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Background@#When suspicious lesions are observed on computer-tomography (CT), invasive tests are needed to confirm lung cancer. Compared with other procedures, bronchoscopy has fewer complications. However, the sensitivity of peripheral lesion through bronchoscopy including washing cytology is low. A new test with higher sensitivity through bronchoscopy is needed. In our previous study, DNA methylation of PCDHGA12 in bronchial washing cytology has a diagnostic value for lung cancer. In this study, combination of PCDHGA12 and CDO1 methylation obtained through bronchial washing cytology was evaluated as a diagnostic tool for lung cancer. @*Methods@#A total of 187 patients who had suspicious lesions in CT were enrolled. PCDHGA12methylation test, CDO1 methylation test, and cytological examination were performed using 3-plex LTE-qMSP test. @*Results@#Sixty-two patients were diagnosed with benign diseases and 125 patients were diagnosed with lung cancer. The sensitivity of PCDHGA12 was 74.4% and the specificity of PCDHGA12 was 91.9% respectively. CDO1 methylation test had a sensitivity of 57.6% and a specificity of 96.8%. The combination of both PCDHGA12 methylation test and CDO1 methylation test showed a sensitivity of 77.6% and a specificity of 90.3%. The sensitivity of lung cancer diagnosis was increased by combining both PCDHGA12 and CDO1 methylation tests. @*Conclusion@#Checking DNA methylation of both PCDHGA12 and CDO1 genes using bronchial washing fluid can reduce the invasive procedure to diagnose lung cancer.
RESUMO
A nodular density was detected on a chest radiograph taken from a 57-year-old Korean woman who was visiting a hospital for a routine check. Chest computed tomography revealed a 4.8 cm lobulated mass in the right lung and another focal nodular lesion in the left lung; biopsies of both lungs revealed adenocarcinoma. We conducted DNA sequencing and peptide nucleic acid clamping to investigate the potential double primary lung cancer. The results verified that the mass in the right lung had a mutation in the epidermal growth factor receptor, whereas the nodule in the left lung had a wild-type sequence, showing that these two were genetically different cancers from one another. Thus, we demonstrate that genetic testing is useful in determining double primary lung cancer, and we herein report on this case.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Adenocarcinoma , Biópsia , Constrição , Diagnóstico Diferencial , Fator de Crescimento Epidérmico , Testes Genéticos , Neoplasias Pulmonares , Pulmão , Radiografia Torácica , Receptores ErbB , Análise de Sequência de DNA , TóraxRESUMO
Chylothorax or chylous ascites are rare manifestations of liver cirrhosis. We report a rare case of simultaneous chylothorax and chylous ascites in a patient with hepatitis B virus-related liver cirrhosis. A 76-year-old woman was referred to our hospital with a pleural effusion on her right side. She had no history of recent medical procedures, trauma or tumor. There was no evidence of mass or thoracic duct obstruction in a computed tomography scan. Pleural fluid and ascites were confirmed as chylothorax and chylous ascites by chemistry analysis. Despite thorough conservative care, there was no improvement. Pleurodesis was planned, but hepatic encephalopathy developed suddenly and she did not recover.
Assuntos
Idoso , Feminino , Humanos , Ascite , Química , Quilotórax , Ascite Quilosa , Encefalopatia Hepática , Hepatite B , Cirrose Hepática , Derrame Pleural , Pleurodese , Ducto TorácicoRESUMO
A nodular density was detected on a chest radiograph taken from a 57-year-old Korean woman who was visiting a hospital for a routine check. Chest computed tomography revealed a 4.8 cm lobulated mass in the right lung and another focal nodular lesion in the left lung; biopsies of both lungs revealed adenocarcinoma. We conducted DNA sequencing and peptide nucleic acid clamping to investigate the potential double primary lung cancer. The results verified that the mass in the right lung had a mutation in the epidermal growth factor receptor, whereas the nodule in the left lung had a wild-type sequence, showing that these two were genetically different cancers from one another. Thus, we demonstrate that genetic testing is useful in determining double primary lung cancer, and we herein report on this case.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Adenocarcinoma , Biópsia , Constrição , Diagnóstico Diferencial , Fator de Crescimento Epidérmico , Testes Genéticos , Neoplasias Pulmonares , Pulmão , Radiografia Torácica , Receptores ErbB , Análise de Sequência de DNA , TóraxRESUMO
Chylothorax or chylous ascites are rare manifestations of liver cirrhosis. We report a rare case of simultaneous chylothorax and chylous ascites in a patient with hepatitis B virus-related liver cirrhosis. A 76-year-old woman was referred to our hospital with a pleural effusion on her right side. She had no history of recent medical procedures, trauma or tumor. There was no evidence of mass or thoracic duct obstruction in a computed tomography scan. Pleural fluid and ascites were confirmed as chylothorax and chylous ascites by chemistry analysis. Despite thorough conservative care, there was no improvement. Pleurodesis was planned, but hepatic encephalopathy developed suddenly and she did not recover.
Assuntos
Idoso , Feminino , Humanos , Ascite , Química , Quilotórax , Ascite Quilosa , Encefalopatia Hepática , Hepatite B , Cirrose Hepática , Derrame Pleural , Pleurodese , Ducto TorácicoRESUMO
BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Assuntos
Humanos , Acinetobacter baumannii , Acinetobacter , Antibacterianos , APACHE , Diagnóstico , Prontuários Médicos , Mortalidade , Pneumonia Associada à Ventilação Mecânica , SulbactamRESUMO
BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Assuntos
Humanos , Acinetobacter baumannii , Acinetobacter , Antibacterianos , APACHE , Diagnóstico , Prontuários Médicos , Mortalidade , Pneumonia Associada à Ventilação Mecânica , SulbactamRESUMO
Splenic pseudocyst is a rare disease associated with chronic and acute pancreatitis splenic pseudocyst is treated by distal pancreatectomy and splenectomy. A 47-year old woman with a 10-year history of alcohol abuse presented with epigastric and left upper quadrant pain of 3 days duration. Abdominal CT showed a 4.0x4.5 cm sized cystic lesion in the tail of the pancreas. Analgesics was administrated for the relief of abdominal pain. On the 4th hospital day, the patient complained more of left upper quadrant pain, so we took follow up CT scans. On follow up CT, one large splenic pseudocyst with size of 9.5x4.5x10.0 cm was noted. The patient was treated conservatively by percutaneous catheter drainage and discharged on the 13th hospital day. This case is the first case report of splenic pseudocyst treated conservatively, not by surgery in Korea.
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Feminino , Humanos , Pessoa de Meia-Idade , Doença Aguda , Alcoolismo/diagnóstico , Drenagem , Pseudocisto Pancreático/diagnóstico , Pancreatite/complicações , Esplenopatias/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND/AIMS: The endoscopic findings and clinical relevance of portal hypertensive colopathy are not well described in Korea. We aimed to do a retrospective study of mucosal changes in the colon of patients with liver cirrhosis and to find their association with clinical characteristics. METHODS: We reviewed the clinical data and endoscopic findings of 48 patients with liver cirrhosis and 48 patients, matched for age and sex, with irritable bowel disease (IBS) who underwent colonoscopy over a 5 year span. RESULTS: Patients with liver cirrhosis were more likely to have colitis-like lesions and vascular abnormalities than IBS patients. Low platelet count (p=0.005) and severe esophageal varices (p=0.011) were associated with portal hypertensive colopathy, whereas the etiologies and severity of cirrhosis were not associated with these findings. CONCLUSIONS: Portal hypertensive colopathy can be defined with colitis-like lesions or vascular lesions. These lesions are more frequently present in patients with more severe esophageal varices and thrombocytopenia.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colonoscopia , Varizes Esofágicas e Gástricas/etiologia , Hipertensão Portal/complicações , Mucosa Intestinal/patologia , Síndrome do Intestino Irritável/complicações , Cirrose Hepática/complicações , Contagem de Plaquetas , Estudos Retrospectivos , Índice de Gravidade de Doença , Trombocitopenia/etiologiaRESUMO
Primary lung cancer frequently metastasizes to distant organs. The pancreas is a relatively infrequent site of metastasis. Furthermore, obstructive jaundice resulting from pancreatic metastasis is extremely rare. This paper examines the case of a 65-year-old woman with small cell lung cancer initially presenting with extrahepatic biliary obstruction. The patient underwent percutaneous transhepatic biliary drainage. The obstruction was relieved with a stent placement, then the woman was treated with combination chemotherapy (irinotecan, cisplatin) and a complete remission achieved in six months.
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Humanos , Feminino , Idoso , Stents , Neoplasias Pancreáticas/secundário , Neoplasias Pulmonares/complicações , Icterícia Obstrutiva , Carcinoma de Células Pequenas/complicaçõesRESUMO
BACKGROUND AND OBJECTIVES: This study was performed to evaluate the clinical usefulness of the carotid intima-media thickness (IMT) as a screening test for coronary artery disease (CAD), and evaluate the differences in the carotid IMT in CAD patients with age- and sex-matched healthy subjects and hyperlipidemic hypertensive patients. SUBJECTS AND METHODS: The study was conducted on a total of 609 subjects; 229 patients with CAD (mean age; 53 yrs, 148 males), 207 age- and sex-matched hyperlipidemic hypertensive patients (mean age; 52 yrs, 115 males) and 173 age and sex matched healthy subjects (mean age; 52 yrs, 100 males). The carotid IMT was semi-automatically measured using high-resolution ultrasound. The clinical variables and carotid IMT in the study subjects were compared, and the data analyzed. RESULTS: The mean carotid IMT in patients with CAD (0.87+/-0.19 mm) was significantly higher than that in hyperlipidemic hypertensive patients (0.72+/-0.14 mm, p<0.001) and the healthy subjects (0.66+/-0.11 mm, p<0.001). Also, the carotid IMT in the hyperlipidemic hypertensive patients was significantly higher than that in the healthy subjects (p=0.001). The prevalence of carotid plaques was also significantly different between the CAD, hyperlipidemic hypertensive and healthy groups; 29.3, 18.4 and 8.7%, respectively (p<0.001). The cutoff values for differentiating CAD patients from healthy subjects and hyperlipidemic hypertensive patients were both 0.754 mm, with sensitivities and specificities of 72 and 80% and 72 and 66%, respectively, inform an ROC curve analysis. CONCLUSION: The carotid IMT was more increased in patients with coronary artery disease than in the hyperlipidemic hypertensive patients and healthy subjects. Therefore, the cutoff value (0.754 mm) of the carotid IMT could be a clinically useful screening test for predicting significant CAD and for differentiating high risk patients.
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Humanos , Artérias Carótidas , Espessura Intima-Media Carotídea , Doença da Artéria Coronariana , Vasos Coronários , Programas de Rastreamento , Prevalência , Curva ROC , UltrassonografiaRESUMO
The association of Graves' disease and idiopathic thrombocytopenic purpura(ITP) is a rather rare, but well documented condition, and has also been reported a few times in Korea. At present, two main hypothetical mechanisms are used to explain the association of the two diseases; the presence of autoimmunity, which leads to both diseases, and activation of the reticuloendothelial system by thyroid hormone. A 33 year old female patient visited our hospital with mucosal bleeding and purpura over her entire body of 3 days duration. Her initial platelet count was 2x109/L, and the thyroid function tests showed a suppressed TSH level of 0.09 mU/L(0.4~3.1) and elevated levels of triiodothyronine and free thyroxine. The levels of anti-thyroglobulin Ab anti-TPO Ab, and anti-TSH receptor Ab were also elevated. The clinical, laboratory and bone marrow findings were compatible with Graves' disease associated with ITP. She was treated with methylprednisolone and propylthiouracil, after which her platelet count increased and thyroid function normalized. We report a case of Graves' disease associated with ITP, which was treated well by glucocorticoid and antithyroid medications
Assuntos
Adulto , Feminino , Humanos , Autoimunidade , Medula Óssea , Doença de Graves , Hemorragia , Coreia (Geográfico) , Metilprednisolona , Sistema Fagocitário Mononuclear , Contagem de Plaquetas , Propiltiouracila , Púrpura , Púrpura Trombocitopênica Idiopática , Testes de Função Tireóidea , Glândula Tireoide , Tiroxina , Tri-IodotironinaRESUMO
Gastric carcinoid tumor is a rare neoplasm that occupies less than 1% of total gastric tumor. Especially, gastric carcinoid tumor with hemorrhage has been very rare. A sixty-three-year old male patient was admitted to the hospital because of hematemesis and melena. On the endoscopic examination, a 2 cm-long polypoid mass with central ulcer and hemorrhagic erosions was seen on the anterior wall of the mid-body without active bleeding. Endoscopic ultrasonography revealed that the lesion was limited to submucosa without evidence of metastasis to adjacent lymph node. We experienced a case of gastric carcinoid tumor accompanied with upper gastrointestinal bleeding. The patient underwent extended wedge resection and omentectomy under the diagnosis of type 3 carcinoid tumor. This tentative diagnosis was based on clinical and pathological findings. We report a case of gastric carcinoid with bleeding that is probably type 3.
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Humanos , Masculino , Tumor Carcinoide , Diagnóstico , Endossonografia , Hematemese , Hemorragia , Linfonodos , Melena , Metástase Neoplásica , ÚlceraRESUMO
BACKGROUND AND OBJECTIVE: The endothelial function, carotid intima-media thickness (CIMT) and arterial stiffness are known as surrogates of atherosclerosis, but it is not clear whether these surrogates can discriminate patients with coronary artery disease (CAD) from those with risk factor. The intention was to compare these 3 surrogates in patients with CAD and those with risk factor only. SUCJECTS AND METHODS: Forty-three patients with CAD (mean age:58, 32 men), 18 age and sex matched healthy people (mean age:52, 9 men) and 16 patients (mean age:53, 12 men) with atherosclerosis risk factor only were enrolled. The endothelial function (flow-mediated brachial artery dilation, FMD) and CIMT were measured by high-resolution ultrasound and the arterial stiffness by an oscillometric method. RESULTS: There was a significant difference between the CAD and risk factor groups (3.46+/-1.3% vs. 5.77+/-2.54%, p0.05) in the measured FMD. The CIMT showed a significant difference between the CAD and healthy groups (0.89+/-0.14 mm vs. 0.78+/-0.07 mm, p0.05). There were significant differences among all groups in relation to the arterial stiffness (CAD group:1524+/-289 cm/sec, risk group:1342+/-202 cm/sec, healthy group:1195+/-119 cm/sec, p<0.05). The arterial stiffness showed significant correlation with the FMD (r=-0.322, p=0.005) and CIMT (r=0.310, p=0.007). CONCLUSION: Of the 3 surrogates, the arterial stiffness measurement showed the best reliability in differentiating the CAD from the risk factor only groups as well as from healthy subjects. This study suggests the arterial stiffness can be used as a novel noninvasive test for early diagnosis of CAD in patients at high risk of atherosclerosis.