The anemia associated with renal failure does not respond to usual therapeutic measures. What is the place of repeated massive blood transfusions in the treatment of long-term hemodialized patients? It may be stated that anemia is one of the great problems on uremic patients. On well maintained hemodialysis, transfusion may aggrevate erythropoiesis due to the disturbance of homeostasis. In this report, we investigated a relation of the erythropoiesis to the blood transfusion in long-term hemodialized patients.
Our patients consisted of well-maintained long-term hemodialized patients (Group A) and poorly-maintained (Group B).
Group B required more transfusions than Group A. Group A divided into 3 Groups; Group I did not required transfusion for 6 months or more, Group II did not take blood for 3 or 4 months and Group III tend to require a little transfusion. In the most of Groups I and II, ferrokinetic studies reveal the type of iron deficiency anemia and erythropoietin (ESF) in the plasma are detectable, but Group III showed an ineffective erythropoiesis in ferrokinetics and ESF are not detected except one patient. ESF disappeared after transfusion in the plasma on hemodialized patients. In a case of Group II, ESF in his plasma which had not been detected, appeared on the 50th day after the cessation of transfusion.
In our opinion, it is not necessary to do transfusion in long-term hemodialized patients before symptomes of anemia again become prominent.

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Euglobulin Clot Lysis Time (ELT) was measured with a Time Saving Recorder (Carmanan Co., England) for 67 normal subjects comprising 34 males (aged 22∼41) and 33 females (aged 12∼52) and for 17 acute and chronic leukemia patients, and an evaluation was made of the values obtained.
Standarization of clot formation was undertaken as the prerequisite study. The following basic points were tested: the adequate volume of the standard clot, the adequate thrombin concentration, the effect of the contact system on ELT, the effect of the period of euglobulin precipitation on ELT, and the effect of the fibrinogen content of the standard clot on ELT. In the case of normal ELT's, the mean value and its deviation, the effect of the contact system, the correlation between plasma fibrinogen content and ELT, and the relation between ELT and the standard fibrin plate method were assessed. In the case of the leukemia patients' plasma ELT, the mean value and its deviation were obtained, and a comparison was made with the normal values. The results may be summarized as follows:
1) The adequate volume of the standard clot was 0.5∼0.6 ml for our assay system using the Time Saving Recorder.
2) A thrombin concentration of 20 u/ml∼50 u/ml in the 0.1 ml thrombin sample was adequate for 0.5 ml of euglobulin.
3) The period of euglobulin precipitation was observed to influence the enzymatic activity when it extended over 24 hours.
4) The contact system was observed to enhance slightly only weak fibrinolysis, implying that it is not necessary to use intact plasma for practical application of the ELT Recorder.
5) The fibrinogen content of the standard clot was observed to influence the ELT in an in vitro experimental system, but in practical observations there was no correlation between plasma fibrinogen level and ELT.
6) There was a tendence for ELT to be correlated with the fibrinolytic activity determined by the standard fibrin plate method.
7) The average ELT value for the 67 normal subjects was 263 minutes and its standard deviation was 125 minutes. There were no significant differences between males and females.
8) A clear prolongation of ELT was observed in the leukemia patients. The average value was 784±447 minutes.

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Increasing importance of preventive and therapeutic measures for concurrent microbial infections during induction therapies for acute leukemia is recognized. Infections account for approximately 60% of the direct cause of death in patients with acute leukemia. Septicemias from gram-negative rods of enteric origin are major threat in patients with extreme neutropenia. “Intestinal sterilization” was attempted in 14 patients with acute leukemia under induction therapy by the combined oral use of gentamicin, kanamycin and amphotericin B in association with well-cooked dietary regimen. Serial quantitative stool cultures for aerobic, anaerobic and fungal organisms revealed that “intestinal sterilization” was effective in suppressing fecal flora in significantly high percentages of specimens. The cessation of oral antibiotic regimen and well-cooked diet was followed by a prompt return of fecal flora, however. The incidence of febrile episodes while patients were on “intestinal sterilization” schedule was lower than that of a control group of patients under the similar morbid situation without “intestinal sterilization”. This difference was not statistically significant. Anorexia and nausea were common, but they were generally mild and did not necessitate interruption of the regimen. “Intestinal sterilization” appears to deserve further study as a supportive therapy for the treatment of acute leukemia.

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A male patient, aged 46 years, had noted high fever and easy fatiguability 2.5 months before admission. He was treated by home doctor with prednisolone and antibiotics. He was admitted to our hospital, as anemia developed and no improvement was induced by these treatment. Physical examination on admisson revealed slight hepatosplenomegaly without lymphadenopathy. No hemorrhagic tendency was observed. His Hb level was 11.2 g/dl. Leukopenia and thrombocytopenia were noted. Urinalysis revealed slight proteinuria. A number of large atypical reticulum cells were detected on bone marrow smears. Small number of these atypical cells were seen on peripheral blood smears. Except for accelerated BSR, no remarkable changes were observed in various laboratory examinations. In the terminal stage, mild jaundice developed. Either reticulum cell sarcoma or Hodgkin's disease was suspected clinically. He died on 7th hospital day.
Autopsy revealed lesions consistent with Hodgkin's disease in the spleen and bone marrow where many Reed-Sternberg's cells were found. Hodgkin's cell emboli were observed within blood vessels of the cereberum, liver, kidneys, adrenals and pituitary gland. Except for mild involvement of a few of the peripancreatic lymph nodes, Hodgkin's lesion was not observed in the other lymph nodes.

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A case of severe autoimmune hemolytic anemia with a specific autoantibody type associated with polymyositis is described.
A 13-year-old girl was admitted to our hospital, because she had the following symptoms for 3 days; rapidly progressing severe anemia, weakness, fever and jaundice. On her admission she was severely anemic and slightly icteric. Her liver, spleen and lymphnodes were not palpable. No abnormal neurological symptoms were exhibited by the patient. Laboratory studies were as follows; hemoglobin was 6.4 gm. per cent, red blood cell count was 1,840,000 per cu. mm. and reticulocyte count was 7.8%. Direct Coombs' test was positive but indirect Coombs' test was negative. Serum total bilirubin was 5.3 mg. per cent of which 3.4 mg. per cent was indirect bilirubin fraction. Anti-Rh-e antibody, anti-white-blood-cell antibody, anti-thrombocyte antibody and anti-nucleus antibody were detected in her serum. She was diagnosed as having hemolytic crisis due to an autoimmune mechanism and was successfully treated with a high dose of corticosteroid.
On the 12th day of admission her proximal muscles of all extremities suddenly became tender and weak. Histological examination of the biopsy specimen obtained from deltoideus muscle revealed widespread degeneration of the muscle fibers and diffuse perivascular infiltration of lymphocytes. The diagnosis of polymyositis was confirmed from these findings. Cases of hemolytic anemia with positive Coombs' test have been observed not rarely in patients with certain collagen diseases, especially systemic lupus erythematosus. However, the association of this disease with polymyositis is rare. To our knowledge only two cases have been reported previously. However, the possibility that we are observing a transient period of SLE in this patient is not ruled out.

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A case of long-term survivor of leukemic lymphosarcoma was reported. At 8 yrs 9 mos, a snore was noted and one month later lymphnode swelling at the both sides of the neck and tonsillar hypertrophy were observed. The diagnosis of lymphosarcoma was made and irradiation was done over the neck, axilla and mediastinum.
Four months later lymphnodes swelling was noted at both sides of inguinal region. After the swelling was confirmed as the invasion of lymphosarcoma by biopsy, irradiation was done.
At 9 yrs 6 mos, fever and pallor were noted. By hematological examination 13% and 22.8% of tumor cells observed in each peripheral and bone marrow smears. Neither hepatosplenomegalia nor lymphnode swelling was observed. By combined administration of both prednisolone and vincristine sulfate, complete remission was obtained and mintained by the combined administration of 6-MP and cyclophosphamide following single administration of 6-MP.
The patient is still under complete remission 5 yrs and 2 mos after leukemic transformation.

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Four cases of giant hemangioma with coagulation abnomalities were observed. The tumors appeared at epigastric region in 2 mons. old female, at right shoulder in 2 mons. female, at lumbar region in 5 mons. old male and at left trunk in 1 yr old children.
Extensive coagulation studies were carried out in all cases thrombocytopenia (100,000/cmm), low fibrinogen concentration (200 mg/dl) and increased fibrinolysis (thrombin time, euglobulin lysis time or fibrin-fibrinogen degredation product) were observed.
Three infant cases were treated with conventional deep X-ray and or electron radiation therapy up to 540-1700 R for 1-3 weeks the treatment resulted in decrease in the size of tumors and the coagulation abnormalities were corrected to normal.
One case of 1 yr old girl revealed severe hemorrhagic tendency due to primary fibrinolytic activity after surgical procedure to the tumor. Antifibrinolytic therapy with t-AMCHA etc. was followed by significant improvement of hemorrhages.

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A 17-year-old male student was admitted to our hospital because of long-standing fever of unknown origin not responded to antibiotics. Physical examination showed no skin lesions. Hematologic study revealed pancytopenia and partial megaloblastic marrow. The serum L. casi activity was obviously decreased and the serum B₁₂ value was slightly decreased, too. An exploratory laparotomy for obscure fever disclosed mesenteric panniculitis. Although treatment with corticosteroid and folic acid was partially effective upon the hematologic abnormalities and fever, the patient was expired after hematemeses on the 194th hospital day. The post-mortem examination established the diagnosis of systemic Weber-Christian disease involving omental, mesenteric, pericardial, pleural and subcutaneous adipose tissues.
Both increased folate requirement caused by the expansive inflammation with long-standing fever and inadequate dietary folate intake due to anorexia were presumed as the mechanism of folate deficiency, on the basis of laboratory and pathological findings. For pancytopenia, however, not only folate deficiency but also multiple factors including shortened blood cell survival, hypersplenism and bone marrow panniculitis appeared to be responsible. Furthermore, relationship between this disease and immunologic deficiency is discussed.

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A case of lymphosarcoma which converted into leukemia to be found with morpholo gically atypical lymphoblastic cells in a 16 year old boy was reported. When the leukemia itself seemed to have been suppressed effectively with the use of antileukemic agent, leukemic meningitis developed which was fatal. Autopsy specimen showed a pathological picture of acute leukemia with remarkable tumor cell infiltration into lymph nodes, spleen, kidney and bone marrow. The central nervous system involvement was seen in dura, pia mater as well as in brain parenchyma where the perivascular tumor cells infiltration recognized in and around both small arteries and arterioles. It was shown that frequent leukemic transformation had been observed with lymphosarcoma and also pointed out that complication of meningeal leukemia has been seen in frequently in cases of leukemic change.

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