Comparison of FAB and WHO Classifications and Validation of WHO Classifications in 218 Korean Patients with Myelodysplastic Syndrome / 대한진단검사의학회지

BACKGROUND: World Health Organization (WHO) proposed a new classification of myelodysplastic syndrome (MDS) in 1999, based on significant modifications of the original FAB proposals. The aim of the present study was to validate the new classification with respect to prognostic importance. METHODS: Two hundred and eighteen patients were diagnosed with MDS according to the FAB criteria between August 1989 and June 2001 in the Asan Medical Center. They were studied retrospectively to evaluate morphological, clinical and cytogenetic data for diagnosis and clinical outcomes with long-term follow up, and reclassified with a new WHO classification. RESULTS: According to the original FAB classification, 218 patients were classified as RA 78, RARS 17, RAEB 76, RAEB-t 38 and CMML 9. They were reclassified to the WHO classification to RA 24, RARS 6, RCMD 51, RCMD-RS 11, RAEB-1 42, RAEB-2 51, del(5q) syndrome 1 and unclassifiable 2. Twenty-one cases of RAEB-t and 9 cases of CMML were reclassified to acute myeloid leukemia and myelodysplastic syndrome/myeloproliferative disease (MDS/MPD). Among the reclassified groups in the WHO classification, there is a significant difference in prognosis between RA and RCMD (median survival, not reached vs. 28.4 months, P=0.020), and in leukemic transformation between RAEB-1 and RAEB-2 (5% vs. 37%, P=0.001). CONCLUSIONS: These data provide the proper evidence, especially of prognosis and leukemic transformation for the WHO classifications. We recommended using the WHO classification rather than the FAB classification of the diagnosis of MDS.

Development of WebBased Laboratory-Information-Accessing System / 대한의료정보학회지

There is still lack of a convinient system that connect referring physicians to the information system of referral hospitals, We proposed to develop the laboratory-information-accessing system(LISA) for physicians referred to AMC referral center with Web-based internet technology. We constructed the menu of AMC Referral Center as a part of Asan Medical Center(AMC) homepage. The information of the referred patients wee collected in the separate internal server and then transferred to the external network sever by a batch. Referring physicians was able to connect to AMC Referral Center via AMC homepage and then browse the list of their patients by putting their identification number and password. At the next, the physicians chose the patients and the test item to be displayed. In order that the referral system is established tin the medical part, the LISA world be more needed, in the society, which internet is getting popular. This LISA was introduced successfully now, and it could be a model of national standard for hospital information system.

Conventional Treatments in Patients with Hodgkin's Disease / 대한암학회지

PURPOSE: We conducted this study to determine the efficacy of conventional treatments for patients with Hodgkin's disease and identify the patients who have poor prognosis and need high-dose chemotherapy and autologous stem cell transplantation. MATERIALS AND METHODS: Between Jun. 1989 and Dec. 1997, 50 patients were enrolled and 39 patients were evaluable. Patients were treated with radiotherapy (5 patients) or combination chemotherapy (21 patients) or combined chemotherapy and radiotherapy (13 patients) according to their disease stage. Chemotherapy regimens were C-MOPP (cyclo- phosphamide, vincristine, procarbazine, and prednisone), MOPP (mechlorethamine, vin- cristine, procarbazine, and prednisone), ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), alternating C-MOPP/ABVD, and MOPP/ABV hybrid. Radiation therapy was performed when there was residual tumor after chemotherapy or bulky disease. The response to treatments was analyzed by clinical stage I-II and stage III-IV patients group, respectively. RESULTS: The complete response rate was 76.9% for total patients, 83.3% for stage I-II patients, and 71.4% for stage III-IV patients. Of the 30 patients achieving complete response, four (13.3%) relapsed at 6, 12, 22, and 28 months after complete response, respectively. The median follow-up duration was 24 months. Nine patients died. Four patients died of Hodgkins disease. Three-year overall survival rate was 72.9% for total patients, 72.5% for stage I-II patients, and 70% for stage III-IV patients. Two-year disease- free survival rate was 77.6% for total patients, 79% for stage I-II stage patients, and 73.9% for stage III-IV patients. The prognostic factor analysis showed that performance status affected the disease-free survival rate. CONCLUSION: Conventional treatments in patients with Hodgkins disease showed results comparable to previous studies. But we were unable to identify the patients, who need high-dose chemotherapy and autologous stem cell transplantation, because of small number of study patients and short follow up duration.

The olloimrnunizotion rote of onti-c concurrent with onti-E in R1R1 potients / 대한수혈학회지

Anti-E and anti-c is one of the clinical significant irregular antibodies developing a delayed hemolytic transfusion reaction and hemolytic disease of the newborn. Since anti-c occurs frequently with anti-E in immunized people whosoe cells are E-and c-, it has been recommended to select blood of the patient's own R1 phenotype for transfusion, even when the presence of anti-c cannot be demonstrated in his/her serum. To determine the utility of this approach, we reviewed the blood bank laboratory records of patients identified anti-E and anti-c in his/her serum in Severance hospital over a 12 year period (1985-1996). During the 12-year period of study, 53 patients were identified with anti-E and/or anti-c; 30(56.6%) patients had anti-E alone, 6(11.3%) had anti-c, and 17(32.1%) had both. Thirty eight of forty two patients whose Rh-hr phenotypes were tested were R1R1. Of these 38 R1R1 patients, 16 patients (42.1%) presented with anti-c concomitant with anti-E. Ouru study showed that the incidence of antni-c in R1R1 patients with anti-E is similar to that of studies reported in Caucasian groups. We highly suggest the transfusion protocol of prophylactic use of c negative blood for R1R1 patients with anti-E. Furthermore, because anti-c may be present in concentrations too low to be detected, the enzyme technique is recommended in parallel with standard serologic methods for the identification of irregular antibodies.

A case of giant hemangioma of the liver presenting with fever of unknown origin

A 37 year-old-woman was admitted to the hospital because of 15 days' duration of continuous fever. Routine studies for detection of fever foci were negative. Imaging studies revealed giant hemangioma of the liver with central thrombosis. The fever persisted for a period of 4 weeks, and subsided after conservative management. We report a case of hepatic hemangioma presenting with fever of unknown origin. The condition is very rare, but should be regarded as one of the causes of fever of unknown origin.