We reported a case of hemolytic transfusion reaction that was related to multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea after serial RBC transfusions. A forty-nine year old female visited the emergency room (ER) with hematochezia. She had previously received 16 units of packed RBCs from 2003 to Jan 2007 for her intermittent esophageal varix bleeding. No specific antibodies were identified before this visiting. At the ER, under the request for packed RBCs, we identified anti-E antibody within her serum. Her blood type was AB, RhD+ with the phenotype of CcDe. She received 5 units of E antigen negative RBCs. However, she showed hemolytic transfusion reactions such as mild fever with a decrease of hemoglobin from 11.4 g/dL to 6.8 g/dL after the transfusion. From the 8th to the 10th hospital day, another 3 units of E-antigen negative with the least incompatible RBCs were transfused to the patient, but the level of hemoglobin was not definitely increased. At the 14th hospital day, she received a final 2 units of leuko-reduced RBCs without E, M and Jkb antigens. Her hemoglobin was increased right after the final transfusion. We found that the patient's serum reacted with multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea antibodies. She finally recovered from acute varix bleeding and was discharged on the 26th hospital day with the level of hemoglobin being 8.3 g/dL.
Antibodies ; Blood Group Incompatibility ; Emergencies ; Esophageal and Gastric Varices ; Female ; Fever ; Gastrointestinal Hemorrhage ; Hemoglobins ; Hemorrhage ; Humans ; Phenotype ; Varicose Veins

BACKGROUND: Cardiac troponin I (cTnI) is most recently described and has nearly absolute myocardial tissue specificity, as well as high sensitivity. But an increased value for cTnI that indicates myocardial injury is not always synonym of myocardial infarction or ischemia due to coronary artery disease. METHODS: Retrospective follow-up study for whom underwent coronary angiography for suspected coronary artery disease was done if they had an elevated cTnI value and angiographically normal or minimal disease. RESULTS: 33 patients were qualified. Cut-off value for elevated cTnI was 0.06 ng/mL. Increased cTnI values were attributed to severe congestive heart failure in 7 patients, variant angina in 7 patients, myocarditis in 5 patients, pericarditis in 1 patient, severe myocardial bridge in 1 patient, rhabdomyolysis in 1 patient and cerebral infarction in 1 patient. Tachycardia was precipitating cause in 4 patients (sinus tachycardia, paroxysmal supraventricular tachycardia, paroxysmal atrial fibrillation and sustained ventricular tachycardia for each), two of whom had hemodynamic compromise. 2 of 33 patients had no identifiable cause for a rise in cTnI value. There was no acute myocardial infarction at 42+/-34 weeks follow-up. CONCLUSIONS: Although cTnI is a sensitive and specific marker of myocardial injury, an elevation of cTnI value may have a cause other than myocardial infarction or ischemia and may occur without significant angiographic coronary artery disease.
Atrial Fibrillation ; Cerebral Infarction ; Coronary Angiography ; Coronary Artery Disease ; Follow-Up Studies ; Heart Failure ; Hemodynamics ; Humans ; Ischemia ; Myocardial Infarction ; Myocarditis ; Organ Specificity ; Pericarditis ; Retrospective Studies ; Rhabdomyolysis ; Tachycardia ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Troponin I* ; Troponin*

We examined lymphocyte subpopulations of peripheral blood from BLV infected and noninfected Holstein-Friesian dairy cattle reared in Korea by flow cytometry using monoclonal antibodies specifically reactive with bovine leukocyte differentiation marker. Lymphocyte subpopulations expressing BoCD11b, B-B2, CD5, B, MHC II-DP, MHC II-DQ, and MHC II-DR antigens were significantly abundant in the BLV(+) group than the BLV(-) group (p<0.01). On double staining, subpopulation of B-1a(BoCD5+ BoCD11b+) lymphocytes was significantly increased in leukemic group. However, T-lymphocyte lineage expressing BoCD2, BoCD4, BoCD8, and WC1 antigens was significantly lower than in the BLV(+) group (p<0.01). However the absolute number of T-lymphocytes expressing BoCD2, BoCD4, BoCD8, and WC1 antigens in BLV(+) group remained with in the normal range. Furthermore mean ratio of BoCD4/BoCD8 in the BLV(+) groups was higher than that in the BLV(-) group. Taken together, cellular immune responses did not seem to significantly be decreased in the leukemic cattle.
Animals ; Antibodies, Monoclonal ; Cattle* ; Enzootic Bovine Leukosis* ; Flow Cytometry ; Immunity, Cellular ; Korea ; Leukemia Virus, Bovine* ; Leukocytes ; Lymphocyte Subsets* ; Lymphocytes* ; Reference Values ; T-Lymphocytes

BACKGROUND: Cardiovascular MR has recently been reported that it can determine the viable myocardium. We investigated this study to determine the usefulness of cardiovascular MR in prediction of wall motion recovery after revascularization in acute myocardial infarction METHODS: Both cardiovascular MR with contrast enhancement and coronary angiogram were performed in 19 patients with acute myocardial infarction who treated with precutaneous intervention or thrombolytic therapy. Six months follow-up angiogram and MR study were also preformed. Thirty two matched segments model of the left ventricle were used to analysis the wall motion change and the grade of transmural extent of hyperenhancement (TEI). RESULTS: Among 628 segments, 177 segments showed wall motion abnormality. In group of segments showing hypokinesia (68 segments), the proportion of segments showing wall motion improvement was not different from that of the akinetic segments group (109 segments) (50% vs 41.3%, p=0.26). The proportion of segments showing wall motion improvement were 60.5% in group of TEI grade 0, 58.9% in TEI grade I, 51.2% in TEI grade III, 29.4% in TEI grade IV, 8% in TEI grade V. If the groups were divided into two according to cut-off value of TEI 50%, In the group of TEI less than 50%, 67 out of 118 segments (56.8%) showed wall motion improvement in contrast with 12 out of 59 segments (20.3%) in the group of TEI above 50% (p<0.001). The status of baseline wall motion abnormality (hypokinesia or akinesia) did not effect on wall motion improvement after revascularization. CONCLUSIONS: The baseline wall motion abnormality (hypokinesia or akinesia) did not predict the wall motion improvement. But, TEI grade was significant factor to predict the wall motion improvement.
Follow-Up Studies ; Heart Ventricles ; Humans ; Hypokinesia ; Magnetic Resonance Imaging ; Myocardial Infarction* ; Myocardium ; Thrombolytic Therapy

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.
Cardiology ; Coronary Angiography ; Electrocardiography ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Myocardial Infarction* ; Necrosis

DA-8159, a selective inhibitor of phosphodiesterase type 5, was developed as a new drug for erectile dysfunction. The effect of DA-8159 on the electroretinogram (ERG) and the retinal histopathology were evaluated in rabbits. The ERG was performed prior to, and 1 and 5 hr after DA-8159 (5 to 30 mg/kg) administration. The plasma concentration of DA-8159 was determined at each time point, and retinal microscopic examination was also performed. There was no statistically significant ERG change at any dose or at any time. Though the 30 Hz flicker showed a prolongation of the implicit time at 5 hr after the administration of either DA-8159 15 mg or 30 mg/kg (p<0.05), but concurrent amplitude decreases were not statistically significant. At a dose of 5 mg/kg, no test drug was detected in the blood after either 1 or 5 hr. At either 15 mg/kg or 30 mg/kg, there was a dose-dependent increase in the blood concentration after 1 hr of drug administration, which decreased with time. In light and electron microscopic examinations of the retina, there was no remarkable change at any dose. These results suggest DA-8159 has a low risk potential to the retina, but further evaluation on the visual functions in human is needed.
3',5'-Cyclic-GMP Phosphodiesterase/*antagonists & inhibitors ; Animals ; Dose-Response Relationship, Drug ; Electroretinography/*drug effects ; Humans ; Male ; Phosphodiesterase Inhibitors/blood/*pharmacology ; Pyrimidines/blood/*pharmacology ; Rabbits ; Retina/*cytology/*drug effects

BACKGROUND AND OBJECTIVES: Cardiovascuar MR using contrast enhancement has recently been reported to be useful for diagnosing myocarditis. It is also well known that irreversible myocardial injury by epicardial coronary artery flow obstruction spreads from the endocardium to the epicardium in a wave-front pattern with a time-dependent manner. We investigated characteristics of the patterns of contrast-enhanced MR imaging according to the underlying myocardial injury mechanism. SUBJECTS AND METHODS: Of all 275 patients who underwent coronary angiogram at our hospital due to cheat pain and elevated cardiac enzymes between October, 2002 and August, 2003, 48 patients who underwent cardiac MR were enrolled in this study. We retrospectively analyzed the pattern of delayed hyperenhancement according to presence or absence of a documented infarct related artery. Endomyocardial biopsies were done in selected patients. RESULTS: Contrast MR images of all patients showed delayed hyperenhancement. The study group was divided into 2 groups according to whether the areas of hyper-enhancement were involved in the sub-endocardial portion (endocardial sparing pattern, ESP) or not. In 8 patients (Group A, 17%) who showed the endocardial sparing pattern on contrast MR, the findings of coronary angiogram were all normal. In 40 patients (Group B, 83%), who did not show the endocardial sparing pattern on contrast MR, 39 patients (97.5 %) had an infarct related artery on coronary angiogram (p=0.001). Endomyocardial biopsies were performed in 3 patients of group A. The findings of the 3 biopsies were 2 cases of definite myocarditis and 1 case of myocardial degeneration. CONCLUSION: The endocardial sparing pattern of myocardial injury demonstrated by delayed enhancement MR imaging was very useful to predict the presence of an infarct related artery in patients with myocardial necrosis that has been determined by elevated cardiac enzymes. This result can be a useful clue to determine the nature of the underlying injury mechanism such as ischemic or non-ischemic.
Arteries ; Biopsy ; Coronary Vessels ; Endocardium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction ; Myocarditis ; Necrosis ; Pericardium ; Retrospective Studies

PURPOSE: This study was designed to compare Transilluminated Powered Phlebectomy (TIPP) with conventional surgical treatment (high ligation of the greater saphenous vein and above knee stripping with varicosectomy). METHODS: 428 cases of varicose veins, managed surgically at our hospital, were reviewed. A retrospective review of clinical records, between November 2000 an March 2003, was performed. The patients were divided into one of two groups: TIPP or a conventional operation. All the patients had at least a C2 CEAP disease. RESULTS: The demographics, hospital stays and operating times for the two groups were similar. However, a TIPP was associated with significantly fewer incisions (4.4+/-1.5 vs 8.2+/-3.9; P<0.001) and recurrence (n=14, 6% vs n=24, 12%; P=0.003). The incidence of a postoperative hematoma developing was more common with TIPP (n=20, 9% vs n=1, 0.5%; P=0.023). The problem of a hematoma formation in TIPP was solved by the insertion of a small closed suction drain. Skin perforation and wrinkling, and dermatosclerosis, were only complicated in the TIPP. The mean pain scores (out of 10) for the TIPP and conventional operation groups, at 2 and 7 days and 4 weeks, were 4.8, 1.4 and zero, and 4.8, 2.8 and zero, respectively. The cosmetic satisfaction score was higher in the TIPP group (8.7 vs 5.7; P<0.001). CONCLUSION: With respect to pain, cosmetic satisfaction and residual varicose, the outcomes in the TIPP group were significantly better than those in the conventional operation group.
Demography ; Hematoma ; Humans ; Incidence ; Knee ; Length of Stay ; Ligation ; Lower Extremity* ; Recurrence ; Retrospective Studies ; Saphenous Vein ; Scleroderma, Localized ; Skin ; Suction ; Varicose Veins*

PURPOSE: There has been considerable controversy about whether acid reduction surgery is a definitive surgical treatment for perforated duodenal ulcer with numerous methods having been described. The controversy has increased with the development of the Proton Pump inhibitor and the discovery of Helicobacter Pylori (HP), because the recurrence and morbidity have been shown to decrease with simple closure followed by a good medical therapy against HP and the ulcer. This study is an evaluation of simple closure as an alternative treatment of perforated duodenal ulcer. METHODS: This retrospective study reviewed the records of 288 patients with surgically-treated ulcer perforation. After 62 patients were excluded, 128 patients treated with simple closure were compared with 98 patients treated with definitive surgery. In the simple closure group, we compared 50 patients treated with Proton Pump inhibitor and 78 patients treated with H2 blocker. Also, the influence of various factors such as age, delayed operation, size of ulcer perforation, operative methods, associated diseases, and complications were analyzed to evaluate recurrence, morbidity and mortality. RESULTS: After mean follow up for 53.7 months, 56.6% of patients treated with simple closure had fewer post operative complications and a lower recurrence rate compared with definitive surgery. The infection rate by HP of 81.6% in our study was similar to that of other studies. Some factors as age (>60), duration of symptoms (>24 hours), size of ulcer perforation (>10 mm), associated disease and operative time showed an influence on the mortality. CONCLUSION: Recent advances in the treatment of perforated peptic ulcer such as the development of the Proton Pump inhibitor and the discovery of HP have shown that after simple closure, an adequate medical treatment of ulcer can effectively decrease the recurrence rate, morbidity and mortality.
Duodenal Ulcer* ; Follow-Up Studies ; Helicobacter pylori ; Humans ; Mortality ; Operative Time ; Peptic Ulcer ; Proton Pumps ; Recurrence ; Retrospective Studies ; Ulcer

BACKGROUND: Inappropriate sinus tachycardia(IST) manifests chronic nonparoxysmal sinus tachycardia in healthy individuals and is characterized by consistently elevated heart rate and exaggerated responses to minimal physical activity. Heart rate variability(HRV) using 24-hour Holter monitoring represents one of the methods of evaluating the harmony of autonomic nervous system activity. So, authors investigate the autonomic nervous system activity by the HRV in patients with IST. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity through the time domain analysis of heart rate variability with 24-hour Holter monitoring between 23 patients with IST and 23 healthy control subjects. None of the patients had organic heart disease as determined by routine laboratory examination and echocardiography. And then, time domain measures(mean NN, SDNN, SDANN, SD, rMSSD, pNN50) were analyzed. RESULTS: The mean age of patients and control were 38+/-10 and 37 9 years, respectively(p=S). The mean clinical heart rate of patients and control was 104 5/min and 72+/-5/min, respectively(p<0.05). Among the time domain indices, mean of all normal RR intervals(mean NN), standard deviation of all normal RR intervals(SDNN), standard deviation of mean RR interval(SDANN), mean of standard deviations of all normal RR intervals(SD), root mean square successive differences between adjacent normal RR intervals(rMSSD), and percent of difference between adjacent normal RR intervals(pNN50) in the patient group were significantly shorter compared to control group(p<0.01). CONCLUSION: In IST, cardiac vagal influence on the heart rate is blunted.
Autonomic Nervous System ; Echocardiography ; Electrocardiography, Ambulatory ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Motor Activity ; Tachycardia, Sinus