Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 26, Issue 2
Displaying 1-33 of 33 articles from this issue
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  • Treatment of Acute Myelogenous Leukemia with Concurrent Administration of N4-behenoyl-ara-C, Aclacinomycin A, 6-Mercaptopurine and Prednisolone
    Teruo INO, Minoru SAITO, Toshikazu MATSUI, Suzuaki SHIMIZU, Haruhi SHI ...
    1985 Volume 26 Issue 2 Pages 139-146
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.139
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    Thirty-seven patients with acute myelogenous leukemia were treated with a combination of N4-behenoyl-1-β-D-arabinofuranosylcytosine (130 mg/m2 as a 3-hr intravenous infusion), aclacinomycin A (13 mg/m2 as an intravenous infusion), 6-mercaptopurine (70 mg/m2 orally) and prednisolone (40 mg/m2 orally) for remission induction. A course of treatment was continued until the bone marrow became severely hypoplastic not extending over 14 days. Patients who achieved complete remission (CR) received 3 additional courses of consolidation therapy with same drug combination, and maintenance and intensification therapy followed.
    CR was obtained in 20 out of 29 evaluable patients (69%), and the median duration of CR and survival were 8 mo and 15 mo, respectively. Remission rate and its duration, and survival of patients 51 years of age and older were similar to those of patients 15-50 years old. Patients with M4, M5 subtype had a higher remission rate than patients with M1, M2, M3 subtypes combined, but their remission duration and survival appeared shorter. Five out of 6 cases who did not respond prior DCMP therapy attained CR. Central nervous system relapse was observed in 2 out of 20 CR cases. Hematological toxity was a dose limiting factor but this was manageable.
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  • Effect of Plasma Factor on Lymphocyte Surface Markers
    Yoshitatsu SEI, Keiji OKUBO, Kaori YASUDA, Mitsuo YOKOYAMA
    1985 Volume 26 Issue 2 Pages 147-152
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.147
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    The expression of cell surface antigens of human peripheral lymphocytes was affected by a plasma factor.
    Blood samples were collected from 16 healthy subjects including sample with 8 high T4/T8 ratio and other 8 samples with low T4/T8 ratio. Platelet-rich plasma and lymphocytes of both groups were exchanged and incubated in vitro.
    The T4/T8 ratio of the lymphocytes from the high T4/T8 ratio group (M=2.23, SD=0.77) was predominantly decreased (M=1.74, SD=0.44 p 0.005) by mixing with platelet-rich plasma from the low T4/T8 ratio group. In contrast, the T4/T8 ratio of lymphocytes from the low T4/T8 ratio group (=0.92, SD=0.31) was markedly increased (M=1.12, SD=0.39, p 0.005) by mixing with platelet-rich plasma from the high T4/T8 ratio group. The absolute number of lymphocytes were not altered during the procedure. The value was not changed by adding either platelet without plasma or platelet free plasma.
    These results suggested that the appearence of the T4 and T8 antigens on the cell membrane surface are influenced by a plasma containing platelet for the maintenance of immune homeostasis.
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  • Production of Monoclonal Antibodies Against Factor IX and Their Immunological Characterization
    Akira YOSHIOKA, Yoshiaki OHKUBO, Masato NISHINO, Toshiyuki SAKAI, Mits ...
    1985 Volume 26 Issue 2 Pages 153-158
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.153
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    Monoclonal antibodies to human factor IX were produced by immunization of Balb/c mice with purified factor IX and fusion of spleen cells with SP-1 murine myeloma cells. Antibody-producing hybridomas were detected by an enzyme-linked immunosorbent assay (ELISA) using specific polyclonal (rabbit) anti-factor IX and peroxidase conjugated anti-mouse IgG, and by coagulation inhibitor methods (Bethesda). One of them, monoclonal antibody (3A6), with titers of 1×105 tested by the ELISA and 5,000∼8,000 inhibitor units/ml was obtained.
    The antibody possessed only IgG1 heavy chains and pI 6.4 or 6.5. This has high affinity for a coagulation site on factor IX. The activities of factors II, V, VII, VIII, X, XI and XII were not affected in coagulation tests after incubation of normal plasma with 3A6 monoclonal antibody.
    3A6 immobilized on Sepharose can be used to deplete factor IX from plasma. One ml (2 mg of IgG) of the affinity column removed factor IX from 60 ml of normal plasma.
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  • Immunoradiometric Assay of Factor IX Antigen Using Monoclonal Antibody and Classification of Hemophilia B
    Akira YOSHIOKA, Yoshiaki OHKUBO, Masato NISHINO, Toshiyuki SAKAI, Mits ...
    1985 Volume 26 Issue 2 Pages 159-165
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.159
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    A two-site solid phase immunoradiometric assay (IRMA) method was developed using 3A6-monoclonal antibody as a coating antibody to quantitate factor IX antigen (IXAg) in plasma samples from patients with hemophilia B. The results of the new method were compared with those obtained on the same plasma samples using the conventional factor IX coagulation assay and Laurell rocket (electroimmunoassay; EIA) method. The lower limit for the detection of IXAg by the IRMA was 0.1-0.02 u/dl. The lower detection limit for IXAg using EIA was about 10u/dl. The improved sensitivity of the new IRMA enabled quantitation of low levels of IXAg in patients with severe or moderate hemophilia B and comfirmed the presence of excess IXAg compared to IXC in a relatively high proportion of cases (21 out of 39 tested).
    Thirty-nine patients with hemophilia B were classified according to IXAg assayed by IRMA into two types. In 12 cases, there was no detectable IXAg (Type I), and the antigen was present in 27 cases (Type II), which included 5 cases of Type IIa with roughly the same amount of IXAg as IXC, 21 cases of Type IIb with excess antigen, and one case of Type IIc with excess activity. The IRMA using 3A6-monoclonal antibody may provide us with one of the useful tools to elucidate the pathoetiology and pathophysiology of hemophilia B.
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  • Study on the Levels of Anti-A, Anti-B Isoagglutinin Titer in Various Kinds of Concentrates for Hemophilia Treatment
    —with Special Regard to the Manufacturing Process of Factor VIII Concentrate—
    Yukiharu TOMITA, Minoru INAGAKI, Masashi TAKI, Takuma MIURA, Nobuo SAI ...
    1985 Volume 26 Issue 2 Pages 166-170
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.166
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    In order to investigate the cause of hemolysis during the replacement therapy of hemophilia, the study on the levels of anti-A and anti-B isoagglutinin titer was carried out in three commercial factor VIII concentrates, two factor IX concentrates and two activated prothrombin complex concentrates (APCC), respectively. Furthermore, the study on the level of anti-A and anti-B isoagglutinin titer was carried out in the samples of manufacturing process of factor VIII concentrates.
    It was revealed that the concentrate which was produced by the PEG-glycine method showed high level of isoagglutinin titer, while the concentrate which was produced by the DEAE cellulose method showed low level of isoagglutinin titer. Long term observation of Coombs test in three hemophiliacs receiving a large amount of factor VIII concentrate confirmed the above-mentioned results. A positive direct Coombs test was noted in one patient who received the high isoagglutinin concentrate, while direct Coombs test was negative in the other two patients who received both the low isoagglutinin concentrate and blood type specific concentrate.
    The present study indicates that factor VIII concentrate which reveals low isoagglutinin titer can be used in the high dose replacement therapy of hemophiliacs instead of blood type specific concentrate.
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  • Long Term Prognosis of Idiopathic Thrombocytopenic Purpura
    Manabu YAMANAKA, Takeo NOMURA
    1985 Volume 26 Issue 2 Pages 171-176
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.171
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    A long term prognosis of 180 patients with ITP was analysed. Results were quite similar to that obtained from a few years follow up survery for a prognosis of ITP reported previously. A complete remission could be expected when recovery can be obtained within 7 months of onset in cases of acute ITP. Clinical judgment of the effectiveness of splenectomy in chronic ITP could be done at the time of one year after splenectomy.
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  • Antiplatelet Antibody and Circulating Immune Complexes in Patients with Idiopathic Thrombocytopenic Purpura
    Yoshiyuki KURATA, Satoru HAYASHI, Machiko OSHIDA, Tadahiro TSUBAKIO, T ...
    1985 Volume 26 Issue 2 Pages 177-183
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.177
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    Platelet antibodies (PLAB) and circulating immune complexes (CIC) were measured to investigate the role of PLAB and CIC in the mechanisms of thrombocytopenia in patients with idiopathic thrombocytopenic purpura (ITP). These patients had increased amounts of platelet-associated immunoglobulins (PAIG), platelet-binding immunoglobulins (PBIG) and CIC levels. The PBIG or CIC values were found to be no correlation with the platelet counts in contrast with the existence of inverse correlation between the PAIG values and the platelet counts. These results suggest that PBIG and CIC may not be so important factors as PAIG in the mechanisms of thrombocytopenia in patients with ITP.
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  • High-Dose Cytosine Arabinoside in Acute Leukemia: A Cooperative Study
    Akio URABE, Fumimaro TAKAKU, Hideaki MIZOGUCHI, Osamu YAMADA, Yoshihis ...
    1985 Volume 26 Issue 2 Pages 184-188
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.184
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    High-dose cytosine arabinoside (3g/m2 as a 120-min infusion every 12 hours for 6 days) was administered to 30 patients with relapsed refractory acute leukemia with the following results: 12 patients (40%) achieved complete remission, and 5 patients achieved partial remission. The median duration of complete remission was more than 4 months. The toxicity was tolerable, and remission could be achieved even in patients who had failed to respond to cytosine arabinoside in conventional doses.
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  • Five Children with Hemolytic Uremic Syndrome
    —Their Clinical Course and Findings in Coagulation and Fibrinolysis System—
    Junko SUDA, Toshio SUDA, Masayoshi YANAGISAWA, Shigeharu TERUKINA, Yoi ...
    1985 Volume 26 Issue 2 Pages 189-194
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.189
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    Five children with hemolytic uremic syndrome during five years (1976∼1981) were reported. Their clinical courses were various. In two cases, the main problem was gastrointestinal symptoms, and the problem of HUS was transient. In one case, the main problem was CNS disturbance, and at the time of admission there were no findings of thrombocytopenia or uremia but there were findings of hemolysis and decreased GFR. In other two cases, they had high levels of blood urea nitrogen and creatinine, which were normalized without a specific treatment such as peritoneal dialysis or blood dialysis. Coagulation and fibrinolysis examinations of these 5 cases revealed prolonged PT and PTT in one case, high levels of fibrinogen in 3 cases, decreased plasminogen in one case, and decreased anti-thrombin III activity in 2 cases. FDP in blood and urine was detected in examined all cases. There were thrombocytopenia except one case. These findings showed widespread variations of coagulation and fibrinolysis as well as their clinical courses.
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  • Gas Producing Cellulitis in a Case with Acute Lymphoblastic Leukemia
    Akimichi OHSAKA, Akihiro TSUBOYAMA, Keiichi SUDA, Masaji MAEZAWA, Kazu ...
    1985 Volume 26 Issue 2 Pages 195-200
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.195
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    We report a case of 23-year-old female with acute lymphoblastic leukemia (ALL) terminating in gas producing cellulitis presumably due to gram-negative bacterial infection. She was diagnosed as having ALL (null cell type, TdT positive) on April 24, 1980, at Jichi Medical School Hospital and achieved complete remission (CR) with the administration of five courses of VP therapy consisting of vincristine and prednisolone. On March 11, 1981, she was admitted to the hospital for the third time because of relapse. Despite of several courses of various combination chemotherapy, she failed to achieve CR. When her granulocyte count became almost zero in August, she complained of high-grade fever and a pain in the perianal region. She was found to have a rapidly progressive perianal cellulitis. On August 27, 1981, subcutaneous emphysema developed in bilateral forearms and inguinal regions, and septicemia due to gas producing microorganisms was suggested. In spite of an intensive combination therapy of antibiotics, her condition rapidly deteriorated, and she expired on that day.
    At autopsy bone marrow was marked hypocellularity with scattered foci of leukemic cells. It was to be noted that subcutaneous and mediastinal emphysema, and generalized bacterial embolism, prominent in the liver, kidneys, lungs, and rectum were detected. Postmortal bacterial culture revealed Klebsiella pneumoniae, although the anaerobic culture technique carelessly was not performed. These findings may suggest a possibility that in this case K. pneumoniae produced gas in many organs.
    Although gas producing infection is a relatively rare complication of leukemia, we should always keep in mind the gas producing cellulitis and abscess.
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  • Acute Leukemia with Different Cytochemical Findings in Bone Marrow and Lymph Node
    Itsuki OMORI, Chihiro SHIMAZAKI, Akira NISHIO, Harue HARUYAMA, Takuji ...
    1985 Volume 26 Issue 2 Pages 201-205
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.201
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    A case of a 41-year-old man with systemic lymphadenopathy was evaluated from cytochemical findings of leukemic cells and clinical responses for anti-leukemic agents. At first, diagnosis of acute myeloblastic leukemia was made based upon the routine morphological examination of the peripheral blood and the bone marrow specimen. In further examination, the myeloid feature was demonstrated in the leukemic cells of the bone marrow, in contrast to the lymphoid feature in those of the lymph node, supporting the diagnosis of mixed leukemia. Furthermore, cytogenetic study showed almost same karyotypic abnormalities including a ring chromosome, which suggested the leukemic transformation on the near level of pluripotent stem cell.
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  • A Case of Acute Myelocytic Leukemia Complicated with Intracerebral Leukemic Tumor
    Takehiko KONDA, Toshifumi YASUYAMA, Mamoru NAKANO, Kyoichi INOUE, Hiro ...
    1985 Volume 26 Issue 2 Pages 206-211
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.206
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    A case of acute myelocytic leukemia (AML) complicated with intracerebral leukemic tumor is reported.
    A 45 year-old housewife was found to be anemic during medical examination in October, 1981. She was treated for anemia from December 2. Because of continuing fever and general malaise, she was transferred to the Toyama Medical and Pharmaceutical University Hospital on December 21. She was diagnosed as AML (FAB classification M2) by hematological examination, and the DCMP two-step therapy was immediately started. Despite good response to the therapy, she complained of vertigo, nausea, vomiting and cerebellar signs early in August, 1982. Brain computed tomographic examination revealed a high density area near the cerebellar vermis, and diagnosis of meningioma was made. Because her symptoms became worse, she was operated on August 24. The resected tumor had brown color and smooth surface. The size of tumor was 4.5×3.0×2.5 cm and the weight was about 10 g. Histologically, the tumor consisted of a mass of leukemic cells combined with proliferated reticulin fibers. Histological diagnosis was leukemic tumor. One and half month after the operation she died of pulmonary hemorrhage.
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  • A Case of Autoimmune Hemolytic Anemia Associated with Ovarian Dermoid Cyst
    Kimiaki IKEDA, Yasuhiro IMAZONO, Yoshinori SHIMAMOTO, Hiroyuki SATO, S ...
    1985 Volume 26 Issue 2 Pages 212-216
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.212
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    Autoimmune hemolytic anemia (AIHA) associated with ovarian dermoid cyst is presented. A 40-year-old woman was admitted because of anemia and jaundice in August, 1981. Normocytic normochromic anemia with reticulocytosis and hypercellular bone marrow with marked erythroid hyperplasia was observed. LDH1,2 and indirect bilirubin were elevated and serum haptoglobin level was low. Direct Coombs' test was positive. The patient was diagnosed as warm type AIHA. The IgG was assinged anti-e specificity. Ovarian dermoid cyst was found by body CT. Although prednisolone were effective moderately, anemia was markedly improved after removal of the ovarian dermoid cyst. The positive Coombs' test turned to be negative 3 months after operation. No significant antibody against the patient's RBC was detected both in the cyst fluid and in the supernatant of the cultured cells from the cyst.
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  • Acute Lymphocytic Leukemia, Complicated with Generalized Cryptococcosis Successfully Treated by Amphotericin B; A Case Report
    Tetsuhito KOJIMA, Miwako MATSUZAKI, Masayuki SANO, Hisamitsu SUZUKI, Y ...
    1985 Volume 26 Issue 2 Pages 217-222
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.217
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    A case of ALL (acute lymphocytic leukemia), complicated with generalized cryptococcosis was treated successfully by amphotericin B.
    A 63 years old woman had been febrile since February, 1983. A diagnosis of ALL (FAB; L2) was established and a remission induction chemotherapy with THP-adriamycin, vincristine and prednisolone was begun on March, 3. Thereafter she went into CR (complete remission) on May, 6, but generalized cryptococcosis developed. Cryptococci were found in blood, subcutaneous. tissue and cerebrospinal fluid. Amphotericin B and 5-fluorocytosine were administered, then meningitis and skin lesions were improved markedly. However, because of side effects, amphotericin B was replaced by ketoconazole or miconazole. Then, skin lesions were relapsed and brain small abscesses developed. Therefore, an administration of amphotericin B was restarted and generalized cryptococcosis was nearly cured. Seven months latter. amphotericin B was discontinued and no relapse of cryptococcosis was seen up to date.
    CR for ALL was maintained by vincristine only throughout the course.
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  • An Autopsy Case of Chronic Myelomonocytic Leukemia After a Long-term Follow-up
    Fumio KAWANO, Hirotsune NOMURA, Michio HIHUMI, Koichi ARAKI, Masato US ...
    1985 Volume 26 Issue 2 Pages 223-228
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.223
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    We report a case of chronic myelomonocytic leukemia (COMMoL) which has been followed for 7 years and 4 months after onset. This case was considered to have the longest survival among the cases of CMMoL reported in Japan.
    A 54-year-old male first noted bleeding tendency in January, 1975. At that time peripheral blood examination showed platelets 49×103/cmm and WBC 6,250/cmm with 16% monocytes. Accordingly, the absolute monocyte number was 1,000/cmm. Monocytosis persisted, and the absolutel monocyte number increased to 5,000/cmm in Apri, 1980.
    In March, 1981, he was admitted to our hospital because of high fever and left hypochondralgia. On admission the spleen and liver were palpable 3 cm and 4.5 cm below the costal margins, respectively. The bone marrow showed slight hypercellularity with and an increase of granulocytes and monocytoid cells. The monocytoid cells showed moderately positive peroxidase reaction and positive non-specific esterase activity. Regarding phagocytosis, surface markers (Fcγ and C 3 receptors) and chemotaxis, they did not differ appreciably from the normal monocytes.
    He died of an unexpected accident in April, 1981 and autopsy was performed. The spleen and liver were enlarged, weighing 445 and 1,750 g, respectively. The infiltration of mononuclear cells was seen moderately in the liver and slightly in the spleen. In the bone marrow, immature granulocytes and monocytoid cells proliferated but were not monotonus.
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  • Autologous Bone Marrow Transplantation in a Patient with Lymphoma Type Adult T Cell Leukemia
    Norio ASOU, Kenji SAKAI, Kazunari YAMAGUCHI, Fumio KAWANO, Mituaki YOS ...
    1985 Volume 26 Issue 2 Pages 229-233
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.229
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    A 62-year-old female with lymphoma type adult T cell leukemia (ATL) was treated by high dose chemoradiotherapy and autologous bone marrow transplantation.
    67Ga scan and CT scan disclosed only left cervical lymphadenopathy. Abnormal cells and HTLV proviral DNA were demonstrated in lymph node cells, but not in peripheral blood lymphocytes or bone marrow cells.
    By local irradiation and combination chemotherapy, left cervical lymph node disappeared. Prior to transplantation, she was given large dose cyclophosphamide and 10 Gy total body irradiation. On March 7, 1984, cryopreserved autologus bone marrow cells were thawed and infused into the patient.
    Five weeks after transplantation, granulocytes and platelets were restored. In the next week, however, ATL cells appeared in the peripheral blood, and the patient died of hypercalcemia and acute renal failure.
    Autologous bone marrow transplantation may be one approach for the treatment of lymphoma type ATL.
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  • Candidiasis of the Liver in two Patients with Acute Promyelocytic Leukemia During Initial Remission Induction
    Ikuo MIURA, Yasunori KIMURA, Akira MIURA, Tsutomu WATANUKI
    1985 Volume 26 Issue 2 Pages 234-240
    Published: 1985
    Released on J-STAGE: February 02, 2009
    DOIhttps://doi.org/10.11406/rinketsu.26.234
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    Candidiasis of the liver developed during the initial remission induction treatment in two patients with acute promyelocytic leukemia. Both patients experienced abdominal pain, high fever and hepatomegaly, and the second patient developed strikingly elevated serum alkaline phosphatase (ALP). Ultrasonography demonstrated intrahepatic lesions of increased echogenecity and CT scan revealed low-density areas without contrast enhancement. A quantitative measurement of anticandida antibody level confirmed that deep-seated candida infection had occured. The second patient underwent treatment with amphotericin B, 5-FC and minocycline without success. It is important to make prophylactic use of amphotericin B in patients with acute leukemia even during initial remission induction therapy.
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