Invasive aspergillosis has been increasing as the number of severe immunocompromised hosts rises. Particularly, in allogeneic hematopoietic stem cell transplantation (HSCT) recipients, incidence of invasive aspergillosis ranges from 4 to 10%. Even with appropriate treatment, the prognosis of invasive aspergillosis in allogeneic HSCT recipients remains poor, showing high mortality rate. Herein, we report a case where invasive aspergillosis in a patient with acute myelogeneous leukemia progressed to disseminated aspergillosis after allogeneic HSCT. A 31-year-old woman with acute myelogenous leukemia had invasive aspergillosis after third reinduction chemotherapy. After administering amphotericin B, the patient underwent the wedge resection of lung, and HLA-matched allogeneic HSCT was then conducted. On day 14 of transplantation, the patient died of disseminated aspergillosis, including possible cerebritis and endocarditis despite the amphotericin B therapy.
Adult ; Amphotericin B ; Aspergillosis* ; Drug Therapy ; Endocarditis ; Female ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunocompromised Host ; Incidence ; Leukemia ; Leukemia, Myeloid, Acute ; Lung ; Mortality ; Prognosis ; Stem Cell Transplantation

Invasive aspergillosis has been increasing as the number of severe immunocompromised hosts rises. Particularly, in allogeneic hematopoietic stem cell transplantation (HSCT) recipients, incidence of invasive aspergillosis ranges from 4 to 10%. Even with appropriate treatment, the prognosis of invasive aspergillosis in allogeneic HSCT recipients remains poor, showing high mortality rate. Herein, we report a case where invasive aspergillosis in a patient with acute myelogeneous leukemia progressed to disseminated aspergillosis after allogeneic HSCT. A 31-year-old woman with acute myelogenous leukemia had invasive aspergillosis after third reinduction chemotherapy. After administering amphotericin B, the patient underwent the wedge resection of lung, and HLA-matched allogeneic HSCT was then conducted. On day 14 of transplantation, the patient died of disseminated aspergillosis, including possible cerebritis and endocarditis despite the amphotericin B therapy.
Adult ; Amphotericin B ; Aspergillosis* ; Drug Therapy ; Endocarditis ; Female ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunocompromised Host ; Incidence ; Leukemia ; Leukemia, Myeloid, Acute ; Lung ; Mortality ; Prognosis ; Stem Cell Transplantation

BACKGROUND/AIMS: The distribution of hepatitis C virus (HCV) genotypes varies geographically. In Korea, genotypes 1 and 2 comprise more than 90% of HCV infections, while genotype 6 is very rare. This study compared the clinical and epidemiological characteristics of patients with genotype 6 HCV infection with those infected with HCV genotypes 1 and 2. METHODS: This was a prospective, multicenter HCV cohort study that enrolled 1,173 adult patients, of which 930 underwent HCV genotype analysis, and only 9 (1.0%) were found to be infected with genotype 6 HCV. The clinical and epidemiological parameters of the genotypes were compared. RESULTS: The patients with genotype 6 HCV had a mean age of 41.5 years, 77.8% were male, and they had no distinct laboratory features. A sustained virologic response (SVR) was observed in four (67%) of six patients who received antiviral therapy. Risk factors such as the presence of a tattoo (n=6, 66.7%), more than three sexual partners (n=3, 33.3%), and injection drug use (n=3, 33.3%) were more common among genotype 6 patients than among genotypes 1 or 2. CONCLUSIONS: The epidemiology and treatment response of patients infected with genotype 6 HCV differed significantly from those with genotypes 1 or 2, warranting continuous monitoring.
Adult ; Antiviral Agents/therapeutic use ; Asian Continental Ancestry Group ; Cohort Studies ; Female ; Genotype ; Hepacivirus/*genetics ; Hepatitis C, Chronic/*diagnosis/drug therapy/epidemiology ; Humans ; Liver/pathology ; Male ; Middle Aged ; Prospective Studies ; RNA, Viral/blood ; Republic of Korea ; Risk Factors ; Sexual Behavior ; Substance-Related Disorders/complications ; Tattooing

The best treatment modality for spontaneous intracerebral hemorrhage still remains to be controversial. Stereotactic surgery can be performed safely and easily but its indication and optimal timing of operation have to be determined. We treated 80 patients with spontaneous intracerebral hemorrhage by stereotactic surgery from October 1994 to December 1997. We investigated clinical status of the patients before and after surgery, amount of hematoma, evacuation rate, timing of operation, transcranial Doppler sonography(TCD), and computerized tomography(CT) findings. The results were as follows: 1) The outcome of early surgery(within 24 hours of bleeding) was better than that of late surgery(after 24 hours of bleeding)(p=0.034). 2) The outcome was better in the patient with higher evacuation rate(p=0.014). 3) TCD monitoring showed beneficial effect of surgery on hemodynamic status. We conclude that the early surgery within 24 hours after bleeding is correlated with the better outcome, and TCD monitoring is useful for evaluation of perioperative hemodynamic change.
Cerebral Hemorrhage* ; Hematoma ; Hemodynamics ; Hemorrhage ; Humans

Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.