BACKGROUND: Inflammatory cytokines play an important role in human immune responses to malaria, although the role of these mediators in pathogenesis is unclear. In this study, we evaluated changes in cytokine levels following chemotherapy, and determined whether cytokine levels in serum correlated with the hematological parameters in the Korean vivax malarial patients. METHODS: The study population was composed of 31 patients in Inje University Ilsan Paik Hospital who were diagnosed with Plasmodium vivax infection. Cytokine profiles, including tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-10 levels, were assessed in serum samples obtained from the malaria patients three times, at the time of diagnosis (stage I) and after treatment with hydroxychloroquine (stage II) and primaquine (stage III). The level of each cytokine was measured using commercially available serum-based ELISA kits. Hematological parameters were simultaneously measured using a hematology autoanalyzer. RESULTS: At thetime of diagnosis, the TNF-alpha (mean, 62.9 pg/mL), IL-6 (mean, 45.5 pg/mL), and IL-10 (mean, 237.7 pg/mL) levels in the malaria patients were higher than the reference values. After treatment with hydroxychloroquine, these levels (TNF-alpha, P<0.01; IL-6, P<0.05; IL-10, P<0.01) significantly decreased to near-normal levels. Significant positive correlations were observed among the cytokine levels, but not between the cytokine levels and other hematological parameters. CONCLUSIONS: In this study, TNF-alpha, IL-6, and IL-10 levels increased at the time of diagnosis and rapidly decreased to normal levels after treatment the levels of these cytokines did not correlate with other hematological parameters.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Hematology ; Humans ; Hydroxychloroquine ; Interleukin-10 ; Interleukin-6 ; Interleukins ; Malaria ; Malaria, Vivax ; Plasmodium vivax ; Primaquine ; Reference Values ; Tumor Necrosis Factor-alpha

BACKGROUND: Generally, laypeople perceive blood transfusion risk differently from experts like physicians. Acknowledging such differences may improve risk communication. This study characterized how blood transfusion experts in Korea perceive the blood transfusion risks compared to laypeople in a past study. METHODS: A one-month e-mail survey targeting blood transfusion experts was conducted in October 2007. The questionnaire was designed to assess the demographics of the respondents, their response to the term 'blood transfusion', and the perceived risks of a transfusion. In all, 103 interviews were completed. RESULTS: The words evoked by the term 'blood transfusion' included blood, blood donation, life, surgery, and risk. About 24.2~31.1% of the respondents gave a moderate or high rating for the perceived risk of blood transfusion. About 72.8% of experts agreed that the blood supplied in Korea is safe, while 55.6% of laypeople agreed to the same question. If they needed a transfusion, about 85.4% of the respondents replied that they would accept the blood transfusion, and experts were more willing to receive a blood transfusion than laypeople. The relative perceived blood transfusion risk was 4.4+/-2.8 (out of 10), which was similar to the result with laypeople. CONCLUSION: Experts, as compared to laypeople, think that the blood supplied in Korea is safer and had higher acceptance rates of transfusion. Awareness of such differences may be helpful when sharing medical decisions between medical staff and their patients at blood transfusion scenes.
Blood Donors ; Blood Transfusion ; Surveys and Questionnaires ; Demography ; Electronic Mail ; Humans ; Korea ; Medical Staff

The very rare D--/D-- phenotype lacks C, c, E, e antigens with strong expression of the D antigen. A 31-year-old woman delivered her second baby, 3.6 kg girl at 38+4 weeks' gestation through repeat-Cesarean section. Her parents were not consanguineous. She had one artificial abortion, one Cesarean section with red blood cell transfusion and two spontaneous abortions. Her red cells were typed as O, D+C-c-E-e- and did not react with anti-Hr(o) (Rh 17). Her serum reacted with all of the screening cells and identification panel cells with strength of (++)~(+++). The baby was mildly jaundiced 12 hours after delivery. At 1 day after delivery, total bilirubin was 17.7 mg/dL, and direct and indirect antiglobulin tests were both positive. Phototherapy was immediately given for the baby but jaundice and anemia were worsened. Twenty six milliliter of the mother's whole blood was given twice to the baby after plasma depletion and leukocyte reduction. The baby showed improvement of jaundice and anemia, and discharged at hospital day 14. As far as we know, this is the third reported case of hemolytic disease of the newborn occurred in the D--/D-- mother with anti-Hr(o) in Korea, and the first case that was neither fatal nor treated with intensive medical care.
Abortion, Spontaneous ; Adult ; Anemia ; Bilirubin ; Cesarean Section ; Coombs Test ; Erythrocyte Transfusion ; Female ; Hepatitis B e Antigens ; Humans ; Infant, Newborn* ; Jaundice ; Korea ; Leukocytes ; Mass Screening ; Mothers ; Parents ; Phenotype* ; Phototherapy ; Plasma ; Pregnancy

BACKGROUND: The blood processing works are composed of phlebotomy, donor testing, manufacturing, storage, transportation, and quality control. Among these, storage, transportation and quality control are done partially at the blood collection centers and finally accomplished at the hospital blood banks. We tried to analyze blood processing costs in hospital blood banks. METHODS: Blood processing costs are divided into physician works, practice expenses, and professional liability insurance according to RBRVS (Resource-Based Relative Value Scale). Physician works were analyzed according to the study of the 'Physician work RBRVS committee of the Korean society for laboratory medicine'. For the practice expenses, three university hospital blood banks data were analyzed. The costs for the blood supply of small clinics or hospitals without blood banks were investigated by questionnaire. RESULTS: Comprehensive works of physician were such as laboratory administration, quality control, preparation of procedure manual, education, quality improvement control. Specific works of physician were such as supervision over technologists, analysis of quality control data, management of blood inventory, storage and issue, blood utilization review, management of adverse transfusion reaction, blood return and disposal. As for one unit of blood, the standard labor time of technologists was 28.8 minutes (which is equivalent of 7,680 won) and the mean equipment cost was 592 won. The mean cost of small clinics or hospitals for blood supply was 12,150 won. CONCLUSION: The reimbursement of blood processing cost for the hospital blood bank would contribute to stable blood bank administration, stable blood supply and safe transfusion.
Blood Banks* ; Blood Group Incompatibility ; Education ; Humans ; Insurance ; Liability, Legal ; Organization and Administration ; Phlebotomy ; Quality Control ; Quality Improvement ; Tissue Donors ; Transportation ; Utilization Review ; Surveys and Questionnaires

Although surgical options for double outlet right ventricle (DORV) with non-committed ventricular septal defect (VSD) are vary in accordance to the morphological characteristics, it is very difficult to use biventricular repair technique when there is tricuspid chordae originating from conal septum or when the distance between the tricuspid valve and the pulmonic valve is too short. We report our clinical experience of biventricular repair of DORV with non- committed VSD by VSD rerouting to the pulmonary artery and arterial switch in case of a presence of conal tricuspid chordae and short distance between the tricuspid valve and the pulmonic valve.
Double Outlet Right Ventricle* ; Heart Septal Defects ; Heart Septal Defects, Ventricular* ; Pulmonary Artery ; Tricuspid Valve

Left ventricular thrombosis is a frequent and potentially dangerous complication in acute myocardiac infarction, but its occurrence and adequate therapy has not been known in patients with Dor procedure for the ischemic cardiomyopathy. We report a patient, 45 year-old male, who had a new left ventricular thrombus developed after coronary arterial bypass graft, Dor procedure, and removal of the left ventricular thrombus for ischemic cardiomyopathy. Left ventricular thrombus was disappeared on the follow-up cardiac MRI following intravenous heparin injection and oral coumadin therapy. This case suggest that anticoagulation therapy may prevent patients with the severe left ventricular dysfunction and apical aneurysm and dyskinesia from developing the left ventricular thrombus, and that thrombi will resolve without clinical evidence of systemic embolism.
Aneurysm ; Cardiomyopathies ; Dyskinesias ; Embolism ; Follow-Up Studies ; Heart Aneurysm ; Heparin ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Thrombosis* ; Transplants ; Ventricular Dysfunction, Left ; Warfarin

Annuloaortic ectasia, aortic regurgitation (AR), and ventricular septal defect (VSD) in patients with right ventricular hypoplasia is a very rare condition. We report a patient who underwent aortic root replacement with a composite graft for annuloaortic ectasia associated with VSD and AR in right ventricular hypoplasia. The patient was a 19 year-old male. Transthoraic echocardiogram and cardiac catheterization revealed a perimembranous VSD (2 cm in diameter), severe AR, annuloaortic ectasia, bipartite right ventricle with hypoplasia, and hypoplastic tricuspid valve. Operative findings showed that free margins of the right and noncoronary cusps were markedly elongated, thickened, and retracted, and commissure between the right coronary cusp and the noncoronary cusp was fused and calcified. VSD was closed with an autologous pericardial patch and composite graft aortic root replacement using direct coronary button reimplantation was performed, and the hypertrophic muscle of the right ventricular outflow tract was resected. The patient had transient weaning failure of cardiopulmonary bypass and was discharged at the postoperative 14 days without any problems.
Aortic Valve Insufficiency* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiopulmonary Bypass ; Dilatation, Pathologic* ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Male ; Replantation ; Transplants ; Tricuspid Valve ; Weaning ; Young Adult

BACKGROUND: The long-term results of combined mitral valve repair and aortic valve replacement (AVR) have not been well evaluated. This study was performed to investigate the early and long-term results of mitral valve repair with AVR. MATERIAL AND METHOD: We retrospectively reviewed 45 patients who underwent mitral valve repair and AVR between September 1990 and April 2002. The average age was 47 years; 28 were men and 17 women. Twelve patients had atrial fibrillation and three had a previous cardiac operation. The mitral valve disease consisted of pure insufficiency (MR) in 34 patients, mitral stenosis (MS) in 3, and mixed lesion in 8. Mitral valve disease was due to rheumatic origin in 24 patients, degenerative in 11, annular dilatation in 8, and ischemia or endocarditis in 2. The functional anatomy of mitral valve was annular dilatation in 31 patients, chordal elongation in 19, leaflet thickening in 19, commissural fusion in 13, chordal fusion in 10, chordal rupture in 6, and so on. Aortic prostheses used included mechanical valve in 32 patients, tissue valve in 12, and pulmonary autograft in one. The techniques of mitral valve repair included annuloplasty in 32 patients and various valvuloplasty of 54 techniques in 29 patients. Total cardiopulmonary bypass and aortic cross clamp time were 204+/-62 minute and 153+/-57 minutes, respectively. RESULT: Early death was in one patient due to low output syndrome (2.2%). After follow up of 57+/-37 months, late death was in one patient and the actuarial survival at 10 years was 96+/-4%. Recurrent MR developed grade II or III in 11 patients and moderate MS in 3. Three patients required reoperation for valve-related complications. The actuarial freedom from recurrent MR, MS, and reoperation were 64+/-11%, 86+/-8%, and 89+/-7% respectively. CONCLUSION: Combined mitral valve repair with AVR offers good early and long-term survival, and adequate techniques and selection of indication of mitral valve repair, especially in rheumatic disease, are prerequisites for better long-term results.
Aortic Valve* ; Atrial Fibrillation ; Autografts ; Cardiopulmonary Bypass ; Dilatation ; Endocarditis ; Female ; Follow-Up Studies ; Freedom ; Humans ; Ischemia ; Male ; Mitral Valve Stenosis ; Mitral Valve* ; Prostheses and Implants ; Reoperation ; Retrospective Studies ; Rheumatic Diseases ; Rupture

In off-pump coronary artery bypass grafting (CABG), multiple proximal anastomosis may increase the risk of cerebral embolism (air, debris) and aortic injury (dissection, pseudoaneurysm). Radial artery (RA) has no intraluminal valve such as saphenous vein. We applied Cabrol technique using aortic root replacement for proximal anastomosis in off-pump CABG. Cabrol technique using RA graft can reduce numbers of proximal anastomosis and reduce number of aortic manipulation in off-pump CABG. We report a Cabrol technique for proximal anastomosis in off-pump CABG with RA graft.
Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Intracranial Embolism ; Radial Artery* ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Transplants*

BACKGROUND: Filter paper blood samples are convenient for sampling, storage and transport, and widely used for diagnostic and epidemiological studies of Plasmodium species. Our study was aimed to establish antibody and DNA tests using filter paper and to evaluate the usefulness of filterpaper blood sample and storage duration at room temperature. METHODS: 50 L whole blood of 45 Plamsmodium vivax infected patients were spotted on filter paper, dried, and kept in a drawer at room temperature. The paired, whole blood samples were stored at -70degrees C freezer temperature. The filter paper samples were used for PCR at 12 and 24 months. The standard filter paper samples (5, 000, 500, 100, 50, 5, 1 parasite/microL) were made from 3 patients and used for polymerase chain reaction every 3 months until 2 years, antibody test filter paper samples were used every month for 8 months. As standard, -70 degrees C whole blood samples were used. RESULTS: P. vivax DNA was detected in all (45/45) of the filter paper samples by PCR during 24months of storage. Detection limit of PCR was 1 P. vivax/microL using standard filter paper samples for12 months of storage, and 5 P. vivax/microL samples after that. The P. vivax antibody was detected perfectly(43/43) from filter paper samples during 5 months of storage. After that, the antibody detectionrates were, respectively, 81.4% (35/43), 60.5% (26/43), 51.2% (22/43) at six, seven and eight months. CONCLUSIONS: Filter paper blood samples stored at room temperature remained stable for PCR and antibody studies for 1 year and 5 months, respectively.
DNA* ; Epidemiologic Studies ; Humans ; Limit of Detection ; Plasmodium ; Plasmodium vivax* ; Polymerase Chain Reaction