S phase partial synchronization by N⁴-behenoyl-1-β-d-arabinofuranosylcytosine (BH-AC) was attempted in 13 adults with acute nonlymphocytic leukemia. The patients whose marrow leukemic blasts were normo- or hypocelluar and showed labeling indices (LI) of 3∼10% as determined by our rapid ³H-TdR autoradiography were selected and administrated BH-AC 100mg/day by 3-hour drip intravenous infusion for 2 or 4 days. LI rose significantly (P<0.01) from 5.3±1.7% to 9.9±3.5% in 2 days treatment group and from 5.0±2.2% to 10.6±6.7% in 4 days treatment group (P<0.05). Slight nausea but not pain of salivary gland and megaloblastic change in marrow were observed during administration of BH-AC. The mechanism of synchronization by BH-AC was considered S phase prolongation by the inhibition of DNA synthesis.
Remission induction therapy by DCMP or DBMP at a proper time carefully determined by LI of marrow blasts according to our new protocol gave complete remission rate of 85.7%, i.e., 6 of the 7 firstly treated cases and that of 57.1%, i.e., 4 of the 7 reccurent cases.
From our above-mentioned results, S phase partial synchronization by BH-AC by the use of our rapid autoradiography is considered to be a useful tool for treatment of leukemia.

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A 49-year-old man was admitted to Nagoya City University Hospital on July 11, 1978, for a further examination of fever of unknown origin, anemia and muscle weakness. Physical examination revealed marked muscle weakness and atrophy in the proximal muscle of the extremities. On admission, his hemoglobin was 10.9g/dl, reticulocytes 46%, platelelts 45.2×10⁴/mm³, WBC 19,600/mm³ with 84% of neutrophils. His bone marrow smear revealed an erythroid marrow. A shortened ⁵¹Cr red cell life span, positive direct Coombs test, elevated reticulocytes, increased serum bilirubin, markedly decreased haptoglobin led to the diagnosis of autoimmune hemolytic anemia (AIHA). A diagnosis of polymyositis was also made from myogenic changes in EMG and muscle biopsy findings. Anemia and muscle weakness were improved, and the levels of LDH, CPK, GOT and ESR were normalized by the administration of prednisolone and azathioprine. To our knowledge, cases of AIHA complicated by polymyositis are very few. This case is of interest from the point of view of understanding the onset of antoimmune disease because of the simultaneously involvement of two organs in one individual.

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An aged patient with acute leukemia, who has survived more than five years in complete remission, is reported. The patient was diagnosed as acute myelomonocytic leukemia at the age of 69. On admission, the proliferation of leukemic cells was remarkable in his peripheral blood and bone marrow. He had high fever, anemia and bleeding tendency due to thrombocytopenia. Complete remission was achieved within two months by initial combination chemotherapy (Predonine, Ara-C, Vincristine). Following the initial therapy, second combination chemotherapy, Daunomycin, Ara-C and Predonine, was performed. Shortly after the maintenance therapy of 6-MP, the signs of toxic hepatitis appeared. Without maintenance therapy for more than 4 years, he has survived 5.2 years and there has been no relapse.
Generally, intensive combination chemotherapy is not very efficacious on an aged patient with acute leukemia. However, this patient responded to relatively intensive chemotherapy very well. Among the prognostic facters, response of leukemic cells to chemotherapy seemed to be most significant in the survival of the present case.

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Two splenectomized patients with hairy cell leukemia were reported. One was 67-year old male with marked leukocytosis (case Y. Y.), the other was 76-year-old female with pancytopenia (case I. T.). Both showed insidious onset, splenomegaly and the presence of hairy cells in the peripheral blood, but no lymphadenopathy. Morphological, cytochemical and immunological analysis were studied on the neoplastic cells in the peripheral blood and spleen.
The neoplastic cells of the both cases showed hairy appearance under phase contrast microscopy, and also were Pox (-), Acp (+), TRAcp (-), PAS (-), α-NA-Est (+), and phagocytic activities (-) for latex particles, carbon black particles and sensitized erythrocytes. Ribosome lamella complex was negative in both cases. On immunological analysis, the neoplastic cells in case Y. Y. showed FcR (+), C3R (-), SmIg (-), Ia like antigen (+), and increased stimulation index in mixed lymphocyte culture. In case I. T., the neoplastic cells showed FcR (-), C3R (+), SmIg-IgG (+), and Ia like antigen (+).
These findings of the neoplastic cells suggested their B-lymphocyte nature. As to the treatment, splenectomy was effective for the patient with pancytopenia, on the other hand, leukapheresis was effective for the patient with leukocytosis.
Twenty cases including the present 2 cases so far reported in Japan were reviewed, and the difference of hairy cell leukemia in Japan from that in USA and Europe was discussed.

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A 52-year-old man with classical rheumatoid arthritis of 10 years' duration was admitted to our clinic because of anemia. Physical examination showed anemia, swelling of rt. DIP (III), exertional pain of the rt. elbow joint, a subcutaneous nodule at the left elbow joint, moist rales in bilateral lower lung fields and systolic heart murmur in the left 2nd rib region. Blood examination revealed severe anemia with no reticulocytes, but neither leukopenia nor thrombopenia was found. Bone marrow study revealed hypoplasia of all erythroid elements. Chest X-ray showed no mass in the anterior mediastinum. From the above findings, a diagnosis of pure red cell aplasia complicated with rheumatoid arthritis was made. Although there was no evidence of thymoma, thymectomy was undertaken under medinoscopy with no remarkable effect. Since July 21, 1978, prednisolone was given with some improvement. On August 1, he was attacked by arterial thrombosis of the left superficial volar arch, which soon disappeared by anticoagulant therapy. During long-term medication of prednisolone, a critical increase in reticulocytes developed in November, 1979, later followed by recovery of anemia and increase in erythroid elements in the bone marrow. Through this case, possible participation of autoimmune mechanism in the development of both pure red cell aplasia and rheumatoid arthritis was discussed.

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A 53-year-old female suddenly developed petechiae on her thighs on June 22, 1979. She visited a doctor who made a diagnosis of severe aplastic anemia by hematological examination, and was reffered to the Nagoya 1 st Red Cross Hospital for bone marrow transplantation on July 16. On admission examination revealed a severe pancytopenia and hypocellular bone marrow: RBC was 2.11×10⁶/μl, reticulocyte 0.4%, WBC 2,300/μl with 2% neutrophils and platelets 2,100/μl in peripheral blood and hematopoietic cells 3.6% in the bone marrow. Prior to transplantation, she was conditioned with intravenous cyclophosphamide, 2,500mg a day, for four days. On July 24, she received a bone marrow aspirate (8.4×10⁹ nucleated cells) from an HLA-identical sibling (50-year-old female). She was treated periodically with intravenous methotorexate for prevention of GVHD. About two weeks later, her hematological findings suggested a successful engraftment. But because of delayed recovery of hematopoietic cells, methotrexate was changed to prednisolone on the 68 th day. Thereafter all hematopoietic elements increased rapidly without any sign of GVHD. At present she is completely healthy and hematologically normal: RBC was 3.73×10⁶/μl, WBC 6,000/μl with 36% ncutrophils and platelets 5.1×10⁵/μl in periperal blood on March 4, 1980.

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A 70 years old woman was admitted to the Nihon University Hospital in December 1974 because of general fatigue, loss of appetite, hepatomegaly and papules for 2 months. The platelet counts on admission was 3.2×10⁶/μl, the bone marrow aspiration and biopsy revealed marked increase in number of magakaryocytes. The diagnosis of essential thrombocythemia was made on the base of thrombokinetic studies.
Total 198mg of Busulfan was given to maintain platelet counts between 0.5 and 1.7×10⁶/μl.
In April 1979, the platlet counts decreased to 0.14×10⁶/μl, leukocyte counts was 35,200/μl, with 87.5% of blast cells. Bone marrow aspiration showed 71.8% of blast cells with Auer rods. Diangosis of acute myeloblastic leukemia was made. A complete remission was not achieved with various antileukemic agents. She died of intracranial bleeding in October 12, 1979. Our case and 7 case of blastic transformation from essential thrombocythemia in literature were discussed.

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A twenty-two-year-old male recognized tumors of 1.5×1.5 cm on the both submandibular regions at the middle of October, 1979, and a diagnosis of eosinophilic granuloma of lymph nodes was made by a biopsy of the tumor at the Department of Surgery, Toranomon Hospital, on December 10, 1979. He was referred to the Department of Hematology on January 14, 1980, for further treatment.
On admission two lymph node masses of 1.2×1.2 and 7×4 cm were palpable. Both masses were elastic and hard. Tenderness and local itching of the tumor masses, hepatosplenomegaly and pain and swelling of bones were absent.
Peripheral blood examinations did not reveal any abnormalities in WBC and eosinophil counts. A bone roentgenogram and a bone scintigram by technetium were normal.
⁶⁰Co irradiation of 250 rads was applied twelve times, totalling 3,000 rads with benefical results on the swelling of the lymph nodes. He was discharged on February 16, 1980. The subsequent course was uneventful.

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A case of Burkitt lymphoma in a 52-year-old Japanese male is reported. The patient was admitted because of a right mandibular tumor in July 1979. On physical and laboratory examinations, hepatosplenomegaly, hypercalcemia and kidney dysfunction were recognized.
A mandibular tumor biopsy revealed the so-called starry sky appearance. The serum EB virus antibody and tumor cell EB virus nuclear antigen were undetectable. The tumor cells, having basophilic cytoplasm and prominent vacuoles, possessed B cell surface markers and carried a 14 q+ chromosome abnormality.
Treatment with cyclophosphamide resulted in the regression of the jaw tumor. However, the lymphoma cells began to appear in the peripheral blood with invasion into the bone marrow. The relapse was complicated by hypercalcemia and azotemia and the patient died 3.5 months after onset. Postmortem examination revealed tumor cell infiltration in the ribs, lumbar vertebrae, trachea, kidneys, liver, spleen and prostate. Calcium deposition was present in the kidneys, lungs, liver, spleen, heart and aorta.

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Two cases of Fanconi's anemia found in one family was reported. They were children of parents who were 1 1/2 cousins by marriage. The children's first cousins, two brothers of parents of second cousin marriage, had died of aplastic anemia in their ealy childhood.
In the first case, onset of the disease occurred when the girl was 7 years old. Her younger brother became the second case when he was 10 years old. Each child had prominent epicanthus, a brown spot on their abdominal wall and abnormal dermatoglyphics. Only the first case was slightly less than average in height and weight. Chromosomal abnormalities confirmed the diagnosis. After the time course of about ten years, she died of pancytopenia, but her brother is alive yet, and has no symptoms, although he has only slight anemia and also a slight degree of thrombocytopenia.

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