[Rapidly progressed chronic myelomonocytic leukemia associated with severe skin infiltration].

A 79-year-old man developed nodular skin eruption in his trunk in March 1995. He was diagnosed as CTCL and hospitalized to the department of dermatology and low dose VP-16 therapy was started. 6 months later, he was referred to our department because of severe melena. On admission, marked monocytosis was observed both in the bone marrow (43.6%) and peripheral blood (monocyte > 1,000/microliter). Skin biopsy showed infiltration of large mononuclear cells in the dermis and subcutaneous tissue. Thus a diagnosis of CMML with skin infiltration was made. Skin eruption developed over his entire skin and peripheral monocytes increased over 5,000/microliter. Chemotherapy was started and skin infiltration was slightly improved, but the disease developed into acute phase and he died 3 months after admission.

[Spinal cord stab injury by acupuncture needle: a case report].

It is very rare for neurosurgeons to encounter cases of spinal cord injury caused by a broken acupuncture needle. A 45-year-old man was referred to our clinic because of urinary retention about two weeks after acupuncture therapy (a needle was broken during treatment). The patient showed no motor weakness, or sensory disturbance. The needle was seen transversely stabbing the spinal cord at C1/2 on CT imaging and X-ray film. In all of the reported seven cases of longitudinal stab injuries (posterior puncture), sensorimotor disturbances were present. In transverse stab injuries (lateral puncture), however, two cases did not show motor weakness but sensory disturbance. The centrifugal pathway for micturition in the spinal cord lies in the middle one third of the lateral columns and in the width of the central canal. The patient complained of urinary retention because the bilateral descending fibers might have been stabbed by the needle. Surgical treatment relieved the patient from his complaint.