Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 50, Issue 12
Displaying 1-10 of 10 articles from this issue
Picture in Clinical Hematology No.41
The 69th Annual Meeting of the Japanese Society of Hematology/
The 49th Annual Meeting of the Japanese Society of Clinical Hematology
Special Award Received Lecture
Clinical Study
  • Hiroshi FUJITA, Shigeko NISHIMURA, Kazuyuki OYAMA
    2009 Volume 50 Issue 12 Pages 1687-1691
    Published: 2009
    Released on J-STAGE: January 13, 2010
    JOURNAL RESTRICTED ACCESS
    We retrospectively studied the CT findings of sternal bone in 129 patients with hematological diseases who underwent bone marrow aspiration in Tokyo Metropolitan Bokutoh Hospital between August 2005 and July 2007. Sternal findings demonstrated sternal foramen (3 cases), incomplete fracture (1 case) and irregularity and decreased bone density of the visceral cortical bone (first intercostal space: 66 cases, third intercostal space: 3 cases). Irregularity and decreased bone density of the visceral cortical bone were significantly related to findings of decreased bone density in the third lumbar spine, indicating osteoporosis. These findings suggest that sternal bones demonstrated various bone diseases such as sternal foramen, fracture and osteoporosis, and that bone marrow aspiration from sternal bones might not be as safe as previously thought.
    Download PDF (1287K)
  • Akihisa SAWADA, Naoki SAKATA, Banryoku HIGUCHI, Yasufumi TAKESHITA, Ta ...
    2009 Volume 50 Issue 12 Pages 1692-1699
    Published: 2009
    Released on J-STAGE: January 13, 2010
    JOURNAL RESTRICTED ACCESS
    Invasive fungal infection (IFI) is a serious complication of chemotherapy for hematological malignancies and autologous/allogeneic hematopoietic stem cell transplantation in children and shows a high mortality rate. We performed a randomized trial comparing micafungin (MCFG), a new anti-fungal agent, with fosfluconazole, a prodrug of fluconazole (FF) conventionally used as a prophylactic agent, for prophylaxis against IFI. Cefpirome was administered as prophylaxis against bacterial infection, and meropenem+minocycline as an empiric window therapy for febrile neutropenia. MCFG 2 mg/kg/day (max 100 mg/day) and FF 10 mg/kg/day (max 400 mg/day) were both safe and effective (event free ratio of IFI, MCFG 94.4% vs FF 94.3%) without significant difference. Thus, MCFG is safe and can be used for prophylaxis against IFI in children.
    Download PDF (784K)
Case Reports
  • Katsuhiro TOGAMI, Yuya NAGAI, Hiroshi ARIMA, Sonoko SHIMOJI, Takahiro ...
    2009 Volume 50 Issue 12 Pages 1700-1705
    Published: 2009
    Released on J-STAGE: January 13, 2010
    JOURNAL RESTRICTED ACCESS
    We report here two patients with chronic disseminated intravascular coagulation (chronic DIC) secondary to aortic aneurysm, who were successfully treated with continuous subcutaneous infusion of heparin. The patients were 69- and 89-year-old males, who were admitted to our hospital because of thrombocytopenia and marked bleeding tendency. The underlying conditions were aortic dissection and aortic aneurysm, respectively. Coagulation test demonstrated that these patients had DIC, and a diagnosis of chronic DIC secondary to aortic aneurysm was made. Anti-coagulation treatment with oral camostat mesylate and daily subcutaneous infusion of heparin calcium was started. However, the treatment was insufficient to control chronic DIC, and these patients developed recurrent severe subcutaneous hemorrhages. Therefore, we attempted continuous subcutaneous infusion of heparin using a mobile infusion pump. This delivery of heparin markedly improved the coagulopathy, and the hemorrhagic episode disappeared with good compliance in the use of infusion equipment in these patients. Continuous subcutaneous infusion of heparin using a mobile infusion pump is effective and useful for long term treatment of chronic DIC by the outpatient department.
    Download PDF (1028K)
  • Yoshihiro MUKAIYAMA, Satoshi HASHINO, Masahiro ONOZAWA, Kouhei OKADA, ...
    2009 Volume 50 Issue 12 Pages 1706-1710
    Published: 2009
    Released on J-STAGE: January 13, 2010
    JOURNAL RESTRICTED ACCESS
    Pyogenic spondylitis is regarded as a rare infectious disease. The incidence of this disease has been increasing recently due to an increase in the ratio of elderly people in the population as well as an increase in immunocompromised hosts complicated by cancer, diabetes mellitus and liver cirrhosis. Allogeneic hematopoietic stem cell transplantation (HSCT) is now performed widely as a curative treatment for various malignant hematological diseases. However, allogeneic HSCT causes chronic immunocompromise. There is no case report describing infectious spondylitis after HSCT. Here we describe a case of infectious spondylitis after HSCT and discuss risk factors and treatment. The patient was a 56-year-old female with AML-M1 who underwent allogeneic HSCT in our hospital. She developed back pain and fever about 150 days after HSCT and became unable to walk due to the severity of back pain. MRI T1 images showed a low intensity area, T2 images showed a high intensity area and Gd-DTPA-enhanced images showed a high intensity area at the S1-2 disk space. Clinical findings and MRI findings suggested pyogenic spondylitis. Back pain improved gradually after conservative treatment with meropenem (MEPM) for two weeks. After 4 weeks of MEPM administration, she had fully recovered and there has not been any recurrence of back pain to date. In conclusion, pyogenic spondylitis should be considered in the differential diagnoses for HSCT recipients with severe back pain.
    Download PDF (902K)
  • Daisuke HIGETA, Akihiko YOKOHAMA, Youhei OSAKI, Kenichi TAHARA, Momoko ...
    2009 Volume 50 Issue 12 Pages 1711-1714
    Published: 2009
    Released on J-STAGE: January 13, 2010
    JOURNAL RESTRICTED ACCESS
    A 59-year-old man was referred to our hospital due to nephrotic syndrome with IgM paraproteinemia. Physical examination demonstrated marked hepatomegaly and anasarca. Serum M-protein was 0.94 g/dl and urinary analysis detected the presence of Bence Jones protein. Bone marrow plasma cell count was 11.2%. Histological examination demonstrated AL-type amyloid deposition in the liver, kidneys, bone marrow, stomach and rectum. These findings led to a diagnosis of IgM multiple myeloma with systemic amyloidosis. Although there was no apparent response to 2 courses of vincristine, doxorubicin and dexamethasone (VAD) regimen, subsequent treatment with bortezomib in combination with dexamethasone resulted in a rapid reduction in M protein to 0.49 g/dl, approximately half the pre-treatment level.
    Download PDF (1530K)
  • Naoya MIMURA, Hideki TSUJIMURA, Mikiko ISE, Chikara SAKAI, Hiroshige K ...
    2009 Volume 50 Issue 12 Pages 1715-1719
    Published: 2009
    Released on J-STAGE: January 13, 2010
    JOURNAL RESTRICTED ACCESS
    Here we report three cases of hepatitis B virus (HBV) reactivation after cessation of preemptive lamivudine therapy in B-cell lymphoma patients treated with rituximab plus CHOP (R-CHOP). Two patients received eight cycles of R-CHOP, and one received two cycles of R-CHOP followed by two courses of rituximab. As all the patients were HBV surface antigen (HBsAg) positive, lamivudine was administered simultaneously with R-CHOP to prevent virus reactivation. All the patients developed hepatitis due to HBV reactivation 6, 8 and 13 months after completion of chemotherapy, and 4, 2 and 2 months after cessation of lamivudine, respectively. They were treated with either lamivudine or entecavir and all achieved full recovery. When HBV carriers undergo immunosuppressive anticancer treatment, prophylactic antiviral therapy is well recognized as effective. However, the optimal method of prophylaxis has not yet been established. Since the introduction of rituximab, new problems such as delayed HBV reactivation from HBsAg positive patients and de novo hepatitis B from HBsAg negative patients have emerged. Guidelines for prophylactic antiviral therapy in the era of rituximab need to be established.
    Download PDF (821K)
  • Tetsuo NISHIMOTO, Kazuo HATANAKA, Akihito MATSUOKA, Kouji UEDA, Noboru ...
    2009 Volume 50 Issue 12 Pages 1720-1724
    Published: 2009
    Released on J-STAGE: January 13, 2010
    JOURNAL RESTRICTED ACCESS
    High-dose chemotherapy supported by autologous peripheral blood stem cell transplantation (PBSCT) is beneficial for patients with relapsed or refractory but chemosensitive diffuse large B-cell lymphoma (DLBCL). However, most elderly patients are not indicated for that therapy and receive supportive treatment only. We describe here two elderly patients with relapsed or refractory DLBCL who achieved prolonged disease-free survival after undergoing intermediate-dose melphalan therapy supported by PBSCT (MEL100) three times. Case 1 was an early relapse (within one year) after the first remission and case 2 was a second relapse. Both cases are currently alive without relapse and have maintained a good performance status for 41 months and 32 months, respectively, after MEL100. Febrile neutropenia and herpes zoster as non-hematological toxicities (grade≥3) occurred only in case 1. Considering the benefits vs. toxic effects, this regimen may improve the prognosis of elderly patients with relapsed or refractory DLBCL by MEL100.
    Download PDF (784K)
feedback
Top