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14 巻, 7 号
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臨床研究
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苅家 利承, 鎌倉 正英, 小沼 宗心, 大橋 辰哉, 増山 善明, 吉利 和, 久米 章司, 浅川 英男, 小宮 正文1973 年 14 巻 7 号 p. 749-756
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありThe present paper reports a case of α-methyldopa (Aldomet) induced Coombs positive hemolytic anemia in Japanese and discusses some clinical and etiological points.
A 57-year-old woman had been administered “Aldomet” 500 mg/day for two years developed anemia and laboratory examinations revealed Hb 9.6g/100 ml, RBC 2.59×106, Ht 24.5%, reticulocyte 9.5%, serum bilirubin 1.7mg/100 ml, and S-LDH 453u. Both direct and indirect Coombs tests (D.C.T. and I.C.T.) were positive, showing positive with anti-IgG and anti-κ, but negative with anti-λ. Spherocytosis was observed and red cell osmotic fragility increased. The red cell ATP level was low, and Na+, K+ATPase activity higher normal. Glucose-6-phosphate dehydrogenase activity was increased. A bone marrow examination showed erythroid hyperplasia (M:E=1:1). “Aldomet” was discontinued and anemia and reticulocytosis improved gradually. Although both D.C.T. and I.C.T. remain positive (six months later), the titers decreased significantly.
We found another Coombs positive case among fourteen hypertensive Japanese on “Aldomet”.
The red cell membrane enzyme, Na+, K+ATPase, was measured and the kinetics showed Km for K+ (potassium) of 2.7 mM (normal 2.6-3.5 mM). But Na+, K+ATPase and total ATPase, which were plotted as a function to ATP concentration, showed a peak at 0.3 mM ATP concentration and hence Lineweaver-Burks plot was not linear. This peak disappeared after the antibody elution technique.
This finding suggests that some population of red cell ATPase, especially Na+, K+ATPase, has gotten an altered affinity to ATP by way of antibody attachment to the cell membrane.抄録全体を表示PDF形式でダウンロード (552K) -
—Pneumomediastinographyを中心として—中田 安成, 有森 茂, 多田 慎也1973 年 14 巻 7 号 p. 757-761
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありFew reports are found in literature concerning the thymus and hypoplastic anemia. The planimetry of the thymus area in pneumomediastinography of three patients with hypoplastic anemia is reported herein. Case 1 was a 31-year-old male. His bone marrow revealed maturation arrest. Duration of his illness was about 14 years and 14,000mg of prednisolone and 5,650 units of corticotropin were administered. Case 2 was a 49-year-old male. His bone marrow showed a combination of maturation arrest and hypocellurality. The onset of anemia was 14 months ago, and he was treated with 1,945 mg of prednisolone and 1,420 units of corticotropin. The third case was 31-year-old female. The history of hypoplastic anemia began in the 5th month of pregnancy in 1964. Since then 1,220 mg of prednisolone and 400 units of corticotropin were administered prior to pneumomediastinography. Her bone marrow also revealed maturation arrest. The thymus area of pneumomediastinography in these patients was 15.4, 18.0, 20.4 square cm in Case 1, 2 and 3, respectively, and the mean was in 17.9 square cm. The size of thymus in patients with hypoplastic anemia was the same as those of patients with Hashimoto's thyroiditis, Behçet disease, Sjögren's syndrome and myasthenia gravis, and much larger than those of systemic lupus erythematosus and rheumatoid arthritis. The thymic shadow in the patients with hypoplastic anemia had densities suggestive of a mixture of fat and lymphoid tissue. The relationships of the thymus and anemia, and of the thymus and corticosteroid hormone has been discussed.抄録全体を表示PDF形式でダウンロード (633K) -
月本 一郎, 豊坂 比沙子, 田代 安司, 長尾 大1973 年 14 巻 7 号 p. 762-768
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありThe therapeutic effect of cytosine arabinoside and daunomycin on leukemic blast cells in the bone marrow was evaluated. Changes in proliferative capacity were evaluated by serial measurements of the number of cells in mitosis and the per cent of cells in deoxy-ribonucleic acid (DNA) synthesis and ribonucleic acid (RNA) synthesis as indicated by ability to incorporate 3H-thymidine or 3H-uridine. Seven cases of acute myeloblastic leukemia of children were studied. These patients had recieved and were resistant to all other standard chemotherapeutic agents at this time.
Cytosine arabinoside was given by an intravenous injection in a dose of 100 mg/m2. The in vivo H3-thymidine labeling index of leukemic blast cells decreased rapidly 4 hours after injection of cytosine arabinoside and recovered within 24 hours. This phenemenon indicated that cytosine arabinoside inhibited DNA synthesis and achieved partial synchronization of the cells.
Daunomycin was given by an intravenous injection in a dose of 1 mg/kg body weight. Four hours after completion of the injection, there were no remarkable changes in mitotic and 3H-thymidine labeling indexes. Twenty-four to 48 hours after injection both mitotic and labeling indexes had decreased markedly and recovered to the control level gradually within 72 to 96 hours. Mean grain count of labeled cells were unchanged. The in vivo 3H-thymidine labeling index of cells decreased or increased 4 hours after injection of daunomycin. The in vitro 3H-thymidine lebeling index of leukemic cells decreased rapidly 4 hours after incubation with daunomycin. These data indicated that daunomycin inhibited DNA synthesis more slowly than cytosine arabinoside. One explanation was that leukemic cells in G1 (G0) phase could incorporate daunomycin injected, which would persist in the cells and show inhibitory effect of DNA synthesis when those cells marched into S phase. Another was that inhibitory effect of daunomycin for the leukemic cells in G1 (G0) phase to enter S phase, probably through inhibition of RNA synthesis.抄録全体を表示PDF形式でダウンロード (522K) -
太田 瑛子, 三浦 裕, 戸沢 敬夫1973 年 14 巻 7 号 p. 769-776
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありHuman fibrin-agar plate (H-FAP) method for the estimation of fibrinolytic activity is described. This method using human fibrinogen is based on the Fibrin-Agar-Plate (FAP) method reported previously (3).
Human fibrinogen was purified by removal of plasminogen and plasmin directly from the commercial fibrinogen by affinity chromatography (Cuatrecasas et al. (4) and Mertz et al. (6)). Four protein bands were separated by disc electrophoresis from the purified fibrinogen obtained as above. No lysis was observed in the presence of urokinase or streptokinase over the range of units tested, when fibrinogen has been clotted with thrombin. This was also confirmed in thrombelastogram.
The H-FAP was prepared in a similar manner as described in the previous report (3): Seven ml of a barbital buffer solution containing 2% of agar (pH 7.8) were mixed with 3 ml of the same buffer solution containing 3 mg of purified human fibrinogen at 40 to 50°C. When the agar-fibrinogen mixture has solidified as gel at room temperature, 5 units (1.5 ml) of thrombin were added. Twenty units of U. K. were found optimal for the activation of euglobulin.
Various samples can be compared and observed for a long period in diseases related to fibrinolysis in the same lot of H-FAP, because it is stable when stored in a refrigerator (4°C).抄録全体を表示PDF形式でダウンロード (932K) -
—走査型電顕による検討—塚田 理康, 小川 哲平1973 年 14 巻 7 号 p. 777-784
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありFour ml of native whole blood and whole blood with anticoagulants, adenosine, AMP or aspirin were passed through the columns manually at a flow rate of one ml per 10 sec., and effluent blood was collected in four aliquots of 1 ml each.
Not only adhering but also aggregation of platelets were detected on the surface of glass beads even after first ml of native whole blood were passed through the columns. The more whole blood were passed through the column, the more platelets were retained by the column by means of their aggregation on glass surfaces. When glass heads were washed with 10 mM EDTA saline, aggregated platelets disappeared and only same adhered platelets remained on the surface.
Decalcification of whole blood, or adding of adenosine or AMP to the native whole blood, almost inhibited platelet retention by means of peventing platelet aggregation on glass surface.
Aspirin which was thought to inhibit secondary platelet aggregation due to ADP, epinephrine or collagen, in vivo or in vitro, had no effect on the retention rate of platelets.
Retention of platelets by glass bead columns appeared to be determined by platelet adhesion to glass surface and platelet aggregation due to exogenous ADP, which induced no secondary aggregation of platelets.抄録全体を表示PDF形式でダウンロード (1818K) -
大城 孟, 向井 清, 洪 性徳1973 年 14 巻 7 号 p. 785-794
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありOn the appearance of secondary anemia associated with chronic liver disease (liver cirrhosis etc) many workers had already suggested that such varied processes as hemorrhage, nutritional deficiency, hemolysis, marrow depression and hypervolemia might play a part. The purpose of this study was to investigate the correlation between secondary anemia and these processes, especially hemolysis. We paid attention to serum haptoglobin (Hp) as the indicator of hemolysis. Serum Hp was measured by means of single radial immunodiffusion.
The results were as follows.
1. The secondary anemia among patients in chronic liver disease (liver cirrhosis etc) appeared in frequency of 54.2% and showed the normo-hyperchromic, normomacrocytic, nonsuturated type.
2. This anemia seemed to appear under the various combinations of these processes.
3. Serum Hp level which had remarkably decreased in chronic liver disease incresed rapidly after splenectomy. These phenomena supported that hemolysis was certainly present in chronic liver disease and the main field of hemolysis was spleen.
4. As there was no correlation between red blood cell counts and serum Hp level, it was unlikely that secondary anemia of patients in chronic liver disease with the signs of hemolysis was solely due to hemolysis.
5. Hemolysis was not related to the degree of splenomegaly and portal hypertension.
6. From the data of ahaptoglobinemia in liver fibrosis, glissonitis and Banti's syndrome, the maximum increase rate of serum Hp was about twice of the normal.抄録全体を表示PDF形式でダウンロード (864K) -
秋月 健, 鈴木 孝雄, 田中 鉄五郎1973 年 14 巻 7 号 p. 795-799
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありDetermination of Total Iron Binding Capacity (TIBC) using Res-O-Mat Fe kit (TIBC) offered by Daiichi Radioisotope Labs., Ltd. was investigated.
Procedure of this kit was easier than colorimetry or immunological method and the error in assay due to iron contamination of instruments or reagents and deproteinization as in colorimetry was hard to occur in this kit method.
The reproducibility of assay value of the same serum was good (coefficient of variation was 5%) and no effect of keeping in a frozen state could be observed.
The corelation between TIBC value by this kit and the value of SI+UIBC by the other method was good (γ=0.89) and the value by this kit was slightly the lower.
With normal subjects, TIBC value and transferrin was corelated well, but with various diseases, both were not so well corelated. In iron deficiency anemia, anemia of pregnancy, leukemia and aplastic anemia, TIBC value was higher than the value of SI+UIBC.
Though further investigation will be needed in the future, this kit method is found to be useful in clinical application, because the exact TIBC value is obtained easily in a short time by anyone.抄録全体を表示PDF形式でダウンロード (364K)
症例
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木村 あさの, 小松 良彦, 呉 道朗, 河村 節子, 吉田 豊, 永井 一徳1973 年 14 巻 7 号 p. 800-804
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありA 35 years aged farmer came to our department with a complaint of epigastric fullness in April, 1967. Five months later splenomegaly and leukopenia (1,500/cmm) with absolute neutropenia, relative monocytosis and 8% of reticulum cells in peripheral blood were found. Aspiration of bone marrow, biopsy of lymph nodes and measurement of intra-splenic pressure were performed, and a diagnosis of reactive reticulosis and hypersplenism was made. On Jan. 9, 1968 splenectomy was performed, and the spleen weighed 1,860 gm. The histological diagnosis was splenitis. Patient had felt well until June, 1970 when he was admitted to our department because of easy fatigability and fever of unknown etiology. At this time the liver was 8 fingerbreadth palpable with elevated ZTT and γ-globulin and normal transaminases. The peripheral blood smear showed 72% small lymphocytes and 3% metamylocytes. Four erythroblasts were counted with 100 leukocytes. With steroid therapy the symptoms improved and hepatomegaly disappeared. In May 1971, bleeding tendency and jaundice appeared and reticulum cells of 80% were seen in the peripheral WBC of 51,000/cmm. Patient died of hepatic coma one month later. The diagnosis of malignant reticulosis was confirmed after autopsy.抄録全体を表示PDF形式でダウンロード (747K) -
平井 博子, 浅原 朗, 鈴木 亮而1973 年 14 巻 7 号 p. 805-811
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありA 66-year-old man with myelofibrosis and paroxysmal nocturnal hemoglobinuria was reported. The patient was diagnosed as myelofibrosis, because leukoerythroblastic anemia and hepatosplenomegaly suggesting extramedullary hematopoiesis were evident, and fibrosis of the bone marrow was confirmed by biopsy. Although he showed no hemoglobinuria since his admission, a number of signs of intravascular hemolysis such as the presence of hemosiderin in urine, the low value of haptoglobin and the increase of LDH showing isozyme pattern suggestive of hemolysis, the shortened erythrocyte life span, the positive Ham's and sugar water test, and the decrease of acetylcholineesterase activity suggested myelofibrosis complicated with paroxysmal nocturnal hemoglobinuria. He has been followed with the administration of protein anabolic hormones and washed erythrocyte transfusion.抄録全体を表示PDF形式でダウンロード (632K) -
—電子スピン共鳴法でHb M Hyde Park (=M Akita) Diseaseと判明した1例—衣笠 昭彦, 乾 明彦, 三宅 宗隆, 曾山 浩吉, 楠 智一, 中村 恒男, 亘 弘1973 年 14 巻 7 号 p. 812-820
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありA case, 7-year-old girl, of Hb M Hyde Park was presented. The diagnosis was made on data gained by ESR (electron spin resonance) determining method. The half time of her red cell life span was estimated by 51Cr method and disclosed to be 15 days. The bone marrow showed marked erythroid hyperplasia, although no abnormalities were found on the myeloid series. The amount of the D-2, 3-diphosphoglycerate in her red cell was within normal limits.
In this report, the authors mentioned the efficacy of ESR determining method for diagnosing the Hb M disease. The accuracy and simplicity are the best point of ESR method.抄録全体を表示PDF形式でダウンロード (852K) -
加藤 友義, 判治 康彦, 西村 豊, 山川 毅, 細井 惇, 加藤 作郎, 小栗 隆1973 年 14 巻 7 号 p. 821-830
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありCongenital afibrinogenemia in two sisters aged 8 years and 4 days were reported with a summarized review on the 25 reported cases in Japan.
Bleeding episodes of both patients started with umbilical bleeding in the newborn periods. An elder sister was given fibrinogen or fresh blood on hemorrhagic episodes, but suffered from acute hepatitis for 2 months at the age of 5 years.
A younger sister had umbilical bleeding on the 3 rd day of life which was ceased promptly by the fibrinogen administration, but she suffered from septicemia and died on 8 days of life.
In both patients fibrinogen in the blood was not detected by coagulative, physicochemical and immunological methods. Abnormalities of clotting factors other than fibrinogen, circulating anticoagulants and hyperfibrinolysis were not demonstrated. The platelet aggregation was studied on the elder sister and another congenital afibrinogenemic boy of 4 years old. ADP-induced platelet aggregation was decreased especially by a low concentration of ADP. This finding confirmed that the fibrinogen was necessary for ADP-induced platelet aggregation.抄録全体を表示PDF形式でダウンロード (1525K) -
—その電子顕微鏡的考察—及川 浩助, 村田 輝紀, 大滝 正通, 稲葉 竜太郎, 三上 雅嗣, 佐藤 功, 遠藤 一靖, 小野寺 清寿, 鈴木 隆城, 新井川 勝久 ...1973 年 14 巻 7 号 p. 831-837
発行日: 1973年
公開日: 2008/10/31
ジャーナル 認証ありA 69-year old man of Bence Jones (λ) type plasmacytoma is described, who showed numerous virus-like particles electronmicroscopically in his myeloma cells; 5% of the myeloma cells of bone marrow contained round shaped inclusion bodies of 0.5∼5 μ in diameter, in which numerous virus-like particles of 40∼90 mμ in diameter were seen. Inclusions and particles were surrounded by a unit membrane, which was about 90 Å thick and could be resolved into a triple-layered structure. The particles were located along periphery of, or scattered in the inclusions. Occasionally they were found in endoplasmic reticulums.
Though they superficially resembled A-particles, they did not possess double membrane and were not as uniform in size as A particles. Buddings or releasing out of the particles from cells, B-particles, and C-particles, were not found.
These observations suggest that they are probably not viruses. They may be closely related to Golgi vesicles, because in this case Golgi vesicles were well developed, inclusions existed near Golgi area, and the pictures which suggested transition from Golgi vesicles to the particles were often recognized.抄録全体を表示PDF形式でダウンロード (1501K)
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