Integration of the Innate and Adaptive Immunity by CD137-CD137L Bidirectional Signals: Implications in Allograft Rejection / 대한이식학회지

Two-signal models are useful in explaining various types of immune responses. In particular, secondary, so-called costimulatory, signals are critically required for the process of T-cell activation, survival, differentiation, and memory formation. Early studies in rodent models showed that targeting T-cell costimulatory pathways elicits immunological tolerance, providing a basis for development of costimulatory therapeutics in allograft rejection. However, as the classic definition of T-cell costimulation continues to evolve, simple blockade of costimulatory pathways has limitations in prevention of allograft rejection. Furthermore, functions of costimulatory molecules are much more diverse than initially anticipated and beyond T cells. In this mini-review, we will discuss CD137-CD137L bidirectional signals as examples showing that two-signals can be applicable to multiple phases of immune responses.

Characteristics of Stable Pelvic Bone Fractures with Intra-abdominal Solid Organ Injury

PURPOSE: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. METHODS: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. RESULTS: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. CONCLUSION: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

Retroperitoneal Mucinous Cystadenoma

We present a case of a primary retroperitoneal mucinous cystadenoma, which is a relatively rare tumor found exclusively in women. This tumor is difficult to correctly diagnose preoperatively. Although there is little published information regarding the CEA levels in the cystic fluid of cystic tumors arising in the retroperitoneum, a high CEA level in the cystic fluid is a useful diagnostic marker for a primary retroperitoneal mucinous tumor. The appropriate management of retroperitoneal mucinous cystadenomas is the total removal of the cyst. The retroperitoneal approach for retroperitoneal cystic tumors is useful, has a lower risk of traumatizing the bowel than the intra-abdominal approach, and does not require compression of the other organs. We report the successful resection of a retroperitoneal mucinous cystadenoma through the retroperitoneal approach.

Thallium-201 SPECT in the Evaluation of Postoperative Tumor Recurrence on the Chest Wall in Lung Cancer / 결핵

No abstract availalbe.

Mesenchymal Chondrosarcoma of the Cervical Spine

Mesenchymal chondrosarcoma is a rare tumor occurring in both bone and soft tissues and exhibits characteristic of a malignant nature. The authors experienced a case of mesenchymal chondrosarcoma occurring in a 23-year-old woman which had invaded the cervical spine. The patient presented with severe both shoulder pain, left upper extremity weakness(Grade IV) and paresthesia at admission. Radiologic studies of the cervial spine showed an aggressive osteolysis of C4 vertebral body, pedicle and lamina with compression of the spinal cord posteriorly on C3, C4, C5 levels. The tumor was totally removed by a combined anterior and posterior approach. The removed vertebral body was replaced with autogenous bone and stabilized by Codman locking plate symtem. The pathological examination showed characteristic of mesenchymal chondrosarcoma.previous symptoms well improved postoperatively. The authors present a case of mesenchymal chondrosarcoma with review of literature.

The Effect of Intra-Arterial Papaverine Injection in Cerebral Vasospasm / 대한뇌혈관학회지

Cerebral vasospasm continues to be the leading cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. In this study, 10 patients who showed clinical and angiographic vasospasm treated with internal carotid papaverine infusion(total dose: 180-300 mg/one hour). Two patients had marked angiographic reversal of the arterial narrowing following papaverine infusion and dramatic reversal of profound neurologic deficits. The final outcome of these patients was good recovery. Four patients showed decreased circulation time on angiography and three of these patients improved clinical status, but deteriorated conscious level 3-4 days after papaverine infusion. One of these patient, vasospasm was observed on repeated angiography, but no more papaverine was infused and finally showed severe disability. The second patient developed cardiac arrest during re-papaverine infusion, so cessation of the intra-arterial infusion and CPCR was done, but she died. The third patient did not perform angiography and final outcome was moderate disability. The remained 4 patients showed nonspecific change in angiography after papaverine infusion and all of these patients died. Arterial narrowing in middle cerebral artery distribution appeared to be more responsive to papaverine infusion than the spasm in the anterior cerebral arteries. The over all results of intra-arterial papaverine infusion was at least partially effective, but not satisfactory to relieve clinical and angiographic vasospam. The further more exact infusion method should be clarified to improve vasospasm through papaverine injection.

Two Cases of Cerebral Aspergillosis Following Cranial Operation: Case Report

No abstract available.

Intracerebral Hemorrhage Related with Anticoagulants and Thrombolytic Agents

Anticoagulant(heparin, warfarin) or thrombolytic agent(urokinase, tissue plasminogen activator) can be one of the causes of spontaneous ICH. Even though ICH related with anticoagulants and thrombolytic agents represent low incidence and slow progression, the final outcome usually very poor. Recently the use of anticoagulants and thrombolytic agents have been increased for recanalization of cerebral and myocardial infarction. Therefore, the importance of possible ICHs related to these agents need to be reemphesized. The authors analysed 18 patients of ICH related with anticoagulants and thrombolytic agents to evaluate the underlying mechanism, their characters, the factors which influence the formation of ICH and the prognosis. Eighteen cases of ICH related with anticoagulants and thrombolytic agents were analysed through the medical record, operation record and brain CT. In this study, patients in sixth decade showed the highest incidence. The most common primary disease was middle cerebral infarction(67%). Urokinase was most commonly infused for recanalization of cerebral and myocardial infarction. The mean duration between drug administration and hemorrhagic attack was 59 hours(with range from 1 hour to 96 hours). After onset of the hemorrhage, fourteen of eighteen cases revealed prolonged prothrombin time more than 1 1/2 to 2 times of control and nine of fourteen cases revealed prolonged thrombin time more than 1 1/2 to 2 times of cotrol. The mean volume of ICH was 31cc and locations of hemorrhage were lobar(45%), ganglionic(22%), thalamic(22%) and cerebellar(11%) in decreasing orders. Brain CT scans revealed that 12 cases were single hematoma and 6 cases were multiple hematoma. Twelve cases were treated conservatively and six cases were operated with stereotactic surgery(3 cases) and open craniotomy (3 cases). One case with stereotactic surgery and the other case with craniotomy were reoperated because of rebleeding and retained hematoma, respectively. The neurological condition before administration of anticoagulants and thromb-olytic agents was relatively good, but suddenly deteriorated after hemorrhage attack. Almost all cases(94%) prese-nted poor porgnosis as wholly dependent, vegetative and dead at discharge except one case of small cerebellar ICH. In this study, previously existed infarction and anticoagulants itself contributed to the occurrence of intracerebral hemorrhage. The prolonged prothrombin time may be useful predictable value in the formation of ICH. Although we could not find definitive factors to influence the prognosis, the mortality rate of multiple hematoma was much higher than single hematoma. The final outcome of these patients were very poor. Therefore, the choice of agents, dosage and duration of administration should be considered more judicious.

A Case of Thyroid Follicular Carcinoma Metastatic to the Petrous Bone

Among thyroid cancer patients, metastatic skull bone is rare, especially in the skull base region. The authors describe the case of a 42-year-old man with thyroid follicular carcinoma which metastasized to the left petrous bone. During the previous year, the patient had suffered from left tinnitus, hearing loss and peripheral facial nerve palsy; An CT and MRI scans demonstrated severe permeative bone destruction, as well as an enhancing soft tissue mass in the left petrous bone. Left carotid angiography revealed multiple feeding vessels, mainly via the occipital and superior laryngeal artery. The feeders were occluded by intra-arterial embolization with N-butylcyanoacrylate(NBCA). The patient underwent subtotal petrosectomy with near total removal of the tumor, followed by total thyroidectomy. He returned to work one month postoperatively and showed no evidence of recurrence during the follow-up period of seven months.