We report three cases of neuroendocrine tumors of the lung characterized by large pleomorphic cell with frequent mitosis, which show neuroendocrine differentiation by both light microscopy or electron microscopy and iminunohistochemistry. These tumors have been categorized as large cell neuroendocrine carcinoma by Travis et al.(1991) in contrast with non-small cell lung cancer with neuroendocrine differentiation. In the latter, neuroendocrine differentiation is not evident by light microscopy and must be demonstrated by imunohistochemstry or by electron microscopy. The prognosis of large cell neuroendocrine carcinoma, together with non-small cell lung cancer with neuroendocrine differentiation, appears to be worse than cancer without neuroendocrine differentiation and intermediate between atypical carcinoid and small cell lung cancer. Larger numbers of patients will be needed to demonstrate significant differences in survival.
Lung Neoplasms

Hematopoietic neoplasm coexpressing CD4 and CD56 includes a subset of acute myeloid leukemia with myelomonocytic differentiation, plasmacytoid monocyte tumor, and other immature hematopoietic neoplasms of undefined origin. Herein, we report a CD4+CD56+CD68+ hematopoietic tumor that was thought to be a tumor of plasmacytoid monocytes. This case is unique in the absence of accompanying myelomonocytic leukemia and the faint expression of cCD3 on the tumor cells. The patient was a 22-yr old man presented with multiple lymphadenopathy and an involvement of the bone marrow. Tumor cells were large and monomorphic with an angulated eosinophilic cytoplasm of moderate amount. Nuclei of most tumor cells were eccentric and round with one or two prominent nucleoli. Rough endoplasmic reticulum was prominent in electron microscopic examination. Tumor cells expressed CD4, CD7, CD10, CD45RB, CD56, CD68, and HLA-DR and were negative for CD1a, CD2, sCD3, CD5, CD13, CD14, CD20, CD33, CD34, CD43, CD45RA, TIA-1, S-100, and TdT. cCD3 was not detected in the immunostaining using paraffin tissue, but was faintly expressed in flow cytometry and immunostaining using a touch imprint slide. T-cell receptor gene rearrangement analysis and EBV in situ hybridization showed negative results. Cytochemically, myeloperoxidase, Sudan black B, and alpha naphthyl butyrate esterase were all negative.
Adult ; Antigens, CD/*biosynthesis ; Antigens, CD3/*biosynthesis ; Antigens, CD4/*biosynthesis ; Antigens, CD45/biosynthesis ; Antigens, CD56/*biosynthesis ; Antigens, Differentiation, Myelomonocytic/*biosynthesis ; Bone Marrow Cells/pathology ; Cell Nucleus/pathology ; Eosinophils/metabolism ; Flow Cytometry ; Gene Rearrangement ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis/*metabolism ; Lymph Nodes/pathology ; Male ; Microscopy, Electron ; Monocytes/*metabolism ; Receptors, Antigen, T-Cell/metabolism

PURPOSE: The exposure to domestic animals has been increased, but there is no systematic evaluation for the clinical importance of animal antigens in Korea. The purpose of this study is to evaluate the significance of animal epithelial antigens as the causative allergens in childhood asthma and rhinitis. METHODS: In 228 children with asthma and rhinitis, allergic skin tests were done with 72 extracts, including 5 animal epithelial antigens. RESULTS: According to the results of allergy skin tests, 208 out of 228 children showed positive skin reactions to more than one antigens, and 128(61.4%) showed positive reactions to animal epithelial extracts. Among them, 17(8.1%) were mites non-sensitive to house dust and sensitive to animal epithelium. The positive reaction to each antigens were as follows:D. farinae(72.6%), D. pteronyssinus(69.7%), rabbit(40.3%), cat(33.1%), dog(24.0%), horse(16.8 %), and cow(14.9%). The degree of skin reactions to animal epithelial antigens were weaker than those to house dust mites. The positive concordance rates between skin tests and specific IgE reactions to D. pteronyssinus and cat/dog were 89.1%, and 25.9%, respectively. We experienced six patients with asthma and rhinitis who suspected animal epithelium as a causative allergen. CONCLUSION: Up to 61.4% of children with respiratory allergy showed positive reactions to animal epithelial extracts and 8.1% of them were house dust mites non-sensitive cases. Therefore, animal epithelium should be investigated as a causative allergen when skin reactions were strong and showed positive specific IgE antibodies.
Allergens ; Animals* ; Animals, Domestic ; Antibodies ; Asthma* ; Child* ; Dust ; Epithelium* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Korea ; Mites ; Pyroglyphidae ; Rhinitis* ; Skin ; Skin Tests

BACKGROUND AND OBJECTIVES: A more simple medical record form has been needed for a more qualified and cost-effective health care. A short-term admission medical record (SAMR) is a standard fill-in-the-blank form on the patients' conditions for common otolaryngologic diseases. The aim of this study is to determine the efficiency of the SAMRs. MATERIALS AND METHOD: Nineteen doctors who had residency training in the Department of Otolaryngology of Ewha Womans University Mokdong Hospital from the year 1995 through 2000 were included in this study. Questionnaires consisted of 11 comparative questions: the subjects were instructed to express their degrees of satisfaction with conventional medical records (CMRs) and SAMRs on a 100mm visual analogue scale for each question. The degrees of satisfaction with SAMRs were compared to those with CMRs. RESULTS: There were no statistically significant differences in the degrees of satisfaction between the two types of records for accurate evaluation of patients' condition, efficient communication between medical and paramedical personnels, and the value of verified records in the medicolegal conflicts and insurance claims. However, the degrees of satisfaction with SAMRs were higher than those with CMRs for communication between doctors, the value in medical research, time-saving, simplicity, paper-saving and their convertibility into electronic medical records. CONCLUSION: SAMRs provides patients of common otolaryngologic diseases with not only the necessary conditions of medical records, but also the basis of computer-based patient records. In addition, SAMRs may be also be more cost-effective than CMRs.
Allied Health Personnel ; Delivery of Health Care ; Electronic Health Records ; Female ; Humans ; Insurance ; Internship and Residency ; Medical Records* ; Otolaryngology ; Otorhinolaryngologic Diseases* ; Surveys and Questionnaires

BACKGROUND: There has been no systematic investigation of the necessary core procedures in primary care in Korea. The purpose of this study is to examine the core procedures necessary in primary care and to have the results reflected in residency programs. METHODS: A mail survey was conducted fram May 2, to August 20, 1997 among 478 physicians who qualified as a family physician specialist since 1989. The contents of the questionnaire included 1) sex, age, locatian and size of the hospital 2) of the 93 procedures that should be taught during residency pragrams as suggested by the [American Academy of Family Physicians] and the [Korean Academy of Family Physicians a) procedures taught in residency programs, b) procedures performed by practicing family physicians, and, c) procedures considered as necessary in primary care. RESULTS: 1) Of the 93 procedures, 78 were taught in residency programs, 35 were performed by practicing family physicians, and 77 were considered necessary in primary care. 2) All of the 35 procedures performed by family physicians were taught in the residency programs. Of the 77 procedures considered necessary in primary care, 71 were taught but the remaining 6 were infrequently taught. 3) 7 procedures were taught but was considered unnecessary ; Procedures taught but not actually performed amounted to a total of 43. 4) 42 procedures were considered necessary but not performed. 5) More procedures were performed by male doctors(p<0.05). Surgical procedures were performed more often in regional hospitals than those in Seoul and in the larger cities(p<0.05), and more were performed in private practice(p<0.05). CONCLUSIONS: Although almost all of the procedures considered necessary in primary care were taught in residency programs, many procedure's were not being performed in current medical practice. We suggest that it would be more effective to intensively train the core procedures than to provide exposure to a wide array of procedures. As the procedures performed were found to vary in relat
Humans ; Internship and Residency* ; Korea ; Male ; Physicians, Family ; Postal Service ; Primary Health Care ; Seoul ; Specialization ; Surveys and Questionnaires

BACKGROUND: Patients with lymph node-negative breast cancer show a 10-year recurrence rate of approximately 20%. In node-negative breast cancer, the prognostic factors are age, menopause, tumor size, hormone receptors, p53, DNA ploidy, Ki-67 index (Ki-67) and c-erbB2. Of these, ErbB2 (the protein of the c-erbB2 gene) is a member of the receptor tyrosine kinase family. Overexpression of ErbB2 is known to regulate cell proliferation, differentiation, growth and apoptosis via the ErbB2/Phosphoinositol 3-Kinase (PI 3-K)/Akt signaling pathway. Therefore, it is important to identify high- risk patients that would benefit from adjuvant therapies related with ErB2. For this purpose, the prognostic relevance of the ErbB2/PI 3-K/Akt pathway was examined in node-negative breast cancer. METHODS: A retrospective analysis was performed on the hospital records of all 72 patients diagnosed with breast cancer, and who underwent surgical treatment between January 1996 and December 2003. Clinicopathological data were compared with the results of immunohistochemical staining using the phospho-specific antibody for the expression of Akt. RESULTS: The mean age of the patient's was 48.6 years. Phospho-Akt (pAkt) was expressed in 24 cases (33.3%), but there was no statistical relationship between pAkt expression and the known prognostic factors of breast cancer. There was no statistical significance in the survival rates between the pAkt positive and negative expression groups (P=0.123). In the ErbB2 positive patients, the expression of pAkt was associated with a shorter disease-free survival (P=0.045), and the disease-free survival was shorter in patients whose tumors expressed pAkt and had a high level of Ki-67 (P=0.040). CONCLUSION: The co-expression of ErbB2 and pAkt positivity implied a poor prognosis in node-negative breast cancer patients, and the co-expression of high Ki-67 and pAkt positivity also revealed a poor prognosis in these patients. These results show that the expression of pAkt could be considered a prognostic marker of node-negative breast cancer with ErbB2 positive expression and high levels of Ki-67.
Apoptosis ; Breast Neoplasms* ; Breast* ; Cell Proliferation ; Disease-Free Survival ; DNA ; Female ; Hospital Records ; Humans ; Menopause ; Ploidies ; Prognosis ; Protein-Tyrosine Kinases ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: This study is directed to evaluate standardized developmental test performances of infants and children who, as fetuses, had mild isolated cerebral ventriculomegaly diagnosed by ultrasound. METHODS: All prenatal sonographic findings from 2001 to 2002 were evaluated. Live isolated mild ventriculomegaly (IMVM) of 10-15 mm were observed in 95 cases (1.1 percent). Standardized developmental testing of 40 cases of IMVM and 36 cases in a comparison group were offered to parents Both groups of children were adjusted to normal antepatum subjects with respect to sex, race, indication for ultrasound and gestational age at the time of ultrasound. Test of cognitive and motor development (Bayley Scales of Infant Development, Second Edition; BSID-II) were administered by developmental examiners. RESULTS: Forty cases and 34 comparison sujects completed the testing. The IMVM and comparison groups were similar with respect to parental age, gestational age, birth weight, familial socioeconomic status. The IMVM subjects scored lower than the comparison group on both the BSID-II, but there was not statistically significant. differences; metal development index (MDI) (92.7+/-12.9 vs 94.7+/-14.1, P=0.47) and psychomotor development index (PDI) (100.3+/-14.1 vs 101.3+/-10.7, P=0.75). Eleven cases (27.5 percent) of IMVM group and five cases (14.7 percent) of the comparison group were developmentally delayed, but most cases in both groups showed mild delays. Resolution or lack of progression, lateral ventricle diameter < or= 12 mm and females were associated with better scores, but there were not statistically significant. Polarity, and head circumference were not related to later development. CONCLUSION: This study show children with MIVM did not delay performance in the developmental test, but we might suggest a tendency to increase the risk of mild developmental delay.
Birth Weight ; Child ; Child Development ; Continental Population Groups ; Female ; Fetus ; Gestational Age ; Head ; Humans ; Hydrocephalus ; Infant ; Lateral Ventricles ; Parents ; Social Class ; Ultrasonography ; Weights and Measures

BACKGROUND: C-reactive protein is an acute phase reactant, which can be increased by either (both) infectious or (and) non-infectious and non-specific reaction of cells and tissue metabolism. Also C-reactive protein is known to have a relationship between changes in lipid and glucose metabolism. In recent studies, the possibility of being a prognostic factor of cardiovascular risk factors and serum C-reactive protein concentration within conventional reference ranges in otherwise normal people has also received little attention. Therefore, in this study, we tried to look for the relationship between C-reactive protein and cardiovascular risk factors of a healthy adult. METHODS: We analyzed the results of the surveys and chemistries given to 3,548 healthy men and women who have visited the heath promotion center in a certain university hospital. We assayed the C-reactive protein by means of rate nephelometry. We omitted the case of 123 people who went over 1mg/dL. We compared C-reactive protein of normal and abnormal range of each risk factor and went through the multiple regression analysis for the factors with significant differences. RESULTS: When C-reactive protein concentration of normal and abnormal of cardiovascular risk factors were compared by t-test, there were differences according to age (p<0.001), sex (p<0.001), body mass index (p<0.001), WBC (p<0.001), systolic blood pressure (p<0.001), diastolic pressure (p<0.001), total cholesterol (p<0.00), HDL-cholesterol (p<0.05) and smoking (p<0.01). We could not find any significant difference of triglycerides. After going through multiple regression analysis for the risk factors, which showed a significant difference by t-test, we found out that the C-reactive protein increased as cholesterol (p<0.01), body mass index (p<0.01) and WBC (p<0.001) increased. As for HDL-cholesterol (p<0.001), the C-reactive protein increased as it decreased. Age, sex, smoking history, systolic blood pressure, and diastolic blood pressure did not show significant relationship we were looking for. CONCLUSION: C-reactive protein was not related to age, smoking history ,blood pressure, and triglycerides among cardiovascular risk factors, but was related to body mass index, cholesterol, HDL-cholesterol and WBC. This relationship indicated that even if the C-reactive protein was in normal range a person with C-reactive protein should be aware of the risk involved for cardiovascular diseases.
Adult ; Blood Pressure ; Body Mass Index ; C-Reactive Protein* ; Cardiovascular Diseases ; Cholesterol ; Female ; Glucose ; Humans ; Male ; Metabolism ; Nephelometry and Turbidimetry ; Reference Values ; Risk Factors* ; Smoke ; Smoking ; Triglycerides

PURPOSE: Adverse reactions to mosquito bites have been recognized for some time, and these usually consist of large swellings, generalized urticaria, angioedema, and less frequently asthma. There have been some efforts to define immunologic characteristics of mosquito allergens throughout the world. But, in Korea, the immunologic analysis of mosquito allergen have not been made. METHODS: Extracts of locally distributed female mosquito Culex pipiens, were prepared from their heads and thoraxes. By sodium dodecylsulfate-polyacrylamide gel electrophoresis, proteins of two extracts were isolated. Then their proein bands were transferred to nitrocellulose membrane. Immunoblotting was performed with sera of allergic patients to mosquito bites, then completed by antibodies to human IgE. RESULTS: Immunoblotting showed IgE binding proteins weighing 70 kD, 60 kD, 34 kD in Culex pipiens. CONCLUSION: We found that mosquito antigens induced IgE response, and it suggested that species-specific antigens exist. Further investigation using salivary gland extracts from Culex genus are needed in identifying specific allergens.
Allergens* ; Angioedema ; Antibodies ; Asthma ; Collodion ; Culex* ; Culicidae* ; Electrophoresis ; Female ; Galectin 3 ; Head ; Humans ; Immunoblotting ; Immunoglobulin E ; Korea ; Membranes ; Salivary Glands ; Sodium ; Thorax ; Urticaria

BACKGROUND: In Caucacians, almost all RhD-negatives have deletion in RHD gene and the RHD genotyping by PCR-SSP is a valuable tool. The aim of this study is to investigate the frequency of RHD gene deletion in RhD-negative Korean donors and evaluate the clinical usefulness of various RHD genotyping methods in Korean. METHODS: Two hundred fifty RhD-positive blood obtained from Blood Transfusion Research Institute and 119 RhD-negative blood samples were obtained from Korea Red Cross Dong Bu Center. Phenotyping of RhD, RhC/c, and RhE/e antigen was performed using polyclonal and monoclonal antibodies(Dade AG, Switzerland). PCR-SSP was performed by primer sets, specific for exon 3, exon 4, exon 5, exon 6, exon 7, exon 9, and exon 10 of RHD gene and for exon 2, intron 4, and intron 4-exon 5 common to RHD and RHCE genes. RESULTS: The phenotypes of 250 RhD-positives consisted of 106(42.4%) CCee, 93(37.2%) CcEe, 26(10.4%) ccEE, 21(8.4%) Ccee, 3(1.2%) ccEe, and 1(0.4%) ccee. In RhD-negative donors, 62(52.1%) were ccee, 37(31.1%) Ccee, 10(8.4%) ccEE, 6(5.0%) CcEe, 2(1.7%) ccEE, and 2(1.7%) CCee. Twenty-two out of 101 RhD-negatives showed no deletion in all used methods. Deletion frequency of RhD negatives varied according to the methods: 76(75.3%) in intron 4-exon 5 boundary; 74(73.3%) in intron 4; 72(71.3%) in exon 4; 67(66.3%) in exon 7; 63(62.4%) in exon 10; 9(8.9%) in exon 5; no deletion in exon 3, exon 6, and exon 9. Different RhD phenotypes also showed different RHD gene deletion frequency: 80-90% deletion in ccee; 70% in ccEe; 40-50% in Ccee and CcEe; no deletion in CCee phenotypes. CONCLUSIONS: RHD gene deletion frequency varied according to the methods applied and individual's own RhD phenotypes. Therefore, RHD genotyping is not appropriate for a routine test in Blood Bank and individual variation should be considered in prenatal care of RhD-negative women.
Academies and Institutes ; Blood Banks ; Blood Transfusion ; Exons ; Female ; Gene Deletion ; Humans ; Introns ; Korea ; Phenotype ; Polymerase Chain Reaction* ; Prenatal Care ; Red Cross ; Tissue Donors*