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Volume 25, Issue 5
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[in Japanese]1984 Volume 25 Issue 5 Pages 607-612
Published: 1984
Released on J-STAGE: January 26, 2009
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Toshiaki KARUBE, Mieko MAEHARA, Hiroko IJIMA, Hiromu MUCHI1984 Volume 25 Issue 5 Pages 613-618
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSThree cases of childhood ALL were treated with a combination of BH-AC, ACM, 6-MP, and prednisolone. BH-AC is a newly synthesized derivative of ara-C with high anti-tumor activity and resistant to cytidine deaminase. ACM is also a new anthracycline bearing low cardiotoxicity. These patients had become resistant to multidrug treatment such as vincristine, cyclophosphamide, adriamycin, and L-asparaginase. Case 1 was in the first induction, Case 2 in the second relapse, and Case 3 in the first relapse. The protocol consisted of intravenous infusions of BH-AC 160 mg/m2 for five days and ACM 20 mg/m2 for three days with oral administration of 6-MP 50 mg/m2 and prednisolone 60 mg/m2 for five days. Regarding to side effects, leukopenia, thrombocytopenia and/or mild gastrointestinal symptoms were seen in all patients, and parotitis in one patient. It was concluded that this regimen was effective for the treatment of refractory ALL in childhood without severe side effects, although the number of the patients was not enough for definite evaluation.View full abstractDownload PDF (464K) -
—with Special Reference to the Possible Role of Increased Active Oxygen Generation in the Pathogenesis of Coronary Thromboarteritis—Yukie NIWA, Ichiro YANAGIDA, Kyoichi SOMIYA1984 Volume 25 Issue 5 Pages 619-626
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSTo examine the possible correlation between mucocutaneous lymph node syndrome (MCLS) and thromboarteritis, we studied the capacity of polymorphonuclear leukocytes (PMNs) from 31 pediatric patients with MCLS to generate active oxygens (AO) and to release lysosomal enzymes. Cultured endothelial cells from human umbilical cord vein were also incubated with PMNs to assess AO-induced tissue. injury. Within five days of MCLS onset, AO production, except for chemiluminescence generation, was markedly increased and the 51Cr release from labeled endothelial cells was significantly elevated. The lysosomal enzyme release was slightly, but significantly, higher. In the presence of superoxide dismutase and catalase, the 51Cr release was reduced to the control level, indicating the specificity of the effect of AO endothelial cell damage. At more than six to seven days after MCLS onset, the PMN functions were normal or decreased and the 51Cr release was reduced. The grade of an increase in AO generation by PMNs from the patients with bacterial infections was lower than that from MCLS patients within five days of onset. Further PMNs from bacterial patients did not induce significant increase in 51Cr release from cultured endothelial cells. In view of reports that coronary occlusion may appear one week after MCLS onset, we suggest that in the early stage of MCLS, a marked increase in AO generation induced by activated PMNs gives rise to coronary vascular injury, possibly leading to thromboarteritis and aneurysm formation.View full abstractDownload PDF (628K) -
Yoshihisa MORISHITA, Suzuaki SHIMIZU, Hiroshi IMURA, Masataka OKAMOTO, ...1984 Volume 25 Issue 5 Pages 627-639
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSPulmonary complications were studied in 213 patients with leukemia and lymphoma. The incidence of pulmonary lesions was 38.5% and diffuse changes were encountered twice more frequently than localized ones. Etiological diagnosis during life was difficult. In 38 out of 62 cases with diffuse lesions, their etiology was not determined. In 9 out of 28 cases with localized lesions their etiology was not clear. In some of these cases autopsy clarified their etiology.
Among localized cases, infection, mainly of bacterial origin and infiltration of underlying diseases were two main etiologies. On the other hand, diffuse lung lesions were of various etiology; 29 infections (bacteria 8, fungus 9, virus 8, p.carinii 2), 11 tumor infiltrations, 11 interstitial pneumonia, 3 vascular origins. In these cases with diffuse lesions of different etiology, clinical findings such as fever, cough, dyspnea, low PO2, high LDH, increased CRP, and hypoalbuminemia were observed, but not helpful in differentiating the etiology. Eight out of 11 cases of interstitial pneumoonia occurred during or after tapering of glucocorticoid.
The mortality rate was as high as 54.4% of all lung diseases. Retrospective studies on the chest X-ray pictures showed that diffuse ill-defined opacities or multilocated consolidations were associated with poor prognosis.
The diagnostic value of transbronchoscopic lung biopsy and therapeutic implications of empirical glucocorticoid administration for etiologically undiagnosed lung lesions were also discussed.View full abstractDownload PDF (945K) -
Tomomitsu HOTTA, Makoto UTSUMI, Taiji KATO, Hideaki MAEDA, Hisami YAMA ...1984 Volume 25 Issue 5 Pages 640-648
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSIn order to evaluate the classification for myelodysplastic syndromes (MDS) proposed by FAB Co-operative Group, a retrospective follow-up study was performed in 59 patients with MDS. These patients were classified by the initial hematological findings according to FAB criteria into 5 types of MDS as follows: 17 cases of refractory anemia (RA), 9 cases of RA with ring sideroblasts (RARS), 15 cases of RA with excess of blasts (RAEB), 5 cases of chronic myelomonocytic leukemia (CMML) and 13 cases of RAEB in transformation (RAEB-T). Evolution to overt leukemia had occurred in 4 cases (23%) of RA, 1 case (11%) of RARS, 9 cases (60%) of RAEB, 2 cases (40%) of CMML and 9 cases (69%) of RAEB-T. Duration from diagnosis to overt leukemia was 9 months in RAEB and 3 months in RAEB-T. The present results showing good correlation between the type of disease and the clinical course in MDS prove propriety of the FAB classification. Although there are some problems to be solved, FAB classification is a useful tool with which to estimate the prognosis of MDS patients.View full abstractDownload PDF (747K) -
Nobuaki IWATA, Eri WAKAMATSU, Sosuke OIKE, Sadanori UMEGAE, Mitsuhiro ...1984 Volume 25 Issue 5 Pages 649-654
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSAmong 15 patients with ALL, 4 patients with blastic crisis of CML and 10 patients with non-Hodgkin lymphoma who received several courses of combination chemotherapy including vincristine or vindesine, 4 patients showed a transient and repeated indirect hyperbilirubinemia corresponding to the vinca alkaloid administration. Hyperbilirubinemia appeared after 4-5th injection in 3 cases and it was evidint following the first administration in a remaining case. Serum bilirubin reached the peak concentration on 2-3 days after vinca alkaloid injections and returned to normal within 5-7 days. Slight reticulocytosis was observed in two cases. On the other hand, the levels of serum LDH, GOT, GPT and Al-P remained within normal limits. Scince the administration of vinca alkaloid alone in these patients resulted in a similarly transient elevation of indirect bilirubin, it was presumed that the observed hyperbilirubinemia might represent a vinca alkaloid-induced hemolytic reaction.View full abstractDownload PDF (394K)
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Tsuyoshi NAKAMAKI, Susumu OZAWA, Kenji SAIKI, Umeki INOUE, Shigeru TOM ...1984 Volume 25 Issue 5 Pages 655-659
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSThe thromboembolism is one of the well-known complications in patients with autoimmune hemolytic anemia.
Episodes were commonly venous thrombosis or pulmonary embolism developed after receiving treatments such as splenectomy or corticosteroid therapy in the previous reports.
This paper reports a case whose cerebral thrombosis with thrombocytosis was an initial symptom of warm-type autoimmune hemolytic anemia.
A 34-year-old woman was admitted because of right monoplegia and aphasia. A cerebral infarction was documented by computerized tomography. The hematologic study revealed macrocytic anemia with 14.3% of reticulocytosis. The platelet count was highly elevated (83.6×104/cmm.) The direct Coombs-test was positive. The patient was diagnosed as warm-type autoimmune hemolytic anemia. The hemostatic study showed a hypercoagulability on thrombelastogram caused by thrombocytosis and increase of fibrinogen. On the other hand, a qualitative platelet defect was found which consisted of impaired collagen-, ADP- and epinephrine induced aggregation and reduced ATP release. The plasma β-thromboglobulin was elevated.
Not only the hypercoagulability associated with thrombocytosis, but the platelet defect which leads to the formation of platelet aggregates and to thrombosis in vivo, might play an important role on the occurrence of cerebral thrombosis in this case.View full abstractDownload PDF (332K) -
Atsushi NISHIKAWA, Kiyoshi SAITO, Schoichiro TANIUCHI, Toshio OHNISHI, ...1984 Volume 25 Issue 5 Pages 660-665
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSSix children with untreated T-cell acute lymphoblastic leukemia (T-ALL) in sequence between 1978 and 1982 were treated with combination chemotherapy regimen (Protocol C) using vincristine (VCR), prednisolone (Pre), daunorubicin (DM) or doxorubicin (Adr) and L-asparaginase. Complete remission was achieved in 5 out of 6 cases. Five children who achieved complete remission were further treated with 2400 rads of cranial irradiation combined with intrathecal methotrexate (MTX). Maintenance therapy was done with daily 6-MP and weekly cyclophosphamide plus periodic reinforcement of VCR, Pre and DM every 8 weeks. Two out of the three patients with WBC over 50,000/cu. mm. in their first visits died after 4.5 and 17 months, while three patients with WBC under 50,000/cu. mm. in their first visits are now alive at 21.5, 34 and 48 months. Patients with T-ALL with WBC under 50,000/cu. mm. at their first visits had a chance of longer survival and those with WBC over 50,000/cu. mm. at the first visits should be treated more aggressively.View full abstractDownload PDF (438K) -
Kazuhiko MATSUNO, Hiroaki NISHIYAMA, Kunikane KIM, Shoji HAGIWARA, Hir ...1984 Volume 25 Issue 5 Pages 666-672
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSBone lesions are rare in primary macroglobulinemia in the literature. A case of primary macroglobulinemia with hemostatic defects, succeeded in the operation for pathologic fracture of femur infiltrating of neoplastic cells is reported.
A 67-years-old woman admitted to our hospital because of jaundice and fracture in the neck of right femur. She had moderate normochromic anemia, and bone marrow aspiration revealed an increase in abnormal lymphoid cells. Immunoelectrophoresis demonstrated M protein indentified as Ig M-λ. She had diagnosed as primary macroglobulinemia based on her laboratory findings.
After the improvement of post-transfusion hepatitis, she was operated upon for the replacement of artificial head of the femur. Specimens of fractured bone disclosed the same proliferation of abnormal lymphoid cells as bone marrow. So we considered fractured bone was caused by infiltration of neoplastic lymphoid cells.
Preoperative coagulation tests revealed prolonged template Ivy bleeding time and decreased platelet aggregation, while they were normalized after plasma exchange, paralleled to decrease in serum IgM levels. Plasma exchange is recommended for the treatment of bleeding in primary macroglobulinemia.View full abstractDownload PDF (717K) -
Yoshikado KANETO, Tsuneo SUMIYOSHI, Yasuhiko IISHI, Keiichi IGUCHI, Ma ...1984 Volume 25 Issue 5 Pages 673-678
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA case of BJP (λ) myeloma with non-secretory IgD was described.
The patient, 74-year-old male, was found to have multiple osteolytic lesion with severe pain, anemia and emaciation. The erythrocyte sedimentation rate was 110 mm/hr; hemoglobin, 7.0 g/dl; white blood cell count, 11,200/μl; platelet count, 185×103/μl; BUN, 44.6 mg/dl; creatinine, 2.44 mg/dl. The total serum protein was 4.0 g/dl with low level of γ-globulin (8.2%). The serum immunoglobulin levels were significantly decreased: IgG 360 mg/dl, IgA 35 mg/dl, IgM 16 mg/dl, IgD less than 2 mg/dl and IgE 33 IU/ml. Electrophoretic and immunoelectrophoretic examination of the serum and urine revealed trace amounts of monoclonal λ-BJP, amounting to less than 0.3 g/day in the urine, but no monoclonal immunoglobulin. The bone marrow cells of the sternum (NCC 40×103/μl) consisted of 51% plasma cells. The majority of the plasma cells was proved to have intracellular IgD (λ) by immunofluorescence examination with FITC conjugated monospecific antisera, indicating that the patient suffered from BJP (λ) myeloma with non-secretory IgD. The patient was treated with intermittent administration of melpharan and prednisolone, and his general condition greatly improved, but died of pneumonia after 4 years from the onset of symptom.
This case seems to be the fourth report of non-secretory IgD myeloma and should be valuable to clarify the differentiation process of IgD-synthesizing B-lymphocyte to the plasma cell.View full abstractDownload PDF (1000K) -
Hiromi YASHIGE, Yoshiaki SONODA, Kazuhiro NISHIDA, Shoichiro TSUDA, Ta ...1984 Volume 25 Issue 5 Pages 679-684
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA 36-year-old male was admitted to our hospital on 26th November, 1981. He complained of gingival bleeding, persistent high fever, and severe general fatigue. Hematological findings were as follows; the white blood cell count was 28,200/mm3 with 93% of leukemic cell, and the platelet count was 40,000/mm3. Bone marrow aspiration revealed that the frequency of atypical promyelocytes was 80.4%, and he was diagnosed as acute promyelocytic leukemia. The chromosomal abnormality such as 46, XY, t(8; 17) (p22; q21)/47, XY, +8, t(8; 17) (p22; q21) was disclosed by the direct method. Although he was treated with the combined chemotherapeutic regimen consisted of daunomycin, 6-MP, and prednisolone, the number of leukemic cells did not decrease. Then he was treated with adriamycin, methotrexate, ACNU, and prednisolone. But the therapy was not effective. On 11th December, 1981, the urine volume was 5 liter per day and the specific gravity of urine was decreased to 1.010. Therefore diabetes insipidus was suspected. Leukemic cells were found in cerebro-spinal fluid, and the level of antidiuretic hormone was very low. The pitressin test was positive. All these findings are compatible with the diagnosis of diabetes insipidus complicated by meningeal leukemia. Repeated intrathecal injection of methotrexate was very effective for meningeal leukemia, and diabetes insipidus also improved. On 12th January, 1982, he complicated pneumonia and died on 8th February, 1982. Autopsy of head was not permitted.View full abstractDownload PDF (522K) -
Yukihiro AKAO, Shinko TAKAGI, Haruya YOSHIKAWA, Hiroshi SAO, Akikazu H ...1984 Volume 25 Issue 5 Pages 685-691
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA 16-year-old male was suffered from acute hepatitis from the beginning of December, 1981 to the beginning of January, 1982. He felt general malacia in the beginning of February and was admitted to the hospital on April 14. Severe aplastic anemia was diagnosed with hematological examination as follows: granulocyte count of 1,186/μl, reticulocyte count of 0.865×104/μl, platelet count of 19,000/μl in peripheral blood and 23.5% hematopoietic cells in bone marrow.
He was prepared for marrow transplantation with cyclophosphamide, 3,000 mg a day for 4 days in our hospital. A bone marrow aspirate (3.6×108/kg) from his HLA identical sibling (18-year-old female) was infused on May 14. He received intermittent methotrexate therapy after grafting to modify GVHD. Evidence for engraftment was presented on day 21 with a moderate cellular marrow, grater than 500/μl granulocytes 24 days after grafting. His red blood cell types changed to the donor type completely on day 180. On day 24, the patient developed erythema on his face like SLE. A skin biopsy showed grade I GVHD. In these days liver function abnormality accompanied without elevating bilirubin. The erythema resolved rapidly with prednisolone 30 mg a day, and his hepatic damage also improved gradually. But after the last dose of MTX on day 102 his liver function abnormality deteriorated. By re-starting weekly MTX and dose up of prednisolone, it was improved.
Although he now suffers from chronic GVHD of liver and oral mucosa he is enjoying normal life in good hematological condition over one year after bone marrow transplantation.View full abstractDownload PDF (491K) -
Tsunefumi SHIBUYA, Sei-ichi OKAMURA, Yoshiyuki NIHO, Takashi IMAMURA, ...1984 Volume 25 Issue 5 Pages 692-698
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA case of phenacetin-induced hemolytic anemia confirmed by the demonstration of the metabolite N-acetyl-p-aminophenol from her urine was reported. The patient repeated marked methemoglobinemia and hemolysis following habitual ingestion of about up to 15 grams of phenacetin because of her psychotic disorder. On admission, unstable hemoglobinemia or enzymopathy was suspected because of the presence of Heinz bodies and because she steadfastly denied the ingestion of any drugs. Assay of RBC enzyme levels was normal, and unstable hemoglobinemia was also denied. 51Cr method revealed that survival of autologous and isologous RBC was shortened with a half disappearance time of 2.5 days. N-Acetyl-p-aminophenol, a metabolite of phenacetin, was demonstrated in the urine and a large quantity of phenacetin was discovered in her belongings. As soon as phenacetin was stopped, the signs of hemolysis disappeared. It was concluded that the cause of phenacetin abuse was attributable to the psychotic illness. It should be emphasized that phenacetin-induced hemolysis should be considered as a cause of anemia even when anemic patients strongly deny the drug ingestion.View full abstractDownload PDF (555K) -
Haruo NAKAMURA, Yasuko AOKI, Shoko SATO, Masaki NAKAZAWA, Toshiro NAGA ...1984 Volume 25 Issue 5 Pages 699-704
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSWe described abnormalities in the development of primary granules in myeloblast, promyelocyte and mature neutrophils from the blood of a patient with acute myelogenous leukemia. We reported the morphological, cytochemical and electron microscopical findings of immature and mature leukemic cells. Cytochemical findings were heterogenous and electron microscopic studies revealed considerable heterogeneiety in distribution of primary and specific granules in mature leukemic cells. It was noteworthy that there was strong activity of peroxidase but no activity of α-naphthyl AS-D chloroacetate esterase and acid phosphatase in the primary granules of the immature leukemic cells as well as in the Auer body. Electron microscopic studies of immature leukemic cells showed the characteristic distribution and morphology of the granules and the partial development of endoplasmic reticulum in the cytoplasm. Therefore, the less development of junctional vesicles derived from the endoplasmic reticulum is presumably a reflection of developmental abnormalities of granules in the leukemic cells from the patient, although abnormal formation of granulesis considered to be derived from dysfunction of Golgi complex.View full abstractDownload PDF (977K) -
Kohei MIYAZONO, Minoru YOSHIDA, Seiichi KITAGAWA, Akihiro TSUBOYAMA, S ...1984 Volume 25 Issue 5 Pages 705-711
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA patient with acute myeloblastic leukemia suffered from cough, sputum and high fever after the completion of fourteen days of a combination chemotherapy with N4-behenoyl-β-D-arabinofuranocylcytosine, aclacinomycin-A, 6-mercaptopurine and prednisolone. An x-ray film of the chest revealed a fungus ball in the left upper pulmonary lobe and Aspergillus fumigatus was detected in a culture of sputum. One week later, he experienced two attacks of visual loss which lasted eighteen hours each. A fim of computed tomographic (CT) scan of the brain showed a hemorrhagic infarction in the left occipital lobe. An echocardiogram disclosed thickness of the tricuspid valve and the mitral valve which suggested endocarditis. The symptoms and signs improved markedly after administration of antifungal drugs. If a patient with severe and prolonged granulocytopenia develops multiorgan involvement, dissemination of aspergillus infection should be kept in mind and the early empirical use of antifungal agents is a reasonable therapy.View full abstractDownload PDF (837K) -
Yukitaka FUKUSHIMA, Yasunori KIMURA, Mitsuyuki FUKUDA, Akihiko YAMAGUC ...1984 Volume 25 Issue 5 Pages 712-718
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA 56-year-old man was admitted to the Akita University Hospital because of a giant hematoma in the left side of his chest in December 1977. The platelet count on admission was 315.9×104/mm3, and the bone marrow aspiration and biopsy revealed marked increase in number of megakaryocytes. The Philadelphia chromosome was negative. Diagnosis of essential thrombocythemia was made. Phlebotomy, Busulfan, 32P and ACNU were used to decrease the platelet count. The platelet level was maintained less than 100×104/mm3 and leukocyte count was about 2.0×104/mm3 during one year.
In April 1979, the platelet count was suddenly decreased to 23.2×104/mm3 and leukocyte count was 5,400/mm3, with 13% blast cells. Under the diagnosis of acute myeloblastic leukemia (M1), induction therapy was repeatedly done for 8 months, but a complete remission was not achieved. He died of sepsis at December 21, 1979. A postmortem examination revealed acute myelogenous leukemia associated with early mild myelofibrosis, moderate hepatosplenomegaly and bilateral chronic hemorrhagic pneumonia caused by aspergillus and serratia.View full abstractDownload PDF (640K) -
Shinichiro OKAMOTO, Haruhiko OGATA, Teruhiko YOSHIDA, Yukiko OHEDA, Ta ...1984 Volume 25 Issue 5 Pages 719-723
Published: 1984
Released on J-STAGE: January 26, 2009
JOURNAL RESTRICTED ACCESSA case of acute myeloblastic leukemia (AML), who achieved partial remission by high dose cytosine arabinoside, was reported.
The 50 year old male was diagnosed as AML on February, 1982 and complete remission (CR) was achieved by the combination chemotherapy of daunomycin (DM), cytosine arabinoside (Ara-C), vincristine (VCR), 6-mercaptopurine (6MP), prednisolone (PSL), CR continued until August, 1982. At the first relapse, reinduction with the combination chemotherapy of behenoyl-Ara-C, DM, VCR, 6MP, and PSL resulted in bone marrow hypoplasia with relative increase of leukemic cells. Thus, high dose Ara-C was administrated intravenously over 2 hours at a dose of 4g every 12 hours for 6 days. After the severe bone marrow aplasia and some side effects, he achieved partial remission. The side effects and sequela associated with high dose Ara-C therapy were acceptable. This case suggested that high dose Ara-C therapy could be applied to a case of leukemia which is refractory to the conventional treatment.View full abstractDownload PDF (408K)
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1984 Volume 25 Issue 5 Pages 724-737
Published: 1984
Released on J-STAGE: January 26, 2009
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1984 Volume 25 Issue 5 Pages 738-744
Published: 1984
Released on J-STAGE: January 26, 2009
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1984 Volume 25 Issue 5 Pages 745-750
Published: 1984
Released on J-STAGE: January 26, 2009
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1984 Volume 25 Issue 5 Pages 751-755
Published: 1984
Released on J-STAGE: January 26, 2009
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