Summary:on day 35. When patients whose specimens tested positive for CMV by shell vial culture were treated with ganciclovir prophylactically, it prevented the development of CMV-IP From 1992 to 1995, 105 patients received PBSCT in our hospitals and we observed no incidence of CMV-pneufrom asymptomatic CMV infection. There are, however, few reports of the development to clinical CMV infection in monia. To clarify whether activation of CMV occurs in these patients, shell vial cultures, CMV antigenemia and patients receiving peripheral blood stem cell transplantation (PBSCT). From 1992 to 1995, 105 patients with leukemia, lymphoma every 1 to 2 weeks after transplantation to determine or solid tumors of advanced stage received PBSCT in our whether and when CMV was activated. Two patients hospitals. Seventeen patients were monitored for CMV actitested positive transiently by DNA-PCR but negative vation by three viral detection methods on day 35, and six throughout by both antigenemia and RT-PCR. These patients were monitored every 1 to 2 weeks. Details of 17 results suggest that the risk of CMV infection is low patients are given in Table 1. For prophylaxis of CMV because the incidence of CMV activation in patients infection, all patients received irradiated blood products receiving PBSCT is low.which were depleted of leukocytes by filters. They were Keywords: CMV; interstitial pneumonia; PBSCT; antialso treated with acyclovir at a dose of 15 mg/kg/day for genemia assay; shell vial culture method; RT-PCR method 30 days and anti-CMV antibody hyperimmune globulin at a dose of 200 mg/kg once a week for 3 months, and once every 2 weeks for the next 3 months after transplantation. 5CMV interstitial pneumonia (IP) is a significant complication after allogenic BMT (alloBMT). The incidence of Samples CMV-IP was about 20% and the mortality rate about 80% over a 10-year period.1-3 Prevention and treatment of Bronchoalveolar lavage (BAL) samples, peripheral blood CMV-IP is an important factor in improving the prognosis leukocyte (polymorphonuclear cells (PMNC) and monoof alloBMT patients. Recently, combined therapy with gannuclear cells (MNC)) samples and urine samples were ciclovir and anti-CMV hyperimmune globulin in the early taken from the patients on day 35 after transplantation. In stages of CMV-IP has been shown to improve survival, and addition, six of the patients were evaluated for the presence the mortality rate of such patients could be reduced to 10-of CMV antigen and DNA in PBLC using antigenemia and 20%. [4][5][6][7] To further reduce the mortality rate, it is necessary PCR methods every 1 to 2 weeks after transplantation. The to prevent the development to CMV-IP from asymptomatic BAL fluid was centrifuged and divided into supernatant CMV infection. 5,6 Schmidt et al 8 evaluated 104 patients (BALF) and pellet-containing BAL cells (BALC). BALF who had received alloBMT and from whom BAL was taken and BALC were prepared for CMV testing with shell vial culture and PCR methods. 5 × 10 4 cells obtained from cytospins ...

Key words cytomegalovirus infection, oral valganciclovir, progressive hearing loss.Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection. Approximately 10-15% of congenitally infected neonatal infants exhibit clinical evidence of congenital infection at birth. 1 This group is more likely to experience sequelae, including microcephalus, sensor neural hearing loss, cognitive, motor and visual deficits and seizures. 2 Previous studies have shown that approximately half of the children with symptomatic congenital CMV infection develop hearing loss, and the majority of these children experience continued postnatal deterioration of their hearing. 3,4 Ganciclovir is an antiviral agent that acts against herpes viruses and has been used successfully to treat CMV infection. 5 In addition, it has been reported that ganciclovir therapy, begun in the neonatal period in symptomatic infants with a CMV infection involving the central nervous system, prevents hearing deterioration. However, the efficacy of ganciclovir for hearing deterioration in patients beyond the neonatal period is unknown. 6 In this report we present the case of a five-month-old girl who was treated with oral valganciclovir for progressive hearing loss resulting from congenital CMV infection. Case report Clinical course before oral valganciclovir treatmentA 31-year-old pregnant woman was admitted to our hospital at 37 weeks of gestation with suspected intrauterine growth retardation and fetal bilateral lateral ventricle enlargements. She was a healthy woman of gravida 2, para 1, and had a healthy 3-year-old daughter who attended a kindergarten. She had worked in a dental clinic as a dental hygienist, including during her pregnancy. Her cytomegalovirus-specific immunoglobulin (Ig)M and IgG at 31 weeks of gestation were negative and positive, respectively.The female baby was born by vaginal delivery at 38 weeks of gestation. The umbilical artery pH was 7.309 and the Apgar score at five minutes was 7. The bodyweight, height and head circumference at birth were 2338 g (below 10th percent tile), 44.5 cm and 29.5 cm (below 10th percent tile), respectively. The baby's general condition was relatively good, and did not show hepatosplenomegaly or external malformation at birth. Although an ultrasonography of the head revealed the bilateral lateral ventricle enlargements and hypocerebellum, the presence of intracranial calcification was unclear. She was diagnosed as having congenital CMV infection at the first week of life by newborn screening for congenital CMV by urine specimen, which was one of the ongoing projects of a research group in the Ministry of Health, Labor and Welfare in Japan. Pediatricians, ophthalmologists, microbiologists and otolaryngologists in our hospital started regular checkups on her.The patient's bodyweight and head circumference at 1 month of age were 3364 g and 34.7 cm, respectively. She showed normal eye movements from 2 months of age. However, her head control was insufficient, and an assessment by developmen...

:Objectives : To evaluate whether peripheral arterial catheter management is more effective than umbilical arterial management in very preterm neonates.Methods : Thirty -eight very preterm neonates born in Fukushima Medical University Hospital between October 2008 and March 2010 were evaluated. A peripheral arterial catheter was inserted in 19 neonates (peripheral group) and an umbilical arterial catheter in the remaining 19 neonates (umbilical group).Results : The median gestational ages of the peripheral and umbilical groups were 195 and 185 days, respectively (p=0.04). The systolic and diastolic blood pressure (BP) was significantly higher in the peripheral group than in the umbilical group (p=0.03 and p=0.001). There was a significant relationship between BP at cannulation and urinary output after cannulation for 24 h in the peripheral group (r s =0.49, p=0.03) ; however, no such significant relationship was found in the umbilical group.Conclusions : We considered that peripheral artery catheters provide a well -functioning route for continuous BP monitoring, even in very preterm neonates. Because umbilical catheter placement might affect urinary output, we speculated that peripheral arterial catheter placement would be a more effective management strategy than umbilical arterial catheter placement in very preterm neonates. Further studies of larger populations are necessary to evaluate the effectiveness of arterial management including long -term follow -up studies.

CGD is a rare inherited immunodeficiency disorder that is caused by disability of oxidative killing. We presented a two-yr-old boy with CGD who was suffering from multiple systemic abscesses. He received the first BMT from his HLA-haploidentical mother after conditioning with Flu, melphalan, and ATG. Although the maximum of 42% donor chimerism was achieved, it disappeared 73 days after the BMT. Then, we performed 5/6-matched unrelated cord blood re-transplantation after conditioning with Flu, Bu, and TBI (2 Gy). Engraftment and complete donor chimerism were achieved on days 18 and 19, respectively. The patient is now free from infection and maintains complete donor chimerism without GVHD 36 months after the cord blood re-transplantation. We postulate that the unrelated CBT has a potential to be an alternative strategy and might be beneficial for patients with CGD who do not have an HLA-identical donor.

Idiopathic hyperammonemia (IHA) has been described as a complication of intensive chemotherapy for the treatment of hematologic malignancy but has subsequently been found in patients undergoing bone marrow transplantation and in those with solid tumors treated with 5-fluorouracil. Although IHA is a rare complication, it is sometimes associated with high mortality in hematologic malignancies. Here we report the case of a 15-year-old boy in whom hyperammonemia developed during the initial treatment with prednisolone for newly diagnosed acute lymphoblastic leukemia and who survived after early detection and oral lactulose therapy. To the best of our knowledge, this is the first report of IHA that was not induced by intensive chemotherapy, stem cell transplantation, or asparaginase therapy in a patient with newly diagnosed leukemia, but developed during an initial treatment with a steroid. Early detection of IHA by measuring the plasma ammonia level in patients with neurological symptoms may improve the outcome.