No abstract available.
Acupuncture ; Sarcoidosis

No abstract available.
Lymphoma*

Background: Delta checks increase patient safety by identifying automated hematology analyzer errors. International standards and guidelines for the complete blood count (CBC) delta check method have not been established. We established an effective, practical CBC delta check method and criteria. Methods: We assessed five delta check methods for nine CBC items (Hb, mean corpuscular volume, platelet count, white blood cell [WBC] count, and five-part WBC differential counts) using 219,804 blood samples from outpatients and inpatients collected over nine months. We adopted the best method and criteria and evaluated them using 42,652 CBC samples collected over two weeks with a new workflow algorithm for identifying test errors and corrections for Hb and platelet count. Results: The median delta check time interval was 1 and 21 days for inpatients and outpatients (range, 1–20 and 1–222 days), respectively. We used delta values at 99.5% as delta check criteria; the criteria varied among the five methods and between outpatients and inpatients. The delta percent change (DPC)/reference range (RR) rate performed best as the delta check for CBC items. Using the new DPC/RR rate method, 1.7% of total test results exceeded the delta check criteria; the retesting and resampling rates were 0.5% and 0.001%, respectively. Conclusions We developed an effective, practical delta check method, including RRs and delta check time intervals, and delta check criteria for nine CBC items. The criteria differ between outpatients and inpatients. Using the new workflow algorithm, we can identify the causes of criterion exceedance and report correct test results.

BACKGROUND: We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. METHODS: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. RESULTS: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). CONCLUSIONS: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.
Catheterization ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Emergency Service, Hospital ; Heart Atria ; Humans ; Incidence ; Jugular Veins* ; Radiography ; Random Allocation ; Subclavian Vein ; Thorax ; Vena Cava, Superior

Livedo vasculitis is a chronic dermatosis characterized by recurrent painful ulceration of the lower limbs, which heals to leave atrophie blanche. The precise pathophysiology is not known. Antiplatelet, anticoagulant, fibrinolytic therapies and anabolic steroids have been reported to be helpful in this syndrome. However, no consistent benefit has been demonstrated with any treatment modality. Recently, pulsed intravenous immunoglobulin therapy has been reported to be effective in some refractory cases. We herein report two cases of recalcitrant livedo vasculitis which were effectively treated with pulsed intravenous immunoglobulin therapy. These were the first trials carried out in Korea.
Immunization, Passive* ; Immunoglobulins* ; Korea ; Lower Extremity ; Skin Diseases ; Steroids ; Thrombolytic Therapy ; Ulcer ; Vasculitis*

BACKGROUND: Early T-lymphocyte activation-1 (Eta-1) is a secreted phosphoprotein which regulates a variety of cells involved in the immune and nonimmune systems. It is unique in the sense that it regulates various immune functions, as well as acting as an extracellular matrix protein. The Eta-1 gene has been mapped to the same genetic locus as the Rickettsia resistance gene (Ric), and Eta-1 expression is a part of an early T-dependent response to Orientia tsutsugamushi infection in susceptible hosts. In an initial effort to study Eta-1's mechanism of protection against Orientia tsutsugamushi infection, we attempted to produce Eta-1 in E. coli and to produce monoclonal antibodies against recombinant Eta-1. METHODS: Expression plasmids containing GST-Eta-1 were generated by cloning the polymerase chain reaction-amplified N-and C-terminal Eta-1 fragments into the cloning sites of pGEX-3X. The expressed protein was purified using a GST column and injected into BALB/c mice. Hybridoma clones reactive to Eta-1 were produced and analyzed with ELISA and Western blot. RESULTS: Expression plasmids containing GST-Eta-1 were generated by cloning the polymerase chain reaction-amplified N-and C-terminal Eta-1 fragments into the cloning sites of pGEX-3X. N-and C-terminal fragments of Eta-1 were generated as bacterially expressed GST fusion proteins. However, the expression of full-length Eta-1 was very poor. We immunized BALB/c mice with purified Eta-1 N-terminal fragments. Their spleen cells were used for cell fusion. We obtained two hybridoma cell lines secreting antibodies against Eta-1, but not against GST. Conclusions:We produced Eta-1 protein produced in E. coli. The expression of C-terminal Eta-1 fragments was poor, therefore it appeared that this part of Eta-1 was toxic to E. coli. We obtained monoclonal antibodies which were reactive in ELISA test and Western blot. These monoclonal antibodies could be useful in the analysis of the function of Eta-1 in the pathogenesis of tsutsugamushi disease as well as other diseases.
Animals ; Antibodies ; Antibodies, Monoclonal ; Blotting, Western ; Cell Fusion ; Cell Line ; Clone Cells ; Cloning, Organism ; Enzyme-Linked Immunosorbent Assay ; Escherichia coli* ; Escherichia* ; Extracellular Matrix ; Genetic Loci ; Hybridomas ; Mice ; Orientia tsutsugamushi ; Osteopontin ; Plasmids ; Rickettsia ; Scrub Typhus ; Spleen ; T-Lymphocytes

PURPOSE: In hemodynamically unstable patients, tissue perfusion is decreased and various means of continuous observation are required. However, prior methods for observing hemodynamic instability are invasive and/or difficult for continual observation. The present study evaluated the usefulness of the perfusion index (PI) in monitoring hemodynamically unstable patients in the emergency department. METHODS: From December, 2009 to April, 2010, patients admitted to our hospital emergency department with signs of hemodynamic instability were studied. Vital signs and stroke volume index (SVI) and cardiac index (CI) were measured, and PI was continuously monitored by a Radical-7 pulse oximeter (Masimo, USA). Each variable was measured 1 hour before and after treatment, and treatment methods included fluid therapy and vasoconstrictors, according to the patient condition. Status on changes and correlation between variables following treatment were confirmed through the Wilcoxon rank test and Spearman correlation test, respectively. The standard level of significance was p<0.05. RESULTS: Of the 26 patients, 19 were male (73.1%), with an average age of 68.54+/-14.32 years. Significant changes in each variable 1 hour before and after treatment were mean arterial pressure 53.51+/-8.29mmHg / 74.68+/-12.95 mmHg (p<0.001), SVI 26.70+/-14.04/34.27+/-13.56(p<0.001), CI 2.12+/-1.02/3.12+/-1.53(p<0.001), and PI 1.23+/-1.00/1.77+/-1.32(p<0.001). Variations of heart rate (R=-0.430, p=0.032) and SVI (R=0.432, p=0.031) were correlated to the variation of PI (dPI). CONCLUSION: PI may be useful in monitoring hemodynamically unstable patients in the ER.
Arterial Pressure ; Cardiac Output ; Emergencies ; Fluid Therapy ; Heart Rate ; Hemodynamics ; Humans ; Male ; Oximetry ; Perfusion ; Stroke Volume ; Vasoconstrictor Agents ; Vital Signs

PURPOSE: In hemodynamically unstable patients, tissue perfusion is decreased and various means of continuous observation are required. However, prior methods for observing hemodynamic instability are invasive and/or difficult for continual observation. The present study evaluated the usefulness of the perfusion index (PI) in monitoring hemodynamically unstable patients in the emergency department. METHODS: From December, 2009 to April, 2010, patients admitted to our hospital emergency department with signs of hemodynamic instability were studied. Vital signs and stroke volume index (SVI) and cardiac index (CI) were measured, and PI was continuously monitored by a Radical-7 pulse oximeter (Masimo, USA). Each variable was measured 1 hour before and after treatment, and treatment methods included fluid therapy and vasoconstrictors, according to the patient condition. Status on changes and correlation between variables following treatment were confirmed through the Wilcoxon rank test and Spearman correlation test, respectively. The standard level of significance was p<0.05. RESULTS: Of the 26 patients, 19 were male (73.1%), with an average age of 68.54+/-14.32 years. Significant changes in each variable 1 hour before and after treatment were mean arterial pressure 53.51+/-8.29mmHg / 74.68+/-12.95 mmHg (p<0.001), SVI 26.70+/-14.04/34.27+/-13.56(p<0.001), CI 2.12+/-1.02/3.12+/-1.53(p<0.001), and PI 1.23+/-1.00/1.77+/-1.32(p<0.001). Variations of heart rate (R=-0.430, p=0.032) and SVI (R=0.432, p=0.031) were correlated to the variation of PI (dPI). CONCLUSION: PI may be useful in monitoring hemodynamically unstable patients in the ER.
Arterial Pressure ; Cardiac Output ; Emergencies ; Fluid Therapy ; Heart Rate ; Hemodynamics ; Humans ; Male ; Oximetry ; Perfusion ; Stroke Volume ; Vasoconstrictor Agents ; Vital Signs

OBJECTIVE: The purpose of this study was to study the clinical efficacy of Levonorgestrel-releasing intrauterine system (Mirena(R)) for patients who have abnormal uterine bleeding before menopause or sustaining vaginal spotting during postmenopaual hormone replacement therapy. METHODS: Between June, 2001 and June, 2003, forty six premenopausal women with abnormal uterine bleeding such as menorrhagia and intermenstrual bleeding who did not prefer surgical treatment (Group 1) and twenty four postmenopausal patients with vaginal spotting (Group 2) were included in this study. The various parameters such as uterine bleeding, dysmenorrhea, volume changes of myoma or adenomyosis, and endometrial thickness were evaluated by transvaginal ultrasound examination before and after Levonorgestrel- releasing intrauterine system usage. RESULTS: A significant reduction in abnormal bleeding (26.3 vs 11.0) (p<0.0001) and dysmenorrhea (11.6 vs 6.1) (p<0.0001) were noticed. However, there was no significant change in volume of uterine myoma (40.0 vs 11.3) (p=0.282) and adenomyosis (103.0 vs 95.83) (p=0.266) before and after Mirena(R) insertion in Group 1. Vaginal spotting during hormone replacement therapy disappeared completely in 18/24. Also there was a significant reduction in endometrial thickness (6.3 vs 4.9) (p<0.0001) after Mirena(R) insertion in both group 1 and group 2. CONCLUSION: Levonorgestrel-releasing intrauterine system insertion was acceptable and convenient therapeutic modality for abnormal uterine bleeding of premenopausal abnormal uterine bleeding and vaginal spotting during the postmenopausal hormone replacement therapy.
Adenomyosis ; Dysmenorrhea ; Estrogen Replacement Therapy ; Female ; Hemorrhage ; Hormone Replacement Therapy ; Humans ; Leiomyoma ; Menopause ; Menorrhagia ; Metrorrhagia ; Myoma ; Ultrasonography ; Uterine Hemorrhage*

BACKGROUND: Alzheimer's disease (AD) and Parkinson's disease associated with dementia (PDD) are considered to be frequent types of cortical and subcortical dementia. Definitive diagnosis of neurodegenerative diseases is impossible without biopsy. Single photon emission computed tomography (SPECT) of the brain has long been used for years with cognitive disorders. Nevertheless, differential brain perfusion of patients with PDD and AD who exhibit mild dementia has not been reported. Therefore, we investigated the differences in the cerebral perfusional pattern using perfusion SPECT between mild AD and mild PDD to help clarify the diagnosis in the early stage of these dementias, since accurate diagnosis is crucial in decision regarding treatment, appropriate advice, management and prognosis. METHODS: Thirty-one patients with mild PDD and 32 patients with mild probable AD were enrolled in this study. All subjects underwent 99mTc-hexamethyl propylene amine oxime perfusion SPECT and general neuropsychological tests, and these data including perfusion images were analyzed. RESULTS: Perfusion SPECT showed hypoperfusion in frontal, parietal and temporal regions in both PDD and AD patients with mild dementia. Hypoperfusion in the occipital and cerebellar regions was significantly apparent in only PDD patients. CONCLUSION: Comparison of mild PDD with mild AD showed a significantly decreased perfusion in the occipital and cerebellar region in patients with mild PDD. Cerebral perfusion in the occipital region and the cerebellum could be a crucial differential diagnostic method of these diseases in the early phase. Further studies are needed for a definitive conclusion.
Alkenes ; Alzheimer Disease ; Biopsy ; Brain ; Cerebellum ; Dementia ; Humans ; Neurodegenerative Diseases ; Neuropsychological Tests ; Parkinson Disease ; Perfusion ; Tomography, Emission-Computed, Single-Photon