All issues
Volume 51, Issue 5
Displaying 1-9 of 9 articles from this issue
- |<
- <
- 1
- >
- >|
Picture in Clinical Hematology No.44
-
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...2010 Volume 51 Issue 5 Pages 313
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSDownload PDF (1620K)
Clinical Study
-
Yoko ADACHI, Toshiya SUMIKUMA, Ryogo KAGAMI, Akira NISHIO, Koji AKASAK ...2010 Volume 51 Issue 5 Pages 315-319
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSThere have been some reports on the efficacy and tolerability of an oral itraconazole (ITCZ) solution as prophylaxis for fungal infection in patients with hematological malignancies. However, there are some cases where the bitter taste of oral ITCZ solution leads to an interruption of administration because the patient refuses to take this medicine. Therefore, we prospectively investigated the pharmacokinetics and promotion of treatment adherence in patients taking oral ITCZ solution mixed with a beverage. Compared with the responses of patients taking oral ITCZ solution with water, the taste of the agent was improved significantly when mixed with orange juice, although the plasma concentration of the agent did not differ between the two groups. Using this method, we can expect an improvement in treatment adherence and this method can easily be applied in clinical practice. This method is highly useful and should become common knowledge.View full abstractDownload PDF (761K)
Case Reports
-
Kazue TAKAI, Koji NIKKUNI, Hiroyuki SHIBUYA, Hideki HASHIDATE2010 Volume 51 Issue 5 Pages 320-325
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSWe report three patients who presented with high fever, anasarca, hepatosplenomegaly, lymphadenopathy and severe thrombocytopenia accompanied by reticulin fibrosis of the bone marrow. This constellation of symptoms is not compatible with any known disease entity, and we had difficulty in diagnosis and treatment. A 47-year-old woman was suspected of having splenic lymphoma and received one course of CHOP regimen followed by continued steroid therapy. Her condition was improved but repeatedly became exacerbated with tapering of steroid. A 56-year-old man was treated with steroid pulse therapy and splenectomy without improvement. Histology of the liver and spleen did not show any specific findings. Immunosuppressive therapy with cyclosporin A was successful. Another 49-year-old man showed histological findings of paracortical hyperplasia with vascular proliferation and atrophic germinal centers on inguinal lymph node biopsy. These findings were similar to those of the hyaline-vascular type of Castleman disease or POEMS syndrome, but non-specific. Although he received steroid pulse therapy, he died of multiple organ failure. Autopsy demonstrated cytomegalovirus infection and hemophagocytic histiocytosis without malignant lymphoma. We suggest that this constellation represents a new clinical entity belonging to systemic inflammatory disorders with a background of immunological abnormality, requiring prompt and vigorous immunosuppressive therapy.View full abstractDownload PDF (6583K) -
Tomoe NEMOTO, Yuriko SAITO, Michihide TOKUHIRA, Atsushi TOMIKAWA, Mori ...2010 Volume 51 Issue 5 Pages 326-331
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSAn 83-year-old woman had been suffering from palpitations and fatigue for a month. An annual screening test revealed an increased WBC count so she was referred to our hospital. CBC showed extremely elevated WBC count (186,300/μl), in which the population of blastic eosinophils was over 90%. The eosinophils expressed CD7/13/33/34/DR, and the karyotype demonstrated 47,XX,+8. The fusion gene of FIP1-LP/PDGFRα in peripheral blood was negative. As plural effusion due to the underlying disease progressively worsened, she was given prednisolone and hydroxyurea, but the effect was limited. Steroid pulse therapy and imatinib (100 mg/day) were administrated. As a result, a prompt response was observed. The WBC count rapidly decreased, but tumor lysis syndrome led to acute renal failure and disseminated intravasucular coagulation appeared. Supportive therapies such as artificial dialysis and transfusions were conducted, but unfortunately she died because of alveolar hemorrhage.View full abstractDownload PDF (1636K) -
Minako MORI, Daichi INOUE, Hiroshi ARIMA, Yohko TAKIUCHI, Seiji NAGANO ...2010 Volume 51 Issue 5 Pages 332-338
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSThe prognosis of angioimmunoblastic T cell lymphoma (AITL) is poor because of chemotherapy-resistance and the short duration of remission. In recent years, cyclosporin A (CyA) has been employed as a alternative treatment for AITL in some patients with the rationale that CyA inhibits the activity and proliferation of neoplastic T cells. We herein report 4 chemotherapy-resistant AITL patients who were treated with oral CyA. The dosage of CyA was individually determined in each patient in order to achieve a blood CyA concentration of around 200 ng/ml at the trough level. A patient in whom AITL had relapsed 3 months after high dose chemotherapy with autologous hematopoietic stem cell transplantation (HSCT) achieved a sustained complete remission (CR) with CyA and underwent allogeneic HSCT. In 2 patients who had failed to respond to conventional chemotherapies, the circulating lymphoma cells rapidly disappeared after the initiation of CyA, and one of these patients demonstrated a durable CR. The other patient showed a good response to CyA, but the agent was discontinued because of infection. The remaining one patient with advanced AITL did not respond to CyA and died of disease progression. To our knowledge, the efficacy of CyA for chemotherapy-resistant AITL, even in a leukemic state, has not previously been reported.View full abstractDownload PDF (2185K) -
Hitotaka TAKASAKI, Takayoshi TACHIBANA, Masatsugu TANAKA, Atsuo MARUTA ...2010 Volume 51 Issue 5 Pages 339-344
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSA 47-year-old man was admitted to our hospital in June 2009 because of fatigue and blast cells in peripheral blood. Bone marrow examination showed that 67% leukemic cells were positive for myeloperoxidase (MPO) and negative for esterase stain. Flow cytometric analysis (FCM) revealed the expressions of CD2, cyCD3, CD5, TdT, CD13 on the blasts. Chromosome analysis of the bone marrow cells demonstrated 46, XY in 18 of the 20 analyzed cells, 46,XY,t(1;11)(q21;p15) in 1 of the 20 analyzed cells, and 47,XY,+11 in 1 of the 20 analyzed cells. The patient was diagnosed as having mixed phenotype acute leukemia, T/myeloid, NOS, according to the WHO classification. He received induction chemotherapy for ALL, but could not achieve complete remission (CR). After initial treatment, residual leukemic cells with CD13, CD33 and MPO were detected by FCM; therefore, he received re-induction chemotherapy for AML, and achieved CR. Acute leukemia of ambiguous lineage is a relatively rare subtype in acute leukemia and standard chemotherapy has not been established. It was suggested that the selection of chemotherapy based on the results of FCM was successful in our patient.View full abstractDownload PDF (2039K) -
Taemi OGURA, Teruyuki KAJIUME, Yasuhiko SERA, Hiroshi KAWAGUCHI, Makit ...2010 Volume 51 Issue 5 Pages 345-348
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSA 26-year-old man with chronic granulomatous disease complicated by multiple liver abscess was admitted to our hospital for hepatic resection and allogeneic bone marrow transplantation (BMT) from an HLA-matched sibling. We diagnosed the patient with Aspergillus liver abscesses based on computed tomographic findings, elevated serum levels of β-D-glucan, positive test for galactomannan antigen, and the findings of laboratory cultures. Since the liver abscess could not be treated by drainage and administration of antifungals, we resected the posterior segments of the liver, which contained the abscess (S1, S6). However, abscess recurred in the remaining part of the liver 1 month later. The patient received allogeneic BMT from an HLA-matched sibling. During BMT, we continuously administered liposomal amphotericin B (L-AMB) via the hepatic artery (25 mg/day) to treat the liver abscess. There were no adverse effects during hepatic arterial infusion of L-AMB, and the liver abscess disappeared after BMT. These results suggest that hepatic arterial infusion of L-AMB is effective in treating fungal abscess in the liver.View full abstractDownload PDF (1002K)
Short Reports
-
Yasufumi KAWASAKI, Tatsuki NAKAZORA, Munehiro SUZUKAWA, Takayuki TOMIN ...2010 Volume 51 Issue 5 Pages 349-352
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSA 59-year-old man with primary myelofibrosis developed motor and sensory neurological disturbance of the legs. Magnetic resonance imaging (MRI) demonstrated a mass lesion of the thoracic vertebra at Th4-6, and in the thoracic vertebral canal at Th4-9, which compressed the spinal cord. Needle biopsy of the mass lesion demonstrated extramedullary hematopoiesis. Initial treatment with bolus methylprednisolone was ineffective and, after subsequent radiation therapy, the mass lesion disappeared and the neurological symptoms ameliorated; however, regrowth of the extramedullary lesion was observed one month later. Surgical resection of the extramedullary lesion, laminectomy, and subsequent radiation were performed. The clinical course after the final treatment was good with no neurological symptoms, although the follow-up period is still short.View full abstractDownload PDF (1073K) -
Asumi HIGASHIYAMA, Satoshi HASHINO, Masahiro ONOZAWA, Mutsumi TAKAHATA ...2010 Volume 51 Issue 5 Pages 353-356
Published: 2010
Released on J-STAGE: June 09, 2010
JOURNAL RESTRICTED ACCESSA 61-year-old man was admitted to our hospital with dyspnea on effort. Neither computed tomography scan nor chest X-ray film detected any specific findings that could explain hypoxemia. Since 67Ga scintigraphy showed abnormal uptake in the bilateral lungs, transbronchial lung biopsy (TBLB) was performed. The TBLB specimen was diagnosed as intravascular large B-cell lymphoma (IVLBCL). There was no involvement of any other organ considered typical of IVLBCL. In cases showing clinical findings such as hypoxia despite mild pulmonary radiographic changes, a definitive diagnosis should be made using methods such as TBLB with consideration given to the possibility of IVLBCL.View full abstractDownload PDF (2801K)
- |<
- <
- 1
- >
- >|