Enzyme-linked immunosorbent assay for detecting anti-pertussis toxin antibody in mouse

PURPOSE: Although the DTaP and Tdap vaccines used to prevent pertussis have been used for a long time, there is no standard method for measuring pertussis antigens. Therefore, this preliminary study was conducted to develop an enzyme-linked immunosorbent assay method using an animal model for measuring antibodies against pertussis toxin, the most important pertussis pathogenic antigen, in the sera of vaccinated mice. MATERIALS AND METHODS: Bordetella pertussis Tohama phase I was cultured for 24–30 hours, and then pertussis toxin was purified from the culture medium by chromatography. Purified pertussis toxin was diluted in phosphate-buffered saline-coating buffer, and 100 µL of diluted pertussis toxin was added to each well and reacted at room temperature for 4 hours. Positive serum was diluted to 1/1,250–1/80,000 and negative serum was diluted to 1/50 to determine the coating concentration with the optimal signal/noise ratio. Optimal test conditions were confirmed from the dilution factors of the secondary antibody and streptavidin horseradish peroxidase (SA-HRP). RESULTS: Optimal conditions were as follows: 4 µg/mL for coating antigen; 1/40,000 for secondary antibody; and 1/1,000 for the SA-HRP dilution factor. Comparison of the sera obtained from mice treated with a developing vaccine and commercial vaccine with National Institute for Biological Standard and Control standard serum under the established conditions showed the following results: 1,300.62, 534.94, and 34.85, respectively. CONCLUSION: The method developed in this study is suitable for measuring anti-pertussis toxin antibodies and may be applicable for clinical sample analysis or indirect diagnosis of pertussis.

Detergent Solution-induced Alkaline Burn of Hand: A Case Report and Review of Literature

We present an interesting case of arbitrary chemical burn resulting from exposure to an undiluted detergent solution as a folk remedy. A 59-year-old woman came to the emergency department presenting chemical burn on her hand. She was affected by housewife's eczema on her left hand and wanted to cure the lesion. So three days before she came to hospital, she had put her hand into an undiluted detergent solution for an hour as a folk remedy for eczema. The patient was treated with foam dressing while the wound was demarcated. After three weeks, she underwent full-thickness skin graft on her 4(th) finger only. On postoperative day 14, the grafted skin was well-taken and on postoperative day 32, the wound was healed completely with a nail growth. Dish detergent solution has been widely used in kitchen but there is no documented report of chemical burn resulting from a detergent solution. When this patient came to our hospital at first time, the wound was so inflammatory and partial necrosis was combined. So we waited for demarcation preparing even for amputation. But with application of appropriate foam dressing, the patient was healed well and required only partial skin graft. We may encounter the patients suffer from the chemical burns due to usual detergent sometimes. But we do not need to perform surgical treatment immediately. Instead, appropriate dressing will be helpful to minimize operation range.

Chordae Rupture and Acute Mitral Regurgitation Associated with Infective Endocarditis in a Patient Undergoing Hemodialysis / 대한내과학회지

Acute pulmonary edema in patients undergoing hemodialysis is a common cause of hospital admission and is often associated with fluid overload or congestive heart failure. Here, we report a rare case of chordae rupture and consequent severe mitral valve regurgitation due to infective endocarditis presenting as sudden onset pulmonary edema after properly conducted hemodialysis.

The Impact of Arterial Micro-calcification of the Vascular Access on Coronary Artery Calcification and Cardiovascular Mortality in Incident Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: The aim of this study was to explore the relationship between arterial micro-calcification (AMiC) and coronary artery calcification, and to determine the impact of AMiC on cardiovascular mortality in incident hemodialysis patients. METHODS: One hundred and nineteen hemodialysis patients who received vascular access surgeries between April 2011 and May 2015 were included in this study. AMiC was diagnosed by pathologic examination of arterial specimens acquired during surgery, using von Kossa stain. All patients underwent multi-detector computed tomography imaging, and coronary artery calcium scores (CACS) were calculated. We evaluated the association between AMiC and CACS in these patients, and examined the incidence of cardiovascular death (through Febraury 2017) in patients with and without AMiC. RESULTS: The mean age of the patient group was 64.3 ± 13.0 years, and 64% were male (n = 76). Of 119 patients, 67 (56.3%) were positive for AMiC of the vascular access. The mean CACS was 430.4 ± 720.2 (0-3,954), and 99 patients were considered positive for CAC (83.1%). By multivariate logistic regression analysis, CACS was independently associated with AMiC. The mean follow- up period was 35.5 ± 17.8 months. During this time there were 26 all-cause deaths, of which 17 were cardiovascular. Kaplan-Meier survival analysis revealed that AMiC was associated with cardiovascular mortality (log rank = 9.0, p < 0.05). CONCLUSIONS: AMiC may be associated with coronary artery calcification in incident hemodialysis patients, and may also be a risk factor for cardiovascular mortality.

Enterocolic Fistula caused by Acute Colitis in a Hemodialysis Patient / 대한내과학회지

Enterocolic fistulas are commonly associated with previous surgery, Crohn's disease, diverticulitis, radiation therapy, and malignancy. Here, we report a rare case of enterocolic fistula caused by acute colitis in a hemodialysis patient. A 62-year-old man on maintenance hemodialysis underwent a radical nephrectomy via a paramedian incision due to spontaneous right kidney rupture and was treated with prophylactic antibiotics. On the 16th day of antibiotic therapy, he complained of abdominal pain and diarrhea. Abdominal computed tomography (CT) and ascitic fluid culture revealed acute bacterial peritonitis and sigmoidoscopy showed acute colitis. After treating these diseases with adequate antibiotics, the abdominal pain and ascites were relieved, but the diarrhea persisted. Abdominal CT obtained 7 days later showed an enterocolic fistula. To our knowledge, this is the first case of enterocolic fistula due to acute colitis in Korea.

A Case of Acute Infective Endocarditis Initially Presenting as Acute Pyelonephritis

Infective endocarditis carries high risk of morbidity and mortality. Rapid diagnosis and effective treatment are essential to good patient outcome. However, nonspecific symptoms and various clinical manifestations make early diagnosis difficult. Here we report on an unusual case of infective endocarditis initially presenting as acute pyelonephritis (APN). A 44-year-old female with a history of heart surgery was admitted for fever and both flank pain. The patient had undergone dental extraction 3 weeks prior to admission. Her lab work and physical examination revealed pyuria, positive bacterial culture of both blood and urine, costovertebral knocking tenderness, and CT findings consistent with APN, leading to her initial diagnosis as APN. Despite treatment with antibiotics, her symptoms did not improve while further physical examination revealed newly developed Osler's nodes and Janeway lesions. Echocardiography showed vegetation of the aortic valve with severe aortic regurgitation. She was diagnosed as a case of infective endocarditis and was treated successfully.

Extensive Bilateral Lemierre Syndrome due to Methicillin-Resistant Staphylococcus epidermidis in a Patient with Lung Adenocarcinoma / 결핵및호흡기질환

Lemierre syndrome (LS) is a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. LS is commonly caused by normal anaerobic flora and treated with appropriate antibiotics and anticoagulation therapy. Although the incidence of disease is very rare, 15% cases of LS are fatal even in the antibiotic era because of disseminated septic thromboemboli. We reported a case of extensive bilateral LS due to methicillin-resistant Staphylococcus epidermidis in a 63-year-old female with lung adenocarcinoma. Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically. However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture. Despite intensive antibiotic and anticoagulation therapies, extensive septic thrombophlebitis involving the bilateral IJV and superior vena cava developed. Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.

The prevalence and clinical characteristics of cancer among anemia patients treated at an outpatient clinic

BACKGROUND: Anemia is the most common hematologic condition encountered in outpatient clinics. It is often overlooked because it is common among patients; however, anemia is one of the leading indicators of cancer. This study examined the prevalence and characteristics of cancer among anemia patients who visited an outpatient clinic. METHODS: The data were collected by reviewing the records of an outpatient clinic from January 2007 to December 2011. RESULTS: In total, 502 patients (52 males, 450 females) were diagnosed with anemia. Cancer prevalence among anemia patients was 5.57% (25.0%, men; 3.3%, women); further, the most frequently diagnosed cancer was colorectal cancer (22.5%), followed by advanced gastric cancer (16.1%), breast cancer (9.6%), myelodysplastic syndrome (9.6%), cervical cancer (6.4%), renal-cell carcinoma (6.4%), and thyroid cancer (6.4%). The prevalence of cancer was 4.1% in those aged 40-49 years, 4.2% in the subjects in their fifties, 8.0% in those in their sixties, 21.6% in those in their seventies, and 55.6% in those aged over 80 years. The cancer prevalence among iron deficiency anemia (IDA) patients was 6.18% (28.8%, men; 3.5%, women). The cancer prevalence in postmenopausal and premenopausal female IDA patients was 16.0% and 1.6%, respectively. CONCLUSION: Among anemia patients, male patients aged over 40 years and female patients aged over 60 years, along with postmenopausal female patients, were more likely to be diagnosed with cancer. Consequently, male IDA patients, and female patients aged over 60 years must be carefully evaluated for the possibility of malignancy.

The prevalence and clinical characteristics of cancer among anemia patients treated at an outpatient clinic

BACKGROUND: Anemia is the most common hematologic condition encountered in outpatient clinics. It is often overlooked because it is common among patients; however, anemia is one of the leading indicators of cancer. This study examined the prevalence and characteristics of cancer among anemia patients who visited an outpatient clinic. METHODS: The data were collected by reviewing the records of an outpatient clinic from January 2007 to December 2011. RESULTS: In total, 502 patients (52 males, 450 females) were diagnosed with anemia. Cancer prevalence among anemia patients was 5.57% (25.0%, men; 3.3%, women); further, the most frequently diagnosed cancer was colorectal cancer (22.5%), followed by advanced gastric cancer (16.1%), breast cancer (9.6%), myelodysplastic syndrome (9.6%), cervical cancer (6.4%), renal-cell carcinoma (6.4%), and thyroid cancer (6.4%). The prevalence of cancer was 4.1% in those aged 40-49 years, 4.2% in the subjects in their fifties, 8.0% in those in their sixties, 21.6% in those in their seventies, and 55.6% in those aged over 80 years. The cancer prevalence among iron deficiency anemia (IDA) patients was 6.18% (28.8%, men; 3.5%, women). The cancer prevalence in postmenopausal and premenopausal female IDA patients was 16.0% and 1.6%, respectively. CONCLUSION: Among anemia patients, male patients aged over 40 years and female patients aged over 60 years, along with postmenopausal female patients, were more likely to be diagnosed with cancer. Consequently, male IDA patients, and female patients aged over 60 years must be carefully evaluated for the possibility of malignancy.