A Multicenter, Open-label, Clinical Trial to Assess the Effectiveness and Safety of Allogeneic Hematopoietic Stem Cell Transplantation Using Reduced-intensity Conditioning in Relapsed/refractory Anaplastic Large-cell Lymphoma in Children

No standard treatment for relapsed or refractory anaplastic large-cell lymphoma (ALCL) has been established. This study is a multicenter, open-label trial to examine the effectiveness and safety of transplantation with reduced-intensity conditioning (RIC) for patients under 20 years old with relapsed or refractory ALCL. We defined RIC as the administration of fludarabine (30 mg/m2/day) for five days plus melphalan (70 mg/m2/day) for two days and total body irradiation at 4 Gy, followed by allogeneic hematopoietic stem cell transplantation

The Effect of Interim FDG-PET-guided Response-Adapted Therapy in Pediatric Patients with Hodgkin’s Lymphoma (HL-14) : Protocol for a Phase II Study

This trial enrolls patients with untreated Hodgkin’s lymphoma aged<20 years at diagnosis and examines the effects of omitting radiation therapy if the FDG-positron emission tomography (PET) findings after two completed cycles of combination chemotherapy are negative. It thereby aims to determine whether patients who truly require radiation therapy can be identified by FDG-PET. If so, this modality could be used to omit radiation therapy for all other patients, decreasing the risk of serious long-term complications without affecting survival rates. The outcomes of patients for whom FDG-PET is used to assess early treatment response will also be determined

Cases of Pediatric Pyelonephritis: A Single-Center Retrospective Study from an Extended-Spectrum β-Lactamase-Producing Escherichia coli Endemic Area in Japan

Background: Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has been increasingly recognized as the cause of upper urinary tract infection (UTI) in children. We have been using flomoxef at our department since 2017 as the first-line empiric therapy for children diagnosed with UTIs, and we avoid using carbapenems, which are considered the first-line treatment for ESBL-producing E. coli. However, reports on the use of flomoxef for UTIs are limited, especially for pediatric patients. The presence of vesicoureteral reflux at the onset of pyelonephritis is a concern. Severe vesicoureteral reflux can lead to repeated UTI and future deterioration of renal function, but the indication for voiding urethrography, which closely examines the presence of vesicoureteral reflux complications, is controversial. Methods: We retrospectively reviewed the laboratory findings, treatment, and clinical course of 96 pyelonephritis cases experienced at our department over a 7-year period from April 2014 to March 2021. Results: ESBL-producing E. coli were identified as the cause of pyelonephritis in 51% of cases, and this value was significantly higher (88%) in 2017. No significant differences were found in the febrile period or recurrence rate between the flomoxef-initiated group and other antibiotics groups. We also examined clinical indicators to predict vesicoureteral reflux and found no significant differences in ultrasonographic findings of hydronephrosis. Conclusion: In the present series, 51% of all pyelonephritis cases were found to be caused by ESBL-producing E. coli, with a significant increase in recent years. Flomoxef may be a useful alternative to carbapenem for ESBL-producing E. coli and the initial antibiotic of choice for upper UTIs in children. The indication for voiding cystourethrography should be carefully determined

Idiopathic Adult Intussusception : A Case Report

Adult intussusceptions account for 5-10％ of all intussusception cases and are considered rare, whereas they are most commonly encountered in children. Among adult cases, idiopathic intussusceptions are pretty rare. A 36-year-old male was admitted to our hospital with abdominal pain. His body temperature was 37.0℃, the white blood cell count was 14,000/μl and CRP 0.01mg/dl. A standing abdominal X-ray showed slight niveau formation. Computed tomography demonstrated the multiple concentric ring sign. His condition detoriorated and a laparotomy was performed. Intraoperatlvely,a mass measuring six centimeters in diameter was seen in the left side of the hepatic flexure of the transverse colon. The diseased intestine was reducted with Hutchinson’s maneuver. No lesions or malignancy were found, however an ileocecal resection was performed to prevent recurrence of the intussusception. The resected specimen showed congestion and wall thickening. Pathological examination of resected specimen showed marked congestion and hemorrhage with coagulation necrosis. The patient’s postoperative course was uneventful and he was discharged from our hospital on the 10th postoperative day. After nineteen months’follow up,no recurrence of the intussusception has been seen. Reduction of the bowel followed by minimum bowel resection should be considered to prevent recurrence of the intussusception and to avoid short gut or adhesional ileus

Malignant Lymphoma of the Ileum Treated by Laparoscopically Assisted Bowel Resection : A Case Report

Primary malignant lymphoma of the small intestine is uncommon. We herein present a case of malignant lymphoma of the ileum, which was treated by laparoscopically assisted surgery. A 60-yearold male with lower abdominal pain and vomiting was admitted to our hospital. A standing abdominal X-ray showed niveau formation. Computed tomography demonstrated circumferential wall thickening in the terminal ileum. Laparoscopically assisted surgery was performed under a diagnosis of tumor of the ileum. Under laparoscopic exploration, tumor of the ileum was detected. Partial resection of the ileum and dissection of lymph nodes were performed extracorporeally. Histological findings demonstrated diffuse large atypical lymphocytes with vesicle-like chromatin and clear nucleolus. Immunologically, CD20 and CD79a were positive. These findings were compatible with those of diffuse large B-cell lymphoma. Paraintestinal lymph nodes were also involved. The postoperative course was uneventful. Neither gallium scintigraphy nor FDG-PET showed any scintillation. The patient was given R-CHOP therapy and is currently doing well with no sign of recurrence. In conclusion, we propose that laparoscopic surgery for malignant lymphoma of the small intestine is a feasible and promising therapeutic option, especially in a case demonstrating bowel obstruction, because this procedure is thought to be minimally invasive,allows quick postoperative recovery and shortened hospital stay could be expected

Dissetion of Superior Mesenteric Artery which Required resection of a Large Amount of the Small Intestine and the Colon : A Case Report

Superior mesenteric artery (SMA) dissection is rare. We herein report about a case of SMA dissection which required resection of a large amount of the small intestine and the colon. A 59-year-old male with vague lower abdominal pain and diarrhea was admitted to our hospital. An erect abdominal X-ray showed niveau. His condition deteriorated and on the fifth day from the onset, an enhanced computed tomography (CT) revealed the SMA was dissected along 3 cm of its length from its origin, and the blood supply to the small intestine was shuttered in association with false lumen formation. Finally, the patient was necessitated an emergency surgery. A grayish ischemic small intestine and ascending colon were seen along with a moderate amount of ascites. The ischemic part of the intestine was resected. Pathological findings revealed coagulation necrosis with inflammatory cell infiltration, blood congestion, and hemorrhage. This coagulation necrosis was compatible with hemorrhagic necrosis due to intestinal ischemia. In conclusion, enhanced CT was available for detecting SMA dissection. If a patient with acute abdomen of unknown origin is encountered, SMA dissection should be ruled out, because ischemic intestine due to SMA occlusion is time-dependent and life-threatening. Furthermore, in the case of extensive bowel resection, the management of short bowel syndrome is thought to be essential