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Volume 44, Issue 10
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[in Japanese]2003 Volume 44 Issue 10 Pages 995-1003
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (355K)
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Takafumi MATSUSHIMA, Hiroshi HANDA, Akihiko YOKOHAMA, Tohru SAKURA, Ki ...2003 Volume 44 Issue 10 Pages 1004-1009
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSWe evaluated the clinical outcome of 92 patients younger than 60 years who were treated between January 1987 and May 2003. Low, Int-1, Int-2 and High risk groups categorized by IPSS consisted of 7, 34, 24 and 27 patients, respectively. There was no significant difference in the overall survival between 30 patients who received allogeneic stem cell transplantation and 62 patients who did not. Allogeneic stem cell transplantation provided significantly better outcomes in the Int-2 and the High risk groups. Risk factors for overall survival were age and disease status at transplantation. Acute and chronic GVHD did not influence the relapse free survival rate. Allogeneic stem cell transplantation is a curative therapy for MDS. It is necessary to reduce transplantation related death and to perform stem cell transplantation as soon as possible for patients with Int-2 or High risk of IPSS.View full abstractDownload PDF (308K)
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Manabu MATSUNAWA, Keiichiro KAWAKAMI, Jun-ichi HISATAKE, Junko SUZUKI, ...2003 Volume 44 Issue 10 Pages 1010-1014
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 21-year-old man was admitted to our hospital for acute hepatitis of unknown cause. His liver function improved with rest, but worsened 2 months later. He developed a high fever and pancytopenia. The serum level of cytokines including TNF-α, IFN-γ, IL-6, and M-CSF was elevated, and hemophagocytes were seen in bone marrow. These findings suggested a hemophagocytic syndrome-like state. With prednisolone, γ-globulin, and G-CSF, the high fever disappeared and the patient's liver function gradually recovered. However, the severe pancytopenia persisted. The bone marrow became acellular with a small number of hemophagocytes, and hepatitis-associated aplastic anemia was diagnosed. After immunosuppressive therapy with ATG, CyA and G-CSF was started, and the patient showed hematopoietic reconstitution. The bone marrow CD4+/CD8+ lymphocyte ratio recovered to within the normal range, and the serum cytokines including TNF-α and IFN-γ decreased. The increase in serum cytokines, particularly TNF-α and INF-γ, as well as the presence of activated T cells associated with the preceding hemophagocytic syndrome-like state may have predisposed this patient to aplastic anemia.View full abstractDownload PDF (342K) -
Jiroh YAMASAKI, Tomoko HATA, Kengo FUCHIGAMI, Katsuhiro TOGAMI, Miyuki ...2003 Volume 44 Issue 10 Pages 1015-1019
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA Fifty-two year old male, who had received a renal transplantation from his sibling 14 years previously, was referred to our hospital because of leukocytosis, anemia and thrombocytopenia. A bone marrow examination revealed an increase of leukemic blasts with morphological dysplasia of mature hematopoietic cells. The diagnosis of acute myeloid leukemia (AML) with multilineage dysplasia without antecedent myelodysplastic syndrome was made. Since the patient's general condition and the function of the transplanted kidney were well maintained, intensive therapy for his AML was chosen. The dosage of the immune suppressive reagents that were administered to prevent the rejection of the transplanted kidney were reduced during chemotherapy to minimize the adverse effect of immune suppression, and G-CSF was administrated to shorten the neutropenic period. Along with these supportive strategies, cytosine arabinoside and idarubicin-based induction therapy followed by four courses of intensive consolidation therapy were successfully performed without disturbing his renal function. It is suggested that intensive chemotherapy is feasible for post-transplant AML patients when their general condition and transplanted renal functions are well maintained.View full abstractDownload PDF (376K) -
Yasuhisa KAWAGUCHI, Yasushi MIYAZAKI, Kazutaka KURIYAMA, Masao TOMONAG ...2003 Volume 44 Issue 10 Pages 1020-1025
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSOn March 16, 2000, a 37-year-old male was admitted to another hospital for fever, erythema of the limbs, and swelling of the right lower leg. The leukocyte count was 19,800/μl, and the ratio of eosinophils was 61%, suggesting marked eosinophilia. Thoracic computed tomography (CT) revealed pneumonia in the left lung. However, the patient was negative for autoantibodies or parasitic antibodies. Administration of prednisolone at 80 mg/day resulted in a marked inprovement of the symptoms and the eosinophilia. For diagnosis, detailed examination, and treatment, the patient was referred and admitted to our department on March 28. The dose of prednisolone was gradually decreased. On April 15, the agent was discontinued. Eosinophilia was not observed, however erythema of the limbs and swelling of the right lower leg recurred. Skin biopsy revealed in mild edema of the corium and eosinophilic infiltration, suggesting episodic angioedema associated with eosinophilia (EAE). In 1984, Greich et al. reported 4 patients with repeated angioedema, hives, and marked eosinophilia, and proposed the term EAE. Since then, more than 50 patients have been reported in Japan. Only 4 of these patients were males. We report on the present male patient together with the pathological findings.View full abstractDownload PDF (1472K) -
Hiroto NARIMATSU, Yoshihisa MORISHITA, Akio KOHNO, Shigeki SAITO, Kazu ...2003 Volume 44 Issue 10 Pages 1026-1031
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 57-year-old woman with acute lymphoblastic leukemia (ALL) developed an antibiotics-resistant fever after remission induction therapy. Chest X-ray and computed tomography scan revealed multiple consolidations and cavities. Successively, numerous subcutaneous nodules and a thyroid mass emerged. Aspergillus flavus (A. flavus) was cultured from both sites. Despite the patient's granulocyte recovery, the fever persisted and multiorgan function deteriorated rapidly. However, she was successfully treated with intensive supportive therapy including continuous hemodialysis and filtration. Prolonged use of amphoterin B and itraconazole failed to cure her aspergillosis, but the illness remained indolent thereafter.View full abstractDownload PDF (1280K)
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Wataru TAKAHASHI, Yukihiro ARAI, Fumihiko NAKAMURA, Yuko NAKAMURA, Kin ...2003 Volume 44 Issue 10 Pages 1032-1035
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 62-year-old female was diagnosed as having acute lymphocytic leukemia in October 2001. She achieved complete remission after induction therapy with L-asparaginase, doxorubicin, vincristine and prednisolone. However, an invasive fungal infection developed in the lung, followed by a sudden complete atrioventricular block. Her heart rate was brought back to normal by the administration of isoproterenol. In spite of anti-fungal therapies, the patient finally succumbed to pneumonia in January 2002. Autopsy revealed an invasion of fungi into the lung, mitral valves and atrioventricular node. We need to pay attention to such a cardiac complication when an immunocompromised host suffers from an invasive fungal infection.View full abstractDownload PDF (394K) -
Hiroshi GOMYO, Tohru MURAYAMA, Chiho OBAYASHI, Ishikazu MIZUNO, Tamio ...2003 Volume 44 Issue 10 Pages 1036-1039
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 50-year-old man developed invasive pulmonary aspergillosis after induction chemotherapy for acute lymphoblastic leukemia. He was treated with 5-fluorocytosine and intravenous amphotericin B (AMPH-B). During antifungal therapy, he developed aspergillus pericarditis and complete atrioventricular (A-V) block. The pericardial effusion was decreased and the A-V block was improved after treatment with intravenous and intrapericardial instillation of AMPH-B. Because the patient's renal function deteriorated, AMPH-B was replaced with itraconazol after the latex agglutination (LA) test for an aspergillus-specific antigen showed a negative result. The patient, however, died from disseminated aspergillosis. Aspergillus DNA was detected in retrospective analysis of the serum which had been negative with the LA test. This case indicates that LA is not sufficient for diagnosis and post therapy evaluation of invasive aspergillosis. PCR or other methods should be used concomitantly with LA. Intrapericardial instillation of AMPH-B might be effective for patients with aspergillus pericarditis in whom surgical treatment is not indicated.View full abstractDownload PDF (456K) -
Toyotaka IGUCHI, Kenji YOKOYAMA, Tamihiro KAMATA, Yasuo IKEDA, Shinich ...2003 Volume 44 Issue 10 Pages 1040-1043
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 20-year-old man was referred to our hospital because of leukocytosis and was diagnosed as having chronic myelogenous leukemia in lymphoblastic crisis. His left leg began to swell soon after the beginning of induction chemotherapy and deep vein thrombosis (DVT) was confirmed by doppler echography, which progressed to compartment syndrome next day. After placing a venous filter in the inferior vena cava, the patient successfully underwent thromboembolectomy. Venous congestion due to massive lymphadenopathy enlarged kidneys, and a hypercoagulable condition due to the rapid destruction of leukemic cells may have contributed to the formation of the thrombus. This case demonstrates the importance of aggressive surgical intervention for severe DVT in patients with leukemia.View full abstractDownload PDF (258K) -
Masashi OHE, Michihumi KOHNO2003 Volume 44 Issue 10 Pages 1044-1046
Published: 2003
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSMacrolides have immuno-modulatory effects as well as anti-bacterial effects. We successfully treated three idiopathic thrombocytopenic purpura (ITP) patients with clarithromycin (CAM). Case 1: A 69-year-old male ITP patient was treated with CAM at a dose of 400 mg/day. His platelet count increased from 5.6×104/μl to 10.1×104/μl. Case 2: A 72-year-old male ITP patient was treated with CAM at the same dose. The platelet count increased from 1.3×104/μl to 12.3×104/μl. Case 3: A 68-year-old female ITP patient was treated with CAM at the same dose. The platelet count increased from 2.3×104/μl to 13×104/μl. These facts suggest that CAM is useful in the treatment of ITP.View full abstractDownload PDF (174K)
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