BACKGROUND: Immunoglobulins exist in the serum, mostly in a union type of heavy and light chains. Free light chain types exist in an extremely small quantity and are useful in the diagnosis and follow up of multiple myeloma, but are also increased in autoimmune diseases such as SLE. The aim of this study was to evaluate the usefulness of the serum free light chain in discriminating between monoclonal and polyclonal gammopathy. METHODS: Between January and June of 2003, we identified 15 patients with monoclonal gammopathy and 12 patients with polyclonal gammopathy on serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE). We measured the serum concentration of the free light chain using Beckman Coulter IMMAGE(TM) analyzer with FREELITE(TM) reagents and calculated the kappa/lambda (kappa/lambda) ratio. We also measured the free light chain of 35 healthy controls to establish a reference range. RESULTS: The reference ranges established in this study were 4.97-12.84 mg/L for kappa light chains, 6.71-18.09 mg/L for lambda light chains, and 0.46-1.01 for the kappa/lambda ratio. The free light chains were abnormal in all 27 but 2 patients with polyclonal gammopathy on SPEP. The kappa/lambda ratio was abnormal in 12 of the 15 patients with monoclonal gammopathy and in none of the 12 patients with polyclonal gammopathy. CONCLUSIONS: Our results suggest that the kappa/lambda ratio can be a useful tool to discriminate between monoclonal and polyclonal gammopathy, especially in the case of vague SPEP results, or when monoclonal gammopathy is suspected in SPEP.
Autoimmune Diseases ; Diagnosis ; Discrimination (Psychology)* ; Electrophoresis ; Follow-Up Studies ; Humans ; Immunoassay* ; Immunoglobulins ; Indicators and Reagents ; Multiple Myeloma ; Paraproteinemias* ; Reference Values

No abstract available.
Myeloid Cells*

BACKGROUND: Cyclosporine has a narrow therapeutic window and many serious side effects. The new oral microemulsion cyclosporine is known to have better absorption profile than non-microemulsion cyclosporine. The purpose of this study was to confirm above finding in stable renal transplant patients and also to compare correlation between AUC0-4 and C0, C2. METHODS: We checked the absorption profile of microemulsion cyclosporine group (N=15, ME group) and non-microeulsion cyclosporine group (N=15, NE group). All Patients had received renal transplantation at least 12 months before. Blood sampling for cyclosporine level was drawn before and at 1, 2, 3 hour after the cyclosporine morning dose (respectively C0, C1, C2 and C3). AUC0-4 was calculated with the formula: 256+C1+0.9xC2+1.4xC3. Age, sex, body weight, serum creatinine and cyclosporine dose were not different between ME group and NE group, but duration after transplantation was significantly higher in NE group (4.7+/-0.8 versus 3.0+/-1.9 year, p<0.05). RESULTS: AUC0-4 in ME group was significantly higher than NE group (2, 816+/-721 versus 2, 055+/-658 ng.h/mL, p<0.05). AUC0-4/dose, Cmax and Cmax/ dose were significantly higher in ME group. But these statistical differences were not consistent in both sexes. The difference of absorption profile between ME and NE group existed only in the female sex. In ME group, C1 correlated best with AUC0-4 (C0: r=0.493, C1: r=0.911, C2: r=0.906, C3: r= 0.789) and in NE group, C2 was the best (C0: r= 0.064, C1: r=0.958, C2: r=0.980, C3: r=0.912). CONCLUSION: Microemulsion cyclosporine is more bioavailable than non-microemulsion cyclosporine in stable renal transplant patients. C2 is better single time point marker for therapeutic drug monitoring in stable renal transplant patients than C0.
Absorption* ; Area Under Curve ; Body Weight ; Creatinine ; Cyclosporine* ; Drug Monitoring* ; Female ; Humans ; Kidney Transplantation ; Transplantation*

BACKGROUND: Blood CD4+ T-lymphocyte (T4) count is a major clinical marker for the diagnosis and management of AIDS, and flow cytometry is considered the gold standard for T4 enumeration. Our aim was to compare the 2-color and 4-color flow cytometric methods for T-cell subset analysis in HIV-infected patients. METHODS: T-cell subsets such as T3, T4, T8, and CD3+CD4-CD8- double negative T cells (DN T) were analyzed from the whole blood of 40 HIV-infected patients by using both 2-color and 4-color methods on a Cytomics FC500 analyzer. Statistical analyses using simple linear regression, paired t-tests, and Bland-Altman plots were performed. RESULTS: The measured T3 (%), T4 (%), T4 (/microL), T8 (%), T8 (/microL), and DN T (%) differed significantly between the 2 methods (P<0.05), whereas the T4/T8 ratio did not. T3 (%), T4 (%), T4 (/microL), T8 (%), T8 (/microL), and T4/T8 measured by the 2 methods showed good correlation, with correlation coefficients above 0.96, whereas DN T (%) did not. The mean differences in T4 (%) and T8 (%) were 0.39% (limit of agreement (LoA), -1.64~2.43) and 1.26% (LoA, -3.37~5.89), respectively. CONCLUSIONS: Although there were statistically significant differences in the T cell subsets measured between the 2 methods, the differences were minor, and the 2 methods showed good correlation. As confirmed in this study, DN T (%) estimated by the 2-color method is lower than the actual value. We suggest that although the 2 methods can be used interchangeably, the 4-color method is recommended for the analysis of some specific subpopulations such as DN T (%).
Biomarkers ; Flow Cytometry ; HIV ; Humans ; Linear Models ; T-Lymphocyte Subsets ; T-Lymphocytes

No abstract available.
Aged ; Antineoplastic Agents/therapeutic use ; Bone Marrow/pathology ; Fusion Proteins, bcr-abl/genetics/metabolism ; Humans ; Imatinib Mesylate/therapeutic use ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications/*diagnosis/drug therapy ; Leukocyte Count ; Male ; Multiple Myeloma/complications/*diagnosis/drug therapy ; Platelet Count ; Polymerase Chain Reaction ; Thrombocytosis/etiology

No abstract available.
Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive*

This report documents a case of myeloid erythrophagocytosis in a patient with myeloproliferative disorder. The patient had pancytopenia and his marrow was hyperplastic with erythrophagocytosis by myeloid cells of various stages, including myeloblasts. He was diagnosed to have a prefibrotic stage of chronic idiopathic myelofibrosis. The erythrophagocytosis by myeloid cells persisted even after 2 months of treatment for the primary disorder.
Erythrocytes/*pathology ; Human ; Male ; Middle Aged ; Myeloid Cells/*pathology ; Myeloproliferative Disorders/*pathology ; Pancytopenia/pathology ; *Phagocytosis

Gray platelet syndrome (GPS) is one of primary hemostatic disorders with characteristics of moderate bleeding tendency, thrombocytopenia, gray platelet on Wright-Giemsa stained smear and absence of platelet -granule. It is known to be mostly inherited by autosomal dominance but not all. We report a case of gray platelet syndrome diagnosed in a woman with bleeding tendency such as easy bruise and evaluate clinical usefulness of mean platelet component (MPC), mean platelet volume (MPV) and platelet component distribution width (PCDW) using ADVIA 120 (Bayer Diagnostics, NY, USA).
Blood Platelets ; Contusions ; Female ; Gray Platelet Syndrome* ; Hemorrhage ; Hemostatic Disorders ; Humans ; Mean Platelet Volume ; Thrombocytopenia

A 19-year-old, woman who had been diagnosed as systemic lupus erythematosus (SLE) a year ago, was admitted because of fever, dizziness, and sustained postoperative bleeding after a hemorroidectomy. On admission, a CBC revealed pancytopenia (Hb 6.2 g/dL, WBC 1,200/microL, platelets 11,000/microL) with a shift to themicroLeft, and the FDP and D-dimer were positive. She was treated for sepsis and disseminated intravascular coagulation. Granulocyte colony-stimulating factor (G-CSF) was administrated twice for severe neutropenia. An increase in WBC and immature myeloid cells, mainly hypergranular promyelocytes on the peripheral blood followed and was considered to be the effect of G-CSF. To evaluate the cause of pulmonary infiltrates, bronchoalveolar lavage (BAL) was performed on the 5th day of admission. The BAL fluid revealed many promyelocytes and myelocytes with occasional structures recognized as Auer rods. Acute promyelocytic leukemia (APL) was confirmed on the bone marrow study and chromosome analysis. Unfortunately, the patient died of septic shock on the 9th day of admission. We report here a very rare case of APL diagnosed in a SLE patient, the diagnosis of which was somewhat delayed due to the use of G-CSF and superimposed sepsis.
Bone Marrow ; Bronchoalveolar Lavage ; Diagnosis ; Disseminated Intravascular Coagulation ; Dizziness ; Female ; Fever ; Granulocyte Colony-Stimulating Factor ; Granulocyte Precursor Cells ; Hemorrhage ; Humans ; Leukemia, Promyelocytic, Acute* ; Lupus Erythematosus, Systemic* ; Myeloid Cells ; Neutropenia ; Pancytopenia ; Sepsis ; Shock, Septic ; Young Adult

BACKGROUND: The human placenta is an important organ in the maintenance of pregnancy, having functions in maturation and differentiation until the end of pregnancy. The bcl-2 protein is a proto-oncogene that prevents apoptosis and maintains cell survival. However, the mechanism through which bcl-2 inhibits apoptosis is unclear. The aims of this study are to localize bcl-2 at the placenta and to determine whether the expression of bcl-2 in early normal pregnancy is different from that of a missed abortion. METHODS: Immunohistochemistry was performed for bcl-2 in formalin-fixed chorionic villi and decidual tissue collected from five early normal pregnancies and eleven missed abortions having histories of recurrent abortions during the first trimester. RESULTS: The bcl-2 protein was observed in the syncytiotrophoblasts of chorionic villi and decidua in both the normal pregnancy and the missed abortion, and the expression of bcl-2 significantly increased in the missed abortion group (p<0.05). CONCLUSION: The bcl-2 may be necessary to maintain pregnancy through modulating the survival of the syncytiotrophoblast and decidua without affecting cell proliferation, and the increased bcl-2 expression is presumed to be a reparative process to the increased apoptotic activity.
Abortion, Habitual ; Abortion, Missed ; Apoptosis ; Cell Proliferation ; Cell Survival ; Chorionic Villi ; Decidua ; Female ; Humans ; Immunohistochemistry ; Placenta ; Pregnancy Trimester, First ; Pregnancy* ; Proto-Oncogenes ; Trophoblasts