PURPOSE: To evaluate the usefulness of the CT-guided percutaneous lung biopsy for the solitary pulmonary nodules smaller than 15 mm in diameter. MATERIALS AND METHODS: Between April 2002 and May 2003, we evaluated twenty-five patients (11 men, 14 women, mean ages: 52.5 years) who had solitary pulmonary nodules, which we could not discriminate as being benign or malignant on the CT findings. All the subjects had CT-guided percutaenous cutting needle biopsy (PCNB) performed on them at our institution. A definitive diagnosis of benignity or malignancy was established to retrospectively analyze the patient's records. We evaluated the accuracy, sensitivity, specificity and complications of PCNB for the definitive diagnosis of benignity or malignancy. The sensitivity and specificity of PCNB were determined using the Chi-square test, and the correlations with pneumothorax and emphysema after biopsy were analyzed using Spearman's rank correlation coefficient. RESULTS: In two nodules of the twenty-five nodules, no definitive diagnosis could be established. Of the remaining twenty-three nodules, 7 (30.4%) were malignant and 16 (69.6%) were benign. Twenty (87%) of the twenty-three definitively diagnosed nodules were correctly diagnosed with PCNB. Of the twenty nodules, 6 (30%) were malignant and 14 (70%) were benign. The sensitivity and specificity of the malignant nodules were 85.7% (6/7) and 100% (16/16), respectively. The sensitivity and specificity of the benign nodules were 87.5% (14/16) and 85.7% (6/7), respectively. Post-biopsy complication occurred in nine patients (36%): Hemoptysis (n=4, 16%) and pneumothorax (n=5, 20%). However, there was not a statistical significance between pneumothorax and emphysema after biopsy (r=0.3, p=0.15). CONCLUSION: When CT-guided percutaneous lung biopsy of the solitary pulmonary nodules smaller than 15 mm in diameter was performed without an on-site cytopathologist, we know that PCNB can yield high diagnostic accuracy and very few complications.
Biopsy ; Biopsy, Needle* ; Diagnosis ; Emphysema ; Female ; Hemoptysis ; Humans ; Lung ; Male ; Needles* ; Pneumothorax ; Retrospective Studies ; Sensitivity and Specificity ; Solitary Pulmonary Nodule*

OBJECTIVES: Klinefelter syndrome is the most common genetic cause of male infertility and presents with 47, XXY mainly or 46, XX/47, XXY mosaicism. It is characterized by hypogonadism and azoospermia due to testicular failure, however, sporadic cases of natural pregnancies have been reported. With the development of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI), sperm can be retrieved successfully and ART is applied in these patients for pregnancy. It has been suggested that the risk of chromosome aneuploidy for both sex chromosome and autosome is increased in the sperms from 47, XXY germ cells. Considering the risk for chromosomal aneuploidy in the offspring, preimplantation genetic diagnosis (PGD) could be applied as a safe and more effective treatment option in Klinefelter syndrome. The aim of this study is to assess the outcome of PGD cycles by using FISH for sex chromosome and autosome in patients with Klinefelter syndrome. MATERIALS AND METHODS: From Jan. 2001 to Dec. 2003, PGD was attempted in 8 cases of Klinefelter syndrome but TESE was failed to retrieve sperm in the 3 cases, therefore PGD was performed in 8 cycles of 5 cases (four 47, XXY and one 46, XY/47, XXY mosaicism). In one case, ejaculated sperm was used and in 4 cases, TESE sperm was used for ICSI. After fertilization, blastomere biopsy was performed in 6~10 cell stage embryo and the chromosome aneuploidy was diagnosed by using FISH with CEP probes for chromosome X, Y and 17 or 18. RESULTS: A total of 127 oocytes were retrieved and ICSI was performed in 113 mature oocytes. The fertilization rate was 65.3+/-6.0% (mean+/-SEM) and 76 embryos were obtained. Blastomere biopsy was performed in 61 developing embryos and FISH analysis was successful in 95.1% of the biopsied blastomeres (58/61). The rate of balanced embryos for chromosome X, Y and 17 or 18 was 39.7+/-6.9%. The rate of aneuploidy for sex chromosome (X and Y) was 45.9+/-5.3% and 43.2+/-5.8% for chromosome 17 or 18, respectively. Embryo transfer was performed in all 8 cycles and mean number of transferred embryos was 2.5+/-0.5. In 2 cases, clinical pregnancies were obtained and normal 46, XX and 46, XY karyotypes were confirmed by amniocentesis, respectively. Healthy male and female babies were delivered uneventfully at term. CONCLUSION: The patients with Klinefelter syndrome can benefit from ART with TESE and ICSI. Considering the risk of aneuploidy for both sex chromosome and autosome in the sperms and embryos of Klinefelter syndrome, PGD could be offered as safe and more effective treatment option.
Amniocentesis ; Aneuploidy ; Azoospermia ; Biopsy ; Blastomeres ; Chromosomes, Human, Pair 17 ; Embryo Transfer ; Embryonic Structures ; Female ; Fertilization ; Germ Cells ; Humans ; Hypogonadism ; Infertility, Male ; Karyotype ; Klinefelter Syndrome* ; Male ; Mosaicism ; Oocytes ; Pregnancy ; Preimplantation Diagnosis* ; Prostaglandins D ; Sex Chromosomes ; Sperm Injections, Intracytoplasmic ; Spermatozoa

GVHD (Graft-versus-Host Disease) results from the cytotoxic T lymphocytes from the bone marrow recognizing the recipient's minor histocompatibility antigens. In experimental murine models, either CD4+ or CD8+ T-cell subsets can cause GVHD, depending upon the particular strain combination utilized. Recent studies suggest that the keratinocyte undergo apoptosis in GVHD. However, morphological data supporting this concept are still lacking. The present study was undertaken in order to document apoptosis in experimental acute GVHD via sequential analysis of ultrastructure .Acute GVHD was produced across minor histocompatibility loci using appropriately matched murine strains. Acute GVHD was mediated with the use of highly purified preparations of donor CD4+ and CD8+ T-cell subsets. Whole T cells were used as a positive control and T cell depleted bone marrow as a negative control. Conventional transmission electron microscopy was used to define apoptosis structurally Sequential ultrastructure revealed that the keratinocyte underwent apoptosis in CD4+, CD8+ and whole T cell groups. This study demonstrates the sequential ultrastructure of the keratinocyte undergoing apoptosis from the beginning to the end. Both of the basal and the suprabasal keratinocytes show the morphology of early apoptosis, and the detachment of the tonofibril from the basement membrane and the adjacent cell was the general findings in the apoptotic cell Sequences of the cytoplasmic condensation was demonstrated . Through ultrastructural quantitation the apoptotic indices were depicted in all the experimental groups. Characteristically, numerous lymphocytes underwent apoptosis in CD8+ groups at day 28 and 35.
Apoptosis* ; Basement Membrane ; Bone Marrow Transplantation* ; Bone Marrow* ; Cytoplasm ; Epidermis* ; Humans ; Keratinocytes ; Lymphocytes ; Microscopy, Electron, Transmission ; Minor Histocompatibility Antigens ; Minor Histocompatibility Loci ; T-Lymphocyte Subsets ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic ; Tissue Donors

No abstract available.
Cytogenetics* ; Leukemia* ; Phenotype*

BACKGROUND: This study was designed to estabilish serum LDL cholesterol(LDL-C) and HDL cholestrol(HDL-C) levels in the Korean adult population and to identify the difference in sex, age, and living place and the incidence of high risk group and the affecting factors on the serum lipid levels. METHODS: The serum LDL-C and HDL-C distribution in the normal Korean abult population were studied in 5,278 cases(males 2,802 and females 2,476) in the age groups of 3rd to 8th decade. Data were collected from 33 institutes and hospitals throughout the country during the period of June 1989 to December 1990. The serum Lipid levels were examined in the state of fasting of at least 12 hours. Total cholesterol and triglyceride levels were measured by enzymatic assays and HDL-C levels were determined by precipitation methods. The level of LDL-C was determined indirectly using the formula by Friedwald [LDL-C=total cholesterol-(HDL-C+triglyceride/5)]. RESULTS: The mean level of LDL-C was 112.1mg/dl. Males had 110.0mg/dl and females had 114.5mg/dl without statistical significance between gender, but levels were significantly higher in the 4th decade in males and in the 6th, 7th and 8th decade in females. The LDL-C levels rose gradually with the increase of age. The peak level of LDL-C for the males was in the 7th decade and that for the females was in the 8th decade. The mean level of serum HDL-C was 45.1mg/dl. Males had 43.8mg/dl and females had 46.6mg/dl without statistical significance between gender, but levels were significantly higher in the 3rd, 4th, 5th and 6th decade in females. The incidence LDL-C level of > or = 160mg/dl was 10.0%. Males had 8.2% and females had 12.1% with significantly higher incidence in females, especially in 6th decade females. The incidence of LDL-C level of > or = 160mg/dl of big cities was 10.7% and that of smaller cities & towns was 8.8% with significantly higher incidence in big cities. But, there was no significant difference in gender between big cities and smaller cities & towns. The incidence of LDL-C level of > or = 160mg/dl was significantly higher in 7th decade males in big cities and that of big cities and smaller cities and smaller cities & towns was 15.9% and 5.2%, respectively. The incidence of HDL-C level of <35mg/dl was 17.4% Males had 20.0% and females had 14.5% with significantly higher incidence in males, especially in 4th decade males. The incidence of HDL-C level of <35mg/dl of smaller cities & towns was 19.8% and that of big cities was 16.2% with significantly higher incidence in smaller cities & towms. Males in smaller cities & towns had 23.1% and males in big cities had 18.1% with statistical higher in smaller cities & towns. But, there was no significant difference in females between big cities and smaller cities & towns. The incidence of HDL-C level of <35mg/dl was significantly higher in 4th and 6th decade males in smaller cities & towns and that of smaller cities & towns and big cities was 26.8%, 25.6% and 16.2%, 17.7%, repectively. The significantly positively related factors for serum LDL-C level were age, BMI, systolic blood pressure(SBP), location and occupation. And those for serum HDL-C level were SBP and family history and negatively related factor for HDL-C level were BMI, smoking, and exercise. CONCLUSION: This study can provide the basic date base for prevention and management of coronary heart disease among Korean population.
Academies and Institutes ; Adult* ; Cholesterol ; Cholesterol, HDL* ; Cholesterol, LDL* ; Coronary Disease ; Enzyme Assays ; Fasting ; Female ; Humans ; Incidence ; Korea ; Male ; Occupations ; Smoke ; Smoking ; Triglycerides

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker of acute kidney injury. There is a growing body of evidence suggesting that NGAL is also a marker of kidney disease and severity in chronic kidney disease (CKD). We studied the utility of urinary NGAL in more accurately predicting renal function in patients with diabetic CKD. METHODS: We studied possible relationships between urinary NGAL, estimated glomerular filtration rate (eGFR), and proteinuria in diabetic CKD patients and in healthy populations. RESULTS: Urinary NGAL levels were significantly higher in CKD patients than in healthy controls (96.0 [2.7 to 975.2] ng/mL vs. 18.8 [1.3 to 81.9] ng/mL, P=0.02), and the GFR was lower among CKD patients (49.3 [13.1 to 78.3] mL/min/1.73 m2 vs. 85.6 [72 to 106.7] mL/min/1.73 m2, P<0.0001). The urinary NGAL level showed a significant inverse correlation with GFR (r=-0.5634, P<0.0001). The correlation analyses between urinary protein level and urinary NGAL levels and GFR were as follows: urine protein and urinary NGAL (r=0.3009, P=0.0256), urine protein and GFR (r=-0.6245, P<0.0001), urine microalbumin and urinary NGAL (r=0.1794, P=0.2275), and urine microalbumin and GFR (r=-0.5190, P=0.0002). CONCLUSION: From these results, we concluded that urinary NGAL is a reliable marker of renal function in diabetic CKD patients. However, urinary NGAL did not provide more accurate information regarding renal function than GFR.
Acute Kidney Injury ; Glomerular Filtration Rate ; Humans ; Kidney Diseases ; Lipocalins ; Neutrophils ; Proteinuria ; Renal Insufficiency, Chronic

BACKGROUND: Laboratory diagnosis for ovarian cancer is mostly based on the quantitative determination of CA125. Over the past years, a number of additional markers for ovarian cancer have been proposed and studied. Human epididymis protein 4 (HE4) has accordingly emerged as a new biomarker for the detection of ovarian cancer. To evaluate the new automated HE4 assay, we studied analytical performance, and established reference ranges. METHODS: We evaluated precision performances and linearity of the HE4 assay. We also evaluated reference ranges for HE4 and CA125 according to age. Lastly, we investigated the correlation between HE4 and CA125. RESULTS: The precision study showed excellent results for both high and low control. The 95% upper reference ranges for HE4 and CA125 levels were 81.0 pmol/L (90% confidence interval [CI], 63.0-103.1) and 28.6 U/mL (90% CI, 25.4-36.4), respectively. There was no correlation between HE4 and CA125 (r = -0.002, P = 0.9793) in healthy women. Reference ranges of HE4 tended to be slightly higher for the older groups as compared to the younger groups. CA125 were considerably decreased in the oldest age group (ages 70 to 79). CONCLUSIONS: The new automated HE4 assay showed good analytical performance, age-related variable results and no correlation with CA125. Though further studies for clinical and diagnostic effectiveness of HE4 assay in screening and diagnosing ovarian cancer are needed for routine use of HE4, HE4 in combination with CA125 is likely to be more useful diagnostically than CA125 alone.
Clinical Laboratory Techniques ; Epididymis ; Female ; Humans ; Male ; Mass Screening ; Ovarian Neoplasms ; Reference Values

BACKGROUND: ZD1839 (Iressa(R)Gefitinib) is an orally active, selective epidermal growth factor (EGF) receptor tyrosine kinase inhibitor that blocks signal production pathways in cell proliferation. It is currently used in the treatment of advanced stage non-small cell lung cancer. Cutaneous side effects commonly associated with ZD 1839 treatment include acneiform eruption, dry skin and hair growth abnormalities. Cutaneous eruptions result from direct interference with functions of EGF receptor signaling in the skin. OBJECTIVE: The purpose of our study was to investigate the clinical features of cutaneous side effects of ZD 1839 in Korean with literature review. We also analysed the relationship between skin rash severity, onset and objective tumor response. METHOD: We retrospectively reviewed medical records and the histologic materials of 23 Korean patients who had been treated with ZD 1839 at Ajou University Hospital from March 2002 to September 2003 . RESULTS: The results are summarized as follows. 1. The most common cutaneous side effect was acneiform skin rash (56%) which is a well known complication of ZD 1839. 2. Acneiform eruptions were easily controlled by oral antibiotics, such as minocycline and topical retinoid ointment. 3. The second common side effect was dry scaly skin (43%). 4. We also found acute paronychia, finger tip desquamation, alopecia and intertrigo. 5. The severity of the skin rash correlated well with the treatment response of ZD 1839. 6. When the skin rash appeared within 1 week after taking ZD 1839, the skin rash was severe, and the tumor responded well to the ZD 1839. CONCLUSION: The results of this study suggest that acneiform eruption and dry skin are the most common cutaneous side effects of ZD 1839. The association between rash severity and onset of tumor response suggests that the rash may serve as a marker of response to ZD1839 therapy and may be used to guide treatment to obtain optimal response. However, further prospective studies on the potentially important association between rash severity or onset and outcome of treatment with ZD 1839 are needed.
Acneiform Eruptions ; Alopecia ; Anti-Bacterial Agents ; Carcinoma, Non-Small-Cell Lung ; Cell Proliferation ; Epidermal Growth Factor ; Exanthema ; Fingers ; Hair ; Humans ; Intertrigo ; Medical Records ; Minocycline ; Paronychia ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Retrospective Studies ; Skin

Polyomavirus disease is a re-emerging infectious complication in renal transplantation. It manifests as symptomless renal dysfunction and progresses to graft loss unless the prompt diagnosis and intervention are initiated. A gold standard for diagnosis is the renal biopsy. Recently, the molecular diagnosis can be made using plasma PCR technique before histologic confirmation. Reduction of immunosuppression is a mainstay of treatment. Leflunomide and other antiviral agents could be used successfully in selected cases. The screening using urine decoy cell and subsequent plasma PCR may detect the BK viral replication, and preemptive intervention will prevent development of overt nephropathy without risk of rejection. This review will cover the recent advances and clinical issues in diagnosis and management of polyomavirus disease, mainly BK virus associated nephropathy.
Antiviral Agents ; Biopsy ; BK Virus ; Immunosuppression ; Isoxazoles ; Kidney ; Kidney Transplantation ; Mass Screening ; Plasma ; Polymerase Chain Reaction ; Polyomavirus ; Polyomavirus Infections ; Rejection (Psychology) ; Transplants

Transforaminal lumbar epidural block is a common procedure for the patients with back pain and radiating pain. But during the procedure, complications such as subdural or intrathecal block can occur. Because the procedure is conducted with contrast media and fluoroscopy, anesthesiologists must have deep understanding of the normal radiologic findings of epidural, subdural and intrathecal contrast images. During attempted transforaminal lumbar epidural block with fluoroscopy, we observed an unusual shaped pulsatile contrast image accidentally. Based on our experience, we report the subdural contrast image during transforaminal lumbar epidural block in radiologic aspects.
Back Pain ; Contrast Media ; Fluoroscopy ; Humans