Efficacy of imatinib mesylate (STI571) treatment for a patient with rheumatoid arthritis developing chronic myelogenous leukemia

We report on an 80-year-old man with rheumatoid arthritis (RA) who presented with chronic myelogenous leukemia (CML). Five years after the onset of RA, the CML diagnosis was made. The patient was treated for CML with 300 mg of imatinib mesylate (STI; signal transduction inhibitor 571) for 8 weeks. Laboratory tests showed that the C-reactive protein level, percentage of cells exhibiting the Philadelphia chromosome (Ph1), WBC count, and Lansbury index for RA all dropped respectively from 7.5 mg/dl to 1.0 mg/dl, 74.9% to 1%, 25, 100/microl to 9900/microl, and 51% to 14%. Administration of imatinib mesylate is felt to be effective in treating not only CML but also RA in the active stage.

Microdiscectomy and second operation for lumbar disc herniation

To prevent recurrence and avoid the second operation, the authors analyzed the clinical features and surgical outcome of 214 patients (157 males and 57 females) who underwent lumbar microdiscectomy, 16 of whom required second operation. The mean age was 34.6 years (range, 12-62 years). The average follow-up period was 4 years 5 months. The overall incidence of second operation was 7.5%. Second operation was performed because of recurrence of herniation in nine patients, and residual bony compression at the lateral recess in two. The incidence of second operation was significantly higher in teenagers than in patients in other age decades (P < 0.01), and in patients with protrusion-type herniation than in those with extrusion-type or sequestration-type herniation (P < 0.01). To prevent the necessity for second operation, careful and thorough discectomy, especially deep to the posterior longitudinal ligament, and decompression at the lateral recess are useful.