A study was undertaken to know the intestinal fungal flora in patients with leukemia who frequently have complications with deep-seated fungal infections.
The results were as follows;
(1) The fungal counts per gram of feces in those leukemic patients receiving no antifungal agents ranged from 10^1.5 to 10^7.5 with a mean of 10^3.86, which were larger than those in healthy subjects ranging from 10² to 10⁴ with a mean of 10^2.55. Also, the leukemic patients exhibited greater variations in fungal counts than the control. Furthermore, the former maintained larger fungal counts for a longer period of time than the latter.
(2) In 12 patients with leukemia, the following fungi were isolated from feces: C. albicans (8 patients), Torulopsis (5), C. tropicalis (3), C. Krusei (1), and Aspergillus (1).
(3) As regards the effect of orally administered Amphotericin B on fecal fungi, the drug resulted in a marked reduction in fungal counts in the intestinal tracts. Neither subjective nor objective side effects were noted in a prolonged therapy.
In patients with leukemia, it is suspected that fungal overgrowth in the intestinal tracts, as combined with the diminished resistance to infection of the hosts, may have very much to do with the presence of deep-seated fungal infection.
It might be recommended that a concurrent therapy with oral amphotericin B is initiated as a precautionary means for treating patients with leukemia since deep-seated fungal infections are very difficult to control in these patients once diagnosed.

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Hemophilia and its related diseases are hereditary diseases of blood coagulation disorder. No abnormalities of sex and autosomal chromosomes have been reported in many cases of the above mentioned by the tissue culture method, but recently, Elves, Witkowski and others have reported anomaly of X-chromosome in few cases. Sex and autosomal chromosomes were analysed on cultures of leucocytes obtained from the peripheral blood on 12 cases of hemophilia A patient and 2 cases of its carriers, 4 cases of hemophilia B patient, one case of Factor VII deficiency patient and Factor X deficiency patient, a female von Willebrand's disease, and a blood coagulation disorder (Hemophilia A suspected). The following results were obtained: The counts of all cases analysed in this report indicated the normal modal number of 46 chromosomes in the range 90∼100 per cents.
The relative length, —the ratio to the total length of autosomal chromosomes— of X chromosomes in hemophilia A patients were in range 48∼53 (normal range 51∼58), but centromere index and arm ratio were in the normal range. Other chromosotmes were normal. X and autosomal chromosomes of hemophilia B patients were normal. The relative length of their Y chromosomes were in the range 26∼33, but their centromere index and arm ratio were normal.
Sex chromosomes of a factor VII deficiency patient, a factor X deficiency patient and a female von Willebrand's disease were normal, but it was interesting that the length of No. 6th of autosomal chromosome were longer than that of the normal subject.

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The inhibition of plasmin system by 4-(2-carboxyethyl) phenyl-trans-4-aminomethyl cyclohexane carboxylate hydrochloride was studied in vitro, and compared with by Trasylol and AMCHA.
1. The substance was capable of an activity to inhibit both plasmin and plasminogen activation. A striking difference between DV 1006 and AMCHA was that the former inhibited casein digestion by plasmin, but the latter had essentially no effect. The caseinolysis induced by plasmin was inhibited competitively by DV 1006.
2. The AGLMe-lysis induced by urokinase was inhibited competitively by DV 1006 in 10^-4M order and by AMCHA in 10^-2M order. Trasylol had no effect on AGLMe-lysis by urokinase.

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Varicella infection is one of the most serious complications to the patients who receive a steroid and/or anti-tumor drug because they are often in a fatal course. On the other hand in a few cases, which recovered from severe varicella infection and other severe infection e. g. candidasis, staphylo- streptococcosis, spontaneous or long term remission occurs without apparent relationship to therapy. Concerning with these problems we report following two cases.
Case 1. A 4-year-old Japanese girl with a history of acute stem cell leukemia beginning in March 1968. After treatment with prednisolone for 10 weeks, she received weekly injection of methotrexate as a maintenance therapy. On 10 June, 1969 she developed an exanthem of varicella and readmitted to our hospital on the next day. In two days the rash increased in severity, the patient had encephalopathy and received 200 ml of whole blood from two adults. On 20 June fever disappeared and rash reached to crust. During the course of varicella infection methotrexat was discontinued. After that time she received a maintenance therapy with methotrexate or 6MP until today without relapse.
Case 2. A 4-year-old Japanese girl with acute lymphocytic leukemia beginning in July 1968. After treatment with prednisolone for about 8 weeks, she received a maintenance therapy with 6MP or methotrexate. In September 1969, however, she has been in relapse and readmitted to our clinic on 10 September. After treatment with prednisolone and 6MP for 2 months, she showed marked improvement in the clinical and hematological state. On 23 Nov. she developed serious varicella and had somnolence, high fever, nausea and vomiting, then she received 180 ml of whole blood from her mother. Her general condition improved in a few days, and the varicella rash, fever and meningeal signs subsided. Although administration of antileukemic drugs was discontinued during the course of varicella, she has been in complete remission clinically and hematologically. After that time she has received a main-tenance therapy with 6MP and methotrexate without relapse.

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Effect of chemotherapy in acute myelogenous leukemia of adults is less satisfactory than that in childhood acute lymphocytic leukemia in respect to complete remission rate as well as survival.
This is a report of two cases of AML of adult surviving more than five years.
Case 1: A 22 year old female had a diagnosis of acute myelogenous leukemia established in September, 1965. A complete remission lasting for 21 2/3 months was obtained with combined use of 6MP, cyclophosphamide and corticosteroid. The second remission was induced with the oral methotrexate and lasted for 7 2/3 months. No maintenance therapy was performed for these two remissions. The third complete remission induced by the treatment with mitomycin C, cyclophosphamide and corticosteroid was maintained with cyclic maintenance therapy composed of 6MP, cyclophosphamide, methotrexate and corticosteroid. This resulted in the 31 months' duration of complete remission until March, 1971, when she had the third relapse. The forth complete remission was obtained with daunomycin, 6MP-R, cytosine arabinoside and corticosteroid given simultaneously. This remission has been maintained up to the present with cyclic maintenance therapy. She has been surviving for five years and 9 months since the diagnosis of her AML.
Case 2: Acute myelogenous leukemia was diagnosed in a 25 year old male in March, 1966. Oral administration of massive dose of corticosteroid obtained complete remission. This remission had been maintained without relapse with cyclic maintenance therapy with 6MP, cyclophosphamide, methotrexate, corticosteroid and cytosine arabinoside for five years until April, 1971, when the therapy was entirely discontinued. He is currently being observed with monthly hematological check-up.
Discussions are made concerning the long-term survival of acute leukemia with special emphasis on the effectiveness of maintenance therapy.

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Di Guglielmo syndrome usually progreses through 3 stages in the successive order of erythremic, erythroleukemic and leukemic pictures. The reverse progression, beginning with leukemic picture and terminating in erythroleukemic or erythremic picture is very rarely observed, though its possibility is theoretically conceivable. This paper deals with a report of such a rare case.
A 40-year-old female was admitted because of numerous petechiae over the entire body surface. The blood examination disclosed normal RBC and platelet count, and WBC 76,000/cumm with 94% myeloblast. The bone marrow examination revealed 96% myeloblasts and 26% normoblastic erythroid cells. However, 99% of the hypoplastic erythroid cells were sideroblasts including 25% of ringed form. She was treated with VEMP combination therapy, with subsequent complete remission 2 months later. During the 6 months period of the remission, the patient received maintenance therapy of 6 MP and Endoxan. On the relapse her blood picture showed severe anemia and appearance of few myeloblasts, normoblasts and megaloblastic cells. Bone marrow examination showed marked proliferation of both myeloblasts and erythroid cells with large number of PAS positive, mono- or multi-nucleated megaloblastic cells containing prominent nucleoli. Despite discontinuation of 6MP and parenteral administration of VB₁₂, normoblasts and megaloblastic cells in the bone marrow increased gradually.
Of particular interest in this case was the presence of many ringed sideroblasts in the initial typical leukemic stage. This findings was extraordinarily in contrast to our observation on sideroblast in usual acute leukemia cases. Since ringed sideroblast is considered to be an evidence of neoplastic process involving erythroblastic proliferation, it is able to postulated in this case that erythroblasts were possessed of possibly neoplastic disturbance even in the initial stage and finally developed malignant proliferation.
Chromosomal analysis of bone marrow cells revealed an apparent shortage of the long arms of G₂₂ comparing to that of G₂₁, suggesting a close relation to Ph¹-like chromosome occasionally noticed in Di Guglielmo syndrome.
Those two findings supports the concept that Di Guglielmo syndrome belongs to myeloproliferative diseases.

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