A clinical analysis of juvenile dermatomyositis; focus on clinical manifestations at diagnosis / 소아과

PURPOSE: Juvenile dermatomyositis (JDM) is the most common of the idiopathic inflammatory myopathies in children. The purpose of this study is to observe demographic, initial presentations, duration of time between disease onset and diagnosis, clinical manifestations and laboratory findings at diagnosis of patients with JDM. METHODS: Forty seven patients identified at Seoul National University Children's Hospital from January 1986 to May 2007. Medical records were reviewed retrospectively focusing on initial presentations, clinical manifestations and laboratory findings at the time of diagnosis of patients with JDM. RESULTS: Male and female patients were 25 and 22, respectively and sex ratio was 1.14:1. The average age at the time of diagnosis was 6.51 years. Skin rash (94%) was the most common symptom, followed by the proximal muscle weakness (89%). The disease activity score was 10.8. The duration between the onset of the skin rash and the muscle weakness and diagnosis was 7.18 and 4.70 months, respectively. The serum muscle enzymes, LDH, AST, CK and aldolase, were elevated in the patient with JDM. Autoimmune antibodies, antinuclear antibody, anti SSA antibody and anti SSB antibody, were negative findings. Electromyography findings were consistent with JDM in 88% of the patients, the muscle biopsy was in 91% and all MRI findings were compatible with those of patients with JDM. The most common symptom besides musculocutaneous lesions was the calcinosis (62.5%). The most common site of calcinosis was the pelvic area and buttocks. CONCLUSION: This study shows that the major symptoms are proximal muscle weakness and cutaneous lesion, and they are important to diagnose JDM.

Histochemical Detection of Glycoconjugates in the Male Reproductive System of the Horse

Lectins are glycoproteins of plant and animal origin that have the ability to bind specific carbohydrate residues of cell glycoconjugates, particularly in terminal positions. In this study, the binding of lectins, Dolichos biflorus agglutinin (DBA), soybean agglutinin (SBA), Bandeiraea simplicifolia BS-1 (isolectin B4), Triticum vulgaris (WGA), Arachis hypogaea (PNA), and Ulex europaeus (UEA-I), was studied in the reproductive systems of male thoroughbred horses.DBA was detected in the stereocilia of the caput and corpus epididymis, and in the vas deferens. It was weakly detected in connective tissue of the corpus epididymis. Strong SBA staining was seen in epithelial cells in the testis, stereocilia of the corpus and cauda epididymis, and in the vas deferens. There were intense positive reactions for isolectin B4 in interstitial cells in all tissue and serosa of the vas deferens. PNA staining was seen only in stereocilia in the caput and corpus epididymis, and in the vas deferens. Strong WGA staining was seen throughout the testis, except in Sertoli cells, stereocilia, and connective tissue. UEA-I was detected in secondary spermatids, stereocilia, and epithelial cells of the cauda epididymis.These results show that degenerating cells in the testis, epididymal tubules, and vas deferens have differential affinities for lectins, and suggest that lectins play a role in the reproductive system of the horse. The heterogeneity of the lectin staining pattern in the reproductive tubules of adult horses suggests that the carbohydrate composition of each cell type is region specific.

Gene Expression Profile Analysis of Human Breast Cancer Using cDNA Microarrys / 한국유방암학회지

PURPOSE: The aim of this study was to classify breast carcinomas based on variations in gene expression patterns derived from cDNA microarrays and to correlate tumor characteristics to clinical outcome. METHODS: A total of 7 pairs of breast tumors and control tissues were taken at the time of primary surgery for array analysis. Then, performed microarray experiments in breast cancer tissues with the cDNA microarray spotted 3,063 clones of genes, were analyzed by hierachical clustering. RESULTS: Thirteen genes were over expressed in tumor samples regardless of their histopathological features and ER status, those were including, vitamin A responsive gene, proliferating cell nuclear antigen (PCNA), and signal transducer and activator of transcription 1 (STAT1). Twenty-four genes were down-regulated in tumor sites, those were including, discoidin domain receptor family mamber 2, crystallin alpha B, and myosin light polypeptide kinase. We also identified the differentially expressed genes between ER positive and negative tumors. PCNA, FLJ20500, STAT1, signal recognition particle 9 kD, and proteasome activator subunit 2 were more predominantly expressed in ER negatives. Serine protease 23, vitamin responsive gene, fibronectin 1, and SERPINA1 genes were more highly expressed in ER positive tumors. We further classified the patients according to their gene expression patterns with Cluster program. Clustering results divided patients into two distinct groups, the first group consists of only estrogen receptor (ER) negative tumors and they showed more higher gene expression levels of cell replication and cycle, invasion and metastasis, those considered poor prognosis signature. The other group mostly consists of ER positive tumors. CONCLUSION: These results support the feasibility and usefulness of this systematic approach to studying variation in gene expression patterns in human cancers as a means to dissect and classify solid tumors. We believe, this gene expression profile will outperform all currently available clinical parameters in predicting disease outcome.

Genetic Polymorphism of the Serum Proteins of Horses in Jeju

The study was carried out to investigate the genetic polymorphism of the serum proteins of horses in Cheju. They were assigned to three groups; 45 Cheju native horses(CNH), 60 Cheju racing horses(CRH) and 60 Thoroughbreds(TB). We analyzed the phenotypes and gene frequencies of serum proteins which were albumin (Alb), vitamin-D binding protein(GC), esterase (ES), A1B glycoprotein(A1B) and transferrin(TF) loci using horizontal polyacrylamide gel electrophoresis (HPAGE).All of the loci, except A1B in TB, showed polymorphisms and different allelic and phenotypic frequencies in all three groups. ESS and TFF1 were not observed in CNH. Allelic frequencies of AlbB, ESI, TFD and TFF1 were high in TB. All of the loci, except ES locus in CRH, appeared to be in a state of Hardy-Weinberg equilibrium from goodness-of-fit test in all three groups Heterozygosity estimates at Alb, ES and TF loci were high, but GC and A1B loci were low in all three groups. Average heterozygosities in CNH, CRH and TB were 0.3535, 0.3555 and 0.2726, respectively. Results showed differences in the frequencies of alleles and phenotypes of several serum protein loci between CNH and CRH, suggested that CRH might be crossed with other breeds of horses in some degree.

Effects of the Ketogenic Diet on Pentylenetetrazole-Induced Seizure

PURPOSE: Despite decades of clinical experience with the ketogenic diet(KD), its efficacy and mechanisms of action have been examined in few animal studies. The present study was designed to investigate the effects of the KD on pentylenetetrazole(PTZ)-induced seizure severity in rats. METHODS: Thirty-eight male Sprague-Dawley rats were divided into two equal groups. Dietary treatment was initiated at P22. The KD group was fasted for a day and then fed a KD consisting of a [fat] : [protein+carbohydrate] ratio of 4.3 : 1 for 26 days, while the control group was fed a standard rodent chow. Blood beta-hydroxybutyrate(beta-OHB) levels were assayed on treatment days 0, 20, and 24. Seizures were chemically induced by intraperitoneal injection of PTZ(60mg/kg of body weight) between treatment days 22 and 27. Seizure severity was evaluated by using a scoring system of seizure behaviors : 0, no seizure; 0.5, abnormal behavior; 1, myoclonic jerk; 2, myoclonic jerk with jumping; 3, forelimb clonus with preserving righting reflex; 4, generalized clonic seizure with brief loss of righting reflex; 5, generalized tonic clonic seizure; 6, expire. A greater score represents a more severe seizure. RESULTS: Blood levels of beta-OHB were low(<0.3mM) and showed no significant differences in both groups on day 0. Rats fed the KD developed an increased level of ketosis that was significantly above the levels found in the control group on days 20 and 24 (p<0.001). The KD group(2.37+/-0.27) exhibited significantly(p<0.05) lower seizure score than the control group(3.37+/-0.35). CONCLUSION: The KD was previously reported to increase PTZ-induced seizure thresholds in rats. In our study, rats fed the KD exhibited significantly decreased PTZ-induced seizure scores relative to controls. This suggests that the KD can not only increase the resistance to seizure but also decrease the severity of seizure induced by PTZ.

Development of Bronchopulmonary Dysplasia and the Peripheral and Tracheal Aspirate Neutrophil Counts and Cytokine Concentrations of Tracheal Aspirate in Preterm Infants with Acute Respiratory Failure

PURPOSE: The purposes of this study were to analyze the association of peripheral and tracheal aspirate neutrophil counts and tracheal aspirate cytokines [interleukin (IL)-8, IL-6, IL-10] concentrations with the development of bronchopulmonary dysplasia (BPD) in preterm infants intubated due to acute respiratory failure, and to speculate the causal relationship between the prenatal or early postnatal inflammation of the lung and the development of BPD. METHODS: A prospective study was conducted from April 1997 to March 1998 in 27 preterm infants, who were admitted to the neonatal intensive care unit of Seoul National University Children's Hospital and intubated due to acute respiratory failure. Tracheal aspirates were collected via endotracheal tube immediately after intubation. Tracheal aspirate neutrophil counts were measured by cytospin method and, cytokine concentrations were measured by ELISA method in the supernatant after centrifugation. RESULTS: BPD was diagnosed in 59.3% (16/27) of preterm infants. Compare to the non-BPD group, the BPD group had lower gestational age (27.6+/-1.3 weeks versus 32.0+/- 1.2 weeks), lower birth weight (1,112+/-228 g versus 1,666+/-334 g), higher incidence of patent ductus arteriosus (27.3% versus 81.3%), increased number of neutrophils (80,337+/-133,993/mL versus 2,672+/-6,600/mL), and increased IL-8 concentration (1,045.4+/-1,346.5 pg/mL vs 106.9+/-151.0 pg/mL) of tracheal aspirate. After control of compounding variables, increased IL-8 concentration of tracheal aspirate was found to be an independent risk factor for BPD (odds ratio; 27.7, 95% confidence interval; 1.8-436.2). CONCLUSION: Prenatal or immediate postnatal lung inflammation is an important risk factor for the development of the BPD, and the lung injuries responsible for the development of BPD might begin at the prenatal or immediate postnatal period.

Effects of Cisapride on QTc Interval and QT Dispersion in Preterm Infants

PURPOSE: Cisapride, a prokinetic agent, is widely used in preterm infants with feeding intolerance or gastroesophageal reflux. Although cisapride is regarded as a safe drug, increased QTc interval or ventricular arrhythmia has been reported in adults and neonates. So we prospectively examined the effects of cisapride on the QTc interval and QT dispersion in preterm infants. METHODS: QTc interval and QT dispersion were determined just before and 4.9+/-1.7days after the start of the cisapride treatment in 15 preterm infants with cisapride between April 1, 1998 and August 31, 1998. RESULTS: Cisapride significantly increased QTc interval(P<0.05), and this had no correlation with birthweight or gestational age. Three(20%) of the 15 cases were found to have QTc interval above 0.450, but they were clinically asymptomatic. QT dispersion did not increase significantly. CONCLUSION: Cisapride use in preterm infants is associated with an increase in QTc interval. High dose or longterm use of cisapride in preterm infants should be used cautiously, and when used, monitoring the QTc interval should be considered.

Comparison of Continuous versus Intermittent Infusion of Indomethacin in PDA of Preterm Infants

PURPOSE: Patent ductus arteriosus (PDA) of prematurity is very important disease to study because it causes many cases of perinatal morbidity and its incidence is now increasing. Nowadays indomethacin is the drug of choice for PDA closure, but its use has been limited due to its side effects. Therefore, we compared the effect and side effects of indomethacin according to the infusion method, continuous versus intermittent infusion, to find better an administration method. METHODS: Twenty-five preterm infants who were admitted to Seoul National University Children's Hospital (SNUCH) NICU from March 1995 to August 1996 with a diagnosis of respiratory distress syndrome (RDS) and PDA, were enrolled. They were randomly assigned to intertmittent lV group or continuous lV group. Each group received three intermittent doses or continuous infusion over 36 hours, respectively. We analyzed the perinatal history, time of diagnosis and treatment of PDA, size of PDA, and compared the laboratory parameters, intraventricular hemorrhage (IVH), periventricular echogenecity (PVE), ductal closure and perinatal morbidity before and 48 hours after indomethacin administration between the two groups. RESULTS: Fourteen infants (birth weight 1,149 +/- 373g) were intermittent lV group and eleven infants (birth weight 1,212 +/- 504g) were continuous lV group. There were no significant difference between the groups in perinatal history, pretreatment laboratory parameters, ductal closure, and perinatal morbidity. Patients with IVH of grade 2 or more increased significantly in intermittent lV group (50%) compared to continuous lV group (9%), and PVE progressed significantly in intermittent lV group (64%) compared to continuous lV group (18%). CONCLUSION: Continuous infusion of indomethacin for PDA closure in preterm infants with RDS appears to be as effective as intermittent infusion of indomethacin in closing PDA and have less side effects such as IVH and PVE progress.

The Efficacy of Fetal Ultrasonography and Postnatal Abdominal Ultrasonography for the Diagnosis of Neonatal Abdominal Mass

PURPOSE: Most neonatal abdominal masses are benign in nature, but early detection and management is important to avoid the development of complications. So, we studied the causes of neonatal abdominal masses and the efficacy of ultrasonography for early detection and diagnosis. METHODS: We reviewed 36 newborn infants with abdominal masses who had been admitted to the nursery and Neonatal Intensive Cave Unit of Seoul National University Children' s Hospital from Jan. 1, 1989 to Dec. 31, 1995. RESULTS: The mean gestational age was 38 weeks and the male to female ratio was 22 : 14. All masses were benign and the most common etiology was hydronephrosis (41.7%). The following etiologies were multicystic dysplastic kidney, polycystic kidney, ovarian cyst, hemangioendothelioma, teratoma, meconium peritonitis, mesenteric cyst and intestinal duplication cyst. All except one were detected before the first 48hours, and among them, 32 cases (88.9%) detected antenatally. All patients except one who died shortly after birth, were examined by abdominal ultrasonography, and 31 of 35 masses (88.6%) had the same diagnosis of ultrasonography. Five cases had associated abnormalities in the opposite kidney and other organs. CONCLUSION: The most common etiology of neonatal abdominal masses was hydronephrosis and majority of masses originated from genitourinary system. Most abdominal masses were detected antenatally and abdominal ultrasonography was an efficient method for the diagnosis of neonatal abdominal masses.

Photogrammetric study and classification of the lip in korean adult female

Photogrammetric analysis and study of the beauty sense for lip are important for the planning of aesthetic and reconstructive lip surgery. The purpose of this study is to determine average value of the lip dimensions and to classify shape of the lip in Korean adult female. We took measurements from life sized photographs of the one hundred Korean adult female aged from twenty to forty nine years. We have classified shape of the lip as seven types by measured heights of upper and lower vermilion. Measured data were analysed to obtain mean, standard deviation and proportional indices. The following results were obtained.1. The mean and standard deviation of photogrammetric measurements of lip were presented below; philtral length was 15.2+/-2.0 mm, height of maximal point of Cupid's bow was 9.7+/-1.5 mm, upper vermilion height was 8.2+/-1.4 mm, lower vermilion was 10.9+/-1.4 mm, lower facial height was 67.5+/-4.5 mm, mouth width was 46.9+/-3.6 mm, bialar was 37.8 +/-2.6 mm, nasolabial angle was 87.0+/-9.0.2. The standard proportional indices of lip dimension were presented below; mouth width-lower facial height index was 69.6+/-6.3%, bialar width-lower facial height index was 56.2+/-4.5%, nose-mouth width index was 81.0+/-5.5%, upper and lower vermilion height-lower facial height index 28.3+/-3.5%, upper and lower vermilion height-mouth width index was 40.9+/-5.3%, philtral length-mouth width index 32.6+/-5.2%, upper vermilion-lower vermilion height index was 76.4+/-13.8%. 3. The classification of shape of the lip is presented below; standard type is most frequent type(55%) and the upper and lower vermilion height is measured within mean +/- 1 SD, second most common type is upper thick type(10%), upper thin type is 9%, lower thick type is 8%, both thick type is 7%, lower thin type is 6%, both thin type is 5%.

Association of Early Postnatal Neutropenia and Development of Bronchopulmonary Dysplasia in Preterm Infants

PURPOSE: To see if a similar relationship exists between the decreased number of circulating neutrophils and the development of bronchopulmonary dysplasia (BPD) in preterm infants, we tried to test the hypothesis that claims that preterm infants, who develop BPD, have decreased number of circulating neutrophils than those who do not develop BPD. METHODS: A retrospective cohort study was conducted in 167 preterm infants from August 1995 to July 1997, who were admitted in the neonatal intensive care unit (NICU) of Seoul National University Children's Hospital. RESULTS: BPD was diagnosed in 16% (27/167) of preterm infants. We compared the clinical characteristics of the study population according to the presence or absence of BPD. Compared to non-BPD group, the BPD group had a lower gestational age (29.4 +/- 2.7weeks versus 32.7 +/- 1.7 weeks), lower birth weight (1,240 +/- 486g versus 1,780 +/- 420g), lower incidence of prenatal steroid use (2/27 versus 41/140), decreased number of circulating neutrophils (3,622 +/- 4,866/microliter versus 7,586 +/- 4,545/microliter) at 1 day of life. After adjusting for the variables of the above risk factors, neutropenia (<2,500/microliter) in the peripheral blood increased the odds ratio of developing BPD (OR : 46.3, 95% CI : 17.3-117.2). CONCLUSION: Early postnatal neutropenia might be an important risk factor for the development of BPD and lung injury responsible for the development of BPD might begin at the early postnatal period.

Association of Early Postnatal Neutropenia and Development of Bronchopulmonary Dysplasia in Preterm Infants

PURPOSE: To see if a similar relationship exists between the decreased number of circulating neutrophils and the development of bronchopulmonary dysplasia (BPD) in preterm infants, we tried to test the hypothesis that claims that preterm infants, who develop BPD, have decreased number of circulating neutrophils than those who do not develop BPD. METHODS: A retrospective cohort study was conducted in 167 preterm infants from August 1995 to July 1997, who were admitted in the neonatal intensive care unit (NICU) of Seoul National University Children's Hospital. RESULTS: BPD was diagnosed in 16% (27/167) of preterm infants. We compared the clinical characteristics of the study population according to the presence or absence of BPD. Compared to non-BPD group, the BPD group had a lower gestational age (29.4 +/- 2.7weeks versus 32.7 +/- 1.7 weeks), lower birth weight (1,240 +/- 486g versus 1,780 +/- 420g), lower incidence of prenatal steroid use (2/27 versus 41/140), decreased number of circulating neutrophils (3,622 +/- 4,866/microliter versus 7,586 +/- 4,545/microliter) at 1 day of life. After adjusting for the variables of the above risk factors, neutropenia (<2,500/microliter) in the peripheral blood increased the odds ratio of developing BPD (OR : 46.3, 95% CI : 17.3-117.2). CONCLUSION: Early postnatal neutropenia might be an important risk factor for the development of BPD and lung injury responsible for the development of BPD might begin at the early postnatal period.

Comparison of Continuous Versus Intermittent Infusion of Indomethacin in PDA of Preterm Infants

PURPOSE: Patent ductus arteriosus (PDA) of prematurity is very important disease to study because it causes many cases of perinatal morbidity and its incidence is now increasing. Nowadays indomethacin is the drug of choice for PDA closure, but its use has been limited due to its side effects. Therefore, we compared the effect and side effects of indomethacin according to the infusion method, continuous versus intermittent infusion, to find better an administration method. METHODS: Twenty-five preterm infants who were admitted to Seoul National University Children's Hospital (SNUCH) NICU from March 1995 to August 1996 with a diagnosis of respiratory distress syndrome (RDS) and PDA, were enrolled. They were randomly assigned to intertmittent lV group or continuous lV group. Each group received three intermittent doses or continuous infusion over 36 hours, respectively. We analyzed the perinatal history, time of diagnosis and treatment of PDA, size of PDA, and compared the laboratory parameters, intraventricular hemorrhage (IVH), periventricular echogenecity (PVE), ductal closure and perinatal morbidity before and 48 hours after indomethacin administration between the two groups. RESULTS: Fourteen infants (birth weight 1,149 +/- 373g) were intermittent lV group and eleven infants (birth weight 1,212 +/- 504g) were continuous lV group. There were no significant difference between the groups in perinatal history, pretreatment laboratory parameters, ductal closure, and perinatal morbidity. Patients with IVH of grade 2 or more increased significantly in intermittent lV group (50%) compared to continuous lV group (9%), and PVE progressed significantly in intermittent lV group (64%) compared to continuous lV group (18%). CONCLUSION: Continuous infusion of indomethacin for PDA closure in preterm infants with RDS appears to be as effective as intermittent infusion of indomethacin in closing PDA and have less side effects such as IVH and PVE progress.

Para-aortic Lymph Node Dissection in Gastric Cancer

The para-aortic lymph nodes are the most distal resectable intra-abdominal nodes, to which most lymphatic channels from the stomach converge. Metastasis of gastric cancer to these nodes is regarded as a distant metastasis, and the patient's prognosis is known to be dismal. The purposes of this study are to identify the frequency of metastasis in the para-aortic lymph nodes and to evaluate the therapeutic effect of dissection of these nodes in gastric cancer. Macroscopically identified para-aortic lymph nodes from the left renal vein to the aortic bifurcation were dissected during operation in 173 patients, from among all the patients who underwent surgery for gastric cancer at Kyungpook National University Hospital from 1990 to 1994. Metastases in the para-aortic lymph nodes were found in 26 cases (15%). The frequency of para-aortic lymph node metastasis increased significantly with increasing tumor size and Borrmann type. Neither the tumor location, the depth of invasion, nor the histologic type affected the frequency of metastasis. There were two operative mortalities (1.2%). Twenty-six patients (15%) remained hospitalized for more than 3 weeks postoperatively. There seemed to be a higher incidence of postoperative morbidity in patients with positive para-aortic lymph nodes than in patients with negative nodes, but this difference was not statistically significant. The five-year survival rate of patients with para-aortic lymph node metastasis was 14.4%. Among the patients with para-aortic lymph node metastasis, skip metastasis was found in 11 cases (42%). There seemed to be some survival advantage in patients with skip metastasis, as compared to the positive n3 cases. However, this was not a statistically significant difference. Dissection of the para-aortic lymph nodes did not cause any significant disadvantage in postoperative mortality and morbidity. However, it could not prevent peritoneal seeding or hematogenous metastasis. Based on these data, dissection of the para-aortic lymph nodes seems to have little therapeutic effect, but provides information for accurate staging.

Influence of Phototherapy on Incidence of Patent Ductus Arteriosus in Very Low Birth Weight Infants

PURPOSE: Patent ductus arteriosus (PDA) is a common disease in very low birth weight infants (VLBWI). Hemodynamically significant PDA increases the morbidity and mortality of premature infants. Based on experimental model, light inhibits the constriction of immature piglet's ductal rings. No specific mechanism adequately explains the effect of light on the relaxation of PDA. Several hypotheses, including activation of photosensitive metabolites, alterations in receptors, or alterations in prostaglandin metabolism, have been postulated. The purpose of this study was to evaluate the influence of phototherapy on incidence of PDA in VLBWI. Mehtods : Sixty-three infants with birth weights less than 1,500 gm from March 1994 to February 1996 who were admitted in NICU of Seoul National University Children's Hospital were included. Thirty-four infants from March 1995 to February 1996 were shielded with aluminium foils on left chest during phototherapy (Shield group) and twenty-nine infants from March 1994 to February 1995 were not shielded (No shield group : control group). We investigated the incidence and the perinatal risk factors of PDA. RESULTS: 1) The incidence of PDA was 18% in shield group and 41% in control group. There was statistically significant between the two groups (P<0.05). 2) There was not statistically significant between two groups with gestational age, birth weight, sex, delivery mode, etc. 3) The perinatal risk factors which were statistically significant were group and presence of respiratory distress syndrome (RDS), and use of artificial surfactant. With linear logistic regression analysis, only group (OR=8.3, 95% CI=1.17-58.69) and presence of RDS (OR=21.3, 95% CI=1.39-329.81) were proved to be related to the occurrence of PDA. CONCLUSIONS: We conclude that chest shielding during phototherapy is a simple and inexpensive method to decrease the incidence of PDA.

THE ADIPOFASCIAL TURN-OVER FLAP FOR SOFT TISSUE DEFECT OF THE WRIST AND HAND

No abstract available.

A Severe Case of Hemolytic Disease of the Newborn due to Anti-M Antibody / 대한수혈학회지

Anti-M antibody is usually a naturally occurring antibody reacting optimally 4 degrees C and is not considered to be clinically significant. Rarely has anti-M been implicated in hemolytic disease of the newborn(HDN) and the true incidence of HDN due to anti-M has not been well delineated. Authors report the second case of hemolytic disease of the newborn due to anti-M in Korea. A 3-days old baby boy was admitted due to jaundice and severe anemia which were developed at birth. The blood type of his mother was A, CcDEe, Ns, while the blood type of the infant of was A, CcDEe, MNs. The mother's serum had anti-M which wits strongnly positive in room temperature and albumin phase. The reaction was only weakly positive in the antiglobulin phase. Direct antiglobulin test of baby's red cells was negative, while the serum was weakly positive in polyethylene glycol-Coombs test. The antibody was found to be partially IgG through the treatment with dithiothreitol. After an exchange transfusion and phototherapy, the anemia and jaundice were corrected and and the patient discharged at the age of 16.