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Abstract We describe a case where intermittent and continuous administrations of a small amount of immune globulin were effective in the treatment of refractory chronic immune thrombocytopenic purpura by systemic lupus erythematosus (SLE). Steroid pulse therapy and cyclophosphamide pulse therapy were considered for thrombopenia. However, the patient had compressed fracture of the lumbar vertebrae due to osteoporosis and right external malleolus ulcer with complications of infection. Therefore, high-dose intravenous immune globulin (IVIG) therapy (400 mg/kg daily for 5 consecutive days) was administered. Then, as a maintenance therapy, a small amount of 400 mg/kg for 1 day (400 mg/kg monthly) was given in an intermittent and continuous manner, which resulted in improvement of thrombocytopenia and reduction of the amount of steroid administered.

Abstract A 53-year-old man was diagnosed with polymyositis (PM) in 1997 and treated with prednisolone. The subjective symptoms of pneumonitis were poor. However, the KL-6 values were elevated to 2230 IU/l in March 2001. Abdominal computer tomography findings revealed a pancreatic-tail tumor and multiple liver nodules, diagnosed as primary pancreatic adenocarcinoma with multiple liver metastasis. The stage of the pancreatic cancer was IV, and curative surgery of the tumor was not indicated. Chemotherapy and radiotherapy were administered for the liver metastasis. However, these therapies were ineffective against the tumors. The patient died on 12 September 2001. If a high level of KL-6 is found without the increasing activity of lung disease containing interstitial pneumonia in PM patients, examination for the internal malignancies including pancreatic cancer should be performed, although cases of PM with a significantly high level of KL-6 associated with pancreatic cancer are rare.

Background: There have been no reports on the efficacy of noninvasive positive pressure ventilation (NPPV) in elderly patients. Objectives: The purpose of this study was to clarify the efficacy and identify the predictors of a successful outcome of NPPV in patients over the age of 75 years with acute hypercapnic respiratory failure (AHRF). Methods: We retrospectively evaluated the data of 42 patients (21 men) with AHRF who were treated at our unit. The patients were divided into survivor and nonsurvivor groups, and the clinical parameters measured prior to the initiation of NPPV were compared between the 2 groups. Results: The mean age of the patients was 83.0 ± 6.3 years. The etiology of the respiratory failure was acute exacerbation of chronic obstructive pulmonary disease in 19 patients, acute cardiogenic pulmonary edema in 18 patients, idiopathic pulmonary fibrosis in 3 patients, sequelae of tuberculosis in 1 patient, and asthma in 1 patient. Of the 42 patients, 33 (78.6%) survived. All patients with a Glasgow Coma Scale (GCS) score ≥9 and/or an APACHE II score <29 survived after the initiation of NPPV. Conclusion: An APACHE II score <29 and a GCS score ≥9 were predictors of a successful outcome of NPPV in elderly people.

We report a rare case of portal vein thrombosis (PVT) associated with antiphospholipid syndrome (APS) and hepatitis C virus-related cirrhosis. A 59-year-old woman with hepatitis C virus (HCV) infection was admitted because of coma. The blood test showed a typically cirrhosis pattern including an elevated serum ammonia level. Abdominal computed tomography showed liver cirrhosis and thrombus in the right branch of the portal vein. To elucidate the cause of PVT, antiphospholipid antibodies were examined. Both IgG anti-cardiolipin antibody (ELISA) and IgG anti-cardiolipin-β2 -glycoprotein I complex antibody (ELISA) were positive. When PVT is detected in a patient with cirrhosis, it might be necessary to examine antiphospholipid antibodies to clarify the cause of PVT.

Evaluation of protein intake of patients with liver cirrhosis (LC) would facilitate optimal nutritional support. However, it has never been done on the basis of urinary urea nitrogen (UUN). The aim of this study, therefore, is to determine the usefulness of the estimated protein intake (EPI) based on UUN in patients with LC. A total of 42 patients with early-stage LC were enrolled in this study. The actual protein intake (API) was defined as the dietary protein intake (1.0 g/kg/d) plus supplementation of any enteral diets containing branched-chain amino acids (BCAA). We calculated EPI from UUN using the formula [UUN (g/d) + 0.031 x body weight (kg)] x 0.625. We examined the correlation between EPI and API, the EPI/API ratio (EAR), and the correction based on the results. A significant positive correlation was found between API and EPI (r = 0.703, p < 0.001). The EAR in all patients was 0.84 +/- 0.11. EPI times 1.2 was the correction needed to adjust EAR to 1. The corrected EPI was correlated with API (r = 0.704, p < 0.001). The corrected EAR of all 42 patients was 1.01 +/- 0.13. In conclusion, for patients with early-stage LC, an EPI calculated from UUN may be a useful tool for optimal nutritional support. The corrected EPI would be very useful for improved monitoring of early-stage LC.

We describe a case where intermittent and continuous administrations of a small amount of immune globulin were effective in the treatment of refractory chronic immune thrombocytopenic purpura by systemic lupus erythematosus (SLE). Steroid pulse therapy and cyclophosphamide pulse therapy were considered for thrombopenia. However, the patient had compressed fracture of the lumbar vertebrae due to osteoporosis and right external malleolus ulcer with complications of infection. Therefore, high-dose intravenous immune globulin (IVIG) therapy (400 mg/kg daily for 5 consecutive days) was administered. Then, as a maintenance therapy, a small amount of 400 mg/kg for 1 day (400 mg/kg monthly) was given in an intermittent and continuous manner, which resulted in improvement of thrombocytopenia and reduction of the amount of steroid administered. [PUBLICATION ABSTRACT]

A 53-year-old man was diagnosed with polymyositis (PM) in 1997 and treated with prednisolone. The subjective symptoms of pneumonitis were poor. However, the KL-6 values were elevated to 2230 IU/l in March 2001. Abdominal computer tomography findings revealed a pancreatic-tail tumor and multiple liver nodules, diagnosed as primary pancreatic adenocarcinoma with multiple liver metastasis. The stage of the pancreatic cancer was IV, and curative surgery of the tumor was not indicated. Chemotherapy and radiotherapy were administered for the liver metastasis. However, these therapies were ineffective against the tumors. The patient died on 12 September 2001. If a high level of KL-6 is found without the increasing activity of lung disease containing interstitial pneumonia in PM patients, examination for the internal malignancies including pancreatic cancer should be performed, although cases of PM with a significantly high level of KL-6 associated with pancreatic cancer are rare. [PUBLICATION ABSTRACT]

Hyperthermia (HT), in combination with other conventional therapeutic modalities, has become a promising approach in cancer therapy. In addition to heat-induced apoptosis, an augmented immunological effect is considered to be a benefit of hyperthermic treatment over chemo- or radiotherapy. Here, we investigated the effect of regional HT targeting the liver on immune cells, especially T cells and antigen-presenting cells, which are important in recognizing and eliminating tumor cells and pathogens such as viruses. In healthy volunteers exposed to such regional HT, both CD4(+) and CD8(+) T cells that express an activation marker CD69 increased transiently at 1 h post-treatment, with a subsequent decrease to base levels at 6 h after the treatment. At 24 h post-treatment, the percentage of CD69-positive cells significantly increased again but only among CD8(+) T cells. IFN-gamma production from PHA-stimulated peripheral blood mononuclear cells was gradually and significantly increased in the 2 days following the heating procedure, peaking at 36 h post-treatment. Furthermore, we found marked increases in plasma levels of IL-1beta and IL-6 starting at 24 h post-treatment. With regard to the number of each leukocyte subpopulation, a transient and dramatic decrease in the number of a subset of monocytes, CD14(+) CD16(-) cells, was observed at 1 h after the hyperthermic treatment, suggesting that the regional HT aimed at the liver may have influenced the extravasation of blood monocytes. No significant changes in T-cell activities or monocyte counts were observed in the volunteers exposed to heating of the lungs or the legs. These results suggest that heating of the liver may efficiently induce cellular immune responses to liver cancers.