Early ambulation after total knee arthroplasty prevents patients with osteoarthritis and rheumatoid arthritis from developing postoperative higher levels of D-dimer

This study aimed to clarify the therapeutic effects of postoperative ambulation after total knee arthroplasty (TKA) on deep venous thrombosis (DVT) in patients with osteoarthritis (OA) and rheumatoid arthritis (RA) after TKA. Subjects of this study were thirty-seven inpatients (21 inpatients : OA, 16 inpatients : RA) undergoing TKA (32 female and 5 male). Subjects were divided into two groups, deep venous thrombosis (DVT) group (n=25) and non-DVT group (N group, n=12). The cutoff value was 10.0 g/ml plasma D-dimer level measured on 7th postoperative day. The N group was below the cutoff value. Another cutoff value divided into two groups, ambulatory group (n=26) and non-ambulatory group (n=11). Ambulatory group was the date of ambulation beginning below 7th day. Statistical analysis confirmed that all subjects showed a significant correlation to the date of ambulation. Postoperative ambulation beginning had strong association with the level of D-dimer (r=0.71). Group comparison showed that the non-ambulatory group had significant higher values of D-dimer than ambulatory group (P=0.022). Typical case supported these results. Postoperative early ambulation within a week after TKA kept patients with OA and RA after TKA lower level of D-dimer

Two cases of retroperitoneal hematoma caused by combination of anticoagulant therapy and 5-fluorouracil

We reported two cases of retroperitoneal hematoma in patients who received a combination of anticoagulant therapy and5-fluorouracil (5-FU). We should be aware of the possible interaction of this combination therapy and monitor prothrombin time (PT) prolongation. CT is useful for evaluation of the disease

ミゾリビンによる急性尿酸性腎症とメソトレキサートによる骨髄抑制を併発した1例

症例は83歳,男性.近医で関節リウマチの診断で加療(プレドニゾロン2mg,メソトレキサート(MTX)4mg),他に高尿酸血症,高血圧で加療中であった.当院へ入院13日前にミゾリビン(MZ)150mg追加投与された.入院2日前に食欲不振と全身倦怠感で近医を受診,尿素窒素99.5mg/dl,クレアチニン7.8mg/dlと急性腎不全を認めたため当院へ紹介入院した.入院時の検査所見で尿酸26.5mg/dLと著明な高尿酸血症を認めMZによる急性尿酸性腎症と診断した.そのためMZ及び尿酸の除去を目的に緊急血液透析を施行した.尿酸値及び腎機能は速やかに改善した.しかし,入院後より血小板及び白血球数の減少を認めた.骨髄検査では骨髄異形成症候群様であり,MZに加えMTXの関与を推測された.その後汎血球減少も改善している.本症例はMZの血中濃度も高くMZの排泄遅延による高尿酸血症のため急性腎不全を合併し更に腎機能の増悪がMTXによる無効造血を発症した可能性が考えられた.MZと尿酸も血液透析により体外への除去が可能でありMZによる急性尿酸性腎症の場合は早急な血液透析が有効である.An 83-year-old man was diagnosed with rheumatoid arthritis at a nearby hospital for which he was administered methotrexate (MTX) and prednisolone. Thirteen days before admission, he had started mizoribine (MZ) 150mg. Two days before admission to our hospital, he was admitted to a nearby hospital for appetite loss and general fatigue. Laboratory tests showed renal dysfunction at nearby hospital, and he was consequently admitted to our hospital for further examination. On admission, we reasoned that renal dysfunction had resulted from hyperuricemia during MZ administration because the serum concentration of uric acid (26.5mg/dL) and MZ (trough level, 5.14μg/mL) were markedly elevated. Accordingly, MZ treatment was terminated, and hemodialysis was initiated. The patient subsequently showed an improvement in his condition and renal function recovered. However, pancytopenia developed soon after admission, and bone marrow aspiration showed myelodysplastic syndrome-like lesions. We suspected MTX and MZ to be the main cause of pancytopenia. Because the onset of acute renal failure had been attributed to MZ, it was conjectured that the dose of MTX was too high. Therefore, MTX administration was cancelled, and pancytopenia ameliorated. In cases of transient renal dysfunction with MZ, it is necessary to consider discontinuation of MZ and initiation of hemodialysis