Introduction : The purpose of this study was to clarify the effectiveness of a home exercise (HE) program for hemophilic patients.
Methods : An intervention study was conducted over twelve weeks for patients aged 16 to 60 years, inclusive. Exercise guidance to assist in the improvement of their knee function was provided to the patients. Using questionnaires and assessments of physical function, we measured the physical condition of the patients before and after HE. Guidance about the strengthening of knee extensor muscles, static stretching of knee flexor muscles and standing balance training, as well as advice for the promotion of physical activities, was provided on an individualized basis. Muscle force and range of motion of the knee, modified Functional Reach (mFRT), 10 meter walking time, and 3 minute gait distance were all measured. All patients were surveyed for bleeding frequency, activities of daily living (ADL), and health related quality of life (HRQOL : SF-36), respectively.
Results : Twenty-two patients with an average age of 37.2 years, were included in the analysis, with 86.4% of them having a history of severe of hemophilia (coagulation factor level <0.01 IU mL−1). There were significant improvements in strength of knee extensor and range of extension of the knees, mFRT, 10 meter gait time, 3 minute gait distance, ADL, and physical function of SF 36. There was a significant correlation between Ex for locomotive activities and change of 3 minute gait distance. No increase in bleeding frequency was noted.
Conclusion : HE for hemophilic patients is useful for the improvement of muscle force and range extension of the knees, mFRT, gait speed, and ADL. Individualised guidance for improvement of physical activities and knee function is necessary for improvement of overall physical function.

Two cases of secondary oral squamous cell carcinoma (SCC), which developed in recipients of hematopoietic stem cell transplantation (HSCT) for leukemia, are reported. The first patient underwent allogeneic HSCT for chronic myelogenous leukemia at 32 years of age. He suffered from chronic graft-versus-host-disease (GVHD) of the oral mucosa after HSCT, and has subsequently received immunosuppressive therapy. He experienced metachronous multiple SCCs in the maxillary gingiva and the dorsum of the tongue at 36 years and 40 years of age, respectively. The second patient received autologous HSCT for acute myelogenous leukemia at 22 years of age, and she did not experience GVHD after transplantation. SCC developed in the lateral border of the tongue at 27 years of age. PCR analysis detected both HPV16 and HPV18 in the tongue tumor of the first patient, and only HPV18 in that of the second patient, suggesting that the infection of high-risk HPVs was possibly involved in the development of post-HSCT oral cancers in these patients. Since risk factors for post-HSCT oral SCC are not yet well recognized, long-term close follow-up is necessary for the early detection of secondary oral cancers in all transplant recipients.