Recent biological studies have been progressing for analysis of cyology of leukemic cells, in childhood acute lymphoblastic leukemia (ALL). Immunologic and genetic analysis of ALL have contributed to more rational classification, relating to clinical features and prognositic factors.
Theses analysis have identified subgroups with poor prognosis. Suitable therapeutic regimens for the subgroups have been sucessing in long survival rate of the patients. The therapy consist of remmision induction therapy, central nervous system leukemia prophilaxis, consolidation and maintenance. The use of more intensive induction and consolidation therapy has improved the survival rates, especially for the patients with high risk factors. The recent studies in therapeutic regiments for childhood ALL reveales 60-80% of long term survival. As increasing number of long term survivors, it becomes important problems of late complications related to the disease or its treatmens. Devices of therapy with less toxic not only during theapy but also after off therapy, and more cureable therapies are expected.

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The author remarked general consideration on leukoerythroblastosis and commented on the clinical importance to be aware of this hematological finding. It was emphasized not to use the term synonymous with leukemoid reaction by clarifing definition of the finding. The author also documented about the diseases or pathological conditions which show this finding with speculative comments on the pathogenesis of each state. The first group to show this finding is myelophthisis which contains bone marrow carcinomatosis, storage diseases, marrow granuloma and marrow necrosis. The second group is hematological diseases and the third one is of miscellaneous states.
Leukoerythroblastosis are much frequently seen in marrow carcinomatosis. It was advocated to use the term myelophthisis only to express the state in which the bone marrow is occupied by non-hematopoietic cells or tissue, not to express the disease of aplastic anemia as it meant before in Japan. Lastly, the author recommended a discriminant between marrow carcinomatosis and other states by reticulocytes and erythroblasts counts.

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Since February 1993, 99 patients with benign prostatic hyperplasia have been treated with transurethral microwave thermotherapy (TUMT) using the Prostatron device. The International Prostate Symptom Score (I-PSS) and quality of life (QOL) score were used to evaluate subjective symptoms. Four weeks after treatment, I-PSS (10.8±6.7) was much lower than baseline (20.1±7.0) and 6 months and 1 year later, this score was maintained at significantly low level (p<0.0001). QOL score showed same tendency as the I-PSS. The peak flow rate significantly increased from 8.9±4.9ml/sec to 9.7±3.1ml/sec after 1 year (p<0.018). The average flow rate was increased from 4.39±2.5ml/sec to 5.87±2.61ml/sec after 8 weeks then gradually decreased, though it remained significantly high after 1 year. Residual urine volumes significantly decreased after 1 year. Subjective and objective parameters were also well maintained for 1 year after treatment. These results indicated that TUMT is an alternative treatment to surgery for symptomatic benign prostatic hyperplasia.

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Multicenter clinical study was performed cross sectionally concerning diabetic nephropathy using the network of national hospitals. Totals of 199 outpatients with NIDDM were registered from 9 national hospitals and following results were obtained. (1) Among patients with albumin excretion rate (AER)<40μg/min, AER, urinary transferrin (TF) and NAG excretion rates were significantly higher in patients with poor glycemic control than in those with good glycemic control. On the other hand, in patients with more advanced nephropathy, there was not any difference in AER, urinary TF and NAG excretion between patients with good and poor glycemic control. (2) Plasma lipid peroxide (LPO) levels were higher in patients with poor glycemic control than in those with good glycemic control, which suggests that patients with poor glycemic control are exposed in oxidative stress. (3) Plasma lactoferrin levels positively correlated with plasma LPO levels, which suggests that plasma lactoferrin level could be a good marker for the oxidative stress. (4) Urinary excretion of type IV collagen (coll) increased as nephropathy progressed. Urinary coil was not affected by glycemic control. In patients with advanced nephropathy (AER<200μg/min ), urinary coil negatively correlated with creatinine clearance. These data suggest that urinary coil could be useful in evaluating diabetic nephropathy. Based on the results of this study, prospective study has begun to establish the best way to prevent the progression of diabetic nephropathy.

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We employed nasal pressure support ventilation (NPSV) in three patients with muscular dystrophy (MD). Case 1 was a 10-year-old boy with Duchenne type MD and mental retardation, who suffered from obstructive sleep apnea. In case 2, we switched from intermittent positive pressure ventilation via a nasal mask to NPSV because of frequent desaturation due to massive air leakage from mouth. The third patient had congenital-type MD with severe mental retardation. The ventilatory support system used was the PB 335 (Puritan Bennett Inc. USA). NPSV was effective in all cases. We consider that NPSV is worth considering for mechanical ventilation of patients with MD. Because it is easy to use, NPSV is also well adjustable for children and patients with mental retardation. On the other hand, since tidal volume is not ensured, care must be taken to avoid hypoventilation due to decreased compliance, and careful observation is necessary. In conclusion, al-though some unsolved problems remain, NPSV is a useful method of mechanical ventilation for pa-tients with MD.

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Pulmonary thromboembolism is frequently associated with gynecological disorders. However, the indication of inferior vana cava (IVC) filter placement remains controversial. We reported 2 cases of IVC filter placement.
Case 1: 46 years old female was admitted because of shock and hypoxemia. She was diagnosed as having pulmonary thromboembolism caused by huge myoma uteri. In order to prevent from reccurrence of pulmonary thromboembolism, an IVC filter was inserted before stopping anticoagulant agent during operation for her myoma.
Case 2: 39 years old female was admitted to resect her ovarian cancer. She had deep vein thrombosis and hypoxemia, and was diagnosed as having pulmonary thromboembolism. Then, an IVC filter was inserted before operation. In either case, pulmonary thromboemblism did not recur.
IVC filter placement for the patients with pulmonary thromboembolism accompanied by gynecological disorders is safe, well tolerated, and can offer effective therapy with low probability of treatment failure.

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The patient was a 4-year-old girl diagnosed as acute lymphocytic leukemia, who had received peripheral blood stem cell transplantation (PBSCT). She was followed up without any treatments and showed petechiae on her lower extremities one year after PBSCT. A diagnosis of idiopathic thrombocytopenic purpura was made by a bone marrow examination and by elevated plateletassociated IgG. Her platelet count was soon increased by γ-globulin and followed corticosteroid. The recurrence of ITP has not been recognized despite of ceased medication.

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We report a 70-year-old man whose intractable senile purpura was successfully treated with oral animal collagen. The patient complained of purpuric macules on the arms. His past history revealed cerebral infarction at age 30 and gastric cancer at age 64. The latter was resected subtotally and reconstructed. After the operation, he had anemia with iron deficiency and ulcer of residual stomach. Anti-HCV antibody was positive. He has been bedridden for 6 years. As his gastric discomfort was severe, it was hardly possible to treat his purpura with oral drugs. However, the skin lesions did not respond to 14 weeks of treatment with various protections and topical applications. Then, we tried oral gelatinized pig foot (Achilles tendon portion, 33g/day), because oral animal collagen can strengthen vessels and prevent aging. His purpura cured almost completely in 3 weeks.

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