We evaluated a 72-year-old woman who was experiencing dysphagia. Esophageal leiomyosarcoma was diagnosed by barium meal study, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), by computed tomography (CT). A barium meal study and esophagoscopy performed 3 months before the diagnosis of esophageal leiomyosarcoma showed no abnormalities. Therefore, the tumor appeared to have grown rapidly during the 3-month period.

Aged↗

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Brain injury-induced rapid-cycling affective disorder successfully treated with valproate.

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Adolescent↗

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Rapidly and infiltratively growing Crohn's carcinoma of the small bowel: serial radiologic findings and a review of the literature.

We carried out a retrospective evaluation of serial changes in the small bowel radiographs of a patient with small bowel cancer accompanied by long-standing Crohn's disease. During the 8 months before diagnosis, marked morphological changes were noted. A solitary and irregular protrusion, and rapidly growing stricture under careful medical management of the underlying disease may indicate the development of cancer.

Adenocarcinoma↗

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Treatment of standard-risk acute lymphoblastic leukemia in children: the results of protocol AL841 from the Kyushu-Yamaguchi Children's Cancer Study Group in Japan.

A total of 62 patients with standard-risk acute lymphoblastic leukemia received three-drug induction consisting of vincristine, prednisolone, and L-asparaginase (l-Asp) followed by consolidation therapy with intermediate-dose methotrexate (MTX), intrathecal MTX, and 18 Gy of cranial irradiation. Maintenance therapy consisting of 6 drugs including daunorubicin (DNR, 450 mg/m2 in total) was continued for 3 years. Patients were randomized and half of them received weekly l-Asp during maintenance therapy as a late intensification. Complete remission (CR) was achieved in 61/62 (98.4%), and 11 of 61 patients relapsed. At 10 years, the event-free survival (EFS) was 80.6 +/- 5.0% and overall survival was 88.7 +/- 4.0%; median follow-up time was 9.3 years. The 10-year EFS of patients with additional l-Asp (84.8 +/- 6.2%) was superior to that without l-Asp (75.9 +/- 7.9%), although it was not statistically significant. No patients who received a full dose of DNR and maintained CR developed heart failure, although the shortening fraction decreased from 41.0% at diagnosis to 35.2% (median). The protocol AL841 provided good long-term disease control without severe late cardiac dysfunction.

Antineoplastic Combined Chemotherapy Protocols↗

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CT of lymphoepithelial cysts of the pancreas.

OBJECTIVE: To clarify imaging and clinicopathologic features of lymphoepithelial cysts (LEC), a benign lesion of the pancreas. MATERIALS AND METHODS: Two male patients with LECs that were found incidentally and proven surgically were reviewed. RESULTS: Sonography revealed a hypoechoic mass in both cases, one of which had septation and an intracystic isoechoic component within it. The mass was shown as low attenuation on unenhanced CT, and the intracystic solid component was not enhanced by dynamic CT or computed tomographic arteriography. One lesion had calcifications around the mass. Magnetic resonance imaging showed hyper- in hypointensity on T1-weighted imaging and hypo- in hyper- on T2-weighted imaging in one case. Both lesions were located on the surface of the head of the pancreas, and the main pancreatic ducts appeared normal on endoscopic retrograde pancreatography. Both patients were asymptomatic. CONCLUSION: These imaging and clinical findings suggest LEC, which should be considered when one encounters cystic lesions of the pancreas.

Humans↗

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Efficacy of roxithromycin in the treatment of mycoplasma pneumonia.

Macrolide and tetracycline antibiotics, which are protein synthesis inhibitors, are effective in the treatment of mycoplasma pneumonia. We evaluated the clinical efficacy and safety of roxithromycin, a new macrolide antibiotic, in the treatment of mycoplasma pneumonia. Roxithromycin was administered orally to patients who had been definitely diagnosed through Mycoplasma pneumoniae isolation or serum antibody titer as having mycoplasma pneumonia. The efficacy assessment was based on clinical signs and symptoms of infection as well as bacterial culture from clinical samples. Clinical efficacy was excellent in 6 cases, good in 6 cases and fair in 1 case, with an efficacy rate of 92.3%. The bacteriological effect was evaluated in 6 patients: the organism was eradicated in 4 cases and unchanged in 2 cases. In this study, the MIC of roxithromycin against M. pneumoniae fell in the range 0.0156-0.00625 mg/l. No adverse reaction was observed. As for abnormal laboratory findings, two cases showed elevated serum glutamic-pyruvic transaminase (S-GPT), one elevated serum glutamic-oxaloacetic transaminase and S-GPT, and one reduced neutrophil counts. From our results, we consider that roxithromycin is useful in the treatment of mycoplasma pneumonia.

Administration, Oral↗

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The administration regimen of isepamicin in patients with chronic respiratory tract infection.

A total of 34 patients with intractable chronic respiratory tract infections were treated with isepamicin and/or piperacillin in different dosage regimens. A comparison of the bacteriological effect using a cross over method showed a reduction in the count of Pseudomonas aeruginosa in sputum in the group receiving once-a-day isepamicin combined with piperacillin, compared with the twice-a-day combined administration. A comparison of the clinical and bacteriological efficacy between the different regimen groups revealed no noticeable difference. The clinical effect of this regimen is comparable to the conventional regimen, but has the advantages of a safer dosage and ease of administration.

Adult↗

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Trends of genetic relationship of serotype 23F penicillin-resistant Streptococcus pneumoniae in Japan.

No data on the genetic analysis of penicillin-resistant Streptococcus pneumoniae (PRP) in Japan has been reported. The SmaI restriction endonuclease digested patterns of chromosomal DNAs from 15 PRP serotyped 23F isolated in Japan were analyzed by pulsed-field gel electrophoresis (PFGE). The isolates were genetically heterogeneous and seven different PFGE patterns were identified. Nine strains were also resistant to erythromycin and tetracycline. Four strains revealed resistance to ceftriaxone. The PFGE patterns of some strains isolated in Nagasaki University Hospital were identical to each other and closely resembled those of isolates from three different areas of Japan. These results indicate a need for additional studies by PFGE to determine the possibility of clonal spread in Japan.

Anti-Bacterial Agents↗

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Primary pontine hemorrhage: clinicopathological correlations.

In 18 autopsies from patients with primary pontine hemorrhage we studied the sites of bleeding, the volumes and development of hematomas and clinicopathological correlations. A modular optical electronic planimeter was introduced to measure the size of hematomas. The series of patients can be divided into 2 groups from the viewpoint of bleeding sites, their development and clinical symptomatology. These are 1) the tegmentobasilar type and 2) the tegmental type. The precise location of the origin of hemorrhage, and the approximate volume of hematomas can now be determined with the help of computerized tomography. This information will be of help in understanding clinical symptoms. Two different typical patient reports, selected from the collection, are presented.

Aged↗

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The discrepancy between chemotaxis and leukotriene B4 production in a patient with chronic neutrophilic leukemia.

Chronic neutrophilic leukemia (CNL) is a rare type of leukemia. We diagnosed a 81-year-old woman as CNL because she showed that sustained leukocytosis dominated by mature neutrophils, hepatosplenomegaly, high neutrophilic alkaline phosphatase (NAP) score, absence of the Ph1 chromosome and no evidence of leukemoid reaction. During the clinical course, she did not manifest hemorrhagic tendency or infection. We also examined neutrophilic function including chemotaxis, chemiluminescence, nitroblue tetrazolium (NBT) dye reduction, which all indicated normal neutrophil function. Using a reversed phase-high pressure liquid chromatography (HPLC), we detected the production of leukotriene B4 (LTB4) in neutrophils. We found that the LTB4 production was decreased in neutrophils whereas they showed normal chemotaxis. This discrepancy has never, to our knowledge, been reported before in case of CNL.

Aged↗

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Clinical evaluation of 12 cases of antimicrobial drug-induced pneumonitis.

The diagnosis of drug-induced pneumonitis is generally difficult, and it is made clinically by Tamura's criteria. We experienced 12 cases (7 definite and 5 possible cases) of antimicrobial drug-induced pneumonitis (one of case was the first case caused by carbapenem). Symptoms such as fever (11/12), cough (10/12) and dyspnea (10/12) and laboratory data such as eosinophilia (7/12), elevation of IgE (4/6) and hypoxia (11/12) were commonly seen in these patients, although they were not specific. Lymphocyte stimulation test (5/11) and provocation test (4/8) were quite suggestive of drug allergy. Bronchoscopy has been used for confirmation of pneumonitis. Transbronchial lung biopsy revealed alveolitis (4/9) or alveolar fibrosis (3/9), and bronchoalveolar lavage showed lymphocytosis (6/6) and depression of OKT4/T8 ratio (3/5). The combination of bronchoscopic and immunological examinations were more confirmative for diagnosis.

Adult↗

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An effective salvage regimen with aclarubicin for daunorubicin-resistant acute non-lymphocytic leukemia in children.

We evaluated the efficacy and toxicity of aclarubicin for acute non-lymphocytic leukemia (ANLL) refractory to daunorubicin in childhood. Twenty-four patients were treated with aclarubicin and prednisolone with or without 6-mercaptopurine and behenoyl-cytosine arabinoside daily for 5 to 14 days. Of 21 evaluable patients, 14 (67%) responded: 12 obtained complete remission and 2 partial remission. The median time to reach complete remission was 37 days (range, 16 to 60 days), and the median duration of complete remission was 5.5 months (range, 2 to 41 months). The cumulative dose of anthracycline administered before the study was not considered significant for the response. The only major complication was severe bone marrow suppression; infectious episodes occurred in 14 patients (58%) and three died of sepsis and/or bleeding. The observed non-hematologic toxicities included hematuria, an elevation of serum amylase, nausea/vomiting, and angitis. In addition, one patient showed abnormal cardiac function. Aclarubicin is therefore considered a highly active drug for remission reinduction of previously treated children suffering from ANLL with an acceptable toxicity.

Aclarubicin↗