BACKGROUND: Invasive pulmonary aspergillosis, a frequent fungal infection in immunocompromised patients, is known to have a poor prognosis despite the use of antifungal therapy in leukemic patients. We studied the outcome of surgical resection of invasive pulmonary aspergillosis where bleeding tendency, localized recurrence of infection, and incidence could be reduced. MATERIAL AND METHOD: We retrospectively reviewed 14 patients with a hematological malignancy where invasive pulmonary aspergillosis was diagnosed during the 10 years between 1998 and 2007. From the medical records, we reviewed the type and treatment of the hematological malignancy, including the diagnostic methods of invasive pulmonary aspergillosis, the preoperative hematological conditions and their management, and the surgical methods and records. We also analyzed the development of postoperative complications and patient mortality, the recurrence of postoperative invasive pulmonary aspergillosis, and if the patients had a bone marrow transplant. RESULT: Fourteen patients with invasive pulmonary aspergillosis and a hematological malignancy underwent a pulmonary lobectomy. One patient had a complication of bronchopleural fistula, but there were no other serious complications such as bleeding or wound infection, and none of the patients died postoperatively. CONCLUSION: We have shown that pulmonary lobectomy is a safe and effective therapy for invasive pulmonary aspergillosis in patients with hematological malignancies that allow further treatment of the hematological malignancy.
Bone Marrow ; Fistula ; Hematologic Diseases ; Hematologic Neoplasms* ; Hemorrhage ; Humans ; Immunocompromised Host ; Incidence ; Invasive Pulmonary Aspergillosis* ; Medical Records ; Mortality ; Postoperative Complications ; Prognosis ; Pulmonary Aspergillosis ; Recurrence ; Retrospective Studies ; Wound Infection

BACKGROUND: Clostridium difficile infection (CDI) is a nosocomial condition prevalent in patients with hematological disorders. We aimed to identify the risk factors associated with the development of CDI and assess the mortality rate at 15 and 30 days among hematologic patients admitted to a tertiary care center. METHODS: We conducted a retrospective case-control study from January 2010 to December 2015. Forty-two patients with hematologic malignancy and CDI, and 84 with hematologic disease and without history of CDI were included in the case and control groups, respectively. RESULTS: Univariate analysis revealed that episodes of febrile eutropenia [odds ratio (OR), 5.5; 95% confidence interval (CI), 2.3–12.9; P<0.001], admission to intensive care unit (OR, 3.8; 95% CI, 1.4–10.2; P=0.009), gastrointestinal surgery (OR, 1.2; 95% CI, 1.1–1.4; P<0.001), use of therapeutic (OR, 6.4; 95% CI, 2.5–15.9; P<0.001) and prophylactic antibiotics (OR, 4.2; 95% CI, 1.6–10.7; P=0.003) in the last 3 months, and >1 hospitalization (OR, 5.6; 95% CI, 2.5–12.6; P<0.001) were significant risk factors. Multivariate analysis showed that use of therapeutic antibiotics in the last 3 months (OR, 6.3; 95% CI, 2.1–18.8; P=0.001) and >1 hospitalization (OR, 4.3; 95% CI, 1.7–11.0; P=0.002) were independent risk factors. Three (7.1%) and 6 (14.2%) case patients died at 15 and 30 days, respectively. CONCLUSION: The risk factors for developing CDI were exposure to therapeutic antibiotics and previous hospitalization. Hematological patients who developed CDI had higher early mortality rates, suggesting that new approaches for prevention and treatment are needed.
Anti-Bacterial Agents ; Case-Control Studies ; Clostridium difficile ; Clostridium ; Hematologic Diseases ; Hematologic Neoplasms ; Hospitalization ; Humans ; Intensive Care Units ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers

PURPOSE: A laparoscopic splenectomy (LS) has been proposed as a substitute to an open splenctomy (OS) in the treatment of benign hematological diseases that are refractory to medical therapy in many centers. However, in Korea, many clinicians do not inform patients of the option of a LS in whom a splenectomy is needed. This study was undertaken to compare the safety, the outcome including the clinical benefits of a LS and an OS for a variety of benign hematological diseases. METHODS: The records of 137 patients who underwent a splenectomy (15 OS and 122 LS) at the Asan Medical Center between January 1998 and December 2002 were reviewed retrospectively. The patient demographics, surgical indications, perioperative results, morbidity, mortality and clinical outcome were evaluated. RESULTS: Open splenectomies were performed by 4 surgeons and a LS was performed by one surgeon after receiving informed consent regarding each procedure (OS & LS). Thirty eight cases (28.2%) were transfered to our department from another hospital without being given any information of LS. There was no significant difference in age, gender, ASA grading, previous abdominal surgery and comorbid diseases between the two groups. The average operating time was longer in those given a LS than OS (P<0.05, 128 min. vs 98 min. respectively), but the volume of intraoperative blood loss was significantly lower for those receiving LS (P<0.05, 114+/-11.1 ml vs 201+/-10.1 ml, respectively). Five patients (4.1%) required a conversion to an open splenectomy during LS as a result of intraoperative bleeding (4 case) and severe adhesion (1 case). The mean postoperative analgesic (NSAID, Nonsteroidal Anti-inflammatory Drug) requirement was significantly smaller in those receiving a LS than an OS (P<0.05, 4.3 days vs 1.5 days, respectively). The length of the hospital stay was shorter in the LS group than in the OS group (P<0.05, 5.3+/-1.0 days vs 9.4+/-1.2 days, respectively) and there were significantly lower perioperative complications in the LS group than in the OS group (P<0.05, 11.5% vs 40%, respectively). There was no significant differences in the remission rate of ITP in those receiving a LS and OS (P>0.05, 84% vs 78%, respectively) during a mean follow-up period of 38+/-12 months. CONCLUSION: LS takes longer to perform but results in minimal blood loss, less analgesics, a shorter postoperative stay and fewer complications than OS. In addition, a laparoscopic splenctomy is a safe, efficacious and a superior treatment for patients with various benign hematological disorders. Therefore, it is strongly recommended that surgeons inform patients of the option of a LS and give consideration to a transfer to other hospitals where advanced laparoscopic procedures are feasible.
Analgesics ; Chungcheongnam-do ; Demography ; Follow-Up Studies ; Hematologic Diseases ; Hemorrhage ; Humans ; Informed Consent ; Korea ; Length of Stay ; Mortality ; Retrospective Studies ; Splenectomy*

BACKGROUND: Cardiovascular diseases related mortality attributes to approximately one fourth of mortality in Korea, and management of chronic diseases is essential for the prevention of cardiovascular diseases. Through the health screening program, early detection and prevention of chronic disease are made possible, and this will improve the health status of examinees. In the current national health examination (NHE), counseling and continuous management after NHE have not been properly made. We aimed to investigate examinees' knowledge of the result form of NHE in order to find the ways of improvement. METHODS: We recruited 120 examinees, who have undergone general health examination and life turning point health examination (LTPHE), and conducted survey from January 7, 2016 to January 26, 2016. Participants answered questionnaires regarding demographic characteristics, health screening related factors, and their knowledge and attitude towards NHE. Answers were converted to Likert scale, and student t-test, one-way ANOVA, and linear regression models were used for the analyses. RESULTS: Examinees' knowledge of the result form was lowest in the blood test category. When age and type of institution were adjusted, the examinees in their 60s had significantly lower knowledge of all the categories of result forms except urine test in comparison to the younger examinees. When type of institutions were compared, examinees, who had undergone NHE in health screening clinics, had significantly lower knowledge of several categories of result forms in comparison to those who had undergone NHE in private clinics and general hospitals. Examinees' knowledge of the LTPHE result form was lowest in categories of “mild cognitive impairment and dementia” and “fall down and voiding difficulty.” CONCLUSIONS: The result form of NHE should be revised so that examinees in old age can easily understand. Examinees' knowledge of the result form was lower in health screening clinic; thus, quality of health screening clinic should be improved for continuous care after NHE.
Cardiovascular Diseases ; Chronic Disease ; Cognition Disorders ; Counseling ; Hematologic Tests ; Hospitals, General ; Humans ; Korea ; Linear Models ; Mass Screening ; Mortality

PURPOSE: Laparoscopic splenectomy (LS) is the procedure of choice in treating hematologic diseases, however there are controversies concerning malignancy and splenomegaly. This study was performed in order to examine the safety and efficacy of LS and hand-assisted laparoscopic splenectomy (HALS) in the management of patients with various splenic tumors and splenomegaly. METHODS: Fifteen patients who had undergone laparoscopic splenectomy for suspected splenic tumors between May, 1998 and December, 2000 were evaluated. We conducted a review, recording previous abdominal surgery, diagnostic work up, size of spleen, accessory spleen, type of surgery, morbidity, mortality, and length of hospital stay. A retrograde analysis was conducted using the medical records of the patients. RESULTS: The average splenic length was 22.4 cm (range, 14~37 cm), and the average weight was 1,210 gm (range, 210~3,700 gm). There were two types of operations performed. LS was accomplished in 7 cases and HALS in 8 cases. All operations were completed without any conversion to open surgery. The average intraoperative blood loss was 153.5 ml (range, 45~830 ml). The average postoperative stay was 5.2 days (range, 3~9 days). Only one complication (subphrenic abscess) developed (7%), which was resolved by percutaneous drainage. No deaths occurred. The pathologic findings were lymphoma (4), hemangioma (4), islet cell tumor (2), lymphangioma (3), myelofibrosis (1), and hematoma (1). CONCLUSION: LS and HALS are safe and feasible procedures for the treatment of most neoplastic splenic diseases with splenomegaly. HALS is an alternative approach for overcoming the technical and oncological challenges that often accompany malignant splenic diseases such as splenomegaly, perisplenitis and hilar lymphadenopathy. As the indications for LS including HALS are expanded, the role of LS and HALS in various splenic tumors will become more clearly defined.
Adenoma, Islet Cell ; Conversion to Open Surgery ; Drainage ; Hemangioma ; Hematologic Diseases ; Hematoma ; Humans ; Length of Stay ; Lymphangioma ; Lymphatic Diseases ; Lymphoma ; Medical Records ; Mortality ; Primary Myelofibrosis ; Spleen ; Splenectomy* ; Splenic Diseases ; Splenomegaly

BACKGROUND: Invasive fungal infection (IFI) is an important cause of morbidity and mortality in patients with hematologic malignancy. Patients with IFI who fail to standard therapy have poor prognoses. We investigated the efficacy and safety of caspofungin (CAS) in Korean adults with hematologic diseases and IFI who did not respond to the conventional antifungal therapy. MATERIALS AND METHODS: Patients with IFI refractory or intolerant to standard antifungal therapy received CAS 50 mg IV daily after 70 mg loading dose on day 1. Efficacy and safety of CAS were assessed in patients who received more than one dose. Favorable response [complete (CR) or partial (PR)] was defined as significant improvement of all clinical symptoms, signs, and radiologic abnormalities. RESULTS: From Feb. 2004 to Feb. 2005, 55 patients who met the inclusion criteria were enrolled. There were 32 male and 23 female patients with mean age of 38.2 years (range, 16-65). Underlying diseases were acute leukemia (33 cases), myelodysplastic syndrome (12 cases), chronic myelogenous leukemia (3 cases), and other hematologic diseases (7 cases). Thirty-six patients were receiving chemotherapy and 13 patients were under hematopoietic stem cell transplantation (HSCT). The number of proven, probable, possible, and indeterminate IFI cases was 1, 5, 47, and 2, respectively. Conventional amphotericin B, intravenous itraconazole, and liposomal amphotericin B were administered for average of 14.9 days prior to administering CAS. Mean duration of CAS therapy was 12.8 days (range, 1-45). Twenty-three patients (41.8%) showed favorable responses (CR:PR=8:15) at the end of CAS therapy. Chemotherapy group, neutropenic state, remitted state of underlying disease, and no steroid therapy were significant prognostic factors for favorable response. Eight (14.5%) patients developed drug-related adverse events such as fever, skin eruption, and hepatic dysfunction which were reversible after discontinuation of CAS. Drug-related nephrotoxicity was not observed. CONCLUSION: On the basis of our investigation, CAS was effective and safe as a salvage therapy of refractory IFI or as an alternative for patients intolerant to standard antifungal agents.
Adult ; Amphotericin B ; Antifungal Agents ; Drug Therapy ; Female ; Fever ; Hematologic Diseases* ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation ; Humans ; Itraconazole ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Male ; Mortality ; Myelodysplastic Syndromes ; Prognosis ; Salvage Therapy* ; Skin

BACKGROUND: Invasive fungal infection (IFI) is an important cause of morbidity and mortality in patients with hematologic malignancy. Patients with IFI who fail to standard therapy have poor prognoses. We investigated the efficacy and safety of caspofungin (CAS) in Korean adults with hematologic diseases and IFI who did not respond to the conventional antifungal therapy. MATERIALS AND METHODS: Patients with IFI refractory or intolerant to standard antifungal therapy received CAS 50 mg IV daily after 70 mg loading dose on day 1. Efficacy and safety of CAS were assessed in patients who received more than one dose. Favorable response [complete (CR) or partial (PR)] was defined as significant improvement of all clinical symptoms, signs, and radiologic abnormalities. RESULTS: From Feb. 2004 to Feb. 2005, 55 patients who met the inclusion criteria were enrolled. There were 32 male and 23 female patients with mean age of 38.2 years (range, 16-65). Underlying diseases were acute leukemia (33 cases), myelodysplastic syndrome (12 cases), chronic myelogenous leukemia (3 cases), and other hematologic diseases (7 cases). Thirty-six patients were receiving chemotherapy and 13 patients were under hematopoietic stem cell transplantation (HSCT). The number of proven, probable, possible, and indeterminate IFI cases was 1, 5, 47, and 2, respectively. Conventional amphotericin B, intravenous itraconazole, and liposomal amphotericin B were administered for average of 14.9 days prior to administering CAS. Mean duration of CAS therapy was 12.8 days (range, 1-45). Twenty-three patients (41.8%) showed favorable responses (CR:PR=8:15) at the end of CAS therapy. Chemotherapy group, neutropenic state, remitted state of underlying disease, and no steroid therapy were significant prognostic factors for favorable response. Eight (14.5%) patients developed drug-related adverse events such as fever, skin eruption, and hepatic dysfunction which were reversible after discontinuation of CAS. Drug-related nephrotoxicity was not observed. CONCLUSION: On the basis of our investigation, CAS was effective and safe as a salvage therapy of refractory IFI or as an alternative for patients intolerant to standard antifungal agents.
Adult ; Amphotericin B ; Antifungal Agents ; Drug Therapy ; Female ; Fever ; Hematologic Diseases* ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation ; Humans ; Itraconazole ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Male ; Mortality ; Myelodysplastic Syndromes ; Prognosis ; Salvage Therapy* ; Skin

BACKGROUND: Although many studies have focused on the association of hyperuricemia with components of metabolic syndrome, there are only few studies of independent relation between uric acid and metabolic syndrome itself. In this study, we evaluated healthy subjects and assessed the relationship of serum uric acid with metabolic syndrome. METHODS: Between January and February of 2005, we evaluated 164 healthy patients who visited a health evaluation center. Patients were evaluated for metabolic syndrome and risk factors were assessed using a questionaire, blood test and physical examination. RESULTS: Metabolic risk factors significantly increased as uric acid level markedly increased (P<0.05). Even after limiting the variables such as age, sex, smoking, exercise, total cholesterol, low-density lipoprotein cholesterol, and LogCRP, the group with metabolic syndrome had markedly increased uric acid levels than those without metabolic syndrome [Odds ratio 1.494 (95% CI, 1.072~2.084)]. CONCLUSION: The number of components of metabolic syndrome increased according to serum uric acid level. Uric acid level was significantly higher in metabolic syndrome than normal. Even after considering health behavior variables such as smoking, alcohol status, and exercise, they showed an independent relationship. Further massive prospective studies on whether collecting serum uric acid level can be used as a screening test or predictor of mortality for early metabolic syndrome and cardiovascular disease will be needed.
Cardiovascular Diseases ; Cholesterol ; Health Behavior ; Hematologic Tests ; Humans ; Hyperuricemia ; Lipoproteins ; Mass Screening ; Mortality ; Physical Examination ; Risk Factors ; Smoke ; Smoking ; Uric Acid*

Persistent bone marrow aplasia after intensive chemotherapy is uncommon, but is one of the fatal complications in patients with acute myeloid leukemia (AML). Although allogeneic hematopoietic stem cell transplantation (HSCT) is considered to be contraindicated for patients who have hematologic diseases with serious infections, such as bacterial septicemia or invasive fungal diseases, combined with prolonged neutropenia due to frequent morbidity and mortality, such risks can be overcome by non-myeloablative conditioning and best supportive care. Here, we report an AML patient with persistent marrow aplasia after induction therapy, treated successfully with reduced-intensity allogeneic HSCT despite severe bacterial and fungal infections.
Anemia, Aplastic ; Bone Marrow* ; Drug Therapy* ; Hematologic Diseases ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia, Myeloid, Acute* ; Mortality ; Neutropenia ; Sepsis ; Stem Cell Transplantation* ; Stem Cells*

Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies that can extend patients' life expectancy and improve quality of life. Primary care physicians (PCPs) are often involved in the process of diagnosis and follow-up of MDS patients, especially those in low-risk groups. They can therefore play an important role in improving patient care and quality of life by ensuring early referral and participating in supportive management. There is also a shortage of oncologists which increases the importance of the role of PCPs in management of MDS patients. In the face of limited resources, PCPs can improve access and quality of care in MDS patients. This article provides an overview of the common manifestations, diagnostic approaches, and therapeutic modalities of MDS for PCPs, with a focus on when to suspect MDS, when a referral is appropriate, and how to provide appropriate supportive care for patients diagnosed with MDS.
Adult ; Bone Marrow Diseases ; Diagnosis ; Follow-Up Studies ; Hematologic Neoplasms ; Humans ; Life Expectancy ; Mortality ; Myelodysplastic Syndromes* ; Patient Care ; Physicians, Primary Care ; Primary Health Care* ; Quality of Life ; Referral and Consultation