Erratum: Author's Name Correction / 결핵및호흡기질환

No abstract available.

Usefulness of Serum Cortisol in Assessment for the Severity of Community-Acquired Pneumonia / 결핵및호흡기질환

BACKGROUND: High cortisol levels are frequently observed in patients with severe infections are of prognostic value in sepsis. The aim of this study was to evaluate the clinical usefulness of serum cortisol in assessment for the severity of community-acquired pneumonia (CAP). METHODS: This study analyzed the results of 52 CAP subjects admitted in Changwon Fatima Hospital between July 2008 to May 2010. Total serum cortisol, infection markers such as C-reactive protein (CRP), procalcitonin (PCT) and CURB (Confusion, Uremia, Respiratory rate, Blood pressure)-65 were examined retrospectively. RESULTS: In clinically unstable subjects on admission day 4, baseline serum cortisol, CURB-65, and CRP were elevated significantly compared to those of stable subjects. Area under curve (AUC) of cortisol, CRP, and CURB-65 from ROC curves were 0.847, 0.783, and 0.724 respectively. In the subjects with serum cortisol > or =22.82 microg/dL, CRP, PCT, CURB-65 score, and mortality were significantly elevated. CONCLUSION: These findings suggest that measurement of serum cortisol in early stage may provide helpful information in the assessment of CAP severity.

Usefulness of Procalcitonin in the Assessing the Severity of Community-Acquired Pneumonia Patient / 결핵및호흡기질환

BACKGROUND: Thus far, research studies on community-acquired pneumonia (CAP) have focused on its clinical severity. Recently, it has been determined that procalcitonin (PCT) level is correlated with severity of CAP. A retrospective study conducted at our hospital used risk predictability and PCT to determine whether or no PCT is useful in assessing the severity of CAP. METHODS: This study covered 92 CAP cases that were admitted to the respiratory department at Changwon Fatima Hospital between July 1, 2008 and June 30, 2009. All enrolled subjects were measured for infection markers and risk predictability. RESULTS: Based on hospital admission data, enrolled subjects had Pneumonia Severity Index (PSI) scores serving as risk predictors showed that both PCT and white blood cell (WBC) were statistically significant as infection markers (p=0.001, 0.037). Thus, this study used ROC curves in PSI for data analysis. As a result, it was determined that the area under curve (AUC) of PCT and WBC was 0.694 and 0.593 respectively, indicating that PCT has a higher test value for WBC, when PCT was higher than 0.745 ng/mL. In addition, it was found that PCT levels higher than 0.745 ng/mL had higher PSI scores than the group with PCT lower than 0.745 ng/mL (p=0.032). CONCLUSION: In order to predict risk of pneumonia cases admitted due to symptoms of CAP, it is important to consider PCT as well as PSI, and follow-up monitoring of PCT cases.

Usefulness of Procalcitonin in the Assessing the Severity of Community-Acquired Pneumonia Patient / 결핵및호흡기질환

BACKGROUND: Thus far, research studies on community-acquired pneumonia (CAP) have focused on its clinical severity. Recently, it has been determined that procalcitonin (PCT) level is correlated with severity of CAP. A retrospective study conducted at our hospital used risk predictability and PCT to determine whether or no PCT is useful in assessing the severity of CAP. METHODS: This study covered 92 CAP cases that were admitted to the respiratory department at Changwon Fatima Hospital between July 1, 2008 and June 30, 2009. All enrolled subjects were measured for infection markers and risk predictability. RESULTS: Based on hospital admission data, enrolled subjects had Pneumonia Severity Index (PSI) scores serving as risk predictors showed that both PCT and white blood cell (WBC) were statistically significant as infection markers (p=0.001, 0.037). Thus, this study used ROC curves in PSI for data analysis. As a result, it was determined that the area under curve (AUC) of PCT and WBC was 0.694 and 0.593 respectively, indicating that PCT has a higher test value for WBC, when PCT was higher than 0.745 ng/mL. In addition, it was found that PCT levels higher than 0.745 ng/mL had higher PSI scores than the group with PCT lower than 0.745 ng/mL (p=0.032). CONCLUSION: In order to predict risk of pneumonia cases admitted due to symptoms of CAP, it is important to consider PCT as well as PSI, and follow-up monitoring of PCT cases.

Clinical Outcomes of Early Vancomycin Administration before Identification of Methicillin-resistant Staphylococcus aureus in Patients with Nosocomial Pneumonia / 대한구급학회지

BACKGROUND: The aim of this study is to determine the clinical outcomes of early vancomycin administration before identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients with nosocomial pneumonia on a ventilator. METHODS: We retrospectively reviewed patients with nosocomial pneumonia in a 20-bed medical ICU during a period of 2 years and 2 months. This study included 52 inpatients, who were admitted for more than 72 hr and had a new or progressive lung infiltrate plus at least two of the following three criteria for pneumonia: abnormal body temperature (>38oC or 10,000/mm3 or <3,000/mm3), and purulent bronchial secretions. All of the MRSA were identified in tracheal aspirates during mechanical ventilation. RESULTS: A total of 23 patients who received vancomycin prior to identification of MRSA exhibited a 28-day mortality rate of 60%, while 29 patients who received vancomycin after identification of MRSA showed a 28-day mortality rate of 40% (p=0.17). There was no statistically significant difference in severity index and routine laboratory findings between the two groups. CONCLUSIONS: Early vancomycin administration before identification of MRSA does not appear to affect the mortality rate for patients with nosocomial pneumonia.

Right Ventricle Ejection Fraction Contributes Severity of Dyspnea in Chronic Obstructive Pulmonary Disease (COPD) / 결핵및호흡기질환

BACKGROUND: Patients with COPD generally complain of very different degrees of dyspnea regardless of their pulmonary function. The study, we assessed the right ventricular ejection fraction in relation to dyspnea in COPD patient. METHODS: The pulmonary function including the diffusion capacity was measured. The right ventricle ejection fraction (RVEF) was measured using a first-pass radionuclide scan by multigated acquisition (MUGA). Forty patients with chronic obstructive pulmonary disease (COPD) were stratified for dyspnea according to the Medical Research Council (MRC) scale. Moderate dyspnea and severe dyspnea is defined as MRC 2/3 (n = 16) and MRC 4/5 (n = 24) respectively. RESULTS: The baseline pulmonary function tests including DLCO and the resting arterial blood gas were similar in the moderate and severe dyspnea group, with the exception of the residual volume (% predicted) (moderate 160 +/- 27, severe 210 +/- 87, p < 0.03). The right ventricle ejection fraction was significantly (p < 0.001) lower in the severe dyspnea group (25 +/- 8) than in the moderate group (35 +/- 6). The independent factor assessed by multiple logistic regression revealed only the severity of dyspnea to be significantly associated with RVEF (p < 0.02). CONCLUSION: This study showed that the right ventricle ejection fraction would contributes to severity of dyspnea in patients with a similar pulmonary function.

Factors Associated with Early Death in Patients with Community-Acquired Pneumonia / 결핵및호흡기질환

BACKGROUND: Early death is an important problem associated with the management of community-acquired pneumonia. However, there is little information on the risk factors associated with it. The aim of this study was to identify the factors associated with early death in community-acquired pneumonia patients. METHODS: From January 1999 to July 2004, 1,487 adult patients with community-acquired pneumonia who were admitted to the pulmonary department via emergency center were examined. Early death was defined as those who died within 2 days of hospitalization. The clinical and laboratory aspects of the patients who died early (n=30) were compared with those of an age and gender matched control population (n=60) . RESULTS: In the early death group, respiratory rate, heart rate, and blood urea nitrogen (BUN) were significant higher (p<0.05 for all), while the arterial pH, systolic pressure, and PaO2 were significant lower (p<0.05 for all) than the control. The independent factor significantly associated with early death was tachypnea (OR, 7.049). CONCLUSION: The importance of an early clinical assessment in emergency center with community-acquired pneumonia needs to be emphasized in order to recognize patients at risk of early death.

A Case of Blastomycosis after Traveling around Non-Endemic Area / 결핵및호흡기질환

Blastomycosis is a systemic pyogranulomatous disease that is caused by a thermally dimorphic fungus, Blastomyces dermatitidis. it's the disease is endemic in the south-eastern and south central states of the USA, which border the Mississippi and Ohio Rivers, the mid-western states and Canadian provinces bordering the Great Lakes as well as in a small area of New York and Canada adjacent to the St. Lawrence River.1 We encountered a case of blastomycosis, representing as a pulmonary manifestation after traveling around a non-endemic area and report it with a brief review of the relevant literature.

Importance of Carbon Monoxide Transfer Coefficient (KCO) Interpretation in Patients with Airflow Limitation / 결핵및호흡기질환

BACKGROUND: The single-breath carbon monoxide diffusion capacity (DLCO) and the per unit alveolar volume (KCO; DLCO/VA) gave discordant values when there was an abnormal alveolar volume (VA). However, the clinical significance of the discordant values in patients with airflow limitation has not been examined. This study investigated the DLCO and KCO changes after improving the airflow limitation. METHOD: The baseline DLCO and KCO with lung volume were measured in patients with an airflow obstruction. The effective alveolar volume was measured using the single-breath CH4 dilution method. The patients divided into two groups according to the baseline values: (1) increased KCO in comparison with the DLCO (high discordance) (2) decreased or not increased KCO in comparison with the DLCO (low discordance). The diffusion capacity and lung volume were measured after treatment. RESULTS: There was no significant difference in the baseline lung volumes including the FEV1 and FVC between the two groups. The FEV1 and FVC were significantly increased in the high discordance group compared with the low discordance group after treating the airflow limitation. The DLCO and alveolar volume were significant higher in the high discordance group compared with the low discordance group while the TLC was not. CONCLUSION: The discordance between the DLCO and KCO could be translated into an airflow reversibility in patients with an airflow limitation

Change of Lung Volumes in Chronic Obstructive Pulmonary Disease Patients with Improvement of Airflow Limitation after Treatment / 결핵및호흡기질환

BACKGROUND: It is important to predict the exercise capacity and dyspnea, as measurements of lung volume, in patients with COPD. However, lung volume changes in response to an improvement in airflow limitation have not been explored in detail. In the present study, it is hypothesized that lung volume responses might not be accurately predicted by flow responses in patients with moderate to severe airflow limitations. METHODS: To evaluate lung volume responses, baseline and follow up, flow and lung volumes were measured in moderate to severe COPD patients. The flow response was defined by an improvement in the FEV1 of more than 12.3%; lung volume changes were analyzed in 17 patients for the flow response. RESULTS: The mean age of the subjects was 66 years; 76% were men. The mean baseline FEV1, FEV1/FVC and RV were 0.98L (44.2% predicted), 47.5% and 4.65 L (241.5%), respectively. The mean follow up duration was 80 days. The mean differences in the FEV1, FVC, TLC and RV were 0.27 L, 0.39 L, -0.69 L and -1.04 L, respectively, during the follow up periods. There was no correlation between the delta FEV1 and delta RV values(r=0.072, p=0.738). CONCLUSION: To appropriately evaluate the lung function in patients with moderate to severe airflow limitations; serial lung volume measurements would be helpful.

The Time Responses of Spirometric Values in Response to Single Doses of Inhaled Salbutamol / 결핵

BACKGROUND: An assessment of the presence and the degree of reversibility of airflow obstruction is clinically important in patients with asthma or chronic obstructive pulmonary disease. However, the time responses of spirometric parameters in response to bronchodilator have not been well investigated. METHODS: We studied 15 patients with asthma. Spirometric and mini-Wright peak expiratory flow measurements were performed at 15, 30, 45, and 60 minutes after using single dose(200 micro gram) of inhaled bronchodilator, salbutamol. RESULTS: The mean values of forced expiratory volume in one second(FEV1) and forced vital capicaty(FVC) were significantly increased at 60 minutes after using bronchodilator in comparison to 15 minutes. And peak expiratory flow rate measured by either mass flow sensor or mini-Wright peak flow meter were significantly increased at 45 minutes after using bronchodilator in comparison to 15 minutes. CONCLUSIONS: To appropriate evaluation of the bronchodilator response in patients with reversible airflow limitation, it would be useful measuring either FEV1 or PEF at the later time point 60 or 45 minutes in comparison to 15 minutes after using bronchodilator.