No abstract available.
Humans ; Hepatitis, Toxic/*diagnosis/*etiology ; Acute Disease

Herein, we report a case of unusually elevated serum insulin level as a result of increased anti-insulin antibody (IA)-bound insulin after continuous subcutaneous insulin infusion therapy. Detecting free insulin (unbound IAs) levels after polyethylene glycol pre-treatment could be useful to assess functional insulin levels in diabetic patients receiving insulin therapy. The E170 insulin assay can estimate total insulin (bound IAs and free insulin) levels, but it does not measure the levels of exogenous insulin analogues.
Humans ; Insulin ; Insulin Antibodies ; Polyethylene Glycols

Medicinal herb-induced liver injury reported on the literature ranges from mild elevation of liver enzymes to fulminant liver failure and liver cirrhosis. Medicinal herbs are common ingredients of traditional Chinese herbs. The mechanisms of medicinal herb-induced liver injury are mainly intrinsic hepatotoxicity. In addition to the potential for hepatotoxicity, medicinal herbs frequently induce herb-drug interaction and herb-herb interaction and may affect its own efficacy and safety. Sometimes hepatotoxicity of medicinal herbs originates from the substances of illegal adulterations and contaminations rather than its own indigenous components. Moreover, individual susceptibility to toxic liver injury should be considered in every instance. Two fundamental problems exist in the management of medicinal herbs-induced liver injury. One is a problem on the verification of herbal medicinal prescriptions, because the details of the herbal prescriptions are not usually disclosed to the public in Korea. Another one is a nation-wide prevailed misconception asserting natural products such as medicinal herbs are not harmful.
Asian Continental Ancestry Group ; Biological Products ; Drug-Induced Liver Injury* ; Herb-Drug Interactions ; Humans ; Korea ; Liver ; Liver Cirrhosis ; Liver Failure, Acute ; Plants, Medicinal* ; Prescriptions

Medicinal herb-induced liver injury reported on the literature ranges from mild elevation of liver enzymes to fulminant liver failure and liver cirrhosis. Medicinal herbs are common ingredients of traditional Chinese herbs. The mechanisms of medicinal herb-induced liver injury are mainly intrinsic hepatotoxicity. In addition to the potential for hepatotoxicity, medicinal herbs frequently induce herb-drug interaction and herb-herb interaction and may affect its own efficacy and safety. Sometimes hepatotoxicity of medicinal herbs originates from the substances of illegal adulterations and contaminations rather than its own indigenous components. Moreover, individual susceptibility to toxic liver injury should be considered in every instance. Two big problems exist in the management of medicinal herbs-induced liver injury. Because the release of prescriptions is not obligatory in Korea, it is impossible to identify ingredients in case of medicinal herbsinduced liver injury. Misconception on the safety of medicinal herbs prevails throughout the country.
Asian Continental Ancestry Group ; Drug-Induced Liver Injury* ; Herb-Drug Interactions ; Humans ; Korea ; Liver ; Liver Cirrhosis ; Liver Failure, Acute ; Plants, Medicinal ; Prescriptions

Acetaminophen (AAP) is an antipyretic and analgesic agent, which is sold under many brand names including Tylenol. Although AAP rarely induces hepatotoxicity by an idiosyncratic mechanism, it is one of intrinsic hepatotoxins with a narrow therapeutic window. The overdose of AAP is the single most common cause of acute liver failure in the United States. In Korea, recent increase of working parents adds to the cause of overlooking children's AAP intoxication. Therapeutic dose of AAP is mostly converted to an inactive compound in the liver by conjugation with sulfate and glucuronide, with a small fraction (less than 5%) metabolized via the cytochrome P-450(CYP) system. The CYP enzymes oxidize AAP to produce a highly reactive metabolite: N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified in the liver by conjugation with hepatic glutathione (GSH). In case of AAP overdose a large amount of NAPQI depletes hepatic glutathione. Then the excess NAPQI binds to hepatocellular proteins, initiating cell death. The toxicity of AAP may be enhanced by agents that either increase the production of NAPQI or reduce the supply of GSH. N-acetylcysteine(NAC) replenishes hepatic GSH, thereby detoxifying NAPQI. Early administration of NAC minimizes the hepatotoxicity. In general the survival rate from AAP-induced acute liver failure has been increased with the use of NAC and liver transplantation.
Acetaminophen ; Cell Death ; Cytochromes ; Glutathione ; Humans ; Korea ; Liver ; Liver Failure, Acute* ; Liver Transplantation ; Parents ; Survival Rate ; United States

BACKGROUND: Carbohydrate-deficient transferrin (CDT) levels have rarely been determined in an Asian population. We evaluated the analytical performance of a test for measuring CDT levels by using capillary electrophoresis (EP). METHODS: We determined the precision of CDT measurement by using capillary EP and nephelometry and compared the CDT values obtained using both the methods. We included healthy control subjects, abstinent patients with liver disease, and individuals consuming varying amounts of alcohol. RESULTS: The CDT measurement by using capillary EP were correlated well with those CDT measurement by using nephelometry, N Latex CDT assay, Y=0.5706X+1.581, R=0.930. The results obtained from both methods showed good qualitative agreement with each other (kappa coefficient=0.61). Genetic variants of transferrin isoforms were detected in 4.1% of the tested population. Both the CDT and gamma-glutamyl transpeptidase (GGT) levels in the abstinent patients with liver disease were significantly higher than those in healthy abstinent individuals (0.9% vs. 0.5%, 109.5 mg/dL vs. 28.5 mg/dL, respectively), but the difference in CDT values in the 2 groups was less pronounced for the CDT values. Individuals who had a mean daily alcohol intake of more than 60 g/day showed significantly higher CDT levels than those who had a mean daily alcohol intake of less than 60 g/day (1.9% vs. 0.7%, P=0.03). CONCLUSIONS: The CDT test using capillary EP showed good performance, and this method has several advantages such as automation and detection of variant forms. Thus, CDT can be a more useful marker than GGT for monitoring alcohol abstinence, especially in patients with liver disease.
Adolescent ; Adult ; Aged ; Automation ; Electrophoresis, Capillary/*methods ; Female ; Gene Frequency ; Humans ; Liver Diseases, Alcoholic/diagnosis ; Male ; Middle Aged ; Nephelometry and Turbidimetry/methods ; Protein Isoforms/analysis ; ROC Curve ; Republic of Korea ; Transferrin/*analogs & derivatives/analysis ; gamma-Glutamyltransferase/analysis

BACKGROUND: Insulin assays are affected by varying degrees of interference from anti-insulin antibodies (IAs) and by cross-reactivity with recombinant insulin analogues. We evaluated the usefulness of the E170 insulin assay by assessing IA effects and cross-reactivity with 2 analogues. METHODS: Sera were obtained from 59 type 2 diabetes patients receiving continuous subcutaneous insulin infusion and 18 healthy controls. Insulin levels were determined using an E170 analyzer. To investigate the effects of IAs, we performed IA radioimmunoassays, and analyzed the differences between directly measured insulin (direct insulin) and polyethylene glycol (PEG)-treated insulins (free, IA-unbound; total, IA-bound and unbound insulin). We performed in-vitro cross-reactivity tests with insulin aspart and insulin glulisine. RESULTS: In IA-positive patients, E170 free insulin levels measured using the E170 analyzer were significantly lower than the direct insulin levels. The mean value of the direct/free insulin ratio and IA-bound insulin, which were calculated as the difference between total and free insulin, increased significantly as endogenous IA levels increased. The E170 insulin assay showed low cross-reactivities with both analogues (< 0.7%). CONCLUSIONS: IAs interfered with E170 insulin assay, and the extent of interference correlated with the IA levels, which may be attributable to the increase in IA-bound insulin, and not to an error in the assay. The E170 insulin assay may measure only endogenous insulin since cross-reactivity is low. Our results suggest that the measurement of free insulin after PEG pre-treatment could be useful for beta cell function assessment in diabetic patients undergoing insulin therapy.
Adult ; Aged ; Aged, 80 and over ; Cross Reactions ; Diabetes Mellitus, Type 2/blood/immunology ; Female ; Humans ; Infusions, Subcutaneous ; Insulin/analogs & derivatives/*blood/chemistry/immunology ; Insulin Antibodies/*blood ; Male ; Middle Aged ; Polyethylene Glycols/chemistry ; Radioimmunoassay/instrumentation/*methods ; Recombinant Proteins/analysis/immunology/metabolism

BACKGROUND: Bronchial anthracofibrosis (BAF), which is associated with exposure to biomass smoke in inefficiently ventilated indoor areas, can take the form of obstructive lung disease. Patients with BAF can mimic or present with an exacerbation of chronic obstructive pulmonary disease (COPD). The purpose of the current study was to investigate the prevalence of BAF in Korean patients with COPD exacerbation as well as to examine the clinical features of these patients in order to determine its clinical relevance. METHODS: A total of 206 patients with COPD exacerbation were divided into BAF and non-BAF groups, according to computed tomography findings. We compared both clinical and radiologic variables between the two groups. RESULTS: Patients with BAF (51 [25%]) were older, with a preponderance of nonsmoking women; moreover, they showed a more frequent association with exposure to wood smoke compared to those without BAF. However, no differences in the severity of illness and clinical course between the two groups were observed. Patients in the BAF group had less severe airflow obstruction, but more common and severe pulmonary hypertension signs than those in the non-BAF group. CONCLUSION: Compared with non-BAF COPD, BAF may be associated with milder airflow limitation and more frequent signs of pulmonary hypertension with a more severe grade in patients presenting with COPD exacerbation.
Anthracosis ; Biomass ; Female ; Humans ; Hypertension, Pulmonary ; Lung Diseases, Obstructive ; Prevalence ; Pulmonary Disease, Chronic Obstructive* ; Smoke ; Tomography, Spiral Computed ; Wood

Multicentric Castleman's disease (CD) is a rare atypical lymphoproliferative disorder, which is characterized by various systemic manifestations. Some patients with multicentric CD may have concomitant lung parenchymal lesions, for which lymphoid interstitial pneumonia (LIP) is known to be the most common pathologic finding. Follicular bronchiolitis and LIP are considered to be on the same spectrum of the disease. We describe a case of multicentric CD with pulmonary involvement, which was pathologically proven as follicular bronchiolitis.
Bronchiolitis ; Giant Lymph Node Hyperplasia ; Humans ; Lip ; Lung ; Lung Diseases, Interstitial ; Lymphoproliferative Disorders

Background: Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) is increasingly used for immunosuppressive drug tests. However, most LC-MS/MS tests are laboratory-developed and their agreement is unknown in different Korean laboratories.This interlaboratory comparison study evaluated test reproducibility and identified potential error sources. Methods: Test samples containing three concentrations of tacrolimus, sirolimus, everolimus, cyclosporine, and mycophenolic acid were prepared by pooling surplus samples from patients undergoing routine therapeutic drug monitoring and tested in duplicate in the participating 10 clinical laboratories. Reconstitution and storage experiments were conducted for the commonly used commercial calibrator set. The robust estimators of reproducibility parameters were calculated. Spearman’s rank correlation coefficient (rho, ρ) was used to evaluate the correlation between drugs. Multiple linear regression was used to determine whether the experimental conditions alter the calibration curves. Results: The reproducibility coefficient of variation exceeded 10% only for sirolimus concentrations 1 and 2 (10.8% and 12.5%, respectively) and everolimus concentrations 1 and 2 (12.3% and 11.4%, respectively). The percent difference values showed weak correlations between sirolimus and everolimus (ρ = 0.334, P = 0.175). The everolimus calibration curve slope was significantly altered after reconstitution following prolonged 5°C storage (P = 0.015 for 14 days; P = 0.025 for 28 days); the expected differences at 6 ng/mL were 0.598% for 14 days and 0.384% for 28 days. Conclusions LC-MS/MS test reproducibility for immunosuppressive drugs seems to be good in the Korean clinical laboratories. Continuous efforts are required to achieve test standardization and harmonization, especially for sirolimus and everolimus.