Purpose: The aim of this study was to clarify clinical features and treatment outcomes of patients with Hodgkin lymphoma (HL) in our institution.
Patients: The study included 36 HL patients who were treated with chemotherapy alone or in combination with radiotherapy from January 2003 to October 2012.
Results: Twenty-four patients had nodular sclerosis and 6 had the mixed cellularity subtype. The age ranged from 20 to 81, with a median of 61, and 18 patients were aged 60 or older. Eight patients had localized disease, while 28 fell into the advanced disease category. According to the international prognosis scoring scheme, 14 and 22 patients had disease with a favorable and an unfavorable prognosis, respectively. Twenty-nine patients were initially treated with ABVd/ABVD combination chemotherapy and 7 received planned radiotherapy. Twenty-three (63.9%) patients achieved a complete response, and the overall response rate was 72.2%. Two treatment-related deaths occurred. At a median follow-up of 3.0 years, the estimated 5-year progression-free survival (PFS) and overall survival (OS) rates were 66.1 and 75.0%, respectively. The survival in elderly patients aged ≥60 was inferior to that of younger patients aged <60 (5-year PFS rate, 54.7 vs. 76.2%; 5-year OS rate, 55.0 vs. 94.1%, respectively, P = 0.014), presumably due to significant comorbidities and treatment toxicities.
Conclusion: The outcomes of younger HL patients were comparable to those of the JCOG 9305 study. At present, ABVD is suggested for most elderly patients with HL, but more tolerable and less toxic regimens should be developed for this particular HL population.

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 We previously described 4 patients (cases 1 to 4) with acquired thrombotic thrombocytopenic purpura (TTP) and showed that rituximab exhibited both short- and long-term favorable effects. In this paper, we report 4 additional patients (cases 5 to 8) with TTP who showed variable disease severities and anti-ADAMTS13 inhibitor titers. These 4 patients were treated using plasma exchange (PEx) and steroids, and 3 received 4 doses of rituximab weekly, which resulted in a long-term complete response. In the 8 patients with TTP we encountered, 4 had an anti-ADAMTS13 inhibitor titer of >5.0 BU/mL at presentation. Although all 4 patients were treated with PEx, high- or standard-dose steroids, and weekly rituximab, inhibitor rebound associated with the recurrence of thrombocytopenia and elevation of LDH levels was noted in 3 patients shortly after the initial response, while two developed the recurrence of neurological manifestations, which required intravenous sedation under mechanical ventilation. Thus, the dosage and administration schedule of rituximab should be optimized for patients with high inhibitor titers, and additional immunosuppressive agents may be considered in refractory cases. On the other hand, 5 patients previously had an episode of infectious disease that preceded the presentation, which suggested that infection is a triggering factor for the development of TTP.

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Background: Severe Group A Streptococcus (GAS) infections began to be reported in the 1980s. The most common portals of entry for GAS infections are the pharynx and skin, but in many cases, the portal of entry cannot be identified. We report here 2 cases with severe GAS infection that developed after the harvesting procedure for endometrial cytology.
Case 1: A 46-year-old, gravida 1, para 1 woman presented with yellowish discharge and pruritus vulva. She underwent harvesting of endometrial cytology, and her vaginal discharge was subjected to bacterial culture. The next day, severe stomachache developed. Two days after the initial presentation, she was admitted to our emergency department due to high fever and shock. As pelvic inflammatory disease (PID) associated with septic shock was suggested, we first treated her with empiric antibiotics, intravenous dopamine, and fluid resuscitation. Then, GAS was isolated from not only the vaginal culture, but also the blood; a diagnosis of invasive GAS infection was established. The patient was next treated with benzylpenicillin, intravenous immunoglobulin, and direct hemoperfusion with polymyxin B-immobilized fiber. She finally underwent laparoscopic surgery with intraperitoneal drainage.
Case 2: A 52-year-old, gravida 2, para 2 woman underwent a complete physical examination in our hospital, including harvesting for endometrial cytology. She vomited, felt a chill, and exhibited shivering on the exami nation day. The next day, she was admitted to our emergency department due to high fever and shock. GAS was isolated from both vagina and blood cultures, establishing the diagnosis of severe invasive GAS infection. She was treated with antibiotics, intravenous dopamine and noradrenaline, and rapid fluid resuscitation, resulting in improvement of her condition without further treatments.
Conclusion: We experienced 2 cases of invasive GAS infection that developed after the harvesting procedure for endometrial cytology. We often perform cytological analysis of the endometrium, but have seldom experienced invasive GAS infection. Physicians have to be aware that invasive GAS infection can occur after routine intrauterine procedures such as harvesting for cytology of the endometrium.

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