Clinical characteristics of pulmonary arteriovenous malformations in Koreans.

BACKGROUND AND OBJECTIVE: Although pulmonary arteriovenous malformations (PAVMs) are rare, they are important in clinical practice because they are associated with life-threatening complications such as brain abscess, stroke and lung haemorrhage. The aims of the present study were to characterize PAVMs in a Korean population and to examine the incidence and factors associated with cerebral complications, which are a major cause of mortality. METHODS: The medical records of patients with PAVMs between 2000 and 2013 were retrospectively reviewed. PAVMs were confirmed by enhanced chest computed tomography or by pulmonary angiography. RESULTS: Ninety patients (median age, 47.5 years; 81.8% female) with PAVMs were included. Twelve patients (13.3%) were clinically diagnosed with hereditary haemorrhagic telangiectasia (HHT) according to the Curacao criteria. Sixty-three patients underwent transcatheter embolization with no severe adverse events. Three patients required retreatment during a mean follow-up period of 3.3 years. Six and 14 patients suffered brain abscess or stroke, respectively, as a complication of PAVMs. These complications were not associated with the diameter of the arteries feeding the PAVMs (odds ratio, 1.106; 95% confidence interval, 0.895-1.366; P = 0.352) CONCLUSIONS: PAVMs are less associated with HHT in Koreans than in Western populations. Transcatheter embolization of PAVMs is safe and effective, and physicians need to consider treating the small arteries feeding PAVMs to prevent cerebral complications.

Comparison of clinical features and outcomes of hospitalized adult patients with novel influenza A (H1N1) pneumonia and other pneumonia.

OBJECTIVES: A novel swine-origin influenza A (H1N1) virus caused worldwide outbreaks starting in April 2009. The aim of this study was to evaluate the clinical characteristics and outcomes of pandemic 2009 H1N1 pneumonia by comparing to community-acquired pneumonia (CAP) of other origin. METHODS: The authors conducted a prospective cohort study of consecutive adult (over 15 years old) patients with suspected CAP requiring admission to a tertiary university-affiliated hospital during the second wave of pandemic 2009 H1N1 influenza. Based on the results of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis, the staff completed a standard assessment form and managed the patients according to a uniform protocol. Clinical characteristics, as well as laboratory and radiologic findings, were collected and compared between pandemic 2009 H1N1 pneumonia and CAP of other origin. The primary outcome was in-hospital mortality and secondary outcomes were duration of hospitalization, duration of intensive care unit (ICU) stay, and requirement of mechanical ventilation. RESULTS: A total of 135 patients with suspected CAP were included in the study. Of these, 59 patients were RT-PCR positive for H1N1 virus, and 76 patients were RT-PCR negative. Patients with H1N1 pneumonia were significantly younger than those with CAP of other origin (46.0 years vs. 68.0 years, p < 0.01) and more frequently had nonspecific symptoms (p < 0.01), initial leukopenia (8.5% vs. 0.0%, p = 0.01), lymphopenia (45.8% vs. 26.3%, p = 0.02), low values of C-reactive protein (CRP; 5.2 mg/dL vs. 13.4 mg/dL, p = 0.02), bilateral abnormalities (57.7% vs. 29.7%, p < 0.01) on chest radiography, ground glass opacities (43.9% vs. 12.8%, p < 0.01) on chest computed tomography, and low values of pneumonia severity index (PSI) score (56.0 vs. 91.0, p < 0.01) than those with CAP of other origin. However, there were no significant differences in infection severity, clinical outcome, length of ICU stay, requirement for mechanical ventilation, and mortality between the two groups. CONCLUSIONS: This study shows that clinical characteristics and outcomes of 2009 H1N1 pneumonia are comparable to those of CAP of other origin. However, some characteristics, including younger age, nonspecific symptoms (including headache, leukopenia, and fatigue), lymphopenia, lower initial CRP and PSI score, and radiologic findings (including bilateral abnormalities and ground glass opacities), may help clinicians to diagnostically differentiate between H1N1 pneumonia and CAP of other origin before the result of RT-PCR are obtained.

Inhaled nitric oxide improves the survival of the paraquat-injured rats.

The purpose of this study was to evaluate the effects of inhaled nitric oxide (NO) on the paraquat-induced lung injury in rats. The rats were assigned to four groups: control; inhaled NO (5 ppm); paraquat (PQ, 30 mg/kg); and PQ+NO group. For first 18 h the inhalation of NO mixed with room air was performed. Total white blood cell (WBC), neutrophil, total protein, lactate dehydrogenase (LDH), transforming growth factor-beta1 (TGF-beta1) in serum and/or bronchoalveolar lavage (BAL) fluid, serum malonaldehyde (MDA), and myeloperoxidase (MPO) of lung were measured and lung histopathology were also reviewed. The 72-h survival rate of PQ group was 58%, but the survival rate of PQ+NO group, NO group and control group were 100%, respectively. The serum MDA and TGF-beta1 in BAL fluid and blood of PQ+NO group were significantly lower than those of PQ group. However, inhaled NO did not decrease the elevated total WBC and neutrophil counts, and total protein, LDH and MPO activity in the lung injured by PQ. The alveolar septal thickening and inflammatory cell infiltration were not different between PQ and PQ+NO groups. NO inhalation may be beneficial for the survival of paraquat-induced injured rats by attenuating lipid peroxidation and production of TGF-beta1.