[Hypereosinophilic syndrome accompanied with digital gangrene: efficacy of therapeutic angiogenesis by autologous bone marrow mononuclear cells transplantaion].

A 62-year-old-man presented to our hospital with complaints of coldness, numbness, pain, weakness and cyanosis on the fingers and toes in March 2010. Laboratory findings revealed marked eosinophilia (46.6%; WBC 20600/µl), an elevation of serum creatine kinase, proteinuria and hematuria. He was diagnosed as hypereosinophilic syndrome (HES) without evidence to support a diagnosis of underlying diseases causing eosinophilia. After the initiation of corticosteroid therapy, peripheral eosinophil count was dramatically decreased, and both serum CK value and urinary findings became normalized. However, his symptoms persisted and digital necrotic changes developed. Angiography of the bilateral upper and lower extremities showed multiple arterial occlusions with poor collaterals. The digital gangrenes were unresponsive to peripheral circulation ameliorators and gradually progressed. In July 2010, autologous transplantation of bone marrow mononuclear cells was performed for achievement of therapeutic angiogenesis. His digital skin color was ameliorated by the angiogenic therapy in two weeks, and digital gangrenes did not progress after that. After amputation of his fingers and toe, cut surfaces healed with favorable epithelization, and the symptoms were subsequently eliminated. Moreover, during three years after the therapy, as well as the effect on the skin lesion, the significant improvement in peripheral circulation was observed. Therefore, we proposed that therapeutic angiogenesis by autologous bone marrow mononuclear cells transplantation was a novel and effective treatment for intractable digital gangrene associated with HES.

[Reference range of the auditory brainstem response for the patients in the NICU].

Since the auditory brainstem response (ABR) test is a test for the brainstem capacity and hearing function, it is recorded at the discharge from the neonatal intensive care unit (NICU) in our hospital. Although the reference range for the normal full-term newborn infants is well documented, that for the pre-term newborn and/or low birth weight infants is yet to be determined. The latency between wave-I peak and wave-V peak (I-V inter peak latency) on the ABR test was measured on the 254 infants (124 males and 130 females) of 36 to 45 corrected weeks old which was defined as the sum of the gestational weeks and weeks after birth at the test. The reference range for each corrected age group is set as mean +/- standard deviation. The mean value tends to be short as the corrected age increases, while it is not affected by the gestational weeks, body weight on birth, blood bilirubin level, neonatal asphyxia (defined as Apgar score at 1 minute after birth is less than 5), or intrauterine growth retardation. Eight out of 254 patients showed the abnormal values; among the 8 patients, 3 had brain diseases (intraventricular hemorrhage, intracranial hemorrhage, and microcephaly) and 1 with Down's syndrome. Thus the brain stem function testing at a discharge from NICU is important for the neurophysiological prognosis of the patients and the ABR test with the reference range defined here can be a useful tool.