Keiki Yokoo

Significance of Combined Emphysema in Idiopathic Pulmonary Fibrosis and Serum Surfactant Protein-D as a Prognostic Factor

1Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, South-1 West-17, Chuo-ku, Sapporo 060-8556, Japan 2Department of Respiratory Medicine, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo 006-8555, Japan *Corresponding author Masanori Shiratori, MD Associate Professor Department of Respiratory Medicine and Allergology Sapporo Medical University School of Medicine South-1 West-17 Chuo-ku, Sapporo 060-8556, Japan Tel. +81-11-611-2111 (ext. 32390) Fax: +81-11-613-1543 E-mail: siratori@sapmed.ac.jp

Occult Thyroid Follicular Carcinoma Diagnosed as Metastasis to the Chest Wall

Chest wall tumors are relatively rare, and hematogenous metastasis to the chest wall is very rare. We herein describe a rare case of occult thyroid carcinoma as metastasis to the chest wall in an 80-year-old woman. The patient received detailed examinations of the chest wall tumor, and the results suggested that she had occult thyroid carcinoma. Surgery was then performed to remove all of her thyroid. As a result, she was diagnosed with follicular carcinoma of the thyroid. We report an extremely rare case of occult thyroid carcinoma diagnosed as hematogenous metastasis to the chest wall.

Serial Measurements of Tricuspid Regurgitation Pressure Gradient by Echocardiography Predict Prognosis In Idiopathic Pulmonary Fibrosis

Background and Objectives: Idiopathic Pulmonary Fibrosis (IPF), especially with emphysema, reportedly involved with Pulmonary Hypertension (PH). However, it is not elucidated whether pulmonary arterial pressure changes serially during the course and influence on prognosis in IPF. We examined whether serial measurements of Tricuspid Regurgitation Pressure Gradient (TRPG) by echocardiography were meaningful predictors of IPF patient survival. Methods: We retrospectively investigated 83 IPF patients. The echocardiographic TRPG cutoff was set at 30 mmHg, and the subjects were divided into two groups: high TRPG and normal TRPG. We also evaluated the relationship between serial TRPG changes during follow-up. Results: A total of 28 patients were included in the high TRPG group. The high TRPG group showed significantly lower %FVC and %DLco, higher A-aDO 2 , shorter 6-minute walk test distance, and more frequent emphysema than the normal TRPG group. The high TRPG group also had poorer survival than the normal TRPG group. A multivariate Cox proportional hazard model demonstrated that TRPG, %FVC, and A-aDO 2 significantly affected patient survival. Thirty-six patients underwent echocardiography twice. At the time of the second echocardiog- raphy, 7 patients with normal TRPG at baseline (n=22) increased to a TRPG of more than 30 mmHg. These patients had significantly showed poorer survival. Conclusions: TRPG is an independent prognostic factor in IPF. Emphysema involvement, de- creased DLco, and decreased FVC were associated with an increase in TRPG. Serial measure- ments of TRPG are recommended for the early detection of PH and predict prognosis in IPF patients.