Acquired hemophilia is a rare disease, diagnosed in individuals without any prior bleeding history. The incidence rate is reported to be 1 to 4 patients per million population. We report a case of acquired hemophilia diagnosed incidentally on postoperative bleeding after tooth extraction. A 71-year-old man was referred to our department because of postoperative bleeding after extraction of the lower anterior teeth. The patient had no previous episodes of bleeding tendency. Initial laboratory evaluation revealed a prolonged activated partial thromboplastin time (APTT) and decreased coagulant activity of factor VIII . Further examination revealed the presence of factor VIII inhibitors at the value of 3 Bethesda units. In our patient, the use of activated factor VII concentrates, effective for severe bleeding tendency in patients with acquired factor VII inhibitors, was unnecessary. He successfully responded to treatment with factor VIII concentrates and corticosteroids to control hemorrhage and inhibit the formation of autoantibodies against factor VIII (factor VIII inhibitors).
We designed chemotherapeutic regimens combining docetaxel (TXT) and TPP (THP-ADM, CDDP, PEP) or TXT and TPF (THP-ADM, CDDP, 5 FU) for the treatment of oral squamous cell carcinomas and evaluated their primary effects. Nine patients were treated. Forty milligrams of TXT per square meter was administered on day 2 intravenously. The patients were 6 men and 2 women 43 to 55 years of age (mean age, 50) years at presentation. The primary site was the tongue in 6 patients and the mandibular gingiva in 2. TNM classification was T 2 in 4 patients, T 3 in 2, T 4 in 2, and N 2 b in 2. All cases were M 0.The response rate with a combination of TXT and TPP was 100% (CR 50%, PR 50%) and that with a combination of TXT and TPF was also 100% (CR 50%, PR 50% ) . Among the 5 patients who additionally received surgery, the Ohboshi & Shimozato classification was II B in 3 and N B in 2.The main side effects were febrile neutropenia, anorexia, and stomatitis, but there was no effect on subsequent treatment.We conclude that our chemotherapeutic regimens are effective against oral squamous cell carcinoma.
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