BACKGROUND: Mixed cryoglobulinemia occurs predominantly in association with chronic liver diseases, infections, autoimmune diseases, and malignancies. Mixed cryoglobulinemia has been classified as essential if no primary disease is identified. Recently, mixed cryoglobulinemia has been reported in cases of hepatitis C virus(HCV) infection in foreign countries, but there have been few reports on the subject In our country. The aim of this study was to assess the prevalence and clinical features of HCV infection in patients with cryoglobuline mia in Korea. METHODS: Eighty-five patients with detectable serum cryoglobulin were studied between June 1996 and January 1997 at Hanyang university Hospital. Anti-HCV antibodies (Ab) were tested In all patients by particle agglutination method (ASAN HCV. PA Kit) and confirming a positive results, were tested by the microparticle enzyme immunoassay method (IMx, Abbott). Medical records were analyzed retrospectively to compare the clinical features between anti-HCV Ab positive and anti-HCV Ab negative patients. RESULTS: Anti-HCV antibodies were found in 12 out of 85 (about 14%) patients with cryoglobulinemia. Six of these patients were diagnosed as rheumatoid arthritis and 4 as osteoarthritis, and 2 as fibromyalgia syndrome. Nine of the 12 patients had no remarkable abnormalities in their liver function test results and there were no statistical differences between anti-HCV _Lb positive and negative groups. There were no meaningful differences between the two groups in immunologic data such as rheumatoid factor, C reactive protein, antinuclear antibody, and antiperinuclear factor. CONCLUSIONS: We found the association of HCV infection and cryglobulin in Korean patients with cryoglobulinemia and recommend routine anti-HCV Ab testing in patients with cryoglobulinemia even if they have normal liver function test results.
Agglutination ; Antibodies, Antinuclear ; Arthritis, Rheumatoid ; Autoimmune Diseases ; C-Reactive Protein ; Cryoglobulinemia* ; Fibromyalgia ; Hepatitis C Antibodies ; Hepatitis C* ; Hepatitis* ; Humans ; Immunoenzyme Techniques ; Korea ; Liver Diseases ; Liver Function Tests ; Medical Records ; Osteoarthritis ; Prevalence* ; Retrospective Studies ; Rheumatoid Factor

BACKGROUND: This study was set to determine the antinuclear antibody (ANA) frequency and fluorescence pattern, as well as the incidence of drug-induced lupus (DIL) in patients on long term medications with cardiovascular drugs and antihyperglycemic agents. METHODS: Sera from 301 patients on medications with cardiovascular drugs or antihyperglycemic agents for at least 6 months and 105 serum samples from healthy controls were tested by indirect immunofluorescence on immunotype (IT)-1 cells, and the medical records were retrospectively reviewed. The patients included 39 on digoxin, 38 on theophylline, 8 on theophylline and digoxin, 26 on captopril, 15 on diltiazem, and 182 on antihyperlycemic agents. RESULTS: ANA was positive in 3 of the 105 normal controls (3%). Thirty four percent of patients on medication with digoxin, 29% on theophylline, 31% on captopril, 7% on diltiazem, and 8% on antihyperglycemic agents were positive for ANA. The prominent ANA pattern was cytoplasmic type in patients on digoxin and theophylline, and the speckled type in captopril, however, most of them showed low titers. CONCLUSIONS: Long-term ingestion of theophylline, digoxin, captopril were shown to influence ANA, but not for diltiazem and antihyperglycemics. Therefore, patients on long-term medications with theophylline, digoxin, captopril should be regularly tested for ANA.
Antibodies, Antinuclear* ; Captopril ; Cardiovascular Agents* ; Cytoplasm ; Digoxin ; Diltiazem ; Eating ; Fluorescence ; Fluorescent Antibody Technique, Indirect ; Humans ; Hypoglycemic Agents* ; Incidence ; Medical Records ; Retrospective Studies ; Theophylline

OBJECTIVE: This study set out to determine the antinuclear antibody (ANA) frequency and fluorescence pattern, as well as the incidence of drug-induced lupus (DIL) in patients on long term medications with anticonvulsants. METHODS: Sera from 200 patients on medications with anticonvulsants for at least 6 months and from 105 healthy controls were tested by indirect immunofluorescence on immunotype (IT)-1 cells, and the medical records were retrospectively reviewed. The patients included 72 on valproic acid, 24 on phenytoin, 75 on carbamazepine, and 29 patients on two or more anticonvulsants. RESULTS: ANA were positive in 3 of the 105 normal controls (3%). Twenty nine percent of patients on valproic acid, 26% on phenytoin, 8% on carbamazepine, and 34% on two or more different anticonvulsants were positive for ANA. The cytoskeletal pattern was prominent in patients on valproic acid and the speckled pattern in phenytoin. Most were of low titers. CONCLUSION: Long-term ingestion of valproic acid and phenytoin were shown to influence ANA, while carbamazepine was not. No definite relationship was observed between ANA positivity and DIL. However, positive ANA indicates effects of anticonvulsants on the immune system, and therefore progression to DIL cannot be ruled out. Therefore, patients on long-term medications with anticonvulsants should be regularly tested for ANA.
Antibodies, Antinuclear* ; Anticonvulsants* ; Carbamazepine ; Eating ; Fluorescence ; Fluorescent Antibody Technique, Indirect ; Humans ; Immune System ; Incidence ; Medical Records ; Phenytoin ; Retrospective Studies ; Valproic Acid

BACKGROUND: Routine typing for HLA-B27 has been usually accomplished by the microcytotoxicity assay in Korea because it does not require special equipment and is easily reproducible. Recently, an immunofluorescence method and the polymerase chain reaction have also been applied for HLA-B27 testing. However, the current economic crisis in Korea have led domestic manufacturers to develop a Korean HLA-B27 typing kit. The aim of this study was to assess the advantages and disadvantages of this kit and to assess the possibility of replacing the currently used foreign-made kits with this domestic one. METHODS: HLA-B27 testing by the microcytotoxicity test was performed on 116 patients during a period of 3 months in 1998. The Biotest typing tray and the Chongkundang typing tray were tested simultaneously. Results: There was no difference in results in 116 samples (positive: 39, negative: 77). The Korean typing tray showed high false positivity of the negative control well (8 point: 1 case, 6 point: 33 cases, 4 point: 47 cases, 2 point: 17 cases, 1 point: 18 cases) and 6 of the HLA-B27 negative cases showed false positivity in one of the four HLA-B27 wells. Typing of HLA-Bw4 and Bw6 revealed an inconsistency in five and six cases, respectively. CONCLUSIONS: Despite of the false positivity of the negative control in Korean panel, we believe that Korean typing tray can replace the foreign-made tray due to its low cost and adequate performance. Because placenta of Korean multiparous women was used for the kit, Chongkundang typing tray seems to correlate better with Korean HLA-B27 subtypes.
Cytotoxicity Tests, Immunologic ; Female ; Fluorescent Antibody Technique ; HLA-B27 Antigen* ; Humans ; Korea ; Placenta ; Polymerase Chain Reaction

BACKGROUND: The purpose of this study was to determine that the assessment of serum neuron specific enolase(NSE) could provide a reliable early predictor of neurologic outcome after cardiac arrest. METHODS: Prospective, observational study was performed from April 1996 to March 1998 at a university teaching hospital ED. Serum NSE concentrations were analysed twice at 24 and 48 hours after return of spontaneous circulation(ROSC). Neurologic outcome was categorized using cerebral performance category(CPC). RESULTS: Twenty-nine patients(16 were men) were enrolled during the study period. The mean age was 50.8 years. Nine(31%) of them showed good outcome defied as CPC 1-3, and 20(69%) patients showed bad outcome defied as CPC 4-5. In the good outcome group, the serum NSE was revealed 33.8+/-9.3 ng/ml at 24 hours, 34.0+/-4.73 ng/ml at 48 hours. While in the bad outcome group, it was 99.5+/-11.7 ng/ml and 114.6+/-15.8 ng/ml. The NSE at 48hr after ROSC was more prescise than that of 24hr. When the cutoff value of 50 ng/ml at 48 hr, the sensitivity was 82%, and specificity was 93%. CONCLUSION: This study suggest that the serum NSE may represent a valuable, noninvasive, and useful clinical tool for prediction of neurologic outcome after cardiac arrest.
Heart Arrest* ; Hospitals, Teaching ; Humans ; Neurons* ; Observational Study ; Phosphopyruvate Hydratase* ; Prospective Studies ; Sensitivity and Specificity

Inositol-1,4,5-triphosphate [IP3] receptors binding protein released with IP3 (IRBIT) was previously reported as an activator of NBCe1-B. Recent studies have characterized IRBIT homologue S-Adenosylhomocysteine hydrolase-like 2 (AHCYL2). AHCYL2 is highly homologous to IRBIT (88%) and heteromerizes with IRBIT. The two important domains in the N-terminus of AHCYL2 are a PEST domain and a coiled-coil domain which are highly comparable to those in IRBIT. Therefore, in this study, we tried to identify the role of those domains in mouse AHCYL2 (Ahcyl2), and we succeeded in identifying PEST domain of Ahcyl2 as a regulation region for NBCe1-B activity. Site directed mutagenesis and coimmunoprecipitation assay showed that NBCe1-B binds to the N-terminal Ahcyl2-PEST domain, and its binding is determined by the phosphorylation of 4 critical serine residues (Ser151, Ser154, Ser157, and Ser160) in Ahcyl2 PEST domain. Also we revealed that 4 critical serine residues in Ahcyl2 PEST domain are indispensable for the activation of NBCe1-B using measurement of intracellular pH experiment. Thus, these results suggested that the NBCe1-B is interacted with 4 critical serine residues in Ahcyl2 PEST domain, which play an important role in intracellular pH regulation through NBCe1-B.
Animals ; Carrier Proteins ; Hydrogen-Ion Concentration ; Mice ; Mutagenesis, Site-Directed ; Phosphorylation ; S-Adenosylhomocysteine ; Serine*

Drug-eluting stent (DES) implantation is currently the standard treatment for various types of coronary artery disease. However, previous reports indicate that stent fractures, which usually occur after a period of time from the initial DES implantation, have increased during the DES era; stent fractures can contribute to unfavorable events such as in-stent restenosis and stent thrombosis. In our present report, we describe two cases of zotarolimus-eluting stent fracture: one that was detected six hours after implementation, and the other case that was detected immediately after deployment. Both anatomical and technical risk factors contributed to these unusual cases of immediate stent fracture.
Coronary Artery Disease ; Drug-Eluting Stents ; Percutaneous Coronary Intervention ; Risk Factors ; Stents* ; Thrombosis

BACKGROUND: The emergence of metronidazole (MTZ) resistance among Helicobacter pylori (H. pylori) isolates has compromised the efficacy of the triple therapy. Therefore, special attention should be given toward reliable methods for determining the in vitro susceptibility. But susceptibility testing of H. pylori is not yet either standardized or routinely performed. The purpose of this study was to establish more reliable, but simple to perform and cost-effective antimicrobial susceptibility testing method. METHODS: With 135 clinical isolates of H. pylori, antimicrobial susceptibility tests for MTZ and clarithromycin (CLR) were performed by antibiotic gradient method (E test, AB BIODISK, Sweden) and disk diffusion method (disk method), and the results were compared with the reference modified broth microdilution method (broth method). RESULTS: Resistant rates of Korean isolates of H. pylori for MTZ and CLR were 46.2% and 2.2%, respectively. There was 100% agreements between the E test, disk method and the broth method for CLR. For MTZ, however, agreements between the results obtained by the three methods were variable. Between the E test and broth method, the agreements were 85.1% in terms of susceptibility categories, 80.5% between the disk and broth method, and 93.1% between the E test and disk method. CONCLUSIONS: Routine susceptibility testing of H. pylori to MTZ seems to be required in Korea. The broth method is recommended for MTZ until more accurate, simple and practical alternative method become available. For the CLR, the disk method is recommended, because it is reliable, simple, and economical.
Clarithromycin ; Diffusion* ; Helicobacter pylori* ; Helicobacter* ; Korea ; Metronidazole

BACKGROUND: Inducible MLS(B) (macrolide-lincosamide-streptogramin B) resistance in staphylococci is not detected by standard susceptibility test methods. Failure to identify inducible MLS(B) resistance may lead to clinical failure during clindamycin therapy. We determined the prevalence of inducible MLS(B) resistance in erythromycin-resistant staphylococcal isolates. MATERIALS AND METHODS: We evaluated all 2,792 non-duplicate staphylococcal strains: 1,402 Staphylococcus aureus and 1,390 coagulase-negative staphylococci (CoNS) isolated from May 2008-June 2009 at one-unoversity hospital. Testing for inducible MLS(B) was accomplished by the disk approximation test (D-test) in accordance with the recommendations of the Clinical and Laboratory Standards Institute (CLSI). RESULTS: Of the 2,792 staphylococcal isolates, 892 S. aureus isolates and 740 CoNS isolates were resistant to erythromycin. Among the 892 erythromycin-resistant S. aureus isolates, the overall prevalence of inducible MLS(B) was 21.3% (16.2% of MRSA and 76.3% of methicillin-susceptible S. aureus). Among the 740 erythromycin-resistant CoNS isolates, the overall prevalence of inducible MLS(B) was 16.5% (16.0% of methicillin-resistant CoNS and 18.7% of methicillin-susceptible CoNS). The D-test was positive in 88.8% of S. aureus and 28.4% of CoNS isolates, which were erythromycin-resistant and clindamycin-susceptible. CONCLUSIONS: There are some variations in the prevalence of inducible MLS(B) resistance in clinical staphylococcal isolates. It is important that clinical laboratories report inducible MLS(B) resistance for erythromycin-resistant and clindamycinsusceptible staphylococcal isolates.
Clindamycin ; Erythromycin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Prevalence ; Staphylococcus ; Staphylococcus aureus

PURPOSE: This study was performed to evaluate the availability of classification of lacunar syndrome and of diffusion weighted MRI as initial diagnostic tools for patients with lacunar syndrome. METHODS: From January 1 to October 31, 2001, we prospectively studied patients presenting with lacunar syndrome. All patients were scanned using diffusion-weighted MRI and were then classified into categories based on the diagnosis pure motor stroke and ataxic hemiparesis, sensory motor stroke, pure sensory stroke, dysarthria-clumsy hand syndrome, and others. RESULTS: The total number of patents was 72 ; 60 cases of lacunar infarcts and 12 cases of lacunar hemorrhage. There were 42 cases of pure motor stroke and ataxic hemiparesis, 17 cases of sensory motor stroke, 8 cases of dysarthria-clumsy hand syndrome, 3 cases of pure sensory stroke, 2 cases of others. Lacunar syndrome can be caused by lesions in a variety of locations, and specific location can cause a variety of lacunar syndromes. With diffusion-weighted MRI, lacunar syndromes were visible in 91.7% of the patients (66/72) and lacunar infarcts were visible in 90% (54/60). The mean size of the lacunar infarcts was 11.90+/-5.04 mm and the mean volume of lacunar hemorrhages was 4.70+/-2.08 ml. CONCLUSION: This study showed that the classification of lacunar syndrome was of little benefit in the diagnosis and treatment of a lacunar infarct. Diffusion-weighted MRI, however, was a good initial diagnostic tool in cases of lacunar infarcts. An additional study of the availability of diffusion weighted MRI for use in cases of hemorrhagic lesions is needed.
Classification* ; Diagnosis ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Hand ; Hemorrhage ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Paresis ; Prospective Studies ; Stroke ; Stroke, Lacunar*