E. histolytica has a simple life cycle with two stages: an infective cyst and an invasive trophozoite. It lives on humans as its host. Its infection occurs through the ingestion of the cyst form, and the disease begins when the trophozoite, converted at the small intestine, adheres to colonic epithelial cells with a latent period of two days to four months. In some instances, amoebic abscess formations can occur at the liver, lung, brain, or spleen via the lymphoid system. Rare cases of amoebiasis in neonates have been reported, much less any intrauterine infections in the world that may have occurred during the gestation period. We've recently experienced a case of neonatal amoebiasis that entailed after-birth vomiting and bloody stool. The infant seemed pre-infected with E. histolytica before birth.
Abscess ; Amebiasis* ; Brain ; Colon ; Eating ; Entamoeba histolytica ; Epithelial Cells ; Humans ; Infant ; Infant, Newborn ; Intestine, Small ; Life Cycle Stages ; Liver ; Lung ; Parturition ; Pregnancy ; Spleen ; Trophozoites ; Vomiting*

BACKGROUND: The hemopoietic stem cells increase in number during the regeneration after chemotherapy or bone marrow transplantation (BMT). Although the proportion of hemopoietic stem cells and their differentiation have been studied by immunophenotyping using the flow cytometry, no substantial research efforts have been directed toward the regenerating marrow. We attempted to discover the proportions of undifferentiated stem cells, committed stem cells, B cell precursors, and myeloid precursors in the regenerating bone marrows during complete remission (CR) and after engraftment of BMT. METHODS: Bone marrow samples from 82 patients with acute leukemia in CR and from 25 patients after BMT engraftment, along with 22 control samples, were used to find the numbers of CD38-/CD34+, CD38+/CD34+, CD19+/CD34+, and CD13,33+/CD34+ cells in the large lymphocyte gate by flow cytometry. We cross-analyzed our results in terms of groups: CR, BMT, and initial diagnosis groups. We performed significance tests on age, relapse, chromosomal abnormalities, clinical outcomes, and initial immunophenotypes of the leukemic cells. RESULTS: The proportions of CD38-/CD34+, CD38+/CD34+, CD19+/CD34+, and CD13,33+/CD34+ cells are more highly distributed in acute B-lymphoblastic leukemia than the normal group and also in the CR than the BMT group. CD19+/CD34+ cells were increased in the relapse group and CD38+/ CD34+, CD19+/CD34+, and CD13,33+/CD34+ cells were increased in the group with chromosomal abnormality. The results were irrelevant to the initial immunophenotype of the leukemic blasts. CONCLUSIONS: The increases of the markers spanned too widely to apply one specific cutoff value to analyze them. They seemed to be the results of normal regeneration, irrelevant to relapse or initial immunophenotype of leukemic blasts.
Acute Disease ; Antigens, CD19/*metabolism ; Antigens, CD34/*metabolism ; Antigens, CD38/*metabolism ; Bone Marrow/physiology ; *Bone Marrow Transplantation ; Flow Cytometry ; Follow-Up Studies ; Granulocyte Colony-Stimulating Factor/therapeutic use ; Hematopoietic Stem Cells/immunology/metabolism ; Humans ; Immunophenotyping ; Leukemia/drug therapy/*metabolism/therapy ; Regeneration ; Remission Induction

BACKGROUND: A new HPV DNA chip test for the infection of 22 HPV genotypes was recently developed in Korea. This test using PCR and hybridization is inherently vulnerable to contamination, and to subjective qualitative test judgment. Hence, it warrants rigorous quality assurance measures. The authors would like to share operational experiences of the guidelines developed at Catholic University Holy Family Hospital. METHODS: Our quality assurance system of HPV DNA chip test comprised external quality controls, inter-laboratory proficiency tests, and internal quality controls. For the external quality controls, we analyzed the results of four years of participation in the quality assurance program by the Korean Laboratory Medicine Quality Assurance Association. The inter-laboratory proficiency tests with BioMedLab were done by single blind tests using patients' samples showing negative, single and multiple infections. The internal quality control dealt with methods to prevent contamination, and with reproduction tests. RESULTS: The results from the external quality control revealed consistency with HPV-16 in 7 trials during 4 years. The inter-laboratory proficiency tests showed a 82% consistency rate, 10 cases of inconsistency showing positive or negative mismatches, and 8 cases of genotypic mismatches. The 10 mismatches were due to the weak laser power of the scanner used in BioMedLab. The genotypic contamination rate found in the internal quality control was 3.3%, and the contamination by HPV-35 with low incidence rate was often observed. The contamination was not easily eliminated by re-tests from hybridization, but 80% of it was removed when re-tested with the remaining samples. The fluorescence intensity was not reproducible nor provide quantitative or semi-quantitative information. CONCLUSIONS: For quality assurance regarding HPV DNA chip tests, we suggest the following be implemented: technical quality control to rule out the false-negative and false-positive during PCR and hybridization; scanner quality control to prevent reading errors; and inter-laboratory proficiency tests.
DNA* ; Fluorescence ; Genotype ; Human papillomavirus 16 ; Humans ; Incidence ; Judgment ; Korea ; Oligonucleotide Array Sequence Analysis* ; Polymerase Chain Reaction ; Quality Control ; Reproduction

BACKGROUND: Human papillomavirus (HPV) prophylactic vaccines, bivalent types for HPV-16/18 with 70% prophylactic expectation, have been developed based on the genotypes found prevalent in the western countries, but little is known for those in Korea. Using a DNA chip test, we evaluated the clinical efficacy of HPV genotype based on cervical abnormalities. METHODS: As the initial diagnostic tests, HPV DNA chip tests and Papanicolaou smear (PAP) were used for 1,211 subjects. Cervical colposcopy directed biopsies were performed for 626 among the 1,211 subjects within one month. RESULTS: The most frequently found genotypes in all HPV-positive specimens (n=445) were HPV-16 (22.0%), 58 (13.9%), 52 (11.0%), 51 (9.0%), 56 (8.5%), and 18 (7.2%). HPV prevalence was significantly higher in specimens where PAP and biopsy results were closer to malignancy. The HPV genotype distribution of the histologically confirmed cervical high-grade squamous intraepithelial lesions (HSIL) or carcinoma cases showed HPV-16, 58, 52, 18, and 33, in descending order. The HPV DNA chip sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of cervical HSIL or carcinoma were 76.9%, 70.1%, 72.1%, and 75.8%, respectively, Of these, the sensitivity and NPV were higher than those of PAP. PPV and NPV of HPV-16 were 90.5% and 60.7%, respectively, being the highest among the genotypes. CONCLUSIONS: We confirmed that HPV-16 genotype was also very important for the diagnosis of HSIL and cervical carcinoma in Korea. However, contrary to the findings in the western countries, the prevalence of HPV-58 was higher than that of HPV-18. Moreover, as the other HPV genotype reports were rare in Korea, further studies are required with the HPV DNA chip test before the nationwide adoption of the vaccines.
Adolescent ; Adult ; Aged ; Colposcopy ; DNA, Viral/analysis/isolation & purification ; Female ; Genotype ; Humans ; Middle Aged ; *Oligonucleotide Array Sequence Analysis ; Papillomaviridae/classification/*genetics/isolation & purification ; Papillomavirus Infections/*diagnosis/epidemiology/virology ; Papillomavirus Vaccines ; Polymerase Chain Reaction ; Reproducibility of Results ; Sensitivity and Specificity ; Uterine Cervical Neoplasms/*diagnosis/prevention & control/virology ; Vaginal Smears/methods ; Young Adult

BACKGROUND: The aim of this study is to organize the maximum surgical blood order schedule (MSBOS) of red blood cells (RBCs) for elective surgeries according to the International Classification of Diseases, Ninth Revision, Clinical Modification guidelines (ICD-9-CM) and we compared the results with the previously reported MSBOSs. METHODS: From 1 March to 31 August 2007, the data of the transfused RBCs for elective surgeries in our hospital were analyzed. The MSBOS was organized as the average number of units of transfused RBCs for the type of surgery, according to the ICD-9-CM. The results were compared with the MSBOSs that were previously reportedfrom 1982 to 2004 in Korea. RESULTS: A total of 121 types of 3,375 surgeries were performed. Type & screen for 91 types (81.3%), 1 unit for 20 types (13.8%), 2 units for 7 types (3.8%), 3 units for 1 type (0.4%) and 4 units for 2 types (1.8%) were recommended. There was a minimal difference between these results and the range for the previously reported MSBOSs. CONCLUSION: It seems that the MSBOS showed minimal change since 2004. We organized the MSBOS according to the guidelines of the ICD-9-CM. Standardization of the surgery name should be considered to achieve more useful utilization of MSBOS.
Appointments and Schedules ; Erythrocytes ; International Classification of Diseases ; Korea

We report a case of IgA kappa light chain deposition disease and combined adult Fanconi syndrome with Auer rod-like intracytoplasmic inclusions in plasma cells and proximal renal tubular cells in a 54-yr-old female. Cytochemical stainings revealed a strong acid phosphatase activity of the inclusions and weak periodic acid-Schiff positivity, whereas the reactions for peroxidase and alpha-naphthyl acetate esterase were negative. An immunostaining verified IgA-kappa inside the plasma cells. Kidney biopsy revealed Bence Jones cast nephropathy with kappa light chain positivity, and Congo red staining was negative. Electron microscopy showed needle-shaped crystals located in tubular epithelial cells.
Fanconi Syndrome/diagnosis/etiology/*pathology ; Female ; Humans ; *Immunoglobulin A/analysis ; Immunoglobulin kappa-Chains/analysis ; Inclusion Bodies/*ultrastructure ; Kidney Tubules, Proximal/pathology/*ultrastructure ; Middle Aged ; Paraproteinemias/*pathology ; Plasma Cells/pathology/*ultrastructure

Dermatofibrosarcoma protuberans(DFSP) is an unusual, locally aggressive, cutaneous neoplasm of low grade malignancy. Several histologic variants have been described. Among them, fibrosarcomatous dermatofibrosarcoma protuberans is associated with a higher rate of local recurrence and distal metastases as well as a shorter latency period of time until recurrence than does ordinary DFSP. As a result, it needs more intense treatments and more vigorous follow up. A 37-year-old man presented with an asymptomatic erythematous hard nodule and several reddish papules on the chest for 2 years. Histopathologic examination revealed fibrosarcomatous dermatofibrosarcoma protuberans. We, herein, report an unusual case of fibrosarcomatous dermatofibrosarcoma protuberans.
Adult ; Dermatofibrosarcoma* ; Follow-Up Studies ; Humans ; Latency Period (Psychology) ; Neoplasm Metastasis ; Recurrence ; Thorax

Bowen's disease is a kind of squamous cell carcinoma in situ. In some cases, a pagetoid growth pattern can be observed with cytologically atypical clear cells arranged singly or in nests. The differential diagnosis of clear-cell Bowen's disease includes primarily Paget's disease and malignant melanoma in situ. A 66-year-old man presented with intermittently painful, solitary, well-demarcated, annular, erythematous, scaly plaque on the left fourth finger for 7 months. This had been treated by cryotherapy 8 months earlier, following the diagnosis of Bowen's disease. The skin biopsy specimen revealed nests of atypical clear cells in upper layer of the epidermis in addition to typical features of Bowen's disease. We, herein, report a rare case of clear-cell Bowen's disease, which is thought to have developed after cryotherapy.
Aged ; Biopsy ; Bowen's Disease* ; Carcinoma, Squamous Cell ; Cryotherapy* ; Diagnosis ; Diagnosis, Differential ; Epidermis ; Fingers ; Humans ; Melanoma ; Skin

BACKGROUND: Final diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) may take years demanding a quick diagnosis measure. We used the facts that PNH cells are damaged in acid, and reagents for measuring reticulocytes in Coulter DxH800 (Beckman Coulter, USA) are weakly acidic and hypotonic, to create a new PNH screening marker. METHODS: We analyzed 979 complete blood counts (CBC) data from 963 patients including 57 data from 44 PNH patients. Standard criteria for PNH assay for population selection were followed: flow cytometry for CD55 and CD59 on red blood cells (RBCs) to a detection level of 1%; and fluorescent aerolysin, CD24 and CD15 in granulocytes to 0.1%. Twenty-four PNH minor clone-positive samples (minor-PNH+) were taken, in which the clone population was <5% of RBCs and/or granulocytes. Excluding PNH and minor-PNH+ patients, the population was divided into anemia, malignancy, infection, and normal groups. Parameters exhibiting a distinct demarcation between PNH and non-PNH groups were identified, and each parameter cutoff value was sought that includes the maximum [minimum] number of PNH [non-PNH] patients. RESULTS: Cutoff values for 5 selected CBC parameters (MRV, RDWR, MSCV, MN-AL2-NRET, and IRF) were determined. Positive rates were: PNH (86.0%), minor-PNH+ (33.3%), others (5.0%), anemia (13.4%), malignancy (5.3%), infection (3.7%), normal (0.0%); within anemia group, aplastic anemia (40.0%), immune hemolytic anemia (11.1%), iron deficiency anemia (1.6%). Sensitivity (86.0%), specificity (95.0%), PPV (52.1%), and NPV (99.1%) were achieved in PNH screening. CONCLUSION: A new PNH screening marker is proposed with 95% specificity and 86% sensitivity. The flag identifies PNH patients, reducing time to final diagnosis by flow cytometry.
Antigens, CD15/metabolism ; Antigens, CD24/metabolism ; Antigens, CD55/metabolism ; Antigens, CD59/metabolism ; Biomarkers/metabolism ; Blood Cell Count ; Erythrocytes/cytology/metabolism ; Flow Cytometry ; Granulocytes/cytology/metabolism ; Hemoglobinuria, Paroxysmal/*diagnosis/metabolism ; Humans ; Sensitivity and Specificity

BACKGROUND: The usefulness of the CytoDiff flow cytometric system (Beckman Coulter, USA) has been studied in various conditions, but its performance including rapidity in detecting and counting blasts, the most significant abnormal cells in the peripheral blood, has not been well evaluated. The objective of this study was to evaluate the performance of the CytoDiff differential counting method in challenging samples with blasts. METHODS: In total, 815 blood samples were analyzed. Samples flagged as "blasts" or "variant lymphocytes" and showing <10% blasts by manual counts were included. In total, 322 samples showed blasts on manual counts, ranging from 0.5% to 99%. The CytoDiff method was performed by flow cytometry (FC500; Beckman Coulter, USA) with a pre-mixed CytoDiff reagent and analyzing software (CytoDiff CXP 2.0; Beckman Coulter). RESULTS: The average time required to analyze 20 samples was approximately 60 min for manual counts, and the hands-on time for the CytoDiff method was 15 min. The correlation between the CytoDiff and manual counts was good (r>0.8) for neutrophils and lymphocytes but poor (r<0.8) for other cells. When the cutoff value of the CytoDiff blast count was set at 1%, the sensitivity was 94.4% (95% CI; 91.2-96.6) and specificity was 91.9% (95% CI; 89.0-94.1). The positive predictive value was 88.4% (95% CI; 84.4-91.5) (304/344 cases) and negative predictive value was 96.2% (95% CI; 93.9-97.7) (453/471 cases). The CytoDiff blast counts correlated well to the manual counts (r=0.9223). CONCLUSIONS: The CytoDiff method is a specific, sensitive, and rapid method for counting blasts. A cutoff value of 1% of at least 1 type of blast is recommended for positive CytoDiff blast counts.
Adult ; Female ; Flow Cytometry/*instrumentation ; Humans ; Leukocyte Count ; Leukocytes/*cytology ; Lymphocytes/cytology ; Male ; Neutrophils/cytology