, Eun Sook Kang, Ki Sook Hong, Gyoung Hee Kim Congenital Pelger-Huët anomaly is an autosomal dominant disorder affection leukocyte differentiation manifested by the presence of unsegmented of bilobed nuclei with increased condensation, but it is generally assumed that it has no clinical effects. We observed a case of congenital Pelger-Huët anomaly in 9 year-old boy. He was admitted to Ewha Womans University Hospital due to fever and diagnosed as viral infection of upper respiratory tract. On routine peripheral blood examination, we found majority of the neutrophils had uni-or bilobed nuclei. In familial examination, his mother & brother have had Pelger-Huët anomaly without any significant symptoms. On neutrophil function test, moderate defect of chemotaxis was noted.
, Seon Hee Cheon, Ki Sook Hong Rifampin-induced thrombocytopenia has been recognized as an immunological reaction associated with intermittent high dose therapy, or after administration of rifampin fo11owing aninterruption of therapy, and rarely seen with daily low dose therapy.
The patient was a 64 year-old male who was given rifampin 600mg daily for treatment of recurrent pulmonary tuberculosis. He had been received antituberculous treatment includingriftmpin 4 years ago. Spontaneous gum bleeding, petechiae on whole body, hemoptysis wasnoted two weeks after initiating the treatment. His platelet count was 5000/mm^3. Antituberculous medication was discontinued, but the platelet count was not recovered. He diedof severe hypoxemia due to pulmonary hemorrhage.
With the essential use of rifampin for the treatment of tuberculosis infections, clinicianshould recognize the possible complication of this drug causing such serious immunologic reactions as thrombocytopenia, hemolytic anemia, and acute renal failure with daily or intermittenttheupy.
, Ki Sook Hong In recent years, fungi have Played an increasingly important role as pathogens innosocomial infection, and the incidence of nosocomial fungemia appears to be increased as aresult of clinical and therapeutic factors. We investigated the incidence of fungemia and relationbetween the predisposing factors and fungal species to be helpful in the prevention and early diagnosis of nosocomial fungemia.
We reviewed 45 cases of fungemia in Ewha Womans University DongdaemoonHospital from Jan. 1991 to Oct. 1995 to examine the predisposing factors, underlying illness,concomitant bacteremia, morality and outcome by the fungal species.
During recent five years, fungemia was increased in incidence.
These results suggest that the incidence of fungemia are increased as a result ofvarious predisposing factors and removal of the predisposing factors will be helpful in the prevention of nosocomial fungemia.
Citations
, Ki Sook Hong Coagulase-negative staphylococci(CNS) once considered nonpathogenic contaminants, recently represent the leading organisms of hospital-acquire bacteremia in catheter-associated infections, immunocompromised patients and neonates. patients and neonates.
We reviewed 141 caews of CNS isolated from blood in Ehwa Womans University Dongdaemoon Hospital, from March 1993 to February 1994 and deagnosed as pathogens or contaminants by clinical data and performed species identification and antimicrobial susceptibility test.
The results were as follows:
1) 46.8% of isolated CNS from blood was diagnosed as pathogens and most common age of CNS bacteremia was less than 1 month(39.0%). The most frequent underlying desease was respiratory tract infection(28.1%) followed by neonatal desorder(17.2%), malignancy(12.5%) and urinary tract infection(6.3%).
2) The most common identified species of CNS bacteremia was
3) The antimicrobial susceptibility results of CNS bacteremia showed multi-drug resistance to penicillin(96.9%), cephalothin(75.0%), ampicillin/sulbactam(70.3%), oxacillin(70.3%), tetracycline(67.1%) and erythromycin(48.4%). But vancomycin resistance showed 1.6% of CNS bacteremia. Among CNS species,
These results that species identification and antimicrobial susceptibility test of CNS isolated from blood will be useful diagnostic tool of CNS bacteremia.
, Soon Nam Lee, Jeong Hee Hahm Selective absence of serum IgA is the most commonly diagnosed form of human immnndeficiency disease, being reported in about one in 500-700 subjects in population surverys. Datailed clinical and laborattory studies of subjects with selective IgA deficiency generally reveal significantly increased incidence of sinopulmonary infection, gastrointestinal symptomatology, autoimmune disease and autoantibodies.
Authors experienced selective IgA deficiency associated with an scleroderma in a 25 years old young woman. She had pulmonary tuberculosis, high IgE level, reactive rheumatoid factor, positive for antinuclear antibody, and no presence of anti-IgA antibody.
Presented study was conducted to determine that the hepatitis C virus(HCV) may play a role in the pathogenesis of chronic liver disease including hepatocellular carcinima and liver cirrbosis.
Using 2nd generation EIA author examined serum anti-HCV in total 2,641 cases, including liver disease, physical check-up subjects at EWHA Womans University Hospital during 1 year of 1992.
The results were as fo11ows : Among total 2,641 patients, overall prevalence of anti-HCV was 4.5%, 1.7% positive rate for subjects whose physical check-up. Among total 103 anti-HCV positive patients, the majority was chronic liver disease, liver cirrhosis, and hepatoma. The positivity of HBs Ag in anti-HCV positive patients was 4.4% and the anti-HBc was 49.5%. The mean ALT level was 69.3 U/L and the abnormal high level was found in 57.3% in anti-HCV positive patients.
On the basis of the results above, anti-HCV test is very useful for the diagnosis and management in not only chronic liver disease such as hepatocellular carcinoma and cirrhosis, but also chronic hepatitis diagnosed as B-hepatitis.
Microparticle enzyme immunoassay (MEIA) for thyrotropin (TSH) was evaluated and results were compared with those of immunoradiometric assay (IRMA) procedure. Coefficient of variations of within day precision was 3.8-9.6% and those of between day precision was 3.6-17.2%. Correlation between the MEIA(Y) and two site IRMA(X) was excellent (Y=1.0445X-0.1538, r=0.9948). The sensitivity of the assay (mean±2 SD of the zero standard) was 0,0158 µIU/ml. The concentration measured in 497 healthy subjects were ranged from 0.2-3 µIU/ml (mean 1.37 µIU/ml, SD 0.59).
Conclusively, MEIA is more fully automated than IRMA, well correlated with IRMA, can be reliable method for screening test of thyroid function.
With the development of monoclonal antibodies. they have various utilities for in-vitro diagnosis in differentiating tumor cell type, and for therapeutic purposes. I experimented the reaction of many known and new monoclonal antibodies using flow cytometry.
The results are as follows:
1) There were 18 cases of B-lineage Acute lymphoblastic leukemia(ALL)(64%), 8 cases of T-lineage ALL(28%), 1 case of B-myloid ALL(4%) and 1 case of B cell All(4%) in 28 cases of ALL.
2) The reactions with anti-CD9, CD10, CD19, CD24, CD34, CD72 and HLA-DR were positive in most cases of non-T-All, and the reaction with ani-CD13, CD33, CD40 were relatively positive in a few cases of non-T-ALL.
3) The reaction with anti-CD24, CD19, CD20, CD72 and HLA-DR was strong positive in 1 case of Hairy cell leukemia(HCL).
4) There were 17 cases of B-Chronic lymphoytic leukemia(CLL)(71%), and 4 cases of T-CLL(17%) in 24 cases of CLL.
5) There were 8 cases of B-non Hodgkin's malignant lymphoma(NHL)(57%), and 4 cases of T-NHL(29%) in cases of MHL.
6) There were positive reaction with anti-CD2 in normal bone marrow, fetal bone marrow with anti-CD19, tonsil with anti-CD4, anti-CD19, and thymus with anti-CD2.
Immunophenotype with panel of monoclonal antibodies using flow cytometry is very helpful to take diagnosis and treatment for hematologic malignancies.
, Ok Kyung Kim Three new developed enzyme immunoassays(EIA) for urinary pregnancy tests were compared with the three older latex agglutination assays(LATEX) in the urine samples of 138 patients.
The examined kits included EIA (Testpack hCG-Urine. Tandem ICON II hCG Urine, Target hCG) and direct LATEX (Betatex direct, Pregnancy Quick test, Synchron hCG).
The results were as follows:
1) The coincidence rate between EIA and direct LATEX is 91%. The coincidence rate between EIA and radioimmunoassay(RIA) is 100%.
2) The range of the discrepancy between EIA and LATEX is 79mlU/ml to 855mlU/ml.
3) When the EIA is considered to be the standard method. the sensitivity and specificity of Latex are 78% and 100%.
4) The hCG of the urine specimen which were found to be negative by EIA and LATEX is below 50mlU/ml.
5) There is no false positive result in proteinuria(2+) and bloody urine(1+) in the EIA and Latex.
5) There is no false positive result in proteinuria(2+) and bloody urine(1+) in the EIA and Latex.
We conclude EIA is the nost sensitive procedure(lowest detection limits)for qualitatively detecting hCG in urine samples secreted by early pregnancy.
Induction of intestinal tumor by subcutaneous injection of 1, 2-dimethylhydrazine(DMH), 20 mg/kg/week, during 20 weeks was studied in rats fed by vitamin A(retinol) 50 µg, 500 µg/day.
Mucosal epithelial cell hyperplasia and mitosis in one crypt was not significantly inhibited by vitamin A administration(P>0.05). In electron microscopic findings, the cytoplasmic vacuoles were decreased in DMH+vitamin A-treated rats than DMH only. Dysplasia of the colonic mucosa in DMH+vitamin A-treated group were more slowly developed than DMH-treated rats. In DMH-treated rats the tumors were early detected after 14 weeks, but in DMH+vitamin A-treated groups were seen after 20 weeks.
All these findings suggest that vitamin A can effectively prevent cytotoxicity of carcinogen in early phase, but can not prevent carcinogenesis in late phase.
, Woon Sup Han, Ok Kyung Kim The fact that the administration of 1,2-dimethylhydrazine 2Hcl(DMH) to rats by weekly subcutaneous injections causes the development of epithelial tumors of the large intestine has been known. But the axact processes of of early morphologic changes of colonic lesion induced by DMH treatment in the rats have not been fully testified as yet. The objective of the dissertation research is to examine early morphologic changes of colonic lesion induced by DMH treatment in the rats. Total seventy cases including 14 control rats of Sprague Dawley male rats were analyzed by histopathologic changes. One is 20mg/kg/wk DMH treated rat group and the other is 40mg/kg/wk DMH treated rat group. DMH was injected s.c. at the start of each treatment weekly during 20 weeks, and the animals were killed at 1, 3, 5, 6, 7, 9, 12, 14, 17 or 20 weeks both in 20mg/kg/wk DMH treated group and in 40mg/kg/wk DMH treated group. The following results were obtained: Hyperplasia and mitosis of the crypt are presented in early phase of DMH treatment. Cellular dysplasia, carcinoma in situ, and invasive carcinoma are shown in later phase of DMH treatment. The same changes as the above are also identified in electron microscopic findings. The more doses of DMH are injected to rats, the more evident these findings are presented. The alkaline phosphatase activity in glandular epithelial cells are observed in cellular dysplasia and neoplastic changes. The alkaline phosphatase may be considered as tumor marker.
, Woon Sup Han, Ok Kyung Kim Most optic gliomas are benign astrocytomas that might better be considered hamartomas than true neoplasms. Optic gliomas rerely becomemalignant and their morbidity is mainly due to enlargement of the tumor. The presenting symptoms and signs are variable depending on the location of the tumor. We experienced a huge optic chiasm and optic nerve glioma which caused hydrocephalus, vomiting, gait disturbance and decreased visual acuity in 4 years old boy.
, Woon Sup Han, Ok Kyung Kim A malignant mixed mesodermal tumor of the bladder from 70-year-old woman is presented. Malignant mixed mesodermal tumor is a designation applied to carcinosarcoma characterized by the presence of heterologous mesenchymal elements. The tumor tends to be large, bulky, intraluminal tumors that grows rapidly and infiltrates widely. The tumor occurs predominantly in elderly men, and aggresive surgical treatment is indicated because of the poor prognosis. Histologically this neoplasm was composed of epithelial components of transitional and squamous cell carcinoma, and mesnechymal components of fibrosarcoma, chondrosarcoma, and osteogenic sarcoma.
, Ki Sook Hong Cardiac troponin T(cTnT) levels are elevated in patients with chronic renal fail-ure(CRF) with dialysis which represent myocardial damage. But the cut-off levels were different in laboratories and clinical physicians. We conducted a study to find out the cut-off levels of acute myocardial infarction(AMI), ischemic heart disease(IHD), and cardiovascular disease (CVD) in CRF patients with dialysis and prognostic aspect according to cTnT levels.
Cardiac troponin T(cTnT) of total 98 patients(men 43, women 55, mean age 60.4±13.0 years) was reviewed the diagnosis and progress for 3 years by the medical records. Serum cTnT by Elecsys 2010(Roche diagnostics, Germany), the 4th generation assay was performed.
Mean cTnT level of total 98 patients was 0.26ng/mL and the patients with CVD were 59(60.2%) and their cTnT level was 0.41 ng/mL. The mean levels of cTnT in AMI, IHD, and CVD were 1.10, 0.52, and 0.41 ng/mL, respectively. cTnT, CK, CK-MB, and glucose were increased according to severity of cardiovascular disease. The cut-off levels of cTnT in AMI, IHD, and CVD was 0.10, 0.07 and 0.06 ng/mL. The sensitivity and specificity of AMI, IHD, and CVD in each cut-off level were 88.2/71.6%, 76.2/71.4%, and 81.4/71.8%, respectively. The survival rate above cTnT 0.1 ng/mL during 3 years was significantly decreased(p<0.001) than less than 0.1 ng/mL.
The degree of cTnT elevation in CRF patients with dialysis represents severity of cardiovascular disease and poor survival rate.
, Sun Hee Roh, Jin Kyeong Park, Jung Youn Jo, Sung Shin Kwon, Eun Jin Shim, Kyung Joo Kwon, Young Wook Noh, Kyung Jong Lee, Jung Yoon Yoon, In Seon Kim, So I Kim, Dong Ryeol Ryu, Soon Hee Sung, Ki Sook Hong Rapidly progressive glomerulonephritis(RPGN) is one of the most calamitous renal disease which is clinically characterized by sudden and relentless deterioration in renal function within weeks to months and associated with the pathologic finding of extensive extracapillary proliferation. Pauci-immune RPGN is mostly associated with anti neutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis, but renal-limited RPGN may be found in part. We experienced a case of ANCA positive RPGN associated with polyclonal gammopathy without systemic symptoms. A 64-year-old woman was admitted with gross hematuria and azotemia. Laboratory findings revealed polyclonal gammopathy and severe anemia without definite cause, and she was diagnosed as C-ANCA positive crescentic glomerulonephritis without systemic vasculitis. She was treated with steroid pulse therapy and her renal function and anemia were progressively improved. We report herein a rare case of C-ANCA positive crescentic glomerulonephritis associated with polyclonal gammopathy and severe anemia with the review of literature.
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