Clinical Characteristics of Pneumonia Occurred in Hemodialysis Patients / 대한신장학회지

PURPOSE: The most common infectious diseases in hemodialysis (HD) patients are sepsis and pneumonia. Although there are many data about sepsis in HD patients, pneumonia in HD patients is rarely reported. This study was conducted to compare clinical severity of pneumonia between HD patients and healthy persons. METHODS: This study enrolled 36 HD patients who were admitted for pneumonia. Age- and sex-matched 37 persons with pneumonia who did not have any other medical illness were included as a control. We compared clinical manifestations, laboratory and radiologic findings, complications, and clinical course between HD patients and controls. RESULTS: The positive rates of blood and sputum bacterial culture in the HD patients were higher than in those in the controls (blood; 17.6% vs. 2.7%, p=0.028, sputum; 30.3% vs. 5.4%, p=0.005). Compared to the controls, the HD patients had higher incidence of thrombocytopenia (25.0% vs. 0%, p=0.001) and hypoxia (41.7% vs. 2.7%, p=0.000). The number of the lobes involved was larger and higher incidence of bilateral lesions and parapneumonic effusions were observed in the HD patients. In addition, the HD patients had higher incidence of recurrence than the controls (16.7% vs. 0%, p=0.025). Pneumonia-related mortality rate tended to be higher in the HD patients than the controls but there was no statistical differences between the two groups (11.1% vs. 0%, p=0.054). CONCLUSION: This study shows that pneumonia in HD patients takes a more severe clinical course than in healthy persons. It seems that pneumonia in HD patients has a higher propensity to develop bacteremia.

Diagnostic value of ultrasonography to distinguish between benign and malignant lesions in the management of thyroid nodules / 대한내과학회지

BACKGROUND: Thyroid ultrasonography can accurately detect nonpalpable nodules, estimate the size of the nodule during follow-up, and discriminate between solid nodules and simple cysts. Many studies have recently been done to detect malignant thyroid nodules by high-resolution ultrasonography. However, the exact role of high-resolution ultrasonography in distinguishing benign from malignant nodules is still unresolved. We analyzed the sonographic characteristics of thyroid nodules and assessed the diagnostic value of ultrasonography. METHODS: We retrospectively analyzed the sonographic feature of thyroid nodules in patients who had been examined with fine-needle aspiration cytology or had surgery for a thyroid nodule at St. Mary's Hospital, Korea from January 2003 to January 2005. Sonographic features that suggested malignancy include microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was more tall than it was wide. If even one of these sonographic features was present, the nodule was classified as category 3 (malignant). If a nodule had none of the features described, it was classified as category 2 (benign). Anechogenic cystic nodule was classified as category 1 (benign). RESULTS: Of 124 lesions classified as category 3, 60 were malignant. Of 418 lesions classified as category 1 or 2, 409 was benign. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy based on sonographic classification method were 90%, 86.5%, 48.4%, 97.8%, 86.5%, respectively. CONCLUSIONS: Our results identified sonographic classification with calcification, margin, echogenicity and shape as useful tool in the differentiation of malignant from benign nodule. In view of the high value of negative predictive value of sonographic classification, a more aggressive approach is recommended only for nodules with category 3.