BACKGROUND: CD22 is a glycoprotein expressed on the surface of normal mature B cells and in the cytoplasm of normal B cell precursors. Cytoplasmic CD22 (cCD22) has been proposed as a immunologic marker for the diagnosis of B-lineage acute lymphoblastic leukemia (ALL) while membrane CD22 (mCD22) has been used as the marker for chronic lymphocytic leukemia, B-lineage lymphoma, and hairly cell leukemia, and mCD22 has not been routinely used for the diagnosis and subgrouping of ALL. The purpose of this study was to examine the expression of mCD22 in B-lineage ALL and its clinical significance. METHODS: From 1992 to April, 1998, the leukemic cells of 64 patients newly diagnosed as B-lineage ALL by immunophenotyping were analyzed by the direct immunofluorescence method using monoclonal antibodies including mCD22. RESULTS: mCD22 was positive in 53% (34/64) of all patients, 50% (21/42) of children and 59% (13/22) of adults. According to the immunologic classification, mCD22 was positive in 44% (4/9) of group II, 53% (19/36) of group III, 69% (11/16) of group IV, but negative in 3 cases of group V and VI. The complete remission rate of the mCD22 negative group in group III was significantly higher than that of the mCD22 positive group (P=0.008). There were significant differences in survival rates between the mCD22 positive group and the mCD22 negative group in group II, III and IV (P=0.046) and the above observed significant difference was seen when group III was separately tested (P=0.014). CONCLUSIONS: Our study demonstrated that the expression of mCD22 may be a poor prognostic factor in B-lineage ALL and that mCD22 shall be clinically used as a prognostic marker especially in group III, which is most common among the subgroups of B-lineage ALL.
Adult ; Antibodies, Monoclonal ; B-Lymphocytes ; Biomarkers ; Child ; Classification ; Cytoplasm ; Diagnosis ; Fluorescent Antibody Technique, Direct ; Glycoproteins ; Humans ; Immunophenotyping ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma ; Membranes* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Survival Rate

BACKGROUND: Hemophagocytic lymphohistiocytosis(HLH) is a rare and fatal disorder in children. Recently its clinical characteristics and etiology of uncontrolled activation of cellular immune system in genetically predirected patients have keen elucidated. The authors analyzed the clinical characteristics and response to immunosuppressive agents of HLH patients in single institute. METHODS: The authors retrospectively analyzed various clinical data including CSF and bone marrow examination at diagnosis and follow up period in the 6 patients who were diagnosed as HLH at Asan Medical Center during last 2 years. Antithymocyte globulin(ATG : 10 mg/kg/day) and methylprednisolone(methyl-PD: 5 mg/kg/day) for 5 consecutive days as induction treatment and cyclosporin A(CsA) as maintenance treatment after induction with weekly intrathecal methotrexate for 5-6 weeks were given to the recently diagnosed 3 patients. RESULTS: All the patients except one were infants. Persistent fever, hepatosplenomegaly and pancytopenia were observed in all the patients. Family history of suspicious HLH was observed in 4 patients(67%). The characteristic elevated serum triglyceride(TG) level and/or decreased fibrinogen level were noted in all. Mild to moderate CSF pleocytosls with increased lymphocytes and monocytes was also observed in all during the disease course. Variable degree of nonqr-Langerhans cell histiocytic infiltration and hemophagocytosis were observed in all the cases. Of the 3 patients treated with ATG and methyl-PD, one achieved complete remission and the others achieved partial remission within 2 weeks of treatment, but all expired after 5 months, remission with CsA. Regardless of treatment regimen, all the 6 patients expired due to CNS sequelae of HLH. CONCLUSIONS: HLH mainly developed in infants. Persistant fever, hepatosplenomegaly and pancytopenia were observed in most cases with the characteristic change of serum TG and/or fibrinogen level. HLH should be included in the differential diagnosis in patients with these features especially when the family history of suspicious HLH is present, and histologic comfirmation of HLH could be easily accomplished with bone marrow study in most cases. Remission induction of HLH could be achieved with immunosuppressive treatment but it was difficult to maintain long term remission.
Bone Marrow ; Bone Marrow Examination ; Child ; Chungcheongnam-do ; Cyclosporine ; Diagnosis ; Diagnosis, Differential ; Fever ; Fibrinogen ; Follow-Up Studies ; Humans ; Immune System ; Immunosuppressive Agents ; Infant ; Lymphocytes ; Lymphohistiocytosis, Hemophagocytic* ; Methotrexate ; Monocytes ; Pancytopenia ; Remission Induction ; Retrospective Studies

BACKGROUND: Despite the development of empiric antibiotics in treatment of neutropenic fever(NF) in pediatric cancer patients, bacterial infection is still the most important cause of death in these patients. In this study the authors analyzed clinical characteristics and tried to find out the possible risk factors of the pediatric cancer patients who succumbed to the documented bacterial infection after episodes of neutropenic fever. METHODS: 17 pediatric cancer patients expired after episodes of neutropenic fever(NF) in the pediatric department of Asan Medical Center from Mar. 1990 to Feb. 1996 were grouped by the results of bacterial culture. 7 cases (Group A) had documented bacterial culture results and 10 cases (Group B) had negative culture results. The clinical characteristics of these two groups were analyzed retrospectively. RESULTS: There were no differences in the types of cancer between the two groups. All the documented bacteria were gram negative organisms and all cultured from the blood. There were no differences between the two groups in the treatment duration, known risk factors of infection before and at the onset of fever, antibiotics administered, and interval from the onset of NF to the administration of antibiotics. The response rate of initial empiric antibiotics was lower in group A(14%) compared to Group B(40%), even though all the cultured organisms except 2 cases in Group A were sensitive to initial empirical antibiotics. Septic shock was the cause of death in 86% of Group A patients, but only in 10% of Group B patients. The other causes of death were progression of cancer, bleeding, hepatic failure, adult respiratory distress syndrome and multiple organ failure, which showed no difference between the 2 groups. The interval from the onset of fever to death was significantly shorter in Group A(6.2+/-2.3 days) compared to Group B(24.9+/-18.6 days). CONCLUSIONS: Bacterial infection is still the most frequent cause of death after NF. Most patients succumbed to the documented bacterial infection showed rapid progression of bacteremia to septic shock despite administration of sensitive antibiotics. The known risk factors of infection before the onset of NF and other treatment factors shows no differences between the two groups in this study. These results suggest that the bacteremia is obvious risk factor of poor outcome after NF episode, and antibiotics alone may be insufficient to prevent the rapid progression of septic shock in these patients.
Anti-Bacterial Agents ; Bacteremia ; Bacteria ; Bacterial Infections ; Cause of Death* ; Chungcheongnam-do ; Fever* ; Hemorrhage ; Humans ; Liver Failure ; Multiple Organ Failure ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Risk Factors ; Shock, Septic

The characterization of genetic variation at the level of DNA has generated significant advances in gene mapping and disease diagnosis, and forensic identification of individuals. It is now possible to identify individual DNA from various tissue specimens, like hair, using the PCR and oligonucleotide probes. To date, however, the number of hairs needed, the preservation conditions, and the kinds of hair suitable for DNA extraction have not been well known. We performed DNA extraction using hairs from different body sites, using different numbers of hairs, under various different preservation conditions to investigate the acquisition conditions of DNA data from hair using PCR and specific HLA-DQA probe. HLA-DQA genotyping of DNA extracted from peripheral blood was performed to compare the results of hair and blood HLA-DQA genotyping from individuals. The results are as follows: 1) The concentration of DNA extracted from a single strand of hair is 5.23+/-0.54 g/ml. It is possible to extract sufficient DNA for HLA-DQA genotyping from a single strand of hair. 2) DNA concentration is different according to body site. Concentrations are 7.01+/-0.33 g/ml in scalp hair, 6.28+/-0.29 g/ml in axillary hair, and 6.10+0.24 microgram/ml in pubic hair. 3) There is no difference between the electrophortic bands resulting from DNA extracted from the hair of an individual preserved under different conditions, such as room temperature, exposure to sunlight, exposure to low temperature (+4degrees C), or exposure to moisture. 4) There is no difference between the electrophoretic bands resulting from DNA extracted from hair of a single individual preserved for different lengths of time. 5) In an individual, the HLA-DQA genotype obtained from peripheral blood is identical to that obtained from hair. Even though the amout of DNA obtained from hair is limited, it is possible to identify the HLA-DQA genotype of an individual using a single strand of hair. This requires adequate extraction of DNA for PCR analysis using an allele specific probe. We believe that HLA-DQA genotyping using the PCR method on DNA extracted from hair is useful for disease diagnosis and forensic science.
Alleles ; Chromosome Mapping ; Diagnosis ; DNA* ; Forensic Sciences ; Genetic Variation ; Genotype ; Hair* ; Oligonucleotide Probes ; Polymerase Chain Reaction* ; Scalp ; Sunlight

BACKGROUND: The addition of clonidine to local anesthetics for regional block has been shown to increase the duration of anesthesia and analgesia. This study was designed to determine whether the addition of clonidine to bupivacaine would produce an extension of the analgesic effect after intercostal nerve block (ICNB). METHODS: After informed consent, 30 ASA 1 or 2 patients undergoing appendectomy under general anesthesia were randomly divided into two groups. Before induction of anesthesia, ICNB using a posterior approach was performed with 15 ml of 0.25% bupivacaine plus epinephrine 1:200,000 with (Group BEC; n = 15) or without (Group BE; n = 15) clonidine 75 microgram. Analgesia was assessed by cold testing at 1/min intervals until cold sensation decreased. The duration of analgesia (time between injection and onset of pain) was recorded. We also recorded the visual analogue scale (VAS) of pain, the number of supplemental analgesics, heart rate and blood pressure, and side effects over 24 hours postoperatively. RESULTS: The onset time, duration of analgesia, number of analgesics, and heart rate and blood pressure were comparable in both groups. VAS scores were significantly lower in Group BEC than in Group BE at 12, 16, and 20 hours postoperatively. CONCLUSIONS: The addition of clonidine to bupivacaine with epinephrine may be a useful adjunct and can prolong the duration of analgesia after ICNB without significant side effects.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia and Analgesia ; Anesthesia, General ; Anesthetics, Local ; Appendectomy ; Blood Pressure ; Bupivacaine* ; Clonidine* ; Epinephrine ; Heart Rate ; Humans ; Informed Consent ; Intercostal Nerves* ; Pain, Postoperative* ; Sensation

No abstract available.
Humans ; Parents* ; Siblings*

The authors experienced a case of early fracture of an alumina ceramic liner after ceramic-on-ceramic total hip arthroplasty, without any history of trauma. A 47-year-old male visited our center, due to a sudden crunching sound from the right hip at three weeks, after a ceramic-on-ceramic total hip arthroplasty for the osteonecrosis of right femoral head. Plain radiographs revealed multiple radio-opaque fragments around the displaced neck of the femoral stem. There were severely comminuted fracture of the ceramic liner with slight black staining of the surrounding tissue, and even damaged the surface of the ceramic head, on the operative field. The fractured liner and a damaged head were replaced with a new ceramic liner and head, after the removal of the fractured ceramic fragments, as completely as possible. Careful follow up with a caution for early ceramic liner fracture should be required in ceramic-on-ceramic total hip arthroplasty.
Aluminum Oxide ; Arthroplasty ; Ceramics ; Follow-Up Studies ; Fractures, Comminuted ; Head ; Hip ; Humans ; Male ; Middle Aged ; Neck ; Osteonecrosis

A study on changes of serum HDL-cholesterol level in various diseased states was performed. Diseased groups were nephrotic syndrome, liver cirrhosis, hyperthyroidism, hypothyroidism and chronic alcoholism. Following results were obtained. 1) Compared to normal control group, levels of HDL-cholesterol in nephrotic syndrome were lower but the difference was significant statistically. 2) In liver cirrhosis, the result showed much lower levels than normal control group with high significance. 3) In both hyper-and hypothyroidism group, the levels of HDL-cholesterol were significantly lower than normal control group. 4) In chronic alcoholism, the levels were significantly higher than normal control group. 5) Except for the group of chronic alcoholism, the levels of HDL- cholesterol were higher in female groups than male groups, but was of no significance statistically.
Alcoholism ; Cholesterol ; Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Liver Cirrhosis ; Male ; Nephrotic Syndrome

No abstract available.
Female ; Ovary* ; Teratoma*

No abstract available.
Calcium* ; Fetal Blood* ; Phosphorus*