Causes and Clinical Features of Vitamine B12 Deficiency Megaloblastic Anemia / 대한혈액학회지

BACKGROUND: Vitamim B12 deficinecy is not a common disease and the causes and clinical findings were not clearly documented in Korea so far. Concerning that vitamin B12 deficiency caused by gastrectomy is not uncommon, we analysized the causes of vitamin B12 deficiency and clinical findings. METHODS: We reviewed the clinical records of cases diagnosed as vitamine B12 deficiency megaloblastic anemia in Hallym Medical Center from July, 1992 to Octorber, 2004. RESULTS: Forty five cases were included. Twenty five cases were performed gastrectomy and 8 cases had pernicious anemia, however the causes of 10 cases with vitamin B12 deficiency were not clear. The rate of the cases induced by gastrectomy were increased after 2001 compared with the rate before this point. Six cases were combined with iron deficient anemia. In five of the 6 cases who were combined with iron deficient anemia, the MCV and MCH were not increased. Forty three cases had anemia and anemia-associated symptoms such as dyspnea and weakness. Some of the cases complained diarrhea, numbness, or ataxia. CONCLUSION: We found that the gastrectomy was the dominant cause of vitamin B12 deficient megaloblastic anemia in this study. We suggest that vitamin B12 deficient megaloblastic anemia should be considered in follow-up of the cases of gastrectomy.

A Phase II Study of Ifosfamide, Carboplatin, and Epirubicin (ICE) Combination Chemotherapy for Extensive Disease of Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the efficacy and safety of ifosfamide, carboplatin and epirubicin (ICE) combination chemotherapy for extensive disease small cell lung cancer (SCLC) patients, who had received no previous chemotherapy, we performed phase II trial between August 1998 and January 2001. MATERIALS AND METHODS: The study group comprised of 21 patients. Ifosfamide, 1,500 mg/m2, was given with mesna, 900 mg/m2, intravenously for 12 hours on days 1, 2 and 3, and carboplatin, 4.5 mg/ml/min, for target AUC, and epirubicin, 60 mg/m2, were given intravenously for 90 minutes on day 1. The cycle of treatment was repeated at 4 week intervals. RESULTS: Twenty-one patients with extensive disease SCLC were treated at Hallym University between August 1998 and January 2001. One patient was unable to be evaluated because of lost to follow-up. Of the 20 patients able to be evaluated, an objective response was observed in 13 (65%). There were no complete responses. The median response duration, time to progression and median overall survival were 15.4, 18.3 and 34 weeks, respectively. Toxicities were acceptable, with dose reduction for myelosuppression necessary in only a minority of the patients. A total of 85 cycles of chemotherapy were given to the patients. The median number of cycles completed was 4. Grade III and IV hematological toxicities included anemia (4.7%), neutropenia (3.5%) and thrombocytopenia (3.5%). Most non-hematological toxicities were grade I or II. CONCLUSION: These results suggested that ICE combination chemotherapy for extensive disease SCLC is effective, and can be safely administered with acceptable toxicities.

Femoral Neck Fracture in Young Adult: 25 Cases Treated with Multiple Pinning / 대한정형외과학회잡지

In general. femoral neck fracture in young adult presents poor prognosis due to the high velocity injury, high angle shear fracture, and poor candidate for arthroplasty. In addition to the relative rarity of the injury, the high incidence of aseptic necrosis and nonunion have been reported in the management of these fractures. 25 cases of femoral neck fracture in young adult were treated with multiple pinning and analyzed at Sung-Ae general hospital from 1987 to 1994 after 28 months follow up in average with review of charts, X-ray and clinical result. There were 18 male and 7 female, 5 cases of them had significant polytrauma to other organs or skeletal system, authors tried to treat them as soon as possible to decrease the interval time between fracture and fixation (the average time was 39.7 hours.) Union occurred in all of Garden stage I (4 cases) and II (4 cases), but in Garden stage III (7 among 8 cases) and IV (7 among 9 cases) the union rate was lower. Average union time was 16.5 weeks. The incidence of complications (12%, 3 among 25 cases) was higher in displaced fractures group (Garden stage III, IV) and also in poorly reduced group of Garden’s alignment index. In conclusion, the prognosis of femoral neck fractures in young adult was related with mainly initial reduction and rigid fixation than the initial injury.

Neurosonographic Abnormality; Periventricular Echodensities and Intraventricular Hemorrhage: Usefulness in Predicting Neurodevelopmental Outcome in Very-Low-Birth-Weight, Preterm Infants

Serial neurosonographic examinations are routinely performed at frequent intervals during nursery course of all preterm infants of very low-birth-weight who are admitted to the intensive care nursery of Presbyterian Medical Center from November 1, 1990 to July 30, 1992. After discharge, the following survivors who had received periodic, serial scanning by meas of cranial ultrasonography were longitudinally observed in an interdisciplinary neurodevelopmental follow-up program to a mean corrected age of 13 months. Neurodevelopmental outcome was assessed by means of Vojta's postural reaction and other neurological examinations. The results are as follows: 1) The incidence of PV-IVH in the study was 79%. 2) According to Papile's grading system of PV-IVH, gradel was 20%, gradell was 46%, gradelll was 19%, and grade IV was 13%. 3) The risk factors associated with PV-IVH were birth weight, gestational age, apgar score, ventilator care, RDS, and sepsis. 4) The mortality of PV-IVH was 20% for gradel, 19% for gradell, 44% for gradelll, and 67% for grade lV. 5) According to relationship between PV-IVH and neurodevelopmental outcome, in two of the four subjects with grade lll PV-IVH, moderate/severe CCD was developed. 6) According to relationship between PVE with cysts and nuerodevelopmental outcome, moderate/severe PVE with periventricular cysts larger than 3mm in diameter was associated with development of severe CCD.

Clincial Study on Very Low Birth Weight Infants

Medical records of very low birth weight infants weighing less than 1500 grams at birth were reviewed and analyzed. One hundred and forty three infants who were admitted to neonatal intensive care unit of Presbyterian Medical Center, including those who were born and transferred from other hospitals, from January 1987 to December 1991 were examined and the following results were obtained; 1) The incidence of very low birth weight infant was 1.21% 2) The most common maternal risk factor was premature labor and the next was toxemia. 3) The most common disease of very low birth weight infant was neonatal hyperbilirubinemia and the next was septicemia. 4) Twenty five infants (38.5%) of intensive care group and 67 infants (85.9%) of Not-ventilated group survived with overall survival rate of 64.6%. 5) The heavier birth weight and longer intrauterine period were factors offering better chance for survival. 6) Among 43 (30%) infants expired, 7 (16.3%) died within 24 hours after birth, 12 (27.9%) died in second or third day, 4 (9.3%) died between fourth and seventh day, and 20 (46.5%) died between eighth.and twenty eighth day.