We have experienced a case of deflation failure of Inoue balloon in the left atrium during mitral balloon valvuloplasty in a 44 year old male patient with tight mitral stenosis, who died just after emergency open heart surgery for removal of undeflated Inoue balloon and mitral valve replacement because of associated acute hemorrhagic myocardial infarction.
Adult ; Balloon Valvuloplasty ; Emergencies ; Heart Atria ; Humans ; Male ; Mitral Valve ; Mitral Valve Stenosis ; Myocardial Infarction ; Thoracic Surgery

BACKGROUND: Alloimmunization to RBC antigens may cause delayed hemolytic transfusion reactions and delayed serological transfusion reactions. In the present study, the frequency of alloimmunization and its clinical significance were evaluated. METHODS: Antibody screening tests for 17,365 samples from 11,372 patients were retrospectively analyzed during a 25-month period from February 2003 to March 2005. The records of transfusions and the clinical characteristics of the patients who had initially negative screening tests that converted to positive tests were evaluated. The unexpected antibody screening and identification tests were performed using the LISS/Coombs gel test with the DiaMed-ID system. RESULTS: The positive rate of the antibody screening tests was 1.36% (155/11,372). Thirty-eight patients (0.63%, 38/5,993) showed positive antibody screening tests from an initially negative screening. The most common clinically significant alloantibodies were Rh group antibodies (52.6%). The mean transfused RBC units, mean interval and mean transfusion frequencies for patients with initially negative antibody screening tests that converted to positive findings were 3.7 units, 56 days and 1.7 times, respectively. Antibodies from nine patients became undetectable following the first detection assay. CONCLUSION: RBC alloimmunization detected by unexpected antibody screening tests did not correlate with the quantity of transfusion and frequency of transfusion. One should be careful to recognize antibodies that are positive in an initial antibody screening test that subsequently become undetectable.
Antibodies ; Blood Group Incompatibility ; Humans ; Isoantibodies ; Mass Screening* ; Retrospective Studies

Hyperacute or acute accelerated rejection caused by preformed antibody in sensitized patients resulted in increased waiting period and complicated posttransplant hospital course. Intravenous immunoglobulin (IVIG) has known to have anti cytotoxic effect by blocking the anti HLA antibody. PURPOSE: We investigated the effect of IVIG on hyperacute and acclerated rejection of the heart graft in the presensitized rat. METHODS: Recipients (Wistar) were sensitized from repeated allo (Lewis) skin graft and followed by heterotopic allo cardiac transplantation. A guinea pig was used for the xenotransplantation model. IVIG (Green Cross kappa, 400 mg/kg in allotransplantation, 800 mg/kg in xenotransplantation) was given just before heart transplantation. Graft survival and donor specific IgG, IgM and complement were measured. RESULTS: Graft survival was 7.2 days in non sensitized allogenic heart transplantation (n=9), 1.3 days in sensitized allogenic recipients (n=7). Graft survival was prolonged from 1.3 days to 4.4 days with IVIG treatment (n=5). As for xenogenic transplantation, graft survival was prolonged from 30 min to 7.4 hr with IVIG treatment (n=5). Donor specific IgG and IgM and complement increment were blocked by IVIG during the IVIG treatment. Donor specific IgG and Ig M and complement were increased after the cessation of IVIG treatment. CONCLUSION: IVIG was able to prolong the graft survival of the sensitized allograft and xenograft. Suppression of the donor specific IgG, IgM and complement might be one of the underlying mechanisms. A further studies have to follow to clarify the more detailed mechanism.
Allografts ; Animals ; Complement System Proteins ; Graft Survival ; Guinea Pigs ; Heart Transplantation* ; Heart* ; Heterografts ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Rats* ; Skin ; Tissue Donors ; Transplantation, Heterologous ; Transplants

Organ transplantation has become a' widely accepted treatment modality for end-stage organ disease. The shortage of allogenic donors for organ transplantation has brought about the necessity of xenotransplantation as an unlimited source of organ donation. However, organ transplantation between different species have never been successful because of hyperacute rejection. Although the mechanism of this phenomenon is not fully understood, many researchers believe that the natural antibodies present in the recipient's serum may bind to the graft and induce the activation of complement cascade triggering the process of hyperacute rejection. ...continue...
Antibodies ; Complement System Proteins ; Heterografts ; Humans ; Organ Transplantation ; Tissue and Organ Procurement ; Tissue Donors ; Transplantation, Heterologous ; Transplants

Purification of islets in pancreas islet cell transplantation has some potential advantages ,such as more safety, improved islet cell implantation, and reduced immunogenicity, compared with an unpurified pancreas islet cell transplantation. We evaluated the effect of islet cell purification on islet yields, hemodynamics, and graft outcome following intraportal canine pancreas islet cell transplantation. The baseline characteristics, including body weight, pancreas weight and collagenase recirculation time for the unpurified group(n=12) and the purified group(n=17) did not show any significant difference(P>0.05). The mean cell pellet volume before intraportal injection was 25.4 ml in the unpurified group and 7.2ml in the purified group(P<0.05). Islet equivalent(IE) was 103,100+/-62,700 in the unpurified group and 68,900+/-45,600 in the purified group(P>0.05). Mean recovery rate of islet after purification was 66.8%. The portal pressure change after intraportal islet injection was significantly less in the purified group(16.2+/-11.3 cmH2O vs 6.2+/-2.0 cmH2O, P<0.05). Also, the pulse rate change was significantly less in the purified group(14.5+/-5.9/min vs 6.3+/-4.5/min, P<0.05). A comparison of the hemodynamic changes and islet yields according to the degree of purity(high purity> OR =70%, n=4 vs low purity <70%, n=13) in the purified group, showed significant hemodynamic stability in the high purity group, but no significant difference in the islet recovery rate between the low and high purity group(58.6% vs 61.7%). Glucose was controlled in 3 cases(25.0%) in the unpurified group and 7 cases(41.2%) in the purified group. Death due to portal hypertension occurred in 2 cases(16.7%) in unpurified group and 2 cases(11.7%) in the purified group. Interestingly, in the highly purified group, all the animals were alive with normoglycemia during the follow up period. We conclude that purified pancreas islet cell transplantation, especially in a highly purified group, has distinct hemodynamic advantages compared with unpurified islet transplantation following intraportal islet injection. However further research to develop the methods that will minimize the loss of islet yields during purification and enhance the purity is neccessary to achieve a successful islet transplantation with a long-term good result.
Animals ; Body Weight ; Collagenases ; Follow-Up Studies ; Glucose ; Heart Rate ; Hemodynamics ; Hypertension, Portal ; Islets of Langerhans Transplantation ; Islets of Langerhans* ; Pancreas* ; Portal Pressure ; Transplants

We describe a case of thrombocytopenia-absent radius syndrome suspected by ultrasonography, later confirmed by fetal blood analysis. From this case we confirmed the usefulness of three-dimensional ultrasonography in diagnosing abnormalities in the fetal skeletal system and genetic counseling.
Fetal Blood ; Genetic Counseling ; Prenatal Diagnosis ; Radius ; Thrombocytopenia ; Upper Extremity Deformities, Congenital

PURPOSE: To review the results of postoperative radiation therapy (PORT) for residual non-small cell lung cancer (NSCLC) following surgical resection and evaluate multiple clinicopathologic prognostic factors. MATERIALS AND METHODS: A total of 58 patients, who completed scheduled PORT for positive resection margin, among 658 patients treated with PORT from January 2001 to November 2011 were retrospectively analyzed. Radiation therapy was started at 4 to 6 weeks after surgery. Chemotherapy was also administered to 35 patients, either sequentially or concurrently with PORT. RESULTS: The median age of patients was 63 years (range, 40 to 82 years). The postoperative pathological stage I NSCLC was diagnosed in 10 (17.2%), stage II in 18 (31.0%), and stage III in 30 patients (51.7%). Squamous cell carcinoma was identified in 43, adenocarcinoma in 10, large cell in 1, others in 4 patients. Microscopic residual disease (R1) was diagnosed in 55 patients (94.8%), and the remaining three patients were diagnosed with gross residual disease (R2). The median dose of PORT was 59.4 Gy (range, 50.0 to 64.8 Gy). Chemotherapy was administered to 35 patients (60%), and the median follow-up time was 22.0 months (range, 6.0 to 84.0 months). The 3-year locoregional relapse-free survival and distant metastasis-free survival rates were 82.1% and 52.9%, respectively. The median overall survival was 23.8 months (range, 6.0 to 84.1 months), and the 3-year overall survival rate was 58.2%. Chemotherapy did not influence the failure pattern or survival outcome. CONCLUSION: PORT is an effective modality for improving local tumor control in incompletely resected NSCLC patients. Major failure pattern was distant metastasis despite chemotherapy.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Drug Therapy ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Retrospective Studies ; Survival Rate

BACKGROUND: Identifying the donor and isolation-related factors during the islet isolation would be greatly helpful to improve the result of human islet isolation for successful clinical islet transplantation. METHODS: Sixty-nine pancreata from cadaveric donors were isolated with standard protocol and analyzed to identify the donor factors and isolation variables for successful isolation. Islet isolations recovered > or = 100,000 Islet Equivalent (IEQ, n=53) were compared to islet mass less than 100,000 IEQ (n=16). RESULTS: The mean islet recovery was 216.0 x 10(3) +/- 173.7 x 10(3) (IEQ) before purification and 130.6 x 10(3) +/- 140.2 x 10(3) (IEQ) after purification. Mean purity was 54 +/- 31%. Mean age of donor was 31.2 +/- 13.2 year and mean cold ischemic time was 6.9 +/- 6.2 hour. Quality of isolated islets was acceptable in terms of bacterial culture, viability and secretory function in vitro and in vivo. In univariate analysis on successful isolation, status of pancreas was the only significant factor and sex, duration of collagenase expansion and digestion time were marginal factors. Stepwise multivariate logistic regression analysis showed donor sex, status of pancreas and digestion time were significant factors for the successful islet isolation. CONCLUSION: This study confirms some donor factors and variables in isolation process can influence the ability to obtain the successful isolation of human islet. Enough experiences and pertinent review of donor and isolation factors can make islet isolation successful, supporting the clinical islet transplantation without spending of cost.
Cadaver ; Cold Ischemia ; Collagenases ; Digestion ; Humans* ; Islets of Langerhans Transplantation ; Logistic Models ; Pancreas* ; Tissue Donors

BACKGROUND: Scutellaria baicalensis Georgi extract is used as a traditional herbal medicine. The efficacy of Scutellaria baicalensis Georgi extract is known for antioxidative activity, antiinflammation effect, antibacterial effect, inhibitory effect of melanin synthesis, sun protection effect, antiallergy effect, and etc. OBJECTIVE: We confirmed the cell viability or inhibitory effect of melanin synthesis in HaCaT (human keratinocyte cell line) and B16F10 (murine melanoma cell line) cells and the skin safety test through a clinical test (dermal irritation study) for Scutellaria baicalensis Georgi extract, according to the extraction methods. METHODS: We checked the cell viability, using MTT assay and inhibitory effect of melanin synthesis in B16F10 cells or HaCaT cells for thirty one Scutellaria baicalensis Georgi extract, according to the extraction methods. Then, we evaluated the skin safety for selected eight Scutellaria baicalensis Georgi extract through a primary dermal irritation test. RESULTS: Among the thirty one Scutellaria baicalensis Georgi extracts, according to the extraction methods, we selected eight Scutellaria baicalensis Georgi extracts that were not detected with cell toxicity in HaCaT cells and B16F10 cells, and could have inhibited the melanin synthesis in B16F10 cells. The selected eight Scutellaria baicalensis Georgi extracts identified the skin safety through a primary dermal irritation test. CONCLUSION: We expect clinical trials for whitening efficacy based on inhibitory effect of melanin synthesis and human skin safety for Scutellaria baicalensis Georgi extracts.
Cell Survival ; Herbal Medicine ; Humans ; Keratinocytes ; Melanins ; Melanoma ; Scutellaria ; Scutellaria baicalensis ; Skin ; Solar System

PURPOSE: Islet cell transplantation, as an alternative approach to endocrine cell replacement to treat the diabetes mellitus, has received significant attention because it holds several advantages over whole gland transplantation. However cell damage from islet isolation and immunologic rejection after transplantation prevent from successful clinical application for diabetic patients. Culture of cells at low temperature has known to stabilize the cell viability, and to decrease the immunologic antigenicity. Aim of this study is to investigate the effect of culture at 24oC on cell viability, cellular function, immunogenicity and cytokine profiles in rat pancreas islet. METHODS: Pancreas islets were isolated from Lewis rat and cultured at 24oC or 37oC during 14 days. Islet recovery after culture period was counted as islet equivalent number, and islet viability was examined with fluorescent vital staining (FDA/PI). Islet function was measured with glucose stimulation test. Annexin V expression and MHC class I and II expression were measured with flow cytometric assay for apoptosis and immunogenicity respectively. Lymphocyte cell proliferation through mixed lymphocyte islet culture was examined with WST-1 proliferation assay. Cytokine profiles were analyzed with quantitative real time RT-PCR. All these parameters were measured on 1, 3, 5, 7, 14 culture days after islet isolation. RESULTS: Islet recovery was higher in islet cultured at 24oC than in islet cultured at 37oC without change of viability. Insulin secretion after glucose stimulation was more effective in 24oC culture condition. Decrease of apoptotic cell death was demonstrated in 24oC cultured islet. MHC class I and II expression on islets and lymphocyte proliferation when cocultured with islets were less prominent in 24oC cultured islet. TNF-alpha and IL-4 cytokine expression was higher in islet cultured at 24oC than in islet cultured at 37oC. IL-1beta and IL-10 cytokine expression were similar in both culture condition. CONCLUSION: This study demonstrated that cell recovery and function are increased in islet cultured at 24oC than in islet cultured at 37oC while antigenicity and proinflammatory cytokine expression are decreased. Low temperature culture can be a good approach to prevent the loss of islet mass, and to reduce the immunologic rejection of transplanted islet for successful clinical islet transplantation.
Animals ; Annexin A5 ; Apoptosis ; Cell Death ; Cell Proliferation ; Cell Survival ; Diabetes Mellitus ; Endocrine Cells ; Glucose ; Humans ; Insulin ; Interleukin-10 ; Interleukin-4 ; Islets of Langerhans Transplantation ; Islets of Langerhans* ; Lymphocytes ; Pancreas* ; Rats* ; Tumor Necrosis Factor-alpha