Difficulties in calculation that hindered the practice of the delta check in the past is now no longer a problem thanks to the development of computers. But, high false positive rates, which creates heavy burden of checking-work load, are still a problem in the practice of the delta check. We propose a new approach to the reduction of false positive rates, naming our method "the multi-item univariate delta check (MIUDC) method". By the multi-item univariate delta check method, we mean a method in which univariate delta checks are performed on multiple items and specimens with the positive univariate delta check in at least k items receive a detailed investigation. Using data collected in the Department of Clinical Pathology at Korea University Guro Hospital via the Korea University Laboratory Information System, our research found that if we put specimens with positive univariate delta check in at least four test items (k=4) under a detailed investigation, check-out volumes will be light and efficiency will be high. As for test items deserving of more interest, total cholesterol, albumin, and total protein are appropriate because the false positive rate associated with them in the MIUDC was zero in a simulation study.
Chemistry, Clinical* ; Cholesterol ; Clinical Laboratory Information Systems ; Korea ; Pathology, Clinical ; Quality Control*

BACKGROUND: A few recent studies have been conducted to analyzing the blood usage with regard to diagnosis of Korean recipients. We performed a study to analyze the usage of blood components. METHODS: Transfused components such as packed red blood cells (RBC), whole blood (WB), fresh frozen plasma (FFP), and platelet components (PLT) were estimated by the principal diagnoses of the patients, who were discharged from February 1998 to January 1999, according to the International Statistical Classification of Diseases (ICD)-10. RESULTS: Eleven percentage (2,227/20,650) of inpatients were transfused. The transfusion rate of hospitalized patients for RBCs, WBs, FFPs, and PLTs was 10.1%, 0.4%, 4.0% and 16.2 %, respectively. There was a difference in the sex ratio (1.6 male/female) in all blood components transfused. Of all investigated blood components (22,523 units), 10,729 units (47.6%) of RBCs, 240 units (1.1%) of WBs, 5,355 units (23.8%) of FFPs, and 6,199 units (27.5%) of PLTs were transfused. The hospitalized patients who received 1 unit of RBCs was 12.9%, and 2 units were most frequent transfused units (25.6%). Seventy-four percent of all 22,523 units were used in four diagnostic categories of highest blood usage; injury and poisoning (29.2%), nonhematologic neoplasms (16.3%), digestive system disease (16.1%) and circulatory system disease (12.5%). CONCLUSION: We performed usage analysis of blood components with regard to diagnosis, comparing the previous studies in other hospitals. This study could provide baseline transfusion information in relation to diagnosis, and help improve the quality control of blood utilization and transfusion practice.
Blood Platelets ; Classification* ; Diagnosis ; Digestive System Diseases ; Erythrocytes ; Humans ; Inpatients ; Plasma ; Poisoning ; Quality Control ; Sex Ratio

Syphilis is easily diagnosed by serologic testing or by identification of the causative organism, Treponema pallidum. Syphilis usually presents a distinct painless primary ulcer or chancre. However, the initial clinical impressions of even the most experienced specialist in sexually transmitted diseases (STDs), may be wrong 40% of the time. We report a case of atypical primary syphilis that was presented with painful ulceration on the penis and showing negative VDRL results. We amplified the DNA polymerase I gene of Treponema pallidum in the penile ulcer lesion to detect syphilis and got the a successful result. The patient was treated with benzathine penicillin G.
Chancre ; DNA Polymerase I* ; Humans ; Male ; Penicillin G Benzathine ; Penis ; Polymerase Chain Reaction* ; Serologic Tests ; Sexually Transmitted Diseases ; Specialization ; Syphilis* ; Treponema pallidum* ; Ulcer

BACKGROUND: Red blood cell (RBC) sorbitol has been implicated in the pathogenesis of organic complications of diabetes mellitus. W8 investigated RBC sorbitol level as an indicator of glucose control or diabetic complications, and also evaluated whether RBC sorbitol/plasma glucose ratio is an indicator of diabetic complications. METHODS: RBC sorbitol levels were measured in 43 healthy persons and 133 diabetes mellitus (DM) patients by enzymatic method. We also tested linearity, inter- and intra- assay precisions. Plasma glucose and Hb Alc were measured by hexokinase method and HPLC, respectively. Hospital records were reviewed. RESULTS: The intra- and inter-assay coefficients of variation of RBC sorbitol test are 8.7% and 28.5%, respectively. Linearity is good. The RBC sorbitol level(3.60+/-1.00 ug/mL) and RBC sorbitol/plasma glucose ratio (2.37+/-0.98%) in diabetic patients are significantly higher than those in normal control (1.69+/-0.43 ug/mL, 1.85+/-0.49 per mill), respectively(p<0.0001). We can't observe correlation between RBC sorbitol and Hb Alc in BM patients, but observe that in non-treatment DM patients. We also observed correlation between Hb Alc and glucose and reverse correlation between RBC sorbitol ratio and Hb Alc. We can't find significant relation between diabetic complications and RBC sorbitol or RBC sorbitol/plasma glucose. CONCLUSIONS: We suggest that the reference range of normal RBC sorbitol level and RBC sorbitol/plasma glucose ratio by enzymatic method are 1.69+/-0.86 ug/mL and 1.85+/- 0.98%,. These Ire significantly different from DM patients and may be useful in diagnosis of DM.
Blood Glucose ; Chromatography, High Pressure Liquid ; Diabetes Complications ; Diabetes Mellitus* ; Diagnosis ; Erythrocytes ; Glucose ; Hexokinase ; Hospital Records ; Humans ; Reference Values ; Sorbitol*

BACKGROUND: Red blood cell (RBC) sorbitol has been implicated in the pathogenesis of organic complications of diabetes mellitus. W8 investigated RBC sorbitol level as an indicator of glucose control or diabetic complications, and also evaluated whether RBC sorbitol/plasma glucose ratio is an indicator of diabetic complications. METHODS: RBC sorbitol levels were measured in 43 healthy persons and 133 diabetes mellitus (DM) patients by enzymatic method. We also tested linearity, inter- and intra- assay precisions. Plasma glucose and Hb Alc were measured by hexokinase method and HPLC, respectively. Hospital records were reviewed. RESULTS: The intra- and inter-assay coefficients of variation of RBC sorbitol test are 8.7% and 28.5%, respectively. Linearity is good. The RBC sorbitol level(3.60+/-1.00 ug/mL) and RBC sorbitol/plasma glucose ratio (2.37+/-0.98%) in diabetic patients are significantly higher than those in normal control (1.69+/-0.43 ug/mL, 1.85+/-0.49 per mill), respectively(p<0.0001). We can't observe correlation between RBC sorbitol and Hb Alc in BM patients, but observe that in non-treatment DM patients. We also observed correlation between Hb Alc and glucose and reverse correlation between RBC sorbitol ratio and Hb Alc. We can't find significant relation between diabetic complications and RBC sorbitol or RBC sorbitol/plasma glucose. CONCLUSIONS: We suggest that the reference range of normal RBC sorbitol level and RBC sorbitol/plasma glucose ratio by enzymatic method are 1.69+/-0.86 ug/mL and 1.85+/- 0.98%,. These Ire significantly different from DM patients and may be useful in diagnosis of DM.
Blood Glucose ; Chromatography, High Pressure Liquid ; Diabetes Complications ; Diabetes Mellitus* ; Diagnosis ; Erythrocytes ; Glucose ; Hexokinase ; Hospital Records ; Humans ; Reference Values ; Sorbitol*

METHODS: We investigated and compared the epidemiologic characteristics of the E. cloacae isolation in the period of outbreak (April-June, 1998) with those in the control period (January-March, 1998). To identify the risk factors for E. cloacae sepsis, we retrospectively conducted a chart review for the patients who had E. cloacae sepsis during the period of outbreak. On the basis of these results, environmental culture was performed hospital wide. RESULTS: Ten clinical isolates E. cloacae were recovered from the blood of ten patients from April to June. 1998. Seven out of 10 patients recieved ERCP procedure just before E. cloacae sepsis. Hence, we performed surveillance study in the endoscopy room before and after the procedure. The survey showed that distilled water which was used for washing the endoscopy was contaminated with E. cloacae, which was suspected to be the common source of this outbreak. Therefore, we changed distilled water into sterilized distilled water on washing the endoscopy. After this correction was performed, the incidence of ERCP-associated E. cloacae sepsis declined markedly (P<0.011). CONCLUSION: We investigated an outbreak of ERCP-related E. cloacae sepsis and the outbreak was successfully controlled by removing the source of infection.
Cholangiopancreatography, Endoscopic Retrograde* ; Cloaca ; Endoscopy ; Enterobacter cloacae* ; Enterobacter* ; Humans ; Incidence ; Methods ; Retrospective Studies ; Risk Factors ; Sepsis* ; Water

BACKGROUND: According to previous investigation on antibiotic use at Dankook University Hospital, cephalosporin and aminoglycoside were the most commonly used antibiotics accounting for 52.8% and 30.4% of total antibiotics used, respectively. In almost all cases, antibiotics were prescribed for prophylaxis rather than for treatment the ratio for prophylaxis vs. treatment intent was 3.9:1 and 3.6: 1 for cephalosporin and aminoglycoside, respectively. Thus, we performed a study to investigate the current usage of cephalosporin and aminoglycoside before and after the surgical procedures. METHODS: We retrospectively analyzed the appropriateness of prophylactic use of antibiotics on 14 major operative procedures (26.4% of total operations) for patients discharged during July, 1997. RESULTS: Among 8 kinds of operative procedure performed on 105 cases, in which prophylactic antibiotic use was recommended, appropriate antibiotic use was observed in only 2 cases of non- perforating appendectomy. For 7 operative procedures, in which use of 1st generation cephalosporin is recommended, 1st cephalosporins were used only on 37.8% (44/92) of cases, whereas 2nd cephalosporins were used for most of other cases. An average of 2.5 DDD of 2nd cephalosporin, which was a pertinent dose, was used on non-perforating appendectomy. However, on all the other 7 operative procedures, the dose exceeded the recommended dose. Inappropriate antibiotic use was observed for 6 operative procedures, for which prophylactic antibiotic use was not recommended. The combination of cephalosporin and aminoglycoside was used in all but 3 types of operative procedures. CONCLUSION: During most of the pre- and post-operative period, antibiotics were combined, overused, misused, and inappropriately used.
Aminoglycosides* ; Anti-Bacterial Agents ; Appendectomy ; Cephalosporins* ; Dichlorodiphenyldichloroethane ; Humans ; Retrospective Studies ; Surgical Procedures, Operative

BACKGROUND: According to previous investigation on antibiotic use at Dankook University Hospital, cephalosporin and aminoglycoside were the most commonly used antibiotics accounting for 52.8% and 30.4% of total antibiotics used, respectively. In almost all cases, antibiotics were prescribed for prophylaxis rather than for treatment the ratio for prophylaxis vs. treatment intent was 3.9:1 and 3.6: 1 for cephalosporin and aminoglycoside, respectively. Thus, we performed a study to investigate the current usage of cephalosporin and aminoglycoside before and after the surgical procedures. METHODS: We retrospectively analyzed the appropriateness of prophylactic use of antibiotics on 14 major operative procedures (26.4% of total operations) for patients discharged during July, 1997. RESULTS: Among 8 kinds of operative procedure performed on 105 cases, in which prophylactic antibiotic use was recommended, appropriate antibiotic use was observed in only 2 cases of non- perforating appendectomy. For 7 operative procedures, in which use of 1st generation cephalosporin is recommended, 1st cephalosporins were used only on 37.8% (44/92) of cases, whereas 2nd cephalosporins were used for most of other cases. An average of 2.5 DDD of 2nd cephalosporin, which was a pertinent dose, was used on non-perforating appendectomy. However, on all the other 7 operative procedures, the dose exceeded the recommended dose. Inappropriate antibiotic use was observed for 6 operative procedures, for which prophylactic antibiotic use was not recommended. The combination of cephalosporin and aminoglycoside was used in all but 3 types of operative procedures. CONCLUSION: During most of the pre- and post-operative period, antibiotics were combined, overused, misused, and inappropriately used.
Aminoglycosides* ; Anti-Bacterial Agents ; Appendectomy ; Cephalosporins* ; Dichlorodiphenyldichloroethane ; Humans ; Retrospective Studies ; Surgical Procedures, Operative

BACKGROUND: The aim of our study is to determine maximum surgical blood order schedule (MSBOS) in elective surgery through analyzing usage of blood products such as packed red cells and whole blood at Dankook University Hospital. We would like to establish the guidelines for effective utilization of blood products by introducing MSBOS to our hospital. METHODS: We calculated average amount of transfused blood for each elective surgery based on the discharge records of patients from January 1997 to December 1998 at Dankook University Hospital. Only those operations performed more than 5 times were included in this study. Average number of transfused units per patient of each operation was selected for MSBOS. RESULTS: For two years, the total number of surgery was 15,497 and the number of transfused operations was 1,682 (10.85%). Operation groups transfused below 10% was 77.3% of all 199 operation groups. The number of operation groups whose average of transfused blood was below 0.5 units was 80.3%. Type and screen (T&S) was recommended in 140 (70.4%) of all the operation groups. Of total groups MSBOS of 2 units was estimated in 4 groups (2.0%), of 3 in 14 groups (7.0%), 4 of 4 groups (2.0%), 5 of 2 groups (1.0%), 6 of 4 groups (2.0%), 7 of 7 groups (3.5%), and 8 in 2 groups (1.0%), respectively. CONCLUSION: We established MSBOS through the previous transfusion data of surgical operations over two years. To enforce MSBOS is needed for better medical services, which would decrease blood disuse and medical cost.
Appointments and Schedules* ; Humans

BACKGROUND: Nontuberculous mycobacteria (NTM) are considered opportunistic pathogens, and several species of NTM are associated with human diseases that typically involve the pulmonary, skin/soft tissue, or lymphatic systems; such infection may also cause disseminated diseases. Recent studies have reported increasing rates of NTM-induced disease worldwide. METHODS: Respiratory samples are being analyzed for acid-fast bacilli (AFB) culture and NTM identification at Dankook University Hospital in Cheonan, Korea, from September 2005 to September 2011. Identification is performed by using polymerase chain reaction-restriction fragment length polymorphism analysis targeting a novel region of the rpoB gene. RESULTS: A total of 25,133 specimens were received for AFB culture, of which 1,014 (4.0%) were NTM-positive. A total of 267 samples from 186 patients were tested for NTM identifications, and 232 samples from 157 patients were positive for NTM species. Among the patients who tested positive for NTM, 65.6% were men and the average age was 63.3 years. Mycobacterium avium complex, the most commonly detected NTM pathogen, was found in 65.9% of the 232 samples. The annual average percentage of NTM isolates from AFB culture-positive specimens was 31.3%: the highest rate was seen in 2011 (44.3%), followed by 2009 (37.4%) and 2010 (37.2%). An upward trend in NTM incidence was found during the study period. CONCLUSION: The prevalence of pulmonary NTM isolates continues to increase in Cheonan, suggesting that pulmonary NTM disease is becoming increasingly common.
Age Distribution ; Humans ; Incidence ; Korea ; Male ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Prevalence