PURPOSE: Acute immume thrombocytopenic purpura (ITP) is relatively common hematologic disease in children. Most acute ITP is recovered within 6 month spontaneously and the complication is rare. But 10~20% of the ITP patient became a chronic form. Infection with Epstein-Barr virus (EB virus) in developing country usually occurs during infancy and early childhood. Acute ITP associated with EB virus is likely to develop chronic ITP in current literatures. We studied the pattern of laboratory findings in long term follow up of ITP with EB virus infection. METHODS: One hundred and seventy nine patients diagnosed with ITP admitted to the division of pediatric hematology, Gachon Medical Center and Hanyang University Hospital between Mar. 1991 and Jun. 2001 were reviewed retrospectively. Serologic test for EB virus was available for 57 patients and 25 of them were follow up at least 6 months. Evidence of acute EB virus infection was defined as a positive Viral Capsid Antigen (VCA) IgM or positive Anti VCA IgG and negative Ebstein-Barr virus Nuclear Antigen (EBNA). Complete remission (CR) was defined as a recovery of platelet count of more than 100 109/L and partial remission (PR) as a recovery of platelet count of 50~100 109/L, maintained for at least 6 months. RESULTS: Sixteen out of 57 patients were associated acute EB virus infection. Of this group, 8 patients were follow up at least 6 months. Forty one of 57 with no evidence of acute EB virus infection, 17 were follow up at least 6 months. The clinical and laboratory data was not different significantly in children with and without acute EB virus infection in admission. In EB virus infection group of 6 months follow up, platelet count was significantly lower than control group in 6 months follow up (P=0.006). Five patients of 8 (63%) with acute EB virus infection had chronic ITP and 2 of 17 (12%) with no evidence of EB virus infection had chronic ITP in follow up 6 months. CONCLUSION: Patients with EB virus associated ITP tended to resolved more slowly than those without EB virus infection and also showed tendency to become chronic ITP.
Capsid ; Child ; Developing Countries ; Follow-Up Studies ; Hematologic Diseases ; Hematology ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Platelet Count ; Purpura, Thrombocytopenic ; Purpura, Thrombocytopenic, Idiopathic* ; Remission, Spontaneous ; Retrospective Studies ; Serologic Tests

The CD1 system is a novel antigen-presenting system for T cell recognition of lipid and glycolipids in antimicrobial immunity. Lepromatous leprosy is characterized by lack of cell-mediated immunity against M.leprae. The lack of cell-mediated immunity in lepromatous leprosy has been suggested to be correlated with weak CD1 expression on antigen presenting cells. In order to define how CD1 is down-regulated on M. leprae-infected antigen-presenting cells, we examined effects of interferon-gamma(IFN-gamma) on interleukin-10 (IL-10) secretion and CD1 expression of M.leprae-infected macrophages from granuloma of lepromatous leprosy. Our results showed that a significant trend of increased CD1 expression in response to decresed IL-10 secretion from M.leprae-infected macrophages by IFN-gamma. These results suggest that the local cytokine milieu, especially the balance between IFN-gamma and IL-10, is an important determinant in the regulation of CD1 in lepromatous lesions.
Antigen-Presenting Cells ; Glycolipids ; Granuloma ; Immunity, Cellular ; Interferon-gamma* ; Interleukin-10* ; Leprosy ; Leprosy, Lepromatous* ; Macrophages*

BACKGROUND: At the present time, more than 100 cases of squamous cell carcinoma (SCC) developing in neurotrophic ulcers of leprosy have been reported. But the histopathologic features and the differences between SCC in leprosy and de novo SCC was not described. OBJECTIVE: The purpose of this study was to evaluate the characteristics of SCC in leprosy and to investigate growth dynamics of SCC in ulcers in leprosy. METHODS: We reviewed the clinical features and the degree of histopathologic differentiation of 13 cases of SCC in ulcers of leprosy patients presenting at the KLCA from 1986 to 1998. And immunohistochemical staining with PCNA(proliferating cell nuclear antigen) and TUNEL staining were done in paraffin-embedded tissue sections from 18 sites of 13 cases of SCC in ulcers of leprosy. RESULTS: 1. The average duration of leprosy and of an ulcer prior to diagnosis of SCC was 43 years and 19 years, respectively. 2. Histopathologic grading of 13 cases was performed as follows:10 cases were well-differentiated and 3 cases were moderately-differentiated. 3. The PCNA LI(labelling index) was 47.26+/-7.38% in well-differentiated group and 48.86+/-9.39% in moderately -differentiated group. 4. The apoptotic index(AI) was 45.57+/-8.68% in well- differentiated group and 29.38+/-1.06% in moderately differentiated group. The AI in de novo SCC was 45.09+/-6.18%. CONCLUSION: (1) Malignant change in chronic ulcer in leprosy may be found more often if patients are examined with care. (2) Our leprosy case with SCC is a 63-year-old male with past history of lepromatous leprosy of 43 year duration having ulcer problems for 19 years before presenting with SCC on an average. (3) High-degrees of malignancy in SCC of leprosy patients might be caused by extended cell survival due to decreased apoptosis rather than increased cell proliferation.
Apoptosis ; Carcinoma, Squamous Cell* ; Cell Proliferation ; Cell Survival ; Diagnosis ; Humans ; In Situ Nick-End Labeling ; Leprosy* ; Leprosy, Lepromatous ; Male ; Middle Aged ; Proliferating Cell Nuclear Antigen ; Ulcer*

BACKGROUND: Hemolysis is one of the chief side-effects of dapsone. But the frequency and severity of hemolysis have not been fully elucidated in patients with leprosy. OBJECTIVE: The purpose of our study was to determine the effect of dapsone on hematologic profile in patients with leprosy. METHODS: We did a retrospective analysis of the effect of daily dapsone(100mg/day) in 26 newly-registered cases undergoing multi-drug therapy. Complete blood count(CBC) was performed on their initial visit and at intervals between one and six months. In 10 cases, glucose-6-phosphate dehydrogenase(G-6-PD) levels were determined and in 12 cases iron study was performed. RESULTS: 1. The average hemoglobin was found to fall by 2.9+/-1.4g/dl, from 13.2+/-1.5g/dl, to a nadir of 10.5+/-1.5g/dl(p<0.01). 2. In 13 cases in whom red cell profiles were available, there was a hemoglobin fall from 12.8+/-1.5g/dl to 10.8+/-1.7g/dl(p<0.01) and a hematocrit fall from 37.0+/-4.6% to 32.9+/-4.8%(p<0.05). There was a increase in mean corpuscular volume(MCV) from 90.7+/-2.9fl to 95.2+/-2.8fl(p<0.01). The mean corpuscular hemoglobin(MCH) and mean corpuscular hemoglobin concentration(MCHC) changed from 31.3+/-2.3pg/cell to 31.2+/-1.4pg/cell(p<0.05) and from 34.6+/-2.2g/dl to 32.9+/-0.7g/dl(p<0.05), respectively. 3. Ten patients had G-6-PD measured and nine had normal levels. One with a low G-6-PD had a relatively dramatic hemoglobin fall. 4. Serum iron studies in 12 cases revealed reduced serum iron in 6 cases but normal or increased ferritin in all cases and decreased total iron binding capacity(TIBC) in 6 cases. CONCLUSION: After dapsone treatment almost all patients had a fall in their hemoglobin concentration and an increase in MCV. Impaired iron utilization was a common finding and deficiency of G-6-PD may be a factor aggravating the hemolytic effect of dapsone in leprosy patients.
Dapsone* ; Erythrocyte Indices* ; Ferritins ; Glucose-6-Phosphate ; Hematocrit ; Hemolysis ; Humans ; Iron ; Leprosy* ; Retrospective Studies

BACKGROUND: Hemolysis is one of the chief side-effects of dapsone. But the frequency and severity of hemolysis have not been fully elucidated in patients with leprosy. OBJECTIVE: The purpose of our study was to determine the effect of dapsone on hematologic profile in patients with leprosy. METHODS: We did a retrospective analysis of the effect of daily dapsone(100mg/day) in 26 newly-registered cases undergoing multi-drug therapy. Complete blood count(CBC) was performed on their initial visit and at intervals between one and six months. In 10 cases, glucose-6-phosphate dehydrogenase(G-6-PD) levels were determined and in 12 cases iron study was performed. RESULTS: 1. The average hemoglobin was found to fall by 2.9+/-1.4g/dl, from 13.2+/-1.5g/dl, to a nadir of 10.5+/-1.5g/dl(p<0.01). 2. In 13 cases in whom red cell profiles were available, there was a hemoglobin fall from 12.8+/-1.5g/dl to 10.8+/-1.7g/dl(p<0.01) and a hematocrit fall from 37.0+/-4.6% to 32.9+/-4.8%(p<0.05). There was a increase in mean corpuscular volume(MCV) from 90.7+/-2.9fl to 95.2+/-2.8fl(p<0.01). The mean corpuscular hemoglobin(MCH) and mean corpuscular hemoglobin concentration(MCHC) changed from 31.3+/-2.3pg/cell to 31.2+/-1.4pg/cell(p<0.05) and from 34.6+/-2.2g/dl to 32.9+/-0.7g/dl(p<0.05), respectively. 3. Ten patients had G-6-PD measured and nine had normal levels. One with a low G-6-PD had a relatively dramatic hemoglobin fall. 4. Serum iron studies in 12 cases revealed reduced serum iron in 6 cases but normal or increased ferritin in all cases and decreased total iron binding capacity(TIBC) in 6 cases. CONCLUSION: After dapsone treatment almost all patients had a fall in their hemoglobin concentration and an increase in MCV. Impaired iron utilization was a common finding and deficiency of G-6-PD may be a factor aggravating the hemolytic effect of dapsone in leprosy patients.
Dapsone* ; Erythrocyte Indices* ; Ferritins ; Glucose-6-Phosphate ; Hematocrit ; Hemolysis ; Humans ; Iron ; Leprosy* ; Retrospective Studies

An IgM anti-phenolic glycolipid-I(PGL-I) antibodies in leprosy was measured using specimens of dried capillary blood collected on filter paper from the skin smear site instead of sera from venous blood. We also measured IgM antibodies from venous blood collected on filter paper. The correlation among the three samples was good. So I concluded the collection of capillary blood on filter paper is a convenient method for handling, mailing and storage of samples.
Antibodies* ; Capillaries* ; Immunoglobulin M* ; Leprosy ; Postal Service ; Skin

Sensitivity to estrogen has been described previously. The clinical picture is varied with pruritus, either generalized or localued or as urticaria. The hallmark of estrogen dermatitis is the cyclic premenstrual flare. The patient reported here had cyclic erythema multiforme-like lesions and showed a positive intradermal skin test to estrogen. A 20-year-old female patient presented with a periodic 5 year duration of skin lesions on both hands. The eruption commenced in the second half of the menstrual cycle, worsened through the luteal phase but the lesion almost disappeared during menstruation. An intradermal skin test to estrone showed positive results. However, a skin test with medroxyprogesterone acetate was negative. After systemic steroid and antihistamine therapy, the lesions were found to be significantly improved.
Dermatitis* ; Erythema ; Erythema Multiforme ; Estrogens* ; Estrone ; Female ; Hand ; Humans ; Luteal Phase ; Medroxyprogesterone Acetate ; Menstrual Cycle ; Menstruation ; Pruritus ; Skin ; Skin Tests ; Urticaria ; Young Adult

BACKGROUND: Chronic actinic dermatitis comprises a spectrum of chronic photosensitivity disorders. Treatment includes avoidance of UV light, application of broad-spectrum topical sunscreens, PUVA therapy, corticosteroid, azathioprine and cyclosporine. OBJECTIVE: Our purpose was to determine the efficacy of cyclosporine in the treatment of chronic actinic dermatitis. METHODS: Six patients with chronic actinic dermatitis refractory to conventional treatment were treated with cyclosporine 100-200mg a day for four to eighteen weeks. RESULTS: In all six patients improvement of the skin lesions and itching were dramatic, but in three of them hyperterision developed during the cyclosporine treatment. After stopping the cyclosporine therapy, their blood pressures normalized within two to five weeks. Other side effects of cyclosporine were not found. Although the skin lesions of all of the six patients were aggravated more or less after stopping the cyclosporine therapy, we could maintain their improved states with topical corticosteroids and oral antihistamines. CONCLUSION: 1. Cyclosporine is a good alternative in treating chronic actinic dermatitis patients who are suffering from severe symptoms refractory to conventional therapy. 2. Hypertension is the frequent side effect of cyclosporine.
Adrenal Cortex Hormones ; Azathioprine ; Cyclosporine* ; Histamine Antagonists ; Humans ; Hypertension ; Photosensitivity Disorders* ; Pruritus ; PUVA Therapy ; Skin ; Sunscreening Agents ; Ultraviolet Rays

BACKGROUND: It is important to understand the morphologic characteristics for the identification of a microorganism. Electron microscopy has contributed a great deal to the field of mycology. Scanning electron microscope (SEM) has become a useful tool to study three-dimensional images of fungi. Vacuum dessicator aqueous fixation is a useful sample preparation technique for SEM examination of fungal specimens without surFace distortions. OBJECTIVE: This study was done to observe the three-dimensional structures of dermatophytes preserving their natural growth characteristics. METHODS: Trichophyton rubrum, T. mentagrophytes, Microsporum canis, M. gypseum, and Epidermophyton floccosum were isolated and cultured on Sabourd agar, corn meal agar, or rice agar plate. Vacuum dessicator aqueous fixation was utilized as p preparation technique for SEM examinations of fungi. RESULTS: Vacuum dessicator aqueous fixation led us to examine the aerial mycelia including conidia of the dermatophytes under SEM. The five species of dermatophytes showed their own characteristic structures especially on microconidia and macroconidia. CONCLUSION: The use of ultrastructural research has made it possible to identify the species of fungi and can be expanded and improved along with the development of SEM and specimen preparation techniques.
Agar ; Arthrodermataceae* ; Epidermophyton ; Fungi ; Imaging, Three-Dimensional ; Meals ; Microscopy, Electron ; Microscopy, Electron, Scanning ; Microsporum ; Mycology ; Spores, Fungal ; Trichophyton ; Vacuum ; Zea mays

BACKGROUND: PUVA has been used effectively in the treat,ment of vitiligo, but the mechanism by which PUVA stimulat.es melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and t,he incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes* ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo*