Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 22, Issue 9
Displaying 1-14 of 14 articles from this issue
  • Toshiro NAGASAWA, Tsukasa ABE
    1981 Volume 22 Issue 9 Pages 1394-1400
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    Platelet-bound surface IgG (PL-IgG) was quantitatively measured in 16 patients with I. T. P., 15 normal subjects and six patients with hypersplenism using complement lysis inhibition assay. Also the correlation between PL-IgG and in vivo 51Cr-platelet survival was studied in 16 I. T. P..
    The mean values of PL-IgG in I. T. P., normal subjects and hypersplenic patients were 241.2±151.8, 35.1±16.9, and 44.1±13.6 ng/107 platelets respectively. However, the values of PL-IgG in I. T. P. were widely distributed from 50 to 525 ng/107 platelets. Two cases in 16 patients showed near normal level of PL-IgG.
    The negative correlations between PL-IgG and 51Cr platelet survival (γ=-0.686, P<0.05), and platelet count (γ=-0.499, P<0.05) before treatment in 16 I. T. P. cases were observed. However, two cases out of 16 patients showed low platelet count and low level of PL-IgG. Also two cases in 8 patients whose 51Cr-platelet survival time showed within 24 hours revealed near normal PL-IgG.
    The changes of PL-IgG were followed during treatment in three cases with I. T. P.. Case 14 responded well to steroid therapy. The initially high PL-IgG promptly decreased as circulating platelets increased. Case 15 had transient response to steroid therapy. High PL-IgG did not decrease, although circulating platelets increased. Patient was placed on cyclophosphomide and then PL-IgG decreased to normal range. Case 16 had no initial response to steroid therapy. PL-IgG did not decrease in spite of 2 months of high doses of steroid. Patient had splenectomy and then PL-IgG rapidly decreased and platelet count increased to normal range.
    In conclusion, PL-IgG could be measured by complement lysis inhib tion assay. The reduction of PL-IgG became good indication to evaluate an effectiveness of treatment and to predict a prognosis of I. T. P.
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  • Kazuo YOSHIOKA, Takashi YAMAMOTO, Eiko YAMAUCHI, Shin-ichi MIZUNO, Hir ...
    1981 Volume 22 Issue 9 Pages 1401-1405
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    FDP (fibrin/fibrinogen degradation products) in serum from patients with DIC (disseminated intravascular coagulation) have been characterized using a method of immunoabsorption followed by SDS-polyacrylamide gel electrophoresis. In all five patients with DIC, fragment D-dimer, derived from cross-linked fibrin, as well as fibrinogen degradative fragments (X, Y, D) were detected. It appears that in DIC primary and secondary fibrinolysis may take place, and both anticoagulants and anti-fibrinolytic agents should be given.
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  • Teiji HASHIMOTO, Michio YATABE, Kenichi SHIMADA, Emiko YAMAZAKI, Kenic ...
    1981 Volume 22 Issue 9 Pages 1406-1411
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    Infections are the most dangerous complications in malignancies. We examined PMN leukocyte functions in ALL and other malignancies of children with regard to chemotaxis, phagocytosis, NBT test, deformability, adherence and intracellular killing activity. Chemotaxis, phagocytosis and adherence activity were decreased to about 50% of the control values. NBT test was within normal limit in all cases, deformability was suppressed moderately only in ALL and intracellular killing activity was also depressed.
    Based on these findings, it was suspected strongly that impaired PMN leukocyte function was one of the most important causes of the undue susceptibility to infections of children in ALL and other malignancies.
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  • Koichiro TSUJI, Masashige TSUKADA, Atsushi KOMIYAMA, Taro AKABANE
    1981 Volume 22 Issue 9 Pages 1412-1419
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    Clinical observations were performed in 11 cases of testicular involvement in childhood acute leukemia.
    1) The incidence of this involvement was 18.6% of male children with acute leukemia. When studied in relation to the type of leukemia, the incidence was higher in acute monocytic leukemia (AMoL) and acute lymphoblastic leukemia (ALL) than in acute myeloblastic leukemia (AML): the value was the highest in T cell ALL (T-ALL). The incidence increased as the survival time was prolonged.
    2) The median interval from the diagnosis of leukemia to onset of testicular involvement was 30.9 months.
    3) Testicular involvement was frequent among children diagnosed at from 2 to 8 years of age and with marked organomegaly.
    4) Of 9 cases with isolated testicular leukemia 7 had subsequent relapse with the median interval of 8.4 months. Of 11 cases with testicular involvement 8 died with the median interval of 14.4 months.
    5) The testicular involvement in long-term survivors did not necessarily mean a poor prognosis.
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  • Makiko FUKAYAMA, Yoshiro MURAI, Hiroaki OKABE, Mayumi MORI, Takuo SHIR ...
    1981 Volume 22 Issue 9 Pages 1420-1427
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    An 80-year-old man was admittde to Tokyo Metropolitan Geriatric Hospital on Feb. 13, 1978 because of the swelling and pain in the left submaxillar region. Histological study on the specimen biopsied near the gingiva of the left lower molar revealed that the tumor occupying the left portion of mandibula was plasmacytoma. Hb was 10.8 g/dl, RBC 342×106/μl, Ht 31.5%, WBC 3,300/μl. Bone marrow smear showed 19.8% of atypical plasma cells. The patient was diagnosed as multiple myeloma (IgA, λ+BJP, κ) from the immunoelectrophoretic analyses. Electrocardiogram showed AV block, and CTR was 67% on an X-ray film of the chest. There were abundant atypical plasma cells in the aspirated pericardial effusion, indicating an infiltration of myeloma cells into pericardial cavity. Local therapy with 60Co-irradiation to tumor decreased the size of tumor. In addition, a chemotherapy was carried out, and CTR decreased from 67 to 60%.
    A case of multiple myeloma with two different light chains and pericardial infiltration is presented.
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  • Yuzuru NAKAMOTO, Umihiko SAWADA, Toshiteru OHSHIMA, Toshihide TOHKAI, ...
    1981 Volume 22 Issue 9 Pages 1428-1433
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    A case of pyruvate kinase variant and its family study are reported. The patient, 26 year-old female, was admitted to our hospital in January 1980 because of anemia and jaundice. On physical examination, anemia and jaundice in the conjunctiva and hepatomegaly were detected. During her hospitalization, there were no symptoms except general fatigue and slight dizziness. Laboratory data revealed macrocytic anemia, slight hyperbilirubinemia with predominant elevation of indirect bilirubin, elevated serum LDH level, reticulocytosis and positive hemosiderin in urine. The enzymatic analysis of red blood cell showed low PK activity (14.9%). In the family study of PK activities in her father, mother, elder brother and younger brother were 47.6%, 102.3%, 64.1%, and 21.3%, respectively. From these data it was suggested that her father and elder brother were heterozygotes, and her mother was a heterozygote of the PK variant which was probably different in character from that of her fater. The patient and her younger brother were homozygotes. Although the site of hemolysis in PK variant has been proposed to be mainly in the spleen, the possibility of intravascular hemolysis could not boe denied.
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  • Hiroshi MOHRI, Hiroaki NISHIYAMA, Hiraku MORI, Kazuhiko MATSUNO, Haruo ...
    1981 Volume 22 Issue 9 Pages 1434-1440
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    A 26 year-old female was diagnosedas acute myelomonocytic leukemia in May, 1977. A complete remission was attained with the chemotherapy consisting of daunorubicin, cytosine arabinoside, 6-MP, and prednisolone. During remission, breast cancer (medullary adenocarcinoma) was complicated in June, 1978. Relapse was observed in September of the year after mastectomy. She was again given various combined chemotherapies with little success.
    In July 1979, a rise in body temperature was observed and periproctal abscess by E. coli was diagnosed. Antibiotics were effective for the abscess, but the body temperature rose again. In August, she died because of complete atrioventricular block.
    At autopsy, fungeal infection with leukemic infiltration was observed in the conduction system of the heart.
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  • Yoshifuji MATSUMOTO, Yoshiro KATOH, Masao HIGAMI
    1981 Volume 22 Issue 9 Pages 1441-1447
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    A case of common variable immunodeficiency (CVID) associated with drug-induced marked granulocytopenia is described.
    A 17-year-old boy referred to our hospital for further examination on agammaglobulinemia. He had a history of recurrent infections since 9 years of age. Family history was non-contributory. Laboratory studies on admission disclosed marked hypogammaglobulinemia of all classes and depressed antibody titers against bacteria, virus and blood groups, but normal responses in vivo skin test and in vitro lymphocyte stimulation with mitogens, normal numbers of peripheral T and B-cells, normal morphology and in vitro function of neutrophils, normal complement activities, and intrinsic defect of B-cells, which were demonstrated by using coculture study of T and B-cells for secreting immunoglobulins in vitro. A diagnosis of CVID was made. Gammaglobulin was given intravenously and two days after antibiotics treatment with sulbenicillin sodium (SB-PC) and gentamicin (GM) a marked leukopenia with 7% of immature neutrophils was found. For 6 days thereafter neutrophils completely disappeared from peripheral blood, and drug-induced granulocytopenia was suspected. Bone marrow showed maturation arrest of granulopoiesis. SB-PC and GM were stopped. Over the next 3 days leukocytecounts gradually returned to normal with transient leukemoid reaction and without any bacterial infections. Antiteukocyte agglutinating antibodies could not be demonstrated.
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  • Kohki AOYAMA, Kenichi SUGITA, Yukiaki MIYAGAWA, Atsushi KOMIYAMA, Taro ...
    1981 Volume 22 Issue 9 Pages 1448-1453
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    Two cases of Pre-B-cell leukemia in childhood were reported. Immunologic studies demostrated no rosette formation with SRBC at 37°C lack of surface immunoglobulins, and presence of cytoplasmic-IgM in the lymphoblast.
    On electron microscopy, the lymphoblast had round nuclei, abundant free ribosomes, several strands of rough endoplasmic reticulum in the cytoplasm, and no microvilli on the surface.
    Clinically, the patients easily entered to complete remission. However, the duration of first remission was somewhat short, being about one year. There was a tendency to repeat relapses.
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  • Junko MURAKAMI, Jin TAKEUCHI, Yoshio HAYAKAWA, Masumi BABA, Umihiko SA ...
    1981 Volume 22 Issue 9 Pages 1454-1462
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    A case of Ph1-positive ALL in a t (13q 14q) carrier is reported. A 34-year-old woman was admitted to the Nihon University Hospital complaining of high fever, palpitation, chest pain and generalized lymphadenopathy on August 17, 1979. Hematological examination on admission revealed that the WBC count was 211,000/μl with 97.5% blast cells, and the nucleated cell count in the bone marrow was 880,000/μl with 97.8% blast cells. A diagnosis of ALL (L2 by the FAB classification) was made. The blast cells had high TdT activity but had neither T nor B markers. At the time of diagnosis, she had no hepatosplenomegaly. Blood examination showed normal NAP score and no increase in basophils. The level of vitamin B12 in serum was more than 3,200pg/ml. However, a complete remission could not be achieved with either BH-AC·DMP or LVP; the latter combination therapy induced partial remission. In spite of vigorous chemotherapy and supporting therapy, she died of pulmonary bleeding in January 1980.
    On admission, cytogenetic analysis of the bone marrow cells revealed a karyotype of 44, XX, -8, -13, -14, +t (13q 14q), t (9q+; 22q-) in 100% (25/25) of mitoses. Peripheral lymphocytes and skin fibroblasts of the patient showed a karyotype of 45, XX, -13, -14, +t (13q 14q). When the patient was in partial remission in October 1979, Ph1 chromosome could not be found out in any of 25 mitoses of her bone marrow cells, but t (13q 14q) still existed in them. From these clinical and laboratory findings, this case was diagnosed as Ph1-positive ALL in a t (13q 14q) carrier.
    The coincidence of Ph1 chromosome and t (13q 14q) is discussed in this paper.
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  • Akira KANETO, Masao YOSHITAKE, Naoki IKEJIRI, Teruhito KOGA, Yutaka SH ...
    1981 Volume 22 Issue 9 Pages 1463-1468
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    A case of immunoblastic lymphadenopathy which underwent transformation into immunoblastic sarcoma associated with polyclonal hypergammaglobulinemia at later date is reported.
    A 52-year-old man hospitalized on March 11, 1980, with anemia and generalized lymphadenopathy. Laboratory findings showed marked anemia, reticulocytosis and positive Coombs' test. Serum gammablobulin level remained slight increase on admission. The lymph node of the neck was examined by biopsy and initially interpreted as showing immunoblastic lymphadenopathy. Therapy with prednisolone was started. However, there was no objective effect on the patient's condition, and the lymph nodes remained large. In addition to prednisolone, cyclophosphamide was administered, but anemia and hepatosplenomegaly aggravated. Two months after admission, histological findings of rebiopsied lymph node of the neck demonstrated monotonous proliferation of immunoblasts and monoclonal staining pattern of heavy chain class Ig G and lambda light chain type in the cytoplasm of these cells using immunoperoxidase method (PAP technique). A diagnosis of immunoblastic sarcoma was made. Serum gammaglobulin level rapidly increased and of interest was the finding that there was diffuse, polyclonal hepergammaglobulinemia on immunoelectrophoresis. The level of serum gammaglobulin reached 4.9 g/dl. Hepatosplenomegaly increased and high fever continued, and thus, combination chemotherapy with VEMP was tried. However, his condition continued to deteriorate with progressive pancytopenia and high fever. He died of sepsis four months after admission.
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  • Jun KIMURA, Naondo SUZUKI, Hisao TOMIOKA, Hidenori TAKAHASHI
    1981 Volume 22 Issue 9 Pages 1469-1477
    Published: 1981
    Released on J-STAGE: January 26, 2009
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    The 6th case of IgE myeloma in Japan (15th case in the world) was reported in the present communication.
    71 year-old female was admitted to Orthopedic clinic of Sakura National Hospital on November 12, 1979 due to right shoulder pain which appeared on June 1979.
    Osteolytic and osteoporotic foci were found in the skull, right scapula and right ilium bone without any physical and neurological signs. Complete blood countings were as follows: RBC 248×104/mm3, Hemoglobin 8.3 g/dl, WBC 3,100/mm3, platelet 15.4×104/mm3. Blood smear showed red cell rouleaux formation without any abnormal lymphoid or plasmacytoid cells.
    Total serum protein level was 7.6 g/dl. Monoclonal protein was observed at fast γ-region by cellulose-acetate electrophoresis. On immunoelectrophoresis, this monoclonal protein made specific M-bow against anti-IgE and anti-kappa antisera. By single radial immunodiffusion, amount of IgE was calculated as 1.5 g/dl. 53.6% of bone marrow cell was myeloma cells which were stained with anti-IgE and anti-kappa antisera by indirect immunofluorescent technique.
    Electronmicroscopic observation of myeloma cells revealed that those cells had plasmacytoid characteristics. Bence Jones protein was negative during clinical course and no renal dysfunction was observed.
    Those findings supported the diagnosis of IgE myeloma with kappa light chain.
    She has been treated with melphalan, cyclophosphamide, vincristine, ACNU and prednisone.
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