A Case of Therapy-Related Acute Leukemia With Mixed Phenotype With BCR-ABL1 After Treatment of Diffuse Large B-Cell Lymphoma

No abstract available.

A practical approach for assessing chemosensitivity in colorectal cancer cell lines by comparative analysis of cell viability and thymidylate synthase mRNA expression / 대한외과학회지

PURPOSE: The purpose of this study is to suggest a probable problem in chemosensitivity tests performed in practice and to speculate on practicable measures for more accurate chemosensitivity evaluation. METHODS: Three colorectal cancer cells (RSC, RRC1, and RRC2) were treated with 5-fluorouracil (5-FU). Inhibition percentage (%inhibition) of cancer cells and relative quantitation of thymidylate synthase (TS) mRNA were measured on day 2, day 5 after replacement of 70% media on day 2, day 7, and day 3 after replacement of all media on day 7. Doses that produced 50% inhibition (Dm) were calculated to evaluate drug effect. Relative quantitation of TS mRNA and correlations between TS mRNA levels and 5-FU concentrations were analyzed. RESULTS: RRC1 was more resistant than RRC2 on day 7, but Dm value of RRC2 increased three days after replacement of media from 12.3 to 18.1. Mean TS mRNA levels of RSC on D2 and D7 were significantly lower than those of RRC1 and RRC2, respectively (P = 0.004, P = 0.004 on D2; P = 0.010, P = 0.006 on D7). TS mRNA levels in RRC1 were significantly reversely correlated with 5-FU concentrations on day 2 (correlation coefficient = -0.867, P = 0.015). On the other hand, correlations were not significant in RRC2 (r = 0.067). CONCLUSION: Evaluating %inhibition of cancer cells at one point in chemosensitivity tests seems to be inadequate in determining chemotherapeutic regimens. Multilateral approaches, such as trials evaluating cancer cell survival before and after media replacement and correlations between TS mRNA levels and 5-FU concentrations, needs to be implemented for the practical application of chemosensitivity tests.

Degree of Agreement between Phadia EliA ENA and Euroimmun line Immunoassay; Comparison of Two Methods to Evaluate the Ability to Detect ENA Antibodies / 고신대학교의과대학학술지

OBJECTIVES: The purpose of this study is to compare newly developed assay for identification of ENA antibody, Phadia EliA ENA with Euroimmun line immunoassay by analyzing the degree of agreement and the individual antibodies between two methods. METHODS: A total of 82 patient samples were used. Indirect immunofluorescence assay using Hep-2 cell was performed to screen the antinuclear antibody (ANA). Euroimmun line immunoassay (LIA) and Phadia EliA ENA assay were tested to identify the antibodies against extractable nuclear antigens (ENAs). Kappa statistics was used to evaluate the degree of agreement. RESULTS: Mean age of patients was 41.0 (8-79), and the M:F ratio was 21:61. ANA was positive in 74 samples, and negative were 8 samples. Kappa analysis of the 82 tested samples showed a moderate strength of agreement (kappa = 0.521, P = 0.000). There were differences in the order of identified individual antibodies between two methods (Ro > La = RNP > Centromere > Sm > Scl-70 in Phadia EliA ENA, Ro > RNP > Sm>La > Scl-70 > Centromere=Jo-1 in Euroimmun LIA). Ro antibody was most frequently identified in Phadia EliA ENA negative-Euroimmun LIA positive specimens (Ro > RNP = Jo-1 > La = Sm = Centromere > Scl-70). CONCLUSIONS: A moderate strength of agreement was observed between the Phadia EliA ENA and the Euroimmun LIA. There seemed to be a significant difference in the ratio of individual antibodies, especially in the anti-Ro and Sm antibodies.

Pilot Study of the Clinical Significance of Serum and Urinary HER-2/neu Protein in Bladder Cancer Patients

PURPOSE: HER-2/neu overexpression is documented in some bladder cancers. To our knowledge, there are no current studies evaluating urine HER-2/neu levels. Therefore, we examined the clinical significance of serum and urine HER-2/neu protein in bladder cancer. MATERIALS AND METHODS: Urothelial bladder carcinoma patients (n=38, including 31 men and 7 women) and healthy controls (n=25, including 20 men and 5 women) were included in the study. Urine cytology and serum and urine HER-2/neu levels were measured before the transurethral resection of bladder tumor procedure. Prognostic factors including tumor stage, histologic grade, tumor size, multiplicity, and preoperative urine cytology and their association with urinary HER-2/neu were analyzed by simple and multiple regression analyses. RESULTS: There was no significant difference in serum HER-2/neu between the two groups (p=0.489). The mean urinary HER-2/neu was 7,586.82 relative luminescence unit (RLU) in bladder cancer patients and 4,245.84 RLU in healthy controls. The mean RLU values of urinary HER-2/neu in the bladder cancer patient group were significantly higher than in healthy controls (p=0.012). An receiver operating characteristic curve was generated, and using the cutoff value of > or =4,800 RLU of urinary HER-2/neu, 71.1% sensitivity and 84.0% specificity were obtained. Among the clinical factors, only positive preoperative urine cytology samples were associated with urinary HER-2/neu levels by both simple and multiple regression analyses. CONCLUSIONS: Bladder cancer patients demonstrated significantly higher urinary HER-2/neu than did healthy controls. These findings suggest that urinary HER-2/neu may be valuable as a new urinary marker. The application of urinary HER-2/neu needs additional investigation.

Amylase, lipase, and volume of drainage fluid in gastrectomy for the early detection of complications caused by pancreatic leakage / 대한외과학회지

PURPOSE: Pancreatic leakage is a serious complication of gastrectomy due to stomach cancer. Therefore, we analyzed amylase and lipase concentrations in blood and drainage fluid, and evaluated the volume of drainage fluid to discern their usefulness as markers for the early detection of serious pancreatic leakage requiring reoperation after gastrectomy. METHODS: From January 2001 to December 2007, we retrospectively analyzed data from 24,072 patient samples. We divided patients into two groups; 1) complications with pancreatic leakage (CG), and 2) no complications associated with pancreatic leakage (NCG). Values of amylase and lipase in the blood and drainage fluid, volume of the drainage fluid, and relationships among the volumes, amylase values, and lipase values in the drainage fluid were evaluated, respectively in the two groups. RESULTS: The mean amylase values of CG were significantly higher than those of NCG in blood and drainage fluid (P < 0.05). For lipase, statistically significant differences were observed in drainage fluid (P < 0.05). The mean volume (standard deviation) of the drained fluid through the tube between CG (n = 22) and NCG (n = 236) on postoperative day 1 were 368.41 (266.25) and 299.26 (300.28), respectively. There were no statistically significant differences between the groups (P = 0.298). There was a correlation between the amylase and lipase values in the drainage fluid (r = 0.812, P = 0.000). CONCLUSION: Among postoperative amylase and lipase values in blood and drainage fluid, and the volume of drainage fluid, the amylase in drainage fluid was better differentiated between CG and NCG than other markers. The volume of the drainage fluid did not differ significantly between groups.

Practical Application of Quantitative HiSens Auto Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination for Diagnosing Syphilis; Comparison Analysis between Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination Test and Rapid Plasma Reagin Car / 감염과화학요법

BACKGROUND: The purpose of this study was to evaluate validity of quantitative RPR LTIA, HiSens Auto RPR LTIA (HBi Corp., South Korea) and to decide an adequate cutoff value for syphilis screening. MATERIALS AND METHODS: A total of 549 serums or plasma specimens from patients were tested with RPR LTIA and RPR card tests. Degree of agreement between the two methods was analyzed, and validity of RPR LTIA test was analyzed by receiver operating characteristic (ROC) curves. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC statistics of the RPR LTIA test were analyzed to decide an adequate cutoff value. RESULTS: Agreement analysis showed slight to moderate agreement (k=0.093-0.588, P=0.000). Kappa value had its highest value at the cutoff value of 1.3 and 1.6 (k=0.588, P=0.000). Kappa value at the cutoff value of 1 ranked second (k=0.578. P=0.000). A plot of ROC curve showed a statistically valid result to differentiate between a syphilis test positive group and a syphilis test negative group (AUC=0.92, P=0.000). The cutoff values in RPR LTIA test ranged between 0.65 and 1.15 when both sensitivity and specificity were higher than 80%. CONCLUSION: HiSens Auto RPR LTIA test showed statistically valid result to differentiate between syphilis test groups. Considering the importance of sensitivity in screening for syphilis and the degree of agreement with RPR card test, the cutoff value of 1 in HiSens Auto RPR LTIA test is thought to be adequate.

Practical Application of Quantitative HiSens Auto Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination for Diagnosing Syphilis; Comparison Analysis between Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination Test and Rapid Plasma Reagin Car / 감염과화학요법

BACKGROUND: The purpose of this study was to evaluate validity of quantitative RPR LTIA, HiSens Auto RPR LTIA (HBi Corp., South Korea) and to decide an adequate cutoff value for syphilis screening. MATERIALS AND METHODS: A total of 549 serums or plasma specimens from patients were tested with RPR LTIA and RPR card tests. Degree of agreement between the two methods was analyzed, and validity of RPR LTIA test was analyzed by receiver operating characteristic (ROC) curves. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC statistics of the RPR LTIA test were analyzed to decide an adequate cutoff value. RESULTS: Agreement analysis showed slight to moderate agreement (k=0.093-0.588, P=0.000). Kappa value had its highest value at the cutoff value of 1.3 and 1.6 (k=0.588, P=0.000). Kappa value at the cutoff value of 1 ranked second (k=0.578. P=0.000). A plot of ROC curve showed a statistically valid result to differentiate between a syphilis test positive group and a syphilis test negative group (AUC=0.92, P=0.000). The cutoff values in RPR LTIA test ranged between 0.65 and 1.15 when both sensitivity and specificity were higher than 80%. CONCLUSION: HiSens Auto RPR LTIA test showed statistically valid result to differentiate between syphilis test groups. Considering the importance of sensitivity in screening for syphilis and the degree of agreement with RPR card test, the cutoff value of 1 in HiSens Auto RPR LTIA test is thought to be adequate.

The Power of the Quiz: The Experience of a Medical English Class using Moodle / 한국의학교육

PURPOSE: The purpose of this research is to evaluate whether quizzes using moodle are useful for academic achievement in a medical English class and to introduce moodle to educators based on the author's teaching experience. METHODS: After a final examination in a medical English class, the author surveyed (scale of 1 low to 5 high) the degree of satisfaction of students and the usefulness of quizzes provided on the author's homepage using moodle. Students had been recommended to solve the quizzes on the homepage voluntarily. The author analyzed statistical differences of the final examination scores between the students who completed the quizzes and those who did not. RESULTS: A total of 59 students completed the survey (collection rate=81.9%). On the question of satisfaction about the medical English class and the question of usefulness of quizzes, scores of mean, maximum, and minimum were 4.29 (SD=0.56), 5, and 3, and 4.03 (SD=0.72), 5, and 2, respectively. Statistically significant differences in the final examination scores were observed between the students who completed quizzes and those who did not. CONCLUSION: A tool for students' self-directed study is needed for improving academic achievement. In particular, various educational programs and environments provided by moodle are thought to be very useful. The quizzes the author made with moodle were very effective in the aspect of achievement.

Discrepancy Between the 2007 Korean Medical Licensing Examination and the 2006 Learning Objectives for Medical Students / 한국의학교육

PURPOSE: The purpose of this research was to evaluate the relationship between the 2007 Korean medical licensing examination (KMLE) and the 2006 Learning Objectives for Medical Students (LOMC) produced by the Association of Korean Medical Colleges' Council of Deans. METHODS: A total of 493 questions from the 2007 KMLE and the 2006 LOMC were used. The percentage and the frequency of each LOMC used in the 2007 KMLE were analyzed. The possibility of answering questions guided by the LOMC was analyzed. When questions could not be answered using the LOMC, we further categorized these questions into areas of medicine and specific causes. RESULTS: A total of 669 (14.03%) learning objectives were used to solve questions from the 2007 KMLE. A learning objective was used a maximum of 5 times in the 2007 KMLE, and the percentages of one time, 2 times, 3 times, 4 times, and 5 times were 84.90%, 12.11%, 2.39%, 0.45%, and 0.15%, respectively. Four hundred six of 493 questions were solvable using the learning objectives, and 87 (17.65%) were not. When several steps were needed to solve a question, 15 questions (17.24%) could not be solved due to a lack of learning objectives for some of those steps. Overall, the 87 unsolvable questions were from internal medicine (37.9%), obstetrics & gynecology (14.9%), medical law (12.6%), pediatrics (10.3%), general surgery (9.2%), psychiatry (6.9%), and preventive medicine (1.1%). Questions difficult to solve specifically due to absent learning objectives were in the areas of treatment and procedure (29.67%), test and diagnosis (13.19%), symptoms (9.89%), pathophysiology (7.69%), complications (6.59%), and disease entity (6.59%). CONCLUSION: Discrepancy was observed between the 2007 KMLE and the 2006 LOMC. To solve this problem, the reorganization of both the KMLE and the LOMC based on a clear consensus of a primary care physician's role is believed to be needed.

Prevalence of Class A Extended-Spectrum beta-Lactamases in Clinical Isolates of Acinetobacter baumannii and Pseudomonas aeruginosa / 대한진단검사의학회지

BACKGROUND: Prevalence of class A extended-spectrum beta-lactamases (ESBLs) has been investigated repeatedly in members of family Enterobacteriaceae in Korea, but only rarely in Acinetobacter baumannii and Pseudomonas aeruginosa. The aims of this study were to determine the prevalence of class A ESBL-producing A. baumannii and P. aeruginosa and to characterize the genotypes. METHODS: During the period of June to September 2004, clinical isolates of A. baumannii and P. aeruginosa were collected from patients in Kosin University Gospel Hospital, Busan, Korea. Antimicrobial susceptibility was determined by the disk diffusion and the agar dilution methods, and ESBLproduction by the double-disk synergy test. Transferability of ceftazidime-resistance of ESBL-producers were tested by conjugation. The isoelectric points of ESBLs were determined by isoelectric focusing. Searches for blaTEM, blaSHV, blaCTX-M, blaPER-1, blaVEB, and blaGES/IBC genes were performed by PCR amplification, and the genotypes of ESBLs were determined by a direct nucleotide sequence analysis of the amplified products. RESULTS: A total of 58 clinical isolates of A. baumannii and 77 P. aeruginosa were collected. Three (5.2%) isolates of A. baumannii and four (5.2%) P. aeruginosa isolates showed positive results in the double-disk synergy test using ceftazidime and imipenem disks, and one (1.7%) A. baumannii and two (2.6%) P. aeruginosa isolates showed positive results in that test using ceftazidime and cefoxitin disks. The most prevalent class A ESBL genotype in A. baumannii isolates was blaPER-1 (n=6), and blaSHV-12 gene was also found in one P. aeruginosa isolate. CONCLUSIONS: It is concluded that class A PER-1 ESBL-producing A. baumannii isolates are spreading, and SHV-12-producing P. aeruginosa has emerged in Korea. The spread of class A ESBLs could compromise the future usefulness of expanded-spectrum -lactam antibiotics for the treatment of A. baumannii and P. aeruginosa infections.

Molecular Epidemiology of Vancomycin-resistant Enterococci Isolated from Patients in a Neonatal Intensive Care Unit / 대한임상병리학회지

BACKGROUND: Recently, an acquired resistance to vancomycin in enterococci has become a serious clinical problem. For the prevention of further propagation of vancomycin-resistant enterococci (VRE), epidemiological study of the infection is essential, but studies on the VRE infection are rare in Korea. We conducted an analysis of the epidemiology of a VRE outbreak in a neonatal intensive care unit (NICU) to clear up the route of propagation of the VRE. METHODS: Vancomycin-resistant Enterococcus faecium (VREFM) strains were isolated from urine specimens of seven patients, rectal swabs from seven patients, and three skin swabs from two patients in the Kosin Medical Center neonatal intensive care unit, Pusan, Korea. Antimicrobial susceptibilities were tested by a disk diffusion method and agar dilution method. Genotypes of vancomycin-resistance were determined by PCR and SmaI-digested genomic enterococcal DNAs were analyzed by pulsed-field gel electrophoresis. RESULTS: All of the 17 strains of VREFM were resistant to ampicillin, vancomycin, and teicoplanin and they showed the same genotype (vanA). SmaI-digested genomic DNAs of seven strains isolated from urine were typed as I (1), II (1), IIIb (4), and IV (1). Three strains from skin swabs were I (2) and II (1). Six strains from rectal swabs were I (2), II (1), and IIIa (3). Genomic DNA typing of one isolate from a rectal swab failed. Each genomic DNA type of VREFM strains isolated from skin swabs of two patients were the same with those from urine specimens as I and II, respectively. CONCLUSIONS: This study suggests that VRE strains colonized in the intestines can cause infections after skin colonizing and can be transmitted/propagated to other people through skin contact. In conclusion, it is important for the prevention of the dissemination of VRE that controls for patients' skin hygiene, as well as hand washing by medical persons, be put in place.

Donor Cell Repopulation after Bone Marrow Transplantation and Heterotopic Partial Liver Transplantation in Rats Prework for Chimerism

PURPOSE: Improvements in the prevention or control of rejection of kidneys and livers have been largely interchangeable and then applicable. However, the mechanism by which antirejection treatment permits any of these grafts to be accepted has been an immunological enigma. Recently, the exchange of migratory leukocytes between the transplant and the recipient, with consequent long-term cellular chimerism in both has been the basis for acceptance of all whole-organ allografts and xenografts. METHODS: The donors of liver transplants were male Lewis rats weighing 100-150 g in all experiments groups. Male Brown Norway rats were the experimental group and female Lewis were the control group. Heterotopic partial liver transplantation was performed by Lee's method without arterial reconstruction. All procedures were performed under ether anesthesia. Bone marrow was taken from the tibias and femurs and was processed in RPMI 1640. The cell counts of suspensions were 2.5x10(8) per experiment. Genomic DNA prepared from peripheral blood and various tissues. Male Lewis Sry-specific oligonulceotide primers were used. RESULTS: In allogenic liver transplantation with bone marrow transplants (LEW-BN), donor cells were detected in the liver, and the spleen by day 7. However, in rejection cases, donor cell were not detected in any tissues. In isografted transplants (LEW-LEW), after bone marrow transplantation, donor cells were found in lymph nodes, the liver, and peripheral blood. In isografted transplants (LEW-LEW), after liver transplantation donor, cells were only found in the grafts. CONCLUSION: In allogenic liver transplantation with bone marrow transplantation, chimerism induction was augmentedwith bone marrow-derived stem cells. Therefore, it is necessary to have many samples to investigate more precisely chimerism and rejection after liver transplantation with bone marrow transplantation.

A Case of Acute Myelogenous Leukemia with a 47,XYY Karyotype / 대한임상병리학회지

A 61 year-old male patient admitted with the complaint of chest pain. During the evaluation, immature cells were found on the peripheral blood smear. Bone marrow aspiration and biopsy were performed. Diagnosis of acute myelogenous leukemia(FAB classification, M2) was made. In the chromosome study using peripheral blood and bone marrow, 47,XYY karyotype was established. Acute myelogenous leukemia has rarely been diagnosed in patients with 47,XYY karyotype, and the effect of extra Y chromosome on oncogenesis is not clear. More studies are needed to be done to clear up the relation between XYY karyptype and leukemia.

Detection of p53 Mutant and isochromosome 17q in Myelodysplastic Syndromes and Leukemias / 대한임상병리학회지

BACKGROUND: The p53 gene is a tumor suppressor gene situated in the short arm of chromosome 17(in 17p13 band). The p53 mutation is often correlated with the worsening or relapsing of the hematologic malignancies, and the loss of the short arm of chromosme 17 is associated with a p53 mutation on the remaining allele in several hematologic malignancies. In this study, we investigated correlations between cytogenetic rearrangements leading to 17p deletion, the presence of mutant p53 protein and single strand conformational polymorphism analysis of the p53 gene in myelodysplastic syndromes and leukemias. METHODS: In this study, we analyzed 60 patients with different hematologic malignancies, including 26 acute myelogenous leukemia, 16 acute lymphoblastic leukemia, 7 myelodysplastic syndrome, and 11 chronic myelogenous leukemia. Cytogenetic analysis of the bone marrow was performed by using the G-banding method. Mutant p53 protein was detected using a mouse monoclonal antibody, which reacts with mutant p53. The Polymerase chain reaction and the single strand conformational polymorphism analysis(PCR-SSCP) of exons 5 to 8 of the p53 gene were performed on only 20 patients with acute myelogenous leukemia. RESULTS: Only 1(1.7%) out of 61 patients showed a deletion of the short arm of chromosome 17 through isochromosome 17q and mutant p53 protein. This patient with chronic myelogenous leukemia underwent a clinical transition from chronic to blastic phase. But, PCR-SSCP of the p53 gene was not performed on this patient with isochromosome 17q and mutant p53 protein. CONCLUSIONS: Even though analysis of the p53 gene by PCR-SSCP was not fully performed, this report suggests that the frequency of p53 mutant may be rare in Korean patients with myelodysplastic syndromes and leukemias. In addition, further investigation is required for the correlation between immunofluorescence and PCR-SSCP to detect p53 mutations.

Microbial Contamination of Autologous Peripheral Blood Stem Cell / 대한수혈학회지

BACKGROUND: The incidence and clinical consequences of microbiological contamination of autologous peripheral blood stem cells are not well documented. Therefore, we retrospectively analysed our experience with microbial contamination of autologous peripheral blood stem cell concentrates. METHOD: We have determined the incidence and clinical significance of positive microbiologic cultures in series of 52 peripheral blood stem cell concentrates in 14 patients undergoing multiple apheresis procedures for autologous stem cell rescue. Specimens for bacterial cultures were obtained after processing of the autografts just prior to freezing. RESLUTS: The incidence of microbial contamination was 7.7%. The microorganism cultured was coagulase negative Staphylococcus. The patient with contaminated leukapheresis products received two culture-positive stem cell concentrates and three culture-negative stem cell concentrates without adverse clinical sequelae. No microorganism present in the stem cell autograft was recovered in vivo in the posttransplantation period, although fever as a sign of infection occurred in this patient. CONCLUSIONS: Although microbial contamination may occur during autologous peripheral blood stem cell collection and cryopreservation, this report suggests that peripheral blood stem cell contamination may not play a significant role in the infectious complications of autologous peripheral blood stem cell transplantation.

A Case of Vibrio parahaemolyticus Septicemia in a Patient with Liver Cirrhosis / 대한임상미생물학회지

V. parahaemolyticus was isolated from blood culture of a 34-year old female patient with HCV viral hepatitis and liver cirrhosis. V. parahaemolyticus is one of the frequent causative agents of gastrointestinal infection, but rarely causes septicemia. This case is thought to be the 3rd report of V. parahaemolyticus septicemia in Korea.

Prevalence of Extended-spectrum beta-lactamase-producing Enterobacteriaceae and Evaluation of Methods for Detection / 대한임상미생물학회지

BACKGROUND: Increased isolation of extended-spectrum beta-lactamase (ESBL)-producing Entero bacteriaceae resistant to third generation cephalosporins and aztreonam has been noted recently. This study was to determine the prevalence of resistance to these drugs and ESBL in Enterobacteriaceae and to evaluate the methods for de tection. METHODS: During the period of October, 1997 and March, 1998, a total of 731 clinical isolates of Enterobacteriaceae were collected from patients of the Kosin Medical Center, Pusan, Korea. Antimicrobial susceptibility test by disk diffusion method and double disk synergy test were performed. MICs of beta-lactams were determined by agar dilution method. And ESBL genotypes were determined by polymerase chain reaction. RESULTS: About 10% of Escherichia coli isolates and 20% of Klebsiella pneumoniae isolates were intermediate or resistant to the third generation cephalosporins or aztreonam. Sensitivities of cefotaxime, ceftazidime, ceftriaxone and cefpodoxime disks for the detection of ESBL- producing strains of E. coli and K. pneumoniae by NCCLS standards were 100%, respectively, but that of aztreonam disk was 97%. Positive predictive value of the ceftazidime disk was higher than those of other disks. Twenty strains of E. coli, 20 K pneumoniae, 19 Enterobacter spp., six Citrobacter freundii, and eight Serratia marcescens showed positive results in double disk synergy test. The transconjugant strain of K. pneumoniae K20482 had blaSHV, and remains of transconjugants of ESBL-producing K. pneumoniae, Enterobacter spp. and S. marcescens had blaTEM. CONCLUSIONS: In this study, many strains of Enterobacteriaceae isolated in Korea were resistant to third generation cephalosporins and aztreonam. Some of the strains of Enterobacter spp. and S. marcescens as well as E. coli and K. pneumoniae produced ESBL, and majority of these strains had blaTEM. In the detection of ESBL-producing strains of E. coli and K. pneumoniae by NCCLS standards, all of the antimicrobial agent disks tested were useful, but ceftazidime disk was most effective because of its highest positive predictive value.

Clinical evaluation of Lewis antigen expression on erythrocytes in cancer patients / 대한수혈학회지

BACKGROUND: CA 19-9, a tumor marker for pancreatic cancer, was reported to be related to the Lewis phenotype. ABO and Lewis antigen are thought to influence the colonization and inflammatory reaction of H. pylori infection. Therefore, we investigated the possible clinical utilization of Lewis blood antigen in characterizing cancer patients by retrospectively evaluating 396 cancer patients' laboratory data. METHODS: Distribution of Lewis blood phenotype of the cancer patients, possible correlation between the Lewis phenotype on erythrocytes and the serum IgG antibody for H. pylori, between the Lewis phenotype on erythrocytes and the level of serum CA 19-9, between Lewis blood phenotype and ABO blood group, and between ABO blood group and serum IgG for H. pylori were investigated. RESULTS: In total 396 cancer patients, the Lewis blood phenotype of Le(a+b-), Le(a-b+), Le(a-b-), and Le(a+b+) occupied 23%, 55.1%, 19%, and 3%, respectively. Patients with Lewis phenotype of Le(a-b-) showed the lowest sero-positive rate of the serum IgG antibody for H. pylor. In 20 stomach cancer patients, 1 out of 8 Le(a+b-) patients showed change in the phenotype to Le(a-b-) and 2 out of 10 Le(a-b+) patients showed change to Le(a-b+) before and after the operation. In 11 pancreatic cancer patients, the frequency of Le(a-b-) was relatively high (36.4%). In 3 out of 4 Le(a-b-) patients, increase in serum CA 19-9 level was noticed. The frequency of Le(a-b+) phenotype in each ABO blood group was higher than any other Lewis phenotypes (O 58.0%, A 53.5%, B 62.3%, AB 46.2%). 8 out of 11 Le(a+b+) patients were blood type O. CONCLUSION: Sero-positive rate of H. pylori was the lowest in Le(a-b-) patients, indicating the possible correlation between low H. pylori infection rate and Le(a-b-) phenotype. Le(a-b-) pancreatic cancer patients showed significant increase in the serum CA 19-9 level. Most Le(a+b+) patients have blood type O. The ABO blood group and serum IgG for H. pylori did not show any significant correlation.

A Case of Leclercia adecarboxylata Isolated from Dialysate in a Patient with Continuous Ambulatory Peritoneal Dialysis / 대한임상미생물학회지

A 60-year-old male with continuous ambulatory peritoneal dialysis was admitted because of abdominal discomfort and turbid dialysate. He had a history of chronic renal failure due to diabetic nephropathy. His WBC count of perpheral blood was 8,500/mm3 (neutrophil 92%), and that of dialysate was 1,400/mm3 (polymorphonuclear leukocyte 69%, lymphocyte 31%). Pure growth of Leclercia adecarboxylata was isolated from dialysate. The L. adecarboxylata isolate was susceptible to ampicillin, ampicillin/sulbactam, cephalothin, cefoperazone, cefoxitin, cefotaxime, ceftazidime, aztreonam, imipenem, gentamicin, tobramycin, amikacin, tetracycline, trimethoprim- sulfamethoxazole and ciprofloxacin. Cephalothin & amikacin were added into dialysate, and his clinical symptoms and turbidity of dialysate were resolved. L. adecarboxylata has been rarely isolated from clinical specimens. To our knowledge, this is the first report of L. adecarboxylata isolated from clinical specimen in Korea. On review of the world literature, we found only 7 cases of L. adecarboxylata infections. This microorganism has been isolated from lower extremity wounds and sputum as part of a mixed flora in 3 cases and 1 case, respectively, but it was the only microorganism isolated from cultures of blood in 3 cases. These 3 patients with bacteremia due to L. adecarboxylata had severe underlying diseases, and clinical symptoms were developed after invasive procedures. All of the L. adecarboxylata isolates from clinical specimens were susceptible to antimicrobial agents tested, and the responses to antibiotic therapy were excellent. It is difficult to identify this organism because its biochemical reactions are similar to those of Escherichia coli, therefore careful identification is required. And additional studies are necessary to determine the pathogenic potential and route of infection of this organism.

PPrevalence of Staphylococcus aureus Isolates with Decreased Susceptibility to Teicoplanin and Evaluation of Methods for Detection / 감염

BACKGROUND: The purpose of this study was to investigate the prevalence of Stap hylococcus aureus with decreased susceptibility to glycopeptides in Korea and to evaluate the methods for detection. METHODS: From March to May 1998, 106 clinical isolates of S. aureus were collected from patients of the Kosin Medical Center . Antimicrobial susceptibilities for vancomycin and teicoplanin were determined by NCCLS disc diffusion method and the MICs were determined by agar dilution method. Correlation between both results was evaluated. RESULTS: MICs of vancomycin and teicoplanin against S. aureus isolates were 0.5 ~2 microgram/mL and 0.25 ~8 microgram/mL. Some S. aureus isolates showed decreased susceptibility to teicoplanin (MIC 4 microgram/mL, 33 strains; MIC 8 microgram/mL, 1 strain), but none showed decreased susceptibility to vancomycin. A positive correlation was observed between the inhibitory zone diameters of teicoplanin disc and the MICs of teicoplanin(P< 0.0 1). Inhibitory zone diameter differences between vancomycin and teicoplanin discs also showed a positive correlation with the MICs of teicoplanin (P< 0.01). Strains whose inhibitory zone diameters of teicoplanin disc were less than 16 mm, the sensitivity and positive predictive value for the detection of strains with MICs more than 4 microgram/mL were 100 % (34/ 34) and 43% (34/ 79), respectively. In strains with inhibitory zone diameter difference of more than 4 mm, the sensitivity and positive predictive value of detection in MICs of more than 4 microgram/mL were 94 % (32/ 34) and 70 % (32/46), respectively. CONCLUSION: Although S. aureus with intermediate or full resistance to glycopeptides was not isolated in this study, few strains had decreased susceptibility to teicoplanin. We conclude that when the inhibitory zone diameters of teicoplanin disc are less than 16 mm or inhibitory zone diameter difference between vancomycin and teicoplanin discs is more than 4 mm, the presence of S. aureus isolates with decreased susceptibility to teicoplanin should be suspected.