PURPOSE: Transcatheter arterial chemoembolization (TACE) and subsequent percutaneous ethanol injection (PEi) was attempted in 8 patients with 9 hepatocellular carcinomas (HCCs) for complete tumor necrosis of HCCs less than 5cm in greatest diameter. MATERIALS AND METHODS: PEI was performed with 2-8ml of absolute (99.9%) ethanol two weeks after TACE under CT or ultrasound guidance. For each patient PEI was done twice to four times within 4-10 days of each procedure. After completion of a series of PEI, follow up examination (range:3 months-l.5 year period) was done with angiography, CT or ultrasound and correlated with serum alpha-fetoprotein (AFP) level. RESULTS: On follow up anglograms, the lesions completely disappeared or decreased in size without tumor vessels or staining in 5 of 6 patients. On follow up CT of 6 patients, the lipiodol-laden HCCs were surrounded by non-enhancing low density and the losion sizes were slightly decreased or not changed. These are suggestive of necrosis of tumor itself and adjacent liver parenchyma. The tumors could not be detected on follow up ultrasound examination in 2 patients. Serum AFP was decreased in 7 patients and was well corresponded to the results of imaging modalities. CONCLUSION: The authors concluded that the combined TACE and PEI is an appropriate treatment for small HCCs having high surgical risks.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular* ; Ethanol* ; Follow-Up Studies ; Humans ; Liver ; Necrosis ; Ultrasonography

BACKGROUND: Streptococcus viridans group (SVG) is the normal flora of the upper respiratory tract, skin and genitourinary tract, and is the major causative agent isolated in 30-40% of bacterial endocarditis patients. However, SVG has not been properly identified to the species level for lack of diagnostic system which enables the accurate identification of SVG. Poyart et al. have recently described the identification of SVG to the species level by DNA sequencing of superoxide dismutase gene (sodAint). Using this method, we report here the identification of SVG isolated from the patients in Seoul National University Hospital within recent 2 years. METHODS: According to the method by Poyart et al., a set of two oligonucleotides, D1 (5 '-CCI TAY ICI TAY GAY GCI YTI GAR CC-3 ') and D2 (5 '-ARR TAR TAI GCR TGY TCC CAI ACR TC-3 ') were used as PCR primers, and PCR products of 480-bp size were obtained. The PCR products purified by MicroSpin S-400 HR Column were sequenced using ABI-PRISM 3700 Sequence Analyzer. D1 and D2 were used as sequencing primers. The clinical isolates were respectively identified as the species showing the greatest sequence homology which was demonstrated by the BLAST program provided by NCBI(USA). RESULTS: Clinical strains isolated from 26 patients who had shown two or more positive blood cultures were analyzed by DNA sequencing of superoxide dismutase gene, which showed 6 strains of S. salivarius, five S. oralis, four S. sanguis, three S. pasteuri, three S. equisimilis, two S. gordonii, one S. constellatus, one S. luteciae, and one S. mitis. S. salivarius and S. sanguis were clearly discriminated, while S. equisimilis and S. pyogenes were not. Species identification results by conventional method seldom corresponded to those by DNA sequencing. Among 7 patients suspected to have bacterial endocarditis, S. sanguis were isolated in 4 patients, and S. gordonii, S. oralis, S. pasteuri in one, respectively. Among 17 patients with liver cirrhosis or cancer, S. salivarius were isolated in 6 patients, and S. oralis in four. CONCLUSIONS: In this study, we could identify the species of SVG isolated from the patients with bacteremia; S. sanguis were frequently isolated from patients with bacterial endocarditis, while S. salivarius from ones with malignancy. These results imply that a different group of underlying diseases could show correspondingly different group of SVG species which cause bacteremia, and we suggest that further pathophysiological study on the correlations between underlying disease and the species of SVG be performed.
Bacteremia ; Endocarditis, Bacterial ; Homosexuality, Male ; Humans ; Liver Cirrhosis ; Male ; Oligonucleotides ; Polymerase Chain Reaction ; Respiratory System ; Seoul ; Sequence Analysis ; Sequence Analysis, DNA ; Sequence Homology ; Skin ; Streptococcus* ; Superoxide Dismutase ; Viridans Streptococci*

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic autoimmune disease with a poor prognosis in untreated patients, and combination therapy with steroidsand cyclophosphamide is the current standard treatment. Treatment with immunosuppressive agents results in high remission rates; however, there is a considerable morbidity related to the immunosuppressive state, such as life-threatening infections. To reduce serious immunosuppressant-related adverse effects, potentially promising treatment options, including plasma exchange, cytapheresis, administration of intravenous immunoglobulin and TNF-alpha blocking agents have been developed. We performed plasma exchange with steroid pulse therapy for a 52 year-old female patient with pulmonary hemorrhagewith ANCA-associated crescentic glomerulonephritis. After combination therapy, the pulmonary hemorrhage and renal function recovered and myeloperoxidase (MPO)-ANCA decreased.
Antibodies, Antineutrophil Cytoplasmic ; Autoimmune Diseases ; Cyclophosphamide ; Cytapheresis ; Cytoplasm* ; Female ; Glomerulonephritis ; Hemorrhage ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Middle Aged ; Peroxidase ; Plasma Exchange* ; Plasma* ; Prognosis ; Tumor Necrosis Factor-alpha ; Vasculitis*

Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy. It represents initially as thrombocytopenia and is associated with venous or arterial thrombosis. It has been reported that platelet factor 4/heparin complex antibody plays an important role in the pathogenesis of HIT. Patients on hemodialysis have a high risk of developing HIT because heparin is administrated in hemodialysis as anticoagulant. Thrombocytopenia usually occurs 5 to 10 days after the onset of administration, but occasionally, it may occur rapidly in patients who have preformed antibodies from recent heparin use. We report here 2 cases of HIT with platelet factor 4-heparin reactive antibody in hemodialysis patients.
Antibodies ; Blood Platelets ; Heparin ; Humans ; Immunoassay* ; Renal Dialysis ; Thrombocytopenia* ; Thrombosis

No abstract available.
beta-Glucosidase* ; Gaucher Disease*

BACKGROUND: This study was purposed to find out the differences in the lymphocyte subsets and differential cell counts of the bronchoalveolar lavage (BAL) fluid in patients with interstitial lung disease (ILD) and to analyze the differences according to their ages, gender and smoking habits. METHODS: BAL fluid samples of 141 ILD patients were examined for lymphocyte subsets and differential cell counts, and the differences among the patients were analyzed according to their diseases. Then, within the three most common disease groups, the differences were further analyzed by the age, gender and smoking habit of the patients. RESULTS: There were no statistically significant differences in total cell counts (per millimeters of BAL fluid) among the patient groups with each ILD. However, significant differences were observed in the percentages of neutrophils, lymphocytes, eosinophils, and macrophages of BAL fluid. Also, in lymphocyte subset analyses, the percentages of total T cells, B cells, CD4+ T cells, CD8+ T cells, CD4/CD8 T cell ratios, and NK cells were significantly different among the patients with each ILD. However, within the same disease group, there were no differences in differential cell counts and lymphocyte subset analyses according to the age, smoking habit, and gender of the patients. CONCLUSIONS: Although the age, smoking habit and gender did not have an effect on the BAL fluid analyses among the patients with the same ILD, there were significant differences among the patients with each ILD; therefore, the differential cell counts and lymphocyte subset analyses of BAL fluid can be useful in differential diagnosis for determining the types of ILD.
Adult ; Aged ; Bronchoalveolar Lavage Fluid/*cytology ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases, Interstitial/diagnosis/*epidemiology/etiology ; Lymphocyte Count ; Lymphocyte Subsets/immunology ; Male ; Middle Aged ; Smoking

No abstract available.
Stomach Neoplasms*

PURPOSE: The purpose of this study was to assess the usefulness of CT angiography(CTA) with spiral CT in evaluation of intracranial vascular lesions. MATERIALS AND METHODS: CTA and conventional angiography(CA) were performed in 22 patients with suspected intracranial vascular lesion. Nine patients had 10 aneurysms and 2 patients had arteriovenous malformation(AVM)s, while the remaining 11 patients had no vascular lesion. Twenty seconds after beginning injection of contrast media(100 mL with use of a power injector at the rate of 3 mL/sec), CT scanning(30-second continuous exposure and 60-mm length) was performed with a table speed of 2mm/sec and a section thickness of 2mm. The starting point was selected at the floor of the sella turcica. The resulting data were reformatted by MIP and SSD after reconstruction of 1 mm interval. For aneurysm, its size, shape, direction, neck and the relationship to adjacent vessels were compared to CA. RESULTS: The aneurysm diameter was ranged between 3mm and 20mm and all aneurysms were clearly visualized with CTA. CTA findings of the size, shape, direction, and neck of aneurysms and the relationship between aneurysm and adjacent vessels were well correlated with CA. In one case of aneurysm, calcification of the aneurysm wall was demonstrated on CTA. In one case of AVM, the nidus and its arterial supply and venous drainage were well visualized. In the other case of AVM, however, the feeding artery of AVM was not demonstrated on CTA(it was also unclear on CA). CONCLUSION: CTA with spiral CT may be useful in the evaluation of intracranial vascular lesion and valuable as a screening test for intracranial aneurysm.
Aneurysm ; Angiography* ; Arteries ; Drainage ; Humans ; Intracranial Aneurysm ; Mass Screening ; Neck ; Sella Turcica ; Silver Sulfadiazine ; Tomography, Spiral Computed*

PURPOSE: To identify the mechanism of azaline B-dependent apoptosis, the regulation of Fas and FasL genes has been investigated. MATERIALS AND METHODS: Azaline B was subcutaneously injected into Sprague-Dawley rats. The levels of Fas receptor (Fas) and Fas ligand (FasL) were detected by reverse transcription-polymerase chain reaction (RT- PCR). Azaline B-dependent apoptosis was determined by terminal deoxynucleotidyl transferase-mediated dUTP nick and labeling (TUNEL) and DNA fragmentation assay. Transacting factor of FasL promoter was identified by DNase I footprinting and DNA mobility shift assay. RESULTS: The azaline B-treated testis (250microgram/kg body wt/day) had decreased to 70+/-2.5% and 38+/-1.8% of the normal testis weight at 3 and 5 days after the injection, respectively, but the weights of the testis were not changed after pretreatment of follicle-stimulating hormone (FSH) and testosterone. Apoptosis of the testis was detected by DNA fragmentation assay and TUNEL assay after the azaline B treatment. The levels of Fas and FasL mRNA were increased by the treatment of azaline B in both time- and dose-dependent manners. In DNase I footprinting assay with FasL promoter, the nuclear factor prepared from control was bound with at least four sites: SP-1 binding site at 283, NF-kappa B binding site at 219, TATA at 132 and the gamma-interferon response element (gamma-IRE) at 78. gamma-IRE was completely protected by the nuclear extract prepared from azaline B-treated rat testis. In DNA mobility shift assay, the binding activity of gamma-IRE binding protein was increased after azaline B treatment. CONCLUSIONS: These results suggest that Fas-FasL system may be important to azaline B-dependent apoptosis in rat testis and that gamma-IRE binding protein is related to the azaline B-dependent regulation of FasL gene.
Animals ; Antigens, CD95 ; Apoptosis* ; Binding Sites ; Carrier Proteins ; Deoxyribonuclease I ; DNA ; DNA Fragmentation ; Electrophoretic Mobility Shift Assay ; Fas Ligand Protein ; Follicle Stimulating Hormone ; In Situ Nick-End Labeling ; Interferon-gamma ; NF-kappa B ; Rats* ; Rats, Sprague-Dawley ; Response Elements ; RNA, Messenger ; Testis* ; Testosterone ; Weights and Measures

Selective arterial embolization can reduce the size and pressure whtihin the nidus of the arteriovenous malformations(AVMS) and diminish the number of feeding pedicles, making subsequent surgical excision technically easier and safer, especially in those AVM patients whose lesions are judged to be inoperable or respectable with major risk. Authors have successfully and repeatedly performed selective arterial embolizations with polyvinyl alcoholfoam(PVA foam) and isobutyl-2-cyanoacrylate(IBCA) to a large AVM at the left basal ganglia, thalamus and lateral ventricles, and a large cortical AVM near right motor strip.
Arteriovenous Malformations* ; Basal Ganglia ; Humans ; Lateral Ventricles ; Polyvinyls ; Thalamus