No abstract available.
Base Sequence* ; Bone Marrow Transplantation* ; Bone Marrow* ; Chimerism* ; DNA* ; Genome, Human* ; Graft vs Host Disease* ; Humans ; Humans* ; Leukemia* ; Polymerase Chain Reaction* ; Recurrence* ; Tandem Repeat Sequences* ; Transplants*

Mycoplasma pneumoniae is the most common etiologic agent of pneumonia in school-aged children and young adults. It involves not only the respiratory system but includes extrapulmonary complications such as exanthem, hemolysis, arthritis, hepatic dysfuction, cardiac disease, and central nervous system disease. The pathogenesis of extrapulmonary involvements may be an autoimmune phenomena. Recent studies suggest that bronchial asthma can be initiated by Mycoplasma pneumoniae infection. We experienced a five-year-old girl suffering simultaneously from Guillain-Barr syndrome and initial bronchial asthmatic attack after mycoplasma pneumonia. She was admitted with lower-leg pain and weakness for three days. Ten days before admission, she was coughing and showed on a chest X-ray, pneumonic infitrations of both subhilar peribronchial areas. The titers of anti-mycoplasma antibody and cold hemagglutinin were 1:80 and 1:32, respectively. With a progression of paralysis to the upper extremities, she showed dyspnea, dysphagia and right facial palsy on the second hospital day. We performed a tracheostomy and started artificial ventilation. Unexpectedly, she showed continuous dyspnea, poor lung aeration and revealed severe hypoxemia in serial arterial gas analysis. Intravenous theophylline, high-dose corticosteroid and intravenous immunoglobulin therapy resulted in a progressive improvement of lung condition. She recovered completely from neurologic and pulmonic complications after five weeks.
Anoxia ; Arthritis ; Asthma* ; Central Nervous System ; Child ; Cough ; Deglutition Disorders ; Dyspnea ; Exanthema ; Facial Paralysis ; Female ; Heart Diseases ; Hemagglutinins ; Hemolysis ; Humans ; Immunization, Passive ; Lung ; Mycoplasma pneumoniae ; Mycoplasma* ; Paralysis ; Pneumonia ; Pneumonia, Mycoplasma* ; Respiratory System ; Theophylline ; Thorax ; Tracheostomy ; Upper Extremity ; Ventilation ; Young Adult

The treatment planning and dosimetry of small fields for stereotactic radiosurgery with 10 MV x-ray isocentrically mounted linear accelerator is presented. Special consideration in this study was given to the variation of absorbed dose with field size, the central axis percent depth doses and the combined moving beam dose distributon. The collimator scatter correction factors of small fields (1x1~3x3 cm2) were measured with ion chamber at a target chamber distance of 300cm where the projected fields were larger than the polystyrene buildup caps and it was calibrated with the tissue equivalent solid state detectors of small size (TLD, PLD, ESR and semiconductors). The central axis percent depth doses for 1x1 and 3x3 cm2 fields could be derived with the same acuracy by interpolating between measured values for larger fields and calcu1ated zero area data, and it was also calibrated with semiconductor detectors. The agreement between experimental and calculated data was found to be under +/-2% within the fields. The three dimensional dose planning of stereotactic focusing irradiation on small size tumor regions was performed with dose planning computer system (Therac 2300) and was verified with film dosimetry. The more the number of strips and the wider the angle of arc rotation, the larger were the dose delivered on tumor and the less the dose to surrounding the normal tissues. The circular cone, we designed, improves the alignment, minimizes the penumbra of the beam and formats ball shape of treatment area without stellate patterns. These dosimetric techniques can provide adequate physics background for stereotactic radiosurgery with small radiation fields and 10 MV x-ray beam.
Axis, Cervical Vertebra ; Computer Systems ; Film Dosimetry ; Particle Accelerators ; Polystyrenes ; Radiosurgery* ; Semiconductors

Background: Recent studies have successfully implemented next-generation sequencing (NGS) in HLA typing. We performed HLA NGS in a Korean population to estimate HLA-A, -B, -C, and -DRB1 allele and haplotype frequencies up to an 8-digit resolution, which might be useful for an extended application of HLA results. Methods: A total of 128 samples collected from healthy unrelated Korean adults, previously subjected to Sanger sequencing for 6-digit HLA analysis, were used. NGS was performed for HLA-A, -B, -C, and -DRB1 using the AllType NGS kit (One Lambda, West Hills, CA, USA), Ion Torrent S5 platform (Thermo Fisher Scientific, Waltham, MA, USA), and Type Steam Visual NGS analysis software (One Lambda). Results: Eight HLA alleles showed frequencies of ≥ 10% in the Korean population, namely, A*24:02:01:01 (19.5%), A*33:03:01 (15.6%), A*02:01:01:01 (14.5%), A*11:01:01:01 (13.3%), B*15:01:01:01 (10.2%), C*01:02:01 (19.9%), C*03:04:01:02 (11.3%), and DRB1*09:01:02 (10.2%). Nine previous 6-digit HLA alleles were further identified as two or more 8-digit HLA alleles. Of these, eight alleles (A*24:02:01, B*35:01:01, B*40:01:02, B*55:02:01, B*58:01:01, C*03:02:02, C*07:02:01, and DRB1*07:01:01) were identified as two 8-digit HLA alleles, and one allele (B*51:01:01) was identified as three 8-digit HLA alleles. The most frequent four-loci haplotype was HLA-A*33:03:01-B*44:03:01:01-C*14:03-DRB1*13:02:01. Conclusions We identified 8-digit HLA-A, -B, -C, and -DRB1 allele and haplotype frequencies in a healthy Korean population using NGS. These new data can be used as a representative Korean data for further disease-related HLA type analysis.

Background: HLA-DQ typing in deceased donors is not mandatory in Korea. Therefore, when patients develop DQ antibodies after kidney transplantation (KT) from deceased donor, it is impossible to determine whether they are donor-specific antibodies (DSA). We developed DQ prediction programs for the HLA gene and evaluated their clinical utility. Methods: Two HLA-DQ prediction programs were developed: one based on Lewontin’s linkage disequilibrium (LD) and haplotype frequency and the other on an artificial neural network (ANN). Low-resolution HLA-A, -B, -DR, and -DQ typing data of 5,603 Korean patients were analyzed in terms of haplotype frequency and used to develop an ANN DQ prediction program. Predicted DQ (pDQ) genotype accuracy was analyzed using the typed DQ data of 403 patients. pDQ DSA agreement, sensitivity, specificity, and false-negative rate was evaluated using 1,970 single-antigen bead assays performed on 885 KT recipients. The clinical significance of DQ and pDQ DSA was evaluated in 411 KT recipients. Results: pDQ genotype accuracies were 75.4% (LD algorithm) and 75.7% (ANN). When the second most likely pDQ (LD algorithm) was also considered, the genotype accuracy increased to 92.6%. pDQ DSA (LD algorithm) agreement, sensitivity, specificity, and falsenegative rate were 97.5%, 97.3%, 98.6%, and 2.4%, respectively. The antibody-mediated rejection treatment frequency was significantly higher in DQ or pDQ DSA-positive patients than in DQ or pDQ DSA-negative patients (P < 0.001). Conclusions Our DQ prediction programs showed good accuracy and could aid DQ DSA detection in patients who had undergone deceased donor KT without donor HLA-DQ typing.

A retrospective analysis has been made of 40 patients with pineal region tumors and CNS germ cell tumors who were treated at Yonsei University Hospital, Department of Radiation Oncology between 1971 and 1985. A tissue diagnosis was obtained before radiotherapy in 19 patients and 21 patients were irradiated without histological diagnosis. Among 19 biopsy-proven cases, 14 were germinomas, 2 were teratomas, and the others were two pineocytomas and one pineoblastoma. In the earlier period, every attempt was made to obtain a tissue pathology by either stereotaxic biopsy or open craniotomy before irradiation. However, in recent years, with the advent of CT scan, a trial radiotherapy with a modest dose of 20 Gy in 2 weeks was attempted in cases of highly suspected germinomas by CT scan findings. Further management after trial radiation depended on the radiation response shown on the follow-up CT scan and tumor marker study. Radiation fields varied from a small local field to whole brain or entire neuroaxis irradiation. Most patients received 40-50 Gy to the primary tumor site and 20-30 Gy to the neuroaxis. Twenty-nine of the total 40 patients are alive without of disease 22-144 months after treatment and the overall 5-year recurrence-free survival rate was 74.4%, Univariate analysis of prognostic factors at presentation showed that tumor type was highly correlated with outcome. Two of fourteen biopsy-proven germinomas and none of nine presumed germinomas by trial radiation recurred. On the other hand, five of six patients who showed poor response to trial radiation died of uncontrolled disease and only one patient with elevated AFP in serum and CSF was salvaged by chemotherapy. On the basis of the results of this study, application of trial radiation therapy without tissue biopsy is well justified as a treatment modality in a suspected germinoma by CT scan finding. Aggressive combined modality approaches with surgery, radiotherapy and chemotherapy need to be investigated to improve results in radioresistant tumors.
Biopsy ; Brain ; Craniotomy ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Germ Cells* ; Germinoma ; Hand ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Pathology ; Pinealoma ; Radiation Oncology ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Teratoma ; Tomography, X-Ray Computed

BACKGROUND: Recently, the incidence of cardiovascular diseases has increased in Korea. Hypercho-lesterolemia is a major risk factor for cardiovascular diseases. Atorvastatin (Lipitor(R)) is prescribed for the treatment of hyperlipidemia in Korea, but its effect has not been studied. Therefore, we investigated the lipid lowering effect of atorvastatin in Koreans. METHODS: This study included 82 hypercholesterolemic patients who visited the Department of Family Practice of Ajou University Hospital from January 1, 2000 to December 31, 2001. The mean age of the subjects was 47.8 years in the range of 27 to 66 years. Our study included 41 controls and 41 subjects who were administered atorvastatin 20 mg daily for 3 months. Fasting serum lipid levels were measured at baseline and at 3 months. Specific dietary and exercise interventions were not instructed. RESULTS: At 3 months, the serum total cholesterol and LDL were significantly lower in atorvastatin group than in the control group (Total cholesterol; -5.5+/-16.7%, vs 25.5+/-15.8%, P<0.05, LDL cholesterol; 1.4+/-28.5%, vs -30.1+/-28.9%, P<0.05). The serum triglyceride in atorvastain group showed no significant difference relative to the controls (Control: -5.8+/-34.2%, Atorvastatin: -3.5+/-54.8%, P=0.81). But, Serum triglyceride level decreased by -14.3+/-33.2% in the control and -39.0+/-23.2% in the atorvastatin group among the patients whose baseline triglyceride level was over 200 mg/dl (P<0.05). There was no significant differences in HDL-cholesterol (Control: 3.0+/-22.6%, ATORVASTATIN: -0.9+/-18.8%, P=0.38). The effect of atorvastatin was not influenced by age, sex, BMI and other risk factors. CONCLUSION: Atorvastatin lowered significantly the serum total cholesterol, LDL and triglycerides in Korea. Regardless of age, sex, BMI, but had no effect on HDL level.
Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Family Practice ; Fasting ; Humans ; Hypercholesterolemia* ; Hyperlipidemias ; Incidence ; Korea ; Risk Factors ; Triglycerides

A Modified irradiation technique utilizing a linear accelerator for radiation surgery within the brain was performed in 4 patients. Three of them had brain tumors and one small arteriovenous malformation in midbrain. A Hitchcock stereotactic apparatus and a 10 MeV linear accelerator have been adapted and special computer programs for dosimetry were obtained and studied experimentally with a phantom model. Stereotactic radiosurgery is a valuable tool in the treatment of inoperable, deep seated intracranial lesions, the major advantage being high efficacy and smoothness of the procedure, as well as short hospitalization times.
Arteriovenous Malformations ; Brain ; Brain Neoplasms ; Hospitalization ; Humans ; Mesencephalon ; Particle Accelerators* ; Radiosurgery*

OBJECTIVE: Both constitutive and inducible forms of nitric oxide synthase exist in endothelial cells. Disorders that produce acute lung injury frequently release endotoxin and cytoknes, such as interferon(IFNgamma) and tumor necrosis factor (TNFalpha). Endotoxin and these cytokines likely act as important mediators of cell injury. Because nitric oxide (NO) avidly reacts with iron, it may affect the activity of key enzymes, such as mitochondrial aconitase, which contain an iron-sulfur structure as a prosthetic group. METHOD: We studied the effect of IFNgamma, TNFalpha and E. coli lipopolysaccharide(LPS) on NO production and mitochondrial aconitase activity in cultured rat lung microvascular endothelial cells(RLMVC). RESULT: Exposing RLMVC for 24 hours to IFNgamma(500 U/mL), TNFalpha(300 U/mL) and LPS(5 microgram/mL) significantly increases nitrite production to 20+/-1 micrometer compared to 0.07 micrometer in control cells(P<0.05, n=4). Cytokine treatment also reduced mitochondrial aconitase activity from 196+/-8 to 102+/-34 nmole/min/mg of cell protein(P<0.05, n=4). Treatment with the inhibitor of nitric oxide synthase N-monomethyl-L-arginine(NMMA) (0.5 mM) not only significantly blunted the cytokine-mediated increase in nitrite formation (3+/-0.5 micrometer vs 20+/-1 micrometer with cytokines, P<0.05, n=4), but also prevented the cytokine-mediated drop in aconitase activity (161+/- 24 vs. 196+/-8 nmole/min/mg of cell protein, NS). CONCLUSION: Exposing RLMVC to IFNgamma, TNFalpha and E. coli LPS substantially decreases mitochondrial aconitase activity. Nitric oxide appears to mediate this effect. Our results suggest that the excessive production of NO by endothelial cells, in response to cytokines and endotoxin, may inhibit the function of the endothelial cell itself.
Aconitate Hydratase* ; Acute Lung Injury ; Animals ; Cytokines* ; Endothelial Cells* ; Iron ; Lung* ; Nitric Oxide Synthase ; Nitric Oxide* ; Rats* ; Tumor Necrosis Factor-alpha

Quadricuspid aortic valves (QAVs) is a rare congenital malformation. We report two cases of QAV associated with aortic regurgitation. The one is incidentally diagnosed and uncomplicated, and the other is symptomatic and associated with infective endocarditis. In most cases, QAVs are associated with valve regurgitation, with a concurrent stenosis in some patients, while only a small number of QAVs are functionally normal. Once the diagnosis has been made, echocardiographic follow-up is recommended, because of progression to severe valve regurgitation and the risk of infective endocarditis.
Aortic Valve Insufficiency* ; Aortic Valve* ; Constriction, Pathologic ; Diagnosis ; Echocardiography ; Endocarditis* ; Humans