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Volume 24, Issue 5
Displaying 1-21 of 21 articles from this issue
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[in Japanese]1983 Volume 24 Issue 5 Pages 487-490
Published: 1983
Released on J-STAGE: January 26, 2009
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[in Japanese]1983 Volume 24 Issue 5 Pages 491-497
Published: 1983
Released on J-STAGE: January 26, 2009
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[in Japanese]1983 Volume 24 Issue 5 Pages 498-506
Published: 1983
Released on J-STAGE: January 26, 2009
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Masatoshi HAYASHI, Hideo TOKUHIRO, Fumio KUTO, Ryuichi KIKAWADA, Yasus ...1983 Volume 24 Issue 5 Pages 507-516
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSLeucine aminopeptidase (LAP) activity was quantitated using leucine amide as the substrate (LA activity) and its isozyme pattern was studied in sera, peripheral leukocytes and lymph node tissue extracts from normal individuals and patients with various hematological and lymphogenous disorders. Serum LA activities in patients in transitional and blastic phases of chronic myelogenous leukemia (CML) were elevated and higher than those in chronic phase of CML. LA activities were elevated in serum from patients with T cell lymphoma and all types of malignant lymphoma except for a patient with B cell lymphocytic lymphoma in advanced stages (IVB and leukemic). Serum LA activities were also elevated in patients with benign lymphadenitis which affected exclusively the paracortical area of the lymph node. LA activities in granulocytes from patients with CML were lower than those in normal granulocytes. Blastic cells from patients with acute myeloblastic and lymphoblastic leukemias showed lower activities than any other leukocytes. In leukemic monocytes from patients with acute monocytic leukemia, the mature monocytes showed higher LA activities than the immature monocytes. Lymph node tissue extracts from patients with T cell lymphoma differed from those with B cell lymphoma in having higher LA activities. The isozyme pattern of serum with elevated LA activity always showed a higher activity in the β fraction and zymograms of leukocytes and lymph node tissue extracts from all patients except for a few patients with CML showed most of these LA activities were electrophoreticaly demonstrated in the β fraction.
Serum LA activity appeared to well reflect the progress and recovery of some hematological and lymphogenous disorders, and to provide a useful parameter for the evaluation of patients with these disorders.View full abstractDownload PDF (605K) -
Satoshi YOSHIKAWA, Akikazu HIRAIWA, Yukihiro AKAO, Hiroshi SAO, Tatsuy ...1983 Volume 24 Issue 5 Pages 517-525
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSIn patients with leukemia and aplastic anemia who received allogeneic bone marrow transplantation, the association between titer of antibodies in serum to cytomegalovirus (CMV) and herpes simplex virus (HSV) using complement fixation (CF) method and their infections was analysed.
(1) All seven patients examined had CMV infections following transplantation and they had negative or very low CF titer to CMV prior to marrow graft.
(2) Three patients who had the titer more than 1: 512 after marrow transplantation recovered from CMV infections.
(3) A large number of granulocyte transfusions from random donors were performed in all patients. The association of granulocyte transfusions with CMV infections was strongly suspected.
(4) 321 persons of 371 healthy donors (62.3%) had negative CF antibodies to CMV. It was considered that seronegative donors should have priority as potential donors of granulocyte transfusions.
(5) Four seronegative patients for HSV prior to marrow graft did not develop HSV infection. Five out of seven seropositive patients before transplantation, however, were suffered from HSV infection following marrow graft.
(6) Whenever patients had more than 1: 128 titers to HSV, no symptome of HSV infection appeared.View full abstractDownload PDF (654K) -
Yoshiaki SONODA, Taira MAEKAWA, Junichi EDAGAWA, Masafumi TANIWAKI, Sh ...1983 Volume 24 Issue 5 Pages 526-532
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSCytogenetic studies of erythroid progenitor cells (CFU-E, BFU-E) were performed in three patients with Ph1-positive CML. In 2 patients cytogenetic studies were simultaneously carried out on myeloid progenitor cells (CFU-C). Erythropoietic colonies were prepared using a methylcellulose culture method originally described by Iscove et al. (1974) with modifications. Myeloid progenitor cells were assayed in methylcellulose culture using a human placental conditioned medium (HPCM) as a colony stimulating factor.
On the 7th day of culture, there were two types of erythroid colonies originated from CFU-E and BFU-E. The former consisted of 8 to 50 cells of poly-and/or orthochromatic erythroblasts. On the other hand, the latter comprised 80 to 100 cells of basophilic erythroblasts. Mitotic indices were 3.2% for CFU-E and 4.5% for BFU-E, respectively. The Ph1-negative cells were found in the chronic phase of 2 patients with CML. Three out of 9 (33.3%) analyzable metaphases obtained from BM BFU-E of case 2 were Ph1-negative. Conversely, 56 metaphase cells obtained from BM CFU-C were uniformly Ph1-positive. Case 3, which was diagnosed as CML 8 years ago and now in remission, showed a high incidence of erythroid colony formation of bone marrow cells. In this case, 2 out of 104 (1.9%) analyzable metaphases obtained from BM CFU-E were Ph1-negative. In case 1, which showed an abnormal erythroid colony formation in the blastic phase, double Ph1 chromosomes and lp- marker chromosome were found in metaphase cells obtained from abnormal BFU-E.
Present data disclose that the Ph1-negative normal erythroid precursor cells persist in some patients with CML. However, the frequency of Ph1-negative cells is different between myeloid and erythroid precursor cells. Its significance is now under way to investigate.View full abstractDownload PDF (1146K) -
Part II. Anti-ATLA antibody in the families of ATL patientsMasatoshi FUJISHITA1983 Volume 24 Issue 5 Pages 533-539
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSAntibody to ATLA (ATL-associated antigens) were investigated in sera from healthy family members of 12 ATL patients. Of a total of 85 family members, 34 were anti-ATLA positive and included 2 of 3 husbands, 5 of 5 wives, 2 of 3 mothers and 11 of 28 children (10 of 18 children of mother patients compared with 1 of 10 children of father patients). Mothers of a seropositive healthy blood donor and of a patient with T-lymphoma were also anti-ATLA positive. On the other hand, in families of 5 seropositive patients who had received blood transfusion for diseases other than T-cell malignancy, 3 of 15 members were anti-ATLA positive and 1 of the 3 seropositive persons had also received blood transfusion. These findings strongly suggest that ATLV is likely to be transmitted vertically from mother to offspring and horizontally between husband and wife.View full abstractDownload PDF (525K) -
Toshihiro HARA, Kenichi KOIKE, Masashige TSUKADA, Atsushi KOMIYAMA, Ta ...1983 Volume 24 Issue 5 Pages 540-546
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSVindesine, a new member of the family of vinca alcaloids, was applied to the reinduction therapy for relapsed childhood acute lymphoblastic leukemia (ALL).
Fifteen children with ALL who had relapsed 2 to 5 times were treated with Vindesine, L-asparaginase and prednisolone (VDS-VLP therapy). The therapy schedule in this study consisted of: Vindesine 2mg/M2/week intravenously (IV): L-asparaginase 600 IU/M2 IV on days 8∼22: prednisolone 50mg/M2/day orally in 3 divided dose.
Complete remission occurred in 46.7% (7/15), and partial remission in 33.3% (5/15). In children with non T, non B-ALL, the complete remission rate was 55.6% (5/9). In children with T-ALL, the same rate was 40.0% (2/5).
Side effects of VDS-VLP therapy were mainly granulocytopenia and thrombocytopenia, but they were relatively mild.
The Charactaristics and advantages of VDS-VLP therapy were as follows:
1) VDS-VLP therapy was most effective in non T, non B-ALL.
2) VDS-VLP therapy was also effective in relapsed T-ALL.
3) Complete remission could be obtained in some children who had resistance to Vincristine.
4) Low dose L-asparaginase could avoid hypofibrinogenemia or disturbance of pancreatic function.
These results indicate that VDS-VLP therapy is effective in children with relapsed ALL.View full abstractDownload PDF (441K)
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Simeru KAMIHIRA, Mitsuru SAKITANI, Michito ICHIMARU, Kenichiro KINOSIT ...1983 Volume 24 Issue 5 Pages 547-552
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSAdult T cell leukemia-lymphoma (ATL) proposed by Takatsuki et al. is an endemic disease in the Southwestern district of Japan. Intrafamilial clusters of ATL have been frequently reported. Hinuma et al. found some antibodies reacting with antigens in MT-1 cells established from an ATL patient, which carried type C virus in sera of most ATL patients. These antigen and antibody were designated ATLA and ATLA antibody, respectively. This virus is sugested as leukemogenesis of ATL.
We performed sero-epidemiologic survey of ATL patients and their families. 31.6% of family members of patients with ATL and 7.0% of family members of patients with other malignancies were positive for the antibody. we proved the antibody in 100% of patients with ATL, 66.7% of T cell lymphoma, 12.5% of non-T cell lymphoma, 36.8% of acute nonlymphatic leukemia and less than 7% of other disorders. In family members of patient with ATL, the spouse and siblings of the patient were of high positive rate for the antibody. On the other hand, when a mother was positive for the antibody, her children were frequetly positive. For example, in serologic study of an intrafamilial cluster, 7 of the 8 family members in twe generations were positive for antibody.
Thses data suggest that there is a close relationship between ATL and the virus infection, moreover both vertical transmission from a mother to her children and horizontal transmission from spouse to spouse or from siblings to siblings are hinted as mode of natural transmission.View full abstractDownload PDF (410K) -
Mitsuru HASEBE1983 Volume 24 Issue 5 Pages 553-558
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSCase reports of Jordans' anomaly are uncommon. A 22-year-old male student had been treated for congestive cardiomyopathy since January 1975. On February 20, 1979, peripheral blood smears stained with May-Grünwald-Giemsa revealed granulocytes and monocytes containing 1∼3μ in diameter of vacuoles in their cytoplasma. In the bone marrow blood smears few vacuoles were observed in the promyelocytes. The count of vacuoles gradually increased in number with maturation of granulocytes, and reached up to 14 in segmented neutrophils. The vacuoles were found in plasma cells, but not in the lymphocytes, erythrocytes or megakaryocytes. These vacuoles were negative for PAS staining but were stained deep red with Demel' staining. These cytoplasmic vacuoles were also found in the myocardium, but not in the left femoral muscle.
There are only three reports of Jordans' anomaly including the present case in Japan.View full abstractDownload PDF (924K) -
Yoshikazu IIZUKA, Tameshi SUGIYAMA, Tomo FUZITA, Taiko TAKANASHI, Tomo ...1983 Volume 24 Issue 5 Pages 559-563
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA 70 year old male came to the Department of Internal medicine of Heiwa Memorial Hospital because of vetigo at November 20, 1980.
The hemoglobin was 13.2g/dl, RBC 436×104/μl and WBC 3,200/μl Total serum protein was 7.7g/dl and monoclonal protein was observed. On immunoelectrophoresis, this monoclonal protein formed M-bow against anti IgG and anti Kappa antiserum. Plasma cells were observed in 12.4% of bone marrow cells. Patient was diagnosed to have IgG multiple myeloma of Kappa light chain.
He complained of bloody stool at December 9, 1981. Colon was examined and sigmoid colon cancer was found. The histological diagnosis was adenocarcinoma of sigmoid colon.View full abstractDownload PDF (603K) -
Kiyoshi KIMIZU, Akira HAMADA, Toshihiro HABA, Chikashi KITOH, Haruo TA ...1983 Volume 24 Issue 5 Pages 572-579
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA 62 year-old man with prostatic hypertrophy was admitted to our hospital. Preoperative examination revealed IgA-κ M-proteinemia; moderate osteoporosis and bone marrow infiltration by immature plasma cells, leading to a diagnosis of multiple myeloma. He also had hyperviscosity syndrome; headache, retinal bleeding and retinal vein engorgement; the relative viscosity of the serum was 5.7. Plamapheresis was performed until the relative viscosity decreased to 2.91. He underwent suprapubic prostatectomy on the 36th day after admission. Massive hemorrhage (2,800ml) occurred intraoperatively. Between 1970∼1980, 14 cases of myeloma with hyperviscosity syndrome were reported in the Japanese literature. These cases suggested a relationship between hyperviscosity syndrome and the molecular configuration (polymerization or aggregation) rather than the amount of the myeloma protein. Analytical ultracentrifugation of our patient's serum demonstrated the presence of polymerized IgA. Postoperatively he had a mild degree of anemia and thrombocytopenia; on the 10th day after surgery, immature plasma cells appeared in the peripheral blood and a few days later, right pleural effusion was observed. The effusion contained many myeloma cells. The patient died on the 84th hospital day of respiratory failure. At autopsy, myeloma cells were found in the bone marrow, liver, spleen, pancreas, kidney, right pleura and pericardium of the right atrium.View full abstractDownload PDF (884K) -
Hiroshi SAO, Haruya YOSHIKAWA, Tomoyuki MURAYAMA, Yukihiro AKAO, Akika ...1983 Volume 24 Issue 5 Pages 580-587
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA case of BJP·κ multiple myeloma presenting myeloma cells invasion into the cerebrospinal fluid as determined by immunofluorescent technique was reported.
A 59 year-old woman was admitted to First Nagoya Red Cross Hospital on June 5, 1981, who had been diagnosed BJP·κ multiple myeloma two years before, due to diplopia and ptosis of left side.
The X-ray of the skull showed destruction of left sphenoidal bone and computed tomography demonstrated a high density mass extending from left sphenoidal bone to left temporal lobe. Lumbar puncture revealed plasmacytoid cells in CSF, which were stained with anti κ antiserum by immunofluorescent technique.
By AAAP therapy (ACNU 50mg d.i./2 weeks, adriamycin 20mg i.v./2 weeks, methotraxate 10mg i.v./2 weeks & 15mg i.t./1 week, prednisolone 60mg i.v./2 weeks and hydrocortisone 20mg i.t./1 week), myeloma cells in CSF and cranial nerve palsy disappeared. The remission of CNS-myeloma was kept for about 5 months.
There have been a few reports of meningeal invasion of myeloma cells. Only 20 cases in which plasma cells or plasmacytoid cells had heen revealed in CSF could be collected.View full abstractDownload PDF (1126K) -
Kenji NIIYA, Hirokuni TAGUCHI, Shizuo YOSHIMOTO, Isao MIYOSHI, Masatos ...1983 Volume 24 Issue 5 Pages 588-593
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSSerum from a patient with multiple myeloma showed a monoclonal protein, classified by immunoelectrophoresis as IgG. The M-protein was nonreactive with anti-IgG-Fab and anti-light chain antisera, but the free lambda light chains were present in the serum.
In the M-protein, contrary to the gamma heavy chain disease, the presence of light chains was demonstrated by electrophoresis of the reduced protein in sodium dodecyl sulfate polyacrylamide gel.
It was suggested that the Fab fragment of the M-protein had structural abnormalities.View full abstractDownload PDF (756K) -
Tadatoshi KURATSUJI, Yukio IWASAKI, Tadashi OJIMA, Ja Yung LEE, Eisuke ...1983 Volume 24 Issue 5 Pages 594-599
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSHemolytic jaundice complicating infectious mononucleosis occurred in a 14-year-old girl with hereditary elliptocytosis. She had no history of hemolysis. Negative direct Coombs' test and negative cold antibody of anti-i specificity did not suggest the autoimmune hemolysis. She recovered spontaneously. Electrophoresis of hemoglobin and Heinz body formation test were normal, and twenty-two kinds of enzymes of red cells were within normal limits, but slightly increased osmotic fragility in twenty-four hour incubated blood.
Members of this family, totalling fifty-three through four generations, were evaluated, and elliptocytes were found in six of them. None of these elliptic members had any history and any evidence of hemolysis.View full abstractDownload PDF (485K) -
Katsuhiro HAYASHI, Haruki NAKAMURA, Yuji ONISHI, Kazuo TAMURA, Toshihi ...1983 Volume 24 Issue 5 Pages 600-606
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA 67 year-old female was admitted to our hospital because of marked leukocytosis and hepatosplenomegaly. On admission, red cell, leukocyte and platelet counts were 512×104, 82.8×103 and 16.3×104/mm3 respectively. The analysis of peripheral blood smear showed marked increase of mature neutrophils (band 14; segmented 82; eosinophils 2 and lymphocytes 2%). NAP score was as high as 342. Hypercellularity of myeloid cells at various maturational stages was seen in bone marrow smears. The karyotype was a normal female pattern. According to these findings, a diagnosis of chronic neutrophilic leukemia was made for this patient. Marrow CFU-C, CFU-E and peripheral CFU-C were increased. Liver biopsy revealed sinusoidal infiltration of mature neutrophils, which seemed to cause hepatosplenomegaly without primary liver disease.
During the follow up period of 10 months, neutrophils gradually increased to 100×103/mm3 or more, and on the other hand, red cells decreased to 396×104 and pletelets to 4.0×104/mm3.View full abstractDownload PDF (854K) -
Hiromitsu MATSUZAKI, Fumio KAWANO, Mahito NAKAYAMA, Kazutaka MATSUSHIT ...1983 Volume 24 Issue 5 Pages 607-611
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSWe experienced two cases of acute leukemia with chronic interstitial nephritis. During maintenance chemotherapy with such anti-cancer agents as daunorubicine, vincristine, cytarabine, cyclophosphamide and neocarziostatine, renal functional impairment insidiously developed, finally leading to uremia which necessitated blood dialysis. One patient died of pneumonia and alimentary tract bleeding, while another is still alive in a good condition. Their renal tissues demonstated tubular atrophy, interstitial fibrosis and infiltration by chronic inflammatory cells. Immunofluorescence studies on sections failed to show localization of immunoglobulins, C3 or fibrin. Lung fibrosis was also considered on the basis of roentgenological findings and pulmonary function (%DLCO 14%) in one patient. Hypercalcemia and uricemia were not observed. We speculate that a direct nephrotoxic effect of the anti-cancer agents is the most likely cause of the chronic interstitial nephritis.View full abstractDownload PDF (605K) -
Shintaro ANDO, Shigeichi MATSUMURA, Toshio KANEKO, Noboru MATSUMOTO, M ...1983 Volume 24 Issue 5 Pages 612-617
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSAn autopsy case of adult T-cell leukemia with generalized cytomegalovirus infection and pneumocystis carinii pneumonia is reported. The patinet was a 54-year-old man who was born in Yamaguchi prefecture. On admission, he had nodular erythema, soft swelling in bilateral submandibular regions and granular erythema around the neck. The laboratory examinations revealed white blood cell count of 12,300/mm3 with a differential showing 52% atypical lymphocytes with lobulated or convoluted nuclei, of which 96.8% were T cell. Bone marrow specimen also showed mild infiltration of the same atypical lymphocytes (5.3%). Hemoglobin was 12.5g/dl and platelet count was 28.0×104/mm3. Serum immunoglobulins were reduced and IgG was 500mg/dl. From these findings, a diagnosis of adult T-cell leukemia was made. Repeated chemotherapies including cyclophosphamide, vincristine, pepleomycin and adriamycin failed to induce hematological remission, and the patient died of gradually developed respiratory failure. Autopsy disclosed generalized cytomegalic inclusion disease and pneumocystis carinii pneumonia on both sides. Early diagnostic procedures and effective therapy for such refractory infections are required for the management of adult T-cell leukemia.View full abstractDownload PDF (633K) -
Shigetake YOSHIOKA, Akihiko FUJIMORI, Tomoo FUJISAWA, Chiyoko NEGISHI, ...1983 Volume 24 Issue 5 Pages 618-625
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA Japanese family with G-6-PD deficiency associated with increased erythrocyte ATPase activities and reduced blood ATP levels, is described and discussed. To our knowledge, this may be the first report on G-6-PD deficiency associated with increased erythrocyte ATPase activity and decreased blood ATP level.
The propositus was a 6-month-old infant, who visited our out-patient clinic because of slight anemia, having the past history of severe neonatal jaundice. Laboratory examinations revealed RBC 3.78×106/μl, Hb 11.7g/dl, Ht 33.2%, reticulocyte count 33‰, platelet count 330×103/μl, and WBC 12,200/μl with normal differentials. Erythrocyte G-6-PD activity was moderately decreased in association with the abnormal results of glutathione stability test and Heinz body formation test, increased erythrocyte ATPase activity, and reduced blood ATP level.
This patient, as well as affected three other members of the family, showed no hemolytic crisis nor jaundice even during his respiratory tract infections or on medications of various drugs.
Further studies are needed to clarify the cause of increased ATPase activities and low blood ATP levels in these family mebers. The biochemical characterization of this variant is in progress.View full abstractDownload PDF (513K) -
Kazutoshi ONO, Yasushi NAITO, Kazuo YAMASAKI, Seiichi OKAMURA, Kenji K ...1983 Volume 24 Issue 5 Pages 626-631
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSWe report a case of adult T cell leukemia (ATL) arised 8 years after diagnosed as dermatomyositis. The patient was a 54-year-old female.
At the age of 48, she was diagnosed as dermatomyositis. She complained of gait disturbance. Her serum CPK, LDH, GOT were markedly elevated and the findings of EMG and muscle biopsy were compatible with dermatomyositis.
In Oct. 1981, she visited our hospital because of general fatigue and dysphagia. The count of her white blood cells was 11,100/cmm, 31% of which had convoluted nucleus and basophilic cytoplasm and formed E rossette with sheep red blood cells. These abnormal lymphoid cells were also found in lymph nodes of the neck, subcutaneous tissue and ascites. Therefore, the diagnosis of ATL was made.
There have not been a report on ATL in relation to dermatomyositis. Possible relationship between dermatomyositis and ATL is discussed.View full abstractDownload PDF (585K) -
Eiichi NAGURA, Kohei KAWASHIMA, Hisamitstu SUZUKI, Ryuzo OHNO, Kazumas ...1983 Volume 24 Issue 5 Pages 632-638
Published: 1983
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA case of refractory acute myeloblastic leukemia, who achieved complete remission (CR) by a new anti-leukemic agent, 4'-(9-acridinylamino) methanesulfon-m-anisidide (AMSA), was reported. The patient, 27 years old female, visited our hospital on 23rd of July 1979, complaining of anemia. The findings of peripheral blood and bone marrow aspiration showed that she had acute myeloblastic leukemia. (M1 in FAB classification) First she was treated by combination chemotherapy of behenoyl Ara-C (BH-AC), daunomycin (DM), 6-mercaptopurine (6MP) and prednisolone (Pred), and reached CR of 66 weeks. At the first relapse she was given combination chemotherapy of BH-AC, aclacinomycin (ACM), 6-MP and Pred, and entered CR of 53 days again. The total doses of DM and ACM were 840 mg and 580 mg respectively. At the relapse after this second CR, AMSA was administered intraveneously over 1 hour diluted in 250ml of 5% glucose in water at a dose of 112.5 mg daily for 3 days and 75 mg daily for 2 days consecutively, and on 22 days later 112.5 mg daily for 5 days. After bone marrow aplasia and heart failure, she achieved CR on the 30th day of the second course. CR duration was 30 days. The site of relapse was CNS, and hematological remission lasted 58 days more. The side effects associated with AMSA therapy included myelosupression-related infection and bleeding tendency, heart failure with myocardial damage and phlebitis.View full abstractDownload PDF (614K)
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