The case of a 63-year-old woman who received arsenious acid (As₂O₃) treatment for acute promyelogenous leukemia (APL) is reported. Although she achieved complete remission (CR) with 45mg/m² all-trans retinoic acid (ATRA), multiple liver and spleen abscesses developed as complications during the first consolidation chemotherapy with mitoxantrone and cytarabine. Antibiotic and antifungal treatments were performed for two months, when bone marrow recurrence of APL was detected. After re-remission induction therapy with daunorubicin and cytarabine, one cycle of treatment with 0.15mg/kg As₂O₃ for five weeks was administered as consolidation therapy because of the therapy-resistant liver and spleen abscesses. After the treatment, PMLRARA chimera mRNA became undetectable. The liver and spleen abscesses gradually reduced, and bone marrow remained in CR for at least 24 months after the As₂O₃ therapy. It is suggested that As₂O₃ may be useful as consolidation therapy for patients with APL.

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A 78-year old female was admitted on January 13, 2006 due to respiratory dysfunction resulting from left heart failure accompanied by lung congestion. The patient had received a mechanical prosthetic valve (CarboMedics 27mm) in mitral position with posterior leaflet preservation and tricuspid valve annulopasty on December 4, 2001.
Echocardiographic examination revealed moderate mitral regurgitation and an elevated transvalvular pressure gradient of 36mmHg, suggesting a prosthetic valve dysfunction. A cineradiogram showed that one of the leaflets of the prosthesis was completely immovable. Despite intensive medical treatment her dyspnea and oligurea persisted, and urgent surgical intervention was clearly indicated. At surgery one of the leaflets of the prosthesis was found to be covered by a pannus accompanied by thrombosis on both the atrial and ventricular sides. The pannus originated from the endocardium of the preserved posterior leaflet and had folded around the cuff of the prosthesis from the previous operation. The dysfunctioning prosthesis was replaced by another mechanical valve (CarboMedics 27mm). A preoperatively diagnosed relapse of tricuspid regurgitation was also reconstructed using DeVega’s method. Though the patient initially required high doses of innotropic support and continuous hemodiafiltration, she recovered uneventfully and was discharged on the 51st postoperative day after adequate rehabilitation. When doing mitral valve replacement preserving the posterior leaflet, it must be confirmed that the movement of the leaflet is smooth.

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[in Japanese]

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