The Effect of Epigallocatechin-3-gallate on HIF-1alpha and VEGF in Human Lung Cancer Cell Line / 결핵및호흡기질환

BACKGROUND: Epigallocatechin-3-gallate (EGCG) is the major catechin in green tea, and has shown antiproliferative, antiangiogenic, antimetastatic and cell cycle pertubation activity in various tumor models. Hypoxia can be induced because angiogenesis is insufficient for highly proliferating cancer. Hypoxia-inducible factor-1alpha (HIF-1alpha) and its downstream target, vascular endothelial growth factor (VEGF), are important for angiogenesis, tumor growth and metastasis. The aim of this study was to determine how hypoxia could cause changes in the cellular phenomena and microenvironment in a non-small cell culture system and to examine the effects of EGCG on a HIF-1alpha and VEGF in A549 cell line. METHODS: A549 cells, a non-small cell lung cancer cell line, were cultured with DMEM and 10% fetal bovine serum. A decrease in oxygen tension was induced using a hypoxia microchamber and a CO2-N2 gas mixture. Gas analysis and a MTT assay were performed. The A549 cells were treated with EGCG (0, 12.5, 25, 50 micromol/L), and then examined by real-time-PCR analysis of HIF-1alpha, VEGF, and beta-actin mRNA. RESULTS: Hypoxia reduced the proliferation of A549 cells from normoxic conditions. EGCG inhibited HIF-1alpha transcription in A549 cells in a dose-dependent manner. Compared to HIF-1alpha, VEGF was not inhibited by EGCG. CONCLUSION: HIF-1alpha can be inhibited by EGCG. This suggests that targeting HIF-1alpha with a EGCG treatment may have therapeutic potential in non-small cell lung cancers.

Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia / 결핵및호흡기질환

BACKGROUND: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. METHODS: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. RESULTS: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were 10.58 dollars for multiple-use, open suction, 28.27 dollars for single-use, open suction and 23.76 dollars for multiple-use, closed suction. CONCLUSION: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.

A Case of Empyema and Mediastinitis by Non-typhi Salmonella / 결핵및호흡기질환

There are few reports of the pleuropulmonary involvement of a non-typhi Salmonella infection in immunocompromised patients with AIDS, malignancy, collagen vascular diseases, extended use of corticosteroids, sickle cell disease, or diabetes. We report a case of a non-immunocompromised patient who presented with concomitant empyema and mediastinitis due to Salmonella without a comorbid disease. A 26-year-old male patient, with a history of pneumonia 5 years earlier and having lived abroad for several years, presented chronic cough and febrile sensation. Pneumonia, empyema and mediastinitis were noted in a chest CT scan and Salmonella enteritidis and beta-hemolytic streptococcus were identified from a culture of the pleural fluid. Initially, he was treated with cefepime, metronidazole and clarithromycin. He was cured clinically and radiographically after an 8 week treatment with antibiotics. In conclusion, this report suggests that S. enteritidis can cause empyema and mediastinitis, albeit rarely.

Microenvironments and Cellular Proliferation Affected by Oxygen Concentration in Non-Small Cell Lung Cancer Cell Line / 결핵및호흡기질환

BACKGROUND: Abnormal angiogenesis can induce hypoxia within a highly proliferating tumor mass, and these hypoxic conditions can in turn create clinical problems, such as resistance to chemotherapy. However, the mechanism by which hypoxia induces these changes has not yet been determined. Therefore, this study was conducted to determine how hypoxia induces changes in cell viability and extracellular microenvironments in an in vitro culture system using non-small cell lung cancer cells. METHODS: The non-small cell lung cancer cell line, A549 was cultured in DMEM or RPMI-1640 media that contained fetal bovine serum. A decrease in the oxygen tension of the media that contained the culture was then induced in a hypoxia microchamber using a CO2-N2 gas mixture. A gas analysis and an MTT assay were then conducted. RESULTS: (1) The decrease in oxygen tension was checked the anaerobic gas mixture for 30 min and then reoxygenation was induced by adding a 5% CO2-room air gas mixture to the chamber. (2) Purging with the anaerobic gas mixture was found to decrease the further oxygen tension of cell culture media. (3) The low oxygen tension resulted in a low pH, lactic acidosis and a decreased glucose concentration in the media. (4) The decrease in glucose concentration that was observed as a result of hypoxia was markedly different when different types of media were evaluated. (5) The decrease in oxygen tension inhibited proliferation of A549 cells. CONCLUSION: These data suggests that tumor hypoxia is associated with acidosis and hypoglycemia, which have been implicated in the development of resistance to chemotherapy and radiotherapy.

Diagnostic Value of ADA Multiplied by Lymphocyte to Neutrophil Ratio in Tuberculous Pleurisy / 결핵및호흡기질환

BACKGROUND: Many diagnostic approaches for defining the definitive cause of pleurisy should be included due to the large variety of diseases resulting in pleural effusion. Although ADA is a useful diagnostic tool for making a differential diagnosis of pleural effusion, particularly for tuberculous pleural effusion, a definitive diagnostic cut-off value remains problematic in Korea. It was hypothesized that ADA multiplied by the Lymphocyte/Neutrophil ratio(L/N ratio) might be more powerful for making a differential diagnosis of pleural effusion. METHODS: One hundred and ninety patients, who underwent thoracentesis and treatment in Chung-Ang University Hospital from January, 2005 through to February 2006, were evaluated. The clinical characteristics, radiologic data and the examination of the pleural effusion were analyzed retrospectively. RESULTS: 1. Among the 190 patients, 59 patients (31.1%) were diagnosed with tuberculous pleurisy, 45 patients(23.7%) with parapneumonic effusion, 42 patients(22.1%) with malignant effusions, 36 patients(18.9%) with transudate, and 8 patients(4.2%) with empyema. One hundred and twenty one patients were found to have an ADA activity of 1 to 39 IU/L(63.7%). Twenty-nine were found to have an ADA activity of 40 to 75 IU/L(15.3%) and 40 were found to have an ADA activity of 75 IU/L or greater(21.0%). 2. Among the patients with tuberculous pleurisy, 5(8%), 18(30%) and 36 patients(60%) had an ADA activity ranging from 1 to 39 IU/L, 40 to 75 IU/L, and 75 IU/L or greater, respectively. In those with an ADA activitiy 40 to 75 IU/L, 18 patients(62%) had tuberculous pleurisy, 9(31%) had parapneumonic effusion and empyema, and 1(3.4%) had a malignant effusion. 3. In those with an ADA activity of 40 to 75 IU/L, there was no significant difference between tuberculous pleurisy and non-tuberculous pleural effusion(tuberculous pleurisy : 61.3 +/- 9.2 IU/L, non-tuberculous pleural effusion : 53.3+/-10.5 IU/L). 4. The mean L/N ratio of those with tuberculous pleurisy was 39.1 +/- 44.6, which was significantly higher than non- tuberculous pleural effusion patients (p<0.05). The mean ADA x L/N ratio of the tuberculous pleurisy patients was 2,445.7 +/- 2,818.5, which was significantly higher than the non-tuberculous pleural effusion patients (level p<0.05).5. ROC analysis showed that the ADA x L/N ratio had a higher diagnostic value than the ADA alone in the group with an ADA between 40-75 IU/L. CONCLUSION: The ADA multiplied by the lymphocyte-to-neutrophil ratio might provide a more definitive diagnosis of tuberculous pleurisy.

Immunohistochemical Study of C-erbB-2 and VEGF Expression in Non-Small Cell Lung Cancer / 결핵및호흡기질환

BACKGROUND: Mutated or deregulated expression of C-erbB-2 causes this gene to function as a potent oncogene. Vascular endothelial growth factor (VEGF) is a crucial angiogenic molecule in lung cancer. Both C-erbB-2 and VEGF can promote growth, proliferation and metastasis in non-small cell lung cancer (NSCLC). The purpose of this study was to investigate evaluate the relationship between the expressions of the C-erbB-2 and VEGF genes using immunohistochemistry. MATERIALS AND METHODS: Ninety-five patients with NSCLC were involved (60 squamous cell carcinoma and 35 adenocarcinoma). The formalin-fixed paraffin embedded specimens were immunohistochemically stained for C-erbB-2 and VEGF using the avidin-biotin complex method. RESULTS: Positive C-erbB-2 expression was observed more often in adenocarcinomas than squamous cell carcinomas (p<0.05). Although the immunohistochemical expressions of C-erbB-2 and VEGF in non-small-cell lung cancer showed increased tendencies at an advanced stage, the correlation between early and advanced cancers was insignificant. In adenocarcinomas, the expressions of VEGF and C-erbB-2 were significantly (p<0.05). CONCLUSION: The overexpression fo C-erbB-2 was significantly higher in adenocarcinomas than squamous cell carcinomas, and correlated with the expression of VEGF in adenocarcinomas of the lungs.

The Clinical Manifestation of Pulmonary Infection in AIDS Patients / 결핵및호흡기질환

BACKGROUND: In AIDS patients, the respiratory tract is one of the most frequently involved site of by an opportunistic infection, and an even common, casual pulmonary infection manifests in a peculiar ways in AIDS patients. In Korea, because of the low prevalence of AIDS, there is insufficient data compared with other Southeast Asian counties. However, considering the sexual behavior of the younger generation, it is expected that it will not be long before AIDS becomes a major public health issue in Korea. This study examined the clinical manifestation of HIV positive people and AIDS patients. The pulmonary manifestion of HIV-positive was evaluated. This study focused on the differences in the clinical manifestation between AIDS patients with pulmonary disease and simple HIV positive people. The characteristics of common pulmonary infections in AIDS patients were also analyzed. METHOD: The medical records of 28 HIV positive patients who visited the hospital of ChungAng University Hospital from January, 2001 to February, 2006 were analyzed retrospectively. RESULT: Twenty-seven patients out of 28 HIV positive patients were male and the average age was 40.6(23-65). Patients in their thirties were most commonly affected. Elven patients had pulmonary diseases. Pulmonary tuberculosis (4 cases) and pneumocystis pneumonia (4 cases) were the most common respiratory infection. One patient showed a peculiar type of systemic cryptococcus. which was accompanied by lung and pleural dissemination. The CD4+lymphocyte count of patients with a pulmonary infection was significantly lower in patients with a pulmonary manifestation than those with only a HIV infection (79.5/mm3 vs 400/mm3, respectively)(p<.05). Patients with pulmonary disease were in a more severe immunosuppressive state. There were 4 patients with pulmonary tuberculosis, 4 with pneumocystis pneumonia, 4 with secondary syphilis, 2 with primary syphilis, and 2 with HZV infection. The average CD4 lymphocyte counts was 56/mm3 in those with pulmonary tuberculosis, 42/mm3 in those with pneumocystis pneumonia, and 455/mm3 in those with secondary syphilis. CONCLUSION: This study examined the clinical manifestation of HIV positive patients, particularly AIDS patients with pulmonary disease, A more severe immunosuppressive status was observed in HIV-related pulmonary compared with those with HIV-related extrapulmonary disease, and the frequency of pulmonary tuberculosis in pulmonary disease was higher than expected. Respiratory infection in AIDS manifest in uncommon ways e.g. disseminated cryptococcosis involving the lung and pleura. Evidently, AIDS patients with a respiratory infection have a more severe form of immunosuppression than those with a simple HIV infection. As expected, patients with a pulmonary infection were in a more severe immunosuppressed state than those with a simple HIV infection. Opportunistic infections can show peculiar clinical presentations in AIDS patients.

Risk Factors for Mortality in Community-Acquired Pneumonia Patients Admitted to a Referral Hospital / 결핵및호흡기질환

BACKGROUND: Pneumonia is the most common cause of death among infectious diseases with community-acquired pneumonia being the sixth leading cause of death in the USA. In Korea, several studies have evaluated the prognosis of community-acquired pneumonia with a limited number of patients and risk factors. This study, evaluated all the possible risk factors (including the pneumonia severity index; PSI) in for the community-acquired pneumonia patients admitted to a referral hospital. METHODS: The medical records of patients admitted to the Chung-Aug University Yongsan Hospital between January 2002 and January 2005 for community-acquired pneumonia were reviewed retrospectively. The demographic data, comorbidity, radiographic findings and laboratory results which might influence the prognosis of pneumonia were analyzed. RESULTS: Among 179 patients admitted for community-acquired pneumonia, 29 patients died (mortality 16%). The risk factors for mortality in the comorbidity category were congestive heart failure and a myocardial infarction. The laboratory data, showed that albumin, LDH, total cholesterol, HDL, PT, aPTT, hemoglobin and blood urea nitrogen (BUN) were related to the prognosis. For the pneumonia severity index, the mortality rate increased in a step-wise manner from class I through class V. CONCLUSIONS: Comorbidities such as congestive heart failure and myocardial infarction as well as the albumin, LDH, total cholesterol, HDL cholestreol, prothrombin time, activated partial thrombotin time, hemoglobin and blood urea nitrogen(BUN) are important risk factors for mortality in patients with community-acquired pneumonia. PSI is a valuable index for evaluating the prognosis of community-acquired pneumonia.

Clinical implication of Dendritic Cell Infiltration in Cervical Tuberculous Lymphadenitis / 결핵및호흡기질환

BACKGROUND: Cervical tuberculous lymphadenopathy is a very common disease with a similar incidence to pulmonary tuberculosis. Dendritic cells play a role of initial antigen presentation of this illness. Nevertheless, the precise role of these antigen-presenting cells according to the clinical features in unclear. The aim of this study was to determine the clinical implication of dendritic cell infiltration in the cervical lymph nodes. METHODS: A review of the clinical characteristics was carried out retrospectively based on the clinical records and radiography. Immunohistochemical staining was performed on the available histology specimens of 72 cases using the S-100b polyclonal antibody for dendritic cells. The number of dendritic cells with tuberculous granuloma were determined. A x2 test, unpaired T test and multiple logistic regression analysis were performed. RESULTS: Thirty percent of subjects had previous or concurrent pulmonary TB. Twenty one percent of cases showed a positive reaction on the AFB stain. Within a granuloma, the number of infiltrated dendritic cells was 113.0+/-7.0. The incidence of fever and cough decreased with increasing infiltration of dendritic cells Multivariate regression analysis showed that the infiltration of dendritic cells could significantly contribute to fever. CONCLUSION: Overall, dendritic cells can control a Mycobacterium tuberculosis infection and modulate the immune response, as well as resolve the clinical manifestations of TB lymphadenopathy.

Detection of Serum Anti-p53 Antibodies and Their Significance in Patients with Colorectal Cancer / 대한진단검사의학회지

BACKGROUND: Mutations of the tumor suppressor gene p53 cause subsequent cellular accumulation of p53 gene product and a specific immunologic response. Detection of circulating antibodies against p53 protein has been evaluated for a tumor marker or prognostic factor for several cancers including those of the breast, stomach, ovary and lung. METHODS: Serum samples from 74 colorectal cancer patients were obtained preoperatively and anti-p53 antibody was measured by enzyme immunoassay (Anti-P53 ELISA II: PharmaCell, France). Carcinoembryonic antigen (CEA) and Carbohydrate antigen (CA) 19-9 were measured in parallel. Tissue p53 protein expression was examined by immunohistochemical staining. RESULTS: Anti-p53 antibodies were positive in the serum from 34% (25/74) of patients, but normal controls were all negative. Anti-p53 antibodies were significantly associated with p53 protein overexpression. CEA and CA19-9 were detected in 38% and 11%, respectively. There was no correlation among anti-p53 antibody, CEA and CA19-9. No differences were found between the anti-p53 antibody positive and negative groups in the following parameters: tumor site, histologic grades, Dukes stages, margin invasion, vessel invasion, lymph node and distant metastasis, and survival duration. CONCLUSIONS: The measurement of serum anti-p53 antibody is not suitable for preoperative markers of prognostic significance, but can be used as a simple serological marker for detection of p53 alteration. There should be more studies of the serum p53 antibody as a possible marker for postoperative monitoring in colorectal cancer.

Multi-center Study on Cost Effectiveness of Anti-Tuberculosis Drug Susceptibility Test

BACKGROUND: The anti-mycobacterial susceptibility test is performed on only a small percentage of clinical isolates in Korea. The aim of this study is to propose an anti-mycobacterial susceptibility testing scheme, which is not only economic and practical but also fully informative to physicians. MATERIALS AND METHODS: The anti-mycobacterial susceptibility test results of 502 strains, isolated from five university-affiliated hospitals, were analysed. The interpretation of the results and the need for second-line drug susceptibility test were judged according to the recommendation of NCCLS M24-A guidelines. RESULTS: The isolates from 10% (38/363) of treatment-navie patients and 61% (85/139) of re- treatment patients showed resistance to at least one of the anti-mycobactial agents; 3% (11/363) and 44% (61/139) of isolates from each group were multi-drug resistant. According to the recommendation by NCCLS, the percentage of patients not needing the susceptibility test results for second-line drugs were 96% for treatment-naive and 47% for re-treatment patients. CONCLUSION: Since the susceptibility test against first-line drug is sufficient for 95% of treatment- navie patients with tuberculosis patients, susceptibility test against second-line drugs may be performed only when it is necessary. As for the re-treatment patients with tuberculosis, susceptibility test for both first-line and second-line drugs should be performed simultaneously.

Multi-center Study on Cost Effectiveness of Anti-Tuberculosis Drug Susceptibility Test

BACKGROUND: The anti-mycobacterial susceptibility test is performed on only a small percentage of clinical isolates in Korea. The aim of this study is to propose an anti-mycobacterial susceptibility testing scheme, which is not only economic and practical but also fully informative to physicians. MATERIALS AND METHODS: The anti-mycobacterial susceptibility test results of 502 strains, isolated from five university-affiliated hospitals, were analysed. The interpretation of the results and the need for second-line drug susceptibility test were judged according to the recommendation of NCCLS M24-A guidelines. RESULTS: The isolates from 10% (38/363) of treatment-navie patients and 61% (85/139) of re- treatment patients showed resistance to at least one of the anti-mycobactial agents; 3% (11/363) and 44% (61/139) of isolates from each group were multi-drug resistant. According to the recommendation by NCCLS, the percentage of patients not needing the susceptibility test results for second-line drugs were 96% for treatment-naive and 47% for re-treatment patients. CONCLUSION: Since the susceptibility test against first-line drug is sufficient for 95% of treatment- navie patients with tuberculosis patients, susceptibility test against second-line drugs may be performed only when it is necessary. As for the re-treatment patients with tuberculosis, susceptibility test for both first-line and second-line drugs should be performed simultaneously.

Evaluation of FAN-aerobic Blood Culture Bottle in BacT/Alert3D System / 대한임상미생물학회지

BACKGROUND: This study was designed to evaluate the performance of FAN-aerobic bottles (FANA) in comparison with standard-aerobic bottles (STD-A) in BacT/Alert3D blood culture system. METHODS: A total of 596 pairs of blood cultures, submitted from Emergency Department of Pusan National University Hospital between July and December 2004, were evaluated. In addition to the routine blood culture protocol using standard blood culture bottles, 5 ml of blood samples was inoculated into FAN-A bottles for this study. RESULTS: Microorganisms were grown in 84 (14.1%) of 596 cultures; of those, 15 were positive in STD-A only (2.5%), 35 in FAN-A only (5.9%), and 34 in both (5.7%). The positive rate in FAN-A bottles was significantly higher than that in STD-A bottles (P<0.001). The species of isolates and detection time showed no difference between the blood culture bottles. CONCLUSION: In the BacT/Alert3D blood culture system, the use of FAN-A bottles instead of the standard aerobic bottles should yield a higher positive rate.

Serum Anti-p53 Antibodies and p53 Protein Expression and Their Prognostic Relevance in Patients with Gastric Cance / 대한진단검사의학회지

BACKGROUND: Several cancer patients have developed antibodies that recognize the overexpressed p53 protein. In some tumor types, the presence of these antibodies is associated with a poor prognosis. Gastric cancer is a highly prevalent disease associated with a high mortality rate, so there is a need for improved serological markers for disease detection and disease behavior. METHODS: To evaluate the clinical relevance of anti-p53 antibodies and tissue p53 protein expression in gastric cancer, we investigated the presence of serum anti-p53 antibodies in 61 gastric cancer patients, using two enzyme-linked immuno-sorbent assay systems (Dianova p53-autoantibodies ELISA Kit, Hamburg, Germany (A); Pharma Cell Anti-p53 ELISA Kit II, Paris, France (B)), and p53 protein expression was immunohistochemically stained. RESULTS: We have detected serum anti-p53 antibodies in 9.8% (6/61), 18.0% (11/61) of gastric cancer patients before operation by using the A and B kit, respectively, but in none of 21 cancer-free individuals. The detectable expression of p53 protein in tissue was recognized in 49.2% (30/61) of gastric cancer patients, and in 100% (6/6) and 72.7% (7/11) of the patients with anti-p53 Ab by using the A and B kit. The presence of anti-p53 antibodies was significantly associated with high tumor stages, lymph node metastasis, advanced cancers, intestinal histological type, larger tumor size and infiltrating type, and short survival. The overexpression of the p53 protein was significantly associated with large sized tumors, advanced cancers, high tumor stage (III, IV), lymph node metastasis, distant metastasis, early death and high recurrence rate, and short survival. A positive rate for gastic CONCLUSIONS: We have shown that anti-p53 antibodies are closely related to p53 protein overexpression in tumor tissues and could be useful not only as a predictor of an unfavorable prognosis before operation, but also as a serological tumor marker for an increase in the detection rate of gastric cancer by a combination assay with anti-p53 antibodies, CEA and CA 19-9, although not as a screening test.

Molecular Strain Typing of Legionella Isolates from Water in Cooling Towers of Big Buildings in Busan, Korea / 대한임상미생물학회지

BACKGROUND: It is important to define a source of infection when outbreak of Legionella infections has occurred. The performance of a molecular strain typing method was evaluated for environmental and clinical isolates of Legionella pneumophila. METHODS: Thirteen environmental strains, eleven clinical isolates and one type strain (ATCC 33152) of Legionella pneumophila were used for the analysis of pulsed field gel electrophoresis. RESULTS: All 25 strains were discriminated into 21 types. Two strains isolated from different locations in a same building showed different types. Each two, four, and two strains were shown as the same PFGE patterns. CONCLUSIONS: Even though PFGE typing of Legionella pneumophila is excellent for strain differentiation, the same pattern does not necessarily indicate the same source of isolates.

The Clinical Significance of Antibody Screening Test Including Di(a+) Panel Cell in Asian-Mongoloid Populations

The Di(a) antigen is well known as one of the antigens with low incidence among Caucasians; however, it has been discovered with a relatively higher incidence among Mongoloid populations. Thus, it has been speculated that the incidence of unexpected antibody against the Di(a) antigen might be relatively higher among these populations. Hemolytic transfusion reactions (HTRs) and hemolytic disease of the newborns (HDNs) caused by anti-Di(a) have been reported sporadically. However, there has been no prospective study on the incidence of anti-Di(a) in Mongoloid populations particularly. The authors conducted a series of antibody screening tests on 11,219 Korean individuals for 25 months, by using three kinds of screening cells including Di(a) cell. Anti-Di(a) was detected in 8 patients, seven of whom had a history of transfusions or were multigravida. The incidence of anti-Di(a) measured in this study was higher than expected, ranked third among unexpected antibodies identified during the period of the study, so it is strongly recommended that the Di(a+) panel cell must be incorporated into antibody screening test for safer transfusion in Asian-Mongoloid populations.

A Case of Extramedullary Plasmacytomas of Posterior Mediastinum, and Gingiva associated with Fulminant Hepatic Failure, which Developed in the Course of Multiple Myeloma / 대한혈액학회지

Multiple myeloma is usually restricted to bone marrow, but extramedullary involvement can occur in the form of plasmacytomas. Several cases of multiple myeloma which developed into mutiple extramedullary involvements have been reported. We report a case of extramedullary plasmacytomas of posterior mediastinum, and gingiva, which developed in the course of mutiple myeloma in a 57-year-old man. The patient progressed to fulminant hepatic failure resulting in rapid fatal outcome.

Evaluation of Diagnostic Utility of Intradermal Test for the Diagnosis of Clonorchis sinensis Infestation / 대한임상미생물학회지

BACKGROUND: The intradermal test for the screening of Clonorchis sinensis is difficult to interpret because the sensitivity and persistence rates of reactions after treatment are not well known. METHODS: Stool egg examinations and intradermal tests for C. sinensis and Paragonimus westermani were performed for 1,207 persons who lived in endemic areas of C. sinensis infestation, and epidemiologic data were also surveyed. RESULTS: The infestation rate of C. sinensis was 12% (male 14%, female 9%). It was higher in Southeastern area of Gyungsang Namdo Province and Ulsan (22%) than in Busan (10%), whereas much higher in Gangseo/Buk/Sasang (28%) than in other areas of Busan. The performance of C. sinensis intradermal test was as belows; sensitivity 45%, specificity 80.8%, positive predictive value 24%, negative predictive value 92%, and diagnostic efficiency 77%. Positive C. sinensis intradermal reaction persisted for longer than 40 years after treatment of C. sinensis infestation in at least 30% of patients. C. sinensis intradermal reaction turned to be positive within 4 months after intake of raw fish in more than half the patients. CONCLUSION: The infestation rate of C. sinensis was still very high in inhabitants around Nakdong River, an endemic area. We think that C. sinensis intradermal test is inadequate to diagnose current clonorchiasis.

A Case of Agammaglobulinemia Detected by ABO Discrepancy in a 13-year-old Girl / 대한진단검사의학회지

We report a case of agammaglobulinemia detected by ABO discrepancy in a 13-year-old girl. At first, she visited Pusan National University Hospital complaining of joint swelling and pain. For trans-fusion, the ABO blood grouping was done. The cell typing was B, but anti-A was not found in the serum with repeated testing. Then, serum protein electrophoresis, immunoelectrophoresis and immunoglob-ulin quantitation showed a markedly decreased level in gamma-globulin. B lymphocyte was less than 1% of peripheral lymphocytes. There were no remarkable abnormal findings in the clinical and laboratory results of her parents. The patient represented an apparent agammaglobulinemia without clinically significant infection for three months. Further follow-up is needed to evaluate the patient.

A Case of Anti-Xga in a Young Man without Previous Transfusion / 대한진단검사의학회지

We report a case of naturally occuring anti-Xga in a 22-year-old man suffering from multiple traumas, who had no past history of transfusion or transplantation. The positive reaction was detected at 37 degrees Cin the antibody screening test with LISS/Coombs card (DiaMed AG, Cressier, Morat, Switzerland), which disappeared at the enzyme phase with the NaCl/Enzyme card (DiaMed AG). The Xga antigen was negative on his red cell surfaces. The unexpected antibody was finally identified as anti-Xga. We found four of twelve units of packed red blood cells that were compatible with the patient's serum. Anti-Xga is a very rare unexpected antibody in Korea, so we need more study in order to determine incidence and the significance of this antibody.