Lanthanum carbonate hydrate has an inhibitory effect on phosphorus absorption and is reported to be deposited on the mesenteric lymph nodes, gastric mucosa, and bone. The lanthanide paramagnetic metal gadolinium is the main contrast medium used in magnetic resonance imaging (MRI). However, the influence of gadolinium on MRI has not been fully clarified. We used 1.5 T and 3.0 T MRI scanners to image lanthanum carbonate hydrate at concentrations of 0, 0.001, 0.003, 0.01, 0.03, 0.1, 0.3, and 1.0 mol/L using spin echo and gradient echo sequences. The resultant MRI artifacts were evaluated on T₁-, T₂-, and T₂^*-weighted images, and 1/T₁, 1/T₂, and 1/T₂^* values were calculated. Lanthanum carbonate artifacts were not produced under all experimental conditions. The concentration of lanthanum carbonate hydrate exhibited proportional relationships with 1/T₂ and 1/T₂^* (p<0.05), but had little effect on 1.5 T images. T₂ and T₂^* were shortened by lanthanum carbonate hydrate. Higher lanthanum carbonate hydrate concentrations reduced the signal intensity of T₂ images, but had little influence on T₁ values.

When we provide medical treatment to patients who refuse blood transfusions, we are occasionally faced with difficult decisions, as common medical practice regards resuscitation as the highest priority. The patient’s right to refuse both blood transfusions and treatment must be respected, but in life-threatening situations treatment policies must take medical, ethical, and legal considerations into account. To aid decision-making in cases such as those mentioned above, it is necessary to have developed a policy that is appropriate not only for the individual, but also for the hospital. We initiated hemodialysis therapy in a chronic renal failure patient who refused a blood transfusion. We discuss this case in terms of how the patient's religious values affected the treatment policy and the impact of this on risk management at our hospital.

A 66-year-old male, who had been on hemodialysis for 15 years due to diabetic nephropathy, was admitted to our hospital complaining of a fever that had lasted for 5 days prior to his admission. His primary fever workup revealed the reactivation of Epstein-Barr virus (EBV). Further examinations were conducted, which resulted in a diagnosis of multiple myeloma. Immune dysfunction associated with M-protein production by multiple myeloma was considered to have induced EBV reactivation. Chemotherapy resulted in remission. Thus, the patient recovered as a result of the early detection and treatment of multiple myeloma. This case showed that the reactivation of EBV due to decreased immune function can cause fever of unknown origin (FUO). Although it is rare, EBV it should be considered as one of the causes of FUO.