BACKGROUND: Chimerism analysis used to be one of the most valuable methods for monitoring patients after allogeneic hematopoietic stem cell transplantation (SCT). The relationship between the mixed chimerism status and the risk of relapse has been controversial. We analysed the clinical significance of mixed chimerism for the prediction of relapse after SCT. METHODS: Between October 2000 and January 2002, 16 patients with haematologic malignancies treated with SCT were included in this study. The median follow-up periods were 11.5 months (range 5-32 months) after SCT. For chimerism analysis, STR (D13S317, D5S818, D7S820) and VNTR (D1S80, D17S30) loci were amplified by PCR. Patients who exhibited complete donor hematopoiesis at all times during the follow-up period were defined as CCG (complete chimerism group) and those who showed mixed chimerism at least once at any time were definded as the MCG (mixed chimerism group). Relapse was considered based on clinical, hematologic and cytogenetic findings. RESULTS: MCG was 63% (10/16). Relapse was observed in 80% (8/10) of MCG and none of CCG (P>0.05). Among 8 relapsed patients, two patients showed MC 1 month prior to relapse and 4 patients changed to MC from CC at relapse status. The remaining 1 patient continued to show CC. CONCLUSIONS: Mixed chimerism seems to be associated with a high risk of relapse. For early detection of relapse, chimerism analysis may need to be performed at shorter time intervals than once a month.
Chimerism* ; Cytogenetics ; Follow-Up Studies ; Hematopoiesis ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Polymerase Chain Reaction ; Recurrence ; Tissue Donors

BACKGROUND: The t(11;14)(q13;q32) is known to be one of the most frequent chromosomal abnor-malities found in multiple myeloma (MM). However, studies on t(11;14) in MM have been problemat-ic due to the fact that MM cells proliferate poorly in vitro. The purpose of our study is to evaluate inci-dence, clinical, and hematologic findings of MM with IgH and cyclin D1 gene rearrangement and to investigate the usefulness of interphase FISH (fluorescence in situ hybridization). METHODS: The study group included 36 patients (23 newly diagnosed MM, 8 relapsed MM, 5 per-sistent MM after treatment) admitted to Mokdong and Gil Hospital from November 1998 to July 2002. Interphase FISH was performed with IGH/CCND1 dual color, dual fusion translocation probe (Vysis Inc, Downers Grove, IL USA), using bone marrow mononuclear cells. RESULTS: Incidence of IgH and cyclin D1 gene rearrangement by interphase FISH was 19%. One patient with normal karyotype and another patient without any metaphase cells showed IgH and cyclin D1 gene rearrangement with interphase FISH. The lambda light chain subtype was more frequently found in patients with rearrangement (4/5, 80%) than those without rearrangement (6/23, 26%) (P<0.05). No significant differences were found in other clinical and hematologic findings in the two groups. CONCLUSIONS: We suggest that MM with IgH and cyclin D1 gene rearrangement is associated with the expression of lambda light chain. Interphase FISH may be helpful in samples with normal karyotype or no metaphase cells for detection of gene rearrangement of MM.
Bone Marrow ; Cyclin D1* ; Cyclins* ; Gene Rearrangement ; Genes, bcl-1* ; Humans ; Incidence ; Interphase* ; Karyotype ; Metaphase ; Multiple Myeloma*

This case presents a 34-year-old man who had a huge parasagittal meningioma. Initial treatment consisted of preoperative external carotid artery embolization and partial tumor resection. During the resection, we found that the tumor invaded the adjacent calvarium, and due to massive hemorrhage, total removal of the tumor was impossible. The patient was treated with intraoperative radiation therapy (IORT) (25 Gy via 16 MeV) as an adjunctive therapy. Eight months after IORT, we were able to remove the tumor completely without surgical difficulties. IORT can be considered an useful adjunctive therapy for the superficially located, huge, and highly vascular meningioma.
Adult ; Journal Article ; Human ; Intraoperative Care* ; Magnetic Resonance Imaging ; Male ; Meningeal Neoplasms/surgery ; Meningeal Neoplasms/radiotherapy* ; Meningeal Neoplasms/pathology ; Meningioma/surgery ; Meningioma/radiotherapy* ; Meningioma/pathology ; Vascular Neoplasms/surgery ; Vascular Neoplasms/radiotherapy* ; Vascular Neoplasms/pathology

Electrical stimulation of the cerebellar fastigial nucleus(FN) increases cerebral blood flow(CBF) and reduces brain damage after focal cerebral ischemia. The authors studied whether the neuroprotection elicited from electrical stimulation of the cerebellar FN is attibutable to the elevation in regional CBF(rCBF) or reduction in release of excitatory amino acid sprague-Dawley rats were anesthtized with a mixture of halothane(3% for the indurction and 1% for maintenance) and oxygen and artificially ventilated through a tracheal cannula. Arterial pressure, blood gases and body temperature were monitored. The middle cerebral artery(MCA) was occluded distal to the lenticulostriate branches. The FN was then for 2 hours, over the regions corresponding to the ischemic core and penumbra. Postiischemic release of glutamate and aspartate were measured by microdialysis for 2 hours at the same site of measurement of rCBF. Infarct volume was determined 8 hours later in 2,3,5-triphenyl tetrazolium chloride(TTC)-stained sections FN stimulation(n=12) increased mean arterial pressure by 28+/-16mmHg. In nonstimulated control rats(n=12), mean AP was not changed significantly during the experimental procedures. Compared with nonstimulated animal, stimulation of FN for 1 hour following MCA occlusion siginficantly increased rCBF in ischemic core and penumbra by 53.6% and 67.6% respectively. And the volume of infarction decreased by 42% at 8 hours after MCA occlusion. The concentration of glutamate and aspartate in ischemic core after MCA occlusion increased both in the control group(to 12.2+/-3.3 folds and 10.4+/-4.1 folds respectively) and in the stimulation group(10.5+/-2.8 and 11.2+/-4.1 folds, respectively). The concentration of glutamate and aspartate in penumbra did change significantly neither in the control group(to 2.5+/-1.3 folds and 1.8+/-0.6 folds respectively) nor in the stimulation group(1.9+/-0.5 folds and 2.1+/-0.4 folds, respectively). There was no significant difference between the two groups.
Animals ; Arterial Pressure ; Aspartic Acid ; Body Temperature ; Brain ; Brain Ischemia ; Catheters ; Electric Stimulation ; Excitatory Amino Acids ; Gases ; Glutamic Acid ; Infarction ; Microdialysis ; Oxygen ; Rats* ; Rats, Sprague-Dawley

Cortical spreading Depression(CSD) is a transient depression of neuronal activity that spreads across the cortical surface and is associated with profound changes in blood flow, extracellular ion concentration. Direct Current(DC) potentials and cell membrane potentials. One of the electrophysiological disturbance in the periinfarct surrounding is spontaneous occurrence of repeated CSD like DC shifts associated with increased energy demand. Due to restricted blood flow to the periinfarct border zone, elevated metabolic demand is potentially hazardous. So the authors designed this experiment to verify the correlation between periinfarct cortical spreading depression and ischemic volume following permanent middle cerebral artery(MCA) occlusion in rats. Sprague-Dawley rats(n=27) were anesthetized with 0.5~1% halothane, and artificially ventilated through a tracheal cannula. Arterial pressure, blood gases and body temperature were controlled. The middle cerebral artery(MCA) was occluded distally to the lenticulostriate branches. Measurements of CSD activity were made for 4 hours in each animal infarct volume was determined 6 hours later in 2,3,5-triphenyl tetrazolium chloride(TTC)- stained section. For 4 hours after MCA occlusion, the CSDs were found in all experimental animals with a range of 2~9 times. Those CSDs were of varying duration: "small"(1min) SDs and mean of total duration of SD was 10.5+/-10.3 min during 4 hours of MCA occlusion. Neuropathological evaluation of brain infarct in the rats, which had been allowed to survive for 6 hours after MCA occlusion showed a mean volume of 89.7+/-45.3 mm3. Serial observation of duration of CSD prologation of duration of CSD nor the frequency of CSD in the penumbral zone correlated with the volume of infarct.However total duration of CSD was slightly related with the infarct volume after 6 hours of the permanent MCA occlusion(r=0.414, p=0.0318) .
Animals ; Arterial Pressure ; Body Temperature ; Brain ; Catheters ; Cell Membrane ; Cortical Spreading Depression* ; Depression ; Gases ; Halothane ; Neurons ; Rats* ; Rats, Sprague-Dawley

Ten brain tumor patients underwent wide resection of the tumor followed by Intraoperative Radiation Therapy (IORT) at the first surgery or at the second salvage surgery after failure of conventional external beam irradiation. Two patients(1 meningioma, 1 glioblastoma multiforme) were treated at the first surgery and 8 patients(3 anaplastic astrocytoma, 3 glioblastoma multiforme, 1 meningioma, 1 gliosarcoma) were treated after salvage surgery. The IORT doses were ranged from 15-25 Gy depending on the tumor volume and previous radiation therapy. The neurological status(Karnofsky performance status) was improved in 4 cases, not changed in 6 cases after IORT. There were several complications after IORT; radiation necrosis, communicating hydrocephalus, wound infection, and abnormal CT findings such as diffuse low density area in an around operation site. The radiation necrosis was confirmed by operation in a recurrent meningioma patient 12 months after IORT. At follow-up, ranging from 1 to 16 months, there was no deaths. Based on our limited experiences, the IORT might be one of the adjuvant therapeutic modalities especially for the malignant brain tumors and unresectable huge meningioma.
Adult ; Astrocytoma/radiotherapy/surgery ; Brain Neoplasms/pathology/*radiotherapy/*surgery ; Combined Modality Therapy ; Female ; Glioblastoma/radiotherapy/surgery ; Gliosarcoma/radiotherapy/surgery ; Human ; Intraoperative Care ; Male ; Meningioma/radiotherapy/surgery ; Middle Age ; Salvage Therapy

The time course of hydroxyl radical generation in the brain and the intensity of brain hydroxyl radical(OH) generation were examined in rat during the first four hours after postischemia reperfusion. Hydroxyl radical production was measured using the salicylate trapping method in which the production of 2, 3-dihydroxybenzoic acid(DHBA) in hippocampus(CA1) 5 minutes after salicylate administration was used as an index of OH formation. The interstitial concentration changes of salicylate and 2, 3-DHBA were detected by intracerebral microdialysis following the intraperitoneal administration of salicylate(150mg/kg) using high pressure liquid chromatography-electrochemical(HPLC-EC) and -ultraviolet(-UV). Adult Sprague-Dawley rats were subjected to 20 minutes of bilateral carotid artery occlusion(BCAO) in either normotensive or hypotensive state. Serial changes of cerebral blood flow(CBF) were monitored by H2 clearance method. CBF of normotensive BCAO group(n=6) was found to be decreased only to 52% of baseline value, and OH production after reperfusion did not develop in this group. Rats in the BCAO hypotensive group(n=10) showed remarkable reduction of CBF to 27% of baseline(p<0.05) and 2~4 folds increase of 2, 3-DHBA/salicylate during the first 40 minutes of recirculation . Hydroxyl radical production in rats died(n=5) after the insult was significantly higher and lasted longer than that in rats survived(n=5)(p<0.05). Concentration of salicylate in perfusate increased during 100 minutes after the peritoneal injection and before reaching to a plateau, which lasted for 3 hours. The changes of cerebral tissue concentration of 2, 3-DHBA differed from those of salicylate. In 2, 3-DHBA, the plateau was reached rather slowly than that of salicylate and lasted for 2 hours. These data indicate that lobal cerebral ischemia could be induced by temporary BCAO only if the systemic hypotenion is accompanied, it can not be induced in normotensive group. The hydroxyl radical produced brain damage is prone to develop early in the reperfusion period and is correlated with the severity of ischemic insult.
Adult ; Animals ; Brain ; Brain Ischemia* ; Carotid Arteries ; Hippocampus ; Humans ; Hydroxyl Radical* ; Microdialysis ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury* ; Reperfusion*

Spinal subdural hematoma is an uncommon entity having a higher incidence in patients with bleeding diathesis or receiving anticoagulant therapy. Lumbar puncture should be done meticulously especially in patients with a bleeding tendency. Spinal subdural hematoma should be considered as a possible diagnosis in patients with coagulopathy, having sustained a minor trauma, or having had a recent lumbar puncture, showing progressive neurological deficits suggestive of a spinal disorder. In such patients, early diagnosis and proper treatment is imperative in order to minimize any neurological sequelae. We report a case of a 7-month-old infant in a septic condition diagnosed with chronic spinal subdural hematoma that had occurred following repeated lumbar punctures.
Diagnosis ; Disease Susceptibility ; Early Diagnosis ; Hematoma, Subdural ; Hematoma, Subdural, Spinal* ; Hemorrhage ; Humans ; Incidence ; Infant* ; Spinal Puncture

Spontaneous intracerebral hemorrhage is one of the most devastating forms of cerebrovascular disease in the field of neurosurgery, and is most frequently associated with the hypertension in the distribution of the penetrating vessels, or can be secondary to other factors, like aneurysm, arteriovenous malformation, glial tumor, metastasis, infarction, anticoagulation therapy, coagulation disorders such as leukemia or thrombocytopenia. Although many cases of recurrent hypertensive intracerebral hemorrhage have been reported, bilateral simultaneous hemorrhage has not been reported. The authors report a case of bilateral simultaneous hypertensive intracerebral hemorrhage in a 62-year-old male, which was treated by conservative management.
Arteriovenous Fistula ; Basal Ganglia* ; Cerebral Hemorrhage ; Hemorrhage ; Humans ; Hypertension ; Infarction ; Intracranial Hemorrhage, Hypertensive* ; Leukemia ; Male ; Middle Aged ; Neoplasm Metastasis ; Neurosurgery ; Thrombocytopenia

No abstract available.
Pituitary Neoplasms*