Spontaneous regression of neointimal hyperplasia in a patient who underwent percutaneous coronary intervention with a bare metal stent / 대한내과학회지

Many interventional cardiologists rely upon percutaneous coronary intervention (PCI) with drug-eluting stents (DES), but DES may provoke serious complications, such as stent thrombosis and delayed restenosis. Previous studies of bare metal stent placement showed regression of neointimal proliferation after 6 months. Here, we report the case of a 50-year-old man demonstrating spontaneous regression of neointimal hyperplasia after undergoing PCI with a bare metal stent to treat a middle left anterior descending (LAD) artery lesion. Coronary angiography showed 90% diffuse restenosis at 6 months after stent placement, but the patient refused PCI due to monetary concerns. After 29 months, follow-up angiography revealed spontaneous regression of restenosis in the middle LAD.

Influence of Lactate Dehydrogenase and Cyclosporine A Level on the Incidence of Acute Graft-versus-host Disease After Allogeneic Stem Cell Transplantation

Previous reports have suggested that a high serum cyclosporine A (CsA) level could result in a lower incidence of acute-graft-versus-host disease (aGVHD). An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia. In this study, we retrospectively analyzed the records of 24 patients who received allogeneic SCT from an HLA-matched sibling donor for acute and chronic myelogenous leukemia. Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment). A higher serum level of CsA and lower serum LDH level at the third week after SCT were associated with a lower incidence of aGVHD (P=0.015, 0.030). In multivariate analysis, the serum CsA level (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.022-0.652, P=0.0014) and serum LDH level (HR, 6.59; 95% CI, 1.197-36.316, P=0.030) at the third week after SCT were found to be independent factors that were significantly associated with the development of aGVHD. We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.

Reverse Seroconversion of Hepatitis B following Allogenic Hematopoietic Stem Cell Transplantation from a Hepatitis Immune Donor in a Multiple Myeloma Patient

A 52-yr-old male with multiple myeloma underwent autologous stem cell transplantation in June 2002. In August 2004, the multiple myeloma had recurred. The patient received allogenic stem cell transplantation in September 2005. Before undergoing transplantation, the presence of HBsAb and the absence of HBsAg were noted. The patient underwent allogenic peripheral blood stem cell transplantation (PBSCT) from a sibling donor who was hepatitis surface antibody (HBsAb) positive and hepatitis surface antigen (HBsAg) negative. Nineteen months after the PBSCT, the liver function tests showed elevation of the aminotransferases. The patient was HBsAg positive and HBsAb negative. The liver biopsy specimen revealed hepatitis. The reactivation of a hepatitis B virus infection, in a hepatitisB immune patient, referred to as reverse seroconversion, is a rare complication of hematopoietic stem cell transplantation.

A Case of Granulocytic Sarcoma in the Brain of a Patient with Acute Erythroleukemia

Granulocytic sarcoma is a localized tumor that's composed of immature granulocytic cells and this is more common in patient with 8;21 translocation. We present here a case in a 64-year-old man who was diagnosed with acute myelogenous leukemia (erythroleukemia) that had a complex hyperdiploid karyotype. While he underwent chemotherapy, he developed nausea, vomiting, headache and dysarthria. After several diagnostic work-ups, granulocytic sarcoma in the cerebellum and leptomeningeal metastasis of his leukemia were found on the magnetic resonance imaging and the cerebrospinal fluid cytology.

A Hospital-based Tabletop Exercise for Pandemic Influenza Preparedness: Design and Evaluation / 감염과화학요법

BACKGROUND: To evaluate the usefulness and compliance of a hospital-based tabletop exercise in setting of pandemic influenza in hospitals. MATERIALS AND METHODS: Tabletop exercise was held in Pusan National University Hospital and forty two hospital employees were invited to participate in the exercise. The scenario for hospital-based tabletop exercise was designed. It consisted of three modules, which simulated the influx and outbreak of H5N1 influenza that was epidemic in Southeast Asia. Pre-, post-exercise surveys were completed by anonymous questions. RESULTS: Thirty-seven (88%) of 42 invited participants attended exercise. All members of the administration group and the ancillary services group participated. But, only 77% members of the clinical services group participated. In pre-exercise survey, priorities of eight goals regarding skills and knowledge during exercise were inquired., The highest priorities pointed out by the respondents were "Increase the knowledge of pandemic influenza" (22%), "Development of strategies for optimal communication among employees within specific department" (19%) and "Development of strategies for improved coordination between facilities within the health system" (19%). Twenty-one (57%) of participants completed the post-exercise surveys. At post-exercise surveys, 81% of the participants stated that the tabletop exercise was extremely or very useful, 86% of the participants also stated that it increased their knowledge of pandemic influenza. CONCLUSION: Tabletop exercise is an effective modality for increasing pandemic influenza preparedness in hospitals, and this method is useful for guiding preparedness activities within the hospital environment. Further studies to determine the appropriate method of discussion, questionnaire, duration of exercise and injection are needed.

The Efficacy and Adverse Effect of Hydroxyurea as Compared with Anagrelide in Essential Thrombocythemia

BACKGROUND: Although the platelet count may not always correlate with the risk of thrombosis, there is evidence that a strict control of the platelet count decreases the incidence of thrombotic and hemorrhagic complications. However, it is difficult to select an appropriate platelet-lowering agent. This retrospective study was performed to assess the efficacy and adverse effect of the use of hydroxyurea and anagrelide for patients with essential thrombocythemia. METHODS: Sixty patients with essential thrombocythemia received either hydroxyurea (n=30) or anagrelide (n=30). Early responses and adverse effects of hydroxyurea and anagrelide in the patients were retrospectively analyzed. RESULTS: Treatment with anagrelide or hydroxyurea resulted in a rapid decrease of the platelet count within two weeks. The response rates after treatment with hydroxyurea and anagrelide were 83% and 77%, respectively. As compared with patients treated with hydroxyurea, patients treated with anagrelide presented with adverse effects such as headache palpitation was also frequently noticed (P=0.001). However, serious hemorrhage (n=2) and transformation to leukemia (n=1) occurred in patients treated with hydroxyurea. CONCLUSION: Both anagrelide and hydroxyurea were effective and well-tolerated agents for the reduction of the platelet count. Long-term efficacy and adverse effects of the drugs remain to be determined.

A Hospital-based Tabletop Exercise for Pandemic Influenza Preparedness: Design and Evaluation / 감염과화학요법

BACKGROUND: To evaluate the usefulness and compliance of a hospital-based tabletop exercise in setting of pandemic influenza in hospitals. MATERIALS AND METHODS: Tabletop exercise was held in Pusan National University Hospital and forty two hospital employees were invited to participate in the exercise. The scenario for hospital-based tabletop exercise was designed. It consisted of three modules, which simulated the influx and outbreak of H5N1 influenza that was epidemic in Southeast Asia. Pre-, post-exercise surveys were completed by anonymous questions. RESULTS: Thirty-seven (88%) of 42 invited participants attended exercise. All members of the administration group and the ancillary services group participated. But, only 77% members of the clinical services group participated. In pre-exercise survey, priorities of eight goals regarding skills and knowledge during exercise were inquired., The highest priorities pointed out by the respondents were "Increase the knowledge of pandemic influenza" (22%), "Development of strategies for optimal communication among employees within specific department" (19%) and "Development of strategies for improved coordination between facilities within the health system" (19%). Twenty-one (57%) of participants completed the post-exercise surveys. At post-exercise surveys, 81% of the participants stated that the tabletop exercise was extremely or very useful, 86% of the participants also stated that it increased their knowledge of pandemic influenza. CONCLUSION: Tabletop exercise is an effective modality for increasing pandemic influenza preparedness in hospitals, and this method is useful for guiding preparedness activities within the hospital environment. Further studies to determine the appropriate method of discussion, questionnaire, duration of exercise and injection are needed.