巻号一覧
23 巻, 5 号
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第23回総会
招待講演
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Rainer, STORB1982 年 23 巻 5 号 p. 597-603
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証あり骨髄移植を既報の方法で行う時，一つの問題はGVHDであるが，危険な急性GVHDは全患者の約20%に起こる。ATGやprednisoneが有効であるが，全患者の約8%はこれで死亡する。急性GVHDの予防法，例えばCyclosporin Aや移植片から抗T抗体によるT細胞の除去等が探求されねばならぬ。移植後6カ月以上生存する患者の20∼30%に慢性GVHDが起こるが，これにはprednisoneまたはこれとazathioprineやcyclophosphamideとの併用が有効である。移植後4カ月以内にみられる最も重篤な感染症は間質性肺炎であるが，前処置として全身X線照射を受けた白血病患者に起こりやすい。これには，免疫再構築を促す有効な手段や有力な抗ウイルス剤の開発が必要である。当研究チームは，最近in vitroモデルのGVHDを抑制し，X線に敏感な細胞がヒトの流血中に存在する事実をつきとめた。
成績：1976年までの再生不良性貧血（再不貧）への移植成績は，5∼10年生存率が46%であったが，失敗の主因は拒絶であった。これは移植前の頻回輸血と移植細胞数の過少によるものであった。これを克服するために，donor造血幹細胞を含むと思われる白血球分画を移植患者に投与したところ，拒絶を約1/3に減少させることができ，生存率を70%に高めることができた。
急性白血病の移植患者では拒絶はまれであるが，深刻な問題は再発である。1976年までは末期の患者に移植が行われたが，6∼11年間生存した者は100例中13人(13%)であった。生存者の分析で，graftが白血病細胞を攻撃する効果(graft versus leukemia effect)があることが確認された。1977年以降，早期の完全寛解期，つまり白血病細胞数が少なく，かつ体力が十分ある時期に移植する試みがなされた結果，非リンパ性白血病で再発率が10%で，長期生存率は58%に上昇した。
CML急性転化例の非寛解期に行った移植の生存率は16%であったが，寛解期に行った3例は3例とも生存中である。また12人のCMLに一卵性双生児をdonerとして型の通り移植を行ったところ，8例が18∼62月間完全寛解中である。この成績はCMLに対する同種移植が十分期待できることを示唆する。
HLAの合致する同胞や，一卵性双生児が得にくい今日，1, 2のHLA lociの合わない家族から移植成功例も報告され，移植適用を拡大できるという希望をもたせる。最近，急性白血病に非血緑のdonorから移植して成功した世界第1例を経験した。抄録全体を表示PDF形式でダウンロード (613K)
臨床研究
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橋本 禎嗣, Michio YATABE, 島田 堅一, 辻 恵美子, 小松 和男, 渡辺 新, 東 音高1982 年 23 巻 5 号 p. 604-607
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありWe examined monocyte bactericidal function in acute leukemia of children with regard to quantitative NBT test and intracelluar hilling activity.
NBT test was suppressed in almost all cases and intracellular hilling activity was decreased in about a third cases.
Based on these findings, it was suspected that impaired bacterial function of monocytes, as that of polymorphonucler leukocytes, caused undue susceptibility to the infections in childhood leukemia.抄録全体を表示PDF形式でダウンロード (306K) -
斎藤 宏1982 年 23 巻 5 号 p. 608-616
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありThe storage iron level of normally working subjects and patients was examined by using the indices of storage iron as serum ferritin, total iron-binding capacity, serum iron and others. Iron absorption and loss were tested in the most of the cases of iron deficiency anemia.
Iron was administered orally or intravenously to the subjects with storage iron deficiency without anemia and to the patients with iron deficiency anemia. No significant increase of hemoglobin was observed in the subjects with storage iron deficiency without anemia, except a case with storage iron deficiency without anemia, except a case with iron deficiency anemia like symptom. Considering the level of storage iron and hemoglobin, this case may be classified as “Iron deficiency disorder”, a disease state different from normal or iron deficiency anemia. The recovery of hemoglobin by iron therapy was sufficient in simple iron deficiency anemia. However, it was insufficient when a complication was related to the other kind of anemia than iron deficiency anemia.
The information of storage iron ensures the diagnosis and therapy of iron deficiency anemia and above described “iron deficiency disorder.”抄録全体を表示PDF形式でダウンロード (617K) -
赤尾 幸博, 平岩 明和, 吉川 治哉, 田原 徹, 佐尾 浩, 山内 辰也, 吉川 敏, 宇野 裕, 直江 知樹, 内藤 和行, 山口 博 ...1982 年 23 巻 5 号 p. 617-622
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありThree patients with leukemia were received bone marrow transplantation from HLA identical but ABO incompatible donor. (two major ABO incompatibilities and one minor ABO incompatibility)
Plasma in the marrow inoculum was removed by centrifugation in minor ABO incompatible case.
Remval of mature erythrocytes from the marrow inoculum was performed by using cell separator (Hemonetics Model 30) because of the low isohemagglutinin titers before transplantation in the major ABO incompatible cases.
Acute hemolysis, graft rejection, the chronic hemolysis and delayed recovery of all blood elements were not recognized in all three cases but GVHD appeared in two cases.
Success of ABO incompatible bone marrow transplantation made it easy to choose donors and recognize the engraftment.抄録全体を表示PDF形式でダウンロード (436K) -
佐賀 務, 岡藤 和博, 南 真司, 近藤 邦夫, 大竹 茂樹, 尾高 和亮, 手島 博文, 塩原 信太郎, 末永 孝生, 石野 千津子, ...1982 年 23 巻 5 号 p. 623-633
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありThe incidence, risk factors, diagnosis and treatment of interstitial pneumonia (IP) were studied on 15 patients treated with allogeneic and autologous bone marrow transplantation (BMT) following the same conditioning regimen of cyclophosphamide and total body irradiation (1,000 rad). The incidence of IP was 53% (8/15) and the mortality rate of it was 50% (4/8). Four of prognostic factors studied seemed to be associated with a high risk of IP: aging, delayed immune recovery, allogeneic BMT and seroconversion of titer of antibody to cytomegalovirus after transplantation. The early onset of IP and its relapse were poor in prognosis. The outstanding clinical findings were dry cough, more than 20 mmHg increase of calculated alveolar-arterial O2 tension difference and abnormal shadow of chest X-ray picture. More than 2 of these 3 findings were useful for diagnosis of IP. Etiologically cytomegalovirus and Pneumocystis carinii were domin ating about half of cases with IP and idiopathic cause seemed rather fewer. No causative organism could be detected by transbronchial lung biopsy in 4 cases. For the prevention of IP, it is important to keep out the risk factors with prophylactically giving interferon and co-trimoxazole.抄録全体を表示PDF形式でダウンロード (821K) -
厨 信一郎, 檀 和夫, 野村 武夫, 浜口 裕之, 坂巻 壽, 天野 正道, 川田 健一1982 年 23 巻 5 号 p. 634-642
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 58-year-old man presented with pyrexia lasting for a week. He had received amoxicillin, phenacetin and diphenhydramine for “flu” over a period of 7 days, all of which were discontinued after the development of fever. The initial WBC was 1,400/mm3 with an entire lack of granulocytes. The bone marrow contained abundant CFU-C, myeloblasts and promyelocytes but was devoid of myelocytes and later myeloid series. A timed sequence of myeloid maturation followed, beginning with the appearance of myelocytes on hospital day 3. This was followed by successive increases in metamyelocytes and mature granulocytes as CFU-C, myeloblasts and promyelocytes rapidly declined. A blood granulocyte peak was attained on hospital day 10 while myelocytes and metamyelocytes declind in the bone marrow. Influence of the drugs on CFU-C colony formation from the patient's bone marrow after recovery was examined by the semisolid agar culture system added with the drugs at concentrations attainable in the body. Amoxicillin and phenacetin significantly depressed the colony formation while diphenhydramine did not show such an effect. Addition of the patient's serum collected at the active phase of the disease did not intensify the depressive effect of the two drugs. It is concluded that the bone marrow toxicity of both amoxicillin and phenacetin was responsible for agranulocytosis in this patient rather than peripheral destruction of granulocytes.抄録全体を表示PDF形式でダウンロード (623K) -
I. T細胞サブセットの異常甲斐 俊朗, 原 宏, 永井 清保, 伊福 秀貴, 三沢 真人, 藤田 茂1982 年 23 巻 5 号 p. 643-650
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありNumbers of peripheral lymphocytes and lymphocyte subpopulations were studied in 5 patients undergoing allogeneic bone marrow transplantation (BMT) for acute leukemia (AL) or aplastic anemia (AA). Peripheral lymphocyte counts returned to normal level within a month after BMT in two of five patients, but did not return to normal until death (60, 78 and 69 days after BMT respectively) in the other three patients with AL.
The ratio of circulating T-cells detected by sheep red cell-rosetting techniques was normal in all patients. But imbalance of T-cell subsets was found out in either short-term survivors (No. 003 and 004) or a long-term survivor (No. 101). The data obtained were itemized as follows: 1) Ia-like antigen positive cells confirmed by indirect immuno fluorescent-staining techniques with use of rabbit antihuman B cell antibodies were increased in all patients. 2) Peanut-agglutinin receptor positive cells which were thought to be immature T-cells were present in high percentage. 3) IgM-Fc receptor positive cells (Tμ cells) were markedly decreased. 4) OKT4+T cells were decreased and OKT8+T cells were normal or above normal. As the results, the ratio of OKT4+/OKT8+ was inverted.
These results indicate that the imbalance of T-cell subsets might be one of the factors making patients immunodeficient following BMT. We consider that it should be an urgent problem to clarify the immune functions of these T-cell subsets.抄録全体を表示PDF形式でダウンロード (546K)
症例
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中野 千鶴子, 井上 正和, 神谷 斉, 野崎 秋一, 山際 幹和, 山際 裕史1982 年 23 巻 5 号 p. 651-657
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありMalignant histiocytosis is characterised by a systemic, neoplastic proliferation of histiocytes and their precursors. The clinical and pathologic expressions are quite variable among children with this entity and there is no uniform conceptual classification.
In this paper, a 12 y.o. boy was reported to have malignant histiocytosis with unusual clinical picture such as unhealing granuloma and hypergammaglobulinemia. The patient was admitted with remittent fever of one month's duration, swollen tender left leg, and a necrotic and ulcerative granulation in the soft palate. The laboratory examinations on admission showed leucopenia and raised serum IgG and IgE. There was no lymphadenopathy or hepatosplenomegaly. The biopsy of the palatal lesion mainly consisted of granulomatous tissues with necrosis. The infiltration of atypical histiocytes was observed around the necrosis in small amounts. However the repeated biopsies of the palatal lesion and left leg revealed negative for atypical histiocytes. The granulomatous lesions were progressive, and were resistant to antibiotic therapy, and the patient subsequently developed hepatosplenomegaly. Malignant histiocytosis was seriously suspected. VEMP chemotherapy and irradiation were instituted to cause a temporary regression of granuloma but the patient died after one month. Atypical histiocytes were demonstrated in the peripheral and the bone marrow blood smears at the late stage and the diagnosis of malignant histiocytosis was confirmed by postmortem needle biopsy of the spleen.抄録全体を表示PDF形式でダウンロード (845K) -
雨宮 章, 浜田 宏, 山田 兼雄, 目黒 嵩1982 年 23 巻 5 号 p. 658-665
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA case of 32-year-old female wjth an inhibitor against factor VIII procoagulant actvity was treated in 1975 at St. Marianna Hospital in Kawasaki city. She became ecchymotic 3 months after her second delivery. After another six months, she was diagnosed as 7 weeks pregnant and an artificial abortion was carried out due to her bleeding episodes. As the bleeding did not stop after the abortion, a hysterectomy was carried out even though bleeding from the surgical wound still persited. At this time, she was first refered to St. Marianna Hospital. Examinations at the time of admission showed a marked prolonged partial thromboplastin time (PTT) and a low level of factor VIII (1.1%). Further examinations revealed that the low level of factor VIII was due to the inhibitor against factor VIII (2.75 old Oxford unit).
The level of factor VIII was elevated to 23% and the inhibitor fell to 0.37 u when the patient was checked 7 months after the initial examination at St. Marianna Hospital. The inhibitor class of this patient was IgG. Based on the patient's clinical manifestation of the bleeding, it was suspected that she acquired the inhibitor after the 2nd delivery. It is uncertain whether the level of the inhibitor was increased due to her third pregnancy, because no examinations were performed before the third pregnancy.抄録全体を表示PDF形式でダウンロード (581K) -
木本 元治, 守永 真一, 山口 潜, 浅井 一太郎, 塚田 理康, 松谷 章司, 神山 隆一1982 年 23 巻 5 号 p. 666-670
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 30-year-old housewife visited the Gynecological Department of Toranomon Hospital on February 19, 1981, becuase of abnormal genital bleeding, palpitation and dizziness of two weeks' duration. She was referred to the Depart ment of Hematology because of pancytopenia.
On admission on February 20, blood examination revealed marked normochromic anemia, thrombocytopenia and leukopenia (WBC 3100) with 31% myeloblasts and 4.5% promyelocytes. Auer bodies were observed both in immature and polymorphonuclear neutrophils. A sternal marrow aspirate revealed hypercellular marrow (nucleated cells 255,000/cu. mm.) with 77.2% myeloblasts and 8.8% promyelocytes, both with Auer bodies, and marked reduction in erythroblasts and megakaryocytes. Electronmicroscopic study of same material revealed Auer bodies in polymorphonucler neutrophils, besides in myeloblasts and promyelocytes.
A diagnosis of acute myeloblastic leukemia was made; a complete remission was attained by remission induction therapy. On April 2 an improvement of the peripheral blood picture and marked reduction in leukemic cells and reappearance of normal hematopoietic cells in the bone marrow smear were confirmed.抄録全体を表示PDF形式でダウンロード (492K) -
千場 純, 松永 敬一郎, 加藤 清, 石ケ坪 良明, 児玉 文雄, 伊藤 章, 福島 孝吉1982 年 23 巻 5 号 p. 671-677
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 38-year-old woman with complaints of hematuria, lower abdominal pain and high fever was diagnosed as thrombotic thrombocytopenic purpure (TTP) by typical clinical findings including severe hemolytic anemia, thrombocytopenia, moderate proteinuria and paroxysmal convulsions accompanied with hemiparesis. She progressively became comatic with apnea within a week, inspite of the treatment with oral administration of 8 mg dexamethasone daily in addition to transfusions of fresh blood and platelet-rich plasma. Then, the therapy was changed to intravenous administration of 15 mg dexamethasone, 110 mg dipyridamole and 60,000 units of urokinase daily, while under controlled respiration using a respirator. She recovered spontaneous breathing and clear consciousness within ten days without any residual defects. After remission, She was well controlled by daily combined medications of 1.0 g Aspirin and 150 mg dipyridamole with prednisolone, which was gradually decreased and discontinued by the day of her discharge.
A brief discussion was added referring to other documents and reports.抄録全体を表示PDF形式でダウンロード (475K) -
北村 浩一, 浦 恭章, 丹羽 勇, 島崎 千尋, 中西 忍, 浜見 拓哉, 春山 春枝, 伊勢村 卓司, 中川 雅雄, 伊地知 浜夫1982 年 23 巻 5 号 p. 678-683
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 37-year-old male was admitted to our hospital, because of spiking fever which did not respond to the administration of antibiotics. On admission, there was marked hepatosplenomegaly, but no lymphadenopathy.
Peripheral blood examination showed pancytopenia, and a bone marrow aspiration revealed hypoplasia and smears showed almost normal except for very low percentage of unclassified abnormal cells. Other abnormal laboratory data includes slight elevation of GOT and GPT. In spite of the administration of some antibiotics, high fever continued and the physical status was deteriorated. The second bone marrow aspiration revealed immature lymphoid cells and VP therapy was started, resulting in poor response and progression of pancytopenia and liver dysfunction. Serial bone marrow aspirations performed during this period revealed some immature histiocytes phagocytizing red cells or thrombocytes, and a final diagnosis as malignant histiocytosis (M. H.) was made. ACNU in a dose of 120 mg (2 mg/kg) was administered and the marked improvement of clinical and hematological findings was achieved in a short period.
The clinical course of this patient suggested that frequent aspirations of bone marrow were useful for the diagnosis of M. H. and that ACNU would be one of the drugs of choice for the treatment of M. H..抄録全体を表示PDF形式でダウンロード (512K) -
内海 眞, 大西 一功, 山田 英雄, 平林 紀男, 深谷 哲昭, 柴田 哲男1982 年 23 巻 5 号 p. 684-691
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA-68-year-old man was admitted to the Nagoya University Hospital on February 12, 1980, for the evaluation of fever, easy fatigability and leukocytosis. On admission physical examination revealed slight fever, splenomegaly of 1.5 finger breadths below the costal margin, swelling of the right inguinal lymphnode and skin rashes on both legs. His peripheral blood showed hemoglobin of 7.0 g/dl, reticulocytes of 5.8%, platelets of 17.0×104/cmm and white blood cells of 102,000/cmm with 23% monocytes and 67% neutrophils. Most of these monocytes showed an irregular nuclear shape and extremely weak peroxidase reaction. NAP score was 172 (control 292). A bone marrow smear showed hyperplasia of granulo-monocytic series with 5% myeloblasts. Five percent out of whole leukocytes were positive for the double staining of specific and non-specific esterase activity. Ph1 chromosome in marrow cells was negative. Bone marrow culture for CFU-C showed the colony formation of 159/2×105 mononuclear cells (control 100±10). Some of the blood chemistry data were as follows; serum LDH 916U, serum uric acid 9.8 mg/dl, serum iron 98 mcg/dl, serum ferritin 360 ng/ml, serum lysozyme 239 mcg/ml, serum β2-microglobulin 10.01 mg/l, serum V. B12 3,200 pg/ml. CRP was negative and ESR was 7 mm in the first hour.
A diagnosis of chronic myelomonocytic leukemia was made and the patient was followed without specific therapy. It is great interest that there were 3 cases of leukemia in this family including the present patient. This is the 7th family in Japan that has more than 2 cases of leukemia in one pedigree. During incidental urinary infection, white blood cell count elevated up to 255,000/cmm, but gradually returned by the treatment with cephalexin. Except for this complication, the patient did well until March 20, 1980, when he died unexpectedly due to an accident.抄録全体を表示PDF形式でダウンロード (751K) -
保利 敬, 木村 暢宏, 兵働 孝子, 仁保 喜之, 三宅 恒徳, 国広 潔, 中村 清子, 岡 泰正, 松尾 征治, 大塚 正秋1982 年 23 巻 5 号 p. 692-699
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありIn October 1978, a 64-year-old female was diagnosed as CMMoL because of monocytosis (8,500/mm3), myeloid hyperplasia in the bone marrow, positive non-specific esterase stain of leukocytes, and increased titer of the serum and urinary lysozyme. Her blood type was A type. Since her symptoms were subsided, she had been discharged and followed in the outpatient clinic. She, however, was re-admitted to our hospital because of fever, hepatosplenomegaly, and the increase of blastic cells. On the second admission, her blood type changed to Am type from A type. She was diagnosed as blastic crisis of CMMoL due to the increase of immatured monocytoid cells, increased monoblasts in the bone marrow, and thrombocytopenia. At that time, cytogenetic analysis of the peripheral blood cells revealed a karyotype of 46, XX, t (3 q-; 21 q+). After DCVP therapy, her blood type changed back from Am type to A type with a partial remission.
On blastic crisis, abnormalities of erythroid series—the alteration of the blood type—as well as myeloid series were found, therefore it was suggested that CMMoL blastic crisis results from the leukemic change of hemopoietic stem cells.抄録全体を表示PDF形式でダウンロード (679K) -
杉浦 ゆり, 伊藤 国明, 王 伯銘, 浅井 隆善, 藤岡 成徳, 熊谷 朗1982 年 23 巻 5 号 p. 700-707
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありThe patient was a 60 years old man with pure red cell aplasia and thymoma. He developed granulocytopenia, hypogammaglobulinemia and hypothyroidism. Tests for immunological function showed abnormalities of both humoral and cellular immunity. The patient was found to have suppressor T cell which inhibited immunoglobulin production of B cell. His anemia was refractory to fluoxymesterone, cyclophosphamide and coiticosteroid. Following thymectomy, the clinical remission was induced with corticosteroid. However, hypogammaglobulinemia and hypothyroidism remained until he died. The bone marrow cells did not respond to erythropoietin in vitro. The blood plasma had no antibody to erythroblasts as detected by immunofluorescence technique. To discuss the pathogenesis of pure red cell aplasia, it would be of interest to know various associations with this anemia. We reviewed the literature on pure red cell aplasia nd thymoma in Japan for the past three years.抄録全体を表示PDF形式でダウンロード (530K) -
田中 暁, 山田 和範, 伊藤 忠弘, 北 堅吉, 安藤 光宣, 那須 芳, 横山 正一, 富元 一彦, 白川 茂1982 年 23 巻 5 号 p. 708-714
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありIn Shizuoka district the satisfactory investigation of so-called T-cell malignancy has not been done. Seven cases in Shizuoka district were presented.
T-cell malignacies in our series were devided into T-cell malignant lymphoma (4 cases), T-cell acute lymphocytic leukemia (T-ALL) (2 cases) and adult T-cell leukemia (ATL) (one case).
Of 11 cases of non-Hodgkin malignant lymphoma, the ratio of T-cell malignant lymphoma was 36.4% in Shizuoka City Hospital.
A case diagnosed as T-cell malignant lymphoma with mediastinal mass developed into T-IBS. In two cases of T-cell malignant lymphoma the size of enlarged lymph nodes reduced, moreover pleural and pericardial effusion disappeared temporarily by administration of L-asparaginase alone.
We observed eosinophilia in the smear of peripheral blood in a case of T-cell malignant lymphoma and ATL respectively.
Elevated serum IgE concentration have been noticed in three cases of T-cell malignant lymphoma, but reduced in all cases after chemotherapy.抄録全体を表示PDF形式でダウンロード (607K) -
戸川 敦, 下田 雅大, 杉原 尚, 万納寺 正清, 八幡 義人, 那須 義功, 山下 貢司1982 年 23 巻 5 号 p. 715-722
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 62-year-old male with multiple myeloma and generalized extramedullary plasmocytomas is reported.
He was admitted to our hospital with anemia, proteinuria and facial edema. Bone marrow examination revealed a nucleated cell count of 26.8×104/μl, containing 32.5% plasmocytoid cells. Bence Jones protein (BJP) of lambda type was positive in the urine, amounting to 35 g/day, and M-component was negative in the serum. Bone survey showed punched-out shadows in the skull and compression fracture of the fifth lumbar vertebra. The diagnosis of myeloma was confirmed and the patient was treated. The plasma cell count in the bone marrow and the amount of BJP in the urine had decreased but, at this time, wide-spread subcutaneous plasmocytomas were present following subdural plasmocytoma at the level of cervix to thorax. There were also infiltration of myeloma cells from the left parotid gland to the left suprapalate, cell infiltration of lymphnodes around the trachea, left recurrent nerve and aorta and a giant plasmocytoma in the head of the pancreas. In addition to local irradiation, the patient was treated with chemotherapy but responded poorly. He died of anuria and cachexia.
A long term culture has been set up using tissue from a biopsy of a subcutaneous plasmocytoma.
Development of the disease is discussed in correlation with evolution of the plasma cell and some other cases with giant plasmocytoma of the pancreas are collected from literature.抄録全体を表示PDF形式でダウンロード (861K) -
安藤 晴夫, 小池 和夫, 佐々木 英夫1982 年 23 巻 5 号 p. 723-729
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありThe first case was a 64-year-old male. He felt general malaise in September 1979, and complained gingival bleeding and purpuras in the next month. In November he admitted to our hospital because of fever. Physical examination revealed anemia in his conjunctiva, but neither lymphadenopathy nor hepatosplenomegaly. Hematological examination showed pancytopenia with 9.5% blastic cells having positive peroxidase reaction in the peripheral blood. Bone marrow showed hypoplasia including 23% blastic cells. The conservative therapy did not result in clinical and hematological improvement, but complete remission was achieved after administration of oxymetholone (30 mg/day) for 40 days.
The second case was a 71-year-old female She has repeated symptoms like common cold from spring in 1980. In July, she felt general malaise and fever. She admitted to our hospital in August because of nasal bleeding and palpitation. On admission, physical examination showed anemic conjunctiva and purpuras on the upper arm and upper anterior chest. But she had not lymphadenopathy and hepatosplenomegaly. Hematological examination revealed pancytopenia, but no blastic cells in the peripheral blood. Bone marrow showed hypoplasia including 39.6% blastic cells with positive peroxidase reaction. She achieved complete remission after administration of methenolone for about 45 days.
We found the recovery of normal hemopoiesis and decrease of blastic cells after the androgen therapy. Thus, it is indicated that a part of leukemia is considered to be a differentiation disorder which can be improved by androgen therapy.抄録全体を表示PDF形式でダウンロード (654K) -
伊藤 粋子, 広野 茂1982 年 23 巻 5 号 p. 730-735
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありIt is well known that microangiopathic hemolytic anemia (MHA) is caused by various etiologies, such as metastatic cancer, disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura and hemolytic uremic syndrome etc. However, only a few cases of MHA were reported so far which was caused after administration of anti-cancer drugs. In our clinics two cases with early gastric cancer and colon cancer were experienced which were treated with anti-cancer drugs including 5-FU, Mitomycin C, Endoxan and Toyomycin in 10 courses after operations and developed MHA and renal insufficiency. As these two cases were free from metastasis of cancer, MHA in these patients was not supporsedly invited from malignant metastases but from anticancer drugs. Laboratory examination revealed that DIC was not present in these patients and findings were improved rapidly after administration of aspirin and dipyridamole.抄録全体を表示PDF形式でダウンロード (481K) -
武藤 重明, 佐々木 龍平, 青山 雅, 高久 史麿, 吉本 正博, 八幡 義人1982 年 23 巻 5 号 p. 736-742
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA case of hereditary stomatocytosis is reported. A 43-year-old female with persistent anemia and jaundice was admitted to the Hospital of Jinchi Medical School. She was born uneventfully and did not have a severe neonatal jaundice. She had been noticed to have anemia and jaundice since she was 16 years old. However, she had been well except for an increase of these symptoms in occasions of overwork or upper respiratory infection.
On physical examination, she had anemia, Jaundice and hepatosplenomegaly. Laboratory data revealed: stomatocytes 30∼40% on peripheral blood film, RBC 264×104/mm3, Hb 9.2 g/dl, Ht 31.0%, reticulocyte count 19.8%, serum total bilirubin 1.9 mg/dl (indirect bilirubin 1.1 mg/dl), apparent half life of the 51Cr-labeled red cells 5.8 days, negative Coombs' test, increased osmotic fragility of red cells, negative Ham's test, erythroid hyperplasia in bone marrow, normal enzyme activities in erythrocytes, normal electrophoretic pattern of hemoglobin.
Family studies showed that her father and aunt had the same abnormalities as those of the patient.抄録全体を表示PDF形式でダウンロード (484K) -
土橋 卓也, 木村 暢宏, 仁保 喜之, 岡 泰正, 活田 融, 隅田 〓男, 大塚 正秋, 三井 徹次, 大原 幸彦1982 年 23 巻 5 号 p. 743-748
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありThe cold agglutinin disease occurs seldom in cases of autoimmune hemolytic anemia. Especially secondary cold agglutinin disease is rare and only a few cases have been reported in Japan.
In this report, a case of cold agglutinin disease with T cell lymphoblastic lymphoma is docummented. A 76-year-old woman was admitted to our hospital because of fever, anorexia and abdominal discomfort. On physical examination, generalized lymphadenopathy and hepatosplenomegaly were recognized. In addition, chest X ray showed large amount of left pleural effusion. Laboratory examinations revealed severe anemia with reticulocytosis and presence of abnormal lymphocytes in the peripheral blood and pleural fluid. From the high titer cold agglutinin and positive direct and indirect Coombs' test a diagnosis of cold agglutinin disease was made. In this case, cold agglutinin possessed nature of Ig M (κ) and anti-I. Lymph node biopsy disclosed a presence of malignant lymphoma, lymphoblastic. After anticancerous therapy, symptoms of cold agglutinin disease gradually subsided.抄録全体を表示PDF形式でダウンロード (670K) -
木本 元治, 村上 康文, 守永 真一, 山口 潜, 浅井 一太郎, 塚田 理康, 松谷 章司, 神山 隆一1982 年 23 巻 5 号 p. 749-756
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 37-year-old male was admitted to the Department of Hematology on August 18, 1977, with chief complaints of lassitude and paleness. Hepatosplenomegaly and lymphadenopathy were absent. A blood examination revealed moderate normochromic anemia, thrombocytopenia and leukocytosis of 56,000/cu. mm. with 92.0% atypical lymphoblasts. In a bone marrow aspirate 99.4% of the nucleated cells were atypical lymph oblasts.
A diagnosis of acute lymphoblastic leukemia was made and a complete remission was obtained on September 27 after a combination chemotherapy for induction.
On June 28, 1978, he was re-admitted with complaints of general lymphadenopathy. Liver and spleen were not palpable. No atypical lymphoblasts were found in the bone marrow and blood smears, and their differential counts were normal. Pathological findings of the biopsied left axillary node were closely similar to those of lymphosarcoma: normal architecture of the lymph node disappeared and a diffuse proliferation of the immature lymphoblast-like cells was evident.
A diagnosis of lymphosarcoma-like relapse of acute lymphoblastic leukemia was made and a complete remission was obtained by BACOP therapy. On February 20, 1979, he was re-admitted with a relapse of acute lymphoblastic leukemia. There was no lymphadenopathy nor splenomegaly. In spite of the combination chemotherapy he succumbed to a complicated sepsis.抄録全体を表示PDF形式でダウンロード (1098K) -
川勝 秀一, 富永 正志, 林 鐘声, 東道 伸二郎, 新川 正治, 今宿 晋作, 三宅 宗隆1982 年 23 巻 5 号 p. 757-761
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 12-year-old girl with ataxia-telangiectasia developed into acute lymphocytic leukemia in September 1977. Hematological examination revealed Hb 4.8 g/dl, WBC 1,400/μl (blast 57%), platelets 379×103/μl nucleated cells. Marker studies revealed null cell type. She attained complete remission in December, 1977 after 3 courses of chemotherapy with adriamycin, cytosine arabinoside, 6-mercapto-purine (6MP) and prednisone. CNS prophylaxis with intrathecal methotrexate and irradiation (2,296 rad) to the skull was given, then maintained on 6MP. Nine months later, the patient relapsed hematologically and had two more relapses. After third reinduction, she maintained on the combination of methotrexate and L-asparaginase for 18 months. In July, 1981, she died of hyponatremia, interstitial pneumonia and pneumothorax soon after 4th bone marrow relapse. The patient survived leukemia for 45 months. We surveyed 25 cases of leukemia associated with ataxia-telangiectasia from the literature and found only one previously published null cel type acute lymphocytic leukemia.抄録全体を表示PDF形式でダウンロード (417K) -
西尾 昌憲, 黒田 聡, 武田 倬, 真柴 裕人, 飯島 憲司, 中村 克己1982 年 23 巻 5 号 p. 762-767
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 22-year-old female was admitted on September 8, 1980 because of fever, arthralgia, urticaria and abdominal distention. On admission, anemia, petechiae, urticaria, lymphadenopathies, hepatosplenomegaly and ascites were recognized. Findings of peripheral blood showed 4.9 g/dl of hemoglobin, 3×104/μl of platelet and 8,900/μl of WBC. Bone marrow aspiration revealed 42.4% of abnormal immature cells. Basophilic granules and erythrophagia were demonstrated in these abnormal cells by May-Giemsa stains. These granules showed a negative reaction to peroxidase and a positive reaction to acid phosphatase. Plasma histamine level was 10.8μg/dl and blood heparin level was 0.17 IU/ml, which were higher consentration than normal level.
Other laboratory findings on admission were discribed as follows: LDH 1199 Wroble, uric acid 10.6 mg/dl, bleeding time 11.5 min., clotting time 8 min., PT 68%, fibrinogen (Fbg) 300 mg/dl, FDP 40∼80 μg/ml, antithrombin III (AT III) 10.2 mg/dl, α2-plasmin inhibitor (α2 PI) 6.5 mg/dl, ESR 72 mm in 1 hour. These signs and laboratory findings suggested that she suffered from mastocytoma with DIC. She was treated by daunorubicin, predonisolone, gabexate mesilate and sodium heparin. However, she took a rapid downhill course.
On 11th day after admission, laboratory data showed as follows: platelet 2.9×104/μl, PT 6%, PTT 160 sec., Fbg 110 mg/dl, FDP 160∼240 μg/ml, AT III 7.8 mg/dl, α2 PI 2.6 mg/dl, ESR 4 mm in 1 hour.
On the same day, she died of acute renal failure complicated with DIC.抄録全体を表示PDF形式でダウンロード (715K) -
平岩 明和, 吉川 敏, 赤尾 幸博, 吉川 治哉, 田原 徹, 芳賀 圭五, 宇野 裕, 木村 鈴代, 藤井 初美, 直江 知樹, 内藤 ...1982 年 23 巻 5 号 p. 768-776
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 40-year-old male who was diagnosed as Ph1-positive chronic myelocytic leukemia on February 1979, had been treated with dibromomannitol. On November 22, 1979, he was admitted to the 1st Nagoya Red Cross Hospital with a diagnosis of blastic transformation. Since complete remission was not obtained by combined chemotherapies, bone marrow transplantation (BMT) from HLA-identical brother (43-year-old) was planned. For cytoreduction, he received splenic irradiation for 20 days (3,750 rad) and high-dose combination chemotherapy (ACNU 50 mg/d, ADM 30 mg/d, NCS 2,000 U/d, BH-AC 250 mg/d, Pred. 30 mg/d) during 4 days. Prior to transplantation, he was conditioned with cyclophosphamide 60 mg/kg/d on each of two consecutive days followed by 850 rad (midline tissue dose) total body irradiation. On February 5, 1980, marrow cells (2.5×108/kg) were infused intravenously. He received intermittent Methotrexate post grafting to modify graft-versus-host disease (GVHD). However 5 weeks after BMT, GVHD of grade II appeared in the skin and the liver. For the treatment of GVHD and delayed recovery of hematopoietic cells, Methotrexate was changed to prednisolone (15 mg/d, orally) on day 39. Thereafter all hematopoietic elements increased in peripheral blood and GVHD was well controlled in the skin but remained in the liver. Successful engraftment has been demonstrated by red blood cell type in change to the donor type on day 126. No Ph1-positive cells were detected and no leukemic cells were morphologically found in bone marrow.
Generalized herpes zoster infection developed on day 160 followed by interstitial pneumonitis with severe dyspnea. He died on day 170 due to respiratory failure. Autopsy demonstrated cytomegalic inclusion body in the lung tissue and no leukemic cells in any tissues.抄録全体を表示PDF形式でダウンロード (1144K) -
福永 謙, 浜田 朗生, 徳重 愛二郎, 有泉 隆裕, 星 順隆, 赤塚 順一, 福永 真治1982 年 23 巻 5 号 p. 777-782
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありAn eight year-old boy with acute undifferenciated leukemia developed meningeal leukemia after complete remission which lasted 4 years and 7 months. This complication of central nervous system was treated with intrathecal infusions of methotrexate and hydrocortisone and he went into complete recovery. However, he developed severe interstitial pneumonia soon after the last infusion of methotrexate. Despite intensive therapy with antibiotics, Pentamidine and trimethoprims-ulfamethoxazole, he eventualy died in a rapid course of 8 days after admission. Autopsy revealed fibrous changes of the alveoli and hyaline membrane formation. However, the laboratory findings didn't show any evidence of bacterial, viral or protozoan infection. These data rather suggest pulmonary complication of methotrexate which was used for long periods since the onset of his leukemia.抄録全体を表示PDF形式でダウンロード (718K) -
横山 新一郎, 佐野 元春, 浅野 洋治, 布上 直和, 鶴岡 延熹, 清水 盈行, 塩川 章, 風間 和男1982 年 23 巻 5 号 p. 783-791
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 73-year-old female was admitted on September 1980 because of lumbar and upper back pain. Physical examinations revealed severe anemia and hepatosplenomegaly. Peripheral Blood: Hb 7.6 g/dl, RBC 277×104/cmm, Ht 23.4%, reticulocyte 22‰, WBC 5,000/cmm with leukoerythroblastosis, rouleaux formation and tear drop cells, platelet 12.2×104/cmm. Bone marrow aspirations performed twice were dry tap. Biochemical analysis of the blood: total protein 9.0 g/dl with M-spike (24.5%) in the beta globulin region. Serum IgG level was 4,640 mg/dl, IgA 86 mg/dl and IgM 90 mg/dl. Immunoelectrophoresis of the serum revealed IgG (κ) type paraprotein. On bone survey, considerable generalized osteoporosis with compression fructures of Th11 and Th12 were demonstrated. Although a definite diagnosis of multiple myeloma was not made, clinical and laboratory features suggested that a diagnosis of premyeloma might be made. Biopsied specimens from the bilateral iliac crest showed myelofibrosis without marked increase in the plasma cells. Ferrokinetics: PID T1/2 47 min.; radioactivity was high over the spleen with sharp decline and low over the livr and bone marrow.
Therefore, this patient probably had premyeloma associated with myelofibrosis.
The possible relationship between the two disorders is discussed.抄録全体を表示PDF形式でダウンロード (985K)
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