Kwangha Lee

Metabolic burden measured by (18)f-fluorodeoxyglucose positron emission tomography/computed tomography is a prognostic factor in patients with small cell lung cancer.

Purpose Evidence regarding the usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in predicting the prognosis of non-small cell lung cancer is increasing. However, data on small cell lung cancer (SCLC) are scarce. The aim of this study was to evaluate the prognostic value of metabolic parameters measured using 18F-FDG PET/CT in patients with SCLC. Materials and Methods We conducted a retrospective review of 114 patients with pathologically proven SCLC (26 cases of limited disease and 88 cases of extensive disease) who underwent pretreatment 18F-FDG PET/CT. The maximal SUV (SUVmax) was used quantitatively for determination of FDG PET activity. The SUVmax of the primary tumor (primary SUVmax), the sum of SUVmax values of malignant lesions (SUVsum), and the mean SUVmax of malignant lesions were calculated. Results The patient population was subdivided using a median SUVsum value of 24.6. High SUVsum showed a significant association with known factors for poor prognosis, including higher neuron-specific enolase (p=0.010), CYFRA 21-1 (p=0.014), and extensive disease status (p=0.007). Patients with high SUVsum had significantly shorter median overall survival (6.6 months vs. 13.0 months, p<0.001) and progression-free survival (5.2 months vs. 8.0 months, p<0.001) than patients with low SUVsum. Results of multivariate analysis showed that SUVsum, chemotherapy cycles, and the response to first-line treatment were significant prognostic factors of survival. In contrast, mean SUVmax and primary SUVmax were not significant predictors of survival. Conclusion In this study, metabolic burden represented by SUVsum from pretreatment 18F-FDG PET/CT was an independent prognostic factor in patients with SCLC.

Sarcoidosis Mimicking Cancer Metastasis Following Chemotherapy for Ovarian Cancer

We report on a rare case of sarcoidosis that developed after chemotherapy for ovarian cancer, and mimicked a cancer metastasis. A 52-year-old female diagnosed with stage III ovarian cancer underwent curative surgery and postoperative chemotherapy. Four months later, her whole-body positron emission tomography and computed tomography (CT) scan showed high uptake in the mediastinal lymph nodes, and ovarian cancer recurrence was suspected. Biopsy of the mediastinal lymph nodes and subcutaneous nodules revealed noncaseating granulomas. These lesions resolved spontaneously without treatment; however, newly developed perilymphatic and centrilobular nodules were observed on follow-up chest CT. Surgical biopsy of these lesions also showed noncaseating granulomas. She was finally diagnosed with sarcoidosis.

Clinical utility of rapid pathogen identification using matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry in ventilated patients with pneumonia: A pilot study

We evaluated the clinical utility of rapid identification of microorganisms in bronchoalveolar lavage (BAL) fluid using matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF MS) in terms of the clinical outcomes of ventilated patients with pneumonia.

Physiologic Effect and Safety of the Pumpless Extracorporeal Interventional Lung Assist System in Patients With Acute Respiratory Failure—A Pilot Study

Interventional lung assist (iLA) effectively reduces CO(2) tension and permits protective lung ventilation in patients with acute respiratory distress syndrome. However, there is little experience in using iLA in acute respiratory failure from various causes and no experience for small body sizes such as Asian patients. We evaluated the physiologic effect and safety of the iLA device in patients with acute respiratory failure from various causes. We enrolled 11 consecutive patients with severe respiratory failure from various causes. Wire-enforced cannulae (13-15 Fr) were inserted under ultrasound guidance and connected to iLA. Arterial blood gas analysis, ventilator parameters, hemodynamic parameter, and adverse events were recorded serially. During the first 24h of iLA use, mean blood flow was 1.08±0.15L/min, PaCO(2) decreased from 83.9±23.4mmHg to 40.7±10.2mmHg, and PaO(2) /FiO(2) ratio increased from 110±37 to 141±74. Minute ventilation decreased from 9.4±2.5 to 6.3±1.5L/min, and peak inspiratory pressure decreased from 30.3±7.1cm H(2) O to 28.8±9.4cm H(2) O. No serious adverse events were observed during iLA use. iLA showed effective CO(2) removal, allowed for reducing the invasiveness of mechanical ventilation in patients with severe respiratory failure from various causes even using a small-sized catheter and was safe in small body-sized patients.

Associations between Single Nucleotide Polymorphisms of High Mobility Group Box 1 Protein and Clinical Outcomes in Korean Sepsis Patients

Purpose High mobility group box 1 (HMGB1) plays a central role in the pathogenesis of sepsis and multiple organ dysfunction syndromes. We investigated the associations of a single nucleotide polymorphism (SNP; rs1045411) in HMGB1 with various clinical parameters, severity, and prognosis in patients with sepsis, severe sepsis, or septic shock. Materials and Methods We enrolled 212 adult patients followed for 28 days. All patients were genotyped for rs1045411, and the serum levels of HMGB1 and several cytokines were measured. Results The proportions of patients according to genotype were GG (71.2%), GA (26.4%), and AA (2.4%). Among patients with chronic lung disease comorbidity, patients with a variant A allele had higher positive blood culture rates and higher levels of various cytokines [interleukin (IL)-1β, IL-6, IL-10, IL-17, and tumor necrosis factor-α] than those with the GG genotype. In the analysis of those with diabetes as a comorbidity, patients with a variant A allele had higher blood culture and Gram-negative culture rates than those with GG genotypes; these patients also had a higher levels of IL-17. In the analysis of those with sepsis caused by a respiratory tract infection, patients with a variant A allele had higher levels of IL-10 and IL-17 (all p<0.05). This polymorphism had no significant impact on patient survival. Conclusion The variant A allele of rs1045411 appears to be associated with a more severe inflammatory response than the GG genotype under specific conditions.

Clinical role of serum pre-B cell colony-enhancing factor in ventilated patients with sepsis and acute respiratory distress syndrome.

Abstract Background: We measured serum levels of pre-B cell colony-enhancing factor (PBEF), which has been suggested as a novel biomarker of sepsis and acute respiratory distress syndrome (ARDS), and evaluated its use as a prognostic biomarker. Methods: PBEF was measured in 104 adult ventilated patients who were diagnosed with sepsis upon admission using an enzyme-linked immunosorbent assay. Results: The mean age of our patients was 62.9 ± 12.1 y, and 62 (59.6%) patients were male. The median PBEF level was 5.4 ng/ml (range 1.1–150.7 ng/ml). Non-survivors (n = 57) demonstrated significantly higher PBEF levels than survivors (18.7 ± 34.5 vs 6.9 ± 6.1 ng/ml; p = 0.022). Most particularly, patients with PBEF levels ≥ 10.4 ng/ml (n = 27) demonstrated higher hospital mortality than patients with PBEF levels < 10.4 ng/ml (n = 77) (74.1% vs. 48.1%; p = 0.025). Univariate logistic analysis determined PBEF ≥ 10.4 ng/ml to be an independent factor associated with hospital survival (hazard ratio = 0.324, 95% confidence interval = 0.123–0.854; p = 0.023). Among patients with sepsis-induced ARDS (n = 59), non-survivors (n = 35) demonstrated significantly higher PBEF levels than survivors (n = 24), but not interleukin-6 (IL-6) levels. Conclusions: Our findings indicate that high PBEF is associated with poor clinical outcomes in ventilated patients with sepsis and sepsis-induced ARDS. Serum PBEF might be a better predictor of mortality than IL-6 in patients with sepsis-induced ARDS.

Pleurodesis Using Mistletoe Extract Delivered via a Spray Catheter during Semirigid Pleuroscopy for Managing Symptomatic Malignant Pleural Effusion

Background: Talc poudrage during thoracoscopy is considered the standard procedure for patients with symptomatic malignant pleural effusion (MPE). Until now, no alternative technique other than talc poudrage for pleurodesis during medical thoracoscopy has been proposed. Liquid sclerosants, such as mistletoe extract, have been sprayed evenly into the pleural cavity during semirigid pleuroscopy for chemical pleurodesis. Objective: We conducted a retrospective study using the database of semirigid pleuroscopy to identify the usefulness of pleurodesis using a mistletoe extract delivered via a spray catheter during semirigid pleuroscopy for symptomatic MPE. Methods: All consecutive patients with symptomatic MPE who underwent semirigid pleuroscopy from October 2015 to September 2016 were registered. The responses were evaluated using chest X- ray or computed tomography 4 weeks after pleurodesis. Results: The study included 43 patients who underwent pleurodesis with mistletoe extract via a spray catheter during semirigid pleuroscopy. Complete and partial responses were seen in 21 (49%) and 19 (44%) patients, respectively. The median duration of chest tube placement after pleurodesis was 7 days (range 6–8 days) in the 40 patients with complete or partial responses. No cases of severe hemorrhage, empyema formation, respiratory failure, or procedure-related mortality were observed in the subjects at 4 weeks after semirigid pleuroscopy. Conclusion: Pleurodesis with mistletoe extract delivered via a spray catheter during semirigid pleuroscopy is a safe and effective procedure for managing symptomatic MPE.

Predictors of Recurrence after Curative Resection in Patients with Early-Stage Non-Small Cell Lung Cancer

Background There have been various results from studies concerning the predictors of recurrence in early-stage nonsmall cell lung cancer (NSCLC). Therefore, an accurate assessment is needed to guide effective adjuvant therapy. We investigated the predictors of a recurrence in patients with resected, early-stage NSCLC and the risk factors associated with locoregional or distant recurrence. Methods This retrospective study was conducted on patients at the Pusan National University Hospital from January 2006 to December 2011. Patients with pathological stages I or II were included in this study, as based on the seventh edition TNM staging system. Multivariate Cox proportional hazard models were used to identify factors associated with recurrence. Results Two hundred and forty-nine patients were included. Among them, 180 patients were stage I, and 69 were stage II. Overall, by multivariate analysis, the independent factors associated with a 5-year total recurrence were the presence of visceral pleural invasion (VPI) (p=0.018) and maximal standardized uptake values (SUVs) of tumors on positron emission tomography (PET) >4.5 (p=0.037). The VPI was the only independent risk factor associated with both locoregional and distant recurrence, in the analysis of the patterns of tumor recurrence and their risk factors. In the subgroup analysis of stage I patients, three variables (male, VPI and resection margin positive) were significantly associated with a 5-year recurrence. Conclusion The independent factors associated with postoperative recurrence in early-stage NSCLC were as follows: PET SUV >4.5 and the presence of VPI. For patients with those factors adjuvant therapy should be recommended as a more efficacious treatment.

Outcomes and prognostic factors in patients with prolonged acute mechanical ventilation: A single-center study in Korea

PURPOSE The purpose of the study is to evaluate outcomes and objective parameters related to poor prognosis in patients who were defined as prolonged acute mechanical ventilation (PAMV; ventilator care ≥96 hours) in the medical intensive care unit of a university-affiliated tertiary care hospital in Korea. MATERIAL AND METHODS We analyzed retrospectively clinical data gathered from the medical records on day 4 of MV between 2008 and 2013. In total, 311 were categorized as PAMV. RESULTS Their median age was 67 years (range, 18-93 years), and 71.7% were male. The 28-day mortality rate after intensive care unit admission was 34.7%. Four variables on day 4 of mechanical ventilation (need for neuromuscular blockers [hazard ratio {HR}, 2.432; 95% confidence interval, 1.337-4.422], need for vasopressors [HR, 2.312; 95% confidence interval, 1.258-4.248], need for hemodialyses [HR, 1.913; 95% confidence interval, 1.018-3.595], and body mass index ≤21 kg/m(2) [HR, 1.827; 95% confidence interval, 1.015-3.288]) were independent factors associated with mortality based on a Cox proportional hazards model. As the number of these prognostic factors increased, the survival rate decreased. CONCLUSIONS Four clinical factors (body mass index ≤21, requirement for neuromuscular blockers, vasopressors, and hemodialysis) on day 4 of mechanical ventilation were associated with 28-day mortality in PAMV patients.

Hypersensitivity Pneumonitis Caused by Cephalosporins With Identical R1 Side Chains

Drug-induced hypersensitivity pneumonitis results from interactions between pharmacologic agents and the human immune system. We describe a 54-year-old man with hypersensitivity pneumonitis caused by cephalosporins with identical R1 side chains. The patient, who complained of cough with sputum, was prescribed ceftriaxone and clarithromycin at a local clinic. The following day, he complained of dyspnea, and chest X-ray revealed worsening of inflammation. Upon admission to our hospital, antibiotics were changed to cefepime with levofloxacin, but his pneumonia appeared to progress. Changing antibiotics to meropenem with ciprofloxacin improved his symptoms and radiologic findings. Antibiotics were de-escalated to ceftazidime with levofloxacin, and his condition improved. During later treatment, he was mistakenly prescribed cefotaxime, which led to nausea, vomiting, dyspnea and fever, and indications of pneumonitis on chest X-ray. We performed bronchoalveolar lavage, and the findings included lymphocytosis (23%), eosinophilia (17%), and a low cluster of differentiation (CD) 4 to CD8 ratio (0.1), informing a diagnosis of drug-induced pneumonitis. After a medication change, his symptoms improved and he was discharged. One year later, he was hospitalized for acute respiratory distress syndrome following treatment with ceftriaxone and aminoglycosides for an upper respiratory tract infection. After steroid therapy, he recovered completely. In this patient, hypersensitivity reaction in the lungs was caused by ceftriaxone, cefotaxime, and cefepime, but not by ceftazidime, indicating that the patients hypersensitivity pneumonitis was to the common R1 side chain of the cephalosporins.