared clinical and radiological differences between group F, N, and S. RESULTS: Of the 60 cases, group F was 25, group S was 25, and group N was 10. Among the group S, 5 cases showed reactivity against PRL, 1 against GH, 1 against both PRL and GH, 1 against TSH and GH, 2 against ACTH, 11 against FSH and 4 against both LH and FSH. Radiologically, invasiveness was noted in 8 in group S, compared to 3 in group N and 1 in group F (p=0.02). Intratumoral bleeding was noted in 7 of group S, 2 of group N and 2 of group F (p>0.05). CONCLUSION: Silent adenomas were thought to behave more aggressive than other subgroups of pituitary adenomas. And so we suggest the immunohistochemical study against adenohypophyseal cells may be helpful for evaluating clinical course of pituitary adenoma, expecially for, NFAs.

A case of multicentric reticulohistiocytosis / 대한내과학회지

Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, characterized by severe rapidly destructive polyarthritis and erythematous papulonodular skin lesions. This disorder involves primarily skin and joints, but it has been reported to affect nearly every organ system. Histological analyses of skin, mucosa and synovia reveal that multinucleated giant cells and proliferating histiocytes have smooth eosinophilic ground-glass cytoplasm. We report a case of a 46-year-old woman who was presented with multiple arthritis and erythematous patch on the V-neck and hard nodules on both hands, elbows, great toes, and auricles. About 25% of the reported patients with MRH have been associated with cancer, but MRH is not considered to be a paraneoplastic disorder. She has not been found any other malignant disease. She has been treated with NSAIDs, corticosteroid, alendronate, hydroxychloroquine, and low-dose methotrexate. Cyclosporin A was added to achieve complete remission later on. After 6 months, she was more improved in symptoms of multiple arthritis and skin nodules.

A Case of Vulvar Glassy Cell Carcinoma / 대한산부인과학회잡지

Vulvar glassy cell carcinoma (GCC) is a very rare neoplasm. Although GCC is considered to be a poorly differentiated variant of adenosquamous carcinoma, its real nature is still debatable. We report a case of GCC of the vulva in a 53-year-old woman and review the literatures. The patient had bleeding from the lesion of the vulva and pelvic MRI revealed left inguinal lymph node enlargement. Histologically a cytoplasm of ground glass appearance was observed with a distinct cell wall and large nucleus containing prominent nucleoli. The clinical stage of the tumor was III as classified by the International Federation of Gynecology and Obstetrics (FIGO). She was treated by a left hemivulvectomy and bilateral inguinal lymphadenectomy and followed by external irradiation to the pelvis and left inguinal area. The patient was still alive without evidence of disease after 12 months treatment.

Immature Gastric Teratoma in a Neonate

Gastric teratoma (GT) is an exceeding rare lesion seen most often in male infants, comprising less than 1% of all teratomas in children. A 2-day-old male child was preoperatively diagnosed to have gastric teratoma on ultrasonogram and abdominal computed tomography (CT). On laparotomy, Dumbbell-shape GT was located on lesser curvature of stomach and complete excision of the tumor was performed. The histological examination revealed immature teratoma of the stomach. The child is well 10 months after surgery.

Immature Gastric Teratoma in a Neonate

Gastric teratoma (GT) is an exceeding rare lesion seen most often in male infants, comprising less than 1% of all teratomas in children. A 2-day-old male child was preoperatively diagnosed to have gastric teratoma on ultrasonogram and abdominal computed tomography (CT). On laparotomy, Dumbbell-shape GT was located on lesser curvature of stomach and complete excision of the tumor was performed. The histological examination revealed immature teratoma of the stomach. The child is well 10 months after surgery.

Sysmex SE-000: Evaluation on the Morphologic Flags and Determination of the Review Criteria / 대한임상병리학회지

BACKGROUND: We evaluated the performance of leukocyte differential counting and clinical usefulness of the morphologic flags of the SE-000, and set optimal criteria for selecting and reviewing the specimens with increased abnormal cells. METHODS: From the results of SE-000 and manual leukocyte differential counting in 100 healthy control and 520 patient specimens we evaluated the correlations on the leukocyte fractions as well as the frequency, sensitivity and false positivity of the flags. After determination of the review criteria we calculated total review rate from the 3,403 consecutive CBC specimens. RESULTS: In both control and patient groups the correlation between two methods was high with the exception of monocytes and basophils. Regarding the morphologic flags, Blast was sensitive (86.9%) however could not detect mature looking lymphoblasts. Immature granulocyte showed high sensitivity (93.7%). Left shift showed the highest frequency (34.6%) and false positive rate (82.8%). Atypical lymphocytes and NRBC showed relatively low sensitivity (63.6%, and 50.5%, respectively). We determined to review the slide when 1) All morphologic flags except Left shift are marked, 2) WBC 20,000/microliter, Hb 600,000/microliter, 3) Severe deviation of leukocyte fractions or 4) Specially requested by physician. As a result, total review rate was 25.0% while 14 abnormal cases with no flags could be additionally detected. CONCLUSIONS: A new review criteria determined from the results of CBC and leukocyte differential together with morphologic flags could reduce the review rate without skipping the abnormal cases.

Sysmex SE-000: Evaluation on the Morphologic Flags and Determination of the Review Criteria / 대한임상병리학회지

BACKGROUND: We evaluated the performance of leukocyte differential counting and clinical usefulness of the morphologic flags of the SE-000, and set optimal criteria for selecting and reviewing the specimens with increased abnormal cells. METHODS: From the results of SE-000 and manual leukocyte differential counting in 100 healthy control and 520 patient specimens we evaluated the correlations on the leukocyte fractions as well as the frequency, sensitivity and false positivity of the flags. After determination of the review criteria we calculated total review rate from the 3,403 consecutive CBC specimens. RESULTS: In both control and patient groups the correlation between two methods was high with the exception of monocytes and basophils. Regarding the morphologic flags, Blast was sensitive (86.9%) however could not detect mature looking lymphoblasts. Immature granulocyte showed high sensitivity (93.7%). Left shift showed the highest frequency (34.6%) and false positive rate (82.8%). Atypical lymphocytes and NRBC showed relatively low sensitivity (63.6%, and 50.5%, respectively). We determined to review the slide when 1) All morphologic flags except Left shift are marked, 2) WBC 20,000/microliter, Hb 600,000/microliter, 3) Severe deviation of leukocyte fractions or 4) Specially requested by physician. As a result, total review rate was 25.0% while 14 abnormal cases with no flags could be additionally detected. CONCLUSIONS: A new review criteria determined from the results of CBC and leukocyte differential together with morphologic flags could reduce the review rate without skipping the abnormal cases.

The Characteristics of Residual Leukocyte in Sepacell PLS-5A Filtered Platelet Concentrates / 대한혈액학회지

BACKGROUND: We evaluated residual leukocytes characteristics of white cell(WBC) reduction filter in platelet concentrates. Differential count and lymphocyte subset changes were measured before and after leukocyte filtration in platelet concentrates. MATERIAL AND METHODS: Ten units of platelet concentrates were prepared and were filtered with WBC-reduction filter(Sepacell PLS 5A, Japan). After filtration of blood products, WBC and differential leukocyte count and lymphocyte subsets were counted by microscopic examination of Wright-Giemsa stained smear and Facscan(Becton-Dickinson, USA). Monoclonal antibodies used for lymphocyte subset test were CD3(FITC), CD4(FITC), CD8(PE), CDl4(PE), CDl6(PE), CDl9(PE), CD33(PE), CD56(PE), IgGl(FITC), IgG2(PE). RESULTS: The main population of residual leukocytes after filtration was mainly lymphocytes(96.7%), and CD3 positive T lymphocytes showed 23.8% positivity of residual leukocyctes and the next were NK cell(8.7%). B lymphocytes were rarely found(<0.01%) and CD4/ CD8 ratio was within normal limits. CONCLUSION: The leukocyte reduction filters(Sepacell PLS-5A) would be effective for prevention of platelet alloimmunization but not sure about the effect for prevention of TA GVHD.

Removal of Yersinia enterocolitica from Packed RBCs with WBC-Reduction Filters / 대한임상병리학회지

BACKGROUND: Aseptic technique and cold storage of blood can reduce the incidence of transfusion-associated infections. But, none of these precautions eliminates the potential of drawing contaminated blood from an asymptomatic carrier with psychrophilic organisms such as Yersinia enterocolitica. We evaluated the ability of WBC-reduction filters to prevent the growth of bacteria in packed RBCs that are artificially inoculated with Y. enterocolitica. METHODS: Twenty units of packed RBCs donated from 20 healthy individuals were divided into 4 groups. Group A and B were inoculated with 10 CFU/mL of Y. enterocolitica and group C and D were inoculated with 100 CFU/mL of Y.enterocolitica. After 24 hours of cold storage, group A and C were filtered through WBC-reduction filter (Sepacell R 500A: Asai medical, Japan) and returned them to storage. Group B and D served as unfiltered controls. We collected blood weekly from day 1 to day 35 of storage. Bacterial growths were compared between 4 groups. RESULTS: The prefiltration WBC count was 8,880/ L (SD 1464.2/ L, n=20). After filtration residual WBC count was 210/ L (SD 99.8/ L, n=10). All cases of group B & D (10 & 100 CFU/mL inoculation without filtration) showed growth over 105 CFU/mL after 3 weeks storage. But in filtered groups, only 1/5 (20%) of group C (100 CFU/mL inoculation with filtration) and 4/5 (80%) of group A (10 CFU/mL inoculation with filtration) showed growth over 105 CFU/mL after 3 weeks. CONCLUSIONS: The use of WBC-reduction filter have ability to reduce the risk of transfusion transmitted bacteremia in packed RBCs.

Post-transfusion Survival of SAG-M Additive Solution Preserved Red Blood Cells / 대한수혈학회지

BACKGROUDNS: In Korea, CPDA-1 solution is currently used for blood preservation and by this anticoagulant solution, RBCs can be preserved for up to 35 days at the refrigerate temperature. RBC additive solutions (AS-1, AS-3, AS-5, SAG-M, SAG-PM) are widely used in the other countries for longer preservation of RBCs (42 days). We studied the survival of transfused RBCs preserved in SAG-M additive solution. MATERIALS AND METHODS: 400 mL of whole blood were collected from 8 healthy volunteers, Plasma was removed by centrifugation separation method at 2,960g, 10 minute and replaced by 100 mL of SAG-M additive solution. Autologous transfusions were done in two groups on day 20 and 42 with Na51CrO4 (Dupont, USA) labelled RBCs. After 3, 10, 15, 20, 30 minutes and 1, 2, 24 hours, 20 days, the venous blood samples were collected from the volunteers, and their radioactivities were measured by the Gamma-counter (Cobra II, Germany), and 24 hour survival rate were calculated by Moroff's method. RESULTS: The mean 24 hour survival rate was 89.0% in 20 days preservation group and 71.8% in 42 days preservation group. The mean half life of transfused RBCs were 27.8 days (n=2)and 24.3 days (n=4) in 20 days and 42 days preservation group, respectively. No complications were observed during the study period. CONCLUSIONS: The RBCs preserved in SAG-M additive solution were near within allowable survival rates for transfusion.

The study of RHD gene mutation in weak D / 대한수혈학회지

BACKGROUND: The weak D is characterized serologically by a weak or negative agglutination reaction with polyclonal anti-D in an immediate-spin test and agglutination is enhanced in the indirect antiglobulin test. Weak D has a lower number of D antigen or weaker antigen density than are normal D positive red cells. Here we studied the cause of weak D antigenicity at genetic level and compared to that of normal D RBCs. METHODS: The amplification of RHD gene and RHCcEe gene site was done in normal D(n=20), weak D(n=8), D negative group(n=20) by polymerase chain reaction and by based on D typing in these individuals compared to that of serologic D typing. In addition, to detect RHD gene mutation and nucleotide sequence difference of weak D group compared to normal D RBCs, single stranded conformational polymorphism PCR was simultaneuosly perfomed in two group by RHD amplified product(189 bp). We analysis the correlation RHD genotyping and serological phenotyping, and also analysis the difference of nucleotide sequence between two group in genetic level. RESULTS: The RHD genotyping was completely matched normal D(n=20), D negative group(n=20) but weak D group(n=8) showed same genotype of normal D RBCs. In single stranded conformational polymorphism PCR, weak D phenotypes does not show any abnormalities at the genomic level when compared to the RHD gene in normal D phenotypes. CONCLUSIONS: RHD PCR showed good correlation with conventional serologic test but weak D genotype was same as that of normal D RBCs. The weaker immunogenicity of weak D is not explained by genomic DNA difference itself.

The Rh(D) RBC Antigen Density Measurement by Flowcytometry / 대한수혈학회지

BACKGROUNDS: The Rh antigens are important m clinical practice. The classification of Rh phenotype is usually based on the antigen detection done by conventional serologic method, but it has many limitation such as delicate grading of antigen expression. Recently, Flowcytometry has been introduced in immunohematology to detect and quantitate cell bound immunoglobulins to assess blood cell antigens and related antibodies. So, we tried these method to detect Rh(D) antigen and measure its density and evaluated the possibility of clinical usage. MATERIALS AND METHODS: We performed a flowcytometric analysis for the expression of D antigen in D-positive, negative and weak D group in indirect immune fluorescence assay by using polyclonal antibodies. We measured the intensity of immunofluorescence as a degree of antigen density and analysed the difference of mean channel fluorescence value(MCF) among these groups. RESULTS: Weak D groups had the lower fluorescence than D-positive group, while D-negative sample showed the same fluorecence as negative ntrol. The difference of fluorescence intensity of D antigen between that of C antigen were not observed and were statistically insignificant. CONCLUSION: Flowcytometry appear to be a good tool for antigen density measurement in immunohematologic areas and shows the possibility of application to other aspect.

The Effect of Fentanyl, Esmolol and Labetalol on Hemodynamic Responses to Endotracheal Intubation / 대한마취과학회지

This study was done to determine the attenuating effect of fentanyl, esmolol and labetalol on the undesirable hemodynamic response to endotracheal intubation. Eighty patients, ASA physical status I-II, scheduled for elective surgery, were randomly divided to 4 groups(n=20, respectively), received a preintubation dose of either normal saline, 3 ug/kg fentanyl, 3 ug/kg fentanyl and 2.5 mg/kg esmolol, or 3 ug/kg fentanyl and 0.5 mg/kg labetalol. Controlled blood pressure and heart rate were recorded in the operating room at arrival of patients. Denitrogenation was done and 3 ug/kg fentanyl was administered at minute 0. Either sympathetic blocker was intravenously infused for 1 minute at minute 1. Induction was accomplished by administering 5 mg/kg thiopental sodium at minute 3, Larynogscopy and endotracheal intubation were performed by one investigator at minute 5. Data from patients in whom intubation required more than 15 seconds were excluded. Heart rate and blood pressure were recorded every minute for 10 minutes after administration of fentanyl. Highest value of heart rate and systolic blood pressure in all groups were recorded 1 minute after endotracheal intubation. Maximum percent increase in systolic blood pressure(meanSD) after intubation were significantly lower in fentanyl(4%+/-17%), esmolol and fentanyl(-5%+/-14%), and labetalol and fentanyl(-3%+/-20%) groups than in the normal saline(27%+/-15%) group(P<0.05). Maximal percent increase in heart rate was significantly lower only in esmolol and fentanyl(4%+/- 18%)group than in normal saline(27%+/-23%) group(P<0.05). The authors observed that combined pretreatment with esmolol and fentanyl provided more reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.

Detection of Platelet-Specific Antibodies Employing Modified Antigen Capture ELISA(MACE) / 대한수혈학회지

Widely used tests for the detection of platelet antibodies in Korea include platelet suspension immunofluorescence test(PSIFT), enzyme immunoassay and mixed passive hemagglutination(MPHA). In these tests, removal of HLA antigens from platelet are required to detect platelet-specific antibodies. Modified antigen capture ELISA(MACE) is known to be very sensitive for the detection of platelet-specific antibodies, in which specific platelet glycoprotein, captured by the monoclonal antibody is used as a target antigen. MACE is very useful for the detection of platelet-specific alloantibodies in neonatal alloimmune thrombocytopenia(NAIT) and posttransfusion purpura(PTP). We employed MACE in our laboratory, using AP2(anti-GPIIb/IIIa, monoclonal), #30 sera(anti-PlA1), 90-545 sera(anti-HLA-B51+52) and LYS sera(multispecific HLA antibodies). LYS sera had been used as our positive control( 1:120) in MPHA. Platelet from PIA1(+), HLA-B5 I, blood group O healthy male donor, gave positive result with #30 sera(1:40) and negative result with 90-545 sera in MACE. With LYS sera, MACE showed negative in 1:120, but positive in 1:20. So LYS sera was thought to contain strong multispecific HLA antibodies and relatively weak antibody(-ies) reacting with GPllb/Illa. Further studies employing different monoclonal antibodies, such as anti-GPIb/IX, -GPIa/Ila and -GPIV are under way.

A clinical study of three severe infantile asthmatics / 소아알레르기및호흡기학회지

No abstract available.

The Effect of Needle Type on the Postdural Pucnture Headache / 대한마취과학회지

The development of postdural puncture headache is releated to patient's age, size, pregnancy, sex and type of the dural puncture needle, direction of the needle bevel. We studied the effect of needle type, 25 gauge Whitacre and 25 gauge Quincke, on the incidence of postdural puncture headache and other complications after spinal anesthesia in 300 patients. The following results were observed: 1) The incidence of postdural puncture headache is similar between 25 gauge Whitacre needle group and 25 gauge Quincke needle group(4%, respectively). 2) The onset time of headache was 10-48 hours(83%) and the duration was about 48 hours(75%) postoperatively.