Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 22, Issue 10
Displaying 1-27 of 27 articles from this issue
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  • Studies on Blood Component Transfusion with Continuous Blood Cell Separator (IBM 2997)
    Part 1: Effects of Blood Component Extraction on Donors
    Hironobu TOKI, Morihiro ISHIKAWA
    1981 Volume 22 Issue 10 Pages 1525-1530
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1525
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    We studied the safty of blood component extraction procedure with continuous-flow cell separator (IBM 2997) for normal donors. The changes of CBC and blood chemistry before and after blood component extraction were investigated.
    1) The significant decrease of WBC, hemoglobin and hematocrit was seen in the leucocyte extraction group.
    2) The significant decrease of platelets and WBC was seen in the platelet extraction group.
    3) Indirect bilirubin, serum protein, albumin, calcium and inorganic phosphate decreased significantly after the procedure. Other liver and kidney function tests showed decreased values, because of dilution due to blood expansion by infusion of physiologic saline.
    4) In three cases among 34 donors mild citrate adverse reaction were noted.
    In conclusion, blood component extraction procedure with IBM 2997 is considerd a safe method for donors.
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  • Studies on Administration of S-Sulfonated Immunoglobulin (GGS) to Patients with Multiple Myeloma
    —The Method for Determination of Serum GGS Levels and the Metabolism in the Patients—
    Yoshikazu AKAHONAI, Toshiroh SUGIYAMA, Haruyasu YOSHIZAKI, Shigeyuki M ...
    1981 Volume 22 Issue 10 Pages 1531-1537
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1531
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    When S-sulfonated immunoglobulin (GGS) was administered to patients with multiple myeloma, difficulty was generally encountered in determining GGS levels in sera, because a large number of M-proteins interfered with serum GGS measurement. A new method for determination was devised, however, using single radial immunodiffusion in which anti-light chain (L-chain) serum against the opposite type of L-chain to the patient's M-protein was employed.
    By this method, the serum GGS levels given to these patients returned to the previous levels from 3 to 17 days after administration, and the catabolism of GGS in these patients seemed to increase in comparison with normal controls and patients with hypogammaglobulinemia. There, however, was no correlation between the catabolic rate of GGS and the concentrations of total serum protein, M-protein and residual immunoglobulins.
    From these results, it seems noteworthy that the GGS supplement for the treatment or prophyraxis of various infections in these patients was concluded within shorter periods than the 20 to 25 days that has been observed to be the half life of GGS in other patints. Therefore, this method would seem to be advantageous for the determination of dosage and course of the treatment.
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  • ACNP Therapy for DCMP-Resistant Acute Leukemia
    Tomoki NAOE, Akikazu HIRAIWA, Yukihiro AKAO, Toru TAHARA, Haruya YOSHI ...
    1981 Volume 22 Issue 10 Pages 1538-1544
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1538
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    A new combination chemotherapy codenamed ACNP was designed for DCMP-resistant acute leukemia.
    The protocol consisted of four to seven-day course of BH-AC 150mg/m2/day (DI) and prednisolone 20mg/m2/day (PO) along with ADR 25∼15mg/m2/day (IV) and NCS 1.5∼1.2mg/m2/day (IV) on the day 1, 2, 4 and 7. To achieve a very hypoplastic bone marrow (NCC 1×104/μl) on the day 7, the dose and the schedule were ajusted.
    19 courses of ACNP were administered in 14 therapy-resistant patients with the age from 15 to 69 (median 44); AML 6, APL 3, AMoL 2, AMMoL 1, ALL 2.
    7 cases (AML 4, APL 3) obtained complete remission. The median duration to reach CR was 25 days from the beginning of ACNP therapy. The median duration of CR and survival were 7 months and 12 months, respectively.
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  • Clonal Evolution in Relapse of Acute Lymphoblastic Leukemia
    Yasuhide HAYASHI, Yasuhiko KANEKO, Rokuo ABE, Masaharu SAKURAI
    1981 Volume 22 Issue 10 Pages 1545-1551
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1545
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    Sequential cytogenetic studies were performed in 5 patients with acute lymphocytic leukemia (ALL) who achieved remission and later had a relapse. One patient had tetraploidy in their leukemic cells at diagnosis as well as in relapse, in whom detailed studies were not possible. The other 4 patients showed 6 clonal evolutions in total. Three evolutions showed clones derived from the original ones seen at diagnosis, and another a clone which was entirely different from the original one. Another one was progression from diploidy to pesudodiploidy. In the remaining one, there was a shift in the modal chromosome number, but the exact nature of the evolution was not determined because of the insufticient analysis at diagnosis.
    The modal chromosome number had increased in one, decreased in two and unchanged in the others. Partial trisomy of chromosome 1 appeared in two patients, and karyotypic instability in one. Remission was not achieved after the discovery of the clonal evolution, and the median survival for the 4 patients after the evolution was only 3.3 months. Clonal evolution appears to be an unfavorable prognostic sign in ALL as it is in chronic myeloctic leukemia (CML).
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  • A Case with Two M-Components (IgG-κ, IgA-κ)
    Chihiro SHIMAZAKI, Kazuo NISHIDA, Yoshio TAKAHASHI, Yoshio FUKUMOTO, A ...
    1981 Volume 22 Issue 10 Pages 1552-1557
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1552
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    A Case with Two M-components (IgG-κ, IgG-κ) was reported.
    A 47 year-old female was admitted to our hospital for the further evaluation and treatment of liver dysfunction and low back pain on July 1979. Physical examination revealed mild anemia and tenderness of the lumber spine. Liver was not palpable. Laboratory findings were as follows. Erythrocyte sedimentation rate was normal 12mm/hr and Bence Jones protein in the urine was negative. Hematological examination showed mild anemia with a hematocrit value of 33.4%. Liver function test showed a ZTT of 12.6 units and TTT of 1.3 units. Serum electrophoresis showed an M-component of 15.5% and two M-components (IgG-κ, IgA-κ) were detected by immunoelectrophoretic studies. Serum IgG was measured to be 1700mg/dl, IgA 456mg/dl and IgM 47mg/dl by radial immunodiffusion method. Bone marrow examination showed 90000 nucleated cells/cmm with 9.4% plasma cell and the patient was considered to be in a premyelomatous stage with two M-components.
    Cytometric study was performed on plasma cells in the bone marrow smear and histogram of the nucleus-cytoplasma ratio (N/C ratio) showed double peaks in their distribution. Discussion was made on the reference to the clonality of two M-components based on the morphological studies.
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  • A Case of Splenic Hemangiosarcoma Complicated by Disseminated Intravascular Coagulation
    Masaki NAKAZAWA, Takashi HANADA, Haruo NAKAMURA, Toshiro NAGASAWA, Yas ...
    1981 Volume 22 Issue 10 Pages 1558-1564
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1558
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    A case of splenic hemangiosarcoma complicated by disseminated intravascular coagulation (DIC) was reported, with discussion of its splenic origin and Kasabach-Merritt syndrome.
    A 42-year-old man was transferred to Tsukuba University Hospital on Apr. 3, 1979, because of anemia, thrombocytopenia and hepatospenomegaly. He had had an episode of back pain on the left side 4 months before the admission. The blood count disclosed reticulocytosis. The peripheral blood smear showed erythroblasts, tear drop cells, fragmented red blood cells and Howell-Jolly bodies. The bone marrow aspiration was dry tap and a needle biopsy disclosed myelofibrosis. The ferrokinetic study suggested hemolysis and marked extramedullary hematopoiesis in the spleen. The coagulation study showed elevated FDP value and shortened plasma fibrinogen survival. As to the cause of hepatosplenomegaly, liver scintigram and celiac angiogram suggested hepatosplenic malignant tumors, probably hemangiosarcoma of splenic origin. A diagnosis of hepatosplenic malignant tumors with complications of secondary myelofibrosis, DIC and microangiopathic hemolytic anemia was made. During admission the malignant tumors gradually enlarged and DIC aggravated in spite of anticoagulation therapy. The patient died on June 24. The autopsy revealed an advanced hemangiosarcoma of splenic origin with extensive systemic metastasis and generalized hemorrhagic diathesis.
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  • An Autopsy Case of Multiple Myeloma with Disseminated Necrotizing Leukoencephalopathy
    Hiroko HIRAI, Torao TAKETANI, Masahisa MATSUMOTO, Kinya HAYAKAWA, Akie ...
    1981 Volume 22 Issue 10 Pages 1565-1571
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1565
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    The administration of cyclophosphamiade, melphalan, etc. to a 48-year-old woman who had IgG-K myeloma resulted in remission of the disease after 14 months. Subsequently, a serious orientational disorder occurred 6 months after the remission, followed by progressive dementia. Freqent attacks of spasm and serious clouding of consciousness occurred in the last stage of the disease. The patient died 6 years after the first consultation. Autopsy findings revealed the following: a decrease in brain weight (final wt., 920g); wide-ranging atrophy of and defects in the white matter of the cerebrum, especially, of the vertex and the occipital lobe; necrosis, demyelinization, and Alzheimer-II glia, mainly in the white matter of the vertex and the occipital lobe as histological findings. Some comments on this disease are also made on the basis of the related literature.
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  • A Case of Pure Red Cell Aplasia Terminated in Erythroleukemia
    Takayuki TAKAHASHI, Takashi HOSHINO, Shiro NAKAYAMA, Yoshiaki TAKASHIM ...
    1981 Volume 22 Issue 10 Pages 1572-1580
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1572
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    A 52-year-old man who had marked pallor showed severe anemia with nearly absent reticulocyte and distinctive bone marrow erythroid hypoplasia in association with normal WBC and platelet counts. No thymoma was found on chest X-ray. A clinical diagnosis of pure red cell aplasia (PRCA) was made, although a possibility of preleukemic state was suspected hematologically, based on such abnormal findings as presence of cytogenetic abnormal clone, 46, XY, t (8q-; 20q+) and ringed sideroblast in the bone marrow and appearance of rare blastoid cell and megakaryocyte in the circulating blood. Administration of piridoxin, prednisolone, cyclophosphamide and methenolone showed no effective response on his erythropoiesis except for a return of bone marrow M/E ratio toward the normal range.
    After 15 months from admission, following administration of folic acid, myeloblast and erythroblast began to appear in the circulation and gradually increased along with bone marrow erythroid hyperplasia with megaloblastoid change and excess myeloblast (8.6%), indicating erythroleukemic conversion. Five months later, hematological examination revealed blastic marrow, leukocytosis over 3×104 cells with 53% myeloblast and persisting same abnormal karyotype. He died of adrenocortico-insufficiency. An autopsy revealed erythroleukemic infiltration in the bone marrow, spleen, liver and kidney. The relation between PRCA and preleukemic state was discussed.
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  • An Adult Case of Long-term Survivor of Acute Lymphoblastic Leukemia
    Haruaki HOSHIZAKI, Yoko NIKI, Yuri BABA
    1981 Volume 22 Issue 10 Pages 1581-1586
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1581
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    A 55-year-old female had noticed enlargement of the lymph nodes in her right inguinal region in May 1971 followed by gradual anemia. The patient was admitted to our hospital in October 1971. Laboratory findings showed moderate anemia and lymphocytosis in which 60% were lymphoblasts. Bone marrow was highly cellular and more than 90% of the nucleated cells were lymphoblasts. Acute lymphoblastic leukemia was diagnosed. Therapy with vincristine, 6-MP, methotrexate and predonisolone for three weeks led to clinical and bone marrow remission. After achievement of complete remission, she received maintenance therapy with predonisolone only. Afterward the patient was hospitalized with gastric ulcer, pneumonia and Menier's syndrome, otherwise she had remained in complete remission. In May 1979, seven years and six months after the first achievement of remission, the patient relapsed with a few lymphoblasts in her peripheral blood. Bone marrow showed poor cellularity with 80% of lymphoblasts which indicated null cells by surface merker tests. In spite of therapy with various antileukemic drugs, the second remission was not able to achieved and she died in August 1980. The surviving period of the patient was about nine years after the onset of the illness.
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  • Report of a Case of Acute Myelofibrosis with Regression of the Bone Marrow Fibrosis on Autopsy
    Masaru OKUNO, Yoshiyuki KURATA, Takashi MACHII, Yoshio KANAYAMA, Akira ...
    1981 Volume 22 Issue 10 Pages 1587-1594
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1587
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    A 40-year-old man was admitted on April 1978 with 2 months history of anemia. The peripheral blood showed pancytopenia and 16 percent blast cells. Anisocytosis and poikilocytosis of red blood cells were not noted. No hepatosplenomegaly and lymphadenopathy were found. Bone marrow aspiration was unsuccessful, however the bone marrow biopsy showed the finding of myelofibrosis with foci of increased numbers of erythroblasts, megakaryocytes and blast cells. On the basis of these findings, a diagnosis of acute myelofibrosis was made. The blast cells were negative in PAS, α-naphthyl acetate esterase and naphthol ASD chloroacetate esterase, while were positive in peroxidase and acid phosphatase. The blast cells had no surface markers and TdT activity was positive. The blast cells increased in peripheral blood and bone marrow since May 1978. A good response was obtained with 6MP and vincristine, but the patient died on December 1978 from septicaemia caused by the citrobacter aerogeneus. On autopsy bone marrow showed marked regression of fibrosis with increased numbers of blast cells.
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  • A Case of Non-Hodgkin's Lymphoma with Huge Splenomegaly, Pancreatic Pseudocyst, and Intracystic Bleeding
    Tomoki OKAZAKI, Hisamaru HIRAI, Keiya OZAWA, Shigeru SHIONOYA, Akio UR ...
    1981 Volume 22 Issue 10 Pages 1595-1602
    Published: 1981
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.22.1595
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    A 44-year-old male patient was admitted to the hospital in March, 1980, complaining of a massive splenomegaly and was diagnosed to have non-Hodkin's lymphoma around the spleen, based on the pathological findings on laparotomy. He received BACOP chemotherapy with a marked improvement. However, there appeared another cystic mass in the upper abdomen during the treatment, which was suspected to be a pancreatic pseudocyst. Fortunately, it became smaller with the ordinary BACOP chemotherapy. After a successful treatment, he had been followed as an outpatient. In March, 1980 he was readmitted to he hospital, complaining of splenomegaly and systemic lymphnode swelling. In June, 1980 he died of systemic infiltration of malignat lymphoma despite an intensive chemotherapy and radiotherapy. At autopsy there was a large, necrotic lumen behind stomach, which involved spleen, pancreas, duodenum, and left-diaphragm. The inner wall of the lumen consisted of necrotic tissue of malignant lymphoma. There was no pancreatic pseudocyst in malignant lymphoma.
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