Data on the clinical outcomes and role of brain natriuretic peptide (BNP) levels in patients with chronic cor pulmonale are limited. A total of 69 patients with chronic cor pulmonale, admitted for dyspnea (January 2007 to September 2011) to three university hospitals, were retrospectively reviewed. All of the patients had right ventricular (RV) dysfunction on echocardiography. The median age was 70.0 yr, and chronic obstructive pulmonary disease (40.6%) and tuberculosis-destroyed lung (TDL, 27.5%) were the leading causes of chronic cor pulmonale. At the 1-yr follow-up, the mortality rate was 15.9%, and the readmission rate was 53.7%; patients with TDL had higher mortality (31.6% vs. 10.0%; P = 0.059) and readmission rates (78.9% vs. 43.8%; P = 0.009) than those with non-TDL diseases. The area under the receiver operating characteristic curve for admission BNP levels to predict readmission was 0.788 (95% confidence interval [CI], 0.673-0.904), and the sensitivity and specificity of the cut-off value were 80.6% and 77.4%, respectively. In multivariate analysis, high admission BNP levels were a significant risk factor for subsequent readmission (hazard ratio, 1.049; 95% CI, 1.005-1.094). Additionally, admission BNP levels were well correlated with cardiac troponin I (r = 0.558), and delta BNP also correlated with delta RV systolic pressure (n = 25; r = 0.562). In conclusion, among hospitalized patients with chronic cor pulmonale, admission high BNP levels are a significant risk factor for subsequent readmission. Therefore, more intensive monitoring and treatment are needed in patients with higher BNP levels.
Aged ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood ; Patient Readmission ; Prognosis ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Heart Disease/*blood/mortality ; ROC Curve ; Retrospective Studies ; Tuberculosis, Pulmonary/complications

BACKGROUND: Acute exacerbations form a major component of the socioeconomic burden of COPD. As yet, little information is available about the long-term outcome of patients who have been hospitalized with acute exacerbations, although high mortality rates have been reported. The aim of this study was to determine predictors of long-term mortality after hospitalization for acute exacerbation of COPD. METHODS: We performed a retrospective cohort study of consecutive patients admitted to the hospital for COPD exacerbation between 2000 through 2004. Patients who had died in hospital or within 6-months after discharge, had tuberculosis scar, pleural thickening or bronchiectasis by chest radiography or had been diagnosed with malignancy during follow-up periods were excluded. RESULTS: Mean age of patients was 69.5 years, mean follow-up duration was 49 months, and mean FEV1 was 1.00L (46% of predicted). Mortality was 35% (17/48). In the multivariate Cox regression analysis, heart rate of 100/min or more (p=0.003; relative risk [RR], 11.99; 95% confidence interval [CI], 2.34-61.44) and right ventricular systolic pressure (RVSP) of 35mmHg or more (p=0.019; RR, 6.85; 95% CI, 1.38-34.02) were independent predictors of mortality. CONCLUSION: Heart rate and RVSP in stable state may be useful in predicting long-term mortality for COPD patients admitted to hospital with acute exacerbation.
Blood Pressure ; Bronchiectasis ; Cicatrix ; Cohort Studies ; Follow-Up Studies ; Heart Rate ; Hospitalization* ; Humans ; Mortality* ; Pulmonary Disease, Chronic Obstructive* ; Radiography ; Retrospective Studies ; Thorax ; Tuberculosis

Kyphoscoliosis is a disease manifested as lateral curvature of spine and accompanying rotation of the vertebrae, resulting in distortion of rib cage. A curve greater than 40 degrees in considerd to be severe and most likely to be associated with physiologic derangements in cardiac and pulmonary function. Restrictive lung disease and pulmonary hypertension progressing to cor pulmonale are the major causes of mortality in patients with kyphoscoliosis. However, pregnancy itself increases cardiac output and circulating blood volume, and decreases total lung capacity due to enlarged uterus. So tidal volume is increased in pregnant women to compensate. But in kyphoscoliosis patients pulmonary fucntion is already impaired and cardiovascular reserve is minimal. So there is increasing tendency in actue cor pulmonale. Recently we experienced a case of cesarean section in patient with kyphoscoliosis, and observed severe hemodynamic changes especially in pulmonary capillary wedge pressure and cardiac output. And we investigated 7 cases of cesarean section of patients with kyposcoliosis.
Anesthesia* ; Blood Volume ; Cardiac Output ; Cesarean Section* ; Female ; Hemodynamics* ; Humans ; Hypertension, Pulmonary ; Lung Diseases ; Mortality ; Pregnancy ; Pregnant Women ; Pulmonary Heart Disease ; Pulmonary Wedge Pressure ; Ribs ; Spine ; Tidal Volume ; Total Lung Capacity ; Uterus

Despite the well-known bleeding diathesis in patients with end-stage liver disease, inappropriate hypercoagulation is also emerging as a major concern. Pulmonary thromboembolism (PTE) is a major cause of perioperative morbidity and mortality during liver transplantation (LT). Flat-line thromboelastography is reported to predict PTE during LT. In this case, a 52-year-old woman with hepatocellular carcinoma underwent living-related LT. During the pre-anhepatic phase, one unit of apheresis platelets was transfused because of thrombocytopenia (32,000 /ml). After 20 minutes, blood pressure became unstable and circulatory collapse suddenly developed. In the middle of cardiopulmonary resuscitation, transesophageal echocardiography was immediately conducted, which revealed flail thrombi in the right atrium. Rotational thromboelastometry (ROTEM) conducted at that time was surprisingly flat in 4 channels, contradictory to the finding of hypercoagulation. This finding lead to a management dilemma during LT. Flattening in ROTEM requires caution in interpretation of severe hypocoagulation or ongoing PTE.
Blood Component Removal ; Blood Platelets* ; Blood Pressure ; Carcinoma, Hepatocellular ; Cardiopulmonary Resuscitation ; Disease Susceptibility ; Echocardiography, Transesophageal ; Female ; Heart Atria ; Hemorrhage ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Middle Aged ; Mortality ; Platelet Transfusion* ; Pulmonary Embolism* ; Shock ; Thrombelastography* ; Thrombocytopenia

Biomarkers ; blood ; Child ; Child, Preschool ; Critical Illness ; Early Diagnosis ; Heart Failure ; blood ; diagnosis ; mortality ; Humans ; Infant ; Intensive Care Units ; Mucocutaneous Lymph Node Syndrome ; blood ; diagnosis ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Predictive Value of Tests ; Prognosis ; Pulmonary Heart Disease ; blood ; diagnosis ; Risk Assessment ; Sepsis ; blood ; diagnosis ; Ventricular Dysfunction, Left ; blood ; diagnosis

OBJECTIVETo evaluate the predictive value of admission plasma B-type natriuretic peptide (BNP) and pulmonary capillary wedge pressure (PCWP) for long term cardiovascular events in patients with chronic heart failure (CHF).

METHODSA total of 134 patients [70 males and 64 females, mean age (71.28 +/- 8.22) years] with CHF were included in this study. PCWP was measured with a Swan-Ganz catheterization and plasma BNP level was determined by a rapid immunofluorescence assay (Triage, Biosite, USA) in all patients on admission day. Left ventricular end diastolic diameter (LVEDD) and cardiothoracic ratio (CRT) were measured within 24 hours before or after catheterization. All CHF patients received conventional therapy and the rates of cardiac death and rehospitalization were used as end points during 3-year follow up.

RESULTS(1) LVEDD, CRT, PCWP and BNP were increased in patients with cardiac events compared with patients without cardiac events (P < 0.01). (2) Multivariant logistic analysis showed that PCWP (OR = 1.423, 95% CI 1.163 - 1.741) and BNP (OR = 1.005, 95% CI 1.002 - 1.007) were the independent factors for cardiac events. (3) The area under the receiver operating curve (ROC) of BNP and PCWP to predict cardiac death was 0.846 (95% CI 0.771 - 0.922) and 0.762 (95% CI 0.666 - 0.875), respectively. The sensitivity was 76.5% and the specificity was 75.2% with BNP cutoff point of 720.5 ng/L, and the sensitivity was 68.1% and the specificity was 76.2% with PCWP cutoff point of 19.5 mm Hg (1 mm Hg = 0.133 kPa) for predicting cardiac deaths. (4) The survival rate of patients with BNP < or = 702.5 ng/L and PCWP < or = 19.5 mm Hg were significantly higher than that in patients with BNP > 702.5 ng/L (OR = 4.383, 95% CI 1.407 - 13.650) and PCWP > 19.5 mm Hg (OR = 2.843, 95% CI 1.013 - 8.854).

CONCLUSIONBoth plasma BNP and PCWP on admission day are independent predictors for long term cardiac events in patients with CHF.

Aged ; Chronic Disease ; Female ; Follow-Up Studies ; Heart Failure ; diagnosis ; mortality ; physiopathology ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Predictive Value of Tests ; Prognosis ; Pulmonary Wedge Pressure ; ROC Curve ; Survival Rate

We took clinical observation for low-birth-weight infant who had been delivered at Chosun University Hospital during the last 4 years from July, 1972 to June, 1976. The results obtained were as follows; 1) High incidence of low-birth-weight infant was found in group of gestational period, 31-33 weeks and birth weith, 1501~1750 gm . and those were 16 cases. 2) The incidence of low-birth weitht infant was 8.4% and there was no different distribution between male and female. 3) Incidence of low-birth-weight infant by maternal age was in order of the group of 26-30 years old, the group of 20-25 years old and the group of 31-35 years old and the incidence by parity was higher in multiparity than in primiparity. 4) Incidence of low-birthpweight infant by the type of delivery was in order of normal vaginal delivery, breech delivery and C-section delivery. 5) Etiology of low-birth-weight infant was in order of multiple pregnancy, toxemia, placenta previa and abruptio placenta, premature repture of membrane and congenital syphilis. 6) Mortality rate by weight-gestational age was lower in the group of apprepriate for gestational age infant than in the group of small for gestational age infant and in the group of large for gestatonal age infant. 7) Higher mortality rate was noted in the group of lower birth weight infant, the group of more shortened gestational period and the group of lower Apgar score. 8) Incidence of twin was 11.4% and death was noted only 1 case in male group. 9) In the respect of physiologic weight loss, an average maximal weight loss 9.3% of birth weitht and average maximal weight loss was appeared on 8th day after birth and the duration of returning to the birth weight was 13.5 days. 10) Average body measurements at birth were as follows: head circumference, 30.5cm, length, 43.9cm, and chest circumference, 27.7 cm and there was tendency of lower value of body measurements in the group of lower birth weight. 11) In the chest x-ray which was taken within 12 hours after normal finding was 98 cases (81.0%), hyaline membrane disease. 7(5.8%), atelectasis, 6(5.0%), congenital heart disease, 2(1.7%) and 1 case (0.8%) of pneumothorax. 12) In the peripheral blood cell count, there was higher value of Hb, RBC and Hct in the group of higher weight, but this proportional relationship was not found in WBC count.
Apgar Score ; Birth Weight ; Blood Cell Count ; Female ; Gestational Age ; Head ; Heart Defects, Congenital ; Humans ; Hyaline Membrane Disease ; Incidence ; Infant ; Infant, Low Birth Weight* ; Infant, Newborn ; Male ; Maternal Age ; Membranes ; Mortality ; Parity ; Parturition ; Placenta ; Placenta Previa ; Pneumothorax ; Pregnancy ; Pregnancy, Multiple ; Pulmonary Atelectasis ; Syphilis, Congenital ; Thorax ; Toxemia ; Weight Loss