Drug Resistance Rate of New Pulmonary Tuberculosis Patients Treated from the Private Sector in 2003~2005 / 결핵및호흡기질환

BACKGROUND: Surveillance of TB drug resistance (DR) is essential for providing information on the magnitude and trends in resistance, for developing treatment guidelines and for monitoring the effect of interventions. Up to now national surveys of drug resistance of M. tuberculosis have been conducted four times since 1994 among patients registered at health centers. The purpose of this study is to estimate the prevalence of primary drug resistance among new cases identified in private sector, and to compare it with the previous national drug resistance surveys. METHODS: The study collected results of drug susceptibility testing (DST) performed at the Korean Institute of Tuberculosis by the request of private sector from January 2003 to December 2005, and then finally selected new cases for the analysis from the database of Korean TB Surveillance (KTBS) by matching patients' name and social identification numbers. RESULTS: Of the 5,132 new patients included in the study, 689 (13.4%) patients were found to have drug resistance at least one drug, 530 patients (10.3%) were isoniazid resistant, 195 patients (3.8%) were multi-drug resistant (MDR), and 21 patients (0.4%) were extensively drug resistant (XDR). The rate of drug resistance tended to decrease annually but it was not statistically significant. When compared with previous national DR surveys in 2003 and in 2004 respectively, they were not significantly different. CONCLUSION: The prevalence of DR among new cases managed in the private sector did not show significant difference from that of new patients registered in the public sector in the same year.

Clinical aspects of an outbreak of Serratia marcescens infections in neonates / 소아과

PURPOSE: We evaluated an outbreak of Serratia marcescens infections in 24 neonates in a neonatal intensive care unit(NICU). METHODS: From January to August, 2004 a nosocomial outbreak of S. marcescens occurred in our NICU. We describe the clinical characteristics of the outbreak and analyse the risk factors for infections with S. marcescens. After the outbreak stopped, 7 isolates from blood were typed using rapid amplified polymorphic DNA analysis(RAPD). RESULTS: S. marcescens was isolated from 24 neonates, 19 infected and 5 colonized. Seven out of nineteen neonates had bacteremia, 4 had ventilator associated pneumonia, 4 had purulent conjunctivitis, 2 had UTI, 1 had meningitis and 1 had a wound infection. Three neonates died due to S. marcescens infection, 2 of 3 had ventilator associated pneumonia, 1 had meningitis complicated with abscess. The mortality rate of S. marcescens infection was 15.8%. Factors associated with S. marcescens infections were previous antibiotic therapy, indwelling catheter and use of ventilators. The isolated strains were resistant to most antibiotics, but frequently sensitive to imipenem, bactrim and amikacin. RAPD typing results show that at least 3 epidemic strains were related with this outbreak. But one genotype was predominant type in this outbreak. The control measures were instituted and the outbreak stopped within 2 months. CONCLUSION: S. marcescens can cause rapidly spreading outbreaks associated with fatal infections in neonates. If S. marcescens is isolated from clinical specimens, meticulous infection control measures and epidemiologic investigations should be done at an early stage of the outbreak.

Strategy for Management of Giant Invasive Pituitary Adenoma

OBJECTIVE: Giant invasive pituitary adenoma looks histologically benign, but these tumors have an aggressive clinical course. The authors review 10 cases and discuss the results obtained and the strategy to use for the management of giant invasive pituitary adenoma. METHODS: Out of a series of 155 pituitary adenomas treated surgically between 1994 and 2002, ten patients with giant invasive pituitary adenoma were selected and their clinical problems, radiologic findings, extent and invasiveness, hormonal and histologic findings and surgical results were analyzed retrospectively. RESULTS: There were 4 male and 6 female patients, with an average age of 47 years and an average follow-up period of 42 months. The average size of tumor was 50.7mm. These tumors revealed severe invasions into surrounding structures. 8 patients underwent transsphenoidal approach(TSA) operations, 1 patient with transcranial operation and 1 patient with combined TSA and transcranial operation. In all cases, subtotal resection was performed. The histologic findings were 2 prolactinomas and 8 hormonal non-function adenomas. The therapies administered after surgical removal consisted of conventional fractionated radiotherapy (2 patients), treatment with dopamine agonists to control hyperprolactinemia (2 patients), and treatment with hormone replacement (2 patients). CONCLUSION: Giant invasive pituitary adenomas are characterized by different forms of expansion and invasiveness and variable clinical problems. Because of their aggressive expansion and invasiveness, there are many different strategies which can be considered for their management. The authors obtain good results by choosing conservative surgical removal and multidisciplinary treatments with serial radiological and hormonal follow-up.

Spontaneous Spinal Subdural Hematoma: Treatment with Lumbar Drainage

We report a rare case of spontaneous spinal subdural hematoma(SSDH). A 63-year-old man presented with radicular pain and paraparesis on both legs for several months. On magnetic resonance images, SSDH was found in lumbar region. Electrodiagnostic report showed bilateral lumbosacral polyradiculopathy, such as cauda equina syndrome. SSDH was drained with lumbar drainage at L4-5 level without direct exploration. The patient improved after drainage of the hematoma and then he was able to walk independently.

Cross Resistance of Fluoroquinolone Drugs on gyrA Gene Mutation in Mycobacterium tuberculosis / 결핵및호흡기질환

BACKGROUND: Fluoroquinolone drugs are an important anti-tuberculous agent for the treatment of multi-drug resistant tuberculosis. However, many drugs belonging to the fluoroquinolones have different cross resistance to each other. METHODS: Sixty-three ofloxacin (OFX) resistant and 10 pan-susceptible M. tuberculosis isolates were selected, and compared for their cross resistance using a proportion method on Lowenstein-Jensen media, containing ofloxacin (OFX), ciprofloxacin (CIP), levofloxacin (LVX), moxifloxacin (MXF), gatifloxacin (GAT) and sparfloxacin (SPX), at concentrations ranging from 0.5 to 3microgram/ml. DNA extracted from the isolates was directly sequenced after amplifying from the gyrA and gyrB genes. RESULTS: The 63 OFX resistant M. tuberculosis isolates showed complete cross resistance to CIP, but only 90.5, 44.4, 36.5 and 46.0% to LVX, MXF, GAT, and to SPX, respectively. Fifty-one of the isolates (81.0%) had point mutations in codons 88, 90, 91 and 94 in gyrA, which are known to be correlated with OFX resistance. The Gly88Ala, Ala90Valand Asp94Ala mutations in gyrA showed a tendency to be susceptible to MXF, GAT and SPX. Only 4 isolates had mutations in the gyrB gene, which did not affect the OFX resistance. CONCLUSION: About 60% of the OFX resistant M. tuberculosis isolates were susceptible to GAT, SPX and MXF. These fluoroquinolones may be useful in the treatment of TB patients showing OFX resistance.

External Ventricular Drainage System with Long Subcutaneous Tunnel

OBJECTIVE: The goal of this study is to introduce a new method of external ventricular drainage system to reduce the complications of infections by making a long subcutaneous tunnel. METHODS: Between January 2002 and March 2003, 59 cases of ventriculostomy including 44 cases of short subcutaneous tunnel and 15 cases of long subcutaneous tunnel were performed and analysed. Subarachnoid hemorrhage and intraventricular hemorrhage were major indications for ventriculostomy. RESULTS: No infection was noted in the group of 15 patients with long subcutaneous tunnel. Whereas, 6 cases(13.6%) of infection was diagnosed in the group of 44 patients with short subcutaneous tunnel. The ventriculostomy was kept maximally for 11(mean 7.4)days without infection in the patients with long subcutaneous tunnel. CONCLUSION: To reduce the infection as a complication of ventriculostomy, we devise a new drainage system that involves the long subcutaneous tunnel.

Subependymal Giant Cell Astrocytoma with a Large Third Ventricular Hematoma

Subependymal giant cell astrocytoma(SEGA) is the most common intracranial tumor in patients with tuberous sclerosis(TS) and relatively benign tumor that arises in the subependymal layer of the lateral ventricle. It may occur independently, or in association, with TS and usually is found in adolescents and young adults. However, it is extremely rare that SEGA has caused intratumoral and intraventricular hemorrhage. We are reporting a case with a large third ventricular hematoma well encapsulated with fibrous tissue, originating in SEGA around foramen Monro of the lateral ventricle.

Delayed Cerebellar Hemorrhage after Supratentorial Burr-Hole Drainage

We report two cases with delayed cerebellar hemorrhage developed after supratentorial burr-hole drainage, and review the literature. Burr-hole drainage was performed at both sides of bilateral chronic subdural hematomas. The total amount of drainage per day was more than 300ml of hematoma mixed with cerebrospinal fluid(CSF) and the differences in doses between the two sides were significant in both cases. The symptoms improved after drainage but abrupt deterioration of neurological status occurred with the development of cerebellar hemorrhage on postoperative day 4 and 5, in each case. Although both patients were elderly, 75 and 86 years old, they did not have any coagulation defect or episode of severe increase in their blood pressures during drainage. We believe that suprate-ntorial CSF overdrainage can cause cerebellar upward shift, with resultant injury of weakened cerebellar vessels in old age.

Anterior Cervical Interbody Fusion with Carbon-Composite Cages and Local Autobone for Cervical Disc Disease

OBJECTIVE: The aim of this study is to assess the technical feasibility, the clinical and radiological results of the interbody fusion with a carbon-composite cage and local autobone following anterior cervical discectomy. METHODS: From November 2001 to April 2002, fifteen patients with symptomatic degenerative cervical disc disease underwent this procedure. After standard microsurgical anterior approach, cervical interbody fusion was performed with carbon-composite cage and local autobone of operative site. The average follow-up period was 8.7 months. RESULTS: Postoperatively, all patients experienced clinical improvement and follow-up cervical X-ray films checked six months postoperatively demonstrated complete interbody fusion. One patient complained of transient swallowing difficulty, one patient noticed operative site hematoma and four patients noticed implant subsidence. CONCLUSION: This technique is considered as an easier implantation procedure than the previous techniques. The other advantages of this interbody fusion are immediate stability with good clinical response, no complication at donor site and easy to assess the fusion.

The Minimum Concentration and Preservation Time of Ethanol for Sterilization of Donor Sclera: In Vitro Study

PURPOSE: We studied to investigate the minimum concentration and preservation time of ethanol for sterilization of donor sclera. METHODS: Fresh sclera was inoculated with Staphylococcus epidermidis(ATCC 155), Staphylococcus aureus(ATCC 28213), Pseudomonas aeruginosa(ATCC 27843), and transferred to preservative vials containing the concentration of ethanol(10, 30, 50, 70, and 90%) or trypticase soy broth(TSB, control) and stored at room temperature. The sclera was then homogenized, plated on blood agar, and incubated at 37 degreesC for 24 hours. Colonies were counted at 6, 12, 24, 48, and 72 hours. RESULTS: Staphylococcus epidermidis and Staphylococcus aureus were recovered from contaminated sclera plates preserved in 10% ethanol until 72 hours and in 30% ethanol until 12 hours, but no bacteria was recovered from the sclera preserved in more than 50% ethanol(P<0.05). Pseudomonas aeruginosa was recovered in 10% ethanol until 72 hours but not recovered in more than 30% ethanol until 24 hours(P<0.05). However, all three species were recovered from the control sclera preserved in TSB until 72 hours. CONCLUSIONS: From the above results it is concluded that the concentration of more than 50% ethanol for at least 6 hours is recommendable as human sclera disinfectants.

Detection of Pyrazinamide Resisitance in Mycobacterium Tuberculosis by Sequencing of pncA Gene / 결핵

BACKGROUND: Examining the biological susceptibility of Mycobacterium tuberculosis to pyrazinamide (PZA) in vitro is very difficult as PZA is inactive under normal culture conditions. The susceptibility test, an enzyme assay for Pzase activity, and a genetic test for pncA gene mutations, were performed in order to predict PZA resistance. METHODS: 28 cultured clinical isolates of Mycobacterium tuberculosis were tested. The biological susceptibility was performed by the absolute concentration method using Lowenstein-Jensen media. The PZase activity was tested by means of Wayne's method. A 710-bp region includes the entire open reading frame of pncA was amplified and sequenced. RESULTS: All six strains with positive PZase activity exhibited no pncA mutations with one strain showing a false resistance in the biological susceptibility test. Among the 22 strains with no PZase activity, 21 exhibited showed pncA mutations. In the biological suscaptibility test, 20 strains were resistant, and one was susceptible, and the other failed to test. The mutation types varied with ten missense, one silent and one nonsense mutation 1 slipped-strand mispairing, and 6 frameshift mutations. Three strains had an adenine to guanine mutation at position - 11 upstream of the start codon. CONCLUSION: The mutation at the pncA promotor region is frequent at -11 upstream position. Automatic sequencing of pncA is a useful tool for rapid and accurate detection of PZA resistant M.tuberculosis, and for demonstrating the epidemiological relatedness of the PZA-resistant M.tubersulosis strains.

Analysis of Chromosomal DNA of Shingella Isolates Using Pulsed-Field Gel Electrophorrsis / 대한임상미생물학회지

BACKGROUND: It is difficult to control an outbreak of Shigella infection, because of the ease of transmission and the resistance to multiple antibiotics. Recently, there were outbreaks of Shigella infection in Chinju area. The objective of this study was to investigate the molecular epidemiology of the outbreaks using pulsed-field gel electrophoresis(PFGE). METHOD: Thirteen S. flexneri strains, 25 S. sonnei strains from Chinju and 15 S. sonnei strains from Pusan were studied. All strains were isolated from stool cultures of diarrheal patients. Identification and antimicrobial susceptibility test those were tested by Vitek GNI and GNS-LH. Chromosomal DNA restricted with Xbal was resolved by PFGE. RESULT: All the S. flexneri strains and 23(92%)S. sonnei strains from Chinju were resistant to one or more antimicrobial agents. All the clinical isolates of S. flexneri showed the same PFGE pattern which was different from type strains(KTCC 2517). PFGE patterns of 25 (100%) S. sonnei strains from Chinju and 12 (80%) S. sonnei strains from Pusan were identical to those of type strain (KTCC 2009). Three S. sonnei strains from Pusan showed distinct PFGE patterns, respectively. CONCLUSION: PFGF demonstrated identical restriction pattern among most of Shigella isolates from Chinju and Pusan, indicating that an outbreak with genetically related strains had occurred. PFGE was useful in molecular epidemiology of Shigella outbreaks

Screening of Urine Culture Specimens by Gram Stain, Urinalysis and Urine Microscopic Examinations / 대한임상미생물학회지

BACKGROUND: The purpose of this study was to discover ways to screen urine culture specimens through Gram stains, urine stick analyses and microscopic examinations for the laboratory cost saving. METHODS: One hundred and fifty-eight urine specimens for culture were included. Fifty uL of urine were inoculated onto one well each of 10-well slide, dried on the hot plate, and Gram-stained. The results combined with routine urinalyses including urine nitrite and leukocyte esterase, and pyuria, were compared with the routine culture results. RESULTS: The screening of bacteriuria by Gram stains, urinalyses and microscopic examinations revealed the high sensitivity (91.9%) and negative predictive value(95.5%) with cost saving of 41.8% of inoculating media. Not considering the Gram stains, the screening revealed 83.8% sensitivity and 92.5% negative predictive value, even if the cost saving of inoculating media were as high as 50.1%. CONCLUSION: It was demonstrated that it was sensitive and economic and produced rapid preliminary results to screen bacteriuria by the Gram stains combined with urinalyses and microscopic examinations.

Evaluating the Usefulness of the ICT Tuberculosis Test Kit for the Diagnosis of Tuberculosis / 결핵

BACKGROUND: Early diagnosis of tuberculosis is critical, especially in Korea, an area where tuberculosis is endemic. Because antibody responses to some membrane proteins of Mycobacterium tuberculosis are not comparable, and the policy of BCG vaccination and the prevalence of tuberculosis are different from country to country, the usefulness of the serological diagnostic tests is questionable in Korea, even though they have been confirmed to be useful in other countries. In the specific context of Korea, we tried to evaluate the validity of the ICT Tuberculosis Test (ICT), a membrane-based antibody kit that purports to detect the 5 M. tuberculosis complex-specific antigens including 38-kDa protein. METHOD: 68 patients with tuberculosis were tested: 37 had no history of previous tuberculosis, and 31 were reactivated cases. The control group comprised 77 subjects: 25 healthy adults, 35 hospital workers with frequent contact with tuberculosis patients, and 17 in-patients with non-tuberculous respiratory diseases. RESULTS: The diagnostic sensitivities of the ICT were 87% and 73% in patients with versus without previous history of tuberculosis, respectively. The sensitivities of smear-positive and smear-negative patient groups were 81% and 73%, respectively. Both of the two patients with extrapulmonary tuberculosis tested positive through the ICT. The specificities of the ICT were 88%, 94%, and 94% in healthy adults, hospital workers, and non-tuberculous patients, respectively, with an overall specificity of 92%. Conclusion: It is suggested that when combined with traditional techniques, the ICT is an useful tool for the diagnosis of pulmonary tuberculosis. The procedure is simple, easy to perform, rapid, and needs no equipment. It shows 73% sensitivity and 92% specificity for the diagnosis of tuberculosis.

Evaluating the Usefulness of the ICT Tuberculosis Test Kit for the Diagnosis of Tuberculosis / 결핵

BACKGROUND: Early diagnosis of tuberculosis is critical, especially in Korea, an area where tuberculosis is endemic. Because antibody responses to some membrane proteins of Mycobacterium tuberculosis are not comparable, and the policy of BCG vaccination and the prevalence of tuberculosis are different from country to country, the usefulness of the serological diagnostic tests is questionable in Korea, even though they have been confirmed to be useful in other countries. In the specific context of Korea, we tried to evaluate the validity of the ICT Tuberculosis Test (ICT), a membrane-based antibody kit that purports to detect the 5 M. tuberculosis complex-specific antigens including 38-kDa protein. METHOD: 68 patients with tuberculosis were tested: 37 had no history of previous tuberculosis, and 31 were reactivated cases. The control group comprised 77 subjects: 25 healthy adults, 35 hospital workers with frequent contact with tuberculosis patients, and 17 in-patients with non-tuberculous respiratory diseases. RESULTS: The diagnostic sensitivities of the ICT were 87% and 73% in patients with versus without previous history of tuberculosis, respectively. The sensitivities of smear-positive and smear-negative patient groups were 81% and 73%, respectively. Both of the two patients with extrapulmonary tuberculosis tested positive through the ICT. The specificities of the ICT were 88%, 94%, and 94% in healthy adults, hospital workers, and non-tuberculous patients, respectively, with an overall specificity of 92%. Conclusion: It is suggested that when combined with traditional techniques, the ICT is an useful tool for the diagnosis of pulmonary tuberculosis. The procedure is simple, easy to perform, rapid, and needs no equipment. It shows 73% sensitivity and 92% specificity for the diagnosis of tuberculosis.

Clinical Characteristics and Prognostic Factors of Bacteremia and Sepsis / 대한내과학회지

OBJECTIVES: In spite of the improvement in therapeutic strategy, the mortality rate from sepsis is still high. The purpose of this study was to examine the clinical characteristics and prognostic factors of sepsis to get help in treatment and estimation of prognosis of sepsis. METHODS: We analyzed the clinical and bacteriologic data of 313 admitted patients with bacteremia at Pusan National University Hospital from Jan., 1996 to Dec., 1997 retrospectively and all patients were categorized into 4 groups (bacteremia, sepsis, severe sepsis, septic shock) by the definition from American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992. RESULTS: 1) Male to female ratio was 1.22: 1 and mean age was 52 years. 2) The overall mortality rate was 32.3% and the mortality rates of bacteremia, sepsis, severe sepsis and septic shock were 14.9%, 22.8%, 52.0%, and 95.2%, respectively. 3) Underlying diseases predisposing to bacteremia were diabetes mellitus(14.4%), solid cancer (13.1%), hematologic malignancy(10.2%) and liver cirrhosis(9.9%), but the most common was no underlying disease. 4) Among the total 80 species of isolated microorganisms, gram-positive organisms were responsible in 169 cases, gram-negative organisms in 218 cases. E. coli was isolated most frequently, followed by S. aureus, S. epidermidis, K. pneumoniae, Enterococcus spp., Enterobacter spp., Str. viridans group, CNS, P. aeruginosa and S. typhi. 5) Although the source of bacteremia could not be identified in 28.8% of the patients, the others had the primary site of infections ; skin(17.9%), gastrointestinal tract(16.9%), respiratory tract(12.5%), urinary tract(9.9%) and biliary tract(7.3%). 6) The mortality rate in patients with gram-positive bacteremia was 39.4%, with gram-negative bacteremia was 20.9% and with polymicrobial bacteremia was 33.3%. MRSA sepsis showed the highest mortality rate(58.8%), followed by Enterococcus spp.(50.0%), K. pneumoniae (35.0%), P. aeruginosa(27.3%) and E. coli(18.8%). 7) There was significant relation between etiologic organisms of bacteremia and the primary site of infections. 8) Using logistic regression analysis, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying diseases. CONCLUSION: Sepsis occurred in 16 patients among 1,000 adult admitted patients and overall mortality rate was 32.3%, still high. The mortality rate had positive correlation with the severity of sepsis. Among 16 evaluated risk factors of mortality, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying disease.

Clinical Performance of the Amplified Mycobacterium tuberculosis Direct Test for the Detection of Mycobacterium tuberculosis in Non-respiratory Specimens / 대한임상병리학회지

BACKGROUND: The Amplified Mycobacterium tuberculosis Direct Test (AMTDT) has been developed for the direct detection of M. tuberculosis complex in respiratory specimens. Traditional methods for diagnosis of extrapulmonary tuberculosis such as the acid-fast bacilli (AFB) stain have their well-known limitations. We investigated the usefulness of the AMTDT for a wide range of non-respiratory specimens to establish early diagnosis of extrapulmonary tuberculosis. METHODS: 346 specimens (219 urine, 117 pleural fluid, 6 ascitic fluid, 2 lymph node, 1 gastric aspirate, and 1 pus specimens) from 340 patients referred from November 1997 to September 1998 were tested by the AMTDT. The AMTDT results were evaluated by comparing with clinical diagnosis and smear results. RESULTS: The overall sensitivity, specificity, and positive and negative predictive values of the AMTDT were 82.9%, 93.8%, 64.2%, and 97.6%, respectively. There were no difference in sensitivity and specificity between pleural fluid and urine specimens. In 31 specimens from tuberculosis patients concurrently tested with AMTDT and stain, 15 were only AMTDT positive and 4 were only stain positive. Among the results considered to be false positive, 47.2% of cases were shown as being less than 150,000 relative light units (RLU). In 30 specimens from tuberculosis patients during or after treatment, all six of the patients with reactivation or aggravation were AMTDT positive, and one case was considered to be false positive. CONCLUSIONS: Our study demonstrates the efficacy of the AMTDT in diagnosing extrapulmonary tuberculosis. Prudent interpretation of the AMTDT's results is recommended in case of that being less than 150,000 RLU.

Clinical utility of Amplified Mycobacterium tuberculosis Direct Test in the Diagnosis of Pulmonary Tuberculosis / 결핵

BACKGROUND: Acid-fast stain and cultures for diagnosis of pulmonary tuberculosis are primary and essential method, but have their limitation:low sensitivity and time consuming. The objective of this s tudy is comparison of amplified Mycobacterium tuberculosis direct test(MTD) by the conventional AFB smears and cultures in the detection of Mycobacterium tuberculosis in respiratory specimens. METHODS: During the period between November, 1997 and May, 1998 a total of 267 respiratory specimens (sputum 173, bronchial washing 94) from 187 patients suspected pulmonary tuberculosis were subjected to AFB smears, cultures and MTD test. MTD is based on nucleic acid amplification. We compared the MTD with 3% Ogawa culture method. In positive AFB smear and negative MTD specimen, positive culture identification between nontuberculous mycobacterium and M.tuberculosis was assesed by using Accuprobe M.tuberculosis complex probe. In negative AFB smear and negative AFB culture, MTD results are assessed by clinical follow-up. RESULTS: 1) Compared with culture in sputum and bronchial fluid specimens, sensitivity and specificity of MTD in positive AFB smear is 79.7% and 20.0%, sensitivity and specificity of MTD in negative AFB smear specimens is 75.0% and 79.7%. 2) Discrepant analysis is assessed by clinical follow-up and other specimen results beyond study. Culture negative but MTD positive specimens were proved to be true positive and gave MTD sensitivity 79.2%, specificity of 84.4%, positive predictive value 80.5% and negative predictive value 83.2%. 3) 14 out of 31 specimens in negative AFB smear, negative AFB culture and positive MTD showed pulmonary tuberculosis diagnosed on clinical follow-up and sensitivity is 45.2%. 4) 2 out of 13 specimens in positive AFB smear, positive AFB culture and negative MTD diagnosed as nontuberculous mycobacterium by Accuprobe culture. CONCLUSION: This study suggested that MTD in respiratory specimens is simple and rapid diagnostic method, but considered adjuvant method rather than replace the conventional AFB smear and culture.

Comparison of Three Egg-based Solid Media for Culture of Mycobacteria from Clinical Specimens / 대한임상병리학회지

BACKGROUND: Single egg-based Ogawa medium is used for mycobacterial culture in nearly all tertiary care or medical school-affiliated hospital in Korea. However, it is expected that some mycobacteria would grow so lately or never in only one media, even if mycobacteria are present sufficiently in the specimen. To estimate the efficiency of inoculation to two or more egg-based media for isolation of mycobacteria, positive culture rates and detection time were compared among three media. METHODS: 193 clinical specimens, which referred to laboratory of Pusan National University Hospital for 2 months, including 123 specimens of patients with mycobacteriosis, were processed and inoculated to Eiken, VITE and KT media. The isolates were identified and classified to Mycobacterium tuberculosis and non-tuberculous mycobacteria (NTM) by AccuProbe method. The positive culture results were analyzed by McNemar test and t-test. RESULTS: M. tuberculosis and NTM were isolated in 65 (34.0%) and 14 (7.4%) specimens, resulting in positive culture rates of 41.4%. Of the 123 patients' specimens, 63 cases were positive in culture of VITE media, which were significantly higher than 50 cases of Eiken and 45 cases of KT media. In 43 positive-stained specimens, twelve to twenty samples (29.3-48.8%) failed to grow in at least one media. The colonies were visible at 24.9 to 30.7 days after inoculation, and VITE and KT media detected visible colonies 4.5 and 2.5 days more rapidly than Eiken media, respectively. CONCLUSIONS: Inoculation to two or more egg-based media is useful for increasing culture positivity and early detection of colonies for mycobacterial culture.

Immunohistochemical Study on the Expression of Topoisomerase II alpha and Glutathione S-Transferase pi in Acute Myeloid Leukemia / 대한임상병리학회지

BACKGROUND: Topoisomerase II (topo II) is a major target of anthracyclines and epipodophyllotoxins for anticancer treatment. The expression of topo II is low in drug resistant cell lines. High levels of glutathione S-transferase (GST)pi have been associated with emergence of cell lines resistant to alkylating agents or adriamycin. METHODS: By immunostaining with paraffin embedded bone marrow tissues, the expression of topo II alpha and GSTpi was investigated in 51 patients with acute myeloid leukemia (AML), and the relation of topo II alpha and GSTpi expression to treatment response in 29 patients with AML following induction chemotherapy was also evaluated. RESULTS: Topo II positive cells varied from less than 1% to 60% of leukemic cells and 20 (39.2%) were negative for topo II (positive cells<10%). Treatment response following chemotherapy was not related to topo II. 26 (51.0%) were positive for GSTpi. GSTpi expression was related to treatment resistance of the patients following chemotherapy. In the patients who showed both topo II alpha negative and GSTpi positive, the frequency of treatment resistance following chemotherapy was high. CONCLUSIONS: This study suggests that immunostaining of topo II alpha and GSTpi with the bone marrow paraffin sections of AML patients can be useful to predict the treatment response following chemotherapy and that further study including more patients with prospective study may substantiate topo II alpha and GSTpi as multidrug resistant markers.