No abstract available.
Hematologic Neoplasms* ; L-Lactate Dehydrogenase* ; Lactic Acid*

BACKGROUND: It is understood that amylase is poor and lipase is a little better than amylase in specificity for the diagnosis of acute pancreatitis. But we recognized that the general knowledge was resulted from the study of inappropriate design of some researchers. So, we tried to find out the true diagnostic value of amylase and lipase by the study of appropriate design, and with the above result, evaluated the usefulness of lipase as a diagnostic test for acute pancreatitis. METHODS: We reviewed the serum levels of the amylase and lipase in 33 patients complaining acute abdominal pain diagnosed as acute pancreatitis by image study (computed tomography, ultrasonography) , and in the 134 patients of control group who, with abdominal pain, were diagnosed finally as non-pancreatic disease at discharge after admission and treatment. Serum amylase and lipase activity were measured by aca IVTM (Chiron Inc.). RESULTS: The sensitivity of amylase and lipase for the diagnosis of acute pan creatitis was 81.8% and 87.8%, respectively. The specificity of amylase and lipase for the diagnosis of acute pancreatitis was 92.5% and 86.5%, respectively. The sensitivity and specificity was 84.6% and 96.3% respectively, when two enzymes were combined by 'and' strategy. The lipase activity remained elevated longer than the amylase in acute pancreatitis. CONCLUSIONS: On the contrary of the general knowledge, sensitivities and specificities of the amylase and lipase were fairy high and didn't show big dirt ferences between two enzymes. Though only one of the two enzymes could be selected for the diagnosis of acute Pancreatitis, using both of the enzymes increased the specificity, and lipase was useful to detect the patient who came to hospital a few days later after the onset of symptom.
Abdominal Pain ; Amylases ; Diagnosis* ; Diagnostic Tests, Routine ; Humans ; Lipase* ; Pancreatitis* ; Sensitivity and Specificity

BACKGROUND: Urine ketone test is commonly used to screen for diabetic ketoacidosis (DKA). Ketonuria also develops in patients with disease conditions other than DKA. However, the prevalence of DKA in patients with ketonuria is not known. We investigated the prevalence of ketonuria and characteristics of patients with ketonuria and estimated the prevalence of DKA among them to study the clinical significance of ketonuria as an indicator of DKA. METHODS: We studied 1,314 adult and 1,027 pediatric patients who underwent urinalysis. The prevalence of ketonuria in the different groups of patients, classified according to the types of their visits to the institution, was investigated, and the relationships between ketonuria and albuminuria, glycosuria, and bilirubinuria were evaluated. RESULTS: The overall prevalence of ketonuria was 9.1%. The prevalences of ketonuria in adult and pediatric patients were 4.3% and 15.2%, respectively. The prevalences of ketonuria were the highest in the adult (9.7%) and pediatric (28%) patients in the group that had visited the emergency department. Among patients with ketonuria, 7% adult and 3.8% pediatric patients showed glycosuria. CONCLUSIONS: This study showed that the prevalence of DKA in patients with ketonuria, defined as the simultaneous presence of ketone bodies and glucose in urine, was only 7%. Therefore, we concluded that ketonuria might be clinically significant as an indicator of acute or severe disease status rather than of DKA.
Adult ; Albuminuria ; Diabetic Ketoacidosis ; Emergencies ; Glucose ; Glycosuria ; Humans ; Ketone Bodies ; Ketosis ; Prevalence ; Urinalysis

OBJECTIVE: Quantitative experiment and analysis of the result with statistical techniques are an essential part of the medical article for acquiring objective confidence. But errors on application, calculation, and interpretation of statistics and insufficient explanation of the used statistical technique deprive the reader of reliance on the article. We identified the statistical techniques and errors that were commonly encountered, and both of researchers and readers should recognize, in the Journal of the Korean Rheumatism Association (JKRA). We identified the frequency of the statistical techniques and errors from the 136 articles in the 1994~1998 editions of the JKRA. Each different kind of statistical techniques and errors in the same article were counted separately, but two or more of the same kind of statistical techniques and errors in an article were counted as one. One hundred and seventy-seven statistical techniques were encountered and 75 statistical errors were identified. The most frequently used techniques were descriptive statistics, and common errors and the observed numbers of the errors were as follow : 1. performing statistical techniques for two groups on the comparison of three or more groups(14), 2. mentioning the statistical technique without using it(14), 3. using mean and standard deviation instead of median and range on the ordinal data(12), 4. using standard error instead of standard deviation for the description of data spread(11), 5. using p value without the statistical name(11). CONCLUSION: The most frequently encountered statistical technique and error are descriptive technique and performing statistical techniques for 2 groups on the comparison of 3 or more groups, respectively. The authors? careful application of the basic statistics would be the real solution to reduce the statistical errors.
Rheumatic Diseases*

BACKGROUND: Helicobacter pylori(H. pylori) has been implicated in the pathogenesis of chronic active gastritis and peptic ulcer disease. All patients with ulcers who are infected with H. pylori receive antimicrobial therapy. Therefore diagnosis of H. pylori infection is imperative for the treatment gastritis or ulcer patients. We evaluated the four diagnostic methods and three culture media for the isolation of H. pylori. MATERIALS AND METHODS: Rapid urease test(CLO test), modified Gram stain, culture, and nested polymerase chain reaction (PCR) were performed with 108 gastroscopic biopsy specimens from patients with peptic ulcer or chronic gastritis. Among them 40 specimens were inoculated onto each of 5% sheep blood agar, e99 Yolk emulsion (EYE) agar, and 7% horse blood agar containing antibiotics. RESULTS: The positive rates were the highest by the PCR(72%), 67% by modified Gram stain, 64% by CLO test, and 57% by culture. Among the three media the horse blood agar (selective medial) gave the highest isolation rate (48%), followed by sheep blood agar (45%), and EYE agar (38%). CONCLUSION: Though PCR was the most sensitive method for the detection H. pylori modified Gram stain was sensitive enough, simple, rapid, and economical as the routine diagnostic method of H. pylori. For the culture of H. pylori combination of sheep blood agar as nonselective media and horse blood agar as selective media would show the highest isolation rate.
Agar ; Anti-Bacterial Agents ; Biopsy* ; Culture Media* ; Diagnosis ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Horses ; Humans ; Peptic Ulcer ; Polymerase Chain Reaction ; Sheep ; Ulcer ; Urease

BACKGROUND: Diabetes diagnosis can be made using different laboratory tests, including the fasting plasma glucose (FPG) test, 75-g 2-h oral glucose tolerance test (2-h OGTT), and hemoglobin A1c (HbA1c) test; however, these tests have different meanings. This study aimed at comparing patient characteristics based on the diagnosis using each of these 3 tests. METHODS: A total of 750 adults suspected of having diabetes and aged > or =18 years underwent the following tests on the same day: FPG, 2-h OGTT, HbA1c, insulin, general chemistry, and routine urinalysis. The patients were divided into 8 groups based on the combination of positive and negative results of each of the 3 tests, and the characteristics of the patients were compared among groups. RESULTS: In the group that tested positive for all 3 tests, the FPG, 2-h OGTT, HbA1c, homeostasis model assessment for insulin resistance, alanine transaminase, triglyceride, and urine glucose positive values were higher than those of the group that tested positive using the 2-h OGTT and HbA1c test. In the group that tested positive using the 2-h OGTT, blood urea nitrogen was higher than that of the group that tested positive using the HbA1c test. CONCLUSIONS: The characteristics of the patients differed between the tests that yielded positive diagnostic results. This may be related to the fact that the 3 tests indicate different states of glucose metabolism. The results of the 3 tests were significantly different; therefore, it may be more effective to combine the results of the 3 tests to comprehensively describe patient characteristics.
Adult ; Alanine Transaminase ; Blood Glucose ; Blood Urea Nitrogen ; Chemistry ; Diabetes Mellitus ; Diagnosis ; Fasting ; Glucose ; Glucose Tolerance Test ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Metabolism ; Triglycerides ; Urinalysis

No abstract available.
Pathology, Clinical*

BACKGROUND: The direct/total (d/t) bilirubin ratio can be used to distinguish the causes of jaundice in many patients who have increased levels of direct and indirect bilirubin. However, the reference range of the d/t ratio has not been established, hindering its clinical usefulness. This study assessed the clinical usefulness of the d/t ratio. METHODS: Paired total bilirubin and direct bilirubin tests (N=4,357) of cholestasis, hemolytic anemia, and neonatal jaundice were evaluated. Regression analyses were performed between total bilirubin and direct bilirubin, and between total bilirubin and the d/t ratio for each disease. Theoretical correlation models were established and used to compare the regression analyses data. RESULTS: The theoretical model and regression equation between total bilirubin and direct bilirubin displayed linear correlations for all three cholestatic diseases. The model and regression equation between total bilirubin and the d/t ratio showed reciprocal curve correlations for the cholestatic diseases. When the total bilirubin concentration exceeded approximately 10 mg/dL, the rate of change of the d/t ratio decreased and converged to a constant value between 0.7 and 0.9. CONCLUSIONS: If the total bilirubin concentration exceeds 10 mg/dL, cholestatic diseases can be diagnosed if the d/t ratio is more than 0.7. However, if the total bilirubin concentration is lower than 10 mg/dL, cholestatic diseases should be considered even if the d/t ratio is lower than 0.7. Therefore, use of the d/t ratio with total bilirubin could prove to be valuable in clinical settings.
Anemia, Hemolytic ; Bilirubin* ; Cholestasis ; Humans ; Hyperbilirubinemia ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal ; Models, Theoretical ; Reference Values

BACKGROUND: For the diagnosis of varicella-zoster virus (VZV) infection, virus culture has been considered the reference method, but it gives delayed results and needs cell culture facilities. Shell vial culture is more rapid, but it also takes 2 days or more and needs cell culture. Immunofluorescent (IF) method has known to be rapid and sensitive. We compared the tube culture, shell vial culture, and direct IF method to find the most efficient diagnostic method. In addition, the MRC-5 cells were compared with A549 cells for the recovery of VZV in culture. METHODS: A total of 48 specimens were obtained from skin vesicles of patients with clinical herpes zoster. The vesicle smears were stained with FITC-conjugated monoclonal antibody. The vesicle aspirates obtained in 2 mL of viral transport media were inoculated into shell vials and tubes containing MRC-5 and A549 cell monolayers. After 48 h of incubation at 36degrees C the shell vials were stained with VZV-specific monoclonal antibody. The tubes were stained with the same antibody after 3 weeks or when the monolayer showed cytopathic effect. RESULTS: The positive rates of direct IF, shell vial culture, and tube culture were 67.5%, 87.5%, and 72.5% respectively. The positive rate of direct IF was increased to 96.4% when inadequate specimens for the direct IF were excluded. The MRC-5 and A549 cells showed no significant difference in the isolation rates of VZV in both shell vial and tube culture. CONCLUSIONS: Direct IF is the most rapid and practical method for the laboratory confirmation of VZV infection when the swab specimen is adequately obtained. The MRC-5 cells are recommended for the tube culture and A549 cells for the shell vial culture.
Cell Culture Techniques ; Diagnosis ; Herpes Zoster ; Herpesvirus 3, Human* ; Humans ; Skin*

BACKGROUND: The reference interval of anion gap established in the 1970s has been changing as the method of electrolyte measurement changes. It is also influenced by preanalytical errors. But there are only a few reliable reports that examined the effect of various preanalytical errors. Furthermore, there has been no report of values measured by the instrument being used in our laboratory. Therefore, we attempted to establish a reference interval of anion gap measured by Hitachi 7170s minimizing preanalytical errors, and analyzed the effect of a delay in electrolyte measurement and of sample exposure to the air. METHODS: The subjects were 538 healthy people who attended Hanyang university hospital health clinic with normal blood levels for albumin, creatinine and glucose. The plasma Na+, K+, Cl-, and total carbon dioxide (TCO2) were measured by Hitachi 7170s autoanalyzer (Boehringer Mannheim, Indianapolis, USA). To examine the effect of the delay between blood withdrawal and electrolyte measurement and the loss of CO2 by exposure to the room air after bottle opening, the subjects were divided into group A (124 subjects) and group B (414 subject) whose electrolyte results were reported within and after 20 minutes, respectively, of blood withdrawal and the two groups were compared with each other for the electrolytes and anion gap. Anion gap was calculated by the formula, [Na+- (Cl-+TCO2)]. RESULTS: Compared with group A, TCO2 of group B decreased by 0.9 mmol/L (P<0.001) and the anion gap increased by 0.6 mmol/L (P=0.009). The reference interval of anion gap was established based on the group A at the value of 5.4-13.4 mmol/L. CONCLUSIONS: The reference interval of anion gap determined in this study was lower than the value commonly used and should be established with a minimum delay in electrolyte measurement and sample exposure to the air.
Acid-Base Equilibrium* ; Carbon Dioxide ; Creatinine ; Electrolytes ; Glucose ; Plasma*