Profiles of infectious complications on the outcomes for the recipients of allogeneic hematopoietic stem cell transplantation / 대한내과학회지

BACKGROUND: We wanted to investigate the effect of infectious complications on the outcome of patients who received allogeneic hematopoietic stem cell transplantation (HSCT), and we determined the risk factors for predicting infectious complication and the mortality in allogeneic HSCT recipients. METHODS: We enrolled all the patients who underwent allogeneic HSCT at Samsung Medical Center from February 1996 to October 2003. RESULTS: A total of 139 patients were enrolled. A total of 450 infectious episodes were observed in 131 allogeneic recipients (90.8%). Infectious complications occurred in the allogeneic recipients [3.243.00 episodes/patient]. Microbiologically documented infection (MDI), clinically documented infection (CDI), and unknown fever (UF) accounted for 41.6%, 34.0% and 24.4%, respectively, of the total infections. Pneumonia (15.1%) was the most common infection. Among the 187 MDIs, bacterial infection, viral infection and fungal infection accounted for 50.3%, 39.6%, and 7.5%, respectively. Twelve of 24 deaths in the late post-transplantation period were related with infection. The statistically significant risk factors for infection related to mortality, by multivariate analysis, were the underlying disease risk, the duration of neutropenia, the failure of stem cell engraftment, acute GVHD, MDI, UF, the number of infectious episodes, bacteremia, fungemia, pneumonia, genitourinary tract infections, S. aureus, E. coli, Pseudomonas spp., Aspergillus spp., Non-albicans candida and CMV diseases. CONCLUSIONS: The incidence of fungal infections was still low in our institute, even though prophylaxis for fungal infections was not applied, except for gargling with nystatin. In addition, most of them were non-albican Candida and Aspergillus species. Therefore, routine fluconazole prophylaxis may not be needed in our institute.

A case of the primary malignant melanoma arising from uterine endometrium / 대한내과학회지

Malignant melanoma arising in the uterine endometrium is extremely rare. Only 12 cases of malignant melanoma of the uterine endometrium have been previously reported to date. All of them were metastatic cases. The most common presenting symptom was abnormal uterine bleeding. We report a case of primary malignant melanoma arising from the uterine endometrium. A 63-year-old multigravid woman presented with uterine bleeding. The pathologic review of an endometrial curettage specimen suggested an undifferentiated malignant tumor. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Final pathologic examination revealed malignant melanoma. Immunohistochemical studies demonstrated reactivity of tumor cells for HMB-45 and S-100 protein. She had no previous history of malignancy. Whole body PET scan was performed in an effort to find the primary site of malignant melanoma and showed no demonstrable abnormal FDG uptake suggesting malignancy elsewhere. This case is the first report of primary malignant melanoma involving uterine endometrium in Korea.

Four cases of transient hyperammonemic encephalopathy following continuous infusion of 5-fluorouracil / 대한내과학회지

5-Fluorouracil (5-FU) is a chemotherapeutic agent commonly used in the treatment of a variety of solid tumors. Common adverse effects of fluorouracil chemotherapy include diarrhea, mucositis and myelosuppression. However, neurologic toxicities including hyperammonemic encephalopathy are rare and not well recognized. Transient hyperammonemic encephalopathy related to continuous infusion of high-dose 5-FU has rarely been reported. We report four cases of transient hyperammonemic encephalopathy in patients receiving continuous infusion of 5-FU. The mentality of all patients was altered during or just after the infusion of 5-FU. There were no focal neurological signs, laboratory excluding hyperammonemia or radiological abnormalities. After patients received adequate hydration and repeated lactulose enema, the mental status completely recovered within one or two days, and serum ammonium level subsequently returned to normal. In conclusion, we suggest that a transient hyperammonemic encephalopathy should be considered in differential diagnosis of patients receiving continuous 5-FU infusion with altered mentality.