Plasma cell leukemia producing monoclonal immunoglobulin E.

A 78-year-old male with lumbar pain and dim consciousness presented the clinical pictures of plasma cell leukemia (PCL) producing a large amount of monoclonal immunoglobulin E (IgE)/kappa protein. Laboratory investigation demonstrated an elevated serum calcium level and renal dysfunction. Systemic bone X-ray survey disclosed only a solitary osteolytic lesion.

A cost-effectiveness evaluation of reticulocyte measurement in new outpatients with or without hematologic disorders.

Background: Although reticulocyte counts provide very useful information, few studies have analyzed the cost-effectiveness of this testing.

Methods: The yield and cost of reticulocyte count testing were analyzed in 719 new outpatients who visited the comprehensive medicine clinics and received both reticulocyte and complete blood count (CBC) testing. A "useful result" (UR) of the testing was defined as a finding that contributed to a change in a physician's diagnosis or decision-making between the pre- and post-test diagnosis.

Economic consequence of immediate testing for C-reactive protein and leukocyte count in new outpatients with acute infection.

Background: There have been few well-designed studies that assess the cost-effectiveness of near-patient immediate testing.

Methods: We analyzed the economic outcome of immediate testing for C-reactive protein (CRP) and white blood cell count (WBC) in 305 new outpatients with acute infections. Patients were randomized into two groups: 147 patients were tested immediately for CRP and WBC before the physician's initial consultation (advance testing), and 154 patients were not subjected to advance testing.

Expression level of MDR1 message in peripheral blood leukocytes from healthy adults: a competitive nucleic acid sequence-based amplification assay for its determination.

Accurate quantification of multidrug resistance-1 gene (MDR1) expression in target cells would be of important therapeutic value in predicting cellular response to anticancer drugs. Because certain normal cells in peripheral blood physiologically express MDR1, increasing the sensitivity of the detection methods might result in confounding low-degree expression in tumor cells with physiologic expression in normal cells. The purpose of this study was to determine MDR1 mRNA expression levels in peripheral blood leukocytes obtained from healthy adult volunteers using a competitive nucleic acid sequence-based amplification (NASBA) assay.

A competitive nucleic acid sequence-based amplification assay for the quantification of human MDR1 transcript in leukemia cells.

Background: Because clinical drug resistance is caused by low-grade expression of a responsible gene, highly sensitive methods are desirable for its detection in clinical settings. We developed a quantitative nucleic acid sequence-based amplification (NASBA) assay for multidrug resistance-1 (MDR1) transcripts, and applied it to clinical samples.

Method: MDR1 transcripts were amplified using the NASBA technique combined with sandwich hybridization of amplified MDR1 mRNA followed by chemiluminescence detection on an automated analyzer.

[Special comments--problems in systematic review for diagnostic accuracy of high-sensitivity C-reactive protein assay in neonatal infection].

We conducted a systematic review for the diagnostic accuracy of high-sensitivity C-reactive protein assay for neonatal infection. In total, 558 relevant published reports were found in a search of MEDLINE and Igaku-Chuo-Shi. With our inclusion and exclusion criteria, we finally selected 30 primary studies for meta-analysis.

Utilization of common inflammatory markers in new, symptomatic, primary care outpatients based on their cost-effectiveness.

Few studies have demonstrated the optimal usage of common inflammatory markers, alone or in combination, based on the cost-effectiveness. We analyzed the yield and cost of C-reactive protein (CRP), white blood cell count (WBC), erythrocyte sedimentation rate (ESR), sialic acid, and protein fractionation in 177 new primary care outpatients with inflammation-related symptoms. A useful result (UR) was assigned if tests contributed to a change in physician's diagnosis or decision-making.

Large diversity in transport-mediated methotrexate resistance in human leukemia cell line CCRF-CEM established in a high concentration of leucovorin.

To elucidate the mechanism(s) of methotrexate (MTX) resistance as a possible reason underlying treatment failure in high-dose MTX regimens combined with leucovorin (LV) rescue, we established MTX-resistant human T-cell leukemia cell line CCRF-CEM cells in the presence of excess LV, and characterized their properties. Continuous exposure of the cells to escalating concentrations of MTX up to 20 microM in the presence of 1000 nM LV resulted in establishment of three MTX-resistant sublines with a wide disparity of resistance degree over a 4 logarithmic range (approximately 40-, 900- and 44,000-fold, respectively). Transmembrane transport of MTX in these sublines was diminished to 52%, 35% and 12%, respectively.

[Common diagnostic tests under the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) in the United States].

The lower quality of laboratory testing in unlicensed physicians' office laboratories(POLs) had led to legislation of the Clinical Laboratory Improvement Amendments of 1988(CLIA '88) in the United States. This legislation extended laboratory regulations for quality control and assurance, personnel qualification, record-keeping, and proficiency testing to all laboratories regardless of size, complexity, or location, including POLs and ancillary testing sites in a hospital. According to the implementation of the CLIA '88 in 1992, all testing sites in this country must have inspections and a certificate issued by the federal government.

Yield and cost of individual common diagnostic tests in new primary care outpatients in Japan.

Background: Appropriate diagnostic testing involves considerations of cost-effectiveness. We examined the cost-effectiveness of individual tests in a panel of tests defined by the Japan Society of Clinical Pathology.

Methods: We studied 540 new, symptomatic primary care outpatients with a set of 30 common diagnostic tests [the Essential Laboratory Tests (2); ELT(2) panel] for clinical evaluation and identification of occult disease.