BACKGROUND: Stool culture for enteric pathogens constitutes a significant portion of the workload in clinical microbiology. Several reports recommended that selenite enrichment have been used only in stool cultures from suspected carriers, during outbreaks, and other special circumstances for cost-effectiveness. We evaluated the usefulness of selenite F enrichment for the isolation of Salmonella in routine stool cultures. METHODS: Stool specimens submitted from March to October, 1999 were inoculated onto MacConkey(Mac) agar and Salmonella-Shiegella(SS) agar and into Selenite F(SF) enrichment broth. After overnight incubation, the SF broth was subcultured onto a second SS agar. RESULTS: Total 45 strains of Salmonella spp. were recovered from 1,338 stool specimens and Shiegella or other enteric pathogens were not recovered. Twenty out of the forty-five Salmonella spp.(44%) were recovered on Mac agar and 33 of 45 Salmonella spp.(73%) on SS agar, 45 out of 45 Salmonella spp.(100%) after SF enrichment and 35 of 45 Salmonella spp.(78%) on Mac and/or SS agar. Ten Salmonella spp. were recovered only after SF enrichment, but no Salmonella spp. were recovered only on the primary Mac agar or SS agar. After SF enrichment, Salmonella spp. grew more purely and heavily than on the primary medium. CONCLUSIONS: These results suggest that SF enrichment is necessary to routine stool cultures and the elimination of the primary Mac or SS agar is cost-effective than the elimination of SF enrichment.
Agar ; Disease Outbreaks ; Salmonella* ; Selenious Acid*

BACKGROUND: The immunologial alterations of tertian malaria are poorly understood. We investigated the hematological and immunological findings to know immunological mechanism of tertian malaria. METHODS: Forty patients with tertian malaria, hospitalized in the three affiliated hospitals of Catholic University Medical College, were enrolled in this study. The hematologic examination was performed by Coulter STKS. Atypical lymphocytes, eosinophils and plasmodium burden were counted manually. The immunoglobulin and complement concentrations were measured by nephelometry( Behring nephelometer analyzer, Germany) and automated chemiluminescence system(ACS 180, USA). The peripheral blood lymphocyte subsets were analyzed by flow cytometry using anti- CD3, CD4, CD8, CD19, CD25 and CD56 monoclonal antibodies(Becton Dickinson, San Jose, USA) and negative control. RESULTS: Anemia, lymphopenia, thrombocytopenia and eosinopenia were observed, and the eosinophil count was correlated to platelet count. The numbers of CD3+, CD8+, CD19+, CD56+, CD3-/CD56+ and CD8+/CD56+ lymphocytes were lower in tertian malaria than in control group(P<0.05). At 8th week after treatment, the percentage of CD8+ lymphocytes became significantly higher than before. The percentage of CD19+ lymphocytes was correlated to the number of eosinophils and thrombocytes(r=0.641, 0.417, P=0.000, 0.006). The serum concentrations of IgM and IgE were higher in tertian malaria than in control group. At 1st week after treatment, the IgE concentration became significantly lower than acute stage(P=0.014). The C3 and C4 concentrations were higher in tertian malaria than in control group. The C4 concentration became the same to the control group at the first week after treatment and was correlated to hemoglobin concentration. CONCLUSIONS: The eosinopenia with high IgE concentration could be a valuable marker of tertian malaria and IgE and C4 concentrations could be useful for serial monitoring after treatment.
Anemia ; Complement System Proteins ; Eosinophils ; Flow Cytometry ; Humans ; Immunoglobulin E ; Immunoglobulin M ; Immunoglobulins ; Korea* ; Luminescence ; Lymphocyte Subsets ; Lymphocytes ; Lymphopenia ; Malaria* ; Plasmodium ; Plasmodium vivax ; Platelet Count ; Thrombocytopenia

BACKGROUND: Multidrug-resistant Streptococcus pneumoniae occasionally cause treatment failure in various pneumococcal infection in children. The pneumococcal strains carried at the nosopharynx are frequently found at the time of invasive infection in one individual. We investigated the prevalence of nasopharyngeal carriage of S. pneumoniae and antibiotic susceptibility patterns among children attending day care center and compared the rates of antibiotic resistance of those strains with strains recovered from clinical specimens of patients at a tertiary care hospital. METHODS: Two-hundred nine children from 3 centers distributed at Jong-Ro area of Seoul, Korea were enrolled from May to June, 1998. Swabs were obtained from posterior nasopharynx and cultured onto tryptic soy agar containing 5% sheep blood without and with 10 microgram/mL gentamicin for 24 hours. Clinical isolates included the non-invasive isolates from sputum, ear discharge and sinus aspirate and the invasive isolates from cerebrospinal fluid and blood. Antimicrobial susceptibilities were determined with E-test and agar dilution method. RESULTS: The overall prevalence of nasopharyngeal carriage was 32.5%(68/209). The children >4, 5< OR = years of age have the highest carriage rate(36.7%). But there were no significant differences of prevalence in gender and centers. The prevalences of decreased antibiotic susceptibilities in the nasopharyngeal isolates and clinical isolates were, respectively: penicillin(75% vs 86%, NS); cefotaxime(20% vs 48%, p<0.05); multiresistance(57% vs 86%, p<0.05). Younger the age and female in gender, higher the resistance rate to penicillin. CONCLUSIONS: There was no significant difference in antimicrobial resistance of pneumococci between healthy nosopharyngeal carriages and clinical isolates causing invasive or non-invasive infections. The results acquired from this surveillence would provide a useful guide in an appropriate choice of antimicrobial agents for management of pneumococcal diseases.
Agar ; Anti-Infective Agents ; Cerebrospinal Fluid ; Child* ; Day Care, Medical* ; Drug Resistance, Microbial ; Ear ; Female ; Gentamicins ; Humans ; Korea* ; Nasopharynx ; Penicillins ; Pneumococcal Infections ; Pneumonia ; Prevalence ; Seoul* ; Sheep ; Sputum ; Streptococcus pneumoniae* ; Streptococcus* ; Tertiary Healthcare ; Treatment Failure

BACKGROUND: Synchron LX20(Beckman Coulter, Fullerton, USA) is an automated chemical analyzer introduced in 1998. It is still not completely evaluated on clinical fields, is set in the Asan Medical Center for the first time in Korea. We evaluated the performance of the analyzer before routine use to prevent critical errors, to confirm the manufacturer's instructions, and to establish a specific data system for our institute. METHODS: For glucose, BUN, creatinine, total protein, albumin, uric acid, cholesterol, total bilirubin, direct bilirubin, ALT, AST, LD, gamma-glutamyltransferase(gamma-GT), CK, amylase, lipase, Na, K, Cl, CO2, Ca, phosphorus and Mg, within-day precision, between-day precision, degree of correlation, linearity, recovery rates and reportable ranges were completely or partly analyzed. Specimen selection, specimen preparation and the statistical methods followed the guidelines of National Committee for Clinical Laboratory Standards as much as possible. The calculations were performed with computer software, EP_Suite(MarChem Associates, Concord, USA). RESULTS: The within-day coefficients of variations(CVs) of most items were less than 5.0%. Ninety six percent of items showed between-day CVs less than 10.0%. All items had %relative nonlinearities less than 2.5%. The correlation coefficients of BUN, creatinine, AST, ALT, total bilirubin, direct bilirubin, gamma-GT, glucose and UA exceeded 0.975. The recovery rates were analyzed for BUN, creatinine, glucose and UA, and all were in the range of 98.2% to 102.3%. Reportable ranges were wide enough for all items. CONCLUSIONS: Linearity, precision, recovery rates and reportable ranges were satisfactory. A few CVs were relatively large due to the significant effects caused by the small differences among the measured values of low concentration specimens. Some items showed low correlation coefficients probably due to insufficient device familiarization period.
Amylases ; Bilirubin ; Cholesterol ; Chungcheongnam-do ; Creatinine ; Glucose ; Information Systems ; Korea ; Lipase ; Phosphorus ; Uric Acid

BACKGROUND: 1,5-Anhydroglucitol(1,5-AG) has shown to be a better indicator for current status of glycemia than HbA1c or fructosamine. The concentration of 1,5-AG is stable because of large storage pool and metabolic inertness, little influenced by assay variation with broad range of values. Since its reabsorption is competitively inhibited by glucosuria, plasma 1,5-AG decreases with increasing hyperglycemia in diabetic patients. But impairment of renal function may also affect its concentration. We introduced 1,5-AG as a new marker of glycemic control and evaluated the clinical usefulness and the effect of renal function. METHODS: We assayed plasma concentration of 1,5-AG using gas chromatography mass spectrometry in 36 healthy controls, 39 diabetic patients with normal renal function, 19 nondiabetic patients with chronic renal failure. We examined the relationship bewteen 1,5-AG and HbA1c or glucose. Correlation between 1,5-AG and serum creatinine was also investigated. RESULTS: 1,5-AG concentrations were significantly reduced in diabetic patients and in patients with chronic renal failure, compared to healthy controls. 1,5-AG had negative correlation with plasma glucose and HbA1c in healthy controls and diabetic patients with normal renal function, but not in patients with chronic renal failure. The value of 1,5-AG varies wider than that of HbA1c. CONCLUSIONS: 1,5-AG showed close correlation with glucose and HbA1c and detected subtle changes in glycemia. Therefore, measurement of 1,5-AG would be useful in monitoring glycemic control in diabetic patients with normal renal fucntion. But it would be inappropriate to use 1,5-AG for the evaluation of glycemic control in patients with renal failure.
Blood Glucose ; Creatinine ; Fructosamine ; Gas Chromatography-Mass Spectrometry ; Glucose ; Humans ; Hyperglycemia ; Kidney Failure, Chronic ; Plasma ; Renal Insufficiency

BACKGROUND: The determination of apo E polymorphism through the phenotyping is not suitable for large studies in the clinical laboratories because of various problems. So apo E genotyping has been developed. We present a method of apo E genotyping using a modified amplification refractory mutation system(ARMS) technique. METHODS: We used four primers to detect the region containing two mutation points coding amino acid residues 112 and 158 and have developed a method of apo E genotyping by the modified ARMS technique. Apo E genotyping were performed by both the modified ARMS technique and the INNO-LiPA Apo E kit(Innogenetics, Belgium) with the following frequency distribution: Epsilon2/2(n=10), Epsilon3/3(n=15), Epsilon4/4(n=7), Epsilon2/3(n=9), Epsilon2/4(n=12), Epsilon3/4(n=13). RESULTS: All the samples gave the correct and clear amplification patterns. Modified ARMS correctly distinguished among the six apo E genotypes. The apo E genotypes determined by both methods for every specimen studied were in complete agreement. CONCLUSIONS: This modified ARMS technique involved only two stages: PCR and agarose gel electrophoresis. Since apo E genotyping by the modified ARMS is reliable, simple to perform, less time consuming, and not expensive, we conclude that it is suitable for large sample studies in the clinical laboratories.
Apolipoproteins E ; Apolipoproteins* ; Arm* ; Clinical Coding ; Electrophoresis, Agar Gel ; Genotype ; Polymerase Chain Reaction*

BACKGROUNDS: Stone analysis is essential to determine the possible cause of stone formation and treatment of urolithiasis. Physical analysis using Fourier transform infrared spectroscopy(FT-IR), compared to chemical analysis, requires minimal sample volume, shows uniform sensitivity and specificity to all components and provides quantitiative results with greater reproducibility. We compared urinary stone analysis using FT-IR and chemical ananlysis. METHODS: From January 1996 to May 1999, 515 urinary stones were analyzed. For physical anlaysis, we used FT-IR system 2000(Perkin-Elmer Co., U.S.A.) and SpectrumTM software(Perkin-Elmer Co., U.S.A.). Chemical analyses for calcium, phosphate, uric acid, carbonate, magnesium, ammonia, oxalate and cystine were performed. Stone analyses with FT-IR were compared to those with chemical analysis. Clinical findings and the other laboratory findings including routine urinalysis, serum tests, and 24 hour urine test were also investigated. RESULTS: We analyzed 515 urinary stones from 501 patients. Sex ratio was 2.8: 1 and mean age was 48 years. Physical analyses were performed in 515(100%) stones and 81.2% of them showed mixed composition. And 79.4% included calcium oxalate monohydrate or dihydrate. Calcium oxalate monohydrate(63.3%), uric acid(11.3%), calcium oxalate dihydrate(9.9%), and carbonate apatite(8.3%) were commonly found as a major component. Chemical analyses could be done in only 454 cases(88.2%) due to insufficient sample and the most common positive findings were calcium(50.0%), phosphate(33.0%), and uric acid(18.5%). Seventy-one cases(15.6%) with negative chemical reactions to all components were mixed stones except 9 cases. When the stone components were analyzed by FT-IR and chemical method, we found full agreements in only 2.3%, partial agreements in 56.3%, poor agreements in 11.5% and no agreements in 4.3% of total cases. Hypercalciuria and natriuresis were found in 36.1% and 23.0%, respectively. The pH of urine shows significant differences in uric acid and struvite stones compared to the pH of the others(P<0.05). CONCLUSIONS: We found difficulties in detecting minor or mixed components of urinary stone and in analyzing small sized stone by chemical methods. Physical analysis using FT-IR can provide more accurate determinations of composition of urinary stones and can be significantly useful in diagnosis, treatment and prevention of urolithiasis.
Ammonia ; Calcium ; Calcium Oxalate ; Carbon ; Cystine ; Diagnosis ; Fourier Analysis ; Humans ; Hydrogen-Ion Concentration ; Hypercalciuria ; Magnesium ; Natriuresis ; Sensitivity and Specificity ; Sex Ratio ; Uric Acid ; Urinalysis ; Urinary Calculi* ; Urolithiasis

A case of acute biphenotypic leukemia with mixed blast morphology and combined myeloid and T-lymphoid features is reported. The leukemic cells consisted of small to medium sized hand mirror shaped blasts and large blasts with cytoplasmic granules and some cytoplasmic inclusion bodies. The blast cells were found to be immature T-lymphoid cells(CD2+ and CD7+) that also expressed the myeloid antigens such as CD13 and CD33. In the review of the literatures, additional cases of acute mixed leukemia-hand mirror variant show strong expression of adhesion moleules such as CD2, CD7, and CD11b. Cytogenetic studies revealed a trisomy 4 previously described in acute undifferentiated myeloblastic leukemia with hand-mirror cells. This case represents a morphologically and phenotypically distinct subtype of acute biphenotypic leukemia with hand mirror morphologic features. Adult acute leukemia cases with hand mirror morphology should be considered the possibility of mixed lineage leukemia and processed further studies.
Adult* ; Cytogenetics ; Cytoplasmic Granules ; Granulocyte Precursor Cells ; Hand ; Humans ; Inclusion Bodies ; Leukemia ; Leukemia, Biphenotypic, Acute ; Trisomy

Tuberculosis can be superimposed on many hematologic disorders. Numerous hematologic abnormalities are also associated with tuberculosis, especially disseminated form. With this controversy, when the patient has tuberculosis and hematologic abnormalities, it is important to differentiate tuberculosis from primary hematologic disorder. Especially, most patients with tuberculosis and pancytopenia have been reported to have underlying hematologic disorder. We present two rare cases in which patients with myelodysplastic syndrome had disseminated tuberculosis involving the bone marrow.
Bone Marrow ; Humans ; Myelodysplastic Syndromes* ; Pancytopenia ; Tuberculosis*

BACKGROUND: The commonly recommended therapeutic range is an activated partial thromboplastin time(APTT) of 1.5 to 2.5 times the control value, which may be inappropriate for some reagents. The aim of this study is to evaluate the correlation of APTT and anti-Xa activity and to compare two methods of determining the therapeutic range of APTT during unfractionated heparin treatment. METHODS: We measured anti-Xa activity and APTT in 80 plasmas from patients treated with unfractionated heparin. We performed correlation analysis between anti-Xa activity and APTT or APTT ratio(heparinized APTT/baseline APTT). The therapeutic range determined by anti-Xa activity of 0.35-0.7 U/mL was compared with the therapeutic range based on minimizing potential thrombosis and bleeding error. RESULTS: The anti-Xa activity-vs-APTT correlation was slightly, but not significantly, improved by converting APTT(r=0.835) to APTT ratio(r=0.883). The APTT therapeutic range predicted by anti-Xa activity-vs-APTT regression analysis was 68.7 to 139.5 seconds(66.6-127.9 seconds for logarithmatically transformed APTT), whereas the range predicted by minimization-of-error technique was 68 to 97 seconds. CONCLUSIONS: The established therapeutic APTT range based on linear regression analysis was not considered to be optimal. The therapeutic range based on minimizing the potential clinical errors may further improve error rate, but prospective study with a larger number of patient samples would be required to apply in clinical field.
Hemorrhage ; Heparin* ; Humans ; Indicators and Reagents ; Linear Models ; Partial Thromboplastin Time* ; Plasma ; Thromboplastin ; Thrombosis