BACKGROUND: When organ transplantation or HLA-matched platelet transfusion is considered, accu-rate identification of HLA antibody specificity in the recipient's serum is very important. In this study, we report our experience in an international quality control program. METHODS: For external quality control in a HLA antibody test, the International Serum Exchange Program distributes serum samples, generally showing polyspecific reactivity for cross-reactive epitope groups (CREGs), to participating laboratories: 4 samples per survey, 10 surveys per year. Participating in the program from May 1998 to August 2000 (24 surveys), we performed HLA antibody identification of 96 serum samples by the AHG-CDC (anti-human globulin-complement dependent cytotoxicity) method using frozen lymphocyte trays (36 lymphocyte panels). We compared the results of our laboratory with those of the total participants (all methods combined, 72 to 92 laboratories per survey) using the analyzed survey results distributed by the program organizer. RESULTS: We analyzed the survey results for the antibodies to relatively common HLA antigens in Koreans (antigen frequency >1%). For the HLA antibodies detected in >or=20% of participants, our detection rate was higher by 10-15% than that of all laboratories (HLA-A, 76% vs 65%; HLA-B, 73% vs 57%). And for the HLA antibodies detected in >or=50% of the participants, our detection rate was as high as 88% for HLA-A and 87% for HLA-B. Our detection rate for a few antibody specificities was lower than that of all laboratories, namely HLA-A1, A3, B35, and B55. Among these, A1, A3, and B55 were of lower incidence antigens in Koreans (antigen frequency 3-4%), indicating that the low detection rate was due to a limitation in the composition of lymphocyte panels. CONCLUSIONS: In general, our detection rate of HLA antibodies was superior to the average detection rate of the total participant laboratories. We would be able to improve the low detection rate for a few antibody specificities to lower incidence antigens by refining the composition of lymphocyte panels.
Antibodies ; Antibody Specificity ; HLA Antigens ; HLA-A Antigens ; HLA-A1 Antigen ; HLA-B Antigens ; Incidence ; Lymphocytes ; Organ Transplantation ; Platelet Transfusion ; Quality Control ; Transplants

PURPOSE: The purpose of this study was to analyze effects of a community-based case management program for clients with hypertension living in the community. METHODS: The research design was a one group pre and post-test design with 30 participants with hypertension who agreed to participate in the 8-12 week case management program provided by case managers from the National Health Insurance Corporation in 2002. Data were collected three times, before and after the case management services, and 6 months later. Outcomes included changes in blood pressure, knowledge of hypertension and daily life practices, including alcohol consumption, smoking, exercise, and medication adherence. RESULTS: Repeated-measures ANOVA and post-hoc tests of means revealed significant differences before and after service for systolic blood pressure, daily life practices (monitoring body weight and BP, low salt and cholesterol and high vegetable diet, and stress-relief practices), and exercise. The goal for medication adherence was attained after service. Significant improvements from baseline to 6 months after service were observed in measures of salt and vegetables in diet. There were no significant differences on hypertension knowledge, alcohol consumption or smoking behavior between before service and after, and at 6 months. CONCLUSION: The findings provide preliminary evidence that case management intervention can have positive outcomes on BP control, daily life practices, exercise, and medication adherence for clients with hypertension. However, additional interventions are needed to sustain long-term effects.
Activities of Daily Living ; Aged ; Alcohol Drinking/prevention & control/psychology ; Blood Pressure ; Case Management/*organization & administration ; Community Health Services ; Diet, Sodium-Restricted ; Female ; Humans ; Hypertension/psychology/*therapy ; Korea ; Male ; Medication Adherence/psychology ; Middle Aged ; Patient Education as Topic ; Smoking Cessation/psychology

BACKGROUND: The spectrum of clinical presentations of extrapulmonary tuberculosis (EPT) is so diverse that it may mimic other systemic diseases and often leads physicians to misdiagnosis. Since its diagnosis is largely depended on physician's suspicion of the disease, it would be worthwhile to scrutinize the clinical characteristics of EPT. We retrospectively evaluated clinical manifestations of 312 patients who were diagnosed as EPT in a tertiary referral hospital. METHODS: The medical records of 312 patients, diagnosed as having EPT at Youngdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. RESULTS: Total 312 patients, 149 (47.8%) men and 163 (52.2%) women with age ranged from 13 years to 87 years, were included in this study. The most common site of the involvement was pleura (35.6%). Patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain on infected site (48.1%). Leukocytosis, anemia, and elevated ESR and CRP were found in 12.8%, 50.3%, 79.3%, and 63.1% of the patients, respectively. Twenty-four percent of patients had underlying medical illnesses such as old age over 60 years, diabetes mellitus or liver cirrhosis. In 67.3% of patients, tuberculosis was suspected at initial visit. However, tuberculosis was microbiologically proven in only 23.7% of patients. Histopathological diagnosis of EPT was made in 48.7% of patients. The time interval from symptom onset to diagnosis varied, and mean duration was 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. CONCLUSION: Although EPT had a wide spectrum of clinical manifestations and its diagnostic methods were lack, high index of suspicion could be obtained from chest radiograph, localized or systemic symptoms, and several laboratory parameters reviewed in this descriptive study. In case of doubt, early treatment instead of awaiting microbiological result may be necessary to avoid the devastating complications.
Anemia ; Diabetes Mellitus ; Diagnosis* ; Diagnostic Errors ; Female ; Humans ; Leukocytosis ; Liver Cirrhosis ; Male ; Medical Records ; Pleura ; Radiography, Thoracic ; Retrospective Studies ; Tertiary Care Centers ; Tuberculosis

Recombinant human erythropoietin is a synthetic glycoprotein hormone and has the effect on bone marrow erythroid progenitor cells. Therefore, recombinant human erythropoietin has been frequently used as an agent treating anemia in chronic renal failure patients. However, Stockenhuber reported that recombinant human erythropoietin also affected other bone marrow progenitor cells (colony- forming unit-granulocyte-erythrocyte-macrophage, colony-forming-gra-nulocyte-macrophage). This reports may suggest a possible casual relationship between acute myeloid leukemia and erythropoietin. Acute myeloid leukemia is a rare disease in patients with chronic renal failure especially on erythropoietin treatment. By this time only a case of acute leukemia in chronic renal failure was reported by Campistrus in 1995. Campistrus's case was on the remission state of acute myeloid leukemia, and erythropoietin was administered to treat anemia of chronic renal failure. Also no previous case of acute myeloid leukemia developed in chronic renal failure patients on erythropoietin treatment was yet reported in Korea. So, we report a case of acute myeloid leukemia developed in a pre-dialysis chronic renal failure patient but on erythropoietin treatment.
Anemia ; Bone Marrow ; Erythroid Precursor Cells ; Erythropoietin* ; Glycoproteins ; Humans ; Kidney Failure, Chronic* ; Korea ; Leukemia ; Leukemia, Myeloid, Acute* ; Rare Diseases ; Renal Insufficiency ; Stem Cells

Simple liver cysts are common and benign lesions, and most of them are detected by ultrasonography (US) or computed tomography (CT) during a medical checkup. Because simple liver cysts are generally asymptomatic, they do not require treatment, although hemorrhage, infection or rupture may occur in rare cases and these cases must receive proper treatment. The diagnosis of simple liver cysts is usually easy because of their typical morphological findings on US or CT. However, when a liver cyst contains hemorrhage or it is inflamed on imaging studies, it is sometimes difficult to differentiate simple hepatic cysts from such conditions as cystadenoma and cystadenocarcinoma. In this report, we describe a case of simple liver cyst that was complicated by intracystic hemorrhage, and this malady was initially diagnosed as biliary cystadenocarcinoma. We successfully treated this lesion by left lateral segmentectomy.
Cystadenocarcinoma ; Cystadenoma ; Diagnosis ; Hemorrhage* ; Liver ; Mastectomy, Segmental ; Rupture ; Ultrasonography