To identify a prognostic marker that is less sensitive to variations in the elapsed time since paraquat ingestion, we assessed the time between paraquat ingestion and a negative dithionite urine test as a prognostic parameter in patients with acute paraquat intoxication. Forty-one patients with acute paraquat intoxication were enrolled in this study and analyzed to verify significant determinants of mortality and organ dysfunction. The amount of paraquat ingested, paraquat plasma levels, and the time to a negative urine dithionite test were significant independent risk factors predicting mortality. The amount of paraquat ingestion, and the time to a negative urine dithionite test were independent risk factors predicting organ dysfunction. With a cut-off value of 34.5 hr for the time to negative conversion of the urine dithionite test, the sensitivity and specificity for mortality were 71.4% and 75.0%, respectively. The incidence of acute kidney injury and respiratory failure above 34.5 hr were 100% and 85.0%, respectively. In conclusion, the time to a negative urine dithionite test is the reliable marker for predicting mortality and/or essential organ failure in patients with acute paraquat intoxication, who survive 72 hr.
Acute Kidney Injury/etiology/mortality ; Adult ; Aged ; Dithionite/*urine ; Female ; Herbicides/blood/*toxicity ; Humans ; Liver Diseases/etiology/mortality ; Male ; Middle Aged ; Paraquat/blood/*toxicity ; Respiratory Insufficiency/etiology/mortality ; Risk Factors ; Time Factors

Triple valve surgery is usually complex and carries a reported operative mortality of 13% and 10-yr survival of 61%. We examined surgical results based on our hospital's experience. A total of 160 consecutive patients underwent triple valve surgery from 1990 to 2006. The most common aortic and mitral valve disease was rheumatic disease (82%). The most common tricuspid valve disease was functional regurgitation (80%). Seventy-four percent of the patients were in New York Heart Association (NYHA) class III and IV. Univariate and multivariable analyses were performed to identify predictors of early and late survival. Operative mortality was 6.9% (n=11). Univariate factors associated with mortality included old age, preoperative renal failure, postoperative renal failure, pulmonary complications, and stroke. Of them, postoperative renal failure and stroke were associated with mortality on multivariable analysis. Otherwise, neither tricuspid valve replacement nor reoperation were statistically associated with late mortality. Survival at 5 and 10 yr was 87% and 84%, respectively. Ninety-two percent of the patients were in NYHA class I and II at their most recent follow-up. Ten-year freedom from prosthetic valve endocarditis was 97%; from anticoagulation-related hemorrhage, 82%; from thromboembolism, 89%; and from reoperation, 84%. Postoperative renal failure and stroke were significantly related with operative mortality. Triple valve surgery, regardless of reoperation and tricuspid valve replacement, results in acceptable long-term survival.
Adult ; Aged ; Anticoagulants/adverse effects/therapeutic use ; Aortic Valve/*surgery ; Female ; Heart Valve Diseases/complications/mortality/*surgery ; Heart Valve Prosthesis Implantation/*methods ; Hemorrhage/chemically induced/epidemiology ; Humans ; Intraoperative Complications/mortality ; Kidney Failure/etiology ; Male ; Middle Aged ; Mitral Valve/*surgery ; Postoperative Complications/mortality ; Reoperation ; Risk Factors ; Severity of Illness Index ; Stroke/etiology ; Survival Analysis ; Thromboembolism/epidemiology ; Tricuspid Valve/*surgery

Few studies have reported on the long-term prognosis of anti-neutrophil cytoplasmic antibody (ANCA)-negative renal vasculitis. Between April 2003 and December 2013, 48 patients were diagnosed with renal vasculitis. Their ANCA status was tested using indirect immunofluorescence and enzyme-linked immunosorbent assays. During a median (interquartile range) follow-up duration of 933.5 (257.5-2,079.0) days, 41.7% of patients progressed to end stage renal disease (ESRD) and 43.8% died from any cause. Of 48 patients, 6 and 42 were ANCA-negative and positive, respectively. The rate of ESRD within 3 months was higher in ANCA-negative patients than in ANCA-positive patients (P = 0.038). In Kaplan-Meier survival analysis, ANCA-negative patients showed shorter renal survival than did ANCA-positive patients (log-rank P = 0.033). In univariate Cox-proportional hazard regression analysis, ANCA-negative patients showed increased risk of ESRD, with a hazard ratio 3.190 (95% confidence interval, 1.028-9.895, P = 0.045). However, the effect of ANCA status on renal survival was not statistically significant in multivariate analysis. Finally, ANCA status did not significantly affect patient survival. In conclusion, long-term patient and renal survival of ANCA-negative renal vasculitis patients did not differ from those of ANCA-positive renal vasculitis patients. Therefore, different treatment strategy depending on ANCA status might be unnecessary.
Age Factors ; Aged ; Antibodies, Antineutrophil Cytoplasmic/*analysis ; Cohort Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Kidney Diseases/*diagnosis/mortality ; Kidney Failure, Chronic/etiology ; Male ; Microscopy, Fluorescence ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Vasculitis/complications/*diagnosis/mortality

Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection as a complication of end stage liver disease. The outcome is related to the severity of hepatorenal function, gastrointestinal bleeding, and many others; however it is not well known whether the infection acquisition sites have an effect on the prognosis of SBP. In order to identify the prognostic significance of the acquisition sites, we studied 106 patients who were diagnosed as culture positive SBP between October 1998 and August 2003. Thirty-two episodes were nosocomial and 74 were community acquired. Gramnegative bacilli such as Escherichia coli were dominant in both of the nosocomial and community-acquired SBPs. Despite significantly higher resistance to cefotaxime in nosocomial isolates compared to community-acquired isolates (77.8% vs. 13.6%, p=0.001), no difference was found regarding short or long term prognosis. Infection acquisition sites were not related to short or long term prognosis either. Shock, gastrointestinal bleeding and renal dysfunction were related to short term prognosis. Only Child-Pugh class C was identified as an independent prognostic factor of long-term survival.
Time Factors ; Survival Rate ; Shock/etiology/mortality ; Prognosis ; Peritonitis/complications/microbiology/*pathology ; Multivariate Analysis ; Middle Aged ; Male ; Klebsiella pneumoniae/drug effects/growth & development ; Kidney Diseases/etiology/mortality ; Humans ; Gastrointestinal Hemorrhage/etiology/mortality ; Female ; Escherichia coli/drug effects/growth & development ; Drug Resistance, Bacterial ; Cross Infection/complications/microbiology/pathology ; Community-Acquired Infections/complications/microbiology/pathology ; Ciprofloxacin/pharmacology ; Cefotaxime/pharmacology ; Bacterial Infections/complications/microbiology/*pathology ; Anti-Bacterial Agents/pharmacology ; Aged

Microscopic polyangiitis (MPA) is a systemic vasculitis affecting small vessels. To determine the clinical features and outcomes of MPA in Korean patients, we retrospectively reviewed the medical records of patients diagnosed with MPA at a single medical center in Korea between 1989 and 2006. The 18 patients who met the Chapel Hill criteria for MPA had a mean (+/-SD) age at the time of diagnosis of 62.4+/-12.7 yr. Renal manifestations and general symptoms were the most common features of MPA, with lung involvement also very common. Antineutrophil cytoplasmic antibodies (ANCA) were present in 17 of the 18 patients (94%). Of 17 patients treated with steroids and cyclophosphamide, 11 (65%) had stable or improved course. One patient treated with steroids without cyclophosphamide showed disease progression. Ten of the 18 patients (56%) died at a median follow-up of 8 months. MPA in Korean patients was distinguished by a higher rate of lung involvement, especially alveolar hemorrhage, which was the leading cause of death in our patients. Korean patients were also older at MPA onset and were more likely positive for ANCA. Other overall clinical manifestations did not differ significantly.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antibodies, Antineutrophil Cytoplasmic/blood ; Cyclophosphamide/therapeutic use ; Drug Therapy, Combination ; Female ; Hemorrhage/etiology ; Humans ; Kidney Failure/etiology ; Korea ; Lung Diseases/etiology ; Male ; Middle Aged ; Polyarteritis Nodosa/*diagnosis/drug therapy/mortality ; Pulmonary Alveoli/blood supply/pathology ; Retrospective Studies ; Steroids/therapeutic use ; Survival Analysis ; Treatment Outcome

The aim of this study was to evaluate the survival of 395 previously untreated cervical cancer patients with at least one high risk factor following concurrent chemoradiation and to assess the toxicities. Two different chemotherapy regimens were used for concurrent chemoradiation. In the patients with squamous cell carcinoma, 100 mg/m2 of cisplatin was infused intravenously, followed immediately by five consecutive daily administrations of 5-fluorouracil, 1,000 mg/m2/day, each infused intravenously over 24 hr. As for the patients with adenocarcinoma, 70 mg/m2 of cisplatin, 250 mg/m2 of cytoxan and 45 mg/m2 of adriamycin were administered intravenously on days 1, 2, and 3, respectively. The 5-year survival rate was 54.4+ACU- with stage III and IV, 62.6+ACU- with lymph node metastasis on computed tomogram or MRI, 77.9+ACU- with stage I-II disease with lesion size +AD4- or +AD0-4 cm, and 50.3+ACU- with small cell carcinoma or adenocarcinoma. Side effects from concurrent chemoradiation such as nausea, vomiting, and alopecia were present in all 395 cases. Anemia, leukopenia, thrombocytopenia, hepatotoxicity, and nephrotoxicity were observed to varying degrees, but there was no toxic death. This study suggests that cisplatin-based concurrent chemoradiation in treating cervical cancer patients with high risk factors is effective and relatively well tolerated, with acceptable toxicity.
Adenocarcinoma/radiotherapy ; Adenocarcinoma/mortality ; Adenocarcinoma/drug therapy ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use+ACo- ; Antineoplastic Agents, Combined/adverse effects ; Carboplatin/administration +ACY- dosage ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/drug therapy ; Cervix Neoplasms/radiotherapy+ACo- ; Cervix Neoplasms/mortality ; Cervix Neoplasms/drug therapy ; Chemotherapy, Adjuvant/adverse effects ; Cisplatin/administration +ACY- dosage ; Combined Modality Therapy ; Comparative Study ; Cyclophosphamide/administration +ACY- dosage ; Doxorubicin/administration +ACY- dosage ; Female ; Fluorouracil/administration +ACY- dosage ; Gastrointestinal Diseases/etiology ; Gastrointestinal Diseases/epidemiology ; Hematologic Diseases/etiology ; Hematologic Diseases/epidemiology ; Hepatitis, Toxic/etiology ; Hepatitis, Toxic/epidemiology ; Human ; Kidney Diseases/epidemiology ; Kidney Diseases/chemically induced ; Korea/epidemiology ; Life Tables ; Lymphatic Metastasis ; Middle Age ; Particle Accelerators ; Radiotherapy, High-Energy+ACo-/adverse effects ; Retrospective Studies ; Risk ; Survival Analysis ; Treatment Outcome

The aim of this study was to evaluate the survival of 395 previously untreated cervical cancer patients with at least one high risk factor following concurrent chemoradiation and to assess the toxicities. Two different chemotherapy regimens were used for concurrent chemoradiation. In the patients with squamous cell carcinoma, 100 mg/m2 of cisplatin was infused intravenously, followed immediately by five consecutive daily administrations of 5-fluorouracil, 1,000 mg/m2/day, each infused intravenously over 24 hr. As for the patients with adenocarcinoma, 70 mg/m2 of cisplatin, 250 mg/m2 of cytoxan and 45 mg/m2 of adriamycin were administered intravenously on days 1, 2, and 3, respectively. The 5-year survival rate was 54.4+ACU- with stage III and IV, 62.6+ACU- with lymph node metastasis on computed tomogram or MRI, 77.9+ACU- with stage I-II disease with lesion size +AD4- or +AD0-4 cm, and 50.3+ACU- with small cell carcinoma or adenocarcinoma. Side effects from concurrent chemoradiation such as nausea, vomiting, and alopecia were present in all 395 cases. Anemia, leukopenia, thrombocytopenia, hepatotoxicity, and nephrotoxicity were observed to varying degrees, but there was no toxic death. This study suggests that cisplatin-based concurrent chemoradiation in treating cervical cancer patients with high risk factors is effective and relatively well tolerated, with acceptable toxicity.
Adenocarcinoma/radiotherapy ; Adenocarcinoma/mortality ; Adenocarcinoma/drug therapy ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use+ACo- ; Antineoplastic Agents, Combined/adverse effects ; Carboplatin/administration +ACY- dosage ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/drug therapy ; Cervix Neoplasms/radiotherapy+ACo- ; Cervix Neoplasms/mortality ; Cervix Neoplasms/drug therapy ; Chemotherapy, Adjuvant/adverse effects ; Cisplatin/administration +ACY- dosage ; Combined Modality Therapy ; Comparative Study ; Cyclophosphamide/administration +ACY- dosage ; Doxorubicin/administration +ACY- dosage ; Female ; Fluorouracil/administration +ACY- dosage ; Gastrointestinal Diseases/etiology ; Gastrointestinal Diseases/epidemiology ; Hematologic Diseases/etiology ; Hematologic Diseases/epidemiology ; Hepatitis, Toxic/etiology ; Hepatitis, Toxic/epidemiology ; Human ; Kidney Diseases/epidemiology ; Kidney Diseases/chemically induced ; Korea/epidemiology ; Life Tables ; Lymphatic Metastasis ; Middle Age ; Particle Accelerators ; Radiotherapy, High-Energy+ACo-/adverse effects ; Retrospective Studies ; Risk ; Survival Analysis ; Treatment Outcome

Paroxysmal nocturnal hemoglobinuria (PNH) is a progressive, systemic, life-threatening disease, characterized by chronic uncontrolled complement activation. A retrospective analysis of 301 Korean PNH patients who had not received eculizumab was performed to systematically identify the clinical symptoms and signs predictive of mortality. PNH patients with hemolysis (lactate dehydrogenase [LDH] > or = 1.5 x the upper limit of normal [ULN]) have a 4.8-fold higher mortality rate compared with the age- and sex-matched general population (P < 0.001). In contrast, patients with LDH < 1.5 x ULN have a similar mortality rate as the general population (P = 0.824). Thromboembolism (TE) (odds ratio [OR] 7.11; 95% confidence interval [CI] (3.052-16.562), renal impairment (OR, 2.953; 95% CI, 1.116-7.818) and PNH-cytopenia (OR, 2.547; 95% CI, 1.159-5.597) are independent risk factors for mortality, with mortality rates 14-fold (P < 0.001), 8-fold (P < 0.001), and 6.2-fold (P < 0.001) greater than that of the age- and sex-matched general population, respectively. The combination of hemolysis and 1 or more of the clinical symptoms such as abdominal pain, chest pain, or dyspnea, resulted in a much greater increased mortality rate when compared with patients with just the individual symptom alone or just hemolysis. Early identification of risk factors related to mortality is crucial for the management of PNH. This trial was registered at www.clinicaltrials.gov as NCT01224483.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; Area Under Curve ; Child ; Dyspnea/etiology ; Female ; Hemoglobinuria, Paroxysmal/*diagnosis/drug therapy/mortality ; Hemolysis ; Humans ; Kaplan-Meier Estimate ; Kidney Diseases/complications/diagnosis ; L-Lactate Dehydrogenase/metabolism ; Male ; Middle Aged ; Odds Ratio ; ROC Curve ; Registries ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Thromboembolism/complications/diagnosis ; Young Adult

This study evaluated the significance of aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV) events in chronic hemodialysis patients. Hemodialysis patients who took both an abdominal CT and echocardiography were divided into a low-ACI group (n = 64) and a high-ACI group (n = 64). The high-ACI group was significantly older, had a longer dialysis vintage and higher comorbidity indices, and more patients had a previous history of CV disease than the low-ACI group. The ACI was negatively correlated with LV end-diastolic volume or LV stroke volume, and was positively correlated with the ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E' ratio), a marker of LV diastolic function. The E/E' ratio was independently associated with the ACI. The event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group, and the ACI was an independent predictor for all-cause deaths and nonfatal CV events. In conclusion, ACI is significantly associated with diastolic dysfunction and predicts all-cause mortality and nonfatal CV events in hemodialysis patients.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Aorta, Abdominal ; Blood Flow Velocity ; Blood Pressure ; Calcinosis/*etiology ; Cardiovascular Diseases/*complications ; Disease-Free Survival ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/*complications/mortality ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Regression Analysis ; Renal Dialysis ; Risk Factors ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left/complications/*physiopathology

Although oxidized low-density lipoprotein (LDL) and lysophosphatidylcholine (LPC) have been proposed as important mediators of the atherosclerosis, the long-term contribution to the risk of cardiovascular disease (CVD) in hemodialysis patients has not been evaluated. This study investigated the relation between oxidized LDL and LPC levels with long term risk of CVD. Plasma oxidized LDL and LPC levels were determined in 69 Korean hemodialysis patients as a prospective observational study for 5 yr. During the observation period, 18 cardiovascular events (26.1%) occurred including 6 deaths among the hemodialysis patients. The low LPC level group (< or = 254 microM/L, median value) had much more increased risk of CVD compared to the high LPC level group (> 254 microM/L) (P = 0.01). However, serum levels of oxidized LDL were not significantly different between groups with and without CVD. In adjusted Cox analysis, previous CVD, (hazard ratio [HR], 5.68; 95% confidence interval [CI], 1.94-16.63, P = 0.002) and low LPC level (HR, 3.45; 95% CI, 1.04-11.42, P = 0.04) were significant independent risk factors for development of CVD. It is suggested that low LPC, but not oxidized LDL, is associated with increased risk of CVD among a group of Korean hemodialysis patients.
Adult ; Aged ; Asian Continental Ancestry Group ; Cardiovascular Diseases/*diagnosis/etiology/mortality ; Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic/blood/complications/diagnosis ; Lipoproteins, LDL/*blood ; Lysophosphatidylcholines/*blood ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Renal Dialysis ; Republic of Korea ; Risk Factors