The dissolution rates of rare earth oxides and two types of rare earth containing functional materials into water, saline solution, and Gamble's fluid were measured in order to evaluate the ...biological effects of rare earth-containing functional materials. The tested materials were yttrium, lanthanum, cerium and neodymium oxides, and neodymium-boron-iron magnet alloy (NdBFe) and lanthanum-mish-metal-nickel-cobalt (LmNiCo) hydrogen-containing alloy. The dissolution rates of the rare earth oxides were very low, resulting in concentrations of rare earth elements in the test solutions of the order of ppb. In the most extreme case, Gamble's fluid dissolved 1,400 times more of the rare earth oxides than pure water. Fairly high concentration of neodymium were found in the dissolving fluids, which means that trace neodymium present as an impurity in each rare earth oxide dissolved preferentially. For yttrium oxide, the ratio of neodymium to yttrium that dissolved in the saline solution was greater than 78,000 to 1, taking into account the amount of each that was originally present in the yttrium oxide.
We report three cases of fusariosis that occurred during the treatment of acute leukemia, during the past 5 years at our institution. Case 1: A 70-year-old male with relapsed and refractory acute ...lymphoblastic leukemia (ALL) developed fever and multiple nodular lesions in both the lungs. Blood culture that was subsequently obtained revealed Fusarium species. Treatment with liposomal-amphotericin B (L-AMB) was ineffective, and the condition of the patient deteriorated rapidly leading to death. Case 2: A 28-year-old male with T-ALL developed echthyma gangrenosum (EG) ulcers on the scrotum during conditioning for transplantation. Antifungal therapy with L-AMB was ineffective, and later, itraconazole and micafungin (MCFG) were introduced. However, the engraftment was not achieved, and the patient died on day 27. Microbiological examination of EG samples collected on day 13 revealed infection by Fusarium species post mortem. Case 3: A 50-year-old male with blast crisis of chronic myeloid leukemia developed EG primarily on the trunk during chemotherapy. The patient died without any response to L-AMB and MCFG. A culture obtained from EG on day 19 yielded Fusarium species, post mortem. The prognosis of fusariosis is extremely poor. However, skin lesions such as EG may assist in the early diagnosis of the disseminated disease.
We report a case of a type 2 diabetic patient with end-stage renal disease (ESRD) who experienced repeated pyrexia after each hemodialysis session due to acetate intolerance. A 62-year-old man with ...type 2 diabetic kidney disease was admitted to our hospital for dialysis initiation. Since the first dialysis session, he had experienced general malaise and fever with temperatures of 37～39℃ after dialysis. On the basis of intensive laboratory examinations, no evidence suggestive of the presence of infection, cancer or collagen diseases was demonstrated. The endotoxin concentration in the dialysate was within the acceptable range. Changes of the dialyzer membrane and anticoagulant agent were unsuccessful. Finally, we changed from bicarbonate dialysate containing a small amount of acetate to completely acetate-free dialysate, which effectively led to disappearance of the pyrexia. Given the clinical course, the cause of the pyrexia was considered to be acetate intolerance. We need to add acetate intolerance to the list of differential diagnoses of pyrexia associated with hemodialysis.
1)The Keio University School of Medicine introduced a "white coat ceremony" in 2006 and the taking of an oath written by medical students in 2007 for fourth–year students as part of medical ...professionalism education just before the start of clinical clerkships. 2)Through activities in 2009, the oath–writing project was highly evaluated by students, and 84% of students felt that Keio University should continue the project. 3)A challenge for the future is finding new ways to encourage more students to participate in the project.
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