Air-leakage syndrome after allogeneic peripheral blood stem cell transplantation from unrelated donor / 대한내과학회지

Bronchiolitis obliterans, a late, non-infectious pulmonary complication of bone marrow transplantation (BMT), is an obstructive airway disease associated with chronic graft-versus-host disease (cGVHD). We report a rare case of air-leakage syndrome including pneumothoraces, pneumomediastinum, and subcutaneous emphysema with bronchiolitis obliterans after allogeneic peripheral blood stem cell transplantation (PBSCT) from an unrelated donor. The pathogenesis of air-leakage syndrome is not fully understood, and its management has not yet been established. This patient was treated with high-concentration oxygen, tube thoracostomy, percutaneous drainage with a pigtail catheter to relieve the tension pneumomediastinum, and mechanical ventilatory support. The patient has now recovered and is being followed on an outpatient basis.

The prevalence of fatigue in cancer patients at St. Vincent's hospital / 대한내과학회지

BACKGROUND: Fatigue is one of the most common problems in terminally ill cancer patients in North America and Europe. However, fatigue has been almost neglected by health care professionals and even by patients and their families in Korea. We studied the prevalence and characteristics of fatigue in cancer patients who were admitted to St. Vincent's Hospital. METHODS: Ninety-three competent patients who were admitted to the cancer or hospice ward were asked to answer whether they had fatigue or other cancer related problems on three occasions on April 4, 11 and 18, 2006. Additional demographic data were also analyzed. RESULTS: Thirty (32.3%) of the 93 patients responded that they had fatigue. The response was from 20/71 male and 10/22 female patients. The median age was 66 years (range 35-84 years). The ECOG performance status was 1, 2 and 3 in 10, 12 and 8 patients respectively. Lung cancer (21 patients) was the most common malignancy followed by gastric cancer, colon cancer and other cancers. Fourteen patients received chemotherapy, 13 patients received supportive care and 3 patients received chemoradiotherapy. Other cancer related symptoms were pain (17 patients), anorexia (16 patients), sleep disturbance (14 patients), and anxiety and depression. The severity of fatigue was grade 1, 2, 3 in 17, 6 and 7 patients respectively. Twenty-eight patients had anemia based on the WHO scale, and there was no relationship between the grade of fatigue and hemoglobin level. CONCLUSIONS: Fatigue was a frequent symptom in cancer patients (32%) and more frequent in female patients (45%). More attention needs to be paid to the significance of fatigue in cancer patients.

A case of Erdheim-Chester disease that presented with chronic renal failure / 대한내과학회지

Erdheim-Chester disease is a rare non-langerhans cell histiocytic disorder of an unknown cause that may associate with multisystem, rapidly fatal, infiltrative disease. We report here on a case of Erdheim-Chester disease in a 45-year-old man who presented with chronic renal failure. The patient visited a local clinic due to renal failure that was accidentally diagnosed on a routine health examination. At that time, abdominal computed tomography revealed retroperitoneal fibrosis and bilateral hydronephrosis. However, he did not visit hospital for further evaluation. After 1 year, he visited our clinic due to exertional dyspnea that had developed several months previously. The chest and abdominal CT showed interstitial pneumonitis and pleural effusion and there was progressed hydronephrosis and perirenal fibrosis. He was diagnosed with Erdheim-Chester disease based on the characteristic findings of pleural biopsy (interstitial fibrosis, infiltration of macrophge, CD68-positive but S-100 negative). The patient was treated with insertion of a double J catheter and immunesuppression with prednisolone and azathioprine. Erdheim-Chester disease is a rare disease, but it should be considered in those patients displaying chronic renal failure with retroperitoneal fibrosis.

Clinical Implication of Natriuretic Peptides and Left Atrial Volume for the Screening Methods of Advanced Diastolic Dysfunction in the Community

BACKGROUND: Recently, B-natriuretic peptide (BNP) level and left atrial volume index (LAVi) were known to correlate with indices of LV diastolic function. As a screening method, we tried to evaluate the efficacy to BNP, ANP, and LAVi to predict the advanced diastolic dysfunction that means myocardial relaxation abnormality and elevated LV filling pressure. METHODS: In 100 patients who referred for echocardiography, Doppler recording of the mitral inflow and tissue Doppler imaging of the mitral annulus were obtained and classified into 4 diastolic function grades (normal, impaired relaxation, pseudonormal, and restrictive). Advanced diastolic dysfunction was defined as pseudonormal and restrictive physiology. LAVi was measured by modified Simpson's method in apical 4-chamber view at end-systole. Plasma levels of BNP and ANP were measured on the same day as echocardiogram was done. RESULTS: BNP and ANP levels were increased as diastolic function grade was worsening (BNP : 60+/-92, 108+/-204, 778+/-1,023 and 1,426+/-1,421 pg/ml, p<0.001; ANP: 22+/-30, 23+/-26, 94+/-92, 96+/-61 pg/ml, p<0.001). LAVi was also increased as diastolic dysfunction was advanced: 24+/-7 ml/m2, 27+/-9 ml/m2, 37+/-12 ml/m2, 45+/-12 ml/m2, p<0.001. The areas under the curve of receiver-operator characteristic curve for BNP, ANP and LAVi to detect the advanced diastolic dysfunction were 0.91, 0.88 and 0.84, respectively. BNP of 137 pg/ml, ANP of 34 pg/ml, and LAVi of 30 ml/m2 were the best values of sensitivity and specificity, respectively. CONCLUSION: These data suggest that BNP, ANP and LAVi provide meaningful sensitivity and specificity for the detection of advanced diastolic dysfunction, respectively. Among these, BNP is better than ANP or LAVi for the screening method to predict the advanced diastolic dysfunction.