Clinical Characteristics and Therapeutic Efficacy of Low Dose Cytarabine in High Risk Myelodysplastic Syndrome / 대한혈액학회지

BACKGROUND: High risk myelodysplastic syndrome has various clinical courses and refractoriness to various therapies. It is important to analyze clinical characteristics and therapeutic responses in high risk myelodysplastic syndrome. METHODS: Sixty nine cases of primary high risk myelodysplastic syndrome at diagnosis were enrolled in this study at Kyungpook National University Hospital and Taegu Hyosung- Catholic University Hospital from January 1987 to June 1996. We have investigated the clinical characteristics and therapeutic outcomes after low dose cytarabine chemotherapy. RESULTS: 1) The median age of the patients was 48 years. Male to female ratio was 2.1:1. The each numbers of RAEB, CMML and RAEB-T patients were 38, 11 and 20, respectively. 2) The most common chief complaint was dyspnea on exertion. General weakness, fever and dizziness were also observed. The most common physical finding was pallor. 3) The peripheral blood findings showed anemia in 65 cases (94.2%), thrombocytopenia in 64 cases (92.8%), leukopenia in 32 cases (46.4%) and pancytopenia in 26 cases (37.7%). 4) Twenty two cases transformed to acute myelogenous leukemia during the follow-up periods. Chemotherapy was done in 18 cases among 22 cases of transformed acute myelogenous leukemia. Complete remission was achieved in 3 cases (16.7%), partial remission in 4 cases (22.2%) and no response in 11 cases (61.1%). 5) Forty seven cases were treated by low dose cytarabine chemotherapy. Complete response was achieved in 11 cases (23.4%), partial response in 13 cases (27.7%) and no response in 23 cases (48.9%). Median duration of complete response was 12 weeks. 6) We made score system, which based on Sanz score and Gattermann score, according to age, hemoglobin, platelet and bone marrow blast. Overall survival was higher in group A (score or = 6). Complete response of low dose cytarabine chemotherapy was higher in group A than group B but overall survival according to low dose cytarabine chemotherapy was not different in group A and group B. CONCLUSION: Low dose cytarabine chemotherapy was not effective in survival benefit. Score system according to prognostic factors was important to predict therapeutic response and prognosis. In the future, more intensive therapeutic plan and analysis of prognostic factors should be considered.

Prospective Study on Success and Complication Rate of Central Venous Catheterization in a University-affiliated Hospital / 대한내과학회지

OBJECTIVES: The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study. METHODS: Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hematology/ oncology Department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, ID numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5 categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others. RESULTS: The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4 performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%. CONCLUSION: The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4 times at initial trial.