Bone marrow transplantation has become an accepted treatment for malignancy(particulary leukemia and lymphoma), aplastic anemia, and certain inborn errors of metabolism. In addition to the problem of severe, prolonged myelosuppression, bone marrow transplantation is associated with several unusual complications. Among the complications such as GVHD, graft rejection, interstitial pneumonia and veno-occlusive disease, involvement of the gastrointestinal tract by GVHD is associated with high graft failure and mortality. Intestinal GVHD is usually manifest clinically as voluminous secretory diarrhea accompanied by abdominal cramping, ileus, nutritional depletion, and, at times, hemorrhage. We experienced a case of severe intestinal GVHD after allogeneic marrow transplantation for treatment of severe aplastic anemia. He received bone marrow from his elder sister, HLA-matched multiparous woman and suffered from large amount of watery diarrhea with skin rash 34 days after transplantation. 1n spite of prednisolone therapy the symptom was progressed. After sigmoidoscopic mucosal biopsy, intestinal GVHD was confirmed and we tried methylprednisolone pulse therapy. Skin lesion was improved but the amount of diarrhea was increased with intermittent abdominal cramping. We tried ALG(anti-lymphocyte globulin) and conservative management but the patient did not respond the therapy. He succumbed to pneumonia and acute respiratory insufficiency complicated with GVHD, 70days after transplantation.
Anemia, Aplastic* ; Biopsy ; Bone Marrow Transplantation* ; Bone Marrow* ; Colic ; Diarrhea ; Exanthema ; Female ; Gastrointestinal Tract ; Graft Rejection ; Hemorrhage ; Humans ; Ileus ; Leukemia ; Lung Diseases, Interstitial ; Metabolism, Inborn Errors ; Methylprednisolone ; Mortality ; Pneumonia ; Prednisolone ; Respiratory Insufficiency ; Siblings ; Skin ; Transplants

PURPOSE: Dendritic cells (DCs) are considered the most professional antigen-presenting cells (APCs) because of their unique role in initiating immunity against threatening antigens. Recently, hypertonicity has been suggested to be involved in the activation and development of immune cells such as T cells. And tonicity enhancer binding protein (TonEBP) has been thought to play a pivotal role in this process. Here, we studied the maturation status of DCs and expression of TonEBP in DCs exposed to hypertonic condition. METHODS: Murine bone marrow-derived DCs were generated in the presence of GM-CSF for 6 days, and then exposed to hypertonic media. We evaluated the functional capacities and maturation of DCs using flow cytometry, mixed lymphocyte reaction, and cytokine analysis. Also we investigated the expression of TonEBP in DCs cultured in variable hypertonic media. RESULTS: Mild hypertonicity made CD11c+ DCs to have up-regulation of CD40, 80, and 86. DCs exposed to 320 mOsm/kg media stimulated allogeneic T cell proliferation most effectively compared to DCs exposed to other tonic conditions. However, DCs exposed to 400 mOsm/kg media showed similar stimulatory capacities to isotonic control. Consistent with the phenotype changes, IL-1, 6, and TNF-alpha secretion increased in CD11c+ DCs exposed to mild hypertonic condition. Though we confirmed that TonEBP was expressed in CD11c+ DCs, the amount of upregulation was not dependent on the degree of hypertonicity. CONCLUSION: Our results suggest that hypertonicity enhances the maturation and activation of DCs.
Antigen-Presenting Cells ; Carrier Proteins ; Cell Proliferation ; Dendritic Cells ; Flow Cytometry ; Granulocyte-Macrophage Colony-Stimulating Factor ; Interleukin-1 ; Lymphocyte Culture Test, Mixed ; Osmolar Concentration ; Phenotype ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; Up-Regulation

BACKGROUND: Prediction of therapeutic response to radioactive iodine (RAI) in Graves disease is poorly understood. Although thyrotropin binding inhibitor immunoglobulin (TBII) level is a strong index for relapse after antithyroid drug treatment, conflicting results are described regarding its prognostic significance in Graves disease treated with RAI. This study is to evaluate possible prognostic factors including TBII wbich affect the outcome of RAI therapy in Graves disease. METHODS: Two hundred and one patients with Graves disease who were followed for over 12 months after RAI treatment were studied retrospectively. The subjects were divided into hypothyroid, euthyroid and hyperthyroid groups, based on the thyroid function evaluated at 12 months after RAI therapy. We evaluated the association of clinical parameters including patients age, goiter size, degree of hyperthyroidism and TBII index with outcome of RAI treatment. RESULTS: In Graves disease, response rate to RAI was 70.1% (hypothyroid 22.4% and euthyroid 47.7%) until 12th month. The mean age of hypothyroid group was 40+/-11 years, significantly older than that other groups (euthyroid: 33+/-12, hyperthyroid: 35+/-13, p<0.05). Initial level of thyroid function, duration of antithyroid drug treatment prior to RAI, goiter size and dosage of RAI were not significantly different between the groups. There were 61 patients who had both TBII tests before and after RAI. Twelve had negative TBII and 49 had positive TBII before RAI admini-stration. The rate of unremitted hyperthyroidism after RAI therapy was significantly lower in patients with negative TBII than in those with positive TBII prior to RAI treatment( 0% versus 46.9%, p<0.05). CONCLUSION: Graves patients with positive TBII prior to RAI therapy were associated with lower therapeutic response to RAI than those with negatve TBII. And old age was associated with the development of early hypothyroidism after RAI therapy. These results suggest these factors be also considered in the treatment of Graves disease with RAI.
Goiter ; Graves Disease* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Immunoglobulins ; Iodine* ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyrotropin

Autoimmune hepatitis (AIH) is a chronic, autoimmune disease of the liver that occurs when the body’s immune system attacks liver cells, causing the liver to be inflamed. AIH is one of the manifestations of a coronavirus disease 2019 (COVID-19), as well as an adverse event occurring after vaccination against severe acute respiratory syndrome coronavirus 2 (SARSCoV-2). Few cases of AIH have been described after vaccination with two messenger RNA (mRNA)-based vaccines—BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)—against SARS-CoV-2. Herein, we report a case of AIH occurring after Pfizer-BioNTech COVID-19 vaccine. A 27-year-old female presented with jaundice and hepatomegaly, appearing 14 days after receiving the second dose of Pfizer-BioNTech vaccine. Her laboratory results showed abnormal liver function with high total immunoglobulin G level. She was diagnosed with AIH with histologic finding and successfully treated with oral prednisolone. We report an AIH case after COVID-19 vaccination in Korea.

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.
Male ; Humans ; Biopsy

No abstract available.
Female ; Gonadotropin-Releasing Hormone* ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*

Actinomycosis is a chronic suppurative and granulomatous-disease caused by Actinomycosis israelli. Clinical presentation of the abdominal form of actinomycosis is nonspecific-pain, fever, leukocytosis, increased erythrocyte sedimentation rate, a sensation of abdominal mass and a formation of fistula. In addition, abdominal actinomycosis may mimic a carcinoma, diverticular abscess, inflammatory bowel disease, and tuberculosis. Most of abdominal actinomycosis develops after trauma, appendicitis, diverticulitis or gastrointestinal perforation. We report a case of abdominal actinomycosis preoperatively mimicking as colon carcinoma, which had no predisposing factors.
Abscess ; Actinomycosis* ; Appendicitis ; Blood Sedimentation ; Causality ; Colon* ; Diverticulitis ; Fever ; Fistula ; Inflammatory Bowel Diseases ; Leukocytosis ; Sensation ; Tuberculosis

The aim of this study was to evaluate the efficacy of clinical strategies to reduce nosocomial sepsis (NS) in extremely low birth weight infants (ELBWI) less than 1,000 g. Data from the period before (P1, 1995-2000) and after (P2, 2001-2002) implementation of the strategies were collected and analyzed. The intervention strategies included restriction of antibiotic therapy, less use of invasive procedures such as umbilical vessel catheterization and endotracheal intubation, establishment of guidelines for hand-washing, infant handling, and central intravascular line management. NS was defined as positive blood cultures in symptomatic patients after the third day of life with the use of antibiotics for more than 5 days. Although the gestational age (GA) and birth weight (BW) were significantly lower in P2 (GA 26.7 +/-2.1 wk; BW 796 +/-130 g) compared to P1 (GA 27.2 +/-1.6 wk; BW 857 +/-121 g), the incidence of NS decreased significantly from 70% (69/99) in P1 to 17% (24/71) in P2 with the implementation of the intervention strategies. The coagulase negative Staphylococcus infection was also significantly reduced from 34% in P1 to 11% in P2. The implementation of the clinical strategies was quite effective in reducing the incidence of NS in ELBWI.
Cross Infection/*prevention & control ; Female ; Humans ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Male ; Sepsis/*prevention & control

OBJECTIVE: To evaluate patients with adnexal masses that were managed surgically during pregnancy and their effect on fetal outcome. METHODS: The data were reviewed concerning pregnant women who required surgery at Samsung Cheil hospital between January 1996 to December 2001. Among 50,126 deliveries, 255 cases of ovarian tumors were evaluated for clinical aspects, histologic patterns, and obstetrics and fetal outcome. RESULTS: 1. The prevalence of ovarian mass in pregnancy was 0.5% (255 cases in 50,126 deliveries). 14 cases of malignant tumors were founded. 2. The maternal mean age was 28.7+/-3.6 years old, mean gavida was 1.8+/-1.1, and mean parity was 0.3+/-0.5. 3. The mean gestational weeks of diagnosis was 11.9+/-8.6 weeks. Prenatal operations were performed in 160 cases, and 95 cases of ovarian masses were operated at delivery time by cesarean section. 4. In the group of prenatal operation, preterm delivery and caesarian section rate were decreased at operation before 23 gestational weeks (P<0.05). 5. In 42 cases, Emergency operations were done. Mean delivery weeks was 36.7+/-7.2 weeks and was earlier than elective operation group (P<0.05). 6. The mean size of ovarian mass was 9.5+/-3.8 cm. The pathologic features of the 255 lesions were as follows: 98 benign cystic teratomas, 43 mucinous cystadenomas, 31 endometriomas, 20 serous cystadenomas, 14 simple cysts, 14 paraovarian cysts, 6 follicular cysts, 5 corpus luteal cysts, 5 theca luteal cysts, 3 hydrosalpinx, 2 fibromas, and 14 malignant tumors. 7. The 231 patients for whom the outcome of pregnancy was available, 18 (7%) gave birth before 37 weeks of gestation, while 3 (1.2%) experienced spontaneous abortions, 2 artificial abortions, and 1 hysterotomy. CONCLUSION: Most adnexal masses identified by sonography during pregnancy were small, simple cysts that did not pose a risk a pregnancy. However the percentage of malignant tumors or tumors of low malignant potential was 1.8 fold greater than previously reported. Surgical intervention at <23 weeks of gestation might have not been adverse outcomes.
Abortion, Spontaneous ; Cesarean Section ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis ; Emergencies ; Endometriosis ; Female ; Fibroma ; Follicular Cyst ; Humans ; Hysterotomy ; Obstetrics ; Parity ; Parturition ; Pregnancy* ; Pregnant Women ; Prevalence ; Teratoma

We performed this study to compared pregnancy outcome between low dose aspirin alone and aspirin plus prednisolone treatment in patient of recurrent spontaneous abortion associated with antiphospholipid antibodies. From May 1994 to March 1996, forty-two patients of recurrent spontaneous abortion associated with antiphospholipid antibodies were randomized to receive either low dose aspirin alone(LDA group, n=21) or aspirin plus prednisolone(AP group, n= 21). When pregnancy was confirmed, women were stared with 100mg of aspirin oral daily until 29 weeks of gestation and thereafter 50 mg daily until 35 weeks of gestation in LDA group. In AP group, aspirin administration was same as LDA group and prednisolone was administrated 30 mg oral daily until 24 weeks of gestation and thereafter 10 mg daily until 35 weeks of gestation. Lupus anticoagulant(LAC) was positive in 15 patients, anticardiolipin antibody (ACL) was positive in 24 patients, and both were positive in 3 patients. There was not significant difference in the rate of spontaneous abortion between LDA and AP group[7/21(33.3%) vs 3.21(14.3%)]. There was also no significant difference in live birth rate between LDA and AP groups[14/21(66.7%) vs 18/21(85.7%)]. In LAC positive patients, there was lower rate of live birth in LDA group than in AP group, but not significantly different[4/8(50.0%) vs 6/7(85.7 %)]. In ACL positive patients, there was no significant difference in live birth rate between LDA and AP groups[10/12(83.3%) vs 11/12(91.7%)]. In the case of both LAC and ACL positive patients, there was also no significant difference in live birth rate between LDA and AP group [0/1(0.0%) vs 1/2(50.0%)]. There were no significant difference in mean gestational age and mean fetal body weight at delivery between LDA and AP groups(35.5+/-3.0 vs 36.7+/-2.5 wks, 2546.0+/-685.9 vs 2693.3+/-683.6 gm). There were also no significant difference in the rate of cesarean section due to fetal distress, the rate of Apgar score less than 7 at 5 minutes, the rate of admission to neonatal intensive care unit, and the rate of perinatal mortality between two groups. There was no congenital anomalous fetuses in all study patients. We found that combined treatment of aspirin plus predinisolone might be potentially more effective than low dose aspirin alone in patients of recurrent spontaneous abortion associated with antiphospholipid antibodies, especially in patients of LAC positive.
Abortion, Spontaneous* ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid* ; Apgar Score ; Aspirin* ; Cesarean Section ; Female ; Fetal Distress ; Fetal Weight ; Fetus ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Live Birth ; Perinatal Mortality ; Prednisolone* ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*