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Human herpes virus-6 (HHV-6) encephalitis is one of the life-threatening complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Early diagnosis and intervention are important for the prevention of poor prognosis and sequelae. Although hyponatremia is known to be associated with HHV-6 encephalitis, it is unclear whether the preceding hyponatremia is a useful hallmark for the diagnosis of HHV-6 encephalitis. We retrospectively reviewed 134 consecutive patients who underwent allo-HSCT at our institution and evaluated the relationship between HHV-6 encephalitis and hyponatremia. Interestingly, 7 (50%) of 14 patients who developed HHV-6 encephalitis presented hyponatremia within a week before the onset of HHV-6 encephalitis. On the other hand, only 14 (11.7%) out of 120 patients without HHV-6 encephalitis developed hyponatremia. Hyponatremia, treating as a time-dependent covariate, was significantly correlated with the incidence of HHV-6 encephalitis. Moreover, the diagnostic accuracy analysis showed that the coexistence of hyponatremia and central nerve system (CNS) dysfunction strongly suggests HHV-6 encephalitis. In conclusion, our study suggests the likelihood of HHV-6 encephalitis significantly increases in the patients with CNS dysfunction following hyponatremia after allo-HSCT and this combination may help in early diagnosis and intervention of HHV-6 encephalitis after allo-HSCT.

We report a case of acute myeloid leukemia (AML) with two cytogenetically unrelated clones. The patient was a 45-year-old male who was diagnosed with acute monoblastic leukemia (AMoL). Initial G-band analysis showed 51,XY,+6,+8,inv(9)(p12q13)c,+11,+13,+19[12]/52,idem,+Y[8], but G-band analysis after induction therapy showed 45,XY,-7,inv(9)(p12q13)c[19]/46,XY,inv(9)(p12q13)c[1]. Retrospective FISH analysis revealed a cryptic monosomy 7 clone in the initial AML sample. The clone with multiple trisomies was eliminated after induction therapy and never recurred, but a clone with monosomy 7 was still detected in myelodysplastic marrow with a normal blast percentage. Both clones were successfully eliminated after related peripheral blood stem cell transplantation, but the patient died of relapsed AML with monosomy 7. We concluded that one clone was de novo AMoL with chromosome 6, 8, 11, 13, and 19 trisomy and that the other was acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) with chromosome 7 monosomy showing different responses to chemotherapy. Simultaneous onset of cytogenetically unrelated hematological malignancies that each have a different disease status is a rare phenomenon but is important to diagnose for a correct understanding of the disease status and for establishing an appropriate treatment strategy.

CD4(+) T cell effectors are crucial for establishing antitumor immunity. Dendritic cell maturation by immune adjuvants appears to facilitate subset-specific CD4(+) T cell proliferation, but the adjuvant effect for CD4 T on induction of cytotoxic T lymphocytes (CTLs) is largely unknown. Self-antigenic determinants with low avidity are usually CD4 epitopes in mutated proteins with tumor-associated class I-antigens (TAAs). In this study, we made a chimeric version of survivin, a target of human CTLs. The chimeric survivin, where human survivin-2B containing a TAA was embedded in the mouse survivin frame (MmSVN2B), was used to immunize HLA-A-2402/K(b)-transgenic (HLA24(b)-Tg) mice. Subcutaneous administration of MmSVN2B or xenogeneic human survivin (control HsSNV2B) to HLA24(b)-Tg mice failed to induce an immune response without co-administration of an RNA adjuvant polyI:C, which was required for effector induction in vivo. Although HLA-A-2402/K(b) presented the survivin-2B peptide in C57BL/6 mice, 2B-specific tetramer assays showed that no CD8(+) T CTLs specific to survivin-2B proliferated above the detection limit in immunized mice, even with polyI:C treatment. However, the CD4(+) T cell response, as monitored by IFN-γ, was significantly increased in mice given polyI:C+MmSVN2B. The Th1 response and antibody production were enhanced in the mice with polyI:C. The CD4 epitope responsible for effector function was not Hs/MmSNV13-27, a nonconserved region between human and mouse survivin, but region 53-67, which was identical between human and mouse survivin. These results suggest that activated, self-reactive CD4(+) helper T cells proliferate in MmSVN2B+polyI:C immunization and contribute to Th1 polarization followed by antibody production, but hardly participate in CTL induction.

Since the safety of folinic acid administration and its efficacy for reducing the toxicity of methotrexate (MTX) remain controversial, we assessed the effect of folinic acid administration after MTX treatment for GVHD prophylaxis on the incidence of oral mucositis and acute GVHD. We retrospectively analyzed data for 118 patients who had undergone allogeneic hematopoietic stem cell transplantation and had received MTX for GVHD prophylaxis. Multivariate analysis showed that systemic folinic acid administration significantly reduced the incidence of severe oral mucositis (OR = 0.13, 95%CI 0.04-0.73, P = 0.014). There was also a tendency for lower incidence of severe oral mucositis in patients who received folinic acid mouthwash (OR = 0.39, 95%CI 0.15-1.00, P = 0.051). No significant difference was observed in the incidence of acute GVHD between patients who received systemic folinic acid administration and those who did not (P = 0.88). Systemic folinic acid administration and mouthwash appear to be useful for reducing the incidence of severe oral mucositis in patients who have received allogeneic hematopoietic mucositis in patients who have received allogeneic hematopoietic stem cell transplantation using MTX as GVHD prophylaxis.

A 22-year-old woman presented with high fever, chest tightness and cough in January 20XX. Since CT scans revealed an anterior mediastinal mass, percutaneous needle biopsies of the mass were performed and she was diagnosed with T-cell lymphoblastic lymphoma (T-LBL). After the immunophenotype of lymphocytes in her pleural effusion had been identified, she received CHOP therapy because her dyspnea worsened, and induction therapy for acute lymphoblastic leukemia was subsequently performed after confirmation of her diagnosis as T-LBL. During this induction therapy, she developed paralytic ileus. One week thereafter, she suddenly exhibited visual disturbance, headache and nausea. Her cerebrospinal fluid was normal. Magnetic resonance imaging showed symmetrical high signal intensities on T2-weighted and fluid-attenuated inversion recovery images, and low signal intensities on T1-weighted images in the cortical and subcortical white matter of the posterior parietal and occipital lobes. Based on these findings, she was diagnosed as having posterior reversible encephalopathy syndrome (PRES). During chemotherapy for hematologic malignancies, some patients with PRES reportedly develop paralytic ileus or tumor lysis syndrome. PRES should be considered in patients with neurological abnormalities following such complications during chemotherapy.

Nutrition may be critical for neurodevelopment and can affect the later development of schizophrenia. Recently, a marked reduction in breast-feeding was reported in infants that developed schizophrenia in later life (McCreadie, R.G., 1997. The Nithsdale Schizophrenia Surveys. 16. Breast-feeding and schizophrenia: preliminary results and hypothesis. Br. J. Psychiatr. 170, 334-337). In the present study, we investigated feeding patterns during the infancy of 100 schizophrenia patients, 37 of their siblings and 200 age-matched healthy controls using a structured written questionnaire. Having been breast-fed was not negatively associated with schizophrenia.

A 56-year-old female was diagnosed with acute myeloid leukemia (FAB: AML-M1). G-banding karyotype of her bone marrow showed complete tetraploidy (92, XXXX [24/24]). Although she achieved complete remission (CR) after induction therapy and maintained CR during consolidation therapy, relapse occurred only 2 months after discharge. When the relapse occurred, bone marrow karyotypic analysis showed complete tetraploidy again. The patient received reduced-intensity cord blood transplantation (RI-CBT), which induced CR for the second time. The patient is currently alive 24 months after transplantation and there have not been any signs of recurrence to date. There have been a few reports of AML with near-tetraploidy, but cases of AML with complete tetraploidy are extremely rare. Tetraploid AML has been reported to have a poor prognosis and there have been very few cases maintaining CR over the long term after chemotherapy alone. This is the first case of complete tetraploid AML successfully treated by RI-CBT. The clinical course of this case suggests that hematopoietic stem cell transplantation during the first CR phase should be considered a treatment option for tetraploid AML.

A 70-year-old male, who had undergone resection of gastric malignant lymphoma in 1992, presented with cervical lymph node swelling in January 2008. Pathological examination of the lymph node biopsy demonstrated recurrence of malignant lymphoma, and he was treated with the R-CHOP regimen. Although he did not develop fever during the first through third course of R-CHOP, from the fourth course, he repeatedly demonstrated fever over 38°C for about one week after each course of chemotherapy, despite the absence of neutropenia. Helicobacter cinaedi infection was confirmed by blood culture each time. Although it is difficult to diagnose Helicobacter cinaedi infection by the standard culture method, increased numbers of recent reports especially in immunocompromised patients have emphasized the importance of diagnosing Helicobacter cinaedi infection.

Etiology of bacterial infections in the field of oral surgery was studied. A total of 270 samples collected from patients with encapsulated abscess in their oral cavities was examined and bacteria were isolated from the 244 samples (90.4%). The following results were found; 1) Organisms more than one from one sample were frequently isolated from cases with parodontitis, pericoronitis and gnathitis. Isolation of anaerobic bacteria was common (54.2%). 2) Streptococcus milleri and Streptococcus sanguis and Capnocytophaga species were the most common isolates among aerobic gram-positive and gram-negative bacteria, respectively. 3) Peptostreptococcus micros and Eubacterium lentum were most frequent isolates among gram-negative anaerobic bacteria. Among gram-negative bacteria, Oral Group Bacteroides, especially Bacteroides gingivalis, Bacteroides intermedius, Bacteroides buccae and Bacteroides oralis were most prominent. 4) Isolation frequency of bacteria (both species and strains) was high from samples obtained from patients before antibiotic chemotherapy. 5) Most strains were sensitive to Midecamycin acetate and Josamycin. Minimum inhibitory concentration of 80% isolates (MIC80) against these antibiotics was 0.39 microgram/ml.

We report that granulocyte transfusion (GTX) was effective for prolonged pneumonia at allogeneic bone marrow transplantation. A 58-year-old man with MDS-RAEB-2 was admitted to our hospital for allogeneic bone marrow transplantation. He was complicated with pneumonia, which was not improved with G-CSF and antibiotics. We therefore decided to perform a GTX transplantation. During the period of neutropenia, pneumonia did not deteriorate. A combination of allogeneic stem cell transplantation and GTX is expected not only to improve transplantation results but also to expand the adaptation for transplantation. However, detailed investigation of the effect of GTX in allogeneic stem cell transplantation should be performed, and more cases should be accumulated.

Optimal dose of N-22 (Mofezolac), a new non-steroidal anti-inflammatory agent, was evaluated in a double-blind comparative study on post-exodontic pain, at 3 single dosing levels of 100 mg, 150 mg and 200 mg, respectively. The results are summarized as follows.1) A total of 197 cases subjected for analysis are broken down into a group of 68 cases with a 100mg dose, that of 64 eases with a 150mg dose and that of 65 cases with a 200mg dose, respectively. No significant deviation in clinical background factors of all cases was recognized.2) A total of 189 cases (67 cases-100mg, 60-150mg arid 62-200mg) were subjected for analysis of its efficacy. Analysis by U-test proved both 150 mg and 200mg groups to be significantly superior (P

Clinical usefulness of N-22 (Mofezolac; N), a new non-steroidal antiinflammatory agent, on post-exodontic pain was evaluated at a single dose level of 150mg/time, in a double-blind comparative study, in comparison with Mefenamic acid; M also at a single dose level of 500 mg/time; results are summarized as follows.Of a total of 228 cases, 33 with no onset of post-exodontic pain took neither of the agents and were therefore removed, meaning that 195 cases were subjected for analysis, in comparison with M put under previously well controlled studies. No significant difference in patient background factors between N and M groups was found. Based on the protocol, either N or M was administered alone for evaluation at a single dose level/time. Double dummy method was used in allotment for administration of 4 kinds of test agents-N, NI, N's placebo and M's placebo.Of a total of 193 efficacy evaluable cases (N-96 & M-97), 25.0% of N group and 11.3% of M were rated “Remarkably improved” in final global improvement rate, with N group found significantly superior (P

TO THE EDITOR: This is a rare case report of fungemia caused by Trichosporon dermatis in a patient with refractory Burkitt's leukemia who was administered prophylactic voriconazole.

We stressed the importance to check consequent voltage change dependent on the etiopathogenetic varieties of the disease. The voltage showed rapidly increasing curves in cases with non-specific pericarditis, which would mean the myocardium showing inflammatory enlargement resulted from supermyocarditis after affection. Contrastly, those of secondary ones were not significantly changed. Those findings on voltage change are very useful guidline to diagnose the disease particularly in cases with vague synptoms and/or cases without obvious finding in the eary stage, besides to lend making differential diagnosis on the varieties of the disease.

A double blind comparative study was performed on TA-60, a new anti-inflammatory deug of phenylpropionic acid group, for the treatment of pain after dental extraction and there has been difficulty in determining the optimal dosage. The subjects consisted of a total of 151 cases of which 38 cases were assigned to the 200mg group, 37 cases to the 400mg group, 41 cases to the 600mg group and 35 cases to the placebo group.There was a definite dosage correlation with respect to the rate, onset and duration of efficacy and also for clinical usefulness.One case of 200mg group (0.9%) experienced adverse reaction possibly related to TA-60.On the basis of the present results the optimal close of TA-60 was estimated to be around 400mg.

Arthrography of the temporomandibular joint (TMJ) was introduced more than forty years ago, but did not become very popular, in Japan until recently. This is probably due to the fact that the arthrographic technique was considered to be difficult. Also at the time, we did not have any clear concept of treatment which was possible.We use the X-ray TV system (fluoroscopy) for TMJ arthrography, and to determine the puncture point of the TMJ compartment to the hard tissue, such as fossa, and condyle. As a result, we can enforce the TMJ arthrography very easily.TMJ arthrography provides a method for superior differentiation of TMJ afflications. Our technique is one way to produce information of great clinical significance.

The advantages are:(1) Stabilization of osteotomized bone fragment can be sure and complete.Relapse is less than with wire osteosynthesis.(2) In mandibular osteotomy, owing to monocortical osteosynthesis, damage to neurovascular bundle and root of teeth is rare.Miniplate can be used in maxilla that has thin layer of cortical bone.(3) Le Fort I osteotomy, zygomatic arch suspension wiring to stabilize bone fragments is unnecessary.(4) The period of intermaxillary fixation is shorter than wire osteosynthesis. Opening of the mouth can be possible during operation and immediate postoperation.Since 1982, we used miniplate in 63 cases of orthognathic surgical procedure with very satisfactory results.

Clinical efficacy and safety of Midecamycin acetate (MOM) were compared with those of Josamycin (JM) in patients with oral and maxillofacial infections under multicentered double-blind controlled study, and the following results were obtained.1. The overall clinical effectiveness rate was 77.4% for MOM group and 77.4% for JM group, judged by committee members with no significant difference.2. Clinical effectiveness rate classified by diagnosis was 78.8% for MOM group and 78.0% for JM in periodontal infections but no significant difference was observed.In pericoronitis, clinical effectiveness rate was 76.3% for MOM and 62. 5% for JM, but no significant difference was observed.In osteitis of jaws, clinical effectiveness rate was 76.3% for MOM and 85.9% for JM, but no significant difference was observed.3. As to improvement rate of clinical signs and symptoms, no significant difference was observed.4. Some side effects were observed in 7 patients (3.3%) in the MOM group and 12 patients (5.6%) in the JM group with no significant intergroup difference in incidence of these side effects.5. Some abnormal laboratory findings were observed in 4 patients (4%) in the MOM group and one patient (0.9%) in the JM group with no significant intergroup difference in incidence of these abnormal laboratory findings.6. The clinical usefulness rate judged by doctors in charge was 72.9% for MOM group and 76.2% for JM group, with no significant difference.From the above results, it was concluded that MOM had the same efficacy as JM for the treatment of oral and maxillofacial infections with half doses of JM.

It is generally said that the causes of velopharyngeal incompetence in the absence of overt cleft palate are paralysis of the levator veli palatini muscle, short soft palate, or deformity of the nasopharynx.We experienced a case of a 15-year-old girl with cleft palate-type speech caused by congenital velopharyngeal incompetence with unilateral palate muscle paresis and short soft palate.We inspected speech and velopharyngeal functions and precisely practised analysis of speech on auditory impression, observation of nasopharynx with fiberscope, measurements of soft palate and nasopharynx by cephalometric radiography, electromyographic evaluation of bilateral levator veli palatini muscles, biopsy of levator veli palatini muscle tissue, analysis expiration air from oral and nasal cavity during phonation by flow nasality graph, and accoustic analysis of speech sound by soundspectrograph.We performed a inferiorly based posterior pharyngeal flap operation in this case, and got a good result. Postoperative hypernasality was distinctly diminished and improvement of articulation was achieved.

The risks after homogeneous blood transfusion must be minimized in oral and maxillofacial surgery. The risks include infectious diseases such as posttransfusional hepatitis, adult T-cell leukemia (ATL), acquired immunodeficiency syndrome (AIDS), etc., incompatibility o hemotypes and antibody formation. Autotransfusion is the transfusion of blood of a patient back into himself. We applied autotransfusion in 45 cases of maxillofacial deformities to prevent the above mentioned diseases and side effects since July 1983.No case of posttransfusional hepatitis was encountered and safety of this method was confirmed.

The efficacy of Amfenac Sodium (Fenazox®), nonsteroid anti-inflammatory agent on temporomandibular joint pain was clinically evaluated in 28 temporomandibular arthrosis patients. Amfenac Sodium dosage of 200 mg was given orally in 4 times daily for two weeks.The results were as follows:1) Temporomandibular joint pain and limitation of mouth opening because of pain improved remarkedly.2) Effectiveness of Amfenac Sodium was “Excellent” in 5 cases (17.9%), “Good” in 12 cases (42.9%) and “Fair” in 10 cases (35.7%).3) Side effects were observed in 8 of the 28 cases. Most of those 3 cases had slight gastrointestinal disorders and only two cases were dropped.4) The usefulness of Amfenac Sodium was in 3 cases (10.7%) “Excellent”, 13 cases (46.4%) “Good” and 10 cases (35.7%) “Fair”.It is suggested that Amfenac Sodium is useful for relief from temporomandibular joint pain in temporomandibular arthrosis patients.

Kimura's disease, eosinophilic granuloma of soft tissues, is a chronic inflammatory condition and appears as subcutaneous tumor-like nodules in the head and neck regions. Histopathologically, it is characterized by the presence of lymphoid follicles, marked infiltration of eosinophils, fibrosis and vascular proliferation. This disease occurring in the orofacial region is relatively rare, only 14 cases having been previously reported. We describe 3 additional cases of Kimura's disease and discuss these in relation to angiolymphoid hyperplasia with eosinophilia.

In case of severe mandibular prognathism with open bite requiring more than 15 mm of mandibular posterior repositioning, it is said that the sagittal splitting methods (Obwegeser I method (1955, 1957) and Obwegeser-Dal Pont (1958) method) are not indicated. In our two cases manifesting severe mandibular prognathism with open bite we performed the Obwegeser II (1964) method. In one of these case we performed partial tongue resection to prevent postoperative relapse. The desired results with regards to facial appearance and occlusion were achieved in both cases.

In order to reconstruct the perfect shape of jaw bones, we developed the new operation procedures by using reimplantation of resected jaw portion treated by freezing and warming. The operation procedures which we developed are as follows.One is the one-stage procedure in which immediate reconstruction is performed intraorally, indicated for benign tumors and tumorlike conditions. The other is the two-stage procedure in which late reconstruction is performed extraorally, indicated for malignant tumors.We resect the affected jaw bone with the intact part included, and remove the affected parts from the resected jaw portion under direct observation, then decorticate the inner layer of the cortical bone and drill small holes on the cortical bone to prevent the cracking by deep freezing and to ensure the revascularization from the surrounding soft tissue.In order to kill the tumor cells within the resected jaw bones totally, we use two different freezing and warming treatments. The resected jaw portion is put into the freezing chamber at-85 degrees C for 45 minutes, and then immersed into physiological saline solution at+ 45 degrees C for 15 minutes. When the freezing apparatus is not available, the resected jaw portion is immersed into liquid nitrogen at-195 degrees C for 5 minutes, and then immersed into phisological saline solution at 45 degrees C for 10 minutes. These treatments are repeated three times respectively. After the treatment the cells in the lesion decreased in number and became low staining drastically.In the malignant cases the resected jaw portion is treated by the freezing and warming mentioned above, then lyophilized and stored in a vacuous bottle at the room temperature for over 18 months.The combination of resected jaw portion and fresh autogenous marrow and cancellousbone are used for reconstruction. The former is expected to play a role as an anatomical template, and the latter is used as a material capable of inducting osteogenesis.The one-stage procedure was performed in 6 cases and two-stage procedure in 2 cases. The mandibular reconstruction was performed in 7 eases and maxillary reconstruction in 1 case. No tumor recurrence was observed and satisfactory results without complication were obtained. At the postoperative biopsy of time reimplanted area, a large number of bone cells were observed in the bone that presented layers and remodelling, implying the absorption and new bone formation in the reimplanted bone.

The sagittal splitting technique of the mandibular ramus was developed by Obwegeser (1955) and introduced in Japan by Takahashi (1969). Today this operation technique is widely used to correct, not only mandibular prognathism, but also mandibular retrusion, open bite, facial asymmetry, abnormal occlusal plane, disharmony between centric occlusion and centric relation, decortication for mandibular osteomyelitis and extirpation of mandibular cysts. However this technique is said to be the most difficult among the osteotomy techniques. Application of this technique to small Japanese women whose mandibular ramus are thin, with minimum spongiosa on the superior portion and V-shaped, is often difficult.So, we developed the improved technique suitable for Japanese's small mandible. We use the disposable, thin, saw blade for oscilating bone saw (Aesculap-Werke, W-Germany) according to following procedures. 1) inducting bone grooves are made on the inner and outer surface of the mandibular ramus with Lindemann bur. 2) small holes are drilled in the anterior surface of the mandibular ramus. 3) osteotomy of the mandibular ramus, except the posterior part of the mandibular canal, is performed. 4) then splitting of the mandibular ramus is completed with a fine microchisel. The osteotomized surface was found to be always flat and smooth. The osteosynthesis with AO rag screws was always possible. Our technique is simple and easy even for operators with little experience, and also effective for preventing the relapse and to shorten the period of the intermaxillary fixation.