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Volume 45, Issue 5
Displaying 1-13 of 13 articles from this issue
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[in Japanese], [in Japanese]2004 Volume 45 Issue 5 Pages 341-346
Published: 2004
Released on J-STAGE: July 28, 2009
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[in Japanese]2004 Volume 45 Issue 5 Pages 347-354
Published: 2004
Released on J-STAGE: July 28, 2009
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[in Japanese], [in Japanese]2004 Volume 45 Issue 5 Pages 355-364
Published: 2004
Released on J-STAGE: July 28, 2009
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[in Japanese]2004 Volume 45 Issue 5 Pages 365-371
Published: 2004
Released on J-STAGE: July 28, 2009
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Isao TAKAHASHI, Seiichi YORIMITSU2004 Volume 45 Issue 5 Pages 372-377
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSThis paper describes the epidemiological aspects of ITP in Kochi prefecture. Five hundred and twenty three patients were newly registered over the past 14 years (from April 1, 1989 to March 31, 2002). They comprised 192 men (36.7%) and 331 women (63.3%), yielding a female to male ratio (F/M) of 1:1.7. The proportions of children (≤14 y/o), adults (15-64 y/o) and the elderly (≥65 y/o) were 24.9%, 51.6% and 23.5%, respectively, and F/M ratios were 1:0.8 in children, 1:3.0 in adults and 1:1.3 in the elderly, showing elimination of the sex difference in the elderly. Average annual incidences per 100,000 population were estimated by 2 calendar year periods (Period I: '89-'90, II: '91-'92, III: '93-'94, IV: '95-'96, V: '97-'98, VI: '99-'00, VII: '01-'02). The incidence of ITP showed a significant increase over the past 14 years, particularly in the elderly (I: 0.90, II: 0.67, III: 1.89, IV: 3.52, V: 3.05, VI: 4.10, VII: 3.17). The increase of ITP in the elderly concomitant with the increase in the size of the elderly population is probably not only exclusive to Kochi prefecture but also seen throughout Japan, therefore, the establishment of the optimal therapeutic management of ITP in the elderly including the eradication of Helicobacter pylori is required.View full abstractDownload PDF (392K) -
Yoshitaka MORI, Hideo WADA, Hiroshi SHIKU, Hideo YAGI, Masanori MATSUM ...2004 Volume 45 Issue 5 Pages 378-382
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSSevere deficiency of ADAMTS13 activity was recently found in patients with thrombotic thrombocytopenic purpura (TTP). The great advance associated with these basic and clinical studies on ADAMTS13 is the possible elucidation of the pathogenesis of TMA (thrombotic microangiopathy). However, the exact pathogenetic mechanism in TMA without severe deficiency of ADAMTS13 activity remains unknown due to heterogeneity of the disease. In this study, there were 7 patients with TTP, 7 with HUS, 3 with drug-induced HUS, 1 with VOD, and 1 with IVL out of 19 TMA patients with a moderate deficiency (6∼70%) of ADAMTS13 activity. Five of the 7 TTP patients had a poor outcome. Plasma thrombomodulin and t-PA-PAI-1 complex levels in TMA patients with a moderate deficiency of ADAMTS13 activity were significantly higher than those in patients with a severe deficiency of ADAMTS13 activity. These data suggest that the etiology in these patients may be systemic vascular endothelial cell damage.View full abstractDownload PDF (298K)
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Kazuyuki MURASE, Takuya MATSUNAGA, Rishu TAKIMOTO, Naoki TAKAHIRA, Aki ...2004 Volume 45 Issue 5 Pages 383-386
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 31-year-old pregnant woman was referred to our hospital due to anemia and thrombocytopenia, and was diagnosed as having myelodysplastic syndrome (refractory anemia) with autoimmune thrombocytopenia. Administration of high dose methylprednisolone and γ-globulin did not raise her platelet count, and she subsequently delivered a healthy baby after the transfusion of a large amount of platelets. Although the anemia spontaneously improved after delivery, the platelet count remained unchanged. Prednisolone was thus administered a second time, which did finally increase the platelet count. This is the first reported case of a pregnant woman with myelodysplastic syndrome in whom corticosteroid administration was effective for thrombocytopenia.View full abstractDownload PDF (610K) -
Hiroto OHGUCHI, Toshiaki SAI, Yoichi HAMAZAKI, Junichi KAMEOKA, Takesh ...2004 Volume 45 Issue 5 Pages 387-392
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 51-year-old woman was admitted to our hospital with a diagnosis of acute myeloid leukemia (M1) in January 2002. During the course of induction therapy, she developed a fever and chest radiography revealed bilateral infiltrates. She was treated with broad-spectrum intravenous antibiotics and fluconazole, but her condition continued to worsen. She then began receiving amphotericin B, although there was no evidence of a fungal infection from the sputum culture and serologic testing. The patient soon became afebrile and improved clinically. On the 87th hospital day, however, she had a bout of abrupt massive hemoptysis and died of exsanguination. The diagnosis of aortobronchial fistula due to pulmonary mucormycosis was obtained at autopsy. Because of the angioinvasive tendency of mucormycosis, fatal hemoptysis in some patients with pulmonary mucormysosis has been reported, but most cases involve hemoptysis resulting from mucor invasion of the pulmonary artery. To our knowledge, this case represents the fourth description of pulmonary mucormycosis with fatal bleeding from the aorta.View full abstractDownload PDF (446K) -
Chronic active Epstein-Barr virus infection treated with reduced intensity stem cell transplantationNaoki SAKATA, Emiko SATO, Akihisa SAWADA, Masahiro YASUI, Masami INOUE ...2004 Volume 45 Issue 5 Pages 393-396
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 31-year-old woman had been suffering from fever and a sore throat since January 1999, and had a left neck lymphadenopathy in December 1999. Pathological findings of the biopsied lymphnode suggested malignant lymphoma. She was finally diagnosed as having a chronic active Epstein-Barr virus (EBV) infection because of abnormal antibody titers against EBV antigens and an increased EBV load in her peripheral blood. After receiving chemotherapy consisting of CHOP and high dose cytarabine, the amount of the EBV genome decreased below the detection limit before BMT. Therefore, instead of a conventional myeloablative transplant, we performed BMT using reduced-intensity conditioning regimens consisting of fludarabine and melphalan from an HLA-identical sibling donor. After 14 months, the patient remained in complete remission. Menstruation occurred on day 83 following BMT, and the serum level of LH and FSH on day 316 were within normal range. Under these circumstances, RIST seems to be one of the curative treatments for the patients with CAEBV with minimal late side effects.View full abstractDownload PDF (321K) -
Rika SAKAI, Atsuo MARUTA, Etsuko YAMAZAKI, Aki KAMIJO, Jun TAGUCHI, Ri ...2004 Volume 45 Issue 5 Pages 397-401
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSWe report herein a 21-year-old hepatitis B virus (HBV) female carrier who developed persistent fever, lymphadenopathy and pancytopenia in September of 2000. Hemophagocytes were found in the bone marrow smears. Epstein-Barr virus (EBV) serology showed positive for VCA-IgG, IgM and EB-ER and negative for EBNA. The EBV genome was detected in the peripheral blood. The patient was diagnosed as having EBV-associated hemophagocytic syndrome (EBV-AHS) and received chemotherapy. Although she was treated with lamivudine three months after the initiation of chemotherapy, she developed severe hepatitis. She recovered from the hepatitis through a combination of plasma exchange, immunosuppressive and antiviral therapies. Because of the refractoriness of her EBV-AHS to chemotherapy, she received allogeneic peripheral blood stem cell transplantation (PBSCT) from her HLA-identical brother. Hepatitis B did not recur after the PBSCT under administration of lamivudine. The EBV genome in the peripheral blood disappeared soon after the PBSCT but it was revealed again after the initiation of prednisolone for the treatment of acute GVHD. A donor lymphocyte infusion (DLI) was given on day 169 and the EBV genome copy number in the peripheral blood gradually decreased and disappeared. Although the origin of the EBV-infected cells could not be determined as being from the host or donor, DLI was a useful treatment for the recurrence of EBV infection after allogeneic stem cell transplantation for EBV-AHS.View full abstractDownload PDF (487K)
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Hideaki SAKABE, Yuki YAGI, Rie KAKINOKI, Kohei YOSHIKAWA, Tetsuya INOU ...2004 Volume 45 Issue 5 Pages 402-404
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSWe report two cases of long-standing iron-deficiency anemia in a young man and an elderly woman that improved after eradication of Helicobacter pylori. Neither patient demonstrated any bleeding symptoms nor reported an extremely unbalanced diet. However, H. pylori infection was demonstrated with the urea breath test. After successful eradication of H. pylori, the iron-deficiency anemia dramatically improved in both patients, making it unnecessary to administer ferric medicine for about 20 months. These cases suggest that eradication of H. pylori may be useful in treating some patients with long-standing iron-deficiency anemia.View full abstractDownload PDF (342K) -
Mutsuko MIYAZAKI, Akihiko TAGUCHI, Shizu SAKURAGI, Noriyuki MITANI, Ka ...2004 Volume 45 Issue 5 Pages 405-407
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 67-year-old male was admitted because of lymphocytosis and huge splenomegaly. Abnormal lymphocytes had cytoplasmic hairy projections and were negative for tartrate-resistant acid phosphatase staining. The bone marrow aspirate contained many lymphocytes with the same morphology. Flow cytometric analysis revealed an increase in IgM and κ positive B cells. They were positive for CD11c, CD19, CD20 and FMC7, and negative for CD5, CD10 and CD25. The patient was diagnosed as having hairy cell leukemia, Japanese variant. Initially interferon-α was administered for a month, decreasing the numbers of leukemic cells but with little effect on splenomegaly. Subsequent administration of cladribine (0.09 mg/kg, 7 days) showed a remarkable effect, and the patient has been in complete remission for 8 months.View full abstractDownload PDF (248K) -
Shigeo TOYOTA, Norihiko NAKAMURA, Kazuo DAN2004 Volume 45 Issue 5 Pages 408-410
Published: 2004
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 63-year-old man was admitted because of general malaise, fever, headache, generalized lymphadenopathy and hepatomegaly in July 2002. He was diagnosed as having multiple myeloma (MM) (IgG-κ type) with atypical plasma cells in the bone marrow, lymph nodes and cerebrospinal fluid. Systemic and intrathecal chemotherapy were effective. Because of an increase of polyclonal IgE, electrophoretic patterns revealed an M-peak which was not as sharp as that in IgG myeloma. IgE production is not impaired by the pathologic process in MM patients.View full abstractDownload PDF (252K)
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