Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 23, Issue 10
Displaying 1-25 of 25 articles from this issue
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  • Studies on Immunoglobulin Synthesis by Normal Lymphocytes in Monoclonal Immunoglobulinemias
    Tadao FUNATO, Tomoko OSHIKAWA, Asao KOIDE, Yasushi HIRASAWA, Hideki OH ...
    1982 Volume 23 Issue 10 Pages 1525-1532
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1525
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    We investigated whether T cells and macrophages from peripheral blood of patient with monoclonal immunoglobulinemias suppress the immunoglobulins sythesis by cocultured normal lymphocytes in the presence of pokeweed mitogen. Immunoglobulin-secreting cells (plaque forming cells) were enumerated in a Protein A-reverse hemolitic plaque assay.
    It was found that the macrophages from four of eight patients with myeloma significantly inhibited the capasity of B cells to mature into immunoglobulin secreting cells. Moreover, the immunoglobulin production by normal lymphocytes was also noted to be suppressed in co-culture with the macrophages from normal individuals that were with the culture supernatant in myeloma cell line (H.T.). The suppressor T cells from patient with myeloma or benign monoclonal immunoglobulinemia had no effect on the immunoglobulin secreting cells.
    These results suggest that the macrophages, which are stimulated with a factor released by myeloma cells, mediated the suppressive effect on immunoglobulin production by B cells in certain patients with myeloma.
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  • Treatment of 30 Adult Patients with Acute Lymphoblastic Leukemia
    Eiichi NAGURA, Kohei KAWASHIMA, Hisamitsu SUZUKI, Yukio KATO, Ryuzo ON ...
    1982 Volume 23 Issue 10 Pages 1533-1539
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1533
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    Thirty adult patients, aged 15 years and older, with previously untreated acute lymphoblastic leukemia were treated with various chemotherapeutic regimens. The overall response rate was 73% (22/30). Seventeen complete remissions (CR) were attained by the initial regimen, and 5 CRs by additional chemotherapies. The combination chemotherapies consisting of vincristine (V)+daunomycin (D)+prednisolone (P), V+P, vindesine+P, V+cyclophosphamide (C)+6-mercaptopurine+P, V+D+C+P and others produced the response rates of 86% (6/7), 67% (6/9), 17% (1/6), 33% (1/3), 67% (2/3) and 50% (1/2), respectively. The median response duration was 155 days (23∼1155), and the median surval times were 387 days+for CRs and 96 days for nonresponders (P<0.01). Somewhat low response rates were observed among patients with thrombocytopenia (<50,000/mm3) or those aged greater than 40 years. There was no relation between the response rate and WBC count, severity of anemia or FAB classification (L1 or L2). Twenty cases were analized according to leukemic cell surface phenotypes. There was no difference in either rate or duration of CR between the null cell group (11 cases) and the T cell group (7 cases), but younger patients and CNS involvements were more frequent in the latter qroup.
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  • Studies on Blood Coagulation in Ulcerative Colitis and Crohn's Disease
    Kazuo MORI, Nobuo HIWATASHI, Sozo SUZUKI, Koji SUGAI, Shizue HISA, Hid ...
    1982 Volume 23 Issue 10 Pages 1540-1548
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1540
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    An investigation was made on 23 aspects of blood coagulation, including 1) screening tests, 2) coagulation factor activities and 3) platelet function tests in 35 cases of ulcerative colitis and 19 cases of Crohn's disease using a classification of increased and decreased coagulability. Of the 35 cases of ulcerative colitis, 2 severely affected cases were accompanied with disseminated intravascular coagulation syndrome (DIC) and 1 died after emergency surgery.
    Increased fibrinogen content, factor VIII, IX activity and platelet count, accelerated platelet aggregation and retention rate were found in many cases of active stage of the disease. At the time of remission, this hypercoagulability was generally normalised in many cases, but still remained in a few cases.
    From above results, most cases of the disease showed definite signs of hypercoagulability. When marked hypercoagulability and DIC are present, anticoagulant therapy should lead to a favorable effect.
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  • Variation of Ratio of Adenosine Deaminase Activity to Purine Nucleoside Phosphorylase Activity Detected in T-cell Leukemic Cells
    Keizo MAEDA, Kazuhiko ITO, Nobuo YAMAGUCHI, Nobuo SAKURA, Tomofusa USU ...
    1982 Volume 23 Issue 10 Pages 1549-1554
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1549
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    Adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) activities were measured with the lymphocyte fraction from patients with various lymphoproliferative disorders. The ratio of ADA activity to PNP activity (ADA/PNP) was high in T-cell malignancies including T-cell chronic lymphocytic leukemia, adult T-cell leukemia, Sézary syndrome and T-cell lymphosarcoma and one case with null cell lymphosarcoma. The values determined in other lymphoproliferative disorders and nonlymphocytic leukemias were low and equivalent to the values (<1) obtained in nomal controls. These results suggest that undifferentiated T-cells have high ADA/PNP ratios and higher values indicate more undifferentiated T-cell malignancies.
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  • Acute Lymphocytic Leukemia—Immunological Classification and Prognosis
    Po-min CHEN, Chi-kuan Ho, Tien-szu HWANG, Minoru OGASAWARA, Kokichi KI ...
    1982 Volume 23 Issue 10 Pages 1555-1560
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1555
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    Acute lymphocytic leukemia (ALL) was classified into 7 subtypes according to the analysis of surface markers of leukemic cells of 37 patients with acute lymphocytic leukemia in Formasa. These subtypes included T, B, and null cell types and types originated from their precursors at different identifiable stages of maturation of lymphocytes, such as Ia-type, cALL-type, pre B-type, and defective B-type. T-ALL was less frequent in Formasa than in Japan and other western countries. The prognostic value of this classification and its relevance to the clinical manefestation of acute lymphocytic leukemia were investigated. In general, this classification was proved to have relationship to clinical status. For example, T-and B-ALL were resistent to chemotherapy and showed unfaborable prognosis, and pre B-ALL occurred in adults, sensitive to the treatment, however, relapsed easily.
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  • A Case of T-cell Malignancy with Clinical Manifestations of Chronic Leukemic Reticuloendotheliosis
    Seiji TSUTSUMI, Toshio ASAI, Akinori TAKASAWA, Harumitsu MIZUNO, Masah ...
    1982 Volume 23 Issue 10 Pages 1561-1570
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1561
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    A case of T-cell malignancy with clinical manifestations of chronic leukemic reticuloendotheliosis was reported. The patient (37-year-old male) was admitted to our hospital because of abdominal mass, fever and weight loss. A huge spleen, pancytopenia and atypical cells in the bone marrow (24%) were the most prominent findings in physical and laboratory examinations on admission. Temporary reduction in size of the huge spleen was brought about with the administration of prednisolone, and then, splenectomy and liver biopsy were performed.
    Histology of the excised spleen and liver biopsy were consistent with so called chronic leukemic reticuloendotheliosis. Ribosome-lamella-complex and tartrate-resistant acid phosphatase were absent in atypical cells. In addition, there were no hairy cells. Surface-marker analysis identified them as T-lymphocytes.
    Following splenectomy, the number of atypical cells increased in the bone marrow as well as in the blood. Hepatomegaly, lymphadenopathy and extranodal lesions such as the left testicular and multiple subcutaneous tumors developed. The patient died of respiratory failure 3 years and 6 months after the onset. Autopsy disclosed leukemic infiltration to the bone marrow, heart, liver. kidneys, adrenal glands, accessory spleen and lymph nodes (thoracic, portal, perigastric, peripancreatic and retroperitoneal).
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  • A Case of Polyclonal Immunoblastosis (Kojima)
    Keiko ITO, Mayumi YAMAMURA, Shigeki OHTAKE, Shintaro SHIOBARA, Takeshi ...
    1982 Volume 23 Issue 10 Pages 1571-1577
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1571
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    Polyclonal immunoblastosis was first described by Kojima. According to Kojima, although this entity is in accordance with angio-immunoblastic lymphadenopathy with dysproteinemia (Frizzra, et al, 1974) and immunoblastic lymphadenopathy (Lukes, et al, 1975) in many clinical characteristics such as systemic lymphadenopathy, hepatosplenomegaly and polyclonal hypergammaglobulinemia, it differs leukemic change and short-term, fatal outcome in clinical findings, and frequent presence of mitotic figures of immunoblasts and their infiltration in the sinus, blood vessels and pericapsular tissues in histology of the biopsied lymph node.
    A 67-year-old female was admitted to our clinic because of skin rash and fever of 4 month duration. Physical examination on admission revealed generalized lymphadenopathy and hepatosplenomegaly, and laboratory examination showed polyclonal hypergammaglobulinemia with various autoantibodies in the blood. In the periperal blood, plasma cell-like mononuclear cells with the basophilic cytoplasm were observed occasionally during admission in a few percents.
    A lymph node biopsy was performed three times, and all biopsy specimens showed prominent proliferation of immunoblasts, plasmablasts and plasma cells with their mitotic figures, focal proliferation of small arborizing vessels and deposit of the amorphous acidophilic interstitial material, all being compatible with polyclonal immunoblastosis.
    Combined chemotherapy with cyclophosphamide, vincristine and prednisolone was given with some transient effect, but her course was always in downhill and died 3 month after diagnosis.
    Post morten examination showed prominent proliferation of immunoblasts, plasmablasts and plasma cells in all organs except for the bone marrow, but in the lymph node, immunoblasts, small arborizing vessels and acidophilic interstitial material were decreased as compared with the previous biopsied section. In summation, the above-mentioned data might suggest that polyclonal immunoblastosis, inconsistently with Kojima, is neoplastic rather than cataplastic.
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  • Lung Cancer Associated with Two M-Proteins (IgA-κ, IgA-λ) in Serum and Bence Jones Protein (λ-Type) in Urine; Report of A Case
    Hirokazu IMAI, Yasushi NAKAMOTO, Tetsuo AKIHAMA, Akehisa KUWAYAMA, Aki ...
    1982 Volume 23 Issue 10 Pages 1578-1583
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1578
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    A 60-year-old man was admitted to Akita City Hospital because of unconsciousness on April 23, 1980. He had been treated as pneumonia and diabetes mellitus.
    Physical examination disclosed rhonchi in the right lower lung, decreased deep tendon reflexes, and semicoma without pathological reflexes. Laboratory examination revealed; ESR, 38 mm/h, BJP (λ) in urine, positive, serum IgG concentration, 1,169 mg/dl, IgA 2,508 mg/dl, IgM 99 mg/dl. Serum electrophoresis showed two abnormal peaks in α2∼β and γ-region, and two M-components (IgA-κ, IgA-λ) were observed by immunoelectrophoreris. M. W of IgA-κ seemed to be larger than that of IgA-λ by immuno gel filtration study. Bone marrow aspiration study showed 140,000 nucleated cells/cmm with 10% plasma cells containing flaming and mitotic cells. On the 33rd Hospital day he died without improvements of conciousness.
    Autopsy findings were as follows; 1) tracheal cancer in the bifurcation (undifferentiated type), metastasizing to lymphonodes, lungs, thoracic and lumbar vertebrae. 2) hemorrhagic duodenal ulcer. 3) slightly diabetic changes. Histological study disclosed a pronounced plasma cell infiltration surrounding the mass of the neoplasm. Immunoenzymologic method revealed that plasma cells surrounding the tumor contained IgA-κ dominantly, but in the bone marrow without metastasis they had IgA-λ dominantly.
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  • An Autopsy Case of Acute Monocytic Leukemia Presented as Interstitial Pneumonitis
    Hiroshi NARA, Fumio CHATANI, Katsuyuki AOZASA, Gozo NISHIMOTO, Toshiki ...
    1982 Volume 23 Issue 10 Pages 1584-1588
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1584
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    This report describes the case of a 48-year-old man hospitalized because of respiratory failure and unconsciousness. Physical examination revealed the absence of hemorrhagic diathesis, hepatosplenomegaly and lymphadenopathy.
    Laboratory data showed leukocytosis (19,400/cmm) and marked hypoxemia (Pao2 25.3 mmHg). Although he was diagnosed as having interstitial pneumonitis by chest roentgenogram, bacterial and viral tests were negative. Antibiotics were administered, but dyspnea progressed.
    Atypical monocytoid cells began to appear in the peripheral blood, reaching 69% of leukocytes, and the patient died on the 12th day of hospitalization. No anti-leukemic agents had been administered. These atypical monocytoid cells were identical with the cells observed in M5 of FAB Classification.
    Pathological examination of autopsy material revealed a generalized, invasive proliferation of immature monocytoid cells. Enzymatic and cytochemical examinations confirmed a diagnosis of acute monocytic leukemia. Because no findings suggestive of infection could be detected, we concluded that the pneumonitis-like change observed at presentation was caused by leukemic infiltration into the lungs.
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  • A Case of Pure Red Cell Aplasia (PRCA) with a Serum IgG Inhibitor to Erythropoiesis and Diabetic Nephropathy
    Shinichiro OKAMOTO, Keisuke TOYAMA, Takao SARUTA, Sachio OZAWA, Mihoko ...
    1982 Volume 23 Issue 10 Pages 1589-1593
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1589
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    A 73-year-old male with diabetic nephropathy of 2 years' duration was admitted to our hospital because of severe anemia. Blood examination showed severe anemia with no reticulocytes and bone marrow smear revealed marked erythroid hypoplasia. Blood chemistry showed high serum level of erythropoietin and mild elevation of serum creatinine level. From the above findings, a diagnosis of PRCA complicated with diabetic nephropathy was made.
    To investigate the pathogenesis of PRCA in this case, we used in vitro culture technique to study the effect of patient's IgG on erythroid colony formation. The patient's IgG markedly inhibited erythroid colony formation (CFU-E) from normal marrow. This inhibitory effect of patient's IgG was complement independent and subsided when the patient's IgG was pretreated with anti-human IgG rabbit serum. These findings suggest that serum IgG inhibitor to erythropoiesis may contributed to the cause of PRCA in this case.
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  • Changes of Hemopoiesis in a Child with Aplastic Anemia Effectively Treated by Syngeneic Bone Marrow Transplantation
    Koichro TSUJI, Kuniaki NAGANUMA, Yoshio YAGI, Noboru NOROSE, Kenichi K ...
    1982 Volume 23 Issue 10 Pages 1594-1599
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1594
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    A 11-year-boy with aplastic anemia effectively treated by syngeneic bone marrow transplantation is reported. Prior to transplantation, donor bone marrow cells were cocultured with patient peripheral blood lymphocytes. Since no significant inhibition of colony forming unit in culture (CFU-C) nor burst forming unit-erythroid (BFU-E) was seen in this coculture study, the transplantation was carried out without pretransplant immunosuppression. Transfusion of 3.1×108 nucleated bone marrow cells/kg from an identical twin donor, representing 4.8×105 CFU-C/kg and 5.1×104 BFU-E/kg, resulted in hematological recovery within two months. This observation suggests that, in this case, aplastic anemia may result from stem cell defects.
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  • A Case of Adult T-cell Leukemia with a Huge Splenomegaly, Pancytopenia and Prolymphocytosis after Splenectomy
    Shin MATSUDA, Tsutomu SHICHISHIMA, Hideo KIMURA, Tadashi SATO, Tokuo Y ...
    1982 Volume 23 Issue 10 Pages 1600-1606
    Published: 1982
    Released on J-STAGE: January 26, 2009
    DOIhttps://doi.org/10.11406/rinketsu.23.1600
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    An autopsy case with adult T-cell leukemia was reported. A 43 year-old who came from yonezawa city was admitted to our hospital with chief complaints of hepatosplenomegaly and pancytopenia. At this time, there were no leukemic changes in peripheral blood or bone marrow, and no lymphadenopathy. After plateletkinetics, splenectomy was performed, because thrombocytopenia was due to enlarged spleen which was shown to be congested with a weight of 3420 gr and was no evidence of leukemic infiltration. Peripheral blood picture recovered in normal range immediately after the splenectomy. Leukocytosis with prolymphocytes was recognized from 8th month after splenectomy. Besides the prolymphocytes, abnormal mononuclear cells with convoluted or lobulated nuclei were recognized about 10% in peripheral blood. Both these abnormal cells were T-cell origin. Bone marrow aspirate showed normocellular feature with 96.8% for leukemic cells. The leukemic cells in peripheral blood responded slightly to corticosteroid, cyclophosphamide and vincristine therapy. Thes case was diagnosed to be adult T-cell leukemia with prolymphocytes and convoluted lymphocytes.
    Autopsy revealed slight leukemic cell infiltration in various organs, lymphadenopathy in thoracic and peritoneal cavity and hypocellular bone marrow. Pathological diagnosis was adult T-cell leukemia.
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