1.COPD Patients with Exertional Desaturation Are at a Higher Risk of Rapid Decline in Lung Function.
Changhwan KIM ; Yong Bum PARK ; So Young PARK ; Sunghoon PARK ; Cheol Hong KIM ; Sang Myeon PARK ; Myung Goo LEE ; In Gyu HYUN ; Ki Suck JUNG ; Dong Gyu KIM
Yonsei Medical Journal 2014;55(3):732-738
PURPOSE: A recent study demonstrated that exertional desaturation is a predictor of rapid decline in lung function in patients with chronic obstructive pulmonary disease (COPD); however, the study was limited by its method used to detect exertional desaturation. The main purpose of this study was to explore whether exertional desaturation assessed using nadir oxygen saturation (SpO2) during the 6-minute walk test (6MWT) can predict rapid lung function decline in patients with COPD. MATERIALS AND METHODS: A retrospective analysis was performed on 57 patients with moderate to very severe COPD who underwent the 6MWT. Exertional desaturation was defined as a nadir SpO2 of <90% during the 6MWT. Rapid decline was defined as an annual rate of decline in forced expiratory volume in 1 second (FEV1) > or =50 mL. Patients were divided into rapid decliner (n=26) and non-rapid decliner (n=31) groups. RESULTS: A statistically significant difference in exertional desaturation was observed between rapid decliners and non-rapid decliners (17 vs. 8, p=0.003). No differences were found between the groups for age, smoking status, BODE index, and FEV1. Multivariate analysis showed that exertional desaturation was a significant independent predictor of rapid decline in patients with COPD (relative risk, 6.8; 95% CI, 1.8 to 25.4; p=0.004). CONCLUSION: This study supports that exertional desaturation is a predictor of rapid lung function decline in male patients with COPD.
Aged
;
Anoxia/diagnosis/etiology
;
Exercise/*physiology
;
Female
;
Forced Expiratory Volume/physiology
;
Humans
;
Male
;
Middle Aged
;
Pulmonary Disease, Chronic Obstructive/*physiopathology
;
Respiratory Function Tests
;
Retrospective Studies
2.Improved severe hepatopulmonary syndrome after liver transplantation in an adolescent with end-stage liver disease secondary to biliary atresia.
Tae Jun PARK ; Keun Soo AHN ; Yong Hoon KIM ; Hyungseop KIM ; Ui Jun PARK ; Hyoung Tae KIM ; Won Hyun CHO ; Woo Hyun PARK ; Koo Jeong KANG
Clinical and Molecular Hepatology 2014;20(1):76-80
Hepatopulmonary syndrome (HPS) is a serious complication of end-stage liver disease, which is characterized by hypoxia, intrapulmonary vascular dilatation, and liver cirrhosis. Liver transplantation (LT) is the only curative treatment modality for patients with HPS. However, morbidity and mortality after LT, especially in cases of severe HPS, remain high. This case report describes a patient with typical findings of an extracardiac pulmonary arteriovenous shunt on contrast-enhanced transesophageal echocardiography (TEE), and clubbing fingers, who had complete correction of HPS by deceased donor LT. The patient was a 16-year-old female who was born with biliary atresia and underwent porto-enterostomy on the 55th day after birth. She had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed severe hypoxia (arterial O2 tension of 54.5 mmHg and O2 saturation of 84.2%). Contrast-enhanced TEE revealed an extracardiac right-to-left shunt, which suggested an intrapulmonary arteriovenous shunt. The patient recovered successfully after LT, not only with respect to physical parameters but also for pychosocial activity, including school performance, during the 30-month follow-up period.
Adolescent
;
Anoxia
;
Arteriovenous Fistula/etiology
;
Biliary Atresia/*diagnosis/etiology
;
Cyanosis/complications
;
Dyspnea/complications
;
Echocardiography, Transesophageal
;
End Stage Liver Disease/complications/*surgery
;
Female
;
Hepatic Artery/abnormalities
;
Hepatopulmonary Syndrome/*diagnosis/ultrasonography
;
Humans
;
*Liver Transplantation
;
Osteoarthropathy, Secondary Hypertrophic/complications