Autoimmune sera have been used in the diagnosis of autoimmune diseases as well as the analysis of nuclear substructures. In an attempt to study the biological characteristics of the nuclear matrix, we screened human sera using immunofluorescent staining and immunoblot. We detected antibodies against nuclear matrix (NM), a remnant nonchromatin protein compartment after the treatment of detergent, salt and nuclease, in 212 out of 284 tested sera (74.6%) by immunoblot. Peptides with molecular weights of 70 kDa, 50 kDa and 25 kDa were detected in the order of frequency. Clinical informations of 198 out of 212 cases were available and went as follows: 38 cases were autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis; 132 non-autoimmune and non-neoplastic diseases; 16 neoplastic diseases and 12 cases unclassified. The immunofluorescent staining intensity by anti-nuclear matrix protein (NMP) antibodies decreased variably, but fibrillogranular, speckled and nucleolar immunolocalization patterns were retained after in situ fractionation. Ku70 and La protein were detected by anti-NMP antibodies. Immunolocalization by anti-NMP antibodies indicates that the NMPs constitute a variety of characteristic nuclear substructures and may serve as autoantigens in diverse human diseases. In addition, the presence of Ku70 and La protein as NMPs suggests that the NM can be functionally active in association with DNA or RNA.
Autoantigens/analysis* ; Autoimmune Diseases/immunology ; Autoimmune Diseases/blood ; Base Sequence ; DNA, Complementary ; DNA-Binding Proteins/analysis* ; Fluorescent Antibody Technique, Indirect ; Hela Cells ; Human ; Immunoblotting ; Molecular Sequence Data ; Nuclear Matrix/immunology ; Nuclear Proteins/analysis* ; Ribonucleoproteins/analysis* ; Tumor Cells, Cultured

BACKGROUND: Vasoplegic syndrome is an increasingly recognized disease in perioperative medicine and is characterized by severe hypotension, normal or elevated cardiac output, and decreased systemic vascular resistance. It occurs commonly after cardiopulmonary bypass but may also occur after other types of surgery.CASE: Vasoplegic syndrome developed in our patient during posterior lumbar interbody fusion because of administering nicardipine after phenylephrine. However, the blood pressure did not increase as expected despite simultaneous use of norepinephrine and vasopressin to increase the reduced systemic vascular resistance.CONCLUSIONS: We present a case of vasoplegic syndrome that developed during posterior lumbar interbody fusion and was treated successfully with methylene blue.
Blood Pressure ; Cardiac Output ; Cardiopulmonary Bypass ; Humans ; Hypotension ; Methylene Blue ; Nicardipine ; Norepinephrine ; Phenylephrine ; Vascular Resistance ; Vasoplegia ; Vasopressins

In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist.The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of “no-touch time,” circulatory death was declared.Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.

In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist.The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of “no-touch time,” circulatory death was declared.Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.

The Korean Triage and Acuity Scale (KTAS) Committee under the Korean Society of Emergency Medicine developed a Korean pre-hospital emergency patient classification tool (Pre-hospital Korean Triage and Acuity Scale [Pre-KTAS]) under contract from the Ministry of Health and Welfare, Korea. The classification tool was developed separately for adults and children. The patient’ s emergency level is classified into five distinct levels and is the same as the KTAS classification system, which is a hospital-level emergency patient classification tool.

OBJECTIVE: It was suggested that the cause of microalbuminuria is heterogeneous in NIDDM. However, only a few studies are available that investigated the renal pathology in NIDDM patients with microalbuminuria. This study was undertaken to evaluate renal pathology in Korean NIDDM patients with microalbuminuria. METHODS: Fifty NIDDM patients with microalbuminuria and without retinopathy were undertaken renal biopsy. Renal pathologic findings were classified as follows: group A, near-normal finding; group B, typical diabetic nephropathology; group C, atypical patterns of renal injury (mild glomerular change with disproportionally severe tubulointerstitial lesion, arteriolar hyalinosis or global glomerular sclerosis); group D, non-diabetic renal lesion. RESULTS: Seventeen patients were classified into group A, 19 into group B and 8 into group C. Six patients had non-diabetic renal lesions and they were all confirmed to be IgA nephropathy. Fasting blood sugar and GFR were significantly higher in group B than in group A and group C respectively, and systolic blood pressure was higher in group C than in group A. CONCLUSION: Renal pathology in microalbuminuric NIDDM patients without retinopathy was heterogeneous. This may explain heterogeneous clinical meaning of microalbuminuria in NIDDM.
Biopsy ; Blood Glucose ; Blood Pressure ; Diabetes Mellitus, Type 2* ; Fasting ; Glomerulonephritis, IGA ; Humans ; Pathology* ; Population Characteristics*

BACKGROUND: Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described. METHODS: Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests. RESULTS: All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure. CONCLUSIONS: C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.
Anti-Bacterial Agents ; Biopsy ; Cholangitis ; Coxiella burnetii ; Eosinophils ; Fever ; Fibrin ; Granuloma ; Hepatitis ; Humans ; Hyperbilirubinemia ; Liver ; Q Fever

BACKGROUND: Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described. METHODS: Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests. RESULTS: All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure. CONCLUSIONS: C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.
Anti-Bacterial Agents ; Biopsy ; Cholangitis ; Coxiella burnetii ; Eosinophils ; Fever ; Fibrin ; Granuloma ; Hepatitis ; Humans ; Hyperbilirubinemia ; Liver ; Q Fever

Actinomycosis is a chronic, slowly progressive, and suppurative disease caused by filamentous anaerobic bacteria Actinomyces, which results in characteristic sulfur granules. Clinically, actinomycosis can present with a mass-like lesion, and this bacterial nidus has been frequently mistaken for a malignancy. For that reason many patients undergo surgical resection before the correct diagnosis is established. We report a case of a 63-year-old man with a solitary, asymptomatic pancreatic actinomycosis that masqueraded as pancreatic cancer. He did not have any other concurrently infected organs and did not have any signs or symptoms of infection. All radiologic images of the patient favored a malignancy to a great extent rather than an inflammatory mass. He was finally diagnosed with actinomycosis by endoscopic ultrasound (EUS)-guided fine needle aspiration biopsy without surgery. After one month of treatment with antibiotics, the pancreatic head mass was completely resolved on the follow-up computed tomography (CT).
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Bacteria, Anaerobic ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Middle Aged ; Pancreas ; Pancreatic Neoplasms* ; Sulfur ; Ultrasonography

Collagenous gastritis (CG) is a rare disorder that is characterized by the presence of a thick subepithelial collagen band with multiple infiltrated inflammatory cells of the gastric mucosa. CG is divided into two major subsets: first, in children and young adults presenting with severe anemia and abdominal colic pain (pediatric-type CG); and second, in adult patients with chronic watery diarrhea associated with collagenous colitis (adult-type CG). We report two cases of pediatric-type CG, each presenting with refractory anemia and chronic diarrhea.
Adult ; Anemia ; Anemia, Iron-Deficiency ; Anemia, Refractory ; Child ; Colic ; Colitis, Collagenous ; Collagen ; Diarrhea ; Gastric Mucosa ; Gastritis ; Humans ; Iron ; Young Adult