Splenectomy for hypersplenism caused by adult T-cell leukemia: Report of a case

A 45-year-old woman with previously diagnosed chronic type adult T-cell leukemia (ATL) presented with abdominal discomfort and red eruptions on her arms and legs. Anemia, thrombocytopenia, hypercalcemia, and splenomegaly indicated progression to acute-type ATL. Combined chemotherapy resulted in normalization of the serum calcium level and improvement in her symptoms. However, the severe anemia and thrombocytopenia persisted, necessitating transfusions of red blood cells (RBC) and platelets three times a week. We performed splenectomy in an attempt to reduce the total volume of malignant cells and improve the hypersplenism. After the operation, the RBC and platelet counts increased gradually, and the transfusions were stopped on postoperative day (POD) 3. Splenectomy should be considered as an optional treatment for hypersplenism caused by ATL when hypersplenism cannot be controlled by chemotherapy in patients without a high surgical risk.     

Informed consent of the family in the chemotherapy for lung cancer

In Japan where the question of cancer notification has yet to be resolved, it is difficult to obtain an informed consent from the patient himself in clinical studies of the chemotherapies for cancer. In fact, the chemotherapy is administered while not enough explanation is given to the family let alone the patient. Such is the present situation. For the purpose of finding out the best possible method at present, we carried out a method whereby an informed consent of the family is substituted for a consent of the patient in phase II study of inoperable non-small cell carcinoma of the lung. As a result, the consent was obtained from 21 (91.3%) out of 23 families. This method should be taken into consideration as a feasible one under the present circumstances. It was in only one family (4.3%) that a consent on the notification of diagnosis from the family to the patient was obtained. In order for the informed consent to be established, efforts to form a social consensus on cancer notification are needed.     

Oncogenic Vitamin D Resistant Hypophosphatemic Osteomalacia (Benign Ossifying Mesenchymal Tumor of Bone): Case Report

A 53-year-old Japanese woman suffered hypophosphatemic osteomalaciasecondary to bone tumor. Her clinical symptoms did not improvefor a long time following the oral administration of Alfacalcidol(vitamin D₃). A bone survey using radiographs revealed a smalltumor located in the proximal head of the left fibula. Hypophosphatemiaand low levels of 1-alpha, 25-dihydroxycholecalciferol (1-alpha,25(OH)²D³returned towards normal levels soon after an enbloc tumor resection,and bone pain and muscle weakness gradually disappeared. Thehistology, especially of the trabecular bone of the left fibula,showed typical features of osteomalacia with demineralization.The tumor comprised numerous small blood vessels, spindle shapedor oval neoplastic cells, a few multinucleated giant cells,osteoid tissue with or without calcification, chondroid tissueand hemangioma. The spindle shaped or oval cells contained around nucleus with no mitotic figures. These clinical and histologicalfindings coincide well with a diagnosis of benign ossifyingmesenchymal tumor of the bone with vitamin D resistant hypophosphatemicosteomalacia.     

Successful treatment of an adult patient with pulmonary abscess secondary to congenital cystic adenomatoid malformation

We report a case of a 29 year old male who at age 25, developed a pulmonary abscess in the left lower lobe. A left lower lobectomy was performed following two recurrences on antibiotic treatment. The result of histopathological examination confirmed congenital cystic adenomatoid malformation (CCAM), a congenital disease characterized by multiple cysts resulting from adenomatous hyperplasia of the bronchial epithelia. In many cases, respiratory distress occurs during the neonatal period, and in about 80–85% of patients, CCAM is diagnosed before the age of two years due to respiratory infection. CCAM which was diagnosed in adulthood is very rare.     

Measurement error in assessing the size of posterior subcapsular cataracts from retroillumination photographs

Twenty-six eyes with posterior subcapsular opacities of various sizes were photographed with the Neitz-Kawara Retroillumination camera. The outline of the opacity in a single photograph of each opacity was traced onto a transparent plastic overlay twice by two independent outliners. Two methods were used to estimate the area within the outlines of the opacities. In the first, a transparent overlay with a standard grid was used to count the number of boxes within the outlines. The second method used computer planimetry to estimate the area within the tracings. We estimated the measurement error associated with a single outlining of an opacity and the contribution of the measurement error to overall sample size requirements in studies comparing the mean areas of posterior subcapsular opacities. Variability in the measurement techniques contributed fewer than 20 additional subjects to overall sample size estimates, a small contribution to total sample size requirements in most studies. An outliner's inherent variability in outlining an opacity was a much larger contributor to the measurement error than was variability in assessing the area of the outline of the opacity. While within outliner variability was similar for the two persons outlining the opacities, there were systematic differences in the way the two traced the outlines. Variability from the use of separate photographs of the same opacity taken by different photographers was minimal.