Clinical significance of minimal residual disease in adult acute lymphoblastic leukemia

Monitoring minimal residual disease (MRD) in patients with acute lymphoblastic leukemia (ALL) is a useful way for assessing treatment response and relapse. We studied the value of MRD and showed a correlation with relapse for 34 adult patients with ALL. MRD was evaluated by real-time quantitative polymerase chain reaction (RQ-PCR) with probes derived from fusion chimeric genes (BCR/ABL) (n = 12) or PCR-based detection of clonal immunoglobulin and T cell receptor gene rearrangements (n = 16), or both (n = 6). We analyzed 27 of the 34 patients who could be examined for MRD on day 100 after induction therapy. The overall survival (OS) rate (45.0%) and relapse-free survival (RFS) rate (40.0%) at 2 years in complete remission (CR) patients with MRD level ≥10^?3 (n = 12) were significantly lower than those in CR patients with MRD level <10^?3 (n = 15) (OS rate 79.0%, RFS rate 79.4%) (log-rank test, P = 0.017 and 0.0007). We also applied multicolor flow cytometry for comparison with MRD results analyzed by PCR methods. The comparison of results obtained in 27 follow-up samples showed consistency in 17 samples (63.0%) (P = 0.057). MRD analysis on day 100 is important for treatment decision in adult ALL.     

Prevalence of and risk factors for low bone mineral density in Japanese female patients with systemic lupus erythematosus

To examine the prevalence of and risk factors for low bone mineral density (BMD) (osteoporosis or osteopenia) in Japanese female patients with systemic lupus erythematosus (SLE). We performed BMD measurements by dual X-ray absorptiometry at the lumbar spine and the hip and collected basic and lifestyle-related, clinical and treatment characteristics among 58 SLE patients. Odds ratios (ORs) and their 95% confidence intervals (CIs) were assessed for associations between low BMD and selected factors among SLE patients. The mean BMD?±?SD was 0.90?±?0.17?g/cm² at the lumbar spine and 0.76?±?0.17?g/cm² at the hip. The prevalence of osteopenia (2.5 SD?<?T score?<?1 SD) was 50.0% and that of osteoporosis (T score?<?2.5 SD) was 13.8% in our SLE patients. After adjustment for age and disease duration, we found the number of deliveries (OR?=?5.58, 95% CI?=?1.31?C26.06; P?=?0.02) to be a risk factor for overall low BMD (T score?<?1 SD) and a maximal dosage of >50?mg/day of oral corticosteroids (OR?=?0.25, 95% CI?=?0.07?C0.91; P?=?0.035) as a preventive factor for low BMD at the lumbar spine. Reduced BMD, especially in spinal trabecular bone, was pronounced in Japanese female patients with SLE, particular in those with a history of delivery. A history of high-dose oral corticosteroids was associated with the preservation of BMD at the lumbar spine, however, further study is needed considering the limited sample size.     

Cephalometric calcified carotid artery atheromas in patients with obstructive sleep apnea

Background  

In the progress of atherosclerosis, the carotid artery calcifies and sometimes appears as a calcified mass on a cephalometric radiograph.     

Management of intruded primary teeth after traumatic injuries

Intrusions occur frequently in the primary dentition. It has been reported that conservative treatment of the intruded primary tooth is preferred if the apex is away from the permanent tooth germ. Conservative treatments include waiting for spontaneous re-eruption, and surgical re-positioning and fixation. Few papers have been published in Japan comparing the prognoses of intruded primary teeth between these two different modes of treatment. Therefore, optimal treatment for intruded primary teeth has been a topic of controversy among clinicians. The aim of this study was to compare the outcomes of intruded primary teeth between these two modes of treatment. Moreover, we examined the issue of treatment of choice for intruded primary teeth. The subjects consisted of 17 children referred to the Hiroshima University Hospital Department of Pediatric Dentistry for the treatment of 21 intruded primary teeth. Fourteen teeth were allowed to spontaneously re-erupt (group W), and 7 teeth were repositioned and fixed (group R). Antibiotic therapy and irrigation were performed in all intruded teeth. Treatment outcomes were evaluated using the following parameters: re-eruption, pathological pulp changes, increased mobility, discoloration, pulp canal obliteration, pathological root resorption, and disturbances of permanent teeth. In group W, root canal treatment or extraction were not performed since re-erupted teeth reveal no signs of infection. On the other hand, in group R, 57% of teeth required endodontic treatment or extracted due to signs of infection. The result showed treatment outcomes in group R were worse than those in group W. Our study indicates that most intruded primary teeth re-erupt with a favorable prognosis. Therefore, observation with irrigation and antibiotic therapy should be the treatment of first choice.     

Dipeptidyl peptidase‐4 inhibitor‐associated bullous pemphigoid in a patient with acquired reactive perforating collagenosis

Bullous pemphigoid (BP) is a common autoimmune blistering disorder with unknown etiology. Recently, increasing numbers of BP cases which developed under the medication with dipeptidyl peptidase‐4 inhibitors (DPP4i), widely used antihyperglycemic drugs, have been reported in published works. Here, we report a case of DPP4i (teneligliptin)‐associated BP that developed in a 70‐year‐old Japanese man. Interestingly, the patient had acquired reactive perforating collagenosis (ARPC), which is also known to be associated with the onset of BP. In the present case, clinical, histopathological and immunological findings suggested that DPP4i rather than ARPC was associated with the onset of BP.     

Idiopathic osteosclerosis in the mandible associated with abnormal tooth root formation

Idiopathic osteosclerosis (IO) is a localized, well-defined, intrabony radiopaque lesion within cancellous bone. The causes of IO are still unknown and most lesions are nonexpansile and asymptomatic, so they are often detected incidentally on radiographic examination for other purposes. In the case of jaw lesions, IO is considered to be of no clinical significance and usually requires no treatment. This paper describes two clinical cases about the long-term treatments and observations of mandibular IO in adolescents. The lesions were associated with abnormal tooth root formation and tooth malposition. In these cases, the orthodontic treatments finished successfully without any complication despite the lesions. IO in the jaw needs regular follow-up to ensure normal orofacial development during adolescence.     

Current trends of sentinel lymph node biopsy for breast cancer--a surgeon's perspective.

Sentinel lymph node biopsy (SLNB) is standard care for patients with early-stage breast cancer, and axillary lymph node dissection (ALND) is considered unnecessary when sentinel lymph nodes (SLNs) are tumor-free. Additional non-SLN metastasis in patients with positive SLNs can be estimated using several risk factors such as primary tumor size, metastatic tumor size in SLNs, lymphatic vessel invasion, and so on. All patients with positive SLNs may be treated with further ALND based on their own risk for non-SLN metastasis. Recent randomized clinical trials have already proved less surgical morbidity and better QOL for SLNB alone compared with ALND. However, trials concerning the efficacy of ALND in positive SLNB patients in preventing local regional recurrence and improving overall survival compared with no ALND, and also, concerning the effectiveness of ALND compared with axillary radiation therapy (RT), have not yielded clear results. The prognostic significance of micrometastasis in SLNs or bone marrow also remains to be determined. So far SLNB is not acceptable for patients with positive nodes in the axilla at initial diagnosis even if their axillary metastases are down-staged to negative by neoadjuvant chemotherapy. Although basically SLNB does not need to be performed for patients with pure ductal carcinoma in situ (DCIS), it is recommended for patients with an initial diagnosis of DCIS which is large, palpable, high grade, or found in younger patients. Because these types of DCIS have higher incidences of accompanying invasive lesions. In addition if patients will undergo mastectomy, SLNB is recommended because of the inability to perform SLNB after mastectomy. SLNB may be acceptable for patients with T3 or T4b tumors, even though SLN identification is lower yet SLN involvement is higher compared with T1 or T2 tumors, and systemic adjuvant therapy is more important for patients with T3 or T4b tumors. SLNB is a bridge to further axillary treatment such as ALND or axillary RT, and which strategy, including no further treatment, is best considered individually based on recurrence risk, treatment responsiveness and use or non-use of systemic therapy.