巻号一覧
18 巻, 10 号
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綜説
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鎌田 七男1977 年 18 巻 10 号 p. 1191-1202
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありPDF形式でダウンロード (1012K)
臨床研究
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長尾 忠美, 渡辺 克仁, 小松田 光真, 有森 茂1977 年 18 巻 10 号 p. 1203-1210
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありWhile the techniques for rearing germfree animals have been applicated to human medicine and acceptance of bioclean system has been generally good, many problems remain to be done in its management. To solve these problems, the authers have set up a germfree isolation unit in Tokai University Hospital and performed to establish optimum conditions for using aminar flow rooms.
The experiment utilized two healthy human volunteers. The first case is a 31-year-old male and the second is a 48-year-old male. The first case was confined to the laminar flow room for a period of 25 hours and the second case was confined to it for 7 days. Nursing and medical procedures were carried out through gauntlet-type glove techniques and no personnel entered into the room. Stool cultures showed evidence of bacterial suppression after the administrations of antibiotics and sterile food, entire body cleaning with chlorhexidine and staying in the bioclean room. No bacterias were ditected in stool, throat and body surface without hair on the seventh day after the entrance of the room. It was achieved to suppress completely the patient's own flora. Immunological changes were observed in the volunteers under the germfree environment, but no remarkable changes were observed in the examinations of urine, stool, clinical physiology, hematology and blood chemistry. Though the second case became slightly hysteric after the confinement on the fifth day after the entrance of the room, it was not so severe to stop the experiment and it was resolved with good nursing care.抄録全体を表示PDF形式でダウンロード (582K) -
中辻 理子, 広重 幸雄, 藤井 寿一, 末次 信昌, 松本 昇, 三輪 史朗, 渡辺 精四郎, 大西 博三, 佐々木 功典, 加来 浩平1977 年 18 巻 10 号 p. 1211-1219
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証あり1) The clinical and pathological studies on the hepatic diseases in 51 autopsy cases with leukemias were reported.
2) In 40 cases (78%), the weight of the liver was heavier than 1500 g. Leukemic infiltration and deposition of hemosiderin could not account for this increased weight of the liver.
3) Leukemic infiltration was seen in both sinusoid and portal area in most cases, and there was no specific pattern of infiltration according to the type of leukemias. Leukemic infiltration alone could not cause the increase in serum transaminase levels.
4) Liver abscess was found in 11 cases, in which septicemia had been demonstrated in 7 cases, and hypoalbuminemia was usually seen in these patients.
5) In 3 cases who had been treated with 1-asparaginase, hypoalbuminemia and decreased cholinesterase activity were main laboratory abnormalities and prominent fatty degeneration was a common finding at autopsy.
6) A diagnosis of viral hepatitis was made in 13 cases histologically, in which 2 patients died from fulminant hepatitis. Secondary hemochromatosis was found in 10 cases, in which elevated blood glucose levels were noted in 9 cases. The amount of blood transfused and the degree of hemosiderin deposition was not necessarily correlated, and reduced reutilization of iron and ineffective erythropoiesis were presumed to be the enhancing factors of hemosiderosis in leukemias.抄録全体を表示PDF形式でダウンロード (1349K)
症例
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豊田 貫雄, 高田 三千尋, 原 修身, 末友 祥正, 外山 圭助, 斉藤 太郎1977 年 18 巻 10 号 p. 1220-1225
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA 49-year-old male with hairy cell leukemia is reported. He developed a feeling of fullness and hardness of the abdomen one month prior to admission and was discovered to have a massive splenomegaly. Laboratory examination showed leukocytosis, mild anemia and thrombocytopenia. Sixty-two to 89 per cent of the peripheral white blood cells and 27 to 42 per cent of the bone marrow cells were lymphoid mononuclear cells with numerous cytoplasmic projections (4 to 6 μm in length) characteristic of the so-called “hairy cells”. Scanning electron microscopic observation of these cells revealed an unique surface structure characterized by many long villous processes mixed with some ruffled membranes, which appeared to be different from either lymphocytes or monocytes. Transmission electron microscopic examination, however, failed to show ribosome-lamella complex. These cells were positive for tartrate resistant acid phosphatase. Phagocytic activity of latex particles by these cells was negative. Rosette assays of hairy cells indicated the presence of receptors for EA (IgG) rosettes and no receptors for E or EAC rosettes. Surface immunoglobulin bearing cells were not significantly increased. These findings seemed to suggest histiomonocytic nature of the hairy cells in this case.抄録全体を表示PDF形式でダウンロード (1323K) -
中沼 安二, 太田 五六, 久保田 幸次, 紺谷 一浩, 古川 仭, 羽岡 直樹, 松原 藤継1977 年 18 巻 10 号 p. 1226-1232
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA 67-year-woman of midline malignant reticulosis was reported. She complained of nasal obstruction and fever, and it was found that her nasal cavity was covered by granulation tissue and crustae. Biopsies obtained from her nasal granulation tissue showed atypical reticulum cell proliferations with inflammatory cell infiltration and necrosis. Finally, she died of dissemination of atypical and pleomorphic reticulum cells mainly in the spleen, liver and visceral lymph nodes. An infiltrative and pleomorphic character of atypical reticulum cells with inflammatory cells was compatible with midline malignant reticulosis. Disappearance of her nasal changes by VEMP therapy was noted.抄録全体を表示PDF形式でダウンロード (985K) -
吉川 治哉, 西嶋 憲治, 岡本 一也1977 年 18 巻 10 号 p. 1233-1240
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA case of disseminated tuberculosis complicated with disseminated intravascular coagulation (DIC) was reported.
The 75-year-old female patient was admitted to our hospital because of anorexia and dyspnea. Six years before entry, left nephrectomy was performed under the diagnosis of chronic pyelitis. Several days before admission malaise, anorexia, dyspnea and chills developed. On entry she appeared acutely ill, was dyspneic, cyanotic, subicteric and moderately dehydrated. The temperature was 37.3°C, the pulse 106, the respiration 36, and the blood pressure 96 mmHg of systolic. On physical examination ecchymosis was noted on the right upper arm and no adenopathy nor hepato-splenomegaly noted. The lungs were clear, and the heart size was normal, the rhythm was rapid and regular; no murmur was heard. A chest film showed ill-defined infiltration in the right middle field but no micronodular interstitial densities were seen. Hematological findings revealed slight degree of erythrocytosis (535×104/mm3), moderate leukopenia (3,300/mm3, with 7 per cent myelocytes and 37 per cent metamyelocytes) and thrombocytopenia (8.7×104/mm3). An aspirate of sternal marrow was hypocellular, showed the presence of granuloma and acid-fast bacteria by histological studies of the clot section. Coagulation studies revealed marked decrease of fibrinogen, prolongation of prothrombin time and Kaolin partial thromboplastin time together with positive FDP in the serum, which was suggestive of the presence of DIC. Severe disfunction of the liver and kidney was showed by laboratory findings. The gangrene of the right hand appeared on the 2nd day and developed, while the platelet count decreased to 2.4×104/mm3 on the 3rd day. Despite heparin therapy she died on the 4th day.
Postmortem examination revealed the presence of extensive miliary tuberculosis with early granuloma formation. In addition there was hemorrhagic erosion of the duodenal bulb, while fibrin thrombus formation was noted in this portion and the lung.抄録全体を表示PDF形式でダウンロード (1455K) -
薗田 精昭, 沢井 公和, 三沢 信一, 滝野 辰郎, 阿部 達生, 岡部 英俊1977 年 18 巻 10 号 p. 1241-1245
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありWe experienced a case of 61-year-old female with AML treated with prednisolone and 6-mercaptopurine resulted in acute renal failure. This patient recovered from renal failure by hemodialysis, and then a hematoligical complete remission was obtained.
Recently, uric acid nephropathy following intensive chemotherapy has increased. A recovery from oliguric state by allopurinol has previously been reported but hemodialysis with various supporting therapy is very effective for uric acid nephropathy.抄録全体を表示PDF形式でダウンロード (417K) -
森島 泰雄, 神谷 忠, 緒方 完治, 高松 純樹, 石黒 順造, 鯉江 捷夫, 山田 一正, 浅井 紀一, 吉川 敏1977 年 18 巻 10 号 p. 1246-1252
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありFour cases with congenital F. XII deficiency from a family were reported. A 38-yrs-old female (case 1) was found to have a markedly prolonged kaolin-activated partial thromboplastin time in preoperative coagulation tests. The F. XII clotting activity (F. XII-Act) was less than 1% of normal and F. XII antigen (F. XII-Ang) measured by radioimmunoassay was less than 0.1%.
Case 2 (her mother, 74-yrs-old), case 3 (her sister, 57-yrs-old) and case 4 (her brother, 30-yrs-old) showed 15, 22 and 14% of F. XII-Act and 22, 22 and 24% of F. XII-Ang respectively. None of them had had a hemorrhagic tendency, and appendectomy in case 1 and cesarean section in case 3 were quite uneventful. Case 1 was supposed to be a homozygous state and the others heterozygous traits. The levels of Fletcher and Fitzgerald factors, and of complements (CH50, C3 and C4) were normal in case 1. The levels of plasmin, plasminogen and SK-activated plasmin measured by the method of fibrin plate were normal and inhibitors to fibrinolysis were also within normal range in all cases.
In contrast, kaolin-activated euglobulin lysis time (K-ELT) was markedly prolonged in case 1 and moderately in the others in proportion to their F. XII activities.
It was shown that the prolonged K-ELT of plasma from case 1 was remarkably corrected by addition of a small amount of normal plasma and that K-ELT of normal plasma became shortened according to the increase of incubation time of the plasma with kaolin, although that of patient's plasma (case 1) was not affected by contact with kaolin and remained prolonged.
These results suggest that F. XII plays an important role in the initiation of intrinsic pathway not only of blood coagulation but also of fibrinolysis. F. XII deficient cases reported in Japan by 1976 were summarized briefly.抄録全体を表示PDF形式でダウンロード (483K) -
神山 隆一, 石井 善一郎, 武村 民子, 榎本 英寿, 花岡 正儀, 横尾 敦夫1977 年 18 巻 10 号 p. 1253-1259
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありAn autopsy case of 62-year-old male with primary myelofibrosis was reported. His course was about 13 years and leukemic transformation was seen in the last period.
At autopsy, tumor formation was revealed in the bone marrow, liver, retroperitoneal space and skin etc., in which the proliferation of myeloblasts was found as pushing through fibrous connective tissue, associated with increase of atypical megakaryocytes. Moreover, collagen fibers in the bone marrow and retroperitoneal space and so on showed fibrous long spacing-like fibers which were about 2,000Å in diameter, approximately 1,000Å periodic cross-banding.
These findings support that primary myelofibrosis should be understood as one of myeloproliferative disorders rather than as a reactive, compensatory lesion.抄録全体を表示PDF形式でダウンロード (1345K) -
立花 昭生, 木本 元治, 山口 潜, 浅井 一太郎, 塚田 理康, 松川 正明, 神山 隆一1977 年 18 巻 10 号 p. 1260-1265
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA 27-year-old lineman was admitted to the hospital with generalized lymph node swelling on January 28, 1975. A diagnosis of lymphosarcoma had been made on a biopsy specimen of the left cervical node at another hospital.
On admission examinations revealed the swelling of the bilateral cervical, left axillary and bilateral hilar lymph nodes. Complete remission was not achieved by combination chemotherapy during six weeks by vincristine, cyclophosphamide and prednisolone. At the beginning of July, 1975, swelling of the right cervical nodes was again noted and he was re-admitted on July 17. Irradiation with 60Co and injections of bleomycin were ineffective: numerous lymphosarcoma cells, more than 90 per cent of the nucleated cells appeared in the bone marrow aspirates and peripheral blood and the diagnosis of lymphosarcoma cell leukemia was made. Treatment with BACOP and L-asparaginase gave an excellent result: He was discharged with no swelling of the superficial lymph nodes, absent hepatosplenomegaly, disappearance of lymphosarcoma cells and the normal hematopoiesis in the bone marrow.
On April 17, 1976, swelling of the left cervical nodes reappeared and bone marrow aspirates revealed the findings of lymphosarcoma cell leukemia. During the re-administration of L-asparaginse fever ran high up to 40°C and Escherichia coli was detected from the blood cultures. He succumbed on June 5, 1976.
Autopsy revealed lymphoblastic lymphosarcoma, aspergillosis, pneumonia and bacteremia with Psudomonas aeruginosa.抄録全体を表示PDF形式でダウンロード (776K) -
厨 信一郎, 檀 和夫, 松井 良樹, 工藤 秀機, 川田 健一, 野村 武夫, 浅川 英男1977 年 18 巻 10 号 p. 1266-1271
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA case of 64-year-old man of chronic lymphocytic leukemia with IgM paraproteinemia was reported. He was admitted to our hospital with a complaint of general malaise. Physical examination showed generalized lymphadenopathy and splenomegaly. The initial hemogram revealed hemoglobin, 10.7 g/dl; hematocrit, 32%; platelet count, 66,000/mm3; white blood cell count, 33,800/mm3 with 87% mature lymphocytes. The bone marrow was characterized by a massive infiltration of mature small lymphocytes. Total serum protein was 8.2 g/dl, and paper electrophoresis showed a narrow peak in the fast γ region. Immunoelectrophoresis demonstrated an IgM-κ paraprotein. Individual immunoglobulin quantitation was as follows: IgG 2,000 mg/dl, IgA 498 mg/dl, and IgM 826 mg/dl. Urinary Bence Jones protein was negative. The patient has been followed without any specific treatment over a period of 20 months. Although some progression has occurred in the disease during this follow-up period, he is apparently leading a normal life.抄録全体を表示PDF形式でダウンロード (701K) -
本堂 克, 塩岡 誠, 亀谷 正明, 清水 勝, 松友 啓典, 小島 峯雄1977 年 18 巻 10 号 p. 1272-1278
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA case of T cell chronic lymphocytic leukemia (CLL) associated with lung cancer found in a 33-year-old female was reported.
The proliferated leukemic cells in the peripheral blood were lymphocyte-like cells with smaller and lobulated or invaginated nuclei. The proliferated lymphocytes were identified as T cell by examing the surface markers. Spontaneous formation of rosettes with sheep erythrocytes (Erosettes) and cytotoxicity test with ATS were used as T cell markers whereas cytotoxicity test with ABS, receptor for the third component of complement (EAC-rosettes) and cell surface immunogloburin (Sm-Ig) were employed as B cell marker.
Such a case of CLL associated with malignant neoplasm is rare in Japan.抄録全体を表示PDF形式でダウンロード (799K)
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