A case of rapid desensitization for rituximab-induced delayed hypersensitivity reaction

Rituximab is a monoclonal antibody used for the treatment of B-cell malignancies, including diffuse large B-cell lymphoma. Infusion-related hypersensitivity reactions to rituximab is well known, and delayed hypersensitivity reactions to rituximab are also reported. Desensitization is commonly used to prevent immediate hypersensitivity reactions, but recently there have been cases of successful desensitization therapy for delayed hypersensitivity reactions. A 66-year-old patient who underwent rituximab treatment for diffuse large B-cell lymphoma showed repeated rituximab-induced delayed hypersensitivity reactions with whole body rashes. Intravenous rapid desensitization was performed by using a 1-bottle, 11-step protocol for 6 cycles and thereafter hypersensitivity reaction did not recur. We herein reported a case of delayed hypersensitivity reaction caused by rituximab, which was successfully desensitized using our 11-step protocol.

Hematologic Complication of Respiratory Virus Infection / 소아감염

OBJECTIVE: Cytopenia is a common hematologic complication of viral infections. However, information regarding hematologic effects of common respiratory virus infections is scarce. This study aimed to evaluate hematologic complications and the clinical course of patients infected with common respiratory viruses. METHODS: We retrospectively analyzed 496 patients with respiratory tract infections admitted to the Department of Pediatrics, Wonkwang University Hospital from November 2011 to March 2012 using multiplex real-time polymerase chain reaction to detect the presence of respiratory viruses and hematologic abnormalities. RESULTS: Respiratory viruses were identified in 379 patients. Respiratory syncytial virus (RSV) was most frequently detected (55.7%), followed by influenza A (Flu-A, 23.0%). Further, cytopenia was observed in 35.5% of RSV-infected patients, 25.0% of Flu-A-infected patients, and 34% of patients infected by other viruses. Each virus caused a decrease in 3 blood cell component values, which corresponded with cytopenia frequency. Of the 379 infected patients, 83 had anemia (9.71+/-1.09 g/dL); 46 had neutropenia (803.70+/-263.09 cells/mm3); and 23 had transient thrombocytopenia (142,434.78+/-86,835.18 cells/mm3). However, no patient required treatment. A comparison of clinical characteristics between RSV- and Flu-A-positive patients with anemia revealed that RSV-infected patients had significantly longer duration of hospitalization. RSV was detected more commonly in young neutropenic patients, who had a shorter duration of fever. CONCLUSIONS: Our findings suggest that infections, particularly RSV and Flu-A, result in varying degrees of cytopenia, which usually improves without treatment and does not affect the clinical course of the infection.

Emergent hysterectomy and angiographic embolization for the management of obstetrical hemorrhage: 8-year experiences / 대한산부인과학회지

OBJECTIVE: To compare the clinical characteristics and outcome of hysterectomy and angiographic embolization in the management of obstetrical hemorrhage unresponsive to conservative management. METHODS: We retrospectively analyzed 88 patients who underwent hysterectomy and 53 patients who underwent angiographic embolization for the management of obstetrical hemorrhage from January 1999 to July 2007. We analyzed the maternal characteristics and outcomes by the review of medical records and telephone interview. Nonparametric test was performed for comparison of both groups. RESULTS: Angiographic embolization for the management of obstetrical hemorrhage is on the increase year by year, consisting of about three quarters of total cases in the last year. The most common indication of hysterectomy was abnormal placentation (68.2%) followed by uterine atony (25.0%). For the embolization, the most common indication was uterine atony (54.7%) followed by abnormal placentation (17%). The median pre-operative hemoglobin was significantly lower in embolization group than hysterectomy group [8.3 (3.8~12.7 g/dL) vs. 10.8 (2.4~13.7 g/dL), P<0.001]. There was no difference in the total transfusion amount of packed RBC between the two groups. The median hospital stay was shorter in embolization group [8 (5~57 days) vs. 6 (3~14 days), P<0.001]. Overall success rate of embolization was 89% and procedure-related acute complications were not occurred. Of the total population, there was one maternal death in the hysterectomy group. We found that most women who underwent the embolization resume normal menstruation. CONCLUSION: Angiographic embolization for the management of obstetrical hemorrhage is more commonly performed in recent years. Angiographic embolization was associated with shorter hospital stay, reasonable success rate, and minimal complication rate.

Antenatal Predictors of Neonatal Outcome in Fetal Growth Restriction; Efficacy of Biophysical Score, Doppler Ultrasound, Fetal Heart Rate Monitoring / 대한주산의학회잡지

PURPOSE:To identify the antenatal variables predictive of neonatal outcome and to examine the relationship between biophysical score, multivessel Doppler ultrasound and fetal heart rate monitoring in fetal growth restriction (FGR). METHODS:We retrospectively analyzed the pregnancy and neonatal outcomes of 64 growth restricted fetuses delivered at less than 34 weeks of gestation at Samsung Medical Center, from May 2005 to May 2008. The result of Doppler velocimetry including umbilical artery, middle cerebral artery, and ductus venosus and biophysical score (BPS) and fetal heart rate (FHR) monitoring for each subject were reviewed. Adverse neonatal outcome was defined as bronchopulmonary dysplasia, periventricular leukomalacia, grade 3~4 intraventricular hemorrhage, grade 3~4 retinopathy of prematurity, necrotizing enterocolitis, neonatal sepsis, and perinatal mortality. We performed the univariate and multivariate analysis to determine which antenatal fetal surveillance test is the best to predict the adverse neonatal outcome in preterm FGR. We also assessed the degree of agreement of each antenatal test by the Cohens kappa test. RESULTS:By the univariate analysis, significant variables associated with adverse neonatal outcome were gestational age at delivery, oligohydramnios, and abnormal ductus venosus Doppler. However, in the multivariate analysis, gestational age at delivery and oligohydramnios remained as independent predictors of adverse neonatal outcome. Degree of agreement among the antenatal tests expressed by the Cohens kappa was only significant between BPS and FHR monitoring (kappa=0.303, P=0.019). CONCLUSION:Our data suggests that the timing of delivery of growth restricted fetuses less than 34 weeks of gestation should be determined by the gestational age and oligohydramnios, not by the one abnormal antenatal fetal surveillance result. We also confirmed that there are considerable amount of disagreements among BPS, mutivessel Doppler, and FHR monitoring.

The Clinical Results After Open Wedge Osteotomy of Proximal Tibia in Degenerative Knee Osteoarthritis

PURPOSE: The purpose of this retrospective study was to analyze the radiological and clinical results following high tibial osteotomy of the degenerative knee osteoarthritis. MATERIALS AND METHODS: This study included 12 patients who had degenerative knee osteoarthritis and had been treated with high tibial osteotomy with TS-OA plate. Mean age was 50.2 years old(43~62) and mean follow up period was 17.7 Months. Clinical evaluation were analysed by HSS score. RESULT: There were 2 cases of grade 2 and 10 cases of grade 3 based upon the radiological Kellgren classifications before surgery. The mean femorotibial angle was corrected from varus 6 degrees before surgery to valgus 8.5 degrees at the last follow up and the mean angle between mechanical axis and tibia long axis was corrected from varus 6.7 degrees to valgus 1.6 degrees. The Insall-Salvati ratio was changed from 1.07 before surgery to 1.04 at the last follow up and tibial posterior inclination was changed from 8.1 degrees to 10.2 degrees. HSS score was improved from 58 before surgery(5 cases fair, 7cases poor) to 86.3 at the last follow up(9 cases excellent, 3 cases good). CONCLUSION: The high tibial osteotomy is an effective treatment option for the management of degenerative knee osteoarthritis on medial compartment patients before total knee arthroplasty.

Diffusion-weighted Imaging and Proton Magnetic Resonance Spectroscopy of Tuberculous Brain Abscess with a Fluid-fluid Level

We encountered a patient with tuberculous brain abscesses, which is very rare. Diffusion-weighted imaging showed high signal in the lower part of the large abscess cavity and low signal in the upper part of the cavity. Proton MRS showed resonances representing lactate. Combined studies with diffusion-weighted imaging and MRS are useful in the differential diagnosis of tuberculous abscess from other structures that feature ring-enhanced lesions.

A Case of Clear Cell Adenocarcinoma in the Uterine Cervix of 22 Years-Old Virgin / 대한산부인과학회잡지

Clear cell carcinoma of the uterine cervix is rare malignancy that accounts for 4% to 9% of the adenocarcinoma of the cervix. It is thought to originate from Mullerian duct, not from mesonephric duct. The etiology and pathogenesis are yet unclear. But among the suspected etiologies, the prenatal diethyl stilbestrol (DES) exposure is well known to be linked to clear cell carcinoma of the vagina and cervix. This cancer occurs primarily during young age (17 to 23 years) in DES-exposure women, but occurs mainly after menopause in non DES exposure women. The biological behavior and prognosis of the cancer are poorer than those of squamous cell carcinomas and non-clear cell adenocarcinomas. Also DES associated clear cell carcinomas behave less aggressively than those that develop in the absence of a history of DES exposure. We experienced a case of clear cell carcinoma in the uterine cervix of 22 years-old virgin who was not related to DES. So, we presented the case with a brief review of related literature.

Clinical profiles of 10 cases of ovarian malignant mixed mullerian tumor / 대한산부인과학회잡지

Malignant mixed mullerian tumors (MMMT) of the ovary are rare, constituting less than 1% of all primary ovarian tumors. Histologically, tumors include malignant epithelial and sarcomatous elements. MMMT of the ovary is a highly aggressive and rapidly progressive tumor with a poor long-term prognosis. The survival rate is very low inspite of surgery, chemotherapy and radiotherapy. The prognostic factors and optimal treatments for this tumor are still controversial because of its rarity. We experienced ten cases of malignant mixed mullerian tumors of the ovary and report our experiences with a brief review of literature.

Perinatal Outcome in Relation to the Latency of Delivery in Severe Preeclampsia before 32 Weeks of Gestation / 대한주산의학회잡지

OBJECTIVE: To study the differences in the pregnancy outcomes of severe preeclampsia before 32 weeks of gestation in relation to the latency between admission and delivery. METHODS: We reviewed medical records of 89 pregnant women who were managed in Samsung Medical Center because of severe preeclampsia before 32 weeks of gestation between January 1996 and February 2004. We studied the differences in the management and the neonatal outcomes between the immediate delivery group (admission to delivery 2 days). We excluded maternal renal disease, chronic hypertension, multiple pregnancies, diabetes and placenta previa from this study. RESULTS: 40 women were included in the immediate delivery group and 49 women in the expectant management group. Antenatal corticosteroid was given pregnant women in the expectant management group (89.8% vs. 52.5%, p<0.0001). There was no significant difference in the occurrence of small for gestational age- and prematurity-related complications including neonatal mortality. There was significantly less respiratory distress syndrome in the expectant management group (46.9% vs. 62.5%, p=0.0315). However this difference disappeared when the adjustment was made to the gestational age at delivery (p=0.223). CONCLUSION: The latency period does not seem to alter the neonatal prognosis in severe preeclampsia before 32 weeks of gestation but the gestational age at the delivery, a reflection of the severity of the preeclampsia, seems to be the single most important factor for the occurrence of neonatal respiratory distress syndrome.

Maternal and Fetal Outcomes according to the Latency Period in Preterm Premature Rupture of Membrane / 대한주산의학회잡지

OBJECTIVE: To evaluate the clinical characteristics and perinatal outcomes in relation to the latency period after preterm premature rupture of membrane (PPROM). METHODS: We analyzed retrospectively the 223 pregnant women with PPROM who delivered before 34 weeks of gestation in Samsung Seoul Hospital from January 1996 to October 2003. The study population was divided into six groups according to the larency from membrane rupture and delivery (group I: shorter than 6 hours, group II: 6~48 hours, group III: 2~4 days, group IV: 4~7 days, group V: 7~12 days, group VI: beyond 12 days). RESULTS: The mean gestational age (GA) at rupture was 29.6+/-2.6 weeks and the mean GA at delivery was 30.6+/-2.4 weeks. The median latency was 102 hours and 67% of patients delivered within 7 days. The latency was prolonged with GA at rupture before 30 weeks and used of tocolytics. After adjustment of GA at delivery, pathologic chorioamnionitis occurred more frequently in group V than group I. Respiratory distress syndrome occurred less frequently in group II and group IV than group I. Neonatal mortality rate was highest in group I, but the other neonatal morbidities were not significant differences. CONCLUSION: In PPROM with delivery before 34 weeks, prolongation of the latency longer than 6 hours seems to be beneficial for reducing neonatal RDS and mortality, but infectious morbidity seems to increase when the latency was prolonged longer than 7 days without any benefits for perinatal outcomes.

A Case of Delayed Delivery of Second Twin / 대한산부인과학회잡지

With the introduction of assisted reproductive technologies, the incidence of multifetal pregnancies has significantly increased. In vaginal delivery for multifetal pregnancy, the delivery of the second fetus usually follows the first in few minutes. However in rare circumstances, the delivery is delayed for days due to disappearance of uterine contraction after delivery of the first fetus. Successful prolongation of the interdelivery time may improve the neonatal outcomes of the remaining fetus (es), particularly in the cases of extremely premature gestation. We present a case of a delayed delivery of second twin with an interval of 48 days.

Analysis of Compression Behavior on Intervertebral Disc L4-5 in Pedicle Screw System Instrumented Lumbar Spine under Follower Load / 영남의대학술지

BACKGROUND: Confirm the stability of intervertebral disc sustaining each fused lumbar spine cases, comparing vertical compression, A-P shear force and rotational moment on intervertebral disc of instrumented lumbar spine with simple vertical compression load and follower load using finite element analysis. MATERIALS AND METHODS: We analyze the stability of intervertebral disc L4-5 supporting fused lumbar spine segments. After performing finite element modelling about L1-L5 lumbar vertebral column and L1-L4 each fusion level pedicle screw system for fused lumbar spine fine element model. Intervertebral discs with complex structure and mechanical properties was modeled using spring element that compensate stiffness and tube-to-tube contact element was employed to give follower load. Performing geometrical non-linear analysis. RESULTS: The differences of intervertebral disc L4-5 behavior under the follower compression load in comparision with vertical compression load are as follows. CONCLUSION: As a result of finite element interpretation of instrumented lumbar spine, the stability of L4-5 sustaining fused lumbar segment, the long level fused lumbar spine observed hing stability under follower load. This research method can be the basis tool of effects prediction for instrumentation, a invention of a more precious finite element interpretation model which consider the role of muscle around the spine is loaded.

Analysis of Compression Behavior on Intervertebral Disc L4-5 in Pedicle Screw System Instrumented Lumbar Spine under Follower Load / 영남의대학술지

BACKGROUND: Confirm the stability of intervertebral disc sustaining each fused lumbar spine cases, comparing vertical compression, A-P shear force and rotational moment on intervertebral disc of instrumented lumbar spine with simple vertical compression load and follower load using finite element analysis. MATERIALS AND METHODS: We analyze the stability of intervertebral disc L4-5 supporting fused lumbar spine segments. After performing finite element modelling about L1-L5 lumbar vertebral column and L1-L4 each fusion level pedicle screw system for fused lumbar spine fine element model. Intervertebral discs with complex structure and mechanical properties was modeled using spring element that compensate stiffness and tube-to-tube contact element was employed to give follower load. Performing geometrical non-linear analysis. RESULTS: The differences of intervertebral disc L4-5 behavior under the follower compression load in comparision with vertical compression load are as follows. CONCLUSION: As a result of finite element interpretation of instrumented lumbar spine, the stability of L4-5 sustaining fused lumbar segment, the long level fused lumbar spine observed hing stability under follower load. This research method can be the basis tool of effects prediction for instrumentation, a invention of a more precious finite element interpretation model which consider the role of muscle around the spine is loaded.