The Utility of Measuring the Difference between the Two Optic Nerve Sheath Diameters Using Ultrasonography in Predicting Operation Indication in Patients with Traumatic Brain Hemorrhage

PURPOSE: An increase in optic nerve sheath diameter (ONSD) has been associated with elevated intracranial pressure due to brain lesions, such as hemorrhage, infarction, and tumor. The aim of this study was to evaluate whether the difference of both ONSDs can predict surgical treatment in patients with traumatic brain hemorrhage. METHODS: A prospective analysis of the data acquired between September 2016 and November 2016 was performed. We included 155 patients with traumatic brain hemorrhage undergoing computed tomography in the emergency room. We performed an ultrasonography to measure ONSDs for all included patients. The primary outcome of this study was operation indication in patients with traumatic brain hemorrhage. RESULTS: The average age was 63.4±17.0 years (male 60.3±17.3, female 69.8±14.4). There were 61 (39.35%) patients with an indication for operation and 94 (60.65%) patients with an indication for no operation. Indications for operation showed a strong association with the difference of both ONSDs in patients with subdural hemorrhage (p<0.001), no association between them in patients with epidural and intracerebral hemorrhage. In patients with subdural hemorrhage, the area under the curve was 0.988 (0.653-0.998), and the cut-off value for the difference of ONSDs with respect to determining the indications for operation was 0.295 mm f maximizing the sum of the sensitivity (96.9%) and specificity (90.7%) using the receiver operating curve. CONCLUSION: A difference of both ONSDs above 0.295 mm was useful in predicting the indications for operation in patients with traumatic subdural hemorrhage, but not in patients with epidural and intracerebral hemorrhage.

Near-Road Exposure and Impact of Air Pollution on Allergic Diseases in Elementary School Children: A Cross-Sectional Study

PURPOSE: The study aims to classify schools based on traffic pollutants and their complex sources, to assess the environment, to determine the state of allergic diseases among students using the International Study of Asthma and Allergies in children (ISAAC) questionnaire, and to assess their connection to air pollutants. MATERIALS AND METHODS: A total of seven schools were divided into three categories according to the characteristics of their surrounding environments: three schools in traffic-related zones, two schools in complex source zones I (urban), and two schools in complex source zones II (industrial complex). ISAAC questionnaires were administered and the 4404 completed questionnaires were analyzed. RESULTS: The frequency of asthma treatment during the past 12 months showed a significant increase (p<0.05) with exposure to NO2 [1.67, 95% confidence intervals (CIs) 1.03-2.71] in the complex source zones. The frequency of allergic rhinitis treatment during the past 12 months increased significantly with exposure to Black Carbon (1.60, 95% CIs 1.36-1.90) (p<0.001), SO2 (1.09, 95% CIs 1.01-1.17) (p<0.05), NO2 (1.18, 95% CIs 1.07-1.30) (p<0.01) for all subjects. CONCLUSION: In terms of supporting children's health, care, and prevention related to major spaces for children, such as school zones, spaces used in coming to and leaving school, playgrounds, and classrooms are essential to ensuring not only the safety of children from traffic accidents but also their protection from local traffic pollutants and various hazardous environmental factors.

High Frequency of Male Microchimerism in Peripheral Blood Mononuclear Cells of Korean Women with Scleroderma, Resembling Skin Manifestations of Chronic Graft Versus Host Disease / 임상소아혈액종양

BACKGROUND: Bidirectional traffic of cells at the feto-maternal interface has been shown during pregnancy and fetal cells have been found to persist in maternal peripheral blood for decades after childbirth. Fetal-microchimerism has been reported in women with scleroderma, which shares a number of characteristics with chronic graft versus host disease (GVHD), although its contribution to the disease pathogenesis remains unclear. We performed this study to determine the frequency of male microchimerism in peripheral blood of patients with scleroderma or normal healthy women with son. METHODS: PCR targeting the Y chromosome specific DYZ1 sequence was employed to test DNA extracted from peripheral blood mononuclear cells of 26 women with scleroderma and 10 healthy women who had given birth to at least one son. RESULTS: Male DNA was detected in 16 of 26 (61.5%) women with scleroderma. Whereas male DNA was not detected in any healthy women who had given birth to son. CONCLUSION: Although fetal microchimerism in women with scleroderma was documented, additional studies will be necessary to determine whether microchimerism plays a role in the pathogenesis of this or other autoimmune disease.

High Frequency of Male Microchimerism in Peripheral Blood Mononuclear Cells of Korean Women with Scleroderma, Resembling Skin Manifestations of Chronic Graft Versus Host Disease / 임상소아혈액종양

BACKGROUND: Bidirectional traffic of cells at the feto-maternal interface has been shown during pregnancy and fetal cells have been found to persist in maternal peripheral blood for decades after childbirth. Fetal-microchimerism has been reported in women with scleroderma, which shares a number of characteristics with chronic graft versus host disease (GVHD), although its contribution to the disease pathogenesis remains unclear. We performed this study to determine the frequency of male microchimerism in peripheral blood of patients with scleroderma or normal healthy women with son.METHODS: PCR targeting the Y chromosome specific DYZ1 sequence was employed to test DNA extracted from peripheral blood mononuclear cells of 26 women with scleroderma and 10 healthy women who had given birth to at least one son.RESULTS: Male DNA was detected in 16 of 26 (61.5%) women with scleroderma. Whereas male DNA was not detected in any healthy women who had given birth to son.CONCLUSION: Although fetal microchimerism in women with scleroderma was documented, additional studies will be necessary to determine whether microchimerism plays a role in the pathogenesis of this or other autoimmune disease.

A case of primary effusion lymphoma in a patient with alcoholic liver cirrhosis / 대한내과학회지

Primary effusion lymphoma (PEL) is a distinct clinical and pathologic entity characterized by malignant lymphomatous effusion in body cavities, without a detectable tumor mass. The tumor is usually associated with human herpes virus 8 (HHV-8) infection and occurs principally in immunodeficient patients, most commonly those with human immunodeficiency virus (HIV) infection. We report a rare case of PEL in an elderly patient negative for HHV8 and HIV. The patient had a history of alcoholic liver cirrhosis and presented with abdominal distention. The patient was treated with three courses of chemotherapy. In spite of the generally poor prognosis associated with this disease, our patient is still alive with no malignant lymphomatous cells in the peritoneal cavity 24 months after treatment.

Double Autologous Stem Cell Transplantation for Multiple Myeloma: A Korean Single Center Study

BACKGROUND: Although high dose chemotherapy coupled with an autologous stem cell transplantation (ASCT) is widely accepted as effective therapy for multiple myeloma (MM), few reports are available in Korea, especially in the area of double ASCT. We present the results of an institutional retrospective study of 12 patients with MM treated by double ASCT. METHODS: Eligible patients received induction therapy using vincristine, adriamycin, dexamethasone (VAD), and mobilization was performed using cyclophosphamide plus lenograstim. High-dose melphalan (total 200 mg/m2) was used to condition the ASCT. RESULTS: The median interval from diagnosis to ASCT was 6 months (range, 1.8-15.3 months). The median interval between the 1st and 2nd ASCT was 4.4 months (range 2.1-48.7 months). The median follow up was 18.3 months (range 8.1-50.5 months) for the nine surviving patients. No therapy-related mortality occurred. Following induction chemotherapy, two patients experienced CR. Following double ASCT, eight patients experienced CR. The 5 year OS was 59%. The median duration of event free survival was 2.13 years (95% CI, 0.84-3.42). CONCLUSION: Although the results of study did not demonstrate the advantage of double ASCT, this is the first report to outline the outcome of double ASCT for Korean MM patients.

A Case of Severe Chronic Active Epstein-Barr Virus Infection with Hepatic Involvement Confirmed by In Situ Hybridization / 대한간학회지

Epstein-Barr virus (EBV) infection is associated with diverse clinical manifestations. Hepatic involvement by EBV can cause a broad spectrum of histologic and clinical features ranging from acute hepatitis through lymphoproliferative disorders to lymphoma. However, severe chronic active EBV infection with hepatic involvement in adults is quite rare. EBV infection can be demonstrated by serologic test or molecular biologic techniques. In situ hybridization can demonstrate the EBV infection. It has the advantage of precise localization of the virus in infected tissues or tumors. Here we will describe a 46-year-old female who was admitted to our hospital because of general weakness, ready fatiguing, and jaundice. A bone marrow biopsy revealed reactive histiocytosis with hemophagocytosis. A liver biopsy revealed lymphocyte infiltration to portal areas and sinusoids, periportal and pericellular fibrosis, mild cholestasis, and micro-and macro-vesicular fatty change. Although the results of the serologic tests were inconclusive, in situ hybridization studies which were performed on liver biopsy tissue revealed the expression of Epstein-Barr virus-encoded RNA 1 transcripts in lymphocytes infiltrating to hepatic sinusids.

A Clinical Study on Myelodysplastic Syndrome in Childhood / 대한소아혈액종양학회지

PURPOSE: This study was undertaken to investigate the clinical characteristics and prognostic predictors of myelodysplastic syndrome (MDS) in childhood. Method: The characteristics and laboratory findings of 20 patients seen at Asan Medical Center for the past 10 years from September 1989 to August 1998 were reviewed retrospectively with regard to the new International Prognostic Scoring System (IPSS) proposed by International MDS Risk Analysis Workshop. RESULTS: 1) In 20 children with MDS we studied, there was no age or sex predilection unique to the subgroups of MDS. 2) 19 cases (95%) out of the 20 had pallor at the time of diagnosis. Other major clinical findings were bleeding tendency in 11 (55%), fever in 8 (40%), hepatosplenomegaly in 8 (40%), and lymphadenopathy in 3 (15%). 3) The hemoglobin level was less than 10 g/dL in all cases and absolute neutrophil count (ANC) was decreased in 11 cases, thrombocytopenia in 15 cases. Pancytopenia was noted in 8 cases (40%). 4) Of the 20 cases, 9 had refractory anemia (RA), 3 refractory anemia with excess blasts (RAEB), 3 refractory anemia with excess blasts in transformation (RAEBIT), and 5 juvenile chronic myelogenous leukemia (JCML). 5) All RA patients were Intermediate (INT)-1 risk group, and all RAEB children were INT-2 risk group. The 3 cases of RAEBIT fell into INT-1, INT-2, and high risk group. Three cases of JCML were INT-1 group, and 2 cases INT-2 group. 6) Seven cases out of 13 INT-1 group had mean survival of 20.2 month (6~57 month), but only 1 out of 6 INT-2 survived. One case of high risk group succumbed to disease 50 months after diagnosis. CONCLUSION: These results showed that there was no age or sex predilection for the specific subgroup of childhood MDS. All the FAB subtypes of the childhood MDS except RA subgroup had poor survival. In this study, we found the IPSS seemed to be a prognostic predictor in childhood MDS but more cases are needed to confirm the validity of IPSS.

The Relationship between Fat Embolism and Intramedullary Reaming / 대한정형외과학회잡지

To evaluate leading mechanisms of fat embolism, we investigated patients who received femoral procedures prospectively. Forty patients were classified into three groups according to reaming procedures. Group A (10 cases) was the control group who operated with open reduction and internal fixation for peritrochanteric fractures. Group B (18 cases) was composed of hip arthroplasty patients and group C (12 cases) patients received intramedullary nailing procedures due to femoral shaft fracture. Pulmonary function test and chest X-ray were taken to evaluate pulmonary condition. Perfusion and inhalation radionuclide scan proved pulmonary embolism and fat embolism. Arterial blood gas analysis, lipid metabolites (cholesterol, triglyceride and NEFA (Non-esterified Fatty Acid)) and coagulation battery (PT, aPTT, TAT-III (Thrombin anti-thrombin III complex) and D-dimer) were measured in preoperative, intraoperative (reaming and post-reaming) and postoperative period, individually. Although two cases of fat embolism were verified only in group C preoperatively, there was no difference with the incidence of pulmonary embolism between reaming and non-reaming group (P<0.05). Blood gas analysis revealed no difference between control group and reaming one in each stage. NEFA in lipid metabolism was abruptly increased in group C only during reaming procedure. The titer of D-dimer and TAT-III were elevated specifically in fat embolism patients by reaming procedure. We suggest that D-dimer and TAT-III may be preliminary screening tools for the early diagnosis of fat embolism. And the coagulation system seems to be more related to fat embolism rather than lipid metabolism.

A Case of Mesenchymal Hamartoma

An one-day-old female patient was admitted due to marked abdominal distension, cyanosis, right upper quadrant mass, and respiratory failure since birth. We applied ventilator and supportive care immediatly. However, 4 days later, she was dead due to respiratory failure and hemorragic complication. The radiographic finding showed a huge intra-abdominal mass anterior to the intestine. Autopsy findings showed a huge single cystic tumor in the right lobe of the liver. The cysts were filled with sanguinous fluid. There wasn't any signs of necrosis or calcification. Microscopically, the tumor was well demarcated from the adjacent hepatic parenchyma. It consists of connective tissue with dilated lymphatics, vessels, and bile ducts.

Results of Treatment and Prognostic Factors of Lymphoblastic Leukemia: An Analysis in 33 Patients / 대한내과학회지

OBJECTIVES: Rate of complete remission and long-term survival in adult acute lymphoblastic leukemia group has not been as satisfactory as that in childhood ALL. Recently introduction of induction chemotherapy of more intensive combination and various trials of postremission therapy are making improved results better looked forward to. And subtypes of ALL according to the degree of differentiation into T and B cells are identified by using immunologic markers hopefully to work out proper treatment for each subtype. METHODS: We analited results of treatment and differences of complete remission rate, remission duration and overall survival as to various immunologic markers and clinicopathologic characteristics in 33adult ALL patients. RESULTS: Eighty five percents of the 27cases that had VPDL chemotherapy achieved complete remission and both overall median survival and mediom duration of remission were 52weeks. No definite prognostic factors were detected influencing complete remission rate, remission duration and overall survival except that patients with serum albumin level higher than 4.0mg/dL showed highter complete remission rate. Although mature B-ALL showed the shortest overall median survival, degree of differenciation of B-cell and other immunologic markers did not influence on complete remission rate, remission duration or overall survival. CONCLUSION: Further studies are needed to delire the prognostic factors in adult ALL.

Whole blood cyclosporine measurement by fluorescence polarization immunoassay / 대한이식학회지

No abstract available.