Strategy for Improving Core Nursing Competency-based Education / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the core competencies of nursing students and to improve competency-based nursing education. METHODS: A triangulation method was used. A literature review and focus group interviews (FGI) were used to identify nursing core competencies. The present level of nursing competencies of students was identified through the nursing core performance questionnaire. RESULTS: 1) Nursing core competencies, including 23 different competencies, were categorized into seven areas through a literature review and qualitative research. These competencies included: desirable personality, attitude & interpersonal skills, professionalism, nursing knowledge & basic nursing skills, ability to cope with nursing situations, basic ability in nursing research, coping ability with changes in the healthcare environment, and leadership. 2) Core nursing skills, nursing research, and nursing leadership were the three lowest ranking competencies. Some courses in the curriculum were to be newly established in an e-learning system, student's portfolio in non-curriculum. CONCLUSIONS: Further research is needed in order to show effects of the changes. Changes after applying the strategy of a nursing education program will be measured. Continuous research in competency-based nursing education is needed.

The Effects of Soy-Based Infant Formula on Growth and Development, and the Isoflavone Concentration of Plasma and Urine in Full-Term Infants

Soy-based formula has been used for centuries in Korea. Soybeans contain phytochemicals with a biochemically active component, isoflavone. Isoflavone is a kind of phytoestrogens, structurally and functionally similar to estrogen. This study was conducted to investigate the effects of soy-based infant formula on growth, development, and isoflavone concentration in the plasma and urine. Thirty-nine healthy infants who were delivered at K university medical center were recruited. Experimental groups were the breast milk group (n = 15, BM) who were fed breast milk, soy-based formula group (n = 10, SBF) who were fed soy-based infant formula, and the casein-based formula group (n = 14, CBF) who were fed casein-based infant formula for 4 months. HPLC analysis was used to measure the concentration of isoflavones. The measurements of infant weight, length, head circumference and chest circumference were all in the normal growth range and were similar among the experimental groups. No significant differences were found in the scores of total mean of infant development test (Development Quotient, DQ) among the experimental groups. The isoflavone content of soy-based formula was significantly higher than. that of breast milk and casein-based formula. Plasma concentration of daidzein and genistein in the infants fed soy-based formula (daidzein : 264.1 ng/ml, genistein : 392.1 ng/ml) was significantly higher (p<.0001) than that in infants fed breast milk (daidzein : 3.4 ng/ml, genistein : 3.8 ng/ml) and casein-based formula (daidzein: 8.1 ng/ml, genistein: 9.3 ng/ml). Also, urinary daidzein and genistein concentrations in infants fed soy-based formula (daidzein: 19.82 microgram/ml, genistein : 17.89 microgram/ml) were significantly higher (p<.001) than those in infants fed breast milk (daidzein: 0.28 microgram/ml, genistein : 0.22 microgram/ml) and casein-based formula (daidzein : 0.45 microgram/ml, genistein : 0.33 microgram/ml).

The Effects of Soy Milk Supplement on Isoflavone Concentration of Breast Milk, Plasma and Urine from Breast Feeding Woman

Soybeans have been a major protein source for many centuries in Korea. Soybeans contain phytochemicals which are isoflavones, biochemically active component. Isoflavone is a kind of phytoestrogen, structurally and functionally similar to estrogen. It has been reported that the breast milk and blood of breast feeding mothers who consume soy products contain isoflavones. This study was conducted to investigate the effects of soy milk supplement on the isoflavones (daidzein, genistein) concentration of breast milk, plasma and urine from breast feeding woman. Seventeen healthy women who delivered at Kyung Hee Medical Center were recruited. For the first 2 weeks after delivery, seventeen women ingested 400 ml (isoflavone 43.2 mg) of soy milk on the given time starting from the day of giving birth. For the next 2 weeks, soy milk ingestion was withdrawn. Dietary intake and anthropometric data were checked and breast milk, blood, and 24 hr urine samples were collected on the day of giving birth, the 14th (the last day of the supplement phase) and 28th (the last day of the withdrawal phase) day, respectively. HPLC analysis was used to measure the concentration of isoflavones. Dietary intakes of the subjects were inadequate for the Korean RDA regardless of soy milk supplementation. Especially, intakes of vit A, calcium, and iron were very low. The Anthropometric data such as LBM, TBW, PIBW, BMI checked on the day of 14th decreased and maintained their levels by the 28th day. Daidzein concentration in breast milk was not affected by soy milk supplementation. However, genistein concentration decreased by the 28th day (14th day: 0.89 +/- 0.10 microgram/ml, 28th day : 0.48 +/- 0.07 microgram/ml) (p<0.05). Plasma daidzein and genistein concentrations were not changed by the 14th day and decreased by the 28th day (14th day: 49.64 +/- 3.30 ng/ml, 26.72 +/- 2.90 ng/ml, 28th day: 38.30 +/- 4.40 ng/ml, 6.51 +/- 0.50 ng/ml, respectively) (p<0.05). Twenty four hour urine concentrations of daidzein and genistein significantly increased by the 14th day and decreased by the 28th day (14th day: 5.80 :t 0.3 mg/d, 4.17 +/- 0.2 mg/d, 28th day: 6.72 +/- 0.4 mg/d, 5.09 +/- 0.5 mg/d, respectively) (p<0.001). The rate of urinary recovery of daidzein was greater than that of genistein. The results of this study indicate that the supplement of dietary soy milk to the lactating women elevates the contents of isoflavone in the breast milk.

Storage-induced Changes of Plasma Free Hemoglobin, Adenosine Triphosphate, 2,3-Diphosphoglycerate of Cord Blood / 대한임상병리학회지

BACKGROUND: The use of autologous transfusion is gradually increasing since it eliminates transfusion-transmitted viral diseases, and avoids the risk of alloimmunization of red blood cells and posttransfusion graft-versus-host disease. The majority of premature neonates born at less than 1500 g need one or more red blood cell transfusion during the hospitalization and cord blood is considered as the most ideal blood for neonate autologous transfusion. In order to evaluate the adequacy of stored cord blood for autologous transfusion for neonates, the levels of plasma free hemoglobin, red blood cell adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) were measured at the time of collection, and then a week interval by 4 weeks. METHODS: The cord blood was collected in a single donor bag with CPDA-1 by aseptic technique from 28 newborns, stored for 28 days at 4degrees C, and changes in the levels of plasma free hemoglobin, red blood cell ATP and 2,3-DPG were measured at the time of collection, and then a week interval by 4 weeks for 26 cord bloods which were not presented with any bacterial growth during the storage. RESULTS: At the time of sampling, hemolysis was 0.11+/-0.16%, and intracellular ATP and 2,3-DPG were 3.74+/-0.99 mumol/g Hb and 11.67+/-1.21 mumol/g Hb, respectively. During the storage, hemolysis gradually increased to 0.61+/-1.09% on 28 days (p<0.05). ATP gradually decreased to 2.98+/-0.92 mumol/g Hb (80% of initial level) on 28 days(p<0.05). The levels of 2,3-DPG were 4.20+/-0.87 mumol/g Hb (about 35% of initial level) on 7 days(p<0.05) and 1.16+/-0.74 mumol/g Hb (less than 10% of initial level) on 28 days (p<0.001). CONCLUSIONS: In conclusion, ATP and 2,3-DPG levels of cord blood that are related to the viability of red blood cells during the storage were similar to those of adults. Thus the cord blood appeared to be an appropriate source for neonate autologous transfusion, however, more intensive studies on the effects of 2,3-DPG and metabolic products in vivo are necessary since physical conditions and physiology of the red blood cells in the neonates are different in many aspects from those of adults and children.

Surface Marker Analysis in Acute Leukemias / 영남의대학술지

We studied the expression of the cell surface antigen associated with myeloid and lymphoid leukemias on bone marrow or peripheral blood blast cells from 153 leukemic patients including 61 cases of acute myelogenous leukemias(AML), 46 of acute lymphocytic leukemias(ALL) and 12 of acute leukemias. They were analyzed by direct or indirect immunofluorescence method for reactivity with the monoclonal antibodies to B cells(CD10, CD19, SmIg), T cells(CD2, CD5, CD7, CD3, CD4, CD8), myeloid antigen(CD13, CD14, CD33, CD61) and a nonspecific antigen, HLA-DR. Lymphoid associated markers detected on AML is CD7 32.8%, CD10 14.8%, CD5 13.1%, CD2 6.6% and CD19 1.6%. TdT was positive in 4.9% of AMLs. Hybrid leukemias were 8 cases out 61 AML cases and were mainly composed of monocytic lineage, M4 and M5a. Myeloid markers detected in ALL were CD13 2.2% and CD33 2.2%. In this study, immunologically classified ALLs were composed of 65.2% of CALLA (+) B precursor type, 10.9% of CALLA (-) B precursor pattern, 8.7% of T cell type, 2.2% of B cell type, 4.5% of mixed lymphoid lineage(B&T), 2.2% of undifferentiated leukemia, and 6.5% of hybrid leukemia. Twelve cases of acute leukemias ware finally diagnosed to be 5 cases of hybrid leukemia, 3 cases of B lineage, 3 case of T lineage and 1 case of mixed lymphoid(B&T) leukemia. In summary, we think the best method for typing acute leukemias is by using a combination of FAB classification and immunophenotying.

Quantitative Measurement of Hepatitis B Virus DNA by Competitive Nested Polymerase Chain Reaction / 대한임상병리학회지

BACKGROUND: We performed competitive nested polymerase chain reaction (PCR) to evaluate the clinical utility of quantitative measurement of HBV DNA by PCR and it's correlation with other serologic hepatits B markers. Because hepatitis markers such as HBsAg, HBeAg, anti-HBe can not accurately reflect the replication of hepatitis B virus (HBV). METHODS: The internal standard was generated from the HBV core gene by point mutation, which would result in restriction site for the restriction enzyme Eco RI and performed competitive nested PCR followed by densitometric scanning of the amplified products of agarose gel. RESULTS: The sensitivity of nested PCR was 5 molecules in direct observation of agarose gel, but because of the background effect as taking polaroid photo graph it was 50 molecules by using densitometer. When DNA pellets for original 250 microL serum were diluted with 40 microL distilled water the low detection limit was 5.0 x10(3) molecules/microL, however it could be lowered when less diluted. Lower detection limit of densitometer was 6.25 pg by twofold serial dilution of 100 pg of purified HBV DNA PCR products, and regression showed y=0.93x-0.33 (y : density, x : concentration, 6.25 pg considered as 6.25 density). The reproducibility of the densitometer from high concentration was 4.3 +/-0.6 x10(6) molecules/microL(mean +/-SD, CV 14%), and low concentration was 3.7 +/-0.7 x10(4) molecules/microL(mean +/-SD, CV : 20%) Higher concentration of HBV DNA in HBeAg positive cases comparing with HBeAg negative cases was statistically significant (p<0.01). There was no correlation between HBV DNA concentration and serum value of alanine aminotransferase. CONCLUSION: Quantification of HBV DNA should be very useful in clinical follow-up of Post-therapy Patients and in anticipating Prognosis and infectivity of the disease, especially in cases of atypical hepatitis B and hepatitis B without seroconversion of routine hepatitis B markers. The shortcoming of the method seemed to be a rough estimate of HBV concentration as measuring the ratio of specimen/internal standard of two consecutive concentration among 10 folds serially diluted internal standard.

Immunocytochemical Detection of Pneumocystis Carinii in Bronchoalveolar Lavage / 대한세포병리학회지

Pneumocystis carinii is an established cause of pulmonary infections in immuno- compromised hosts. Several cytological stains, such as Papanicolaou, Gomori methenamine silver(GMS) and Diff-Quik have been used for detection of the organism, but occasionally can be laborious and, due to a degree of nonspecificity, may be misleading. We evaluated the diagnostic utility of immunocytochemical stains that recognize P. carinii in bronchoalveolar lavage from experimentally induced P. carinii pneumonia rats(n=15). In addition to routine stains for diagnosis by morphologic recognition of P. carinii on Papanicolaou, GMS and Diff-Quik stains, bronchoalveolar lavage samples were reacted with immunocytochemical stains using monoclonal antibodies(MAB) 092 and 902. In bronchoalveolar lavage P. carinii organisms were detected in 9 of 10 cases (90%) using each MAB 092 and 902, whereas GMS and Diff-Quik stains demonstrated P. carinii in 13(86%) and 11(73%) of 15 cases respectively. In lung tissue specimens(n=15) P. carinii organisms were well identified on GMS stain and immunohistochemical stains using MAB 092 and 902 in all cases. We believe that the immunocytochemical staining using MAB 092 and/or 902 is a very useful and diagnostic tool in addition to GMS and Diff-Quik stain to detect P. carinii organisms in bronchoalveolar lavage.

Evaluation of Automated ESR Measuring system, SEDIsystem(TM) / 영남의대학술지

The ESR is one of the oldest laboratory test still in use. Although it lacks specificity in diagnosis, it can be effective for monitoring disease activity and following-up. The Westergren method is used for reference method, however coefficient of variation has been described 0.8% to 22.9% according to the literature. Since the ESR was invented in 1921, measurement technique has developed and automated measurement is introduced. We analyzed one hundred forty-three patient samples using SEDIsystem' automated ESR measuring system and compared with modified Westergren and Wintrobe methods. Comparison between SEDIsystem' and modified Westergren for ESR measurement yields the following regression equation; y = 0.863x - 1.69 (r=0.830), SEDIsystem'M and Wintrobe y'= 1.14x - 14.7 (r=0.789), rcspectively. We repeated measurement to evaluate reliability, results are not significant in statistically. In conclusion, SEDIsysten' automated ESR measurement correlated with modified Westergren and Wintro" ; methods, reveal reliable results after 4 hours and can report rapidly for large samples. Thus, these results indicate that SEDIsystenT"' automated ESR measurement may be useful tool for clinical practice.

Subtypes of Hepatitis B Surface Antigen Among Chronic Liver Disease / 영남의대학술지

Four subtypes of hepatitis B surface antigen are useful in the epidemiologic studies of the route of virus transmission and clinical significance of simultaneous occurance of hepatitis B surface antigen and antibody to hepatitis B surface antigen in the same serum as well as useful marker for population migration. The sera were obtained from 214 HBs Ag positive patients who are diagnosed as chronic liver disease and following up in the Yeungnam university hospital. The subtypes were determined by solid-phase sandwich EM using monoclonal antibodies. Among 214 specimens, the subtype adr was 93.9%, adw was 2.8%, ayr was 0.9%, ar was 0.9%, adwr was 1.4% and ayw was not detected. There were no correlation between subtype pattern and disease. In summary, the subtype adr was prominent in our study and the difference of subtype pattern by severity of disease was not significant. However, to determine the prognostic value of HBs Ag subtype and relationship between subtype and disease progression, long-term follow up will be needed.

Prevalence of HBV DNA in Packed Red Blood Cells / 영남의대학술지

Assays for HBsAg, HBV DNA, anti-HBc and anti-HBs of 285 units of packed red blood cells supplied by Taegu Red Cross Blood Center were performed to evaluate the correlation between the prevalence of HBV DNA and the serologic markers for hepatitis B virus. None of 285 plasma samples was positive for HBsAg, however, HBV DNA were detected by polymerase chain reaction in 2 samples which both presented only with anti-HBc positivity.. Of 204 samples tested for anti-HBs, 96 samples(47.1%) were positive and among 216 samples tested for anti-HBc, 80 samples(37.0%) were positive. Of 193 samples tested for both anti-HBs and anti-HBc, 80(41.1%) were all negative and 48(24.9%) were positive on both tests. Those samples which showed positivity only to anti-HBc were 25(13.0%). Considering the above results, transfusion-transmitted hepatitis B virus infection could be prevented by discarding anti-HBc positive blood, however, that may bring insufficient supply of donor bloods in the country like Korea where the prevalence of anti-HBc is high. Anti-HBc positive blood unequivocally positive for anti-HBs should be considered noninfectious for HBV and should be allowed to be transfused. It would reduce the amount of discarding donor blood as the routine blood donor screening tests presently used at Korea Red Cross Blood Center supplemented by anti-HBs and anti-HBc testing.

Diagnostic Efficiency of Lactate Dehydrogenase, Crreatine Kinase and Troponin T in Acute Myocardial Infarction / 영남의대학술지

The present study was designed to evaluate the efficiency of total lactate dehydrogenase, total creatine kinase, LD1/LD2 ratio, CK-MB and newly developed troponin T in acute myocardial infarction. The level of troponin T was 0.010.02 pg/L in 34 healthy person, but the peak vaule of acute myocardial infarction ranged in 4.7-24.2 pg/L. Total lactate dehydrogenase was peaked in 1 to 3 days after chest pain and then progressively decreased, but LD1/LD2 ratio was persistently higher than 1.0 for 10 days in most patients. Total creatine kinase and CK-MB were peaked in 1-2 days, and normalized in 3-4 days, so they, were useful in early diagnosis of acute myocardial infarction, but not for the late stages of acute myocardiz l infarction. Troponin T is early elevated and persistently high level for more than 10 days. Comparing with total lactate dehydrogenase, total creatine kinase, LD1/LD2 ratio and CK-MB, troponin-T test improves the efficiency of serodiagnostic method for the detection of ischemic myocardial damage.

Cytologic Analysis of Malignant Effusion / 대한세포병리학회지

Eighty cases of malignant effusion were cytologically studied to elucidate the incidence of primary tumor site and cytologic characteristics of each tumor types. Eighty fluid specimens were composed of 43 ascitic, 35 pleural, and 2 pericardial effusion and primary tumor site had been confirmed by histology. The frequent primary sites were stomach (22 cases, 28%), lung (21 cases, 26%), ovary (11 cases, 14%), liver (7 cases, 9%), and breast (4 cases, 5%). The principal malignant tumors were adenocarcinoma (56 cases, 70%), squamous cell carcinoma (7 cases, 9%), liver cell carcinoma (7 cases, 9%), small cell carcinoma (4 cases, 5%), and non-Hodgkin}s lymphoma (4 cases, 5%). The distinctive cytologic findings according to primary tumor types were as follows ; the gastric adenocarcinomas were mainly characterized by isolated cells and irregular clusters sometimes with signet ring cells. Papillary serous cystadenocarcinoma of ovary showed frequently papillary clusters and occasional psammoma bodies. Breast carcinoma of ductal type showed cell balls with smooth margins. Colonic adenocarcinoma showed rather irregular clusters or palisading pattern of cylindrical cells. Metastatic squamous cell carcinoma, liver cell carcinoma, small cell carcinoma, and non-Hodgkin}s lymphoma showed also characteristic features. These findings indicate that the cytological features observed in the great majority of malignant effusion are similar to those of primary tumor types, which are very helpful to indentify the primary tumor site.

Cytologic Findings of Giant Cell Carcinoma of the Lung / 대한세포병리학회지

Pulmonary giant cell carcinoma is one of the most highly malignant neoplasms of the lung. Although mixed malignant glandular or squamous components may be associated with a giant cell carcinoma, it is a distinct clinical and morphologic entity. We reviewed cytologic presentations of 6 cases of pulmonary giant cell carcinoma. Cytologically, the single most characteristic feature of giant cell carcinoma was an extremely large, bizarre cancer cell engulfing numerous leukocytes. The nuclei of these cells showed occasional prominent nucleoli, and the cytoplasm was abundant. Giant cells were also seen in other types of pulmonary carcinoma, but the giant cells of this neoplasm could be differentiated from those encountered in undifferentiated large cell carcinoma and squamous cell carcinoma by the abundant cytoplasm, the presence of markedly enlarged nuclei, prominent nucleoli, and an significant degree of phagocytosis, In conclusion, precise diagnosis and classification of lung cancer is imperative because of proved correlation between cell type and prognosis.

Comparison study of AAS and ISE method in the lithium analysis of serum and urine / 영남의대학술지

In the method for lithium (Li) analysis, flame emission photometry and atomic absorption spectrophotometry (AAS) have been used most frequently. In addition, lithium can be analyzed by ion-selective electrode (ISE) or fluorscence polarization immunoassay. We evaluated the comparison between AAS method based on the principle of absorption of light at 670.8 nm by Li and ISE method based on the principle of voliage difference generated by Li in contact with lithium ionophore. We compared with those obtained by AAS (AA/AE Spectrophotometer 551, Instrumentation Laboratory Co.) and ISE (SYNCHRON EL-ISE, Beckman Co.) in the serum and urine of 6 pati,,:nts- and evaluated time-related changes of serum lithium concentration after dosing in both methods. The results are summarized-as follows: 1. In within-run precision study for lithium concentration, coefficient variations (CVs, %) ranged from 1.34 to 2.17 for AAS and from 0.34 to 0.85 for ISE method. In between-run precision study for lithium concentration, CVs ranged from 1.23 to 1.72 for AAS and from 0.61 to 1.38 for ISE method. 2. The correlation study between AAS and ISE method resulted in Y= 0.946X+ 0.137 (N = 32, r= 0. 933, X= AAS, Y= ISE) for serum lithium and Y= 1. 092X+ 0. 977 (N= 28, r= 0.943, X= AAS, Y= ISE) for urine lithium. 3. Time-related changes of serum lithium concentration in both AAS and ISE method resulted in peak serum levels about 2 hours after dosing and then rapidly decreased after the peak serum level and finally arrived at nearly initial levels about 9 hours after dosing. 4. The reference range of serum lithium was found as undetectable level for both AAS and ISE method and the reference range of urine lithium to the urine creatinine was 0 0.00014 mmol/mg(mean 0.00002 mmol/mg) for AAS method.

Bacterial growth in artificially contaminated packed red cells following room temperature exposure / 대한수혈학회지

No abstract available.

Results of secondary antibiotics susceptibility test for gram negative bacilli resistant to primary susceptibility test in Yeungnam University Hospital / 영남의대학술지

Major pathogenic Gramnegative organisms such as P. aeruginosa, Serratia species, E. coli, Enterobacter species which are isolated from the specimens in large medical centers are greatly resistant to the commonly used antibiotics. Gramnegative bacilli, which had been isolated in Yeungnam Uni rersity Hospital during the period from December 1992 to April 1993 and turned out to be resistant to the primary antibiotics susceptibility test for chloramphenicoi, ampicillin, eephaiothin,- geniamicitt, tetracyclin, amikin and tobramycin, were subjected to the secondary antibiotics susceptibility test for aztreonam, ceftazidime, ciprofloxacine, cefotaxime, cefamandole, piperacillin, ticarcillin and sulfamethoxazole trimethopime. Out of 315 tested organisms, 167 organisms (53%) were resistant to all secondary antibiotics in vitro. Antimicrobial activity of ceftazidime (37.1%), aztreonam (11. %), ciprofloxacine (7.9%) against Gram negative bacilli were slightly more active than other antibiotics tested, while cefamandole was not active to all the Gramnegative bacilli tested. According to the specimens, E. coli was the most frequently resistant organisms to the primary antibiotics from urine, A. baumanii, from respiratory system and wounds, and P. aeruginosa from various specimens. In summary, Gram negative bacilli resistant to the primarily applied antibiotics also were resistant to the secondary antibiotics. Rearrangement of the antibiotics disks for the antibiotic susceptibility test should be considered.

Comparison of the results of multistix®-SG and comber-9-Test®RL urine dipstick assay / 영남의대학술지

Two types of urine dipstick assays, Multistix-SG and Comber-9-Test RL, were compared for compatibility, accuracy, specificity and predictive values of a positive and negative test in 501 patients' urine and artificially prepared specimen. We found that the results of semiquantitative tests of Multistix-SG and Comber-9-Test RL performed were statistically similar in patients' specimen. The urinary leukocyte esterase tests of Comber-9-Test RL assays compared with urine sediment microscopy in regard to compatibility, sensitivity, specificity, and predictive values of a positive and negative test 83.7%, 48.1%, 90.3%, 47.4% and 90.1%, respectively. The urinary nitrite tests of Comber-9-Test RL assays compared with urine culture tests, in regard to compatibility, sensitivity, specificity, and predictive values of a positive and negative test were 90.3%, 19.4%, 84.7%, 53.8% and 94.1, respectively. For the urinary protein, the sulfosalicylic acid method was the most sensitive test for any kinds of protein, and Multistix-SG appeared more sensitive than Comber-9-Test RL for the albuminuria. For the urinary bilirubin and glucose, two dipstick assays were similar in their diagnostic efficiency. Finally in the urinary occult blood tests, Comber-9-Test RL assays was more sensitive than Multistix-SG.

Computer-assisted interpretative reporting system of serum CK and LD isoenzyme tests / 대한임상병리학회지

No abstract available.

Evaluation of usefullness of selective urine culture / 대한임상병리학회지

No abstract available.

Significance of Low Serum Urea Nitrogen Concentrations / 영남의대학술지

The prevalence of low serum urea nitrogen concentrations (<6 mg/dL) in our patient population was 3.8% (452 per 11,911 determinations), representing 372 individual cases. Of these, 323 of the patients' charts were located, reviewed, and classified into disease groups. Malignant tumor was found in 25.1% of the 323 patients, the remaining patients without malignant tumor had various clinical conditions; pregnancy (19.5%), infectious diseases (12.1%), trauma (10.2%), cerebrovascular accident (6.2%), hepatopathy (5.3%), and miscellaneous conditions (21.6%). The prevalence in female and young aged patients under 5 years was considered due to the lower reference range in these groups than in that of female adult groups, and moreover pregnancy in another superimposing factor in the former group. In regards to the causes of this condition, our study corresponded well to the textbook cited etiology of the low serum nitrogen concentration, although malnutrition and hepatopathy were inverted in their incidental order. We postulated, through the present study, that the low serum urea nitrogen concentration is not pathognomonic findings to suggest specific disease or conditions, but rather to reflect patient's general conditions such as hydration, nutrition, or administration of certain drugs.