臨床血液
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
13 巻, 6 号
選択された号の論文の16件中1~16を表示しています
綜説
臨床研究
  • 松田 保, 村上 誠一, 橋爪 一子
    1972 年 13 巻 6 号 p. 934-938
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    1. Hydroxyethyl starch was applied to seventeen patients as the blood substitute and examined its effects on blood coagulation and fibrinolysis.
    2. 6% solution of hydroxyethyl starch in Ringer's solution with lactate was given ten patients intravenously at the dosis of 12.5ml per kg of body weight over a period of 1 hour.
    The most striking effect of this substance was marked accerelation of thrombin time. Slight reduction in platelet count and fibrinogen titre was observed as well as slight prolongation of bleeding and prothrombin times, probably due to dilution effect of blood, though partial thromboplastin time showed no appreciable change. These effects lasted at least for 1 hour. Transient shortering of euglobulin lysis time was observed immediately after the infusion, but no adverse effect was seen in these patients given hydroxyethyl starch.
    3. As the control, seven patients was infused Ringer's solution with lactate at the dosis of 12.5ml per kg of body weight over a period of 1 hour.
    There were no significant changes in platelet count, partial thromboplastin, prothrombin and thrombin times as well as fibrinogen titre throughout the experiment. Euglobulin lysis time shortened transiently following the administration of Ringer's solution with lactate.
  • 平野 正美, 鯉江 捷夫, 大野 竜三, 山田 一正
    1972 年 13 巻 6 号 p. 939-942
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    A methancsulfonic acid ester of aminoglycols, bis (3-mesyloxypropyl) amine ptoluenesulfonate used orally was found to be very effective in the treatment of chronic myelogenous leukemia.
    1) It was administered daily in a dose of 1 to 2 mg/kg for remission induction and 0.5 to 1 mg/kg for remission maintenance, the dose being adjusted according to blood counts.
    2) A complete remission with normal WBC and complete disappearance of splenomegaly was obtained in all of the 9 patients.
    3) The agent was used for maintaining complete remissions in 10 patients. Its myelosuppression was, within the dose range employed, granulocyte-specific and less long-lasting than that of busulfan.
    4) Side effects was rare and mild; transient upper abdominal discomfort associated with soft stools was noted in 2 patients.
    5) As of the end of February, 1972, the median remission period is 19 1/3 months and that of survival 24 1/3 months.
  • —臨床効果と関連して—
    古沢 新平, 足立 山夫, 野村 武夫, 小宮 正文
    1972 年 13 巻 6 号 p. 943-950
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    The in vivo effects of a single intravenous dose of 5 mg/kg cytosine arabinoside (CA) were studied on the mitotic cycle of leukemic cells and erythroblasts in the bone marrow from 8 adult patients with various types of acute leukemia. The results were correlated with response to the subsequent therapy with CA alone or combined with prednisolone or 6MP.
    The in vitro 3H-thymidine labeling index (LI) and mitotic index (MI) of leukemic cells showed a significant decrease 4 hours after injection of CA and a tendency to recover within 48 hours in all cases studied. However, in only 3 cases where complete remission could subsequently be attained, the LI of leukemic cells at 48 hours returned nearly to or exceeded the pretreatment level. Whereas the value as high as three times the pretreatment level was initially observed in one out of the 3 cases, the LI at 48 hours remained below the pretreatment level when the test was repeated on relapse which was proved refractory to the CA therapy. These results suggest that partial synchronization of leukemic cells in DNA synthesis and/or recruitment of the cells from the resting state into the mitotic cycle can be achieved after a single injection of CA in some cases, and that these two mechanisms may lead to the success of the intermittent CA therapy.
    A marked increase in the percentage of erythroblasts was found 48 hours after injection of CA in the bone marrow from 3 patients. This finding, which may have been caused by a decrease of leukemic cells as well as an increse of erythroblasts, appeaers to be significant in predicting the effectiveness of the CA therapy, since while in 2 out of 3 cases complete remission could be attained by subsequent CA therapy, no significant increase in the percentage of erythroblasts was found in other cases unresponsive to the CA therapy.
  • —Daunomycin, Cytosine arabinoside, 6-mercaptopurine riboside及び副腎皮質ホルモンの四者併用大量間歇療法について—
    平野 正美, 森田 昭光, 佐光 冨士男, 植谷 忠昭, 鯉江 捷夫, 神谷 忠, 大野 竜三, 西脇 洋, 石黒 順造, 小寺 良尚, 江 ...
    1972 年 13 巻 6 号 p. 951-957
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    To improve the complete remission rate of acute leukemia, especially that of acute myelogenous leukemia, 4 agents each of which has an established but limited effect on acute leukemia were combined. Drugs used were daunomycin 25 mg/m2 iv, cytosine arabinoside 80 mg/m2 iv (1 hour infusion), 6 mercaptopurine-riboside 300 mg/m2 iv and prednisolone 60 mg/m2 po. The combination chemotherapy was administered daily in a 4 day course, repeated every 2 weeks. Three courses were administered before it was decided as ineffective.
    As of April 1972, 34 patients (32 adults and 2 children) had been studied: acute myeloblastic leukemia (AML), 16 cases; paramyeloblastic (AMpL), 9 cases; monocytic (AMoL), 8 cases and lymphocytic (ALL) 1 case (The ALL case was refractory to daunomycin+vincristin+prednisolone therapy).
    Of 34 patients 22 (64.7%) obtained complete and 3 (8.8%) partial remissions. There was no difference in the complete remission (CR) rate between previously treated and untreated patients, CR rate being 6/9 (66.7%) and 16/25 (64.0), respectively. The CR rate in each type of acute leukemia was 11/16 (68.8%) in AML, 3/9 (33.3%) in AMpL, 7/8 (87.5%) in AMoL and 1/1 in ALL. The median survival of 25 previously untreated patients is 5 2/3 (1/3∼16) months.
    Twelve out of 23 adults with AGL (AML+AMpL) had complete remissions (CR rate 52.5%). CR rate among 31 adults with acute non-lymphocytic leukemia (AML+AMpL+AMoL) was 61.3%.
    CR was obtained after only 1 or 2 courses of treatment in 19/22 patients. The median duration until CR was 32 days from the beginning of the treatment (14∼64 days). The median remission length currently is 5+months.
    A profound aplastic bone marrow ensued even in those patients who did not reach CR, indicating a potent leukemocidal effect of the regimen.
    Toxic effects of the treatment so far observed includes severe pancytopenia, nausea, vomiting, epilation and liver function abnormalities. As many as 32 among 34 patients showed fever above 38°C some time during the remission induction treatment most likely due to infections. However, only two of them succumbed to the infection.
    The quadruple combination chemotherapy reported here proved to be one of the most potent remission induction therapy of acute leukemia so far reported.
  • —とくに電顕細胞化学的観察を中心に—
    小宮山 淳, 江口 光興, 塚田 昌滋, 赤羽 太郎
    1972 年 13 巻 6 号 p. 958-965
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    Two children with acute monocytic leukemia (Naegeli type) were treated with Daunomycin and achieved complete remissions. The remissions lasted only 3 weeks and 3 months respectively. Limiting toxicity included thrombocytopenia, oral ulceration, alopecia and sinus arrhythmia.
    Ultracytochemical changes in bone marrow leukemic cells, induced by Daunomycin administration, were observed. Particular emphasis was placed on the nucleoli which reduced roundly in size, and the disintegrated nucleolonema was filled with only fine granules. Peroxidase and acid phosphatase activities decreased slightly in intensity in the nuclear envelope and the cavity of granular endoplasmic reticulum, but not in the azur granules. Abundant, irregularly shaped granules with in tensive acid phosphatase activity developed around the Golgi area in a large number of cells.
    The relation between such ultracytochemical changes and cytotoxic action of Daunomycin in the literature was briefly discussed.
症例
  • 銅直 利之, 鈴木 弘文
    1972 年 13 巻 6 号 p. 966-975
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    A 52-year-old Japanese female was admitted to our hospital 15 years ago (Sept., 1956) with edema of the face and legs and shortness of breath. Her past and family histories were not remarkable. There were hyperproteinemia, rapid sedimentation rate and severe anemia (Table 1∼3).
    Petechiae first developed over her both legs after prolonged laundry. In 1958 she was demonstrated to have marked increase in serum γ-globulin and in 6.7S component, abnormal decrease in BMR, PBI and 131I-uptake, and elevated serum total cholesterol; Bence Jones protein, pyroglobulin, macroglobul in and cryoglobulin were not demonstrable; the thyroid gland was slightly palpable but not enlarged. These findings led to a diagnosis of purpura hyperglobulinemica of Waldenström associated with idiopatic myxedema. The administration of thyroid preparation was followed by disappearance of the edema and improvement of anemia but had no effect on the serum protein pattern and purpura.
    Close coagulation surveys were performed in 1964 (Table 4). The only finding of particular note was an unexplained poor response of patient's plasma to tissue thromboplastin, which was corrected by the addition of normal plasma.
    In 1970, thyroid auto-antibodies were detected in the patient's serum; an open biopsy of the thyroid gland revealed histological findings of Hashimoto's disease (Fig. 4). Electrophoretic pattern showed a polyclonal increase in γ-globulin, and immunoelectrophoresis and immunodiffusion revealed also an simultaneous increase in IgG, IgA and IgM (Table 2, Fig. 3).
    Recent coagulation studies demonstrated that the patient's plasma in the presence of thrombin at a low concentration gave a definitely prolonged thrombin time that was corrected by the addition of normal plasma, further addition of CaCl2 or protamine sulfate (Table 5); these hemostatic abnormalities appear to be related to the purpura. An increase in antithrombin was entirely absent in this case.
    The clinical picture and laboratory data hitherto obtained in the present case, except for the purpura, were identical with those of Hashimoto's disease known as one of the most representative autoimmune diseases. Waldenström proposed that purpura hyperglobulinemica might be an “auto-immune” condition. Our present case suggests that the syndrome is due to abnormal globulins produced by Hashimoto's disease.
  • 清 正子, 榛沢 みよ子, 木本 元治, 上田 俊男, 三神 美和
    1972 年 13 巻 6 号 p. 976-980
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    A case of CML in a fifty seven year old female patient of special interest is reported.
    At the onset her chief complaints were abdominal discomfort and fatigue. On physical examination, no splenomegaly was found.
    Hematological examination could not reveal definite sign of CML except bone marrow smears; she showed normal leukocyte count with normal numbers of basophils and normal LAP score. Philadelphia chromosome was clearly identified in bone marrow cells.
    Such conditions lasted about a year and a half then she suddenly showed leukoctyosis with basophilia and low LAP score, at the same time Philadelphia chromosome became quite evident. Spleen was enlarged.
    Six months after the manifestation of CML symptoms, she died of blastic crisis with respiratory infection, then no double Ph' was found, 47 chromosomes due to C excess were mixed.
    This case suggests us some relation among low LAP score, Philadelphia chromosome and reasonable clinical sign of CML as have been pointed out by many authors.
    This case suggests us that both the Philadelphia chromosome and low LAP score do not preceed the other clinical features of CML.
  • 田中 教英, 竹之内 明
    1972 年 13 巻 6 号 p. 981-986
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    The patient was 55 years old male, and diagnosed as diabetes and hypertention. Since 4 years, he was successfully treated with tolbutamide (sulfonylurea group) and hydroflumethiazide or cyclopenthiazide (thiazide group).
    Four years later. he was admitted to this hospital with chief complaints of the gingival hemorrhage and general fatigue. Examination of the blood showed anemia, thrombocytopenia and leucopenia with erythroblast hyperplasia and no young myeloid cells. The marrow showed no myeloblast and hyperplasia of the erythroblast (almost 70% of whole cells), particularly urerythroblasts, megaloblastoid cells and these naked nucleus cell.
    The patient who was diagnosed as acute erythremia from these findings, was given blood transfusion, corticosteroids and 6-mercaptopurine for 5 months and died.
    Some discussions were done about the correlation between sulfonylureas, thiazides and the occurance of the blood dyscrasias in this paper.
  • 廣川 勝晃, 神山 隆一, 山口 黎子
    1972 年 13 巻 6 号 p. 987-995
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    An autopsy case of 62-year-old male with macroglobulinemia Waldenström was reported. The initial sign was swelling of the cervical lymph nodes, spreading gradually to the general lymph nodes. He was admitted to the hospital because of marked anemia and accelerated ESR. Serum electrophoresis showed an M-component, 36%, in γ region, which was demonstrated as IgM-K by immunoelectrophoresis. Ultracentrifugation showed a 15.8S fraction, 33.1%. In a biopsied lymph node, sarcomatous proliferation of various sized lymphocytes was observed and bone marrow puncture revealed marked hyperplasia of erythroblasts and moderate one of lymphoid cells. On autopsy, numerous plasma cells or plasmocytoid cells, occasionally with PAS positive intra-nuclear inclusions, were observed in sarcomatously swollen lymph nodes, and bone marrow was almost replaced by such plasmocytoid cells. Leukemic infiltration of these lymphoid or plasmocytoid cells was observed extensively in the liver, kidneys, spleen, lungs, brain and intestine. By observation with electron microscopy and fluorescent antibody technic on biopsied and autopsied materials, it was considered that those cells producing or containing abnormal macroglobulin were very close to the plasma cell series.
  • 檜森 巽, 氏家 重紀, 菅原 伸夫, 池野 重興, 斉藤 達雄, 三浦 亮
    1972 年 13 巻 6 号 p. 996-1005
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    A 59-year-old man, a farmer, was hospitalized complaining of severe lumbago, pallor and emaciation.
    X-ray films of the bones disclosed generalized osteoporosis and punched-out lesions in the skull. Bence Jones proteinuria was detected. A bone marrow aspirate showed 83.2% replacement of normal marrow elements by markedly atypical myeloma cells resembling monocytes or lymphoreticular cells, being confirmed by electron microscopy.
    The patient was diagnosed as IgD myeloma on immunoelectrophoretic examination. Normal serum total protein level (6.6 g/dl), presence of Bence Jones proteinuria, lambda light chains and electrophoretic mobility in β-range of myeloma protein, which have been mentioned as the characteristics of IgD myeloma in comparison with other types of myeloma, were observed also in this case.
    Analysis of the literature concerning IgD myeloma in Japan suggested that cellular atypism of IgD myeloma cells in this case was the most remarkable one in Japan.
    Administration of cyclophosphamide was moderately effective on lumbago.
  • 長谷川 仁, 長瀬 弘明, 田中 岑也, 池田 靖, 伊藤 康彦, 中島 伸夫
    1972 年 13 巻 6 号 p. 1006-1022
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    A case of reticulosis, 58 years old man, was reported. The initial symptomes were fever and papuloerythematous skin eruption on trunk and extremities, followed by enlargement of cervical and axillary lymph nodes. Biopsy of a cervical lymph node was interpreted as reticulosis. Diffuse hypergammaglobulinemia was present (Fig. 1, Table 2). This was due to an increase in IgG component (Fig. 2). Peripheral blood exhibited atypical mononuclear cells resembling to so called virocytes (Table 3, Photo. 1, 2). Other laboratory findings on admission were not contributory (Table 1). A course of Sigmamycin (Tetracycline 2+Oleandomycin 1) resulted in a remarkable decrease of lymph nodes in size and peripheral atypical cells in number (Fig. 3). However, second course was necessary, that was not so effective for lymph nodes as the initial one. He died of sudden bleeding from stomach. Postmortem examination revealed systemic enlargement of the lymph nodes, splenomegaly and multiple tumors of the stomach with ulcers on their surfaces. Serial lymph node specimens, three biopsies and autopsy, demonstrated a progressively changing pattern (Photo. 3-9, 12-14). Initially diffuse proliferation of reticulum cells and increased vascularity were noted, together with many lymphogonia-like cells. Plasma cells were seen in small number. Subsequently round cells of various sizes and plasma cells increased in number, associated with fibrosis around small vessels. Finally plasma cells predominated, and a lot of multinucleated cells were noted. The normal architecture was almost obliterated. Histologic features similar to that of lymph nodes were present in tumors of the stomach (Photo. 15, 16), and also in the spleen (Photo. 17), bone marrow (Photo. 18), liver, kidneys, lungs, adrenal glands, thyroid gland and testes. The interrelationships between the pathologic findings, peripheral atypical cells and protein abnormality were discussed. In addition, on the basis of clinical and pathologic findings, a possible explanation for the cause of this disease was presented.
  • 御木 達也, 山口 道也, 渡辺 郁代, 大石 光雄, 肥後 理, 堀内 篤
    1972 年 13 巻 6 号 p. 1023-1028
    発行日: 1972年
    公開日: 2008/10/31
    ジャーナル 認証あり
    A twenty-two-year-old male was admitted to the hospital in May 1970 with a high fever and headache. Blood and bone marrow examination disclosed acute lymphocytic leukemia. The patient was treated with BIKE program, which induced a complete remission of only two weeks. Thereafter remissions were obtained. two more times with L-asparaginase, daunomycin and cytosine arabinoside, Shortly before the third relapse the patient developed meningeal leukemia which caused coma of short duration. The meningeal leukemia was treated with intrathecal administration of MTX, and a complete remission was attained to after about a hundred days. But the episode left a significant change in character. Autopsy revealed dural, arachnoidal and intracerebral perivascular infiltration of leukemic cells.
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