Orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft / 대한치과교정학회지

The purpose of this case report was to introduce the concept of orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. A 5-year-old boy patient with Tessier number 0 cleft presented congenitally missing maxillary central incisors (MXCI), a bony defect at the premaxilla, a constricted maxillary arch, an anterior openbite, and maxillary hypoplasia. His treatment was divided into three stages: management of the bony defect at the premaxilla and the congenitally missing MXCIs using a fan-type expansion plate, iliac bone grafting, and eruption guidance of the maxillary lateral incisors into the graft area for substitution of MXCIs; management of the maxillary hypoplasia using sequential facemask therapy with conventional and skeletal anchorage; and management of the remaining occlusal problems using fixed orthodontic treatment. The total treatment duration was 15 years and 10 months. Class I canine and Class II molar relationships and normal overbite and overjet were achieved at the end of treatment. Although the long-term use of facemask therapy resulted in significant protraction of the retrusive maxilla, the patient exhibited Class III profile because of continued mandibular growth. However, the treatment result was well maintained after 2 years of retention. The findings from this case suggest that interdisciplinary and customized approaches are mandatory for successful management of maxillary hypoplasia, bony defect, and dental problems in Tessier number 0 cleft. Moreover, considering the potential of orthognathic surgery or distraction osteogenesis, meticulous monitoring of mandibular growth until growth completion is important.

Soluble CD93 in Serum as a Marker of Allergic Inflammation

PURPOSE: CD93 is receiving renewed attention as a biomarker of inflammation. We aimed to evaluate the potential for serum sCD93 to serve as a novel biomarker for allergic inflammation. MATERIALS AND METHODS: We enrolled 348 subjects with an allergic disease [allergic rhinitis (AR), chronic spontaneous urticaria (CSU), or bronchial asthma (BA)], including 14 steroid-naïve BA patients who were serially followed-up. RESULTS: The serum sCD93 levels (ng/mL) in patients with exacerbated AR (mean±standard deviation, 153.1±58.4) were significantly higher than in patients without AR (132.2±49.0) or with stable AR (122.3±42.1). Serum sCD93 levels in exacerbated CSU (169.5±42.8) were also significantly higher than those in non-CSU (132.4±51.6) and stable CSU (122.8±36.2). This trend was also seen in BA. Serum levels in patients with ICS-naïve BA (161.4±53.1) were significantly higher than those in healthy controls without BA (112.2±30.8), low- and medium-dose ICS users. Serum sCD93 levels in high-dose ICS users (72.2±20.6) were significantly lower than those in low- and medium-dose users. The serum sCD93 levels in steroid-naïve patients with BA (195.1±72.7) decreased after ICS use for 4 weeks (134.4±42.8) and 8 weeks (100.7±13.4), serially. CONCLUSION: Elevated serum sCD93 levels reflected exacerbated status of allergic diseases, including CSU, AR, and asthma. ICS use significantly diminished serum sCD93 levels in steroid-naïve patients with BA. This result may suggest sCD93 in serum as a therapeutic marker for allergic inflammation.

Acute exposure to silica nanoparticles aggravate airway inflammation: different effects according to surface characteristics

Silica nanoparticles (SNPs) are widely used in many scientific and industrial fields despite the lack of proper evaluation of their potential toxicity. This study examined the effects of acute exposure to SNPs, either alone or in conjunction with ovalbumin (OVA), by studying the respiratory systems in exposed mouse models. Three types of SNPs were used: spherical SNPs (S-SNPs), mesoporous SNPs (M-SNPs), and PEGylated SNPs (P-SNPs). In the acute SNP exposure model performed, 6-week-old BALB/c female mice were intranasally inoculated with SNPs for 3 consecutive days. In the OVA/SNPs asthma model, the mice were sensitized two times via the peritoneal route with OVA. Additionally, the mice endured OVA with or without SNP challenges intranasally. Acute SNP exposure induced significant airway inflammation and airway hyper-responsiveness, particularly in the S-SNP group. In OVA/SNPs asthma models, OVA with SNP-treated group showed significant airway inflammation, more than those treated with only OVA and without SNPs. In these models, the P-SNP group induced lower levels of inflammation on airways than both the S-SNP or M-SNP groups. Interleukin (IL)-5, IL-13, IL-1beta and interferon-gamma levels correlated with airway inflammation in the tested models, without statistical significance. In the mouse models studied, increased airway inflammation was associated with acute SNPs exposure, whether exposed solely to SNPs or SNPs in conjunction with OVA. P-SNPs appear to be relatively safer for clinical use than S-SNPs and M-SNPs, as determined by lower observed toxicity and airway system inflammation.

What Are Patients with Thyroid Cancer Surgery Concerned about? / 대한갑상선학회지

BACKGROUND AND OBJECTIVES: To prevent getting wrong information and improve high quality of life, it is necessary to provide accurate information and patient education. This study aimed to collect basic data and develop educational program for thyroid cancer patient by understanding their educational needs. MATERIALS AND METHODS: Between April 16 and June 15, 2012, 159 patients who underwent thyroid cancer surgery were enrolled. This survey consisted of 5 areas including management of the symptom and the complication after surgery, postoperative wound and dietary management, treatment plan after discharge, medication management, and daily life. RESULTS: The most common way for the patients to acquire information about the disease was Internet and the patients who used INTERNET as their information source were 54.7%. Doctors (76.1%) and nurses (21.4%) were the preferred educators for the patients, and small group education was the preferred education method. Specifically the need for "management of the symptom and the complication after surgery" was the highest (3.33), followed by "treatment plan after discharge" (3.31), "medication management" (3.19), "postoperative wound and dietary management" (3.17). CONCLUSION: Medical team including doctors and nurses should be the center to activate small group education for patients. Professional and individualized education program should be developed to give the proper education to patients and their family.

Three-dimensional finite element analysis of the stress distribution and displacement in different fixation methods of bilateral sagittal split ramus osteotomy

OBJECTIVES: This study evaluated a range of fixation methods to determine which is best for the postoperative stabilization of a mandibular osteotomy using three-dimensional finite element analysis of the stress distribution on the plate, screw and surrounding bone and displacement of the lower incisors. MATERIALS AND METHODS: The model was generated using the synthetic skull scan data, and the surface model was changed to a solid model using software. Bilateral sagittal split ramus osteotomy was performed using the program, and 8 different types of fixation methods were evaluated. A vertical load of 10 N was applied to the occlusal surface of the first molar. RESULTS: In the case of bicortical screws, von-Mises stress on the screws and screw hole and deflection of the lower central incisor were minimal in type 2 (inverted L pattern with 3 bicortical repositioning screws). In the case of plates, von-Mises stress was minimal in type 8 (fixation 5 mm above the inferior border of the mandible with 1 metal plate and 4 monocortical screws), and deflection of the lower central incisor was minimal in types 6 (fixation 5 mm below the superior border of the mandible with 1 metal plate and 4 monocortical screws) and 7 (fixation 12 mm below the superior border of the mandible with 1 metal plate and 4 monocortical screws). CONCLUSION: Types 2 and 6 fixation methods provide better stability than the others.

Once-daily Dosing of Arbekacin Can Suppress the Formation of Small Colony Variants of Methicillin Resistant Staphylococcus aureus in an in vitro Pharmacodynamic Infection Model

BACKGROUND: Small colony variants (SCVs) of Staphylococcus aureus have emerged to be commonly associated with persistent and relapsing infections. Arbekacin (ABK) is one of a few alternatives to vancomycin in intractable case of methicillin resistant S. aureus (MRSA) infection. However, it has not yet been defined whethter ABK tends to be efficacious to the MRSA SCVs. In this study, we employed an in vitro pharmacodynamic infection model (IVPDIM) to define efficacies of ABK against MRSA SCVs. MATERIALS AND METHODS: Using four strains of clinically isolated MRSA (MRSA122, MRSA160, MRSA18, MRSA123), we adopted IVPDIM comprised of two-compartment in which effective surface-to-volume ratio of 5.34 cm(-1). Human pharmacokinetic regimen simulations of ABK were as follows: 100 mg every 12 h (q12h), 200 mg q24h, 200 mg q12h, and 400 mg q24h. Samples were taken from each model at 0, 1, 2, 4, 6, 12, 24, and 30 h, and the bacterial colony counts were determined. The experiments were repeated twice with ABK-administered groups and control group. RESULTS: MICs of ABK for MRSA122, MRSA160, MRSA18, and MRSA123 were 2, 2, 2, and 1 microgram/mL, respectively. In case of MRSA122, MRSA160, MRSA18, C(max)/MIC were less than 9.0 except for ABK 400 mg q24h regimen. In MRSA123, C(max)/MIC were 8.9 on average at ABK 100 mg q12h regimen. But, other regimen showed C(max)/MIC >9. Four regimens for 4 strains showed statistically different colony counts at 30 h (P=0.000). The more dosage or less frequent dosing interval, the more colonies tended to reduce in all strains. In 100 mg q12h groups, SCVs were observed in all strains within 24 h. With increment of dosage or changing dosing interval from q12h to 24h, SCVs were reduced (P=0.000). Regimen of 400 mg q24h did not let SCVs appear in all strains of MIC 2 microgram/mL during the experiments. CONCLUSION: SCVs were observed when MIC of ABK against MRSA were 1-2 microgram/mL, especially in most cases of C(max)/MIC <9. Those findings were also associated with re-growth of colony during the experiments. Once-daily dosing of ABK could reduce or eliminate the appearance of SCV.

Once-daily Dosing of Arbekacin Can Suppress the Formation of Small Colony Variants of Methicillin Resistant Staphylococcus aureus in an in vitro Pharmacodynamic Infection Model

BACKGROUND: Small colony variants (SCVs) of Staphylococcus aureus have emerged to be commonly associated with persistent and relapsing infections. Arbekacin (ABK) is one of a few alternatives to vancomycin in intractable case of methicillin resistant S. aureus (MRSA) infection. However, it has not yet been defined whethter ABK tends to be efficacious to the MRSA SCVs. In this study, we employed an in vitro pharmacodynamic infection model (IVPDIM) to define efficacies of ABK against MRSA SCVs. MATERIALS AND METHODS: Using four strains of clinically isolated MRSA (MRSA122, MRSA160, MRSA18, MRSA123), we adopted IVPDIM comprised of two-compartment in which effective surface-to-volume ratio of 5.34 cm(-1). Human pharmacokinetic regimen simulations of ABK were as follows: 100 mg every 12 h (q12h), 200 mg q24h, 200 mg q12h, and 400 mg q24h. Samples were taken from each model at 0, 1, 2, 4, 6, 12, 24, and 30 h, and the bacterial colony counts were determined. The experiments were repeated twice with ABK-administered groups and control group. RESULTS: MICs of ABK for MRSA122, MRSA160, MRSA18, and MRSA123 were 2, 2, 2, and 1 microgram/mL, respectively. In case of MRSA122, MRSA160, MRSA18, C(max)/MIC were less than 9.0 except for ABK 400 mg q24h regimen. In MRSA123, C(max)/MIC were 8.9 on average at ABK 100 mg q12h regimen. But, other regimen showed C(max)/MIC >9. Four regimens for 4 strains showed statistically different colony counts at 30 h (P=0.000). The more dosage or less frequent dosing interval, the more colonies tended to reduce in all strains. In 100 mg q12h groups, SCVs were observed in all strains within 24 h. With increment of dosage or changing dosing interval from q12h to 24h, SCVs were reduced (P=0.000). Regimen of 400 mg q24h did not let SCVs appear in all strains of MIC 2 microgram/mL during the experiments. CONCLUSION: SCVs were observed when MIC of ABK against MRSA were 1-2 microgram/mL, especially in most cases of C(max)/MIC <9. Those findings were also associated with re-growth of colony during the experiments. Once-daily dosing of ABK could reduce or eliminate the appearance of SCV.

The Relation between the High-level Resistance to Fluoroquinolones and the Over-expression of the acrA among Quinolone-Resistant Escherichia coli-Quantification of acrA by Using Real time PCR and Northern hybridization

BACKGROUND: Target point mutation of DNA topoisomerase, which is the typical mode of quinolone resistance, cannot explain high level resistance to quinolones. Therefore, many authors looked into over expression of efflux pump as the possibility. After quantificating the arcA mRNA, which controls AcrAB- TolC, the authors tried to find out the difference in the expression of arcA mRNA according to MIC of ciprofloxacin. The authors also tried to determine the usefulness of real time PCR, which is more reproducible and takes less time than preexisting immunoblot assay, through quantification of acrA. MATERIAL AND METHODS: Mutations in topoisomerase (GyrA, ParC) of 20 quinolone resistant E. coli isolates were identified by PCR and direct DNA sequencing. AcrA level was measured by real time PCR. GAPDH of E.coli was used as endogenous control. The expression of acrA was confirmed through northern hybridization method, the results obtained by real time PCR were compared. RESULTS: 1) Topoisomerase mutations were found in all quinolone resistant E. coli strains. 2) AcrA expression in fluoroquinolone-resistant E. coli was quantified by using real time PCR. There was no relationship between the ratio of acrA expression to GAPDH and MIC of ciprofloxacin. 3) With Northern hybridization, we compared the band of acrA to that of GAPDH in compactness and area. No difference in the expression according to MIC could be found. 4) The results of AcrA/GAPDH were significantly correlated between the real-time PCR and northern blot (P<0.05, correlation coefficiency 0.98). CONCLUSION: In this study, no relationship between overexpression of AcrA gene and high level fluoroquinolone resistance. Therefore, we assume that mechanism other than AcrAB efflux pump is involved in and contribute to high-level fluoroquinolone resistance. However, the degree of efflux pump expression could be confirmed with real time PCR using acrA mRNA. Therefore, real time PCR could be used in the molecular biologic study on the mechanism of resistance to antibiotics.

The Relation between the High-level Resistance to Fluoroquinolones and the Over-expression of the acrA among Quinolone-Resistant Escherichia coli-Quantification of acrA by Using Real time PCR and Northern hybridization

BACKGROUND: Target point mutation of DNA topoisomerase, which is the typical mode of quinolone resistance, cannot explain high level resistance to quinolones. Therefore, many authors looked into over expression of efflux pump as the possibility. After quantificating the arcA mRNA, which controls AcrAB- TolC, the authors tried to find out the difference in the expression of arcA mRNA according to MIC of ciprofloxacin. The authors also tried to determine the usefulness of real time PCR, which is more reproducible and takes less time than preexisting immunoblot assay, through quantification of acrA. MATERIAL AND METHODS: Mutations in topoisomerase (GyrA, ParC) of 20 quinolone resistant E. coli isolates were identified by PCR and direct DNA sequencing. AcrA level was measured by real time PCR. GAPDH of E.coli was used as endogenous control. The expression of acrA was confirmed through northern hybridization method, the results obtained by real time PCR were compared. RESULTS: 1) Topoisomerase mutations were found in all quinolone resistant E. coli strains. 2) AcrA expression in fluoroquinolone-resistant E. coli was quantified by using real time PCR. There was no relationship between the ratio of acrA expression to GAPDH and MIC of ciprofloxacin. 3) With Northern hybridization, we compared the band of acrA to that of GAPDH in compactness and area. No difference in the expression according to MIC could be found. 4) The results of AcrA/GAPDH were significantly correlated between the real-time PCR and northern blot (P<0.05, correlation coefficiency 0.98). CONCLUSION: In this study, no relationship between overexpression of AcrA gene and high level fluoroquinolone resistance. Therefore, we assume that mechanism other than AcrAB efflux pump is involved in and contribute to high-level fluoroquinolone resistance. However, the degree of efflux pump expression could be confirmed with real time PCR using acrA mRNA. Therefore, real time PCR could be used in the molecular biologic study on the mechanism of resistance to antibiotics.

Comparison of Combination Induction Chemotherapy using Idarubicin Plus either Enoron(r) or Sunrabin(r) in Adult Patients with Acute Myeloid Leukemia / 대한혈액학회지

BACKGROUND: To evaluate the effects and toxicity of combination chemotherapy using idarubicin (IDA) plus BH-AC as an induction regimen, we studied two groups of patients with adult acute myeloid leukemia (AML) who received IDA plus either Sunrabin(r) or Enoron(r). METHODS: Twenty-four and twenty-five patients in each group eligible for the induction study were enrolled. The remission induction therapy consisted of IDA 12mg/m2 intravenously for three consecutive days in combination with two kinds of BH-AC, that is Sunrabin(r) or Enoron(r), 300mg/m2 intravenously for seven days. Additional augmentation treatment with BH- AC was given for 3 days based on the results of bone marrow examination performed on the seventh day following initial treatment, i.e. depending on the ratio of the remaining leukemic cells. RESULTS: Complete remission was achieved in 75% vs 74% of each group of patients. The treatment-related mortality during induction chemotherapy was 1 patient in each group. There was no statistical difference in the level of toxicities between two groups. The most frequent side effect after these combination chemotherapy was manageable mucositis. Enoron(r) group showed rather rapid recovery of peripheral blood counts than those of Sunrabin(r) group. CONCLUSION: This study indicate Enoron(r) is comparable to Sunrabin(r) which can be used as an effective induction chemotherapeutic agent in adult patient with AML.

Megadose CD34+ Hemopoietic Stem Cell Transplantation for Patients with High Risk Acute Myeloid Leukemia Who Have No HLA Matched Donor: A Pilot Study of a Full Haplotype Mismatch Transplantation

BACKGROUND: Haploidentical transplantation has become a popular modality of treatment for acute myeloid leukemia (AML) patients lacking donors with matching HLA. We attempted to assess the success rate and ramifications of full haplotype mismatch transplantation. METHODS: Four patients received stem cell transplantation from their full haplotype mismatched family donors. The conditioning regimen included total-body irradiation, intravenous busulfan, antithymocyte globulin, and fludarabine. Megadose CD34+ stem cell transplants were performed, in a dosage range between 10.9 X 10 (6) /kg and 20.6 X 10 (6) /kg. Neither GvHD prophylaxis nor post-transplant G-CSF were administered. We monitored patients' bone marrow cellularity and peripheral blood chimerism using real-time PCR. RESULTS: All patients evidenced stable engraftment. The most frequent side effect was severe mucositis, but all patients recovered successfully, without early death. No patients exhibited acute GvHD. Two refractory patients relapsed soon after transplantation. The other 2 patients have remained in good clinical condition, with a follow-up duration of 1~4 months. CONCLUSION: Using a newly-developed conditioning regimen, we were able to circumvent GvHD and graft failure, which are the main limitations associated with full haplotype mismatch transplantation. According to our analysis of the relevant literature, it appears that this is the first report of such a conditioning regimen.

Megadose CD34+ hemopoietic stem cell transplantation for patients with high risk acute myeloid leukemia who have no HLA matched donor: A pilot study of a full haplotype mismatch transplantation / 대한내과학회지

BACKGROUND: Haploidentical transplantation has become a considerable clinical choice for acute myeloid leukemia (AML) patients lacking a HLA matched donor. We tried to reveal the possible role of a full haplotype mismatch transplantation. METHODS: Four patients received stem cell transplantation from their full haplotype mismatched family donors. Conditioning regimen included total-body irradiation, intravenous busulfan, antithymocyte globulin, and fludarabine. Megadose transplants of CD34+ stem cells were in the range of 10.9 x 106/kg and 20.6 x 106/kg. Neither GvHD prophylaxis nor post-transplant G-CSF were given. We monitored patients' bone marrow cellularity and chimerism in the peripheral blood using real time PCR. RESULTS: All patients showed stable engraftment. The most frequent side effect was severe mucositis, but all patients recovered successfully without early death. Nobody showed acute GvHD. Two refractory patients were relapsed early after transplantation. Other 2 patients have been in good clinical condition with follow-up duration of 1~4 months. CONCLSUION: We could overcome the main limitations-a GvHD and a graft failure- of a full haplotype mismatch transplantation with a newly developed conditioning regimen that might be used firstly according to review of literature. Although our study sample numbers and duration of follow-up are not enough yet, at least in patients who were in complete remission and categorized as high-risk AML, we suggest that this treatment modality should be considered actively.

Very Severe Aplastic Anemia appearing after Thymectomy

Aplastic anemia is a rare complication of thymoma and is extremely infrequent after thymectomy. We present a case of a 60-year-old woman with very severe aplastic anemia appearing sixteen months after thymectomy for a thymoma. She underwent thymectomy for a thymoma in April 2000. Preoperative examination revealed no hematologic abnormality. About sixteen months after the operation, she was readmitted because of pancytopenia with cough and fever. Bone marrow aspiration revealed a very severe hypoplasia in all the three cell lines with over 80% fatty tissue, and chest CT revealed no recurrence of thymoma. Her aplastic anemia had responded to cyclosporine A and granulocyte-colony stimulating factor (G-CSF).

Effect of Donor Lymphocyte Infusion for a Patient with Isolated Knee Joint Relapse of Acute Lymphoblastic Leukemia after Allogeneic Bone Marrow Transplantation / 대한혈액학회지

Isolated extramedullary relapse of acute lymphoblastic leukemia (ALL) after allogeneic bone marrow transplantation (BMT) in the absence of marrow involvement is a rare event, and the mechanisms underlying the selective involvement of extramedullary sites remain undefined. These might be due to relapse in sanctuary sites where the leukemic cells are resistant to preparative regimen, or a stronger graft-versus-leukemia effect in the marrow as compared with peripheral tissues. We report an adult ALL patient who experienced isolated extramedullary relapse in the right pretibial soft tissue and knee joint 42 months after allogeneic BMT. He was treated with localized radiotherapy followed by systemic chemotherapy and donor lymphocyte infusion. After treatment, he is currently well with no evidence of leukemia recurrence for 12 months.

Therapeutic Efficacy of Anagrelide for Thrombocytosis / 대한혈액학회지

BACKGROUND: Thrombocytosis can result in life-threatening thrombotic or hemorrhagic events. Anagrelide acts exclusively on megakaryocytes and has been reported as an useful agent in controlling thromobocytosis associated with chronic myeloproliferative disorders. METHODS: Seven patients with essential thrombocythemia and three with chronic myelogenous leukemia were enrolled and early responses and adverse effects of anagrelide were retrospectively analyzed. The drug was started with a dose of 2 mg/day with increases of 0.5 mg/day every 5~7 days as needed. RESULTS: Anagrelide in starting doses of 2 mg/day reduced the platelet count by 50%, or to less than 600,000/mm3, for at least 28 days in 7 of the 9 (78%) evaluable patients. Adverse effects of the drug were observed in 5 patients and generally well tolerated; headache in 4, gastrointestinal troubles in 2, palpitations and chest tightness in 1, and tinnitus in 1. Changes in hemoglobin or white blood cell counts in peripheral blood were minimal and tolerable. CONCLUSION: The present study shows that anagrelide is a useful platelet-lowering agent in whom hydroxyurea or interferon has failed. Long-term efficacy and adverse effects of the drug remain to be determined.

All-trans Retinoic Acid induced Myositis in a Patient with Acute Promyelocytic Leukemia / 대한혈액학회지

Acute promyelocytic leukemia (APL) is characterized by a specific chromosome translocation t(15;17), which fuses the promyelocytic leukemia (PML) gene to the retinoic acid receptor alpha (RARalpha) gene, and by a unique response to the differentiating agent all-trans retinoic acid (ATRA). Although ATRA does not exhibit the conventional side effects of anticancer agents, it has its own unique side effects including retinoic acid syndrome, Sweet's syndrome, and myositis. Muscular involvement associated with ATRA therapy in APL has been rarely reported. We report a case of isolated myositis induced by ATRA in the induction treatment of APL. ATRA- induced myositis has distinctive clinical features and radiologic findings that should allow its recognition in order to treat promptly with steroid therapy.

Haplotype Mismatch Transplantation using High-dose CD34+ Cells with Stratified New Conditioning Regimens in Patients with Acute Myeloid Leukemia / 대한혈액학회지

BACKGROUND: Although haploidentical transplantation has become a clinical reality for acute myeloid leukemia (AML) patients lacking a HLA compatible donor due to several encouraging reports, it is still considered as one of an experimental treatment modalities. METHODS: Eleven patients received stem cell transplantation from family donors having mismatched HLA haplotypes. For patients who were planned for 2 or 3 major antigens mismatch transplantation, their conditioning regimens included total-body irradiation (TBI), intravenous busulfan, antithymocyte globulin, and fludarabine in 6 patients and non-TBI containing regimen in 2 patients. For 3 patients with 1 major antigen mismatch sibling donor, we used 3 different regimens according to the patients' condition. The median number of infused CD34+ cells were 15.4x10(6)/kg (range, 8~21.2). RESULTS: Ten patients who were followed up for at least median 4 months (range, 17 days-15 months) showed stable engraftment. Patients who received haploidentical transplantation in first or second complete remission (CR), all showed continuous CR within our study period and showed no acute graft-versus-host disease or transplant-related mortality during 100 day posttransplant. Three of 5 patients who were in relapse or refractory state finally died in relapse. Two of 3 patients who received the full haplotype mismatch transplantation in CR died after 4 months posttransplant due to critical infections associated with delayed immune recovery. CONCLUSION: Our experience suggests that haploidentical transplantation is at least, in part, feasible or desperate treatment for patients with high-risk AML in CR. We need further stable plan to enhance the immune recovery for these patients as soon as possible.

Induction Chemotherapy for Patients with Acute Myeloid Leukemia Aged over 60 Years / 대한혈액학회지

BACKGROUND: Clinical and biologic characteristics of elderly patients with acute myeloid leukemia (AML) have not been well defined yet and there is no consensus on the appropriate treatment approach. We analyzed the outcome of these patients in terms of complete remission (CR) and the long-term life expectancy. METHODS: Twenty patients received mitoxantrone at the dose range of 4~8 mg/m2/ day for 3 days according to the patients' condition based on age and performance status, low-dose cytosine arabinoside 10mg/m2 subcutaneously at every 12 hours for 10~14 days, and etoposide 100mg/day per os for 10~14 days. Most of patients achieving CR received at least 1~3 more courses of post-remission therapy with same initial regimen. Nine out of 17 patients receiving more than two courses of post-remission chemotherapy received their cryopreserved peripheral bloods stem cells after the second or third consolidation chemotherapy. RESULTS: Overall, CR was achieved in 16 (80%) out of 20 patients and the median CR duration was 6 months (range 2~17 months). The most frequent complication during the induction chemotherapy was pneumonia (55%). CONCLUSION: The induction chemotherapy regimen including mitoxantrone, cytosine arabinoside, and etoposide seems to be promising in elderly AML patients in terms of CR rate, while its duration was short. Hopefully, it is necessary to develop a new post-remission therapy to maintain long-term disease-free survival in elderly AML patients.

Clinical Features and Risk Factors of the Septic Shock in Patients with Neutropenic Fever

BACKGROUND: The purpose of this study was to evaluate the etiologic organisms, risk factors, and other infectious features of febrile neutropenic patients developing septic shock. METHODS: We reviewed medical record of 457 patients developing neutropenic fever after chemotherapy or hematopoietic stem cell transplantation (HSCT) at Catholic HSCT Center from Jan 1998 to Dec 1999. Out of them, age/sex matched patients without septic shock were enrolled into the control group, and retrospective case-control study was conducted. RESULTS: Overall incidence of septic shock was 8.5%. Most common underlying disease of the two groups was acute leukemia. Microbiologically defined infection (MDI), especially Gram-negative bacterial infection, was significantly more common in the septic shock group than in the control group. Escherichia coli was the most common organism in the two groups (51.3% vs 27.7%, P<0.001). However, empirical use of glycopeptide was more frequent in the shock group (P<0.05). Differing from other report, fatal infection due to viridans streptococci was not observed in spite of quinolone prophylaxis. Mean leukocyte count at the onset of fever was 207/mm3 and 355/mm3 (P=0.027) and mean duration of total febrile day was 12.3 days and 7.8 days, respectively (P=0.001). On multivariate analysis, MDI and leukocyte count at the onset of fever were the significant risk factors for the septic shock. Overall mortality showed higher tendency in the shock group than in the control group (23.1% vs. 12.0%, P=0.057). Especially, in patients with Gram-positive bacterial infection, infection related mortality was significantly higher in the shock group than in the control group (50% vs. 8.9%, P=0.013). CONCLUSION: Although Gram-positive bacterial infection has been increasing, Gram-negative bacteria, including E. coli, were the most common causative organisms for sepctic shock in febrile neutropenic patients. However, considering high mortality in the septic shock caused by Gram-positive bacteria, glycopeptide must immediately be administered to the febrile neutropenic patients developing septic shock.

Infections in Patients with Acute Leukemia: Comparison of Induction Chemotherapy Group and Reinduction Chemotherapy Group

BACKGROUND: Despite the recent advance in chemotherapy and supportive care, infection remains one of the major complications in patients with acute leukemia. The purpose of this study was to determine the patterns and trends of infections in patients with acute leukemia and to find out differences in the infectious features of each chemotherapy group. METHODS: We reviewed medical records of total 326 cases with acute leukemia who had received induction or reinduction chemotherapy at the Catholic Hemopoietic Stem Cell Transplantation Center during Jan. 1998 and Dec. 1999, and compared these data with our previous data published in 1994 and 1999. RESULTS: Out of total 326 cases, 173 cases received induction chemotherapy (IC) and 153 cases received reinduction chemotherapy (RC). Underlying diseases were 211 cases of acute myeloid leukemia and 115 cases of acute lymphoid leukemia. Median age of the patients was 33 years (33 in the IC group vs 31 years in the RC group, P<0.05). Overall, 87% of the cases experienced at least one febrile episodes. Mean leukocyte count at the onset of fever was significantly lower in the RC group than in the IC group (477/mm3 vs 293/mm3, P=0.001). Infections were classified as : 46.1% of microbiologically defined infection, 35.9% of clinically defined infection and 18.0% of unexplained fever. Most common site of infection was respiratory tract in the IC group, and gastrointestinal tract in the RC group. Escherichia coli was the most commonly isolated organism in each group, and gram-negative bacteria including E. coli were more frequently isolated in the RC group than in the IC group (P< 0.05). Infection-associated mortality was significantly higher in the RC group than in the IC group (6.9% vs 11.8%, P=0.03). Comparing with our previous data, the overall mortality was reduced from 50% (early of the 1980s) to 12.3%, whereas the infection still contributed major fraction of mortality and morbidity in the management of patients with acute leukemia. CONCLUSION: The patterns of infection between IC group and RC group are somewhat different and has been changing due to many factors. New preventive, diagnostic, and treatment strategies should be developed, and prophylactic antimicrobials should be meticulously used to prevent the emergence of resistant organisms.