Anti-Ma-associated paraneoplastic cerebellar degeneration in a patient with nodular lymphocyte-predominant Hodgkin lymphoma: a case report

BACKGROUND

Paraneoplastic cerebellar degeneration (PCD) is a devastating paraneoplastic syndrome that occasionally occurs in patients with Hodgkin lymphoma (HL). Anti-Ma2 is a well-characterized onconeuronal antibody and one of the causes of PCD. There has been only one previous report of anti-Ma2-associated paraneoplastic syndrome as a complication of HL. Here we present a rare case of anti-Ma2-associated PCD in a patient with nodular lymphocyte-predominant HL (NLPHL).

CASE PRESENTATION

A 77-year-old man with a 3-month history of gait instability and a 2-month history of oscillopsia was referred to our hospital for further investigation. On examination, his cognition was normal. He had nystagmus in all directions of gaze; specifically, he had horizontal and rotatory nystagmus in the primary position, downbeat nystagmus after right, left, and up gaze, and upbeat nystagmus after down gaze. Although his limb ataxia was mild, his trunk ataxia was so pronounced that he was unable to walk without support. We strongly suspected paraneoplastic syndrome and tested for neuronal autoantibodies. The anti-Ma2 antibody was strongly positive in the blood and cerebrospinal fluid but other antineuronal autoantibodies were negative. Computed tomography showed an enlarged lymph node in the right axilla but no masses. Biopsy confirmed a diagnosis of NLPHL. The NLPHL cells stained with anti-Ma-2 antibody in the cytoplasm, suggesting these abnormal cells contained protein that was cross-reactive with Ma-2.

CONCLUSIONS

To the best of our knowledge, this is the first case of anti-Ma2-associated PCD in a patient with NLPHL that was confirmed using immunostaining of the lymph node tissue with anti-Ma2 antibody. Our case confirms an association between anti-Ma2-associated PCD and NLPHL.

Extracorporeal membrane oxygenation in Stenotrophomonas maltophilia pneumonia during acute myeloid leukemia: A case report

Stenotrophomonas maltophilia (S. maltophilia) is a Gram-negative, multidrug-resistant organism that both opportunistically infects the bloodstream and leads to pneumonia in immunosuppressed patients, including those with hematologic malignancies. In patients with severe respiratory failure, venovenous extracorporeal membrane oxygenation (VV ECMO) can stabilize the respiratory status. However, whether ECMO in patients with hematologic malignancies improves the clinical outcomes is still controversial because ECMO increases the risk of the exacerbation of sepsis and bleeding. We report a case of a 46-year-old man with Stenotrophomonas maltophilia hemorrhagic pneumonia acquired during consolidation chemotherapy for acute myeloid leukemia in whom VV ECMO lead to a good clinical outcome. The stabilization of his respiratory status achieved with VV ECMO allowed time for trimethoprim-sulfamethoxazole antibiotic therapy to improve the pneumonia. We suggest the background of patients, including comorbidities and general conditions, should be taken into account when considering the clinical indications of ECMO.

Taurine Analysis in Milk and Infant Formulae by Liquid Chromatography: Collaborative Study

A collaborative study was conducted on a liquid chromatographic (LC) method for determination of taurine in infant formula and milk powders. Twenty laboratories participated in the analysis of 8 blind duplicates over the range of approximately 3–60 mg/100 g sample. The method involved protein removal, conversion to the dansyl-derivative, and isocratic LC separation with UV and/or fluorescence detection. Following outlier treatment, overall mean RSDR has been estimated at 7.00% for sup. plemented products with a HORRAT value of 1.1. The poorer precision at endogenous levels establishes a lower limit of determination of about 5 mg/100 g. An overall mean RSDr:RSDR value of 0.7 for all products demonstrated acceptable performance.

Nutritional factors affecting length of hospital stay in patients undergoing cardiovascular surgery

Cardiovascular surgery is a highly invasive intervention that is often performed in elderly patients at risks of complications because of malnutrition and reduced immunity. This study investigated nutritional factors that affected length of hospital stay in patients undergoing cardiovascular surgery. Among 68 patients who underwent surgery at the Department of Cardiovascular Surgery of Gifu Municipal Hospital between April 2013 and March 2015, 55 with complete data were included in the analysis. Data on serum albumin (ALB), transferrin (Tf), pre-albumin (PA) and retinol binding protein (RBP) levels were collected. The median length of hospital stay was 29 days (stays of ≥30 days were considered long-term hospitalization). Multivariate analysis (multiple logistic regression) included age (≥ 65 years), sex (female), and ALB (≤ 3.0 g/dL), Tf (≤ 150.0 mg/dL), PA (≤ 10.0 mg/dL) and RBP (≤ 1.5 mg/dL) levels. ALB [odds ratio (OR) 10.37, 95% CI (confidence interval): 1.185-90.80, P = 0.035] and Tf [OR 4.743, 95% CI: 1.375-16.36, P = 0.014] were significantly associated with length of hospital stay. Nutritional management of patients and careful monitoring of ALB and Tf levels can shorten length of hospital stay in patients undergoing cardiovascular surgery.

P5616Risk stratification of cardiovascular events among patients with functionally non-significant coronary stenosis

Introduction

Deferral of percutaneous coronary intervention (PCI) of a functionally non-significant stenosis is associated with a favorable long-term clinical prognosis. However, to date, there has been limited evidence to stratify the risk for the development of cardiovascular (CV) adverse events in patients who were deferred of PCI due to a greater fractional flow reserve (FFR) than 0.80 at the target lesion.

Purpose

We aimed to stratify the risk of CV events in patients with functionally significant and non-significant coronary stenosis.

Methods

This observational study included 458 patients who were proven angiographically intermediate coronary stenoses and were measured FFR, of whom 298 deferred patients with FFR>0.80 and 160 intervened patients with FFR<0.80. The primary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE) including any death, non-fatal myocardial infarction, hospitalization due to heart failure, ischemic stroke and any unplanned revascularization. ROC curve for MACCE indicated the cut-off point of FFR as 0.85 and 0.76 in deferred patients and intervened patients, respectively.

Results

During the observation period, 27 MACCE (9.1%) in the Deferred group, and 33 MACCE (20.6%) in Intervened group were occurred. Kaplan-Meier curves showed a higher MACCE rate in the Intervened group than Deferred group (hazard ratio (HR): 2.19, 95% confidence interval (CI): 1.29–3.71, Figure A). However, even among patients in the Deferred group, the population with “intermediate” FFR (0.81–0.85) had a significantly higher MACCE rate than those with higher FFR (>0.85) (HR 2.55, 95% CI 1.14–5.69, Figure B). This rate was comparable to that of the Intervened group at the remote phase (at 4-year: 32.0% vs. 35.8%). Conversely, in the Intervened group, there was no statistically significant difference in MACCE rate between patients with higher FFR (0.76–0.80) and those with lower FFR (<0.76) (Log-rank: p=0.21, Figure C).

Conclusion

The population with relatively low FFR in patients who were deferred PCI by FFR>0.80 had comparable MACCE rate to patients with FFR<0.80. Close observation after the FFR evaluation should be considered in those population.

P4453Predictors of sustained ventricular arrhythmias during late phase in patients with reduced left ventricular ejection fraction after myocardial infarction

Background

Sustained ventricular arrhythmias (VAs) and death are feared events post myocardial infarction (post-MI). Patients with heart failure post-MI have higher risk of VAs, compared to those without heart failure. Although the risk of sudden cardiac arrest and death post-MI isn't small, previous clinical trials have failed to demonstrate the benefit of early use of implantable cardioverter defibrillators. Moreover, little is known about the relationship between the acute phase and the late phase VAs in patients with heart failure post-MI.

Purpose

The aim of this study was to determine the predictors of the late phase VAs in patients with heart failure post MI.

Methods

We retrospectively analyzed our database of MI patients from January 2012 to September 2016.

Results

A total of consecutive 460 post-MI patients were included in this study (age, 67±12 year-old; male, 336 (73%); STEMI, 281 (61%)). All the patients underwent primary percutaneous coronary intervention. Of those, 90 patients (20%) had depressed left ventricular ejection fraction (LVEF) ≤35%. After a mean follow up period of 30±16 months, 45 patients (50%) had VAs after MI. Among them, 35 patients (78%) had VAs within 48 hours after MI onset, 8 patients (18%) within 7 days 48 hours later, and 21 patients (47%) more than 7 days. Cox-regression analysis showed that VAs within 7 days 48 hours later after MI onset was significantly related to sustained VAs more than 7 days after MI onset (Hazard Ratio, 4.97; 95% Confidence Interval, 1.31–18.9; p=0.019).

Conclusions

VAs in the sub-acute phase after MI predicted sustained VAs in the late phase in this population. Prompt initiation of aggressive antiarrhythmic therapies, including catheter ablation, after MI should be considered to reduce the mortality.

IMPACT ON ABSORBED DOSE RATE IN AIR IN KANTO REGION BY FUKUSHIMA DAIICHI NUCLEAR POWER PLANT ACCIDENT

Absorbed dose rates in air were measured for the whole area of the Kanto region in 2015, 2016 and 2017 (n = 31 147). The mean absorbed dose rates in air for each prefecture measured by car-borne surveys were from 44 to 67 nGy h-1 (13-289 nGy h-1). The absorbed dose rate in air from artificial radionuclides (134Cs + 137Cs) measured by fixed-point observation (n = 507) was from 1 to 14 nGy h-1 (0-105 nGy h-1), and meaning that the contribution ratios of 134Cs and 137Cs were 3-22%. The deposited location of artificial radionuclides was less than 1000 m from ground level and depended on the topography, wind direction and precipitation field.