A new simple method for the analysis of hemolytic reaction by automatic recording with a pouring water device was developed and applied successfully to the measurement of human erythrocyte osmotic resistance. Five μl of whole blood was added to 500 μl of barbital buffered saline in a small test tube placed in a platelet aggregation meter (EEL). Warmed distilled water was poured into the tube through a capillary plastic tubing at a constant rate and the changes in optical density at 660 nm was recorded automatically.
Saline concentration after T seconds in the tube (C_t) was calculated by the following equation: C_t=C_oV_o÷(V_o+RT), C_o: initial conc. of saline, V_o: initial volume of saline, R: rate of pouring water. A typical pattern of the dilution hemolysogram (DHG) showed a reversed S shape, and the points of initial, 50% and complete hemolysis were estimated from this DHG.
This new micro-method was proved to be a simple, rapid and reproducible procedure for the accurate measurement of erythrocyte osmotic resistance.

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It is difficult to distinguish the tuberculous pleural fluid from the carcinomatous one by laboratory examination. In this study, the difference between both fluids was investigated from the aspect of coagulation and fibrinolysis.
Seventy four samples of pleural fluid and 83 samples of plasma were obtained from patients with carcinomatous pleurisy and 21 samples of pleural fluid and 9 samples of plasma were obtaind from patients with tuberculous pleurisy.
On these specimen, the following coagulation and fibrinolytic parameters were measured; high molecular weight fibrinogen/fibrin complex (HMWFC), serial dilution protamine sulfate test (SDPS), ethanol gelation test (EG), fibrin/fibrinogen products (FDP), fibrinogen, coagulation factors (II-XII), α₂-macroglobulin (α₂-MG), α₁-antitrypsin (α₁-AT) and antithrombin III (AT III).
In Pleural fluid, activities of all coagulation factors were less than 20% of those in plasma, but antigen levels of all coagulation factors were higher than the corresponding activities. In almost all pleural fluids, the concentration of α₂-MG and AT III were less than those in plasma, but the concentration of α₁-AT was higher than that in plasma.
FDP and HMWFC in pleural fleuid were twenty times higher than those in plasma, but significant difference between the tuberculous and carcinomatous pleural fleuids was not revealed.
In all tuberculous pleural fluid EG tests was positive. In the carcinomatous pleural fluid, positive incidence of EG test was less than half of the cases. Particularly, EG test was negative in all cases of mesothelioma. From these results, it was suggested that the behavior of paracoagulation tests in pleural fluid had a diagnostic significance for differentiation of pleural diseases.

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Forty-seven children with acute lymphocytic leukemia (peroxidase negative type) recieved treatment during the period of 1973∼1979. Two separate groups, a typical acute lymphoblastic leukemia (ALL) and an acute undifferentiated (AUL) or peroxidase-negative myeloblastic leukemia (Pox (-) AML), were identified on the basis of morphological findings from bone marrow preparations, stained with May-Grünwald-Giemsa.
Both groups were matched by male-female ratio and white blood cell count at diagnosis, and received similar treatment by total therapy. Each group demonstrated 100% complete response at induction treatment. However, 14 AUL or Pox (-) AML found to have significantly poor prognosis, compared to the 33 ALL patients. The follow-up period was a median 24 months, ranging from 3 to 84 months.
In the AUL or Pox (-) AML group, only 4 of the original 14 patients are still alive with a median survival period of 32 months. By contrast, 28 of the 33 ALL patients have survived; the median survival remains to be determined. The number of patients in continuous complete remission for more than 30 months was also significantly different in these two groups; being 2/14 vs. 10/33, respectively. Early relapse accounts for the poor survival rate in the AUL or Pox (-) AML group.
We conclude that cytomorphological classification can be useful in predicting prognosis in cases of childhood acute leukemia.

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Two cases of so-called adult T cell malignancy were presented, one was diagnosed as Sézary syndrome and the other, as adult T cell leukemia. They showed, in common, lymphnode swelling, hepatomegaly, bone lesion associated with hypercalcemia, and exfoliative erythematous skin lesions, in which an infiltration of leukemic cells was found. One patient was born in Kyushu district and the other in Taiwan. Smears of peripheral blood showed convoluted lymphoblastic cells with T-cell markers. Adult T cell leukemia showed multiple cutaneous tumors, but Sezary syndrome did not. At present, it is quite natural that we put both, Sezary syndrome and adult T cell leukemia, into the same clinical category as adult pleomorphic type in T cell malignancy. Hypercalcemia seemed to be caused by bone infiltration, in Sezary syndrome, and a local humoral factor such as osteoclast activating factnr in adult T cell leukemia.

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Two cases of chronic myelogenous leukemia without splenomegaly were reported and Fifty-five cases in literature were reviewed on the clinical manifestations.
1) There were 38 male and 17 female patients: their median age was 46 years with a range from 14 to 72 years.
2) 16 patients had no complaints (29.6%), and 19 patients had gastrointestinal complaints such as hematemesis, melena and epigastralgia (35.2%).
3) The leukocyte counts was lower than 50,000/cmm in 56.4% of patients at their first visit.
4) Gastrointestinal complications, such as stomach ulcer, were found in 23 patients (41.8%).
5) In 14 patients, splenomegaly was present from 1 to 36 months after the first visit. (median duration: 11 month).
6) In 5 patients, spenomegaly was absent during the whole course.
7) In 17 patients, survival duration ranged from 0.25 to 75 months. (median survival: 11 month).
8) Hemorrhge of interstine or brain in was the main cause of death (46.7%).

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A case of erythroleukemia with erythocytosis was described. A 56-year-old male was admitted with a chief complaint of pain on the chest, flank and back. Family and past history was non-contributory. Physical examination revealed multiple lymphadenopathy in cervical and axillar regions, moist rales over both bases of lung, and hepatosplenomegaly. His peripheral blood and bone marrow examinations disclosed a diagnosis of erythroleukemia. CBC showed marked erythrocytosis (RBC 6,030,000, Hb 18.1 Gm/100ml, Ht 57,5%), leukocytosis of 32,100/cmm and thrombocytopenia (28,000/cmm) with 56% of leukemic cells. An aspirate of sternal marrow showed hypercellularity with megaloblastoid change and marked atypism of nucleus in these erythroblasts which had negative peroxidase and positive PAS staining. Index of neutrophil alkaline phosphatase staining was 92% and score was 299. Whole blood viscosity was 8.4 cp. Chest X-rays showed enlarged silhouette and infiltrative shadow in both lower lung fields. Computed tomography of brain revealed scattered multiple low density areas. He poorly responded to the treatment with Ara-C and DNR and developed meningeal leukemia and expired on July 12, 1979.
Autopsy findings revealed multiple infarction in the brain and pancreas. The direct cause of death was concluded to be disseminated candida infections.
It is difficult to conclude that this case of erythroleukemia is on the stage of transformation from polycythemia vera and it might be better to diagnose as erythroleukemia with coexistence of erythrocytosis due to erythroid overproliferation on the stem cell level.

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A recovery case of aplastic anemia probably induced by gold salt (aurothiomalate sodium) was reported. The case was a 43-year-old female who had been given totally 1,550mg of gold salt for about 15 months for the treatment of rheumatoid arthritis. She was admitted due to general fatigue, headache and tinnitus. Hematological findings on admission showed the followings: hemoglobin 4.5g/dl, white blood cell count 3,500/mm³ with relative lymphocytosis (65.5%) and neutropenia (26.5%), platelets 6.2×10⁴/mm³ and hypoplastic bone marrow with marked decrease of erythroid series. The serum level of gold was 250μg/dl. The data of ferrokinetic study was consistent with those of aplastic anemia. Hemoglobin value began to increase 6 weeks later after initiation of androgenic steroid therapy (Primobolan 30mg/day); followed by the gradual recovery of the other peripheral blood cell elements. About 5 months later, hematological data restored normal values (hemoglobin 13.3g/dl, white blood cell count 4,100/mm³ with 53.0% neutrophils, platelets 21.5×10⁴/mm³). The serum level of gold was 80μg/dl.
It was suggested that the hematological recovery in this case was due to the spontaneous recovery of bone marrow function not due to the effect of androgenic steroid.

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A case of acute panmyelosis in a 38 year-old female patient was reported. She was tentatively diagnosed “Erythroleukemia” because of an increased number of atypical erythroblast and myeloblast in the peripheral blood. In a full clinical course, an abnormal proliferation of immature granulocytes, megakaryocytes, and atypical erythroblasts were simultaneously observed. The chemotherapy, such as CMP, DCMP, PADOC and N-CMP, failed in a remission induction. At autopsy, atypical immature granulocytes and megakaryocytes were found to infiltrate liver and kidney.

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A 62-year-old male with adult T-cel lymphoma of pleomorphic type and eosinophilia was reported. He was admitted to the Otolaryngology Department because of the tosillar malignant tumor on March 13, 1979. After the disappearance of the tumor by radiation therapy he was transferred to the Department of Internal Medicine because of abdominal distension and severe diarrhea in Aug. 1979.
On admission physical examination showed generalized lymphadenopathy, hepatosplenomegaly and ascites. Laboratory findings included WBC of 26,700/mm³ with 50% of eosinophils and 8% of lymphocytes, and a bone marrow aspirate showed eosinophilia with no atypism. Diagnosis of malignant lymphoma of diffuse pleomorphic type was made by an inguinal lymph node biopsy. The tumor cells obtained from the node formed rosette with sheep red cells, but no surface immunoglobulin nor EAC rosette formation were detected.
By combination chemotherapy (COPP) eosinophilia disappeared rapidly with improvement of other symptoms within a month. Interstitial pneumonia occurred on Oct. 3, 1979. In spite of a transient effect by trimethoprim-sulfamethoxazole he died of respiratory disturbances on Dec. 18, 1979.
On autopsy mild invasion of lymphoma of diffuse pleomorphic type was detected into the lymph nodes of retroperitoneum and liver. The cause of death was attributed to the interstitial pneumonia. In this paper the authors tried to discuss the relationship of T-cell lymphoma of adult pleomorphic type to the eoninophilia with the review of the literature.

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A 50-year-old man with liver cirrhosis was admitted for the examination of anemia. He had moderate hepatoslenomegaly. Blood examinations revealed marked anemia, slight thrombocytopenia and slight leukocytosis with persistent monocytosis and neutrophilia including immature forms. NAP score was low. The bone marrow showed granulocytic hyperplasia. The numbers of monocytes and blasts were not increased. Serum and urinary lysozyme levels were greatly increased. These findings were consistent with a diagnosis of chronic myelomonocytic leukemia as difined by Miescher et al.
Combined esterase stains of both the blood and marrow showed a predominace of cells staining with both non-specific and chloroacetate esterase. Ultrastructural study of the marrow cells exhibited a predominance of neutrophils with no coexistence of monocytic appearance.
Agar culture of the marrow cells revealed a moderate increase of monocyte-macrophage and eosinophil colonies, and a marked decrease of neutrophil colonies. Liquid culture of the marrow cells revealed that immature neutrophils were replaced mainly by monocytes and macrophages during the culture.
The patient died of a rupture of esophageal varix. The autopsy findings showed that leukemic cells markedly proliferated in the bone marrow and spleen, and slightly in the liver and lymph nodes.

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A case of moderate hemophilia A with relatively rare complications, such as hemophilic pseudotumor and cerebral thrombosis caused by hyperfibrinogenemia and arteriovenous fistulae in upper extremities is presented.
The patient aged 37, was admitted to Niigata University Hospital for the treatment of fistula in the right iliac portion. He was suffering from hemophilic pseudotumor of mandibular and iliac bones at the ages of 9 and 16, and at the age of 28, he fell into a fit of convulsions and unconsciousness during the intensive replacement therapy. As the cause of this neurologic episode, cerebral thrombosis was suspected, since plasma fibrinogen level was higher than 1,000mg/dl. On the third day after the onset, the consciousness became clear but gait disturbance remained.
Arteriovenous fistulae in upper extremities which might have been induced by frequent injections were found at the age of 34.
After rehabilitation, he became able to walk on cruches and was going to be discharged under home replacement therapy of highly concentrated factor VIII agents.

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A 61-year-old farmer was admitted to our hospital because of severe diarrhea and weight loss. He had intermittent watery stool and noticed swelling of the lymphnodes on both sides of the neck in November of 1978. He was admitted to hospital, and leukocytosis was pointed out, but this etiology was not found. Therefore, he was admitted to our hospital in February of 1979. He had severe tinea in his legs and had tinea throughout whole body. Blood examination and biopsy of lymphnode revealed pleomorphic T-cell lymphoma. The examination of duodenal juice and feces for parasitic ova revealed the coccidium infection with malabsorption syndrome. The symptom cleared up by peroral sulfamethoxazole. Though the examination of the feces was repeated, Isospora belli was not found. On admission lymphocytosis progressed, and he suffered from varicella. Soon, vericella was extended. So he died. We discussed the relationship between non-bacterial infection (Coccidium, virus, Fungus, etc.), T-cell lymphoma and suppression of cellular immunity.

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A 66-year-old woman was admitted at the Tokyo University Hospital, because of anemia and abnormal chest shadow. The anemia was normochromic and normocytic. There were no leukopenia or thrombocytopenia. Reticulocyte count was 0‰. Bone marrow aspiration revealed marked erythroid hypoplasia (0.2%), but there were no abnormalities on myeloid series and megakaryocytes. The diagnosis of PRCA was made. A biopsy of the mass in the chest showed thymoma (mixed type).
Prednisolone 60mg per day was administered. After twenty days, the size of the thymoma decreased remarkably, and then marked reticulocytosis was observed. No relapse of PRCA had been observed until her death.
Three hundred and seventy-four days after admission, she died of such complications as infection and cerebro-vascular thrombosis. An autopsy was made. Erythropoiesis was observed in the bone marrow, and a scared mass was found in the place of the thymoma. The histological study revealed very rarely scattered infiltrations of thymoma cells.

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