The mechanism of cytolysis by complement attack of nucleated cells(NC) is of special interest in comparison to that of red blood cells. It is known that NC death by membrane attack comples, C5b-9, is caused by many factors, i.e., efficiency of complex assembly, activation of intrinsic metabolic pathway by signal transduction, cytotoxic effect of the channel itself and natural repair ability. These factors suggest that colloid osmotic lysis, known in red blood cells, does not fully explain the complement-mediated cell death of NC. In this study, the authors investigated correlation between biochemical and morphological changes to prove "Ca2+-mediated metabolic death"8~13) representing a mechanism of NC death caused by C5b-9 attack. The L1210 cells, mouse leukemic cell line carrying small complement channel(TAC5b-91) were used in the experiments. The amounts of intracellular adenine nucleotides to extracellular Ca2+, ouabain, KC1 and dextran were analyzed by bioluminescence method using luminometer. Cell viability was checked by 0.4% trypan blue dye and LDH release. Morphological observation of TAC5b-91 was done by immunocytochemical staining and electron microscope. The results were as follows: 1) The release of ATP, ADP and AMP followed by cell death was rapid and progressive along the incubation time at 37 degrees C and it was accelerated in 1.5 mM of [Ca2+]0. 2) There was no evidence of ATP repairment in the TAC5b-91. 3) Extracellular KC1(150 mM), dextran(0.66 mM) and ATP supplement(0.2 microM) could not effectively inhibit ATP depletion and cell death. Ouabain(27 and 100 microM) enhanced cell death and could not completely prevent ATP loss. 4) Most of the mitochondria showed swelling, loss of cristae and Ca2+ deposit in matrix in the electron microscopic observation. Rapid, sustained and irreversible depletion of adenine nucleotides was due to Ca2+ deposit with destruction of mitochondria and also the leakage through transmembrane channels. Moreover this energy depletion was accelerated by high extracellular Ca2+ concentration. These results indicate that Ca2+-mediated, energy exhaustion is one of the mechanisms of the metabolic cell death by C5b-9 attack of NC.
Mice ; Animals

Mucocele of the appendix is uncomrnon and rarely diagnosed preoperatively. The malignant rountpart-i.e. mucinous cystadenocarcinoma--has the same grross appearance and many micro scopic features in cornmon wilhe the benign form. It rnay be associated with ovarian mucinous cystadenoma of strikingly similar microscopic appearence. A serious complication is a rupture of the mucoeele resulting in pseudomyxoma peritonei. Each case of benign and malignant mucocelr of the appendix falsely diagnosecl as an oovarian tumor before laparotxumy are presented wilh a brief rieview of the literatures.
Appendix* ; Cystadenoma, Mucinous ; Mucins ; Mucocele* ; Pseudomyxoma Peritonei ; Rupture

PURPOSE: This paper is to evaluate radiological features of hypersensitivity pneumonitis, correlated with clinical and pathologic findings. MATERIALS AND METHODS: Patients consisted of 2 men and 3 women, aged 23-51 years old (average 41). Diagnosis was based on the presence of suggestive clinical and radiological findings (chest radiography, high resolutional CT, gallium scintigraphy), and lung biopsy showing characteristic histological features. RESULTS: All patients complained of exertional dyspnea and three patients experienced coughing. On the pulmonary function test, four patients revealed restrictive pattern and one patient was normal. Results of bronchoalveolar lavage, available in four patients, revealed lymphocytosis in three patients and normal finding in one patient. Chest radiographs showed ground glass opacity or diffuse nodular densities. On the HRCT, diffuse nodular opacity and ground glass opacity were seen in variable features. All 4 patients had diffuse increased uptake on the gallium scan. On lung biopsy, a combination of histologic findings showed cellular bronchiolitis, diffuse interstitial infiltrates and non-necrotizing granulomas, consistent with diagnosis of hypersensitivity pneumonitis. CONCLUSION: Hypersensitivity pneumonitis could be diagnosed with these radiological, clinical and pathological findings.
Alveolitis, Extrinsic Allergic* ; Biopsy ; Bronchiolitis ; Bronchoalveolar Lavage ; Cough ; Diagnosis ; Dyspnea ; Female ; Gallium ; Glass ; Granuloma ; Humans ; Hypersensitivity* ; Lung ; Lymphocytosis ; Male ; Radiography ; Radiography, Thoracic ; Respiratory Function Tests

Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of gastrointestinal bleeding. The diagnosis of PAEF is difficult to make. The classic triad of symptoms, i.e. gastrointestinal bleeding, abdominal pain, and a pulsating abdominal mass is overemphasized, as it occurs in less than 11~25% of the patients. For two thirds of the patients, the diagnosis is made in the operating room. Endoscopic and radiographic studies are very helpful, but the absence of abnormalities can not exclude the diagnosis. PAEF is a clinical and surgical challenge associated with high mortality. A high index of suspicion, early diagnosis and prompt and appropriate surgical intervention are essential to patient survival. Two primary aortoenteric fistulas (aortoduodenal and aortoesophageal) cases are presented and the related literature are reviewed.
Abdominal Pain ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal ; Early Diagnosis ; Fistula ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Fistula ; Operating Rooms ; Vascular Fistula

Regardless of an appropriate radiation therapy administered to a patient with a brain tumor, clinical and radiological evidence of progression may still develop because of a recurrence of the tumor and/or radiation necrosis, or even rarely, a radiation induced neoplasm. The evaluation of tumor recurrence and radiation-induced necrosis presents a diagnostic challenge. A thirty eight year old woman was treated for a focal motor seizure on the right side of her face.with a fractionated external beam radiotherapy under the impression of cystic astrocytoma in the left frontoparietal region. After 6 months, she developed a headache, nausea and vomiting, dysphagia, and secondary generalized seizure. A follow-up brain MRI showed a high signal mass lesion in a T2 weighted image and a fluorodeoxyglucose PET revealed hypometabolism in the left frontoparietal lobe, suggesting radionecrosis. It was confirmed as radionecrosis with an expanding edema by open biopsy. We report a cerebral radiation necrosis mimicking recurrent brain tumor.
Astrocytoma ; Biopsy ; Brain ; Brain Neoplasms* ; Deglutition Disorders ; Edema ; Female ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Nausea ; Necrosis* ; Radiotherapy ; Recurrence ; Seizures ; Vomiting

BACKGROUND: To elucidate the mechanism of interaction between depolarizing and nondepolarizing muscle relaxants, train-of-four (TOF) fade during onset of neuromuscular blockade of d-tubocurarine (dTC) with or without decamethonium (C10) was evaluated in a rat phrenic nerve hemidiaphragm preparation. METHODS: Phrenic nerve hemidiaphragm preparations from 250~300 g Sprague Dawley rats (n=20) were suspended in a Krebs solution bubbled with 5% CO2 in O2 at 32oC. Phrenic nerves were stimulated with supramaximal stimuli of 0.2 ms duration at 0.15 Hz single twitch and 2 Hz TOF by a Grass S88 stimulator and the contractions of the hemidiaphragm were detected by a Grass FT03 force transducer then recorded. Estimation of ED50 for the dose response data were performed by a linear regression. The statistical significance of the results was determined by Wilcoxon Rank Sum test. p<0.05 was considered significant. RESULTS: Mean ED50 values of dTC and C10 calculated from the dose response relations were 7.76 microgram/ml and 0.65 microgram/ml respectively. Compared to adminstration of 2xED50 of dTC alone, TOF ratios at 75% and 50% of twitch height were markedly decreased by combination of ED50 of C10 and ED50 of dTC with statistic significance (67 +/- 1.9% vs. 46 +/- 3.1% and 36 +/- 2.5% vs. 7 +/- 2.5%). Conclusion: If fade in response to TOF stimulation represents a prejunctional effect, the results from this study suggests that the presynaptic action of C10 has some role in the mechanism of the interaction between dTC and C10 in the rat.
Animals ; Linear Models ; Neuromuscular Blockade* ; Phrenic Nerve* ; Poaceae ; Rats* ; Rats, Sprague-Dawley ; Transducers ; Tubocurarine*

Trisomy 9 mosaic syndrome is a rarely reported chromosomal abnormality with high incidence of intrauterine growth retardation and perinatal death. Even a baby lives, he has severe mental retardation and significant malformations. The incidence and severity of malformations and mental retardation correlate with the percentage of trisomic cells in the different tissues. The characteristic craniofacial abnormalitis are narrow bifrontal diameter, up-slanted and short palpebral fissures, a prominent nasal bridge with a short root, a prominent lip covering a receding lower lip, low-set, posteriorly rotated, and misshapen ears. Ventricular septal defect is a main cardiac abnormality. Bony hypoplasia and dislocated hips have been frequently reported. Central nervous system, hepatobiliary, gastrointestinal and genitourinary abnormalities also had been reported. The authors report a baby who had characteristic abnormalities of trisomy 9 mosaicism with narrow temples, up-slanted palpebral fissures, a bulbous nose, thin and protruding upper lip, low set and malformed ears, hyperextended wrist and overlapping fingers. Cytogenetic analysis performed to confirm the chromosomal abnormality revealed trisomy 9, low level mosaic type.
Central Nervous System ; Chromosome Aberrations ; Cytogenetic Analysis ; Ear ; Fetal Growth Retardation ; Fingers ; Heart Septal Defects, Ventricular ; Hip ; Incidence ; Intellectual Disability ; Lip ; Mosaicism* ; Nose ; Trisomy* ; Urogenital Abnormalities ; Wrist

No abstract available.
Female ; Humans ; Ovary*

Feto-maternal hemorrhage, the presence of fetal red blood cells in the maternal circulation, occurs in up to 75% of pregnancies. But its volume is usually very small. Feto-maternal hemorrhage of more than 30 ml of whole blood is relatively rare. The key features that lead to early diagnosis are the maternal history, fetal monitoring, the clinical and laboratory findings of anemia and a negative Coombs' test. Diagnosis is confirmed by Kleihauer-Betke test. Perinatal problems include fetal distress, neonatal anemia, hypovolemic shock, and death. The fetal outcome depends on the amount and rate of bleeding. The initial hemoglobin level was a better predictor than the volume of bleeding. We present two cases of severe neonatal anemia associated with massive feto-maternal hemorrhage, which was confirmed by Kleihauer-Betke test.
Pregnancy ; Female ; Infant, Newborn ; Humans

PURPOSE:This study was designed to know the clinical significance and risk factors of hyperkalemia in very low birth weight infants (VLBWI). METHODS:We compared the incidence of hyperkalemia and its associated ECG abnormalities and mortality rate according to birth weight (102 of less than 1,000 g vs. 328 of 1,000 to 1,500 g) in 430 VLBWI who were born from Jan. 2000 to July 2004, retrospectively, and also compared the several parameter according to serum potassium (35 of hyperkalemia vs. 11 of normokalemia) in 49 selected VLBWI who need mechanical ventilation for respiratory distress without oliguria within 72 hours of life to know the risk factors of hyperkalemia. RESULTS:Overall incidence of hyperkalemia in VLBWI was 21.1%, and was significantly higher in below 1,000 g than in 1,000 to 1,500 g (32.4% vs. 17.7%, P<0.05). Hyperkalemia associated ECG abnormalities, life-threatening cardiac arrhythmia, and death were also significantly higher in below 1,000 g. There were no significant differences in maternal or infant's characteristics, laboratory findings and clinical conditions between hyperkalemic vs. normokalemic group. The incidence of cardiac arrhythmia and mortality rate were also significantly higher in hyperkalemic group. CONCLUSION:Early onset nonoliguric hyperkalemia is often associated with life- threatening cardiac arrhythmia and death in VLBWI, especially less than 1,000 g. Although perinatal risk factors were not found in this study, prospective study is needed to establish the preventive strategy and to improve the outcome.
Arrhythmias, Cardiac ; Birth Weight ; Electrocardiography ; Humans ; Hyperkalemia* ; Incidence ; Infant* ; Infant, Very Low Birth Weight* ; Mortality ; Oliguria ; Potassium ; Respiration, Artificial ; Retrospective Studies ; Risk Factors