臨床血液
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
20 巻, 4 号
選択された号の論文の14件中1~14を表示しています
臨床研究
  • 山本 きよみ, 宮地 隆興, 三輪 史朗, 柴田 進
    1979 年 20 巻 4 号 p. 335-345
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    At present 40 kinds of abnormal hemoglobins in 55 families, 4 families with a-thalassemia including HbH disease, 35 β-thalassemia including 4 homozygous β-thalassemia, 6 σβ-thalassemia including one homozygous σβ-thalassemia and one HbE-β-thalassemia have been reported in Japan. About 30% of the patients with abnormal hemoglobin and 45% of thalassemia patients were associated with hemolytic anemia. About 95% of the propositi of thalassemia had various degrees of anemia. Increasing number of patients and carriers of abnormal hemoglobin and thalassemia are expected to be discovered in Japan in the future studies.
  • 鎌田 七男, 小熊 信夫, 田中 龍二, Gauri Shankal, PANT, 蔵本 淳, 甲木 孝人, 日沼 頼夫, 森田 益次, 阿 ...
    1979 年 20 巻 4 号 p. 346-354
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    A high incidence of leukemia and cancer has been observed among heavily exposed atomic bomb survivors in Hiroshima and Nagasaki. They have also been found to have a moderate to high percentage of chromosome aberrations in T lymphocytes and bone marrow cells. Because of technical difficulties in obtaining mitosis of B lymphocytes alone, the presence of chromosome abnormalities has not been demonstrated in these lymphocytes. In this study we have established a new method for culturing individual B lymphocytes sensitive to EB-virus as a colony on soft agar and transferring them to liquid culture for further cell growth. It was found that B lymphocytes from heavily exposed survivors (cases Y. M. and M. S.) still have 50 and 12.5 percent of chromosome aberrations even 30 years after the atomic bomb exposure. No abnormal cells with chromosome aberrations were detected in two other cases as in the control group. Cases Y. M. and M. S. had 38 and 21.5% of T lymphocyte aberrations and 39 and 28.6% of chromosome aberrations in bone marrow cells respectively.
    The method used in this study and the evidence of chromosome aberrations in B lymphocyte for a long period after radiation exposure would be useful in elucidating the process of acute lymphocytic leukemia (B lymphocyte), B cell lymphoma and multiple myeloma.
  • 川島 康平, 森島 泰雄, 加藤 幸男, 鈴木 久三, 竹山 英夫, 小林 政英, 渡辺 英二, 江崎 幸治, 緒方 完治, 高松 純樹, ...
    1979 年 20 巻 4 号 p. 355-363
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    Effectiveness of L-asparaginase as an induction therapy was investigated in 12 patients of acute lymphocytic leukemia and one of peroxidase-negative acute myelocytic leukemia, refractory to conventional chemotherapy. The median age was 26 years (from 10 to 54 years). L-asparaginase was always tried after the multi-combination chemotherapy had proved unsuccessful, either during the initial phase of the disease or during relapse. In all cases except for two who were administered 20 I. U./Kg/day and 132 I. U./Kg/day, the dosis was approximately 200 I. U./Kg/day. The median duration of treatment was 14 days (from 3 to 22 days). Before L-asparaginase treatment, there was a heavy leukemic infiltration (53.2% median) of the bone marrow. The blood showed leukopenia and thrombocytopenia in several patients. Complete remission was obtained in 8 (61.2%) out of 13 cases of acute leukemia. The median remission induction time was 26 days. These 8 cases achieved complete remission within 30 days from the start of L-asparaginase treatment. No correlation of duration of remission induction with dose administered was found. With respect to a correlation between the time needed for remission with L-asparaginase and the duration of this remission, it is too early to mention because 4 out of 8 remission cases are still in complete remission. Clinically, L-asparaginase was well tolerated except for one case, where gastrointestinal complaints and hyperglycemia made it necessary to discontinue treatment after only 3 days. The other one patient developed an anaphylactic reaction which appeared during an attempt to restart the second treatment with L-asparaginase after a resting period General side effects were quite frequent. 92.3% of the cases experienced nausea and anorexia, 23.1% vomiting. An effect on the liver was frequently seen (53.8%). They disappeared quickly or returned normal after the end of the asparaginase course.
    These results seem highly significant, in so far as L-asparaginase was applied for the patient who had previously proved to be refractory to the conventional chemotherapy.
  • —第2報:von Willebrand病の止血管理—
    小林 勲, 高橋 芳右, 真田 雅好, 服部 晃, 高橋 薫, 伊藤 正一, 桜川 信男, 柴田 昭, 品田 章二, 塚田 恒安
    1979 年 20 巻 4 号 p. 364-371
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    It is well known that a new synthetic vasopressin 1-deamino-8-D-arginine vasopressin (DDAVP) increase factor VIII activity and is used for hemostatic control of hemophilia A patients.
    DDAVP was injected intravenously to von Willebrand's disease patients and the coagulation, fibrinolysis and platelet functions were measured. Clinical application of DDAVP to von Willebrand's disease was also discussed.
    Seven subjects with von Willebrand's disease (classical type 4, variant form 3) were injected 10 μg of DDAVP and act PTT, factor VIII activity (VIII: C), factor VIII like antigen (VIII R: AG), von Willebrand factor (VIII R: WF), bleeding time (BT), platelet retention (PR), ristocetin induced platelet aggregation (RIPA) and plasminogen activator (PA) were measured before and after 1 and 2 hours.
    Except one severe case of classical type, all other cases showed shortening of act PTT, increase of VIII: C, VIII R: AG, VIII R: WF and PA, improvement of PR and RIPA and shortening of BT (classical type).
    The grade of increase of VIII: C was 5.4 times and of VIII R: AG was 2.3 times. So, the discrepancy of VIII: C and VIII R: AG was recognized.
    The increase pattern of VIII R: AG and VIII R: WF was very similar but the pattern was different from that of VIII: C.
    In a case of genital bleeding, DDAVP injection showed transient improvement of hemorrhagic tendency.
    DDAVP is useful for elucidation of mechanism and hemostatic control of von Willebrand's disease.
  • 楊井 正紀
    1979 年 20 巻 4 号 p. 372-380
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    In 1972 Allen et al. reported that human polymorphonuclear leukocytes (PMNs) emitted chemiluminescence (CL) during the process of phagocytosis. After that CL response has been used as one of the examination techniques of PMNs function. But this technique is not yet widely used in Japan.
    The author examined the methodological studies of CL response of human PMNs with a liquid scintillation spectrometor (Aloka-LSC 602) and has found that this method is simple, objective, reproducible and economical. Furthermore, this method is useful for screening PMNs abnormalities because the transitional changes of the CL response can be observed.
    By using patients' serum instead of the pooled one, it was possible to know the patients' serum opsonic activity.
    CL response of PMNs of chronic granulomatous disease (CGD) showed a characteristic pattern in which cpm did not elevate, and the CL response of its carrier was intermediate. So this method is valuable for the diagnosis of CGD and its carrier.
    Also CL response is useful for the study of bactericidal mechanism of PMNs.
  • 栗林 俊夫, 富所 隆三, 鈴木 成欣, 黒梅 恭芳
    1979 年 20 巻 4 号 p. 381-387
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    Employing a mixed rosette method, the population of peripheral lymphocytes, which bear both sheep erythrocyte and complement receptors (D-RFC), was determined in 16 cases of healthy children, 18 cases of ALL and 7 cases of AML.
    Though D-RFC was not seen before treatment of 9 cases of ALL, it increased on the 5th day during initial treatment of vincristine and corticosteroid, and decreased to normal range a week later.
    The mean percentage value was 6.4±0.9% (M±SE) during the initial treatment, 1.53±0.2% in remission of ALL, respectively.
    The former was higher than that of normal children (1.9±0.2%) (p<0.01). In AML it was 0.5% during initial treatment, 0.6±0.1% in remission respectively.
    No effect of antileukemic agents in vitro on the percentage of D-RFC in healthy adult lymphocytes was found.
    The figures of D-RFC in ALL studied by Scanning Electron Microscopy were similar to normal T-lymphocyte, having smooth cell surface with some hairs.
症例
  • 小橋 秀広, 三好 勇夫, 坪田 輝彦, 喜多島 康一, 木村 郁郎, 浅野 健夫
    1979 年 20 巻 4 号 p. 388-392
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    A case of atypical hypoplastic anemia that responded to azathioprine is reported. The patient was a 30-year-old female who developed anemia in 1964. She had been treated with blood transfusions before she was admitted to our hospital in 1972, when a diagnosis of hypoplastic anemia was made. She was started on steroid hormone and ACTH with some improvement of pancytopenia. However, despite the same treatment, she gradually became pancytopenic (RBC 124×104/cmm, WBC 2,100/cmm and platelets 2.7×104/cmm) in November 1975. Therefore, in addition to the two drugs, she was placed on azathioprine 50mg/day and this regimen was continued until February 1977. With azathioprine there was a steady increase of RBC followed by some increase of WBC and platelets, as shown by RBC 316×104/cmm, WBC 3,600/cmm and platelets 11.7×104/cmm in April 1977.
    The hematological remission obtained in this case appears to be related to azathioprine administered. The mechanism of action of immunosuppressive agents in hypoplastic anemia is discussed with respect to suppressor lymphocytes.
  • 芦沢 健, 小田 栄司, 桜川 信男, 柴田 昭, 関谷 政雄, 根本 啓一, 岡村 明治, 大西 義久
    1979 年 20 巻 4 号 p. 393-399
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    It has been generally recognized that the lymphadenopathy induced by the anticonvulsant, hydantoin, shows the similar clinical and histological findings to malignant lymphoma, especially Hodgkin's disease.
    In this paper, the case of diphenylhydantoin-induced lymhadenopathy which showed the similar clinical and histological findings to immunoblastic lymphadenopathy was reported.
    A 47-year-old man was administered diphenylhydantoin since April to June 1977. The erythema appeared and disappeared since the time of the administration of diphenylhydantoin. The generalized lymphadenopathy was observed since July 1977, and enlarged gradually, and the abnormal findings of the immunological examination was observed (increased IgM, increased B-cell count, positive antinuclear antibody, etc.). The histological findings of the lymph node by biopsy showed disappearance of nodal architecture, and proliferation of arborizing small vessels with proliferation of immunoblasts whereas almost no acidophilic amorphous interstitial substance was observed.
    These findings were improved by administration of prednisolone. The patient was readministered diphenylhydantoin after four months, and the same results were obtained. Similar cases to this in literatures were reviewed and relationship of the clinical and histological findings between immunoblastic lymphadenopathy and this case was discussed.
  • —α2-plasmin inhibitorからみた投与量について—
    林 滋, 山田 兼雄
    1979 年 20 巻 4 号 p. 400-409
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    A large dosage of urokinase combined with heparin was administered to a patient with arterial thrombosis of the leg. After a 3-day therapy with a dosage of 120,000 to 360,000 units per day, combined with 12,000 units heparin per day, the symptoms of arterial occulusion such as cyanosis, pain, coldness and disappearance of pulsation became worse. A larger dosage of 720,000 to 1,020,000 units urokinase per day, combined with 12,000 units heparin per day, was continued for 6 days and clinical symptoms were rapidly improved. In this period, urokinase was administered in the following two different ways: 360,000 or 720,000 units urokinase was infused within 2 or 4 hours, respectively, and 120,000 to 200,000 units urokinase was infused for following 20 hours. After a larger dosage of urokinase was administered, α2-plasmin inhibitor, plasminogen and fibrinogen decreased and a prominent fibrinolytic effect was observed. Especially, α2-plasmin inhibitor decreased more rapidly than other major inhibitor such as α2-macroglobulin and α1-antitrypsin, and its decrease was inversely correlated (r=-0.89) to the dosage of urokinase per hour. In addition, fibrinolytic effect became more prominent when the decrease of α2-plasmin inhibitor approached 50%. It was concluded from these results that about 500,000 units urokinase per day as well as 100,000 units urokinase per hour were necessary for the treatment of arterial thrombosis.
  • 長谷川 吉康, 伊藤 敬, 関根 今生, 岩本 愛吉, 伊藤 良雄
    1979 年 20 巻 4 号 p. 410-416
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    A 50-year-old woman complained of severe anemia and general fatigue was reported as an autopsy case of chronic myelomocytic leukemia (CMyMoL).
    With marked enlargement of spleen, moderate hepatomegaly and slight lymphadenopathy, she showed severe macrocytic normochromic anemia, marked leukocytosis with monocytosis up to 23% and slight thrombocytopenia in the peripheral blood.
    The bone marrow showed normocellularity, involving an increase of monocytes in each step of maturity.
    The important findings reflecting the increase in monocytes were an increase of urine muramidase activity and an increase of the phagocytosis of India-ink. Ph1 chromosome or other abnormalities of chromosomes were not seen and alkaline phosphatase in the neutrophile leukocytes was high.
    The autopsy findings indicated that immature, partly mature granulocytic and monocytic leukemic cells diffusely proliferated in the bone marrow, liver, spleen, lymph nodes and other organs.
    Thus, the hematological findings of this patient was characterized by an apparent proliferation of mature monocytes in the peripheral blood and a proliferation of monocytes of each step of maturity in the bone marrow.
    Although few attention has been paid to a chronic form of MyMoL, this patient was considered to be fit for one case of CMyMoL already reported by Miescher & Farquet.
  • 久保田 一雄, 仲宗根 豊, 溝口 秀昭, 隅谷 護人, 坂本 忍, 小池 盛雄, 高久 史麿
    1979 年 20 巻 4 号 p. 417-423
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    A 68-year-old male patient was admitted to the hospital because of generalized lymphadenopathy and splenomegaly. Peripheral blood examinations revealed the hemoglobin 10.1g/dl, the platelet count 38,000/mm3 and the white blood cell count 20,800/mm3 with 86.5% mature lymphocytes. From these findings, he was suspected to have chronic lymphocytic leukemia. The examinations of surface markers on the lymphocytes revealed they were of T-cell origin. The histology of cervical and inguinal lymph node biopsy specimens, however, showed that there were a lot of aggregates of epithelioid and reticulum cells among diffuse infiltration of mature lymphocytes and large lymphoblastoid cells. These findings indicated Lennert's lymphoma rather than CLL.
    On autopsy, these epithelioid cells disappeared and only mature lymphocytes remained in all lymph nodes examined. From these autopsy findings and absolute lymphocytosis in the peripheral blood, the final diagnosis was T-cell CLL.
  • 青笹 克之, 宇多 弘次, 吉原 渡, 黒沢 孝成, 河 敬世, 田中 祥介
    1979 年 20 巻 4 号 p. 424-430
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    A patient was a seven-year-old girl and had been in good health until the present illness. She was admitted to the Osaka University Hospital because of fever and systemic lymphadenopathy which was not suppressed by INAH, PAS and any other antibiotics. She was anemic and had a temperature of 38°C.
    Physical and laboratory findings showed no sign of bacterial and viral infections. Lymph nodes were palpable at the right neck, submandibular, left axillar and bilateral inguinal region. Hepatosplenomegaly was also noticed. Immunological studies revealed deficiency of cellular immunity. Lymph node biopsy of the left neck was performed and histological diagnosis was non-specific, chronic lymphadenitis. No chemotherapeutic agents were administrated. She fell into downhill course and died on December 5, 1976.
    Pathological examination of autopsied material revealed generalized, invasive proliferation of morphologically atypical histiocytes and a diagnosis of malignant histiocytosis (Rappaport) was made.
    In this paper we tried to study retrospectively on biopsied materials and discuss the comparison of the findings of biopsied and autopsied lymph nodes. Pertinent literature was reviewed and relationship of malignant histiocytosis and histiocytic medullary reticulosis was discussed.
  • 待井 隆志, 木谷 照夫, 平岡 諦, 小西 一郎, 金山 良男, 垂井 清一郎
    1979 年 20 巻 4 号 p. 431-437
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    A 69-year-old male was incidentally found to have leukocytosis. No lymphadenopathy or hepatosplenomegaly was found, but the peripheral blood leukocyte count was 21,000/mm3, 84% of which was leukemic lymphocytes. These leukemic cells contained characteristically many cytoplasmic azurophilic granules in May-Giemsa stained smears. Ultrastructurally most of these granules showed the structures referred to as parallel tubular arrays (PTA). These cells formed E rosette and also bound ox erythrocyte coated with IgG, thus exhibiting identical surface markers with T lymphocytes bearing Fc receptors for IgG (Tγ cells). The clinical and hematological features of the present case were different from those of “adult T cell leukemias” reported in Japan. It seemed sure that this case could be diagnosed as Tγ-CLL. Apparently Tγ-CLL has not been reported in Japan, so far while Mackenna et al. reported four cases of T-CLL, the leukemic cells of which contained PTA and carried a IgG Fc receptor.
    Morphologic and functional difference bitween Tγ-CLL cells and Tγ cells separated from normal peripheral lymphocytes was also discussed.
  • 吉岡 正和, 松井 克明, 湯本 東吉, 千代 俊夫, 杉山 恭子
    1979 年 20 巻 4 号 p. 438-445
    発行日: 1979年
    公開日: 2009/01/19
    ジャーナル 認証あり
    A 66-year-old male was admitted with complaints of palpitation and shortness of breath on exertion. Peripheral blood and bone marrow examination revealed pancytopenia and hypoplastic marrow. The diagnosis of aplastic anemia was made, and he was treated with blood transfusions, ferrous sulfate, corticosteroid and anabolic steroid. During his clinical course, glycosuria, hyperglycemia and liver cirrhosis were observed. Then he expired because of pneumonia. Autopsy revealed hemochromatosis associated with aplastic anemia, and metal concentration of the liver was measured.
    The association of hemochromatosis with aplastic anemia, which was first reported by Kark (1937), has been reported fairly and said to occur more than accidental. 21 cases of hemochromatosis associated with aplastic anemia have been reported in Japanese literature and 38 cases in 164 cases of hemochromatosis collected from Annual of the Pathological Autopsy Cases in Japan in the period from 1967 to 1976. A possiblity that hemochromatosis developed easily when iron load was added to the iron excess state of aplastic anemia was discussed.
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