Infantile form of histiocytosis X is commonly presented as multiorgan desseminated form such as Letterer-Siwe disease. Lymph node involvement of histiocytosis X is usually accompanied by adjacent bone or skin lesion. Solitary nodal eosinophilic granuloma without evidence of other organ involvement is very rare. A case herein report is a 11 month-old female infant presented with fever and palpable both inguinal lymph nodes. There was neither skin lesion nor hepatosplenomegaly. Laboratory evaluation was within normal range except increased alkaline phosphatase and many neutrophils in urine. Radiologic examination revealed no remarkable bone lesions. And she showed good clinical outcome without evidence of other organ involvements. On microscopic examination of inguinal lymph node it was replaced by infiltration of histiocytes mainly along the sinusoid. Some of histiocytes showed morphologic features of "histiocytosis X cell" having nuclear grooves or multilobulation. Multinulceated giant cells were frequently see. Numerous eosinphils were also infiltrated and showed multifocal microabscess formation. Immunohistochemical staining revealed that majority of histiocytes were postitive for S-100 protein but multinucleated histriocytes, phagocytic histiocytes and those around the abscess were positive for macrophage marker, suck as CD68 and alpha-1-antichymotrypsin. Interestingly some histiocytes showed positivity for both S-100 protein and macrophage marker. These results suggest that histiocytosis X is proliferative disorder of phenotypically heterogenous population of histiocytes in contrast to the theory that it is a proliferative disorder of Langerhans cells.
Infant ; Male ; Female ; Humans

Gestational trophoblastic tumor is one of the curable disease, but metastatic trophoblastic tumor still shows high mortality rate because of resistance to the chemotherapy. Choriocarcinoma may occur after an any type of human pregnancy. The incidence of choriocarcinoma following term pregnancy is very uncommon, and such tumor appears to follow a more aggressive course with more extensive metastatic spread and is less responsive to chemotherapy resulting in a poorer prognosis. Choriocarcinoma presenting as postpartum hemorrhage, and spontaneous tumor perforation with intra-abdominal hemorrhage is even rarer, requiring emergency laparotomy. We had experienced one case of metastatic choriocarcinoma following term pregnancy that required emergency total abdominal hysterectomy due to uterine perforation and hemorrhage. So, we report this case with brief review of literatures.
Choriocarcinoma* ; Drug Therapy ; Emergencies ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Laparotomy ; Mortality ; Postpartum Hemorrhage ; Pregnancy ; Pregnancy* ; Prognosis ; Trophoblastic Neoplasms ; Uterine Perforation*

BACKGROUND: The purpose of this study was to investigate the characteristics of and to analyze the factors re-lated to the cost of the resolution of a medical dispute. METHODS: We have reviewed 2,346 cases reported to the Korean Medical Association(KMA)mutual-aid association from Nov. 1. 1981 to Oct. 31. 1994. RESULTS: The percentage rate of reported cases of were related field as follows .' obstetric gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4% 1,829 cases (80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurators office or the court. The mean settlement amount per case was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treat-ment and care 18.0%, delivery 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were: delivery and Cesarian section 15,190,000 won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patients status were .' death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amout for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complications 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amout where there was a misdiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of a single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/ Cesarian sections were higher than for injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurators office was higher than in out of court without public intervention. CONCLUSIONS: The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctors misdiagnosis, fault, and standard care. Therefore, a reason-able method of resolution for medical dispute is needed.
Anesthesia ; Diagnostic Errors ; Dissent and Disputes ; Humans ; Internal Medicine ; Malpractice* ; Orthopedics ; Police

No abstract available.
Respiratory Syncytial Virus Infections* ; Respiratory Syncytial Viruses*

Single breath-hold gradient echo images with Small Tip. Angle Gradient Echo(STAGE) were evaluated in the study of liver in 16 patients(4 normal liver, 5 hepatoma, 5 cholangiocarcinoma, 1 hemangioma, 1 cavernous transformation of portal vein). We obtained one slice of gradient echo during single breath-hold at the level of pathology defined on conventional spin echo inage. Single breath-hold gradient echo images were compared with spin echo images for image quality and artifacts. Single breath-hold gradient image showed improved resolution of vascular detail and excellent contrast between lesion and adjacent normal liver in hepatoma. Cholangiocarcinoma showed decreased contrast between lesion and biliary trees but improved contrast between lesion and blood vessel. Cavernous transformation of porta vein was noted as tortuous vessel of high signal intensity. Single breath-hold gradient echo scan increased vascular artifact, but decreased respiratory artifact leading to improved image quality. Single breath-hold technique can reduce can reduce imaging time and improve image quality and may be used as complementary method to the spin echo scan.
Artifacts ; Blood Vessels ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Hemangioma ; Liver* ; Magnetic Resonance Imaging* ; Methods ; Pathology ; Trees ; Veins

True cysts of the pancreas are rare, and enterogeous (duplication) cysts are extremely rare. We describe a case of enterogenous cyst of the pancreas located in the retroperitoneum, in which homogenous low attenua-tion, multiloculation, internal septation and cyst wall calcification were noted.
Pancreas*

BACKGROUND: As a result of exposure to human leukocyte antigen(HLA) by pregnancy, blood transfusion and previous organ transplantation, many patients awaiting renal transplantation can develop HLA antibodies. The level of HLA sensitization is determined by PRA(panel reactive antibody) test using a lymphocyte panel from HLA phenotyped selected donors. In Korea, PRA tests have not been performed routinely for organ transplantations. and there is no available data about HLA sensitization in renal transplantation. METHODS: PRA test was done in 136 sera of chronic renal failure(CRF) patients receiving dialysis (hemodialysis 108, peritoneal dialysis 28) by NIH standard microlymphocytotoxicity method with a frozen lymphocytes panel from 36 HLA-typed donors. PRA positive sera were re-tested after dithiothreitol(DTT) treatment and analyzed for HLA antibody specificities. RESULTS: Thirty five out of 136 sera(25.7%) showed positive PRA values in HLA antibody screening test. The PRA(%) values of the 35 positive sera were distributed into 1-10%(n=8), 10-20%(n=7), 20-50%(n=12) and 50%-100%(n=8). respectively. After DTT treatment, the change of PRA reactivity was divided into three groups. The PRA values of Group A(22 sera: 63%) showed no change, Group B(7 sera: 20%) declined, and Group C(6 sera. 17%) completely disappeared after DTT treatment. The specificities of HLA antibodies were identified in 19 out of 35 sera(54%). The success rate in defining antibody specificities was 0 at PRA values of 1-10% and 70-100%, and high at PRA values of 20-70%. CONCLUSION: We observed that about a quarter of CRF patients have developed HLA antibodies of immunoglobulin class-IgG, mixed IgG and IgM, and IgM HLA antibody in decreasing order of frequency.
Antibodies ; Antibody Specificity ; Blood Transfusion ; Dialysis ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Isoantibodies* ; Kidney Failure, Chronic* ; Kidney Transplantation ; Korea ; Leukocytes ; Lymphocytes ; Mass Screening ; Organ Transplantation ; Peritoneal Dialysis ; Pregnancy ; Tissue Donors ; Transplants

BACKGROUND: In pregnancy, paternal human leukocyte antigen (HLA) that the fetus possesses can induce the development of cytotoxic HLA antibodies in the pregnant women. We investigated the frequency and the characteristics of HLA antibodies during the pregnancy in Koreans. METHODS: Sera from 192 pregnant women (46 in the 1st trimester, 120 in the 2nd and 26 in the 3rd trimester) were tested for the presence of HLA antibody. Home made lymphocyte panel from 36 volunteers whose HLA-A, B and C antigens had been already identified 3nd formerly frozen in a liquid nitrogen tank were dispensed in duplicate into 72-well microplates and used as testing trays Test sera of one pregnant women with one negative control serum were dispensed in each plate and the plates were tested by microlymphocytotoxic method using anti-human immunoglobulin. The results were observed under fluorescence microscope and PRA (panel reactive antibody) values were determined by the percentage of wells showing positive reactions. HLA antibody specificities were identified by analysis of reaction characteristics. RESULTS: Among the 192 sera, 22 (11.5%) showed positive PRA value (PRA > 0%) in HLA antibody screening tests, in which 20 were less than 50% and 2 were more than 50% of PRA value. Two of the 46 subjects (4.3%) in the 1st trimester, 15 of the 120 (12.5%) in the 2nd and 5 of the 26 (19 2%) in the 3rd trimester were positive for HLA antibody. Among the 22 positive sera , specificities of HLA antibodies were identified in 14 (64%) sera: 8 sera had HLA antibody against single private HLA antigen. 5 had HLA antibodies against two or more antigens. and 1 sera showed anti-Bw4 antibody. CONCLUSION: In 192 pregnant women, 22 (11.5%) had HLA-A, B antibodies and they showed higher frequencies with the progress of pregnancy. Most of the pregnant women who were positive for HLA antibodies showed PRA value less than 50%. HLA antibody specificities were identified in 14 out of 22 positive sera (64%).
Antibodies* ; Antibody Specificity ; Female ; Fetus ; Fluorescence ; HLA-A Antigens* ; Humans ; Immunoglobulins ; Leukocytes ; Lymphocytes ; Mass Screening ; Nitrogen ; Pregnancy ; Pregnant Women* ; Volunteers

BACKGROUND: CD34 positive cell enumeration by flow cytometry is currently used to determine the optimal timing of peripheral blood stem cell collections (PBSC) and to predict engraftment of stem cell transplantation. However, the technical problems and lack of a standardized method are sources of significant variability in the quantitation of the CD34 positive cells. ProCOUNT(TM) (Beckon Dickinson Immuno- cytometry System, USA) kit for three color flow cytometric analysis was introduced to enumerate CD34 positive cells using a standardized method. This study was conducted to evaluate the usefulness of the three color method, ProCOUNT(TM), in comparison with two color method. METHODS: CD34 positive cells from 25 cord blood samples were enumerated by two methods, two color (CD34-PE/CD45-FITC) and three color (ProCOUNT(TM) , nucleic acid dye/CD34-PE/ CD45-PerCP) flow cytometric analysis, in which CD34 positive cells were counted directly in comparison with counting beads introduced in the sample. RESULTS: The count of CD34 positive cells in the cord blood was 28.3(+/-20.0)/uL and 20.9 (+/-16.0) /uL by three color and two color methods, respectively, The number of CD34 positive cells enumerated by ProCOUNTTM kit was well correlated with that by two color method, but the count was significantly higher in the former method (p<0.01). CONCLUSIONS: In the three color method, loss of stem cells was significantly lower than that in the two color method, and it was possible to obtain a direct count of CD34 positive cells by using a standardized procedure.
Fetal Blood* ; Flow Cytometry ; Hematopoietic Stem Cells* ; Stem Cell Transplantation ; Stem Cells

BACKGROUND: CD34 positive cell enumeration by flow cytometry is currently used to determine the optimal timing of peripheral blood stem cell collections (PBSC) and to predict engraftment of stem cell transplantation. However, the technical problems and lack of a standardized method are sources of significant variability in the quantitation of the CD34 positive cells. ProCOUNT(TM) (Beckon Dickinson Immuno- cytometry System, USA) kit for three color flow cytometric analysis was introduced to enumerate CD34 positive cells using a standardized method. This study was conducted to evaluate the usefulness of the three color method, ProCOUNT(TM), in comparison with two color method. METHODS: CD34 positive cells from 25 cord blood samples were enumerated by two methods, two color (CD34-PE/CD45-FITC) and three color (ProCOUNT(TM) , nucleic acid dye/CD34-PE/ CD45-PerCP) flow cytometric analysis, in which CD34 positive cells were counted directly in comparison with counting beads introduced in the sample. RESULTS: The count of CD34 positive cells in the cord blood was 28.3(+/-20.0)/uL and 20.9 (+/-16.0) /uL by three color and two color methods, respectively, The number of CD34 positive cells enumerated by ProCOUNTTM kit was well correlated with that by two color method, but the count was significantly higher in the former method (p<0.01). CONCLUSIONS: In the three color method, loss of stem cells was significantly lower than that in the two color method, and it was possible to obtain a direct count of CD34 positive cells by using a standardized procedure.
Fetal Blood* ; Flow Cytometry ; Hematopoietic Stem Cells* ; Stem Cell Transplantation ; Stem Cells