Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi . Although early diagnosis and appropriate antibiotic therapy improve the prognosis for the majority of patients, life-threatening complications are not uncommon. Here, we present a case of successful veno-veno-type extracorporeal membrane oxygenation for scrub typhus-induced complications, including acute respiratory distress syndrome, myocarditis and multi-organ dysfunction. To our knowledge, this is the first case report of successful extracorporeal membrane oxygenation in complicated scrub typhus in Korea.
Communicable Diseases ; Early Diagnosis ; Extracorporeal Membrane Oxygenation* ; Humans ; Korea ; Myocarditis ; Orientia tsutsugamushi ; Prognosis ; Respiratory Distress Syndrome, Adult ; Scrub Typhus*

A variety of malignant neoplasms have been shown to induce neovascularization, and in some cases the degree of vascularization appears to correlate with an aggressive behavior and risk of metastasis. We compared the degree of vascularization in 11 benign and 33 cancerous lesions of the cervix. The microvessels were identified by immunohistochemistry using antibody to Factor VIII-related antigen in 44 hystrectomy specimens. Three highly vascularized microscopic fields were selected and counted the number of microvessels in 400 magnification. The proportion of the endothelial cell area was also quantified by using the CAS 200 image analysis system. All 33 cases of carcinomas demonstrated a significantly higher microvessel count and an endothelial cell area than those of the benign lesions (p<0.01). There were no significant difference in microvessel count and endothelial cell area among carcinoma in situ, microinvasive carcinoma and invasive carcinoma (p>0.05). Microvessel count and an endothelial cell area in invasive cancers were not correlated with tumor size, depth of invasion, or histologic type (p>0.05).This study showed cervical cancer induces neovascularization in an early stage but it is difficult to predict prognosis and metastasis with microvessel count and an endothelial cell area.
Carcinoma in Situ ; Carcinoma, Squamous Cell* ; Cervix Uteri ; Endothelial Cells ; Female ; Immunohistochemistry ; Microvessels ; Neoplasm Metastasis ; Prognosis ; Uterine Cervical Neoplasms ; von Willebrand Factor

No abstract available.
Multiple Myeloma* ; Oncogene Proteins* ; Oncogenes* ; Proliferating Cell Nuclear Antigen*

In 41 cases of breast cancers, the aneuploidy measured by Image Analyzer was compared with that of flow cytometric analysis, and estrogen and progesterone receptor(ER/PR) and Her-2/neu oncoprotein were immunohistochemically stained and measured by Image Analyzer. In ER/PR, the positive nuclear area(PNA, %) was measured, and in Her-2/neu, the content of oncoprotein was expressed as pg/cell. To assess the usefulness of these parameters as a prognostic factor, the author evaluated the results in relation with tumor size, nuclear grade and lymph node metastasis. The obtained results are summarized as follows: 1) The detection rate (90%) of aneuploidy by image analysis was higher than that (70%) of flow cytometric analysis. The concordance rate of both method was 80%. 2) The positivity of ER was 73% and PR was 34%, and the high PNA of ER and PR was related with high nuclear grade. There was an inverse correlation of the ER PNA with tumor size and PR PNA with negative lymph node. 3) Her-2/neu oncoprotein overexpression was found in only 2 cases and another two showed borderline overexpression. All four cases had DNA tetraploidy. From the above results, it was concluded that the image analyzer could be used in DNA analysis and in quantitation of immunostained ER/PR and Her-2/neu oncoprotein, providing the important information in the management of the breast cancer patients.
Breast Neoplasms

No abstract available.
Methicillin-Resistant Staphylococcus aureus* ; Polymerase Chain Reaction* ; Staphylococcus aureus* ; Staphylococcus*

This study was carried out to demonstrate the mode of ADR-induced cell death(apoptosis) on the light and electron microscopic features, to measure the apoptotic index dependent on various doses of ADR, to investigate the possible mechanism of apoptosis induced by ADR, and to evaluate ISNT method for the detection of DNA strand break. HeLa cells were treated with various doses of ADR 0.1~100.0 microgram/ml and observed under the light and transmission electron microscopes at 6 hours, 1 day and 3 days after ADR treatment. In addition, DNA strand breaks induced by ADR were detected in HeLa cells using the in situ nick translation(ISNT) method. The results were as follows: 1) The cell viability of HeLa cells decreased and the apoptotic index increased following exposure to ADR in a dose-dependent manner, resulting in about 44% of apoptotic index at 100.0 microgram/ml of ADR treatment. 2) Light microscopically, HeLa cells treated with ADR showed shrinkage or condensation of nucleus and cytoplasm. There were various unclear changes showing irregular, large, delineated masses of condensed chromatin abutting on the nuclear envelopes. Later stage of apoptosis revealed contracted and condensed cytoplasm with irregular cell membrane. Electron microscopically, margination of condensed chromatin, dilatation of endoplasmic reticulum under the plasma membrane, aggregation of cytoplasmic organelles with morphologically intact mitochondria, and irregular cell surface with blebbing were observed. 3) ISNT using biotinylated dUTP exhibited strong positive nuclear staining in HeLa cells treated with ADR. There was a marked response at 10.0~20.0 microgram/ml of ADR treatment. It is concluded from the above results that the death of HeLa cells induced by ADR was apoptotic in type based on light and electron microscopic appearance. The apoptotic index correlated with the increasing dose of ADR. ISNT with biotinylated dUTP led to visible evidence of DNA strand breaks following ADR treatment of HeLa cells. ISNT can be used for detection of DNA degradation, caused by activation of endogenous endonuclease, which is an early and specific characteristic of apoptosis.

Coxiella burnetii(C. burneii)was first recognized as the agent of Q fever in 1937. Q fever is an acute self-limited febrile illness. However, it manifests with several clinical symptoms depending upon the organs that are involved. The association of C. burnetii with human neoplasia has been rarely reported. We prospectively studied the 55 patients with fever of unknown origin, pneumonia, hepatosplenomegaly, lymphadenopathy, leukemia, lymphoma, and immunodeficiency and 14 persons who contacted the Q fever patients. The patient's sera were tested for antibodies specific for C. burnetii, using indirct fluorescent antibody techniques (IFA). 1) We serologically confirmed 23 C. burnetii infection. The 23 children with Q fever ranged in age from 0 to 15 years, with mean age of 4 years 11 months. Seventeen were boys and 6 were girls. 2) Characteristic symptoms and signs were fever (9/12 cases), rash (8/14 cases), hepatosplenomegaly (8/8 cases)and lymphadenopathy (14/27 cases). Five cases among 14 asymptomatic cases who contacted Q fever patients showed positive IFA test. One suffered from irregular uterine contraction, 4 weeks after contact with a Q fever patient. 3) There were no history of exposure to domestic animal carriers or contaminated dust, or drinking raw milk except one family. Three attending doctors and her father infected by a patient with Q fever. These suggested the person to person transmission of Q fever in a family and house staffs infected by a patient of Q fever. 4) Q fever (9 cases), acute lymphoblastic leukemia (2 cases), acute myelomonocytic leukemia (1 case), hairy cell leukemia (1case), Kawasaki disease (4 cases) and congenital dyserythropoietic anemia (1 case) showed positive IFA test. 5) Of 9 cases who suffered from lnly Q fever, 7 cases were confirmed hairy cell formation in their peripheral blood. One case was diagnosed as hairy cell leukemia after bone marrow study. Of 7 cases who showed hairy cells, all had hepatomegaly, 6 cases had lymphedenopathy and 5 cases showed splenomegaly. All except 1 case who was not followed cured after treatment. 6) We treated Q fever patients with rifampin and/or ciprofloxacin, and/or tetracyclin (over 8 year-old of age)for 2-4 weeks. One 25 month-old patient with hairy cell leukemia was treated with rifampin, ciprofloxacin and tetracyclin for 4 weeks, and rifampin for 8 months. A pregnant patient was administered with rifampin, and treated with rifampin and ciprofloxacin after delivery. We gave rifampin in one nweborn baby. In conclusion, we suggest that Q fever should be considered in the differential diagnosis of patients with FUO, hepatosplenomegaly and/or immunodeficiency.
Anemia, Dyserythropoietic, Congenital ; Animals, Domestic ; Antibodies ; Bone Marrow ; Child ; Child, Preschool ; Ciprofloxacin ; Coxiella burnetii* ; Coxiella* ; Diagnosis, Differential ; Drinking ; Dust ; Exanthema ; Fathers ; Female ; Fever ; Fever of Unknown Origin ; Fluorescent Antibody Technique ; Hepatomegaly ; Humans ; Internship and Residency ; Leukemia ; Leukemia, Hairy Cell ; Leukemia, Myelomonocytic, Acute ; Lymphatic Diseases ; Lymphoma ; Milk ; Mucocutaneous Lymph Node Syndrome ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prospective Studies ; Q Fever* ; Rifampin ; Splenomegaly ; Uterine Contraction

The incidence and risk factors for hypercalciuria were studied in 23 sick preterm (Group I), 36 well preterm (Group II), 16 sick term(Group III)and 41 well term(Group IV) neonates who were admitted to NICU and nursery of Ewha Woman's University Hospital from May 1988 to February 1992. The results were as follws: 1) The incidences of hypercalciuria were 73.9% in sick preterm (Group I) and 56.3% in sick term (Group III) which were significantly higher than 13.9% of control preterm (Group II) and 7.3% of control term (Group IV). Maximal urinary Ca/Cr ration were 0.63+/-0.503 in group I and 0.50+/-0.513 in group III, significantly higher than 0.19+/-0.142 of control term and 0.17+/-0.131 of control term. 2) In sick neonates with hypercalcuria, birth wight and gestational age were significantly lower and the frequencies of frosemide and intravenous calcium therpy were significantly higher than those of sick neonates without hypercalciuria. 3) In sick neonates, furosemide increased the incidence of hypercalciuria to 90.9%, significantly higher than 57.1% in neonates without furosemide. Maximal urine Ca/Cr ratio 24 hour urine calcium were also significantly higher in neonates with furosemide than those of neonates without furosemide. 4) In sick neonates, intravenous calcium gluconate increased the incidence of hypercalciuria to 86.6%, significantly higher than 54.2% in neonates without intravenous calcium. Maximal urine Ca/Cr ratio and 24 hour urine calcium were also significantly higher in neonates treated with IV calcium than those of neonates without IV calcium. 5) Calcium intake and maximal random urine Ca/Cr ratio were positively correlated (r=0.46, p=o.037). In conclusion, the majority of sick newborns in our intensive care unit were hypercalciuric. Sick condition, premature, furosemide and intravenous calcium gluconate were the risk factors that could lead to hypercalciuria. Use of these agents in sick neonates especially preterm neonates requires careful monitoring of urine calcium excretion.
Calcium ; Calcium Gluconate ; Furosemide ; Gestational Age ; Humans ; Hypercalciuria* ; Incidence ; Infant, Newborn* ; Intensive Care Units ; Nurseries ; Parturition ; Risk Factors

OBJECTIVE: It is generally accepted that ectopic pregnancy (EP) may adversely affected on the female fertility. However, it is not fully understood how it influences on the future fertility after treatment of an EP, so we intended to evaluate its effects, METHODS: This study was undertaken on 473 patients with clinically and pathologically proven diagnosis of ectopic pregnancies at the Department of Obstetrics and Gynecology, Anam Hospital, Kroea University Medical College hom Jan. 1, 1989 to Aug. 31, 1996. RESULTS: The incidence of ectopic pregnancy was 1 in 19.6 deliveries (5.1%). The overall spontaneous conception rate after treatment of ectopic pregnancy was 67.4%, and among them, the rate of intrauterine pregnancy (IUP) and repeat ectopic pregnancy (rEP) was 56.3% and 11.1% respectively. The occurrance rate of infertiity after treatment of EP was 32.6%. The mean time to IUP after treatment of EP was 16.5 months, and 79.0% of all IUP were conceived within 2 years after treatment. The mean time to repeat ectopic pregnancy was 15.9 months. With increasing maternal age, IUP rate was decreased and rEP rate was increased but they were statistically not signiTicant. Repeat EP rate was also increased in multiparous women but it was also statistically not significant. Overall PR (IUP and rEP) was decreased in women who have organic lesions (adhesions, endometriosis, PID etc.) in pelvic cavity(p=0.003). Patients who were treated with conservative surgery achieved a lower conception rate without statistical significance and it may be due to low cases. CONCLUSION: Future fertility rate was not significantly altered by EP itself, but rather affected by patient's age, organic lesions and previous history of pelvic surgery. Recently, the advent of assisted reproductive technology and its associated techniques improved the female fertility in women with such a problem.
Birth Rate ; Diagnosis ; Endometriosis ; Female ; Fertility* ; Fertilization ; Gynecology ; Humans ; Incidence ; Maternal Age ; Obstetrics ; Pregnancy ; Pregnancy, Ectopic* ; Reproductive Techniques, Assisted

OBJECTIVE: The prevalence of multifetal pregnancies has increased up to 30% as a result of the introduction of ovulation inducing agents for assisted reproductive teclmology(ART). An exttemely poor pognosis could be expected for viable pregnancies in multifetal gestation. So, to decrease the consequence of multiple pregnancies and prevent complications, especially premature baby irreversibly damaged, selective fetal reduction to the smaller number of fetuses should be considered in an early gestational period. METHODS: From May 1994 to Apr 1998, transvaginal selective fetal reduction in 13 pati including 9 triplet, 3 quadruplet and 1 quintuplet. Of the 13 patients, 4 were obtained by controlled ovarian hyperstimulation with intrauterine insemination (COH with IUI), 6 were by IVF-ET, 2 wae by controlled ovarian hyperstimulation with natural contact and 1 was by natural conception. Selective fetal reduction using intracardiac KC1 injection and aspiration of amniotic fluid carried out in 8-11 weeks of gestation. RESULTS: After procedures, 8 patients were remained as twin pregnancies, 5 patients as singleton pregnancies and 1 of the remaining twin embryos vanished after procedure. There have been 7 sets of twin delivery including 1 stillbirth and 3 singleton delivery. 1 cases are ongoing state. All of the singleton delivery were completed after 37 weeks of gestation. Of the twin delivery, 2 cases were delivered after 37 weeks of gestation, 2 cases in 35-37 weeks, and 3 cases before 35 weeks of gestation. Unfortunately, 1 stillbirth occurred in 20 weeks of gestation and 2 cases of singleton were aborted. As 3 losses(2 singleton, 1 twin) occurred, the delayed fetal loss rate in this selective fetal reduction was 25.0%(3/12). There was no fetal anomaly related to the procedure. CONCLUSION: Selective fetal reduction in multifetal pregnancies is a rather safe procedure and it may improve the outcome of multiple pregnancies.
Amniotic Fluid ; Embryonic Structures ; Female ; Fertilization ; Fetus ; Humans ; Insemination ; Ovulation ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Multiple ; Pregnancy, Twin ; Prevalence ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted* ; Stillbirth ; Triplets