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Volume 26, Issue 9
Displaying 1-19 of 19 articles from this issue
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3. Clinical and pathological diagnosis of T- and B-lymphoma and its stagingMasanori SHIMOYAMA, Keisuke MINATO, Shigeki SEKI, Masami NAGAI, Takeak ...1985 Volume 26 Issue 9 Pages 1419-1429
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSSurvival time of the patients with T- or B-lymphoma was analyzed with respect to clinical and pathological diagnoses and clinical stage. In T-cell lymphomas, prognosis of the patients with adult T-cell leukemia/lymphoma, immunoblastic lymphadenopathy-like T-cell lymphoma, or lymphoblastic T-lymphoma was found to be worse with median survival time of 4, 7 and 18 months, respectively, than that of those with usual T-lymphoma or cutaneous T-cell lymphoma, who were expected to survive more than 5 years in more than 40% of the cases. In B-lymphoma, more than 70% of patients with follicular B-lymphoma and only about 25% of those with diffuse B-lymphoma are expected to survive for more than 5 years. In follicular B-lymphoma, 90% of patients with Waldeyer's ring B-lymphoma and 50% of those with nodal B-lymphoma are expected to survive for more than 5 years, while in diffuse B-lymphoma, about 35% of patients with Waldeyer's ring B-lymphoma and only 17% of those with nodal B-lymphoma are expected to survive for more than 5 years. Survival time was much influenced by cell morphology in both T- and B-lymphomas. As tumor cell size becomes larger and more pleomorphic, survival time becomes shorter. However, in the same morphologic category, prognossi was worse in T-lymphomas than in B-lymphomas. Clinical stage was not found to have much influence on prognosis of T- and B-lymphoma except some of extranodal T- and B-lymphomas. These results suggest that primary site of tumor, clinical diagnosis and pathological classification of T- and B-lymphoma are more important prognostic factors than clinical stage.View full abstractDownload PDF (760K) -
Tatsuhiko AMAGASAKI, Saburo MOMITA, Junji SUZUYAMA, Yasuaki YAMADA, Sh ...1985 Volume 26 Issue 9 Pages 1430-1435
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSThe incidence of human T-cell leukemia virus (HTLV) carriers was examined in the Nagasaki district, which is known to be an ATL endemic area. Sera from 125 (11.0%) of 1138 adults were revealed to be positive for antibodies against ATL-associated antigen (ATLA) using the indirect immunofluorescence method. In short-term culture, lymphocytes from 20 (23.0%) of 87 carriers expressed ATLA detected by indirect immunofluorescence method.
May-Giemsa stained films were prepared from the peripheral blood of 85 HTLV carriers and 54 sero-negative controls without the use of anticoagulant, and lymphocytes with nuclear irregularity such as indented, binuclear and lobulated forms were counted. The percentage of these irregular lymphocytes were relatively higher in HTLV carriers (2.4% of 100 lymphocytes) than in seronegative controls (1.8% of 100 lymphocytes). Furthermore, HTLV carriers whose lymphocytes expressed ATLA in short-term culture showed significantly higher percentage of irregular lymphocytes (4.0% of 100 lymphocytes). It was suggested that there exist some persons with considerable number of irregular lymphocytes, mimicking the morphology of ATL cells, in HTLV carriers.View full abstractDownload PDF (808K) -
Teruo INO, Naoya ITO, Nobuhide TAKEDA, Shoichi SHIRAKAWA, Kachiko MORI ...1985 Volume 26 Issue 9 Pages 1436-1442
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESS111Indium chloride (111In-Cl3) appears to be a radionuclide appropriate for a bone marrow scanning because of its physical and chemical characteristics; it is, like iron, bound to and transported by transferrin and it has a photopeak suitable for scintigraphy. This study was undertaken to assess the bone marrow function by 111In-Cl3 bone marrow scintigraphy in patients with asplastic anemia.
Bone marrow scintigraphy was performed in 21 patients with aplastic anemia with varying degrees of severity including 15 who had no previous treatments. The scintigrams were taken 48 hours after intravenous injection of 111 MBq (3mCi) of 111In-Cl3. All of them showed various degrees of reduction in uptake of 111In-Cl3 by the marrow. The abnormal scan grade was classified into 3 types: Type I, non-accumulation (5); Type II, low-accumulation (15); Type III, uneven accumulation (1). In type III, degree of radioisotope accumulation between the sternum and the ilium was different, and this difference correlated with that of bone marrow cellularity. In 2 patients of type II, hematological improvement occurred after treatment, which was also accompanied by simultaneous increase of 111In-Cl3 uptake by the marrow. These findings suggested that the degree of radioisotope accumulation in the marrow reflects that of bone marrow cellularity. Type I patients were clinically severe and poor in prognosis as compared to type II and type III patients; four out of 5 died with in 2 months. Bone marrow transplantation may be the treatment of choice in type I patients when feasible.View full abstractDownload PDF (924K) -
Hiroyuki TSUCHIYA, Hiroyuki NUNOI, Izumi AKABOSHI, Shigenori HIGUCHI, ...1985 Volume 26 Issue 9 Pages 1443-1450
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSDifferences in cellular proteins were analyzed by two-dimensional gel electrophoresis (O'Farrell) between lymphoblasts of acute lymphocytic leukemia (ALL, N=4) and normal lymphocytes (N=4). Approximately 240 spots were detected in the gel with normal lymphocyte lysate samples and 350 in lymphoblast cell lysate samples. However, 3 spots in the normal samples and 5 spots in the lymphoblastic cell samples, especially in the onset stage, were missing some of cases. Seventy-one spots, which were stained dark and large in size (major spots), were found in normal lymphocytes and lymphoblastic cell samples. Among them, 5 spots were characteristic of normal lymphocyte samples and 9 spots lymphoblastic samples. Lymphocytes obtained from patients in complete remission still retained some of the leukemic modifications in the cellular proteins. There is a possibility that some of these spots are related to the leukemic change itself.View full abstractDownload PDF (1091K) -
Hideki IFUKU, Yokiko OHE, Shunro KAI, Hiroshi HARA, Kiyoyasu NAGAI, Ta ...1985 Volume 26 Issue 9 Pages 1451-1457
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSNatural Killer (NK) cell activity was studied in peripheral blood lymphocytes after bone marrow transplantation (BMT). NK cell activity rapidly increased and reached nearly normal values between day 30 and 50 in all of the patients with BMT. On long survivors, allogeneic BMT patients had lower NK activity than autologous and syngeneic BMT patients. Furthermore, interferon enhanced NK activity of autologous and syngeneic BMT patients, while it did not enhance in allogeneic BMT patients. Recently, NK cells are considered to participate in the immune surveillance against tumors and virus infected cells. Our studies indicate that a significant difference was found when recovery of NK activity was compared between allogeneic and autologous (syngeneic) BMT, and that the frequency of infections and tumors may appear to be higher in patients with allogeneic BMT.View full abstractDownload PDF (507K) -
Mayumi MORI, Kanichi KURATA, Kenji IKEBUCHI, Makiko FUKAYAMA, Akiyoshi ...1985 Volume 26 Issue 9 Pages 1458-1462
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSThe therapeutic effect of malignant lymphomas (MLs) of aged patients (70 year-old over) were studied. The studied cases were consisted of eighteen, all non-Hodgkin's, nine T cell MLs, and nine B cell MLs, and in stage III and IV. T-cell MLs were treated with various doses of BACOP: two with 2/3 dosage, four with 1/2 and three with 1/3. Their complete remission rate was 56% as a whole and the median survival was four months. All patients with 2/3 dosage treatment represented severe myelosuppression and died from sepsis. In other case of T cell MLs, the degree of myelosuppression was mild but for two cases, the one with hypoplastic marrow from the beginning and the other with low level of creatinine clearance. Other severe adverse reactions were ileus and SIADH. Nine B cell MLs were treated with various regimens mainly consisting of cyclophosphamide, vincristine and predonisolone. Complete remission rate of these cases was 44% and median survival was 18 months, which were lower and shorter than the values of younger patients. They did not have any severe adverse reaction.View full abstractDownload PDF (393K) -
Toshio YAMAZAKI, Munehiro YAMAZAKI, Kozo YASUI, Atsushi KOMIYAMA, Taro ...1985 Volume 26 Issue 9 Pages 1463-1466
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSClinical, hematologic, and immunologic studies were performed on five children with defective monocyte chemotaxis. The five patients were among about 100 children with a history of recurrent infections who were studied for monocyte chemotaxis in Shinshu University Hospital, and included siblings (sister and brother) with primary monocyte dysfunction, one with Chédiak-Higashi syndrome and two with hyper-IgE syndrome. In all of the patients, candidiasis was recurrent and delayed type hypersensitivity was absent. These results indicated that these clinical features were characteristic in patients with defective monocyte chemotaxis.View full abstractDownload PDF (319K) -
Mine HARADA, Mikio UEDA, Shinji NAKAO, Kunio KONDO, Shigeki OHTAKE, Ka ...1985 Volume 26 Issue 9 Pages 1467-1474
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSConsecutive twenty-five patients with acute leukemia including 10 with acute lymphoblastic leukemia (ALL), 12 with acute non-lymphocytic leukemia (ANL) and 3 with leukemic non-Hodgkin's lymphoma were treated with high-dose cyclophosphamide and 10 Gy total body irradiation followed by bone marrow transplantation from 23 HLA-identical and one HLA-mismatched sibling donors and one identical twin donor. The patients ranged from 9 to 46 yr in age (the median, 31 yr). Eleven patients were transplanted at relapse and 14 during complete remission. At the time of analysis (January 15, 1985), 6 transplant patients are alive in unmaintained remission 80, 46, 32, 25, 14 and 9 mo respectively posttransplant. Another patient developed relapse and is now surviving in partial remission 14 mo after transplantation. Primary causes of death in 18 patients were as follows: Interstitial pneumonia in 8 patients, leukemic relapse in 4, hepatic veno-occlusive disease in 2, sepsis in 2, acute GVHD in 1 and chronic GVHD associated with pneumonia in 1. When results were analysed in relation to 1 yr survival, factors such as patient's age, donor's age, type of acute leukemia and clinical condition at transplantation were associated with the survival. The younger age of the patients and transplantation during remission are two favorable factors. These are also important factors affecting early death. Among transplantation-related complications, interstitial pneumonia is one of the most important problems to be solved because it was closely associated with early death. Both acute and chronic GVHD had no effect on early death or 1 yr survival. These observations suggest that long-term survival will be highly expected in younger patients with acute leukemia when bone marrow transplantation is performed during remission.View full abstractDownload PDF (635K)
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Hiromi YASHIGE, Kazuhiro NISHIDA, Shigeo HORIIKE, Shohei YOKOTA, Yuji ...1985 Volume 26 Issue 9 Pages 1475-1480
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 20-year-old Japanese male was admitted to a hospital on 26th February, 1983, under the diagnosis of acute myelogenous leukemia (AML-M2). By September, complete remission was achieved with the sequential BH-AC·DMP and DCMP therapy. In October, he noticed testicular swelling and was admitted to our hospital. On admission, right testis was swollen 7.5×7.5×2.5 cm in size and left testis 4.0×2.5×2.5 cm. Open biopsy of the testis showed marked infiltration of leukemic blasts in the interstitium. Leukemic blasts were 4% of 3,300/mm3 white blood cells in the peripheral blood and 26.0% of 4.5×104/mm3 nucleated cells in the bone marrow. None of BH-AC·DMP, small dose Ara-C, or BH-AC·AMP therapy was effective. On 16th December, he developed high fever, and complained of palpitation and dyspnea. On 18th he died of heart failure due to fungal myocarditis. Chromosome analysis showed a 46, XY, t(8;21)(q22;q22) karyotype.View full abstractDownload PDF (980K) -
Norio KOMATSU, Nobuhiko YOSHIDA, Akihiro TSUBOYAMA, Kazuo KUBOTA, Shin ...1985 Volume 26 Issue 9 Pages 1481-1485
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 21-year-old pregnant woman was admitted to the hospital of Jichi Medical School in March 1984, with a history of petechiae on lower extrimities, and gingival and nasal bleeding. Physical examination revealed anemia, and petechiae on anterior chest and lower extremities. The platelet count was 7,000/μl. She was diagnosed as having a 17th week of pregnancy and idiopathic thrombocytopenic purpura by physical and laboratory findings. An administration of predonisolone (1 mg/kg/day) resulted in a transient increase in the number of platelets, so high-dose immunoglobulin (400 mg/kg/day) was given to the patient for 5 days from the 20th week of pregnancy. The number of platelets reached to a maximal level of 51,000/μl but the increase was only transient. Another two courses of immunoglobulin infusion and a course of prednisolone therapy (1.3 mg/kg/day) were repeated because of aggravation of bleeding tendency. However, those therapies failed to maintain the platelet count over 10,000/μl. The 4th course of high-dose immunoglobulin therapy was begun with an increase in the number of platelets (50,000/μl) and the patient underwent Caesarean operation in the 34th week of pregnancy. A baby-girl (2,695 g) was successfully obtained and a maternal splenectomy was done at the same time. The platelet level of the baby was normal. The platelet count of the patient was increased thereafter, reaching a level of more than 200,000/μl by 2 weeks after the procedures.View full abstractDownload PDF (360K) -
—Immune Suppression of Erythroid Progenitor Cells in the Presence of the Patient's Serum—Naoki TACHIBANA, Norio ONODERA, Yasuhiko IKEDA, Etsuro ITO, Takakazu M ...1985 Volume 26 Issue 9 Pages 1486-1490
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 2-year-old boy was admitted to Hirosaki University Hospital with complaint of pallor in July 1984. The diagnosis of transient erythroblastopenia was made from his severe normocytic, normochromic anemia, reticulocytopenia and erythroblastopenia of bone marrow. Spontaneous recovery was seen one month after initial diagnosis.
In order to determine the mechanism of anemia, we used an in vitro technique for erythroid progenitor cells (CFU-E). Numbers of colonies from normal marrow CFU-E were significantly reduced by the addition of the patient's serum on admission. There was no suppression of colony growth when the patient's serum after recovery was added to the culture.
These findings suggest that transient severe anemia is due to immune suppression of erythropoiesis.View full abstractDownload PDF (351K) -
Mikiro ISEKI, Makoto HIROSE, Shimpei NAKAZAWA1985 Volume 26 Issue 9 Pages 1491-1495
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSTwenty-four cases of May-Hegglin anomaly in one family is reported. This family is the largest one ever reported from Japan.
Their ages ranged from 3 to 79 years and their platelet counts ranged from 2.8×104/μl to 20.3×104/μl. Twenty-three cases were examined for their giant platelets and Döhle like inclusion bodies. All 23 had the giant platelets and 18 of the 23 had Döhle like inclusion bodies in their granulocytes. Seventeen of the 23 (74%) had mild bleeding tendency manifested by purpura and epistaxis.
Five had coagulation studies, including bleeding time, clot retraction, platelet retension by glass beads and aggregation by ADP, collagen, ristocetin and fibrinogen, which were all normal. In one, aggregation by epinephrine was diminished. The diminished aggregation was reproducible in two different concentrations of epinephrine in the presence of normal platelet counts.View full abstractDownload PDF (485K) -
Motoharu SANO, Tsuyoshi NAKAMAKI, Takuo MIYASHITA, Shigeru TOMOYASU, N ...1985 Volume 26 Issue 9 Pages 1496-1500
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSHigh-dose gamma glbulin was used in two patients with acute leukemia accompanied with thrombocytopenia resistant to platelet transfusions. The first case was a 52-year-old man with acute myeloblastic leukemia. After combination chemotherapy, platelets were decreased to 3,000/cmm. In spite of numerous platelet transfusions, platelets were not increased, and the antiplatelet antibody was detected. High-dose of gamma globulin (0.4 g/kg daily for 4 days) was administrated intravenously according to the method of Imbach et al. in the patients with idiopathic thrombocytopenic purpura. Platelet counts rose more than 100,000/cmm during 7 days. The second case was 63-year-old woman with acute lymphoblastic leukemia associated with thrombocytopenia. She was treated with platelet transfusions, but she suffered chills with fever and failed to rise platelet counts. Chills and decreased platelet counts were improved after a high-dose gamma globulin treatment. Intravenous gamma globulin therapy may reduce platelet transfusion reactions and rise platelet counts in thrombocytopenia caused by alloantibody.View full abstractDownload PDF (363K) -
Haruhiko TAKAYAMA, Jingo KAGEYAMA, Soji OKADA, Shinya SUZUKI, Zensuke ...1985 Volume 26 Issue 9 Pages 1501-1505
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 71 year-old woman was admitted to Okayama University Hospital because of head tumors in February 1984. A tumor biopsy revealed a diffuse lymphoma (large cell type by the LSG classification) of the bone.
Although malignant lymphomas are usually considered to be tumors of the lymph node, 25% to 33% of lymphomas are considered to be of extranodal origin. A malignant lymphoma of the bone is quite rare and its rate is reported as 1.4% of all extranodal lymphomas.
She was treated by two courses of CVP regimen and five courses of CHOP regimen, but she did not respond favorably to treatment. She was thus treated by a new experimental combination chemotherapy: cisplatin, mitoxantrone, etoposide and prednisolone. This new treatment appeared effective and she has been in partial remission with the disappearance of her tumors, decrease of lymphadenopathy and normal ALP and LDH level.
We think this combination chemotherapy may be useful in cases resistant to standard chemotherapy, as salvage therapy.View full abstractDownload PDF (650K) -
Shizuo YOSHIMOTO, Kenji YAMATO, Takao KITAGAWA, Masatoshi FUJISHITA, M ...1985 Volume 26 Issue 9 Pages 1506-1511
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 54-year-old man was admitted with fever, generalized lymphadenopathy, and skin eruption. A diagnosis of IBL was mode on laboratory data and histological findings of inguinal lymph node. The serum antibody titer to EBV VCA (IgG) on admission, 4, and 6 months after admission was 1:160, 1:1, 280, and 1:640, respectively. About one year after admission, he developed dysorientation and Jacksonian seizures. A brain CT scan demonstrated large intracranial tumor masses. Their histological diagnosis was malignant lymphoma, diffuse, mediumsized cell type. Immunological analysis of the tumor cells revealed a phenotype of E-, Leu-1-, Leu-2a-, Leu-3a-, OKIa1+, B1+, J5-, SIg-, CpIg-, TdT-, and EBNA-. The EBV genome was detected in the fresh lymphoma cells by the DNA hybridization method. Three months later, the patient died and lymphoma involvement was seen in the cerebrum, cerebellum, tongue, right axillary soft tissue, and right kidney. Malignant lymphoma has been recently reported among immunodeficient individuals such as organ transplant recipients and some of them are associated with EBV. Our patient developed EBV-positive lymphoma during the course of IBL and EBV appears to have played a causative role in the lymphomagenesis in this case.View full abstractDownload PDF (638K) -
Masato IIDA, Yoshio KANAYAMA, Shizuya YAMASHITA, Mitsunobu OHNISHI, Ju ...1985 Volume 26 Issue 9 Pages 1512-1515
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSWe describe a rare case of fatal outcome in an adult patient with idiopathic thrombocytopenic purpura (ITP). A 27-year-old female was admitted to Osaka University Hospital on July 15, 1983, at the 9th day from an abrupt appearance of fever and generalized bleeding tendency including epistaxis, petechiae and gingival bleeding. She was diagnosed as having ITP by the decreased platelet count (0.5×104/μl), hypercellular bone marrow with immature megakaryocytes and elevated level of platelet-associated IgG. Intensive therapy with corticosteroid, high doses of gammaglobulin, platelet transfusions and plasma exchange, did neither increase the platelet count nor improve her condition. She became unconscious on July 17, and died of intracranial bleeding on July 21. Autopsy findings supported the diagnosis of ITP, excluding the possibility of DIC or TTP. This case is an exceptionally severe case, which followed a clinical course of fulminant ITP with severe hemorrhagic diathesis resistant to any treatment. The high fever which persisted during the entire course remains unexplained. This fever might be related to the pathogenesis of the rapidly deteriorating course.View full abstractDownload PDF (324K) -
Akira SHIBUYA, Ki-ichi SAITOH, Seitoku FUJIOKA1985 Volume 26 Issue 9 Pages 1516-1519
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA family of congenital factor XI deficiency, which is rare except in persons of Jewish origin, is reported.
The propositus was a 46-year-old female with a past history of bleeding episodes. She had a bleeding tendency from small cuts. At the age of 16, she got hemorrhage in a thigh muscle after a tumble. She had excessive bleeding following surgical procedures such as tonsillectomy at the age of 28 and gastric polypectomy at the age of 43.
Coagulation studies revealed marked prolongation of blood coagulation time, APTT and plasma recalcification time, while prothrombine time and thrombin time were within normal limits. Factor XI activity was under 5% of normal, but all other factor activities determined were normal. Family study of factor XI activity disclosed following results: her father 42%, her sister 60%, her sister's daughter 44%, her sister's son 72% and her brother's son 115%. None of them had past history of bleeding manifestations.
It was considered that the propositus was major PTA deficiency and her father, sister and sister's daughter were minor PTA deficiency.View full abstractDownload PDF (272K) -
—A Case Report and Review of Literature—Akimichi OHSAKA, Akihiro TSUBOYAMA, Yasuhiko KANO, Shinobu SAKAMOTO, Y ...1985 Volume 26 Issue 9 Pages 1520-1525
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 64-year-old male was admitted to Department of Urology, Jichi Medical School Hospital, because of asymptomatic swelling of the right testis. He underwent orchiectomy on March 2, 1984. Histological examination of the removed tumor disclosed non-Hodgkin's lymphoma (NHL), diffuse, medium sized cell type (Lymphoma Study Group). He moved to our department for further evaluation.
Physical examination revealed bilateral inguinal lymphadenopathy. Histological examination of the lymphnode obtained by biopsy disclosed no involvement of NHL. The level of serum lactate dehydrogenase (LDH) was initially high, but its level was normalized following orchiectomy. Examination by chest X-ray, lymphangiography, abdominal ultrasonography performed before orchiectomy were normal. Examination of films of Gallium-67 scan, computed tomography, bone scan, liver-spleen scan, and barium study of the upper gastro-intestinal tract which were performed after orchiectomy revealed no abnormalities. Histology of bone marrow obtained by trephine biopsy was normal. Therefore, this case was considered to have clinical stage IE lymphoma.
In April, para-aortic lymphnode swelling was detected by ultrasonography, and LDH level elevated again. The patient was irradiated to para-aortic and pelvic fields in a total dose of 30.4 Gy. Thereafter, chemotherapy was initiated with cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP). He remained in complete remission for 12 months.
In the literature, the prognosis of patients with testicular NHL has been poor. In most of the patients, lymphoma was initially localized to the testis, but generalized dissemination of the disease developed within a short time. Therefore, besides orchiectomy and radiation therapy, systemic chemotherapy appeared to play a role in the treatment of the most patients with testicular NHL.View full abstractDownload PDF (679K)
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1985 Volume 26 Issue 9 Pages 1526-1552
Published: 1985
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (2527K)
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