PURPOSE: Retinal neovascularization in diabetes has been thought to follow the release of local angiogenic factors in the retina. We hypothesized that neovascularization of diabetic retinopathy is a systemic vasculogenesis rather than a local angiogenesis. Thus, we evaluated the concentrations of circulating endothelial progenitor cells (EPCs) and stem cell modulation factors such as vascular endothelial growth factor (VEGF), erythropoietin (EPO), and substance p (SP) in the peripheral blood of diabetic retinopathy patients. METHODS: We studied 15 normal controls and 45 Type 2 diabetic patients [non-DR group (n=15), NPDR group (n=15), and PDR group (n=15)]. We measured circulating CD34+mononuclear cells (CD34+MNCs) and c-Kit+mononuclear cells (c-Kit+MNCs) by flow cytometry. VEGF, EPO and SP in the peripheral blood were measured by ELISA. RESULTS: The circulating CD34+MNCs and c-Kit+MNCs increased in the NPDR and PDR groups compared with the control group (P<0.01). The serum level of VEGF was increased in the NPDR and PDR groups compared with the control group (P<0.05). The level of EPO was exclusively elevated in the non-DR group compared with the other three groups (P<0.01). The circulating SP level increased in the NPDR and PDR groups compared with the control group (P<0.05). CONCLUSIONS: The present study is the first to demonstrate that CD34+MNCs, c-Kit+MNCs and their modulator are elevated in diabetic retinopathy patients. Therefore, it is possible that circulating EPCs and serum VEGF, EPO and SP may be involved in the progression of diabetic retinopathy.
Angiogenesis Inducing Agents ; Diabetic Retinopathy* ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin ; Flow Cytometry ; Humans ; Retina ; Retinal Neovascularization ; Stem Cells ; Substance P ; Vascular Endothelial Growth Factor A

BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. METHODS: One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia (PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. RESULTS: Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. CONCLUSION: We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching.
Abdominal Pain ; Analgesia ; Analgesia, Patient-Controlled ; Cesarean Section* ; Diclofenac* ; Dizziness ; Female ; Humans ; Incidence ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention

Giant cell myocarditis(GCM) is a rare inflammatory heart disease which is characterized by multinucleated giant cells and a granulomatous reaction. It usually progresses rapidly and results in a fatal course. We report a patient with giant cell myocarditis who was treated by cardiac transplantation. A 35-year-old male was admitted with dyspnea which had developed 4 months before. On echocardiography, the right and left ventricles were markedly dilated and severe global hypokinesia was noted. He was diagosed with dilated cardiomyopathy with secondary severe mitral regurgitation. His cardiac function deteriorated progressively. He underwent orthotopic heart transplantation. Grossly the heart was enlarged, weighing 420gm and round with a blunt apex. Both right and left ventricles were markedly dilated. There were numerous white patches, measuring up to 4cm, throughout the epi- and myocardium. Microscopically, extensive fibrosis and multiple exuberant granulomas with numerous scattered multinucleated giant cells were seen. Lymphocytes and eosinophils were also frequent. Coronary arteries were unremarkable. Neither microorganisms nor foreign materials were found. By serial endomyocardial biopsies of the transplanted heart, only mild perivascular lymphocytic infiltration was occasionally observed without any evidence of rejection or recurrence of giant cell myocarditis. The patient's postoperative course has been uneventful so far(postoperative 21 months). The etiology of GCM remains to be clarified, although various factors are suspected. No matter what the cause, our experience suggests that this grave disease might be treated well by heart transplantation.
Male ; Humans ; Biopsy

PURPOSE: We evaluated whether aminoguanidine could inhibit VEGF mRNA expression in the retinal pigment epithelial cells cultured at various glucose concentrations. METHODS: Human retinal pigment epithelial cells were cultured in the culture media containing 5.5 mM, or 11 mM, or 16 mM glucose for 5 days, or 7 days, or 14 days respectively. To evaluate an inhibitory effect of aminoguanidine on VEGF mRNA expression, 1 micro M, or 3 micro M, or 10 micro M aminoguanidine was added in the culture media. The VEGF mRNA expression was assayed by northern blot analysis. RESULTS: The VEGF mRNA expression of the cultured retinal pigment epithelial cells increased proportionally with media glucose concentration in culture media. At each glucose concentration of the media, VEGF mRNA expression increased with a prolongation of incubation period. An aminoguanidine inhibited the expression of VEGF mRNA by concentration-dependent manner in 5 day and 7 day incubation, but not in 14 day incubation. CONCLUSIONS: The aminoguanidine could inhibit a new vessel formation in the diabetic retina, and be useful for therapeutic or preventive drug in the diabetic retinopathy.
Blotting, Northern ; Culture Media ; Diabetic Retinopathy ; Epithelial Cells ; Glucose ; Humans ; Hyperglycemia ; Retina ; Retinaldehyde ; RNA, Messenger ; Vascular Endothelial Growth Factor A*

A 35-year-old man was admitted with a 20 day history of generalized edema and muscular weakness of the lower extremities. He was alert with a pale puffy face and an ejection murmur was heard at the cardiac apex. The electrocardiogram disclosed low voltage, first degree atrioventricular block, and a right bundle branch block. During the hospitalization an intractable diastolic hypotension developed, which measured 0 mmHg at the lowest point. At that time the echocardiogram revealed a dilated, akinetic right ventricle. Eventually a multiorgan failure developed and an autopsy following his death presented a fibrofatty replacement of the right ventricular myocardium. This might be a case of an arrhythmogenic right ventricular dysplasia/cardiomyopathy, which is usually characterized clinically by a ventricular tachycardia and may cause a sudden death in young adults.
Adult ; Atrioventricular Block ; Autopsy* ; Bundle-Branch Block ; Death, Sudden ; Edema ; Electrocardiography ; Heart Ventricles ; Hospitalization ; Humans ; Hypotension ; Lower Extremity ; Muscle Weakness ; Myocardium ; Systolic Murmurs ; Tachycardia, Ventricular ; Young Adult

The aim of this study was to assess the involvement of multipotential progenitor cells in the pathogenesis of Mooren's ulcer using immunohistochemical staining techniques. Tissue specimens were collected from 3 Mooren's ulcer patients who underwent lamellar keratectomy. Immunohistochemical staining patterns were analyzed using antibodies: CD34, c-kit, STRO-1, CD45RO, VEGF and alpha-SMA. Strong positive CD34, c-kit and STRO-1 cells were revealed in Mooren's ulcer specimens, especially in the superficial stroma. A few weakly expressed CD34 stroma cells were seen in normal limbal cornea but no immunoreactivity for c-kit and STRO-1 could be found. CD45RO positive T cells were found to have infiltrated in Mooren's ulcer. The immunostaining pattern of VEGF and yen a- SMA was closely correlated with the degree of expression and the number of CD34 positive cells. Bone marrow-derived multipotential progenitor cells may be involved in the pathogenesis of Mooren's ulcer by synergizing with other factors to amplify autoimmune destructive reactions and to contribute to the regeneration process. Specific therapeutic strategies that target the role of these cells in the disease are warranted.
Cornea/*pathology ; Corneal Ulcer/*pathology ; Hematopoietic Stem Cells/*pathology ; Humans ; Multipotent Stem Cells/*pathology ; Research Support, Non-U.S. Gov't

Hairy cell leukemia is an uncommon lymphoreticular disorder which primarily involves bone marrow, spleen, and peripheral blood. Patients, mostly men, present with splenomegaly and pancytopenia usually. A 62-year-old man was admitted with an abdominnal mass which had grown slowly for 20 years. On physical examination, an enlarged spleen was palpated without tenderness. An abdominal CT scan showed a diffusely enlarged spleen, which measured 20 cm in greatest dimension. In the peripheral blood, many atypical lymphocytes with abundant, delicate, surface projections were noted. They had tartrate-resistant acid phosphatase(TRAP) activity. Thrombocytopenia (60,000/mm3) was observed in the complete blood counts, Other laboratory data were within normal limits. He underwent splenectomy. The submitted spleen measured 26x15x5 cm and weighed 2150 gm. It was well encapsulated and the outer surface was smooth. Cut surfaces were diffusely dark-red. White and red pulps were indistinct. There was no mass-like lesion. Microscopically, the spleen consisted of monotonous mononulcear cells which involved red pulp. The white pulp was diminished, and could be barely recognized. Cells had small round nuclei and abundant cytoplasm. Ultrastructurally, cells with numerous slender surface projections were noted. In Korea, hairy cell leukemia is exceedingly rare. We report a case of hairy cell leukemia with characteristic pathologic features of spleen as well as those of peripheral blood.
Male ; Humans

Thin basement membrane nephropathy(TBMN) is defined histologically as follows: 1) By light rnicroscopy only minor abnormalities are detected in the glomeruli at most minor mesangial widening. 2) By electron microscopy, diffuse thinning of glomerular basement rnembrane is demonstrated. 3) By immunofluorescence, absence of immunoglobulins and complement components is demonstrated. 4) Alport's syndrome and systemic diseases that may affect the glomerular structure have been excluded. TBMN presented frequently with recurrent or persistent microscopic hematuria. Massive proteinuria such as in nephrotic syndrome rarely occurs in TBMN. We reported two cases of TBMN presented with typical minimal change nephrotic syndrome.
Basement Membrane* ; Complement System Proteins ; Fluorescent Antibody Technique ; Hematuria ; Immunoglobulins ; Microscopy, Electron ; Nephritis, Hereditary ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Proteinuria

Hemorrhoids are one of the commonest disorders specific to the human. However, the pathogenesis is not well understood so far. Anal submucosa is largely composed of blood vessels, loose connective tissue and smooth muscles, forming muscular network around the venous plexuses. We analyzed the distribution of smooth muscles in the hemorrhoidal tissues. Immunohistochemical stainings for desmin, vimentin, and Factor VIII related antigen were performed using six freshly frozen hemorrhoidal tissues. All of them were diagnosed as external hemorrhoids. Four anal tissues from Miles' operation specimen without hemorrhoids were used as normal controls. In all six cases, venous plexuses were variably dilated and smooth muscle cells were unevenly distributed. In minimally involved areas, there were relatively sufficient amount of perivascular smooth muscles which were arranged in their bundles. In contrast, only single scattered cells or very small amount of smooth muscle bundles were noted around the dilated vascular plexuses in severely affected areas. In two severe hemorrhoidal tissue samples, vascular plexuses were markedly dilated and only single scattered smooth muscle cells were seen. In conclusion, the total amount of smooth muscles in the submucosa of hemorrhoid tissue was reduced than those of the normal controls. The degree of hemorrhoidal dilation was inversely related to the amount of smooth muscles. However, causal relation between diminution of submucosal smooth muscles and venous dilation remains to be clarified.
Humans

Fine-needle aspiration (FNA) of lymph nodes has been regarded as a useful method in the diagnosis of lymphadenopathy. However, this procedure has been shown to be of limited value in the diagnosis of low or intermediate grade malignant lymphomas in some studies. Immunophenotyping is an essential adjunct to cytomorphology for the diagnosis of lymphoma by FNA. Immunophenotyping using flow cytometry (FCM) is rapid, objective and reliable. Using FCM, multiparametric analysis of 33 FNA materials from lymph nodes was performed and profiles of surface markers of lymphoid cells were assessed. In reactive hyperplasia, patterns of cell surface markers were quite variable, but disclosed polyclonality. Most of the B-cell lymphomas showed immunophenotypes for B-cell lineages with their kappa: lambda or lambda: kappa ratio being over 3:1. In T-cell lymphomas, T-cell surface markers were predominantly expressed as well. In conclusion, our results suggest that immunophenotyping of lymph node aspirates is a valuable diagnostic adjunct for lymphoproliferative disorders, particularly in B-cell lymphomas because immunophenotyping can be easily and adequately performed by FCM.
Antigens, CD19/analysis ; Antigens, CD20/analysis ; Antigens, CD3/analysis ; Antigens, CD4/analysis ; Antigens, CD5/analysis ; Antigens, CD7/analysis ; Antigens, CD8/analysis ; B-Lymphocytes/immunology ; B-Lymphocytes/chemistry ; Biopsy, Needle ; Flow Cytometry/methods* ; Hodgkin Disease/pathology ; Human ; Immunophenotyping ; Lymph Nodes/pathology ; Lymph Nodes/chemistry ; Lymphatic Diseases/pathology* ; Lymphatic Metastasis/pathology ; Lymphoma, B-Cell/pathology* ; Lymphoma, Non-Hodgkin/pathology ; T-Lymphocytes/immunology ; T-Lymphocytes/chemistryt