BACKGROUND: The differential diagnosis of clonal and reactive thrombocytosis is clinically relevant because course and treatment are different between them. Several clinical assessments and laboratory tests (degree of such as splenomegaly, duration and degree of thrombocytosis, bone marrow study, cytogenetic study, and platelet function test) are less discriminative, invasive and not commonly available. Therefore, a well discriminative, simple and convenient diagnositic assay is needed. Recently animal experiments demonstrated that recombinant IL-6 administration increased platelets counts by stimulating megakaryocyte maturation and increased hepatic CRP synthesis. So, in this study, we evaluated the usefulness of measurements of IL-6 and CRP levels to distinguish reactive thrombocytosis from clonal thrombocytosis. METHODS: Included in this study were 88 patients with marked thromobocytosis (>600 x10(9)/L) at Asan Medical Center between September, 1995 and March, 1996. The cause of thrombocytosis was determined by reviewing the medical histories. Sixteen patients had clonal thrombocytosis and 72 patients had reactive thrombocytosis. IL-6 was measured by ELISA (Quantikine(TM), R&D system, Inc., Minneapolis, USA) and CRP was assayed by rate immunonephelometry (Array 360 system, Beckman Instruments Inc., USA). RESULTS: The patients with reactive thrombocytosis had significantly higher plasma levels of IL-6 and CRP than patients with clonal thrombocytosis (p<0.01, p<0.001). In 98.6% (71/72) of the patients with reactive thromobocytosis, levels of either IL-6 or CRP were elevated, and 43.8% (7/16) of the patients with clonal thrombocytosis had both IL-6 and CRP in normal range. Of 9 patients with clonal thrombocytosis (56.2%) whose levels of either IL-6 or CRP increased, 7 patients had concomitant acute phase reaction such as infection or post operative status. There was significant correlation between IL-6 and CRP levels (r2=0.4, p<0.0001). CONCLUSION: Elevated levels of either IL-6 or CRP were consistent with reactive thrombocytosis and normal ranges of those suggested clonal thrombocytosis. So measurement of plasma IL-6 and CRP levels is a useful marker for differential diagnosis of clonal and reactive thrombocytosis. For the patients with clonal thrombocytosis who had concomitant acute phase reaction, serial measurements are recommended.
Acute-Phase Reaction ; Animal Experimentation ; Blood Platelets ; Bone Marrow ; C-Reactive Protein* ; Chungcheongnam-do ; Cytogenetics ; Diagnosis, Differential* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-6* ; Megakaryocytes ; Plasma* ; Reference Values ; Splenomegaly ; Thrombocytosis*

No abstract available.
Aged* ; Erythrocyte Indices* ; Humans ; Korea*

The cliniopathological analysis was done on the 104 cases of malignant melanoma diagnosed at the Seoul National University Hospital (SNUH) from 1984 to 1993. The basic clinical data and the pathological items were based on the New Mexico Melanoma Registry Worksheet. The results were as follows. The male to female ratio was 1 : 0.79. Primary cutaneous melanoma was more common in the male (M : F=1 : 0.56) but primary extracutaneous melanoma with slight female dominancy (M : F=1 : 1.25). The peak age was the 6th decade in both cutaneous and extracutaneous malignant melanoma. In 66% (35 cases) of primary cutaneous malignant melanoma, the primary site was located in the acral area (including cases of acral lentiginous and nodular type), of which 63% (41% of total cutaneous melanoma) was acral lentiginous type. Major components of tumor cells were epithelioid. Clark's level of tumor was III or more at the time of the first visit in the majority of the cases (85%). The incidence rate of extracutaneous melanoma was 34.6% (36 cases) among the primary melanoma, and the eyeball (17.3%) was the most prevalent organ. All these features suggest that the racial difference between the Korean and the Caucasian is evident and also that etiologic role of sun damage is not quite marked in the Korean. We also suggest that an early detection program is very important to cure this malignant tumor.
Female ; Humans ; Incidence ; Male ; Melanoma* ; New Mexico ; Seoul ; Solar System

No abstract available.
Cytomegalovirus Infections*

The fatty hamartoma of pericardium is characterized by abnormal accumulations of adipose tissue forming a recognizable mass. We reported a case that could best be put into "fatty hamartoma" group. This 66 year old male presented with atrial fibrillation came in for a anterior mediastinal mass. He received an operation for adenocarcinoma of ascending colon several months ago. The chest CT revealed an inhomogeneous mass in the right anterior mediastinal area, which was not clearly demarcated from the right cardiac border. The heart was deviated to the left side due to the mass. Surgical excision was performed under the impression of cardiac teratoma. The large mass was well encapsulated, and was bright yellow and partly pink, and measured 12x8 cm. Microscopically, the mass consisted predominantly of mature fat cells and abundant fibrous tissue with scattered nests of primitive cardiac muscle cells. Reviewing the literature we found the term "fatty hamartoma" could also refer to rhabdomyolipoma or fibrolipoma. Since it contains entrapped cardiac muscle cells, abundant fibrous tissue, multiple blood vessels and fetal fat cells, it could best the categorized into "hamartoma". The term "fatty" represents it's main component. Therefore we propose the term "fatty hamartoma" that could to be used further.
Male ; Humans ; Adenocarcinoma ; Hamartoma

PURPOSE: To present a case of brain abscess formation accompanied by improvement of orbital cellulitis. CASE SUMMARY: A 54-year-old male came to our clinic complaining of swelling and pain of the left periorbital area and decreased visual acuity (VA) of the left eye. Initial best-corrected visual acuity (BCVA) was 0.3 and intraocular pressure was 27 mmHg in the left eye. Eye movement in all directions was restricted and 4 mm of proptosis was observed in the left eye. An orbital CT scan demonstrated pansinusitis and orbital cellulitis of the left eye. The patient underwent endoscopic sinus surgery and was treated with systemic antibiotics. However, periorbital swelling was aggravated and another orbital CT scan was performed and analyzed. The CT scan showed localized periorbital abscess of the left eye, and the authors performed an incision and drainage (I&D) of abscess procedure. After the operation, BCVA of the left eye was recovered to 0.8 and eye movement improved and periorbital swelling decreased. However, 15 days after the I&D, the patient complained of a severe headache. Brain magnetic resonance imaging (MRI) was performed and showed an abscess of the left frontal lobe of the brain. The authors consulted with a neurosurgeon, and the patient received intravenous antibiotics and mannitol. The headache steadily decreased, and three months after the first visit, a follow-up brain MRI was performed. The MRI showed almost complete disappearance of the abscess and six months after the first visit, BCVA was recovered to 1.0 and eye movement was full in all directions. CONCLUSIONS: Although orbital cellulitis is improved by treatment of antibiotics and surgery, if the patient complains of neurologic symptoms such as headache, other complications such as brain abscess formation should be considered.
Abscess ; Anti-Bacterial Agents ; Brain ; Brain Abscess ; Drainage ; Exophthalmos ; Eye ; Eye Movements ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Intraocular Pressure ; Magnetic Resonance Imaging ; Male ; Mannitol ; Middle Aged ; Neurologic Manifestations ; Orbit ; Orbital Cellulitis ; Porphyrins ; Sinusitis ; Visual Acuity

Angioimmunoblastic lymphadenopathy (AILD) is a systemic disease clinically characterized by fever, generalized lymphadenopathy, hepatosplenomegaly, polyclonal gamma-globulinemia and Cooms' positive hemolytic anemia. The lymph node in AILD reveals a polymorphic feature consisting of a proliferation of small vessels, immunoblasts and plasma cells and acidophilic interstitial material. Progression into immunoblastic sarcoma is reported as high 35% of the patient with AILD. Nathwani et al have observed not only malignant transformation of AILD in sequential tissue examination, but also the coexistence of AILD and immunoblastic lymphoma in the same lymph node or at different sites in the same patient. Multiple clusters or islands of compactly arranged large lymphoid cells constitute the initial histologic evidence of immunoblastic sarcoma. Immunoblastic sarcoma is a large cell lymphoma conceptually related to transformed T-and B-lymphocytes of the extrafollicular compartment of the immune system, which proignosis is poor. We have recently experienced a case of immuno blastic sarcoma arising in angioimmunoblastic lymphadenopathy in a 24-year-old woman. She had history of multiple enlarged lymph nodes in the inguinal, axilla and supraclavicular areas. Previous lymph node biopsies revealed reactive change. Six month later, right axillary lymph node biopsy reveled AILD with focal clusters of immunoblasts. Subsequent lymph node biopsy at the same site revealed diffuse immunoblasic sarcoma, B-cell type. A case presentation with histologic findings and a brief review of literature were done.
Female ; Humans ; Biopsy

BACKGROUND: Many studies suggest that point mutations of ras oncogene develop tumors. The advantages of body fluid analysis are easy accessibility and more simple procedure than tissue specimen. So, we investigated the incidence of K-ras codon 12 mutation in body fluids of patients with malignant solid tumors and tried to define the significance of K-ras codon 12 mutation in body fluids. METHODS: We analyzed 58 specimens of body fluids in patients diagnosed as solid tumor. The first PCR products were digested with BstN1 and then followed the second PCR and BstN1 digestion. Nucleotide sequencing was performed by Sanger's method. RESULTS: The incidences of K-ras codon 12 mutation are 75% in biliary cancer, 50% in pancreatic cancer, 31% in lung cancer, 14% in liver cancer, and 8% in stomach cancer. Mutations of K-ras codon 12 were detected in 24% (9/37) of body fluids with malignant cells and 19% (4/21) of body fluids without malignant cells. The proportions of malignant cells were not different between the patients with and without K-ras codon 12 mutation in effusions with malignant cells. Nucleotide sequencing on one sample of a patient with pancreatic carcinoma revealed single base substitution in codon 12 of K-ras gene from GGT to GAT. CONCLUSIONS: The incidences of ras mutation in body fluids are variable with tumor type. Since K-ras codon 12 point mutation was highly specific, not in those of patients without tumors, examination of K-ras codon 12 point mutation may be an additive diagnostic tool for early detection of metastasis to body fluids.
Body Fluids ; Codon* ; Digestion ; Genes, ras ; Humans ; Incidence ; Liver Neoplasms ; Lung Neoplasms ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Point Mutation ; Polymerase Chain Reaction ; Stomach Neoplasms

No abstract available.
Temporal Bone* ; Tympanic Membrane*

Objective: Behavioral assessments that effectively predict sleep-wake states were tried in animal research. This study aimed to examine the prediction power of an infrared locomotion detector on the sleep-wake states in ICR (Institute Cancer Research) mice. We also explored the influence of the durations and ways of data processing on the prediction power. Methods: The locomotor activities of seven male mice in home cages were recorded by infrared detectors. Their sleep-wake states were assessed by video analysis. Using the receiver operating characteristic curve analysis, the cut-off score was determined, then the area under the curve (AUC) values of the infrared motion detector that predicted sleep-wake states were calculated. In order to improve the prediction power, the four ways of data processing on the prediction power were performed by Matlab 2013b. Results: In the initial analysis of raw data, the AUC value was 0.785, but it gradually reached to 0.942 after data summation. The simple data averaging and summation among four different methods showed the maximal AUC value. The 10-minute data summation improved sensitivity (0.889) and specificity (0.901) significantly from the baseline value (sensitivity 0.615; specificity 0.936) (p ＜ 0.001). Conclusion This study suggests that the locomotor activity measured by an infrared motion detector might be useful to predict the sleep-wake states in ICR mice. It also revealed that only simple data summation may improve the predictive power. Using daily locomotor activities measured by an infrared motion detector is expected to facilitate animal research related to sleep-wake states.