BACKGROUND: The domestic quantity of blood components consumed has been decreasing since 2002, but the rate of a single unit RBC transfusion (SUT) has been on the increase. In the past, a SUT was regarded as an uncesssary procedure, but currently is considered as an effective method to maintain a minimal hemoglobin concentration for physiological needs. We investigated the actual conditions of a SUT. METHODS: We analyzed 800 cases of SUTs performed at a tertiary care university hospital between March 2006 March and February 2007. The subjects of the study were divided into a surgical group (n=561) and medical group (n=239) for the purpose of RBC unit usage and were analyzed by groups and ordering departments, with an analysis of the pre and post-transfusion hemoglobin concentration and hematocrit values. The distribution according to the pre and post-transfusion hemoglobin ranges were calculated. RESULTS: The mean hemoglobin concentration increment of the surgical group was significantly lower than that of the medical group (P<0.0001) and the mean pre and post-transfusion hemoglobin concentrations of the medical group were lower than that of the surgical group (P<0.0001). Approximately 26% cases of the SUTs performed in the surgical group were appropriate, based on a post-transfusion hemoglobin concentration below 10 g/dL. In the medical group, about 75% of the SUTs were appropriate based on a pre-transfusion hemoglobin concentration below 9 g/dL. CONCLUSION: Most transfusions are decided based on various clinical situations and opinions of the clinicians. Therefore, continuous evaluation of the appropriateness of transfusion is necessary. In our study, the appropriateness of a SUT was estimated indirectly based on the pre and post-transfusion hemoglobin concentration. Consequently, policies and strategies for performing asingle unit RBC transfusion are required.
Hematocrit ; Tertiary Healthcare

Jarcho-Levin syndrome (JLS) is a condition manifested by malformations of vertebral bodes and related ribs. There are two major subtypes spondylocostal dysostosis and spondylothoracic dysostosis, with different survival rates, associated malformations, and inheritance patterns. We have experienced an autopsy case of a premature female fetus with multiple congenital anomalies. She was 30 weeks of gestational age, born as the second baby of twins and expired shortly after birth. A post-mortem examination revealed multiple abnormalities including cervicothoracic hemivertebrae, a diminished number of right-sided ribs, and pulmonary hypoplasia with left diaphragmatic hernia. In addition, there were anomalous rotation of the foregut, unfused pancreas and anomalous drainage of the superior vena cava. Chromosomal analysis showed 46, XX, del(4)(q ter).
Abnormalities, Multiple/genetics/*pathology ; Autopsy ; Chromosome Deletion ; Chromosomes, Human, Pair 4 ; Female ; Humans ; Infant, Newborn ; Ribs/*abnormalities ; Spine/*abnormalities ; Syndrome

No abstract available.
Adult ; Aged ; Biopsy ; Colon/*microbiology/pathology ; Fusobacterium/genetics/*isolation & purification ; Humans ; Inflammatory Bowel Diseases/microbiology/*pathology ; Male ; Middle Aged ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/chemistry/genetics/metabolism ; Republic of Korea ; Sequence Analysis, DNA ; Young Adult

BACKGROUND: Periodic monitoring of regional or institutional resistance trends of clinically important anaerobic bacteria is recommended, because the resistance of anaerobic pathogens to antimicrobial drugs and inappropriate therapy are associated with poor clinical outcomes. There has been no multicenter study of clinical anaerobic isolates in Korea. We aimed to determine the antimicrobial resistance patterns of clinically important anaerobes at multiple centers in Korea. METHODS: A total of 268 non-duplicated clinical isolates of anaerobic bacteria were collected from four large medical centers in Korea in 2012. Antimicrobial susceptibility was tested by the agar dilution method according to the CLSI guidelines. The following antimicrobials were tested: piperacillin, piperacillin-tazobactam, cefoxitin, cefotetan, imipenem, meropenem, clindamycin, moxifloxacin, chloramphenicol, metronidazole, and tigecycline. RESULTS: Organisms of the Bacteroides fragilis group were highly susceptible to piperacillin-tazobactam, imipenem, and meropenem, as their resistance rates to these three antimicrobials were lower than 6%. For B. fragilis group isolates and anaerobic gram-positive cocci, the resistance rates to moxifloxacin were 12-25% and 11-13%, respectively. Among B. fragilis group organisms, the resistance rates to tigecycline were 16-17%. Two isolates of Finegoldia magna were non-susceptible to chloramphenicol (minimum inhibitory concentrations of 16-32 mg/L). Resistance patterns were different among the different hospitals. CONCLUSIONS: Piperacillin-tazobactam, cefoxitin, and carbapemems are highly active beta-lactam agents against most of the anaerobes. The resistance rates to moxifloxacin and tigecycline are slightly higher than those in the previous study.
Agar ; Bacteria, Anaerobic* ; Bacteroides fragilis ; Cefotetan ; Cefoxitin ; Chloramphenicol ; Clindamycin ; Gram-Positive Cocci ; Imipenem ; Korea ; Metronidazole ; Piperacillin

BACKGROUND: Acinetobacter spp. is an important nosocomial pathogen for which increasing resistance to multiple antimicrobial agents has been observed. Prevalence of multidrug-resistant (MDR) Acinetobacter spp. in the intensive care unit (ICU) at a teaching hospital in Korea started to increase in 2008. The aim of this study was to determine the source of pathogen spread and to characterize the emerging strains at an early stage of outbreak. METHODS: Samples from respiratory instruments and fomites in the ICUs, as well as from the healthcare workers, were cultured to identify the sources of MDR Acinetobacter spp. Antimicrobial susceptibility was determined by the CLSI disk diffusion method. Pulsed field gel electrophoresis (PFGE) was performed for clinical and environmental isolates in order to determine clonality. Carbapenemase genes were detected by multiplex PCR. Infection control measures including peer-monitoring of hand washing, environmental cleaning and standard precautions were enforced. RESULTS: Among the samples from the ICU tools (105) and healthcare worker's hands (44), 31 (30%) and 2 (5%) respective samples yielded MDR Acinetobacter spp. Among the environmental samples, 90% were from respiratory-related equipment. The majority of clinical and environmental MDR Acinetobacter spp. (44/55) belonged to the pulsotype A. baumannii and carried both bla(OXA-51)-like and bla(OXA-23)-like genes. Even though infection-control measures were enforced, prevalence of MDR Acinetobacter spp. continues to increase. CONCLUSION: An outbreak of MDR Acinetobacter spp. in a Korean hospital was caused by A. baumannii carrying the bla(OXA-23)-gene and was correlated with contaminated respiratory-related instruments in the ICUs. More intensive measures for nosocomial infection control are needed for successful prevention of Acinetobacter spread in hospitals.
Acinetobacter* ; Anti-Infective Agents ; Cross Infection ; Delivery of Health Care ; Diffusion ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Fomites ; Hand ; Hand Disinfection ; Hospitals, Teaching* ; Infection Control ; Intensive Care Units* ; Korea ; Multiplex Polymerase Chain Reaction ; Prevalence

A 60-year-old man presented with a 1-day history of fever, vomiting, and diarrhea. He was diagnosed with severe septic shock on the basis of a body temperature of 38.9degrees C, heart rate of 92/min, respiratory rate of 25/min, WBC count of 22,970/microL, C-reactive protein (CRP) level of 136 mg/L, blood urea nitrogen (BUN) of 34.0 mg/dL, and creatinine of 2.98 mg/dL. On blood culture, Gram-positive cocci were detected in all 6 bottles. Small grayish non-hemolytic colonies were found on blood agar plates after incubation at 37degrees C for 2 days. The isolates were negative for catalase and L-pyrrolidonyl-beta-naphthylamide hydrolysis, and positive for bile-esculin and leucine aminopeptidase activity. The strain was identified as Streptococcus gallolyticus subsp. pasteurianus using Vitek 2 GP II systems. We performed 16S rRNA gene sequencing and detected 100% identity with S. gallolyticus subsp. pasteurianus strain CIP 107122T (1,345/1,345-bp). The patient recovered after receiving ampicillin-sulbactam. This is the first report of phenotypic and genetic identification of S. gallolyticus subsp. pasteurianus causing severe septic shock in a Korean patient.
Agar ; Ampicillin ; Blood Urea Nitrogen ; Body Temperature ; C-Reactive Protein ; Catalase ; Creatinine ; Diarrhea ; Fever ; Genes, rRNA ; Gram-Positive Cocci ; Heart Rate ; Humans ; Hydrolysis ; Leucyl Aminopeptidase ; Middle Aged ; Pyrrolidinones ; Respiratory Rate ; Shock, Septic ; Sprains and Strains ; Streptococcus ; Sulbactam ; Vomiting

PURPOSE: Breast Cancer is an inter-tumoral and intra-tumoral heterogeneous disease. It remains unclear whether this heterogeneity results from different target cells or from different subsets of genetic abnormalities, otherwise from both. We postulated that in addition to genetic cloning, a variety of cells that exist during the defined developmental stages of the human mammary gland could give rise to the heterogeneity of breast cancer. To verify this postulation, we have analyzed pure ductal carcinoma in situ (DCIS) for the expression of the biomarkers that represent the mammary stem cell, the early progenitor cells, and the glandular and myoepithelial cells of the mammary gland. METHODS: We investigated the relationship between the immnuohistochemical expression of the mammary development-associated biomarkers {cytokeratin-18 (CK18), cytokeratin-6 (CK6), alpha-smooth muscle actin (SMA), Wnt-1, Notch 3} and some other factors {the menopausal status, the estrogen receptor (ER) status, the progesterone receptor (PR) status, c-erbB-2, and the number of tumor foci} in 26 cases of DCIS. RESULTS: All 26 cases included in this study showed the positive expressions of CK18 and SMA. The expression of all the markers was not correlated with the menopausal status. The positive expression of CK6 had a statistically significant relationship with a negative estrogen receptor (p=0.014), positive c-erbB-2 (p=0.048), high nuclear grade (p=0.001), and single focus of DCIS (p=0.017). The expression of Wnt-1 and Notch 3 did not have significant correlation with any factors. However, the positive expression of Wnt-1 showed a tendency of a negative ER (p=0.061) and the positive expression of Notch 3 also showed a tendency of a negative ER (p=0.086) and a high nuclear grade (p=0.086). CONCLUSION: The CK6 positive tumor is thought to originate from the more primitive cells compared to the CK6 negative tumor. Unifocality of the CK positive tumor might result from the arrest of differentiation of the original cell after disease affection. DCISs could be categorized into the CK6 positive and negative groups.
Actins ; Biomarkers ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Clone Cells ; Cloning, Organism ; Estrogens ; Keratin-6 ; Mammary Glands, Human* ; Population Characteristics ; Receptors, Progesterone ; Stem Cells*

Metastatic cancers of the stomach are rare. Metastatic diseases of the stomach can occur with melanoma and other primary tumors of the breast, lung, ovary, liver, colon, and testis; however, breast cancer is the most common. Other rare malignant tumors that can involve the stomach include Kaposi's sarcoma, myenteric schwannoma, glomus tumor, small cell carcinoma, and parietal cell carcinoma. On the other hand, solitary fibrous tumors of the pleura are rare soft tissue sarcomas, and most are benign; however, 13 to 36% may be malignant. Metastases may occur in extrathoracic sites, such as the liver, central nervous system, spleen, adrenal gland, and bone. We herein report a case of a 75-year-old man with previously diagnosed brain and liver metastases. He developed a stomach metastasis from a malignant solitary fibrous tumor and presented with gastrointestinal bleeding symptoms.
Adrenal Glands ; Aged ; Brain ; Breast ; Breast Neoplasms ; Carcinoma, Small Cell ; Central Nervous System ; Colon ; Endoscopy ; Female ; Gastrointestinal Hemorrhage ; Glomus Tumor ; Hand ; Hemorrhage ; Humans ; Liver ; Lung ; Melanoma ; Neoplasm Metastasis ; Neurilemmoma ; Ovary ; Pleura ; Sarcoma ; Sarcoma, Kaposi ; Solitary Fibrous Tumors ; Spleen ; Stomach

Pancreatic cancer is a notorious disease with a poor prognosis and low survival rates, which is due to limited advances in understanding of the molecular mechanism and inadequate development of effective treatment options over the decades. In previous studies, we demonstrated that a novel soluble protein named pancreatic adenocarcinoma up-regulated factor (PAUF) acts on tumor and immune cells and plays an important role in metastasis and progression of pancreatic cancer. Here we show that PAUF promotes adhesiveness of pancreatic cancer cells to various extracellular matrix (ECM). Our results further support a positive correlation of activation and expression of focal adhesion kinase (FAK), a key player in tumor cell metastasis and survival, with PAUF expression. PAUF-mediated adhesiveness was significantly attenuated upon blockade of the FAK pathway. Moreover, PAUF appeared to enhance resistance of pancreatic cancer cells to anoikis via modulation of FAK. Our results suggest that PAUF-mediated FAK activation plays an important role in pancreatic cancer progression.
Anoikis/genetics ; Cell Line, Tumor ; Focal Adhesion Protein-Tyrosine Kinases/*metabolism ; Focal Adhesions/genetics/*metabolism ; Humans ; Lectins/genetics/*metabolism ; Pancreatic Neoplasms/enzymology/genetics/*metabolism ; Proto-Oncogene Proteins pp60(c-src)/metabolism ; Signal Transduction/genetics