Prognostic Factors and Scoring Systems for Non-Small Cell Lung Cancer Patients Harboring Brain Metastases Treated with Gamma Knife Radiosurgery / 결핵및호흡기질환

BACKGROUND: The survival of non-small cell lung cancer (NSCLC) patients with brain metastases is reported to be 3~6 months even with aggressive treatment. Some patients have very short survival after aggressive treatment and reliable prognostic scoring systems for patients with cancer have a strong correlation with outcome, often supporting decision making and treatment recommendations. METHODS: A total of one hundred twenty two NSCLC patients with brain metastases who received gamma knife radiosurgery (GKRS) were analyzed. Survival analysis was calculated in all patients for thirteen available prognostic factors and four prognostic scoring systems: score index for radiosurgery (SIR), recursive partitioning analysis (RPA), graded prognostic assessment (GPA), and basic score for brain metastases (BSBM). RESULTS: Age, Karnofsky performance status, largest brain lesion volume, systemic chemotherapy, primary tumor control, and medication of epidermal growth factor receptor tyrosine kinase inhibitor were statistically independent prognostic factors for survival. A multivariate model of SIR and RPA identified significant differences between each group of scores. We found that three-tiered indices such as SIR and RPA are more useful than four-tiered scoring systems (GPA and BSBM). CONCLUSION: There is little value of RPA class III (most unfavorable group) for the same results of 6-month and 1-year survival rate. Thus, SIR is the most useful index to sort out patients with poorer prognosis. Further prospective trials should be performed to develop a new molecular- and gene-based prognostic index model.

Prognostic Factors of Patients Requiring Prolonged Mechanical Ventilation in a Medical Intensive Care Unit of Korea / 결핵및호흡기질환

BACKGROUND: We evaluated the clinical outcomes and prognostic factors of patients requiring prolonged mechanical ventilation (PMV), defined as ventilator care for > or =21 days, who were admitted to the medical intensive care unit (ICU) of a university hospital in Korea. METHODS: During the study period, a total of 2,644 patients were admitted to the medical ICU, and 136 patients (5.1%) were enrolled between 2005 and 2010. RESULTS: The mean age of the patients was 61.3+/-14.5 years, and 94 (69.1%) were male. The ICU and six-month cumulative mortality rates were 45.6 and 58.8%, respectively. There were 96 patients with tracheostomy placement after admission and their mean period from admission to the day of tracheostomy was 21.3+/-8.4 days. Sixty-three patients (46.3%) were successfully weaned from ventilator care. Of the ICU survivors (n=74), 34 patients (45.9%) were transferred to other hospitals (not university hospitals). Two variables (thrombocytopenia [hazard ratio (HR), 1.964; 95% confidence interval (CI), 1.225~3.148; p=0.005] and the requirement for vasopressors [HR, 1.822; 95% CI, 1.111~2.986; p=0.017] on day 21) were found to be independent factors of survival on based on the Cox proportional hazard model. CONCLUSION: We found that patients requiring PMV had high six-month cumulative mortality rates, and that two clinical variables (measured on day 21), thrombocytopenia and requirement for vasopressors, may be associated with prognostic indicators.

Testicular Tuberculosis That Mimicked Testicular Cancer

Next to lymphatic involvement, genitourinary tuberculosis is considered the second most common manifestation of extrapulmonary tuberculosis worldwide. However, testicular and spermatic cord involvement is uncommon. We report here on a case of testicular and spermatic cord tuberculosis that masqueraded as testicular cancer. A 25-year-old man was admitted to our hospital with painless right scrotal swelling for past 2 months. The abdominal CT scan showed a heterogenous testicular mass that was suspicious for being malignancy. He underwent right radical orchiectomy; testicular and spermatic cord tuberculosis was revealed on histopathological examination. This case highlights the importance of taking a thoughtful diagnostic approach for testicular and spermatic cord tuberculosis, including fine needle aspiration before performing surgical exploration.

Maspin Expression and Its Clinical Significance in Non-Small Cell Lung Cancer / 결핵및호흡기질환

BACKGROUND: Maspin (mammary serine protease inhibitor) is a member of the serpin superfamily. A few studies have examined the role of maspin in tumor suppression of non-small cell lung cancer (NSCLC); however, its role in the development and progression of NSCLC still remains controversial. We evaluated the immunohistochemical expression of maspin in order to elucidate its clinical significance in NSCLC. METHODS: We analyzed 145 patients with pathologically confirmed NSCLC, including 66 cases of squamous cell carcinomas (SCCs) and 79 cases of adenocarcinomas (ADCs). We performed a immuno-histochemical stain with maspin and PCNA (proliferating cell nuclear antigen) using tissue microarray blocks. RESULTS: There were 108 men and 37 women in the study population. The mean age of patients in the study was 63.7 years (range, 40.0~82.0; median, 65.0). The proportion of maspin expression was significantly higher in SCCs (52/66, 78.8%; p<0.01) than in ADCs (17/79, 21.5%; p<0.01). Maspin expression was not associated with PCNA (p=0.828), lymph node involvement (p=0.483), or tumor stage (p=0.216), but showed correlation with well-to-moderate tumor differentiation (p=0.012). There was no observed correlation between maspin expression and survival with NSCLC (p=0.218). CONCLUSION: The present study suggests that maspin expression was significantly higher in SCCs than in ADCs and was associated with low histological grade. However, maspin expression was not an independent factor to predict a prognosis in NSCLC.

Outcome of Pandemic H1N1 Pneumonia: Clinical and Radiological Findings for Severity Assessment

BACKGROUND/AIMS: Pandemic influenza A (H1N1) virus infection presents with variable severity. However, little is known about clinical predictors of disease severity. We studied the clinical predictors of severe pandemic H1N1 pneumonia and their correlation with radiological findings. METHODS: We reviewed medical and radiological records of adults with pandemic H1N1 pneumonia. After classification of patients into severe and non-severe groups, the following data were evaluated: demographic data, pneumonia severity index (PSI), CURB65, risk factors, time to first dose of antiviral medication, routine laboratory data, clinical outcome, and radiological characteristics. RESULTS: Of 37 patients with pandemic H1N1 pneumonia, 12 and 25 were assigned to the severe and non-severe groups, respectively. PSI score, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dyhydrogenase (LDH) levels were higher in the severe group than in the non-severe group (p = 0.035, 0.0003, 0.0023, and 0.0002, respectively). AST, ALT, and LDH levels were positively correlated with the radiological findings (p < 0.0001, 0.0003, and < 0.0001, respectively) and with the number of involved lobes (p = 0.663, 0.0134, and 0.0019, respectively). The most common finding on high resolution computed tomography (HRCT) scans was ground-glass attenuation with consolidation (n = 22, 60%), which had a predominantly patchy distribution (n = 31). CONCLUSIONS: We demonstrated a positive correlation between clinical findings, such as serum AST, ALT, and LDH levels, and radiological findings. A combination of clinical and HRCT indicators would be useful in predicting the clinical outcome of pandemic H1N1 pneumonia.

The Effect of Gefitinib on Immune Response of Human Peripheral Blood Monocyte-Derived Dendritic Cells / 결핵및호흡기질환

BACKGROUND: Synergistic antitumor effects of the combined chemoimmunotherapy based on dendritic cells have been reported recently. The aim of this study is to search new applicability of gefitinib into the combination treatment through the confirmation of gefitinib effects on the monocyte derived dendritic cells (moDCs); most potent antigen presenting cell (APC). METHODS: Immature and mature monocyte-derived dendritic cell (im, mMoDC)s were generated from peripheral blood monocyte (PBMC) in Opti-MEM culture medium supplemented with IL-4, GM-CSF and cocktail, consisting of TNF-alpha (10 ng/mL), IL-1beta (10 ng/mL), IL-6 (1,000 U/mL) and PGE2 (1 micro/mL). Various concentrations of gefitinib also added on day 6 to see the influence on immature and mature MoDCs. Immunophenotyping of DCs under the gefitinib was performed by using monoclonal antibodies (CD14, CD80, CD83, CD86, HLA-ABC, HLA-DR). Supernatant IL-12 production and apoptosis of DCs was evaluated. And MLR assay with [3H]-thymidine uptake assay was done. RESULTS: Expression of CD83, MHC I were decreased in mMoDCs and MHC I was decreased in imMoDCs under gefitinib. IL-12 production from mMoDCs was decreased under 10 microM of gefitinib sinificantly. Differences of T cell proliferation capacity were not observed in each concentration of geftinib. CONCLUSION: In spite of decreased expressions of some dendritic cell surface molecules and IL-12 production under 10 microM of gefitinib, significant negative influences of gefitinib in antigen presenting capacity and T cell stimulation were not observed.

Differential Cell Analysis and Lymphocyte Subset Analysis in Bronchoalveolar Lavage Fluid from Patients with Miliary Tuberculosis / 결핵및호흡기질환

BACKGROUND: Bronchoalveolar lavage (BAL) is a useful technique to recover lower airway fluid and cells involved in many respiratory diseases. Miliary tuberculosis is potentially lethal, but the clinical manifestations are nonspecific and typical radiologic findings may not be seen until late in the course of disease. In addition, invasive procedures are often needed to confirm disease diagnosis. This study analyzed the cells and the T-lymphocyte subset in BAL fluid from patients with miliary tuberculosis to determine specific characteristics of BAL fluid that may help in the diagnosis of miliary tuberculosis, using a less invasive procedure. METHODS: On a retrospective basis, we enrolled 20 miliary tuberculosis patients; 12 patients were male and the mean patient age was 40.5+/-16.2 years. We analyzed differential cell counts of BAL fluid and the T-lymphocyte subset of BAL fluid. RESULTS: Total cells and lymphocytes were increased in number in the BAL fluid. The percentage of CD4+ T-lymphocytes and the CD4/CD8 ratio in BAL fluid were significantly decreased and the percentage of CD8+ T-lymphocytes was relatively higher. These findings were more prominent in patients infected with the human immunodeficiency virus (HIV). In the HIV-infected patients, the proportion of lymphocytes was significantly higher in BAL fluid than in peripheral blood. There were no significant differences between the BAL fluid and the peripheral blood T-lymphocytes subpopulation. CONCLUSION: BAL fluid in patients with miliary tuberculosis demonstrated lymphocytosis, a lower percentage of CD4+ T-lymphocytes, a higher percentage of CD8+ T-lymphocytes, and a decreased CD4/CD8 ratio. These findings were more significant in HIV-infected subjects.

Risk Factors Associated with Frequent Hospital Readmissions for Exacerbation of COPD / 결핵및호흡기질환

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea. METHODS: A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge. RESULTS: During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) 36 months, forced expiratory volume in 1 second (FEV1) 40 mm Hg, and arterial oxygen saturation (SaO2) 40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD. CONCLUSION: Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.

Depressive Conditions in Relation to Asthma Severity and Control / 결핵및호흡기질환

BACKGROUND: Psychological factors are increasingly recognized for their influence on the course of asthma, on a worldwide basis. The aim of this study was to assess the presence of depression, anxiety, and asthma-related quality of life in patients with asthma and to evaluate their impact on severity and control of asthma. METHODS: We assessed the severity of asthma by comparing patients' current medications to GINA guideline. The patients were classified into the controlled group (asthma patients with controlled disease) or into the uncontrolled group (asthma patients with uncontrolled disease), which included partly controlled and uncontrolled patients, again based on GINA guideline 2004. Patient-reported depressive symptoms, anxiety, and asthma-related quality of life were evaluated using the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and Korean asthma quality of life (KAQLQ). RESULTS: One hundred and twenty patients were enrolled (mean age, 55+/-1 years; 65% women). Among the 120 patients, 14 (12%) patients were classified as having mild asthma, 88 (73%) as having moderate asthma, and 18 (15%) as having severe asthma. Eighty-one (67%) of the 120 patients were controlled. The asthma-related quality of life showed the difference according to severity of asthma (p=0.002). The prevalence of depression was lower (10% vs 26%, p=0.024) and the asthma-related quality of life was higher (59.951 (29~75) vs 35.103 (18~72), p< or =0.001) in the controlled group. Higher trait anxiety score and lower asthma-related quality of life were associated with depression (p<0.001, p=0.002, respectively). CONCLUSION: Psychological factors, such as anxiety and depression, are strongly associated with asthma control. Therefore, screening and management of depression is needed in patients with asthma.

The First Case of Novel Influenza A (H1N1) Fatality in Korea / 결핵및호흡기질환

Here we report the first fatality caused by H1N1 influenza virus infection with acute respiratory distress syndrome in Korea. A 55-year-old man presented at our emergency department with dyspnea, fever, diffuse myalgia and malaise. Bilateral lung air-space consolidation was detected on his initial chest radiograph combined with severe hypoxemia. He was supported by mechanical ventilation and treated with antibiotics. A nasopharyngeal aspirate was positive for influenza A rapid antigen and oseltamivir was started on day 3 of admission. The nasal swab sample was positive for influenza H1N1 virus by real-time reverse-transcriptase polymerase chain reaction. Despite aggressive treatment, he had refractory hypoxemia and uncontrolled septic shock. On day 5 of admission he went into cardiac arrest and expired.

Pulmonary choriocarcinoma presenting as multiple centrilobular nodules / 대한내과학회지

Choriocarcinoma, a type of germ cell tumor, follows molar pregnancy and gestational events, including abortion and ectopic pregnancy, with significantly elevated serum human chorionic gonadotropin (HCG) levels. Choriocarcinoma is rare, but very aggressive. The most common sites of metastatic involvement are the lung, vagina, and pelvic organs. We report the case of a 54-year-old woman with choriocarcinoma metastatic to the lung, with significant elevation of the serum HCG (>1,000,000 mIU/mL). Chest computed tomography (CT) on admission revealed multiple centrilobular nodules. The pathological examination of the specimen revealed tumor cell emboli in the pulmonary artery.

A Case of Churg-Strauss Syndrome with Diffuse Alveolar Hemorrhage Presenting as Acute Acalculous Cholecystitis / 결핵및호흡기질환

Churg-Strauss syndrome (CSS) is a disorder that is characterized by asthma, hypereosinophilia and systemic vasculitis affecting a number of organs. The manifestations of acute cholecystitis and diffuse alveolar hemorrhage are rarely reported in CSS. A 22-year-old woman with bronchial asthma visited our hospital complaining of right upper quadrant pain with a sudden onset. The abdominal computed tomography (CT) scan revealed gall bladder edema consistent with acute cholecystitis. On the initial evaluation, marked hypereosinophilia was observed in the peripheral blood smear. The nerve conduction velocity measurements and a skin biopsy performed to confirm the organ involvement of disease indicated typical mononeuritis multiplex and necrotizing vasculitis, respectively, which was complicated with CSS. On the 12th hospital day, ground glass opacity and consolidations were newly developed on both lung fields. The bronchoalveolar lavage (BAL) fluid showed increasing bloody return in sequential aliquots that were characteristic of a diffuse alveolar hemorrhage. We report a case of CSS with acute cholecystitis and diffuse alveolar hemorrhage.

Association between Bone Marrow Hypermetabolism on (18)F-Fluorodeoxyglucose Positron Emission Tomography and Response to Chemotherapy in Non-Small Cell Lung Cancer / 결핵및호흡기질환

BACKGROUND: (18)F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used for the diagnosis and staging of non-small cell lung cancer (NSCLC). The aim of this study is to determine whether the bone marrow hypermetabolism seen on FDG-PET predicts a response to chemotherapy in patients with NSCLC. METHODS: We evaluated the patients with advanced NSCLC and who were treated with combination chemotherapy. For determination of the standardized uptake value (SUV) of the bone marrow (BM SUV) on FDG-PET, regions of interest (ROIs) were manually drawn over the lumbar vertebrae (L1, 2, 3). ROIs were also drawn on a homogenous transaxial slice of the liver to obtain the bone marrow/ liver SUV ratio (BM/L SUV ratio). The response to chemotherapy was evaluated according to the Response Evaluation Criteria in Solid Tumor (RECIST) criteria after three cycles of chemotherapy. RESULTS: Fifty-nine NSCLC patients were included in the study. Multivariate analysis was performed using a logistic regression model. The BM SUV and the BM/L SUV ratio on FDG-PET were not associated with a response to chemotherapy in NSCLC patients (p=0.142 and 0.978, respectively). CONCLUSION: The bone marrow hypermetabolism seen on FDG-PET can not predict a response to chemotherapy in NSCLC patients.

Pilomatrix Carcinoma with Lung and Lymph Node

Metastases Pilomatrix carcinoma is a rare locally aggressive hair-follicle tumor. We report a 54-year-old man who presented with a tumor in the left flank that was found by skin biopsy to be pilomatrix carcinoma. A contrast-enhanced computed tomographic scan of the chest, abdomen, and pelvis showed multiple small nodules in both lungs and lymphadenopathy in the abdomen. Video-assisted thoracoscopic biopsy of the lung lesions was consistent with metastatic pilomatrix carcinoma. After intravenous cisplatin and 5-fluorouracil, the skin, lung, and lymph node lesions shrank

Clinical Features of Thymic Epithelial Tumors / 결핵및호흡기질환

BACKGROUND: Thymic epithelial tumors are the most common tumors affecting the anterior mediastinum. The aim of this study is to investigate clinical features of the patients who were diagnosed with thymic epithelial tumors at Pusan National University Hospital. METHODS: We retrospectively reviewed the records of thirty-seven patients who were diagnosed with thymic epithelial tumors from Jan. 1997 to Jan. 2007. The pathological classification and clinical stage of the thymic epithelial tumors were based on the WHO classification and Masaoka's staging system. A total 37 patients were enrolled: 23 were males and 14 were females, and their mean age was 51.3 years. RESULTS: Thirty patients presented symptoms at the time of diagnosis and their symptoms were as follows: chest pain (53%), dyspnea (23%), and cough (17%). Myasthenia gravis was diagnosed in five patients. With respect to the tumor staging, three cases (8%) were stage I, 10 cases (28%) were stage II, 12 cases (32%) were stage III, 6 cases (16%) were stage IVA and 6 cases (16%) were stage IVB. Twenty-four cases (67%) displayed stage III or IV disease. The pathological types according to the WHO classification were as follows: B1 (32%), C (23%), B3 (20%), B2 (16%), AB (6%) and A (3%). Twenty-four patients underwent thymothymectomy and four of these patients relapsed. Stage III or type B3 was common in the relapsed patients. Five patientsexpired. Stage IV or type B3 and C were common in the expired patients. CONCLUSION: In this study, stage III or IV disease and type B3 or C were common at the time of diagnosis and these findings might contribute to postoperative recurrence and a poor outcome.

Relations between Polymorphism of NRAMP1 Gene and Susceptibility to Pulmonary Tuberculosis / 결핵및호흡기질환

Background: Several lines of evidence suggest that a host's genetic factors influence the outcome of exposure to Mycobacterium tuberculosis. The aim of this study was to determine whether polymorphism in NRAMP1 (natural resistance associated macrophage protein 1) gene is associated with the susceptibility or resistance to tuberculosis infection for patients with drug-sensitive pulmonary tuberculosis (DS-TB) and multi-drug resistant pulmonary tuberculosis (MDR-TB). Methods: Eight genetic polymorphisms of the NRAMP1 gene were investigated in patients suffering with DS-TB (n=100) or MDR-TB (n=102), and in healthy normal controls (NC, n=96). The genetic polymorphisms of NRAMP1 were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The frequency of D543N A/G heterogygotes was significantly higher in the DS-TB subjects than the NCs (OR=2.10, 95% CI: 1.00 to 4.41, p=0.049). The frequency of 823C/T T/C heterozygotes was significantly higher in the DS-TB subjects (OR=2.79, 95% CI: 1.11 to 7.04, p=0.029) and the MDR-TB subject (OR=3.30, 95% CI 1.33 to 8.18, p=0.010) than in the NCs. However, the frequency of these genotypes was not different between the DS-TB and MDR-TB subjects. Conclusion: A significant association was found between NRAMP1 823 C/T polymorphism and pulmonary tuberculosis. This result suggests that NRAMP1 polymorphism may be involved in the development of pulmonary tuberculosis in Koreans.

Two Cases of Benign Solitary Schwannoma with Pleural Effusion / 결핵및호흡기질환

Schwannoma represents approximately 40% of neurogenic tumors arising in the mediastinum, and develops along the sympathetic or parasympathetic chain, intercostals nerve, and spinal ganglia. It is usually asymptomatic, and is confronted accidentally but can produce chest pain, cough and dyspnea. However, dyspnea with pleural effusion is rare in patients with benign schwannoma. We encountered two cases of benign schwannoma with pleural effusion. Both cases had similar initial symptoms and the characteristics of a mass but the characteristics of pleural effusion analysis were different. The benign schwannoma was confirmed in two cases using VATS (video-assisted tharawswpic surgery).

A case of spontaneous pneumomediastinum caused by endobronchial tuberculosis / 대한내과학회지

Spontaneous pneumomediastinum is a benign condition, caused by alveolar rupture and associated with many clinical conditions. There are numerous reports of spontaneous pneumomediastinum associated with various origins such as bronchial asthma, labor and a mechanically obstructed airway. A 20-year old woman visited our outpatient clinic because of a productive cough and dyspnea. A pneumomediastinum was seen on the chest radiograph and acid fast bacilli were observed on the sputum study. Endobronchial tuberculosis was diagnosed by bronchoscopy and improved with antituberculous treatment. Here, we report a case of spontaneous pneumomediastinum as a complication of endobronchial tuberculosis and review the medical literature.

Application of Noninvasive Positive Pressure Ventilation in Patients with Respiratory Failure / 결핵및호흡기질환

BACKGROUND: Noninvasive positive pressure ventilation(NPPV) has been increasingly used over the past decade in the management of acute or chronic respiratory failure and weaning of mechanical ventilation. We performed this clinical study to evaluate the usefulness of NPPV in patients who developed acute respiratory failure or post-extubation respiratory failure. METHODS: We analysed thirty four patients(sixteen males and eighteen females, mean ages 58 years) who applied NPPV(BIPAP S/T, Respironics co., USA) for respiratory failure or weaning difficulty at medical intensive care unit(MICU), emergency room and general ward of a tertiary hospital. We evaluated the underlying causes of respiratory failure, duration of treatment, the degree of adaptation, complication and predictive parameters of successful outcome. RESULTS: The overall success rate of NPPV was seventy-one percent. The duration of NPPV applying time, baseline blood pressure, pulse rate, respiration rate, PaO2, PaCO2, SaO2 were not different between success group and failure group. But, the baseline pH was higher in the success group. Predictors of success were higher baseline pH, patients with underlying disease of COPD, improvement of vital sign and arterial blood gas value after NPPV application. The success rate in patients with post-extubation respiratory failure was eighty percent. There were no serious complication on applying NPPV except minor complications such as facial skin erythema, abdominal distension & dry mouth. CONCLUSION: NPPV may be effective treatment in patients with acute respiratory failure or post-extubation respiratory failure in selected cases.

The Prognostic Role of B-type Natriuretic Peptide in Acute Pulmonary Thromboembolism / 결핵및호흡기질환

BACKGROUND: Vital stability and right side heart failure are major prognostic factors of acute pulmonary thromboembolism. While it is important to recognize right side heart failure, it is often difficult in real practice. Recently, several studies have described early diagnostic tools for detecting right side heart failure including echocardiography and biochemical markers. This study, we evaluated the prognostic role of the B-type natriuretic peptide (BNP) in an acute pulmonary thromboembolism. METHODS: Thirty-four patients with a diagnosis of acute pulmonary thromboembolism were enrolled in the study. The BNP levels were measured and echocardiography was performed at the Emergency Department. Data on the prognostic factors including ventilatory support, vital stability, pulmonary artery pressure, degree of tricuspid valve regurgitation, complications and death was collected from the patients' medical records. The patients with an acute pulmonary thromboembolism were divided into two groups based on the vital stability and the BNP level and the cutoff values and prognostic factors of the two groups were compared. RESULTS: The predictors of the vital stability that influence the prognosis of patients with acute pulmonary thromboembolism were the BNP level, ventilatory support and death. The plasma BNP levels showed a strong correlation with the vital stability, ventilatory support, thrombolytic therapy and death. When the BNP cutoff level was set to 377.5 pg/dl in a ROC curve, the sensitivity and the specificity for differentiating between the groups with stable or unstable vital signs was 100% and 90%, respectively. CONCLUSION: This study indicates that a measurement of the plasma BNP levels may be a useful prognostic marker in patients with an acute pulmonary thrombo-embolism.