Anti-Hu Antibody-Mediated Myelopathy Associated with Gastric Adenocarcinoma

Anti-Hu antibody causes paraneoplastic syndrome of the nervous system. Most of the anti-Hu antibodies are found with small cell lung cancer, but can rarely be found with other cancers such as non-small cell lung cancer, prostate cancer, and breast cancer. We report a 57-year-old male patient with advanced gastric adenocarcinoma who had paresthesia and limb ataxia. Electrophysiologic study and imaging showed peripheral neuropathy accompanied with myelitis. Anti-Hu antibody was detected in the patient’s serum, leading to the diagnosis of paraneoplastic syndrome.

A Case of Giant Fibrovascular Polyp of the Esophagus, Treated Successfully by Endoscopic Resection / 대한소화기학회지

Fibrovascular polyps are rare benign intraluminal tumors that usually arise from the cervical esophagus. These often present as very large sized pedunculated polyps and cause symptoms including dysphagia and respiratory distress. Generally, large polyps are surgically excised, while endoscopic resection is limited to smaller polyps. Herein, we present a giant fibrovascular polyp of the esophagus treated successfully by endoscopic resection.

A Case of Low Grade Osteosarcoma Developing in the Middle Skull Base after Radiotherapy of Adenoid Cystic Carcinoma in the Posterior Nasal Cavity / 대한이비인후과학회지

Adenoid cystic carcinoma arises rarely in the nasal cavity and paranasal sinus. Treatment strategy showing the best survival rate includes surgical excision and adjuvant radiotherapy. There were a few case reports of radiation-induced osteosarcoma from adenoid cystic carcinoma overseas but not in Korea. We experienced a case of radiation-induced low-grade osteosarcoma in the middle skull base including sphenoid bone, which had arisen after 10 years of radiotherapy of adenoid cystic carcinoma. Authors present this case with serial imaging findings and literature review.

Percutaneous Cardiopulmonary Support Experience of a National University Hospital in Busan / 고신대학교의과대학학술지

OBJECTIVES: Cardiopulmonary support has been used to treat the patients with refractory cardiogenic shock since 1950s. In advent of portable system its use has been widened considerably. In this retrospective study, we report our single center experience concerning possible indications, complications and outcomes of percutanous cardiopulmonary support (PCPS). METHODS: From January 2013 to March 2014, we searched the patients who were supported by PCPS system by reviewing the medical records in cardiology department at our Hospital. Infectious organism was limited to what was identified within 2 weeks after weaning of PCPS. RESULTS: A total of 9 patients were supported by PCPS with CAPIOX CX(R) system (Terumo inc., Tokyo, Japan) initially for ST-segment elevation myocardial infarction/non ST-segment elevation myocardial infarction in 4 patients, myocarditis in 3 patients, valvular heart disease in 1 patient, and acute respiratory distress syndrome in 1 patient. The mean duration of PCPS support was 79.1+/-76.6 hours and 5 of them were recovered and discharged alive. All the patients needed transfusions of various forms of blood products. And there was one major stroke and one hyperbilirubinemia in related to PCPS treatment. CONCLUSIONS: PCPS treatment was a valuable means to treat the patients with cardiovascular collapse, but not without costs. Efforts to reduce its associated complications should be made to improve outcomes.

Influence of NK cell count on the survival of patients with diffuse large B-cell lymphoma treated with R-CHOP

BACKGROUND: Although adding rituximab to the chemotherapy regimen of cyclophosphamide, vincristine, doxorubicin, and prednisone (R-CHOP) has improved clinical outcomes of patients with diffuse large B-cell lymphoma (DLBCL), several recent studies have shown that the effect of rituximab is dominantly in the non-germinal center (non-GC) subtype compared to the germinal center (GC) subtype. Natural killer (NK) cell count, a surrogate marker of immune status, is associated with clinical outcomes in DLBCL patients in the rituximab era. We investigated whether the impact of NK cells on clinical outcomes differed according to the immunophenotype of DLBCL. METHODS: This study analyzed 72 DLBCL patients treated with R-CHOP between January 2010 and January 2014. RESULTS: Low NK cell counts (<100/microL) were associated with poor progression-free survival (PFS) and overall survival (OS) compared to high NK cell counts. In multivariate analysis, low NK cell count was an independent prognostic factor for PFS and OS. However, survival did not significantly differ between the GC and non-GC subtypes. We examined the clinical influence of NK cells according to the immunophenotype and found that low NK cell counts were significantly associated with poor PFS and OS in non-GC cases, but not in GC cases. CONCLUSION: Low NK cell counts at diagnosis are associated with poor clinical outcomes in DLBCL patients treated with R-CHOP therapy. However, the impact is significant only in non-GC subtype DLBCL, not in the GC subtype.

Monosomal and complex karyotypes as prognostic parameters in patients with International Prognostic Scoring System higher risk myelodysplastic syndrome treated with azacitidine

BACKGROUND: Azacitidine (AZA) is standard care for patients with myelodysplastic syndrome (MDS) who have not had allogeneic stem cell transplantation. Chromosomal abnormalities (CA) including complex karyotype (CK) or monosomal karyotype (MK) are associated with clinical outcome in patients with MDS. METHODS: We investigated which prognostic factors including CAs would predict clinical outcomes in patients with International Prognostic Scoring System (IPSS) higher risk MDS treated with AZA, retrospectively. CK was defined as the presence of three or more numerical or structural CAs. MK was defined as the presence of two or more distinct autosomal monosomies or single autosomal monosomy with at least one additional structural CA. RESULTS: A total of 243 patients who treated with AZA, were enrolled. CK was present in 124 patients and MK was present in 90 patients. Bone marrow blasts > or =15% and CK were associated with poorer response (P=0.038, P=0.007) and overall survival (OS) (P3 CAs was associated with poorer OS (group including 3 CAs vs. only three CAs, P=0.001). CONCLUSION: CK was an important prognostic parameter associated with worse outcome. MK may predict poor survival in only non-CK status. The higher number of CAs was associated with poorer survival.

Incidentally Detected Inoperable Malignant Pheochromocytoma with Hepatic Metastasis Treated by Transcatheter Arterial Chemoembolization

Malignant pheochromocytoma (PCC) is a rare condition. Although the liver is the second most frequent site of metastasis in malignant PCC, no definite treatments have been established. Herein, we report a case of liver metastasis of PCC that was successfully treated by transcatheter arterial chemoembolization (TACE). A 69-year-old man was admitted to the Department of Gastroenterology for evaluation of an incidental hepatic mass in August 2013. He had undergone right adrenalectomy in May 2005 and PCC had been confirmed on the basis of histopathological findings. Liver biopsy was performed, and metastatic PCC was diagnosed. The lesion appeared inoperable because of invasion of the portal vein and metastases in the lymph nodes along the hepatoduodenal ligament. Thus, TACE was performed instead. After TACE, symptoms including dizziness and cold sweating improved, and the patient's serum catecholamine levels decreased. On the basis of this case, we believe that TACE may be a useful treatment for liver metastasis in malignant PCC.

Prognostic Relevance of the Expression of CA IX, GLUT-1, and VEGF in Ovarian Epithelial Cancers

BACKGROUND: Tumor hypoxia is associated with malignant progression and treatment resistance. Hypoxia-related factors, such as carbonic anhydrase IX (CA IX), glucose transporter-1 (GLUT-1), and vascular endothelial growth factor (VEGF) permit tumor cell adaptation to hypoxia. We attempted to elucidate the correlation of these markers with variable clinicopathological factors and overall prognosis. METHODS: Immunohistochemistry for CA IX, GLUT-1, and VEGF was performed on formalin-fixed, paraffin-embedded tissues from 125 cases of ovarian epithelial cancer (OEC). RESULTS: CA IX expression was significantly associated with an endometrioid and mucinous histology, nuclear grade, tumor necrosis, and mitosis. GLUT-1 expression was associated with tumor necrosis and mitosis. VEGF expression was correlated only with disease recurrence. Expression of each marker was not significant in terms of overall survival in OECs; however, there was a significant correlation between poor overall survival rate and high coexpression of these markers. CONCLUSIONS: The present study suggests that it is questionable whether CA IX, GLUT-1, or VEGF can be used alone as independent prognostic factors in OECs. Using at least two markers helps to predict patient outcomes in total OECs. Moreover, the inhibition of two target gene combinations might prove to be a novel anticancer therapy.

Serum Thyroglobulin Varies according to Thyrotropin Levels during Preparation for Treatment by Radioactive Iodine Ablation and Scan / 대한내분비외과학회지

PURPOSE: Periods of L-T4 withdrawal and low iodine diet, which are required prior to the treatment and tracking tests that take place after a thyroidectomy, can be of a long duration and cause suffering for patients. The purpose of this study, conducted in South Korea, was to confirm if periods of L-T4 withdrawal and low iodine diet can be shortened by using TSH level prediction. By inquiring into the correlation between TSH level and serum Tg level, and measurement of the amount of iodine present in urine during the low iodine diet period, a thyroglobulin (Tg) cutoff level can be predicted. METHODS: total of 168 patients were included as research subjects. In each case, L-T4 was suspended 3-4 weeks prior to conducting radioactive iodine ablation and 131I scan, and then a low iodine diet was carried out for 2-4 weeks. Serum TSH, Tg and anti-Tg antibodies were measured on the second week of L-T4 withdrawal, and the spot urine Iodine/Creatinine ratio was measured on the second and fourth week after treatment. RESULTS: Three weeks after L-T4 withdrawal, TSH levels increased to over 30μIU/ml in 97.2% of the patients, and serum thyroglobulin levels also increased with TSH level to over 30μIU/ml. There was no measured difference in the amount of iodine in the subject's urine during the low iodine diet period. CONCLUSION: It was found that L-T4 withdrawal can be reduced to 3 weeks or less, and that the Tg cutoff level differs according to TSH level. Based on these results, we suggested that the low iodine diet period can be reduced to 1-2 weeks.

Assessment of Apoptosis by M30 Immunoreactivity and the Relationship with the MSI status and the Clinicopathological Characteristics of Colorectal Carcinomas

BACKGROUND: The monoclonal antibody M30 recognizes a neoepitope of cytokeratin 18 that's produced during the process of apoptosis, and it is reactive in formalin-fixed, paraffin-embedded tissue. The detailed nature of apoptosis in colorectal cancer is unclear, especially in regard to the MSI status and the clinicopathologic factors. The purpose of this study was to elucidate the apoptosis assessed by M30 immunoreactivity in colorectal cancer and its relationship with the MSI status and the various clinicopathologic factors of colorectal cancers. METHODS: 101 colorectal cancers were classified according to levels of MSI as 12 MSI-H, 4 MSI-L and 85 MSS. Apoptosis was quantified by immunohistochemistry with using M30 CytoDEATH anti-body. RESULTS: The apoptotic index assessed by M30 was significantly increased in the MSI-H and MSI-L colorectal cancer compared to that in the MSS colorectal cancer. Right sided colon cancer showed a significant higher apoptotic index than did the left sided colon cancer. There was also a tendency for decreased apoptosis in metastatic colorectal cancers (Duke's stage D). There was somewhat of an increase of apoptosis in colorectal cancers with mucinous carcinoma and medullary carcinoma, and also in the colorectal cancers with an increased TIL count, but this was not statistically significant. CONCLUSION: M30 immunoreactivity is a valuable method to detect apoptosis in formalin-fixed, paraffin-embedded tissue and it might explain that MSI-H colorectal cancer shows better clinical behavior than MSS colorectal cancer in regard to the increased apoptosis.

Detection of a Hybrid A int Allele by PCR-RFLP / 대한수혈학회지

No abstract available.

Association between Clozapine-Induced Weight Gain and Serotonin 5-HT2C Receptor Gene Polymorphism in Patients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: Weight gain is one of the troublesome adverse reaction to clozapine treatment. This problem can lead to poor adherence to treatment. Clozapine-induced weight gain may be associated with genetic predisposition. Recent studies have shown that a polymorphism of the promoter region of the serotonin 5-HT2C receptor gene is associated with antipsychotic-induced weight gain. This study is to investigate the association of clozapine-induced weight gain with -759C/T polymorphism of serotonin 5-HT2C receptor promoter gene in schizophrenic patients. METHODS: Fifty three patients with schizophrenia were included in this study. The subjects were divided into two groups according to body weight change between the start and 10 weeks of clozapine. The cutoff level of weight change is 5% increase of initial body weight. Genotypes of -759C/T polymorphism were identified from AciI-digested fragments of two-primer products amplified by polymerase chain reaction corresponding to -885 to -634 of the serotonin 5-HT2C receptor gene promoter region on chromosome X. RESULTS: There were no differences of baseline variables between patient groups with and without weight gain. 4 of 32 male patients and 6 of 21 female patients had -759T allele, respectively. The authors found that patients with -759T allele had tendency to show less weight gain than those without this allele. CONCLUSION: These findings suggest that clozapine- induced weight gain may be associated with genetic predisposition in schizophrenic patients.

A Case of Acrocallosal Syndrome with Developmental Delay: A case report

Agenesis of the corpus callosum is a frequent anomaly that presents with a spectrum of clinical features and exhibits variable findings in neurological studies. Callosal agenesis may be an isolated anomaly or may be syndromic as part of more extensive malformations, metabolic and genetic disorders. We experienced a case of agenesis of corpus callosum with developmental delay, diagnosed to acrocallosalsyndrome. Acrocallosal syndrome is an autosomal recessive condition, characterized by agenesis of the corpus callosum, pre- and postaxial polydactyly, minor craniofacial anomalies, and, in most patients, severe psychomotor retardation. We here reported a case of acrocallosal syndrome with the review of literatures.

Molelular genetic analysis of Ael variant phenotype of ABO blood group system / 대한수혈학회지

BACKGROUND: Since the genes encoding glycosyltransferases synthesizing ABO antigens were cloned and sequenced in 1990, genetic polymorphisms and phenotype-genotype correlations have been reported by several investigators, but the genetic basis remains unclear for many subgroups. The Ael phenotype is one of the important A subgroups having very weak A antigen, and recent studies suggested that different alleles can result in this phenotype. METHODS: Three unrelated Ael subgroup samples from Korean blood donors were studied. Exons 6 and 7 of the ABO gene, 91% of the catalytic active part of the glycosyltransferase, were amplified and subjected to direct sequencing. RESULTS: Only C467T substitution in comparison with the consensus sequence of A gene was found in one Ael sample, but this mutation pattern was very commonly observed in normal A1 phenotype of Orientals. The other two samples had T646A (Phe216Ile) and G681A (silent) substitutions beside C467T substitution, reported first from a Japanese Ael individual. CONCLUSIONS: These results indicate that molecular genetic heterogeneity within the Ael subgroup was also seen.

A Clinical Observation of Cutaneous Premalignant and Malignant Tumors / 대한피부과학회지

BACKGROUND: There has been a concern about the incidence of the cutaneous premalignant and malignant tumors. It has increased recently and has varied according to social and environmental influence. OBJECTIVE: The purpose of our study was to clarify the recent trends in cutaneous premalignant and malignant tumors, and to compare them with other reports. METHODS: The 175 cases out of the total number of 34,333 new outpatients were diagnosed cutaneous premalignant and malignant tumors from January, 1990 to December, 2000 at the Department of Dermatology, Yeungnam University Hospital. Incidence and its change, age and sex distribution, and anatomical site were investigated. RESULT: 1. The incidence of cutaneous premalignant and malignant tumors was 0.51%, and increased lately. 2. Among the 175 cases of premalignant and malignant tumors, basal cell carcinoma(30.9%) was the most common, followed by squamous cell carcinoma(22.9%), actinic keratosis(12.6%), Bowen's disease(10.9%). 3. The premalignant lesions were increased and outnumbered squamous cell carcinoma since 1996. 4. Basal cell carcinoma was the most common skin cancer that had markedly increased in comparison with squamous cell carcinoma. 5. Actinic keratosis, Bowen's disease, basal cell carcinoma, squamous cell carcinoma, malignant melanoma on sun exposed areas were much more increased than on non exposed areas. 6. The mean age of patients was 65.3+/-15.0 years, and the age of the majority of cases(94.3%) was over 40 years. 7. The ratio of male to female was 1.01 : 1. The number of females increased relatively in comparison with previous reports. 8. The most common site was the face(55.4%), followed by scalp(12.0%), trunk (12.0%).

Percutaneous Cholecystostomy and Percutaneous Abscess Drainage in Two Patients of Gallbladder Perforation with High Surgical Risk / 대한소화기내시경학회지

Gallbladder perforation is a grave complication of acute cholecystitis, which has a high incidence of morbidity and mortality in the elderly patients. The unfavorable nature of this disease is due in part to a delay in diagnosis because of the similarity in clinical presentation of patients with uncomplicated cholecystitis and those with perforation. Although prompt surgical intervention with cholecystectomy is the treatment of choice, morbidity and mortality rates rise markedly in the elderly patient with severe systemic illness. In acute cholecystitis, percutaneous cholecystostomy is a good alternative to surgical cholecystectomy or is a temporary measure until a patient is sufficiently stable for surgery. In this report, we describe our experience of successful use of percutaneous cholecystostomy and intra- abdominal percutaneous catheter drainage for the therapy of gallbladder perforation in two patients with high surgical risk.

A Case of Cis-AB without B Antigen Expression / 대한수혈학회지

The cis-AB bood type is a rare phenomenon in which both the A and B blood types are inherited from a single parent. The cis-AB persons are not homogeneous with respect to reactivity of their red cells to anti-A and anti-B reagents, and are split into three groups with on the basis of the strength and characteristics of the serologic reactions; these reactivities are A2B3, A1B3 and A2B. A 7-year-old Korean boy was evaluated for paternity because he was presumptively identified as blood group AweakB and known blood types of his father and mother were A. In the repeated ABO blood typing, the child was typed as group A2B3 with weak anti-B, cis-AB being suspected. Both of his mother and father were typed as group A1 in cell and serum typing. In the saliva test and adsorption and elution studies of the parents, B substance was not detected. According to ABO genotyping, the child, mother and father showed cis-AB/O, A1/O and cis-AB/A1, respectively. The paternity was confirmed, but the father had unusual expression of cis-AB genotype. This was the second case of A1/cis-AB with phenotype A1, not expressing B antigen.

A Case of Acute Otitis Media Caused by Providencia stuartii / 대한임상병리학회지

Providencia stuartii is occasionally isolated from patients with chronic otitis media, however it has not been reported as a cause of acute otitis media so far. We recently isolated P. stuartii from the pus specimen of right middle ear of a 2-year-old patient with acute otitis media. The patient was admitted because of right-sided otorrhea for 2 weeks. The symptom was not relieved by first-line empirical antibiotics (amoxicillin-clavulanic acid and netilmicin), but it was subsided dramatically with the changed antibiotics (ceftriaxone and amikacin); the isolate was susceptible to these two antibiotics in in vitro susceptibility testing. To our knowledge, this is the first case report of acute otitis media caused by P. stuartii.

Diagnostic Utility of a Rapid ICT Tuberculosis Assay for the Diagnosis of Pulmonary Tuberculosis / 대한임상미생물학회지

BACKGROUND: Diagnosis of tuberculosis is more complicated because of low sensitivity and time consuming procedures of the conventional diagnostic methods as well as nonspecific clinical features. Recently the serologic diagnosis of tuberculosis has been reported as one of rapid sensitive and specific methods. We evaluated the ability of a rapid ICT Tuberculosis assay(AMRAD/ICT Diagnostics, Syndey, Australia) to detect pulmonary tuberculosis. METHODS: ICT Tuberculosis assay was performed to the sera from 50 patients with pulmonary tuberculosis (24 patients with smear positive, 26 patients with smear negative) and 105 controls (48 patients without tuberculosis, 57 healthy controls). RESULTS: Antibodies were detected in 22 of 24 (92%) smear positive patients and 22 of 26 (85%) smear negative patients who had been clinically diagnosed as having active pulmonary tuberculosis. Two (4.2%) out of 48 patients without tuberculosis and 1 (1.8%) out of 57 healthy controls had a positive antibody response. The overall sensitivity, specificity, and positive and negative predictive value of the ICT Tuberculosis assay were 88%, 97%, 94%, and 94%, respectively. CONCLUSIONS: The ICT Tuberculosis assay was not only sensitive and specific but also rapid and simple. This assay will be useful as a diagnostic method of pulmonary tuberculosis in combination with sputum smear and X-ray.

Simple ABO genotyping method using three polymorphic sites at the ABO locus / 대한수혈학회지

BACKGROUND: Recent progress in the molecular biology of the ABO blood group system has recognized the molecular basis of the red cell antigens and has provided a genetic model for ABO polymorphism at the molecular level. Genotyping methods with the basis of this genetic model were tested for korean blood donors. METHODS: Simple genotyping of the ABO blood group was performed in 253 healthy Korean blood donors by polymerase chain reaction-restriction enzyme length polymorphism (PCR-RFLP) and allele-specific PCR analysis of the only three polymorphic nucleotide positions (nps) 261, 526 and 803 of the ABO blood group gene. Two differen regions of the ABO gene, each of which contained a different polymorphic site (np 261 or 526) were amplified. Amplified products were digested with four restriction enzymes, two complementary pairs, Kpn I and Bst PI, and Bss HII and Ban I to analyze the np 261 and 526, respectively. The np 803 was analyzed by PCR with allele-specific primers. The PCR determined genotypes were compared with serologically determined phenotypes. RESULTS: The results were consistent for all individuals and not different from the proposed genetic model. The ABO genotypes of 253 healthy Korean blood donors were13 AA, 64 AO, 11 BB, 57 BO, 81 OO and 27 AB. CONCLUSIONS: The simple method used in this study may serve as a helpful tool for solving difficulties in serological ABO blood typing in the transfusion and forensic medicine, especially for cases with ABO discrepancy due to genetic variations. This method would be more efficient and informative for genotyping of the Korean population.