A 19-year-old, woman who had been diagnosed as systemic lupus erythematosus (SLE) a year ago, was admitted because of fever, dizziness, and sustained postoperative bleeding after a hemorroidectomy. On admission, a CBC revealed pancytopenia (Hb 6.2 g/dL, WBC 1,200/microL, platelets 11,000/microL) with a shift to themicroLeft, and the FDP and D-dimer were positive. She was treated for sepsis and disseminated intravascular coagulation. Granulocyte colony-stimulating factor (G-CSF) was administrated twice for severe neutropenia. An increase in WBC and immature myeloid cells, mainly hypergranular promyelocytes on the peripheral blood followed and was considered to be the effect of G-CSF. To evaluate the cause of pulmonary infiltrates, bronchoalveolar lavage (BAL) was performed on the 5th day of admission. The BAL fluid revealed many promyelocytes and myelocytes with occasional structures recognized as Auer rods. Acute promyelocytic leukemia (APL) was confirmed on the bone marrow study and chromosome analysis. Unfortunately, the patient died of septic shock on the 9th day of admission. We report here a very rare case of APL diagnosed in a SLE patient, the diagnosis of which was somewhat delayed due to the use of G-CSF and superimposed sepsis.
Bone Marrow ; Bronchoalveolar Lavage ; Diagnosis ; Disseminated Intravascular Coagulation ; Dizziness ; Female ; Fever ; Granulocyte Colony-Stimulating Factor ; Granulocyte Precursor Cells ; Hemorrhage ; Humans ; Leukemia, Promyelocytic, Acute* ; Lupus Erythematosus, Systemic* ; Myeloid Cells ; Neutropenia ; Pancytopenia ; Sepsis ; Shock, Septic ; Young Adult

With a purpose to difine risk factors of respective subtypes of cerebrovascular disease, a case-control study was performed in 1,251 cases with cerebrovascular disease who were admitted to twelve large institutions over the country during the year of 1988. All cases were subtype-proven by computerized tomography. Three hundred and eighty three patients were selected as control among the patients who were admitted to the same hospitals during the same period. The variables were collected prospectively and the data were processed by univariate and multiple logistic regression analyses and the significance was tested by chi-square methods. In the univariate analysis, female sex, being a physical worker, history of hypertension either treated or not and previous stroke history were significantly related with cerebral hemorrhage. Male sex, being aged 60 or more, living in city area, being a mental worker, history of hypertension either treated or not, history of stroke, being a diabetic and positive family history of stroke were significantly related with cerebral infarction. In multiple logistic regression analysis hypertension and alcohol drinking were strong independent risk factors for cerebral hemorrhage. Hypertension, being aged 60 or more, and living in urban area were also independent risk facrots for cerbral infarction. Of the other variables analyzed, socioeconomic class, smoking history or body mass index did not constitute significnat risks for either cerebral hemorrhage or cerebral infarction.
Alcohol Drinking ; Body Mass Index ; Case-Control Studies ; Cerebral Hemorrhage ; Cerebral Infarction ; Female ; Humans ; Hypertension ; Infarction ; Korea* ; Logistic Models ; Male ; Prospective Studies ; Risk Factors* ; Smoke ; Smoking ; Stroke

Three trials of external quality assessment for clinical microbiology laboratory and two workshops were performed in 2003. A total of 19 specimens were distributed. Six specimens were distributed to 241 laboratories with 231 returns in Trial I, Five specimens to 241 laboratories with 225 returns in Trial II, and seven specimens to 245 laboratories with 220 returns in Trial III. The percentages of fully correct results of E. coli, E. faecalis, S. aureus, P. aeruginosa, K. pneumoniae, Candida albicans, P. aeruginosa, S. aureus, E. faecalis, K. pneumoniae, E. coli, and Candida tropicalis were 99%, 83%, 99%, 89%, 97%, 92%, 90%, 98%, 83%, 90%, 99%, and 63%, respectively. The standard deviation (SD) of inhibition zone diameter against each antibiotic was calculated. The within-one-SD percentages on disk diffusion test against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of E. coli (M0301) were 86%, 78%, 86%, 91%, and 76%, respectively. Those against vancomycin and teicoplanin of E. faecalis (M0302) were 77% and 95%, respectively. Those against vancomycin, oxacillin, penicillin G, clindamycin, erythromycin, ciprofloxacin, gentamicin and teicoplanin of S. aureus (M0303) were 82%, 80%, 81%, 81%, 79%, 80%, 88%, and 90%, respectively. Those against ciprofloxacin, gentamicin, imipenem, ceftazidime, and piperacillin of P. aeruginosa (M0304) were 73%, 88%, 85%, 83%, and 78%, respectively. Those against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of K. pneumoniae (M0305) were 89%, 89%, 87%, 81% and 86%, respectively. Thirty-five laboratories on Trial I and Trial II had reported the both results of disk diffusion and MIC methods. Seven laboratories use disk diffusion method or MIC method according to the bacterial species. The performance on the automated or E-test susceptibility tests was generally good. In conclusion, it is necessary that the quality assurance of the individual laboratories should be improved in the identification of Candida tropicalis and Enterococcus spp., and in susceptibility tests against oxacillin, erythromycin and ciprofloxacin of S. aureus, and cephalothin and imipenem of E. coli and vancomycin of E. faecalis in case of disk diffusion method.
Ampicillin ; Candida albicans ; Candida tropicalis ; Cefotaxime ; Ceftazidime ; Cephalothin ; Ciprofloxacin ; Clindamycin ; Diffusion ; Education ; Enterococcus ; Erythromycin ; Gentamicins ; Imipenem ; Korea* ; Oxacillin ; Penicillin G ; Piperacillin ; Pneumonia ; Teicoplanin ; Vancomycin

To estimate the incidence rate of coronary heart disease in Korea, of all residents of the Taegu city aged 25 or above, those who had an acute MI or fatal coronary event between 1 July 1996 and 30 June 1997 were registered. Seven hundreds and eight patients were registered during the study period(685 were identified at hospital and 23 were autopsy cases). Age-standardized annual incidence rate of men in city area was 93 per 100,000(95% CI; 61-142) and 33(95% CI; 16-67) in women(100 in men and 20 in women aged 35-64). The incidence was rapidly increased after age 40 in men, however, in women after age 60. Twenty-eight-days case fatality rate was 45% in men and 47% in women. However, in the age group of 45-59 case fatality rate in women was two times higher than that in men. In conclusion, crude annual incidence rate of CHD in city area was 73 per 100,000 in men and 33 in women. The age-standardized annual incidence of CHD in men(93 per 100,000) was 3.2 times higher than that in women (33 per 100,000) in Korea.
Autopsy ; Coronary Disease* ; Daegu ; Female ; Humans ; Incidence* ; Korea ; Male ; Mortality