Chi Young Park

Clinical Usefulness of Eschar Polymerase Chain Reaction for the Diagnosis of Scrub Typhus: A Prospective Study

BACKGROUND The aim of this study was to determine the diagnostic utility of performing eschar polymerase chain reaction (PCR) for the diagnosis of scrub typhus through a prospective comparison of eschar PCR results with indirect immunofluorescent antibody assay (IFA) results. METHODS We conducted a multicenter prospective study involving patients with possible scrub typhus. Whole-blood samples and eschars were obtained for serological evaluation and PCR. A new crust was formed several days later at the site of the removed eschar. The newly formed crust was taken for performance of the second eschar PCR. Additional blood samples and eschars were collected, if possible, at 1-week intervals for 1 month after antibiotic treatment. RESULTS We prospectively studied 135 patients with possible scrub typhus. Of these patients, 118 had scrub typhus confirmed on the basis of either a single indirect immunofluorescent specific immunoglobulin M titer against Orientia tsutsugamushi of > or = 1:10 or a > or = 4-fold increase in the follow-up titer. The results of nested PCR assay of the eschars demonstrated a sensitivity of 0.86 (95% confidence interval, 0.78-0.92) and a specificity of 1 (95% confidence interval, 0.05-1). Among the 50 patients who showed positive results of eschar PCR at admission, 46 (92%) also showed positive results for the follow-up PCR test of the newly formed eschar after the treatment with antibiotics. CONCLUSIONS The eschar PCR assay was useful as a rapid and reliable test to confirm the diagnosis of scrub typhus, even though the patients received treatment with appropriate antibiotics, such as macrolides, quinolones, and tetracycline, which are all active against Orientia and Rickettsia species.

Deferasirox improves hematologic and hepatic function with effective reduction of serum ferritin and liver iron concentration in transfusional iron overload patients with myelodysplastic syndrome or aplastic anemia

Transfusional iron overload and its consequences are challenges in chronically transfused patients with myelodysplastic syndromes (MDSs) or aplastic anemia (AA).

Health Behaviors of Cancer Survivors: The Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007–09)

OBJECTIVE This study aimed to describe the health behaviors of cancer survivors in the Republic of Korea and to compare them with the health behaviors of two control groups: (i) individuals with no history of cancer but with other chronic diseases and (ii) individuals with no history of cancer or other chronic diseases. METHODS This is a cross-sectional study of 17 311 adults at least 19 years of age who participated in the Fourth Korea National Health and Nutrition Examination Survey (2007-09). Smoking, alcohol drinking, physical activity and cancer screening behaviors of cancer survivors were assessed and compared with those of the two control groups. χ(2) tests and multiple logistic regression analyses were performed to determine the likelihood and predictors of health behaviors. RESULTS The proportion of cancer survivors who were current smokers, heavy drinkers and engaged in physical activity were 9.6, 6.6 and 26.0%, respectively. Cancer screening rates reported among survivors were 44.2, 17.0, 49.8 and 47.7% for stomach, colorectal, breast and cervical cancers, respectively. Cancer survivors showed lower smoking and alcohol drinking rates compared with both control groups after adjusting for sex, age, marital status, education, household income and health insurance. Cancer survivors also showed stomach, breast and cervical cancer screening rates that differed from both control groups. However, in multiple analyses, these differences were not significant. CONCLUSIONS Cancer survivors are more likely to adopt good health behaviors than individuals without a history of cancer. Further study is needed to determine the factors that lead to continued unhealthy behaviors after cancer diagnosis.

Health-related Quality of Life Among Cancer Survivors in Korea: The Korea National Health and Nutrition Examination Survey

OBJECTIVE The purpose of this study was to investigate the quality of life among cancer survivors compared with individuals without a history of cancer (noncancer controls) using the Korea National Health and Nutrition Examination Survey. METHODS The study subjects were 783 adult cancer survivors and 36 456 noncancer controls who participated in the third, fourth and fifth Korea National Health and Nutrition Examination Survey. Demographic factors, health-related behavior, clinical characteristics and health-related quality of life were assessed with self-reported questionnaires. The EuroQoL-5Dimension was used to evaluate health-related quality of life. Descriptive statistics and multiple regression analysis were used to compare health-related quality of life between cancer survivors and noncancer controls. RESULTS About 67% were women and the mean age of the cancer survivors was 60.9 ± 12.4 years. About 52% of survivors were diagnosed with cancer between 45 and 64 years, and more than half of cancer survivors were diagnosed 5 years or less before the interview. The pain/discomfort dimension was the highest reported problem: 43.6% for cancer survivors. The proportion of any reported problem was significantly higher among cancer survivors compared with noncancer controls in terms of mobility (adjusted odds ratio (aOR), 1.56, 95% confidence interval, 1.24-1.97), usual activities (aOR, 1.45, 95% confidence interval, 1.11-1.89), pain/discomfort (aOR, 1.26, 95% confidence interval, 1.04-1.52) and anxiety/depression (aOR, 1.61, 95% confidence interval, 1.29-2.01). CONCLUSIONS Cancer survivors had a significantly lower quality of life compared with noncancer controls. The pain/discomfort dimension was the highest reported problem in cancer survivors.

Influence of pentobarbital-Na on stimulation-evoked catecholamine secretion in the perfused rat adrenal gland.

Objectives The present study was attempted to investigate the effects of pentobarbital-Na, one of the barbiturates which are known to depress excitatory synaptic transmission in the central nervous system at concentrations similar to those required for the induction and maintenance of anesthesia, on catecholamines (CA) secretion evoked by cholinergic stimulation and membrane-depolarization from the isolated perfused rat adrenal gland, and to clarify the mechanism of its action. Methods Mature male Sprague-Dawley rats were anesthetized with thiopenal-Na(40mg/kg, s.c.). The adrenal gland was isolated by the methods of Wakade. A cannula used for perfusion of the adrenal gland was inserted into the distal end of the renal vein. The adrenal gland was carefully removed from the animal and placed on a platform of a leucite chamber. Results The perfusion of pentobarbital-Na(30–300uM) into an adrenal vein for 20 min produced relatively dose-dependent inhibition in CA secretion evoked by ACh(5.32mM) DMPP(100uM for 1 min), McN-A-343(200uM for 2 min), Bay-K-8644(10uM) and high potassium(56mM), while it did not affect the CA secretion of cyclopiazonic acid(10uM). Also, in the presence of thiopental-Na (100uM), CA secretory responses evoked by ACh, DMPP, McN-A-343 and high K+ were markedly depressed. Moreover, in adrenal glands preloaded with ketamine(100uM for 20 min), which is known to be a dissociative anesthetic, CA secretion evoked by ACh, DMPP, McN-A-343 and high K+ were significantly attenuated. Conclusion Taken together, these experimental results suggest that pentobarbital-Na depresses CA release evoked by both cholinergic stimulation and membrane-depolarization from the isolated rat adrenal medulla and that this inhibitory activity may be due to the result of the direct inhibiton of Ca++ influx into the chromaffin cells without any effect on the calcium mobilization from the intracellular store.

Colon perforation during sorafenib therapy for advanced hepatocelluar carcinoma. A case report.

There are no effective conventional systemic cytotoxic therapies for patients with unresectable or advanced hepatocellar carcinoma (HCC). Sorafenib, an oral multi-targeted tyrosine kinase inhibitor, was recently approved for the treatment of patients with HCC. Sorafenib is generally well tolerated and has an acceptable toxicity profile.Gastrointestinal perforation is a rare adverse event. We present a case of transverse colon perforation during sorafenib therapy for advanced HCC. A 68-year-old woman with advanced HCC was treated with sorafenib. Eight weeks later the patient presented with the sudden onset of sharp abdominal pain. Emergency surgery was performed for panperitonitis and a perforation involving the transverse colon.

Soluble transferrin receptor-ferritin index and estimated body iron in iron-deficiency anemia in “select” chronic diseases

Dear Editor, This paper reports valuable parameters, soluble transferrin receptor-ferritin index (sTfR-F) and estimated body iron (EBI), to make the diagnosis of iron deficiency anemia (IDA) in chronic diseases. Based on the textbook definition [1], anemia of chronic diseases do not include anemia caused by bone marrow replacement, blood loss, renal failure, hepatic diseases, hemolysis, and endocrine deficiencies and so those diseases were excluded in this study. In addition, to obtain a high efficiency in detecting IDA from chronic diseases, the patients were limited to those with “select” chronic diseases excluding pernicious anemia, parvovirus B19, and hematologic malignancies. The “select” chronic diseases were arbitrary made for this study. Those patients were admitted to Chosun University Hospital. One hundred seventy-seven patients with select chronic diseases, including 27 patients with chronic infections, 71 patients with chronic diseases, and 79 patients with non-hematologic malignancies, were studied. The male– female ratio was variable and the ages ranged from 18– 81 years. All patients were divided into three disease groups according to the criteria for anemia and IDA (below described). Thus, there were 48 patients with non-anemic state in select chronic diseases (NAsCD group), 110 patients with anemia of select chronic diseases (AsCD group), and 19 patients with IDA in select chronic diseases (IDA-sCD group). The criterion for anemia was a hemoglobin 17%, and concurrent microcytic hypochromic RBC with anisocytosis on the peripheral blood smear. The patients were further divided into four iron status groups according to the grade of iron granules in bone marrow particles as follows: increased iron group showing many iron granules, adequate iron group showing some iron granules, decreased iron group showing a few iron granules, and deficient iron group showing no iron granules. The numbers of patients in the deficient iron group were three (6.25%) of 48 patients in NAsCD, 11 (10.0%) of 110 patients in AsCD, and 18 (94.74%) of 19 patients in IDA-AsCD (Table 1). Hematologic parameters (Hb and CHr), serum ferritin, and sTfR were determined on an ADVIA 120 automated hematology analyzer (Siemens, Tarrytown, NY, USA), an Axsym analyzer (Abbott Laboratories, Abbott Park, IL, USA), and a BNII nephelometer (Dade Behring, Marburg, Germany), Ann Hematol (2009) 88:913–915 DOI 10.1007/s00277-008-0668-4

Deferasirox plus ciprofloxacin combination therapy after rapid diagnosis of Vibrio vulnificus sepsis using real-time polymerase chain reaction

We report a case of Vibrio vulnificus sepsis developed during deferoxamine therapy for transfusional iron overload due to secondary hemochromatosis of myelodysplastic syndrome. The patient was treated with adjuvant deferasirox in combination with ciprofloxacin, after rapid diagnosis of V. vulnificus sepsis using real-time polymerase chain reaction (PCR). This case suggests that since V. vulnificus DNA can be detected by real-time PCR for several days even after patients receive antibiotics, real-time PCR for V. vulnificus is a very useful test for establishing an early diagnosis, even if a patient has been treated with antibiotics prior to admission.

Spontaneous tumor lysis syndrome with resolution of pancytopenia and disappearance of lymphadenopathy in a patient with peripheral T cell lymphoma unspecified

Tumor lysis syndrome is a well-described, serious complication of chemotherapy administered to treat malignancies. However, a very rare event resulting in the spontaneous necrosis of a tumor prior to therapy can also occur, which is termed spontaneous tumor lysis syndrome (STLS). We present a case of a 27-year-old male who presented to the hospital with epistaxis, dyspnea, and cervical lymphadenopathy. Laboratory findings included progressive pancytopenia, hyperuricemia, and acute renal failure. Bone marrow biopsy showed a T cell lymphoid neoplasm that had entirely infiltrated the marrow stroma. The patient was diagnosed with STLS in the setting of a T cell lymphoma with bone marrow infiltration. The patient was immediately treated with a blood transfusion and hemodialysis. After this urgent treatment, the patient’s pancytopenia resolved and the lymphadenopathy disappeared spontaneously. One month post-treatment, the patient’s cervical lymphadenopathy recurred and peripheral T cell lymphoma, not otherwise specified, was confirmed. STLS has previously been reported, however, most known cases of STLS did not show a decreased tumor burden resulting from massive tumor cell death. We present a rare case of STLS with resolution of pancytopenia and disappearance of lymphadenopathy in a patient with peripheral T cell lymphoma not otherwise specified.

Chronic eosinophilic leukemia with 46,XY,1,der(1;7)(q10;p10) translocation.

Chronic eosinophilic leukemia (CEL) is a rare hematologic malignancy difficult to distinguish from hypereosinophilic syndrome (HES). If a clonal cytogenetic abnormality is detected, then it is diagnostic of CEL [1]. We report the first case of a patient with CEL with 46,XY,1,der(1;7) (q10;p10) translocation. A 58-year-old Korean man had already been treated in 1990 for rectal cancer with only surgical resection. The patient complained of nonproductive cough in April 2002, and pneumonia was diagnosed. At the time of diagnosis, leukocytosis with eosinophilia was also revealed. Physical examination showed mild hepatosplenomegaly. The WBC count was 38,000 mm, with eosinophils 21,000 mm; Hb was 14.3 g/dl and platelets 222,000 mm. Examination of bone marrow (BM) aspiration showed 90–95% cellularity with 35% eosinophils and without excess of blasts. Chromosome analysis of BM showed 46,XY,1,der(1;7) (q10;p10) translocation in the metaphases analyzed (Fig. 1), whereas Philadelphia chromosome specific for chronic myelogenous leukemia was not detected. The echocardiogram showed no evidence of eosinophilic infiltration. Gastroduodenoscopy and biopsy revealed early gastric cancer. Colonoscopy showed no evidence of recurrent rectal cancer. The results of chest computed tomography scan revealed pneumonic infiltration on the right upper lung field and thrombosis of the descending aorta. On the basis of the BM and cytogenetical abnormality, the patient was diagnosed as having CEL, rather than HES, or reactive eosinophilia due to rectal or gastric cancer. His CEL with pneumonic infiltration was treated with hydroxyurea and α-interferon. Thereafter, WBC count decreased to 5060 mm (eosinophil count 3000 mm), and cough and pneumonic infiltration improved. He is on anticoagulant therapy for thrombosis. Numerous cytogenetic abnormalities, including trisomy 8, isochromosome 17, monosomy 7, and translocations involving the long arm of chromosome 5 have been described [2, 3]. Some cytogenetical abnormalities are frequently found, especially aberration of the long arm of chromosome 5, where genes implicated in eosinophilopoiesis are located such as interleukin-5. A recent review by Cools described that about half of HES cases harbor the FIP1P1–PDGFRA fusion gene and that these are clonal in origin and should be reclassified as CEL [4, 5]. The cytogenetical finding in our patient is a 46,XY,1,der(1;7) (q10;p10). To our knowledge, this is the first case report of CEL with 46,XY,1,der(1;7)(q10;p10).