The Effect of Granulocyte-Colony Stimulating Factor in Remission Induction Chemotherapy of Acute Myelogenous Leukemia / 대한혈액학회지

BACKGROUND: Colony stimulating factors have been shown to accelerate recovery from severe neutropenia after intensive chemotherapy. To prove its clinical effectiveness, we conducted this study of administration of G- CSF in acute myelogenous leukemia after remission induction chemotherapy. METHODS: Thirty six patients with acute myelogenous leukemia were assigned to one of two groups (21 to G-CSF treated group, 15 to control group) after remission induction che motherapy administration. Treatment with G-CSF (lenograstim, 200ng/m2/d) was started 5 days after the end of chemotherapy and continued until the neutrophil count rose above 1,500/mm3. RESULTS: Treatment with G-CSF shortened neutropenic period after chemotherapy. The median time to recovery to neutrophil counts more than 500/mm3 from the end of chemotherapy was 19 days in G-CSF treated group and 25 days in control group. The incidence of infection was 19 cases in G-CSF treated group and 13 cases in control group and febrile periods were 12 days in G-CSF treated group and 15 days in control group, but there were no statistically significant differences. The duration of antibiotics treatment in G-CSF treated group was shorter than that of control group. There was no evidence that G-CSF could increase remission duration and overall survival. CONCLUSION: Recombinant G-CSF is safe and useful in patients after intensive chemotherapy, accelerating neutrophil recovery and thereby reducing the duration of antibiotics administration.

A Case of Postpartum Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome / 대한혈액학회지

The postpartum thrombotic thrombocytopenic purpura-hemolytic uremic syndrome is a rare complication of normal pregnancy and delivery that is described as a constellation of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. We report a case in patient with postpartum thrombotic thrombocytopenic purpura-hemolytic uremic syndrome who was successfully treated with plasama exchange and prednisolone. Relevant literature was reviewed.

A case of Hydroxyurea-induced fever / 대한내과학회지

A patient with idiopathic hypereosinophilic syndrome is reported who developed a drug fever that may be related to the administration of hydroxyurea. Typically, this form of fever develops after a few weeks of exposure to the drug and disappears with withdrawal of the drug and recurs on reexposure to the drug. The mechanism of hydroxyurea-induced fever remains unclear.

Clinical Efficacy of Combination Chemotherapy with Ifosfamide Cisplatin, and Etoposide(ICE) in Advanced Non-Small Cell Lung Cancer / 결핵

BACKGROUND: To evaluate the efficacy and toxicity of combination chemotherapy using ifosfamide, cisplatin, and etoposide in patients with advanced non-small cell lung cancer(NSCLC). MATERIALS AND METHODS: Thirty-three patients with inoperable NSCLC(stage III b+IV) who had measurable diseases, and had not been treated with chemotherapeutic drugs, were enrolled in this study(from March 1995 to December 1996). The patients received ifosfamide(1500mg/m2/day, a full drop with Mesna on days 1-5), Cisplatin (80mg/m2/day infusion with a hydration on day 2), and Etoposide (100mg/m2/day infusion for 2 hours on days 1-3). The treatment was repeated every 4 weeks. RESULTS: Ten patients showed a partial responses (30.3%). The overall survival time of the responders was longer than that of the non-responders (median 55 vs 22 weeks, p=0.01). The toxicities of this treatment were tolerable. Grade 3 or 4 leukopenia was observed in 21%. There was 1 death related to febrile neutropenia. The non-hematologic toxicity was mild. The relative dose intensity given to the patients was 0.86 ifosfamide, 0.87 cisplatin, and 0.89 etoposide, showing an average dose intensity of 0.87. CONCLUSIONS: A combination regimen of ifosfamide, cisplatin, and etoposide is effective and tolerable for treating advanced non-small cell lung cancer.

Lower leg ulcers associated with long - term hydroxyures therapy / 대한내과학회지

Hydroxyurea is an antineoplastic agent with selective cytotoxicity for cells in the DNA synthesizing phase, or S phase, of the cell cycle. It is commonly used in the treatment of myeloproliferative disorders, e.g., chronic myelogenous leukemia, essential thrombocythemia and polycythemia vera. Its major adverse reactions are reversible and dose dependent marrow suppression and gastroenteric disturbances. Cutaneous side effects such as erythema, hyperpigmentation, lichen planus-like dermatitis, nail discoloration and alopecia, atropy of the skin occur, especially with long-term treatment. Painful leg ulcers in association with hydroxyurea have only rarely been reported. The ulcers were usually extremely painful and typically located near the malleoli but were occasionally found over the tibia, on the dorsal aspect of the feet, calves, knees, heels, and hands. Any minor trauma could precipitate skin breakdown and ulceration and these ulcers tended to heal slowly. No consistent correlation between the dose or duration of hydroxyurea therapy and the occurrence of ulcers. Complete wound healing was achieved by simply discontinuing treatment with hydroxyurea. We describe 2 patients who developed spontaneous painful lower leg ulcers during long-term hydroxyurea therapy for a myeloproliferative disorder(chronic myelogenous leukemia and essential thrombo cythemia). All ulcers were painful and typically located both lateral malleoli. These ulcers healed only after hydroxyurea was withdrawn and with conservative therapy including manual debridement and occlusive dressing.

Ascitic Fluid Analysis for the Differentiation of Malignancy-Related and Nonmalignant Ascites / 영남의대학술지

The differentiation between Malignancy-Related Ascites(MRA) and Non-Malignant Ascites (NMA) is important for further diagnostic and therapeutic procedures. Althought many parameters were investigated, none has provided a complete distinction between MRA and NMA. We investigated several ascitic fluid parameters to determine the differential power, and to ifferentiate malignant-related from nonmalignant-related ascites with a sequence of sensitive parameters followed by specific parameters. For the present sturdy, 80 patients with ascites were divided into two groups: MRA and NMA. The MRA group was consisted of 27 patients with proven malignancy by image study, biopsy, and follow up; 21 of these patients had peritoneal carcinomatosis, but the remaining 6 showed no evidence of peritoneal carcinomatosis. The NMA group was consisted of 53 patients with no evidence of malignancy; among these patients, one had SLE, and others had liver cirrhosis. The samples of blood and ascites were obtained simultaneously, and then the levels of ascites cholesterol, CEA, protein, LDH, cytology, albumin gradient, ascites/serum concentration ratios of LDH(LDH A/S), and ascites/serum concentration ratios of protein(protein A/S) were measured. Applying cut-off limits for determined parameters, we estimated the diagnostic efficacy of each parameter. Among the eight parameters investigated, ascites fluid cholesterol yielded the best sensitive value of 93%(cut-off value 30mg/dl), and cytologic examination and the protein A/S(cut-off value 0.5) showed the most specific value of 100% and 96%, respectively. Based on the above result, the diagnostic sequence with cholesterol as a sensitive parameter, followed by the combination of cytologic examination and protein A/S as specific parameters, was tested in 80 patients. This diagnostic sequence identified 81.5% of patients with malignancy, and all patients with peritoneal carcinomatosis were classified as malignancy-related ascites. In spite of many limitations, this proposed diagnostic sequence may permit a cost-effective and simple differentiation of malignacy-related ascites from nonmalignant ascites