Usefulness of Calcium Injection in Large-volume Leukapheresis / 대한수혈학회지

BACKGROUND: Hypocalcemia is the most common side effect in large-volume leukapheresis (LVL) for collection of peripheral blood stem cells (PBSCs). We evaluated the effect of intravenous calcium infusion on the hypocalcemic symptoms during LVL. METHODS: Seventy-six LVLs with hypocalcemic symptoms were participated in this study. LVLs were performed using Gambro Spectra (blood rate, 80 mL/min; whole blood to ACD-A with heparin, 24:1) until 20 L of blood was processed. Blood flow rate was slowed to 60-70% of initial in 35 LVLs (group A) and 20 mL of 3% CaCl2 was infused intravenously in 41 LVLs (group B). Serum levels of ionized calcium, total magnesium, and electrolytes were determined before and after each LVL and analyzed with students?-test. RESULTS: The observed hypocalcemic symptoms were perioral paresthesias (71%), digital numbness (17%), chest tightness (4%), chills (4%), headache (3%), and vomiting (1%). Serum ionized calcium decreased by 15.9% in group A (P<0.001) and increased by 1.3% in group B. Total magnesium in group A (11.4%, P=0.002) and potassium in both groups (9.5%, P<0.001 and 8.6%, P=0.02, respectively) were significantly reduced. In group A, hypocalcemic symptoms were not completely relieved but weakened in 63%, and blood flow rate had to be kept below 55 mL/min in 37%. In group B, the symptoms were relieved by 20 mL of 3% CaCl2 in 27% and by 40 mL in 73%. CONCLUSION: Reduction of blood flow for relief of hypocalcemia symptoms was only helpful in lightening the symptoms. Intravenous infusion of calcium was more effective and convenient to alleviate hypocalcemic symptoms and did not affect LVL procedures nor serum levels of ionized calcium.

Clinical Significance of Cytoplasmic Staining in Antinuclear Antibody Tests Using HEp-2 Cells / 대한진단검사의학회지

BACKGROUND: Cytoplasmic stainings in antinuclear antibody tests using HEp-2 cells are usually undetermined and the significance has not been fully understood until now. Hence, we evaluated their clinical characteristics and also the coexistence of other autoantibodies in the sera with cytoplasmic stainings in antinuclear antibody tests. METHODS: We reviewed clinical records retrospectively in 53 sera showing cytoplasmic stainings among 3, 610 sera that were tested antinuclear antibodies from January to September, 2002 and performed antimitochondrial antibodies (AMA) tests using indirect immunofluorescence (IIF) and antibodies to antiribosomal P and extractable nuclear antigens (ENA) tests using enzyme immunoassay (EIA). RESULTS: Among 53 sera with cytoplasmic stainings, 31 sera showed an AMA pattern and 15 sera showed an antibody to ribosomal P pattern. Three cytoskeletal and one golgi complex patterns were also observed. The most common diagnosis was autoimmune disorders (32, 60.4%) and hepatic disorders (excluding autoimmune hepatitis) (6, 11.3%). Hepatic disorders including autoimmune, drug-induced, and alcoholic hepatitis were most commonly observed (32.3%) in sera with an AMA pattern. On the other hand, various autoimmune disorders such as SLE, systemic sclerosis, dermatomyositis, and polymyositis were observed (86.7%) in sera with a ribosomal P pattern. Of 31 sera with the AMA pattern, the corresponding antibodies were confirmed in three by IIF and of 15 sera with a ribosomal P pattern, only one was confirmed to have this antibody by EIA. All the confirmed sera showed high titered (>1: 320) cytoplasmic stainings. Antibodies to ENA were positive in sixteen (RnP, 5; Sm, 4; Ro, 5; La, 2) and anti-DNA in three of the sera. CONCLUSIONS: Although cytoplasmic staining patterns are not disease specific, it is suggested that continuous high titer stainings be followed up since they could provide diagnostic help.

The frequency of thiamine deficiency in chronic alcoholics and in patients at a long-term care facility / 대한내과학회지

BACKGROUND: As socioeconomic status has improved, malnutrition has become rare in Korea and generally it is no longer considered as a serious problem in medical practice. However, contrary to the above general belief we managed four patients with beriberi in 1999 and it became apparent that malnutrition might remain a problem in certain groups of patients. In this study, we assessed the nutritional state, especially with respect to thiamine deficiency, in chronic alcoholics and in patients residing at a long-term care facility (LTCF). METHODS: Fourteen chronic alcoholic patients and twenty patients being hospitalized in a long-term care facility were assigned as the study groups. The subjects' mean ages and standard deviations were 48.9+/-10.2 and 50.6+/-6.7, respectively. Medical records were reviewed to determine other aspects of their nutritional status and their dietary patterns. Ten peoples who visited the health promotion center at Inha University Hospital, for routine check-ups were allocated to the control group. Blood total thiamine levels were measured by high-performance liquid chromatography. RESULTS: Body mass indices were significantly lower in chronic alcoholics and in patients at the LTCF than in the control group (p=0.0065). Serum albumin levels were within the reference range in all three groups, but were significantly lower in patients at the LTCF than in the control group (p=0.0013). Moreover, no difference was detected between the alcoholic group and the control group in terms of thiamine levels. However, the mean thiamine level in patients at the LTCF was statistically lower than that of the control group and four (20%) patients in the LTCF group showed subnormal blood thiamine levels. The thiamine level tended to decrease with age in both alcoholics and patients at the LTCF. No correlation was found between thiamine level and the other variables examined, namely, hospital stay, body mass index, and serum albumin level. CONCLUSION: A considerable portion of patients in a long term care facility showed thiamine deficiency, however, no evidence of thiamine deficiency was found among alcoholics. This result suggests that thiamine deficiency in patients at long-term care facility may be more prevalent and that thiamine supplementation may be warranted, especially for those with other thiamine deficiency risk factors.

A case of i Phenotype Siblings with Congenital Cataract / 대한수혈학회지

We report a two-generation Korean family in which 2 siblings have congenital cataract and phenotype i. This report is a first case in Korean people and shows the evidence suggesting the linkage of Ii blood group with a recessive form of congenital cataracts.

Changes of Plasma Lidocaine Concentration with Intravenous Injection in General Anesthesia / 대한마취과학회지

BACKGROUND: Lidocaine is the first amide local anesthetic and used for attenuating cardiovascular responses to endotracheal intubation. This study was conducted to observe changes of plasma lidocaine concentrations and pharmacokinetic parameters of lidocaine in patients who received different doses of lidocaine intravenously. METHODS: 23 adult patients under general anesthesia were divided into 3 groups. Each group patients were received intravenous lidocaine bolus dose of 1, 2, 3 mg/kg, respectively. Serial arterial blood samples were drawn upto 30 minutes and plasma lidocaine levels were determined by immunofluorescence assay. RESULTS: When lidocaine was injected intravenously, peak plasma concentrations measured at 30 seconds were 20.10+/-8.09 microgram/ml, 37.43+/-16.42 microgram/ml and 59.85+/-21.00 microgram/ml respectively on 1, 2, 3 mg/kg lidocaine group. Half-life of lidocaine was not significantly different with increased dose but AUCs(Area Under the Curves) of lidocaine were significantly increased with increased dose (p<0.001). CONCLUSIONS: Overall, plasma lidocaine concentration was reached within 30 secs and peak plasma lidocaine concentration was above 10 microgram/ml in all groups, so systemic toxicity may be developed in all groups. And careful monitoring may be needed until 1, 2, 3 min, respectively because the time when the plasma lidocaine concentrations were reached under 10 microgram/ml is 1, 2, 3 min, respectively.