Although the toxicity of nitroglycerol and nitroglycol, the major ingredients of dynamite, has been well documented regarding their effects on the cardiovascular system, their hemotoxicity has not been fully elucidated. The author observed at the Asa Dynamite Factory that the average blood specific gravity of the employees had been very low and many had been anemic until up to 1962, but their hematologic status was much improved after the renovation of the factory machinery and facilities to reduce the nitroglycol concentrations in the air. Based on these observations, the following experiments were carried out. Nitroglycol in olive oil was injected in the dose of 200 mg/kg to rabbits and NO₃, methemoglobin and Heinz bodies were determined. They were increased sharply after the administration and declined thereafter. The life span of erythrocytes was much reduced when studied by the ⁵¹Cr tagging method. However, the erythrocyte life span among the nitroglycol handlers was not shown to be shortened by the same method, probably because the test was carried out after the improvement of factory facilities.
Tritiated nitroglycol was prepared from ³H-ethylene glycol by nitration. It was diluted out with olive oil and injected to mice and rabbits, and tissue distribution of ³H was determined. ³H was demonstrated in erythrocytes after two hours and ³H concentration in the spleen was markedly increased about the same time, suggesting some damage onto erythrocytes. Urinary excretion of ³H was rapid, but some ³H remained in plasma after 24 hours, in a form not bound to proteins, probably representing breakdown products. In terms of per cent uptake, the liver and kidney were the major organs.

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There are many reports that Vinca alkaloid therapy is effective for leukemia in children, malignant lymphoma, etc. We applied this therapy to seven courses in six patients of multiple myeloma in which therapies with such agents as cyclophosphamide, steroid hormones, etc. had been ineffective. Of these seven courses, the therapy proved to be effective in three couses, but in the remaining four, inffective. In all courses, reduction of the peripheral leukocyte was observed as a side effect. Although this therapy may not be adopted as the first choice for multiple myeloma, it is considered as an alternative when other therapeutic regimens have been inffective.

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Of 214 cases of acute leukemia diagnosed during the years 1952-66, 24 (11.2%) were lymphoblastic. 6 (25%) of the acute lymphoblastic group presented with thymus enlargement; most of these cases had mild symptoms.
Peripheral leukocyte counts were 6,900 to 29,200 per c. mm., and the percentage of blast cells was 0 to 18% in patients with thymoma.
Histological studies of thymus glands in autopsy cases revealed that leukemic infiltration and hemorrhage in acute lymphoblastic leukemia were more remarkable than the other types of leukemia.

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Treatment for 4 cases of pure red cell anemia was discussed. Three cases of them were congenital hypoplastic anemia (Blackfan-Diamond) and the other was acute erythroblastopenia (Gasser).
Cases with congenital hypoplastic anemia fairly well responded to corticosteroid therapy which was given continuously, intermittently or temporalily.
The exellent result was obtained in the case, in which the treatment was begun at 7 month old, immediately after diagnosis was made, resulting in sufficient remission for last 2 years with intermittent administration of corticosteroid.
Although one patient revealed temporaly improvement for 3 months with blood transfusion alone, corticosteroid therapy was generally required to maintain remission in cases with congenital hypoplastic anemia.

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(I) (a) Case I; A housewife (42 years of age). From 34 years of age, she developed symptoms: dryness of oral and nasopharyngeal cavity and lips, reduced perspiration, fever up to around 40°C at 3 times, rhagades of tongue, angular stomatitis, recurrent dental caries, strange sensation on bilateral lower palpebrae, photophobia, and malaise.
Laboratory Findings: There were observed normocytic anemia, rouleaux formation of erythrocytes, bone marrow hypoplasia with as light increase of plasma cell, remarkable increase of erythrocyte sedimentation rate, and extremely high values of the serum colloidal reactions. γ-globulin was 41% and increment of ‘γ-G’ was remarkable.
Gastric anacidity and severe atrophic gastritis were observed by X-ray, gastrocamera and gastric biopsy, which revealed diffuse round-cell infiltration.
Liver biopsy showed no remarkable change in parenchymal cells but a slight infiltration of polynucleated leukocytes and round-cell in Glisson's capsule.
At the same time focal round-cell infiltration of moderate degree in the interstitial tissue was found by renal biopsy.
(b) Cace II; A housewife (42 years of age). From 35 years of age, she gradually started to complain blurred vision and oral dryness.
Laboratory Findings.: A slight increase of plasma cell in bone marrow, remarkable erythrocyte sedimentation rate, positive serum colloidal reactions, increament of γ-globlin and gastric anacidity were conspicuous findings. According to histological figure of biopsy specimen, interstitial nephritis and atrophic gastritis of slight degree was considered.
The above-mentioned two cases were classified to group E of the 5 groups by Bunim.
(II) 75 cases cited in literatures were described.

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A 29-year-old woman was admitted to our hospital because of high fever and hemorrhagic tendency. Approximately four months prior to admission she developed perineal laceration as well as right mastitis after the delivery of the second child, and the mastitis was completely cured following Chloramphenicol administration amounting to 11 grams. She became anorectic and icteric five weeks after the onset of mastitis, and she was diagnosed as acute hepatitis by a local physician. Seven weeks after this episode she complained of high fever, chillness and hemorrhagic tendency, which continued in spite of administration of steroids and blood transfusion. Subsequently she was referred to our clinic.
Physical examination on admission revealed an icteric young woman with generalized petechiae who looked acutely ill. Hematological exams showed: RBC 1.88 million, hemoglobin 7.7 gr%, hematocrit 24% and WBC 1,200 with 95 per cent of lymphocytes. Bone marrow aspirate showed pancytopenia. She died on the 10th hospital day, that is, 10 weeks after the onset of acute hepatitis and 3 weeks after the onset of pancytopenia. Autopsy findings were: Bone marrow was fatty and strikingly hypocellular. Plasma cells and reticulum cells were predominantly present. The liver weight was 1,380 gr, showing submassive necrosis and fibrosis.
Japanese literatures were reviewed dealing two cases of fatal aplastic anemia follwing acute hepatitis, and the discussion was extended to probable pathogenetic correlations between similar type of aplstic anemia and acute hepatitis.

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A 58-year-old male with Bence Jones type myeloma was described. His major signs and symptoms were anemia and lumbago due to marked osteoporosis. On x-ray film of the skull inconspicuous punchedout lesions, were recognized. A serum total protein was 6.1 g/dl. The serum electrophoretic pattern on cellulose acetate membrane showed no abnormality (minor anomaly type), and immunoelectrophoresis revealed no so-called M-bow. During the course of the illness, however, Bence Jones protein was found in the urine which was proved to be type K by immunoelectrophoresis.
This case demonstrated neither abnomal pattern in serum electrophoresis nor characteristic myeloma cells in the bone marrow. The proliferating cells resembled rather lymphoreticular cells on optical microscopy. On electron microscopy, however, they were identified as plasma cells because of well-developed granular endoplasmic reticulums in the cytoplasm.
The diagnosis of multiple myeloma, especially that of Bence Jones type, may sometimes be difficult. On such occasions, it be stressed that not only the “myeloma, cells”, but also clinical findings and protein analysis of the serum and urine are important for the diagnosis.

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A case of paroxysmal nocturnal hemoglobinuria (P.N.H.) with high fetal hemoglobin was reported. The patient (S.T.) was a 33-year-old male. He was admitted to our hospital on Feb. 23, 1967 with complaint of pailness of the face. On admission, he apparently showed a picture of hypoplastic anemia, i.e. normochromic anemia, leucopenia, thrombocytopenia and decreased bone marrow cells. The diagnosis of P.N.H. on the 45th. hospital days was made, because of positive Ham's test, positive Crosby's test, and positive suger-water test. On the other hand, anisocytosis, persistence of reticulocytosis in peripheral blood, decrease of alk-P in neutrophil leucocytes and decrease of Ch-E in red blood cells were also noted. HbF was 3.5∼8.0% by Singer's method. The distribution of fetal Hb between P.N.H. cells and non P.N.H. cells, before and after acid hemolysis was discussed.

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A 53-year-old housewife was admitted to our hospital in October, 1966, with chief complaints of struma and purpura.
For seven years she had suffered from hemorrhagic tendency, and been aware of the struma at the same time without any therapy for it.
The diagnosis of Hashimoto's disease with hypothyroidism was made.
Hematologic examinations revealed severe macrocytic anemia with thrombocytopenia (RBC 189×10⁴, MCV 107, and platelets 38,000.).
The anemia was recovered by prolonged administration of 0.2∼0.1 gm/day of dessicated thyroid pulver.

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A 25-year-old man was transferred to our department from a local hospital on December 15, 1967 for diagnostic examinations for anemia and lumbago.
The patient was well until August 1967 when fatigue and cardiac parpitation were noted more than expected with a mountain climb. The patient, however, did not see a physician until December 7, when the symptoms mentioned above became gradually worse in addition to recent development of lumbago. Anemia of RBC 225×10⁴, Hb 45% (Sahli) was found, and the patient was transferred to our department.
Physical examination on admission was essentially negative except for generalized anemic appearance. Spleen and lymphnodes were not palpable. A marked anemia of hemoglobin 5.49 g/100 ml and a prolongation of plasma clot time were seen.
Bone marrow aspiration was dry tap, and a hemolytic anemia was diagnosed with a high plasma hemoglobin level of 769 mg/100 ml. Blood transfusion caused an elevation of body temperature up to 38°C and did not increase hemoglobin volume as calculated. The patient died on the 15th hospital day, and the autopsy revealed a small carcinoma at the cardia of the stomach with a dissiminated metastasis to the liver, spleen, bone marrow, and others. Microangiopathy with massive tumor thrombi was found in the lungs and kidneys.

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