Isolated left bronchial isomerism that was incidentally detected as a severe obstructive ventilatory disturbance in an asymptomatic adult patient: A case report.

RATIONALE: Left bronchial isomerism is generally associated with abnormal arrangement of the atrium and abdominal viscera; therefore, its diagnosis is confirmed in early childhood. PATIENT CONCERNS: Here we report a rare case involving a 36-year-old man with isolated left bronchial isomerism that presented as an asymptomatic severe obstructive ventilatory disturbance during pulmonary function tests performed as part of routine assessments for an orbital wall fracture. The patient was a current smoker and did not show any respiratory symptoms. DIAGNOSIS: Chest computed tomography revealed left bronchial isomerism, and further tests showed that there was no involvement of other organs. INTERVENTIONS: We recommended smoking cessation and the long-term use of an inhaled long-acting bronchodilator. OUTCOMES: The findings from this case highlight the causative role of left bronchial isomerism in asymptomatic adults with chronic obstructive pulmonary disease. LESSONS: Physicians should consider this condition as a cause of obstructive ventilatory disturbances in asymptomatic adult patients.

Lung abscess by Actinomyces odontolyticus and Parvimonas micra co-infection presenting as acute respiratory failure: A case report.

RATIONALE: Actinomyces odontolyticus and Parvimonas micra are very rare causative organisms of lung abscess and acute respiratory failure. PATIENT CONCERNS: A 49-year-old male patient visited the emergency room with a complaint of sudden onset of shortness of breath, and he developed acute respiratory failure rapidly. DIAGNOSIS: An abscess in the left lower lung field was diagnosed on the computed tomography scan of chest. INTERVENTIONS: Immediate treatment with intravenous antibiotics was initiated along with a pigtail catheter insertion for pus drainage. OUTCOMES: A odontolyticus was cultured on the drained pus and P micra was identified by a blood culture. The patient was successfully weaned from the mechanical ventilator and the lung abscess was completely resolved. LESSONS: To the best of our knowledge, this is the first case report of mixed infection with A odontolyticus and P micra, which caused acute respiratory failure in an immune-competent patient. Therefore, physicians should consider the possibility of these organisms as causative pathogens of a fulminant pulmonary infection even in an immune-competent patient.

Validity of the GOLD 2017 classification in the prediction of mortality and respiratory hospitalization in patients with chronic obstructive pulmonary disease.

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) released an updated document in 2017 that excluded the spirometric parameter in the classification of patients. The validity of this new classification system in predicting mortality and respiratory hospitalization is still uncertain. Methods: Outpatients (n=149) with chronic obstructive pulmonary disease (COPD) who underwent spirometry and six-minutes walking test from October 2011 to September 2013 were enrolled. The overall mortality and rate of respiratory hospitalization over a median of 61 months were analyzed. Kaplan-Meier survival analyses, receiver operaing curve analyses with areas under the curve (AUCs), and logistic regression analyses for GOLD 2007, GOLD 2011, GOLD 2017, and/or BODE index were performed to evaluate their abilities to predict mortality and respiratory hospitalization. Results: Forty-two (53.2%) patients in 2011 GOLD C or D group were categorized into 2017 GOLD A or B group. The odds ratios of GOLD 2017 group C and group D relative to group A were 7.55 (95% CI, 1.25-45.8) and 25.0 (95% CI, 6.01-102.9) for respiratory hospitalization. Patients in GOLD 2017 group A and group B had significantly better survival (log-rank test, p<0.001) compared with patients in group D; however, survival among patients in GOLD 2007 groups and GOLD 2011 groups was comparable. The AUC values for GOLD 2007, GOLD 2011, GOLD 2017, and BODE index were 0.573, 0.624, 0.691, 0.692 for mortality (p=0.013) and 0.697, 0.707, 0.741, and 0.754 for respiratory hospitalization (p=0.296), respectively. Conclusion: The new GOLD classification may perform better than the previous classifications in terms of predicting mortality and respiratory hospitalization.

Impact of coexistent chronic obstructive pulmonary disease on the survival of patients with small cell lung cancer receiving chemotherapy.

BACKGROUND: While there is growing interest in the correlation between chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer, very few studies have examined the interaction between COPD and small cell lung cancer (SCLC). Therefore, the aim of this study was to examine the impact of COPD on the survival of patients with SCLC. METHODS: The medical records of 110 patients with SCLC who received chemotherapy from July 2006 until April 2014 were retrospectively examined. The overall survival (OS) and progression-free survival (PFS) rates of spirometry-diagnosed COPD and non-COPD groups were compared. Predictors for poorer survival were analyzed using Cox proportional hazards regression. RESULTS: Of the 110 SCLC patients, 57 (51.8%) had coexistent COPD. The median OS for the COPD group was 11.6 months and for the non-COPD group was 11.2 months (log-rank test, P = 0.581), whereas the median PFS rates were 6.65 and 6.57 months, respectively (log-rank test, P = 0.559). Multivariate analysis identified Eastern Cooperative Oncology Group performance status ≥ 2 and extensive-stage SCLC as independent risk factors for shorter OS; however, coexisting COPD was not a predictor of survival. CONCLUSIONS: Although over half of the SCLC patients receiving chemotherapy had COPD, coexisting COPD had no impact on the survival of patients with SCLC.

Usefulness of neutrophil to lymphocyte ratio in patients with chronic obstructive pulmonary disease: a prospective observational study.

BACKGROUND/AIMS: Neutrophil to lymphocyte ratio (NLR) in peripheral blood is a useful systemic inflammatory response biomarker. However, NLR has not been studied in patients with chronic obstructive pulmonary disease (COPD). This study was aimed to evaluate the usefulness of NLR in patients with COPD. METHODS: NLR was prospectively measured and compared in patients with COPD exacerbation (n = 59), patients with stable COPD (n = 61), and healthy controls (n = 28). NLR in patients with COPD exacerbation was repeatedly measured in the convalescent period. The correlation between NLR and clinical parameters was evaluated, and the predictors for respiratory hospitalization were analyzed by multivariate logistic regression. RESULTS: NLR values were significantly higher in patients with COPD exacerbation compared with stable COPD patients and controls (12.4 ± 10.6, 2.4 ± 0.7, 1.4 ± 0.5, respectively; p < 0.001). NLR was significantly decreased during the convalescent period in patients with COPD exacerbation (4.5 ± 4.6 vs. 11.5 ± 8.8, p < 0.001). NLR exhibited a significant correlation with the body mass index, degree of airway obstruction, dyspnea, and exercise capacity (BODE) index, the 6-minute walk test, and the modified Medical Research Council scale. NLR ≥ 2.8 was an independent predictor with a borderline significance for respiratory hospitalization (odds ratio, 2.083; p = 0.079). Body mass index and forced expiratory volume in 1 second were independent predictors for respiratory hospitalization. CONCLUSIONS: NLR is a straightforward and effective biomarker of COPD exacerbation that may serve as a predictor for respiratory hospitalization in patients with COPD.

Association between weight change and clinical outcomes in critically ill patients.

PURPOSE: Body weight fluctuates daily throughout a patient's stay in the intensive care unit (ICU) due to a variety of factors, including fluid balance, nutritional status, type of acute illness, and presence of comorbidities. This study investigated the association between change in body weight and clinical outcomes in critically ill patients during short-term hospitalization in the ICU. METHODS: All patients admitted to the Gyeongsang National University hospital between January 2010 and December 2011 who met the inclusion criteria of age 18 or above and ICU hospitalization for at least 2 days were prospectively enrolled in this study. Body weight was measured at admission and daily thereafter using a bed scale. Univariate and multivariate linear and logistic regression analyses were performed to evaluate factors associated with mortality and the association between changes in body weight and clinical outcomes, including duration of mechanical ventilation (MV) use, length of ICU stay, and ICU mortality. RESULTS: Of the 140 patients examined, 33 died during ICU hospitalization, yielding an ICU mortality rate of 23.6%. Non-survivors experienced higher rates of severe sepsis and septic shock and greater weight gain than survivors on days 2, 3, 4, 5, and 6 of ICU hospitalization (P < .05). Increase of body weight on days 2 through 7 on ICU admission was correlated with the longer stay of ICU, and increase on days 3 through 7 on ICU admission was correlated with the prolonged use of mechanical ventilation. Increase of body weight on days 3 through 5 on ICU admission was associated with ICU mortality. CONCLUSIONS: Increase in body weight of critically ill patients may be correlated with duration of mechanical ventilation use and longer stay of ICU hospitalization and be associated with ICU mortality.