INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. Th...INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.展开更多
A nine-year-old girl with Staphylococcus epidermidis meningitis combined with acute disseminated encephalomyelitis （ADEM） was enrolled in the present study, and exhibited sustained fever and headache for 5 days and ...A nine-year-old girl with Staphylococcus epidermidis meningitis combined with acute disseminated encephalomyelitis （ADEM） was enrolled in the present study, and exhibited sustained fever and headache for 5 days and a single seizure episode. Meningeal irritation and disturbance of consciousness were apparent. Cerebrospinal fluid examination revealed increased protein level and pleocytosis. Cerebrospinal fluid culture demonstrated Staphylococcus epidermidis growth. The patient was treated with intravenous cefotaxime, intravenous dexamethasone, and decreasing intracranial pressure for 3 weeks. Seizures and fever symptoms improved, but disturbance of consciousness, muscle weakness, and bilateral limb paresis were significant. IgG index was elevated and oligoclonal bands were positive in the cerebrospinal fluid. Magnetic resonance imaging demonstrated high T2-weighted signals in subcortical white matter, which were consistent with ADEM. High-dose methylprednisolone for 3 days and a 6-day pulse therapy with immunoglobulins resulted in improved clinical symptoms and cerebrospinal fluid examination. The patient＇s temperature dropped to normal, and the headache disappeared. A Staphylococcus epidermidis infection associated with ADEM is uncommon in children. Results suggested that Staphylococcus epidermidis infection could be a pathogenic factor for ADEM, and ADEM is a complication of Staphylococcus epidermidis meningitis.展开更多
Prediction of transformation of acute disseminated encephalomyelitis (ADEM) into multiple sclerosis is of great clinical importance, as it enables timely determination of the tactics for treatment of a patient as well...Prediction of transformation of acute disseminated encephalomyelitis (ADEM) into multiple sclerosis is of great clinical importance, as it enables timely determination of the tactics for treatment of a patient as well as volume of respective therapeutic interventions.This work is aimed at ascertainingthe prognostic factors that determine the risk of transformation of acute disseminatedencephalomyelitis into multiple sclerosis. We have examined 101 patients with the diagnosis ADEM, namely: 28 men and 73 women in the age from 17 up to 53 years (average value31.7 ± 1.01years). To ascertain the prognostic meaning of clinic-paraclinic indices corresponding to patients with ADEM, we estimated the cumulative part of absence of relapses in the group of patients by using the Kaplan-Meyer method with estimating the Fisher criterion and using the most important clinic-paraclinic data. Development of transformation of ADEM into multiple sclerosis is reliably related to the following prognostic signs: degree of disability in accord with the EDSS scale and sizes of demyelination focuses determined using MRT. Criteria for congenial prediction in disease development with delayed appearance of transformation of ADEM into multiple sclerosis are as follows: slight degree (in EDSS scale) of disability and large sizes of demyelination focuses (MRT data).Our analysis of the main clinic-paraclinic indexes obtained using the Kaplan-Meyer method indicates reliability of results and enables us to find a number of important prognostic criteria for development of transformation of ADEM into multiple sclerosis.展开更多
Prediction of development of the multi-phase alternative for the course inherent to acute disseminated encephalomyelitis (ADEM) is of great clinical importance, as it enables timely determination of the treatment tact...Prediction of development of the multi-phase alternative for the course inherent to acute disseminated encephalomyelitis (ADEM) is of great clinical importance, as it enables timely determination of the treatment tactics as well as volume of respective therapeutic interventions. This work is aimed at ascertaining the prognostic factors that determine the risk of development of the multi-phase course in disseminated encephalomyelitis. We have examined 101 patients with the diagnosis ADEM, namely: 28 men and 73 women in the age from 17 up to 53 years (average value 31.7 ± 1.01 years). To ascertain the prognostic meaning of clinic-paraclinic indices corresponding to patients with ADEM, we estimated the cumulative part of absence of relapses in the group of patients by using the Kaplan-Meyer method with estimating the Fisher criterion and using the most important clinic-paraclinic data. Development of the multiphase course in ADEM is reliably related to the following prognostic signs: changes in the neurologic status of patients with ADEM, degree of disability in accord with the EDSS scale as well as sizes of demyelination focuses determined using MRT. Criteria for congenial prediction in disease development with delayed appearance of ADEM relapses in the form of the multi-phase course are as follows: domination of motor impairments over coordinative impairments in neurological status, slight degree (in EDSS scale) of disability and small sizes (up to 4 mm) of demyelination focuses (MRT data). Our analysis of the main clinic-paraclinic indices obtained using the Kaplan-Meyer method indicates reliability of results and enables us to find a number of important prognostic criteria for appearance of the multiphase course in ADEM.展开更多
AIMTo investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery.METHODSThirty-six peri-operative DIC patients...AIMTo investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery.METHODSThirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also evaluated.RESULTSAbscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all).CONCLUSIONEarly administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.展开更多
AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-indu...AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial.展开更多
<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukae...<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukaemia (AML), Acute Promyelocytic Leukaemia (APL) is well established to cause DIC. But there have been reports noted that abnormal DIC parameters also commonly observed in the patients with non-APL AML. This study evaluated the DIC parameters & DIC score according to International Society of Thrombosis and Haemostasis (ISTH) in newly diagnosed non-APL AML patients. <strong>Materials and Methods:</strong> This cross-sectional observational study was conducted in the Department of Haematology, BSMMU, Dhaka, Bangladesh. 48 newly diagnosed non-APL AML patients were enrolled. Platelets count was measured by auto analyzer (Sysmax XT 2000i/Pentra ABX-120DX) as well as checked manually. Prothrombin time, fibrinogen, D-Dimer were measured using STAGO Coagulation analyzer. The ISTH-DIC scoring system was used to calculate DIC score. The statistical analysis was carried out using the Statistical Package for Social Sciences version 24.0 for Windows. Chi-Square test & Fisher exact test was used for categorical variables. Unpaired t-test was used to compare mean between groups. For all statistical tests, p-value less than 0.05 was considered as statistically significant. <strong>Results: </strong>By analyzing 48 newly diagnosed patients with non-APL AML, found that DIC developed in 14.6% patients at presentation. Among the DIC parameters, PT and D-dimer were significantly higher in patients presented with DIC. Patients with DIC exhibit lower expression of CD117, CD34, HLA-DR and statistically significant association with negative expression of HLA-DR (p-value 0.034). No significant association was found between presence of DIC and age, gender, bleeding at presentation, morphological type, WBC count or peripheral blast percentage.<strong> Conclusion:</strong> Abnormalities of DIC parameters in common in patients with AML. A significant portion of patients with DIC have no apparent symptom or bleeding. So, routine screening of DIC parameter at presentation is recommended for early diagnosis & effective management of DIC.展开更多
The Coronavirus pandemic has affected and impacted everyone. Some people may simply not want to admit it;however, it has affected each person in a specific way [1]. Children had to stay home from school and learn virt...The Coronavirus pandemic has affected and impacted everyone. Some people may simply not want to admit it;however, it has affected each person in a specific way [1]. Children had to stay home from school and learn virtually. Parents had the additional stress of going to work, during the pandemic, and finding safe ways to collaborate with others, in order for companies to remain open and provide their services to customers. This pandemic has affected all;however, one age group was affected the most. This age group [2] includes all children. Children have been affected, primarily, in two ways, physically, as well as mentally. This article has the purpose of analyzing the effects of the pandemic that were imposed on children and helping others gain full knowledge. Having the full knowledge of these effects will help individuals to decide for themselves, the extent to which this rapidly spreading virus affected the next generation.展开更多
An 11-year-old boy with acute lymphocytic leukemia(ALL) contracted disseminated candidiasis during induction therapy, which was complicated with rupture of a fungal cranial aneurysm. Ventricular drainage and coil embo...An 11-year-old boy with acute lymphocytic leukemia(ALL) contracted disseminated candidiasis during induction therapy, which was complicated with rupture of a fungal cranial aneurysm. Ventricular drainage and coil embolization of a residual aneurysm in combination with intensive antifungal therapy rescued the patient. Although clinical improvement was achieved, high fever and elevated levels of C-reactive protein and β-D-glucan continued for more than 10 mo. One year later, the ALL relapsed during maintenance therapy with methotrexate and 6-mercaptopurine. After salvage chemotherapy, the patient received unrelated bone marrow transplantation(BMT) in a non-complete remission condition and survived. During subsequent chemotherapy and BMT, no recurrence of the fungal infection was observed under the prophylactic anti-fungal therapy with micafungin.展开更多
BACKGROUND Therapy-related acute promyelocytic leukemia(t-APL)is a rare complication observed in solitary bone plasmacytoma(SBP),and SBP after radiotherapy evolving to APL harboring the FMS-like tyrosine kinase 3-inte...BACKGROUND Therapy-related acute promyelocytic leukemia(t-APL)is a rare complication observed in solitary bone plasmacytoma(SBP),and SBP after radiotherapy evolving to APL harboring the FMS-like tyrosine kinase 3-internal tandem duplication(FLT3-ITD)mutation has never been reported.Here,we present the first case reported until now.CASE SUMMARY We describe a 64-year-old woman who presented with lumbar pain and was initially diagnosed with SBP.However,after one year of radiotherapy treatment,this patient experienced a long-standing bone-marrow-suppressive period and finally developed APL harboring the FLT3-ITD mutation,as confirmed by analyses of clinical features,bone marrow morphology,flow cytometry,cytogenetic examination,and molecular biology.On admission,the patient had disseminated intravascular coagulation and intracranial hemorrhage,and the peripheral blood and bone marrow smear displayed abundant abnormal promyelocytes.Unfortunately,she died when the definite diagnosis was made.CONCLUSION The patient with t-APL harboring FLT3-ITD mutation evolving from SBP after radiotherapy had not been reported and had poor clinical outcomes.FLT3-ITD mutation in t-APL may be a potential pathogenesis of leukemogenesis.We should consider the potential risk of secondary neoplasms in SBP patients after radiotherapy.展开更多
基金supported by the fund of "Clinical Study on Traditional Chinese Medicine for Severe A (H1N1) Influenza Cases 200907001-2A"
文摘INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.
文摘A nine-year-old girl with Staphylococcus epidermidis meningitis combined with acute disseminated encephalomyelitis （ADEM） was enrolled in the present study, and exhibited sustained fever and headache for 5 days and a single seizure episode. Meningeal irritation and disturbance of consciousness were apparent. Cerebrospinal fluid examination revealed increased protein level and pleocytosis. Cerebrospinal fluid culture demonstrated Staphylococcus epidermidis growth. The patient was treated with intravenous cefotaxime, intravenous dexamethasone, and decreasing intracranial pressure for 3 weeks. Seizures and fever symptoms improved, but disturbance of consciousness, muscle weakness, and bilateral limb paresis were significant. IgG index was elevated and oligoclonal bands were positive in the cerebrospinal fluid. Magnetic resonance imaging demonstrated high T2-weighted signals in subcortical white matter, which were consistent with ADEM. High-dose methylprednisolone for 3 days and a 6-day pulse therapy with immunoglobulins resulted in improved clinical symptoms and cerebrospinal fluid examination. The patient＇s temperature dropped to normal, and the headache disappeared. A Staphylococcus epidermidis infection associated with ADEM is uncommon in children. Results suggested that Staphylococcus epidermidis infection could be a pathogenic factor for ADEM, and ADEM is a complication of Staphylococcus epidermidis meningitis.
文摘Prediction of transformation of acute disseminated encephalomyelitis (ADEM) into multiple sclerosis is of great clinical importance, as it enables timely determination of the tactics for treatment of a patient as well as volume of respective therapeutic interventions.This work is aimed at ascertainingthe prognostic factors that determine the risk of transformation of acute disseminatedencephalomyelitis into multiple sclerosis. We have examined 101 patients with the diagnosis ADEM, namely: 28 men and 73 women in the age from 17 up to 53 years (average value31.7 ± 1.01years). To ascertain the prognostic meaning of clinic-paraclinic indices corresponding to patients with ADEM, we estimated the cumulative part of absence of relapses in the group of patients by using the Kaplan-Meyer method with estimating the Fisher criterion and using the most important clinic-paraclinic data. Development of transformation of ADEM into multiple sclerosis is reliably related to the following prognostic signs: degree of disability in accord with the EDSS scale and sizes of demyelination focuses determined using MRT. Criteria for congenial prediction in disease development with delayed appearance of transformation of ADEM into multiple sclerosis are as follows: slight degree (in EDSS scale) of disability and large sizes of demyelination focuses (MRT data).Our analysis of the main clinic-paraclinic indexes obtained using the Kaplan-Meyer method indicates reliability of results and enables us to find a number of important prognostic criteria for development of transformation of ADEM into multiple sclerosis.
文摘Prediction of development of the multi-phase alternative for the course inherent to acute disseminated encephalomyelitis (ADEM) is of great clinical importance, as it enables timely determination of the treatment tactics as well as volume of respective therapeutic interventions. This work is aimed at ascertaining the prognostic factors that determine the risk of development of the multi-phase course in disseminated encephalomyelitis. We have examined 101 patients with the diagnosis ADEM, namely: 28 men and 73 women in the age from 17 up to 53 years (average value 31.7 ± 1.01 years). To ascertain the prognostic meaning of clinic-paraclinic indices corresponding to patients with ADEM, we estimated the cumulative part of absence of relapses in the group of patients by using the Kaplan-Meyer method with estimating the Fisher criterion and using the most important clinic-paraclinic data. Development of the multiphase course in ADEM is reliably related to the following prognostic signs: changes in the neurologic status of patients with ADEM, degree of disability in accord with the EDSS scale as well as sizes of demyelination focuses determined using MRT. Criteria for congenial prediction in disease development with delayed appearance of ADEM relapses in the form of the multi-phase course are as follows: domination of motor impairments over coordinative impairments in neurological status, slight degree (in EDSS scale) of disability and small sizes (up to 4 mm) of demyelination focuses (MRT data). Our analysis of the main clinic-paraclinic indices obtained using the Kaplan-Meyer method indicates reliability of results and enables us to find a number of important prognostic criteria for appearance of the multiphase course in ADEM.
文摘AIMTo investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery.METHODSThirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also evaluated.RESULTSAbscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all).CONCLUSIONEarly administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.
文摘AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial.
文摘<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukaemia (AML), Acute Promyelocytic Leukaemia (APL) is well established to cause DIC. But there have been reports noted that abnormal DIC parameters also commonly observed in the patients with non-APL AML. This study evaluated the DIC parameters & DIC score according to International Society of Thrombosis and Haemostasis (ISTH) in newly diagnosed non-APL AML patients. <strong>Materials and Methods:</strong> This cross-sectional observational study was conducted in the Department of Haematology, BSMMU, Dhaka, Bangladesh. 48 newly diagnosed non-APL AML patients were enrolled. Platelets count was measured by auto analyzer (Sysmax XT 2000i/Pentra ABX-120DX) as well as checked manually. Prothrombin time, fibrinogen, D-Dimer were measured using STAGO Coagulation analyzer. The ISTH-DIC scoring system was used to calculate DIC score. The statistical analysis was carried out using the Statistical Package for Social Sciences version 24.0 for Windows. Chi-Square test & Fisher exact test was used for categorical variables. Unpaired t-test was used to compare mean between groups. For all statistical tests, p-value less than 0.05 was considered as statistically significant. <strong>Results: </strong>By analyzing 48 newly diagnosed patients with non-APL AML, found that DIC developed in 14.6% patients at presentation. Among the DIC parameters, PT and D-dimer were significantly higher in patients presented with DIC. Patients with DIC exhibit lower expression of CD117, CD34, HLA-DR and statistically significant association with negative expression of HLA-DR (p-value 0.034). No significant association was found between presence of DIC and age, gender, bleeding at presentation, morphological type, WBC count or peripheral blast percentage.<strong> Conclusion:</strong> Abnormalities of DIC parameters in common in patients with AML. A significant portion of patients with DIC have no apparent symptom or bleeding. So, routine screening of DIC parameter at presentation is recommended for early diagnosis & effective management of DIC.
文摘The Coronavirus pandemic has affected and impacted everyone. Some people may simply not want to admit it;however, it has affected each person in a specific way [1]. Children had to stay home from school and learn virtually. Parents had the additional stress of going to work, during the pandemic, and finding safe ways to collaborate with others, in order for companies to remain open and provide their services to customers. This pandemic has affected all;however, one age group was affected the most. This age group [2] includes all children. Children have been affected, primarily, in two ways, physically, as well as mentally. This article has the purpose of analyzing the effects of the pandemic that were imposed on children and helping others gain full knowledge. Having the full knowledge of these effects will help individuals to decide for themselves, the extent to which this rapidly spreading virus affected the next generation.
基金Supported by The Grant-in-Aid for Scientific Research from Ministry of Education,Science and Culture Japan,No.24591541 to Masayuki Nagasawa
文摘An 11-year-old boy with acute lymphocytic leukemia(ALL) contracted disseminated candidiasis during induction therapy, which was complicated with rupture of a fungal cranial aneurysm. Ventricular drainage and coil embolization of a residual aneurysm in combination with intensive antifungal therapy rescued the patient. Although clinical improvement was achieved, high fever and elevated levels of C-reactive protein and β-D-glucan continued for more than 10 mo. One year later, the ALL relapsed during maintenance therapy with methotrexate and 6-mercaptopurine. After salvage chemotherapy, the patient received unrelated bone marrow transplantation(BMT) in a non-complete remission condition and survived. During subsequent chemotherapy and BMT, no recurrence of the fungal infection was observed under the prophylactic anti-fungal therapy with micafungin.
基金Natural Science Foundation of Zhejiang Province,No.LY19H290003Zhejiang Provincial Medical and Health Science and Technology Project,No.2020KY196and Foundation of Zhejiang Province Chinese Medicine Science and Technology Planes,No.2017ZB030.
文摘BACKGROUND Therapy-related acute promyelocytic leukemia(t-APL)is a rare complication observed in solitary bone plasmacytoma(SBP),and SBP after radiotherapy evolving to APL harboring the FMS-like tyrosine kinase 3-internal tandem duplication(FLT3-ITD)mutation has never been reported.Here,we present the first case reported until now.CASE SUMMARY We describe a 64-year-old woman who presented with lumbar pain and was initially diagnosed with SBP.However,after one year of radiotherapy treatment,this patient experienced a long-standing bone-marrow-suppressive period and finally developed APL harboring the FLT3-ITD mutation,as confirmed by analyses of clinical features,bone marrow morphology,flow cytometry,cytogenetic examination,and molecular biology.On admission,the patient had disseminated intravascular coagulation and intracranial hemorrhage,and the peripheral blood and bone marrow smear displayed abundant abnormal promyelocytes.Unfortunately,she died when the definite diagnosis was made.CONCLUSION The patient with t-APL harboring FLT3-ITD mutation evolving from SBP after radiotherapy had not been reported and had poor clinical outcomes.FLT3-ITD mutation in t-APL may be a potential pathogenesis of leukemogenesis.We should consider the potential risk of secondary neoplasms in SBP patients after radiotherapy.
