巻号一覧
20 巻, 3 号
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臨床研究
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巽 典之, 福岡 紘一, 植田 高彰, 正岡 徹, 神前 昌敏1979 年 20 巻 3 号 p. 237-245
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありThere are very few reports concerning with the environmental hygienic survey on the long term utilized clean room. Then in this time, fallen bacteria and fallen fungous count, floating bacteria, floating dust count, temperature, humidity, CO2 concentration, precipitated bacterial count and bacteria in water were studied in comparison between the horizontal air flow system and the vertical air flow one which were used for the leukemic patients. Though it is known that the cleanliness of a clean room maintains the class 100 on NASA standard, the cleanliness in the clean room, wl studied, after the long term utilization is much lower than the class 100.
In the horizontal air flow system, many bacteria and fungi could be detected especially at the floor both under the bed and the water space.
In the vertical system, the similar results could be obtained, although the degree of cleanliness was lower than that in the horizontal one.
The followings might cause the contamination;
1) incorrect laminar air flow, 2) bacteria which were from patient's goods (including a bed), water, water space and floor, 3) bacteria which were carried to the bioclean room from outside.
It is difficult to detect the contamination by the determination of fallen bacteria and of floating dust count alone, therefore, it may be considered that the determination of precipitated bacteria and bacterial count in water should be checked.抄録全体を表示PDF形式でダウンロード (681K) -
横山 隆, 藤本 孟男, 伊藤 正宣, 古庄 巻史, 金 平栄, 長谷川 秋彦1979 年 20 巻 3 号 p. 246-252
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA total of thirty-one episodes of central nervous system leukemia (CNS-leukemia) which were under the care of the Kyushu Childhood Leukemia Study Group, were treated with a combination of intrathecal methotrexate (MTX) 15mg/M2 and hydrocortisone (HDC) 15∼30 mg/M2 and/or cytosine arabinoside (CA) 30 mg/M2 and cranial irradiation followed by intrathecal MTX and HDC.
CNS-remission were achieved in 100% of 19 children given intrathecal two agents and 89% of three agents. Difference in CNS-remission rates was not of statistical significance.
Of twenty-eight children who achieved CNS-remission, 10 children maintained with intrathecal two agents every 6∼8 weeks, 5 three agents and 4 recieved 2,400 rads cranial irradiation followed by intrathecal two or three agents every 6∼8 weeks.
The duration of CNS-remission was median 38 mos for Group who developed CNS-leukemia during initial bone marrow remission, 5 mos for Group II who developed at or after bone marrow relapse and 13∼18+mos for Group III who had CNS involvement simultaneously at diagnosis.
Three years CNS-remission rate calculated by modified life-table method was 59% in the two agents maintenance group, 53% in the three agents group and 67% in the radiotherapy group.
Chemical arachinoiditis associated with vomiting and headache developed in 20% of 30 children of intrathecal two or three agents.
In spite of CNS-disease, survival of all children with CNS-leukemia ranged from 12 to 66+months with a median of 38 months.抄録全体を表示PDF形式でダウンロード (559K) -
—3年間の完全寛解後の薬剤中止—藤本 孟男, 佐々木 邦明, 新垣 義清1979 年 20 巻 3 号 p. 253-260
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありBetween April of 1972 and May of 1974, twenty-eight children with acute lymphoblastic or undifferentiated leukemia (Peroxidase negative type) were treated with multi-drug therapy.
Overall of survival rate calculated by Life-Table Method was 67% in 3-year, 63% in 4-year and 55% in 5-year from diagnosis.
Of twelve patients (46%) who continued to remain in initial 3-year complete remission, eight removed from maintenance chemotherapy with a combination of high-dose methotrexate, vincristine, prednisolone, and 6-mercaptopurine. Four have kept on maintenance chemotherapy. Two patients developed relapses (one: bone marrow, one: CNS) at 4 months after cessation of chemothreapy. The remaining six patients have been in initial complete remission with a range of 4 years and one month to 6 years and 5 months.
Three patients who continued to be in 3-year complete remission after an episode of CNS-leukemia also removed from systemic and CNS maintenance chemotherapy. Two developed CNS-leukemia and one occured bone marrow relapse within 7 months after off therapy.
The need for continuing or discontinuing chemotherapy to further maintain a prolonged complete remission in acute leukemia of children is questioned. However, our data indicated that the patients with an episode of CNS-leukemia were at least to need more than 3 years of treatment.抄録全体を表示PDF形式でダウンロード (542K) -
竹中 武昭, 下山 正徳, 湊 啓輔, 北原 武志, 坂野 輝夫, 近田 千尋, 木村 禧代二1979 年 20 巻 3 号 p. 261-267
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありTwenty seven episodes of septicemia in 24 patients with leukemia documented from January 1973 to December 1977 in National Cancer Center Hospital were investigated.
1) Thirty four strains of bacilli were isolated, including 10 strains of Ps. aeruginosa, E. coli, and Kl. pneumoniae, respectively.
Ps. aeruginosa and Kl. pneumoniae were isolated more frequently from the patients during antibiotic therapy (secondary septicemia) than from the patiens with primary septicemia, while E. coli was commonly isolated from the patients with primary septicemia.
2) Twenty-three of the 27 paitents had neutropenia less than 500/cmm when septicemia occurred.
3) Ten out of the 14 patients who had septicemia after induction chemotherapy for leukemia responded antibiotic therapy, but there was only 1 responder among 12 patients who developed septicemia during induction chemotherapy.
Response rate was higher (69.2%) in patients with primary septicemia than in those with secondary septicemia (23.8%).
4) Seven out of 9 paitents (77.8%) who had 3-drug combination antibiotic therapy with aminoglyconside (A), broad synthetic penicillin (B) and cephalosporin (C) responded, while 45.5% (5/11) of the patients with 2-drug combination therapy with A and B responded.
Five out of 7 patients who had granulocyte transfusions with antibiotic therapy responded (71.4%), while 4 out of 12 patients who had only antibiotic therapy responded (33.3%).抄録全体を表示PDF形式でダウンロード (575K)
症例
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新藤 徹郎, 伊藤 敏寛, 福田 光之, 間宮 繁夫, 三浦 亮, 高梨 利一郎1979 年 20 巻 3 号 p. 268-272
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA 59-year-old woman was admitted to our hospital because of fever in September, 1975. A diagnosis of typical acute leukemia was made and the complete remission was easily obtained by anti-leukemic therapy. In May, 1976, however, she was readmitted because of relapse. In spite of several courses of re-induction therapy remission was not obtained again and a severe granulocytopenia continued. In January, 1977, sepsis was complicated and high fever persisted in spite of the combined administration of antibiotics. In February, sdinal paralysis developed suddenly and she died of respiratory distress. Autopsy revealed multiple fungal infections, i.e., candidiasis in the spleen and kidneys, mucormycosis in the liver, mucormycosis and aspergillosis in the lungs. Mucormycotic thrombosis in many dura-arachnoidal vessels caused the spinal cord softening.抄録全体を表示PDF形式でダウンロード (493K) -
遠藤 一靖, 佐伯 重昭, 佐藤 功, 鈴木 隆城, 田島 剛一, 堀野 豊, 三上 雅嗣, 小野寺 清寿, 吉永 馨1979 年 20 巻 3 号 p. 273-279
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA 51-year-old man was found to have Ph1 chromosome-positive CML in August 1971. He was treated by busulfan for 47 months and by carbazilquinone for the following 8 months. In August 1976, he was pale and the spleen was enlarged 8.5 fb below the left costal margin. WBC was 11,000/mm3 with 12% blasts. A bone marrow biopsy showed severe myelofibrosis. A diagnosis of the early stage of blastic crisis was made. On september 30, the spleen, weighing 1,010 gm, was removed. On the seventh postoperative day WBC fell to 5,000/mm3 with a normal differential cell count. The patient's condition improved and he could work for 3 months. In January 1977, WBC was 54,000/mm3 with 28% blasts. Antileukemic treatment with vincristine, prednisolone and 6-MP caused the fall in the peripheral blasts for 4 months, but death occurred 9 months after splenectomy. In the late stage of the disease he had persistent fever with no evidence of bacterial and fungal infection.
The value of splenectomy in CML with blastic crisis is very difficult to evaluate because of the great variation in symptoms of blastic crisis. It was concluded, however, that this case had some obvious benefits such as relief from abdominal discomfort and hemorrhage usually experienced in non-splenectomized patients with blastic crisis.
There was an increase in colony forming cell (CFU-c) in the early stage of blastic crisis when compared with that in the stage before it. The CFU-c rapidly decreased to 0 after the splenectomy. It is likely that the spleen was an important site for the production of CFU-c in the peripheral blood in this case.抄録全体を表示PDF形式でダウンロード (605K) -
赤柴 恒人, 伊藤 武善, 堀越 昶, 東海 俊英, 大島 年照, 天木 一太, 藤井 寿一, 中島 弘二, 三輪 史朗1979 年 20 巻 3 号 p. 280-284
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA case of pyruvate kinase variant is reported. The patient, 21-year-old female, was admitted to our hospital with chief complaints of anemia and jaundice which were noted on artificial abortion. On admission, laboratory findings revealed normochromic anemia, hyperbilirubinemia with predominant elevation in indirect bilirubin, elevated serum LDH level and positive hemosiderin in urine. On physical examination, anemia and jaundice were noticed in the conjunctiva and hepatosplenomegaly was detected. With the progress of anemia and jaundice, subjective symptoms of general fatigue and dizziness were aggravated.
The enzymatic analysis of red blood cells showed lowered PK activity, and kinetic studies revealed elevation of Km PEP and reduction of Vmax, Ki ATP and Km ADP. PK activity on urea stabilitytest was unstable and was hardly activated on FDP. Electrophoresis appeared to be of normal pattern. Optimum pH curve was located within normal range, but the peak was narrow. From these data functional abnormality in pyruvate kinase was suggested in this case and designation of PK Itabashi is proposed.抄録全体を表示PDF形式でダウンロード (369K) -
山崎 宗廣, 斎藤 寛治, 小宮山 淳, 赤羽 太郎1979 年 20 巻 3 号 p. 285-291
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA 12-year-old girl was hospitalized because of an abdominal mass, fatigue, anorexia, and lymphadenopathy. Histologic examination of an inguinal node and cytologic study of pleural effusion provided a diagnosis of lymphosarcoma. Examination of surface markers of neoplastic cells disclosed that the lymphosarcoma was of B cell origin. Remission was attained after treatment with vincristine, cyclophosphamide, 6 MP, and prednisolone, but soon relapse occurred and she died about 4 months after the admission. Light microscopy demonstrated pseudoviral inclusion bodies in the cytoplasm of neoplastic cells from peripheral blood, bone marrow, inguinal node, and pleural effusion. Frequency of the inclusion in the marrow cells was 28% on admission and gradually decreased to 8% shortly before death. On electron microscopy, the inclusion consisted of a large number of vesicles of 500 to 700 Å in diameter surrounded by an unit membrane. The shape of vesicles was round, oval, or rod-like. Some inclusions enclosed amorphous matter of moderate electron density and myelin-like structure in addition to the vesicles. Immunofluorescence study failed to demonstrate IgG and IgM in the inclusion body.抄録全体を表示PDF形式でダウンロード (1695K) -
香月 昭人, 島崎 千尋, 中西 忍, 中田 哲雄, 西尾 晃, 細田 光蔵, 春山 春枝, 杉島 聖章, 伊地知 浜夫, 伊勢村 卓司, ...1979 年 20 巻 3 号 p. 292-300
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA case of Immunoblastic Lymphadenopathy (IBL) with repeated interstitial pneumonitis was reported.
In this case, at the early clinical stage lymph node speciemen showed only reactive lymphadenitis but later it changed to the typical IBL from pathological findings. The remission and relapse of the interstitial pneumonitis which may be due to the infiltration of immunoblasts and lymphadenopathy were repeated without any treatment. From the results of the immunological research of this case, we concluded that the immunological abnormality of IBL might be observed in the quantitative and qualitative aspects.
It may be important for the treatment of IBL to correct this immunological abnormality, since this abnormality is subject to be influenced by various cytotoxic agents and develop to immunoblastic sarcoma.抄録全体を表示PDF形式でダウンロード (1224K) -
根本 博文, 古川 利温, 平尾 準一, 柴崎 正修1979 年 20 巻 3 号 p. 301-307
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA case of 22-month-old girl with erythroleukemia was reported. At the onset, marked erythroblastoid proliferation was observed and later in the clinical course, histiocytoid and myeloblastoid cells increased. At the terminal phase, the latter appeared abundantly in the peripheral blood and the patient died after one year from the onset of the symptoms.
A giant marker chromosome with submedian centromere was persistently observed in bone marrow and peripheral blood cells at various phases of the clinical course. Their karyotype was 46, XX, 20-, mar. +. The karyotype of the lymphocytes was normal. Possible existence of an abnormal clone in common precursors of the erythroblastoid, histiocytoid and myeloblastoid cells in this case was suggested.
The activity of RNA dependent DNA polymerase, using poly rA-dT as the template primer, was high in the bone marrow cells.
A reverse correlation between Hb level and the concentration of erythroblasts in the peripheral blood was observed.
Response to chemotherapy with vincristine, prednisolone and cytosine arabinoside and later with vincristine, daunorubicin and prednisolone was poor and only temporary clinical improvement was obtained.抄録全体を表示PDF形式でダウンロード (492K) -
塙 充弘, 小林 裕, 大石 正晃, 藤沢 弘芳, 松岡 松三1979 年 20 巻 3 号 p. 308-313
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA 41-year-old man, undergone the gastorectomy and splenectomy for gastric cancer 6 years ago, admitted to Seirei Hamamatsu Hospital with high fever (40°C), delirium and shock at night on April 25, 1974. Laboratory findings were as follows: blood sedimentation rate 2mm/hour; WBC 14,000 with 90% neutrophils; creatinine 4.1mg/dl; bilirubin 10.2mg/dl (direct 7.2mg/dl); SGOT 209 U; Al-phos. 39 U (King-Armstrong); prothrombin time 15.5 sec. (control 12.0 sec.); PTT 83.5 sec. (control 37.5 sec.). Microbiological examinations in blood and liquor were negative. The patient died about 26 hours after admission in the state of generalized convulsion appeared after the chills and hallucination. In the autopsy findings, there were extensive bilateral adrenal hemorrhage, scattered focal hemorrhage in the small intestine, several gall stones and small abscess near the Vater's ampulla, but no evidences of carcinoma and its metastasis. Microscopically, thrombi were found in adrenal veins, interlobular hepatic veins and portal veins. These findings support the presence of disseminated intravascular coagulation and the clinical pictures were seemed similar to those cases reported by Ratnoff and Nebehay (1962), Whitaker (1969) and Bisno et al. (1970).抄録全体を表示PDF形式でダウンロード (606K) -
小島 進, 守永 真一, 木本 元治, 山口 潜, 浅井 一太郎, 塚田 理康, 仁科 甫啓, 大山 貴美子, 松谷 章司1979 年 20 巻 3 号 p. 314-319
発行日: 1979年
公開日: 2009/01/19
ジャーナル 認証ありA 22-year-old woman was referred because of anemia and jaundice.
She had been noticed to have jaundice since 2 months after birth, and a diagnosis of hereditary non-spherocytic hemolytic anemia was made. Her parents were the first cousins and her father had been dead with a suspected diagnosis of hemolytic anemia. She was treated with transfusions when she was 3 years of age.
On admission the activity of pyruvate kinase of her RBC was 2.15 units (normal controls: 3.5—5.0) and a decrease in 2,3-DPG and increase in ATP levels were evident. Examinations on hemolysis revealed positive direct and indirect Coombs' tests and the shortened red cell life span with 51Cr T/2 of 18 days.
Examinations of the RBC enzymes were done on her seven relatives and moderate decrease in pyruvate kinase activity was evident in four members including her mother, sister, maternal uncle and aunt.
A diagnosis of pyruvate kinase deficiency with autoimmune hemolytic anemia was made. No improvement of anemia followed the administration of prednisolone; a spleen weighing 530 Gm. was removed and an improvement of anemia and a decrease in the elevated serum bilirubin were evident.
But after the operation the shortening of the red cell life span (51Cr T/2: 8 days) was disclosed just same as in the two previous splenectomized cases with pyruvate kinase deficiency.抄録全体を表示PDF形式でダウンロード (410K)
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