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The present study was designed to evaluate the efficiency of total lactate dehydrogenase, total creatine kinase, LD1/LD2 ratio, CK-MB and newly developed troponin T in acute myocardial infarction. The level of troponin T was in 34 healthy person, but the peak vaule of acute myocardial infarction ranged in 4.7-24.2 . Total lactate dehydrogenase was peaked in 1 to 3 days after chest pain and then progressively decreased, but LD1/LD2 ratio was persistently higher than 1.0 for 10 days in most patients. Total creatine kinase and CK-MB were peaked in 1-2 days, and normalized in 3-4 days, so they were useful in early diagnosis of acute myocardial infarction, but not for the late stages of acute myocardial infarction. Troponin T is early elevated and persistently high level for more than 10 days. Comparing with total lactate dehydrogenase, total creatine kinase, LD1/LD2 ratio and CK-MB, troponin-T test improves the efficiency of serodiagnostic method for the detection of ischemic myocardial damage.

It is important to select appropriate antimicrobials for the treatment of infection according to the results of antimicrobial susceptibility tests (ASTs), yet the clinical isolates are sometimes susceptible to antibiotics that are clinically ineffective or this is due to technical error of the ASTs. So, interpretive reading of ASTs is needed and especially for the β-lactams for treating Enterobacteriacae. This review describes the interpretive reading of ASTs according to natural antimicrobial resistance and the mechanisms of mechanisms, with giving special attention to the antibiotics phenotypes for Enterobacteriacae. Further, as all the diffent tissues have a different antimicrobial concentration for identical antimicrobials, more information is needed on the antimicrobial tissue distribution for the appropriate treatment of infection. (ED note: I hope you send me the paper.)

According to the World Health Organization (WHO) classification system, cases with t(8;21)(q22;q22) should be diagnosed as acute myeloid leukemia (AML) even with a blast count of less than 20 percent in blood or bone marrow. It is an uncommon manifestation, moreover hypocellularity is rarely observed in this subtype of leukemia. Here, we report a case of t(8;21) in a patient with marked hypocellularity of less than 5 percent and a blast count of less than 20 percent. This patient responded relatively well to chemotherapy. An allogeneic bone marrow transplantation was performed with good engraftment. This case suggests that hypocellular AML with a t(8;21) has as good a prognosis as hypercellular AML with t(8;21).

－Abstract－ Background：Interpretative reporting is an important aspect of laboratory medicine. The large menu of laboratory tests available today makes it increasingly difficult for the non-specialist to order and interpret all laboratory tests. The aim of this study was to determine the usefulness of an expert system to interpret laboratory tests and help physicians order the appropriate tests. Materials and Methods：In order to interpret laboratory tests, a rules-based expert system was developed. In this module, if-then rules were used to interpret the given test result patterns (e.g. urinalysis, anemia, hepatitis B virus, hypercholesterolemia, glucose, syphilis, and tumor markers) and select matching text elements. The system was used to evaluate 535 subjects who visited a health-check program. 1) Results：The overall abnormal rate was 50.5% in the expert system; 34% for cholesterol, 9.9% for urinalysis, 8.0% for anemia, 7.7% for thyroid function tests, 4.5% for tumor marker study, 4.7% for hepatitis virus antigen, 4.3% for serum glucose, and 1.1% for syphilis. Conclusion：These results indicate that the application of the expert system for the

Constitutional trisomy 8 is a relatively rare aneuploidy; most identified cases are mosaic with a normal cell line. The phenotype is highly variable from apparently normal to severe disability. The proportion of abnormal cells is dramatically different between tissues and the severity of the phenotype is not directly related to the level of mosaicism. Therefore, it is very difficult to provide a definitive prognosis. We report here a case of constitutional trisomy 8 mosaicism with agenesis of the corpus callosum, congenital heart disease and micrognathia. The trisomy 8 cell line was not detected by prenatal cytogenetic study. This is the fourth reported case of constitutional trisomy 8 mosaicism in Korea.

Simultaneous deficiency of Vitamin and iron induces that the bone marrow erythroid megaloblastosis and peripheral blood macroovalocytosis are masked because of countervailing the tendency of iron deficiency to produce hypochromic microcytic erythrocytes. We report two cases of Vitamin deficiency anemia with low mean corpuscular volume (MCV) due to combined iron deficiency anemia with review of literature.

Background: There are many evidences that inflammation is an important determinant of the development of atherosclerosis and one of the systemic markers of inflammation, C-reactive protein(CRP), is associated with extent of coronary artery disease and risk of coronary events. We assessed the time response of CRP response after coronary angioplasty and it's influence on the clinical restenosis in angina patients. Materials and Methods: Patients included 36 angina patients undergoing single vessel angioplasty. Levels of CRP were measured before and 12, 24, 48, and 72 hours after angioplasty. Clinical restenosis was assessed at 6 months after procedure. Results: Baseline CRP level was mg/dL in stable and mg/dL in unstable angina patients(p mg/dL in stable and mg/dL in unstable angina patient(p

Background: Extended-spectrum -lactamases(ESBL) are enzymes that confer resistance to oxyimino--lactams as well as to penicillins and cephalosporins. Strains of Klebsiella pneumoniae and Escherichia coli that produce ESBL have been increasingly prevalent in many countries. The purpose of this study was to investigate the ESBL production rate of K. pneumoniae and E. coli at the in Yeungnam University Medical Center. Materials and Methods: Thirty-one isolates of K pneumoniae and twenty-five isolates of E. coli were examined for ESBL by double disk synergy test, using 20/ ticarcillin/clavulanic acid and oxyimino--lactam(ceftazidime, ceftaxime, ceftriaxone and aztreonam) disks. Results: Fifty-two percent of K. pneumoniae and sixteen percent of E. coli isolates revealed double disk synergism. Majority of ESBL-producing strains(fifty-five percent) were isolated from patients in the intensive care unit. Conclusion: ESBL production of K. pneumoniae and E. coli were also common at the Yeungnam University Medical Center and pose a serious problem for antimicrobial therapy.

The aim of this study was to evaluate domestic enzyme immunoassay(EIA) kit 'LG RCD 3.0' (LG) for the detection of antibody to hepatitis C virus(anti-HCV) in comparision with Axsym HCV version 3.0(Axsym), Cobas Core anti-HCV EIA(Cobas). Cobas kit shows better clear distinction between positive and negative by signal/cutoff ratio(S/C), but it also reveal relatively high false positive rate. The concordance rate of test results between LG and Axsym was 96.2%, between LG and Cobas was 95.5%, and total agreement between three EIA kit was 93.9%. LG were relative poor distinction between positive and negative results, but it could be applied clinically as a screening tool for hepatitis C in general population. The SIC of one false negative result by LG was 0.91, and false positive were less than 4.0, therefore we concluded it is necessary to confirm by immunoblotting assay when SIC were between 0.8 and 4.0.

We studied the expression of the cell surface antigen associated with myeloid and lymphoid leukemias on bone marrow or peripheral blood blast cells from 153 leukemic patients including 61 cases of acute myelogenous leukemias(AML), 46 of acute lymphocytic leukemias(ALL) and 12 of acute leukemias. They were analyzed by direct or indirect immunofluorescence method for reactivity with the monoclonal antibodies to B cells(CD10, CD19, SmIg), T cells(CD2, CD5, CD7, CD3, CD4, CD8), myeloid antigen(CD13, CD14, CD33, CD61) and a nonspecific antigen, HLA-DR. Lymphoid associated markers detected on AML is CD7 32.8%, CD10 14.8%, CD5 13.1%, CD2 6.6% and CD19 1.6%. TdT was positive in 4.9% of AMLs. Hybrid leukemias were 8 cases out 61 AML cases and were mainly composed of monocytic lineage, M4 and M5a. Myeloid markers detected in ALL were CD13 2.2% and CD33 2.2%. In this study, immunologically classified ALLs were composed of 65.2% of CALLA (+) B precursor type, 10.9% of CALLA (-) B precursor pattern, 8.7% of T cell type, 2.2% of B cell type, 4.5% of mixed lymphoid lineage(B&T), 2.2% of undifferentiated leukemia, and 6.5% of hybrid leukemia. Twelve cases of acute leukemias ware finally diagnosed to be 5 cases of hybrid leukemia, 3 cases of B lineage, 3 case of T lineage and 1 case of mixed lymphoid(B&T) leukemia. In summary, we think the best method for typing acute leukemias is by using a combination of FAB classification and immunophenotying.

Four subtypes of hepatitis B surface antigen are useful in the epidemiologic studies of the route of virus transmission and clinical significance of simultaneous occurance of hepatitis B surface antigen and antibody to hepatitis B surface antigen in the same serum as well as useful marker for population migration. The sera were obtained from 214 HBs Ag positive patients who are diagnosed as chronic liver disease and following up in the Yeungnam university hospital. The subtypes were determined by solid-phase sandwich EIA using monoclonal antibodies. Among 214 specimens, the subtype adr was 93.9%, adw was 2.8%, ayr was 0.9%, ar was 0.9%, adwr was 1.4% and ayw was not detected. There were no correlation between subtype pattern and disease. In summary, the subtype adr was prominent in our study and the difference of subtype pattern by severity of disease was not significant. However, to determine the prognostic value of HBs Ag subtype and relationship between subtype and disease progression, long-term follow up will be needed.

The ESR is one of the oldest laboratory test still in use. Although it lacks specificity in diagnosis, it can be effective for monitoring disease activity and following-up. The Westergren method is used for reference method, however coefficient of variation has been described 0.8% to 22.9% according to the literature. Since the ESR was invented in 1921, measurement technique has developed and automated measurement is introduced. We analyzed one hundred forty-three patient samples using automated ESR measuring system and compared with modified Westergren and Wintrobe methods. Comparison between and modified Westergren for ESR measurement yields the following regression equation; y = 0.863x - 1.69 (r=0.830), and Wintrobe y = 1.14x - 14.7 (r=0.789), respectively. We repeated measurement to evaluate reliability, results are not significant in statistically. In conclusion, automated ESR measurement correlated with modified Westergren and Wintrobe methods, reveal reliable results after 4 hours and can report rapidly for large samples. Thus, these results indicate that automated ESR measurement may be useful tool for clinical practice.

Assays for HBsAg, HBV DNA, anti-HBc and anti-HBs of 285 units of packed red blood cells supplied by Taegu Red Cross Blood Center were performed to evaluate the correlation between the prevalence of HBV DNA and the serologic markers for hepatitis B virus. None of 285 plasma samples was positive for HBsAg, however, HBV DNA were detected by polymerase chain reaction in 2 samples which both presented only with anti-HBc positivity. Of 204 samples tested for anti-HBs, 96 samples(47.1%) were positive and among 216 samples tested for anti-HBc, 80 samples(37.0%) were positive. Of 193 samples tested for both anti-HBs and anti-HBc, 80(41.1%) were all negative and 48(24.9%) were positive on both tests. Those samples which showed positivity only to anti-HBc were 25(13.0%). Considering the above results, transfusion-transmitted hepatitis B virus infection could be prevented by discarding anti-HBc positive blood, however, that may bring insufficient supply of donor bloods in the country like Korea where the prevalence of anti-HBc is high. Anti-HBc positive blood unequivocally positive for anti-HBs should be considered noninfectious for HBV and should be allowed to be transfused. It would reduce the amount of discarding donor blood as the routine blood donor screening tests presently used at Korea Red Cross Blood Center supplemented by anti-HBs and anti-HBc testing.

In the method for lithium (Li) analysis, flame emission photometry and atomic absorption spectrophotometry (AAS) have been used most frequently. In addition, lithium can be analyzed by ion-selective electrode (ISE) or fluorscence polarization immunoassay. We evaluated the comparison between AAS method based on the principle of absorption of light at 670.8 nm by Li and ISE method based on the principle of voltage difference generated by Li in contact with lithium ionophore. We compared with those obtained by AAS (AA/AE Spectrophotometer 551, Instrumentation Laboratory Co.) and ISE(CSYNCHRON EL-ISE, Beckman Co.) in the serum and urine of 6 patients and evaluated time-related changes of serum lithium concentration after dosing in both methods. The results are summarized as follows : 1. In within-run precision study for lithium concentration, coefficient variations (CVs, %) ranged from 1.34 to 2.17 for AAS and from 0.34 to 0.85 for ISE method. In between-run precision study for lithium concentration, CVs ranged from 1.23 to 1.72 for AAS and from 0.61 to 1.38 for ISE method. 2. The correlation study between AAS and ISE method resulted in Y=0.946X+0.137 (N=32, r=0.933, X=AAS, Y=ISE) for serum lithium and Y=1.092X+0.977 (N=28, r=0.943, X=AAS, Y=ISE) for urine lithium. 3. Time-related changes of serum lithium concentration in both AAS and ISE method resulted in peak serum levels about 2 hours after dosing and then rapidly decreased after the peak serum level and finally arrived at nearly initial levels about 9 hours after dosing. 4. The reference range of serum lithium was found as undetectable level for both AAS and ISE method and the reference range of urine lithium to the urine creatinine was 0-0.00014 mmol/mg(mean 0.00002 mmol/mg) for AAS method.

Major pathogenic Gram-negative organisms such as P. aeruginosa, Serratia species, E. coli, Enterobacter species which are isolated from the specimens in large medical centers are greatly resistant to the commonly used antibiotics. Gram-negative bacilli, which had been isolated in Yeungnam University Hospital during the period from December 1992 to April 1993 and turned out to be resistant to the primary antibiotics susceptibility test for chloramphenicol, ampicillin, cephalothin, gentamicin, tetracyclin, amikin and tobramycin, were subjected to the secondary antibiotics susceptibility test for aztreonam, ceftazidime, ciprofioxacine, cefotaxime, cefamandole, piperacillin, ticarcillin and sulfamethoxazole trimethopime. Out of 315 tested organisms, 167 organisms(53%) were resistant to all secondary antibiotics in vitro. Antimicrobial activity of ceftazidime(37.1%), aztreonam(11.%), ciprofioxacine(7.9%) against Gram negative bacilli were slightly more active than other antibiotics tested, while cefamandole was not active to all the Gram-negative bacilli tested. According to the specimens, E. coli was the most frequently resistant organisms to the primary antibiotics from urine, A. baumanii, from respiratory system and wounds, and P. aeruginosa from various specimens. In summary, Gram negative bacilli resistant to the primarily applied antibiotics also were resistant to the secondary antibiotics. Rearrangement of the antibiotics disks for the antibiotic susceptibility test should be considered.

Pure red cell aplasia is uncommon disorder characterized by finding of anemia, absence of nucleated red blood cell in the marrow, absence of reticulocytes in the peripheral blood and normal peripheral platelet and leukocytes counts. We experienced one case of pure red cell aplasia associated with hemolytic anemia characterized by hemoglobinuria, reticulocytopenia, and erythroid hypoplasia of the bone marrow. The cause of the illness was not definitely identified, but we concluded that this patient had simultaneous occurence of PRCA and hemolytic anemia following administration of diphenylhydan. toin after craniotomy rather than virus or bacteria induced. The simultaneous occurance of PRCA and hemolytic anemia is uncommon and the mechanism for diphenylhydantoin induced PRCA and hemolytic anemia is unclear.

Serum lactate dehydrogenase isoenzymes are separated 5 fractions() in normal serum by agrose electrophoresis. An unusual band on the cathodic side of isoenzyme has been found on lactate dehydrogenase electrophores is of serum, called , and the presence of which signifies a poor prognosis for the patients of myocardial infarction. In recent, we have experienced in two patients with myocardial infarction. Cardiac arrest was noted within 24 hours after exhibition of extraband and they did not recover from their illness.

We measured fasting serum angiotensin -converting enzyme (SACE) in 100 healthy controls and 75 coal worker's pneumoconiosis (CWP) patients by a commercial kits(, Fujirio Inc., Japan) and evaluated this manual method. The linear range extends to an activity of 80U/L. Precision on a commercial control serum (ACE control-, Sigma Co.)with a mean value, of 9.47U/L yielded a within-run and between-run CVs are 5.6% (N=15) and 6.9% (N=14) respectively. SAVE in 75 CWP was () ; higher than in healthy controls (, P

Reviewing the results of the blood cultures performed at Yeungnam University Hospital during 4-year-period through January. 1, 1984 to December 31, 1987, the following results were obtained. 1) Out of 808:3 blood specimens cultured microorganisms grew in 582 specimens with positivity rate of 7.20%. Polymicrobial bacteremia was found in 16 patients. 2) Among 582 positive specimens, Gram-positive cocci grew in 189 specimens, and Gram-negative bacilli, in 393 specimens. Clinically significant microorganisms consisted of 82 Staphylococcus aureus, and 20 Strptococcus species in Gram-positive cocci group, 80 Salmonella typhi, 72 Escherichia coli, 72 Salmonella paratyphi A in Enterobacteriaceae, and 46 Pseudomonas cepacia, and 16 Pseudomonas aeruginosa in glucose non-fermentating microorganisms. 3) Increasing incidence of Serratia, Acinetobacter and Pseudomonas species as major nosocomial infection source is noteworthy. They showed increased tendency from 6.3% of 1984 to 17.7% of 1987 of total positive blood cultures. 4) High isolation rate of Pseudomonas species and Aeromonas hydrophilia was noted in summer, while Salmonella typhi showed high prevalence from May to September and in January. 5) In susceptibility tests of isolated organisms, staphylococcus aureus was sensitive to basic antimicrobial agents except for ampicillin. The glucose non-fermentating microorganisms showed high resistance to basic antimicrobial agents in 32.2%. In conclusion, considering the relatively higher incidence of growth of Staphylococcus epidermidis than ideal level indicates that sampling technique should be improved. Secondly, all the hospital staffs in cooperation with Hospital Infection Committee are desirable to pay efforts to decrease the nosocomial infection.

A Study to evaluate the diagnostic significance of M. pneumoniae infection by measurements of cold agglutinin and antimycoplasma antibody titers is performed with 191 pediatric patients who have visited Yeungnam University Hospital during the period through January to July, 1987. Forty eight of 191 cases made follow up tests feasible. The results obtained are as follows : 1. It is necessary to perform routine combined measurements of cold agglutinin and antimycoplasma antibody titers for the all pediatric pneumoniae caser since a large proportion of pneumonia in children is caused by M. pneumoniae. 2. For the diagnosis of M. pneumoniae infection, measurements of cold agglutinin titers alone seems to be les significant than to check both cold agglutinin and antimycoplasma antibody titers. 3. The measurement of antimycoplasma antibody titer appeared to be more specific than cold agglutinin test in the diagnosis of M. pneumoniae infection. 4. The present study urges the necessity of follow up study of cold agglutinin and antimycoplasma antibody titers for those who initially presented with normal titers in both tests, but are clinically suspected for M. pneumoniae infection.