Results of treatment of 41 cases of acute leukemias with Daunomycin are reported. Deunomycin was given alone in 12 cases (10 adults and 2 children); 7 myelogenous, 1 monocytic, 3 lymphatic and 1 case with blastic phase of CML. It was administered concomitantly with oral 6MP 2.5mg/kg and corticosteroid 0.5 mg/kg of prednisolone in 29 cases (27 adults and 2 children); 15 myelogenous, 7 monocytic, 3 lymphatic and 4 cases with blastic phase of CML. A course of Daunomycin administration consisted of intravenous injection of the agent, 0.8 mg/kg, daily for 4 days and the course was repeated as soon as clinically permitted.
A complete remission was obtained in 3 of 12 cases treated with Daunonmycin alone (1 myelogenous, 1 monocytic and 1 lymphatic) and in 17 of 29 cases (58.6%) treated with Daunomycin, 6MP and corticosteroid (7 myelogenous, 5 monocytic, 2 lymphatic and 3 cases with blastic phase of CML).
It is remarkable that the combination chemotherapy induced complete remission in 5 of 7 cases with monocytic leukemia and in 3 of 4 cases with blastic phase of CML.
Myelosuppression was the severest side effect of Daunomycin. However, it relatively spared thrombocytopoiesis. Other side effects include alopecia, skin eruption, nausea and palpitation in a small number of patients. The degree of these toxic effects was such that did not preclude clinical usage of the agent.
Clinically there was no cross-resistance with other antileukemic drugs. Resistance to Daunomycin, however, appears rather easily acquired.
The impression was that severely hypoplastic state of bone narrow is prerequisite for induction of a complete remission in cases treated with the combination chemotherapy.

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The case of a 65-year-old woman with pernicious anemia associated with intrinsic factor autoantibodies in serum and gastric juice is presented. The diagnosis was established from the characteristic hematologic findings including macrocytic anemia, megaloblastic marrow, gastric mucosal atrophy, achlorhydria, a positive Schilling's test and rapid clinical improvement following intensive V. B₁₂ treatment. Two types of intrinsic factor antibodies, blocking and binding antibodies, were found in serum and gastric juice by the gel filtration method, charcoal adsorption, paper electrophoresis, and radioimmuno-diffusion analyses. The antibody titers were much higher in gastric juice when compared to those in serum. Analysis of the immunoglobulin classes has disclosed the coexistenceof IgG and IgA binding antibodies. It was speculated that the appearance of the autoantibodies against endogenous intrinsic factor was the initiating event in the development of pernicious anemia in the present case.

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The cases of systemic lupus erythematosus with presenting symptoms of thrombocytopenic purpura have been rare in Japan.
A 17-year-old female case of systemic lupus erythematosus (S.L.E.) was presented, in which the thrombocytopenic purpura had been the only symptom for three years since the onset. She had been treated with prednisolone, but there was no remarkable improvement. Hemorrhagic diathesis subsided following splenectomy, whereas no significant elevation in platelet count was observed. The histological examination of the spleen disclosed the presence of marked onion skin lesion.
About ten months after splenectomy, clinical manifestations of S.L.E. such as skin rashes, arthritis, carditis, nephritis ans paralytic ileus, developed. These manifestations were successfully treated with salicylates, chloroquine and large dosis of prednisolone. The patient has been followed in the outpatient clinic and is now free from symptoms with minimal dosis of prednisolone.
Differential diagnosis and relationship between idiopathic thrombocytopenic purpura and thrombocytopenic purpura of S.L.E. was discussed.

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A 53-year-old male with primary myelofibrosis was reported. He had dizziness of 8 months' duration and was found on physical examination to have anemia and hepatomegaly of 3 fingerbreadths and splenomegaly of 5 fingerbreadths. No lymphadenopathy was found. Laboratory findings were as follows: peripheral RBC 264×10⁴/cmm, Hb 51%, WBC (nucleated cell count) 27,200, leucocyte alkaline phosphatase score 315. In peripheral blood smear, nucleated red blood cells occupied 55% of nucleated cells. Tear drop poikilocytosis of red blood cells was negative. Serum Vitamin B₁₂ level was very high with the value of 2760 pg/ml. Ph¹ chromosome was negative. Ferrokinetic study with ⁵⁹Fe was suggestive of ineffective erythropoiesis. Bone marrow punctures on sternum were hardly successful and biopsy was done on pelvic bone, revealing fibrosis of the bone marrow. When the biopsy of the liver was made, the patient died of bleeding accident. Autopsy was performed and revealed various degrees of bone marrow fibrosis. Spleen weighed 1580 g with remarkable extramedullary hematopoiesis. No leukemic infiltrations were found.
In this case differential diagnosis between erythremia and myelofibrosis was difficult by peripheral blood smear alone because of high percentage of nucleated red cells. It has been said that vitamin B₁₂ level is a useful means to differentiate myelofibrosis and chronic myelogeneous leukemia. It was inconvenient, however, to use the data of the Vitamin B₁₂ determination in differential diagnosis of the present case. It implies that concept of myloproliferative syndrome should be appropriate in considering the nature of myelofibrosis.

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