A Case of Iatrogenic Wernicke's Encephalopathy Following Chemotherapy and Total Parenteral Nutrition / 대한혈액학회지

Wernicke's encephalopathy is a neuropsychiatric condition generally caused by acute thiamine deficiency. Although it is common in the severe alcoholics, several other causes also have been identified, such as total parenteral nutrition (TPN) use, persistent vomiting, hyperemesis gravidarum, anorexia nervosa and malnutrition. The classic triad of Wernicke's encephalopathy are ataxia, altered mentation and ophthalmoplegia. A 19-year-old boy had been treated with high dose Ara-C and mitoxantrone for acute myelogenous leukemia and intravenous hyperalimentation due to persistent vomiting. He suddenly complained of diplopia, gait disturbance and generalized weakness at 36th day after chemotherapy. Physical examinations showed disorientated mentality, oculomotor palsy and horizental nystagmus. The diagnosis of Wernicke's encephalopathy was made with classical brain MRI and decreased thiamine level. The patient was successfully treated with vitamin B1. We presented a case of acute Wernicke's encephalopathy developed after high dose Ara-C chemotherapy followed by intravenous hyperalimentation in a patient with acute myelogenous leukemia.

Chemoembolization of Hepatocellular Carcinoma: Long-term Survival and Prognostic Factors

PURPOSE: To analyse the long-term survival rate after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma and to determine prognostic factors. MATERIALS AND METHODS: In 1067 hepatocellularcarcinoma patients who had undergone TACE, of long-term survival rate and prognostic factors were retrospecfively analysed. Chemoembolization was accomplished by hepatic arterial infusion of a mixture of Lipiodol and Adriamycin(51%) or by Gelfoam embolization after infusion of the Lipiodol mixture(49%). The survival rate was calculated by the Kaplan-Meier method and multivariate analysis using the weibull model was applied to determine which prognostic factors were statistically significant. RESULTS: Among the 1067 patients, survival rates were asfollows : one-year, 60.6% ; two-year 42.3% ; three-year, 29.1% ; four-year, 23.7% ; and five-year, 14.7 %. The oneyear survival rate and median survival period of 432 patients with tumors 5cm in diameter or smaller were 77.7%and 33 months respectively, significantly higher than those of patients with larger tumors for whom the corresponding figures were 44.8% and 11 months. Other significant prognostic factors(p<0.0001) shown bymultivariate analysis included type of tumor, portal vein invasion and child-pugh classification. CONCLUSION: Theone-year survival rate agter chemoembolization in 1067 patients with hepatocellular carcinoma was 60.6%. The significant prognostic factors were size and type of the tumor, portal vein invasion, and Child-Pugh classification.