Characteristics and Clinical Outcomes of Cancer Patients who Developed Constrictive Physiology After Pericardiocentesis

Background and objectives@#This study aimed to identify the characteristics and clinical outcomes of cancer patients who developed constrictive physiology (CP) after percutaneous pericardiocentesis. @*Methods@#One-hundred thirty-three cancer patients who underwent pericardiocentesis were divided into 2 groups according to follow-up echocardiography (CP vs. non-CP). The clinical history, imaging findings, and laboratory results, and overall survival were compared. @*Results@#CP developed in 49 (36.8%) patients after pericardiocentesis. The CP group had a more frequent history of radiation therapy. Pericardial enhancement and malignant masses abutting the pericardium were more frequently observed in the CP group. Fever and ST segment elevation were more frequent in the CP group, with higher C-reactive protein levels (6.6±4.3mg/dL vs. 3.3±2.5mg/dL, p<0.001). Pericardial fluid leukocytes counts were significantly higher, and positive cytology was more frequent in the CP group. In baseline echocardiography before pericardiocentesis, medial e′ velocity was significantly higher in the CP group (8.6±2.1cm/s vs. 6.5±2.3cm/s, p<0.001), and respirophasic ventricular septal shift, prominent expiratory hepatic venous flow reversal, pericardial adhesion, and loculated pericardial fluid were also more frequent. The risk of all-cause death was significantly high in the CP group (hazard ratio, 1.53; 95% confidence interval,1.10–2.13; p=0.005). @*Conclusions@#CP frequently develops after pericardiocentesis, and it is associated with poor survival in cancer patients. Several clinical signs, imaging, and laboratory findings suggestive of pericardial inflammation and/or direct malignant pericardial invasion are frequently observed and could be used as predictors of CP development.

Atherosclerotic Cardiovascular Disease Risk and Statin Prescription Status in Korean Adult Patients

Background@#Cardiovascular (CV) disease is known as one of the major causes of death from disease worldwide. Statin therapy plays a pivotal role in atherosclerotic cardiovascular disease (ASCVD) lowering the LDL-cholesterol level effectively. The purpose of this study was to evaluate the association of the intensity of statin therapy in adult patients of Korea and the risk of ASCVD of the patient group. @*Methods@#We used data from sample of patients from the Health Insurance Review and Assessment Service (HIRA-NPS-2018). We analyzed the patterns of prescribing statins including types of statin, statin intensity, and number of patients with ASCVD or risk of ASCVD. @*Results@#155,512 patients were included in the analysis, and 27,950 patients (18.0%) was over 75 years. Highintensity statin usage was increased in ASCVD patients compared with the low-intensity statin use. The OR (odds ratio) of highintensity statin were increased in myocardial infarction patients compared with low-intensity statin use showing the highest OR; 12.40 (95% CI; 9.48-16.22). At patient groups of angina, ischemic heart disease and carotid disease, high-intensity statin prescription rate was increased compared with low-intensity statin. However, there was no statistical significance between both statin prescription rates in patients of peripheral arterial disease, abdominal aneurysm, diabetic mellitus and atherosclerosis. @*Conclusion@#The statin prescription rate showed intensity increasing tendency according to the risk of ASCVD. More aggressive statin therapy might be beneficial for the ASCVD patients based on the recent guidelines of dyslipidemia.

Atherosclerotic Cardiovascular Disease Risk and Statin Prescription Status in Korean Adult Patients

Background@#Cardiovascular (CV) disease is known as one of the major causes of death from disease worldwide. Statin therapy plays a pivotal role in atherosclerotic cardiovascular disease (ASCVD) lowering the LDL-cholesterol level effectively. The purpose of this study was to evaluate the association of the intensity of statin therapy in adult patients of Korea and the risk of ASCVD of the patient group. @*Methods@#We used data from sample of patients from the Health Insurance Review and Assessment Service (HIRA-NPS-2018). We analyzed the patterns of prescribing statins including types of statin, statin intensity, and number of patients with ASCVD or risk of ASCVD. @*Results@#155,512 patients were included in the analysis, and 27,950 patients (18.0%) was over 75 years. Highintensity statin usage was increased in ASCVD patients compared with the low-intensity statin use. The OR (odds ratio) of highintensity statin were increased in myocardial infarction patients compared with low-intensity statin use showing the highest OR; 12.40 (95% CI; 9.48-16.22). At patient groups of angina, ischemic heart disease and carotid disease, high-intensity statin prescription rate was increased compared with low-intensity statin. However, there was no statistical significance between both statin prescription rates in patients of peripheral arterial disease, abdominal aneurysm, diabetic mellitus and atherosclerosis. @*Conclusion@#The statin prescription rate showed intensity increasing tendency according to the risk of ASCVD. More aggressive statin therapy might be beneficial for the ASCVD patients based on the recent guidelines of dyslipidemia.

D-dimer/troponin ratio in the differential diagnosis of acute pulmonary embolism from non-STelevation myocardial infarction

BACKGROUND/AIMS@#The aim of this study was to investigate useful cardiac biomarkers in the differential diagnosis of acute pulmonary embolism (APE) with troponin elevation from acute non-ST elevation myocardial infarction (NSTEMI).@*METHODS@#A total of 771 consecutive NSTEMI patients with D-dimer measurements and 90 patients with troponin-I (TnI) elevation out of 233 APE patients were enrolled, and cardiac biomarkers were compared.@*RESULTS@#D-dimer elevation was noted in 382 patients with NSTEMI (49.5%), and TnI elevation was noted 90 out of 233 APE patients (38.6%). Unnecessary coronary angiography was performed in 10 patients (11.1%) among 90 APE patients with TnI elevation. D-dimer was significantly elevated in APE than in NSTEMI (9.9 ± 11.6 mg/L vs. 1.8 ± 4.3 mg/L, p 1.82 before performing coronary angiography to avoid unnecessary invasive procedure.

Prevalence of Atrial Fibrillation in the Elderly in Korea

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia particularly in the elderly and a potent risk factor for ischemic stroke. Screening for AF in asymptomatic individuals might prevent strokes by earlier detection and anticoagulation therapy. We investigated the prevalence of AF in the Korean elderly and its clinical characteristics. METHODS: This study included 1,483 participants (839 males, 644 females) ≥60 years (72.9±5.4 years) who had undergone electrocardiogram (ECG) screening at the senior health promotion center, Gwangju, from March 2014 to June 2014. Their assessments included 12 lead electrocardiograms, questionnaires and physical examinations. RESULTS: AF was detected in 46 individuals (3.1%), and newly detected in 20 of these 46 (43.4%). The prevalence of AF increased sharply with age-1.0% in 60-69 years group, 3.3% in 70-79 years group, and 7.2% in ≥80 years group. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.05-1.17; p25kg/m2) (OR, 2.17; 95% CI, 1.14-4.11; p=0.017), and heart failure (OR, 8.74; 95% CI, 1.45-52.46, p=0.018) were associated with increased risk for AF. CONCLUSION: The prevalence of AF in the Korean elderly was 3.1% and increased steeply with age from 1.0% to 7.2%. Screening with ECG may be considered as nearly half (43.4%) of AF cases were newly detected.

Chemotherapy-Induced Left Ventricular Dysfunction in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: As the numbers of cancer cases and survivors increase, the incidence and natural history of chemotherapy-induced cardiotoxicities in patients with breast cancer may also be expected to change. The present study aimed to investigate the incidence and predictors of chemotherapy-induced left ventricular dysfunction (LVD) in patients with breast cancer. METHODS: From 2003 to 2010, 712 female patients with breast cancer (55.7±10.7 years) were enrolled and divided into the LVD group (n=82, 56.7±10.1 years) and the non-LVD group (n=630, 55.6±10.8 years). Baseline clinical and treatment-related variables were compared. RESULTS: Chemotherapy-induced LVD developed in 82 cases (11.4%). Low body mass index (BMI), low triglyceride level, advanced cancer stage, and the use of doxorubicin, paclitaxel, trastuzumab, or radiotherapy were significant predictors of LVD in a univariate analysis. In a multivariate analysis, low BMI, advanced cancer stage, and the use of target therapy with trastuzumab were independent predictors of chemotherapy-induced LVD. Chemotherapy-induced LVD was recovered in 53 patients (64.6%), but left ventricular function was not recovered in 29 patients (35.4%). CONCLUSION: Chemotherapy-induced LVD was not uncommon and did not reduce in many of our patients with breast cancer. Low BMI, advanced cancer stage, and the use of trastuzumab were independent predictors of chemotherapy-induced LVD in patients with breast cancer. The development of chemotherapy-induced LVD should be carefully monitored in patients with breast cancer who are receiving trastuzumab therapy, have poor nutritional status, and advanced cancer stage.

Usefulness of Cardiac Biomarkers in the Evaluation of Prognosis and Cardiac Involvement in Patients with Acute Aortic Syndrome

OBJECTIVE: To investigate the usefulness of cardiac biomarkers in the evaluation of prognosis and cardiac involvement (CI) in patients with acute aortic syndrome (AAS). METHODS: A total of 260 AAS patients with the measurements of cardiac biomarkers were divided into 2 groups; the survived (n=215, 60.6±13.7 years, 110 males) vs the dead (n=45, 64.5±13.6 years, 19 males). N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac specific troponin-I (cTnI), C-reactive protein (CRP), creatinine kinase (CK), MB fraction of CK (CK-MB), and D-dimer were compared. RESULTS: NT-proBNP and D-dimer were significantly elevated in the dead group than in the survived group (3558.7±5497.2 vs 949.9±2307.3 pg/mL, p<0.001, 4.5±5.1 vs 2.0±3.2 ug/mL, p<0.001, respectively). CI was observed in 59 patients (22.7%), and NT-proBNP was significantly elevated in patients with CI than in patients without CI (2497.7±4671.3 vs 722.5±1489.1 pg/mL, p=0.034). In univariate analysis, Stanford type A, CI, NT-proBNP, and D-dimer were significantly associated with mortality, but NT-proBNP was the only significant independent predictor of mortality in multivariate analysis. By receiver operating characteristic curve analysis, the optimal cut-off value to predict mortality was 517.0 pg/mL for NT-proBNP (area under the curve 0.797, sensitivity 86.7%, specificity 71.7%). CONCLUSION: The elevation of cardiac biomarkers is not infrequent in patients with AAS. NT-proBNP is significantly associated with CI and is an independent predictor of mortality in patients with AAS. The measurement of NT-proBNP would be useful in the risk stratification of AAS.

The Impacts of Living Alone in in-Hospital and One-Year Clinical Outcomes after Acute Myocardial Infarction in Korean Patients

OBJECTIVE: The aim of this study is to evaluate the impact of living alone for in-hospital and one-year clinical outcome after acute myocardial infarction (AMI) in Korean patients. METHODS: A total of 1,700 patients who admitted at the Chonnam National University Hospital were analyzed. We divided the patients into two groups by the existence of a spouse or family member that lived together with the patient at the first time of hospital visit due to AMI. The primary endpoint was composed of in-hospital death and cardiac death during one-year clinical follow-up. Secondary end point was other major adverse cardio-cerebral events (MACCE) including non-fatal MI, repeat revascularization, ischemic or hemorrhagic stroke during one-year clinical follow-up. RESULTS: Living alone patient group had higher proportion of Killip class II-IV (34.3% vs. 26.6%, p=0.006) and higher value of high sensitivity C-reactive protein (2.2+/-4.0 vs. 1.5+/-3.4 ng/mL, p=0.019) than not living alone group. In-hospital death (8.9 % vs. 5.1%, p=0.010) and one-year cardiac death (7.7% vs. 4.6%, p=0.031) developed more in living alone groups. However, living alone was not an independent prognostic factor for in-hospital death (HR 1.51, 95% CI 0.91-2.52, p=0.113) and one-year cardiac death (HR 1.18, 95% CI 0.59-2.34, p=0.64) after multivariate analysis. CONCLUSION: Living alone was not an independent prognostic factor for in-hospital and one-year clinical outcome after AMI.

A Case of Biliary Fascioliasis Mimicking Neoplasia of the Common Hepatic Duct / 대한내과학회지

Fascioliasis is a rare zoonotic disease caused by Fasciola hepatica, the liver fluke. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants containing viable metacercariae. There are two disease stages: the hepatic (acute) and biliary (chronic) stages. The biliary stage of this zoonotic infection is often misdiagnosed because the symptoms are subclinical, with intermittent cholangitis as the only sign. Endoscopic retrograde cholangiopancreatography (ERCP) has been described in the diagnosis of a few cases of fascioliasis. We used this modality to diagnose biliary fascioliasis in a 39-year-old woman with chronic hepatitis B who had intermittent abdominal pain for three years with irregular wall thickening and luminal narrowing of the common hepatic duct (CHD), which resembled neoplasia of the CHD. Following the correct diagnosis, the adult worm was removed using endoluminal forceps via endoscopic sphincterotomy. This case report confirms the diagnostic and therapeutic value of ERCP in patients with biliary fascioliasis that may mimic neoplasia of the CHD.

Impaired Diastolic Recovery after Acute Myocardial Infarction as a Predictor of Adverse Events

BACKGROUND: To investigate the impact of left ventricular (LV) diastolic functional recovery on major adverse cardiac events (MACE) 6 months after acute myocardial infarction (AMI) in patients with preserved LV systolic function. METHODS: A total 463 patients with preserved LV systolic function at 6 months after an AMI were divided into two groups based on the extent of diastolic recovery assessed by echocardiography: group I (n = 241) showed improving diastolic function and group II (n = 222) did not. MACE included death, recurrent myocardial infarction, and rehospitalization due to heart failure, and these events were compared with the patients' characteristics at baseline. RESULTS: Compared with group I, the patients in group II were older and had a higher prevalence of hypertension and diabetes. Blood levels of hemoglobin and triglyceride were lower in group II, whereas the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and of high-sensitivity C-reactive protein were higher in this group than in group I. MACE were significantly more frequent in group II than in group I. Age, elevated NT-proBNP, and impaired diastolic recovery were significant independent predictors of MACE. CONCLUSION: Despite improvement in LV systolic function, LV diastolic function had not improved in 222 patients (47.9%) by the 6-month follow-up after the index AMI, and impaired diastolic functional recovery was found to be an independent predictor of MACE. Evaluation of diastolic function would be a useful way to stratify risk in patients discharged after an index AMI.

Comparison of Triple Anti-Platelet Therapy (Aspirin, Clopidogrel, and Cilostazol) and Double Anti-Platelet Therapy (Aspirin and Clopidogrel) on Platelet Aggregation in Type 2 Diabetic Patients Undergoing Drug-Eluting Stent Implantation

BACKGROUND AND OBJECTIVES: Triple anti-platelet therapy may produce more potent inhibition of platelet aggregation in patients undergoing coronary stent implantation. We tested whether this effect could be maintained in diabetic patients, where platelet reactivity is increased and the risk of stent thrombosis is higher. SUBJECTS AND METHODS: Fifty five type 2 diabetic patients who had undergone drug-eluting stent (DES) implantation and chronic anti-platelet therapy (>1 month) were stratified according to the status of anti-platelet therapy. Platelet aggregation after adenosine diphosphate (ADP; 10 micronmol/L and 20 micronmol/L) stimulation was compared using light transmittance aggregometry between dual (aspirin plus clopidogrel, n=34) and triple therapy (aspirin, clopidogrel plus cilostazol, n=21) groups. RESULTS: The 2 groups had similar clinical and procedural characteristics. Maximal ADP-induced platelet aggregation was significantly lower in the triple therapy group than the dual therapy group (ADP 10 micronmol/L, 37.1+/-15.4 vs. 28.3+/-11.8, p=0.03; ADP 20 micronmol/L, 63.1+/-15.0 vs. 49.1+/-15.1, p=0.01), but there were no differences in diabetic treatment (oral hypoglycemic agent vs. insulin) or diabetic control {hemoglobin Alc (HbA1c)7}. CONCLUSION: Triple anti-platelet therapy showed more potent inhibition of maximal ADP induced platelet aggregation in type 2 diabetic patients receiving chronic anti-platelet therapy. This finding suggests that triple antiplatelet therapy may be more effective in preventing thrombotic complications after DES implantation in type 2 diabetic patients.

Villonodular Synovitis of the Temporomandibular Joint: A Case Report

Villonodular synovitis, also called pigmented villonodular synovitis, is the benign lesion with the characteristic of locally aggressive proliferation of mononuclear histiocyte and giant cell. Typically it involves single joint, especially about 80% of disease occurs in the knee joint. Villonodular synovitis of the temporomandibular joint is very rare disease. Differential diagnosis includes synovial chondromatosis and tumors of the temporomandibular joint. Optimal treatment consists of complete excision of the mass and removal of the synovium including adjacent affected bony structures. This is a case report of villonodular synovitis developed in the temporomandibular joint.

Nephrotic syndrome associated with early neurosyphilis / 대한내과학회지

Nephrotic syndrome, hepatitis, and CNS involvement resulting from secondary syphilis are well-documented complications of neurosyphilis. However, the simultaneous occurrence of these complications is rare. The present report describes a 49-year-old male with early neurosyphilis who presented with features of nephritic syndrome and hepatitis. A diagnosis of neurosyphilis was made by CSF study and serologic tests. After the diagnosis of neurosyphilis, nephrotic syndrome and hepatitis were suspected to be factors of the neurosyphilis. A kidney biopsy revealed membranous nephropathy characterized by subepithelial electron dense deposits and diffuse effacement of foot processes. Abdominal ultrasonography showed hepatitis. The patient was treated with intravenous potassium penicillin G, 4 million units for 2 weeks, and the symptoms and signs resolved after the penicillin therapy. In conclusion, complications experienced by patients with a history of syphilis or syphilis lesions need to be minimized through careful observations and multi-organ treatments.

Nephrotic syndrome associated with early neurosyphilis / 대한내과학회지

Nephrotic syndrome, hepatitis, and CNS involvement resulting from secondary syphilis are well-documented complications of neurosyphilis. However, the simultaneous occurrence of these complications is rare. The present report describes a 49-year-old male with early neurosyphilis who presented with features of nephritic syndrome and hepatitis. A diagnosis of neurosyphilis was made by CSF study and serologic tests. After the diagnosis of neurosyphilis, nephrotic syndrome and hepatitis were suspected to be factors of the neurosyphilis. A kidney biopsy revealed membranous nephropathy characterized by subepithelial electron dense deposits and diffuse effacement of foot processes. Abdominal ultrasonography showed hepatitis. The patient was treated with intravenous potassium penicillin G, 4 million units for 2 weeks, and the symptoms and signs resolved after the penicillin therapy. In conclusion, complications experienced by patients with a history of syphilis or syphilis lesions need to be minimized through careful observations and multi-organ treatments.

Therapeutic Strategy for In-Stent Restenosis Based on the Restenosis Pattern After Drug-Eluting Stent Implantation

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the outcomes of repeated percutaneous coronary intervention (PCI) based on the restenosis pattern in drug-eluting stent (DES) failure. SUBJECTS AND METHODS: From April 2003 to March 2006, all 67 patients (67 lesions) at our 3 centers who had DES in-stent restenosis (ISR) were enrolled. The patients were divided into 3 groups: group I had focal edge restenosis, group II had focal body restenosis, and group III had non-focal restenosis. All patients were treated with conventional PCI including plain old balloon angioplasty (POBA), cutting balloon angioplasty (CBA), and repeated DES implantation (Re-DES). Angiographic and clinical one year follow-up results for the 3 groups were evaluated. RESULTS: Sixteen patients were enrolled in group I, 36 in group II, and 15 in group III. Baseline clinical and angiographic characteristics and the proportion of patients in each group receiving each type of treatment strategy were not significantly different among the groups. Within each group, a comparison of angiographic and clinical outcomes for each therapeutic modality revealed that restenosis rates were not statistically different. Although rates of major adverse cardiac events (MACE) were not statistically different between groups I and II, in group III, MACE were 3-fold higher for the POBA (4/4, 100.0%) and CBA (4/4, 100.0%) subgroups than for Re-DES (1/3, 33.3%) (p=0.06), but the differences did not reach statistical significance. CONCLUSION: The present study suggests that treatment of DES ISR should be individualized according to restenosis pattern: any PCI strategy appears appropriate for focal ISR patterns, while Re-DES might be a better choice for non-focal ISR patterns.

A case of subintimal balloon angioplasty in Buerger's disease / 대한내과학회지

A 27-year-old male was admitted with a three week history of pain and gangrenous changes of his first to fourth right foot toes. Clinical, laboratory and angiographic findings were consistent with Buerger's disease. The patient was treated by subintimal balloon angioplasty of the right anterior tibial artery. The percutaneous subintimal angioplasty was successful, and the patient symptoms and the ankle brachial index was improved. The value of subintimal angioplasty in limb-threatening ischemia in Buerger's disease, has not been established but this case illustrates a role for subintimal angioplasty in acute ischemia.

A Case of Spiradenoma in A Linear Arrangement / 대한피부과학회지

As a rule, spiradenoma occurs as a solitary intradermal nodule measuring 1 to 2cm in diameter. Occasionally, there are several nodules, and rarely, there are numerous small nodules in a zosteriform pattern or large nodules, up to 5 cm, in a linear arrangement. A 51-year-old man presented with a 4-year history of multiple, small, tender nodules which showed a linear distribution along the right subclavian area. The diagnosis of spiradenoma was made by clinical and histopathological findings and all the subcutaneous nodules were completely excised by a surgical method. We, herein, report a rare case of multiple linear spiradenoma.

Clinicopathologic study of Wegener's granulomatosis with special emphasis on early lesions in 10 Korean patients

We reviewed ten cases of Wegener's granulomatosis with special emphasis on the characteristics of the early stage of Wegener's granulomatosis. All patients presented with nonspecific symptoms and signs, so that Wegener's granulomatosis was not initially considered. However, half of the patients had clinical or radiologic disease in the nose/or paranasal sinuses as the primary presenting problems and showed neutrophil microabscess surrounded by palisading epithelioid cells and irregularly arranged giant cells in the nasal biopsy as the most characteristic feature. Five of ten patients were believed to have a protracted superficial phenomenon before involvement of other organs, specifically the lung or kidney. Four of ten patients showed nonreactivity to ANCA test at the time of presentation. Although the number of cases reviewed in this study was small, the rate of nonreactivity to ANCA was higher than those of the larger series. The importance of early diagnosis of Wegener's granulomatosis can not be overemphasized in view of the fact that cases unrecognized clinicopathologically finally progress to full-blown systemic form of Wegener's granulomatosis with poor prognosis. The diagnosis of Wegener's granulomatosis should be based on a thorough and meticulous examination of its characteristic histologic changes in biopsied tissue particularly extravascular foci.

Therapeutic Outcomes of Langerhans' Cell Histiocytosis / 대한혈액학회지

BACKGROUND: Langerhans' cell histiocytosis is a proliferative histiocytic disorder of unknown cause formerly referred to histiocytosis X, with pathologic characteristics of abnormal proliferation of histiocytes which belong to the mononuclear phagocytes. The clinical manifestations range in severity from solitary lytic bone lesions to fatal multisystem disease, typically with indolent clinical courses. The authors reported here, the clinical features and therapeutic outcomes of Langerhans' cell histiocytosis according to stage and prognostic features. METHODS: We reviewed the medical records of 38 cases with Langerhans' cell histiocytosis confirmed by biopsy from March 1983 to March 1998 in Severance hospital for disease course, treatment, and late sequelae. RESULTS: 1) Median age of the patients was 3 years-old, and the male to female ratio was 2.2:1. 2) Fifteen cases were less than 2 years of age, 21 had soft tissue involvements, 10 had more than 4 organ involvement, and 8 had involved organ dysfunction. 3) As for the clinical stages, 19 cases were in stage I, 9 in stage II, 4 in stage III, and 6 in stage IV. As for the pathologic stages, 15 had monostic disease, 2 had polyostic disease, and 21 had multisytemic disease. 4) The incidence of more than 4 organ involvement in cases or = 2 years [53.3% (8/15) vs 8.7% (2/23), P=0.004], and the incidence of organ dysfunction in cases or = 2 years [33.3% (5/15) vs 3% (3/23)], indicating that cases or = 15 years. There was a significant correlation between the presence of more than 4 organ involvement and organ dysfunction (P=0.041). 5) The response rate of all cases was 71% (27 cases), and the response rate of 25 cases who received chemotherapy was 60% (15 cases). There was no difference in the response rate according to the type of chemotherapy. Overall survival rate was 63.4% at 50 months, disease-free survival rate was 56.7% at 24 months. The disease free survival rate was significantly lower in cases younger than 2 years of age than cases older than 2 years of age (P=0.047), in cases with 4 or more organs involvement than 3 or less (P=0.0002), in cases with evidence of organ dysfunction than without evidence of organ dysfunction (P=0.082), and in cases with soft tissue involvement than with only bone involvement (P=0.043). There was significant differences in disease free survival rate according to clinical stage (P=0.001). The overall survival and disease free survival rate of the cases older than 15 years of age were similar to those of the cases younger than 15 years of age were similar to those of the cases younger than 15 years of age. 6) Five cases died during follow-up periods, organ involvement, and organ dysfunction were found to be important prognostic factors, and cases with lesions limited to skeletal system showed more than 90% of survival rate. In the future, clinical investigation enrolled with more cases about the difference of clinical features and therapeutic outcomes between adult patients and pediatric patients should be warranted.

A Case of Mucormycosis in a Patient with Myelodysplastic Syndrome and Review of the Literature in Korea / 감염

BACKGROUND: Mucormycosis is a highly virulent and rapidly progressive infectious disease caused by Mucorales. Immunocompromised hosts, such as patients with poorly controlled diabetes mellitus or diabetic ketoacidosis, patients receiving long-term deferoxamine therapy, and patients with hematologic malignancy, are predisposed to mucormycosis. We presented a case of brain abscess in a patient with myelodysplastic syndrome, and reviewed the cases of mucormycosis reported in Korea. METHODS: Relevant reports on mucormycosis were collected by searching the Korean database of medical literature. A total of 57 cases from 41 reports in Korea were reviewed as to clinical types, predisposing factors, treatments, and outcomes. RESULTS: The male to female ratio was 1.2:1. The mean age was 44 (range 1-72) years. The most frequent predisposing factor was diabetes mellitus (40 %), followed by the use of immunosuppressive agents (21%), and hematologic malignancies (16%). The most frequent clinical type was rhinocerebral (65%), followed by gastrointestinal (12%), pulmonary (9%), cutaneous (7%), and disseminated type (5%). The overall mortality rate was 33.3%, and the mortality rate in patients treated with surgical debridement was lower that in patients treated medically. The mortality rate in patients receiving surgical debridement only 13.3%, surgical debridement plus amphotericin B 26.9%, amphotericin B only 44.4%, and supportive care only 85.7%. Patients with disseminated type had a higher mortality rate than the other types. Conclusions:Early diagnosis of mucormycosis followed by the removal of predisposing factors and aggressive management, such as early surgical debridement and use of amphotericin B greatly affect therapeutic outcome. Therefore, much attention to the clinical features and identification of the organism are warranted. Collaborative evaluation through the collection of more cases with mucormycosis may be required in order to clarify the characteristics of mucormycosis in Korea.