The serodiagnostic test of syphilis employed with the greatest freguency in this country is the VDRL procedure which is one of the flocculation test utilizing cardiolipin-lecithin as an antigen. As well known, the immunologically nonspecific nature of this test relegates it only to screening test, so that all the sera displaying weakly reactive or reactive VDRL in the absence of definite evidence of present or past syphilis should be confirmed by using the specific treponemal antigen tests. However, there are only lirnited numbers of institutions at which the specific treponemal antigen tests are carried out, because the tests usually need quite coaiplicatnl technology and specifically trained personnel. The Treponema. pallidum hema.gglutination assay (TPHA) which was first described by Rathlev in 1965 and established as more improved and standardized procedure in serodia,gnosis of syphilis by Tornizaxva and Kasamatsu (1966) has been found to h as sensitive and specific as the technically more complicated Fluorescent treponemaI antibody absorption (FTA-ABS) or Treponema pallidum immobilization (TPI) po cedure by rnany investigators from different parts of the world during these 10 years. The TPHA has also been found to have definite advantage over the other tests because it is easy to perform and economic. The present authors felt. that the TPHA meight be the most reasonable method to be used in this country and decided to evaluate it in the serodiagnosis of problem cases. Sera from 516 presumed normal persons, 686 pregnant women ancl 1345 patients with various diseases other than syphilis were screened with the standard VDRL procedure as described and recommanded by USPHS. Out of these, 475 of t.he presumed normal persons, 646 of the pregnant women and 1243 of the patient group wit;h various diseases other than syphilis v;ere serologically nonreactive and 10, 12 and Rl sera from each of the above groups, respectively, were found to be true syphilitc with definite evidence of clinical signs or history of syphilis. Thirty-one out of the presumed normal persons, 28 out of the pregnant women and 71 out of the patient group with various diseases other than syphilis showed either weakly reactive or reactive VDRI, in undiluted sera without definite evidence of syphilis and these 130 sera from 130 persons were the subject of the present study. The TPHA was carried out on these 130 sera. according to the ma.nual MEA-TP instructed by National Institute of Health, Japan. The reagents used in this study rvere rnanufactured and supplied hy the Fujizoki Pharmaceutical Co. Ten (32.3%) out of the R1 sera from preaumed normal persons, 11 (39.4%) out of the 28 sera from pregna.nt women a.nd 28 (69.4%) out of the patient group with various disea ses other then syphilis showed reactive TPHA. Eighty-seven of the total 130 sera showed weakly reactive VDRL so called rough result and 19 (21.8%) Of these 87 sera showed reactive TPHA, while 30(69.8%) of the 43 sera which showed reactive VDRL were found to be TPHA reactive. These results arc in general agreement with those of other investigators confirmed by the more complicated FTA-ABS or TPI. The overall incidence of syphilis was 3.87%, 3.35% and 4.38% in presumed normal persons, in pregnant women and in patient group with various diseases other than syphilis respectively. Considering the relative lack of study concerning to the false positive reactions in this country, these results may be helpful to the clinician to rnake a cert.ain diagnostic decision when they meet such a patient whose VDRL is weakly reactive or reactive in the absence of definite evidence of syphilis. The authors concluded that: the MHA-TP technique is easy in performance, economic and highly specific in serodiagnosis and that this technique is highly recommanded in this country. * The authors thank Fujizoki Pharrnaceutical Company, Tokyo, Japan which provided the TPHA reagents used in this study.
Absorption ; Bezafibrate ; False Positive Reactions ; Female ; Flocculation Tests ; Humans ; Immobilization ; Incidence ; Indicators and Reagents ; Japan ; Mass Screening ; Pregnant Women ; Research Personnel ; Serologic Tests* ; Syphilis* ; Treponema ; Treponema pallidum ; United States Public Health Service

Intravascular bronchioloaveolar tumor is now recognized as a pulmonary form of epithelioid hemangioendothelioma, being manifested with bilateral multiple pulmonary nodules in young women. This 34-year-old woman received two occasions of open lung biopsies with interval of 1 year for diffuse nodular infiltrations in both lung fields. Repeated radiographic study 3 year later showed no significant progression of the pulmonary nodular lesions except for pleural effusion. Two occasions of open lung biopsies disclosed similar multiple discrete nodules which consisted of central acellular areas with lacuna-like ghosts and peripheral cellular zone. The tumor cells grew in micropolypoid fashion with preservation of background alveolar frame-works. Ultrastructure disclosed most of neoplastic cells presenting with the features suggestive of endothelial differentiation, and immunohistochemical study revealed the presence of cellular areas which gave positive reaction to factor VIII-related antigen. We support that this is an additional case of epithelioid hemangioendothelioma of the lung that is manifested with a multicetric intrapulmonary vascular endothelial cell growth featuring a vasoformative tendency and participation of topography-specific histologic modification.
Female ; Humans ; Biopsy

No abstract available.

When a Korean child is living in close contact with a person with active pulmonary tuberculosis, the risk of his acquiring the disease is great. In seeking an effective means of reducing this risk to the chi1d, isoniazid was given as secondary chemoprophylaxis to 233 tuberculin-positive children under 5 years of age who were clinically free of disease but were living in close contact with a household member with active tuberculosis. The condition of these children after 9 to 12 months of chemoprophylaxis was compared with a similar control group of 216 children living under exact1y comparable circumstances. An analysis of tile results of this study indicates that secondary chemoprophylaxis with isoniazid is effective and worthwhile for children under 4 years of age who are under constant exposure to tuberculosis. That there was such a protection is indicated by the fact that (1) isoniazid markedly reduced the size of the tuberculin reaction and that (2) only 2 children receiving isoniazid developed active tuberculosis (0.8%) as against the 8 controls who did (3.70%). The faithful cooperation of parents in administering prophylactic isoniazid to small children is often difficult to obtain. This difficulty is suggested by the fact that in the case of the 2 children in the isoniazid test group who developed active tuberculosis, the actual drug intake had been irregularly given and amounted to less than half the prescribed dose.
Chemoprevention ; Child ; Family Characteristics* ; Humans ; Isoniazid ; Parents ; Tuberculin ; Tuberculosis ; Tuberculosis, Pulmonary*

A review of the literature on cancer pain revealed that many persons with cancer receive inadequate analgesia for pain control, due in part to a lack of knowledge of the control of cancer pain by both physicians and nurses. This study is composed of two parts : one is to train nurses to change their knowledge of and attitude toward the pain management of patients having cancer and to evaluate the effectiveness of this training in comparison with other non-trained group ; the other is to test the applicability of the pain management method knowledge and attitude in the levels of pain of oncology patients. General characteristics of nurses such as age, education, educational experiences of cancer pain management were not different in both groups except the clinical experience. General characteristics of cancer patients and pain-related variables such as pain, sleep, daily activities, treatment modalities, causes of pain were not different in both groups except the educational levels of patients. After an eight-hour educational program given to the experimental nurse group, the knowledge and attitude about assessment of cancer pain, pain medication, and pharmacological knowledge were significantly higher in the experimental group than in the control group, while knowledge about classification of analgesics was not significantly different. The amount of analgesics, measured by the morphine equivalent doses, used in the experimental group was significantly lower than in the control group in the first and the last days. The experimental group used more systematic ways of drug changes from non-narcotic analgesics to narcotic analgesics than the control group. This indicated that the control group used fentanyl patches more commonly than in the control group. Cancer pain scores of both group of patients were measured on an hourly bases for a week in both groups. The patients' pain scores of the first day of measurement in experimental group were not significantly higher than those of control group of patients, while those of the last day were significantly higher than those of the control group. This study supports the need for educational program for the management of cancer pain to the nurses and the doctors.
Analgesia ; Analgesics ; Analgesics, Non-Narcotic ; Classification ; Education ; Fentanyl ; Humans ; Morphine ; Narcotics ; Pain Management*

BACKGROUND: Even though the cardiovascular actions of insulin were first described shortly after introduction into clinical practice, the precise physiological role and mechanism of insulin-mediated cardiovascular actions are not known. The aim of the present study was to investigate the changes in hemodynamics after an insulin injection and the role of the autonomic nervous system in mediating the responses to insulin. METHODS: Nine mongrel dogs of the male sex, weighing 20 - 26 kg, were studied. Anesthesia was maintained with pentobarbital and vecuronium after the administration of the loading dose. Femoral and pulmonary artery catheters were placed for obtaining blood samples (ABGA, electrolytes, glucose and plasma catecholamines) and measuring hemodynamic variables. Real time power spectral analysis of R-R interval variability was displayed on the color power spectrum every 30 seconds by a simple connection between the EKG monitor and computer via an A/D converter. After control values were obtained, porcine insulin was administrated intravenously as a bolus injection (2 U/kg). Blood glucose and potassium were maintained within physiological range by simultaneous infusion of 50% glucose (2-4 ml/kg/h) and potassium (0.5-1.0 mEq/kg/h). Parameters were measured respectively in 9 steps; 10min before insulin injection (control), 1, 5, 10, 20, 30, 40, 50 and 60min after insulin injection. RESULTS: Heart rate, mean arterial blood pressure and cardiac output increased and systemic vascular resistance decreased significantly after the insulin injection. No significant changes in plasma norepinephrine and epinephrine levels could be detected. Power spectral density of low frequency and ratio oflow and middle frequency power to high frequency power increased significantly 1min after insulin injection but did not increase thereafter. High frequency power remained significantly below the control value after the insulin injection. CONCLUSIONS: Although catecholamine concentration itself did not show a significant change, PSA data reveals that insulin may exert a stimulatory action on the sympathetic nervous system and a depressive action on the parasympathetic nervous system independent of hypoglycemia immediately after an insulin injection and insulin-induced vasodilation is not related to the autonomic nervous system.
Anesthesia ; Animals ; Arterial Pressure ; Autonomic Nervous System* ; Blood Glucose ; Cardiac Output ; Catheters ; Dogs* ; Electrocardiography ; Electrolytes ; Epinephrine ; Glucose ; Heart Rate ; Hemodynamics* ; Humans ; Hypoglycemia ; Insulin* ; Insulin, Regular, Pork ; Male ; Negotiating ; Norepinephrine ; Parasympathetic Nervous System ; Pentobarbital ; Plasma ; Potassium ; Pulmonary Artery ; Sympathetic Nervous System ; Vascular Resistance ; Vasodilation ; Vecuronium Bromide

The enhanced process of proteolysis of both the basement membrane and the stromal extracelluar matrix (ECM) contributes to the escape of breast cancer cells into the neighboring tissues, eventually leading to the formation of distant metastases. A group of enzymes thought to play a role in tumor cell invasion are the matrix metalloproteinases (MMPs). Much attention has been focused on MMP-2 and MMP-9, which are 2 members of the MMP family active against collagen of the basement membrane. The enzymatic activities of MMP-2 and MMP-9 are inhibited by the tissue inhibitors of metalloproteinases (TIMPs). TIMP-2, one member of TIMPs, inhibits MMP-2 and MMP-9. The imbalance between TIMPs and MMPs permits to tumor invasion and metastasis. Theretore, TIMPs constitute promising targets in the developmemt of anticancer terapies. Immunohistological stainings of MMP-2, MMP-9 and TIMP-2 were performed on paraffin-embedded tissue sections of 31 invasive breast carcinomas. MMP-2 and MMP-9 were associated with neoplastic cell cytoplasms in 65% of the cases and exhibited inter-tumoral variability of the staining intensity. The MMP-2 and MMP-9 stainings did not correlate with presence of metastases at time of diagnosis. TIMP-2 was detected in the peri-tumoral stroma and was present in 81% of the cases. Residual benign breast tissue was negative for TIMP-2 staining. Neoplasms with diffuse TIMP-2 staining (32%) have metastasis significantly more frequently (50% metastasis) than ceses with focal (20% metastasis) or absent (0% metastasis) TIMP-2. We conclude that the clinical outcome such as metastasis is more closely related to the presence of TIMP-2 than the corresponding MMPs. Enhanced TIMP-2 expression, therefore, may denote a stromal response to tumor invasion, indicative of aggressive behavior in the subset breast carcinoma.
Basement Membrane ; Breast Neoplasms* ; Breast* ; Collagen ; Cytoplasm ; Diagnosis ; Humans ; Matrix Metalloproteinases ; Metalloproteases ; Neoplasm Metastasis ; Proteolysis ; Tissue Inhibitor of Metalloproteinase-2 ; United Nations

PURPOSE: To evaluate the correlation between the expression of TIMP-2 (tissue inhibitors of metalloproteinase-2) and negative lymph node involvement of colon and gastric carcinoma. MATERIALS AND METHODS: We studied 26 cases (13 each) of gastric and colon carcinoma specimens along with dissected lymph nodes by immunohistochemical staining to investigate the correlation of the expression of TIMP-2. Lymph nodes involvement by CT scan was defined by size criteria and the presence of central low density. RESULTS: Eight cases with positive lymph node involvement by CT scan showed weak expression of TIMP-2. Ten cases with positive lymph node involvement had weak expression of TIMP-2. Among eight cases with strong expression of TIMP-2 7 patients were negative by radiologic exam. Good correlation between strong TIMP-2 expression and negative lymph node involvement by CT scan was found (<0.05). CONCLUSION: As the expression of TIMP-2 had a good correlation with radiologic involvement of lymph nodes, the study of expression of TIMP-2 in patients with stomach and colon carcinoma might be helpful in planning surgery and predicting the prognosis.
Colon* ; Colonic Neoplasms ; Humans ; Lymph Nodes ; Prognosis ; Stomach ; Stomach Neoplasms ; Tissue Inhibitor of Metalloproteinase-2* ; Tomography, X-Ray Computed

Rectus sheath hematoma (RSH) is an uncommon condition caused by hemorrhage into the rectus sheath. RSH is characterized by abdominal pain and an abdominal mass. This condition is associated with old age, childbirth, abdominal surgery, severe coughing, severe sneezing, anticoagulation therapy, and/or coagulation disorders. We report herein a case of RSH and pelvic cavity hematoma that was induced by dalteparin injection in a 77-year-old woman with pulmonary embolism and deep vein thrombosis, and who was successfully treated by conservative management.
Abdominal Pain ; Aged ; Cough ; Dalteparin* ; Female ; General Surgery ; Hematoma* ; Hemorrhage ; Humans ; Parturition ; Pulmonary Embolism ; Sneezing ; Venous Thrombosis

Rectus sheath hematoma (RSH) is an uncommon condition caused by hemorrhage into the rectus sheath. RSH is characterized by abdominal pain and an abdominal mass. This condition is associated with old age, childbirth, abdominal surgery, severe coughing, severe sneezing, anticoagulation therapy, and/or coagulation disorders. We report herein a case of RSH and pelvic cavity hematoma that was induced by dalteparin injection in a 77-year-old woman with pulmonary embolism and deep vein thrombosis, and who was successfully treated by conservative management.
Abdominal Pain ; Aged ; Cough ; Dalteparin* ; Female ; General Surgery ; Hematoma* ; Hemorrhage ; Humans ; Parturition ; Pulmonary Embolism ; Sneezing ; Venous Thrombosis