Treatment of Catheter-Associated Internal Jugular Vein Thrombosis Using Apixaban for Less Than Three Months in Two Patients With Aggressive B-cell Lymphoma Undergoing Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone Therapy.

The selection of anticoagulant therapy and appropriate duration of treatment for central venous (CV) catheter-associated internal jugular vein thrombosis in patients with malignant lymphoma remain unclear. Two cases of aggressive B-cell lymphomas treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), in which apixaban administered for less than three months was effective against CV catheter-associated internal jugular vein thrombosis, are reported. In one case, the right internal jugular vein thrombosis developed after eight courses of R-CHOP; when apixaban was orally administered for 37 days after the CV catheter was removed, the thrombus completely dissolved and did not recur for 27 months. In the other case, right internal jugular vein thrombosis developed after four courses of R-CHOP; two additional courses of the R-CHOP were administered alongside oral apixaban administration without catheter removal. After 66 days of oral apixaban, the thrombus completely dissolved, the CV catheter was removed, and no recurrence was observed for 8.5 months.

[Research on the Ratio of Anti-Cancer Drug Purchase Costs at Municipal Hospitals in the Aichi Prefecture].

We performed a study on the ratio of anti-cancer drug purchase costs at municipal hospitals in Aichi using meeting materials from the 2020 Aichi Prefectural Public Hospital Pharmacy Directors' Association. The ratio of anti-cancer drug purchase costs to all drug purchase costs at 17 hospitals was 41.5%(average)and 37.1%(median). In addition, we confirmed a positive correlation between all drug purchase costs and the ratio of anti-cancer drug purchase costs for each hospital(r= 0.537, 95%CI: 0.076-0.809, p=0.026). Furthermore, we conducted a univariate analysis on the background of hospitals where the ratio of anti-cancer drug purchase costs is ≥40%. As a result, we confirmed a significant difference(p<0.05)in the cases where there are more than 500 beds, with the approval of designated cancer hospitals, and with the department of hematology. This study clarified that hospitals with active anti-cancer drug treatment tended to increase drug purchase costs.

[Investigation of Anti-Cancer Drugs Suspected as Causative Agents of Allergy by Drug-Induced Lymphocyte Stimulation Test and Subsequent Re-Administration].

Twenty-one patients underwent a drug-induced lymphocyte stimulation test(DLST)withanti -cancer drugs suspected as causative agents of allergy between January 1, 2013, and December 31, 2017, at Ichinomiya Municipal Hospital, and 7 (33.3%)and 14 patients were positive and negative, respectively. Moreover, only 2 out of 21 people had a low value in lymphocyte blast transformation test induced by phytohemagglutinin, and their immune ability was maintained. Two patients suspected of drug eruption were re-administered after a positive determination. Letrozole was re-administered in 1 patient, but exemestane was administered after the patient relapsed. The other patient received lenalidomide in combination with dose-reduction and prednisolone(PSL), and the patient did not relapse. Seven patients were re-administered after negative determination, and none of them relapsed. These results confirmed that re-administration was possible depending on the type of side effects even in DLST positive cases; however, it was necessary to take various precautions. Moreover, DLST results were an index for finding the cause, and it is important to consider other diagnostic methods carefully during re-administration.

[A Case of Hypophosphatemia Induced by Administration of Amrubicin in a Patient with Small Cell Lung Cancer].

A man in his 50s with small cell lung cancer received amrubicin as the fourth-line therapy from August 201X-1. Serum phosphorus levels before treatment were normal at 2.9mg/dL, but grade 2 hypophosphatemia(2.1mg/dL)was observed at the beginning of the 2nd course. He underwent laryngoplasty after the 4th course. Retreatment was initiated in June 201X due to disease progression. After reinitiating treatment, the disease developed to grade 3 hypophosphatemia. As we identi- fied lower levels(1.1mg/dL)at the start of the 10th course, a pharmacist proposed oral phosphate therapy to the attending physician, which we administered. After then, the levels improved to 2.2mg/dL; thus, oral phosphate therapy was interrupted. However, because of a decline in serum phosphorus levels to grade 3, we administered the therapy again, and observed favorable improvement. For hypophosphatemia in this case, general reasons in clinical practice were not applicable; thus, amrubicin is considered to be a most possible cause.

Evaluation by various methods of the physiological mechanism of a high-flow nasal cannula (HFNC) in healthy volunteers.

INTRODUCTION: Several reports have described the usefulness of a high-flow nasal cannula (HFNC). However, the physiological mechanisms of this system are unclear. In the current study, various methods were used to investigate the physiological mechanisms of an HFNC in healthy volunteers. METHODS: The physiological mechanisms of the constant-flow and constant-pressure models of HFNC were studied in 10 healthy volunteers by the oesophageal balloon method, the electrical impedance method and the forced oscillation technique (FOT). RESULTS: The tidal volume (TV) increased markedly during HFNC (off, 30 L/min, 50 L/min: 685.6±236.5 mL, 929.8±434.7 mL, 968.8±451.1 mL). The end-inspiratory oesophageal pressure (EIOP) was not significantly different, but there was a tendency for it to decrease. HFNC 30 L/min and 50 L/min, the increment in TV and the difference in EIOP showed strong negative correlations (p=0.0025, 0.003). The end-expiratory oesophageal pressure (EEOP) increased. The respiratory system reactance at 5 Hz (X5) by FOT decreased significantly. There was a flow rate-dependent EEOP increase, and the positive end-expiratory pressure (PEEP) effect of HFNC was confirmed. There was a correlation between the difference in X5 and the difference in EEOP during HFNC 30 L/min and 50 L/min, with correlation coefficients of 0.534 and 0.404 (p=0.112, 0.281). The amount of change in EEOP and the fluctuation in X5 were positively correlated. CONCLUSIONS: The PEEP effect of HFNC was confirmed by the electrical impedance method and FOT. The increment in TV and the difference in EIOP of HFNC showed strong negative correlations.

Clinical characteristics and outcomes in super-elderly patients (>85 years) with heart failure: single center observational study in Japan.

AIM: The number of elderly patients with heart failure is increasing in Japan owing to the increase in the aging population. In the field of emergency medicine, the treatment and management of elderly patients with heart failure are key issues. We aimed to clarify the clinical characteristics and outcomes of these patients. METHODS: We enrolled 72 consecutive patients (age, 76.5 ± 12.5 years) with heart failure who were admitted to our hospital between January 1 and December 31, 2010. The characteristics and outcomes of super-elderly patients aged >85 years (n = 21) were compared with those of patients aged ≤85 years (n = 51). RESULTS: The overall prevalence of chronic atrial fibrillation was high (43.1%). Underlying diseases, left ventricular function, renal function, in-hospital mortality, hospital stay period, and major complications were similar between the two groups. The super-elderly group had a significantly higher mortality rate and lower event-free survival rate after discharge (log-rank test, P = 0.0018 and P = 0.0032, respectively).The incidence of readmission for heart failure recurrence was 55.0% in the super-elderly group and 25.0% in the younger group. CONCLUSION: There were no significant differences in the background characteristics and in-hospital treatment between super-elderly heart failure patients and younger patients. High mortality and cardiovascular event rates after discharge were observed in the super-elderly group.

[Medical economics evaluation of 5-HT3 receptor antagonist drugs].

At Komaki City Hospital, the drug cost in connection with cancer chemotherapy was re-examined as part of improved management along with the introduction of DPC in July 2008. With due attention to the 5-HT3 receptor antagonists, both the change from injections to oral drugs and the change from brand-name drugs to generic drugs were tried between July 2008 and June 2009. After that, in order to examine the economic impact of these changes, we investigated and analyzed the number of medications, the cost of medicine purchased, and the average drug cost per medication of the 5-HT3 receptor antagonists between April 2008 and September 2009. As a result, the cost of 5-HT3 receptor antagonists purchased decreased greatly, and the impact of the improvement was mainly due to the change to oral drugs, and partially to the change to generic drugs. Therefore, from the viewpoint of hospital economic improvement in DPC, it was thought that the change to oral drugs(5-HT3 receptor antagonists)is given top priority.

[Mantle cell lymphoma mimicking chronic lymphocytic leukemia].

A 62-year-old male was admitted to our hospital complaining of dyspnea in March, 2002. He had remarkable bone marrow invasion with a significant number of leukemic cells, anemia and thrombocytopenia. In addition he had generalized lymphadenopathy including a bulky mass in the left cervix. Surface marker analysis of abnormal cells showed CD 5+, 10-, 19+, 20+, 23+, and kappa+, and immunohistochemistry revealed cyclin D1-positive cells. Chromosome analysis showed del(11q). The patient was diagnosed as having mantle cell lymphoma, stage IVB, and received combination chemotherapy. He could not obtain complete remission and died after 29 months. We found it very difficult in this case to make a differential diagnosis between mantle cell lymphoma and chronic lymphocytic leukemia. We report on this case and summarize the problem of the differential diagnosis.

Rapid screening of leukemia fusion transcripts in acute leukemia by real-time PCR.

We established a real-time PCR method that can simultaneously detect 10 different fusion transcripts (major, minor and micro BCR/ABL, AML1/MTG8, PML/RARalpha, CBFbeta/MYH11, TEL/AML1, E2A/PBX1, MLL/AF4, and MLL/AF9) together with Wilms' tumor gene (WT1) transcripts. This screening method allowed the processing of six specimens concomitantly and required only one working day from RNA extraction to final results. Fifty-seven bone marrow (BM) samples from patients with acute leukemia were retrospectively screened for the presence of fusion and WT1 transcripts without knowledge of the cytogenetic data, and the fusion transcripts were detected in 20 of 57 samples (35.1%). The concordance between the present method and cytogenetic analysis was examined in 38 samples in which the cytogenetic data were available. In 12 of 38 samples, the PCR results agreed with the cytogenetic data, whereas in 4 of the remaining 26 samples, the translocations were detected by real-time PCR alone because of the insufficient number of metaphases obtained and presumably the submicroscopic or masked translocations. The WT1 levels ranged from 400 to 690,000 copies/microg RNA in BM from leukemia patients, whereas 0-470 copies/microg RNA were found in BM cells from BMT donors. This real-time PCR method enables rapid and efficient characterization of acute leukemia in addition to subsequent evaluation of minimal residual diseases.