In the present study an attempt was made to demonstrate the relationship between the prognosis and the initial hematological findings in 46 adults with aplastic anemia who were admitted to our clinic. Significant correlations were observed between the survival term of the patients and neutrophil count, reticulocyte count or platelet count in peripheral blood or percentage of hematopoietic cells (erythroblasts and granulocytes) in bone marrow at initial stage of the disease.
Another attempt was made to classify the disease according to the degrees of initial hematopoietic impairment, combining above mentioned four hematological indices that had been found independently to correlate with survival term. The degrees of hematopoietic impairment were expressed in “Score” of six grades from 0 (severest) to 5 (mildest). Significant correlations were observed between these “Scores” and survival term of the patients.
Finally, cortico-steroid hormones were evaluated on the effect on survival term of the disease. The results failed to confirm the effectiveness of cortico-steroid hormones when the degrees of hematopoietic impairment in treated and untreated groups were taken into consideration.

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The membrane properties of circulating abnormal cells in 12 patients with chronic lymphocytic leukemia (CLL) were studied by immunofluorescence and spontaneous rosette formation with sheep erythrocytes. The function of circulating cells responding to stimulation with phytohemagglutinin (PHA) or pokeweed mitogen (PWM) was also observed.
The results were as follows.
1) Twelve patients with CLL were classified into four categories according to B and T cell markers of circulating cells; CLL of T-cells; 2 cases, CLL of monoclonal B-cells; 5 cases, CLL of polyclonal B-cells; 2 cases, CLL of non B. T-cells; 3 cases.
2) Two patients with T cell surface nature showed clinical feature of so-called prolymphocytic leukemia. Four of the eight patients with B-cell nature showed slightly hypergammaglobulinemia.
3) The circulating cells of patients with CLL showed little or no response to stimulation with PHA or PWM.

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Three cases of childhood aplastic anemia were splenectomized. One of them was improved and the other two cases were relatively improved after splenectomy. Although the bone marrow of these cases was hypocellular before splenectomy, the percentage of erythropoietic cells was 14.0% to 36.8%. A review of the literature revealed 22 documented case histories of splenectomy for childhood aplastic anemia. In this analysis about 45% of these cases appear to have been benefited by splenectomy.
Most authors suggested a gross rate of infection of 5 to 8% follwing splenectomy. In our cases no serious infection was recognized after splenectomy. Splenectomy is a possible treatment in the aplastic anemia which is refractory to any hormones and promotes moderate erythropoiesis in the bone marrow.

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The clinical records of ninety patients with acute leukemia under 15 years of age, who were seen between 1965 and 1973 at the National Children's Hospital, were reviewed.
Major causes of death in acute leukemia were bacterial infection in about 60% of patients and hemorrhage in 20%.
Recently, bacterial infections have increased and fatal hemorrhage declined to about half the early rate. Gram-negative septicemia, pneumonia, perianorectal abscess, otitis media and skin infections were the most common types of bacterial infections.
In first remission induction, 30 patients had no evidence of infection and 40 patients had one or more episodes of infectious diseases. The patients under 2 years of age seemed to be more susceptible to infections.
An absolute neutrophile count of less than 500/cu mm was the herald of serious bactrial infection.
The combinations of carbenicillin and gentamicin or kanamycin were used to treat severe bacterial infections. In 13 patients with septicemia, favorable results were observed in 6 patients.
Serious bacterial infections occurred ln 14 patients and fungal infections were observed in 8 out of 22 autopsied cases, respectively.

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Thirty six adults with acute leukemia were treated with a combination of cytosine arabinoside, vincristine (Oncovin), 6-mercaptopurine, prednisolone, and L-asparaginase (COMPA). The overall complete remission rate was 56%. Complete remission (CR) was achieved in 13 of the 26 patients (50%) with acute myeloid leukemia (AML) and in 7 of the 10 patients (70%) with acute lymphoblastic leukemia. Of the 26 patients with AML 22 had acute myeloblastic leukemia (AMbL), of whom 13 (59%) achieved CR, and none of the 4 patients with acute myelomonocytic or monoblastic luekemia attained CR. In AML there was no difference in the CR rate between the previously treated and untreated patients. The median time of therapy for patients who achieved CR was 14 days and the median time until remission (except for hemoglobin level) was 30 days.
The median CR time was 8.0+months (1.2-35.7+months) in AML and 7.5+months (3.5-15.9 months) in ALL. Six patients with AML and 1 patient with ALL are still in CR, and 4 with AML have remission durations longer than 2 years. The median survival times of complete responders from diagnosis were 15.1 months in AML and 10.6 months in ALL; those from the start of COMPA therapy were 18.9+months in AML and 11.0 months in ALL, respectively. Eleven patients with AML and only 2 with ALL are still alive.
The major side effects other than myelosuppression were liver function abnormalities, gastrointestinal symptoms, fever, and diabetes mellitus. Nine patients died within 4 weeks after the start of therapy. The causes of these deaths were sepsis in 7 patients, cerebral bleeding and diabetic coma in one patient, respectively. All of the 5 patients over the age of 50 succumbed to these early deaths.
COMPA regimen is an effective remission induction therapy for adults with acute leukemia, especially AMbL under the age of 50.

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A 72-year-old male patient with immunoglobulin fragment disease accompanied by a high serum IgE level was reported. He was admitted on June, 1971, with chief complaints of systemic lymph node swelling and bronchial asthma.
Laboratory examinations revealed relative lymphocytosis with a few lymphoblastoid cells and lymphoid cells (an appearance of reticulum cells) in the peripheral blood and in the sternal marrow aspirate the same types of cells increased in number up to 40%. Cellulose-acetate electrophoresis showed diffuse hypergammaglobulinemia with simultaneous increase of IgG, IgA and IgM without the M-component. Moreover, serum IgE was detectable in Ouchterlony diffusion and immunoelectrophoresis and gave measurements of 3.2 mg/dl by the single radial immunodiffusion method. Urinalysis disclosed massive excretion of the κ-chain, λ-chain and Fc like fragments and only the κ-chain showed M-component in starch gel immunoelectrophoresis. Biopsy of the cervical lymph node revealed marked proliferation of lymphoid cells and plasmocytes, some were stained with fluorescence conjugated ε-chain antiserum, other were stained with either fluorescence conjugated κ-chain or λ-chain antiserum.
Prednisolone successfully controlled the complaints, but the patient passed away on Jan. 30, 1973, from acute pneumonia with recurring bronchitis.
Postmortem examination revealed the proliferation of lymphocytes, lymphoid cells and reticulum cells in the lymph nodes, which had penetrated into the neighboring fatty tissue of some lymph nodes. On the other hand, the proliferation of plasmocytes were not so prominent.
From these findings it was postulated that this case might come under immunoproliferative syndrome and some discussions were made on immunoglobulin fragment diseases in the literature.

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Involvement of the eye and the adnexa in leukemia and allied disorders is not uncommon and has been described in detail, while iris involvement is relatively rare. We report a patient who developed leukemic hypopyon in the right eye as a result of leukemic involvement of iris.
A 2-year-old japanese girl was first seen on the dermatology service at Otaru City Hospital on November 1970, with complaint of tumor at right angulus oculi. The diagnosis of lymphoblastic lymphoma was confirmed by skin biopsy.
She was hospitalized twice on the dermatologic clinic in Hokkaido University Hospital and gained each time complete remission by chemotherapy.
First admission to the pediatric clinic was on 19 Aug. 1971, because of abdominal tumor, swelling around the left eye and tumor on the cheek. Following the treatment with L-Asparaginase and Vincristin (V.C.R.), she received 6 MP orally as a maintenance therapy.
On 7 Jan. 1972 she was hospitalized again for leukemic meningitis, which subsided by intrathecal administration of Methotrexate (MTX). On 11 May she required the third admission, because of the leukemic meningitis with hypopyon of the right eye, and she became well again by the treatment of intrathecal MTX. On 7 July 1972 she relapsed. Besides hypopyon of the right eye and meningitis, hematologic findings showed leukemic conversion.
Although remission was obtained with Daunomycin and VCR, she became septic and died on 24 July 1972. Throughout the course of the disease, the degree of hypopyon paralleled well with that of meningitis.

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This 2 2/3-year-old boy was admitted to National Children's Hospital on March, 1971 for pallor. The liver and spleen were palpable. The lymphnodes were not enlarged. X-ray examination of the chest and bone was negative. Examination of the blood showed excessively high platelet counts and hypochromic anemia, but not so remarkable in leucocytes.
Bone-marrow puncture revealed megakaryocytic hyperplasia with ultrastructural morphologic abnormality and we called these findings “hyperplasia focus of platelet demarcation membrane”. Ability of platelet adhesion decreased. Platelet aggregation studies showed the response to epinephrine to be absent, that to ADP decreased, and that to collagen normal. Platelet factor 3 availability was slightly increased,
We thought that this case was extremely rare, since primary thrombocythemia previously never has been reported in an infant. A mechanism for the production of the platelets was discussed, and it is suggested, on the basis of our findings, that the cause of abnormality of the platelet function may be increase in number and ultrastructural morphologic changes.

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A 7-year-old boy was seen at Ohashi Branch Hospital of Toho Univ. on Jan. 21, 1971, with a chief complaint of anemia and abdominal distension. A diagnosis of chronic myelogenous leukemia was made from the peripheral and bone marrow smears, a low score of leukocyte alkaline phosphatase and a positive philadelphia chromosome (Ph').
On July 1973, the initial sign for blast crisis……fever, anemia, joint pains and gradual enlargement of liver and spleeen in association with high rate of blasts in peripheral blood ……was observed, and Ph' with deficiency of the No. 7 chromosome was recognized.
On Oct. 1973, the tumors were observed on the arm, head, chest and the lower part of the leg and grew larger in size. Biopsy of the cubital tumor revealed the leukemic infiltration with immature cells of myeloid series (myeloblastoma).

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