BACKGROUNDS: The Rh antigens are important m clinical practice. The classification of Rh phenotype is usually based on the antigen detection done by conventional serologic method, but it has many limitation such as delicate grading of antigen expression. Recently, Flowcytometry has been introduced in immunohematology to detect and quantitate cell bound immunoglobulins to assess blood cell antigens and related antibodies. So, we tried these method to detect Rh(D) antigen and measure its density and evaluated the possibility of clinical usage. MATERIALS AND METHODS: We performed a flowcytometric analysis for the expression of D antigen in D-positive, negative and weak D group in indirect immune fluorescence assay by using polyclonal antibodies. We measured the intensity of immunofluorescence as a degree of antigen density and analysed the difference of mean channel fluorescence value(MCF) among these groups. RESULTS: Weak D groups had the lower fluorescence than D-positive group, while D-negative sample showed the same fluorecence as negative ntrol. The difference of fluorescence intensity of D antigen between that of C antigen were not observed and were statistically insignificant. CONCLUSION: Flowcytometry appear to be a good tool for antigen density measurement in immunohematologic areas and shows the possibility of application to other aspect.
Antibodies ; Blood Cells ; Classification ; Fluorescence ; Fluorescent Antibody Technique ; Immunoglobulins ; Phenotype

PURPOSE: Myasthenia gravis(MG) is relatively rare in childhood and shows some distinct epidemiologic and clinical features according to ages and races. The role of immunosuppressive therapy such as steroid treatment is not well established. The objective of this study is to characterize clinical features of childhood MG and to evaluate the outcomes of steroid treatment. METHODS: We studied 23 MG patients(7 male and 16 females) with symptom onsets from 1 to 14 years of age(mean 4.1 years). RESULTS: Fifteen patients were ocular type and 6 patients were generalized type. Sero-positivity to acetylcholine receptor antibodies was found in 85% of the patients. Two patients who showed initial ocular manifestations experienced secondary generalization without steroid treatment. Alopecia totalis and moyamoya disease were associated with systemic MG in two cases. Eighteen patients were treated with both anticholine esterase and steroid while 2 patients were treated with steroid only. Complete remission was observed in 6 patients(30%) while 11 patients(55%) had one or more recurrences and only partial responses were acquired in 4 patients(20%). CONCLUSION: We found some different epidemiologic features from western countries including a relatively high proportion of ocular MG and earlier onset age especially in ocular MG. Further long-term follow up study on responses to steroid treatment will be necessary to evaluate clinical benefits in the disease progression.
Acetylcholine ; Age of Onset ; Alopecia ; Antibodies ; Continental Population Groups ; Disease Progression ; Follow-Up Studies ; Generalization (Psychology) ; Humans ; Male ; Moyamoya Disease ; Myasthenia Gravis* ; Recurrence

BACKGROUDNS: In Korea, CPDA-1 solution is currently used for blood preservation and by this anticoagulant solution, RBCs can be preserved for up to 35 days at the refrigerate temperature. RBC additive solutions (AS-1, AS-3, AS-5, SAG-M, SAG-PM) are widely used in the other countries for longer preservation of RBCs (42 days). We studied the survival of transfused RBCs preserved in SAG-M additive solution. MATERIALS AND METHODS: 400 mL of whole blood were collected from 8 healthy volunteers, Plasma was removed by centrifugation separation method at 2,960g, 10 minute and replaced by 100 mL of SAG-M additive solution. Autologous transfusions were done in two groups on day 20 and 42 with Na51CrO4 (Dupont, USA) labelled RBCs. After 3, 10, 15, 20, 30 minutes and 1, 2, 24 hours, 20 days, the venous blood samples were collected from the volunteers, and their radioactivities were measured by the Gamma-counter (Cobra II, Germany), and 24 hour survival rate were calculated by Moroff's method. RESULTS: The mean 24 hour survival rate was 89.0% in 20 days preservation group and 71.8% in 42 days preservation group. The mean half life of transfused RBCs were 27.8 days (n=2)and 24.3 days (n=4) in 20 days and 42 days preservation group, respectively. No complications were observed during the study period. CONCLUSIONS: The RBCs preserved in SAG-M additive solution were near within allowable survival rates for transfusion.
Blood Preservation ; Centrifugation ; Erythrocytes* ; Half-Life ; Healthy Volunteers ; Korea ; Plasma ; Radioactivity ; Survival Rate ; Volunteers

Rubinstein-Taybi syndrome (RTS) is a congenital disorder characterized by typical facial features, broad thumbs and toes, with mental retardation. Additionally, tumors, keloids and various congenital anomalies including congenital heart defects have been reported in RTS patients. In about 50% of the patients, mutations in the CREB binding protein (CREBBP) have been found, which are understood to be associated with cell growth and proliferation. Here, we describe a typical RTS patient with Arnold-Chiari malformation. A mutation in the CREBBP gene, c.4944_4945insC, was identified by mutational analysis.
Arnold-Chiari Malformation ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; CREB-Binding Protein ; Heart Defects, Congenital ; Humans ; Intellectual Disability ; Keloid ; Rubinstein-Taybi Syndrome ; Thumb ; Toes

Muscle relaxation using neuromuscular blocking agent is an essential process for endotracheal intubation and surgery, and requires adequate recovery of muscle function after surgery. Residual neuromuscular blockade is defined as an insufficient neuromuscular recovery that can be prevented by confirming train-of-four ratio >0.9 using objective neuromuscular monitoring. Sugammadex, a novel selective relaxant-binding agent, produces rapid and effective reversal of rocuronium-induced neuromuscular blockade. We report a case of the residual neuromuscular blockade accompanying dyspnea and stridor after general anesthesia in an unrecognized pre-existing symptomless unilateral vocal cord paralysis patient, who had experienced the disappearance of dyspnea and stridor after administration of sugammadex.
Aged* ; Anesthesia, General ; Delayed Emergence from Anesthesia* ; Dyspnea* ; Humans ; Intubation, Intratracheal ; Muscle Relaxation ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Respiratory Sounds ; Vocal Cord Paralysis*

OBJECTIVE: In general, it is known that repetitive regular stimuli induce tolerance and repetitive irregular stimuli induce sensitization. We sought to determine the dopamine response in the rat prefrontal cortex under the repetitive regular and repetitive irregular stimuli. METHODS: After giving irregular and regular electrical stimuli repetitively to rats, we measured the dopamine levels of prefrontal cortex. We compared these results with the dopamine levels of prefrontal cortex of rats which were given just one electrical stimulus. Samples were obtained using in vivo brain microdialysis. Dopamine levels in the samples were measured by high pressure liquid chromatography with electrochemical detection. RESULTS: 1) Dopamine levels of prefrontal cortex of both repetitive regular stimuli group and repetitive irregular stimuli group increased after electrical stimuli. 2) Dopamine levels of prefrontal cortex also significantly increased after just one electrical stimulus. 3) Among the repetitive regular stimuli group, repetitive irregular stimuli group and one stimulus group, the dopamine response was most significant in the repetitive irregular stimuli group. CONCLUSIONS: Repetitive irregular electrical stimuli induce sensitization of prefrontal cortex and repetitive regular electrical stimuli don't induce tolerance of prefrontal cortex.
Animals ; Brain ; Chromatography, Liquid ; Dopamine* ; Microdialysis ; Prefrontal Cortex* ; Rats*

OBJECTIVES: We aimed to develop a common health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea. METHODS: By exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements. RESULTS: As the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies. CONCLUSIONS: We expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.
Computer Security ; Computer Systems ; Continuity of Patient Care ; Delivery of Health Care ; Electronic Health Records ; Health Level Seven ; Humans ; Information Services* ; Korea ; Privacy ; Referral and Consultation ; Workers' Compensation

Rupture of adrenal tumor from various primary origins is a rather rare event. We report here on a ruptured adrenal metastasis from hepatocellular carcinoma, and this ruptured metastasis was observed at the time of the initial diagnosis.
Carcinoma, Hepatocellular* ; Diagnosis ; Neoplasm Metastasis* ; Rupture ; Rupture, Spontaneous*

Scrub typhus, an acute febrile infectious disease caused by R. tsutsugamushi, has been reported from various parts of the far east and pacific rim of Asia including Korea. It is well known that all human pathogenic rickettsia share an affinity to endothelial cells of the small blood vessels and evoke vascular inflammation variably associated with a rash, microthrombi, and hemorrhage. We infected the ICR mice by inoculating sublethal doses of R. tsutsugamushi R19 strain intraperitoneally and observed the pathologic changes by time sequence. The histopathologic features of experimentally induced scrub typhus in the mice were generally nonspecific interstitial inflammations characterized by interstitial pneumonitis, periportal inflammation, multifocal hepatic necrosis, interstitial nephritis, sinusoidal engorgement, and lymphohistiocytic cell infiltration in lymph nodes and spleen. Contrary to the general features of other rickettsial diseases, the pathologic process of scrub typhus experimentally induced by R. tsutsugamushi R19 strain mainly involved the interstitial connective tissue but not the blood vessels.
Animals ; Liver/pathology ; Lung/pathology ; Male ; Mice ; Mice, Inbred ICR ; Scrub Typhus/*pathology ; Spleen/pathology

OBJECTIVES: We analyzed retrospectively incidence, management, and predictors of difficult intubation, which have been known through practical cases. METHODS: A total of 217 cases of difficult intubation (DI) between 2010 and 2014 were investigated. Risk factors such as age, body mass index, Mallampati score, thyromental distance, degree of mouth opening and range of neck motion, Cormack-Lehane grade, intubation and airway management techniques were investigated. The cases of each department were analyzed and the airway management techniques according to simplified risk scores (SRS) were also investigated. RESULTS: The average incidence of DI was 0.49%. Patients undergoing surgery in the departments of oro-maxillo-facial surgery (1.35%), ophthalmologic surgery (0.96%), urologic surgery (0.80%), and head and neck surgery of ear-nose-throat (0.62%) showed the higher incidence of DI. Difficult mask ventilation (10 of 217, 4.6%) was occurred with DI. Higher SRS were related to high rates of video laryngoscope use and fiberoptic guided intubation. There was a decrease in the use of McCoy blades after 2013, an increase in the use of video laryngoscope, and a consistent rate of fiberoptic intubation. CONCLUSION: It is not easy to check all the predictors of DI in a preanesthetic evaluation and the predictors are not accurate. The role of clinical preparation and practical management is important, and the most important thing is to establish a planned induction strategy. Multiple factors system, such as simplified risk factors should be used to evaluate patients to prepare for appropriate airway management techniques in case of DI.
Airway Management ; Body Mass Index ; Head ; Humans ; Incidence ; Intubation* ; Laryngoscopes ; Laryngoscopy ; Masks ; Mouth ; Neck ; Retrospective Studies* ; Risk Factors ; Ventilation