Restoration of Reproductive Potential after Autotransplantation of Frozen Ovaries in Mice Pretreated with Cyclophosphamide / 한국유방암학회지

PURPOSE: Infertility due to ovarian failure that is caused by antineoplastic chemotherapeutic agents is one of the primary problems of female cancer atients who are in their reproductive years. It has become important to preserve the reproductive potential of female cancer patients. This study was conducted to determine whether autotransplantation of frozen ovaries can restore reproductive potential. METHODS: This study included 30 female mice that had normal reproductive potential. The mice were divided into 4 groups: the positive control, the negative control, the comparison group, and the experimental group. The positive control group received right total oophorectomy, and the negative control group received bilateral total oophorectomy. Greater than or equal to 90% of the left ovary was removed in the mice of the comparison group, and then cyclophosphamide was administered. In the experimental group, the right ovary taken out by right total oophorectomy, and this was crypreserved using the vitrification method. And then cyclophosphamide was administered. The cryopreserved ovary was autotransplanted to the left gonadal fat pad after greater than or equal to 90% of the left ovary was removed. The reproductive performance in each group was analyzed according to the pregnancy rate after mating. RESULTS: In the positive control group, all five mice became pregnant, and the number of fetuses was 4 to 5 (mean=4.60+/-0.55). In the comparison group, the pregnancy rate was 50%, and the mean number of fetuses was 1.40+/-0.55. In the experimental group, 7 of 10 (70%) mice became pregnant, and the mean number of fetuses was 4.71+/-2.56. There was no significant difference in the number of fetuses between the positive control and the experimental group (p=0.093), but there was a significant difference in the number of fetuses between the comparison group and the experimental group (p=0.019). CONCLUSION: The results of this study suggest that autotransplantation of frozen ovaries using the vitrification method may restore the impaired ovarian function induced by antineoplastic chemotherapeutic agents.

Clinical Significances of the Unintentional Parathyroidectomy during Operation for Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Many surgeons intend to preserve all of the parathyroids during a thyroid operation; however, they have had the unpleasant experience of achieving unintentional parathyroidectomy. We studied the risk factors for unin-tentional parathyroidectomy and whether these unintentional parathyroidectomies caused symptomatic hypocalcemia. METHODS: We conducted a retrospective review of the medical records and pathologic reports of 95 papillary carcinoma patients who underwent operations between January 1994 and December 2003. We statistically analyzed the correlation between unintentional parathyroidectomy and the risk factors such as tumor size, capsular invasion, including extra-thyroidal extension, and the operation method. RESULTS: Of the total 95 procedures, 14 (14.7%) produced patho-logy reports stating that incidental parathyroid tissue was identified within the thyroidectomy specimen. The majority of the 14 reported cases contained only a single focus of inci-dental parathyroid tissue; however, one of these thyroidectomy specimens contained two foci of parathyroid tissue. The factors such as tumor size, capsular invasion and extensive surgery were not correlated with the prevalence of unintentional parathyroidectomy. There was no association of unintentional parathyroidectomy with postoperative hypocalcemia (P=.449). CONCLUSION: Unintentional parathyroidectomy is not associated with symptomatic postoperative hypocalcemia. The factors such as tumor size, capsular invasion or extensive surgery are not risk factors for unintentional parathyroidectomy.

A Case Report and Systemic Analysis of Articles for Morgagni Diaphragmatic Hernia

It was difficult to determine the clinical situations of Morgagni diaphragmatic hernias of adults on account of its rarity. The aim of this study was to propose diagnostic and therapeutic guidelines for adult Morgagni diaphragmatic hernias. A computerized `Korean study information co.' and `medical research information center' literature search of domestic articles published since 1950 was carried out. These 10 cases in addition to ours were analyzed. The average age at treatment was 68.7 years of age ranging from 51 to 83 years with 90.9% of patients being female. 18.2% of patients had symptoms immediately after trauma. 27.3% of patients were incorrectly diagnosed preoperatively. 90.9% of all treated Morgagni hernias were located on the right side just behind the sternum with hernia sacs. The most common contents of the hernias were the greater omentum and transverse colon. The preferred method of surgery was the trans-abdominal approach. The mortality rate of the hernias was 9.1%. Morgagni diaphragmatic hernias once diagnosed should be referred for surgical repair due to the risk of bowel perforation. The transabdominal approach or laparoscopic surgery is preferred in accurately diagnosed Morgagni diaphragmatic hernias prior to surgery.

The Effects of Multiple Transfusion on the Outcomes of Bone Marrow Transplantation from HLA-matched Sibling Donor in Patients with Severe Aplastic Anemia / 대한소아혈액종양학회지

PURPOSE: We investigated the effects of pretransplant-transfusion on engraftment, graft versus host disease (GVHD) and graft rejection after bone marrow transplantation (BMT) in children with severe aplastic anemia who had HLA-identical sibling donor. METHODS: We reviewed retrospectively the medical records of 47 children with severe aplastic anemia who received grafts from HLA-matched sibling donor using same conditioning regimen (procarbazine, antithymocyte globulin, and cyclophosphamide) from September 1986 to May 2001. GVHD prophylaxis consisted of cyclosporine and short-term methotrexate. Patients receiving multiple transfusion more than 40 transfused units in total before BMT were defined as high-risk group (HRG) and those with less than 40 transfused units were as standard-risk group (SRG). RESULTS: Among 47 patients, 30 patients were classified into SRG and remaining 17 were into HRG. The median time from diagnosis to transplant was 4 (range, 1~14) months in SRG and 36 (range, 3~360) months in HRG. Primary engraftment was achieved in all patients. Acute GVHD (> or =grade II) in HRG (13.3%) was comparable with in SRG (5.9%) (P=0.221), meanwhile corresponding fugures for chronic GVHD was 1 (3.3%) and 2 (11.8%). All of these patients have experienced complete resolution of GVHD and are no longer receiving immunosuppressive therapy. Booster stem cell infusion was needed for poor graft function (n=3) in SRG and also for poor graft function (n=1) or progressive rejection (n=3) in HRG. Five-year disease free survival rate was 100% in SRG and 94.1 6% in HRG (P=0.18). CONCLUSION: These findings suggest that multiple transfusion may be not a risk factor for rejection or poor outcome. Progressive rejection was observed only in patients with multiple transfusion but did not affect the survival.

Complete Remission by Imatinib Mesylate (Glivec) in a Child Relapsing with Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia (Ph (+) ALL) after Unrelated Donor Stem Cell Transplantation / 대한소아혈액종양학회지

The prognosis of patients with Philadelphia chromosome positive acute lymphoblastic leukemia (Ph ALL) who relapsed after allogeneic stem cell transplantation (allo-SCT) is poor. Imatinib mesylate (Glivec (R) ) is an inhibitor of the ABL tyrosine kinase with potent antileukemic activity in advanced Ph ALL. The clinical effects of imatinib on Ph ALL recurring after allo-SCT have not been established. We describe the clinical activity of imatinib in a 7 year-old boy with Ph ALL relapsing after unrelated donor stem cell transplantation. Imatinib as a single agent resulted in rapid elimination of leukemic cells with ensuing prolonged neutropenia and thrombocytopenia. Subsequent hematological recovery by donor-derived cells was associated with grade 3 graft-versus-host disease (GvHD), which responded to cyclosporine A and steroid. Imatinib successfully induced hematologic, cytogenetic and molecular remission of Ph ALL, and restored complete donor chimerism, along with controllable GvHD.

Plasma G-CSF and GM-CSF Concentration and Amount of Their Receptors on the Granulocyte in Kawasaki Disease

PURPOSE: This study aimed to demonstrate the possible pathogenesis of granulopoiesis in patients of Kawasaki disease(KD) using quantitative analysis of G-CSF, GM-CSF and their CSFr. METHODS: The plasma levels of G-CSF, GM-CSF, G-CSFr and GM-CSFr were studied in 14 patients in the acute phase of KD; 13 children with normal peripheral white blood cell counts were used as the normal control group. The plasma concentration of G-CSF, GM-CSF were analyzed by ELISA. The G-CSFr and GM-CSFr on the peripheral granulocytes were analyzed by a quantitative flow cytometric assay and QuantiBRITE, and the quantitative changes of receptors which did not combine with G-CSF and GM-CSF were measured. RESULTS: The total number of leukocytes in KD was similar to normal control group, but the leukocytes increased according to the number of neutrophils. The plasma concentration of G-CSF were decreased similar to normal control group(P=0.133), but that of GM-CSF decreased more than the normal control group(P=0.227). The quantity of G-CSFr, GM-CSFr were revealed to be no less than the normal control(P=0.721, P=0.912). After incubation with excessive G-CSF, the expressed G-CSFr on the neutrophils were decreased in both groups(P=0.554). The quantities of expressions of GM- CSFr on the neutrophil after incubation with the excessive GM-CSF were always increased in both groups(P=0.255). The amount of GM-CSFr of neutrophils are in proportion to total white blood cells (r=0.788, P=0.035), but it wasn't in the case of KD(P=0.644). CONCLUSION: The leukocytosis in KD that mediated by increasing neutrophil was not correlated with the plasma concentrations of G-CSF and GM-CSF, and the amount of expression of G-CSFr and GM-CSFr on granulocyte. It is possible that the reduction of concentration of GM-CSF results by increasing the active GM-CSFr.