Evaluation of Kanto Cica Liquid Reagents for Chemistry Analyzer / 임상검사와정도관리

BACKGROUND: Many reagents have been developed along with advances in chemistry auto analyzer. Deciding on an appropriate reagent is required for an accurate test, diagnosis and efficient laboratory management. We evaluated Cica Liquid reagent produced by Kanto chemical corporation (Tokyo, Japan) for checking reagent ability. METHODS: Twelve chemistry reagents (AST, ALT, ALP, glucose, BUN, creatinine, total bilirubin, direct bilirubin, cholesterol, triglyceride, iron, magnesium) were tested on precision, linearity, interference, and correlation. We have evaluated using Hitachi 7600 (Hitachi High Technologies co., Japan) chemistry auto analyzer in accordance with the CLSI guidelines EP5-A, EP6-A, EP7-A, EP9-A2. EP_Suite (Marchem Associates Inc., USA) and SPSS ver. 11.0 (SPSS Inc., USA) were used for statistics. RESULTS: Precision results were satisfactory to CLIA '88 in all of the analytes except for ALP and magnesium. The linearity was satisfactory in measurement ranges as all analytes showed linearity in polynomial regression result or relative nonlinearity of less than 2.5%. Coefficients of correlation were above 0.985 in all analytes except for direct bilirubin and magnesium. When interference test results were compared with criteria of CLIA '88, low level of AST was positively interfered by hemoglobin and magnesium was negatively interfered by bilirubin. CONCLUSIONS: In conclusion, the Kanto Cica Liquid reagents are valuable in clinical laboratory, since they showed good precision, linearity, and correlation with other reagents.

Study on the Prevalence of Coronary Heart Disease and Albuminuria in Type 2 Diabetic Patients / 대한신장학회잡지

There are opinions that microalbuminuria acts as an independent risk factor for cardiovascular diseases, related to other risk factors such as endothelial cell dysfunction, hypertension, insulin resistance, obesity, hyperlipidemia and platelet aggregation dysfunction in diabetic and non-diabetic patients. We examined the prevalence of microalbuminuria and macroalbuminuria and the relationship of microalbuminuria and macroalbuminuria to coronary heart disease in type 2 diabetic patients. Out of 798 type 2 diabetic patients who were hospitalized at Yonsei medical center from Oct. 1997 to Feb. 1999, we studied 181 patients who had normal renal function and were examined 24 hour urine albumin excretion. According to the amount of urine albumin excretion, 181 patients were categorized into three groups; normoalbuminuria(less than 30mg/24hour), microalbuminuria(30-300mg/24hour) and macroalbuminuria (more than 300mg/24hour). Patients were tested using treadmill test, stress thallium scan, echocardiography, and coronary angiography for the evaluation of coronary heart disease. The freguency of normoalbuminuria, microalbuminuria, and macroalbuminuria in our patients were 50.3%(91/181), 30.9%(56/181), and 18.3%(34/181), respectively. In each group, the prevalence of hypertension were 42.5%, 78.5%, and 82.3%, respectively and the prevalence of cardiovascular disease were 24.7%, 50.0%, and 46.0%, respectively. Microalbuminuria and macroalbuminuria groups showed statistically significant differences in the prevalence of hypertension and coronary heart disease compared with normoalbuminuria group(p<0.05). In addition, the prevalence of diabetic retinopathy were 37.3%, 58.9%, and 55.8%, respectively and microalbuminuria and macroalbuminuria groups showed statistically significant differences in the prevalence of diabetic retinopathy compared with normoalbuminuria group(p<0.05). We conclude that microalbuminuria and macroalbuminuria is a strong predictor of coronary heart disease in patients with type 2 diabetes.

A Case of Liddle Syndrome Associated with Torsades de pointes / 대한신장학회잡지

Liddle syndrome is a rare cause of hypokalemic hypertension and caused by renal tubular sodiurn channel defect resulting in excessive sodium absorption, potassium wasting and metabolic alkalosis. Clinically this syndrome resembles the primary aldosteronism, however, aldosterone and renin secretion are markedly suppressed due to chronic state of volume expansion. This syndrome is transmitted in an autosomal dominant pattern. We have experienced a case of Liddle syndrome, a 74 years old female accompanying severe hypokalemia, long-standing hypertension, metabolic alkalosis and suppressed aldosterone and renin level in serum and urine. She had a history of arrhythmia, torsades de pointes, of unknown cause. We believe that the arrhythmia resulted from severe hypokalemia secondary to this syndrome. Two of her siblings died suddenly, probably from cardio-, cerebrovascular accidents. Five her offspring needed to be evaluated for this syndrome due to its autosomal dominant inheritance. Endocrinologically there was no clue for us to seek other diseases of enzyme deficiency needed in aldosterone synthesis. Once the diagnosis of Liddle syndrome was suspecti, we treated her with amiloride 5mg/day for several days. Thereafter metabolic abnormalities including persistent hypertension, not responded to conventional parenteral potassium replacement and antihypertensive drugs, were reversed and normalized until now. We believe that in some of patients of secondary hypertension of unknown cause, Liddle syndrome should be ruled out, and that the incidence of this syndrome has been underes- timated due to lack of suspicion.

A Case of Pulmonary Eosinophilic Granuloma in a Passive-Smoking Reproductive Female / 결핵

Pulmonary eosinophilic granuloma, a rare form of Langerhans cell histiocytosis confined to lung, has no known etiology and variable natural history. It is characterized by discrete proliferation of Langerhans cells. It is known that over 90% of the patients are cigarette smokers, and it is rarely reported in non- or passive-smoking patients, especially female. Here we describe a case of pulmonary eosinophilic granuloma in a passive-smoking, reproductive female patient presented with spontaneous pneumothorax. We identified S-100 and CDla positive histiocytes on immunohistochemical stain of the lung tissue obtained by open lung biopsy.