No abstract available.
Lymphohistiocytosis, Hemophagocytic*

BACKGROUND: HIV-1 p24 antigen assay is useful for the detection of circulating viruses, and infection prior to seroconversion. However, circulating HIV-1 p24 antigen may be complexed with HIV antibody and prevent it from being detected by antigen capture assay. To detect HIV-1 p24 antigen in the specimen, it is necessary to dissociate immune complexes and confirm the presence of HIV-1 p24 antigen after the neutralization with the specific antibody. METHODS: We tested 32 sera from HIV-1 infected persons who were diagnosed from 1987 tO1996 in Korea for HIV-1 p24 antigen by enzyme linked immunosorbent assay (ELISA.) with or without the dissociation of immune complexes. And we confirmed the antigen assay results by the neutralization with HIV-1 specific antibody as a confirmatory test. We also calculated the concentration of HIV-1 p24 antigen in each specimen. RESULTS: Eleven of 32 sera tested were initially positive for HIV-1 p24 antigen. After the dissociation of immune complexes for 29 sera except two of which signal/cutoff ratios were higher than 7.0 and except one which was not enough for the assay,13 were shown to be positive for HIV-1 p24 antigen and their signal/cutoff ratios were increased by 10 times. Five of antigen negative cases were turned to be positive after the immune complex dissociation. After neutralization with HIV-1specific p24 antibody for sera of 13 which were positive for HIV-1 p24 antigen with or without the immune complex dissociation, all were shown to be neutralized. We have observed more than 90% neutralization reduction for 12 sera and more than 50% less than 90% for one. The average concentration of HIV-1 p24 antigen was8.76pg/ml by antigen assay and was increased to 76.81~g/m~ after immune complex dissociation. CONCLUSION: We concluded that the sensitivity and the specificity of HIV-1 p24 antigen assay could be increased by dissociation of the immune complexes and neutralization with the specific antibody.
Antigen-Antibody Complex* ; Enzyme-Linked Immunosorbent Assay ; HIV ; HIV-1* ; Humans ; Korea* ; Sensitivity and Specificity

No abstract available.
Fractures, Compression* ; Vertebroplasty*

Section of the corpus callosum(SCC) is a useful surgical therapy in selected types of epilepsy, i.e., tonic, atonic, and intractable generalized convulsive seizures. The object of this study was to determine effect of SCC on behaviors, electroencephalography(EEG) and Fos expression in the lithium-pilocarpine model of status epilepticus in the rat. A total of 40 Sprague-Dawley rats were used. They were divided into two groups: control and lesioned group, 20 rats for each. The control group had no callosal section and was injected with lithium-pilocarpine. The lesioned group had callosal section before lithium-pilocarpine injection. In each group, ten rats were used for behavior and EEG monitoring and other 10 were used for Fos expression. The results were as follows: 1) In the SCC group, four(40%) rats never developed status epilepticus, among them two(20%) never exhibited any seizure, while all of the control group developed seizure and status epilepticus. None of the SCC animals died until 24 hours after lithium-pilocarpine injection but 70% of the control animals died within 24 hours of status epilepticus. This difference was statistically significant(p<0.05). 2) The mean latency to the first seizure, status epilepticus and periodic epileptiform discharges after lithium-pilocarpine injection were 34.7+/-2.6min, 32.3+/-1.8min and 180.4+/-9.8min, respectively, in the SCC group, while was 21.0+/-2.0min, 58.2+/-6.9min and 215.6+/-7.2min, respectively, in the control group. These latencies were significantly longer than in the control group(p<0.05). 3) There was a massive Fos expression on the cerebral cortex in the control group at 4 hours after lithiumpi-locarpine injection , while it was less in the SCC group. This difference was statistically significant(p<0.05). In conclusion, complete corpus callosotomy had contributed to the protective effect on the development of status epilepticus in the lithium-pilocarpine model which was similar to that observed in humans. And result of Fos expression suggest that Fos immunohistochemisty may be useful in the study of seizure pathways as a metabolic marker in the lithium-pilocarpine model.
Animals ; Cerebral Cortex ; Electroencephalography ; Epilepsy ; Humans ; Rats* ; Rats, Sprague-Dawley ; Seizures ; Status Epilepticus

Fifteen cases of diffuse axonal injury(DAI) brought about by nonmissile head injury in humans are analyzed. All cases were subjected to comprehensive clinical studies such as measurement of cerebral blood flow by SPECT, continuous intracranial pressure monitoring and multimodality evoked potentials(MEPs). In the patients with DAI, a high incidence of low cerebral perfusion and abnormal MEPs. especially auditory evoked potentials, were found, with high incidence of high velocity traffic accident injury mechanism. On the other hand, a low incidence of increased intracranial pressure was found and dehydrating agents such as glycerol and mannitol did not exert a beneficial influence upon the clinical courses or the outcomes. The outcome of the patients with DAI depended upon the duration of coma and whether or not brain stem signs were noted.
Accidents, Traffic ; Axons ; Brain Stem ; Coma ; Craniocerebral Trauma ; Diffuse Axonal Injury* ; Evoked Potentials* ; Evoked Potentials, Auditory ; Glycerol ; Hand ; Humans ; Incidence ; Intracranial Pressure* ; Mannitol ; Perfusion ; Tomography, Emission-Computed, Single-Photon

Twenty eight year-old male with 3 year history of radiating pain to both thighs and thirty six year-old female with one year history of perineal hypesthesia and constipation were presented. The clinical features, radiologic features, surgical techniques and complications are described. In both cases, postoperative cerebrospinal fluid leakage was developed and managed successfully with lumbar drainage and rest respectively. The preoperatively presented symptoms were completely disappeared after surgery.
Cerebrospinal Fluid ; Constipation ; Drainage ; Female ; Humans ; Hypesthesia ; Male ; Thigh

We report a very rare case of mediastinal tuberculosis in a 57-year old woman who presented with a large mediastinal cyst on chest radiography. She had a 10-year history of exertional dyspnea, but felt comfortable at a rest. A subsequent chest CT suggested a mediastinal cyst with mediastinal lymphadenopathy and communicating pericardial sac. She underwent a thoracotomy and excision of the mass, which was histologically revealed to be of tuberculous origin. Although rare, the apparent increase in the incidence of tuberculosis may result mediastinal cysts being diagnosed mediastinal tuberculosis. We also briefly review mediastinal lymphadenopathy due to tuberculosis.
Dyspnea ; Female ; Humans ; Incidence ; Lymphatic Diseases ; Mediastinal Cyst ; Middle Aged ; Pericardium* ; Radiography ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis*

A cardiac electrophysiologic study (EPS) is a safe procedure with a low complication rate. We report here a case of severe stenosis of the left main coronary artery (LMCA) that was incidentally detected during an EPS; this was successfully managed by stenting the LMCA. The patient was a 75-year-old man with recurrent chest fluttering and no previous angina underwent EPS and he developed acute ischemic chest pain due to induced atrial fibrillation. The coronary angiography showed a critical stenosis in the distal LMCA. The patient underwent percutaneous coronary intervention with a sirolimus-eluting stent in the LMCA. The patient has remained asymptomatic during a 1-year follow-up period. To prevent potentially catastrophic complications, performing a stress myocardial imaging test should be strongly considered before conducting EPS in elderly patients.
Aged ; Atrial Fibrillation ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Electrophysiologic Techniques, Cardiac ; Follow-Up Studies ; Humans ; Percutaneous Coronary Intervention ; Stents ; Thorax

Primary leptomeningeal melanomas(PLMs) are rare aggressive central nervous system(CNS) tumors without systemic foci. It can be very difficult, however, to clearly distinguish PLMs from those that have metastasized. We report a case of malignant leptomenigeal melanoma occurring in the right temporal convexity of a 77-yearold woman. Almost all malignant CNS melanomas in the old are secondary to the cutaneous melanoma and can cause diverse neurological manifestations; certain clinical findings of the presented case-namely, the patient's age, vague neurologic findings and absence of cutaneous lesions -are therefore interesting. Thorough clinical checkups, including whole-body bone scan, whole spine MRI, abdominal ultrasound, and tumor marker studies to find extracranial lesions revealed no abnormalities. Based on these clinical findings, we suppose-though are not certain-that the tumor of the presented case is a PLM.
Female ; Humans ; Magnetic Resonance Imaging ; Melanoma* ; Neurologic Manifestations ; Spine ; Ultrasonography

PURPOSE: We compared diagnostic accuracy using transverse scans and combined transverse and coronal reformation images in the MDCT diagnosis of acute appendicitis. METHODS: MDCT was performed in 100 patients with acute non-traumatic abdominal pain who visited the emergency department. One half was diagnosed acute appendicitis by radiologic and histologic findings and the other half was not. Transverse scan and combined transverse and coronal reformation images were interpreted by six emergency physicians. Emergency physicians included two board physicians, two senior residents, and two junior residents. For comparison of diagnostic value, the chi-square test and cross tabs test were done. RESULTS: For all emergency physicians except one senior resident, the added coronal reformation images tended to increase the diagnostic accuracy. For board physicians, it increased the diagnostic accuracy from 81.5% to 91% (p=0.003). Senior residents increased from 82.5% to 91.5% (p=0.005), junior residents increased from 75.5% to 87% (p=0.002). The diagnostic accuracy of board physicians and senior residents were higher than junior residents for both image types. CONCLUSION: Coronal reformation images improve the accuracy of emergency physicians in the MDCT diagnosis of acute appendicitis.
Abdominal Pain ; Appendicitis ; Emergencies ; Humans