On April, 2009, pandemic influenza (H1N1 2009) emerged in the United States at first. Clinical outcomes of this infection are reported as ranging from self-limited illness to respiratory failure or death. There were more than 250 deaths due to pandemic influenza until March 2010. Influenza-related deaths occurred in the elderly and in patients with underlying medical conditions. Most of the critically ill patients showed severe hypoxia and acute respiratory distress syndrome and required ventilator care. We experienced a 70-year-old man presenting with pandemic influenza (H1N1 2009) with heart failure. He was treated with antival agents, ventalator and extracorporeal membrane oxygenation. But his heart function was aggravared and resulted in his death.
Aged ; Anoxia ; Critical Illness ; Extracorporeal Membrane Oxygenation ; Heart ; Heart Failure ; Humans ; Influenza, Human ; Pandemics ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; United States ; Ventilators, Mechanical

Sarcoidosis is a multi-systemic granulomatous disorder of unknown etiology. The characteristic pathological finding is the presence of non-caseating granulomas. The lungs are primarily affected, however other organs may be involved causing various symptoms and ambiguous laboratory findings can be present. There are a few reported cases of sarcoidosis with elevated tumor markers. We describe a 68-year-old woman presenting with sarcoidosis showing elevated serum carcinoembryonic antigen (CEA). The possibility of cancer arising from serum CEA such as gastrointestinal cancer, breast cancer and lung cancer was excluded. A transbronchial lung biopsy demonstrated a non-caseating granuloma without necrosis. As a result prescribed 30 mg prednisolone daily to the patient and serum CEA was decreased after 1 month of treatment. We report a case of pulmonary sarcoidosis with elevated serum CEA.
Aged ; Biopsy ; Breast Neoplasms ; Carcinoembryonic Antigen ; Female ; Gastrointestinal Neoplasms ; Granuloma ; Humans ; Lung ; Lung Neoplasms ; Necrosis ; Prednisolone ; Sarcoidosis ; Sarcoidosis, Pulmonary ; Biomarkers, Tumor

Sarcoidosis is a multi-systemic granulomatous disorder of unknown etiology. The characteristic pathological finding is the presence of non-caseating granulomas. The lungs are primarily affected, however other organs may be involved causing various symptoms and ambiguous laboratory findings can be present. There are a few reported cases of sarcoidosis with elevated tumor markers. We describe a 68-year-old woman presenting with sarcoidosis showing elevated serum carcinoembryonic antigen (CEA). The possibility of cancer arising from serum CEA such as gastrointestinal cancer, breast cancer and lung cancer was excluded. A transbronchial lung biopsy demonstrated a non-caseating granuloma without necrosis. As a result prescribed 30 mg prednisolone daily to the patient and serum CEA was decreased after 1 month of treatment. We report a case of pulmonary sarcoidosis with elevated serum CEA.
Aged ; Biopsy ; Breast Neoplasms ; Carcinoembryonic Antigen ; Female ; Gastrointestinal Neoplasms ; Granuloma ; Humans ; Lung ; Lung Neoplasms ; Necrosis ; Prednisolone ; Sarcoidosis ; Sarcoidosis, Pulmonary ; Biomarkers, Tumor

BACKGROUND/AIMS: This study compared the clinical benefits of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) with pemetrexed to identify the clinical parameters that correlated with response. METHODS: A retrospective chart review examined patients who were 1) treated with EGFR TKI or pemetrexed, 2) diagnosed with advanced non-squamous non-small-cell lung cancer, and 3) previously treated with platinum-based chemotherapy in Soonchunhyang Bucheon Hospital. RESULTS: Sixty-one patients (18 erlotinib, 18 gefitinib, 25 pemetrexed) were investigated from February 2002 to August 2009. The median follow-up period was 37 months (7~97 months). Overall, their median age was 63 years, 41 patients were non-smokers, 57 patients had adenocarcinoma, and 55 patients were at stage IV. Twenty-one patients received the study drugs as second-line chemotherapy, and others as third-line or more. No significant differences in the overall response rate (erlotinib 33.3% vs. gefitinib 38.9% vs. pemetrexed 20.0%) and progression-free survival (erlotinib 1.9 months vs. gefitinib 3.0 months vs. pemetrexed 2.9 months) were found among the three groups. Female gender was related to a good response to EGFR TKIs (p=0.047). Skin rash in the erlotinib group (p=0.037) and adenocarcinoma in the pemetrexed group (p=0.02) were related to improved progression-free survival. Few side effects were reported. CONCLUSIONS: Both EGFR TKIs and pemetrexed therapy for non-squamous non-small-cell lung cancer were efficient and tolerable after the failure of first-line platinum-based chemotherapy. Further prospective studies are needed to validate the predictive role of the suggested clinical parameters in this study.
Adenocarcinoma ; Disease-Free Survival ; Exanthema ; Female ; Follow-Up Studies ; Glutamates ; Guanine ; Humans ; Lung ; Lung Neoplasms ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Retrospective Studies ; Erlotinib Hydrochloride ; Pemetrexed

Treatment with sorafenib prolongs both the median survival and time to progression by nearly 3 months in patients with advanced hepatocellular carcinoma. Although the effects of combining sorafenib therapy with other anticancer treatment modalities have not been clarified, combination treatment is strongly expected to be beneficial. We report the case of a 50-year-old man who exhibited a partial response and portal vein thrombosis (PVT) revascularization after sorafenib combined with hepatic arterial infusion chemotherapy (HAIC). He exhibited a decrease in tumor size and PVT after 2 months of sorafenib monotherapy. However, no additional response was seen during the subsequent 2 months. To achieve a better tumor response, we combined HAIC with sorafenib. Daily cisplatin (7 mg/m2 on days 1-5) and 5-fluorouracil (170 mg/m2 on days 1-5) were infused repeatedly every 4 weeks, and the sorafenib prescription was modified. After four cycles of combined therapy, both the tumor size and PVT were much improved and exhibited partial response.
Carcinoma, Hepatocellular ; Cisplatin ; Fluorouracil ; Humans ; Middle Aged ; Niacinamide ; Phenylurea Compounds ; Portal Vein ; Prescriptions ; Thrombosis

Extranodal NK-T cell lymphoma is a subtype of non-Hodgkin's lymphoma (NHL) and this most commonly affects the nasal and paranasal cavities. Primary lymphoma of the gallbladder is extremely rare and solitary relapsed extranodal NK-T cell lymphoma of the gallbladder has not yet been reported in Korea. We experienced a case of a solitary relapsed extranodal NK-T cell lymphoma of the gallbladder. One year earlier, a 55-year-old man was diagnosed with extranodal NK-T cell lymphoma of the anus, and he underwent six cycles of chemotherapy with CHOP (cyclophosphamide, adriamycin, vincristine and prednisone), and he achieved complete remission. The patient was admitted for right upper quadrant pain. Computed tomography (CT) performed on readmission revealed gallbladder wall thickening. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed hypermetabolic lesions along the gallbladder wall. The specimen obtained at cholecystectomy revealed CD3(+) and CD56(+) lymphoma, which is characteristic of NK-T cell lymphoma.
Anal Canal ; Cholecystectomy ; Doxorubicin ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Korea ; Lymphoma ; Lymphoma, Non-Hodgkin ; Middle Aged ; Vincristine

BACKGROUND: This study was to evaluate a nationwide nosocomial infection rate and antimicrobial resistance in intensive care units(ICUs) in Korea. METHODS: The study was carried out at 16 university-affiliated teaching hospitals from July through October 2004. We performed a prospective multicenter study to investigate nosocomial infection rates, device-associated infection rated, and causative pathogens and their antimicrobial resistance. RESULTS: The urinary tract was the most commonly involved site. Nosocomial infection rate was 12.48 in medical. ICU (MICU), 9.59 in medical surgical ICU (MSICU), 14.76 in surgical ICU (MSICU), and 11.60 in other lCU. Device-associated infection rates were as follow: 1) rates of urinary catheter-associated urinary tract infection were 4.26 in MICU, 3.17 in SICU, 4.88 in MSICU, and 5.87 in other ICU; 2) rates of central line-associated bloodstream infection were 3.24 in MICU, 1.56 in SlCU, 2.36 in MSICU, and 1.78 in other ICU; 3) rates of ventilator-associated pneumonia were 3.61 in MlCU, 13.05 in SICU, 1.68 in MSICU, and 4.84 in other lCU. Staphylococcus aureus was the most frequently identified microorganism in this study; 93% of S. aurues were resistant to methicillin; 17% of Pseudomonas aeruginosa isolated were resistant to imipenem; 11% of Enterococcus faecium and 18% of Enterococcus faecalis showed resistance to vancomycin. Over a half of Acinetobacter spp, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli showed resistant to fluoroquinolone. Conclusion: This study shows the seriousness of antimicrobial resistance and the importance of infection control in the lCU in Korea. This study should provide a theoretical strategy to enforce the infection control.
Acinetobacter ; Cross Infection* ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Hospitals, Teaching ; Hospitals, University* ; Imipenem ; Infection Control ; Intensive Care Units* ; Critical Care* ; Klebsiella pneumoniae ; Korea* ; Methicillin ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Stenotrophomonas maltophilia ; Urinary Tract ; Urinary Tract Infections ; Vancomycin