Résumé
Thrombocytosis and coagulation systems activation are commonly associated with disease progression and are suggested poor prognostic factors in patients with malignancies. This study aimed to investigate the prevalence and prognostic significance of thrombocytosis and elevated fibrinogen levels in patients with advanced non-small cell lung cancer (NSCLC). Initial platelet counts and fibrinogen levels were reviewed in 854 patients with histologically proven NSCLC. Thrombocytosis was defined as platelet counts > 450 x 10(9)/L. A serum fibrinogen level > 4.5 g/L was considered high. At the time of diagnosis, initial platelet counts and serum fibrinogen levels were evaluated before treatment. Clinicopathologic data including histological type, tumor, node, metastasis (TNM) stage, performance status, treatment method, and survival time were evaluated. Initial thrombocytosis was found in 6.9% of patients, and elevated fibrinogen levels were found in 55.1% of patients. Patients with thrombocytosis had a significantly poorer prognosis than patients with normal platelet counts (P < 0.001). In multivariate survival analysis, thrombocytosis was an independent prognostic factor (P < 0.001). An elevated serum fibrinogen level was associated with poor prognosis (P < 0.001). In conclusion, initial thrombocytosis and a high fibrinogen level are independent factors for predicting poor prognosis in patients with advanced NSCLC.
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Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Plaquettes/cytologie , Carcinome pulmonaire non à petites cellules/diagnostic , Fibrinogène/analyse , Tumeurs du poumon/diagnostic , Stadification tumorale , Numération des plaquettes , Pronostic , Études rétrospectives , Taux de survie , Thrombocytose/complicationsRésumé
PURPOSE: The aim of this study was to elucidate the effects of immunocompromising comorbidities on treatment response and adverse reactions in older tuberculosis (TB) patients. MATERIALS AND METHODS: The medical records of 182 patients older than 65 years with proven TB by positive culture of Mycobacterium tuberculosis and with available drug susceptibility tests were reviewed retrospectively. These patients were subsequently assigned to either the comorbidity group (n=78) or non-comorbidity group (n=104) depending on whether they had immunocompromising comorbidities. RESULTS: The mean durations of treatment were 9.9+/-3.3 months in the comorbidity group and 9.3+/-3.2 months in the non-comorbidity group (p=0.21). M. tuberculosis culture results converted to negative in most patients with available follow-up cultures at two months after treatment. The successful treatment rates were 94.9% and 98.9% in the comorbidity and non-comorbidity groups, respectively (p=0.30). The most common side effects of anti-TB treatment were skin rash/pruritus (13% in the comorbidity group vs. 11% in the non-comorbidity group, p=0.79), gastro-intestinal problems (14% vs. 9%, p=0.25) and hepatotoxicity (14% vs. 7%, p=0.09). CONCLUSION: The present study shows that the successful treatment rate for TB is high and that immunocompromising comorbidities have no effect on the response to treatment and adverse effects in older TB patients.
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Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Facteurs âges , Antituberculeux/effets indésirables , Comorbidité , Sujet immunodéprimé , Isoniazide/effets indésirables , Études rétrospectives , Rifampicine/effets indésirables , Facteurs de risque , Résultat thérapeutique , Tuberculose/traitement médicamenteuxRésumé
Microscopic anthracotic pigment (MAP) is frequently observed in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimen in non-small cell lung cancer, but its clinical interpretation is not well-known. The aim of this study was to evaluate the clinical implication of MAP in mediastinal staging of non-small cell lung cancer. From May 2010 to July 2011, consecutive potentially operable non-small cell lung cancer patients who underwent EBUS-TBNA for mediastinal staging were recruited. Of the total 133 patients, 102 (76.7%) were male patients. Median age was 68 yr. Total 279 mediastinal lymph nodes were sampled by EBUS-TBNA; station 4R (100, 35.8%) and station 7 (86, 30.8%) were the most common sites. Malignant lymph nodes were 100 (35.8%). MAP was observed in 61 (21.7%) lymph nodes, and among them only 3 were malignant lymph nodes (P < 0.001). The lymph nodes with MAP were smaller (9.0 vs 10.8 mm, P = 0.001) and showed low standard uptake values on FDG-PET (4.4 vs 4.7, P = 0.256). In multivariate analysis, MAP was negatively associated with malignant lymph node (adjusted OR, 0.12; 95% CI, 0.03-0.42; P < 0.001). In potentially operable non-small cell lung cancer patients, MAP in endobronchial ultrasound-guided transbronchial needle aspiration specimens is strongly associated with benign mediastinal and hilar lymph nodes.
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Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Bronchoscopie , Carbone/composition chimique , Carcinome pulmonaire non à petites cellules/anatomopathologie , Cytoponction sous échoendoscopie , Tumeurs du poumon/anatomopathologie , Noeuds lymphatiques/anatomopathologie , Métastase lymphatique , Tumeurs du médiastin/anatomopathologie , Analyse multifactorielle , Stadification tumorale , Tomographie par émission de positonsRésumé
BACKGROUND/AIMS: Many studies have investigated angina and its relationship with chronic obstructive pulmonary disease (COPD). However, angina was diagnosed only by noninvasive tests or only by clinical symptoms in most of these studies. The aim of this study was to compare the prognosis, including rate of hospitalization and death from significant coronary artery lesion and nonsignificant coronary artery lesion angina, in patients with COPD. METHODS: Patients with COPD who underwent coronary angiography (CAG) due to angina were reviewed retrospectively at a tertiary referral hospital. COPD is defined as post-bronchodilator forced expiratory volume in 1 sec/forced vital capacity (FEV1/FVC) of < 70%. A significant coronary lesion is defined as at least 50% diameter stenosis of one major epicardial artery in CAG. RESULTS: In total, 113 patients were enrolled. Mean follow-up duration was 39 +/- 21 months. Of the patients, 52 (46%) had mild COPD and 48 (42%) had moderate COPD. Sixty-nine (61%) patients had significant stenosis in CAG. The death rate in the follow-up period was 2.21 per 100 patient-years. No significant difference was observed among the all-cause mortality rate, admission rate, or intensive care unit admission rate in patients who had COPD with or without significant coronary artery disease. Pneumonia or acute exacerbation of COPD was the most common cause of admission. CONCLUSIONS: In patients having COPD with angina who underwent CAG, no significant difference was observed in mortality or admission events depending on the presence of a significant coronary artery lesion during the 2-year follow-up period.
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Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Angine de poitrine/étiologie , Loi du khi-deux , Coronarographie , Sténose coronarienne/complications , Volume expiratoire maximal par seconde , Hospitalisation , Estimation de Kaplan-Meier , Poumon/physiopathologie , Pronostic , Broncho-pneumopathie chronique obstructive/complications , République de Corée , Études rétrospectives , Appréciation des risques , Facteurs de risque , Indice de gravité de la maladie , Spirométrie , Facteurs temps , Capacité vitaleRésumé
BACKGROUND/AIMS: Early diagnosis and appropriate antimicrobial choice are crucial when managing pneumonia patients, and quantitative culture of bronchoalveolar lavage (BAL) fluid is considered a useful method for identifying pneumonia pathogens. We evaluated the quantitative yield of BAL fluid bacterial cultures in patients being treated with antimicrobials and attempted to identify factors predictive of positive BAL cultures. METHODS: Patients over 18 years old and whose BAL fluid was subjected to quantitative culture to identify the organism causative of pneumonia between January 1, 2005, and December 31, 2009, were included. We reviewed the results of BAL fluid bacterial cultures and the clinical records, laboratory tests, and radiographic findings of the patients. RESULTS: BAL was performed on 340 patients with pneumonia. A positive BAL culture, defined as isolation of more than 10(4) colony forming units/mL bacteria, was documented in 18 (5.29%) patients. Of these, 9 bacteria isolated from 10 patients were classified as probable pathogens. The most frequently isolated bacteria were methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa. No independent predictive factor for positive BAL cultures was identified. CONCLUSIONS: The yield of quantitative BAL fluid bacterial culture in patients already on antimicrobials was low. Clinicians should be cautious when performing a BAL culture in patients with pneumonia who are already on antimicrobials.
Sujets)
Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Anti-infectieux/usage thérapeutique , Bactéries/classification , Lavage bronchoalvéolaire , Liquide de lavage bronchoalvéolaire/microbiologie , Bronchoscopie , Loi du khi-deux , Numération de colonies microbiennes , Multirésistance bactérienne aux médicaments , Modèles logistiques , Tests de sensibilité microbienne , Pneumopathie bactérienne/diagnostic , Valeur prédictive des tests , République de Corée , Études rétrospectives , Résultat thérapeutiqueRésumé
Radiographic lesions suggesting old healed tuberculosis (TB) is considered a risk factor for the subsequent development of active TB. The aim of this study was to estimate the positive rates of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) in persons with old healed TB. Participants with lesions suggesting old healed TB on chest images and controls without such lesions were prospectively enrolled between January 1, 2010, and January 31, 2011. TST and the QuantiFERON-TB Gold In-Tube test (QFT-GIT) were performed. In total, 193 participants with old healed TB and 126 controls were recruited. The rates of positive TST and QFT-GIT among patients with old healed TB were 54.6% and 77.7%, respectively. The rates of positive TST and QFT-GIT among patients without old healed TB were 38.9% and 61.9%. Sixteen percent of participants with old healed TB showed negative results by both TST and QFT-GIT. The positive rate of TST waned among participants with old healed TB who were older than 60 yr, whereas QFT-GIT positivity was unaffected by age. The positive rates of TST and IGRA among participants with radiographic lesions suggesting old healed TB was higher than without those lesions. In addition, IGRA may be more accurate than TST for the detection of latent TB infection, especially in populations of individuals older than 60 yr.
Sujets)
Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Facteurs âges , Tests de libération d'interféron-gamma , Études prospectives , Facteurs de risque , Test tuberculinique , Tuberculose/diagnosticRésumé
The purpose of this study was to investigate the long-term clinical course of non-specific interstitial pneumonia (NSIP) and to determine which factors are associated with a response to steroid therapy and relapse. Thirty-five patients with pathologically proven NSIP were included. Clinical, radiological, and laboratory data were reviewed retrospectively. The male-to-female ratio was 7:28 (median age, 52 yr). Thirty (86%) patients responded to steroid therapy, and the median follow-up was 55.2 months (range, 15.9-102.0 months). Five patients (14%) showed sustained disease progression and three died despite treatment. In the five with sustained disease progression, NSIP was associated with various systemic conditions, and the seropositivity of fluorescent antinuclear antibody was significantly associated with a poor response to steroids (P = 0.028). The rate of relapse was 25%, but all relapsed patients improved after re-treatment. The initial dose of steroids was significantly low in the relapse group (P = 0.020). In conclusion, progression is associated with various systemic conditions in patients who show progression. A low dose of initial steroids is significantly associated with relapse.
Sujets)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Anticorps antinucléaires/sang , Études de suivi , Pneumopathies interstitielles idiopathiques/traitement médicamenteux , Pneumopathies interstitielles/traitement médicamenteux , Pronostic , Récidive , Études rétrospectives , Stéroïdes/usage thérapeutiqueRésumé
BACKGROUND/AIMS: Home oxygen therapy (HOT) costs a great deal every year and demand for the service is growing. In Korea, health insurance has covered HOT since November 1, 2006. The objective of this study was to evaluate clinical features of patients who used long-term HOT due to chronic respiratory failure and to determine the appropriateness of oxygen prescriptions. METHODS: Between November 2006 and April 2010, patients prescribed long-term HOT were enrolled in the study at a tertiary university referral hospital and their medical records and telephone survey information were evaluated. In total, 340 patients were evaluated retrospectively. RESULTS: Regarding the initial indications for HOT, their mean PaO2 was 49.8 mmHg and mean SpO2 was 82.2%. Underlying diseases included chronic obstructive pulmonary disease (COPD, 19.8%), lung cancer (12.6%), and interstitial lung disease (11.2%). The admission rate within 1 year was 53.4% and the average number of admissions was 1.64/patient. Other underlying diseases for which oxygen was prescribed, despite not meeting the insurance coverage criteria, were lung cancer (36.6%) and interstitial pneumonia (16.6%). CONCLUSIONS: Home oxygen prescriptions have increased since health insurance coverage was extended. However, cases of oxygen prescriptions frequently do not meet the coverage criteria. It is important to discuss extending the coverage criteria to other disease groups, such as interstitial lung disease and lung cancer, in terms of cost-effectiveness. Further, physicians prescribing oxygen therapy should be educated regarding the criteria.
Sujets)
Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Cause de décès , Maladie chronique , Détermination de l'admissibilité , Service hospitalier d'urgences , Hospitalisation à domicile , Hospitalisation , Hôpitaux universitaires , Couverture d'assurance , Assurance maladie , Estimation de Kaplan-Meier , Oxygénothérapie , Observance par le patient , Évaluation de programme , République de Corée , Insuffisance respiratoire/diagnostic , Études rétrospectives , Facteurs temps , Résultat thérapeutiqueRésumé
BACKGROUND: Pleural effusion is a common and important problem in the intensive care unit (ICU). However, only few studies have focused on the etiology of pleural effusion in the ICU. The aim of this study is to elucidate the etiology of pleural effusion in ICU patients in a tertiary care hospital. METHODS: Patients with pleural effusion in the medical ICU (MICU) and in the emergency ICU (EICU) were studied retrospectively from January 1, 2006 to December 31, 2009. The etiology and profile of pleural effusion were analyzed. RESULTS: Of 1,592 patients admitted to the MICU and EICU during the study period, 78 patients (4.8%) underwent thoracentesis. The mean age was 66.8 +/- 13.3 years, and 52 (66.7%) were men. Parapneumonic effusion (32/78, 41%) was the leading cause of all effusions; malignancy- and heart failure-related effusions accounted for 15 (19.2%) and 14 (17.7%) cases, respectively. Fifteen patients (19.2%) had tube insertion after thoracentesis; in these patients, parapneumonic effusion or empyema was the most common reason for drainage (9/15, 60%). Pneumothorax developed after thoracentesis in 2 patients. CONCLUSIONS: Diagnostic thoracentesis was performed in 4.8% of patients admitted to the ICU; one-fifth of these cases required therapeutic drainage. Parapneumonic effusion was the most common cause of pleural effusion in the ICU in this study.
Sujets)
Humains , Mâle , Drainage , Urgences , Empyème , Coeur , Unités de soins intensifs , Épanchement pleural , Pneumothorax , Études rétrospectives , Soins de santé tertiairesRésumé
The purpose of this study was to investigate risk factors of postoperative pneumonia (POP) after lung cancer surgery. The 417 lung cancer patients who underwent surgical resection in a tertiary referral hospital were included. Clinical, radiological and laboratory data were reviewed retrospectively. Male and female ratio was 267:150 (median age, 65 yr). The incidence of POP was 6.2% (26 of 417) and in-hospital mortality was 27% among those patients. By univariate analysis, age > or = 70 yr (P or = 4.2 hr (P = 0.043), intraoperative red blood cells (RBC) transfusion (P = 0.004), presence of postoperative complications other than pneumonia (P = 0.020), forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) or = 0.15 mg/dL (P = 0.001) were related with risk of POP. Multivariate analysis showed that age > or = 70 yr (OR = 3.563, P = 0.014), intraoperative RBC transfusion (OR = 4.669, P = 0.033), the presence of postoperative complications other than pneumonia (OR = 3.032, P = 0.046), and FEV1/FVC < 70% (OR = 3.898, P = 0.011) were independent risk factors of POP. In conclusion, patients with advanced age, intraoperative RBC transfusion, postoperative complications other than pneumonia and a decreased FEV1/FVC ratio have a higher risk for pneumonia after lung cancer surgery.
Sujets)
Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Facteurs âges , Protéine C-réactive/analyse , Monoxyde de carbone/métabolisme , Transfusion d'érythrocytes , Volume expiratoire maximal par seconde , Mortalité hospitalière , Incidence , Modèles logistiques , Tumeurs du poumon/anatomopathologie , Stadification tumorale , Odds ratio , Pneumopathie infectieuse/épidémiologie , Complications postopératoires , Études rétrospectives , Facteurs de risque , Capacité vitaleRésumé
BACKGROUND/AIMS: To compare the effect of levofloxacin and moxifloxacin on treatment outcomes among patients with multidrug-resistant tuberculosis (MDR-TB). METHODS: A retrospective analysis of 171 patients with MDR-TB receiving either levofloxacin or moxifloxacin was performed. Treatment responses were categorized into treatment success (cured and treatment completed) or adverse treatment outcome (death, failure, and relapsed). RESULTS: The median age of the patients was 42.0 years. Approximately 56% of the patients were male. Seventeen patients had extensively drug-resistant tuberculosis, and 20 had a surgical resection. A total of 123 patients (71.9%) received levofloxacin for a median 594 days, and 48 patients (28.1%) received moxifloxacin for a median 673 days. Other baseline demographic, clinical, and radiographic characteristics were similar between the two groups. The moxifloxacin group had a significantly higher number of resistant drugs (p < 0.001) and a higher incidence of resistance to ofloxacin (p = 0.005) in the drug sensitivity test. The treatment success rate was 78.9% in the levofloxacin group and 83.3% in the moxifloxacin group (p = 0.42). Adverse reactions occurred at similar rates in the groups (p = 0.44). Patients in the moxifloxacin group were not more likely to have treatment success than those in the levofloxacin group (adjusted odds ratio, 0.76; 95% confidence interval, 0.24 to 2.43; p = 0.65). CONCLUSIONS: Both levofloxacin and moxifloxacin showed equivalent efficacy for treating MDR-TB.
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Antituberculeux/effets indésirables , Composés aza/effets indésirables , Études cas-témoins , Loi du khi-deux , Multirésistance bactérienne aux médicaments , Association de médicaments , Tuberculose ultrarésistante aux médicaments/traitement médicamenteux , Modèles logistiques , Mycobacterium tuberculosis/effets des médicaments et des substances chimiques , Odds ratio , Ofloxacine/effets indésirables , Quinoléines/effets indésirables , Récidive , Induction de rémission , République de Corée , Études rétrospectives , Appréciation des risques , Facteurs de risque , Facteurs temps , Résultat thérapeutique , Tuberculose multirésistante/traitement médicamenteuxRésumé
Photodynamic therapy (PDT) can be used as palliative therapy to reduce obstructive symptoms in patients with advanced lung cancer. Herein, we report on the case of a patient with fatal broncho-mediastinal fistula after PDT. A 57-year-old woman was diagnosed as non-small cell lung cancer (squamous cell carcinoma, cT4N3). She received PDT on the endobronchial mass obstructing her right main bronchus twice in 48 hours interval. Two weeks later, concurrent chemoradiation therapy (CCRT) with weekly Paclitaxel/Carboplatin was started. During maintenance chemotherapy, a new nodule in her scalp developed and turned out to be a metastatic nodule. A broncho-mediastinal fistula was suspicious on follow-up chest computed tomography and a broncoscopy revealed an extensively damaged medial right main bronchial wall. On the day following bronchoscopy, the patient died of sudden massive hemoptysis.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Bronches , Bronchoscopie , Carcinome pulmonaire non à petites cellules , Fistule , Études de suivi , Hémoptysie , Tumeurs du poumon , Chimiothérapie de maintenance , Soins palliatifs , Photothérapie dynamique , Cuir chevelu , Thorax , TriazènesRésumé
No abstract available.
Sujets)
Humains , Tumeurs des bronches/chirurgie , Bronchoscopie , Cryochirurgie/méthodes , Tumeurs du poumon/chirurgieRésumé
Epithelioid sarcomas are rare soft tissue sarcomas with a high tumor grade and high local recurrence and metastasis rates. Although the lung is the most common site of metastasis, endobronchial metastasis hasn't been reported yet. We now report a case of epithelioid sarcoma with endobronchial metastasis. A 28-year-old man had recurrent pneumothorax and underwent wedge resection. He presented at our hospital with hemoptysis, dyspnea, and chest pain. Chest computed tomography revealed left pneumothorax, multiple lung nodules and endobronchial lesions at the right lower basal lobe. Bronchoscopy showed a hemorrhagic mass obstructing the bronchus of the right lower basal lobe. Magnetic resonance imaging revealed multiple nodular lesions in the left thigh muscles. The bronchoscopic biopsy of the endobronchial lesion and the muscle biopsy of the thigh showed the same feature epithelioid sarcoma. This is the first case report of an epithelioid sarcoma with endobronchial metastasis that was diagnosed by bronchoscopic biopsy.
Sujets)
Adulte , Humains , Biopsie , Bronches , Bronchoscopie , Douleur thoracique , Dyspnée , Hémoptysie , Poumon , Imagerie par résonance magnétique , Muscles , Métastase tumorale , Pneumothorax , Récidive , Sarcomes , Cuisse , ThoraxRésumé
Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in children. Although previously considered as children's virus, the increasing number of patients who receive immunosuppression after transplantation of bone marrow and solid organs highlighted the role of RSV as a pathogen for opportunistic infection. We report a case of community-acquired respiratory syncytial virus pneumonia in a patient with newly diagnosed leukemia, resulting in acute respiratory distress syndrome (ARDS).
Sujets)
Enfant , Humains , Moelle osseuse , Immunosuppression thérapeutique , Leucémies , Infections opportunistes , Pneumopathie infectieuse , , Virus respiratoires syncytiaux , Infections de l'appareil respiratoire , Transplants , VirusRésumé
BACKGROUND/AIMS: Complete endotracheal tube obstruction is a medical emergency, and partial occlusion causes increased breathing rates and failure to wean off mechanical ventilation. Partial occlusion may be underestimated due to the lack of proper detection methods. We tested whether the sound of an endotracheal tube could be used to detect an endotracheal tube obstruction using an in vitro model. METHODS: An endotracheal tube was connected to a ventilator on one end and a test lung on the other. Sounds were recorded with a microphone located inside the endotracheal tube via a connector. During mechanical ventilation, we changed the endotracheal tube internal diameter from 5.0 to 8.0 mm and different grades of obstruction at different sites were used along the tube. Sound energy was compared among the different conditions. RESULTS: The energy of endotracheal tube sounds was positively correlated with the internal diameter and negatively correlated with the degree of obstruction. The rate of decline in energy differed with obstruction location. When the obstruction was more distal, the rate of decline in endotracheal sound energy was more rapid. CONCLUSIONS: Changes in the sound of an endotracheal tube can be used to detect an obstruction. Further studies are needed for clinical application.
Sujets)
Humains , Obstruction des voies aériennes , Intervalles de confiance , Expiration , Intubation trachéale , Modèles théoriques , Ventilation à pression positive , Statistiques comme sujetRésumé
BACKGROUND/AIMS: The risk of venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism (PE), increases in patients with cancer. Anticancer treatment is also associated with an increased risk for VTE. We conducted this study to investigate the clinical characteristics of patients with cancer and PE related to anticancer treatment in a tertiary care hospital in Korea. METHODS: We retrospectively reviewed the clinical data of patients with an underlying malignancy who were diagnosed with PE by chest computed tomography (CT) with or without lower extremity CT angiography between January 2006 and December 2007 at Seoul National University Hospital. RESULTS: Overall, 95 patients with malignancies among 168 with PE were analyzed. The median age was 64 years. The median time interval from the malignancy diagnosis to the PE diagnosis was 5.5 months. Lung cancer was the most common malignancy (23.0%), followed by pancreatobiliary cancer, stomach cancer, gynecological cancer, breast cancer, and hepatocellular carcinoma. Platinum-containing and pyrimidine analog-containing chemotherapeutic regimens were common. CONCLUSIONS: PE was diagnosed within 1 year after the cancer diagnosis in almost 70% of patients. Lung cancer was the most common underlying malignancy.
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Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Angiographie , Antinéoplasiques/usage thérapeutique , Tumeurs des voies biliaires/traitement médicamenteux , Tumeurs du poumon/traitement médicamenteux , Tumeurs/traitement médicamenteux , Tumeurs du pancréas/traitement médicamenteux , Embolie pulmonaire/épidémiologie , Radiothérapie , Études rétrospectives , Facteurs de risque , Tumeurs de l'estomac/traitement médicamenteux , TomodensitométrieRésumé
BACKGROUND/AIMS: Many patients undergoing a flexible bronchoscopy (FB) experience anxiety and discomfort during the procedure. We assessed whether an additional patient visit after a FB would improve patient satisfaction. METHODS: The study patients were randomly assigned to a control and post-visit groups. The physicians who were scheduled to perform the FB visited the study patients. The control group had one visit before the FB and the post-visit group had a before and after FB visit. The post-visit group received additional information and support during the second visit. Twenty-four hours after the FB, the participants completed questionnaires about discomfort and satisfaction with the procedure. RESULTS: The control and post-visit groups included 151 and 153 patients, respectively. The post-visit group reported having more information after the FB than the control group. The additional post-bronchoscopy visit improved the general patient tolerability of the procedure. The willingness to return for another FB was not affected by the post-bronchoscopy patient visit. CONCLUSIONS: The post-bronchoscopy visit improved patient satisfaction and general tolerability to the procedure. Subjective patient tolerability with the FB may be improved through a post-bronchoscopy visit by providing more information and emotional support to patients.
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Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Bronchoscopie/psychologie , Émotions , Satisfaction des patients , Études prospectivesRésumé
Streptococcus salivarius is a Gram-positive organism that belongs to the viridians group of streptococci. It is a relatively non-virulent bacterium that is part of the normal flora. It is rarely isolated from blood and is usually considered a contaminant. Nevertheless, S. salivarius may cause life-threatening infections, especially in immunocompromised hosts. There have been relatively few reports of S. salivarius pneumonia. Nocardiosis is also a rare opportunistic infection. Pulmonary nocardiosis is difficult to diagnose and, consequently, the diagnosis is often delayed. We report an unusual presentation with multiple pulmonary mass-like consolidations caused by a mixed infection of S. salivarius and Nocardia sp. in a 58-year-old man with rheumatoid arthritis who was taking oral corticosteroid, methotrexate, and leflunomide. The patient's symptoms and radiographic findings improved after six weeks of antibiotic therapy
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Humains , Adulte d'âge moyen , Polyarthrite rhumatoïde , Co-infection , Sujet immunodéprimé , Immunosuppresseurs , Isoxazoles , Méthotrexate , Nocardia , Infections à Nocardia , Infections opportunistes , Pneumopathie infectieuse , StreptococcusRésumé
Human metapneumovirus (hMPV) is a recently recognized human respiratory pathogen, which is known to be associated with upper and lower respiratory tract infections mainly in children, immunocompromised patients, and the elderly. The clinical manifestations of hMPV infections are similar to those of the human respiratory syncytial virus infection, which range from mild upper respiratory tract infection to severe bronchiolitis and pneumonia. Recently, hMPV has come to be thought of as the cause a similar spectrum of disease in adults as that seen in children; however, most of the reports of hMPV infections have focused on infection in children. We report a case of severe hMPV pneumonia requiring mechanical ventilation in an immunocompetent adult in Korea.