Experience of a Performing Alternative Assessment Procedure for Tests without External Proficiency Test Program / 대한수혈학회지

BACKGROUND: Proficiency testing is part of a total quality management program that provides objective evidence of clinical laboratory testing competence for customers, accrediting bodies, and regulatory agencies. Performing alternative assessment procedures for clinical tests, without proficiency testing, is recommended by Clinical and Laboratory Standards Institute (CLSI) guideline. In our study, an alternative assessment procedure was performed for blood bank tests that do not have an external proficiency program. METHODS: The laboratory for development and an evaluation center, supervised the program. Proficiency testing by seven institutions was performed 3 times at 6 month intervals by evaluating isoagglutinin and anti-D titers, and Weak D, Rh C and E typing, using ID-Internal Quality Control (Bio-Rad Laboratories) kits. RESULTS: Isoagglutinin and anti-D titer results were within one fold dilution range for all seven participating institutions, and Weak D, Rh C and E typing results all demonstrated identical antigenic reference patterns. CONCLUSION: An alternative assessment procedure was successfully performed without a proficiency testing program. Commercially manufactured reference materials could be an alternative method to support commutable, external, proficiency testing program.

Malignant Mesothelioma with Hypoglycemia: A Case Report / 대한흉부외과학회지

Pleural mesothelioma is a rare neoplasm originating from pleural mesothelial cell. Hypoglycemia associated with tumor is knowen to be a rare consequence of non-islet cell tumors. A patient having severe, episodic hypoglycemia was found to have a large mass occupying the left hemithorax. The hypoglycemia was resolved immediately after the surgical removal of the tumor. Histologic examination of the tumor revealed localized fibrous mesothelioma.

A Case of Subserosal Stromal Tumor of the Stomach / 대한소화기내시경학회지

Gastrointestinal stromal tumor (GIST) were previously known as smooth muscle tumor like leiomyoma or leiomyosarcoma. Most of them were histologically spindle cell tumors, usually of mesenchymal origin. Stromal tumors account for about 1% to 2% of gastric malignant tumor, and the most important characteristics is their indolent, slow-growing nature, rendering most common definitions of malignancy invalid and inapplicable. The tumors are generally found deep within the stroma and submucosa, and only about half have an intragastric component, detectable by radiography, endoscopy or endoscopic ultra-sonography (EUS). Especially EUS is a valuable technique for diagnosing GIST. We experienced a 35-year-old female patient who complained right upper quadrant pain. She was diagnosed as subserosal stromal tumor by gastrofiberscopy, EUS, abdominal CT and operation. We report a case of gastric subserosal stromal tumor with a review of relevant literatures.

Endoscopic Treatment with ESWL of Impacted Cystic Duct Stones / 대한소화기내시경학회지

BACKGROUND/AIMS: The established treatment for cystic duct stones is surgery, but nonoperative removal of gallstones through percutaneous cholecystostomy can also be a useful procedure in patients at high risk for surgery. Conventional methods using endoscopic or percutaneous stone extraction usually fail due to the inability to access or capture the cystic duct stones in the narrow, long, spiral portion of the cystic duct, especially in impacted cases. As a result stone fragmentation is required during endoscopic stone removal. It is impossible for an electrohydraulic lithotripsy (EHL) to gain access to the stones, due to the rigid distal metal tip of the lithotripter and the narrowness of the long, spiral cystic duct. Using extracorporeal shockwave lithotripsy (ESWL) to disintegrate gallstones is a more effective method for removal of cystic duct stones. Experiences of endoscopic treatment for cystic duct stones of patients with high risk for surgery were reviewed, and conclusions are included in this study. METHODS: Patient records of endoscopic management of cystic duct stones between January, 1994 and December, 1997, were reviewed for methods and results of treatment. Most of the patients had undergone lithotripsy followed by percutaneous transhepatic cholecystostomy.

Spontaneous Intramural Hematoma of the Esophagus / 대한소화기내시경학회지

Spontaneous intramural hematoma of the esophagus is a rare condition in which an intramural hemorrhage leads to a varying degree of submucosal dissection of the esophageal wall. This disorder has been seen predominantly in women in the sixth or seventh decade and has occured with variable etiology. The pathogenesis of this disorder has yet to be clarified. The triad of symptoms of this disorder includes retrostemal pain, mild hematemesis and odynophagia. The diagnosis is usually made by endoscnpy or with an esophagogram, It is important to differentiate esophageal submucosal dissection from other disorders of similar appearance, such as Mallory-Weiss syndrome, esophageal perforation, or dissecting aneurysm, all of which require surgical treatment. The prognosis of spontaneous intramural hematoma of the esophagus (SIHE) is excellent with conservative therapy, but close follow-up care is necessary. A 62-year-old female was admitted to our hospital complaining of chest pain and hematemesis. Endoscopic features showed a large bluish hematoma which obliterated esophageal lumen from the proximal esophagus. We report a case of spontaneous intramural hematoma of the esophagus showing typical endoscopic findings with spontaneous improvement with a review of the literature.