BACKGROUND: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. METHODS: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. RESULTS: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. CONCLUSIONS: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.
Abdomen* ; Body Mass Index ; Humans ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Postoperative Complications ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Ventilation

BACKGROUND: In the background of increasing silver, the measurement of risk factors of cardiovascular system and abilities of controlling that of the aged are becoming the interest. 'Old age' is one of the risk factors of postoperative cardiovascular complication. We summarized diseases, discovered when randomly examined by transthoracic echocardiography (TTE) and frequencies of the diseases in old aged, older than 60 years. So we could discuss the clinical impact of preoperative TTE at resting state over 60 year old for postoperative cardiovascular system of noncardiac surgery. METHODS: For the period 15months, from September 1, 1999 to January 10, 2001, we examined patients who are older than 60 years, to be scheduled to undergo operation of noncardiac surgery, by using SONOS 1000, made by Hewlett-Packkard, USA. 933 patients (595 men and 337 women) were examined. RESULTS: We examined 993 patients, 595 men (63.8%) and 337 women (36.2%), who were aged from 60 years to 93 years (average 68.5+/-7.1 years old). 87.2% of patients had left ventricular relaxation abnormatilties, average ejection fraction at resting state was 62.0+/-6.8%, which is in normal range and left ventricular end diastolic diameter was 49.2+/-5.4 mm. Becoming older, average left ventricular ejection fraction is decreasing, average of desceleration time and IVRT, parameters of LV relaxation abnormality, are increasing but they are not stastically meaningful.There were four cases of dilated cardiomyopathy (0.4%) in which two cases were incidentally discovered by TTE and they had no specific past histories. 38 persons (4.1%) had pulmonary hypertension (RVSP, higher than 35 mmHg) and they had no specific complication at the operations and postoperative state. In 3 of the patients who had pulmonary hypertension, one was incidentally discovered, had Atrial septal defect and all of three had normal LV function. In our study there were 333 patients (35.7%) of Mitral regurgitation and 343 patients (36.8%) of aortic insufficiency which are pathologic change of aging, and patients severe than grade III were 3 patients (0.3%). One was treated by postoperative congestive heart failure at intensive care unit and other 2 patients could not be followed because of transfer and against discharge. 3 patients was diagnosed by Mitral valve prolapse of patients of Mitral regurgitation (0.3%). In case of Aortic valve stenosis, most popular vavular heart disease in old aged patients, have no symptom unless that is severe, often incidentally discover at TTE in our study at pre-operative state. There were 10 patients of aortic valve stenosis (1.1% frequency), 9 cases were mild ones and remaining one case was severe and received aortic valve replacement at Chest surgery department. CONCLUSION: The prevalence of cardiovascular disease that incidentally discovered at TTE in resting state is similar with the result of the reference in for the old aged population and the group of patients who had no symptom at resting state, could have risks of cardiovascular disease. We cannot predict all of the postoperative cardiovascular complication and risks with TTE at resting state in old age patients, but it was useful for screening of valvular diseases, congenital cardiac disease, pulmonary hypertension. It is also good for carrying out before stress TTE with exercise or dopamine. It has an important role for making decision of performing other stress tests in patients who have cardiovascular risk factors and grouping that need to have intervention therapy like the coronary angiography or not. Besides monitoring the cardiovascular system at operation and postoperation periods, medication during the preoperation period and surgical treatments when cardiovascular abnormalities found at TTE, cardiologic medical treatments are needed to lower the postoperative complication rates and improve the prognosis.
Aging ; Aortic Valve ; Aortic Valve Stenosis ; Cardiomyopathy, Dilated ; Cardiovascular Abnormalities ; Cardiovascular Diseases ; Cardiovascular System ; Coronary Angiography ; Dopamine ; Echocardiography* ; Exercise Test ; Female ; Heart Diseases ; Heart Failure ; Heart Septal Defects, Atrial ; Humans ; Hypertension, Pulmonary ; Intensive Care Units ; Male ; Mass Screening ; Middle Aged* ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Postoperative Complications ; Prevalence ; Prognosis ; Reference Values ; Relaxation ; Risk Factors ; Silver ; Stroke Volume ; Thorax

Pulmonary tuberculosis (TB) persists as a great public health problem in Korea. Increases in the overall age of the population and the rise of drug-resistant TB have reinforced the need for rapid diagnostic improvements and new modalities to detect TB and drug-resistant TB, as well as to improve TB control. Standard guidelines and recent advances for diagnosing pulmonary TB are summarized in this article. An early and accurate diagnosis of pulmonary TB should be established using chest X-ray, sputum microscopy, culture in both liquid and solid media, and nucleic acid amplification. Chest computed tomography, histopathological examination of biopsy samples, and new molecular diagnostic tests can be used for earlier and improved diagnoses, especially in patients with smear-negative pulmonary TB or clinically-diagnosed TB and drug-resistant TB.
Biopsy ; Diagnosis* ; Humans ; Korea ; Lung ; Microscopy ; Pathology, Molecular ; Public Health ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

Pulmonary tuberculosis is still serious, one of the great public health problems in Korea. Recently, the increase in the aged population, human immunodeficiency virus coinfection, and drug-resistant tuberculosis have reinforced the need for improved rapid diagnostics and better treatment strategies. The basic principles of care for persons with, or suspected of having, pulmonary tuberculosis are the same worldwide. The standard guidelines and recent advances in diagnosis and treatment are summarized in this article. Prompt, accurate diagnosis of pulmonary tuberculosis should be established using chest radiography, sputum microscopy, and culture in liquid and solid medium. The further evaluation of chest imaging, histopathological examination of biopsy samples, nucleic acid amplification tests, immunological evaluation, and new molecular diagnostic tests supplement earlier, improved diagnosis, especially in patients with smear-negative pulmonary tuberculosis. Standardized treatment regimens of proven efficacy should be used with appropriate patient education and treatment support. The response to treatment and the presence of side effects of antituberculosis drugs should be monitored regularly. In addition, essential public health responsibilities and public-private collaboration must be carried out for effective patient care and pulmonary tuberculosis control.
Biopsy ; Coinfection ; Cooperative Behavior ; Diagnosis* ; HIV ; Humans ; Korea ; Microscopy ; Nucleic Acid Amplification Techniques ; Pathology, Molecular ; Patient Care ; Patient Education as Topic ; Public Health ; Radiography ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary*

BACKGROUND: The cell-mediated immune response plays an important role in tuberculosis. After being activated by mycobacterial antigens, T lymphocytes express a high affinity receptor (IL-2R) for interleukin-2 (IL-2) on their own surface and release a soluble fraction of the IL-2 receptor (sIL-2R) from the cell membrane into the circulation. Neopterin is a metabolite of guanosine-triphosphate, which is produced by stimulated macrophages under the influence of IFN-gamma with a T lymphocyte origin. Therefore, the utility of sIL-2R, IFN-gamma and the neopterin levels as immunologic indices of the cell-mediated immune response and severity of disease in patients with pulmonary tuberculosis was assessed. METHOD: The serum sIL-2R, IFN-gamma and neopterin levels were measured in 39 patients with pulmonary tuberculosis, 6 patients with tuberculous lymphadenitis prior to treatment and 10 healthy subjects. The serum and pleural sIL-2R, neopterin and ADA levels were measured in 22 patients with tuberculous pleurisy. The patients with pulmonary tuberculosis were divided into a mild, moderate and severe group according to the severity by ATS guidelines. To compare the results from these patients with those of the pretreatment levels, the sIL-2R, IFN-gamma and neopterin levels were measured in 36 of the 39 patients(1 patient, expired; 2 patients were referred to a sanitarium) with pulmonary tuberculosis after 2 months of treatment. RESULTS: 1) The serum sIL-2R and IFN-gamma levels were elevated in patients with tuberculosis when compared to those of healthy subjects (0.05). The neopterin concentration in the serum was significantly lower in patients with pulmonary tuberculosis(2967+/-2132.8 pg/ml) than in healthy controls(4949+/-1242.1 pg/ml)(p<0.05). 2) In the pulmonary tuberculosis group, the serum sIL-2R and IFN-gamma levels were higher in patients with severe disease than those in patients with mild and moderate disease. However, the neopterin levels declined as the pulmonary tuberculosis became more severe (p<0.01). 3) The mean serum sIL-2R and IFN-gamma levels declined from 1071+/-1139.4 U/ml to 1023+/-1920.9 U/ml(p>0.05), 41 52.8 pg/ml to 22+/-23.9 pg/ml(p<0.05), respectively, after 2 month of treatment. The mean serum neopterin levels increased from 3158+/-2272.6 pg/ml to 3737+/-2307.5 pg/ml(0.05) after a 2 month of treatment. These findings were remarkable in the severe group of pulmonary tuberculosis with a clinical correlation. 4) In the patients with tuberculous pleurisy, the serum sIL-2R and ADA were significantly higher than those in the pleural fluid, However, the neopterin levels in the sera and pleural effusion were similar. CONCLUSION: On the basis of this study, sIL-2R, IFN-gamma and neopterin measurements may not only provide an insight into the present state of the cell-mediated immune response, but also serve as parameters monitoring of the prognosis of the disease, particularly in patients with severe pulmonary tuberculosis. In addition, an assay of the pleural sIL-2R levels might signal a stimulated local immunity including T cell activation in the tuberculous pleural effusion.

BACKGROUND: The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), became an attractive therapeutic option for advanced non-small-cell lung cancer (NSCLC). Several studies suggested that there might be some different efficacy or response predictors between gefitinib and erlotinib. We compared the efficacy and toxicity of gefitinib and erlotinib in Korean patients with advanced NSCLC and evaluated specific predictors of response for both gefitinib and erlotinib. METHODS: We collected the clinical information on patients with advanced NSCLC, who were treated with gefitinib or erlotinib at the Ewha Womans University Hospital, between July 2003 and February 2009. Median survival times were calculated using the Kaplan-Meier method. RESULTS: Eighty-six patients (52 gefitinib vs. 34 erlotinib) were enrolled. Patient median age was 64 years; 53 (62%) subjects were male. Out of the 86 patients treated, 83 received response evaluation. Of the 83 patients, 35 achieved a response and 12 experienced stable disease while 36 experienced progressive disease, resulting in a response rate of 42% and a disease control rate of 57%. After a median follow-up of 502 days, the median progression-free and overall survival time was 129 and 259 days, respectively. Comparing patients by treatment (gefitinib vs erlotinib), there were no significant differences in the overall response rate (44% vs. 39%, p=0.678), median survival time (301 days vs. 202 days, p=0.151), or time to progression (136 days vs. 92 days, p=0.672). Both EGFR-TKIs showed similar toxicity. In a multivariate analysis using Cox regression model, adenocarcinoma was an independent predictor of survival (p=0.006; hazard ratio [HR], 0.487; 95% confidence interval [CI], 0.292-0.811). Analyses of subgroups did not show any difference in response predictors between gefitinib and erlotinib. CONCLUSION: Comparing gefitinib to erlotinib, there were no differences in the response rate, overall survival, progression-free survival, or toxicity. No specific predictor of response to each EGFR-TKI was identified.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Male ; Multivariate Analysis ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease. Effective treatment is not currently available and the prognosis is poor. The aim of our study was to identify clinical predictors of survival in patients with IPF. METHODS: By using medical record database of a university hospital, we reviewed the records of patients who had been diagnosed as having IPF from January 1996 through December 2007. RESULTS: Among 89 patients considered as having interstitial lung disease (ILD) on computed tomography (CT) of the chest, 22 were excluded because of the diagnosis of other ILDs or connective tissue disease, and finally, 67 met the criteria of IPF. The mean age at the diagnosis of IPF was 70 years (range, 41~87 years) and 43 (64%) were male. The mean survival time following the diagnosis of IPF was 40 months (range, 0~179 months). Among them, 28 cases were diagnosed as the progressive state of IPF on the follow-up CT examination, and the mean duration between diagnosis of IPF and progression was 31 months. Multivariate analysis using Cox regression model revealed that body mass index (BMI) less than 18.5 kg/m2 (p=0.030; hazard ratio [HR], 12.085; 95% confidence interval [CI], 1.277~114.331) and CT progression before 36 months from the diagnosis of IPF (p=0.042; HR, 13.564; 95% CI, 1.101~167.166) were independently associated with mortality. CONCLUSION: Since low BMI at the diagnosis of IPF and progression on follow-up CT were associated with poor prognosis, IPF patients with low BMI and/or progression before 36 months following the diagnosis should be closely monitored.
Body Mass Index ; Connective Tissue Diseases ; Disease Progression ; Follow-Up Studies ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Diseases, Interstitial ; Male ; Medical Records ; Multivariate Analysis ; Prognosis ; Survival Rate ; Thorax

Nontuberculous mycobacteria (NTM) are emerging pathogens that affect both immunocompromised and immunocompetent patients. The incidence and prevalence of NTM lung disease are increasing worldwide and rapidly becoming a major public health problem. For the diagnosis of NTM lung disease, patients suspected to have NTM lung disease are required to meet all clinical and microbiologic criteria. The development of molecular methods allows the characterization of new species and NTM identification at a subspecies level. Even after the identification of NTM species from respiratory specimens, clinicians should consider the clinical significance of such findings. Besides the limited options, treatment is lengthy and varies by species, and therefore a challenge. Treatment may be complicated by potential toxicity with discouraging outcomes. The decision to start treatment for NTM lung disease is not easy and requires careful individualized analysis of risks and benefits. Clinicians should be alert to those unique aspects of NTM lung disease concerning diagnosis with advanced molecular methods and treatment with limited options. Current recommendations and recent advances for diagnosis and treatment of NTM lung disease are summarized in this article.
Diagnosis* ; Humans ; Incidence ; Lung Diseases* ; Lung* ; Mycobacterium ; Mycobacterium avium Complex ; Mycobacterium kansasii ; Nontuberculous Mycobacteria ; Prevalence ; Public Health ; Risk Assessment

The sandwich sign is used to describe mesenteric lymphoma in which mesenteric vessels and fat are enveloped by enlarged mesenteric lymph nodes. We present two cases of primary pleural lymphoma demonstrating the "pleural sandwich sign". Contrast-enhanced computed tomography showed conglomerated parietal pleural and extrapleural masses encasing the intercostal arteries. Histopathological examinations confirmed low grade marginal zone B-cell lymphoma in an 80-year-old man and diffuse large B-cell lymphoma in a 68-year-old man. The pleural sandwich sign may suggest the diagnosis of primary pleural lymphoma.
Aged ; Aged, 80 and over ; Antigens, CD20/metabolism ; Antineoplastic Agents/therapeutic use ; Humans ; Lymphoma, B-Cell, Marginal Zone/*diagnosis/drug therapy/metabolism ; Lymphoma, Large B-Cell, Diffuse/*diagnosis ; Male ; Pleura/*pathology ; Pleural Neoplasms/*diagnosis/drug therapy/metabolism/pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: In patients with chronic obstructive pulmonary disease (COPD), left ventricular (LV) systolic dysfunction and structural changes are rare, while right ventricular (RV) dysfunction and structural alteration and/or LV diastolic dysfunction are common. We evaluated the cardiac structure and function in patients with COPD using echocardiography. METHODS: Echocardiography examinations were performed in 69 patients with clinically stable COPD and without a history of heart disease; 22 control subjects with normal lung function were enrolled for comparison. Echocardiography parameters of the COPD patients were compared with those of the controls, and assessed according to the COPD stage classified using the Global initiative for chronic Obstructive Lung Disease (GOLD) criteria. RESULTS: Patients with COPD had significantly lower body weight (p=0.001) and higher pack-years of smoking than did the controls (p=0.002). The echocardiogram showed that LV end diastolic diameter (p<0.001), LV end systolic diameter (p=0.020), left atrial (LA) diameter (p=0.026), and LV mass in the COPD patients were significantly decreased compared to the controls (p=0.003). However, there were no differences between the COPD patients and controls in the parameters reflecting LV diastolic function and mean RV systolic pressure (RVSP). According to the COPD stage, body weight (p<0.001), body mass index (BMI) (p<0.001), and LV mass were significantly different (p=0.011). In patients with COPD, LV mass (r=0.432) (p<0.001) and BMI were significantly correlated with FEV1% predicted (r=0.600) (p<0.001). CONCLUSIONS: Patients with COPD had lower LV mass and LA and LV diameters than did the controls, even though both groups had normal LV function. In particular, the LV mass appeared to correlate with the lung function in the patients with COPD.
Blood Pressure ; Body Mass Index ; Body Weight ; Echocardiography ; Heart ; Humans ; Hypertension ; Lung ; Lung Diseases ; Pulmonary Disease, Chronic Obstructive ; Smoke ; Smoking