Inguinal hernia developed after radical retropubic surgery for prostate cancer / 대한외과학회지

PURPOSE: In this retrospective study, we aimed to compare the clinical characteristics of inguinal hernia developed after radical retropubic surgery for prostate cancer to the hernia without previous radical prostatectomy. METHODS: Twenty-three patients (group A) who had radical retropubic surgery for prostate cancer underwent laparoscopic or open tension-free inguinal hernia repair from March 2007 to February 2011. Nine hundred and forty patients (group B) without previous radical retropubic surgery received laparoscopic or tension-free open hernia operation. RESULTS: Group A was older than group B (mean +/- standard deviation, 69.6 +/- 7.2 vs. 54.1 +/- 16.1; P < 0.001). Right side (73.9%) and indirect type (91.3%) in group A were more prevalent than in group B (51.5% and 69.4%, respectively) with statistic significance (P = 0.020 and P = 0.023). The rate of laparoscopic surgery in group B (n = 862, 91.7%) was higher than in group A (n = 14, 64.3%, P < 0.001). In comparing perioperative variables between the two groups, operative time (49.4 +/- 23.5 minutes) and hospital stay (1.9 +/- 0.7 days) in group A were longer than in group B (38.9 +/- 16.9, 1.1 +/- 0.2; P = 0.046 and P < 0.001, respectively) and pain score at 7 days in group A was higher than in group B (3.1 +/- 0.7 vs. 2.3 +/- 1.0, P < 0.001). Postoperative recurrence rate was not significantly different between the two groups. CONCLUSION: Inguinal hernia following radical retropubic surgery for prostate cancer was predominantly right side and indirect type with statistic significance compared to hernias without previous radical prostatectomy.

New Assessment of the N1-N2 Substaging in Stage III Colorectal Cancer

PURPOSE: The five-year survival rates of patients with stage III colorectal cancer have been reported widely ranging from 22 to 69 percent. Hence, reliable substaging is important for the management of stage III colorectal cancer patients. Therefore, we tried to assess the substages and investigate the possibility of other discriminating numbers for nodal substaging. METHODS: The 381 patients with node-positive colorectal cancer who had undergone surgery, were retrospectively categorized by the number of positive nodes. The patients were grouped in five ways, and each grouping was divided into two subgroups according to the number of positive nodes. The subgroups of each grouping were as follows; in LN1 group, N1=1, N2>1; in LN2 group, N1=2, N2>2; in LN3 group, N1=3, N2>3; in LN4 group, N1=4, N2>4; in LN5 group, N1=5, N2>5. We compared the survival rate of each groups. RESULTS: Node-positive patients had a five-year survival rate of 55.2 percent. The statistical differences between the N1 and N2 subgroups of each grouping were as follows: LN1 group (P=0.0128), LN2 group (P=0.0052), LN3 group (P=0.6268), LN4 group (P=0.1480), and LN5 group (P=0.6875). CONCLUSION: There were significant differences in the five-year survival rates between N1 and N2 in the LN1 group and LN2 group, but there were no differences between N1 and N2 in the other groupings. These data raise the possibility that a novel N1~N2 substaging (N1: 1~2; N2: >2) is superior to the current N1~N2 substaging (N1: 1~3; N2: >3).

A Totally Extraperitoneal (TEP) Laparoscopic Approach to Incarcerated Inguinal Hernia / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic herniorrhaphy (LH) has an advantage for evaluating the viability of incarcerated bowel. In this retrospective study, we aimed to review the data for use of the TEP technique in treating incarcerated hernias in order to document the feasibility of the laparoscopic procedure. METHODS: During a 2-year period from January 2008 to December 2009, one surgeon (C.S) at our institution operated on 27 patients with acutely (n=3) or chronically (n=24) incarcerated hernia. Incarcerated hernias were divided into acute or chronic types arbitrarily, based on who had symptoms of acute abdominal pain and signs of intestinal obstruction. For acute cases, the TEP procedure was done following laparoscopic transperitoneal evaluation to assess viability of the incarcerated bowel. RESULTS: All patients except one having a femoral hernia were male. Mean age was 41 years old (range, 25~75). No case converted from a laparoscopic to an open procedure. Two acute incarcerated cases contained a segment of small bowel and the other contained small bowel and omentum. All acute cases were operated on successfully on an emergency basis by laparoscopic TEP repair. All chronic cases contained omentum without bowel. In one case of acute and seven cases of chronic type, a small inguinal incision was made to reduce hernia contents. No recurrence was noticed at a mean of 13 months of follow-up. CONCLUSION: If there is no entrapment of bowel in chronic incarcerated cases, the TEP procedure will be satisfactory. It may be reasonable, however, to evaluate viability of bowel transperitoneally before doing a TEP procedure in acute cases.

The Incidence of the Occult Contralateral Hernia in Patients Undergoing Total Extraperitoneal (TEP) Repair of a Left Inguinal Hernia / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic herniorrhaphy (LH) can be used to examine the asymptomatic contralateral side and repair occult contralateral hernias coincidentally with reduced morbidity. In this prospective study, we evaluated the results of diagnostic exploration of the right side during total extraperitoneal (TEP) laparoscopic repair of left side inguinal hernias. METHODS: A prospective study of 100 consecutive male patients undergoing TEP repair by a single surgeon (C.S) between January and June 2008 was conducted. Two cases that had transabdominal preperitoneal (TAPP) prosthetic repair and one intraperitoneal onlay mesh (IPOM) were excluded. We routinely explored the contralateral side to determine the incidence of right side occult hernia. RESULTS: The mean age was 52 (range; 18~82 years). Among the 100 patients, 17 had bilateral, 52 right and 31 left hernias on physical examination prior to surgery. Three of 31 diagnosed preoperatively as left inguinal hernia were confirmed to have occult right hernias (3/31, 9.7%). Among the three patients, two patients with a direct type had the same type of hernia as on the contralateral side (2/10, 20%). Another one patient with an indirect type had direct type of hernia on the contralateral side (1/21, 4.8%). CONCLUSION: Given the low incidence of contralateral side occult hernia with indirect types of hernias, routine exploration may not be indicated during TEP repair. However, it might be, reasonable to explore the contralateral side in patients with a direct type of hernia because of the higher incidence of contralateral occult hernias.

Clinical and Cytogenetic Findings on 31,615 Mid-trimester Amniocenteses / 대한진단검사의학회지

BACKGROUND: Since amniocentesis made prenatal diagnosis feasible in 1967, the method has become a popular tool in obstetric practices. In Korea, the demand for genetic counseling and prenatal tests has increased markedly because the number and proportion of pregnancies in women aged 35 yr and older have increased over a 20-yr period. Here we report clinical and cytogenetic findings on 31,615 mid-trimester amniocenteses. METHODS: To investigate the changes in the annual number of amniocentesis, distribution of indications and age, and cytogenetic findings and abnormality rate according to indications, this study retrospectively analyzed 31,615 cases of mid-trimester amniocentesis performed at Seoul Clinical Laboratories, an independent medical laboratory center, during the past 13 yr (1994-2007). RESULTS: The annual number of amniocenteses has increased substantially since 1994. Among the 31,615 amniocentesis cases, the maternal age between 30 and 34 yr was the most common age group (35.4%). Among clinical indications, abnormal maternal serum screening results have been the most common indication for amniocentesis since 1994. Chromosomal abnormalities were detected in 973 cases (3.1%). Down syndrome was the most common abnormality found (36.9%, 359/973). In sex chromosomal abnormalities, 53 cases of Turner syndromes, 32 cases of Klinefelter syndromes, 20 cases of triple X syndromes, and 15 cases of 47,XYY were diagnosed. Of structural rearrangements, reciprocal translocations between two autosomes were the most common (15.5%, 151/973). Abnormal ltrasonographic findings showed the highest positive predictive value (5.9%) among the clinical indications. CONCLUSIONS: The present study could be used for the establishment of a database for genetic counseling. The discovery of an abnormality provides the option of termination or continuation in the pregnancy, a more suitable obstetric management in Korea.

Ethyl Pyruvate Ameliorates Renal Ischemia- reperfusion Injury

PURPOSE: Reactive oxygen species (ROS) significantly contribute to ischemia-reperfusion injury, and are also associated with the gradual loss of renal function and renal failure following renal transplantation. Pyruvate is an endogenous antioxidant, but its use as a therapeutic agent for treating conditions mediated by oxidative stress is limited due to its poor stability in solution. However, ethyl pyruvate (EP), a soluble pyruvate derivative, has far greater stability than pyruvate; thus, may serve as a practical pyruvate precursor. Therefore, the ability of EP in the prevention of renal ischemia-reperfusion injury was assessed. METHODS: Sprague-Dawley rats (n=54) were subjected to 40 minutes of renal warm ischemia. The animals were divided into three groups: the sham group without warm ischemia (n=18), the EP group (n=18, EP given before ischemia), and the ischemic control (n=18). The serum levels of creatinine and TNF-alpha were measured 1, 3 and 5 days after induction of ischemia. The expression of high mobility group box-1 (HMGB-1), a delayed inflammatory mediator, was also assessed by Western blot of renal specimens. RESULTS: In the EP group, late improvements in the serum levels of creatinine and TNF-alpha were observed in comparison with the ischemic control. Based on this delayed effect, the expression of HMGB-1 was assessed in renal tissue. The HMGB-1 expression increased over time during the ischemia process, but EP suppressed this expression 3 and 5 days after renal ischemia-reperfusion injury. CONCLUSION: These results have demonstrated, for the first time, that EP ameliorates renal ischemia-reperfusion injury. EP attenuates the renal ischemia-reperfusion injury, at least in part, by suppressing the expression of HMGB-1, a late mediator of delayed inflammation.

The Clinical Characteristics and Outcomes of Biofeedback Treatment for Patients with Nonrelaxing Puborectalis Syndrome

PURPOSE: Biofeedback treatment is thought to be appropriate for patients with nonrelaxing puborectalis syndrome (NRPR). The aim of this study is to analyze the physiologic characteristics and to assess the outcomes of biofeedback treatment for patients with NRPR. METHODS: Forty-six (46) patients with NRPR were evaluated with anorectal physiologic studies, including colonic transit time (n=26), anorectal manometry (n=41), defecography (n=46), anal sphincter EMG (n=28), and colonoscopy or barium enema (n=33). The treatment consisted of a training program with EMG-based biofeedback for 30 minutes once a week and routine supportive care, including Kegel practice. RESULTS: The mean age was 52.8 years, and the sex ratio was 1 male to 0.6 female. A delayed colonic transit time was noted in 5 patients (19.26%). In the NRPR group, the maximal voluntary contraction and the mean squeezing pressure were higher than they were for other patients with pelvic outlet obstructive disease. Also, the perineal descents and the dynamic change of anorectal angle were shorter. Polyps were observed in 6 patients (18.2%), melanosis coli in 4 patients (12.1%), and diverticula in 3 patients (9.1%). The rectoanal inhibitory reflex (RAIR) was negative in 3 patients (7.3%). The patients underwent a mean of 4.0 sessions, and the mean follow-up was 7.4 months. Twenty-three (23) patients (82.1%) experienced improved of symptoms or EMG findings. The patients (17.9%) who did not improve had several abnormal findings: neuro-psychologic disease with delayed colonic transit time in 2 cases, negative RAIR in 2 cases, and melanosis coli in one case. CONCLUSIONS: We think that biofeedback training is an effective treatment for patients with NRPR. In addition, several factors, such as neuro-psychologic diseases, delayed colonic transit time, negative RAIR, or melanosis coli may influence the prognosis for biofeedback treatment, so further large-scaled studies will be needed to confirm these findings.

Pyopneumoperitoneum by Spontaneous Rupture of Pyogenic Liver Abscess

Pneumoperitoneum is usually the result of a perforated gastrointestinal (GI) tract associated with peritonitis. However, on rare occasions, spontaneous pneumoperitoneum not associated with a perforated GI tract has been described in the literature. A ruptured liver abscess is one of these occasions, and herein a case that resulted in pneumoperitoneum is reported. A 61-year-old woman was referred to the ER with acute onset of abdominal pain. The patient had been diagnosed as having diabetes mellitus and hypertension. The abdominal examination was not remarkable for tenderness, but her vital signs were unstable. Laboratory investigations revealed a WBC count of 4, 000/mm3, Na+ of 129 mEq/L, and K+ of 3.2 mEq/L. A plain radiography disclosed a minute amount of free air in the left subphrenic space, and a computed tomography (CT) scan visualized a low-density cystic mass suspected to be a gas forming pyogenic liver abscess. A laparoscopic exploration was performed for diagnosis and peritoneal drainage. Under the laparoscopy, a ruptured liver abscess and large amount purulent plaque were observed scattered in the entire peritoneal cavity. Evacuation of the abscess, cholecystectomy, liver biopsies, and peritoneal lavage were carried out after conversion to an open laparotomy. An abscess culture was obtained from the liver, with Klebsiella pneumoniae revealed as the pathogen. The administration of appropriate antibiotics followed the surgery, and she recovered without complications. A ruptured pyogenic liver abscess is an extremely rare and threatening condition despite the advances in diagnostic technology and new strategies for their treatment. However, the appropriate surgical management, followed by effective antibiotic therapy, will recover the patient without serious complications.

The Clinical and Physiologic Characteristics of Patients with Pelvic Outlet Obstructive Disease

PURPOSE: With recent anorectal physiologic studies, functional etiologies of pelvic outlet obstructive disease were evaluated in detail. The current study was designed to assess the clinical and the physiologic characteristics of patients with pelvic outlet obstructive disease. METHODS: one hundred two (102) patients with pelvic outlet obstructive disease were evaluated with anorectal physiologic studies, including the colonic transit time (n=66), anorectal manometry (n=88), defecography (n=102), anal sphincter EMG (n=50), and colonoscopy or barium enema (n=77). The patients were categorized as group I (nonrelaxing puborectalis syndrome), group II (rectocele), group III (sigmoidocele), and group IV (rectoanal intussusception). The clinical and the physiologic characteristics were compared between the groups. RESULTS: The mean age was 51.9 years, and the sex ratio was 1:1.9. the populations of the groups were group I 45.1% (n=46), group II 36.3% (n=37), group III 5.9% (n=6), and group IV 9.8% (n=10). In group II and group III, co-existing etiologies were more, and the incidences of female patients was higher (P<0.05). Delayed colonic transit time was noted in 11 patients (17%). Diverticula was observed in 6 patients (8%), polyps in 12 patients (16%), and melanosis coli in 14 patients (18%). On anorectal manometry, group I showed higher maximal voluntary contraction and mean squeezing pressure than the other groups (P<0.05). On defecography, group I had a shorter perineal descent at rest and a smaller anorectal angle at push (P<0.05). CONCLUSIONS: The current study showed the clinical and the physiologic characteristics of the each functional etiology in patients with pelvic outlet obstructive disease. These results provide fundamental data for diagnosis of and tailored therapy for pelvic outlet obstructive disease.

Linear Arrangement of Multiple Seborrheic Keratosis: Absence of Human Papillomavirus

No abstract available.

The Effect of Nitric Oxide Donor on the Endogenous Endothelin-1 Expression in Renal Ischemia-Reperfusion Injury

PURPOSE: The balance between nitric oxide (NO) and endothelin-1 (ET-1) production is essential to vascular function in controlling organ perfusion, and an elevated ET-1 in the peritubular capillary network, following renal transplantation, can be associated with renal allograft rejection. The administration of a nitric oxide donor during the preischemic period has been shown to protect the kidneys against an ischemia-reperfusion injury, but the mechanism underlying this therapeutic benefit remains to be completely understood. Our hypothesis is that the early administration of the NO donor, sodium nitroprusside (SNP), may suppress ET-1, and thereby improve the renal function in an ischemia-reperfusion injury. METHODS: Sprague Dawley rats were subjected to 60 minutes of renal warm ischemia, followed by a contralateral nephrectomy. Renal biopsies were performed prior to ischemia and reperfusion, and at 1 and 48 hours after the reperfusion. The animals were divided into 4 groups: a sham group, without warm ischemia, an early SNP group (SNP given before ischemia), a late SNP group (SNP given before reperfusion) and an ischemic control group. The ET-1 expression was assessed by a semiquantitative analysis by immunohistochemical staining with the ET-1 monoclonal antibody and Hematoxylin-Eosin stain. The serum creatinine was measured at 48 hours after the reperfusion. RESULTS: There were significant improvements in all parameters of the early SNP group compared with those in the late SNP and ischemic control groups, but there was no difference between the late SNP and ischemic control groups. CONCLUSION: These data suggest that the early administration of SNP in renal ischemia-reperfusion improves the renal function by suppressing the expression of ET-1.

Ischemia-reperfusion Injury after Canine Liver Allo-transplantation: The Effect of Gadolinium Chloride

PURPOSE: The effective suppression of Kupffer cell function is believed to contribute to the prevention of preservation/ reperfusion injury. In this study, the effect of Gadolinium, a synthetic Kupffer cell suppressor, on the reperfusion injury was examined using a canine partial liver transplant model. METHODS: About 70% of the liver was harvested and reimplanted in a mongrel recipient dog weighing 20~25 kg. Gadolinium Chloride (10 mg/kg) was infused via the cephalic vein 24 hour before harvesting the partial liver (Gadolinium group, n=5). Serum Aspartate Aminotransferase (AST) Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH), and morphological grading of the graft were compared with the control group (n=5). Statistical analysis was done with an independent T-test. RESULTS: The total ischemic time was 4 hours and 27 minutes on average. One hour after reperfusion, there were no significant differences in the AST, ALP and LDH level, and the pathologic scores. At 48 hours after reperfusion, the AST (P=0.03) and LDH (P=0.05) levels were significantly lower in Gadolinium group. CONCLUSION: Kupffer cell blockage using the Gadolinium chloride might be an effective way of reducing ischemia reperfusion injury. However, this effect was not evident in the early stages of reperfusion.

Clinical Significance of Mixed Chimerism after Hematopoietic Stem Cell Transplantation / 대한진단검사의학회지

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.

A Case of Bone Marrow Necrosis Preceeding Acute Monoblastic Leukemia / 대한임상병리학회지

Bone marrow necrosis is rarely diagnosed during life but is more often seen at autopsy by accident. The prognosis of patients with bone marrow necrosis secondary to neoplastic disease is extremely poor. We experienced a 59-year-old man with acute monoblastic leukemia who developed bone marrow necrosis preceding leukemia. He's main complaint was continuous lower back pain. First hematologic examination showed anemia with leukopenia and extensive bone marrow necrosis. After suffering from sepsis and only supportive management, he spontaneously recovered from pancytopenia and achieved hypercellular marrow with trilineage hematopoiesis. After 6 months, he was diagnosed as acute monoblastic leukemia (FAB, AML, M5a) from the sudden appearence of leukemic blasts on peripheral blood smears. After induction chemotherapy, complete remission was achieved. Our experience suggests that bone marrow necrosis is not uncommonly associated with hematologic malignancy and occult cancer. When bone marrow necrosis is found, we should do close follow-up to find out underlying hidden malignancy.

CyCD3+MPO- Biphenotypic Leukemia With Unusual Presentation: A Case Report / 대한혈액학회지

No abstract available.

Performance Evaluation of TOSOH Automated Glycohemoglobin Analyzer HLC-723GHb V A1c 2.2TM / 대한임상병리학회지

BACKGROUND: We evaluated the performance of the TOSOH glycohemoglobin analyzer HLC-723GHb V A1c 2.2TM (TOSOH Corp. Kyoto, Japan), a recently introduced automated hemoglobin A1c (HbA1c) analyzer using high performance liquid chromatography (HPLC) method without sample pretreatment. METHODS: The performance characteristics evaluated were precision, linearity, comparison with VARIANTTM (Bio-Rad, Germany) and throughput following NCCLS evaluation protocols (EP5-T2, EP6-P, and EP9-T). RESULTS: The within-run and between-day CV's were 0.910 and 1.328 for low level (6.2%), 1.214 and 1.460 for middle level (8.5%), and 0.789 and 1.449 for high level (10.7%), respectively. We found the perfect linearity of HbA1c (%) from 6.5 to 10.2 (r2=0.9995). Comparison studies between A1c 2.2 and VARIANTTM yielded the following correlation equations; A1c 2.2TM = 0.9915 (VARIANTTM) + 0.1198 %HbA1c (r=0.9936, P < 0.0001). Throughput was 28.0 tests per hour for A1c 2.2TM compared with 15.2 tests for VARIANTTM, which were determined including red blood cell lysis time before sample loading for VARIANTTM. A1c 2.2TM did not need sample pretreatment. CONCLUSIONS: With the above results, A1c 2.2TM shows acceptable performance and is suitable for routine use in the clinical laboratory.

Peripheral Lymphocyte Subsets in Patients with Pulmonary and Extrapulmonary Tuberculosis / 대한임상병리학회지

BACKGROUND: T-cell mediated cellular immunity has been suggested as an important mechanism in mycobacterial infection. Also, it is known that there is a imbalance between helper and suppressor T cells in the pathogenesis of tuberculosis in human. This study was designed to evaluate the changes of lymphocyte subsets in patients with pulmonary and extrapulmonary tuberculosis. METHODS: Lymphocyte subset analysis was performed on 53 pulmonary tuberculosis and 21 extrapulmonary tuberculosis patients. The proportion of total T (CD3+), B (CD19+), helper T (H, CD3+CD4+) and suppressor T (S, CD3+CD8+) cells, natural killer (NK, CD16+CD56+) cells and activated T (CD3+HLA-DR+) cells were analyzed using SimultestTM (Becton-Dickinson, California, USA) by FACSortTM (Becton-Dickinson, California, USA) and each absolute cell counts and helper T/suppressor T (H/S) ratio were calculated. RESULTS: In pulmonary and extrapulmonary tuberculosis patients groups, there were no significant changes in percentage and absolute cell counts of lymphocyte subset compared to control group. But H/S ratio was significantly decreased in both groups and the H/S ratio in extapulmonary tuberculosis was lower than that in pulmonary tuberculosis (1.06+/-0.44 vs. 1.64+/-0.97). CONCLUSION: Decreased or reversed H/S ratio reflect the role of cell mediated immune response in patients with tuberculosis, expecially in the spreading of pulmonary tuberculosis. Lymphocyte subset test seems to be helpful for access the different clinical forms of tuberculosis, pulmonary and extapulmonary tuberculosis.

Evaluation of therapeutic leukapheresis in hyperleukocytic leukemias / 대한수혈학회지

BACKGROUND: Leukemia with hyperleukocytosis is risk factor for early mortality and morbidity. Therepeutic leukapheresis has been recognized as the choice of treatment modality to prevent leukostatic complications by selective removal of abnormal leukocytes. METHODS: We analyzed the clinical and laboratory data in total of 44 therapeutic leukapheresis performed at Samsung Medical Center in 31 patients (15 males, 16 females) with hyperleukocytic leukemias from March 1, 1995 to August 31, 1998. The change of laboratory findings related to therapeutic leukapheresis as well as the correlation between preprocedural and postprocedural hematologic parameters, the degree of leukoreduction and clinical efficacy were evaluated. RESULTS: The age distribution was from 6 months to 77 years with the 35 years of mean age. The most common diagnosis of patients who were performed therapeutic leukapheresis was acute myeloblastic leukemia (15/32, 46.9%) followed by acute lymphoblastic leukemia (9/32, 28.1%), and major leukostatic symptoms were dyspnea and headache. The mean leukocyte count before leukapheresis were 167,400/microliter and the mean leukoreduction per procedure was 50,080/microliter (30.3%). The changes of hemoglobin and platelet count were not significant. The efficacies of therapeutic leukapheresis were 66.7% in acute myeloblastic leukemia, 44.4% in acute lymphoblastic leukemia and 37.5% in other leukemia patients. Patients with low initial leukocyte count and blast count or low final leukocyte count showed higher clinical improvement rate than patients without those parameters. CONCLUSION: The present study for therapeutic leukaphresis indicate that it is relatively safe and can be used to relieve leukostatic symptoms and improve clinical status in leukemic patients.

Epidemiological and Clinical Analysis of Influenza and Viruses Isolation during Winter of 1996-1997 / 감염

BACKGROUND: Although influenza has been a leading cause of global morbidity and mortality, we have few data regarding the epidemiological and clinical characteristics of influenza activity in Korea. Since an outbreak of influenza was recognized during winter of 1996-1997, we analyzed the epidemiological and clinical features of influenza activity in the hospital setting. METHODS: All clinical specimens requested for isolation of influenza virus at Samsung Medical Center from October 1996 to April 1997 were included. Mardin- Darby canine kidney (MDCK) cell line was used for virus culture. Isolated viruses were confirmed with immunostain followed by subtyping. The demographic and clinical characteristics of the patients were reviewed retrospectively. RESULTS: Ninety-eight influenza viruses were isolated from 461 patients (21.3%). Influenza A and B virus was isolated from 58 (54 children and 4 adults) and 40 pediatric patients, respectively. One of 31 influenza A viruses were confirmed as A/Wuhan/359/95-like strain and 5 of 12 influenza B viruses were confirmed as B/Guangdong/8/97-like strains. Two distinctive peaks of influenza activity were recognized and the most common age of patients was less than 1 year for influenza A, and 3 to 5 years for influenza B. Common lower respiratory infections were pneumonia followed by croup, bronchiolitis and laryngitis. CONCLUSION: We analyzed the epidemiological and clinical features of influenza activity during winter of 1996-1997. Although this study was performed not in the community but in the hospital setting, the morbidity caused by influenza may not be low in Korea. Therefore, nationwide surveillance for influenza activity is warranted.

Optimal Blood Ordering for Solid Organ Transplantation / 대한수혈학회지

BACKGROUND: Currently brain dead solid organ transplantations are performed in several institutions, and these are extended in Korea. Especially liver transplantation requires such a large amounts of blood components including filtered and irradiated cellular components that blood bank should give a great support to provide them. For effective management and reducing workload of blood bank in solid organ transplantation, we evaluated the blood component usage according to the type of organ transplantation and suggest a guideline for its optimal blood ordering schedule. METHODS: From February 1995 to October 1997, 143 solid organ transplantations (18 adults and 7 pediatric liver transplants, 115 renal transplants and 3 heart transplants) were performed in Samsung Medical Center. We investigated amount of blood components requested by surgeons or anesthesiologists, and evaluated their usage, discard rate and C/T ratio (crossmatch to transfusion ratio) during perioperative, intraoperative and postoperative period for solid organ transplantation. In liver and heart transplantation, the usage of blood component according to the operative phases was also evaluated. RESULTS: All of the patients who underwent liver and heart transplantation and 15% of the patients who underwent renal transplantation were transfused with blood components during operation. For adult liver transplantation, 31.1 units of leukocyte-depleted red blood cells (LDRBC), 43.6 units of fresh frozen plasma (FFP) and 16.3 units of leukocyte depleted platelets (LDPC) on an average were transfused. Intraoperative salvage using Cell Saver was performed in liver transplantation and the volume of salvaged was 7127.6 mL which was equivalent to 28.5 units of RBCs. The C/T ratio of RBCs was 1.4. In pediatric liver transplantation, 4.8 units of LDRBC and 4.3 units of FFP were transfused with C/T ratio of 1.9. Two of 5 pediatric liver transplantation donors were transfused with 3 units of RBCs, 1.5 units of FFP and 1.0 unit of whole blood by preoperative autologous blood donation. Only 18 out of 115 patients who underwent renal transplantation were transfused with 2 units of RBCs and 2 units of FFP. The discard rate revealed over 60% and C/T ratio was 4.6-5.1 in renal transplantation. For the heart transplantation 1.3 units of RBCs, 5.6 units of FFP, and 7.3 units of LDPC were transfused. The C/T ratio was 3.8. CONCLUSION: Compared with foreign reports, slightly larger amount of blood components were used for liver transplantation, however similar amount were used for renal and heart transplantation. As the results of present study, we propose a guideline for optimal blood ordering schedule for solid organ transplantation considering the marginal safety : 40 units of LDRBC, 50 units of FFP, 20 units of LDPC and 8 units of Cryoprecipitate for adult liver transplantation; 5 units of LDRBC and 6 units of FFP for pediatric liver transplantation; 2 units of LDRBC, 6 units of FFP and 10 units of LDPC for heart transplantation. Additional requests of blood components for liver and heart transplantation might be decided considering the clinical situations.