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

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: 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*

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: 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: Rapid identification of the causative agent among potential bacterial and viral pathogens is important for the management of acute respiratory disease. In this study, we evaluated the analytical performance and clinical usefulness of a recently-introduced multiplex PCR assay, Seeplex(TM)Pneumobacter detection kit (Seegene Inc., Korea) for the identification of respiratory bacterial pathogens. METHODS: One hundred and eighty one nasopharyngeal aspirates were collected from pediatric patients with respiratory symptoms and analysed by multiplex PCR for the detection of Streptococcus pneumoniae (S.P), Haemophilus influenzae (H.I), Mycoplasma pneumoniae (M.P), Chlamydophila pneumoniae (C.P), Bordetella pertussis (B.P) and Legionella pneumophila (L.P). A comparison of multiplex PCR with conventional culture for the isolation of S.P and H.I was performed on 112 specimens. The cross reactivity of multiplex PCR was also evaluated. RESULTS: Of 181 cases, 81 cases were positive by multiplex PCR (44.8%): 52 cases for S.P (28.7%), 47 cases for H.I (26.0%), 9 cases for M.P (5.0%), 3 cases for B.P (1.7%) and 1 case for C.P (0.6%) including multiple infection cases. The agreement rates between multiplex PCR and culture for S.P and H.I were 92.9% (kappa index=0.84, P<0.001) and 91.1% (kappa index=0.75, P<0.001), respectively. There was no cross reactivity with common bacterial and viral pathogens. CONCLUSIONS: Seeplex(TM) Pneumobacter detection kit could be a useful screening tool for the rapid detection of respiratory bacterial pathogens. Further studies with lower respiratory tract specimens would be needed for the clinical evaluation of S. pneumoniae and H. influenzae detected by multiplex PCR.
Adolescent ; Bacterial Infections/*diagnosis ; Child ; Child, Preschool ; DNA, Bacterial/analysis ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Mycoplasma pneumoniae/*isolation & purification ; Pneumonia, Mycoplasma/diagnosis ; *Polymerase Chain Reaction ; Reagent Kits, Diagnostic ; Respiratory Tract Infections/*diagnosis/microbiology ; Sensitivity and Specificity

Hemolytic uremic syndrome is characterized by a triad of clinical findings including microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The precise etiology and pathogenesis of hemolytic uremic syndrome are not established by now. According to clinical reports, hemolytic uremic syndrome is associated with infection(bacteria, virus), connective tissue disease, malignancy, drug and pregnancy. Recently, many investigators have reported that cyclosporine induces hemolytic uremic syndrome. Cyclosporine is one of the immunosuppressants that are essential for kidney transplantation. We experienced one case of hemolytic uremic syndrome that developed after kidney transplantation receiving cyclosporine. A 43-yr-old woman with end-stage renal failure received kidney transplantation from her daughter. After operation, she received cyclosporine for immunosuppression and thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure were developed. She was diagnosed as cyclosporine induced hemolytic uremic syndrome and plasma exchange was started with fresh frozen plasma. The plasma exchange was done 16 times and the clinical symptoms were improved. We present this case with review of literatures.
Acute Kidney Injury ; Anemia, Hemolytic ; Connective Tissue Diseases ; Cyclosporine* ; Female ; Hemolytic-Uremic Syndrome* ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney* ; Nuclear Family ; Plasma Exchange* ; Plasma* ; Pregnancy ; Research Personnel ; Thrombocytopenia