[Epidemiological study of factors associated with quitting a job among pregnant working women].

OBJECTIVE: More women in Japan continue to quit a job when they find out they are pregnant than in other industrialized countries. The purpose of this study was to clarify factors affecting the quitting rate among female workers who become aware they are pregnant. METHODS: All pregnant women visiting or admitted to seven obstetrics medical institutions in Nara Prefecture between November and December 2004 for examination or delivery were surveyed. Of these women, 603 who were working when they discovered their pregnancy were subjects of the analysis. Quitting a job was treated as an event occurrence, and those working at the time of the survey were considered censored cases. The Kaplan-Meier method was used to determine the trend of the quitting rate associated with gestational weeks. The Cox proportional hazard model was used to examine the relationship between quitting a job and workplace factors such as number of staff at the workplace, types of employment, and availability of a legal maternity protection system, and individual factors such as age and thoughts (both subject's and husband's) on continuing work. RESULTS: The quitting rate up to delivery was 63.1%, but this increased to 69.8% when limited to pregnancy with a first child. Significantly independent factors behind continuation of work after discovering pregnancy were the following: receiving time off for medical examinations (HR=0.59, 95% CI (0.41-0.83)), availability of a child care leave system (0.37 (0.22-0.63)), arranged support system after returning from maternity and child care leave (0.60 (0.42-0.87)), workplace ambience is supportive of working after marriage and childbirth (0.59 (0.43-0.81)), and the subject (0.63 (0.43-0.93)) or husband (0.50 (0.30-0.86)) considers it good to continue working during pregnancy. In contrast, a non-regular employee (1.93 (1.46-2.56)) and being young (1.74 (1.10-2.75)) were factors behind quitting a job. CONCLUSIONS: Key conditions that encourage work continuation after becoming aware of pregnancy include creative adjustments at the workplace, motivating women and their husbands to consider work intentions, and having an established legal maternity protection system in the workplace. Moreover, comprehensive implementation of a child care leave system that is not available to all non-regular employees is also desirable.

Multiple myeloma with a variant Burkitt-type translocation, t(2;8)(p12;q24), associated with hyperammonemia.

We report an 82-year-old Japanese woman with multiple myeloma (MM). She developed disorientation due to hyperammonemia after melphalan and prednisolone therapy and abruptly died with a rapid clinical course. Karyotypic analysis of bone marrow showed complex abnormalities including a variant Burkitt-type translocation, t(2;8)(p12;q24), but the patient had IgG-lambda type M-proteinemia. Although patients with MM associated with hyperammonemia have been sporadically reported and their prognosis is poor, specific chromosomal abnormalities in the lesion have not been well characterized. It is, therefore, important to accumulate such patients to find a possible relationship between hyperammonemia and chromosomal abnormalities.

Richter's syndrome presenting as a nasal lymphoma.

Richter's syndrome (RS) is a high-grade large cell lymphoma arising in patients with B-cell chronic lymphocytic leukemia (CLL). The prognosis of RS is very poor and the development of RS is a serious complication of CLL. We present a case of a patient with a 4-year history of B-cell CLL who developed diffuse large B-cell nasal lymphoma. The patient exhibited good response to chemotherapy and irradiation and achieved complete remission. Five months later, the patient suffered leptomeningeal involvement and has been treated with repeated intrathecal chemotherapy. Leukemic cells of the patient expressed CD13. CD13+ CLLs have been reported to have an unfavorable prognosis and this case may support the view.