No abstract available.
Autografts* ; Heterografts* ; Transplants*

BACKGROUND: The platelet-specific antigens which exist specifically on platelets have their antigenic determinant on platelet membrane glycoprotein. The alloantibodies against this antigens are responsible for neonatal alloimmune thrombocytopenia, posttransfusion purpura and platelet refractoriness in multitransfused patients. Discovering of the fact that the polymorphism of platelet-specific antigens is resulted from a single base pair substitution of genomic DNA stimulated studies on genotyping of platelet-specific antigens on various populations. This study was performed to investigate the genotype frequency of platelet-specific antigens in Koreans. METHODS: Using genomic DNA extracted from venous blood of 200 Koreans, genotype of seven platelet-specific antigen systems were determined through allele-specific polymerase chain reaction and restriction fragment length polymorphism. RESULTS: The genotype frequencies of HPA-1 were a+b- 98.0%, a+b+ 1.5%, a-b+ 0.5%; HPA-2, a+b- 85.5%, a+b+ 13.5%, a-b+ 1.0%; HPA-3, a+b- 28.5%, a+b+ 54.0%, a-b+ 17.5%; HPA-4, a+b- 98.0%, a+b+ 2.0%, a-b+ 0.0%; HPA-5, a+b- 95.5%, a+b+ 4.5%; HPA-6W, a+b- 96.0%, a+b+ 4.0%; HPA-7W were a+b- 100.0%, a+b+ 0.0%. CONCLUSION: The gene frequency of HPA-1b in Koreans was lower than that of Caucasian. As a whole, the genotype frequencies of platelet-specific antigens in Koreans were similar to those of the Japanese. However, we found one HPA-1(a-b+) among 200 Koreans, which is very rare in Japanese. This study will serve as a basic data for the study and management of the patients with diseases associated with platelet-specific antigens and antibody reactions in Koreans.
Antigens, Human Platelet* ; Asian Continental Ancestry Group ; Base Pairing ; Blood Platelets ; DNA ; Gene Frequency ; Genotype* ; Humans ; Isoantibodies ; Membrane Glycoproteins ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Purpura ; Thrombocytopenia, Neonatal Alloimmune

Widely used tests for the detection of platelet antibodies in Korea include platelet suspension immunofluorescence test(PSIFT), enzyme immunoassay and mixed passive hemagglutination(MPHA). In these tests, removal of HLA antigens from platelet are required to detect platelet-specific antibodies. Modified antigen capture ELISA(MACE) is known to be very sensitive for the detection of platelet-specific antibodies, in which specific platelet glycoprotein, captured by the monoclonal antibody is used as a target antigen. MACE is very useful for the detection of platelet-specific alloantibodies in neonatal alloimmune thrombocytopenia(NAIT) and posttransfusion purpura(PTP). We employed MACE in our laboratory, using AP2(anti-GPIIb/IIIa, monoclonal), #30 sera(anti-PlA1), 90-545 sera(anti-HLA-B51+52) and LYS sera(multispecific HLA antibodies). LYS sera had been used as our positive control( 1:120) in MPHA. Platelet from PIA1(+), HLA-B5 I, blood group O healthy male donor, gave positive result with #30 sera(1:40) and negative result with 90-545 sera in MACE. With LYS sera, MACE showed negative in 1:120, but positive in 1:20. So LYS sera was thought to contain strong multispecific HLA antibodies and relatively weak antibody(-ies) reacting with GPllb/Illa. Further studies employing different monoclonal antibodies, such as anti-GPIb/IX, -GPIa/Ila and -GPIV are under way.
Antibodies* ; Antibodies, Monoclonal ; Blood Platelets ; Fluorescent Antibody Technique ; Glycoproteins ; HLA Antigens ; Humans ; Immunoenzyme Techniques ; Isoantibodies ; Korea ; Male ; Tissue Donors

It is very important to tallow that pelvic lymphadenectomy associated with proctectomy must be based on the principle of oncologic surgery and encompass all predictable pathways of extension of rectal cancer for curative surgical resection. We investigated the characteristis of lymph node metastasis in patients with rectal cancer prospectively. 108 consecutive patients with rectal cancer underwent curative surgical resection were enrolled in this study. Rectal cancers were divided into two groups, upper and mid-lower. Upper rectal cancer was defined as the tumor above the peritoneal reflexion. Lymph nodes were stratified as mesorectum, distal mesorectum (defined as distal part more than 2 cm from the lower margin of the tumor), intemal iliac, common iliac, presacral, superior rectal artery, inferior mesenteric artery, paraaortic lymph node. Average number of sampled nodes in these groups 18.5+/-10.7, 3.6+/-3, 2.3+/-3, 1.8+/-1.3, 4 +/-4.1, 1.6+/-2, 3.1+/-3.2, 5.4+/-4.7 respectively. 60 of all patients showed positive lymph node. The over all percentages of patients with positive lymph node was 53% in mesorectum, 12% in distal mesorectum, 8% in intemal iliac, 4.5% in common iliac, 4.5% in presacral, 10% in superior rectal artery, 6.5% in inferior mesenteric artery, 4% in paraaortic lymph node. The over all percentages of patients with positive lymph nodes in each group were 60% (27/45), 9% (4/45), 6.5% (3/45),2% (1/45), 2% (1/45), 13% (6/45), 11% (5/45), 1% (1/45) respectively in upper rectal cancer, 49% (31/63), 14% (9/63), 9.5% (6/63), 6% (4/63), 6% (4/63), 8% (5/63),3% (2/63),5% (3/63) respectively in mid-lower rectal cancer. There were skip metastasis in 3 patients with upper rectal cancer, 2 patients with mid-lower rectal cancer. Age, depth of invasion, tumor size, tumor differentiation among clinicopathologic factors were predictive factors of lymph node metastasis to mesorectum. Risk factors of metastasis to extra-mesorectal lymph node were younger age (<40), poorly differentiation, larger tumor size (>5.0 cm), involved circimferential (>50%), and positive CA 19-9 (>37 U/ml). These results suggest that more careful upward lymphadenectomy must be carried out especially in upper rectal cancer and also careful lateral dissection in selected patients and more generous excision of distal mesorectum especially in mid-lower rectal cancer is needed for curative resection according to clinicopathologic factors.
Arteries ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mesenteric Artery, Inferior ; Neoplasm Metastasis* ; Prospective Studies* ; Rectal Neoplasms* ; Risk Factors

Because of the two merits of nonoperative management of blunt abdominal trauma, 1) avoidance of operative morbidity and 2) better treatment of associated injuries, the use of nonoperative management has been extended, but the indications for such treatment have not been sufficiently found. One hundred two(102) cases admitted due to hemoperitoneum, 44 involving surgery and 58 conservative managment, were analyzed for age, sex, cause of injury, injured organ, injury grade, transfusion amount, and shock on admission. The major causes of injury in the nonoperative and the operative groups are as follows : 23 cases of auto-pedestrian accidents and 15 cases of in-car accidents in the nonoperative group and 19 cases of auto-pedestrian accidents in the operative group. In terms of the injured organ, liver trauma was the most frequent, and spleen trauma was next. The difference in the transfusion amount between the two groups was statistically significant; 8.1 units in the nonoperative group and 13 units in the operative group. In conclusion, 1) nonoperative management can be considered as a first choice in children with blunt abdominal trauma and stable vital signs; 2) patients with hemodynamically stable liver injury with AAST OIS grade 4 and isolated splenic injury AAST OIS grade 4 are candidates for nonoperative management; and 3) nonoperative management through emergency care without transfusion can be considered in cases with stable vital signs.
Child ; Emergency Medical Services ; Hemoperitoneum* ; Humans ; Liver ; Shock ; Spleen ; Vital Signs

Barrett's esophagus is a premalignant condition of esophageal adenocarcinoma. Inducible nitric oxide synthase (iNOS) is induced by cytokines and can generate locally high concentrations of nitric oxide (NO), whose metabolites can mediate genotoxicity and influence multistage carcinogenesis by causing DNA damage. Therefore, we evaluated the immunolocalization and expression of iNOS in surgically induced rat Barrett's esophagus. Esophagoduodenal anastomosis was performed in rats for inducing reflux of duodenal contents. Rats were killed at postoperative 10, 20, 30 and 40 weeks. We examined histologic changes and iNOS expression in esophagus by immunohistochemistry and reverse transcription-poly-merase chain reaction. Eighty six percent of experimental rats showed Barrett's esophagus above esophagoduodenal junction. iNOS immunoreactivity was clearly observed in the epithelial cells of Barrett's esophagus, predominantly at the apical surface of epithelial cells. Cytoplasmic staining was also seen only in atypical Barrett's esophagus. iNOS mRNA was detected only in the lower esophagus of experimental group. In conclusion, this study suggests that iNOS has some roles on Barrett's esophagus formation.
Anastomosis, Surgical ; Animals ; Barrett Esophagus/*enzymology/*surgery ; Cytoplasm/metabolism ; DNA Damage ; Disease Models, Animal ; Duodenum/*enzymology/surgery ; Esophagus/metabolism ; Immunohistochemistry ; Male ; Models, Anatomic ; Neoplasms, Experimental/pathology ; Nitric Oxide/metabolism ; Nitric-Oxide Synthase/*biosynthesis ; RNA/metabolism ; RNA, Messenger/metabolism ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors

BACKGROUND: Recent studies suggested that platelets can be activated during the preparation of platelet concentrates (PCs). We designed this study to assess the amount of platelet activation induced by some varialbles during the preparation and storage for the purpose of quality improvement of PCs. METHODS: Using 66 fresh whole blood, we analysed the effects of the variables including the delayed time before preparation of PCs, centrifugal force, pH, 1-hour incubation at room temperature before platelet resuspension and platelet agitation stop. After preparation of PCs under various conditions, the percentage of p-selectin-positive platelets was determined by flowcytometry using monoclonal antibodies CD62. RESULTS: The effects of delayed time within 8 hours before preparation and omission of 1-hour incubation on activaton of platelets were minimal. However, the effects of centrifugation speed and time were very significant. After centrifugation of platelet-rich plasma at 5,000 g for 5 or 7 minutes, percentage of p-selectin-positive platelets was increased up to 40.6% or 72.6% on day 1, and 59.7% or 87.7% on day 5, respectively. A good correlation was observed between pH and percentage of p-selectin expressed platelets (r=-0.8584, P=0.0001 on day 1; r=-0.7199, P=0.0037, respectively). We also observed that platelet agitation stop for 6 hours could activate platelets in PCs significantly. CONCLUSION: High centrifugal force and platelet agitation stop were important variables which could activate platelets significantly during preparation and storage of PCs.
Antibodies, Monoclonal ; Blood Platelets* ; Centrifugation ; Dihydroergotamine ; Hydrogen-Ion Concentration ; P-Selectin ; Platelet Activation ; Platelet-Rich Plasma ; Quality Improvement*

No abstract available.
Carotid Artery, Internal

The first case of chyle ascites in childhood was reported by Morton in 1683. Its reported incidence varies between 1 in 50,000 to 100,000 in hospital admissions. The clinical picture is similar to that of acute diffuse peritonitis, and is most commonly mistaken as perforated appendicitis. Paracetesis, if performed, is the most useful diagnostic option. Treatment modalities fall into four areas-: Exploratory laparotomy with either direct ligation or drainage, A medium chain triglyceride diet, NPO and hyperalimentation or Venoperitoneal shunting. An 11-years old boy was admitted with RLQ pain. He had diffuse abdominal guarding. The initial diagnosis was perforated appendicitis, and appendectomy was performed. During the operation, the abdomen was found to contain 750cc of a thin, milky fluid. It was later diagnosed as chyle ascites. The small bowel mesentery and transverse colon were thickened and edematous, with a pale white subserosal exudate. The laboratory analysis of the ascites was as follows-: protein 4.6 g/dL, albumin 3.0 g/dL, triglyceride 700 mg/dL, cholesterol 113 mg/dL, glucose 209 mg/dL, LDH 848 U/L, and amylase 32 U/dL, with a pH of 9.0. An appendectomy was performed, and two drains placed in the pelvic cavity. In the postoperative-work-up from the abdominal CT scan, the results were normal. The patient-recovered and was discharged without complication 21 days postoperatively.
Abdomen ; Amylases ; Appendectomy ; Appendicitis* ; Ascites* ; Child ; Cholesterol ; Chyle* ; Colon, Transverse ; Diagnosis ; Diet ; Drainage ; Exudates and Transudates ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Laparotomy ; Ligation ; Male ; Mesentery ; Peritonitis ; Tomography, X-Ray Computed ; Triglycerides

BACKGROUND: The ABO antibody titration is important, especially in case of ABO-incompatible hemolytic disease of newborn, ABO-incompatible bone marrow or solid organ transplantation. However, no standard method for ABO antibody titration has yet been established. We surveyed four university hospitals about the methods of ABO antibody titration and performed inter-laboratory proficiency tests. METHODS: Detailed methods of ABO antibody titration were surveyed at four university hospitals. ABO antibody titer was measured by their customary methods using serum samples from six healthy volunteers with blood groups A (n=2), B (n=2) and O (n=2). RESULTS: Procedures of ABO antibody titration, reportable ranges, sample diluent, source of reagent RBCs and interpretation of end-point were different among four university hospitals. Inter-institutional maximum differences of IgM and IgG ABO antibody titer were 16-fold and 32-fold, respectively. CONCLUSION: Standardization of ABO antibody titration method is needed to reduce inter-laboratory variability, and a periodical external quality control survey is necessary to improve the accuracy of the titration.
Blood Group Antigens ; Bone Marrow ; Erythroblastosis, Fetal ; Hospitals, University ; Immunoglobulin G ; Immunoglobulin M ; Infant, Newborn ; Korea ; Organ Transplantation ; Quality Control ; Transplants