No abstract available.

PURPOSE: The close relationship between the size of a tumor burden and the curability of acute leukemia is well established. Therefore, it is very irnportant to detect residual leukemia accurately at low levels. Fluorescence in situ hybridization(FISH) techniques rely on chromosome-specific and gene specific DNA probes to identify numerical and structural chromosomal abnormalities. But the detection limit of FISH in residual leukemia is still uncertain. So we evaluated the detection limit of residual leukemic cells with the chromosomal abnomualities on FISH. METHODS: Cells with monosomy, trisomy and bcr/abl fusion were admixed with normal diploid cells in different concentrations of O%, 0.1%, 0.5%, 1%, 2.5%, 5%, 10%, 20% and 100%. Monosomy and trisomy cells were hybridized with chromosome 1 or 8 or X centromeric probes, and the cells with bcr/abl fusion were hybridized with bcr/abl probe and detected using FISH technique. The number of signals from 150 to 1000 cells were counted. RESULTS: The detection limit was 1% in monosomy assay and 0.5% in trisomy and translocation assay. The proportion of cells showing each signal increased according to the increase of mixed cells. CONCLUSION: FISH for detection of minimal residual leukemia is a sensitive and specific method which could detect at least 1Yo leukemic cells in the samples. Especially, cells with trisomy or translocation could be more easily detected. It could be also used for quantitative monitoring of leukemic cells.
Chromosome Aberrations ; Chromosomes, Human, Pair 1 ; Diploidy ; DNA Probes ; Fluorescence* ; In Situ Hybridization* ; In Situ Hybridization, Fluorescence ; Leukemia* ; Limit of Detection* ; Monosomy ; Neoplasm, Residual* ; Trisomy ; Tumor Burden

Unilateral brachial plexus injury is a rare complication of thoracoscopic sympathectomy, which is generally considered to be a simple and safe procedure. We report on a 20-year-old female patient who developed persistent pain and weakness of the left arm after thoracoscopic sympathectomy for hyperhidrosis. An electromyographic study revealed evidence of denervation at the C5-C7 level, and a nerve conduction study on the left brachial plexus showed decreased amplitude of the compound muscle action potential of the left musculocutaneous and axillary nerves. The above findings are compatible with left brachial plexopathy, with predominant involvement of the lateral and posterior cord. We suggest that this complication was caused by stretch and/or compression of the left brachial plexus when the arm was hyperabuducted upwards during the operation. Careful attention to positioning by the surgeon and anesthesiologist is needed to prevent this debilitating injury.
Action Potentials ; Arm ; Brachial Plexus Neuropathies ; Brachial Plexus* ; Denervation ; Female ; Humans ; Hyperhidrosis ; Neural Conduction ; Sympathectomy* ; Young Adult

Rhino-orbito-cerebral mucormycosis is an uncommon fulminant fungal infection that occurs usually in debilitated or immune suppressed patients. Intracranial lesions such as cerebral ischemia mostly develop secondary to vascular injuries like thrombosis of cavernous sinus or internal carotid artery and also from arteritis. However, intracranial hemorrhage complicated by mucormycosis is very rare. We report a patient with a fatal complicaton of intracranial hemorrhage presumably due to arteritis by mucormycosis. A 66-year-old female patient with uncontrolled diabetes mellitus developed complete ophthalmoplegia in her left eye for two days. Rhinoscopic examination revealed black necrotic turbinate. Orbital CT scan and Brain MRI showed soft tissue material at the left orbital apex and mild deformities in the left lateral cavernous sinus. On the basis of radiological evidence and biopsy, a diagnosis of mucormycosis was established, and the patient underwent surgical debridement followed by an Amphotericin B infusion. On the following day, she suddenly developed a right hemiparesis and stupor. An immediate brain CT scan revealed a large intracranial hemorrhage in the left frontal head region. Removal of the hematoma and a biopsy was performed immediately. A pathological examination revealed a fungal invasion of the small arterial wall and an acute inflammatory reaction of the surounding tissues.
Aged ; Amphotericin B ; Arteritis ; Biopsy ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Cavernous Sinus ; Congenital Abnormalities ; Debridement ; Diabetes Mellitus ; Diagnosis ; Female ; Head ; Hematoma ; Humans ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Mucormycosis* ; Ophthalmoplegia ; Orbit ; Paresis ; Stupor ; Thrombosis ; Tomography, X-Ray Computed ; Turbinates ; Vascular System Injuries

No abstract available.
Hematocrit ; Mucocutaneous Lymph Node Syndrome*

A case of symptomatic bilateral popliteal artery entrapment syndrome is reported. A twenty-one-year old male, a candidate of athlete, complained of coldness, weakness, pallor and cyanosis of right lower leg and intermittent claudication to both calves during walking or exercise for ten months. Studies revealed that the right popliteal artery was completely occluded, but the left popliteal artery was non-occlusive. An endarterectomy and onlay vein patch graft to the thrombosed and fibrotic right popliteal artery, and myotomies of bilateral medial heads of gastrocnemius muscle were done (May 20, 1998). Follow-up examinations for the last ten months showed a complete relief of symptoms with normal distal arterial flow. It is thought that even though the majority of patients present with unilateral calf claudication, the possiblity of bilateral problems need to be also considered.
Athletes ; Cyanosis ; Endarterectomy ; Follow-Up Studies ; Head ; Humans ; Inlays ; Intermittent Claudication ; Leg ; Male ; Muscle, Skeletal ; Pallor ; Popliteal Artery* ; Transplants ; Veins ; Walking

Cardiovascular and cerebrovascular diseases are important causes of death in patients receiving maintenance dialysis. Stroke occurred in high rate with the tendency to worsen prognosis. Also many patients with chronic renal failure(CRF) showed a high risk for stroke. From March 1985 to March 1999, at Wonju Christian Hospital, we investigated retrospectively risk factors, clinical appearance and prognosis for stroke in 20 patients with CRF who undergoing maintenance dialysis. The stroke occurred in nine male and eleven female with a mean age of 49.95+/-9.19 years. Seventeen patients underwent hemodialysis and three patients underwent peritoneal dialysis. Mean duration of dialysis was 50.05+/-34.68 months. Causes of CRF were as follows : 55% glomerulonephritis, 20% diabetes mellitus, 5% polycystic kidney and 20% unknown origin. At the time of stroke, serum protein level was 6.68+/-0.86mg/dL, albumin 3.38+/-0.87g/dL, cholesterol 160.25+/-43.34mg/dL, HDL-cholesterol 41.41+/-11.86mg/dL. All patients were on antihypertensive medication. Mean systolic blood pressure was 197+/-45mmHg, diastolic blood pressure 114+/-23mmHg. Systolic blood pressure of fourteen cases were more than 180mmHg. During hemodialysis, heparin dosage was an average 2425+/-371.48 IU. The types of stroke were intracerebral hemorrhage (ICH, 75%), subdural hematoma(10%), cerebral infarction(15%). One case developed both cerebral hemorrhage and subarachnoid hemorrhage. The sites of hematoma were basal ganglion-thalamus(60%), and subcortex(33.3%). Of these, nine cases had subsequent intraventricular hemorrhage(IVH). One case involved IVH only. The mean volume of hematoma was 66.42+/-29.92mL. Three cases of cerebral infarction developed in midcerebral arterial territory. Prognoses were as follows : Sixteen patients with cerebral hemorrhage died during hospitalization and one case has been monitored via outpatient department. One patient with cerebral infartion died during hospitalization and two have been discharged after symptom was improved. In conclusion, CRF patients undergoing maintenance dialysis showed higher incidence of ICH, unlike the recent studies which showed a higher rate of cerebral infarction to ICH in the general population. There was a higher incidence of stroke in patients whose blood pressure were poorly controlled. The most common site of ICH was basal ganglia and thalamus which was the same as in the general population. In many cases, it accompanied IVH and showed a higher mortality rate. Therefore, it is thought that aggressive blood pressure control is indicated to reduce mortality caused by stroke during maintenance dialysis.
Basal Ganglia ; Blood Pressure ; Cause of Death ; Cerebral Hemorrhage ; Cerebral Infarction ; Cholesterol ; Diabetes Mellitus ; Dialysis* ; Female ; Gangwon-do ; Glomerulonephritis ; Hematoma ; Hemorrhage ; Heparin ; Hospitalization ; Humans ; Incidence ; Infarction ; Male ; Mortality ; Outpatients ; Peritoneal Dialysis ; Polycystic Kidney Diseases ; Prognosis ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Stroke* ; Subarachnoid Hemorrhage ; Thalamus

Enteroviruses are the most common agents of myocarditis and have been implicates in the pathogenesis of dilated cardiopmyopathy. There are still discrepancies in the association of enterovirus and myocardial disease, partially due to lack of data on detection of virus antigen or viral culture in the tissue. For the treatment of fulminant myocarditis, aggressive hemodynamic support is warranted because of its excellent long-term prognosis. This 16 year-old girl was admitted because of anterior chest pain for a day. She had flu-like symptoms such as fever, sore throat and cough at 2 weeks ago. Electrocardiogram showed sinus tachycardia and ST segment elevations in lead II, III, aVF and V1-V4. Troponin T was positive and creatinine phosphokinase was elevated (1323 IU/L) at emergency room. On emergency echocardiogram, inferior wall motion was decreased and the ejection fraction (EF) was 70%. Coronary angiogram showed no thrombus and no significant stenosis in coronary artery, and spasm was not induced with ergonovine. Conventional treatment for congestive heart failure with digoxin (0.25 mg daily) and furosemide (20 mg t.i.d) was started under the impression of myocarditis. On the first hospital day, pulmonary edema and signs of shock were developed. The whole left ventricular(LV) wall motion were markedly decreased and EF was less than 20% on echocardiogram. Despite of intra-aortic balloon pump (IABP) for 4 hours, shock and pulmonary edema was progressed. Mechanical circulatory support was started with left ventricular assist device (LVAD, Bio-pump, Medtronic Bio-Medicus, USA). At the time of operation, central venous pressure was 24cmH20, systolic blood pressure was 75mmHg, left atrium(LA) and LV was dilated and the whole wall of LV showed almost akinesia , and LA appendage was biopsied. After 126 hours of LVAD, LV wall motion was restored and EF was 79% on echocardiogram. LVAD was removed 10 days after operation and she was discharged on 23 days of hospitalization without any heart failure symptoms. Immunohistochemistry of LA showed enteroviral VP1 capsid protein (primary antibody; NoVo Castra Laboratory, UK) over the entire LA wall. Her serum neutralized coxsackievirus B3 (CVB3, H3 variant of Woodruff strain) in neutralization test using horse anti-CVB3 (Nancy strain) antibody (ATCC, V030-501-560) as a positive control. The titer of neutralization Ab in her serum of 21 days increased more than 4 times than that of 2 days.
Adolescent ; Blood Pressure ; Capsid Proteins ; Cardiomyopathies ; Central Venous Pressure ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Cough ; Creatinine ; Digoxin ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Enterovirus ; Ergonovine ; Female ; Fever ; Furosemide ; Heart Failure ; Heart-Assist Devices* ; Hemodynamics ; Horses ; Hospitalization ; Humans ; Immunohistochemistry ; Myocarditis* ; Neutralization Tests ; Pharyngitis ; Prognosis ; Pulmonary Edema ; Shock ; Spasm ; Tachycardia, Sinus ; Thrombosis ; Troponin T

OBJECTIVE: Hypermethylation of CpG island is a common mechanism for the inactivation of tumor suppressor genes. Hypermethylation of the E-cadherin promoter region has been rarely studied in endometrial carcinoma of Korean women. The purpose of this study is to investigate methylation status of E-cadherin promoter region in endometrial carcinomas and endometrial hyperplasias, and analyze the correlation with clinicopathologic variables in endometrial carcinomas. METHODS: We examined the methylation status of the E-cadherin promoter region using methylation specific polymerase chain reaction and immunohistochemical expression (IHC) of E-cadherin in 30 endometrioid endometrial carcinomas and 20 endometrial hyperplasias, and correlated these results with various clinicopathological factors of endometrial carcinomas. RESULTS: Decreased expression of E-cadherin was detected in 13 of 30 (43.3%) endometrial carcinomas and in 1 of 20 (5%) endometrial hyperplasias (p=0.009). Promoter hypermethylation was detected in 12 of 30 (40%) endometrial carcinomas and 2 of 20 (10%) endometrial hyperplasias (p=0.015). Methylation status did not have a significant influence on the tumor grade and lymph node metastasis. However, the hypermethylation rate was significantly higher in stage above Ic (p=0.025). Decreased expression of E-cadherin was associated with tumor grade, tumor stage, and lymph node metastasis in endometrial carcinomas (p=0.01, p=0.02, p=0.03). There was no correlation between DNA hypermethylation and decreased expression of E-cadherin in endometrial carcinomas (p>0.05). CONCLUSION: These results indicate that hypermethylation of E-cadherin promoter region is a frequent event in endometrial carcinoma, which may play an important role in the progression of carcinogenesis. Also, the promoter methylation of E-cadherin in endometrial carcinoma was found to be significantly associated with higher stage above Ic.
Cadherins ; CpG Islands ; DNA ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Female ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Methylation ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Promoter Regions, Genetic

OBJECTIVE: Hypermethylation of CpG island is a common mechanism for the inactivation of tumor suppressor genes. Hypermethylation of the E-cadherin promoter region has been rarely studied in endometrial carcinoma of Korean women. The purpose of this study is to investigate methylation status of E-cadherin promoter region in endometrial carcinomas and endometrial hyperplasias, and analyze the correlation with clinicopathologic variables in endometrial carcinomas. METHODS: We examined the methylation status of the E-cadherin promoter region using methylation specific polymerase chain reaction and immunohistochemical expression (IHC) of E-cadherin in 30 endometrioid endometrial carcinomas and 20 endometrial hyperplasias, and correlated these results with various clinicopathological factors of endometrial carcinomas. RESULTS: Decreased expression of E-cadherin was detected in 13 of 30 (43.3%) endometrial carcinomas and in 1 of 20 (5%) endometrial hyperplasias (p=0.009). Promoter hypermethylation was detected in 12 of 30 (40%) endometrial carcinomas and 2 of 20 (10%) endometrial hyperplasias (p=0.015). Methylation status did not have a significant influence on the tumor grade and lymph node metastasis. However, the hypermethylation rate was significantly higher in stage above Ic (p=0.025). Decreased expression of E-cadherin was associated with tumor grade, tumor stage, and lymph node metastasis in endometrial carcinomas (p=0.01, p=0.02, p=0.03). There was no correlation between DNA hypermethylation and decreased expression of E-cadherin in endometrial carcinomas (p>0.05). CONCLUSION: These results indicate that hypermethylation of E-cadherin promoter region is a frequent event in endometrial carcinoma, which may play an important role in the progression of carcinogenesis. Also, the promoter methylation of E-cadherin in endometrial carcinoma was found to be significantly associated with higher stage above Ic.
Cadherins ; CpG Islands ; DNA ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Female ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Methylation ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Promoter Regions, Genetic