Pulmonary arteriovenous fistula is a congenital vascular malformation in lung resulting from abnormal capillary development and the exact etiology is not well known but it may occur with or without hereditary hemorrhagic telangiectasia. Hereditary hemorrhagic telangiectasia (L-IHT) or Rendu-Osler-Weber disease is an autosomal dominant vascular disorder which associates epistaxis, mucocutaneous and visceral telangicetases, and recurrent hemorrhage with chronic anemia and visceral shuntings. Recently we experienced a case of the pulmonary arteriovenous fistula in a 23 year old woman with a family history of this disease, which was confirmed by pulmonary angiography.
Pulmonary siderosis is one kind of pneumoconiosis, occurs from chronic inhalation of iron or iron oxide. Inhaled iron dust is deposited in the intra-alveolar spaces, which leads to radiological changes and respiratory symptoms. It is diagnosed by iron exposure history, radiological changes, and the evidence of intra-alveolar iron deposit. We have experienced a case of pulmonary siderosis which was confirmed by bronchoalveolar lavage and transbronchial lung biopsy, so report it with a review of literature.
Objective: The aim of this prospective study was to compare the diagnostic performances of dynamic MR imaging and CT for the differentiation of benign and malignant solitary pulmonary nodules (SPNs). Methods: Eighty-one patients with SPNs (32 malignant, 49 benign) underwent dynamic MR imaging (n = 31), dynamic CT (n = 27), or both (n = 23). The degree of peak enhancement of benign and malignant SPNs was compared on both dynamic MR imaging and CT. Receiver operating characteristic (ROC) analysis was performed to compare the diagnostic performances of dynamic MR imaging and CT. Results: The malignant SPNs revealed significantly greater degrees of peak enhancement on dynamic MR imaging (mean ± SD [p%SI] 131.2 ± 46.1 versus 54.2 ± 45.3; range [p%SI] 82.6-260.0 versus −0.7-171.7; P < 0.0001) and CT (mean ± SD [DMI] 37.8 ± 15.1 versus 17.9 ± 21.8; range [DMI] 14.1-68.2 versus −5.4-107.6; P = 0.0004). Although dynamic MR imaging was somewhat superior to dynamic CT, the diagnostic performances of the 2 modalities based on ROC analysis were not statistically significant. Conclusions: Dynamic MR imaging and CT seem to be equally well suited for the differentiation between benign and malignant SPNs.
The clinical course of idiopathic pulmonary fibrosis (IPF) is difficult to predict, partly owing to its heterogeneity. Composite physiologic index (CPI) and gender-age-physiology (GAP) models are easy-to-use predictors of IPF progression. This study aimed to compare the predictive values of these two models. From 2003 to 2007, the Korean Interstitial Lung Disease (ILD) Study Group surveyed ILD patients using the 2002 ATS/ERS criteria. A total of 832 patients with IPF were enrolled in this study. CPI was calculated as follows: 91.0 - (0.65 × %DLCO) - [0.53 × %FVC + [0.34 × %FEV1. GAP stage was calculated based on gender (0-1 points), age (0-2 points), and two physiologic lung function parameters (0-5 points). The two models had similar significant predictive values for patients with IPF (p < 0.001). The area under the curve (AUC) was higher for CPI than GAP for prediction of 1-, 2-, and 3-year mortality in this study. The AUC was higher for surgically diagnosed IPF patients than for clinically diagnosed patients. However, neither CPI nor GAP yielded good predictions of outcomes; the AUC was approximately 0.61~0.65. Although both CPI and GAP stage are significantly useful predictors for IPF, they have limited capability to accurately predict outcomes.
Rationale: In recent decades, diagnosis and treatment recommendations for idiopathic pulmonary fibrosis (IPF) have changed. In Korea, the average life expectancy has increased, unmet healthcare needs have been reduced, and the number of computed tomographic examinations performed has nearly doubled. The Korean Interstitial Lung Disease Study Group conducted a nationwide cohort study for idiopathic interstitial pneumonia, including IPF, and established a registry for IPF.Objectives: Using study data collected by the study group, this study aimed to evaluate longitudinal changes in clinical features, diagnosis, treatment, and mortality and analyze the extent to which changes in medication usage affected IPF-associated mortality.Methods: The study population included newly diagnosed patients with IPF from a cohort study (January 2002 to September 2008, n = 1,839, 2008 group) and prospective registry (January 2012 to August 2018, n = 1,345, 2018 group). Survival curves were estimated using the Kaplan-Meier method, and Cox regression models were used to identify mortality-associated risk factors in each group.Results: The 2018 group was younger, had fewer symptoms, had less honeycombing, underwent more serologic autoimmune marker and pulmonary function tests, had higher oxygen partial pressure and lower carbon dioxide partial pressure values, was less frequently diagnosed by surgical biopsy, and had better survival than the 2008 group. Steroid use and conservative care declined, whereas N-acetylcysteine use increased in this group. Antifibrotic agents were used in only the 2018 group. In the 2008 group, N-acetylcysteine was associated with lower mortality, whereas conservative care was associated with higher mortality. In the 2018 group, the use of antifibrotic agents was associated with lower mortality, and steroid use was associated with higher mortality. The survival rates in the 2008 and 2018 non-antifibrotic agent subgroups were similar.Conclusions: This study analyzed national IPF cohort data spanning 17 years. In clinical practice, the IPF diagnosis was made earlier, steroid and immunosuppressive agent use was reduced, and antifibrotic agents were administered. The survival of patients with IPF has improved over the decades, and antifibrotic use was consistently associated with improved survival.Clinical trial registered with clinicaltrials.gov (NCT04160715).
Background Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in hospital-acquired infection, and is prevalent in intensive care units (ICU). The MRSA colonization rates of the nares and throat were examined in both the ICU and general ward. This study was performed to investigate the MRSA rate and necessity for MRSA screening cultures in patients admitted to ICU. Methods Between June and September 2004, those patients admitted to both the medical ICU and general ward participated in this study. Bacterial cultures were performed on swabs of the nares and throat taken within 24 hours of admission. Clinical data were also collected. Results One hundred and twenty one patients and 84 patients, admitted to the medical ICU and medical general ward, respectively, were investigated. The numbers of nasal MRSA colonization in the ICU and general ward were 3 (2.5%) and 3 (3.6%), respectively. There were 2 (1.7%) cases of throat MRSA colonization in the ICU, but none in the general ward. The MRSA colonization rates of the nares and throat were no different between the ICU and general ward. There were no significant differences in the previous admission, operation history and admission route between the ICU and general ward groups. Conclusion The MRSA colonization rates of the nares and throat were 3.3 and 3.6% in the ICU and the general ward, respectively. The MRSA screening test does not appear to be required in all patients admitted to the ICU, but further studies, including high-risk patients, are recommended.
Behçet's disease is a chronic systemic inflammatory disorder with an unknown etiology. It affects many organs and is characterized by recurrent attacks. Pulmonary artery aneurysms occur more frequent in males, and it is o ne of the rare pulmonary complications of Behçet's disease. It has a poor and prognosis, and is also one of the leading causes of death from Behçet's disease. Here we report a case of suspected Behçet's disease diagnosed by a manifestation of a pulmonary artery aneurysm in a 37-year-old woman.
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