The blood bank of the Seoul National University Hospital has joined the U.K. National External Quality Assessment Scheme(NEQAS) for Blood Group Serology since 1992. We reported correct answers on all occasions for thirty-six samples tested for ABO, RhD typing, and direct antiglobulin test. Among 36 antibody screening and antibody,,identification tests, we missed one anti-S. Among 96 crossmatchings, we made 4 major errors and one minor error. It was interesting that all of the major errors we made were from the sample delivered in mid-summer. Since the items included in the domestic program for the external quality control of blood group serology are very limited in Korea, joining any international quality control program will be necessary for larger blood banks to assure quality of varirous blood bank tests being performed.
Blood Banks ; Coombs Test ; Korea ; Mass Screening ; Quality Control ; Seoul

We report a case of infective endocarditis after flexible sigmoidoscopy. In addition to persistent bacteremia with methicillin-resistant Staphylococcus aureus (MRSA), we found an oscillating intracardiac mass on the tricuspid valve in this patient. The patient had no underlying heart disease or risk factor for the infection due to MRSA. Vancomycin treatment for 42 days was adequate for this case. The pathogen might colonize the patient's rectum and then invade through intestinal mucosa during the endoscopic procedure.
Bacteremia ; Colon ; Endocarditis* ; Heart Diseases ; Humans ; Intestinal Mucosa ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Rectum ; Risk Factors ; Sigmoidoscopy* ; Tricuspid Valve ; Vancomycin

The purpose of this study is to report our 5-year experience with fluoroscopic removal of blunt esophageal foreign body or impacted food in 15 consecutive patients who were referred by endoscopists because they couldn's remove it endoscopically. The foreign body or impacted food was a pieced of meat, a bean, a badug stone or a beef bone. Thirteen patients had underlying disease(11 of corrosive stricture, 2 of postoperative stricture) but 2 patients did not. We removed the object using one of the following 4 techniques: Basket extraction technique, Foley catheter technique, single balloon technique (dilatation of stenosis for passing the food into the stomach and for the treatment of the stricture as well), double balloon technique(removal of the foreign body by trapping it with two valvuloplasty balloons). Removal was successful in all patients. Esophageal perforation occurred in one patient using the single balloon technique, who treated nonoperatively by means of fasting, antibiotics and parenteral alimentation. No procedure related death occurred in these series. In conclusion, fluoroscopic removal of blunt esophageal foreign bodies of impacted food with various techniques is promising alternative to esophagoscopic removal.
Anti-Bacterial Agents ; Catheters ; Constriction, Pathologic ; Esophageal Perforation ; Fasting ; Foreign Bodies* ; Humans ; Meat ; Red Meat ; Stomach

PURPOSE: This study aimed to find any difference in the clinical or the anatomical findings of vertebral artery dissection (VAD) between the trauma and the non-trauma groups. METHODS: We retrospectively reviewed the clinical data and radiologic images of VAD patients. We compared data on symptoms, neurologic deficit, National institutes of health stroke scale (NIHSS) at admission, Rankin score (RS) at admission and discharge, and radiological findings including anatomical features, between the trauma and the non-trauma groups. RESULTS: From January 1997 to May 2006, 42 patients were enrolled and 13 patients (31%) had a history of earlier trauma. Focal neurologic deficit (trauma group 11/13 vs. non-trauma group 11/29), cerebral stroke (10/13 vs. 9/29), and extradural lesions of dissection (6/13 vs. 3/28) were more common in the trauma group than non-trauma group (p=0.007, p=0.017, p=0.018, respectively) and NIHSS at admission and discharge were significantly higher (p=0.012, p=0.001, respectively). Dissecting aneurysms were less frequent in the trauma group (2/13 vs. 19/29, p=0.006). Subarachnoid hemorrhage and unfavorable prognostic value (Rankin score at discharge> or =2) showed no differences between the groups (p=0.540, p=0.267, respectively). CONCLUSION: In VAD patients after trauma, focal neurologic deficit due to ischemic stroke and a steno-occlusive pattern are more frequent than they are in non-trauma patients. The location of dissection was most frequent at the extradural vertebral artery in the trauma group. NIHSS was higher in the trauma groups but the incidence of an unfavorable prognostic value (RS> or =2) was not significantly different between the groups.
Aneurysm, Dissecting ; Humans ; Incidence ; National Institutes of Health (U.S.) ; Neurologic Manifestations ; Retrospective Studies ; Stroke ; Subarachnoid Hemorrhage ; Vertebral Artery Dissection* ; Vertebral Artery*

BACKGROUND: Since the introduction of anti-Rh immunoglobulin prophylaxis, the incidence of hemolytic disease of the newborn (HDN) due to anti-D has remarkably decreased while the number of HDN due to ABO antibodies or minor blood group antibodies remains same. In Caucasians, anti-c, anti-E and anti-K are antibodies most frequently implicated in HDN. But in Koreans, antigenic frequency of Rh or Kell blood group is very different from Caucasians, so it is expected that the frequency of antibodies causing HDN would also be very different. Because there has been no representative data on minor blood group antibodies causing HDN in Korea, we analyzed 79 antibodies associated with HDN. METHODS: From January 1989 to July 1998, we determined the antibody specificity causing HDN in 79 cases. The nature and in vitro characteristics of the antibodies were analyzed. RESULTS: Among 79 cases, ABO antibodies were responsible in 20 cases, and anti-D was responsible in 7 cases. In minor blood group incompatibility, anti-E+c (21 cases) and anti-E (18 cases) antibodies were the antibodies most commonly involved. In ABO incompatibility, Direct Coombs' test (DAT) on baby RBC was positive only in 65% (13/20 cases). In 13 cases, ABO antibodies were detected only in the eluate of baby RBC. In non-ABO incompatibility, 96.6% (57/59 cases) showed positive DAT. In cases associated with anti-E+c and anti-E, Rh subtypes of 20 mothers were all CCDee except one, and Rh subtypes of 12 babies were all CcDEe except one. CONCLUSION: In ABO-HDN, negative DAT was frequently found and the test on baby RBC eluate was an essential part for diagnosis. Among non-ABO incompatibility, Rh incompatibilities, including RhD, were responsible in 94.9% (56/59 cases). Among HDN due to minor blood group antibodies, in contrast to previous reports, we found that anti-E+c was the most common antibody involved in HDN.
Antibodies* ; Antibody Specificity ; Blood Group Incompatibility ; Coombs Test ; Diagnosis ; Humans ; Immunoglobulins ; Incidence ; Infant, Newborn* ; Korea ; Mothers

OBJECTIVES: The purpose of this study was to compare lymph node (LN) staging using ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) with contrast-enhancement (CE) PET/CT and contrast-enhanced neck CT (neck CT) in patients with thyroid cancer with level-by-level comparison with various factors. METHODS: This was a retrospective multicenter study. A total of 85 patients were enrolled. Patients who underwent a preoperative evaluation by CE PET/CT and neck CT for thyroid cancer were enrolled. The gold standard for LN was the combination of surgical pathology and clinical follow-up. We compared CE PET/CT with neck CT using a level-by-level method. Factors, including age, sex, camera, arm position, tumor size, extra-thyroidal extension, tumor location, number of primary tumors, primary tumor maximum standardized uptake value, and the interval from scan to operation were also analyzed. RESULTS: Overall accuracy was 81.2% for CE PET/CT and 68.2% for neck CT. CE PET/CT was more sensitive than neck CT (65.8% vs. 44.7%). Also, CE PET/CT showed higher negative predictive value (77.2% vs. 66.1%). CE PET/CT showed good agreement with the gold standard (weighted kappa [κ], 0.7) for differentiating N0, N1a, and N1b, whereas neck CT showed moderate agreement (weighted κ, 0.5). CE PET/CT showed better agreement for the number of levels involved with the gold standard (weighted κ, 0.7) than that of neck CT with the gold standard (weighted κ, 0.5). The accuracies for differentiating N0, N1a, and N1b were 81.2% for CE PET/CT and 68.2% for neck CT. Level-by-level analysis showed that CE PET/CT was more sensitive and has higher negative predictive value for detecting ipsilateral level IV and level VI LNs than neck CT. Other analyzed factors were not related to accuracies of both modalities. CONCLUSION: CE PET/CT was more sensitive and reliable than neck CT for preoperative LN staging in patients with thyroid cancer.
Arm ; Electrons ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Methods ; Neck* ; Pathology, Surgical ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: The ultrasonography (USG) and computed tomography (CT) are popular diagnostic tools for the diagnosis of acute appendicitis in children, but there are many debates about their clinical significance. The purpose of this study is to clarify the clinical significance of USG, CT and follow-up CT performed subsequently to USG, especially in perforated acute appendicitis in children. METHODS: We have reviewed 419 cases of surgically confirmed acute appendicitis in children under the age of sixteen, who had been treated in Inje University Ilsan Paik Hospital from March 2002 to February 2006. All the clinical data including the results of USG and CT were collected and analyzed. RESULTS: Sensitivity, specificity, positive and negative predictive values of USG were 98.7%, 96.8%, 98.1%, 97.8% in non-perforation group and 90.8%, 100%, 100%, 81.9% in perforation group. Those of CT were 96.4%, 100%, 100%, 96.5% and 86.6%, 100%, 100%, 87.5% respectively. Those of follow-up CT after USG were 100%, 100%, 100%, 100% and 87.5%, 100%, 100%, 92.0% respectively. The duration of using antibiotics in seven patients showed positive correlation with the interval between two imaging studies (r=0.0472, p=0.019). There was no statistical significance of correlation when these imaging studies performed within 30 hours together. CONCLUSION: In most of the cases, single choice between USG and CT would be enough to diagnose the acute appendicitis in children. But, it may be helpful to perform CT as early as possible subsequently to USG when there is discrepancy between initial USG and clinical impression.
Anti-Bacterial Agents ; Appendicitis* ; Child* ; Diagnosis ; Follow-Up Studies* ; Humans ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND: Multiple-locus variable-number tandem-repeat fingerprinting (MLVF) is based on multiplex PCR, utilizing variable number tandem repeat. Our goal was to compare the performance of MLVF in distinguishing clinical Staphylococcus aureus isolates with that of pulsed-field gel electrophoresis (PFGE), which has traditionally been the gold standard. METHODS: Sixty-three clinically significant S. aureus isolates were tested using both PFGE and MLVF. Multiplex PCR for MLVF was performed using PCR primers for clfA, clfB, sdrCDE, sspA, and spa. PFGE was performed with genomic DNA fragments generated by SmaI endonuclease digestion. Banding patterns of MLVF or PFGE were analyzed using InfoQuestFP software. RESULTS: The hands-on time of our modified method was about 3 h, on average, for each of 18 isolates. PFGE (80% cutoff) or MLVF (75% cutoff) separated all of the 63 isolates into 13 and 12 types, respectively. Three types generated by PFGE were identical to those generated by MLVF. PFGE and MLVF yielded similar Simpson's diversity indices, indicating similar discriminatory power. The overall concordance between PFGE and MLVF was low, as represented by adjusted Rand indices (0.266-0.278). PFGE predicted MLVF type better than MLVF predicted PFGE type, as reflected by Wallace coefficients (PFGE cutoff 80% vs. MLVF cutoff 75%, 0.389 vs. 0.233). Analysis of the relationship between a pair of isolates showed 91.0% concordance between the PFGE (80% cutoff) and MLVF (75% cutoff). CONCLUSIONS: Our simple, low-cost, modified MLVF protocol can effectively discriminate between S. aureus clinical isolates. MLVF can replace PFGE for the hospital infection control of S. aureus.
Bacterial Typing Techniques/*methods ; *DNA Fingerprinting ; DNA, Bacterial/analysis ; *Electrophoresis, Gel, Pulsed-Field ; Genotype ; Humans ; Methicillin-Resistant Staphylococcus aureus/classification/genetics/isolation & purification ; Multiplex Polymerase Chain Reaction ; Staphylococcal Infections/*microbiology ; Staphylococcus aureus/*classification/*genetics/isolation & purification

Heparin-induced thrombocytopenia (HIT) is an immunologically mediated complication of heparin therapy resulting in the consumption of platelets and a catastrophic thromboembolism. Both the clinical and laboratory features are important for a diagnosis of HIT. There have been 3 case reports of suspected HIT in Korea. However none have satisfied the laboratory features. We experienced a case of HIT, which satisfied both clinical and laboratory features, in a patient who received heparin during continuous veno-venous hemodiafiltration (CVVHD) used to treat acute renal failure that developed after a total aortic arch replacement with a cardiopulmonary bypass. The decreased platelet count and obstruction of extracorporeal filter of CVVHD by the blood clot was observed while receiving unfractionated heparin. The serum from the patient contained the anti heparin-platelet factor 4 antibody, and the condition was thus diagnosed as HIT. Argatroban, which is a direct thrombin inhibitor, was used to treat the thrombosis.
Acute Kidney Injury ; Aorta, Thoracic* ; Cardiopulmonary Bypass ; Diagnosis ; Hemodiafiltration* ; Heparin ; Humans ; Korea ; Platelet Count ; Thrombin ; Thrombocytopenia* ; Thromboembolism ; Thrombosis

OBJECTIVE: Smoking related cues may elicit smoking urges and psychophysiological responses in subjects with nicotine dependence. This study aimed to investigate the effect of repeated virtual cue exposure therapy using the surround-screen based projection wall system on the psychophysiological responses in nicotine dependence. METHODS: The authors developed 3-dimensional neutral and smoking-related environments using virtual reality (VR) technology. Smoking-related environment was a virtual bar, which comprised both object-related and social situation cues. Ten subjects with nicotine dependence participated in 4-week (one session per week) virtual cue exposure therapy. Psychophysiological responses [electromyography (EMG), skin conductance (SC), and heart rate] and subjective nicotine craving were acquired during each session. RESULTS: VR nicotine cue elicited greater psychophysiological responses and subjective craving for smoking than did neutral cue, and exposure to social situation cues showed greater psychophysiological responses in SC and EMG than did object-related cues. This responsiveness decreased during the course of repeated therapy. CONCLUSION: The present study found that both psychophysiological responses and subjective nicotine craving were greater to nicotine cue exposure via projection wall VR system than to neutral cues and that enhanced cue reactivity decreased gradually over the course of repeated exposure therapy. These results suggest that VR cue exposure therapy combined with psychophysiological response monitoring may be an alternative treatment modality for smoking cessation, although the current findings are preliminary.
Cues ; Heart ; Implosive Therapy ; Nicotine ; Skin ; Smoke ; Smoking ; Smoking Cessation ; Tobacco Use Disorder