High tuberculosis transmission rate in children with nursery exposure to undetected pulmonary tuberculosis.

SETTING: Nursery for newborns in Busan, Republic of Korea. OBJECTIVE: To evaluate tuberculosis (TB) transmission from a health care worker with active pulmonary TB to neonatal contacts. DESIGN: For the first investigation, infants who had been in the nursery 3 months before the index patient was diagnosed with pulmonary TB were enrolled. After a child who had stayed in the nursery 10 months before the diagnosis of the index patient was diagnosed with tuberculous meningitis, a second contact investigation was conducted. RESULTS: Respectively 315 and 1334 children participated in the first and second investigations. The mean age of the contacts was 66.3 days; the rate of latent tuberculous infection (LTBI) at the first investigation was 42.5% (134/315). Only one infant had an abnormal chest X-ray, and was thought to have pulmonary TB. In the second investigation, the mean age of the participants was 17.6 months. The proportion of children with LTBI was 18.7% (249/1334). CONCLUSIONS: The LTBI rate in the present study was much higher than that estimated from other contact investigations. To minimise the risk of nosocomial TB transmission to neonates, screening and management of TB in health care workers should be strengthened.

Nuclear and cytoplasmic localization of ß-catenin in the nail-matrix cells and in an onychomatricoma.

ß-catenin plays an important role in hair morphogenesis. Previously, the nuclear and cytoplasmic localizations of ß-catenin were identified in hair-matrix cells. To evaluate ß-catenin expression in the nail matrix, we obtained human nail units. Immunohistochemistry for ß-catenin was used to evaluate sections of normal nail units and of sections from a single case of onychomatricoma. In the nail unit, ß-catenin was expressed in the nucleus and cytoplasm of the suprabasal nail-matrix cells. Of the other epithelial-cell types, only the cell membrane was ß-catenin-positive. In the nail tissue from the onychomatricoma case, ß-catenin was expressed in the nucleus and cytoplasm of the upper epithelial layers. Our result suggests that ß-catenin plays an important role in nail formation. In addition, ß-catenin expression in onychomatricoma supports the presence of nail-matrix cells in this condition. To our knowledge, this is the first report of ß-catenin expression in the nucleus and cytoplasm of the nail matrix.

Sensory characteristics and consumer acceptability of beef stock containing glutathione Maillard reaction products prepared at various conditions.

The sensory characteristics and consumer acceptability of beef soup samples containing 9 types of glutathione Maillard reaction products (GMRPs) were investigated to examine the effects of the GMRPs produced under different reaction conditions on the flavor of the beef soup. The sensory characteristics of the beef stocks were examined using descriptive analysis. In consumer testing, 50 consumers evaluated the overall acceptability and flavor intensities of beef odor, salty taste, beef flavor, and seasoning flavor in the beef soup samples. It was found that the reaction conditions, including sugar type and pH, affected the sensory characteristics of the beef stock containing the GMRPs. The samples containing the GMRPs reacted at pH 7 were characterized with strong beef flavor, chestnut flavor, and cooked rice flavor. However, the GMRP reacted with xylose at pH 7 (XM7) was significantly stronger in beef-related sensory characteristics than the GMRPs reacted with glucose or fructose at pH 7 (GM7 and FM7). The samples containing the GMRPs reacted at pH 3 had strong acid-related attributes whereas the GMRPs reacted at pH 11 exhibited strong sulfur-related attributes and a bitter taste. Overall, the beef soup containing XM7, which was perceived as having a strong beef odor and flavor, was rated the highest consumer acceptability score. This suggests that XM7 has feasibility as a flavor enhancer. To elucidate its effectiveness further, it is required to apply XM7 in various food systems at varying levels and to compare its flavor enhancing effects with other flavor enhancers such as monosodium L-glutamate in future studies. Practical Application: This study characterized sensory attributes of glutathione Maillard reaction products (GMRPs) reacted under various conditions and evaluated their potential as a flavor enhancer by examining consumer acceptability of beef stock containing the GMRPs. This study showed that the GMRP reacted with xylose at pH 7 had strong 71 beef flavor and the highest consumer acceptability score. The results of this study will provide valuable information for understanding sensory aspect of flavors generated by Maillard reaction of GSH and sugars, since most studies on Maillard reaction focused on chemical reactions. Also, the outcome of this study will help flavor and food industries' efforts to develop a new flavor enhancer for use in a variety of processed food products.

Spontaneous rupture of pheochromocytoma: computed tomography-pathologic features and correlation.

Spontaneous rupture is a rare complication of pheochromocytoma. Its preoperative diagnosis is of great importance in determining treatment and prognosis. We describe computed tomography pathologic findings and correlate their features in a case with ruptured pheochromocytoma.

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease.

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.

4-1BB promotes long-term survival in skin allografts treated with anti-CD45RB and anti-CD40L monoclonal antibodies.

4-1BB (CD137) is a T-cell co-stimulatory molecule that promotes T cell activation. Using a skin transplantation model, we observed that simultaneous administration of monoclonal antibodies (mAb) targeting CD45RB and CD40L prolonged skin allograft in co-stimulation blockade (CTLA4-Ig and anti-CD40L mAb)-resistant mice, because of reducing CD8(+) T cells and CD4(+) CD45RB(high) T cells. Anti-CD45RB mAb (45RB) blocks the activation of T helper 1 (Th1) cells and generates regulatory T cells (T(reg)). The experimental design included five groups: group 1, control; group 2, 45RB-MR1; group 3, 45B-MR1 + 4-IBBL; group 4, anti-CD4 mAb plus group 3 treatment; group 5, anti-CD8 mAb plus group 3 treatment. In this study we highlight the involvement of 4-1BB/4-1BBL in the development of T-cell responses. C57BL/6 recipients of BALB/c skin grafts were treated with 45RB, anti-CD40L mAb (MR1), and antagonistic anti-4-1BBL mAb (4-1BBL) on days 0, 2, 4, 6, and 8 posttransplantation. Additional 4-1BBL further prolonged skin graft survival, although the percentage of splenocyte-derived CD8(+) T cells was reduced similarly in both groups. Use of 4-1BBL seems to have additive effects on T(reg) cells, which play a major role in the maintenance of tolerance. Even after immunosuppressive therapy in combination with CD4(+) T-cell depletion, we did not achieve prolonged graft survival, possibly because of the absense of T(reg) cells, which require CD4-independent CD8(+) T cells, based on the observation of increasing proportion of CD8(+) T cells in similar degree as the control group.

A case of laryngeal posttransplantation lymphoproliferative disease.

The development of posttransplant lymphoproliferative disease (PTLD) is strongly linked to infection with the Epstein-Barr virus (EBV), immunosuppression-state, the type of allograft, and EBV-seronegativity. A 18-month-old girl who had undergone living donor liver transplantation using the left lateral segment from her father was treated with tacrolimus and corticosteroid as an immunosuppressant regimen. She was readmitted 3 months after the transplant to evaluate the etiology of dyspnea and abdominal fullness as well as a decreased urine volume. She was diagnosed as an anastomotic stenosis of the hepatic vein for which she underwent balloon angioplasty. The treatment was repeated at postoperative month 5, 8, and 11. As postoperative 6 months, the result of the serological EBV-CA (IgG/IgM) was positive. In postoperative month 10, the EBV PCR serologic test become positive, and a laryngeal biopsy revealed PTLD. She was treated with acyclovir and gangyclovir as well as reduced immunosuppression. We report herein a rare case of laryngeal PTLD in a patient who had undergone living donor liver transplant with paternal allograft.

Prognostic factors affecting graft and patient survival in cadaveric and living kidney transplantation.

Numerous studies have reported various prognostic factors that affect graft and patient survival in living and cadaveric donor kidney transplantation (KT). The purpose of this study was to evaluate the clinical outcomes and prognostic factors affecting graft and patient survivals in living and cadaveric donor KT. Between February 1995 and December 2001, 421 patients who had undergone cadaveric donor KT (group I: 216 cases, 51.3%) or living donor KT (group II: 205 cases, 48.7%), were retrospectively analyzed. Five-year overall graft survival rates in living was significantly better than that in cadaveric donor KT, respectively (P = .0234). There was no difference in patient survival rates between the two groups. Such factors as absence of rejection, female donor, female recipient, adult KT according to recipient age (>14 years), and donor serum creatinine level just before transplantation (< 2.5 mg/dL) were significantly associated with good graft survival among cadaveric donor KT, whereas two factors-absence of rejection and adult KT according to recipient age (>14 years)-influenced graft survival in living donor KT. In multivariate analysis, the only significant prognostic factor related to graft survival was the presence of rejection. In conclusion, we suggest that the presence of rejection is the only factor that impairs graft survival in both cadaveric and living donor KT, while other factors affected graft survival differently in the two groups.

Expression of neuropeptide Y by glutamatergic stimulation in rat C6 glioma cells.

We have investigated the expression of neuropeptide Y (NPY) in C6 glioma cells after the glutamatergic stimulation by the in situ RT-PCR and immunocytochemical techniques. The expression of NPY mRNA correlated well with immunocytological findings in each series of experiments. NPY protein expression was enhanced by glutamate (1, 10, 50, 100 microM, and 1 mM) dose-dependently, and its expression was slightly increased by N-methyl-D-aspartate (NMDA; 1, 10, 100, 500 microM, and 1 mM) and kainic acid (1, 10, 100, 300 microM, and 1 mM). We pretreated the cells with dopamine, haloperidol, pentylenetetrazol, and muscimol before each stimulation. The pentylenetetrazol and muscimol did not significantly alter the patterns of NPY expression induced by the glutamatergic stimulation. On the other hand, the dopamine and haloperidol pretreatment significantly elevated the levels of NPY expression that were induced by NMDA and kainic acid. Our results indicate that NPY release is closely related to glutamatergic stimulation, and it could be dynamically mediated by GABAergic and dopaminergic costimulation.

Human herpesvirus 8 in Kaposi's sarcoma and Kaposi's sarcoma-mimicking vascular tumors.

Kaposi's sarcoma (KS) had been a rare and unusual vascular tumor until a recent epidemic of a disseminated and fulminant form of KS in AIDS patients. Infectious agents have been suspected of causing KS, and recently partial genomic DNA sequences of human herpesvirus 8 (HHV8) have been identified in AIDS-associated KS lesions. Since then, genomic DNA sequences of HHV8 have been isolated in other forms of KS. Although the partial genomic DNA sequence of HHV8 was reported to be, if rare, identified in vascular tumors other than Kaposi's sarcoma (KS), the presence of HHV8 in a very large fraction of KS indicates that detection of HHV8 by PCR is a useful auxiliary tool in differentiating KS from other KS-mimicking vascular tumors. We examined whether the 233-bp segment of the viral DNA was detected in Korean patients with KS and other KS-mimicking vascular tumors. HHV8 sequences were identified in all of nine classic type of KS but not in three epithelioid hemangioendotheliomas and seven angiosarcomas. Our results confirm the relatively restricted distribution of HHV8 and also argue against the likelihood of secondary colonization of KS cells by HHV8.

Fine needle aspiration cytology of cystic hypersecretory carcinoma of the breast. A case report.

BACKGROUND: Cystic hypersecretory carcinoma (CHC) of the breast is a rare variant of intraductal carcinoma. It is characterized by a multicystic, yellow-brown lesion with gelatinous material grossly and cystically dilated ducts with an eosinophilic secretion microscopically. The histologic or cytologic features can be deceptively bland. CASE: A 37-year-old female presented with an 8-cm-diameter, firm mass in the breast. Radical mastectomy was performed after fine needle aspiration (FNA). The moderately cellular smear had a characteristic background of proficient, intensely staining secretion with bubbling. The cellular components were various, ranging from sheets of benign hyperplastic ductal cells to three-dimensional clusters or papillae of frankly malignant ductal cells, with varying degrees of secretory activity. The background consisted of inflammatory cells, naked nuclei and foamy histiocytes. The cytologic findings correlated well with the histologic features of the tumor, which showed both micropapillary intraductal carcinoma with apocrine metaplasia and focal high grade invasive carcinoma in a background of cystic hypersecretory hyperplasia. CONCLUSION: This was the first reported case of FNA cytology of an invasive form of CHC. CHC has characteristic features on FNA, and so a reliable diagnosis can be made.

Clinicopathologic and immunophenotypic study of non-Hodgkin's lymphoma in Korea. Lymphoreticular Study Group of the Korean Society of Pathologists.

This study sponsored by the Lymphoreticular Study Group of the Korean Society of Pathologists was carried out to provide nationwide data about the histopathologic-immunophenotypic features of malignant lymphomas in Korea. Two hundred and ninety Non-Hodgkin's lymphoma (NHL) among 312 malignant lymphomas collected from three representative areas in Korea were histologically reclassified. Two hundred and fifty three cases were immunohistochemically studied. T-cell lymphoma comprised 35.2% of NHL in this study and showed a quite comparable incidence to that of Japan and China, but it was much higher than in Western countries. A very low prevalence rate of the follicular variety (4.0%) and a higher propensity of primary extranodal involvement (60%) are additional characteristics of NHL in Korea. The most common histologic subtype of B cell lymphoma was diffuse large cell type, whereas the most common subtype of T cell lymphoma was diffuse mixed small and large cell type.