Deep Vein Thrombosis in Patients with Pulmonary Embolism: Prevalance, Clinical Significance and Outcome

PURPOSE: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are considered as similar disease entities representing different clinical manifestations. The objectives of this study were: 1) to determine the prevalence and outcome of DVT in patients with PE; 2) to identify additional risk factors for PE-related unfavorable outcome and 30-day all-cause mortality; and 3) to establish the clinical importance of screening for concomitant DVT. MATERIALS AND METHODS: From January 2013 to December 2015, a total of 141 patients with confirmed PE were evaluated. The prevalence and outcome of DVT in patients with PE was determined. Furthermore, the potential risk factors for PE-related unfavorable outcome and 30-day all-cause mortality were also analyzed. RESULTS: The prevalence of concomitant DVT was 45.4%. PE-related unfavorable outcome was observed in 21.9% of all concomitant DVT, with all-cause mortality of 21.9%. There was no significant relationship between the presence of concomitant DVT and the development of PE-related unfavorable outcome or all-cause mortality. Our results indicated that heart rate >100/min and peripheral oxygen saturation <90% were independent predictors for PE-related unfavorable outcome. Regarding all-cause mortality, active malignancy and hypotension or shock were significant risk factors. CONCLUSION: Our findings demonstrate that approximately half of patients with PE possess DVT. However, this study failed to establish any clinical significance of concomitant DVT for PE-related unfavorable outcome and all-cause mortality. Tachycardia and hypoxemia were identified as significant predictors for PE-related unfavorable outcome along with active malignancy and hypotension or shock as significant risk factors of all-cause mortality.

Serologic Test for Syphilis by Mediace RPR Test for Chemistry Autoanalyzer / 임상검사와정도관리

BACKGROUND: Mediace RPR test for chemistry autoanalyzer, a nontreponemal serologic test for syphilis, was recently introduced in Korea. We evaluated the performance of Mediace RPR test. METHODS: For the evaluation of precision, within-run and total coefficient variations were analyzed. Two hundred and one sera were tested by Mediace RPR test to investigate the distribution of Mediace RPR titers in healthy subjects. Mediace RPR test was compared with RPR card test using 126 sera. RESULTS: Total coefficient variations for positive control, negative control and pooled sera were 9.1%, 46.6% and 35.3%, respectively. The results of Mediace RPR test in healthy subjects showed 0.44+/-0.28 (mean+/-standard deviation) RPR unit (RU), and the positive rate was 3.5% (7/201). The agreement between Mediace RPR test and RPR card test was 73%. In some of the sera with a result of greater than 4.0 RU, Mediace RPR test showed markedly lower results than that of RPR card quantitative test. CONCLUSION: Mediace RPR test has the advantages that it is useful for screening large number of samples and the results are objective. Mediace RPR test can be used as a quantitative test in sera with low titers. Dilution is needed to determine high titers in sera. Adjusting cutoff for the setting of individual hospital is maybe helpful.

Synchronous Multiple Primary Malignant Neoplasm Involving the Uterine Endometrium and Ovary / 대한산부인과학회잡지

Multiple primary malignant neoplasm means that more than 2 cancers are independently developed in one individual. In general, the neoplasms are diagnosed simultaneously or within 6 month interval. Simultaneous presentation of carcinomas involving ovary and uterus is not a common event and presents a diagnostic dilemma when they are of the same histology. We experienced a rare case of multiple primary malignant neoplasm involving the uterine endometrium and the ovary synchronously. Thus we report this case with a review of literatures.

Accelerated Phase Chronic Myeloid Leukemia in Complete Molecular Response with STI571 / 대한혈액학회지

STI571 is an effective agent for the patients with chronic myeloid leukemia (CML). But, complete molecular response with STI571 is rarely reported in accelerated phase CML. Here we report a patient with accelerated phase CML who achieved complete molecular response with STI571. A 60-year old female patient visited emergency room with syncope. Her white blood cell count was 30,800/microliter (basophil 23%), hemoglobin 8.9g/dL, and platelet counts 2,748,000/microliter. Bone marrow was hypercellular with increase in megakaryocyte and basophils (15%). She was diagnosed as an accelerated phase CML. Seven days after stopping hydroxyurea, we used STI571 in a daily oral dose of 600mg. Generalized edema and skin rash were observed 15 days after treatment (all grade 1) and were controlled well with conservative management. Complete hematologic and cytogenetic responses were achieved after 1 month and 3 months of therapy with STI571 respectively. Complete molecular response was simultaneously proven by conventional reverse transcriptase PCR and real-time PCR analysis. The patient still remained in complete hematologic, cytogenetic, and molecular responses for 24 months. Treatment with STI571 was well tolerated and rapid hematologic improvement was observed. This case shows STI571 can induce complete molecular response as well as cytogenetic response in accelerated phase CML.

Prevalence and Clinical Outcome of Penicillin-resistant Pneumococcal Pneumonia / 결핵

BACKGROUND: The incidence of penicillin-resistant streptococcus pneumoniae(PRSP) accounts for almost 70% of all pneumococcal pneumonia cases in Korea. It is still unclear as to whether the efficacy of penicillin or equally active beta-lactam agents is compromised in PRSP pneumonia. This study investigated the prevalence of PRSP in community-acquired pneumonia and its clinical course. METHODS: A total of 42 patients with community-acquired pneumococcal pneumonia were evaluated from July 1999 to May 2001. The cultured strains of Streptococcus pneumoniae were divided into susceptible, intermediately resistant, and resistant strains by an E-test, and the effect of the clinical course was investigated. RESULTS: From a total of 42 patients, 22 (52.4%) patients had an intermediate resistance (MIC 0.1-1 microgram/ml) and six (14.3%) showed a high resistance (MIC> or =2.0 microgram/ml) with current penicillin susceptibility categories. However, according to the classification of the DRSPTWG (Drug Resistant Streptococcus pneumoniae Therapeutic Working Group), there were 11 cases (26.2%) of intermediate resistance and no case of high resistance. Under empirical antimicrobial treatment, there was no difference in the clinical outcome between the penicillin susceptible and resistant group. CONCLUSION: The clinical outcome of PRSP pneumonia with empirical therapy was acceptable. These results suggest that the current MIC breakpoint for penicillin resistance in Streptococcus pneumoniae has been set at a very low level and penicillin resistance according to the NCCLS classification does not significantly influence the outcome of the empirical treatment for pneumococcal pneumonia.

The Effect of the Extents of Pleural Thickening in Tuberculous Pleurisy on the Impairment of Pulmonary Function / 결핵

BACKGROUND: Tuberculous pleurisy treatment improve symptoms such as fever, chest pain, cough, and prevents the progression to active pulmonary tuberculosis and the development of residual pleural thickening that decrease diaphragm and rib cage movement. This study investigated how the degree of residual pleural thidkening affects the pulmonary function. METHODS: Fifty seven patients who were initially diagnosed as having tuberculous pleurisy, were treated with anti-tuberculous medication for 6 months and had residual pleural thickening between May 1998 and January 2000 at the Eulji university hospital were reviewed. A chest X-ray and pulmonary function test(PFT, Sensormedics 2200) were perfored. The predicted value (%) of the forced vital capacity(FVC), forced inspiratory vital capacity(FIVC) and total lung capacity(TLC) were measured. The residual pleural thickening was defined the average of the summation in the lateral chest at the level of the imaginary line intersecting from the cardiophrenic angle to the diaphragmatic dome and the lowest part of the costophrenic angle between them. The results were sorted into three grades according to pleural thickness; <2mm(grade I), 2~10mm(grade II), 10mm(grade III). RESULTS: 1. FVC(% pred) and FIVC(% pred) were statistically different between grade I and III, and II and III. However, there was no difference between the TLC(% pred) between each of the groups. 2. The pleural thickness that cause restrictive dysfunction(FVC<80%) and a statisticall difference, is 3 mm. CONCLUSION: The larger the extent of the residual pleural thickness after antituberculous medication, the greater the reduction in the FVC, FIVC, TLC. A pleural thickness of 3 mm is recommended as a guideline for diagnosing a restrictive pulmonary dysfunction.

Development of multimedia educational system of diagnostic hematology / 대한의료정보학회지

The basic laboratory test for diagnosis of hematological diseases most widely used is microscopic examination of blood smear slides. The purpose of development of integrated hematological management program of microscopic examination is to improve effectiveness of microscopic examination of blood smear slides and to offer references consistent and easy to use. The lists of various blood cells and hematological diseases were prepared, and 2,589 microscopic photo slides were made corresponding to these lists. The images made of microscopic photo slides were developed through multimedia PC and slide scanner. Thirty-seven references always used for hernatological diagnosis were arranged in the form of tables and figures. With integration of these images and references, an application software consists of functions such as reports of peripheral blood cell morphology and bone marrow examination, stepwise learning of diagnostic procedures, finding hematology atlas and references, and reports of other special hematology laboratory tests was developed. The development tool was Visual FoxPro (version 5 .Oa, Microsoft, USA). Internet hematology atlas contained in the homepage of Department of Clinical Pathology of Seoul National University Hospital were also prepared. The contents developed in this study may be a good guideline for diagnosis of hematological diseases. As a good supporting material, hematology atlas, references and internet homepage will be basic study materials that will help medical students and clinicians understand the workflow of hematological diagnosis.