Thrombocytopenia represents a risk for deterioration of liver function after radiofrequency ablation in patients with hepatocellular carcinoma

BACKGROUND/AIMS: We evaluated changes in liver function parameters and risk factors for the deterioration of liver function 12 months after percutaneous radiofrequency ablation (RFA) therapy in patients with hepatocellular carcinoma (HCC). METHODS: The subjects in this retrospective study comprised 102 patients with HCC who had undergone RFA therapy and exhibited no recurrence of HCC 12 months thereafter. Serial changes in serum total bilirubin and albumin, prothrombin time, and Child-Pugh score were evaluated before RFA and 3, 6, 9, and 12 months thereafter. Deterioration of liver function was defined when the Child-Pugh score increased by at least 2 at 12 months after RFA therapy. We determined the factors related to aggravation of liver function after RFA therapy. RESULTS: Liver function had deteriorated 12 months after RFA in 29 patients (28.4%). Serum albumin levels decreased significantly from before (3.7+/-0.1 g/dL, mean+/-SD) to 12 months after RFA therapy (3.3+/-0.1 g/dL, P=0.002). The Child-Pugh score increased significantly during the same time period (from 6.1+/-0.2 to 7.2+/-0.3, P<0.001). Pre-RFA thrombocytopenia (< or =100,000/mm3) was revealed as a significant risk factor for the deterioration of liver function after RFA. However, no patients had episodes of bleeding as a complication of RFA. CONCLUSIONS: Among the liver-function parameters, serum albumin level was markedly decreased in HCC patients over the course of 24 months after RFA therapy. A pre-RFA thrombocytopenia represents a major risk factor for the deterioration of liver function.

Monoclonal Proteinuria as a Prognostic Factor for Multiple Myeloma Patients with Intact Immunoglobulin Type

BACKGROUND: Urine/serum protein electrophoresis (PEP) and immunofixation electrophoresis (IEP) for monoclonal protein (M-protein) are used for initial evaluation in patients with multiple myeloma. We evaluated the prognostic significance of M-proteinuria status and its association with other prognostic factors. METHODS: Between December 2002 and December 2004, 64 de novo symptomatic multiple myeloma patients with intact immunoglobulin (Ig) type were divided into two groups according to their initial urine PEP/IEP findings. RESULTS: Twenty-seven patients with undetectable or free light-chains only were classified into F group, and 37 with whole Ig with or without light-chains were classified into W group. The two groups were similar in sex, age, performance, azotemia, beta2-microglobulin, stage and treatment, but M-protein concentration was significantly higher in the W than in F group (5.1 vs 1.3g/dL, P<0.01). The overall response rate was significantly higher in F group than in W group (80.8% vs 63.6%, P=0.02), whereas the 2-year OS rate did not differ significantly between the groups (81.0% vs 57.7%, P=0.15). CONCLUSION: Monoclonal proteinuria is helpful in identifying patients with advanced disease and poorer prognosis in multiple myeloma.

A case of lactic acidosis caused by thiamine deficiency / 대한내과학회지

Lactic acidosis commonly occurs in association with shock. We encountered lactic acidosis in a patient with normal blood pressure. The patient was a 17 year-old man with acute lymphocytic leukemia. He was admitted for bone marrow transplantation. During hospitalization, he relied on total parenteral nutrition due to his poor oral intake. On the 37th day after admission, he developed lactic acidosis without an episode of hypotension or any causative medication. Because vitamins were not included in the parenteral nutrition, we prescribed thiamine replacement, and this corrected the acidosis within a few hours. Thiamine (in its active derivative) is a coenzyme for pyruvate dehydrogenase; thus, its deficiency causes accumulation of pyruvate and lactate. This case suggests that thiamine deficiency should be included in a differential diagnosis of lactic acidosis in patients who are on total parenteral nutrition without vitamin supplementation.

Postoperative Outcomes of Patients with Severe Aortic Regurgitation and Decreased Left Ventricular Ejection Fraction

BACKGROUND AND OBJECTIVES: The postoperative outcomes of patients with severe aortic regurgitation (AR) and a low ejection fraction (EF) were elucidated. SUBJECTS AND METHODS: The study group consisted of 201 consecutive patients that underwent corrective surgery for isolated AR. The clinical data of patients with a preoperative EF or =50% (n=142, group II) were compared. The clinical follow-up duration was 3.2+/-2.4 years. RESULTS: There was no operative mortality for patients in both groups. Group I patients showed significant improvement of the EF after surgery, from 41+/-6% to 53+/-12% (p<0.001) and the EF (53+/-12 vs 56+/-1%, p=0.09) at follow-up was not significantly different between patients in the two groups. The 5-year survival rate was 70.5+/-8.9% for group I patients and 88.0+/-3.5% for group II patients (p=0.06). The cumulative incidence of congestive heart failure at 5 years was significantly higher in group I patients (32.1+/-9.7% vs 8.5+/-3.1%, p=0.003). Independent determinants of development of congestive heart failure in group I patients were age [hazards ratio (HR)=1.1, 95% confidence interval (CI)=1.02-1.16, p=0.01] and EF (HR=0.82, 95% CI=0.69-0.97, p=0.02). The best cut-off value of the preoperative EF in predicting the development of congestive heart failure was 41.5%, with a sensitivity and specificity of 90.9% and 68.9%, respectively. CONCLUSION: A relatively high 5-year survival rate without operative mortality is anticipated in patients with reduced a preoperative left ventricular ejection fraction (LVEF) and the incidence of congestive heart failure was higher when compared to patients with a normal preoperative LVEF, which could be predicted by the level of the preoperative LVEF.

A Case of Actinobacillus actinomycetemcomitans Bacteremia Associated with Permanent Pacemaker Lead Infection / 감염과화학요법

A 73-year-old man was admitted for intermittent episodes of fever and chills for 3 months. He had been implanted with a permanent pacemaker to control tachy-bradycardia syndrome 7 months before admission. Blood cultures were positive for Actinobacillus actinomycetemcomitans and a 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) WBC scan revealed inflammation on the pacemaker lead in extracardiac site. Oral examination revealed several dental caries. The patient was treated with intravenous ceftriaxone, followed by oral ciprofloxacin without removal of the infected pacemaker lead. He was doing well 10 months without febrile episodes after discontinuation of antibiotics. This report describes the first case of A. actinomycetemcomitans bacteremia associated with a pacemaker lead and localized by 99mTc-HMPAO WBC scan

In Vitro Activities of Isepamicin and Other Aminoglycosides against Gram-Negative Organisms / 감염과화학요법

BACKGROUND: The increasing incidence of multidrug-resistant gram-negative bacteria causing nosocomial infections is an important clinical problem. Isepamicin is a recently developed aminoglycoside which has been known to have potent activity against gram-negative organisms. We evaluated the in vitro activities of isepamicin and other aminoglycosides against a large number of gram-negative organisms. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of isepamicin, amikacin, gentamicin, and tobramycin against 566 gram-negative organisms collected between January 2006 and June 2006 in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined and interpreted according to the recommendations of Clinical and Laboratory Standard Institute (CLSI). The breakpoint MIC used for interpretation of isepamicin was MIC or =64 microgram/mL as resistant. RESULTS: The MIC50/MIC90 of isepamicin for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter cloacae were 1/2, 0.5/>128, 4/16, 16/>128, and 1/2 microgram/mL, respectively. The susceptibilities for E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, and E. cloacae were 100%, 86.4%, 89.7%, 50.0%, and 96.6%, respectively. For E. coli, K. pneumoniae, P. aeruginosa, and E. cloacae, isepamicin had better in vitro activities than gentamicin and tobromycin, and had similar activities with amikacin. For A. baumanii, all four tested aminoglycosides had similar in vitro activities. CONCLUSION: Isepamicin had excellent in vitro activities against gram-negative organisms, except A. baumanii. The overall in vitro activities were similar with amikacin.

Retraction: A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient. Infection and Chemotherapy 2006;38(5):290-295 / 감염과화학요법

We have submitted and published the above paper in Infection and Chemotherapy this October 2006. After the publication, we noticed that identical case was already reported in other journal (The Korean Journal of Laboratory Medicine 2005;25(6):421-424). We hereby regret to have to retract the paper.

A Case of Actinobacillus actinomycetemcomitans Bacteremia Associated with Permanent Pacemaker Lead Infection / 감염과화학요법

A 73-year-old man was admitted for intermittent episodes of fever and chills for 3 months. He had been implanted with a permanent pacemaker to control tachy-bradycardia syndrome 7 months before admission. Blood cultures were positive for Actinobacillus actinomycetemcomitans and a 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) WBC scan revealed inflammation on the pacemaker lead in extracardiac site. Oral examination revealed several dental caries. The patient was treated with intravenous ceftriaxone, followed by oral ciprofloxacin without removal of the infected pacemaker lead. He was doing well 10 months without febrile episodes after discontinuation of antibiotics. This report describes the first case of A. actinomycetemcomitans bacteremia associated with a pacemaker lead and localized by 99mTc-HMPAO WBC scan

In Vitro Activities of Isepamicin and Other Aminoglycosides against Gram-Negative Organisms / 감염과화학요법

BACKGROUND: The increasing incidence of multidrug-resistant gram-negative bacteria causing nosocomial infections is an important clinical problem. Isepamicin is a recently developed aminoglycoside which has been known to have potent activity against gram-negative organisms. We evaluated the in vitro activities of isepamicin and other aminoglycosides against a large number of gram-negative organisms. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of isepamicin, amikacin, gentamicin, and tobramycin against 566 gram-negative organisms collected between January 2006 and June 2006 in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined and interpreted according to the recommendations of Clinical and Laboratory Standard Institute (CLSI). The breakpoint MIC used for interpretation of isepamicin was MIC or =64 microgram/mL as resistant. RESULTS: The MIC50/MIC90 of isepamicin for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter cloacae were 1/2, 0.5/>128, 4/16, 16/>128, and 1/2 microgram/mL, respectively. The susceptibilities for E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, and E. cloacae were 100%, 86.4%, 89.7%, 50.0%, and 96.6%, respectively. For E. coli, K. pneumoniae, P. aeruginosa, and E. cloacae, isepamicin had better in vitro activities than gentamicin and tobromycin, and had similar activities with amikacin. For A. baumanii, all four tested aminoglycosides had similar in vitro activities. CONCLUSION: Isepamicin had excellent in vitro activities against gram-negative organisms, except A. baumanii. The overall in vitro activities were similar with amikacin.

Retraction: A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient. Infection and Chemotherapy 2006;38(5):290-295 / 감염과화학요법

We have submitted and published the above paper in Infection and Chemotherapy this October 2006. After the publication, we noticed that identical case was already reported in other journal (The Korean Journal of Laboratory Medicine 2005;25(6):421-424). We hereby regret to have to retract the paper.

A Case of Infective Endocarditis due to Staphylococcus lugdunensis / 감염과화학요법

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) that is commonly found on the human perineal skin. Contrary to other CNS, S. lugdunensis is a rare contaminant in cultures and has the potential to cause clinically significant infections, including infective endocarditis. Infective endocarditis due to S. lugdunensis have been known to resemble endocarditis due to S. aureus because of its aggressive clinical course and high mortality. We report a case of infective endocarditis caused by S. lugdunensis in a 21-year-old woman. She was cured of the infection with surgical and antibiotic therapy.

A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient / 감염과화학요법

Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.

A Case of Infective Endocarditis due to Staphylococcus lugdunensis / 감염과화학요법

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) that is commonly found on the human perineal skin. Contrary to other CNS, S. lugdunensis is a rare contaminant in cultures and has the potential to cause clinically significant infections, including infective endocarditis. Infective endocarditis due to S. lugdunensis have been known to resemble endocarditis due to S. aureus because of its aggressive clinical course and high mortality. We report a case of infective endocarditis caused by S. lugdunensis in a 21-year-old woman. She was cured of the infection with surgical and antibiotic therapy.

A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient / 감염과화학요법

Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.

Skin Necrosis after a Low-Dose Vasopressin Infusion through a Central Venous Catheter for Treating Septic Shock

This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to norepinephrine, was controlled by an infusion of low-dose vasopressin (0.02 unit/min) through a central venous catheter into the right subclavian vein. After the infusion of low-dose vasopressin, severe skin necrosis with bullous changes developed, necessitating discontinuation of the low-dose vasopressin infusion. The patient expired from refractory septic shock. Although low-dose vasopressin can control hypotension in septic shock patients, low-dose vasopressin must be used with caution because ischemic complications such as skin necrosis can develop even with administration through a central venous catheter.