Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

Background@#Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. @*Methods@#We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. @*Results@#The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96–1.09]). @*Conclusion@#This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.

Modification and Validation of a Complaint-Oriented Emergency Department Triage System:A Multicenter Observational Study

Purpose@#The objective of this study was to modify and validate an emergency department (ED) triage system with improved prediction performance on hospital outcomes by modifying the Korean Triage and Acuity Scale (KTAS). @*Materials and Methods@#We performed a retrospective observational study at three academic universities in South Korea. The KTAS code, determined by the chief complaint and the selected modifier of a patient, was used to derive the Modified KTAS (MKTAS). We calculated the area under the receiver operating characteristics curve (AUC) and the test characteristics to evaluate the performance of MKTAS to predict hospital mortality, critical outcome, and admission. @*Results@#A total of 272402 and 128831 ED visits were used for the derivation and validation of MKTAS, respectively. Compared to KTAS, MKTAS had significantly higher AUC values for the prediction of hospital mortality [MKTAS 0.826 (0.818–0.835) vs. KTAS 0.794 (0.784–0.803)], critical outcome [MKTAS 0.836 (0.830–0.841) vs. 0.798 (0.792–0.804)], and admission [MKTAS 0.725 (0.723– 0.728) vs. KTAS 0.685 (0.682–0.688)]. The sensitivity for predicting hospital mortality and critical outcome, as well as the specificity for predicting admission, were significantly improved. @*Conclusion@#MKTAS was derived by modifying the KTAS, and then validated. Compared with KTAS, MKTAS showed better discriminating ability to predict hospital outcomes. Continuous efforts to evaluate and modify widely used triage systems are required to improve their performance.

Effect of Emergency Department Video-nystagmography for Patients with Dizziness

PURPOSE: We evaluated the effects of emergency department (ED)-based video-nystagmography (VNG) testing on consultation with other departments and length of ED stay of patients with dizziness. METHODS: A before-and-after study was performed at a tertiary ED from May 13, 2011 to May 12, 2012. Adult patients (age> or =15 years) with dizziness were enrolled, excluding patients with incomplete information. We defined the before- and after-phase according to implanting of the ED-based VNG test. The VNG test was performed by an internship physician supervised by 2nd or 3rd grade emergency medicine residents. Primary outcome was any consultation to other specialty departments and the secondary outcome was the length of stay at the ED. The adjusted odds ratios (ORs) with 95% confidence interval (95% CI) for outcomes by phase were estimated using multivariate logistic regression analysis adjusting for potential co-variates. RESULTS: Of 1,485 eligible patients, 1,449 patients (male: 37.0%, mean age: 59.2+/-15.5 years) were enrolled (415 in the before-phase and 1,034 in the after-phase). The final diagnosis group was stroke (4.8%), peripheral vestibulopathy (44.9%), other specific disease (29.0%), and non-diagnostic symptom (21.4%). The consultation request was more reduced in the after-phase (38.1%) than the before-phase (52.5%). The LOS was not changed between both phases (7.4+/-7.5 hours versus 7.4+/-7.3 hours, p=0.76). The adjusted OR (95% CI) for the consultation of after-phase compared to before-phase was 0.46(0.35, 0.61), while the adjusted OR (95% CI) for LOS was 1.39(0.99, 1.95). CONCLUSION: Implementation of ED-based VNG test significantly reduced the consultation with other specialty departments, while LOS was not affected.

Development of Secondary Triage Rules for Interfacility Transfer of Patients with Traumatic Brain Injury

PURPOSE: This study was aimed to develop secondary triage rule for decision of interfacility transfer to higher level of trauma center for patients with traumatic brain injury (TBI). METHODS: In a prospective observational study from August 2006 to December 2007 conducted in an urban tertiary emergency department, data were obtained from patients more than 15 years old and with TBI. Primary outcome was defined as meaningful positive CT findings. Secondary outcome was defined as meaningful intervention. Non-adjusted univariated logistic regression model was derived from result of chi-square test and adjusted model was derived using stepwise selection manner. Hosman-Lemeshow test for the goodness of fit was used. RESULTS: Total number of eligible patients with traumatic brain injury was 653. Primary outcome was positive in 103 patients and secondary outcome was positive in 42 patients. In univariate logistic regression, risk factors were age over 65(OR: 2.40), history of cerebrovascular disease(OR: 7.08), fall over two meter(OR: 6.28), pedestrian struck(OR: 18.5), headache(OR: 2.18), vomiting(OR: 3.03), disorientation(OR: 5.37), any evidence of open fracture(OR: 24.03), Glasgow coma sacle less than 13(OR: 4.97), Racoon's eye sign (OR: 2.50). These 10 risk factors were statistically significant in adjusted model which was derived using stepwise selected manner. Hosman-Lemeshow test for the goodness of fit was used and chi-square was 1.307(p=0.86). This decision rule had a sensitivity of 93.48%, a specificity of 41.13%, and a negative predictive value of 97.32%. CONCLUSION: A sensitive clinical decision rule with high negative predictive value for detection of abnormal CT lesions which need transfer to higher level of trauma center was developed.

DISC-GMCSF (GM-CSF Gene Transduced Defective Infectious Single Cycle Herpes Virus) Gene Therapy in the Established SCCVII squamous cell carcinoma model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Over the past five years, preclinical studies evaluating viral-vector-mediated gene transfer in the treatment of head and neck cancer have reported promising results. The main goal of this study was to evaluate the efficacy of intra-tumoral treatment with DISC virus (defective infectious single cycle herpes virus) carrying a GM-CSF immunomodulatory genes as cancer gene therapy. MATERIALS AND METHOD: Using the SCCVII squamous cell carcinoma model, we determined the in vivo GM-CSF production by ELISA method and evaluated the in vivo effects of DISC-GMCSF on the established tumor model. One of the following preparations was injected every two days to a total of three-doses intratumorally: group I (control): PBS alone, group II: heat inactivated DISC-GMCSF, group III: DISC-GMCSF. To prove the specific anti-tumor response, we analyzed the surface phenotype of tumor infiltrating cells. A flow cytometric analysis was performed using FACScan. RESULTS: Clinically relevant gene transfer could be possible by direct injection of tumors in situ. Intratumoral injection of the DISC-GMCSF (GM-CSF gene transduced defective infectious single cycle herpes virus) resulted in effective in vivo production of cytokines (4,500 pg/0.5 g tumor tissue), but as the progeny of the DISC virus could not be infected by other host cells, the effective cytokine production time seems limited. However, the DISC vector was safe and also allowed to be administered repeated treatments as needed. Effects of DISC-GMCSF injection on tthe established syngeneic tumor model showed the greatest inhibition of tumor growth in the DISC-GMCSF treated group (control vs DISC-GMCSF, p<0.01). In contrast to this, heat inactivated DISC-GMCSF showed no significant tumor suppression effect. It was interesting to note from our in vivo analysis of tumor infiltrating cells that treatment of flank tumors with the DISC-GMCSF virus resulted in a significant increase in the percentage of CD8 positive cells within the tumor (control vs DISC-GMCSF, p<0.05). CONCLUSION: Intratumoral injection of DISC-GMCSF significantly suppressed the tumor growth in established tumor model and induced intratumoral increase in immune effector cells. The results not only confirmed clinically relevant gene transfer but also demonstrated the gene transfer to be an effective anti-cancer therapy.

Combination Gene Therapy Using IL-2 and GM-CSF Genes Transferred by a Defective Infectious Single Cycle Herpes Virus (DISC Virus) in Head and Neck Squamous Cell Cancer Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Herpes Simplex type 2 Defective Infectious Single Cycle virus (DISC virus) is an attenuated virus originally produced as a viral vaccine, but it also serves as an efficient gene transfer vehicle. The main goals of this study were to examine determinants of gene transfer using DISC vectors for squamous cell carcinoma and to evaluate the efficacy of vaccination with the DISC virus carrying a combination of immunomodulatory genes (IL-2, GM-CSF) as cancer therapy in a model of squamous cell cancer in the C3H/HeJ mice. MATERIALS AND METHODS: We determinated the gene and protein expression of DISC-IL-2 and DISC-GM-CSF transfected SCCVII cells by RT-PCR and ELISA method. Also, we evaluated the ex vivo vaccination effects of DISC-IL-2 and DISC-GMCSF on preventing the development of SCCVII tumor. RESULTS: SCCVII cells transduced by the DISC virus vector (MOI=10) carrying the IL-2, or the GM-CSF gene, produced nanogram quantities of IL-2 or GM-CSF per 10(6) cells. Of particular interest was the observation that cells irradiated at different doses (5,000 cGy, 10,000 cGy) secreted levels of GM-CSF or IL-2 that were comparable to non-irradiated cells. In vivo vaccination using tumor cells transduced ex vivo with DISC-IL-2 or DISC-GMCSF resulted in protection against subsequent tumor challenge (p<0.01). Among the multiple immunomodulatory transgenes vaccination groups, the DISC-GMCSF transfected vaccine showed the greatest suppression of tumor development and growth (p<0.001). CONCLUSION: These data demonstrate that: 1) The DISC virus vector is capable of efficient gene transfer to SCCVII cells, 2) The GM-CSF secreting, genetically modified tumor vaccine (SCCVII/GMCSF) efficiently protected against tumor cell challenge and suppressed tumor growth in our tumor model. The DISC virus-mediated, cytokine gene transfer may prove to be useful in clinical therapy for head and neck cancers.

Retropharyngeal Lymph Node Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Little information about the surgical anatomy and technique for retropharyngeal node dissection has been published. The purpose of this study was to review our surgical technique and results of retropharyngeal lymph node dissection. MATERIALS AND METHODS: Eleven advanced oropharyngeal and hypopharyngeal squamous cell carcinoma patients who had been treated with resection of primary tumor and standard neck dissection including retropharyngeal lymph node dissection from 1994 to 1999 were evaluated retrospectively. RESULTS: One of 11 patients had positive retropharyngeal lymph node. The surgical technique used for retropharyngeal lymph node dissection were total laryngopharyngectomy, mandibular splitting or mandibulectomy approach. There was no specific complication of retropharyngeal lymph node dissection except one case of Horner's syndrome. CONCLUSION: Retropharyngeal lymph node dissection was a safe procedure, bet it required total laryngopharyngectomy, madibular splitting or mandibulectomy approach. It was possible to remove retropharyngeal lymph made en-bloc with primary tumor in most cases.

Experimental Study of Laryngeal Chemoreflex in Puppies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mechanical or chemical stimulation of the supraglottic mucosa may result in either or both of two responses: the laryngeal adductor reflex response (LAR), which causes glottic closure, and the laryngeal chemoreflex (LCR), which results in centrally mediated apnea, hemodynamic instability and swallowing. Exaggeration of this normally protective reflexes is thought to be responsible for several disorders, including the sudden infant death syndrome (SIDS). MATERIALS AND METHODS: The supraglottic laryngeal mucosa which was topically stimulated by saline, distilled water, cow's milk and acid at pH 1.0 was introduced in 14 anesthetized puppies of three different age groups. In group I, four puppies were 2-weeks-of-age, and in group II and III, five puppies were 4 and 6-weeks-of-age, respectively. RESULT: 1) Strong acid (pH 1.0) induced the LCR response.20) After stimulating, respiration was depressed initially, followed by later hyperventilation. We found strong contraction or laryngospasm of thyroarytenoid (TA) muscle after a short period of latency. 3) Respiration was not, or minimally depressed in group I. Moderate depression or apnea was elicited in group II and III. 4) After stimulating, the heart rate was reduced, but it had no statistical meaning. 5) We found 3 types of TA muscle contraction pattern. Type I showed no laryngospasm, but large contraction wave was noted by EMG. Type II showed no laryngospasm, but strong contraction was noted initially and followed by some large waves by EMG. Type III showed laryngospasm that was visible to the naked eye and by EMG. 6) Peak to peak amplitude differences of TA muscle were significantly increased statistically in all age groups. CONCLUSION: We suggest that the LCR is an age-dependent response which is absent in very young puppies before 2 weeks and appears after that age. Thus, it has important implications that postnatal neural maturation may influence laryngeal reflex to some extent.

Occult Neck Metastasis in Larynx and Hypopharynx Squamous Cell Carcinomas Confirmed with Simultaneous Bilateral Elective Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neck metastasis is one of the most important prognostic factor in treating head and neck squamous cell carcinomas. Recently, elective neck dissection has been widely accepted for accurate pathologic staging and elective treatment of neck. Occult metastasis rate of laryngeal and hypopharyngeal cancer varies widely depending upon authors. However, occult metastasis rate confirmed with simultaneous bilateral elective dissection is rare. MATERIALS AND METHODS: Fifty patients (100 necks) who underwent surgery for laryngeal and hypopharyngeal squamous cell carcinomas as an initial treatment from 1992 to 1997 were evaluated. All had bilateral elective neck dissection at the time of surgery for the primary treatment. Charts and pathologic reports were reviewed. RESULT: Occult neck metastasis rate by primary site were as follows. Supraglottis ipsilateral 40% (8/20) contralateral 15% (3/20), glottis ipsilateral 18% (4/22), contralateral 0% (0/22), hypopharynx ipsilateral 88% (7/8), contralateral 25% (2/8). CONCLUSION: Supraglottic and hypopharyngeal cancer may need elective neck treatment bilaterally. Contralateral neck occult metastasis from glottic cancer was minimal.

Is it Necessary to Dissect Level I in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma of the larynx and hypopharynx rarely metastasizes to the submental and submandibular lymph nodes. But comprehensive neck dissection including level I is still regarded as a standard treatment of neck in N+ laryngeal and hypopharyngeal cancer. Material and Methods: 82 comprehensive neck dissections of squamous cell carcinoma of laryngeal and hypopharyngeal cancer in 78 patients treated between 1992 to 1998 were pathologically reviewed. RESULTS: Only two cases of metastasis at the level I was noted. These 2 patients received radical neck dissection as a salvage procedure and had multiple nodes metastasis at other levels. CONCLUSION: Lymph nodes of level I are not believed to be at risk for cancers of the larynx and hypopharynx.

Surgery for the Base of the Tongue Cancer in Conjunction with Supraglottic Partial Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cancer arising in the base of the tongue with extension to the supraglottic larynx or cancer of the epiglottis with extension to the base of the tongue require wider surgical approach than conventional supraglottic partial laryngectomy. This paper is to review techniques and postoperative results of mandibular swing approach for resection of the base of the tongue with supraglottic larynx. MATERIALS AND METHODS: We applied mandibular swing approach for three cases of the base of tongue cancer with significant extension to supraglottis. Two patients were stage T3 and the other was T4. RESULTS: In two patients, oral feeding without aspiration was possible with 5X6, 4X5 cm sized base of the tongue resection. Reconstruction was performed using primary repair between resected margin of the tongue and thyroid cartilage. In one case, an unexpected wide submucosal tumor extension to the hypopharynx was found, so a total glossolaryngectomy had to be performed. CONCLUSION: Resection of the base of the tongue beyond foramen cecum and primary repair may be possible without jeopardizing postoperative deglutition. Mandibular swing approach in conjunction with supraglottic partial laryngectomy was useful for the base of tongue cancer with supraglottic extension.

Detection of Mixed Chimerism after Sex-Mismatched Bone Marrow Transplantation Using Fluorescence in situ Hybridization: Engraftment and Follow-up Evaluation / 대한혈액학회지

BACKGROUND: Interphase fluorescence in situ hybridization (FISH) analysis following sex-mismatched bone marrow transplantation (BMT) is a sensitive and quantitative method to better assess the engraftment state and mixed chimerism. METHODS: Twelve patients (allogeneic 11 cases, unrelated 1 case) who underwent sex-mismatched BMT at Chonnam University Hospital from April 1996 through October 1998 were anlaysed chimerism employing FISH. Interphase FISH studies on peripheral blood cytospin slides were performed by using chromosome X alpha-satellite probe in early post-transplant periods at intervals of 3 days and in follow-up periods 6~15 months after BMT. RESULTS: In 11 engrafted patients, the mean percentage of host cells was 3.0% at the period of engraftment (15~25 days). Follow-up interphase FISH studies for ten patients with hematologic remission states after engraftment showed mixed chimerism with variable degree (mean, 4.7%: ranges, 0.5~19.0%). Although three of these patients showed host cells above 5.0% (13.2, 8.0 and 7.0%) transiently, they maintained hematologic remission states. One patient who showed 8.5% (344 days) and 14.5% (596 days) host cells proved to be an engraftement failure. CONCLUSION: Engrafted patients who obtained hematological remission showed variable mixed chimerism by FISH. When the host cells were low rate or increased transiently, mixed chimerism was not related to relapse. However, consecutive increasing host cells suggested engraftment failure or relapse. More sensitive long term follow-up FISH studies will help to evaluate and monitor engraftment status and degree of chimerism.

Filamentous Fungi Isolated from Hospital Air and from Clinical Specimens / 병원감염관리

BACKGROUND: As the population of immunocompromised patients continues to grow, the incidence of infections caused by opportunistic filamentous fungi will continue to increase. Inhalation of fungal spores which are found in the environmental air precedes infection with molds. We investigated the relative frequency of various molds recovered from hospital air as compared to isolates from clinical specimens. METHODS: Air samples were taken from 83 sites in Chonnam University Hospital during December 1997. Air sampler (Biotest, Germany) with Rose Bengal agar strip (Biotest, Germany) was calibrated to take 40 liters of air. The strips were incubated at 37degrees C for 2-14 days. The results of air cultures were compared with those from the clinical specimens during a year (1997). RESULTS: Of 83 air samples cultured, 61 (73.5%) were positive for molds: 43 (51.8%) samples with 1-2 CFU, 15 (18.1 %) samples with 3-5 CFU, and 3 (3.6%) samples with > 5 CFU. A total of 184 molds were isolated and the most frequently recovered molds were Cladosporium (26.0%), followed by Penicillium (25.5%), Aspergillus (18.5%) and Alternaria (9.8%). The most frequently isolated molds from clinical specimens were Aspergillus (62.8%) and Fusarium (20.2%). For Aspergillus species, A. flavus (28,8%) and A. fumigates (25.4%) were predominant among the clinical isolates, whereas A sydowii (44.1%) and A. niger (38.2%) were common in the hospital air. CONCLUSION: This result shows that Cladosporium and Penicillium are the predominant molds in the hospital air and the relative frequency of molds recovered from hospital air is quite different from those of clinical isolates.

A Clinical Analysis of Stomal Recurrence / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Stomal recurrence is defined as a diffuse infiltration of neoplastic tissue at the junction of amputated trachea and skin. The incidence of stomal recurrence has been reported to be 5-15% and it is regarded to be related with several risk factors such as subglottic extension of tumor, advanced T stage, paratracheal lymph node metastasis, previous tracheotomy or the invasion of thyroid gland. The principal treatment is an extensive surgery, however, the prognosis is often extremely poor. Therefore, prevention is regarded to be much more important. The purpose of this study was to evaluate the clinical characteristics of stomal recurrence and to clarify the associated risk factors, methods of prevention and proper management. MATERIALS AND METHODS: We reviewed the data of 178 followed-up patients who underwent total laryngectomy for laryngeal or hypopharyngeal cancers from 1987 to 1996. Among them, 10 cases of stomal recurrence were studied. RESULTS: The overall incidence of stomal recurrence was 5.6% and there was no significant difference according to primary site, T stage and N stage. Subglottic involvement of tumor and previous tracheotomy were positively correlated with the increased incidence of stomal recurrence. CONCLUSION: For cases with such risk factors as considered here, more extensive and meticulous surgery is required. Considering the high rate of mortality, the effort for prevention of stomal recurrence is much more important.

A Case of Neurilemmoma of the Posterior Wall of the Hypopharynx / 대한이비인후과학회지

Neurilemmoma is a relatively rare benign tumor which may be derived from nerve sheath of the peripheral and cranial nerve. And it is a characteristically solitary and well-encapsulated mass. About 25% of neurilemmoma occurs in the head and neck region and therefore the vestibular nerve is most frequently involved. Neurilemmoma arising in the posterior wall of the hypopharynx is thus quite rare. In this study, we report a recent encounter with a case of neurilemmoma originating from the posterior wall of the hypopharynx in a 44 year old male patient. The tumor was successfully removed by lateral pharyngotomy under general anesthesia.

Diagnostic Significance of the Endoscopy-guided Biopsy with Tonsillectomy in Suspected Occult Primary Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An occult primary tumor is defined as histologic evidence of malignancy in the cervical lymph nodes with no apparent primary site of origin for the metastatic tumor. MATERIALS AND METHODS: Twenty-three patients who have failed to detect primary tumor on their initial physical examinations, endoscopy and other imaging studies, underwent endoscopy-guided biopsy under the general anesthesia. The histologic examination of frozen sections was done in the operation room. For those failing to give results by the histologic study, we performed the ipsilateral tonsillectomy biopsy. RESULTS: Nine primary lesions were identified: four cases of tonsillar fossa, one case each of nasopharynx, base of tongue, hypopharynx, supraglottis, and esophagus. In the three of the four tonsillar cancer cases, the primary foci were also identified by tonsillectomy biopsy. All the patients whose primary foci were tonsillar fossa showed metastasis of the jugulodigastric lymph node. CONCLUSION: Our results indicate that patients who are considered to have occult primary tumor should be evaluated by endoscopy-guided biopsy under the general anesthesia. Also, this study finds that if the histologic result of the frozen section were negative, ipsilateral tonsillectomy can be justified, especially for patients who show metastasis of jugulodigastric cervical lymph node.

Fluorescence in situ Hybridization using Chromosome X alpha-Satellite Probe To Evaluate Engraftment and To Monitor Residual Disease after Bone Marrow Transplantation / 대한임상병리학회지

BACKGROUND: Several methods have been used to evaluate the engraftment and to monitor residual disease after bone marrow transplantation (BMT). Among them, karyotyping have been useful in gauging engraftment following opposite sex BMT. More recently, fluorescence in situ hybridization (FISH) has also been applied to determine engraftment and residual status. In order to establish the utility of this method in clinical practice, we have evaluated the data from FISH and several methods. METHODS: We performed FISH using chromosome X alpha-satellite probe (Oncor , USA) on twenty eight peripheral blood and nine bone marrow nuclear cells from eleven patients who underwent sex mis-matched transplant and from a patient who had a loss of X chromosome. RESULTS: In nine patients with well engrafted BMT, signals of host cells showed less than 5% in all patients, evaluated 21-210 days post-transplant. Mixed chimerism was detected in six patients; transiently in early post-transplant period in four, in a patient with engraftment failure, and in a patient with relapse, respectively. CONCLUSION: FISH using X probe is a rapid, quantitative and sensitive 'interphase cytogenetic method' for the evaluation of engraftment and monitoring of residual disease following sex mis-matched BMT or BMT in a patient with a loss of X chromosome; It is especially useful in early post-transplant period when ony a few cells are available during severe cytopenia.

Chromosome Breakage Test for the Diagnosis of Fanconi's Anemia / 대한임상병리학회지

BACKGROUND: Fanconi's anemia (FA) is an autosomal recessive disease characterized by aplastic anemia, pre-malignancy, congenital malformations and chromosome breakage syndromes. As up to 30% of patients have no detectable congenital anomalies, the modern diagnosis of FA rests on chromosomal breakage of patient's cells induced by chemical clastogens such as diepoxybutane (DEB) or mitomycin-C (MMC). METHODS: We have done chromosome breakage test to differentiate FA from 11 aplastic anemia, three Diamond-Blackfan syndrome, three myelodysplastic syndrome, one acute leukemia with congenital anomaly and three siblings of FA. The peripheral blood lymphocytes from each individual were co-cultured in phytohemagglutinin-containing medium by the three methods, i.e., DEB treated, MMC treated and un-treated. RESULTS: Five cases were found to have increased chromosomal breakages to DEB and MMC, confirming diagnosis of FA. Other 21 cases showed no increased chromosomal breakages. No overlap was found between FA group and others (P<0.01). In one FA, there was no increased spontaneous breakage, but increased breakage to DEB and MMC. Of five FA, one case showed no congenital anomalies. CONCLUSIONS: Chromosme breakage test was shown to be simple, reliable and useful in ascertaining the diagnosis of FA.

Plasmid DNA and Random Amplified Polymorphic DNA (RAPD) Analyses of Vancomycin-Resistant Enterococcus faecium Isolates / 대한임상병리학회지

BACKGROUND: Vancomycin-resistant enterococci (VRE) have been increasingly reported worldwide. The understanding of VRE dissemination in the hospital requires a molecular typing of the strains. VRE appeared recently in Chonnam University Hospital. The purpose of this study is to analyse the strains for their genetic relatedness. METHODS: Nine vancomycin-resistant E. faecium isolates, collected from six patients during 1995-1996 in Chonnam University Hospital, were typed using plasmid DNA and RAPD analyses. The plasmid DNA of the isolates was obtained by a alkaline lysis method. For RAPD, eight random primers were used. The cluster analysis was performed by NTSYS-pc (numerical taxonomy system and multivariate analysis system, version 1.50, Applied Biostatistics Inc., CA). RESULTS: Nine VRE isolates were separated into two different molecular types (group A and B) by the plasmid DNA patterns, which were agreed with the RAPD results: the isolates of each group showed the same plasmid DNA patterns and high similarity values in the RAPD analysis. Group A was consisted of two strains isolated from two patients who were admitted at the same room in May 1995. Seven strains of group B were isolated from four patients in the different wards during June 1995 to June 1996. CONCLUSIONS: Nine VRE isolates from six patients were typed to two groups by plasmid DNA or RAPD analysis. These results suggested the intrahospital spread of two clonal strains of vancomycin-resistant E. faecium.

A Case of Choristoma of Tongue Base / 대한이비인후과학회지

The choristoma is a tumor like mass of normal cells in an abnormal location. Intraoral osseous and cartilaginous choristoma is distinctly uncommon. The etiology of choristoma is unknown. It is suggested that the intraoral choristoma is a developmental lesion. Correct diagnosis can be obtained only after histopathologic examination. The treatment of choice is surgical excision. We present a case of osseous and cartilaginous choristoma, occurred on the tongue base and treated by peroral excision, with review of the literatures.