Delayed hemolytic transfusion reaction (DHTR) due to multiple red blood cell (RBC) alloantibodies has rarely been reported in Korea. We report a case of DHTR in a patient with anti-c, anti-E, and anti-Jk(b). A 45-year-old man visited the emergency room with flame burn injury over 61% of his entire body. He received six units of packed RBCs and three units of fresh frozen plasma during the operation for excision and glycerol-preserved allografting. His hemoglobin (Hb) level gradually decreased from 13.5 g/dL on the operation day to 7.8 g/dL on the 11th postoperative day in spite of receiving three and two additional units of packed RBCs on the 8th and 9th postoperative days, respectively. His laboratory data was total bilirubin/direct bilirubin 15.9/11.4 mg/dL, lactate dehydrogenase 983 IU/L, haptoglobin 5.93 mg/dL and plasma hemoglobin 8.0 mg/dL. The urinalysis revealed hemoglobinuria, and the peripheral blood film showed moderate spherocytosis. Both the direct and indirect antiglobulin tests were positive, and the follow-up antibody identification test showed anti-c, anti-E, and Jk(b). His Hb levels increased after he was transfused with two units of packed RBCs without c, E, and Jk(b) antigens. This is a case of DHTR due to alloimmunization, which developed within a short interval after the patient had received multiple transfusions.
Bilirubin ; Blood Group Incompatibility ; Burns ; Coombs Test ; Emergencies ; Erythrocytes ; Follow-Up Studies ; Haptoglobins ; Hemoglobins ; Hemoglobinuria ; Humans ; Isoantibodies ; Korea ; L-Lactate Dehydrogenase ; Middle Aged ; Plasma ; Transplantation, Homologous ; Urinalysis

Macrophage activation syndrome (MAS) is a rare and potentially fatal complication of rheumatic disorders in children. We describe a 13-month-old boy in whom MAS developed as a complication of systemic juvenile rheumatoid arthritis (S-JRA). He suffered from fever and generalized rash followed by multiple joints swelling for four months before admission. Physical examination revealed cervical lymphadenopathy and hepatosplenomegaly. Laboratory findings were: abnormal liver enzymes, increased triglyceride and ferritin levels, coagulopathies resembling disseminated intravascular coagulation, anemia and thrombocytopenia. Hyperplasia of hemophagocytic macrophages was remarkable in his bone marrow. Methylprednisolone and cyclosporin therapy resulted in clinical and laboratory improvements. This is the third case of MAS associated with S-JRA in Koreans, and the first one, in which hemophagocytic macrophages were proven in bone marrow.
Alanine Transaminase/metabolism ; Alkaline Phosphatase/metabolism ; Antigens, CD/blood ; Antigens, Differentiation, Myelomonocytic/blood ; Arthritis, Juvenile Rheumatoid/blood/*complications/pathology ; Aspartate Aminotransferases/metabolism ; Blood Cell Count ; Hepatomegaly/*etiology/pathology ; Humans ; Infant ; Liver/enzymology/pathology ; *Macrophage Activation ; Male ; Partial Thromboplastin Time ; Prothrombin Time ; Splenomegaly/*etiology/pathology ; Syndrome ; gamma-Glutamyltransferase/metabolism

The purpose of this study was to investigate the nationwide prevalence of childhood asthma, eczema and other allergic diseases in Korean school-age children (8-11 yr old) and to assess the difference between residential areas. Among 6,279 elementary schools, 427 schools were randomly selected according to residential area (metropolitan, provincial, rural, and industrial area) by the cluster sampling method. Parents of students completed a modified Korean version of a questionnaire formulated by the International Study of Asthma and Allergies in Childhood (ISAAC). Among 50,200 subjects, 31,026 (61.8%) responded, and 30,893 (99.6%) were analyzed. The 12-month prevalence of wheeze, flexural rash, and allergic rhinitis symptoms were 4.8%, 15.3%, and 32.9%, respectively. The prevalence of diagnosis of allergic diseases in boys was higher than that in girls, with the exception of eczema. In both boys and girls, the difference of the prevalence of allergic diseases among industrial, metropolitan and provincial areas was not statistically significant, but the differences between rural area and other areas were significant. Our results support the importance of contextual effect associated with residential area as causative agents of allergic diseases among Korean school-age children.
Child ; Cross-Sectional Studies ; Eczema/epidemiology ; Exanthema/epidemiology ; Female ; Humans ; Hypersensitivity/*epidemiology ; Male ; Questionnaires ; Republic of Korea/epidemiology ; Respiratory Sounds ; *Rural Population ; Schools ; Sex Distribution ; *Urban Population

OBJECTIVES: The goal was to model and quantify the atmospheric concentrations of volatile organic compounds (VOCs) as the result of the Hebei Spirit oil spill, and to predict whether the exposure levels were abnormally high or not. METHODS: We developed a model for calculating the airborne concentration of VOCs that are produced in an oil spill accident. The model was applied to a practical situation, namely the Hebei Spirit oil spill. The accuracy of the model was verified by comparing the results with previous observation data. The concentrations were compared with the currently used air quality standards. RESULTS: Evaporation was found to be 10- to 1,000-fold higher than the emissions produced from a surrounding industrial complex. The modeled concentrations for benzene failed to meet current labor environmental standards, and the concentration of benzene, toluene, ortho- meta- para-xylene were higher than the values specified by air quality standards and guideline values on the ocean. The concentrations of total VOCs were much higher than indoor environmental criteria for the entire Taean area for a few days. CONCLUSIONS: The extent of airborne exposure was clearly not the same as that for normal conditions.
Benzene ; Humans ; Petroleum Pollution ; Toluene ; Volatile Organic Compounds ; Volatilization ; Xylenes

Cholesterol granuloma is a chronic inflammatory process associated foreign body reaction to hemorrhage-related cholesterol crystals that have been precipitated in the tissue. Cholesterol granuloma of the middle ear usually accompany chronic middleear diseases with diminished ventilation. However, cholesterol granuloma of the paranasal sinus is rare. Impaired drainage, hemorrhage, inadequate ventilation play a significant role in its pathogenesis. Symptoms are diverse according to the location and size of the lesion, and also to the presence of wall erosion of the affected sinus. Diagnosis should be made with his tologic investigation of the operative specimen. Radical clearance of the disease using an endoscopic approach and drainage of the affected sinus cavity is the treatment of choice.
Cholesterol* ; Diagnosis ; Drainage ; Ear, Middle ; Ethmoid Sinus* ; Foreign-Body Reaction ; Granuloma* ; Hemorrhage ; Ventilation

BACKGROUND: Procalcitonin (PCT) is a relatively new marker for bacterial infections, and its diagnostic utility has been variable across the studies. We investigated the diagnostic utility of PCT for the patients with blood culture-positive sepsis, and compared it with that of C-reactive protein (CRP). METHODS: In 1,270 consecutive blood samples, PCT and CRP were simultaneously measured and results were compared according to the five categories of PCT concentrations (<0.05 ng/mL; 0.05-0.49 ng/mL; 0.5-1.99 ng/mL; 2-9.99 ng/mL; > or =10 ng/mL). In 506 samples, they were further analyzed according to the result of blood culture. PCT and CRP were measured using enzyme-linked fluorescent assay (bioMerieux Co., France) and rate nephelometry (Beckman Coulter Co., USA), respectively. Their diagnostic utilities were compared using ROC curves. RESULTS: The mean concentrations of CRP in five categories of PCT were 15.4 mg/L, 42.1 mg/L, 101.2 mg/L, 125.0 mg/L, 167.1 mg/L, respectively (P<0.0001). Both PCT and CRP showed significant differences between the two positive and negative groups of blood culture (PCT, 8.47 vs 2.44 ng/mL, P=0.0133; CRP, 110.48 vs 59.78 mg/L, P<0.0001). The areas under the ROC curves (95% confidence interval) for PCT and CRP were 0.720 (0.644-0.788) and 0.558 (0.478-0.636), respectively, and showed a significant difference (P=0.005). CONCLUSIONS: The diagnostic utility of PCT is superior to that of CRP for the patients with blood culture-positive sepsis. PCT seems to be reliable for sepsis diagnosis, and may provide useful information for the critically ill patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; C-Reactive Protein/*analysis ; Calcitonin/*blood ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant ; Infant, Newborn ; Middle Aged ; Nephelometry and Turbidimetry ; Protein Precursors/*blood ; ROC Curve ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Sepsis/*diagnosis

BACKGROUND: Peritoneal fibrosis is one of the major causes of technical failure in patients on peritoneal dialysis. Epithelial-to-mesenchymal transition (EMT) of the peritoneum is an early and reversible mechanism of peritoneal fibrosis. Human peritoneal mesothelial cells (HPMCs) have their own renin-angiotensin-aldosterone system (RAAS), however, it has not been investigated whether aldosterone, an end-product of the RAAS, induces EMT in HPMCs, and which mechanisms are responsible for aldosterone-induced EMT. METHODS: EMT of HPMCs was evaluated by comparing the expression of epithelial cell marker, E-cadherin, and mesenchymal cell marker, alpha-smooth muscle actin after stimulation with aldosterone (1-100nM) or spironolactone. Activation of extracellular signal-regulated kinase (ERK)1/2 and p38 mitogen-activated protein kinase (MAPK) and generation of reactive oxygen species (ROS) were assessed by western blotting and 2',7'-dichlorofluororescein diacetate staining, respectively. The effects of MAPK inhibitors or antioxidants (N-acetyl cysteine, apocynin, and rotenone) on aldosterone-induced EMT were evaluated. RESULTS: Aldosterone induced EMT in cultured HPMCs, and spironolactone blocked aldosterone-induced EMT. Aldosterone induced activation of both ERK1/2 and p38 MAPK from 1 hour. Either PD98059, an inhibitor of ERK1/2, or SB20358, an inhibitor of p38 MAPK, attenuated aldosterone-induced EMT. Aldosterone induced ROS in HPMCs from 5 minutes, and antioxidant treatment ameliorated aldosterone-induced EMT. N-acetyl cysteine and apocynin alleviated activation of ERK and p38 MAPK. CONCLUSION: Aldosterone induced EMT in HPMCs by acting through the mineralocorticoid receptor. Aldosterone-induced generation of ROS followed by activation of ERK, and p38 MAPK served as one of the mechanisms of aldosterone-induced EMT of HPMCs.
Actins ; Aldosterone* ; Antioxidants ; Blotting, Western ; Cadherins ; Cysteine ; Epithelial Cells ; Humans ; p38 Mitogen-Activated Protein Kinases ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Peritoneum ; Phosphotransferases ; Protein Kinases ; Reactive Oxygen Species ; Receptors, Mineralocorticoid ; Renin-Angiotensin System ; Spironolactone

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) is a major risk factor in atherogenesis and coronary heart disease as well as a primary target of lipid-lowering therapy. LDL-C concentration by direct homogenous assay was compared with that of the Friedewald formula, which is widely used in spite of its limitations. METHODS: Between February and March 2002, we analyzed total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and LDL-C levels in 1, 161 subjects (601 men and 560 women). They were classified according to cutpoints of the National Cholesterol Education Program Adult Treatment Panel III guidelines. The LDL-C results by direct method and the Friedewald formula were compared according to the TG levels and their medical decision values. RESULTS: Overall results of the direct method (Y) and the Friedewald formula (X) were highly correlated (Y=0.90X+13.62, r=0.9225). LDL-C by the Friedewald formula, however, showed a tendency of underestimation at higher TG levels. The results of the direct method were significantly different compared with those of the Friedewald formula when TG > or =200 mg/dL (P<0.05). Although the agreement between the two methods for LDL-C was within an acceptable range, it was relatively poor from near optimal to higher levels of LDL-C compared with optimal levels. CONCLUSIONS: The Friedewald formula is unsatisfactory for clinical purposes, because the levels of LDL-C are unreliable at the TG levels > or =200 mg/dL. Therefore, a direct determination method with better analytical performance is required. A fully automated homogenous assay seems to improve the determination of LDL-C, and may have a role in the diagnosis and management of hyperlipidemic patients.
Adult ; Atherosclerosis ; Cholesterol* ; Coronary Disease ; Diagnosis ; Education ; Humans ; Lipoproteins* ; Male ; Risk Factors ; Triglycerides

BACKGROUND: Biochemical markers can provide objective evidence of heavy alcohol drinking. In this study, we investigated the diagnostic usefulness of carbohydrate-deficient transferrin (CDT), a relatively new marker of alcohol consumption. METHODS: We consecutively enrolled 81 participants aged between 28 and 69 years, consisting of 44 alcohol-dependent patients and 37 age-matched controls. Relative values (%) of CDT were determined in their sera with turbidimetric immunoassay (Bio-Rad %CDT assay, Axis-Shield ASA, Oslo, Norway), and were compared with two conventional markers of alcohol consumption, gammaglutamyl transferase (GGT) and mean corpuscular volume (MCV). RESULTS: The distribution patterns of %CDT among alcohol-dependent patients and controls were significantly different from each other (P=0.0000). Of the 44 alcohol-dependent patients, positive results of %CDT (> or =2.6%), GGT (>50 IU/L), and MCV (>98 fL) were observed in 43 (97.7%), 35 (79.5%), and 24 (54.5%) patients, respectively. The areas under the receiver operating characteristic (ROC) curves (95% confidence interval) for %CDT, GGT, and MCV were 0.995 (0.946-1.000), 0.894 (0.805-0.951), and 0.768 (0.661-0.855), respectively. Discrimination between alcohol-dependent patients and controls, as measured by the areas under the ROC curves, was significantly better for %CDT than for GGT and MCV (P=0.000 and P=0.006, respectively). CONCLUSIONS: CDT seems to be the most reliable of the three markers tested for chronic alcohol consumption, and it may provide a useful information to for the objective detection of alcohol-dependent patients.
Alcohol Drinking ; Alcoholism* ; Biomarkers ; Discrimination (Psychology) ; Erythrocyte Indices ; gamma-Glutamyltransferase ; Humans ; Immunoassay ; ROC Curve ; Transferases ; Transferrin*

BACKGROUND: The detection of antibody to hepatitis C virus (anti-HCV) is the most useful method to investigate past or current HCV infections. We performed a clinical evaluation of ADVIA Centaur HCV assay, a new third generation assay for the qualitative detection of IgG antibody. METHODS: Included in the study were a total of 323 samples (108 positive and 215 negative), for which HCV reverse transcription polymerase chain reaction (RT-PCR) was requested. ADVIA Centaur HCV assay (Bayer Healthcare LLC, Diagnostics Division, Tarrytown, NY, USA) was compared with a currently available and widely used AxSYM HCV version 3.0 assay (Abbott Laboratories, Abbott Park, IL, USA). Samples with discrepant results were retested with each assay, and further tested with a recombinant immunoblot assay (RIBA, LG HCD Confirm, LG Chemical Co., Seoul, Korea). Reproducibility of Centaur assay was evaluated in five groups (two samples in each group) with different index values. RESULTS: The overall concordance rate was 91.6% (296/323) between Centaur and AxSYM assays. It was 100% (108/108) in RT-PCR positive samples and 87.4% (188/215) in RT-PCR negative samples. Discrepant samples (8.4%, 27/323) were all RT-PCR negative, and all except two were Centaur negative and AxSYM positive. In discrepant samples, RIBA showed negative results except for two samples with indeterminate results. The sensitivity and specificity of Cenyaur assay were 98.1% and 65.6%, and the respective figures for AxSYM assay were 98.1% and 54.9%. Reproducibility of Centaur assay was satisfactory. CONCLUSIONS: The overall concordance between Centaur and AxSYM assays was satisfactory. Sensitivity and specificity of Centaur assay were equivalent to or better than those of AxSYM assay. ADVIA Centaur HCV assay seems to be a reliable and useful method for the detection of anti-HCV in clinical laboratories.
Delivery of Health Care ; Hepacivirus* ; Immunoglobulin G ; Polymerase Chain Reaction ; Reverse Transcription ; Sensitivity and Specificity ; Seoul