BACKGROUND: Hemorrhage itself has been shown to produce abnormalities in immunity, particularly depression of the lymphocyte function. In order to better examine the amount of hemorrhage required to suppress the lymphocyte function, we determined the effect of graded fixed-volume hemorrhage on splenocyte proliferation and the lymphocyte subpopulation. METHODS: Male Sprague-Dawley rats(weight, 350~400g) were anesthetized, subjected to hemorrhages of 7.5ml/kg, 15ml/kg, and 22.5ml/kg by percutaneous cardiac puncture with 26G needles. After 1, 2, 4, and 7 days, animals were killed to obtain the blood and spleen. The splenocyte proliferative capacity was measured by using the tritiated thymidine incorporation technique, and the peripheral lymphocyte subpopulation was determined using flow cytometry with the following monoclonal antibodies: T cell(CD3+), T helper cell(CD4+), T cytotoxic cell(CD8+), and B cell(CD45RA+). RESULTS: Hemorrhage of 7.5ml/kg did not induce depression of splenocyte proliferation. However, for hemorrhage greater than 15ml/kg, the splenocyte proliferative capacity was significantly depressed at 2 days after hemorrhage and recovered at 4 days. Hemorrhage induced no changes in the relative percentage of lymphocyte subpopulations and in the number of each cell in peripheral blood. CONCLUSION: This study suggests that cellular immunity is depressed at 48 hrs after a hemorrhage greater than 15ml/kg without any change in the peripheral lymphocyte subpopulation.
Animals ; Antibodies, Monoclonal ; Depression ; Flow Cytometry ; Hemorrhage* ; Humans ; Immunity, Cellular ; Lymphocyte Subsets ; Lymphocytes* ; Male ; Needles ; Punctures ; Rats* ; Rats, Sprague-Dawley ; Spleen ; Thymidine

OBJECTIVE: It has been recognized that cold knife conization has higher incidence of postoperative hemorrhage and many techniques have been developed in an attempt to control hemorrhage. The aim of this study was to evaluate complications of Sturmdorf's suture in cold knife conization and to investigate various measures employed to reduce blood loss. METHODS: The results of 85 patients who had cold knife conization for diagnosis or treatment of cervical intraepithelial neoplasia (CIN) from August, 1997 to July, 2003 were reviewed. RESULTS: Among 85 patients, 83 patients (97.7%) had negative cut margins on conization specimen while 2 patients (2.3%) positive cut margins. 54 patients received no further treatment after cold knife conization and complications occurred in 9 patients (16.7%). Postoperative hemorrhage requiring additional hemostatic procedures occurred in 7 patients (13%), of which 6 patients were rehospitalized and 1 patient was managed at outpatient clinic with gauze packing only. Among 6 rehospitalized patients, hysterectomy was done in 2 patients and electrocoagulation in 1 patient. Packed red cell was transfused in 1 patient and 2 patients were managed with gauze packing only. Postoperative infection was found in 2 patients (3.7%). No other significant complications were noted. CONCLUSION: Cold knife conization using Sturmdorf's suture could be done to get much more accurate results of biopsy with relatively mild complication in magement of CIN, although several days? admission is needed and the other alternative methods seem to be more convenient.
Ambulatory Care Facilities ; Biopsy ; Cervical Intraepithelial Neoplasia ; Conization* ; Diagnosis ; Electrocoagulation ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Postoperative Hemorrhage ; Sutures*

Cytomegalovirus infections (CMV) of the gastrointestinal tract (GI) are common, and most often seen in patients with acquired immunodeficiency syndrome (AIDS), inflammatory bowel disease, or those receiving immunosuppressive therapy. CMV enteritis is uncommon in an immunocompetent individual. A CMV infection of the small bowel accounts for 4.3% of all CMV infections of the GI tract. The GI manifestations of CMV include: diarrhea, bleeding, obstruction and perforation, all of which are usually secondary to discrete erosions or ulceration. High mortality rates have been reported for CMV enteritis. Here, a rare case of CMV enteritis, resulting in segmental ileal ischemia, is reported in a 47-year old man following a traffic accident. On the 17th hospital day, he developed melena, watery diarrhea, fever and abdominal pain. An abdominal computed tomography (CT) on the 23rd hospital day showed an enlarged appendix with mild periappendiceal infiltration and segmental wall thickening in the terminal ileum. An ileocecal resection was performed. Pathological evaluation of the operative specimen revealed CMV inclusion bodies, with ulcerations. The patient was treated with ganciclovir therapy for 3 weeks after which his symptoms improved. If a CMV infection is highly suspected in multiply injured trauma victims, the earlier recognition of potential small bowel involvement can hopefully decrease the incidence of bleeding, ischemic demage to the bowel and perforation, which are usually fatal events.
Abdominal Pain ; Accidents, Traffic* ; Acquired Immunodeficiency Syndrome ; Appendix ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Diarrhea ; Enteritis ; Fever ; Ganciclovir ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Incidence ; Inclusion Bodies ; Inflammatory Bowel Diseases ; Ischemia* ; Melena ; Middle Aged ; Mortality ; Multiple Trauma* ; Ulcer

BACKGROUND: Atherosclerotic vascular disease is major cause of morbidity and mortality in dialysis patients. C-reactive protein(CRP) as a marker of inflammmation appears to be clinically useful in prediction of coronary heart disease and mortality. This study is designed to test whether plasma concentration of CRP correlates with coronary heart disease and mortality in CAPD patients. METHODS: A total of 137 end-stage-renal disease patients undergoing CAPD were included. The measurement of baseline CRP and stress thallium SPECT were performed in all patients. Patients were followed prospectively from initiation of dialysis to June 1999 for analysis of survival rate and cause of death. Coronary angiography performed in 16 of 32 patients showed all positive results. RESULTS: 32 patients showed positive results in thallium SPECT. The baseline CRP concentration were higher among patients with positive results in thallium SPECT than those with negative results(1.05 g/L vs 1.30mg/dL, p<0.001). The survival rate was significantly lower in lower CRP group than higher CRP group (44months vs 26 months, p<0.001). However, There was no difference in cause of death according to serum CRP level. Death from cardiac cause is significantly higher among patients with positive thallium SPECT than negative results. The most common cause of death are, in descending order of frequency, cardiac disease including acute MI, sepsis, cerebrovascular disease. CONCLUSION: The baseline level of inflammation as assessed by the plasma concentration of CRP independently predicts the risk of coronary heart disease and survival in CAPD patients.
C-Reactive Protein* ; Cause of Death ; Coronary Angiography ; Coronary Disease* ; Dialysis ; Heart Diseases ; Humans ; Inflammation ; Mortality* ; Peritoneal Dialysis, Continuous Ambulatory* ; Plasma ; Prospective Studies ; Sepsis ; Survival Rate ; Thallium ; Tomography, Emission-Computed, Single-Photon ; Vascular Diseases

On July 2009, 5 fly larvae were discovered inside the nose of a 76-year-old female. She was living in Cheonan-si, and in a state of coma due to rupture of an aortic aneurysm. Surgery was performed on the day of admission, and the larvae were found 4 days later. By observing their posterior spiracle, the larvae were identified as Lucilia sericata. Considering the rapid development of this species, the infection was likely acquired during hospitalization. Further investigation on the hospital environment should be needed to know the origin of the infection.
Aged ; Animals ; Aortic Rupture/complications ; Cross Infection/diagnosis/parasitology ; *Diptera ; Female ; Humans ; Korea ; *Larva ; Myiasis/*diagnosis/*parasitology ; Nose Diseases/*diagnosis/*parasitology

Teratomas are tumors composed of derivatives of all three germinal cell layers. They have been described in a variety of organs in both children and adults, most commonly in the gonads. Extragonadal intraperitoneal teratomas are very rare. We here report a case of a large mature teratoma of the gastrohepatic ligament in a 20-year-old woman. To the best of our knowledge, a teratoma of the gastrohepatic ligament has never before been described, although there are a few reports of teratomas arising from the greater and lesser omentum.
Adult ; Child ; Female ; Gonads ; Humans ; Ligaments* ; Omentum ; Teratoma* ; Young Adult

BACKGROUND: Both gemcitabine and vinorelbine are effective anticancer drugs with mild toxicity on non-small cell lung cancer, and monotherapy of these drugs are effective as a second-line chemotherapy. The aim of this trial was to assess the response and toxicity of a combination of gemcitabine and vinorelbine in patients of previously treated for non-small cell lung cancer. MATERIALS AND METHODS: 24 patients, initial stage III A/B,IV and previously treated with platinium and taxane based regimens, were enrolled from June 2000 to March 2004. The regimens consisted of vinorelbine 25mg/m2 followed by an infusion of gemcitabine 1000mg/m2 on day 1 and day 8 every three weeks. This course was repeated more than twice. RESULTS: Twenty-four patients were analyzed for the response, survival rate, and toxicities. The overall response was 17% with a complete remission rate of 4%. The median time-to progression (TTP) was 3.1 months (95%, CI 1-10months), and the survival time was 8.2 months (95%, CI 1-23 months). The grade 3/4 toxicities encountered were neutropenia (12.5%), anemia (0%), thrombocytopenia (0%). Non-hematological 3/4 toxicities were not observed. CONCLUSION: A combination of gemcitabine and vinorelbine in patients previously treated for non-small cell lung cancer provides a relatively good response rate, and a low toxicity profile. However, further study will be needed to confirm its effectiveness.
Anemia ; Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Humans ; Neutropenia ; Survival Rate ; Thrombocytopenia

PURPOSE: Hemophagocytic lymphohistiocytosis (HLH) is an important differential diagnosis in infants and children who present with prolonged fever, hepatosplenomegaly, marked hypertriglyceridemia and cytopenia. HLH is currently curable with immunomodulatory therapy, chemotherapy and stem cell transplantation. We evaluated the clinical characteristics and treatment outcomes in patients with HLH. METHODS: We reviewed retrospectively the medical records of 22 children with HLH from January 1996 to June 2003 at Catholic University St. Mary's Hospital. RESULTS: Among the 22 patients, 11 patients were male and the others were female. The median age of onset was 5.5 (0.6~14.4) years including 6 cases presenting before 2 years of age. Family history of suspicious HLH was observed in 3 patients and Epstein Barr virus (EBV) was demonstrated in 10 patients. The most frequent manifestation was fever and the median duration of fever at diagnosis was 18 (6~46) days. Common laboratory findings were neutropenia, anemia, thrombocytopenia, hypertriglyceridemia, hypofibrinogenemia and abnormal liver function tests. Bone marrow examinations showed significant hemophagocytic lymphohistiocytosis in all of these patients. No treatment was needed in 3 patients and 6 patients were treated with high dose immunoglobulin and antiviral agents, 9 cases with chemotherapy and 4 patients were transplanted with sibling bone marrow or unrelated cord blood. The causes of death were refusal to treatment in 1 patient, disease progression in 6 and pulmonary hemorrhage in 1. CONCLUSION: If the disease is familial or relapsing, progressive or persistent even without family history, hematopoietic stem cell transplantation from the best available donor is strongly recommended. In less severe secondary HLH cases, either no treatment or a short duration of therapy might suffice, but future studies are necessary to define these subsets, possibly with additional genetic markers.
Age of Onset ; Anemia ; Antiviral Agents ; Bone Marrow ; Bone Marrow Examination ; Cause of Death ; Child ; Diagnosis ; Diagnosis, Differential ; Disease Progression ; Drug Therapy ; Female ; Fetal Blood ; Fever ; Genetic Markers ; Hematopoietic Stem Cell Transplantation ; Hemorrhage ; Herpesvirus 4, Human ; Humans ; Hypertriglyceridemia ; Immunoglobulins ; Immunomodulation ; Infant ; Liver Function Tests ; Lymphohistiocytosis, Hemophagocytic* ; Male ; Medical Records ; Neutropenia ; Refusal to Treat ; Retrospective Studies ; Siblings ; Stem Cell Transplantation ; Thrombocytopenia ; Tissue Donors

PURPOSE: The prognosis of Philadelphia chromosome-positive acute lymphoblastic leukemiaacute lymphoblastic leukemia with Philadelphia chromosome (Ph ALL) is generally poor and reports from large studies are scarce. We evaluated the clinical characteristics and the efficacy of allogeneic bone marrow transplantation (Allo-BMT) and chemotherapy for children with this type of leukemia. METHODS: Fifteen children diagnosed with Ph ALL among 278 childhood acute lymphoblastic leukemia patients in our St. Mary's hospital from February 1997 to July 2002 were retrospectively reviewed. RESULTS: Of 278 eligible cases, 15 (5.4%) had a Philadelphia chromosome. There were 12 males and 3 females with a median age 9 years (range, 4~13). Initial white blood cell counts ranged from 6.3~446.0 109/L (median, 87.2 109/L). Immunophenotyping studies indicated B-lymphoid phenotype in 13, myeloid/B-lymphoid biphenotype in 2. Of 15 Ph ALL children, 12 patients entered remission after first induction therapy and remained other 3 cases finally had delayed remission. Among evaluable 14 patients, seven received Allo-BMT from HLA-identical sibling or unrelated donor and three of these patients died following recurrence and severe graft versus host disease. Only three patients are alive recently and of them two patients have durable disease free survival more than 24 months. All seven patients who treated with only chemotherapy only died of disease recurrence. CONCLUSION: Unlike the usual type of ALL, Ph ALL is associated with extremely poor prognosis and short remission duration. Therefore, Allo-BMT in first remission was the only treatment modality to cure children with Ph ALL in this study. However, even with Allo-BMT, the relapse rate is quite high. Thus, further study is needed to identify the risk factors affecting treatment outcome and to develop new treatment strategy to overcome this factors.
Bone Marrow Transplantation ; Child* ; Disease-Free Survival ; Drug Therapy ; Female ; Graft vs Host Disease ; Humans ; Hydrogen-Ion Concentration ; Immunophenotyping ; Leukemia ; Leukocyte Count ; Male ; Phenotype ; Philadelphia Chromosome ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Siblings ; Treatment Outcome ; Unrelated Donors

Malignant melanoma is a very rare disease in children. There is an increased risk for the development of malignant melanoma in patient with giant congenital melanocytic nevus. The manifestations of distant metastases in malignant melanoma commonly indicate a poor prognosis. First line treatment of malignant melanoma is excision, but when associated with giant congenital melanocytic nevus, excision is very difficult due to the site and the size of the lesions. However, malignant melanoma is not sensitive to chemotherapy, but a child is more sensitive than an adult. We report a case of unresectable childhood malignant melanoma associated with a giant congenital melanocytic nevus in a 3 year-old female treated with chemotherapy.
Adult ; Child* ; Child, Preschool ; Drug Therapy ; Female ; Humans ; Melanoma* ; Neoplasm Metastasis ; Nevus, Pigmented ; Prognosis ; Rare Diseases