We describe the occurrence of acute type A aortic dissection in a patient with situs inversus totalis. A 37-year-old man presented to the emergency department with acute chest pain. Initial chest X-ray findings showed a right-sided heart and a left-sided liver. Contrast-enhanced computed tomography revealed a Stanford type A acute aortic dissection, aortic root dilatation, and situs inversus totalis. All of the thoracic structures were mirror-image reversed and an abnormal coronary artery was observed. The Bentall operation was performed. This report demonstrates that computed tomography and echocardiography were useful for understanding the anatomy and the presence or absence of concurrent anomalies in a patient with situs inversus totalis. The patient’s postoperative course was uneventful.

BACKGROUND: It is known that the blood collection tube used can cause fluctuations in laboratory test results. We compared test results obtained when blood was collected in V-tube (AB Medical, Korea), BD Vacutainer Tubes (BD, USA), and Greiner Vacuette Tubes (Greiner, USA) in clinical chemistry and thyroid hormone assays. METHODS: One hundred volunteers from three hospitals were recruited and the peripheral blood samples were collected in each of the three serum separation tubes (SSTs). These samples were used for 28 routine clinical chemistry assays and three thyroid hormone assays. The results were analyzed by the Student paired t-test and the Bland-Altman plot. For stability tests, the initial results were compared with the day 1 (24±2 hours), day 3 (72±2 hours), and day 7 (168±2 hours) results, respectively. RESULTS: The difference in the test results obtained from the samples in each tube (V-Tube vs. BD-Tube, V-Tube vs. Greiner-Tube, and BD-Tube vs. Greiner-Tube) were satisfied with the Clinical Laboratory Improvement Amendments of 1988 allowable difference ranges. Except for four analytes (low-density lipoprotein cholesterol, magnesium, potassium, and thyroid-stimulating hormone), all analytes were within the allowable critical difference range based on biological variability. The paired t-test revealed significant differences between the results of nine assays for samples in V-Tube vs. BD-Tube and seven assays for samples in V-Tube vs. Greiner-Tube, but each set of results showed good correlations. The test results on different days showed a significant difference in several assays, but they were within the allowable difference range. CONCLUSIONS: The assay results for blood samples collected in SST V-Tubes were comparable to those obtained when blood was collected in BD Tubes and Greiner Tubes, and the blood collected in V-Tubes also showed excellent results in the stability tests.
Chemistry ; Chemistry, Clinical* ; Cholesterol ; Humans ; Lipoproteins ; Magnesium ; Potassium ; Thyroid Gland* ; Vacuum* ; Volunteers

PURPOSE: The purpose of this study was to propose finite element (FE) modeling methods for predicting stress distributions on teeth and mandible under chewing action. MATERIALS AND METHODS: For FE model generation, CT images of skull were translated into 3D FE models, and static analysis was performed considering linear material behaviors and nonlinear geometrical effect. To find out proper boundary and loading conditions, parametric studies were performed with various areas and directions of restraints and loading. The loading directions are prescribed to be same as direction of masseter muscle, which was referred from anatomy chart and CT image. From the analysis, strain and stress distributions of teeth and mandible were obtained and compared with experimental data for model validation. RESULTS: As a result of FE analysis, the optimized boundary condition was chosen such that 8 teeth were fixed in all directions and condyloid process was fixed in all directions except for forward and backward directions. Also, fixing a part of mandible in a lateral direction, where medial pterygoid muscle was attached, gave the more proper analytical results. Loading was prescribed in a same direction as masseter muscle. The tendency of strain distributions between the teeth predicted from the proposed model were compared with experimental results and showed good agreements. CONCLUSION: This study proposes cost efficient FE modeling method for predicting stress distributions on teeth and mandible under chewing action. The proposed modeling method is validated with experimental data and can further be used to evaluate structural safety of dental prosthesis.
Dental Prosthesis ; Finite Element Analysis ; Mandible ; Masseter Muscle ; Mastication ; Pterygoid Muscles ; Skull ; Sprains and Strains ; Tooth

The aminoglycoside 6'-N-acetyltransferases of type Ib (aac(6')-Ib) gene confers resistance to amikacin, tobramycin, kanamycin, and netilmicin but not gentamicin. However, some isolates harboring this gene show reduced susceptibility to amikacin. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommends a revision of the phenotypic description for isolates harboring the aac(6')-Ib gene. In this study, we determined the aminoglycoside susceptibility profiles of 58 AAC(6')-Ib-producing Enterobacter cloacae isolates. On the basis of the CLSI and EUCAST breakpoints, a large proportion (84.5% and 55.2%, respectively) of these 58 isolates were found to be susceptible to amikacin. However, among the isolates that were shown to be anikacin-susceptible according to the CLSI and EUCAST breakpoints, only 30.6% and 18.8% isolates, respectively, could be considered to have intermediate resistance on the basis of the EUCAST expert rules. Further studies should be conducted to determine the aminoglycoside susceptibility profiles of aac(6')-Ib-harboring isolates from various geographic regions and to monitor the therapeutic efficacy of amikacin in infections caused by these isolates.
Acetyltransferases/*genetics ; Amikacin/pharmacology ; Aminoglycosides/*pharmacology ; Anti-Bacterial Agents/*pharmacology ; Drug Resistance, Bacterial/genetics ; Enterobacter cloacae/*genetics/isolation & purification ; Enterobacteriaceae Infections/diagnosis/microbiology ; Humans ; Microbial Sensitivity Tests ; Polymerase Chain Reaction ; Sequence Analysis, DNA

BACKGROUND: We compared two automated Rapid Plasma Reagin (RPR) assay kits with a manual RPR assay kit to evaluate the possibility of using the two automated RPR assays as an alternative to the manual RPR assay for a quantitative monitoring. METHODS: One hundred eighty-five samples were analyzed, including 16 sera from patients with primary, secondary, and latent syphilis. Measured RPR unit (R.U.) values of two automated RPR assay kits, Mediace RPR (Sekisui Chemical Co., Ltd, Japan) and HBi Auto RPR (HBI Co., Ltd, Korea), were compared with the RPR titers of Macro-Vue RPR card test (Becton Dickinson BD Microbiology systems, USA). As a confirmatory test, Anti-Treponema pallidum EUROLINE WB (IgG) and Anti-Treponema pallidum EUROLINE WB (IgM) (Euroimmun, Germany) were used. RESULTS: There was a prozone effect with Mediace RPR at RPR titer (card test) of 1:16, but not with HBi Auto RPR. The R.U. values of the two automated RPR assays did not show proportional increase to the RPR titer. Agreement between manual RPR and two automated RPR assay kits, Mediace RPR assay and HBi Auto RPR assay, were 83.8% and 83.2%, respectively. CONCLUSIONS: The two automated RPR assay kits could not be used as an alternative to manual RPR test for quantitative analysis of RPR titer. As Mediace RPR shows a prozone effect at relatively low RPR titer, caution is needed in the interpretation of the measured values.
Automation ; Female ; Humans ; Male ; Reagent Kits, Diagnostic ; Reagins/*blood ; Sensitivity and Specificity ; Syphilis/*diagnosis ; Syphilis Serodiagnosis/*methods ; Treponema pallidum

BACKGROUND: The HbA1c has been considered to underestimate glucose level in diabetic patients on hemodialysis, therefore, glycated albumin (GA) was recently introduced to assess the glycemic control for those cases. We evaluated the performance of GA assay kit of Lucica GA-L (Asahi Kasei Pharma Co., Japan) and compare it with HbA1c for estimating glucose levels. METHODS: Tests for precision, linearity and interference were performed and reference interval was determined. Thirty eight of non-hemodialysis and seventy of hemodialysis patients were recruited, whose glucose levels of three-, two- and one-month prior to this study were available for calculating weighted means of glucose (WMGs). The correlation coefficients and the slopes of regression equation between WMG and HbA1c or GA were compared between two groups. Multiple linear regression analyses were used to determine significant predictor for HbA1c and GA. RESULTS: Total CV was 2.2% at concentration of 13.7% and 2.8% at 24.6%. The dilution curve between 15.7% and 62.1% was linear. Reference intervals were 10.0% to 16.5% for male and 11.4% to 17.6% for female. The correlation coefficients between WMG and GA were 0.682-0.713 in hemodialysis and 0.640-0.677 in non-hemodialysis. Those between WMG and HbA1c were 0.568-0.625 in hemodialysis and 0.735-0.783 in non-hemodialysis. The slopes of regression equation between GA and WMG in hemodialysis were 0.080-0.090 and 0.130-0.147 in non-hemodialysis. Those between HbA1c and WMG in hemodialysis were 0.012-0.014 and 0.029-0.032 in non-hemodialysis. GA was not influenced by hemodialysis status while HbA1c was. CONCLUSIONS: The claimed performance characteristic of Lucica GA-L were verified. WMG were better reflected by GA rather than HbA1c in patients on hemodialysis.
Aged ; Blood Glucose/chemistry ; Diabetes Mellitus, Type 2/*diagnosis/metabolism/therapy ; Female ; Hemoglobin A, Glycosylated/analysis ; Humans ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; *Renal Dialysis ; Reproducibility of Results ; Serum Albumin/*analysis

BACKGROUND: The objective of this study was to evaluate the role of proteases on the degradation of parathyroid hormone (PTH) in blood samples. METHODS: Protease inhibitors with specificity against serine proteases (aprotinin), cysteine proteases (E-64), serine and cysteine proteases (leupeptin), metalloproteases (EDTA), or a protease inhibitor cocktail with a broad spectrum of inhibitory activity were added to blood samples. After storage at room temperature (0-48 hr), PTH levels were measured. RESULTS: PTH levels in samples with the protease inhibitor cocktail did not change significantly after 48 hr of storage at room temperature, but the average PTH levels decreased by 40.7% and 20.1%, in samples stored at room temperature and stored at 4degrees C without protease inhibitors, respectively. PTH levels in samples with leupeptin were stable for up to 24 hr. After 48 hr, the mean PTH levels decreased by 17.1%, 16.0%, 26.2%, and 32.1%, with 500 KIU/mL aprotinin, 100 micro mol/L leupeptin, 10 micro mol/L E-64, and 10 micro mol/L EDTA, respectively, in the samples stored at room temperature. CONCLUSIONS: The decrease in PTH levels in blood samples seemed to be due to the degradation of PTH by proteases. Various proteases, including especially serine proteases, would act together to degrade PTH in blood specimen. The PTH degradation may be inhibited in blood specimen with protease inhibitor cocktail.
Aprotinin/pharmacology ; Blood Specimen Collection ; Edetic Acid/pharmacology ; Female ; Humans ; Leucine/analogs & derivatives/pharmacology ; Leupeptins/pharmacology ; Male ; Parathyroid Hormone/*blood/metabolism ; Protease Inhibitors/*pharmacology ; Time Factors

BACKGROUND: Many modern chemistry analyzers are open systems and they can use reagents other than those supplied by the manufacturer of the analyzer. There are many generic reagents for use in open systems. The objective of this study was to evaluate the analytical performance of the BD Lab reagents (BD Lab co., Korea) which were generic reagents. METHODS: Sixteen kinds of reagents of total protein, albumin, blood urea nitrogen (BUN), creatinine, glucose, uric acid, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, alkaline phosphatase (ALP), lactate dehydrogenase (LD), gamma glutamyl transferase (GGT), calcium, inorganic phosphorus, total cholesterol, triglycerides were tested for precision, linearity and correlation according to the NCCLS guidelines (EP5-A, EP6-A, EP9-A2). Toshiba 200-FR Neo (Toshiba Medical Systems Co., Japan) was used in this evaluation. RESULTS: All reagents showed acceptable precision with total coefficients of variation less than 7%. Comparison of BD Lab reagents with the current reagents by regression analysis resulted in slopes ranging from 0.86 to 1.06 and correlation coefficients more than 0.975. Fifteen of sixteen reagents showed good linearity in broad range. CONCLUSIONS: BD Lab reagents showed good precision, linearity, and correlation. Therefore, we conclude that the BD Lab reagents can be an alternative of currently used reagents in chemistry analyzers.
Alanine Transaminase ; Alkaline Phosphatase ; Aspartate Aminotransferases ; Bilirubin ; Blood Urea Nitrogen ; Calcium ; Chemistry* ; Cholesterol ; Creatinine ; Glucose ; Indicators and Reagents* ; L-Lactate Dehydrogenase ; Phosphorus ; Transferases ; Triglycerides ; Uric Acid

BACKGROUND: Plastic tubes have recently been used for blood collection tubes in clinical laboratories. The silicone coated plastic tube is said to be very similar with the glass tube and to show no difference with the glass tube in routine blood test except for some tests such as hormone tests and drug monitoring. So, we investigated the influence of plastic tube on the thyroid hormone test using two types of plastic vacuum tubes. METHODS: A total of 105 cases for the total triiodothyronine (T3), total thyroxine (T4), and thyroid stimulating hormone (TSH) were studied. The glass tube was a plain glass tube, and the plastic tube was a serum separator tube with gel. The plastic vacuum tubes used in this study were the SST II plus tube (Becton Dickinson, Franklin Lakes, USA) and the Vacuette tube (Greiner Bio-One, Kremsmunster, Austria). An IMMULITE 2000 analyzer (Diagnostic Products Corporation, Los Angeles, USA) was used to measure the total T3, total T4 and TSH. RESULTS: Comparisons of the measured values within 1 hour of blood collection in the plastic tube with that in the glass tube are as follows. There was no difference between the Vacuette tube and the glass tube for the three tests, while there was statistically significant difference between the SST II plus tube and the glass tube for the total T3 and total T4. CONCLUSIONS: It might need more cautious interpretation of the results by a solid-phase, competitive chemiluminescent enzyme immunoassay, when the plastic vacuum tube is used as a blood collection tube instead of the glass tube.
Drug Monitoring ; Glass* ; Hematologic Tests ; Immunoenzyme Techniques ; Lakes ; Plastics* ; Silicones ; Thyroid Gland* ; Thyrotropin ; Thyroxine ; Triiodothyronine ; Vacuum*

BACKGROUND: It takes long time to cultivate Mycobacterium tuberculosis on solid media from clinical specimens. Although there is progress in the detection of tuberculosis using liquid media, Ogawa media is broadly used in Korea. In the 1990s, the BACTEC 460 system (Becton Dickinson, Sparks, MD, USA) was used in some laboratories in Korea, but at present, it is not used because of the accumulation of radioactive waste and the risk of cross-contamination. The BACTEC MGIT 960 system (Becton Dickinson, Sparks, MD, USA) is one of the new systems using liquid media. MGIT system uses oxygen-quenching fluorescence sensor technology instead of radioactive material. We evaluated MGIT for the sensitivity and specificity for the diagnosis of Mycobacterium tuberculosis by comparison with Ogawa media. METHODS: A total of 232 sputum specimens were collected from patients admitted to the hospital. All specimens were processed by 4% NaOH and 0.5% NALC. After inoculation of MGIT with 0.5 mL and Ogawa with 0.3 mL of the processed specimen, the media were observed every 3 days until 6 weeks and 8 weeks, respectively. RESULTS: A total of 99 isolates of mycobacteria were recovered from 232 specimens. Ninety nine isolates were detected with MGIT, as contrasted with 64 detected with Ogawa media. The mean times to detection of the Mycobacterium species were 12.6 days for MGIT, 23.7 days for Ogawa media. Contamination rates were 5.1% for MGIT, 5.6% for Ogawa media. CONCLUSION: From our study, we conclude that MGIT is a superior method for recovery rate and time to detection of Mycobacteria to Ogawa media.
Diagnosis ; Fluorescence ; Humans ; Korea ; Mycobacterium ; Mycobacterium tuberculosis ; Radioactive Waste ; Sensitivity and Specificity ; Sputum ; Tuberculosis