We retrospectively evaluated the efficacy and adverse events of thalidomide therapy in 15 patients with refractory multiple myeloma in our hospital. Thirteen eligible patients were evaluated. Five of 13 patients achieved partial response (response rate 38.5%). There was no patient achieved complete remission Adverse events included constipation of grade 1, eruption of grade 2, and peripheral neuropathy of grade 2 were observed.. There were no severe adverse events of grade 3 or above. Three deaths were observed in the responsive group; however those were not considered to be associated with myeloma nor thalidomide. Increases of immunoglobulins other than M-protein were observed after thalidomide therapy in responsive patients, suggesting that thalidomide therapy does not induce severe immunosuppression. Our results suggest that thalidomide therapy is a safe and an effective therapeutic approach for patients with refractory myeloma.

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A 72-years old man suffered from diabetes mellitus visited and was admitted to our hospital because of fever, abdominal fullness and mild consciousness disturbance. The consciousness and respiratory condition worsened rapidly on the next day. Leukopenia, abnormal clotting parameter and low platelet count suggested the contraction of severe infection and disseminated intravascular coagulation (DIC). Despite of intensive care, he died in 24 hour after the admission. On microbiological investigation, Streptococcus pneumoniae was detected in his blood. The autopsy revealed a massive adrenal haemorrhage, aggregation of Gram positive bacteria without infiltration of neutrophils in multiple organ and hypoplasia of the spleen. Splenic dysfunction or diabetes mellitus is known as a risk factor of severe bacterial infection. This case of death was given as acute pneumococcal infection and adrenal haemorrhage result from the infection, which is usually regarded as Waterhouse-Friedrichsen syndrome. This is most frequently seen as a result of meningcocccal infection, it is seen in the case of other bacterial infection. This case is a rare report of Waterhouse-Friderichsen Syndrome induced from pneumococcal infection with hypoplastic spleen and diabetes mellitus.

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We report a rare case of adult cystic lymphangioma of the small bowel mesentery. The patient was a 46-year-old man who presented epigastralgia and fever ; CT scan revealed a mass near the tail of the pancreas, and he was referred to our hospital for further examination. CT images obtained subsequently revealed a 50-mm cystic mass with low attenuation in the root of the mesentery of small intestine, and it seemed to be separated from the bowel loops. The wall of the cystic mass showed enhancement after contrast injection. The mass showed low signal intensity in T1-weighted MR images and high signal intensity in T2-weighted MR images. FDG-PET images revealed slight FDG uptake in the lesion. Double-balloon endoscopy showed no lesions in the lumen of the intestine. The mesenteric tumor was resected at laparotomy and histologically diagnosed as cystic lymphangioma.

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