Comparison between Kidney and Hemoperfusion for Paraquat Elimination

The mortality rate of acute paraquat (PQ) poisoning depends on the PQ concentration in the blood. It has been shown that the kidneys eliminate PQ effectively. However, early renal function deterioration is frequently observed in acute PQ intoxication. This study is designed to compare the efficacy of PQ elimination with hemoperfusion (HP) and kidneys, taking into account the functional deterioration of the kidneys. The amount of renal and HP excretion of PQ were measured during the procedure of HP in patients with acute PQ intoxication. The PQ clearance and the actual amount of PQ elimination by the HP cartridge during the HP procedure were 111+/-11 mL/min (range; 13.2-162.2 mL/min) and 251.4+/-506.3 mg (range; 4.6- 1,655.7) each. While, the renal clearance and actual amount of renal elimination of PQ was 79.8+/-56.0 mL/min (range; 9.7-177.0) and 75.4+/-73.6 mg (range; 4.9- 245.8). As the creatinine clearance decreased, the PQ elimination by HP was as effective as or more effective than the renal elimination. In conclusion, early HP must be provided for life saving treatment in patients with acute PQ intoxication.

Benzene and toluene concentrations in a hemodialysis room in a medium sized South Korean city

BACKGROUND/AIMS: The current study was designed to determine whether the indoor air pollution in a hemodialysis room (HD) was different from that of other comparable areas in a hospital. METHODS: Five air monitor samplers were hung on the ceiling and placed on the table in both the HD and general ward nursing stations, respectively. In addition, five samplers were placed in the nurse's breathing zone of the HD and the general ward, respectively. Ten air monitor samplers were also placed on the edge of the bed in the HD, which represented the patient's breathing zone. The levels of benzene and toluene were analyzed by GC/MS. RESULTS: In the general ward, the toluene concentration was significantly higher in the nurse breathing zone than that for the ceiling or table samples (p=0.001). The benzene concentration was also significantly higher in the general ward nurse breathing zone than that in the HD (p=0.006). In addition, the benzene concentrations on the table were higher at the general ward as compared to the HD (p=0.028), but there was no significant difference between the ceiling, general ward station and HD. CONCLUSIONS: Both the benzene and toluene concentrations in the HD appear to be more affected by the outdoor atmospheric conditions than by any potential indoor internal sources.

Two Cases of Acute Renal Cortical Necrosis Diagnosed by Contrast-Enhanced Computerized Tomography / 대한신장학회지

Renal cortical necrosis (RCN) is a relatively rare cause of acute renal failure. In the past, the incidence of RCN was more higher in obstetrical patients than in non-obstetric patients. But during the last 15 years, the prevalence of RCN in non-obstetric patients have overwhelmed the obstetrical patients. Renal biopsy was an only gold standard diagnostic method for RCN in the past even though it was not performed frequently because of the serious clinical circumstances and coagulopathy generally accompanied by RCN, especially during the early period. Recently, contrast-enhanced computerized tomography was found to provide very characteristic representative findings. Therefore, the importance of contrast-enhanced computerized tomography as non-invasive diagnostic procedure during the initial phase of RCN is stressed. We report two cases of RCN which we have diagnosed early by using contrast-enhanced computerized tomography and treated by hemodialysis.

The significance of the TDx-FLM assay in the fetal lung maturity / 대한산부인과학회잡지

OBJECTIVE: The TDX analyzer, an automated fluorescence polarimeter, has been utilized to assess surfactant content in amniotic fluid. Amniostat-FLM is an immunologic semiquantitative agglutination test for determining the presence of phosphatidylglycerol in human amniotic fluid at concentration indicative of fetal lung maturity. We evaluated the usefulness of the recently introduced TDx-FLM assay in determining fetal lung maturity. METHODS: Seventy-three samples of amniotic fluid were analyzed. Among them, 18 samples were compared with Amniostat-FLM assay. RESULTS: Surfactant/albumin ratio using TDx-FLM assay increased with longer gestational age. And the concordance rate between Amniostat-FLM assay and TDx-FLM assay was 66.9%. CONCLUSION: The TDx-FLM assay appears to be a useful test in the field of fetal lung maturity testing.

The significance of the TDx-FLM assay in the fetal lung maturity / 대한산부인과학회잡지

OBJECTIVE: The TDX analyzer, an automated fluorescence polarimeter, has been utilized to assess surfactant content in amniotic fluid. Amniostat-FLM is an immunologic semiquantitative agglutination test for determining the presence of phosphatidylglycerol in human amniotic fluid at concentration indicative of fetal lung maturity. We evaluated the usefulness of the recently introduced TDx-FLM assay in determining fetal lung maturity. METHODS: Seventy-three samples of amniotic fluid were analyzed. Among them, 18 samples were compared with Amniostat-FLM assay. RESULTS: Surfactant/albumin ratio using TDx-FLM assay increased with longer gestational age. And the concordance rate between Amniostat-FLM assay and TDx-FLM assay was 66.9%. CONCLUSION: The TDx-FLM assay appears to be a useful test in the field of fetal lung maturity testing.

Analysis of Blood Spot 17-Hydroxyprogesterone Concentration According to Gestational Age and Birth Weight / 대한임상병리학회지

BACKGROUND: High levels of 17-hydroxyprogesterone (17-OHP) are frequently observed in premature infants without congenital adrenal hyperplasia. The purpose of this study is to set cut-off limits of 17-OHP on the basis of gestational age at birth and birth weight. METHODS: Blood spot 17-OHP concentrations were measured in 1,000 infants on the 3th day of life at Inha University Hospital. An enzyme-linked immunosorbent assay (ELISA) method (ICN Neoscreen ELISA 17-hydroxyprogesterone kit, ICN Pharmaceuticals. Inc., Japan) was used. The values obtained were analyzed with respect to birth weight and gestational age at birth in order to decide the appropriate cut-off limits in a neonatal mass screening for 21-hydroxylase deficiency. RESULTS: In the neonatal mass screening for CAH, the cut-off limits for determining the 17-OHP for recall, were decided as follows: (1) 57.65, 39.88, 33.52 ng/mL for gestational age at birth of 35 weeks or less, 36-37, and 38 weeks or more, respectively, and (2) 54.88, 43.86, 32.92 ng/mL for birth weight of 2.49 or less, 2.50-2.99, 3.00 kg or more, respectively. CONCLUSIONS: The cut-off limits on the basis of gestational age at birth and birth weight should be used in the screening for congenital adrenal hyperplasia. We believe that the false positive rate in premature infants can be reduced using this method.

A study of microorganisms in oral & maxillofacial infected patients

A Case of Adult Neuroblastoma Involving Bone Marrow / 대한임상병리학회지

Neuroblastoma, which originates in the sympathetic division of the autonomic nervous system, is the most common extracranial solid malignancy in childhood but rarely occurs in adulthood. Only one case of neuroblastoma has been reported in Korean adult. Authors recently experienced a case of neuroblastoma originating from the retroperitoneal cavity with metastasis to the bone marrow and neck. A 29-year-old male was admitted at Inha University Hospital because of abdominal pain and back pain. The patient had a past history of chemotherapy for retroperitoneal tumor in a general hospital 4 years ago. In biochemical test, neuron specific enolase(NSE) was above 260 ng/mL and urine vanillylmandelic acid(VMA) was positive. Immunohistochemical stainings of bone marrow sections, showed positive reactions for NSE, chromogranin, and synaptophysin, however, revealed negative reactions for MIC2, vimentin, and mixed keratin. Pathologic examination showed the characteristic findings of neuroblastoma. We report this case with a review of literature.

A Case of Cerebral Malaria Associated with Renal Failure due to Plasmodium falciparum / 대한임상병리학회지

In recent years, the incidence of imported cases infested with Plasmodium falciparum has been increasing in Korea due to marked increase in travel to malarious area without adequate prophylaxis. Cerebral malaria is an encephalopathy, occasionally associated with infestation of P. falciparum, which can complicate some patients infected with Plasmodium falciparum leading to significant mortality. We experienced a case of 45 year-ld male with cerebral malaria, complicated with disseminated intravascular coagulation and acute renal failure. The patient was thought to be infected in travel to Indonesia, Laos, and Bangkok. Blood smear showed typical multiple intra-rythrocytic ring form trophozoites and banana-haped gametocytes of Plasmodium falciparum. The patient died after comatose state with respiration failure for 24 days despite treatment with exchange transfusion, hemodialysis and chemotherapy. We report this case with a review of the literature.

A Case of Cerebral Malaria Associated with Renal Failure due to Plasmodium falciparum / 대한임상병리학회지

In recent years, the incidence of imported cases infested with Plasmodium falciparum has been increasing in Korea due to marked increase in travel to malarious area without adequate prophylaxis. Cerebral malaria is an encephalopathy, occasionally associated with infestation of P. falciparum, which can complicate some patients infected with Plasmodium falciparum leading to significant mortality. We experienced a case of 45 year-ld male with cerebral malaria, complicated with disseminated intravascular coagulation and acute renal failure. The patient was thought to be infected in travel to Indonesia, Laos, and Bangkok. Blood smear showed typical multiple intra-rythrocytic ring form trophozoites and banana-haped gametocytes of Plasmodium falciparum. The patient died after comatose state with respiration failure for 24 days despite treatment with exchange transfusion, hemodialysis and chemotherapy. We report this case with a review of the literature.

CD34 Analysis according to ISHAGE Guideline / 대한혈액학회지

BACKGROUND: Flow cytometric analysis for CD34 has been widely used for hematopoietic stem cell enumeration. The procedure is simple and rapid for clinical use but the lack of standardization resulted in great intralaboratory variations. In 1995, a guideline for CD34 analysis was established by International Society of Hematotherapy and Gene Engineering (ISHAGE) for reliable testing. We performed CD34 analysis using the ISHAGE guideline in umbilical cord blood (UCB), mobilized peripheral blood (MPB) and leukapheresis product (LP) and compared the results with those of in-house method. METHODS: CD34 analyses were performed in thirty units each of UCB, MPB and LP according to the ISHAGE guideline and in-house method and the results were analyzed by the t-test. Both methods used CD45FITC/CD34PE and its isotype controls. In ISHAGE guideline, among CD34+/ CD45+ cells, only those with low forward scattering, low to intermediate side scattering and low to intermediate CD45 fluorescent intensity were identified as stem cells, and the percentage of those cells among CD45+ cells was calculated. In in-house method, cells expressing both CD34 and CD45 antigens were selected by isotype control and the percentage of CD34+/CD45+ cells among CD45+ cells were calculated. RESULTS: Significant differences were observed in the percentages of CD34+ cells in UCB, MPB and LP between ISHAGE guideline (0.25%, 0.42%, 0.80%) and in-house method (0.40%, 0.55%, 1.20%) (P<0.001). So were the CD34+ cell counts : mean values of CD34+ cells in microliter of UCB, MPB and LP were 20, 40, 1,392 by ISHAGE guideline, and 35, 62, 2,079 by in-house method (P<0.001). CONCLUSION: ISHAGE guideline for CD34 enumaration was considered as a simple, rapid and reliable method for clinical setting and to have economic benefits because no additionalmonoclonal antibodies were required.

A study of 5, 10 - Methylenetetrahydrofolate Reductase ( MTHFR ) polymorphism among the Korean population / 대한내과학회지

Hyperhomocysteinemia has been recognized as an independent risk factor which causes atherosclerosis. The genetic mutation in MTHFR, an enzyme required for efficient homocysteine metabolism, produces a thermolabile enzyme with reduced activity. It has been suggested that thermolabile MTHFR is associated with vascular disease due to increased plasma homocysteine concentration. This study is a preliminary research for identifying the relationship between the MTHFR gene mutation and hypertensive subjects by examining the prevalence of 677 C--

A Case of Agrobacterium radiobacter Peritonitis in a Patient on CAPD / 대한신장학회잡지

Agrobacterium radiobacter is a rare human pathogen and a few cases were reported in the world. The peritoneal cavity in patient maintained on peritoneal dialysis serves as an excellent incubator and culture medium for microorganisms. We experienced a rare human infection as peritonitis with A. radiobacter in Inha University Hospital, Inchon, Korea. The patient was 36 year-old female and maintained on CAPD for one year. She had two times of CAPD peritonitis. She visited to the hospital because of turbid peritoneal fluid. On initial physical examination, she showed mild abdominal tenderness and elevated body temperature. Laboratory findings showed leukocytosis and anemia with elevated serum creatinine level. The analysis of peritoneal fluid showed white blood cell count as many as 1860/mm3 and it's culture revealed A. radiobacter. She received vancomycin and aminoglycoside antibiotics via intraperitoneal route and the CAPD catheter was removed. She was maintained on hemodialysis and reveived isepamicin 100mg a day via intravenous for 7 days. We report our experience of peritonitis caused by A. radiobacter and review the literature of similar cases of peritonitis.

Comparison of High Performance Liquid Chromatography and Fluorescence Polarization Immunoassay for Determination of Total Homocysteine in Human Plasma / 대한임상병리학회지

BACKGROUND: It was purposed to estimate correlation between fluorescence polarization immunoassay (FPIA) and high performance liquid chromatography (HPLC), and precision of individual methods. It was also objected to describe distribution of plasma total homocysteine in Korean adults. METHODS: The subjects were 100 adults admitted to Inha University Hospital during the month of October, 1998. The total plasma homocysteine concentration was measured by FPIA (IMx analyzer, Abbott Laboratories, IL, USA) and by HPLC (ACCLAIM Biogenic Amines Testing System, Bio-Rad Laboratories, CA, USA) using Bio-Rad Homocysteine. RESULTS: Plasma homocysteine levels (mean+/-SD) from Korean healthy adults by FPIA and HPLC were 9.75+/-3.80micromol/L, 7.72+/-3.36micromol/L, respectively. Plasma homocysteine levels according to sex by FPIA were 11.79micromol/L for male, 7.71micromol/L for female, and those by HPLC were 9.47micro mol/L for male, 5.98micromol/L for female, respectively. Intra-assay coefficient variations (CVs) of low, medium, and high concentration by FPIA are 1.83%, 0.47%, and 1.66%, and those by HPLC are 5.53%, 5.37%, and 4.56%, respectively. Inter-assay CVs of low, medium, and high concentration by FPIA are 2.28%, 1.44%, and 1.29%, and by HPLC are 7.23%, 5.54%, and 4.95%, respectively. CONCLUSION: Plasma homocysteine levels from male were significantly higher than female in Korean. Plasma homocysteine levels were increased according to increment of age. FPIA was more convenient, automatic, rapid, and reproducible than HPLC and also excellently correlated with HPLC. It is concluded that FPIA will potentially benefit for quantifying homocysteine in clinical laboratories.

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.

A case of parsely dependent sxercise-induced anaphylaxsis / 천식및알레르기

Exercise-induced anaphylaxis can be associated with ingestion of a specific food. We experienced a case of exercise-induced anaphylaxis followed by ingestion of parsely. A 22- year old female patient was presented with angioedema of the face and chest tightness induced by running after ingestion of parsley within 15 minutes. She had suffered from allergic rhinitis. She had positive reactions to mugwort pollen and parsely extract on skin prick test in a dose dependent manner. Although the oral provocation test with parsely could not induce bronchoconstriction, we could diagnosed as parsely dependent exercise induced anaphylaxis based upon skin prick test and history.

Clinical Charateristics of Pyrethroids Poisoning / 대한내과학회지

OBJECTIVES: Pyrethroids are commonly used pesticides, and acute human poisoning by these insecticides is common in Korea. It has a high affinity to the sodium channel on cell membranes causing blockage, which results in neurotoxicity, hyperexcitation, and death. The purpose of this study was to analyze the clinical characteristics of acute pyrethroid poisoning. METHODS: To evaluate the clinical characteristics (age, sex, causative agents, cause of ingestion, severity of poisoning and its clinical feature, prognosis, complication and results of the treatment), we analyzed the clinical reports of 30 patients with pyrethroid poisoning who were admitted to Soonchunhyang Chunan hospital from January 1992 to July 1997. RESULTS: 1) 18 out of 30 patients with pyrethroid poisoning were male and the largest age group was above 60 years old. 2) The most common cause of ingestion was suicide, in 24 cases (80%). 3) There were 7 classes of causative agents of poisoning and all of these were classified into 2 grades according to the degree of WHO toxicity. Fenvlaerate and cypermethrin were the most common agents. 4) The degree of severity was classified into three groups - mild, moderate and life -threatened. Of these groups, mild poisonig was the most common. There was no significant difference in the age, type of pyrethoid and interval between pyrethroid ingestion and arriving at the emergency room between the three groups. However, the amount of ingestion was significantly higher in the life-threatened group. 5) The most common symptom of the patients was vomiting, in 19 patients. The classification were of three types (5 type I, 11 type II and 1 intermediate type) according to clinical characteristics. 6) There is no specific antidote, therefore therapy is generally supportive. There were three deaths, and the cause of death was respiratory failure. 7) The most common complication was pneumonia, in 3 cases (10%), which occured in almost all patients in the life-threatened group. CONCLUSIONS: The most common age group of poisoing was over 60 years old, and suicide was the most common cause of ingestion. Treatment is supportive, and most causal exposures require only decontamination. There were three deaths, and the cause of death was respiratory failure in each case. The most common complication was pneumonia.

A Case of Chronic Myelogenous Leukemia Manifested bcr-abl Gene Rearrangement in Pleural Effusion / 대한임상병리학회지

Chronic myelogenous leukemia (CML) has been reported to show extra-medullary involvement in 10% of cases and affect mostly lymph nodes and spleen. Extensive pleura involvement of leukemic cells is very rare and no cases of CML infiltrating pleura have been reported in Koreans. Authors recently experienced a case of CML presenting pleural effusion with malignant leukemic cells. A 76-year-old woman was admitted at Inha University Hospital because of dyspnea and rectal bleeding 3 months ago. The patient had a past history of treatment for massive pleural effusion in local clinic 4 month ago. In biochemical test, LD (lactate dehydrogenase) was 620 IU/dL, and serum uric acid was 8.1 ug/dL. Peripheral blood smear showed 3% of blasts and 65% of basophils and bone marrow biopsy revealed marked increase of cellularity. Total cell number of pleural fluid was 14,100/uL and cytological examination of the pleural fluid revealed cells with the morphological features of myeloblasts and occasional megakaryocytes. The bcr-abl gene rearrangement was detected in cells isolated from pleural fluid and bone marrow aspirates. The patient refused treatment with chemotherapeutic for CML and was discharged.

Mycolic Acid Analysis for Identification of Mycobacterium spp. using High-Performance Liquid Chromatography / 대한임상병리학회지

BACKGROUND: Mycobacteria are traditionally identified with biochemical reactions. Since it takes 2 to 6 weeks, more rapid method is needed for timely treatment of mycobacterial infection. Mycolic acid analysis by high-performance liquid chromatography (HPLC) was recently introduced, which showed species-specificity with more than 95% sensitivity and 100% specificity for identifing Mycobacterium spp. within 2-4 hours. In this study, We performed mycolic acid analyses of standard strains of Mycobacterium spp. and two clinical isolates of known M. tuberculosis for demonstrating their species-specific nature and evaluated its reproduciblity. METHODS : 8 standard strains of Mycobacterium spp. (M. tuberculosis H37Rv, M. intracellurae, M. avium, M. fortuitum, M. chelonae subsp. chelonae, M. scrofulaceum, M. kansasii, M. gordonae) and 2 clinical isolates of known M. tuberculosis were analyzed. The extracted mycolic acids which were prepared by 3 steps were analyzed by HPLC with rC18 column. RESULTS: Mean retention time (MRT) of low and high molecular weight internal standards were 3.757min+/-0.017 (C.V. <0.455%) and 9.829min+/-0.015 (C.V. <0.015%), respectively (n=30). The C.V. of MRT for M. intracellurae for positive control showing double cluster pattern was less than 0.3% from 4 injection. The C.V. of MRT for M. tuberculosis H37Rv and 2 clinical isolates of M. tuberculosis with single cluster pattern were less than 0.4%, and 0.9%, respectively. The chromatographic patterns of M. kansasii and M. gordonae showed a single cluster pattern, and M. avium, M. fortuitum, M. chelonae subsp. chelonae, and M. scrofulaceum showed a double cluster pattern which were species-specific nature. CONCLUSIONS: We demonstrated HPLC method was rapid and highly reproducible.

A Case of Atrial Septal Aneurysm with Recurrent Atrial Fibrillation and Cerebellar Infarction

An atrial septal aneurysm is well recognized abnormality of uncertain clinical relevance. An intraatrial aneurysm was demonstrated in the fossa ovalis of a 41-year-old woman who suffered an episode of cerebellar infarction with recurrent atrial fibrillation. The disorder is rarely treated surgically. Most patients with this condition are given life-long anticoagulation, a treatment that may have serious complications. We report a rare case of atrial septal aneurysm with recurrent atrial fibrillation and cerebellar infarction which receiving an appropriate diagnosis and curative treatment.