No abstract available.
Leukemia, Plasma Cell* ; Plasma Cells* ; Plasma* ; Plasmacytoma*

BACKGROUND: The Coapresta 2000 (CP2000; Seikisui, Japan) system is a fully-automated random-access multiparameter coagulation analyzer equipped with a photo-optical clot detection unit. It can perform clotting time assays as well as colorimetric assays. METHODS: We evaluated the analytical performance of CP2000 for several coagulation test parameters and compared its performance with that of the CA-7000 (Sysmex, Japan) system. Fresh and frozen plasma samples were used to evaluate the performance of CP2000 with respect to four routine coagulation test parameters: prothrombin time (PT), activated partial thromboplastin time, fibrinogen, and D-dimer. On-board stability of the liquid reagents was confirmed. Additionally, local international sensitivity index (ISI) verification was performed with four levels of calibrants and direct PT/international normalized ratio (INR) line. RESULTS: The intra- and inter-assay coefficients of variation were below 5% for every parameter in both normal and pathological ranges. Carryover was not detected. The results obtained using CP2000 showed good correlation (r 2 over 0.95) with those obtained by the CA-7000 analyzer. On-board stability in open-vial state, which was expected to be much longer than that of other reagents, was confirmed. Local verification of ISI showed an acceptable bias range of INR, compared with the values using calibrants. CONCLUSIONS: The high-throughput, CP2000 analyzer is a fast, user-friendly system with long on-board reagent stability. Its results were concordant with the CA-7000 analyzer, for analysis of the routine coagulation test parameters. Furthermore, this system would add greater confidence to the reporting of INR data.
Bias (Epidemiology) ; Fibrinogen ; Indicators and Reagents ; International Normalized Ratio ; Partial Thromboplastin Time ; Plasma ; Prothrombin Time

Cytophagic histiocytic panniculitis (CHP) is a rare form of panniculitis, presenting lymphohistiocytic infiltration within subcutaneous fat tissue with phagocytic histiocytes. Associated systemic symptoms includes fever, hepatosplenomegaly, lymphadenopathy, serositis, pancytopenia, hepatic abnormalities, hypertriglyceridemia, and coagulopathy, which are the features of hemophagocytic lymphohistiocytosis (HLH). The patients of CHP associated with HLH may have nonfatal acute/intermittent, or rapidly fatal clinical courses, so the prompt and accurate diagnosis with immunosuppressive treatments are significant.

Exflagellation of the malaria parasite microgametocyte usually occurs in the gut cavity of Anopheles mosquitoes following an infective blood meal. Exflagellation is a very rare event in human blood. Due to its rarity, the appearance of this structure in a peripheral blood smear will easily create a diagnostic dilemma. We report a case of malaria with exflagellated microgametes in human blood that was initially mistaken for a double infection of Plasmodium and another blood flagellate. The patient was a 29-year-old Parkistani man presenting with fluctuating fever accompanied by chills and fatigue for 4 days. Initial peripheral blood smear examination showed a number of Plasmodium ring forms, trophozoites, and gametocytes. Additionally, several filamentous structures resembling blood flagellates were seen. With these features, an initial diagnostic impression of combined infection of malaria and blood flagellate was made. Later, we determined that these structures resembling blood flagellates were exflagellated microgametes of malarial parasite. Therefore, the knowledge that exflagellation may appear in human blood with Plasmodium species infection and being more familiar with differentiation of the morphologic features of other species infection can prevent further possible misinterpretation.
Anopheles ; Chills ; Culicidae ; Fatigue ; Fever ; Humans ; Malaria ; Meals ; Parasites ; Plasmodium ; Trophozoites

No abstract available.
Leukemia, Mast-Cell* ; Mast Cells*

A malignant plasma cell clone usually produces a single abnormal monoclonal protein with a constant isotype. However, switching of paraprotein isotype has been reported to be a transient phenomenon associated with the recovery of B-cell function, and, in some cases, the switching might be misinterpreted as relapse. In August 2008, we encountered a case of a 59-year-old man with proteinuria and high IgG level (5.6 g/dL), kappa free light chain level of 2,660 mg/L, reversed A/G ratio (0.51), and multiple osteolytic lesions. Plasma cells, which accounted for 57% of all the nucleated cells, in bone marrow aspirates were positive for kappa immunostaining. Serum protein electrophoresis showed one M-spike, concentration of 4.87 g/dL in the beta region. Immunofixation electrophoresis revealed the peak as an IgG-kappa monoclonal protein; therefore, a diagnosis of plasma cell myeloma was made. Complete remission was achieved after chemotherapy, and autologous peripheral stem cell collection was performed. In March 2009, the patient underwent high-dose chemotherapy and autologous peripheral stem cell transplantation support. After 2 months, serum protein electrophoresis showed 2 M-spikes in the gamma region with positive IgM-lambda, IgG-lambda, and IgG-kappa, and these bands persisted. The electrophoretic mobility of the IgG-kappa protein was different from that of the original disease protein, and bone marrow results were the same as the previous ones. Although immunoglobulin isotype switch is known to have a benign course, it always requires careful monitoring because, in rare cases, true clonal switching may occur.
B-Lymphocytes ; Bone Marrow ; Clone Cells ; Electrophoresis ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Immunoglobulin Class Switching ; Immunoglobulin G ; Immunoglobulins ; Light ; Middle Aged ; Multiple Myeloma ; Peripheral Blood Stem Cell Transplantation ; Plasma ; Plasma Cells ; Proteinuria ; Recurrence ; Stem Cells

BACKGROUND: The low cardiopulmonary resuscitation (CPR) survival rate in Korea might be associated with inadequate education, an insufficient number of trained medical personnel, the inappropriate management of instruments and drugs in CPR carts. The purpose of this study was to determine the current status of these factors in major Korean university hospitals. METHODS: We surveyed the following items among anesthesiologists at 13 university hospitals via E-mail. The items in the questionnaire were; 1) the time allocated to CPR instruction for medical students and anesthesiology residents in a year, 2) the organization, call system, and the role of each member of the CPR team, 3) the establishment of standard in-hospital CPR protocol, 4) the CPR cart items list and their exchange intervals, and 5) post-CPR reporting. RESULTS: The durations of education for anesthesiology residents and medical students were <3 and 7 hours per year. The CPR team designated on documents differed from actual practice. Only one hospital had a standard CPR protocol. Most hospitals had a list of CPR cart, contents, items but the exchange intervals were irregular. Post-CPR reports were written only in intensive care units and emergency rooms. The involvement of nurses in CPR was minimal. CONCLUSIONS: In conclusion, recommend that the following be established; more profound CPR education program for anesthesiology residents and medical students, appropriate clarification of duties for each CPR team members, a standard in-hospital CPR protocol, and the systematic maintenance of drugs, instruments, and CPR records.
Anesthesiology ; Cardiopulmonary Resuscitation* ; Education* ; Electronic Mail ; Emergency Service, Hospital ; Hospitals, University* ; Humans ; Intensive Care Units ; Korea ; Surveys and Questionnaires ; Students, Medical ; Survival Rate

Laboratory values change with age and interpreting laboratory results from elderly people using the reference intervals for younger adults may not be appropriate. The authors investigated the distribution patterns of routine chemistry values from elderly people to determine whether current reference intervals are also valid for elderly people. A total of 1,215 persons older than 65 years and 1,827 healthy adults below 65 years of age were evaluated. Blood samples were collected after an overnight fast and analyzed for chemistry tests. Computing the central 95th percentile showed that the total protein, albumin, ALP, LD, creatinine, uric acid, triglyceride, HDL-cholesterol, and electrolytes of elderly people were within the standard reference intervals used in our laboratory. For AST and ALT, the upper range of the central 95th percentile in the elderly population was found to be outside the common reference interval. However, the central 90th percentile values of AST and ALT were compatible with the common reference intervals. GGT, BUN, total cholesterol, LDL-cholesterol, and glucose showed higher values than the upper limits of the reference intervals. For common clinical chemistry tests, the common reference values in general should be applicable to elderly people, even though some parameters showed wider distributions in the elderly.
Adult ; Aged ; Chemistry, Clinical ; Cholesterol ; Clinical Chemistry Tests ; Creatinine ; Electrolytes ; Glucose ; Humans ; Reference Values ; Uric Acid

BACKGROUND: Corrected QT (QTc) interval can be modulated by sympathetic and parasympathetic balance. Tracheal intubation causes significant prolongation of the QTc interval due to sympathetic stimulation. This study was designed to elucidate the relationship between baseline autonomic nervous system activity and QTc prolongation after endotracheal intubation using heart rate variability (HRV). METHODS: Sixty-six healthy patients were included and the baseline HRV data were recorded for 5 min before anesthesia. Power spectrum densities were calculated for low frequencies (LF, 0.04-0.15 Hz) and high frequencies (HF, 0.15-0.4 Hz), defined as either LF's or HF's relative part of the total power. Anesthesia was induced with sevoflurane and vecuronium was given. The QTc interval, heart rate (HR) and mean arterial pressure (MAP) were measured before induction (baseline), before laryngoscopy (pre-intubation) and immediately after the intubation (post-intubation). RESULTS: The QTc interval change at post-intubation from baseline (DeltaQTc) showed a significant negative correlation with the HF (r = 0.34, P = 0.006) and positive correlation with LF/HF ratio (r = 0.37, P = 0.005). Patients were retrospectively divided into low-HF/LF (<2.5, n = 44) and high-HF/LF group (>2.5, n = 22). The DeltaQTc was statistically higher in the high-LF/HF group compared to that in the low-LF/HF group (P = 0.048). The HR and MAP at baseline, pre-intubation and post-intubation were not different between two groups. CONCLUSIONS: The QTc interval prolongation after endotracheal intubation is influenced by baseline autonomic conditions and can be exaggerated in patients with activated sympathetic activity or depressed parasympathetic activity.
Anesthesia ; Arterial Pressure ; Autonomic Nervous System ; Heart ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Methyl Ethers ; Retrospective Studies ; Vecuronium Bromide

In patients with acute myeloid leukemia (AML), pleural effusion may be attributed to various factors, including infection, hypoalbuminemia, and renal failure. However, leukemic infiltration of the pleural fluid is rarely reported and poorly understood. Extramedullary diseases have been reported with increasing frequency as the survival rates of patients with AML have increased. However, the reported prognostic effects of leukemic pleural effusion in patients with AML range from none to a worse prognosis. Here, we report a case of acute promyelocytic leukemia (APL) in a patient exhibiting leukemic pleural effusion with fluorescence in situ hybridization (FISH) results indicating the presence of the PML-RARA fusion gene. A 52-year-old man presented with pancytopenia, dyspnea, and fever. He had a medical history of hypertension, end-stage renal disease, and hepatitis B virus-related liver cirrhosis. A peripheral blood smear revealed the presence of multiple abnormally hypergranular promyelocytes. White blood cell differential counts were not performed due to severe pancytopenia. A bone marrow examination, immunophenotyping analysis, and cytogenetic and molecular studies revealed APL. The patient was treated with all-trans retinoic acid immediately after abnormal promyelocytes were observed in the peripheral blood smear, but induction chemotherapy was delayed because of his poor condition. His persistent dyspnea and abdominal discomfort led to a thoracentesis and the observation of abnormal promyelocytes that were positive for PML-RARA fusion gene by FISH. To our knowledge, this is the first report of leukemic pleural infiltration with PML-RARA fusion gene-positivity via FISH.
Bone Marrow Examination ; Cytogenetics ; Dyspnea ; Fever ; Fluorescence ; Granulocyte Precursor Cells ; Hepatitis B ; Humans ; Hypertension ; Hypoalbuminemia ; Immunophenotyping ; In Situ Hybridization ; Induction Chemotherapy ; Kidney Failure, Chronic ; Leukemia, Myeloid, Acute ; Leukemia, Promyelocytic, Acute ; Leukemic Infiltration ; Leukocytes ; Liver Cirrhosis ; Middle Aged ; Pancytopenia ; Pleural Effusion ; Prognosis ; Renal Insufficiency ; Survival Rate ; Thoracentesis ; Tretinoin