臨床血液
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
23 巻, 9 号
選択された号の論文の23件中1~23を表示しています
第23回総会
教育講演III
臨床研究
  • —メチルセルロース法の基礎的検討とその応用—
    高橋 益広, 岸 賢治, 小池 正, 青柳 愛孝, 真田 雅好, 森山 美昭, 柴田 昭
    1982 年 23 巻 9 号 p. 1351-1357
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    In order to perform a reasonable chemotherapy to patients with acute leukemia, drug sensitivity test on leukemic stem cells is considered to be valuable. We tried to form leukemic colony from peripheral blood cells of 22 patients with acute non-lymphocytic leukemia by the method described by M.D. Minden et al and performed drug sensitivity test on leukemic stem cells from 5 patients. According to the colony forming ability and the characteristics of the cells in colony, 22 patients were classified into three groups, which were Group I (no colony formation), 8 cases, Group II (T-cell colony formation), 5 cases and Group III (leukemic colony formation), 9 cases. The number of colonies obtained from Group III is 30-843/2×105 cells depleted of T-cells. Cells in colony had the different characteristics from one patient to another, which were immature granulocytes, macrophage like cells, and blastoid cells. Although there was detected only one type of colonies within a patient, differing from colonies from normal peripheral blood. Drug sensitivity test on leukemic stem cells to daunorubicin and cytosine arabinoside revealed that the sensitivity of leukemic stem cells was similar to that of granulocytic progenitor cells from nomal bone marrow but higher than that of T-cell progenitor cells from Group II.
  • 加藤 雅子, 高 誠信, 荒井 一歩, 木我 豊, 高槻 義夫, 石川 至, 山内 幹雄, 白井 達男, 木谷 信行
    1982 年 23 巻 9 号 p. 1358-1368
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    The neutrophil chemotaxis was measured in 25 cases of disseminated intravascular coagulation syndrome (DIC) by the agarose plate method using 3 kinds of chemotaxins, Zymosan activated serum (ZAS), Bacterial culture filtrates (BCF) and N-formyl-1-methionyl-1-phenylalanine (FMP).
    Different results were obtained depending on the pathogenesis of DIC. In the DIC due to sepsis and other diseases than liver cirrhosis, either chemotaxis or random mobility significantly decreased, especially, the chemotaxis to complement-derived chemotaxin, i.e. ZAS. On the otherhand, both chemotaxis and random mobility were normal in the DIC developing in patients with liver cirrhosis.
    In the sepsis-derived DIC, the neutrophil chemotaxis tended to associate with the levels of antithrombin III, plasminogen and serum CH50. In one case of sepsis-derived DIC, the neutrophil chemotaxis changed parallel to the severity of DIC.
    Endotoxin was frequently demonstrated in the sepsis-derived DIC. As the endotoxin is known to activate the complement system in the blood, it is proposed that the impairment of neutrophil chemotaxis in the sepsis-derived DIC can be due to the chemotactic deactivation of neutrophils, which have come in contact with complement-derived chemotaxin resulting from intravascular complement activation by endotoxin.
  • 金子 晴生, 山内 幹雄, 梅田 正法, 塚原 敏弘, 白井 達男
    1982 年 23 巻 9 号 p. 1369-1376
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    Plasma factor XIII activity level was measured concurrently with its subunits A and S in relation to the change of clinical condition in 86 cases with various hematological diseases.
    In acute leukemia, factor XIII activity and subunit A levels were extremely depressed along with subunit S levels. In cases of remission, these levels returned to normal, while unresponsive cases continued to show depressed levels. In cases with malignant lymphoma, plasma factor XIII activity and subunit A levels were depressed but improved strikingly after treatment. In the chronic stage of CML, these levels were maintained within normal ranges; however, in the acute stage, both factor XIII activity and subunit A levelswere depressed.
    Both subunits A and S levels remained almost within normal range in cases with CLL, multiple myeloma, polycythemia vera, myelofibrosis, aplastic anemia and ITP. Factor XIII activity levels showed changes similar to subunit A levels.
    Depressed factor XIII activity level seemed to be associated with malignant pathological changes and severity. Especially in acute leukemia, depressed subunits A and S levels suggested that their synthesis had been impaired.
    No significant conrrelation was found between platelet count and number of bone marrow megakaryocyte.
  • —t(15; 17)例の頻度および病像について—
    水谷 良子, 清水 智江, 山田 修, 高橋 正知, 片平 潤一, 戸塚 恭一, 泉二 登志子, 押味 和夫, 溝口 秀昭, 岡田 美智子, ...
    1982 年 23 巻 9 号 p. 1377-1382
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    Chromosome analysis of ten patients with acute promyelocytic leukemia (APL) whom we observed in the last seven years revealed that nine patients (three males, six females) had t (15; 17) chromosomes, while fhe remaining one showed a normal female karyotype. Three of the cases with translocation had such additional chromosomal abnormalities as No. 8 trisomy, a No. 6 ring chromosome, and t (1; 9). The geographical distribution of the APL cases with t (15; 17) is uneven, exhibiting higher incidence in Kanto and Hokkaido areas in Japan. Of clinical findings, hepatomegaly less frequently seen in patients with APL was observed in six out of the nine patients with t (15; 17). Only one of those with translocation went into complete remission and the mean survival was 34 days except for the patient during remission, indicating that the patients with t (15; 17) respond poorly to treatment and the prognosis is poor.
  • —自験例2例と本邦報告例の文献的考察—
    白幡 聡, 中村 外士雄, 朝倉 昭雄, 椎木 みどり, 白川 充
    1982 年 23 巻 9 号 p. 1383-1389
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    Two patients with generalized bleeding tendencies due to congenital factor XIII deficiency are described. Their initial bleeding episode was umbilical bleeding in early neonatal period which was characteristic of bleeding of the disease. After that, bleeding in subcutaneous tissue, muscle and oral cavity were frequently observed in their clinical courses.
    Coagulation studies revealed the reduction of ma in thrombelastogram and increased solubility of patients' clot in 1% monochloracetic acid. The activity of factor XIII of first patient's plasma was 2.5% and his levels of subunit a and b were 0% and 45% respectively. The activity of factor XIII of second patient's plasma was 1.5% and his levels of subunit a and b were 0% and 45% respectively. The activity and subunit a of factor XIII of both patients' platelets were deficient. Both first patient's parent and second patient's parent are considered heterozygous carriers, because the assay of factor XIII of their plasma revealed the increase of subunit b/a of the factor.
  • 鎌田 七男, 土肥 博雄, 沖田 肇, 蔵本 淳, 内野 治人, 三浦 恭定, 高久 史麿, 柴田 昭, 前川 正, 小峰 光博, 朝長 万 ...
    1982 年 23 巻 9 号 p. 1390-1399
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    The cooperative study group on “Preleukemia” supported by Grant in-Aid for Cancer Research from the Ministry of Health and Welfare, Japan, designated “refractory anemia with excess of blasts” as one of the project studies in 1980, with the views of clarifing whether patients with RAEB exist in Japan as well as Europe and whether they, if exist, have any particular clinical findings, and of establishing a scoring method for distinguishing RAEB from other hematological diseases.
    Clinical records of suspected RAEB, which had been conceived by Dreyfus, were collected by every member of the study group. This investigation proved the existence of RAEB patients in Japan. Clinical and laboratory findings of fifty eight cases were analysed for the scoring method. The following 13 items were picked up for the criteria and were respectively given scores according to their significance;
    as bone marrow findings
    1) nucleated cell count more than 50×109/L score 12
    2) 7 to 30% of blasts plus promyelocytes score 12
    3) steady state of bone marrow findings more than 6 months score 12
    4) 10 to 50% of erythroblasts score 8
    5) more than 15% of myelocytes+metamyelocytes+bands+segmented neutrophils score 8
    6) less than 20% of lymphocytes score 8
    7) morphological abnormalities more than two series in bone marrow elements score 8
    as peripheral blood findings
    8) more than 50×109/L of platelets score 8
    9) more than 0.5×109/L of neutrophil counts score 4
    10) less than 5% of immature granulocytes score 4
    11) less than 60% of lymphocytes score 4
    12) more than 180 of neutrophil AP score score 4
    13) age older than 50 score 8
    The patients with scores 90 to 100 in total were regarded as definite RAEB, scores 80 to 89 probable RAEB, scores 70 to 79 possible RAEB, and scores less than 69 impossible. The scoring method was applied to other hematological disorders and revealed that the patients with leukemia of M1, M2, M3, M4, or M5 types according to FAB classification and those with aplastic anemia had scores less than 69 without any exception. However, scores of some cases with M6 and primary acquired sideroblastic anemia ranged from 70 to 76.
    From these results, the scoring method is presented as to be instrumental in making the diagnosis of RAEB as a supportive means.
  • 留奥 誠, 久藤 真, 長野 正, 和田 英夫, 村嶋 正幸, 伊藤 質, 李 昌珍, 森藤 隆史, 小西 正昭, 仮谷 嘉晃, 出口 克己 ...
    1982 年 23 巻 9 号 p. 1400-1410
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    Among 181 patients with various hematopoietic malignancies studied during recent 10 years, 43 patients were compatible with the modified Colman's criteria for overt DIC. The frequent basic diseases were: APL (100%, 13 of 13 patients), CML with blastic crisis (50%, 4/8), ALL (36%, 4/11), Hodgkin's disease (IV) (30%, 3/10), ATL (27%, 3/11) and non-Hodgkin's lymphoma (IV) (24%, 6/25). Most patients had more than 2 abnormal test results at the time on admission. This indicated that latent DIC was probably rather common among these patients prior to chemotherapy. The chemotherapy was the most frequent cause for overt DIC. In 17 cases, overt DIC appeared to be caused solely by the chemotherapy [ALL (27%, 3 of 11 patients), AMMoL (23%, 3/13), AML (18%, 3/17) and non-Hodgkin's lymphoma (IV) (16%, 4/25)].
    The most impaired hemostatic parameters during the induction chemotherapy were fibrinogen, ELT, paracoagulation tests and FDP. The changes in these parameters were found to resemble those in overt DIC. The shortened APTT (PTT), seen especially in patients with AML, has been attributed to an increased procoagulant activity or activated procoagulant phase in the process of DIC.
    Chemothrapy should be continued in all patients to control the underlying disease, however, this therapy may intensify or induce DIC. In this respect, we recommend, once chemotherapy is begun, frequent hemostatic studies to monitor any changes in the hemostatic parameters and to identify a possible subsequent need for anticoagulants.
症例
  • 徳永 昭子, 田中 久夫, 田村 しのぶ, 三浦 琢磨, 斉藤 和雄, 山口 英夫, 瀬尾 たい子
    1982 年 23 巻 9 号 p. 1411-1414
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    Recently we had a seven-year-old girl patient who showed Raynaud's phenomenon and hemolytic anemia after suffering from German Measles. In the first stage, she had hematuria and proteinuria, giving serum total bilirubin value of 2.2 mg/dl, GOT of 84 mu/ml, and LDH of 626 mu/ml over. Ribieres' method (osmotic fragility test), sugar water test, Hams' test, direct and indirect Cooms' test and Donath-Landsteiner's test were all negative. Cryoglobulin was negative, but cold agglutinin titer was I: 2048, and CF of German Measles was I: 64, and HI was I: 512. CF of Mycoplasma Pneumoniae was not elevated. After admission, anemia was aggravated and 200 ml of washed packed red cells were transfused using warming coil. When she avoided exposure to cold the clinical manifestations were recovered well. Cold autoantibody was detected in the patient by investigations of the Red Cross Blood Center at Osaka. The case was considered the first case of Pra in Japan that belonged to the IgM class.
  • 永田 ゆみ子, 三輪 哲義, 村井 善郎, 森 眞由美, 山本 達雄, 軽部 俊二, 小池 昇
    1982 年 23 巻 9 号 p. 1415-1419
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A case of Hand-Schüller-Christian disease was reported.
    A 43-year-old woman was well until she began to feel right coxalgia and noticed the xanthomatous dermatitis in her left upper eyelid in 1976.
    In December 1976, a soft nodule was palpable on her right groin. An exploratory operation revealed it to be pyoid exudate from right iliac bone.
    Curettage and drainage were repeated. But the exacerbation of the bone lesion occured with the enlargement of the skin lesion, and painless loss of all teeth.
    In January 1979, a fistula was developed on the right iliac crest and massive bloody exudate was found.
    She was hospitalized because of fever, anemia and cardiac failure.
    The skin biopsy revealed abnormal proliferation of histiocytes and a diagnosis of histiocytosis-X (Hand-Schüller-Christian type) was made.
    Bone X ray and bone scanning showed generalized osteolytic lesions, and chest X ray and echocardiogram revealed the presence of massive pericardial effusion. Pericardocentesis was performed and many foam cells were found.
    KM 2210 was administered with marked improvement for bone lesions, partial regression of skin lesions but no effect on the pericardial effusion.
    This is a very interesting case of Hand-Schüller-Christian disease, from the standpoint of the late onset, the very rare pericardial involvement and the responses to therapy. A review of the pertinent literature was included.
  • 間 栄, 桑原 道雄, 三宅 祥三, 陳 維嘉, 古沢 新平
    1982 年 23 巻 9 号 p. 1420-1426
    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 patient was admitted with chief complaints of fever and hemorrhagic diathesis. Physical examination showed anemia, gingiva swelling, generalized lymphadenopathy and hepatosplenomegaly. Blood examination revealed marked anemia and thrombocytopenia. The leukocyte count was 22,700/μl with 28.5% blasts, 56.0% monocytoid cells and 1.0% eosinophils. Bone marrow study revealed hypercellularity with 39.6% blasts, 10.8% promyelocytes, 12.4% promonocytes and monocytoid cells, and 23.6% eosinophils in various maturational stages.
    The morphology of the eosinophils was atypical in respect of large cell-size, vacuolated cytoplasma, large azurophilic-basophilic granules and asynchronous nuclear-cytoplasmic maturation. Cytochemically, thirty percentage of blasts were peroxidase positive, 40% of blasts were positive for acetate esterase and/or chloroacetate esterase. Eosinophils were positive for chloroacetate esterase, suggestive of leukemic nature. Levels of serum and urine lysozyme were elevated.
    Chromosomal analyses of bone marrow cells were normal. Electron microscopic study revealed the absence of crystalloid internum in specific granules of eosinophils.
    A diagnosis of acute eosinophilo-myelomonocytic leukemia was made. Induction chemotherapy with three courses of DCVP (daunorubicin, cytosine arabinoside, vincristine, and prednisolone) resulted in complete remission. One year later, bone marrow showed the similar finding to that of onset. The reinduction chemotherapy gave no remission, and he died of pneumonia 15 months after the diagnosis.
    At autopsy, leukemic cells were found to infiltrate in bone marrow, liver (2,110 g), spleen (490 g), lung, and kidney etc, although no evidences of reactive eosinophilia such as collagen disease, endocarditis, or parasitic disease were seen.
    Acute eosinophilo-myelomonocytic leukemia seems to be classified as a rare type of M4 variant in the FAB classification.
  • 中西 康雄, 野本 さい子, 根岸 守, 大屋敷 一馬, 横山 淑雄, 山内 保人, 酒井 信彦, 伊藤 久雄, 梅原 千治
    1982 年 23 巻 9 号 p. 1427-1432
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 74-year-old man without previous treatment was found to have an IgA paraprotein on serum immunoelectrophoresis and Bence-Jones protein on urine immunoelectrophoresis. Serum IgA level was 2,400 mg/dl with depressed IgG and IgM levels. Bone marrow aspiration revealed infiltration by both promyelocytes and plasma cells. Chromosomal abnormalities were found. Electron microscopy showed that promyelocytes had a lamellar structure arranged in a concentric circle pattern. The case was thus diagnosed as multiple myeloma complicated by acute myeloid leukemia. Complete remission of leukemia was achieved with combination chemotherapy. Acute leukemia tends to occur at a relatively high incidence in patients with multiple myeloma who are treated with alkylating agents. But the appearance of acute leukemia in patients with multiple myeloma without previous treatment is very unusual. The possible relationship between multiple myeloma and acute leukemia is discussed.
  • 小柳津 直樹, 勝田 吉重, 螺良 愛郎, 森井 外吉, 曽和 正, 岡本 緩子, 佐伯 邦雄, 藤井 康英, 藤竹 英樹, 正司 夏男, ...
    1982 年 23 巻 9 号 p. 1433-1439
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 46-year-old man was admitted to the Kansai Medical University Hospital because of sever anemia. His laboratory data revealed severe refractory anemia with leucopenia. The first smear of bone marrow aspirate revealed a marked granulocytic hyperplasia with predominance of immature myeloid cells and pausity of erythroblastic elements, in which some of megakaryocytes could be found but most of them were dysplastic and micromegakaryocytic. NAP score was extremely low, and neither Auer rods, ringed sideroblasts nor chromosomal abnormarities could be identified. Hypergammaglobulinemia was observed 2 year after entry, serum immunoelectrophoresis gave a picture for monoclonal IgG (kappa) and Bence-Jones protein was proved in urine. He died of panmyelophthisis after long (100 months after entry) course of so-called smoldering leukemia. The autopsy findings revealed that present myeloid disorder would be classified as an atypical leukemia arising from the background of medullary stem cell disorder, namely a hemopoietic dysplasia designated as refractory anemia with an excess of myeloblasts in the bone marrow (Dreyfus), and that the repeated transfusions induced a secondary hemochromatosis and might evoke a plasma cell dyscrasia following lymphoid stem cell disorder.
  • 新井 利政, 吉松 弘, 梅枝 定則, 小峰 光博, 成清 卓二, 前川 正, 八代 邦彦, 土屋 純, 小暮 正久
    1982 年 23 巻 9 号 p. 1440-1445
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 44 year old male was diagnosed as suffering from drug-induced immune hemolytic anemia due to midecamycin, a macrolide antibiotic. He received this antibiotic for 3 days (total 1,200 mg) 3 weeks preceding the onset of massive intravascular hemolysis. On admission severe anemia with reticulocytopenia, jaundice, hepatosplenomegaly, marked elevation of serum lactic dehydrogenase, and undetectable haptoglobin were noted. His serum was dark-brown in color. Gross hematuria, hemoglobinuria and hemosiderinuria as well as mild azotemia were also present. Antiglobulin test was negative.
    Immunological investigations were undertaken to identify the causative agent and to elucidate pathogenetic mechanism. Patient's RBCs which were obtained after subsidence of hemolysis were incubated with several possibly causative drugs including midecamycin, cephalexin, cephalotin, sulpyrine and aminopyrin. RBCs were then washed extensively with saline before they were mixed with his own sera obtained during the period of active hemolysis. Agglutination was positive only with midecamycin-treated RBCs at 25°C but negative at 4°C. The indirect antiglobulin test was performed on his serum as follows: Midecamycin-treated patient's RBCs were incubated with his serum before washing, and they were then allowed to react with the added monospecific antiglobulin sera. Positive agglutination was observed only with anti-IgM globulin suggesting the antibody class being IgM. Agglutination was positive up to 8 times dilution of serum. However, the haptenic inhibition was not demonstrated under the experimental conditions employed.
    These results suggest that generation of IgM antibody directed against midecamycin was responsible for the occurrence of hemolysis in this patient. The hapten-cell mechanism was likely to have played the major role in the pathogenesis, though participation of the innocent bystander mechanism was not completely ruled out.
  • 杉本 正邦, 若林 芳久, 塩川 優一, 高久 史麿
    1982 年 23 巻 9 号 p. 1446-1452
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 55-year-old man who had undergone a craniotomy developed pure red cell aplasia (PRCA) during treatment with diphenylhydantoin (DPH) and phenobarbital. This anemia rapidly improved after discontinuance of the drugs. An in vitro study using the Krantz's method was carried out to observe the influence of DPH, lymphocytes and serum on heme synthesis of the bone marrow erythroblasts. The heme synthesis was determined by the incorporation of radioactive iron into heme as an indicator. The following results were obtained: 1) Heme synthesis of the patient's erythroblasts was remarkably inhibited by DPH at a concentration of 25 μg/ml. 2) His serum or lymphocytes did not produce any influence on the inhibition of heme synthesis by DPH. These results suggest that a possible cause of PRCA was a damage of patient's bone marrow erythroblasts by DPH because of their increased susceptibility to the drug.
  • 佐尾 浩, 吉川 治哉, 赤尾 幸博, 平岩 明和, 高木 信行, 山内 辰也, 吉川 敏
    1982 年 23 巻 9 号 p. 1453-1457
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    An adult case of acute erythroblastopenia (AEP) with cytomegalovirus infection and autoimmune disturbance is reported.
    A 30-year-old woman came to our hospital because of fever and general fatigue. Physical examination revealed no positive finding. Hematological examination showed RBC 515×104l, Hb 15.8 g/dl, reticulocyte 1‰, WBC 2,500/μl and platelet 7.2×104l. Sternal bone marrow examination revealed almost complete absence of erythroid elements and presence of a few giant proerythroblasts.
    After 7 days, a complete recovery of erythropoiesis in the bone marrow was shown.
    Preceding cytomegalovirus infection was considered on the basis of rising anticytomegalovirus antibody titer. In addition, a transient autoimmune disturbance as indicated by high titers of antinuclear antibody and anti-DNA antibody was also revealed.
    Relationship between the viral infection with autoimmune diturbance and etiology of AEP was discussed.
  • 山田 修, 岩間 昌子, 直原 徹, 押味 和夫, 溝口 秀昭, 平山 章
    1982 年 23 巻 9 号 p. 1458-1462
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A case of Hairy cell leukemia accompanied with gall bladder cancer is reported.
    This 70-year-old female was admitted to our hospital because of general malaise and the evaluation of leukocytosis.
    On admission patient was emaciated and was found to have marked hepatosplenomegaly. Lymph nodes were not palpable.
    Laboratory data showed WBC count of 62,500/mm3 with 82% mononuclear lymphoid cells which lacked tartrate-resistant acid phosphatase and ribosome-lamella-complex. Under the phase contrast microscope, however, many hairy cytoplasmic projections were present, and the bone marrow biopsy revealed diffuse leukemic cell infiltration and the increment of reticulin fibers indicating that these findings are in accordance with the characteristics of hairy cell leukemia. On chromosomal analysis karyotype abnormality was detected.
    Immunological studies showed that the hairy cells had both Ia-like antigens and surface immunoglobulin but lacked Fc receptors, C3 receptors and TdT. These findings may suggest that these cells originated from a B cell lineage. On the analysis of cellular immunity, sensitization with DNCB was unsuccessful, PPD skin test was positive, lymphocyte response to PHA mitogen was normal and the absolute number of lymphocytes and monocytes was normal. Natural killer cell function was almost normal after the removal of hairy cells. The relationship between hairy cell leukemia, impaired immunity and secondary malignancies was discussed.
  • 広沢 信作, 神山 隆一, 檀 和夫, 厨 信一郎, 野村 武夫
    1982 年 23 巻 9 号 p. 1463-1467
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 66-year-old woman presented with a 3-month history of pyrexia and cervical lymph node swelling. On examination she had lymph node swellings in the postauricular, cervical, axillar and inguinal areas, and right pleural effusion. The initial blood count revealed normal except for a slight reticulocytosis. The diagnosis of malignant lymphoma (ML. mixed, lymphocytic & histiocytic, diffuse) was confirmed by cervical lymph node biopsy, and the disease was classified into stage IV B as the result of bone marrow aspiration and lymphangiography. On the 9th day in hospital the reticulocyte suddenly disappeared, and anemia rapidly progressed. The bone marrow aspiration showed an entire lack of erythroblasts to establish the diagnosis of pure red cell aplasia (PRCA). After the first course of the combination chemotherapy with cyclophosphamide, vincristine, procarbazine and prednisolone, the lymph node swellings disappeared, and anemia improved.
    The growth of erythroid progenitor cells (CFU-E) from her bone marrow showed a remakable decrease during PRCA, and was normal after the recovery from anemia. The sera obtained during PRCA significantly inhibited the growth of CFU-E from her bone marrow collected after recovery. The inhibitory factor was identified with IgG.
  • 臼井 忠男, 山岸 司久, 石倉 浩人, 和泉 洋一郎, 釜本 隆行, 大久保 直, 小西 博, 三木 昌宏, 沢田 博義, 内野 治人
    1982 年 23 巻 9 号 p. 1468-1474
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 58-year-old female was admitted to our hospital because of shortness of breath and palpitation. Hematological examination revealed severe anemia, thrombocytopenia and leukoerythroblastosis. The neutrophil alkaline phosphatase score of the peripheral blood was high and cytogenetic study showed no Ph1-chromosome. Bone marrow biopsy disclosed a complete aplasia without an apparent fibrotic appearence. Ferrokinetic study was compatible with the extramedullary hematopoiesis (myeloid metaplasia). After the administration of methandrostenolone, anemia and thrombocytopenia improved remarkably. Eight months later, bone marrow biopsy revealed a moderate fibrotic appearence with few hematopoietic cells. The sequential change of the bone marrow histology was discussed with special reference to its relationship with agnogenic myeloid metaplasia and aplastic anemia.
  • —自験例とDown症候群に併発しない先天性白血病78例の文献的考察—
    鹿野 高明, 石川 順一, 佐藤 琢司
    1982 年 23 巻 9 号 p. 1475-1481
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 2-month-old boy was admitted for evaluation of skin nodules observed at 5 days, a tumor on the head found at 1 month and facial nerve palsy. Hematological findings were as follows; RBC 345×104/cmm, Platelet 2.8×104/cmm, WBC 13,500/cmm with 100% blast cells. Bone marrow specimen revealed blast cells 33%. The leukemic cells gave no reactions with Sudan black, PAS and peroxidase. Surface markers of the blast cell were surface immunoglobulin (-), E-rosette formation (-), and common ALL antigen 50%. Karyotype of the bone marrow was 46 XY/53 XY, +3, +7, +12, +14, +14, +20, +21. He obtained complete remission with new DCVP therapy. But he died 5 months after the onset of the treatment.
    Approximately 78 cases of congenital leukemia without Down's syndrome have been reported up to December of 1981 in Japan.
    1) The ratio of males/females was 32/36.
    2) On admission hepatosplenomegaly was found in 93%, and skin nodules in 26/50 (52%).
    3) Laboratory findings at diagnosis; average leukocyte counts were 22.59×104/cmm, average RBC 310×104/cmm, and 15 cases (52%) had platelet count of under 5×104/cmm.
    4) Type of leukemia; AML 39 cases (70%), AMoL 9 cases (16%), ALL 5 cases (8%), stem cell leukemia and Null cell leukemia 4 cases (7%).
    5) Survival time; About half of patients deid within 1 month.
  • 大熊 昭晴, 竹内 仁, 村上 純子, 村上 正人, 早川 佳夫, 馬場 真澄, 武尾 宏, 沢田 海彦, 東海 俊英, 大島 年照, 天木 ...
    1982 年 23 巻 9 号 p. 1482-1488
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 25-year-old man was admitted to the Nihon University Hospital complaining of high fever, general fatigue and leukocytosis on June 26, 1980. Before this admission, he was doubted to have Behçet disease for multiple ulceration of the oral mucosal membrane and on the scrotum. Peripheral blood on admission showed that the WBC count was 24,000/μl with 1.5% of blast cells, 41.5% of myelocyte, 5.0% of metamyelocyte and 4.5% of basophile. The nucleated cell count in the bone marrow was 346,000/μl with 17% of myeloblast, 25.4% of promyelocyte, 25.2% of myelocyte, 12.8% of eosinophile and 3.0% of basophile. Those blasts were positive for peroxydase and PAS stain. NAP rate and score were normal. The serum level of vitamine B12 was 3,200 pg/ml. He had no hepatosplenomegaly on admission. Cytogenetic analysis of the bone marrow cells showed a karyotype of 50, XY, +8, +16, +22q-, t (9q+; 22q-) +mar in 92% of mitoses (double Ph1 chromosome positve). The case was difficult to distinguish blastic crisis of CML from AML (M2). A complete remission could be achieved with BH-AC·DMP therapy. On cytogenetic analysis of the bone marrow in complete remission, the Ph1 positive cells were disappeared. Therefore, the case was retrospectively diagnosed to be Ph1-positive AML.
    He was readmitted because of relapse of AML seven months later, when he developed ulceration on the oral mucosal membrane and the scrotum without peripheral basophilia. Cytogenetic analysis of the bone marrow cells at this time showed the same karyotype as the first admission in 72% of mitoses. A complete remission could be achieved again with BH-AC.AMP therapy. At present, he has been in a complete remission.
  • 沢田 賢一, 沖 一郎, 今野 孝彦, 芝木 秀俊, 今野 武津子
    1982 年 23 巻 9 号 p. 1489-1495
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 52-year-old male has been well until seven months previously, when he began to complain of petechiae. He was admitted to Kitami Red Cross Hospital for examinations of bleeding tendency on November 5, 1979. Physical examinations on admission showed no abnormalities except for petechiae. His peripheral blood count was as follows: RBC 451×104/mm3, WBC 5,600/mm3 (neutrophils 46, monocytes 10, lymphocytes 44%), platelets 8.3×104/mm3. Nucleated cell count of bone marrow was 8.8×104/mm3 and megakaryocytes were 30/mm3. The results for examinations of coagulation and fibrinolysis were normal except for prolonged bleeding time. Tentatively the diagnosis of idiopathic thrombocytopenic purpura (ITP) was made.
    He was discharged from the hospital on November 27, 1979. Since then he was continued to be observed at the out-patient department without any specific treatment for eight months. He was readmitted to the hospital because of eruptions of the skin on lower extremities on June 23, 1980. The physical examinations on admission showed petechiae and erythema nodosum. His peripheral blood count was as follows: RBC 373×104/mm3, WBC 7,700/mm3 (neutrophils 25, monocytes 3, lymphocytes 66, blasts 6%), platelets 10.5×104/mm3. Bone marrow was hypocellular with normal number of megakaryocytes. Blasts in the bone marrow were 11.9%. Acute monocytic leukemia (M 5) was diagnosed on the basis of cytological and histochemical findings.
    Despite the treatments in combination with daunorubicin, cytocine arabinocyde, 6-mercaptpurine and prednisolone (DCMP), remission was not obtained. On the sixty-fourth hospital day he died of pulmonary bleeding due to disseminated intravascular coagulation syndrome, which was confirmed by an autopsy.
  • 名取 英世, 江上 康一郎, 田中 健, 安田 佳織, 山口 達夫, 加地 正郎, 冨松 久信, 神代 正道
    1982 年 23 巻 9 号 p. 1496-1501
    発行日: 1982年
    公開日: 2009/01/26
    ジャーナル 認証あり
    A 37-year-old man was admitted to the hospital because of gingiva bleeding in January, 1981. He was diagnosed as AML by presence of leukemic cells in peripheral blood smears and bone marrow aspirates.
    He was treated with DCMP, but chest X-ray film revealed abnormal shadow in the right upper and middle lobes. In spite of an administration of several antibiotics on the suspicion of pneumonia, abnormal shadow did not improve.
    In May, 1981, suddenly, he developed coma after convulsion, followed by right hemiplegia. He died of the respiratory distress five months after the onset of the bleeding tendency.
    Autopsy findings revealed right pulmonary haemorrhagic infarction, pulmonary thrombosis, endocarditis, gigantic thrombus in the left atrium and necrotic focus of the left internal capsule with cerebral thrombosis by mucor.
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