Cellular Hemoglobin Is a Useful Alternative Parameter when Lipemia Interferes with Hemoglobin Measurement

BACKGROUND: Saline replacement is a difficult and time-consuming procedure employed to measure hemoglobin (Hb) levels when lipaemia interferes with the accurate determination of Hb content. As an alternative method, we tested the reliability of cellular Hb (cHb) measurement. METHODS: Forty-eight lipemic blood samples were analysed with the LH780 (or DxH 800; Beckman Coulter Inc., USA) and ADVIA 2120i (Siemens Healthcare Diagnostics, USA) instruments. We compared the Hb measurements obtained following saline replacement (srHb) with the cHb measurement and with the value of one-third of the hematocrit (1/3Hct). RESULTS: The bias estimate outcomes of cHb with srHb were found to be acceptable at all medical decision points. The average difference between the value of 1/3Hct and initial Hb, srHb, and cHb were 19.7%±3.3%, 2.3%±1.6%, and -0.1%±1.1%, respectively. CONCLUSIONS: cHb measurements may be a feasible alternative to srHb, when lipemia interferes with accurate Hb determinations.

Application of Middleware to Automated Hematology Analyzers / 임상검사와정도관리

BACKGROUND: Test results in a laboratory are simply relayed to the laboratory information system through the interface. Middleware facilitates and manages the interaction between applications across heterogeneous computing platforms. We applied middleware to automated hematology analyzers in a clinical laboratory. METHODS: We used HemLink (Beckman Coulter Korea, Korea) as middleware between the laboratory information system and hematology analyzers. It provides quality control programs including the Westgard multirule chart and moving averages. RESULTS: Unlike the previous system, middleware does not require manual input of the quality control results. Amendment of quality control, if necessary, could be done without the help of hospital information teams. Identification of abnormal results with patient information could be achieved with moving averages. Morphology flags and system flags are checked at remote computers. CONCLUSIONS: Management of quality control results of hematology analyzers was easy via middleware. Thus, middleware could be useful to connect proficiency testing programs with HemLink and to compare results from laboratories using the same middleware.

Characterization of a Vancomycin-resistant Enterococcus faecium Outbreak Caused by 2 Genetically Different Clones at a Neonatal Intensive Care Unit

In July 2010, we identified an outbreak of vancomycin-resistant enterococci (VRE) in our 26-bed neonatal intensive care unit. We performed an epidemiological investigation after clinical cultures of 2 neonates were positive for VRE. Identification, susceptibility testing, and molecular characterization were performed. Cultures of 3 surveillance stool samples of inpatients and 5 environmental samples were positive for VRE. All isolates were identified as Enterococcus faecium containing the vanA gene. Two distinct clones were identified by performing pulsed-field gel electrophoresis. The 2 clones exhibited different pulsotypes, but they represented identical Tn1546 types. Two sequence types, ST18 and ST192, were identified among all of the isolates with multilocus sequence typing. Our investigation determined that the outbreak in the neonatal intensive care unit was caused by 2 genetically different clones. The outbreak may have occurred through clonal spread and horizontal transfer of the van gene.

A Case of Misidentification of Dermabacter hominis as Listeria grayi / 대한임상미생물학회지

Listeria grayi is a catalase-positive, non-spore forming, and glucose-fermenting Gram-positive rod. L. grayi is widely distributed in environments such as soil, water and fresh food. Human infection by L. grayi is very rare, and there have been no cases reported in Korea, and only two cases worldwide. Dermabacter hominis is a relatively new species belonging to the coryneform bacteria and is a component of the normal human skin flora. D. hominis is a non-motile, glucose-fermenting, Gram-positive rod that has similar biochemical characteristics to L. grayi. The authors of the present study report a case initially misidentified as L. grayi via a traditional morphological and biochemical identification method but that was subsequently confirmed as D. hominis using sequence analysis of 16S rRNA.

Sero-positivity of Anti-HAV IgG in Young Hospital Workers / 대한수혈학회지

BACKGROUND: In recent years, the transmission of hepatitis A virus (HAV) through transfusion has been rare; however, recently there has been a case reported in Korea along with a recent increase in the number of HAV infections. In order to provide baseline information regarding sero-positivity of HAV in healthcare workers (HCWs), we tested for the presence of anti-HAV IgG antibodies in hospital employees who were under 40 years old. Data of HCWs as blood donors was analyzed to help management of blood donors. METHODS: Between July and August 2009, we measured anti-HAV IgG antibodies in HCWs who were in their twenties to thirties, using Architect i2000 (Abbott, Chicago, USA). Sero-positivity was obtained according to age and gender. RESULTS: A total of 1824 HCWs participated in this study, and sero-positivity was significantly different by age; 1.8% (5/275) in the 20~24 year old range, 6.7% (44/661) in the 25~29 year old range, 29.7% (159/536) in the 30~34 year old range, and 57.1% (201/352) in the 35~39 year old range. However, there was no significant difference according to gender. CONCLUSION: Sero-positivity of the anti-HAV IgG antibody was low in HCWs under 30 years old. Therefore, vaccination against HAV in this population should be fortified with respect to blood donor management. Moreover, an improved system of recording history with respect to early symptoms of HAV infection as well as vaccination history may be helpful in preventing the transmission of HAV through transfusion.

Two Cases of Acute Myeloid Leukemia with t(16;21)(p11;q22) and TLS/FUS-ERG Fusion Transcripts / 대한진단검사의학회지

Many AML-associated chromosomal abnormalities, such as t(8;21), t(15;17), inv(16), t(9;11), t(9;22) and t(6;9) are well known. The chromosomal aberration of t(16;21)(p11;q22) in AML is rare and it is known to be associated with poor prognosis, young age (median age, 22 yr), and involvement of various subtypes of the French-American-British classification. We report here 2 AML patients with t(16;21)(p11;q22), proved by conventional cytogenetics and/or reverse transcription (RT)-PCR. Erythrophagocytosis by leukemic blasts was observed in both of the cases. One patient was a 24 yr-old male with acute myelomonocytic leukemia. His karyotype was 46,XY,t(16;21)(p11;q22),del(18)(p11.2) and RT-PCR revealed the TLS/FUS-ERG fusion transcripts. Although he received allogeneic peripheral blood stem cell transplantation after the first remission, he died 9 months after the initial diagnosis due to relapse of the disease and graft-versus-host disease. The other patient was a 72 yr-old male with acute myeloid leukemia without maturation. His karyotype was 45,XY,-16,add(21)(q22) and the presence of t(16;21)(p11;q22) was detected by RT-PCR. He was transferred to another hospital with no more follow-up. We suggest that the presence of t(16;21)(p11;q22) and/or TLS/FUS-ERG fusion transcripts has to be considered in cases of AML with erythrophagocytosis.

A Case of Escherichia coli O157 Hemorrhagic Colitis / 대한임상미생물학회지

Escherichia coli O157 is an important serotype of enterohemorrhagic E. coli that causes hemorrhagic colitis worldwide. Outbreaks of E. coli O157 have been assocoated with contaminated food like meat, raw milk, and water, but recently vegetables and fruits have accounted for a growing number of recognized outbreaks. We isolated verotoxin producing E. coli O157 from the stool of a 3 year-old female with bloody diarrhea and abdominal pain. The child had been eating salad with vegetables and fruits frequently.

Polymerase Chain Reaction and Sequencing of Immunoglobulin Heavy Chain Gene Rearrangement in Formalin Fixed, Paraffin-embedded Tissue of Patients with B Cell Lymphoma / 대한혈액학회지

BACKGROUND: Immunoglobulin heavy chain (IgH) gene rearrangement has been known to be a useful marker for determining the clonality as well as detecting minimal residual disease in B cell malignancies. This study was performed to establish single polymerase chain reaction (PCR) methods for the detection of IgH gene rearrangements in formalin-fixed, paraffin-embedded tissue of patients with B cell lymphoma and determine the type of JH segments used. METHODS: We obtained formalin-fixed, paraffin-embedded tissue sections of 44 patients diagnosed with B cell lymphoma at Ajou University Hospital from January 2005 to January 2007 and reviewed medical records retrospectively. After the extraction of DNA, PCR was performed using VH3 and JHPST primers to detect the third complementarity determining region (CDR3) gene of IgH. Sequence analysis of the PCR products was also done in 23 patients. RESULTS: The CDR3 gene rearrangements were detected in 26 (59%) out of 44 patients with B cell lymphoma. Sequence analysis of the amplified CDR3 gene was successful in 16 (70%) of 23 patients. JH3, JH4, JH5, and JH6 segments were used for CDR3 gene rearrangements in 3 (25%), 4 (33%), 1 (8%), and 4 (33%) patients with diffuse large B cell lymphoma, respectively. CONCLUSION: Although there are some limitations due to a low sensitivity less than 60%, single PCR using consensus primers could be an effective tool for the detection of CDR3 gene rearrangements in routine laboratory settings. Furthermore, sequence analysis of the CDR3 PCR products will provide basic information necessary for further studies.

Leukocytosis Prevalence according to Smoking among Men

BACKGROUND: Cigarette smoke exposure accelerates the release of leukocytes from the bone marrow, which is postulated to be mediated by inflammatory cytokines and haematopoietic growth factors released from the lung. METHODS: The study population consisted of 2,270 healthy men above 20 years of age who had visited a health promotion center in a university hospital from January 2005 to December 2005. Baseline health check, self- reported cigarette smoking habit and blood sample were evaluated. The mean count of leukocytes and the leukocytosis prevalence according to smoking amounts were investigated. RESULTS: As the daily smoking amount was increased and as pack years smoked was increased, the mean total WBC count values and the prevalence of leukocytosis were higher (P=0.000). The odds ratio (OR) for leukocytosis according to daily smoking amount compared to no smokers was 1.98 (95% confidence interval (CI) 1.01~3.88) in those who smoked 1/2~1 pack per day and 4.17 (95% CI 1.83~9.48) in those who smoked more than 1 pack per day. The OR for leukocytosis according to smoking pack years compared to no smokers was 2.58 (95% CI 1.22~5.42) in those who smoked 20~30 pack years, 3.31 (95% CI 1.38~7.93) in those who smoked 30~40 pack years and 5.17 (95% CI 2.00~13.32) in those who smoked more than 40 pack years. CONCLUSION: The mean count of leukocytes and the prevalence of leukocytosis were higher in current smokers than no smokers and ex-smokers.

Mechanism of VanB Phenotype in Vancomycin-Resistant Enterococci carrying vanA gene / 대한진단검사의학회지

BACKGROUND: Recently, vancomycin-resistant enterococci (VRE) with the vanA genotype that are susceptible to teicoplanin have been described in Japan, Taiwan, and Korea. The investigators suggested three point mutations in the putative sensor domain of vanS or impairment of accessory proteins VanY and VanZ as an explanation for the VanB phenotype-vanA genotype VRE. In this study, we analyzed Tn1546-like elements to determine the molecular mechanisms responsible for the impaired glycopeptide resistance of clinical VRE isolates with VanB phenotype-vanA genotype from Korea. METHODS: From 2001 to 2004, 28 clinical isolates of Enterococcus faecium with VanB phenotypevanA genotype were collected from 8 different university hospitals in diverse geographic areas in Korea. For structural analysis of Tn1546-like elements, PCR amplifications for internal regions of Tn1546 were performed. The purified PCR products were directly sequenced with an ABI Prism 3100 DNA sequencer. RESULTS: The sequence data of the vanS regulatory gene revealed that none of the isolates had any point mutations in this gene. All 28 isolates had a complete or incomplete deletion of vanY gene. Of these, 13 strains represented a complete deletion of vanZ, and 2 strains showed the deletion of nucleotides near the end point of vanX. CONCLUSIONS: The mechanism of VanB phenotype-vanA genotype in VRE isolates from Korea is not point mutations of vanS but the rearrangements of vanX, vanY and vanZ.

Antimicrobial Resistance and Occurrence of Virulence Factors in Enterococci Isolated from Patients with Bacteremia and Urinary Tract Infection / 대한임상미생물학회지

BACKGROUND: Enterococci have become increasingly predominant as causative agents of nosocomial infections. Infections due to multi-drug resistant enterococci have drawn increasing attention during the past two decades. The purpose of the present study was to evaluate the occurrence of virulence factors and antimicrobial resistance in enterococci isolated from patients with bacteremia or urinary tract infection. METHODS: A total of 209 strains of enterococi (102 Enterococcus faecalis and 107 E. facium) isolated during 8 months of 2005 were collected from 10 university hospitals in Korea. Disk diffusion susceptibility tests were performed using Mueller-Hinton agar. The antimicrobial resistance genes and virulence factors were determined using PCR. RESULTS: In E. faecalis, the rate of resistance to ciprofloxacin, tetracycline, and quinupristindalfopristin was 27.4%, 83.3%, and 85.2%, respectively; no isolates were resistant to ampicillin, vancomycin, teicoplanin, or linezolid. In E. faecium, the rate of resistance to ampicillin, ciprofloxacin, tetracycline, vancomycin, and teicoplanin was 86.9%, 87.9%, 8.4%, 19.6%, and 6.5%, respectively; no strains were resistant to quinupristin-dalfopristin or linezolid. All the E. faecalis strains tested were found to harbor multiple virulence factors, but E. faecium strains were generally without virulence factors except esp. The prevalence of the esp gene was significantly higher in enterococci isolated from urinary tract infection than in those from bacteremia. CONCLUSION: A similar pattern of resistance to antimicrobial agents and prevalence of virulence factors was observed in both the enterococci isolated from bacteremia and urinary tract infection. Our study indicates that host factors are more likely than bacterial properties to influence the development of bacteremia.

Prevalence and Clinical Significance of Intestinal Alkaline Phosphatase in Healthy Adults / 대한진단검사의학회지

BACKGROUND: Intestinal alkaline phosphatase (ALP) is more prevalent in individuals of blood group B or O secretors and increases after a meal, especially, high-fat diet. The purpose of this study was to evaluate the prevalence and clinical significance of intestinal ALP in the sera of healthy adults. METHODS: Whole blood specimens were obtained from 42 healthy adults after fasting for at least 8 hours, and again at 2 hours after a regular meal. ALP was measured by TBA-200FR and analyzed for isoenzymes by Helena REP system. We also tested their ABO blood groups using GENEDIA anti-A and anti-B sera. RESULTS: The levels of fasting ALP, postprandial ALP, and the difference between the fasting and postprandial ALP (ALP difference) were 57.6+/-20.8 (12-111) IU/L, 62.3+/-17.4 (27-120) IU/L, and 4.6+/-15.4 (-8~63) IU/L, respectively. Delta (delta) ALP was 27.6+/-86.3 (-11.4~312.5)%. Among the 42 subjects, 6 were blood group A, 16 group B, 10 group AB, and 10 group O. Intestinal isoenzyme of ALP was detected in two subjects, both of whom were blood group O. The differences in fasting ALP, postprandial ALP, ALP difference, and delta ALP between ABO blood groups were statistically not significant. CONCLUSIONS: Intestinal ALP was detected in 5% of healthy adults, especially, in 20% of blood group O. Intestinal ALP has been known to be of no specific clinical significance. However, when ALP is measured in a non-fasting sample, the presence of intestinal ALP could result in an abnormally high ALP and subsequent unnecessary tests. Therefore, it is recommended that ALP should be measured only after fasting.

Discrimination of Monoclonal Gammopathy Using Immunoassay for Free Light Chains / 대한진단검사의학회지

BACKGROUND: Immunoglobulins exist in the serum, mostly in a union type of heavy and light chains. Free light chain types exist in an extremely small quantity and are useful in the diagnosis and follow up of multiple myeloma, but are also increased in autoimmune diseases such as SLE. The aim of this study was to evaluate the usefulness of the serum free light chain in discriminating between monoclonal and polyclonal gammopathy. METHODS: Between January and June of 2003, we identified 15 patients with monoclonal gammopathy and 12 patients with polyclonal gammopathy on serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE). We measured the serum concentration of the free light chain using Beckman Coulter IMMAGE(TM) analyzer with FREELITE(TM) reagents and calculated the kappa/lambda (kappa/lambda) ratio. We also measured the free light chain of 35 healthy controls to establish a reference range. RESULTS: The reference ranges established in this study were 4.97-12.84 mg/L for kappa light chains, 6.71-18.09 mg/L for lambda light chains, and 0.46-1.01 for the kappa/lambda ratio. The free light chains were abnormal in all 27 but 2 patients with polyclonal gammopathy on SPEP. The kappa/lambda ratio was abnormal in 12 of the 15 patients with monoclonal gammopathy and in none of the 12 patients with polyclonal gammopathy. CONCLUSIONS: Our results suggest that the kappa/lambda ratio can be a useful tool to discriminate between monoclonal and polyclonal gammopathy, especially in the case of vague SPEP results, or when monoclonal gammopathy is suspected in SPEP.

The Study of High Frequence Hearing Loss in Pilots

BACKGROUND: Hearing loss is associated with environmental noises. Not only the strength of the noise but also the exposure time of that seems important. We investigated to find the factors associated with hearing loss in pilots. METHOD: For the anlysis of hearing loss in pilots in the air force, we performed an audiometiric test on 563 pilots from 2000 to 2001 and analysed the results. REUSLT: The type of aircraft or regiment is not associated with hearing loss. The age, tenure and total flight time are the factors associated with hearing loss, especially in the high frequency zone. The flight time in the recent six months is shown not to be associated with hearing loss which means an exposure to noise in a longer term is important. In this study, the hearing threshold increased at 6,000 Hz regardless of age. CONCLUSION: The reason may be due to the noise environment of pilots. Therefore an additional study about pilots' normal limits of hearing threshold at 6,000 Hz and clinical meanings of that is necessary.

Expression of Vascular Endothelial Growth Factor in Diabetic Frozen shoulder / 대한정형외과연구학회지

PURPOSE: To investigate the expression of Vascular Endothelial Growth Factor (VEGF) in diabetic frozen shoulders. MATERIALS AND METHODS: We preformed arthroscopic adhesiolysis on 9 diabetic frozen shoulder patients, and observed the arthroscopic findings. Also, we examined the potential role of VEGF by using samples of synovial tissues from 5 patients, and 2 normal synovial tissues. Immunohistochemical staining and Western blotting were performed using polyclonal antibodies against VEGF. RESULTS: There was hyperemic synovitis in the 9 diabetic frozen shoulder patients. In the 5 patients' tissue samples, there was strong immunostaining and expression to VEGF, but there was little staining and expression in the control group. CONCLUSION: We postulate that VEGF is synthesized and secreted in the synovium of diabetic frozen shoulders and that secreted VEGF binds specific receptors on the endothelial cells of nearby small blood vessels, and leads to the subsequent development of frozen shoulders in diabetic patients.

Health Effects of Air Particle Produced in a Waste Treatment Plant on Residents Living in an Official Residence of Air Base

BACKGROUND: This study was conducted to reveal the health effects of air pollution on the residents living near waste treatment plant. METHODS: We sampled 190 residents as the hogh exposed group, 192 residents as the moderate group, and 139 residents as the low exposed group according to the geographical distances from the waste treatment plant. Self-administered questionnaires for prevalence of respiratory disease, irritation symptoms of mucous membrane (eye, nose, thoat, skin, and respiratory tract), gastrointestinal symptoms, other nonspecific symptoms were conducted. We measured the concentrations of total suspened partcles, Zn, Cu, Cr, Ni, Pb, Cd and As in 3 exposed area. RESULT: Airborne concentrations of total suspended particles measured in exposed area were 485, 365, and 332 micro gram/m(3) which excees the limit value. Airborne concentrations of Zn, Cu, Cr, Ni, Pb, Cd and As were not excees the limit value. The prevalence of respiratory disease of high exposed group (16.8%) was significantly higher than that of moderate group (3.6%) and low exposed group (5.0%). The sysptom score of irrtation sysptoms of mucous membrane, gastrointestinal sysptoms, and other nonspecific sysptoms were increased with exposed level. In multiple linear regression, exposure level was related to all sysptom scores significantly. CONCLUSION: These results suggest that the air pollution of waste treatment plant would influence prevalence of respiratory disease, induce irritation of mucous membrane, gastrointestinal symptoms, and other nonspecific sysptoms.

A Case of Cutaneous Mesenchymal Hamartoma on the face / 대한피부과학회지

Cutaneous mesenchymal hamartoma is a very rare disease which most often presents itself at birth and is composed of collagen fibers, immature fibroblasts, fat cells, blood vessels, and mast cells. We report a case of cutaneous mesenchymal hamartoma on the face.

A Case of BX / 대한수혈학회지

We report a case of BX in a 27-year-old woman admitted for Cessarian section after diagnosis of placenta previa. An ABO discrepancy was observed, such as, group O in cell typing but group B in serum typing. The patient's red cells were agglutinated by anti-H and show the mixed field agglutination by anti-A,B. The results of adsorption and elution test, saliva test and B transferase test show the presence of B antigen, absence of B substance in saliva and no activity of B-transferase. All of these findings were compatible with BX.

Diurnal Variation of Urinary Excretion of Protein Metabolites and Electrolytes / 대한임상병리학회지

BACKGROUND: There have been numerous studies to define the diurnal variation of urinary excretions of substances. It is known that this variation is influenced by many factors. This diurnal variation also affects results of quantitative analysis of random urine. The purpose of this study is to evaluate the maximum excretion time of day for representative urinary analytes and to elucidate the most appropriate time for spot urine quantitative analysis. METHODS: The concentrations of following urinary analytes were measured on healthy male and female volunteers at 06, 08, 12, 16 and 24 hours in August 1995, March 1996 and January 1997: protein, amylase, urea nitrogen, creatinine, uric acid, sodium, potassium, chloride, magnesium, calcium and inorganic phosphorus were measured by Hitachi Model 747 automatic analyzer and microalbumin by Beckman Array 360. The statistical analyses of results were performed by one-way ANOVA and multiple comparison for the significance of difference. RESULTS: The excretion of protein, amylase, urea nitrogen, creatinine, sodium, potassium, chloride, magnesium and inorganic phosphorus showed the diurnal variations. The peak excretion time of protein, amylase, urea nitrogen and creatinine was at early morning. However, that of sodium, pota-ssium, chloride, magnesium and inorganic phosphorus was at afternoon. The excretion of urea nitrogen, sodium, chloride and magnesium revealed the seasonal variations. The excretion of urea nitrogen, sodium and chloride was increased during winter. CONCLUSIONS: The morning urine specimen is considered to be the most appropriate for analysing protein and nitrogenous substances and the afternoon specimen is appropriate for electrolytes.

A Case of Papillary Tubular Adenoma (Tubulopapillary Hidradenoma)

Tubular apocrine adenoma and papillary eccrine adenoma are rare sweat gland neoplasms that appear as a small solitary lesion on the scalp or extremities, respectively. Although these lesions are thought to be distinct entities, there are enough similarities between them to group them under the term tubulopapillary hidradenoma or papillary tubular adenoma. We describe a case showing many tubular structures with papillary projection, syringocystadenoma-like structures, and eccrine hirocystoma-like structures in the axillary area. The term of papillary tubular adenoma or tubulopapillary hidradenoma may be prefered in this case.