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.

Combination chemotherapy with vinorelbine and ifosfamide for advanced non-small cell lung cancer / 대한내과학회지

BACKGROUND: Although cisplatin (CDDP)-based chemotherapy is currently considered to be the most active treatment for advanced non-small cell lung cancer (NSCLC), ultimate prognosis still remains poor. More effective cytotoxic agents are needed to improve outcom of these patients. We evaluated the efficacy and safty of combination chemotherapy with vinorelbine and ifosfamide in patients with advanced NSCLC. METHODS: Thirty-three chemotherapy-nave patients with stage IIIB or IV NSCLC were treated with vinorelbine 25 mg/m2 on days 1 & 8 and ifosfamide 2 g/m2 on days 1, 2 & 3 with mesna every 3 weeks. RESULTS: Among thirty evaluable patients who received the vinorelbine/ifosfamide combination chemotherapy, nine (30%) partial responses were observed. With median follow-up duration of 80weeks, the median response duration and overall survival durations were 23 weeks and 38 weeks respectively. World Health Organization grade 3 to 4 neutropenia and anemia occured in 5% and 4.3% respectively. CONCLUSION: Combination chemotherapy with vinorelbine and ifosfamide is an effective treatment for patients with advanced NSCLC with a manageable toxicity.

Hepatic Injury during Treatment with Antithyroid Drugs in Patients with Hyperthyroidism / 대한내분비학회지

BACKGROUND: Propylthiouracil (PIV) and methimazole (MMI) were widely used for the treatment of hyperthyroidism. Hepatic injury caused by these agents is a rare but serious complication. This study is to investigate the clinical features of hepatotoxicity from antithyroid drugs. METHODS: We reviewed 17 cases of hepatic injury during treatment with antithyroid drugs in patients with hyperthyroidism. Included were 6 cases we experienced and 11 cases reported in Korean literature from 1986 to 1999. We analyzed the clinical features of hepatic injury. RESULTS: Of 17 cases of hepatic injury, 12 were PTU cases and 5 MMI cases. The mean age of PTU cases was 40 years with 6/12 patients over 40 years old and 2/5 MMI cases were over 40 years old. The dose of PTU was 300 mg/d or more in 10/12 cases (83%) and the dose of MMI was 30 mg/d in 3/5 cases (60%). The hepatic injury occurred within 3 months in 8/12 PTU cases (67%) and within 2 months in 4/5 MMI cases (80%). The duration of hepatic injury tended to be longer in MMI cases than in PTV cases (median; 80 vs 41 days, p=0.102). In PTU cases, the duration of hepatic injury was correlated with the duration of drug use before hepatic injury (p<0.05). All of 8 biopsied cases who took PTU had predominantly hepatocellular necrosis. Two biopsied cases who took MMI had cholestatic jaundice and nonspecific abnormality, respectively. Biochemical findings of all MMI cases were compatible with cholestatic jaundice. As to the treatment of hyperthyroidism after hepatic injury, 4/12 PTU cases were treated with RAI therapy, 5 with MMI and one with surgery, and treatment was unknown in two. On the other hand 3/5 MMI cases interestingly entered into spontaneous remission after hepatic injury and 2/5 had RAI therapy. Hepatic dysfunction recurred in each one whom treatment by changing to MMI or PTU was tried on. CONCLUSION: Most of hepatic injury during treatment with antithyroid drugs developed within two to three months of drug use. The hepatic injury related to PTU was mainly cytotoxic whereas that related to MMI was cholestatic. Since there is a cross-reaction between PTU and MMI in hepatotoxicity, RAI therapy or operation shoud be considered as an alternative treatment of hyperthyroidism after hepatic injury.

Stenting of Extracranial Carotid Artery Stenosis

BACKGROUND: Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. METHOD: We treated 19 patients with symptomatic and asymptomatic stenosis of >60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient(Takayasu's arteritis) showed restenosis. Result: Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean(+/-SD) stenosis was reduced from 74.9+/-13.6% to 10.2+/-8.7% and the minimal luminal diameter was increased from 1.4+/-0.8mm to 5.3+/-1.0mm corresponding to an acute gain of 3.9mm. There were no major or minor stokes during follow-up. CONCLUSION: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.