A Patient Presenting Purulent Discharge From Open Window Thoracostomy / 결핵및호흡기질환

A 73-year-old man who had undergone a right pneumonectomy and open window thoracostomy due to tuberculous empyema, presented with purulent discharge from the previous operation site. The computed tomography of the chest showed diffuse pleural thickening and a low attenuated lesion, with air bubbles in a dependent portion of the right hemithorax. These air bubbles were revealed to be due to 7 pieces of retained surgical gauze by flexible bronchoscopy. The patient showed marked clinical improvement with diminished purulent discharge after removal of the foreign bodies.

Plasmafiltration and Synchronized cyclophosphamide therapy in SLE with aplastic anemia / 대한내과학회지

Systemic lupus erythematosus(SLE) is a multisystemic autoimmune disease. In rare case, aplastic anemia can develop as a complication of SLE. We report a case of SLE patient with aplastic anemia and nephrotic syndrome. A 33-year-old woman was admitted because of gum bleeding. After laboratory work up including bone marrow biopsy study, she was diagnosed as SLE with aplastic anemia and nephrotic syndrome. The patient was initially treated with high dose steroid pulse therapy. However the patient did not responded to high dose steroid treatment. We treated the patient with plasma filtration and synchronized cyclophosphamide thrapy followed by monthly intravenous cyclophosphamide treatment. Complete clinical remission of hematologic and renal complications was achieved in this patient. We suggest that plasma filtration and synchronized cyclophosphamide therapy might be one of efffectie treatment modality in the management of severe SLE patient.

A Case of Non-Immune Mediated Marrow Suppression Associated with Phenytoin Therapy / 대한혈액학회지

Diphenylhydantoin (DPH) is one of the most widely used anticonvulsants for treatment and prevention of seizures. However it is frequently associated with drug-induced leukopenia. Hypersensitivity reactions to phenytoin are well recognized and can be severe. Phenytoin is associated with serious hematologic side effects such as agranulocytosis, thrombocytopenia, red cell aplasia and hemolytic anemia, either through humoral or cell-mediated immunemechanism. We describe a 57-year-old male patient who developed a severe granulocytopenia while taking phenytoin for 66 days in the total amount of 21.6 gram. Bone marrow examination showed isolated depletion of myeloid elements. After 10 days of phenytoin withdrawal and G-CSF treatment, the patient recovered from granulocytic suppression. Using in vitro culture, marrow suppression associated with phenytoin therapy was felt to be non-immune mediated marrow suppression.

Donor Leukocyte Infusion as Treatment for Relapsed Leukemia after Allogeneic Bone Marrow Transplantation : Graft-versus-Leukemia Effect / 대한혈액학회지

BACKGROUND: Donor leukocyte infusion (DLI) is an effective therapy for patients who relapse with leukemia after allogeneic bone marrow transplantation (BMT). This is due to the fact that the immune reactivity of infused allogeneic lymphocytes on relapsed leukemia cells plays a major role in the control of leukemia. However, severe graft-versus-host disease (GVHD) and pancytopenia compromise the success of this treatment in a substantial number of patients. METHODS: To evaluate the effect of DLI, we surveyed 6 BMT centers regarding their use of DLI for relapsed leukemia after BMT. Detailed forms were used to gather data regarding the original BMT, relapse, response to DLI, complication and survival. Reports of 11 patients were consequently available for analysis. RESULTS: Five (83.3%) of 6 patients with chronic myeloid leukemia (CML) achieved complete remission (CR) [time-to-CR; 116 (27~180) days after DLI], and currently 4 are alive in CR (49~436 days). Five patients (83.3%) developed GVHD, and 2 developed pancytopenia which was related to DLI. In acute leukemia, all patients received salvage chemotherapy prior to DLI. Only 1 of 3 patients with acute lymphoblastic leukemia (ALL) who had early relapse achieved CR, but durable remission was not yet confirmed (62+ days). Both 2 patients with acute myeloid leukemia (AML) achieved CR, and their CR durations were 242+ and 326 days after DLI, respectively. CONCLUSION: This study demonstrates that DLI can exert considerable effects against myeloid forms of leukemia, especially in CML. Further investigations of separating GVHD from the graft- versus-leukemia effect and finding more effective anti-leukemia approaches on acute leukemiaare necessary to improve the current DLI limitations.

A study on the circulation of CD34+ cells in the peripheral blood of chemotherapy-treated patients with acute leukemia during bone marrow recovery - preliminary study for peripheral blood stem cell transplantation (1) - / 대한혈액학회지

No abstract available.

Surgical intervention in patients with aplastic anemia

Eighteen surgical procedures have been performed on 14 cases of aplastic anemia (AA). Of the 10 major surgical procedures, 7 were emergency and 3 elective. The median duration from the diagnosis of AA to major surgery was 0.5 months (3 days-47.3 months), and the median survival after surgery was 12.3 months (4 days-38 months). The hematological status of AA at the time of major surgery were 3 in partial response (PR), 2 with no response (NR) and 5 at diagnosis, respectively; and those after major surgery were 2 with complete response (CR), 2 in PR, 1 with minimal response, and 2 in NR. Three postoperative complications were sepsis, pneumonia and atelectasis encountered in 2 cases. A total of 3 deaths were caused by infection and cancers. Considering the fact that surgery may not only control complications, but offer the opportunity to give effective therapy for AA and therefore improves chances for survival, it is strongly suggested that active surgical intervention should be performed if the patient's status is not terminal.

A Case of Vitamin B12 Deficiency Megaloblastic Anemia Following Total Gastrectomy

Megaloblastic anemia following gastrectomy is due to the total absence or inadequate secretion of intrinsic factor and is manifested by megalobastic changes in bone marrow, blood cells, and other proliferative cells. In Korea, detailed description and precise analyses of the cases of megaloblastic anemia following gastrectomy are relatively rare in contrast to the potential of its incidence from gastrectomy due to many causes or to the importance of its clinical significance. Here, we present the case of a 51-year old man who had undergone a total gastrectomy with esophagojejunostomy and incidental splenectomy due to early gastric cancer and developed megalobastic anemla 7 years after surgery. After gradual improvement of clinical and hematologic features with treatment of parenteral vltamin Bl2, he was followed-up with vitamin B12 maintenance therapy.

Aplastic Anemia Associated with Stomach

Herein is presented a case of aplastic anemia associated with adenocarcinoma of the stomach which seem- ed to be coincidental. A 52 year-old man was admitted with a 3 year history of dyspnea. Three years previously, he was diagnosed as bone marrow hypoplasia and had been treated with oxymetholone for 1 year. After confirmation of aplastic anemia during the first admission, he was followed up with fluoxymesterone and steriods. One year later, he was readmitted with melena. Fibergastroscopy and an UGl study revealed a fungating mass on the antrum suggestive of stomach cancer. Following perioperative platelet transfusions and intensive supportive care, a subtotal gastrectomy was performed and there were no postoperative complications. Pathologic examinations disclosed a moderately well differentiated adenocarcinoma. This is the first report in Korea of adenocarcinoma of the stomach occurring in a patient with aplastic anemia. He survived 17.5 months after the surgery and 5.4 years after the onset of aplastic anemia. Gastrointestinal bleeding in aplastic anemia may be incorrectly ascribed to steriod use and overlooked, thus the need to fully investigate gastric pathology by endoscopy as well as radiology is streesed. In a patient with pancytopenia, the major surgical procedures are frequently evaded by both surgeons and internists due to the possibility of morbidity from bleeding and infection. In this case, intensive perioperative supportive care and surgery were combined to prolong the patient's survival time.