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Yong Pil Chong,
Su-Jin Park,
Hee Sueng Kim,
Eun Sil Kim,
Mi-Na Kim,
Ki-Ho Park,
Sung-Han Kim,
Sang-Oh Lee,
Sang-Ho Choi,
Jin-Yong Jeong,
Jun Hee Woo, Yang Soo Kim
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ABSTRACT: Persistent Staphylococcus aureus bacteremia (SAB) that fails to respond to appropriate antibiotic therapy is associated with poor outcomes. Comprehensive prospective studies on risk factors and outcomes of persistent bacteremia are limited. We investigated outcomes and risk factors encompassing clinical, pharmacokinetic, microbiologic, and genotypic characteristics associated with persistent bacteremia using a case-control study nested in a prospective cohort of patients with SAB at a tertiary-care hospital from August 2008 through September 2010. We compared the clinical characteristics, management, and outcomes of patients with persistent bacteremia (≥7 d) with controls with resolving bacteremia (<3 d). To detect associations between microbiologic and genotypic characteristics of methicillin-resistant S. aureus (MRSA) isolates and persistent bacteremia, we determined the heteroresistance phenotype, SCCmec type, agr genotype and functionality, multilocus sequence typing, and presence of 41 virulence genes. Our cohort consisted of 483 patients; 76 (15.7%) had persistent bacteremia, 212 (43.5%) had resolving bacteremia. In the multivariate analysis, independent risk factors associated with persistent bacteremia were community-onset bacteremia (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.24-6.87), bone and joint infection (OR, 5.26; 95% CI, 1.45-19.03), central venous catheter-related infection (OR, 3.36; 95% CI, 1.47-7.65), metastatic infection (OR, 36.22; 95% CI, 12.71-103.23), and methicillin resistance (OR, 16.99; 95% CI, 5.53-52.15). For patients with eradicable foci, delay (>3 d) in the removal of the infection focus was significantly associated with persistent bacteremia (OR, 2.18; 95% CI, 1.05-4.55). There were no significant associations of persistent bacteremia with high vancomycin minimal inhibitory concentration, vancomycin heteroresistance, and microbiologic/genotypic characteristics of MRSA isolates. However, initial vancomycin trough level <15 mg/L was an independent risk factor for persistent MRSA bacteremia (OR, 4.25; 95% CI, 1.51-11.96) in the multivariate analysis. Clinical outcomes were significantly worse for patients with persistent bacteremia. Relapse of bacteremia and attributable mortality within 12 weeks after SAB were significantly higher in patients with persistent bacteremia than in those with resolving bacteremia (9.2% [7/76] vs. 2.4% [5/212], p = 0.02 and 21.1% [16/76] vs. 9.4% [20/212], p = 0.009, respectively).In conclusion, patients with SAB should be given early aggressive treatment strategies, including early source control and maintenance of a vancomycin trough level ≥15 mg/L, to reduce the risk of persistent bacteremia.
Medicine 03/2013; 92(2):98-108. · 4.35 Impact Factor
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Sunhyun Ahn,
Joon Seong Park,
Seong Hyun Jeong,
Hyun Woo Lee,
Jun Eun Park,
Mi Hyang Kim, Yang Soo Kim,
Ho Sup Lee,
Tae Sung Park,
Eunkyoung You,
Insoo Rheem,
Joowon Park,
Ji Young Huh,
Myung Seo Kang,
Sung Ran Cho
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ABSTRACT: Acute promyelocytic leukemia (APL) can be life threatening, necessitating emergency therapy with prompt diagnosis by morphologic findings, immunophenotyping, cytogenetic analysis, or molecular studies. This study aimed to assess the current routine practices in APL and the clinico-pathologic features of APL.
We reviewed the medical records of 48 Korean patients (25 men, 23 women; median age, 51 (20-80) years) diagnosed with APL in 5 university hospitals between March 2007 and February 2012.
The WBC count at diagnosis and platelet count varied from 0.4 to 81.0 (median 2.0)×10(9)/L and 2.7 to 124.0 (median 54.5)×10(9)/L, respectively. The median values for prothrombin time and activated partial thromboplastin time were 14.7 (11.3-44.1) s and 29 (24-62) s, respectively. All but 2 patients (96%) showed a fibrin/fibrinogen degradation product value of >20 µg/mL. The D-dimer median value was 5,000 (686-55,630) ng/mL. The t(15;17)(q22;q12 and PML-RARA fusion was found in all patients by chromosome analysis and/or multiplex reverse transcriptase-polymerase chain reaction (RT-PCR), with turnaround times of 8 (2-19) d and 7 (2-13) d, respectively. All patients received induction chemotherapy: all-trans retinoic acid (ATRA) alone (N=11, 26%), ATRA+idarubicin (N=25, 58%), ATRA+cytarabine (N=3, 7%), ATRA+idarubicin+cytarabine (N=4, 9%).
Since APL is a medical emergency and an accurate diagnosis is a prerequisite for prompt treatment, laboratory support to implement faster diagnostic tools to confirm the presence of PML-RARA is required.
Blood research. 03/2013; 48(1):31-4.
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ABSTRACT: BACKGROUND: We evaluated the short-term clinical outcomes and compared the component's sizes of reverse total shoulder arthroplasty (RTSA) in Korean Population. MATERIALS AND METHODS: We performed an RTSA on 42 patients between December 2007 to February 2010. The mean age at surgery was 72.5 ± 5.6 (10 men, 32 women) and average follow-up period was 24 months. Twenty-two cuff tears arthropathy, 15 irreparable massive rotator cuff tears with pseudoparalysis, 5 proximal humeral fractures, and 2 infection cases were included. We evaluated clinical outcomes and also the intra- and postoperative complications to determine if any of the complications were unique to the use of a RTSA in a Korean population. In the anatomic study, 92 uninjured shoulders of 92 patients were used for measuring the inferior glenoid size, and we compared the component's sizes of RTSA with those of the normal population. RESULTS: The ASES (American Shoulder and Elbow), UCLA, and KS (Knee Society) scores significantly improved from preoperative 35 (0-63), 12 (5-27), and 39 (3-81) to postoperative 68 (37-95), 24 (16-35), and 68 (34-88), respectively (P < .05). Postoperative complications were seen in 20% and scapular notching 35%. Three patients required further surgery for shoulder dislocation, periprosthetic fracture, and stem loosening. In the anatomic study, mean radius of the inferior glenoid was 17.1 ± 2.1 mm in male and 15.4 ± 1.6 mm in female. CONCLUSION: The short-term clinical results of an RTSA in Korean population are excellent despite high complication rate. However, the size of the glenoid is sometimes smaller than the baseplate (29 mm diameter) in female patients. More adequate size of the glenoid component should be considered.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 02/2013; · 1.93 Impact Factor
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ABSTRACT: PURPOSE: This study examined the early effect of a subacromial steroid injection on injured rotator cuff tendon. METHODS: Forty rats were allocated into two groups: a steroid injection (group 1) and no injection as control (group 2). A full-thickness defect was made at the unilateral infraspinatus tendon in both groups. A single dose of methylprednisolone was injected in steroid group. The tendon was harvested at 1, 3, 7, 14, and 42 days after surgery; gene expression and immunohistochemical study were performed for type-I/III collagen, tumour necrosis factor (TNF)-α, and extracellular matrix molecules. RESULTS: The type-III to type-I collagen ratio was at 7 days higher in the steroid group than that in the control group and decreased to the control level at 14 days and was maintained until 42 days. The general expression of the MMPs and TIMPs between two groups showed similar pattern regardless of the steroid injection. The gene expression of aggrecan and fibronectin in the steroid group was significantly higher than that in the control group (p < 0.05) at 3 days after surgery. They decreased to the equal level with control group at 7 days after surgery. Both groups showed no significant difference between aggrecan and fibronectin until 42 days after surgery (n.s.). CONCLUSIONS: A subacromial steroid injection may alter the collagen composition and extracellular matrix and interfere with the healing process in an acute tear of rat infraspinatus tendon at the early phase after the injection. However, these alterations seem to become normalized after the early inflammatory healing phase.
Knee Surgery Sports Traumatology Arthroscopy 01/2013; · 2.21 Impact Factor
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So-Youn Park,
Young Hoon Kim,
Duck Jong Han,
Su-Kil Park,
Jung Sik Park,
Heungsup Sung,
Hyun Jung Park,
Sung-Han Kim,
Sang-Ho Choi, Yang Soo Kim,
Jun Hee Woo,
Sang-Oh Lee
Journal of Antimicrobial Chemotherapy 01/2013; · 5.07 Impact Factor
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ABSTRACT: Caspofungin, an antifungal agent that acts on the cell wall by inhibiting β-1,3-glucan synthesis, is likely to be effective for treating Pneumocystis pneumonia, because one of the identifying characteristics of Pneumocystis jirovecii is the presence of β-1,3-glucan in its cell wall. Previous case reports in which the efficacy of caspofungin was found to be favourable have supported this hypothesis. However, of 4 HIV-negative patients who received caspofungin as a salvage regimen at Asan Medical Center, none showed a response. Our negative experience opposes the optimistic view of caspofungin use for Pneumocystis pneumonia expressed in previous reports.
Scandinavian Journal of Infectious Diseases 01/2013; · 1.72 Impact Factor
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Ho Sup Lee, Yang Soo Kim,
Kihyun Kim,
Jin Seok Kim,
Hyo Jung Kim,
Chang-Ki Min,
Cheolwon Suh,
Hyeon-Seok Eom,
Sung-Soo Yoon,
Jae Hoon Lee,
Min Kyong Kim,
Sung-Hyun Kim,
Sung Hwa Bae,
Yeung-Chul Mun,
Deog Yeon Jo,
Joo-Seop Chung
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ABSTRACT: Novel agents to treat multiple myeloma (MM) have increased complete respone (CR) rates compared with conventional chemotherapy, and the quality of the response to treatment has been correlated with survival. The purpose of our study was to show how of early response to bortezomib combined chemotherapy influences survival in patients with newly diagnosed MM who are ineligible for stem cell transplantation. We assessed patient responses to at least four cycles of bortezomib using the International Myeloma Working Group response criteria. The endpoints were comparisons of progression free survival (PFS) and overall survival (OS) between early good response group (A group) and poor response group (B group). We retrospectively analyzed data from 129 patients registered by the Korean Multiple Myeloma Working Party, a nationwide registration of MM patients. The 3 yr PFS for the A and B groups was 55.6% and 18.4%, respectively (P < 0.001). The 3 yr OS for the A and B groups was 65.3% and 52.9%, respectively (P = 0.078). The early response to at least four cycle of bortezomib before next chemotherapy may help predict PFS in patients with MM who are ineligible stem cell transplantation.
Journal of Korean medical science 01/2013; 28(1):80-86. · 0.84 Impact Factor
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Yong Pil Chong,
Eun Sil Kim,
Su-Jin Park,
Ki-Ho Park,
Tak Kim,
Mi-Na Kim,
Sung-Han Kim,
Sang-Oh Lee,
Sang-Ho Choi,
Jun Hee Woo,
Jin-Yong Jeong, Yang Soo Kim
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ABSTRACT: We describe the genetic and microbiological characteristics of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates with agr dysfunction from a tertiary-care hospital in Korea. Of these, ST5-SCCmec type II-agr group II MRSA isolates, which are known to be prevalent in hospital-acquired infections in Korea, were the most abundant, due to clonal spread of a specific agr-defective lineage. This finding suggests that the loss of agr function may confer a potential advantage in a hospital setting. Clonal spread of a specific agr-defective strain was not observed among community-associated MRSA or methicillin-susceptible S. aureus clones, regardless of community or hospital acquisition of infection. agr-defective clones including ST5- and ST239-MRSA were enriched for heteroresistant vancomycin-intermediate S. aureus.
Antimicrobial Agents and Chemotherapy 12/2012; · 4.84 Impact Factor
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Yong Pil Chong,
Song Mi Moon,
Kyung-Mi Bang,
Hyun Jung Park,
So-Youn Park,
Mi-Na Kim,
Ki-Ho Park,
Sung-Han Kim,
Sang-Oh Lee,
Sang-Ho Choi,
Jin-Yong Jeong,
Jun Hee Woo, Yang Soo Kim
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ABSTRACT: Practice guidelines recommend at least 14 days of antibiotic therapy for uncomplicated Staphylococcus aureus bacteremia (SAB). However, these recommendations have not been formally evaluated in clinical studies. To evaluate the duration of therapy for uncomplicated SAB, we analyzed data from our prospective cohort of patients with SAB. A prospective observational cohort study was performed in patients with SAB at a tertiary-care hospital in Korea between August 2008 and September 2010. All adult patients with SAB were prospectively enrolled and observed over a 12-week period. Uncomplicated SAB was defined as follows: negative results of follow-up blood cultures at 2 to 4 days; defervescence within 72h of therapy; no evidence of metastatic infection; catheter-related bloodstream infection or primary bacteremia without evidence of endocarditis on echocardiography. Of 483 patients with SAB, 111 met the study criteria for uncomplicated SAB. Fifty three (47.7%) had methicillin-resistant SAB. When short-course therapy (<14 days) and intermediate-course therapy (≥14 days) were compared, the treatment failure rate (10/38 [26.3%] versus 16/73 [21.9%]) and crude mortality (7/38 [18.4%] versus 16/73 [21.9%]) did not differ significantly between the two groups. However, short-course therapy was significantly associated with relapse (3/38 [7.9%] versus 0/73, P = 0.036). In multivariate analysis, primary bacteremia was associated with a trend toward increased treatment failure (P = 0.06). Therefore, in the treatment of uncomplicated SAB, it seems reasonable to consider at least 14 days of antibiotic therapy to prevent relapse as practice guidelines recommend. Because of its poor prognosis, primary bacteremia even with a low risk of complication should not be treated with short-course therapy.
Antimicrobial Agents and Chemotherapy 12/2012; · 4.84 Impact Factor
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ABSTRACT: BACKGROUND: This study examined whether a mesenchymal stem cells (MSCs)-seeded 3-dimensional construct into a tendon defect would promote cellular differentiation and matrix healing. MATERIALS AND METHODS: Bone marrow was harvested from the iliac crests of 2 male New Zealand White rabbits. The MSCs were cultured, and an open-cell polylactic acid (OPLA) scaffold was encapsulated with these cells. The injury model was a 5-mm × 5-mm-sized full-thickness window defect in the central part of each rotator cuff tendon. The defects on the right side were grafted with the autologous MSCs-seeded OPLA scaffold implant and a biodegradable suture. The same procedure was done on the left side, except a cell-free OPLA scaffold was used. Three rabbits were used as controls, without treatment of the tendon defect. Samples were harvested at 2, 4, and 6 weeks for analysis, which included evaluation of gross morphology, fluorescent analysis, histologic assessment, and immunohistochemistry studies. RESULTS: The expression of immunohistochemical stainings for collagen I was higher in the scaffold with MSCs than in the scaffold without MSCs. The expression of collagen II, however, was not different between the scaffolds with and without MSCs. CONCLUSIONS: Even though this is a short-term study, we demonstrated that many MSCs in the scaffold survived after implantation in an acute rabbit rotator cuff defect. Furthermore, the generation of type I collagen increased more in the scaffold with MSCs than it did in the scaffold without MSCs. MSCs are thought to promote tendon healing by producing type I collagen when they are applied at the tendon defect.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 12/2012; · 1.93 Impact Factor
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So-Youn Park,
Seunghee Baek,
Sang-Oh Lee,
Sang-Ho Choi, Yang Soo Kim,
Jun Hee Woo,
Heungsup Sung,
Mi-Na Kim,
Dae-Young Kim,
Jung-Hee Lee,
Je-Hwan Lee,
Kyoo-Hyung Lee,
Sung-Han Kim
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ABSTRACT: Few antiviral agents are available for treating paramyxovirus infections such as those involving respiratory syncytial virus (RSV), parainfluenza virus (PIV), and human metapneumovirus (hMPV). We evaluated the effect of oral ribavirin on clinical outcomes of paramyxovirus infections in patients with hematological diseases. All adult patients with paramyxovirus were retrospectively reviewed over a 2-year period. Patients who received oral ribavirin were compared to those who received supportive care without ribavirin therapy. A propensity-matched case-control study and a logistic regression model with inverse probability of treatment weighting (IPTW) were performed to reduce the effect of selection bias in assignment for oral ribavirin therapy. A total of 145 patients including 64 (44%) with PIV, 60 (41%) with RSV, and 21 (15%) with hMPV, were analyzed. Of these 145 patients, 114 (78%) received oral ribavirin and the remaining 31 (21%) constituted the non-ribavirin group. 30-day mortality and underlying respiratory death were 31% (35/114) and 12% (14/114), respectively, for the oral ribavirin group vs. 19% (6/31) and 16% (5/31), respectively, for the non-ribavirin group (P = 0.21 and P = 0.56). In the case-control study, the 30-day mortality in the ribavirin group was 24% (5/21) vs. 19% (4/21) in the non-ribavirin group (P = 0.71). In addition, the logistic regression model with IPTW revealed no significant difference in 30-day mortality (adjusted hazard ratio of 1.3; 95% confidence interval [lsqb]95% CI[rsqb] of 0.3 to 5.8) between the two groups. Steroid use (adjusted odds ratio 5.67; P = 0.01) and upper respiratory tract infection (adjusted odds ratio 0.07; P = 0.001) was independently associated with mortality. Our data suggest that oral ribavirin therapy may not improve clinical outcomes in hematologic disease patients infected with paramyxovirus.
Antimicrobial Agents and Chemotherapy 12/2012; · 4.84 Impact Factor
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Ho Sup Lee,
Lee Chun Park,
Eun Mi Lee,
Seong Hoon Shin,
Byeong Jin Ye,
Sung Yong Oh,
Moo Kon Song,
Sang Min Lee,
Won Sik Lee,
Byung Woog Kang,
Myung Hee Chang,
Seok-Goo Cho,
Seung Ah Yahng,
Sung-Soo Yoon,
Ji-Hyun Kwon, Yang Soo Kim
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ABSTRACT: OBJECTIVES:: There is no confirmed treatment strategy for primary intestinal diffuse large B-cell lymphoma (DLBL). In this retrospective study, the purpose is to find an appropriate treatment strategy in patients with primary intestinal DLBL undergoing surgery followed by chemotherapy or chemotherapy alone. METHODS:: Seventy-six patients were newly diagnosed with DLBL and received treatment between March 2004 and June 2011. Forty-seven patients were treated with surgical resection followed by rituximab combined with cyclophosphamide, adriamycin, vincristine, and prednisolone (R-CHOP), and 29 patients were treated with R-CHOP chemotherapy alone. RESULTS:: The characteristics of the patients were as follows: the median age was 56.5 years (range, 15 to 85 y) with a female to male ratio of 1.00:1.45. There was no significant difference in patient characteristics between the 2 groups. The estimated 3-year progression-free survival rates (PFS) and overall survival rates (OS) of surgery followed by R-CHOP (surgery/R-CHOP) and R-CHOP alone (R-CHOP) groups were 92.2% and 74.8% (P=0.009) and 94.2% and 80.7% (P=0.049), respectively. In univariate analysis, significant differences were seen in estimated PFS and OS rates when comparing Lugano stages I and II1 with II2 and IIE (P=0.006 and 0.036), low and low-intermediate risk with high-intermediate risk (P=0.004 and 0.000), and surgery/R-CHOP group with R-CHOP group (P=0.009 and 0.049), respectively. In multivariate analysis, there were no independent predictive factors for survival. CONCLUSIONS:: Patients treated with surgery followed by R-CHOP seemed to have a higher survival rate than those treated with R-CHOP alone. There were no significant prognostic factors for survival, but there were possible prognostic factors such as Lugano stage, International Prognostic Index risk, and treatment modality for PFS and OS.
American journal of clinical oncology 12/2012; · 2.21 Impact Factor
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Soo-Mee Bang,
Hyeon-Seok Eom,
Hun-Mo Ryoo,
Jong-Ho Won,
Seok Jin Kim,
Jae-Yong Kwak,
Bong-Seog Kim,
Je-Jung Lee,
Kihyun Kim,
Hawk Kim, [......],
Junglim Lee, Sung-Soo Yoon,
Dong Soon Lee,
Jae Hoon Lee,
Chang-Ki Min,
Chul Soo Kim,
Jong-Youl Jin,
Min Kyoung Kim,
Hyunchoon Shin,
Sang Kyun Sohn
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So-Youn Park,
Hyun Jung Park,
Song Mi Moon,
Ki-Ho Park,
Yong Pil Chong,
Mi-Na Kim,
Sung-Han Kim,
Sang-Oh Lee, Yang Soo Kim,
Jun Hee Woo,
Sang-Ho Choi
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ABSTRACT: BACKGROUND: Pseudomonas aeruginosa has gained an increasing amount of attention in the treatment of patients with pneumonia. However, the benefit of empirical combination therapy for pneumonia remains unclear. We evaluated the effects of adequate empirical combination therapy and multidrug-resistance in bacteremic Pseudomonas pneumonia on the mortality. METHODS: A retrospective cohort study was performed at the 2,700-bed tertiary care university hospital. We reviewed the medical records of patients with bacteremic pneumonia between January 1997 and February 2011. Patients who received either inappropriate or appropriate empirical therapy were compared by using marginal structural model. Furthermore, we investigated the direct impact of combination therapy on clinical outcomes in patients with monomicrobial bacteremic pneumonia. RESULTS: Among 100 consecutive patients with bacteremic Pseudomonas pneumonia, 65 patients were classified in the adequate empirical therapy group, 32 of whom received monotherapy and 33 combination therapy. In the marginal structural model, only inadequate therapy was significantly associated with 28-day mortality (p = 0.02), and multidrug-resistance was not a significant risk factor.To examine further the direct impact of combination therapy, we performed a subgroup analysis of the 65 patients who received adequate therapy. Multivariate logistic regression analysis identified absence of septic shock at the time of bacteremia (OR, 0.07; 95% CI, 0.01-0.49; p = 0.008), and adequate combination therapy (OR, 0.05; 95% CI, 0.01-0.34; p = 0.002) as variables independently associated with decreased all-cause 28-day mortality. CONCLUSIONS: Our study suggests that adequate empirical combination therapy can decrease mortality in patients with bacteremic Pseudomonas pneumonia.
BMC Infectious Diseases 11/2012; 12(1):308. · 3.12 Impact Factor
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Tark Kim,
Sang-Ho Choi,
Sung-Han Kim,
Jin-Yong Jeong,
Jun Hee Woo, Yang Soo Kim,
Heungsup Sung,
Mi-Na Kim,
Dok Hyun Yoon,
Cheolwon Suh,
Sang-Oh Lee
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ABSTRACT: R-CHOP chemotherapy composed of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone which might increase the risk of Pneumocystis pneumonia in patients with non-Hodgkin lymphoma. We estimated the point prevalence of Pneumocystis pneumonia in non-Hodgkin lymphoma patients according to the number of R-CHOP cycles and investigated whether cytoreduction by chemotherapy is associated with Pneumocystis pneumonia development. We retrospectively established a cohort of patients who received R-CHOP for non-Hodgkin lymphoma in our institution. Using this cohort, we estimated the incidence rate and point prevalence of definite and probable Pneumocystis pneumonia. To assess factors associated with Pneumocystis pneumonia development several clinical variables, including absolute neutrophil and lymphocyte count at the time of non-Hodgkin lymphoma diagnosis and when the last R-CHOP cycle was administered, were compared between patients with and without Pneumocystis pneumonia. Of 713 patients in the cohort, 14 and 18 patients were diagnosed with definite and probable Pneumocystis pneumonia, respectively. The overall incidence of definite and definite plus probable PCP in NHL patients receiving R-CHOP were 2.0 % (14/713; 95 % CI, 1.1-3.3 %) and 4.5 % (32/713; 95 % CI, 3.2-6.4 %), respectively. This corresponded to 3.8 (95 % CI, 2.2-6.4) and 8.4 (95 % CI, 5.9-11.9) per 1000 persons. Many cases of Pneumocystis pneumonia (22/32, 68.7 %) developed after administration of the fourth R-CHOP cycle. However, there was no statistical difference in Pneumocystis pneumonia prevalence between patients receiving four or more cycles of R-CHOP and fewer than. Higher absolute neutrophil count (4,742/mm(3) vs. 2,627/mm(3); p < 0.01) was associated with Pneumocystis pneumonia development at the last R-CHOP cycle, while absolute lymphocyte count at the time of NHL diagnosis was not. Contrary to expectations, Pneumocystis pneumonia is not a frequent complication of R-CHOP treatment for non-Hodgkin lymphoma. Cytoreduction of R-CHOP might not be a risk factor of Pneumocystis pneumonia development. Universal prophylaxis against Pneumocystis pneumonia during R-CHOP treatment could not be strongly recommended.
Annals of Hematology 10/2012; · 2.62 Impact Factor
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ABSTRACT: Forty-three patients with miliary tuberculosis (TB) were evaluated for diagnostic usefulness of ELISPOT assay. Among non-invasive rapid tests available within 3-5 days, ELISPOT had the highest sensitivity (93%), compared with acid-fast bacilli stain (sputum 32% and bronchoalveolar lavage 7%), M.TB-PCR (sputum 53% and bronchoalveolar lavage 36%), and tuberculin skin test (22%). In comparison to 44 patients with lymph node TB, the sensitivity of the ELISPOT assay in patients with miliary TB (93%) was as high as in those with lymph node TB (95%, P = 0.63), whereas the sensitivity of the tuberculin skin test was substantially lower in patients with miliary TB (22%) than in those with lymph node TB (73%, P <.001).
Clinical Infectious Diseases 10/2012; · 9.15 Impact Factor
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ABSTRACT: There are no data on the efficacy of secondary prophylaxis against Pneumocystis pneumonia after solid organ transplantation. Therefore, we investigated the rate of recurrence of Pneumocystis pneumonia after solid organ transplantation in a retrospective cohort study. Between 2005 and 2011, a total of 41 recipients recovered from Pneumocystis pneumonia. Of these, 22 (53.7%) received secondary prophylaxis. None of the 41 recipients experienced recurrence of Pneumocystis pneumonia during the follow-up, regardless of secondary prophylaxis.
Antimicrobial Agents and Chemotherapy 09/2012; 56(11):6041-3. · 4.84 Impact Factor
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Hyun Jung Park,
Sung-Han Kim,
Min-Ju Kim,
Yu-Mi Lee,
So-Youn Park,
Song Mi Moon,
Ki-Ho Park,
Yong Pil Chong,
Sang-Oh Lee,
Sang-Ho Choi,
Jun Hee Woo, Yang Soo Kim
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ABSTRACT: OBJECTIVE: We evaluated the efficacy of linezolid-based salvage therapy compared with glycopeptide-based therapy in patients with persistent (≥7 days) methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B). METHODS: All patients with MRSA-B during 2-year period at a tertiary-care hospital were prospectively enrolled. Linezolid-based salvage therapy was classified if patients switched glycopeptides to linezolid with/without carbapenem due to persistent MRSA-B. Covariate adjustment using the propensity score and inverse probability of treatment weighting (IPTW) using the propensity score were performed to control for bias in treatment assignment. RESULTS: Of 377 patients with MRSA-B, 90 with persistent MRSA-B were included. Of these, 38 (42%) were classified as linezolid-based salvage group and the remaining 52 (58%) as glycopeptide-based therapy group. The duration of persistent bacteremia (median 16 days vs. 10 days; P = 0.008) was longer in linezolid-based salvage group than in the comparator. However, the 30-day mortality (11% vs. 25%; P = 0.08) had a trend toward being lower in linezolid-based salvage group than those in the comparator. Logistic regression models with covariate adjustment and IPTW using propensity scores also revealed that linezolid-based salvage showed a trend toward having better outcome than the comparator, although this did not reach any statistically significance (OR 0.31; 95% CI 0.03-2.95 and OR 0.19; 95% CI 0.01-3.39, respectively). CONCLUSIONS: While having worse prognostic factors compared with glycopeptide-based therapy, linezolid-based salvage therapy revealed a trend toward better outcomes than the comparator. Our data suggest that linezolid-based salvage therapy would be considered in patients with persistent MRSA-B despite the use of glycopeptides therapy.
The Journal of infection 08/2012; · 4.13 Impact Factor
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ABSTRACT: OBJECTIVES: The aim of this study was to determine the accuracy and reliability of shoulder magnetic resonance (MR) arthrography with three-dimensional (3D) isotropic intermediate-weighted turbo spin-echo (TSE) sampling perfection with application-optimised contrasts using different flip angle evolution (SPACE) in the diagnosis of superior labrum anterior-to-posterior (SLAP) lesions compared with two-dimensional (2D) TSE at 3.0 T. METHODS: MR arthrograms, including 2D TSE and 3D TSE-SPACE, in 87 patients who underwent arthroscopy were retrospectively analysed by two reviewers for the presence and type of SLAP lesions. Sensitivity and specificity were compared using McNemar's test, and inter-observer agreement was calculated using Cohen's kappa. Receiver operating characteristic (ROC) curve analyses were performed. RESULTS: The mean sensitivity, specificity and accuracy were 90%, 85% and 86% for 2D TSE, and 81%, 86% and 85% for 3D TSE-SPACE respectively, with no statistically significant differences. Inter-observer agreements were substantial in 2D TSE (κ = 0.76) and 3D TSE-SPACE (κ = 0.68). The areas under the ROC curves were 0.92 for 2D TSE and 0.90 for 3D TSE-SPACE, which were not significantly different. CONCLUSIONS: MR arthrography with 3D TSE-SPACE showed comparable accuracy and substantial inter-observer agreement for the diagnosis of SLAP lesions KEY POINTS : • MR arthrography is regarded as the definitive method of shoulder imaging • Different MR sequences are evolving for SLAP lesions • 3D TSE-SPACE demonstrated comparable overall accuracy to 2D TSE for SLAP lesions • But more false-negative interpretations occurred using 3D TSE-SPACE • Further technical improvement is necessary before 3D TSE-SPACE replaces 2D TSE sequences.
European Radiology 08/2012; · 3.22 Impact Factor
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Journal of Orthopaedic Research 06/2012; 30(12):2056-7. · 2.81 Impact Factor
