Predictors of High Peak Serum CK Levels in Doxylamine Intoxication

BACKGROUND: Because doxylamine succinate (DS) is an over-the-counter medicine, it can be obtained easily and is frequently used in suicidal attempts. Patients usually recover without serious complications, but occasionally rhabdomyolysis and even death can occur in DS intoxication. In this study, the authors tried to find out the independent predictors of high peak serum CK levels, i.e. probable rhabdomyolysis in DS intoxication. METHODS: The medical records of 41 patients who visited a hospital for DS intoxication from January 1, 2002 to April 30, 2003, were reviewed retrospectively. RESULTS: In the group of DS only, initial occult blood of urine (P=0.003), initial WBC count (P=0.003) and confusion (P=0.007) were the best predictors of the peak serum CK level (2=0.724). In the group of DS with other drugs intoxication, initial creatinine level (P=0.003) and initial occult blood of urine (P=0.007) were the best predictors of the peak serum CK level (r2=0.784). In the cases of rhabdomyolysis patients, the time taken for the CK level to be increased over 1,000 IU/L was 1.9level to be increased over 1,000 IU/L was 1.9+/-0.6 days. CONCLUSION: In DS only intoxication, occult blood in initial urine analysis, initial high WBC count and confusion can be thought of as useful clinical predictors for high peak serum CK level case. In DS with other drugs intoxication, initial creatinine level and initial occult blood of urine can be considered as the best predictors. More than 2 days will be needed for the observation of serious complications in DS intoxication.

Trends of Anaerobic Bacteria Isolated from Clinical Specimens / 대한임상병리학회지

BACKGROUND: Anaerobic bacteria constitute a major part of the normal flora of the human skin, mucous membrane and intestinal tract, and can cause various infections. The incidence of anaerobic infections may differ greatly, depending on each country or hospital. METHODS: We evaluated the recent trends of anaerobic bacteria isolated from clinical specimens at Severance Hospital from 1986 to 1995. Specimens were cultured using thioglycollate medium and phenylethanol blood agar (PEBA) for 2-3 days under anaerobic condition. Identification of organism was based on conventional or commercial kit systems. RESULTS: During this period, a total of 2,664 isolates of anaerobic bacteria were obtained from 2,251 clinical specimens. The average number of anaerobes per specimen was 1.2. The frequent sources of isolation were specimens from the abdomen, followed by soft tissue, and head and neck. B. fragilis (46.3%) was the most frequently isolated gram-negative bacilli, and P. magnus (37.6%) and C. perfringens (18.8%) were the most frequently isolated gram-positive anaerobes. Abdominal, soft tissue, and head and neck infections were frequent clinical conditions. Among the anaerobe-positive specimens, only 16.8% yielded anaerobe alone while the remaining 83.2% revealed mixed infection with aerobic bacteria. CONCLUSIONS: It was concluded that B. fragilis is the most common species among gram-negative bacilli, and that P. magnus is the most common among gram-positive cocci. As well, the anaerobes are frequently isolated from specimens of the abdomen, head and neck, and soft tissue; and anaerobic infections are commonly mixed with aerobic bacteria.

The Usefulness of PCR and Early Antigen Immunostaining as a Rapid Identification Method of Cytomegalovirus Infection / 대한임상병리학회지

BACKGROUND: Cytomegalovirus infection is an important cause of morbidity and mortality after organ transplantation. Thus, rapid, sensitive and specific laboratory test, such as CMV antigenemia assay and polymerase chain reaction (PCR) is necessary to determine a patient's risk of CMV disease and to monitor the effectiveness of antiviral therapy. We compared the results of CMV-PCR and CMV early antigen immunostaining (CMV-EA) with CMV-specific IgM antibody to evalutate clinical usefulness for the early diagnosis of CMV infection and monitoring of antiviral therapy. METHODS: We analyzed 170 samples submitted for CMV tests between September 1995 and April 1996 in Yonsei University College of Medicine Severance Hospital. CMV-PCR and CMV-EA were performed with buffy coat cells and detection of CMV-specific IgM antibody was performed by enzyme-linked fluorescent assay (ELFA). RESULTS: One hundred and seventy samples of 159 patients were tested and analyzed. The concordance rate of CMV-PCR, CMV-EA and CMV-specific IgM in the same blood sample was 75.3%. The total incidence of CMV disease was 2.5%. The sensitivity and specificity based on the patients' clinical status of PCR were 100% and 91.6% respectively. In CMV-EA immunostaining method, they were 75.0% and 100% respectively. And, for CMV-specific IgM antibody ELFA, the sensitivity was only 50.0% and the specificity was 96.4%. CONCLUSIONS: CMV-PCR and CMV-EA immunostaining are reliable methods as rapid early detection of CMV infection. The sensitivity and specificity are very high comparing to CMV- specific IgM antibody. It could also be concluded that they have advantages not only for early diagnosis but also monitoring or follow-up of a therapeutic course as quantitative assays.

A Severe Thrombocytopenia Associated with Cyclosporine-Dependent Antiplatelet Antibody Against Platelet Glycoproteins Ib/IX and IIb/IIIa Complexes / 대한임상병리학회지

A 51 year-old woman underwent living related renal transplantation under cyclosporine A immunosuppression. After surgery, she did well initially, but the serum creatinine level subsequently rose to 3.6 mg/dL on postoperative day 95, she was admitted at Severance Hospital for further evaluation. On admission day 4, a renal biopsy was performed, and the microscopic findings revealed an interstitial mononuclear cell infiltrate, suggestive of severe allograft rejection. Because of persistently impaired renal function, the patient was began on twice weekly hemodialysis, and the progression of renal deterioration paralleled the onset of a thrombocytopenia. The platelet count dropped to 13x109/L despite daily platelet transfusion. On admission day 19, antiplatelet antibody against the glycoprotein Ib/IX (GP Ib/IX) and glycoprotein IIb/IIIa (GP IIb/IIIa) complex was detected in the presence of cyclosporine A (CsA) with modified antigen capture ELISA (MACE) assay, thereby implicating the drug. CsA was stopped immediately and immunosuppression drug was changed to FK506. After CsA was discontinued 7 day later, her platelet count returned to normal, up to 170x109/L without requirement of any platelet concentrates. This paper presents the first case of CsA induced thrombocytopenia in Korea which was confirmed by in vitro CsA dependent antiplatelet antibody detection test.