Contrast Media-Induced Nephropathy in Patients with Unruptured Cerebral Aneurysm After Coiling Endovascular Treatment.

BACKGROUND: The endovascular coiling procedure to treat cerebral aneurysms using contrast media has become more popular. However, studies of the incidence of, and risk factors for, contrast media-induced nephropathy (CIN) after coiling procedures have been limited. Thus, we evaluated the incidence and risk factors for CIN in patients who had undergone cerebral aneurysmal coiling procedures. METHODS: We retrospectively reviewed the electric medical records of 380 patients who had undergone cerebral aneurysmal coiling treatment under general anesthesia. CIN was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or a relative increase (≥25%) in the baseline serum creatinine value at 48-72 hours after exposure to a contrast agent. RESULTS: Elective cerebral aneurysmal coiling procedures were performed in 230 patients. Of the 230 patients, CIN developed in 13 (5.6%). The presence of diabetes mellitus (30.8% vs. 9.7%; P = 0.040) and patient age >75 years (30.8% vs. 6.5%; P = 0.012) were risk factors for CIN. CONCLUSIONS: Our study has demonstrated that the incidence of CIN in patients undergoing elective cerebral aneurysmal coiling procedures is ∼6.0%. We also identified underlying diabetes mellitus and advanced age (≥75 years) as potential risk factors.

A case report of unexpected sudden cardiac death due to aortic rupture following laparoscopic appendectomy.

INTRODUCTION: Aortic dissection is a very rare but life-threatening condition associated with a high mortality. Unexpected sudden cardiac death due to aortic rupture following laparoscopic appendectomy is very rare and may be difficult to diagnose. However, early diagnosis of aortic dissection is essential for the timely treatment and outcome of aortic dissection. CASE PRESENTATION: A 50-year-old man underwent a laparoscopic appendectomy. Postoperatively, the patient complained of dyspnea and chest pain. In 25 minutes after arrival in the postanesthesia care unit (PACU), the patient was in asystole. Then, he underwent cardiopulmonary resuscitation (CPR) according to advanced cardiac life support (ACLS) protocol using 1 mg of epinephrine, one 200J DC shock for ventricular fibrillation (V-fib). After that, his noninvasive blood pressure (NIBP) was 80/40 mm Hg, pulse rate (PR) was 140 beats/min, and peripheral oxygen saturation (SpO2) was 84%. His electrocardiogram (ECG) finding was atrial fibrillation (A-fib). After 20 minutes, the patient developed asystole rhythm again and CPR was restarted. He remained severely hypotensive despite vasopressors and died after 5 hours CPR. A forensic autopsy was performed postmoterm and thoracic and abdominal aortic dissection along the root of ascending aorta was present and massive hematoma within right and left thorax was present. CONCLUSION: Acute aortic disease can be difficult to recognize; therefore, diagnosis is sometimes delayed or missed. It is important to recognize the atypical symptoms of aortic dissection and maintain a broad differential diagnosis if patients complained of abdominal pain.

Facility characteristics as independent prognostic factors of nursing home-acquired pneumonia.

BACKGROUND/AIMS: Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics. METHODS: Data on all patients ≥ 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared. RESULTS: Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important. CONCLUSIONS: Unfavorable institutional factors in care homes are important prognostic factors for NHAP.

Reactive oxygen species modulator 1 (Romo1) overexpression is an independent predictor of poor survival in NSCLC patients who undergo surgical resection.

OBJECTIVES: Reactive oxygen species modulator 1 (Romo1) is a novel protein that plays an important role in intracellular reactive oxygen species generation. Romo1 is overexpressed in most cancer cell lines and related to invasiveness and chemoresistance in vitro. However, little information is available on its clinical implications. We investigated the association between Romo1 expression and the clinical outcomes of non-small cell lung cancer (NSCLC) patients who underwent surgical resection. MATERIALS AND METHODS: Romo1 protein expressions were evaluated immunohistochemically in resected tumor specimens. Survival analyses for overall population (n=110) and early-stage patients (n=97) were performed according to clinical parameters including level of Romo1 expression. RESULTS: Multivariate analyses showed that high Romo1 expression in tumor tissues was significantly associated with short disease-free survival (hazard ratio [HR]=3.16, 95% confidence interval [CI]: 1.21-8.22), and with short overall survival (HR=3.22, 95% CI: 1.02-10.21). Stronger associations were observed between Romo1 expression and disease-free survival (HR=3.69, 95% CI: 1.39-9.97) and overall survival (HR=4.21, 95% CI: 1.12-14.67) in stage I and II patients than in the overall population. Romo1 expression was not associated with any clinical parameter including age, gender, smoking status, stage, differentiation, or tumor histology. CONCLUSIONS: Increased Romo1 expression in surgically resected NSCLC was found to be significantly associated with early recurrence and poor survival. Romo1 overexpression could be a potential adverse prognostic marker in this setting.

Suicidal ideation and suicide attempts among diabetes mellitus: the Korea National Health and Nutrition Examination Survey (KNHANES IV, V) from 2007 to 2012.

OBJECTIVE: The present study evaluated the mental health of patients with diabetes mellitus (DM) in Korea and compared it with mental health in the general Korean population. METHODS: All data included in the final analyses were collected from 34,065 subjects (20years of age or older) who participated in the 2007-2012 Korea National Health and Nutrition Examination Survey (KNHANES). The mental health of 3846 DM patients were compared with that of 30,219 controls. RESULTS: A depressed mood for 2 or more continuous weeks was reported by 13.6% of subjects with normal glucose tolerance (NGT), 14.3% of those with impaired glucose intolerance (IFG), and 17.6% of DM patients. Suicidal thoughts were reported by 15.3% of individuals with NGT, 15.6% of participants with IFG, and 17.6% of DM patients. Suicidal attempts were reported by 0.8% of people with NGT, 1.0% of those with IFG, and 1.3% of DM patients. In DM patients, the crude odds ratio (OR) for depressive mood was 1.376 (95% confidence interval [CI]: 1.258-1.504), the OR for suicidal ideation was 1.481 (95% CI: 1.361-1.611) and the OR for suicidal attempts was 1.413 (95% CI: 1.021-1.956). A multivariate analysis revealed that the ORs for depression, suicidal ideation, and suicidal attempts in DM patients were 1.178 (95% CI: 1.070-1.297), 1.152 (95% CI: 1.050-1.263), and 1.413 (95% CI: 1.021-1.956), respectively. CONCLUSIONS: The present study found that DM was associated with a marked increase in suicidal behaviors.

Effect of prolonged incubation time on results of the QuantiFERON TB gold in-tube assay for diagnosis of latent tuberculosis infection.

Previous reports have shown that the sensitivity of the 6-day lymphocyte stimulation test is much higher than those of commercially available gamma interferon release assays (IGRAs). The aim of this study was to elucidate the effect of prolonged incubation on the results of the QuantiFERON TB Gold in-tube (QFT-GIT) assay. Patients aged >20 years with suspected tuberculosis (TB) were recruited prospectively from 1 May 2009 to 31 December 2010. In addition, healthy volunteers with no history of TB treatment were included as controls. For each participant, three sets of the QFT-GIT assay were performed using 24-, 48-, and 72-h incubation tests, and the results were compared. Thirty-seven patients with suspected pulmonary TB and 33 healthy controls were enrolled in the study. Of the 37 patients with suspected TB, the QFT-GIT assay results were positive for 28 (75.7%) after a 24-h incubation period. After prolonged incubation, the results differed in four (10.8%) of the 37 patients suspected of having TB. Among 27 patients with culture-confirmed TB, the sensitivities of the QFT-GIT assay after the 24-, 48-, and 72-h incubation tests were 85.2%, 81.5%, and 81.5%, respectively. Among the 33 healthy controls, the QFT-GIT assay results were positive in two (6.1%) after a 24-h incubation period. The results changed for two (6.1%) of the 33 healthy controls after prolonged incubation. The specificities of the QFT-GIT assay after 24, 48, and 72 h of incubation were 93.9%, 87.9%, and 90.9%, respectively. Prolonging the incubation time did not increase the sensitivity of the QFT-GIT assay. The manufacturer-recommended incubation time of 16 to 24 h should be respected because prolonged incubation can cause indeterminate or false-positive results.

A Case of Septic Azygos Vein Embolism Caused by Staphylococcus aureus Bacteremia.

A Septic embolism is a type of embolism infected with bacteria containing pus. These may become dangerous if dislodged from their original location. Embolisms of this type in the azygos vein are potentially fatal. The diagnosis of septic azygos vein embolism is difficult, so rapid diagnosis and treatment is important to avoid complications. Generally, treatment is enough for appropriate antibiotic therapy without anticoagulant therapy. We report a case of staphylococcal septic embolism in the azygos vein, which was discovered in a 51-year-old man exhibiting chest pain, dyspnea and fever. The patient was treated with antibiotic therapy alone without the use of anticoagulants.

Impact of parenchymal tuberculosis sequelae on mediastinal lymph node staging in patients with lung cancer.

Because tuberculous (TB) involvement of mediastinal lymph nodes (LN) could cause false positive results in nodal staging of lung cancer, we examined the accuracy of nodal staging in lung cancer patients with radiographic sequelae of healed TB. A total of 54 lung cancer patients with radiographic TB sequelae in the lung parenchyma ipsilateral to the resected lung, who had undergone at least ipsilateral 4- and 7-lymph node dissection after both chest computed tomography (CT) and fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT were included for the analysis. The median age of 54 subjects was 66 yr and 48 were males. Calcified nodules and fibrotic changes were the most common forms of healed parenchymal pulmonary TB. Enlarged mediastinal lymph nodes (short diameter > 1 cm) were identified in 21 patients and positive mediastinal lymph nodes were identified using FDG-PET/CT in 19 patients. The overall sensitivity and specificity for mediastinal node metastasis were 60.0% and 69.2% with CT and 46.7% and 69.2% with FDG-PET/CT, respectively. In conclusion, the accuracy of nodal staging using CT or FDG-PET/CT might be low in lung cancer patients with parenchymal TB sequelae, because of inactive TB lymph nodes without viable TB bacilli.

Sequential bilateral lung resection in a patient with Mycobacterium abscessus lung disease refractory to medical treatment.

Mycobacterium abscessus (M. abscessus) is the second most common nontuberculous mycobacteria (NTM) in South Korea. Nevertheless, the diagnosis and treatment of M. abscessus lung disease can be problematic. Surgical resection has been tried for patients with localized M. abscessus lung disease refractory to medical treatment. Here, we report on a 25-year-old woman with M. abscessus lung disease who had been diagnosed and treated three times for pulmonary tuberculosis. She was initially diagnosed as having M. intracellulare lung disease; however, M. abscessus was isolated after several months of medication. She had multiple bronchiectatic and cavitary lesions bilaterally, and M. abscessus was repeatedly isolated from her sputa despite prolonged treatment with clarithromycin, ethambutol, moxifloxacin, and amikacin. She improved only after sequential bilateral lung resection. Based on the experience with this patient, we suggest that, if medical treatment fails, surgical resection of a diseased lung should be considered even in patients with bilateral lesions.

Clinical significance of non-diagnostic pathology results from percutaneous transthoracic needle lung biopsy: experience of a tertiary hospital without an on-site cytopathologist.

BACKGROUND AND OBJECTIVE: More non-diagnostic pathology results may be reported following transthoracic needle lung biopsy (TTNB) when no on-site cytopathologist is available. This study was conducted to analyse the final outcomes in patients with non-diagnostic pathology results, and the factors related to the adequacy of specimens. METHODS: The medical records of consecutive patients who had undergone TTNB from January 2004 to January 2005 were retrospectively analysed. Non-diagnostic pathology results were classified into three groups: (i) atypical cells, (ii) non-specific inflammation and (iii) inadequate specimen. The final diagnosis and clinical outcome for each patient were analysed after additional diagnostic studies and clinical follow up. RESULTS: TTNB was performed on 291 patients. Specimens were adequate in 256 cases. The results were non-diagnostic for 103 patients, and the percentages of atypical cells, non-specific inflammation and inadequate specimen were 15.5% (16/103), 50.5% (52/103) and 40% (35/103), respectively. In 14 patients (87.5%) the diagnosis of atypical cells was confirmed, and in 10 (62.5%) these were due to malignancies. In two patients (3.8%) the lesions reported as non-specific inflammation were eventually confirmed as malignancies. After repeated attempts to confirm their diagnoses, 22 patients (62.9%) with initial reports of inadequate specimen were diagnosed with specific diseases. Specimen adequacy correlated with technical skill, size of the lesion, guidance method and biopsy method. CONCLUSIONS: Non-diagnostic pathology results from TTNB, in the absence of an on-site cytopathologist, are of value in assessing the clinical probability of malignancy and can be useful in the management of lung lesions. However, many other factors should be considered in patients with inadequate specimens.

The role of whole-body FDG PET/CT, Tc 99m MDP bone scintigraphy, and serum alkaline phosphatase in detecting bone metastasis in patients with newly diagnosed lung cancer.

Bone scan (BS) and serum alkaline phosphatase (ALP) concentration are used to detect bone metastasis in malignancy, although whole-body fluoro-D-glucose positron emission tomography computed tomography (FDG PET/CT) is being used increasingly. But BS is still used for the detection of metastatic bone lesion. So we compared the usefulness of PET/CT, BS, and serum ALP in detecting bone metastases in patients with newly diagnosed lung cancer. The medical record database was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, BS, and serum ALP before treatment. We retrospectively reviewed all patients' records and radiological reports. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The sensitivity values were 93.3% for PET/CT, 93.3% for BS, 26.7% for serum ALP concentration, and 26.7% for BS complemented with serum ALP concentration. The respective specificity values were 94.1%, 44.1%, 94.1%, and 97.3%. The kappa statistic suggested a poor agreement among the three modalities. FDG PET/CT and BS had similar sensitivity, but PET/CT had better specificity and accuracy than BS. PET/CT is more useful than BS for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, BS complemented with serum ALP is a cost-effective modality to avoid having to use PET/CT.

Lack of association between matrix metalloproteinase 8 promoter polymorphism and bronchiectasis in Koreans.

The observation that human matrix metalloproteinase (MMP)-8 is over-expressed in ectatic bronchi in patients with bronchiectasis suggests that polymorphisms altering the expression of MMP-8 may contribute to the susceptibility to development of bronchiectasis. We evaluated the association between the presence of bronchiectasis in a Korean population and two single nucleotide polymorphisms (SNPs) (-799C/ T and -381A/G) on the promoter region of the MMP-8 gene that are reported to alter the promoter activity and thereby the gene expression. Genotyping through polymerase chain reaction (PCR) and subsequent automatic sequencing was done in 167 patients with bronchiectasis and their age-, sex-matched healthy controls to reveal that only -799C/T is polymorphic among Koreans. In the patient group with bronchiectasis, the frequency of -799C/C, C/T, and T/T genotypes were 41.9%, 49.7%, and 8.4%, respectively. A similar distribution was observed in the control group: C/C (49.7%), C/T (43.1%), and T/T (7.2%) (p=0.36). In subgroup analysis, no significant difference was observed among the patients according to; the extent of disease (p=0.76), colonization of microorganisms (p=0.56), or association of mycobacteria (p=0.17). From these results, we conclude that -799C/T on the promoter region of MMP-8 lacks association with development of bronchiectasis in Koreans.