Rituximab, an anti-CD20 monoclonal antibody, is an effective target agent against the B lymphocytes in B-cell lymphoid malignancies and various lymphoproliferative diseases. Moreover, the toxicity of rituximab is less severe than that of conventional cytotoxic agents, which has promoted the widespread application of rituximab in the treatment of B-cell lymphoma. However, depletion of B lymphocytes by rituximab, which leads to secondary hypogammaglobulinemia, can cause deterioration of humoral immunity. Although immune reconstitution after hematopoietic stem cell transplantation is known to prevent prolonged hypogammaglobulinemia, very few cases of long-standing hypogammaglobulinemia have been reported. We report herein a case of prolonged hypogammaglobulinemia after rituximab-containing chemotherapy and splenectomy in a patient with non-Hodgkin's lymphoma and discuss the clinical significance and pathogenetic mechanism of this phenomenon with a literature review.
Agammaglobulinemia* ; B-Lymphocytes ; Cytotoxins ; Drug Therapy* ; Hematopoietic Stem Cell Transplantation ; Humans ; IgG Deficiency ; Immunity, Humoral ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Splenectomy ; Rituximab

The lymphoproliferative disease multiple myeloma and the myeloproliferative disease polycythemia vera have different pathogenic mechanisms and different natural courses. Thus, the concomitant development of these two diseases in the same individual is rare. In most previously reported cases of both diseases, one disease was assumed to be a secondary malignancy caused by chemotherapy for the other primary disease. Our case was diagnosed as smoldering myeloma based on increased bone marrow plasma cell numbers and monoclonal gammopathy during a regular follow-up visit for JAK2V617F mutation-positive polycythemia vera, which had not been treated except with phlebotomy. This case provides useful clues for understanding the pathogenesis of these two hematological malignancies and the association between them. Here, we report a case of polycythemia vera with a JAK2V617F mutation combined with smoldering myeloma and discuss the clinical significance and pathogenic association between these disorders of different lineages, along with a literature review.
Bone Marrow ; Follow-Up Studies ; Hematologic Neoplasms ; Multiple Myeloma ; Paraproteinemias ; Phlebotomy ; Plasma Cells ; Polycythemia ; Polycythemia Vera

No abstract available.
Hypereosinophilic Syndrome*

PURPOSE: Liver transplantation is the therapy of choice for patients with acute and acute-on-chronic severe liver failure or hepatocellular carcinoma. But a suitable liver is not always available for transplantation due to limited donor numbers. To increase the number of available liver for transplantation, a non-heart-beating donor (NHBD) liver transplant program is started. In NHBD liver transplantation, warm ischemic injury of liver occurs. The duration of warm ischemia is thought to be the most important risk factor for postoperative complications such as primary nonfunction or severe hepatic dysfunction. Recent evidence indicates that hepatocyte growth factor (HGF) plays an important role as a cytoprotector against hepatic injury by anti-apoptotic effect and mitogen in liver regeneration. Therefore studies also were performed to examine whether HGF influenced the viability and regeneration of hepatocytes from rats, subjected to prolonged warm ischemic injury. METHODS: Male Sprague- Dawley rats were subjected to non-heart-beating death by cervical spine fracture. Rats left in room temperature directly after, 30-minutes, 1-hours before surgery and perfusion was performed for isolating hepatocyte. Among three groups, hepatocyte viability was compared by trypan blue stain. And isolated hepatocytes from 30-minutes warm ischemic group were cultured for 24-hours, which were treated with no HGF and addition of various doses (5 ng/mL, 10 ng/mL, 20 ng/ mL, 40 ng/mL, 100 ng/mL) of HGF. Anti-apoptosis and regeneration of hepatocyte were compared by LDH assay, MTS assay, western blot, and immunocyto-chemistry after a 24-hours culture. RESULTS: The results of hepatocyte viability along the prolonged warm ischemic groups in isolated hepatocytes decreased sequentially 74.8+/-12.6%, 45.0+/-5.4%, 37.8+/-10.4% along directly after, 30-minutes, 1-hours in trypan blue stain (P<0.01). And 24-hour-cultured hepatocytes from 30-minutes warm ischemic group were treated with HGF. The results of LDH assay, MTS assay did not have relation with HGF addition. But the results of western blot and immunocytochemistry shown that HGF doses dependent anti-apoptosis and regeneration of hepatocyte increased. That indicates HGF presumably inhibites apoptotic pathway by phosphorylation. And HGF also makes hepatocyte hypertrophy and albumin synthesis. CONCLUSION: HGF was a potent cytoprotector against hepatic injury by anti- apoptotic effect and mitogen of liver regeneration in NHBD liver animal model. HGF facilitates recovery of the liver from prolong warm ischemic injury. If the more clinical studies and large animal studies are performed, NHBD using liver transplantation will be available with more chances by HGF.
Animals ; Blotting, Western ; Carcinoma, Hepatocellular ; Diminazene ; Hepatocyte Growth Factor ; Hepatocytes ; Humans ; Hypertrophy ; Immunohistochemistry ; Liver ; Liver Failure ; Liver Regeneration ; Liver Transplantation ; Male ; Models, Animal ; Perfusion ; Phosphorylation ; Postoperative Complications ; Rats ; Regeneration ; Risk Factors ; Spine ; Tissue Donors ; Transplants ; Trypan Blue ; Warm Ischemia

PURPOSE: We wanted to evaluate whether epinephrine injection prior to radiofrequency (RF) ablation can increase the extent of thermally mediated coagulation in vivo normal pig liver tissue. MATERIALS AND METHODS: Eighteen RF ablation zones were created in six pigs using a 17-gauge internally cooled electrode under ultrasound guidance. Three RF ablation zones were created in each pig under three conditions: RF ablation alone, RF ablation after the injection of 3 mL of normal saline, and RF ablation after the injection of 3 mL of epinephrine (1:10,000 solution). After the RF ablation, we measured the short and long diameters of the white zones in the gross specimens. RESULTS: Three of the RF ablations were technically unsuccessful; therefore, measurement of white zone was finally done in 15 RF ablation zones. The mean short and long diameters of the white zone of the RF ablation after epinephrine injection (17.2 mm +/- 1.8 and 20.8 mm +/- 3.7, respectively) were larger than those of RF ablation only (10 mm +/- 1.2 and 12.2 mm +/- 1.1, respectively) and RF ablation after normal saline injection (12.8 mm +/- 1.5 and 15.6 mm +/- 2.5, respectively) (p < .05). CONCLUSION: RF ablation with epinephrine injection can increase the diameter of the RF ablation zone in normal pig liver tissue.
Animals ; Catheter Ablation* ; Electrodes ; Epinephrine* ; Liver* ; Swine ; Ultrasonography

Henoch-Schoenlein purpura is predominantly a childhood disease with good prognosis. It is characterized by nonthrombocytopenic purpura, arthritis, arthralgia, gastrointestinal symptoms and glomerulonephritis. Abdominal pain is the most common gastrointestinal symptom, however, some patient with Henoch-Schoenlein purpura have gastrointestinal major surgical complication such as intussusception, bowel infarction, necrosis, stricture and perforation. We report a case of duodenal perforation in a 6-year-old boy with Henoch-Schoenlein purpura, being treated with corticosteroids.
Abdominal Pain ; Adrenal Cortex Hormones ; Arthralgia ; Arthritis ; Child* ; Constriction, Pathologic ; Glomerulonephritis ; Humans ; Infarction ; Intussusception ; Male ; Necrosis ; Prognosis ; Purpura* ; Purpura, Schoenlein-Henoch

BACKGROUND: It is often difficult to make a diagnosis of cardiac ischemia in patients attending emergency department (ED) with symptoms of acute coronary syndromes (ACS) because existing cardiac markers are not sensitive for reversible myocardial ischemia. Ischemia modified albumin (IMA) has recently been shown to be an early and sensitive marker of myocardial ischemia. We investigated the usefulness of ischemia modified albumin (IMA) as an early triage marker for ACS and tried to establish a newly standardized albumin-adjusted IMA index which has been expected to be more sensitive and accurate than conventional IMA value. METHODS: We enrolled 209 consecutive patients (men 95, women 114) who presented to the ED with symptoms suggestive of ACS from June to July, 2005. All patients were classified to ACS group (n=42) and others (n=167) based on diagnosis of cardiologists. The ideal cutoff value of IMA was calculated by the receiver operating characteristic (ROC) curve analysis and diagnostic utilities of combination tests (myoglobin, CK-MB, troponin T and EKG) were compared with those of IMA. The albumin-adjusted IMA index was calculated and applicated from the results of correlation assay between serum albumin concentration and IMA value. RESULTS: Mean IMA level (U/mL) of ACS group was significantly higher than that of non-ACS group (P<0.05) and sensitivity and specificity was 92.9% and 35.9% at a cutoff value of 85.1 U/mL, respectably. In combination with conventional cardiac markers, the sensitivity increased to 96.3%. IMA value had a negative lnear relationship with serum albumin concentration (YIMA= -23.1Xalbumin+200, R=0.99) and albumin-adjusted IMA index was calculated as [IMA index = serum albumin conc. (g/dL) x 23 + IMA (U/mL) -100]. The sensitivity and specificity was 97.6% and 34.1% at a cutoff value of 83.3 IMA index, respectively. CONCLUSIONS: IMA is a useful sensitive marker for the identification of ACS in patients with normal cardiac markers and EKG finding and follow-up combination testing may be required to rule out other diseases. The calculated albumin-adjusted IMA index is recommended to make a diagnosis of ACS more sensitively.
Acute Coronary Syndrome* ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Ischemia* ; Mass Screening* ; Myocardial Ischemia ; ROC Curve ; Sensitivity and Specificity ; Serum Albumin ; Triage ; Troponin T

A 68-year-old man who had suffered left nephrectomy 6 years previously for renal cell carcinoma presented with a 6-week history of melena episodes. Physical examination and laboratory data were irrelevant. Gastroduodenoscopy and colononoscopy could not reveal a bleeding focus. An angiography was undertaken, which confirmed the presence of an abnormal tumor staining at the jejunum. For the preoperative evaluation, a small bowel study showed an about 2 cm sized eccentric filling defect at mesenteric side wall of distal jejunum in the left lower quadrant. A CT scan also showed a heavily enhancing bowel wall thickening. Small bowel resection was performed, and a 3 X 3 cm ulceroinfiltrating jejunal lesion was found which microscopically consisted of a proliferation of trabeculated clear cells. He had an unremarkable postoperative recovery. A follow-up CT scan at 3 months later showed no evidence of recurrence.
Aged ; Angiography ; Carcinoma, Renal Cell* ; Follow-Up Studies ; Hemorrhage ; Humans ; Jejunum ; Melena ; Neoplasm Metastasis ; Nephrectomy ; Physical Examination ; Recurrence ; Tomography, X-Ray Computed

A stercoral perforation of the colon is a very rare condition, which results from stercoral ulcers due to severe, prolonged constipation, and has a very high mortality rate. Herein is presented four cases of stercoral perforation of the sigmoid colon. All the patients were female. They had long standing and severe constipation, with peritonitis, prior to admission. Plain chest or abdominal X-rays revealed the presence of abdominal free air in all cases, and so emergent operations were undertaken. Fecalomas were found in the colon or abdominal cavity, with round and spherical shaped perforated sites. Microscopically, the edges of the ulcers were compressed with the accumulation of lymphocytes. A resection of the perforated colon with a proximal colostomy was performed in one case, a primary closure of the perforated colon and a proximal colostomy in another and a Hartmann's colostomy in the remaining two cases.
Abdominal Cavity ; Colon* ; Colon, Sigmoid ; Colostomy ; Constipation ; Female ; Humans ; Lymphocytes ; Mortality ; Peritonitis ; Thorax ; Ulcer

BACKGROUND/AIMS: Periampullary carcinoma could recur early even after curative resection in the small-sized lesion. The aim of this study is to clarify the clinicopathologic features of early recurrence cases after pancreatoduodenectomy in periampullary carcinoma. METHODS: 15 cases (group I) of recurrence within 6 months after pancreatoduodenectomy were compared clinicopathologically with 17 cases (group II) of no recurrence until 2 years after pancreatoduodenectomy between 1991 and 2000 in Hallym medical center. RESULTS: There were no differences in sex and age distri- butions between two groups (M/F ratio=8/7 vs 8/9, and average age=56.9 vs 57.5). The distributions of primary lesions were 4 cases of ampulla of Vater, 6 cases of common bile duct, 5 cases of pancreatic head in group I; 7 cases of ampulla of Vater, 8 cases of common bile duct, 2 cases of pancreatic head in group II, respectively. There were no differences in tumor size (2.8+/-1.1 cm vs. 2.4+/-1.5 cm), the number of lymph node metastasis, AJCC tumor stage, histological differentiation, neural or lymphatic invasion between two groups. The number of direct invasion to adjacent organs in group I was more than that in group II (p<0.05). CONCLUSION: The increased number of direct invasion to adjacent organs could be an important prognostic factor of early recurrence after pancreatoduodenectomy even in small-sized or no lymph node-metastasized periampullary carcinoma.
Ampulla of Vater ; Common Bile Duct ; Head ; Lymph Nodes ; Neoplasm Metastasis ; Pancreaticoduodenectomy* ; Recurrence*