巻号一覧
18 巻, 11 号
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綜説
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満谷 進1977 年 18 巻 11 号 p. 1291-1302
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 (1068K)
臨床研究
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古川 鋼一, 田中 正夫, 田中 岑也, 中出 泰充, 藤原 義久, 広田 豊, 原 一夫1977 年 18 巻 11 号 p. 1303-1311
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありEight cases of Pneumocystis carinii pneumonitis (PC pneumonitis) associated with hematological malignancies were reported, which were observed at Nagoya National Hospital during the six years ending in January 1977.
The patients, aged 17 to 76, were relatively old. The underlying diseases of PC pneumonitis comprised 3 of acute myelogenous leukemia, 4 of malignant lymphoma, and 1 of leukemic reticulosis. Five of them were in remission, and 3 were in exacerbation at the time when PC pneumonitis developed.
In all cases, fever was initially present, then severe progressive dyspnea developed. In contrast, physical findings were not so marked.
Almost all patients had the history of being treated with large doses of corticosteroids and cytotoxic drugs, which may have exerted an important role in predisposing the patients to PC pneumonitis.
The majority of the cases showed negative Mantoux reaction, and patients except for a case of leukemic reticulosis showed continuously decreased count of peripheral lymphocyte for 30 to 40 days, while they did not necessarily have decreased levels of serum gammaglobulin or of specific immunoglobulins.抄録全体を表示PDF形式でダウンロード (797K) -
中島 隆, 阿部 帥, 依田 安弘, 田上 憲次郎, 工藤 秀機, 川田 健一, 野村 武夫1977 年 18 巻 11 号 p. 1312-1317
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありVitamin B12 (V. B12) malabsorption was observed in a patient with a blind loop in addition to our previous report. This malabsorption was not improved during the administration of tetracycline (TC), unlike the malabsorption previously experienced in four patients with blind loop syndrome. A large number of E. coli resistant to TC was found in the stool of the patient. The administration of Kanamycin effective to E. coli together with TC was followed by improvement of V. B12 malabsorption and disappearance of the E. coli. This finding strongly suggested that the microorganisms resident in the loop were important in the pathogenesis of the V. B12 malabsorption.
A serial study of the patient was performed regarding V. B12 absorption test, qualitative and quantitative analysis of fecal bacteria and in vitro measurement of the bacterial uptake of V. B12. The relationship between the rate of V. B12 absorption and the nature of flora was not apparent.
It was surprising that the rates of the V. B12 absorption tested one year after the cessation of antibiotics were still higher than those before Kanamycin. This phenomenon may suggest some important factors in V. B12 malabsorption other than the bacterial uptake of V. B12.抄録全体を表示PDF形式でダウンロード (427K) -
広田 豊1977 年 18 巻 11 号 p. 1318-1327
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA prospective study was carried out on patients with aplastic anemia to evaluate the hematopoietic effects of fluoxymesterone objectively. The attending physicians treated 41 adults, 20 males and 21 females, suffering from acquired aplastic anemia with 0.5 mg/kg/day of fluoxymesterone. The RBC, hemoglobin, WBC and platelet levels were used as clinical parameters of the effects of therapy, and GOT, GPT and virilization were used to monitor the development of any side effects.
Remission was seen in 43.9% of the patients after three months, and this rose to 64.0% after six months. Six months also seemed to be a reasonable period of therapy from the viewpoint of increasing the RBC and Hb levels.
After both three and six months of therapy, about 70% of the patients showed abnormal GOT and GPT values, while about 30% showed signs of virilization.
This prospective study indicates that fluoxymesterone is a valuable drug for the treatment of aplastic anemia.抄録全体を表示PDF形式でダウンロード (789K)
症例
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中山 志郎, 上野 謙蔵, 星野 孝1977 年 18 巻 11 号 p. 1328-1335
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA 66-year-old female is presented who had peripheral blood and bone marrow pictures similar to so-called hypoplastic leukemia throughout her course of illness, but autopsy disclosed leukemoid reaction secondary to generalized miliary tuberculosis.
She was admitted on Feb. 5, because of pallor. Peripheral blood studies on admission revealed RBC 1.76×106/μl, Hb 4.1 g/dl, Ht 13%, reticulocyte 0.1%, platelet 20×103/μl, and WBC 2,800/μl with about 6.5% blast cells, which were identified as myeloblasts. Bone marrow aspiration revealed hypocellularity with 34.4% blasts similar to those in the peripheral blood. Although the percentage of myeloblasts both in the blood and marrow were decreased shortly after treatment with repeated blood transfusions and corticosteroids, her general condition gradually deteriorated and she died 3 months after admission. Postmortem examination revealed no evidence of leukemic infiltration, while many organs were severely invaded by tuberculous bacilli.
It was strongly suggested that a diagnosis of hypoplastic leukemia should be made only after excluding possible underlying disorders which might induce leukemoid reaction with bone marrow hypoplasia. On this point of view, a comparison was made between the blood pictures obtained from the present case and 5 cases with hypoplastic leukemia confirmed by autopsy. As the results, patients presenting 1) microcytic, hypochromic anemia associated with markedly reduced reticulocyte counts, 2) reduction of myeloblasts after corticosteroid therapy, 3) marked erythroid hypoplasia in the bone marrow and 4) lack of relative lymphocytosis in the blood and marrow might be much more likely to be associated with leukemoid reaction than with real hypoplastic leukemia.抄録全体を表示PDF形式でダウンロード (821K) -
藤井 浩1977 年 18 巻 11 号 p. 1336-1342
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありRefractoriness to any form of treatment is a well-known characteristic of blastic crisis of chronic myelogenous leukemia (CML). We presented a case of blastic crisis of CML, which responded well to a combination therapy of betamethasone and the streptoccocal agent OK-432.
A 65-year-old male was admitted to our hospital on May, 1973, with a chief complaint of left upper abdominal distension. A diagnosis of CML was made from splenomegaly, positive Philadelphia chromosome (Ph1) and the hematological findings of peripheral blood and bone marrow. He was treated with busulfan (2 mg/day) and complete remission was obtained on January, 1974. On February, 1975, he was diagnosed of blastic crisis of CML by hemorrhagic tendency, anemia, thrombocytopenia, rapid enlargement of the spleen and 29.6% of atypical myeloblasts in bone marrow. He was treated with betamethasone and OK-432, which was administrated with a dose of 0.5 units/day intramuscularly and 0.2 to 0.5 units/twice a week intravenously. On March, 1975, complete remission was obtained. Relapse occured on August, 1975 and reinduction of complete remission was achieved by the same therapy of betamethasone and OK-432 on October, 1975. Despite of the maintenance treatment of betamethasone and OK-432 (intramuscularly), the second relapse occured on March, 1976. Since it seemed that resistance to a combination therapy of betamethasone and OK-432 had developed, he was treated with a combination of DCMP therapy and OK-432 (intramuscularly) and partial remission was obtained. But he was died of bronchopneumonia on May, 21th, 1976. Autopsy findings showed the remission state of CML and suggested that the cause of death would be pneumonia.
In this case, the principal effect of OK-432 appeared to be on cytolytic action of leukemia cells and/or on reticuloendothelial function. But cell-mediated action could not be denied.抄録全体を表示PDF形式でダウンロード (577K) -
周防 武昭, 板倉 宰, 今井 淳子, 中村 克己1977 年 18 巻 11 号 p. 1343-1348
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA case of blind loop syndrome with megaloblastic anemia in a 21-year-old female who had been operated on lateral jejuno-transversostomy 8 years prior to the onset of the illness was reported.
Laboratory examinations revealed pancytopenia with hyperchromic macrocytic anemia in the peripheral blood and the presence of a number of megaloblasts and giant metamyelocytes in the bone marrow. X-ray findings of the gastrointestinal tract showed an anastomosis between the transverse colon and the jejunum at the hepatic flexure. Serum vitamin B12 level was remarkably low. Schilling test of urinary excretion of radioactive vitamin B12 revealed decreased absorption of vitamin B12 with no response to the administration of the intrinsic factor.
The large doses of vitamin B12 resulted in a sharp rise in reticulocytes followed by a simultaneous increase in hemoglobin, RBC, WBC and platelet counts, and disappearance of megaloblasts and giant metamyelocytes in the bone marrow.
A side-to-side jejuno-transversostomy and a blind loop was restored by the re-operation.
The patient has been in a state of good hematological remission 3 years after operation.抄録全体を表示PDF形式でダウンロード (531K) -
貞森 直樹, 田川 真須子, 山口 博志, 市丸 道人, 平 芳次, 藤井 薫, 宮川 尚孝, 宮崎 久彌, 森 和夫1977 年 18 巻 11 号 p. 1349-1354
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA 50-year-old man was admitted to the Dept. of Hematology, Nagasaki University Hospital with a diagnosis of acute myelogenous leukemia on 19 Feb. 1975. He was put on a new DCVP (Daunomycin, Cytosine arabinoside, Vincristine and Predonisolone) schedule and got a complete remission after 2 months. In mid-June 1976, right incomplete hemiplegia accompanied by left temporo-parietal syndrom developed, though complete remission still continued hematologically. Electroencephalography showed diffuse slow waves and brain scanning revealed hot area in left Sylvius area. Meningeal leukemia had coexisted. On 13 July 1976, a partial resection of the brain tumor was done. The color of tumor was not green, but yellowish white. Histology of tumor tissue was compatible with myeloblastoma. Microscopy revealed an increase in reticulin by Wilder's stain and elcctron microscopy showed an increase in collagen and reticular fiber. Strong positive peroxidase was seen on stamp preparation. Post non radical operation, liniac irradiation therapy was done to entire brain (3,000 rads in total amount). The patient's general condition became gradually worse and he died on 15 Dec. 1976. Postmortem examination of the brain revealed scattered leukemic cells in the hypothalamus.抄録全体を表示PDF形式でダウンロード (744K) -
中尾 純子, 小川 真, 白倉 卓夫, 朝長 正徳, 井上 達, 田中 康一, 松田 保1977 年 18 巻 11 号 p. 1355-1362
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありAn autopsy case of myelogenous malignant reticulosis associated with neurologic manifestation was presented. The 67-year-old woman was admitted to the hospital because of anemia and marked hepatosplenomegaly. There was no lymphadenopathy. Hematologic and ferrokinetic studies revealed that she had a severe pancytopenia with leukoerythroblastosis and an extramedullary hematopoiesis. A biopsied iliac bone specimen showed the reticulum cell proliferation. From these findings she was diagnosed as myelogenous malignant reticulosis. Three and a half months after admission flaccid paraplegia with paresthesia suddenly occurred, and was followed by disseminated intravascular coagulation, acute bronchopneumonia and acute renal failure. She died approximately five months after the onset of symptoms.
Pathologic findings were as follows: malignant proliferation of atypical mononuclear cells involved almost all bone marrows. The spinal cord was compressed at the inferior thoracic and lumbar region and partly surrounded with the epidural infiltration of tumor cells, and was necrotic and softening.
Finally, the characteristic figures observed in the patient's clinical course were discussed from the autopsy findings.抄録全体を表示PDF形式でダウンロード (1019K) -
若林 芳久, 金口 忠彦, 塩川 優一, 高久 史麿1977 年 18 巻 11 号 p. 1363-1369
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA 54 year-old male was admitted to our hospital with acute renal failure. He had severe oliguria. Physical examination showed edema in face and bilateral lower limbs. No lymphadenopathy, hepatosplenomegaly and hemorrhagic diathesis were noted.
Laboratory data showed a slight normocytic, normochromic anemia with normal leucocyte and platelet count. Differentials of peripheral leucocytes were normal. Blood urea nitrogen, serum creatinine and potassium level were all markedly elevated.
Digital examination of rectum revealed a presence of hard tumorous resistence at the place of prostatic gland. Intravenous pyelography showed hydronephrosis of left kidney. Aortography demonstrated a stenosis above the bilateral iliac arteries. Diagnosis of the acute renal failure by an intrapelvic or retroperitoneal tumor was made.
The patient had been treated with peritoneal dialysis. His oliguria, however continued. After an administration of massive dosis of corticosteroid, remarkable urinary discharge had occurred.
But this effect of corticosteroid diminished gradually.
Fifteen days prior to his death, the patient had hematemesis and abrupt drop of platelet counts were noticed. Bone marrow aspiration performed on that day showed the picture of acute myelogenous leukemia. DCMP therapy started immediately. But his general condition took a turn for worse. The patient died on the 70th day of the admission.
Autopsy showed leukemic infiltration with tumor formation between bladder and rectum. Because of the unusual initial manifestation of the leukemic tumor, this case was considered worth reporting.抄録全体を表示PDF形式でダウンロード (930K) -
上平 憲, 朝長 優, 田川 真須子, 貞森 直樹, 野中 美紀, 木下 研一郎, 市丸 道人, 朝長 昭光, 河野 茂, 松尾 武1977 年 18 巻 11 号 p. 1370-1377
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありA 67-year-old male suffered from malaria in 1944 and tuberculosis of the right kidney in 1963. The diseased kidney was later removed.
He had fatigue and dizziness two month before admission in August 1976 and marked anemia was pointed out. On admission on October 8, he had fatigue and slight fever but lymph nodes and spleen were not enlarged. Hematological investigation showed hemoglobin to be 4.0 g/dl, red blood cells 137×104/cmm, reticulocytes 0.3%, packed cell volume 12%, white blood cells 3150/cmm, platelet count 1.75×104/cmm. The red blood cells showed “dimorphism”. Bone marrow aspirats revealed hyperplasia of normoblasts with many ringed sideroblasts and maturation arrest of the granulocytic series. PAS reaction of the erythroblasts was weakly positive. Chromosome studies of the marrow cells by the Q-band method revealed hypodiploid karyotype (45, XY, ±[C, D, E, F, G], t (2q+; 5q-)).
The diagnosis of sideroblastic anemia (primary acquired?) in preleukemic stage was made on the basis of these hematological and cytogenetic findings. He was treated with pyridoxine and other vitamins, but they were not effective. One week before death, hematological findings changed to the overt leukemia, and he died of acute pneumonia 3.5 months after admission.
The autopsy showed hyperplasia of three series of bone marrow cells, especially abnormal myeloblasts.
The relationship between sideroblastic anemia with chromosome aberrations and the bone marrow and myeloproliferative syndrome was discussed.抄録全体を表示PDF形式でダウンロード (1421K) -
内山 富士雄, 小松田 光真, 市川 幸延, 有森 茂1977 年 18 巻 11 号 p. 1378-1381
発行日: 1977年
公開日: 2009/01/19
ジャーナル 認証ありAn 11 year-old male patient was referred and admitted to the Tokai University Hospital in March, 1976, who had been admitted to another hospital with a diagnosis of aplastic anemia.
He got a little better after treatment with testosterone, prednisolone and ACTH, but sometimes got worse and was complicated with pneumonia. He died in July 1976.
Autopsy findings showed aplastic anemia and disseminated mucor mycosis with gigantic mucor thrombus in the left atrium spreading to the pulmonary vein.
In the patients with aplastic anemia under chemotherapy, difficulty in the diagnosis of complicated mucor mycosis was emphasized.抄録全体を表示PDF形式でダウンロード (618K)
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