A new species of Acanthamoeba was isolated from a freshwater fish in Korea and tentatively named Acanthamoeba sp. YM-4 (Korean isolate YM-4). The trophozoites were 11.0-23.0 micrometer in length and had hyaline filamentous projections. Cysts were similar to those of A. culbertsoni and A. royreba, which were previously designated as Acanthamoeba group III. Acanthamoeba YM-4 can survive at 40 degrees C, and its generation time was 19.6 hr, which was longer than that of A. culbertsoni. In terms of the in vitro cytotoxicity of lysates, Acanthamoeba YM-4 was weaker than A. culbertsoni, but stronger than A. polyphaga. On the basis of the mortality of experimentally infected mice, Acanthamoeba YM-4 was found to be highly virulent. The isoenzymes profile of Acanthamoeba YM-4 was similar to that of A. royreba. An anti-Acanthamoeba YM-4 monoclonal antibody, McAY7, was found to react only with Acanthamoeba YM-4, and not with A. culbertsoni. Random amplified polymorphic DNA marker analysis and RFLP analysis of mitochondrial DNA and of 18S small subunit ribosomal RNA, placed Acanthamoeba YM-4 in a separate cluster on the basis of phylogenetic distances. Thus the Acanthamoeba Korean isolate YM-4 was identified as a new species, and assigned as Acanthamoeba sohi.
Acanthamoeba/*classification/genetics/isolation & purification/*pathogenicity ; Amebiasis/parasitology/*veterinary ; Animals ; DNA, Mitochondrial/analysis ; DNA, Protozoan/analysis ; Fish Diseases/*parasitology ; Gills/parasitology ; Goldfish/*parasitology ; Korea ; Mice ; Phylogeny ; Polymorphism, Restriction Fragment Length ; RNA, Ribosomal, 18S/genetics ; Random Amplified Polymorphic DNA Technique ; Virulence

Acanthamoeba and Naegleria are widely distributed in fresh water, soil and dust throughout the world, and cause meningoencephalitis or keratoconjunctivitis in humans and other mammals. Korean isolates, namely, Naegleria sp. YM-1 and Acanthamoeba sp. YM-2, YM-3, YM-4, YM-5, YM-6 and YM-7, were collected from sewage, water puddles, a storage reservoir, the gills of a fresh water fish, and by corneal washing. These isolates were categorized into three groups based on the mortalities of infected mice namely, highly virulent (YM-4), moderately virulent (YM-2, YM-5 and YM-7) and nonpathogenic (YM-3). In addition, a new species of Acanthamoeba was isolated from a freshwater fish in Korea and tentatively named Korean isolate YM-4. The morphologic characters of its cysts were similar to those of A. culbertsoni and A. royreba, which were previously designated as Acanthamoeba group III. Based on experimentally infected mouse mortality, Acanthamoeba YM-4 was highly virulent. The isoenzymes profile of Acanthamoeba YM-4 was similar to that of A. royreba. Moreover, an anti-Acanthamoeba YM-4 monoclonal antibody reacted only with Acanthamoeba YM-4, and not with A. culbertsoni. Random amplified polymorphic DNA marker analysis and RFLP analysis of mitochondrial DNA and of a 18S small subunit ribosomal RNA, placed Acanthamoeba YM-4 in a separate cluster based on phylogenic distances. Thus Acanthamoeba YM-4 was identified as a new species, and assigned Acanthamoeba sohi. Up to the year 2002 in Korea, two clinical cases were found to be infected with Acanthamoeba spp. These patients died of meningoencephalitis. In addition, one case of Acanthamoeba pneumonia with an immunodeficient status was reported and Acanthamoeba was detected in several cases of chronic relapsing corneal ulcer, chronic conjunctivitis, and keratitis.
*Acanthamoeba/classification/genetics/immunology/pathogenicity ; Amebiasis/diagnosis/epidemiology/*parasitology/therapy ; Animals ; Antigens, Protozoan/analysis/genetics/immunology ; DNA, Mitochondrial/analysis ; DNA, Protozoan/analysis ; Korea/epidemiology ; Life Cycle Stages ; *Naegleria/classification/genetics/immunology/pathogenicity ; Phylogeny ; Polymorphism, Restriction Fragment Length ; Random Amplified Polymorphic DNA Technique/veterinary ; Virulence/genetics

No abstract available.
Humans ; Multiple Birth Offspring ; Twins*

PURPOSE: We investigated serum levels of MTX and accompanying organic toxicities after administration of High-Dose Methotrexate (HDMTX). METHODS: We reviewed a total of 42 courses of HDMTX administration in 6 patients who were diagnosed with osteosarcoma in Hanyang University Hospital from 1993 to 1997. The HDMTX was infused at the doses of 8~12 g/m2, and serum levels were assessed. Leucovorin administration was started 20 hours from the beginning of MTX infusion, and continued until the serum MTX level is below 1x10-7 mol/L and toxicities are not detectable. RESULTS: Of 6 patients (4 males and 2 females), mean age at diagnosis was 11.6 years (8.5~15.6 years). Sites of origin included distal femur in 3, proximal tibia in 1, proximal fibula in 1 and proximal humerus in 1. Serum MTX levels were 1.87+/-0.69x10-4 mol/L at 12~23 hours, and 5.10+/-3.22x10-8 mol/L at 120 hrs after HDMTX infusion. Of 42 courses, hematologic toxicity greater than grade III was observed in 19(45.2%) resulting reduction of dose in 2 patients, and hepatic toxicity greater than grade III in 28(67%). The mean ALT levels was 680+/-563 U in 1st day, and mostly normalized in 10th day. Stomatitis was generally mild, except 1 patient with grade III toxicity. No renal or neurologic toxicity was observed, except 1 seizure episode due to SIADH. CONCLUSION: HDMTX with leucovorin in osteosarcoma was well tolerated, and in majority of courses, serum MTX levels returned to non-toxic level after 120 hours and leucovorin will be desirable to administer during at least 5 days.
Child* ; Diagnosis ; Femur ; Fibula ; Humans ; Humerus ; Inappropriate ADH Syndrome ; Leucovorin ; Male ; Methotrexate* ; Osteosarcoma* ; Seizures ; Stomatitis ; Tibia

PURPOSE: The purpose of this study was to evaluate the spontaneous remission rate in children with chronic ITP. METHODS: The medical records of 21 patients diagnosed with chronic ITP and followed for at least 6 months at Hanyang University Hospital between Mar. 1985 and Feb. 1997 were reviewed. Complete remission(CR) was defined as a recovery of platelet count of more than 100x109/L and partial remission(PR) was defined as a recovery of platelet count of 50-100x109/L, maintained for at least 6 months. RESULTS: Of 21 patients, 9 boys and 12 girls, the mean age at diagnosis was 5.5 years (0.4~15.5 years). The mean platelet count at diagnosis was 26.5x109/L(2-86x109/L). Of 21 patients, 5 with persistent thrombocytopenia and severe bleeding tendency underwent splenectomy. With a median follow up of 39.5 months after splenectomy, 4 achieved CR. The time to CR of the 4 patients were 2 weeks, 13.6, 18.6, 31.0 months, respectively. Of 16 patients, excluding 5 splenectomized children, 6 achieved CR and 4 PR. With a median follow-up of 21 months, the predicted spontaneous CR and PR rate at 5 years were 37.5%, and 68.7%, respectively(The percentage of PR includes that for CR). No serious complications including ICH or death were observed. CONCLUSION: Our study indicates that many cases of chronic ITP in childhood may remit without therapy even several years from onset. Splenectomy should be delayed as long as possible and reserved for the symptomatic and severely thrombocytopenic patient.
Child ; Diagnosis ; Female ; Follow-Up Studies* ; Hemorrhage ; Humans ; Medical Records ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Remission, Spontaneous ; Splenectomy ; Thrombocytopenia

BACKGROUND: The purpose of our investigation was to evalute response to therapy and prognosis according to clinical and pathologic stage. METHODS: Fourteen children who had LCH were diagnosed between Jan., 1987 and Dec., 1996. Of the 14 patients, 3 patients with only skin involvement were excluded from this study. The medical records of 11 patients were reviewed for organ involvement at diagnosis, treatment, disease course, and late sequelae. Results: 1) As for the clinical stages, 4 patients were in stage I, 4 in stage II, one in stage III, and 2 in stage IV. As for the pathologic stages, four had monostotic disease, 2 polyostotic disease and 5 multisystemic disease. 2) All six patients with monostotic and polyostotic disease had a complete response to the therapy and remain alive free of disease. Three of the five with multisystemic disease had a complete response to the therapy, while two had a progression of disease. 3) Sequelae were observed in 3 patients including 2 with diabetes insipidus and 1 with hepatic and pulmonary dysfunctions. 4) The median follow-up time from diagnosis for all patients was 3.5 years. The Kaplan-Meier estimate of survival rate is 91%, with estimated EFS of 81.8% at 5 years. CONCLUSION: The clinical outcome of LCH patients with single system involvement including monostotic and polyostotic diseases were favorable and all remains alive free of disease. Multisystemic disease was associated with several unfavorable prognostic features including diagnosis at age <2 year, dysfunction of involved organs and advanced clinical stage.
Child ; Diabetes Insipidus ; Diagnosis ; Follow-Up Studies ; Histiocytosis* ; Humans ; Kaplan-Meier Estimate ; Medical Records ; Prognosis ; Skin ; Survival Rate

Fractures significantly involving the weight-bearing articular surface and the overlying metaphysis of the distal tibia have deserved notoriety as a severe and challenging subject of ankle injuries. It was not until 1963 that the AO group developed principles for open reduction and internal fixation of pilon fracture. But recently, limited internal fixation of the joint surface combined with external fixation may avoid the soft tissue complications associated with formal open reduction and internal fixation. We have treated 22 cases of tibial pilon fracture with biologic principle. The mean follow-up period was two years ranging from one to three years. According to the Riiedi and Allgower classification, three cases were type I, five cases were type II, and fourteen cases were type III Biologic treatment includes combination of internal and external fixation, external fixation alone, or plating was done with careful soft tissue dissection, limited stripping of fracture fragments, and indirect reduction technique. Radiographic results were assessed by Burwell and Charnley criteria. Three cases of type I, three cases of type II and seven cases of type III pilon fractures obtained good anatomic radiographic results. We also assessed the functional results by Mast and Teipner criteria. Three cases of type I, three cases of type II, six cases of type III pilon fractures obtained good functional outcome. We believed that combination of internal and external fixation provides the patient who has a markedly displaced pilon fracture and diaphyseal comminution with the best chance of good clinical result and minimal risks. As such, we believe biologic treatment is excellent for these injuries.
Ankle Injuries ; Classification ; Follow-Up Studies ; Humans ; Joints ; Tibia ; Weight-Bearing

Osteoid Osteoma occurs anywhere in skeleton. They are most common in lower extremity, particularly femur about 40%. Two-thirds of femoral lesions is in the intertrochanter or intracapsular regions of the hip. The lesion is usually cortical and may extend into the periosteal or endosteal surface of the bone. It is rare in the cancellous bone. We experienced a case of osteoid osteoma in intertrochanteric cancellous portion of the femur in 50 year old man. Many complained right hip pain worsend three weeks before his visit. Radiograph shows sclerosis around a lucent nidus in cancellous portion. The lesion did not extend to the endosteal surface. We have removed nidus and surrounding reactive portion completely with curettage. Follow up radiographic results after 20 weeks, showed no evidence of recurrence.
Adult* ; Curettage ; Femur* ; Follow-Up Studies ; Hip ; Humans ; Lower Extremity ; Middle Aged ; Osteoma, Osteoid* ; Recurrence ; Sclerosis ; Skeleton

No abstract available.
Leukemia, Myeloid, Acute*

The purpose of this study is to evaluate the ventricular conduction abnormalities, especially RBBB, observed electrocardiographically after surgical closure of VSD. The present study population consists of 92 patients with VSD who were surgically corrected at the Hanyang University Hospital during 6 years period from Jan. 1985 to Dec. 1990. We reviewed their clinical records including surgical notes and EKG findings before and after operations. The results of the study were as follows: 1) Male to female ratio was 1.1:1 (48:44) 2) Out of a total of 92 cases of VSD, 65cases(70.7%)were perimembranous type and 27 cases (29.3%)were subarterial type. 3) The normal preoperative EKG findings were seen in 22 patients, LVH in 21 patients, BUH in 47patients, and RVH in 3 patiens. 4) A transatrial approach was performed in 55 cases, right ventriculotomy with or without resection of muscles in right ventricle in 13 cases, and pulmonary arteriotomy alone in 24 cases. 5) The right bundle branch block after operation developed in 33 patients out of the 65 patinets with perimembranous defect and 5 patients out of the 27 patients with subarterial defects. Postoperative RBBB developed more frequently in perimembranous defect than in subarterial defect. 6) Postoperative RBBB occured in 31.8% of the patients with normal preoperative EKG findings, 23.8% with preoperative LVH, 52.1% with BVH and 66.7% with RVH. Postoperative RBBB was more frequently observed in the patients group with preoperative BVH or RVH than the patients with normal or LVH. 7) Postoperative RBBB was observed in 84.6% after right wentriculotomy, in 43.6% after right atriotomy and in 12.5% with pulmonary arteriotomy alone.
Bundle-Branch Block* ; Electrocardiography ; Female ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Male ; Muscles