巻号一覧
23 巻, 6 号
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第23回総会
<シンポジウムII>DICの治療
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青木 延雄, 松木 一雅, 坂田 洋一1982 年 23 巻 6 号 p. 804-810
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありAntithrombin III (AT III) inhibit thrombin or activiated factor X progressively, and inhibitory activity of AT III is drastically accelerated by heparin. Heparin has been widely used for disseminated intravascular coagulation (DIC) to stop the intravascular clotting process. But as its anticoagulant activity depends on the presence of AT III in the blood, heparin may be less effective when AT III is defficient.
In DIC, activated coagulation factors particularly factor X and thrombin react with AT III to form complexes, leading to neutralization of these activities. The complexes are rapidly disposed of by the reticuloendothelial system and dissappear from the circulation.
We have administered AT III concentrates to 22 patients with DIC who failed to respond initially to heparin therapy for the last five years. About 65% of these patients were effectively treated with AT III concentrates by enhancing the effect of heparin and alleviating the burden of excessive plasma transfusion on the cardiovascular system.抄録全体を表示PDF形式でダウンロード (475K) -
山田 兼雄1982 年 23 巻 6 号 p. 811-817
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありThe cases with DIC of newborn infants were investigated at the newborn care unit (N.C.U.) of St. Marianna Hospital, Kawasaki city, Japan, from 1978 to 1981. Out of 178 patients suffering from respiratory distress syndrome (RDS) and severe infectious diseases, 26 cases (14.6%) were diagnosed as DIC. Of 137 cases diagnosed as RDS, 16 cases (11.7%) developed into DIC. Out of 41 cases of severe infectious diseases, 10 cases (25%) developed into DIC.
Three kinds of therapy, in conjunction with basic therapy for fundamental diseases, were carried out for the treatment of DIC. They were exchange transfusion therapy, therapy with vasoactive agents of which phenoxybenzamine (POB) was mainly used, and heparin therapy.
In all cases, the administration of heparin generally resulted in an improvement of the patient's condition. On using exchange transfusion, 4 out of 12 cases with RDS and 2 out of 10 cases with infectious diseases showed inprovement. When exchange transfusion and phenoxybenzamine were employed together, 2 out of 8 cases with RDS showed improvement. Based on the various advantages of each therapy, combined use of three therapies was attempted. The succesful cases with combined use of three therapies were demonstrated.抄録全体を表示PDF形式でダウンロード (512K) -
武田 成彰, 大里 敬一1982 年 23 巻 6 号 p. 818-826
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA retrospective study of the heparin therapy was done in the 62 cases with DIC at our laboratory for previous 9 years. Thirty-five cases (56%) were treated with heparin, and 27 cases (44%) were treated without heparin.
(1) An overall improvement of DIC was obtained in the heparinized cases.
(2) Platelet counts, fibrinogen level, FDP and ethanol gelation test were beneficial laboratory assistance for the initiation of heparin therapy and the estimation of its effectiveness.
(3) DIC was significantly improved when the cause of the syndrome was successively controlled.
(4) Nearly one third of cases who had uncontrolled primary diseases showed improvement of DIC by heparin therapy.
(5) Serum level of AT-III was significantly low in DIC and it did not relate with the recovery rates of DIC during heparin therapy.
(6) The use of heparin to the cases of incompatible blood transfusion was aimed to prevent DIC. Consequently, all cases were symptomatically uneventful. Prophylactic use of heparin in the high risk groups of underlying diseases was advocated.抄録全体を表示PDF形式でダウンロード (648K) -
鈴木 重統, 金川 有一1982 年 23 巻 6 号 p. 827-835
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証あり1) Without heparin, 23 cases of abruptio placenta were treated.
The aim at prohibiting of DIC in the cases abruptio placenta is to induce labour. In these cases there were depletion not only of fibrinogen but also of platelets and of factor V and XIII. Immediately after delivery of fetus and placenta, which are the origins of thromboplastic activity, fresh blood and fibrinogen (4-7 gr) were given.
After 24 hours all 23 cases were improved not only hypercoagulable state but also secondary fibrinolysis without complications.
2) In order to prevent DIC, 18 cases of atonic bleeding were administrated with Aprotinin. (20,000 units).
The concentration of splits products of fibrin deminished about a half value after giving Aprotinin.
These suggest Aprotinin has strongly effected on inhibiting FDP as well as plasminogen-activator.抄録全体を表示PDF形式でダウンロード (663K) -
昆 宰市1982 年 23 巻 6 号 p. 836-842
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありBlood coagulation and fibrinolysis system in 26 patients affected with severe burn was examined. Fourteen cases of the patients demonstrated clinical and laboratory findings of consumption coagulopathy (C. C.), while 12 cases did not. Following conclusions were obtained from such clinical survey.
1) The parients with “severe” burns (third degree burn occupied more than 30% of the body surface, and with concurrent shock) showed high possibility to cause C. C.
2) Therapy for C. C. in severe burns should be started when the patients showed signs of severity as infancy, aging, the third degree burns, and more than 50% of body surface burned. Such cases showed worse prognostic rate due to C. C.
3) Transfusion for the severe burns improved C. C. Baxter method which involves frozen plasma and low molecular weight dextran was found effective. Transfusion should be started as soon as possible.
4) Heparin treatment improved the condition in some extent.抄録全体を表示PDF形式でダウンロード (470K) -
—DICの治療における基本的な問題点—松田 保, 大里 敬一1982 年 23 巻 6 号 p. 843-846
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありPDF形式でダウンロード (376K)
臨床研究
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—第1報— Melphalan, Ifosfamide, Prednisolone交替併用療法の治療効果について瀬崎 達雄, 石井 廣文, 長田 高寿, 足立 富郎, 高橋 功, 大熨 泰亮, 木村 郁郎1982 年 23 巻 6 号 p. 847-853
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありResponse rates, survival times and side effects were compared in 47 patients with multiple myeloma receiving a MIP sequential combination therapy and 23 patients receiving melphalan (M) alone or melphalan with prednisolone (M+P) therapy.
The results were as follows:
1) Response rate evaluated by the reduction of M-protein level and improvement of subjective symptom were higher in MIP group. Therefore, response rate in total evaluation of MIP group was also superior to that of M+MP group.
2) 50% survival time of stage I+II was shorter in MIP group. However, in stage III, response rate for M-protein was higher and 50% survival time was longer than those of M+MP group.
3) As to the frequency of side effects leucopenia and gastrointestinal symptom were slightly more frequent but complicated infection was less frequent in MIP group.
From these results, it was recognized that MIP therapy was a useful combination chemotherapy as remission induction therapy for the patients in the advanced stage of multiple myeloma.抄録全体を表示PDF形式でダウンロード (527K) -
—造血器悪性腫瘍に対するphase II trial—植田 高彰, 窪田 良次, 西郷 勝康, 田中 輝和, 田窪 孝行, 柴田 弘俊, 中村 博行, 正岡 徹, 吉武 淳介, 石上 重行1982 年 23 巻 6 号 p. 854-861
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証あり“High-dose methotrexate (MTX) with citrovorum factor (CF) rescue” treatment was applied to 24 cases of hematological malignancies refractory to other anticancer drugs.
Out of 12 cases with adult acute leukemias, two achieved complete remission (CR) and three, partial remission (PR). Out of 12 cases with malignant lymphomas, two attained CR and six, PR. Among 10 cases who had become refractory to conventional doses of MTX, five showed desirable responses. Two out of 3 cases with T-cell malignancies achieved PR. The duration of remission was shorter than 4 weeks in 10 out of 13 cases.
Main side effects of this treatment were as follows; general fatigue in 54% of patients, nausea in 46%, stomatitis in 24%, neutropenia in 23% and thrombocytopenia in 30%. Severe myelotoxicity was seen in four cases, but in cases given aggressive urine alkalinization, even less toxicity including stomatitis was seen than the conventional MTX administration.
The high-dose MTX with CF rescue treatment would be effective for refractory hematological malignancies without any severe toxicity.抄録全体を表示PDF形式でダウンロード (580K)
症例
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斉藤 敦彦, 津島 隆明, 成田 和義, 藤原 史郎, 河村 節子, 千葉 陽一, 吉田 豊1982 年 23 巻 6 号 p. 862-869
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 57-aged female with multiple myeloma terminated to AML about three years after Melphalan administration was reported.
She was diagnosed to have multiple myeloma in December 1976 and had been treated with Melphalan with good response.
On August 20, 1979, Melphalan was stopped because of redness, swelling and pain of the left knee and low platelet count of 1.6×104/mm3. On admission (August 30, 1979), she was diagnosed as AML by the bone marrow examination and had been treated with combined chemotherapy.
She died of the subarachinoidal hemorrhage by the occipital bruise on September 19, 1979. By the autopsy, she had AML and colon cancer.
Statistical analyses were done with review of literature as to the 109 cases of multiple myeloma terminated to acute leukemia and 292 cases of double malignancies with hematological malignancy.抄録全体を表示PDF形式でダウンロード (648K) -
伊藤 粋子, 広野 茂1982 年 23 巻 6 号 p. 870-874
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありIn 1968 Fukase et al reported a case of solitary myeloma with polyneuritis and endocrine abnormalities. In 1973 Takatsuki et al proposed the hypothesis that plasma cell dyscrasia accompanying polyneuritis, pigmentation and endocrine abnormalities such as gynecomastia may belong to a syndrome. We, recently, experienced a case of extramedullary IgG plasmacytoma with polyneuritis, pigmentation and autonomic neuropathies including paralytic ileus, constipation and hypotension. Immunohistochemical study for peptide hormones in the materials of biopsy revealed that this tumor did not contain ACTH, β-MSH, substance P β-endorphin and neurotensin like immunoreactivities. This finding, therefore, suggested that pigmentation, polyneuritis and hypotension of this case did not result from effects of peptide hormones mentioned above. Thus, it seems likely that symptoms of this case may be due to effects of unknown substances.抄録全体を表示PDF形式でダウンロード (601K) -
—イディオタイプの検討—桜間 照喜, 沢田 賢一, 佐藤 雅寛男, 上村 康二, 出野 正孝, 小梁川 義則, 西平 順, 藤江 禎二, 山本 秀樹, 家子 正裕, ...1982 年 23 巻 6 号 p. 875-883
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 56 year-old male patient with marked lymphocytosis, thrombocytopenia, massive splenomegaly and generalized lymphadenopathy, had diphasic (19S & 7S) IgM-λ type M-components in the serum and a λ type Bence Jones Protein in the urine. His membrane-bound immunoglobulins of the peripheral lymphocytes consisted mainly of IgM-λ type. From these findings, the patient was diagnosed at first as chronic B-lymphocytic leukemia with monoclonal immunoglobulin aberration. Fifteen months later, the patient passed away after developing fever and pulmonary infiltration, with marked decrease of serum M components and peripheral lymphocytes. Post-mortem diagnosis was “malignant lymphoma”, diffuse-poorly differentiated lymphocytic type, and it was found that the lymphoma cells were positive in cytoplasmic IgM-λ type.
Idiotypic analyses of the M-components in the serum and the urine as well as of membrane-bound IgM of the peripheral lymphocytes and of cytoplasmic IgM of the lymphoma cells disclosed that all immunoglobulin components shared the same idiotypic specificity. From the above results, it could be concluded that aberrations occurred in this patient are derived from a single clonal B-cell abnormality.
It is assumed that this case is situated on an intermediary form, “leukemic macroglobulinemia”, which stands between chronic B-lymphocytic leukemia and Waldenström's macroglobulinemia, and that it dedifferentiated to B-lymphoma at the terminal stage.
A concept of B cell malignancy was also discussed.抄録全体を表示PDF形式でダウンロード (742K) -
小林 繁一, 須田 年生, 柳沢 正義, 高橋 正年, 若林 邦夫, 菅原 正, 清水 英男1982 年 23 巻 6 号 p. 884-889
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありThe aim of this report is to describe a result of staging laparotomy in a child case of Hodgkin's disease and to discuss the usefulness of the procedure.
A 9-year-old boy was well until he himself noticed rapid enlargement of left cervical lymphnodes. Without any beneficial effects with antibiotics prescribed by a local phisician, he was referred to our hospital. He had no weight loss, fever or night sweating.
Three months after onset, histological examination of the lymph node biopsy revealed some Hodgkin cells and a mixture of lymphocytes, eosinophils and histiocytes, consistent with Hodgkin's disease of mixed cellularity type. Clinical and laboratory studies, including chest x-rays, chest tomography, 99mTc-Sn-colloid liver and spleen scintigraphy, 67Ga scintigraphy, bone x-rays, bone scintigraphy and bipedal lymphography were all negative. Therefore the clinical stage was decided as IA. But according to former reports, mixed cellularity type was frequently associated with high pathological stages, we performed staging laparotomy. This showed miliary infiltration in spleen and two splenic hilar lymphnodes. Then the pathological stage was IIIA.
The patient was treated with radiotherapy (Mantle field: 4,000 rads, left cervical field: 5,000 rads, paraaortic and splenic hilar field: 2,400 rads), followed by COPP therapy of 20 courses. Eight months after discontinuation of the immunosuppresive therapy, he is now in good health and enjoying school life.
Because of a lack of accurate noninvasive method to search for occult involvement in upper abdomen, staging laparotomy with splenectomy can be a useful and necessary procedure, in spite of a possible hazard of an overwhelming infection.抄録全体を表示PDF形式でダウンロード (527K) -
永田 ゆみ子, 森 真由美, 三輪 哲義, 村井 善郎, 嶋田 裕之, 松島 照彦, 佐藤 典治, 糸山 進次, 新保 敏和1982 年 23 巻 6 号 p. 890-897
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありAn autopsy case of hairy cell leukemia was reported.
In 1978, a 35-year-old woman was admitted to Tokyo University Hospital because of headache, anemia and splenomegaly.
The white-cell count was 6,400/mm3 and 84 per cent was large atipical lymphocytes with 1-tartrate resistant acid phosphatase (+) and hairy appearance examined by phase-contrast microscope and scanning electromicroscope. A diagnosis of hairy cell leukemia was made and splenectomy was performed.
After the operation, anemia and thrombocytopenia were improved, but the white-cell count increased.
In January, 1980, lumbago developed, followed by dyspnea at night. She admitted to our hospital in July, 1980.
The white-cell count elevated to 28,500/mm3. The BUN was 61mg/dl, Cr 5.3mg/dl, Ca 10.2mg/dl and urine protein 10 to 12g/day. Abdominal CT scan revealed marked swelling of bilateral kidneys. Bone-Xp was negative, but 99mTc bone scanning showed abnormal radioisotope uptake in the thoracic and lumbar vertebrae.
Daunorubicin and vincristine were administered and the level of BUN and Cr was decreased. 60Co irradiation to the lumbar lesion was performed with no effect.
In October, 1980, she expired because of mycotic sepsis and massive bleeding.
Autopsy revealed the leukemic cell infiltration to varied organs including kidneys and sternal and spinal bone.
Bone infiltration in hairy cell leukemia is very rare. Only 12 cases were reported in the literature. The pattern of infiltration to bone was reviewed and that of this case was discussed.抄録全体を表示PDF形式でダウンロード (841K) -
藤井 浩, 関 茂樹, 清水 忠雄, 加納 正, 安田 典正1982 年 23 巻 6 号 p. 898-906
発行日: 1982年
公開日: 2009/01/26
ジャーナル 認証ありA 49-year-old man was admitted to our hospital because of a painful lump over the sternum in September, 1975. There was a smooth, elastic hard, 5 by 7 cm mass over the sternum without other abnormalities of physical findings. Skeletal roentgenograms showed an osteolytic lesion only in the sternum. The urine contained 0.24g/day of Bence Jones (λ) protein. There were no abnormalities in the peripheral blood picture and serum electrophoretic pattern. The bone marrow aspirate from the sacrum contained only 2.0 per cent plasma cells with no atypism. Surgical biopsy of the sternal tumor revealed the sarcomatous growth of plasma cells. Then diagnosis of solitary myeloma (BJ-λ) was made. The tumor promptly subsided following chemotherapy.
In July, 1980 as well as in June, 1979, the sternal tumor relapsed, but it promptly subsided following the institution of chemotherapy and/or radiation therapy. In November, 1980, the patient developed liver tumors, and subsequently abdominal tumor and ascites. Through various studies on tumor cells in the ascites, they were found to be of plasma cell origin.
In April, 1981, the patient died of cachexia. At autopsy, multiple tumor-formations by myeloma cells were found in the abdominal cavity, liver, retroperitoneum, diaphragma, left-adrenal gland, mediastinum and lymph nodes. There was no infiltration of myeloma cells in any other bones except for the sternum.
During the whole course of the disease, the repeated bone marrow aspirates contained only 1.0 to 3.2 per cent plasma cells with normal appearance and repeated skeletal roentgenograms showed no osteolytic lesions except for the sternum.抄録全体を表示PDF形式でダウンロード (1158K) -
宮本 祐一, 山口 恭広, 浜崎 四郎, 松永 章1982 年 23 巻 6 号 p. 907-912
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 hospital because of dyspnea. The peripheral blood showed RBC 214×104/mm3, WBC 33,500/mm3, platelets 44.0×104 and reticulocytes 144‰. WBC differential count demonstrated 81% mature atypical lymphocytes and 3.5% lymphoblasts. A bone marrow aspirate revealed 81.0% leukemic cells. These leukemic cells had membrane-surface IgG (κ). Because of severe anemia, reticulocytosis, decreased serum haptoglobin and positive direct Coombs' test, he was diagnosed as autoimmune hemolytic anemia associated with CLL. Moreover, examination of his gastrointestinal tract revealed gastric cancer for which gastric resection was performed.
CLL is known to have a higher incidence of cancer and autoimmune disorder than other types of leukemia, and immunological relationship between them has been discussed. In Japan, however, reports of such cases are few. To our knowledge, our case was the first case of CLL complicated with AIHA and cancer in Japan.
Examination of autopsy-cases of CLL in Japan revealed that the incidence of cancer was 5.2% of CLL.
Case reports of CLL associated with cancer and AIHA from the literature are reviewed and discussed.抄録全体を表示PDF形式でダウンロード (536K)
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