TakaTsuki s et al.

A 9 year old boy with acute lymphoblastic leukemia (ALL) received recombinant human granulocyte colony‐stimulating factor (rhG‐CSF) and showed a marked increment of myeloblasts in the peripheral blood. He was administered repeated courses of intermediate‐dose cytosine arabinoside (Ara‐C) therapy (1500 mg/m2, days 1–5) for frequent central nervous system (CNS) relapse of ALL. The peripheral white blood cell nadir was less than 1000/μL, so he was treated with rhG‐CSF. A marked increment of peripheral blood blasts was noted 3–5 days after rhG‐CSF treatment. These cells decreased with the appearance of mature myeloid cells and disappeared about 2 weeks after the start of treatment. These findings suggested that the blasts might have the ability to differentiate into mature myeloid cells. A control patient with repeated CNS relapse of ALL showed no increment of peripheral blood blasts after similar repeated courses of Ara‐C without rhG‐CSF treatment. Cultured peripheral blood blasts obtained from the present patient showed differentiation into mature myeloid cells by morphological studies and surface marker analysis. These findings indicate that the peripheral blood blasts drawn by G‐CSF were not leukemic blasts but normal myeloblasts.

Background: The aim of this study was to determine preferences regarding transfer of patients with congenital heart disease (CHD) attending a children's hospital in Japan and related factors. Methods and Results: We conducted a self-administered questionnaire survey with CHD patients >15 years of age treated at the pediatric cardiology outpatient clinic of a children's hospital. Logistic regression analysis was used to identify factors related to patient preferences regarding the transfer. One hundred and eleven of the 122 patients given a questionnaire provided valid responses (valid response rate, 91.0%). Sixty-six subjects (64.9%) reported "not being told anything specific" by their physicians about the transfer from the children's hospital, and 72 (59.5%) stated that they "wished to continue attending the children's hospital". Visiting outpatient clinic with parents (OR, 11.00; 95% CI: 2.01-60.97), having low uncertainty about continuing to attend the children's hospital (OR, 0.95; 95% CI: 0.92-0.98), and having high uncertainty about leaving the current physician (OR, 1.04; 95% CI: 1.01-1.07) were significantly related to the patient's wish to continue to attend the children's hospital. Conclusions: There is a need to improve patient education regarding the opportunities for transfer, and to develop a systematic transition program for children's hospitals and aligned specialized adult CHD centers.

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Although varicella is a benign and self-limited disease in children, serious complications can occur. We herein report a case of a 15-month-old boy who required a permanent pacemaker because of complete atrioventricular block as a complication of varicella. Universal vaccination is warranted to prevent such a potentially fatal complication in Japan where varicella is still endemic.