Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 27, Issue 1
Displaying 1-19 of 19 articles from this issue
  • (3) Therapy of Adult T-cell Lymphoma
    Kenichiro KINOSHITA, Shuichi IKEDA, Saburo MOMITA, Hisashi SODA, Junji ...
    1986 Volume 27 Issue 1 Pages 1-7
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    The survival period and effect of chemotherapy of 46 cases with T-cell malignant lymphomas (T-ML) which included many cases with adult T-cell lymphoma were analyzed.
    The results were as follows;
    1) Fifty percent survival of 46 cases with T-ML from the start of chemotherapy was 10 months. Statistical analysis revealed that the prognosis of the patients was not correlated with histologic subtypes according to the LSG criteria, but adversely with the levels of serum LDH before chemotherapy (p<0.05).
    2) Those cases who achieved complete remission, whose LDH levels (LDH≥600 U before chemotherapy) decreased to less than 300 U (normal range; 202∼435 U) by 2 months after start of chemotherapy, in whom Adriamycin (ADM) of more than 40 mg weekly was given at least over 2 weeks in VEPA therapy, and in whom total administration doses of ADM were more than 180 mg by 2 months after the start of chemotherapy, survived significantly longer than the patients who did not achieve above-mentioned items. Administration of ADM more than 40 mg weekly at least over the periods of 2 weeks in VEPA therapy, decrease of serum LDH level to less than 300 U (target point), and total administration doses of ADM more than 180 mg during the period of induction chemotherapy of T-ML, were proposed as strategy to improve the complete remission rate and survival of T-ML.
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  • Fumio BESSHO, Hiroshi KINUMAKI, Shunichiro YOKOTA
    1986 Volume 27 Issue 1 Pages 8-12
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    Ninety-two children with idiopathic thrombocytopenic purpura (ITP) visited the Department of Pediatrics, the University of Tokyo Hospital during 23 years from 1962 to 1984. We compared clinical pictures of acute ITP and chronic ITP and examined the effects of glucocorticoid on the course of acute ITP.
    Male to female ratios were 22/12 for acute ITP and 21/25 for chronic ITP. Age at onset was younger in acute ITP than chronic ITP. Thirty of 33 acute ITP were younger than 6 years old but only 26 of 45 cases of chronic ITP was so. There was no difference in platelet counts at diagnosis between acute ITP and chronic ITP. Presumed causes were found in 25 of 34 cases of acute ITP and 12 of 46 cases of chronic ITP.
    Of 14 cases of acute ITP treated with glucocorticoid, 8 recovered within 1 month but recovery of remaining cases was slow. Initial recovery of untreated 19 cases was prone to be delayed but 18 of them recovered within 3 months.
    None had intracranial hemorrhage or died.
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  • —Correlation with Prognosis—
    Hiroshi KINUMAKI, Fumio BESSHO, Shunichiro YOKOTA, Shuki MIZUTANI, Hid ...
    1986 Volume 27 Issue 1 Pages 13-17
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    The results of follow-up study of 27 children with acute lymphocytic leukemia, in whom cytological examination of the cerebrospinal fluid (CSF) was performed at the time of initial diagnosis, were described. Leukemic cells were found in CSF of 12 cases (CNS (+) group), including 9 cases with normal CSF cell counts, and not found in CSF of 15 cases (CNS (-) group). Complete remission was attained in all cases and the long-term prognosis was not different between the two groups. Seven cases of CNS (+) group and 10 cases of CNS (-) group remain in continuous complete remission for 22∼91 months. It is possible that the prognosis of CNS (+) group was improved by the aggressive CNS therapy for this group. CNS leukemia as an initial relapse occurred not only in CNS (+) group (2 cases) but also in CNS (-) group (2 cases). This fact indicates that the sensitivity of our cytological examination is still not adequate and the CNS involvement must be present at the time of diagnosis of leukemia in almost all cases.
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  • Tetsuji KOYAMA, Ichiro WAKABAYASHI, Eizo KAKISHITA, Kiyoyasu NAGAI, Ak ...
    1986 Volume 27 Issue 1 Pages 18-21
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    We reported earlier that transient hypotention, shock and DIC occur following injection of about 20,000 units of thrombin into esophageal varices for endoscopic embolization. The hypotention and shock seem to be associated with the formation of microthrombi because their onset coincided with decreases in fibrinogen and platelets at a very early stage of DIC. In the present study, after thrombin injection, AaDO2 increased according to blood gas analysis, but no microthrombi could be found in the lung by surface counting using 125I-fibrinogen, and the ratio of thromboxane B2/6-keto PG F increased. Thus, hypotention following thrombin injection may be induced by vasoactive substances disturbing pulmonary circulation and might be relieved by rapid inactivation of these substances.
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  • Shunro KAI, Hideki IFUKU, Yokico OHE, Kazuhiro MAEDA, Hiroshi HARA, Ki ...
    1986 Volume 27 Issue 1 Pages 22-29
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    Six patients with acute leukemia or chronic myelocytic leukemia received allogeneic bone marrow transplantations (BMTs) from major ABO-incompatible siblings by removing incompatible erythrocytes from the aspirated donor marrow. After erythrocyte depletion using Hemonetics blood processor, sixty-eight percent of the original nuclear cells recovered contained 58% of the CFU-E, 57% of the BFU-E and 48% of the CFU-GM. Furthermore, in vitro assay of committed progenitor cells showed that though recipient's serum with complement inhibited the growth of the marrow donor's CFU-E, it failed to inhibit the growth of the BFU-E and CFU-GM. Clinically there was no significant acute hemolytic reaction. All six patients were successfully engrafted and rate of recovery of peripheral blood granulocytes, reticulocytes and platelets was similar to that observed in ABO-compatible marrow transplanted patients. This erythrocyte purging technique is thought to be safe and effective to perform major ABO-incompatible BMT.
    One patient of group A, who was transplanted with group B bone marrow had a delayed immune hemolysis of recipient's red cells. Nine days following BMT the patient experienced a chill, temperature elevation with hemoglobinuria and a drop in hemoglobin level in spite of transfusion of group O RBC. The direct antiglobulin test was positive with C3. Isohemagglutinin titers of IgM- and IgG anti-A were elevated from zero to ×64 and ×4, respectively. As the patient did not have incompatible plasma, these anti-A antibodies were thought to be produced by immunocompetant transplanted donor lymphocytes.
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  • —Combination Protocol of High Dose Methyprednisolone, Prednisolone and Methotrexate—
    Yoshiki SHINOHARA, Shunro KAI, Mahito MISAWA, Yoshihiro FUJIMORI, Taka ...
    1986 Volume 27 Issue 1 Pages 30-35
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    We have used a combination prophylactic protocol to prevent acute graft-versus-host disease (GVHD) for six patients underwent allogeneic bone marrow transplantation (BMT). The protocol, designated as HDMP protocol, consists of high dose methylprednisolone (500 mg/body) immediately before the infusion of marrow graft, followed by prednisolone (40 mg/m2, Day 1∼7) and methotrexate with the dose of 5 mg/m2 on Day 1, 3, 6 and thereafter 10 mg/m2 weekly. We evaluated the availability of this protocol by comparing to the standard protocol using methotrexate (MTX protocol) which were given to seven patients.
    Acute GVHD occurred in three of seven patients using MTX protocol (Grade I: two, Grade IV: one) as compared to all of six patients using HDMP protocol (Grade I: two, Grade II: two, Grade III: two).
    Severe acute GVHD (Grade III or IV) was seen in the patients older than 30 y., suggesting that the age of the patients may be one of the factors affecting the outcome of GVHD as described by others. As for the hematological recovery duration, there was no statistical difference between both groups of the protocol. The mean days of febril episodes following BMT were 17 days per a case for the group of MTX protocol, whereas only two days were observed in all cases using HDMP protocol. Also, no patient was complicated with oral mucositis in the group of HDMP protocol. However, all but one patient with aplastic anemia suffered from troublesome mucositis in the group of MTX protocol.
    In conclusion, HDMP protocol appeared to be not so excellent as the MTX protocol from the aspect of prophylaxis against GVHD, however, it may be better with respect to the easy management of the early complications such as fever and mucositis.
    At present, satisfactory GVHD prophylaxis has not be established yet. More effective regimen should be developed hopefully soon in order to prevent severe GVHD following allogenetic BMT.
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  • Haruto UCHINO, Yataro YOSHIDA, Morihisa YAMAGISHI, Tamotsu MIYAZAKI, M ...
    1986 Volume 27 Issue 1 Pages 36-42
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    Although refractory anemias in the broad sense are not a homogenous disease entity, their spectrum of clinical and hematological features have been sufficiently characterized to permit prospective observation. Based on the clinical and hematological data of 265 patients, new diagnostic criteria for the diagnosis of refractory anemias is proposed.
    The criteria for screening includes
    1) anemia (including bicytopenia and pancytopenia),
    2) cellular marrow,
    3) chronic irreversible course,
    4) absence of underlying causes or drugs and
    5) marrow blasts less than 20%.
    Cases of myloproliferative disorders, aplastic anemia, idiopathic thrombocytopenic purpura or hemolytic anemia be excluded. The criteria for confirmation includes presence of ineffective hemopoiesis and/or dysplastic morphological changes. Refractory anemias in the broad sence are classified into four disease types, primary acquired refractory anemia, primary acquired sideroblastic anemia, refractory anemia with excess of blasts, and refractory cytopenia. Certain morphological features of diagnostic relevance were also described to facilitate the distinction of the disease types.
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  • Hiroshi IKEDA, Gen ITOH, Makoto YAMANOUCHI, Yoshika AMANO, Ryoichi KAT ...
    1986 Volume 27 Issue 1 Pages 43-49
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    A 65-year-old man born in Nagasaki prefecture was admitted to the hospital because of general fatigue. The leukocyte count in the peripheral blood was 50,100/cmm, with 83% atypical lymphocytes showing pleomorphism and deeply indented or convoluted nuclei.
    T cell subset analysis was done with monoclonal antibodies. Leukemic cell had T cell markers (OKT3: 51.1%, OKT4: 92.3%, OKT8: 92.9%, OK-Ial: 2.1%, OKT6: 0.6%, OKT11: 92.4%, OKT9: 35.1%, OKT10: 82.4%, Leu 3a: 74.6%, Leu 2a: 91.4%, J5: 2.2%, B1: 2.2%, and B2: 1.7%). The leukemic cells had the both phenotypes of helper/inducer and suppressor/cytotoxic.
    The chromosome abnormality, karyotype 47, XY, 18P+, +1P-/46, XY, was also found.
    Postmortem examination showed extensive infiltration of leukemic cells in the gastrointestinal tract (tongue. esophagus, stomach, and duodenum), generalized lymph nodes, bone marrow, liver, spleen, pancreas, lung, and kidney.
    The clinical and immunological characteristics were reported.
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  • Yorikazu ISHIKAWA, Tadaatsu ITOH
    1986 Volume 27 Issue 1 Pages 50-53
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    A 13-year-old boy with Burkitt's lymphoma of clinical stage III was refered to us. Remission was achieved by the treatment with COMP. But his disease soon recurred and became resistant to conventional chemoradiotherapy. Marrow lethal therapy using autologous bone marrow transplantation was planned. After confirming no tumor involvement of the marrow, marrow nucleated cells were collected and cryopreserved. But in vitro lymphoma colonies were grown from morphologically normal bone marrow samples. The colonies were huge enough to be seen macroscopically in a 35mm tissue culture plate. They consisted of from 10,000 to 50,000 cells and did not degenerate after 6 weeks in culture. Cells within the colonies were large lymphoblasts with basophilic cytoplasm and many vacuoles in Wright-stained preparation. About 40% of the cells in pooled colonies had surface IgM and 70% had cytoplasmic IgM. Growth of lymphoma colonies in vitro may be a useful tool for evaluating bone marrow involvement with non-Hodgkin's lymphoma.
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  • Yoshikazu AKAHONAI, Akiko TANIMURA, Naoaki NAKAGAWA, Masamitsu MORI, K ...
    1986 Volume 27 Issue 1 Pages 54-59
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    A 46-year-old man was admitted to our hospital with severe anemia and mild jaundice. The patient's poor state of health continued over the past several years. The erythrocytes were revealed to include spherocytes or stomatocytes under an electron scanning microscope with marked fragility against changes in the osmotic pressure, suggesting the presence of in vivo hemolysis. The leucocyte count was decreased, but 11% of myeloblasts were observed as well as a number of normoblasts. In spite of a pancytopenia in the peripheral blood, marked hyperplasia of erythroid cells with a normal differentiation was observed in the bone marrow. Mature granulocytes, however, were not found in it though 4.8% of myeloblasts were observed. The following tests, were negative: Coombs test, Ham test and antinucleic factor. From these findings, he was thought to have myelodysplastic syndrome. The true blood group was verified to be of an A-type from examinations of A-transferase and saliva, though the erythrocytes were not agglutinated by 33 out of 60 normal sera with A- or B-type randamly sampled. Confirmation of Th-polyaggulutination was established by the reaction with lectins and the erythrocytes, an agglutination with Arachis hypogaea and Polybrene.
    This is the second case in Japan which showed Th-polyagglutination of erythrocytes accompanied by myelodysplastic syndrome. The appearance of the Th-antigen on the erythrocyte membranes seems to be associatd with the transformation at the stem cell level.
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  • Miharu YABE, Kazuya IKEDA, Hiroshi ISHIMARU, Nobukazu HOSHI, Seiichiro ...
    1986 Volume 27 Issue 1 Pages 60-63
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    Interstitial pneumonia (IP) is one of the major complications after bone marrow transplantation (BMT). This complication can be due to infectious agents including cytomegalovirus (CMV), Pneumocystis carinii and herpes simplex virus or can be a late consequence of total body irradiation (TBI) and/or drug toxicity. It is still unknown whether and to what extent graft versus host disease (GVHD) can involve the lung. We report a case with chronic myelocytic leukemia in whom late-onset IP was present 180 days after BMT with chronic GVHD. Lung function tests showed restrictive changes, and multiple perfusion defects were recognized in the lung scan using TcMMA. Histologic examination of the lung biopsy revealed patchy idiopathic IP with mononuclear cells, and showed initial focal thickening within medium sized arteries. CMV, Pneumocystis carinii or other infectious organisms were not identified. IP was resolved by steroid administration. IP observed in this patient should be discerned from the more common type of IP after BMT and may be a pulmonary manifestation of chronic GVHD.
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  • Tadaatsu ITO, Yorikazu ISHIKAWA, Masako NODA, Hiroaki SHIRAISHI
    1986 Volume 27 Issue 1 Pages 64-67
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    A six-year-old boy with acute myelogenous leukemia (AML) in first remission received a bone-marrow transplant from his three-year-old HLA-identical sister after preparation with cyclophosphamide and fractionated total-body irradiation. Engraftment was documented by chromosomal analysis on day 14. The patient was placed in a laminar-air-flow bed isolator and no febrile episode was noted during isolation. 100 days after transplantation the patient has no graft-versus-host disease, no infections, and no other complications. Since cytomegalovirus pneumonia after this period, and recurrence of AML is unusual, the probability of long term survival in this patient is high.
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  • Satoru TANABE, Akira SUGAWARA, Mamoru TAKAHASHI, Hiroyuki KOKURYU, Mas ...
    1986 Volume 27 Issue 1 Pages 68-74
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    A 39-year-old female was admitted because of exertional dyspnea. Hepatosplenomegaly was not observed. Laboratory investigation disclosed marked pancytopenia with a few blast cells (29%) in the peripheral blood smear. Peroxidase activity was negative in the blast cells, however, some of them contained small number of basophilic granules. There were no tear drop cells or nucleated erythrocytes. Repeated bone marrow aspirations yielded dry taps. A bone marrow biopsy showed marked myelofibrosis and an increased number of atypical megakaryocytes. Cytogenetic examination of circulating mononuclear cells revealed a 46, XX, t (11q+; 17q-) karyotype. No evidence of extramedullary hemopoiesis was obtained by a ferrokinetic examination. From these findings, a diagnosis of acute myelofibrosis was made.
    After 3 months from admission, white blood cells gradually increased in number exceeding 20,000/mm3 with 80% blast cells. Antileukemic agents including small dose Ara-C were inefective, however, it was noticeable that a lot of basophils began to appear in the circulation after the chemotherapy. On 8th month of admission, the white blood cell count was 60,000/mm3 with 70% basophils and 15% blast cells. These cells were compatible with basophils on several cytochemical stainings including metachromasia with toluidine blue. There was no hiatus in the maturation of basophils. The patient died of pneumonia and hemothorax. An autopsy showed widespread leukemic infiltration of bone marrow, liver, spleen and other organs.
    The patient was the first reported case of acute myelofibrosis terminated in basophilic leukemia. The nature of acute myelofibrosis was discussed in relation to megakaryoblastic leukemia and myelodysplastic syndrome.
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  • Sungyul, LEE, Kenji, OKAJIMA, Shoichi, HASUDA, Kiyoshi TAKATSUKI
    1986 Volume 27 Issue 1 Pages 75-78
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    A 34 year-old married Japanese woman was admitted to Kumamoto University Hospital on June 5, 1984, because of gradual enlargement of the left breast and ipsilateral axillary lymphadenopathy. She had no pain or tenderness and no nipple discharge. Physical examination revealed slight splenomegaly, enlargement of the left axillary lymph nodes, left breast mass which was extremely hard but not tender. The overlying skin showed no fixation or dimpling. The white cell count was 2,600 per cubic millimeter with abnormal cells. and 67Ga-citrate scintigraphy indicated abnormal uptake in the left breast mass. The biopsy of the left axillary lymph nodes confirmed the histological diagnosis of malignant lymphoma, diffuse, mixed cell type. The abdominal echo showed splenomegaly and biopsy specimen of bone marrow showed lymphocytic infiltrates. A case of primary lymphoma of the breast in a 34-year-old woman were well more than 46 months after mastectomy and radiotherapy, then clinical course became rapidly fatal.
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  • —A Case of Non-Hodgkin's Lymphoma—
    Keisei KAWA-HA, Noriaki TAKIYAMA, Shigehiko ISHIHARA, Junichi HARA, Ke ...
    1986 Volume 27 Issue 1 Pages 79-83
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    A ten year-old-boy with T-lineage non-Hodgkin's lymphoma had prolonged antibioticrefractory fever and subcutaneous nodules after consolidation therapy with high-dose cytosine arabinoside. Cultures failed to identify bacterial sepsis. According to the recent reports in which characteristic clinical and radiologic findings in the diagnosis of systemic candidiasis were stressed, CT scan and Ultrasonography were employed to find “abscess-like” lesions in this patient. Because of the similar findings of multiple “abscess-like” lesions in the spleen and multiple lesions in the lungs, we diagnosed that he also suffered from systemic candidiasis. Prompt administration of Amphotericin B resulted in successful eradication of multiple lesions. As reported by others, diagnostic imaging seemed to be quite useful in identifying disseminated candidiasis.
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  • Kiyotaka KAWAUCHI, Hajime SUGIYAMA, Shaw WATANABE, Yoriko SUZUKI, Haru ...
    1986 Volume 27 Issue 1 Pages 84-89
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    A case of malignant lymphoma associated with Sjögren's syndrome is reported. The patient was a 52-year-old woman, having photosensitivity in 1974, and foreign matter feeling and Raynaud's phenomenon in 1979.
    In 1981 she had transient swelling of the left parotid gland. Reduced tear and saliva secretion and left parotid gland tumor were noted in June 1984.
    On admission in October 1984 the left parotid gland tumor was 6×7 cm, and, in addition, general superficial lymphnode swelling was observed. Laboratory examinations revealed polyclonal hypergammaglobulinemia and autoimmune antibodies, such as anti-nuclear, anti-RNP, anti-Sm and anti-SS-A antibody. Concerning xerosis, bilateral keratoconjunctivitis sicca was seen, and an apple tree formation was demonstrated by sialogram. Biopsy of the lymphnodes showed diffuse proliferation of monoclonal cytoplasmic IgG, λ immunoblasts, leading to the diagnosis of malignant lymphoma (diffuse, large cell type based on L.S.G. classification).
    The VEPA (vincristine, cyclophosphamide, prednisolone and adriamycin) therapy was given 5 cycles for the malignant lymphoma, and complete remission was attained.
    No significant change in autoimmune antibodies was found during the period of observation.
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  • —Including one Complicating Intravenous Hyperalimentation or Tube Feeding—
    Hiromasa YAMAUCHI, Nobuaki IWATA, Masamitsu KARASAWA, Hitoshi KATAHIRA ...
    1986 Volume 27 Issue 1 Pages 90-94
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    Megaloblastic anemia due to folate deficiency in 9 patients is reported. In 6 of these patients, the condition developed during either intravenous hyperalimentation or nasogastric tube feeding, whereas in 2, it occurred as a complication of their hematological diseases. Only one was associated with pregnancy. The major cause of deficiency was ascribed to complete cessation of folate intake in 7 patients, and to increased requirment in 2 patients.
    Florid megaloblastic changes were documented in all patients and deoxyuridine (UdR) suppression values were abnormally elevated in all cases so examined. In vitro 3H-UdR incorporation by bone marrow cells improved significantly (to 115∼153% of control) by the addition of folate, but not by vitamin B12. The interval between the start of artificial nutrition and overt megaloblastosis ranged from 5 to 16 weeks with median of 7 weeks. Marked thrombocytopenia below 30×103/ul was noted in 3 of 6 patients with the underlying disorders unrelated to blood dyscrasias. The degree of macrocytosis was less obvious in these 9 patients as compared with that in B12 deficiency.
    The frank folate deficiency is a relatively rare condition under the ordinary circumstances. These experiences, however, clearly indicate that the artificial nutrition without deliberate folate supplement, if prolonged, should be listed as a potential cause of megaloblastic anemia accompanied by some distinct hematological features.
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  • Tetsuo KUWABARA, Kunihisa MIYATA, Norihiko TADA, Atushi WATARI, Atsuko ...
    1986 Volume 27 Issue 1 Pages 95-99
    Published: 1986
    Released on J-STAGE: February 02, 2009
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    Multiple low-density areas of the liver and spleen were detected by computed tomography in three febrile patients with acute myeloblastic leukemia. Diagnosis of hepatic and splenic abscesses was established by laparoscopy and/or splenectomy. Results of cultures of aspirated materials from the abscesses were helpful for selecting appropriate antimicrobial drugs in two patients while negative cultures were obtained in the remaining patient in whom antifungal drugs were effective. Prolonged administration of antimicrobial drugs was required for the cure or improvement of the complicating infections although all of the three patients remained in hematological remission.
    Computed tomography of the abdomen should be made in all instances of unexplained fever during the course of acute leukemia. This practice will prove that hepatic and splenic abscesses, previously thought rare, actually occur in many patients with acute leukemia. The accurate diagnosis and immediate start of a potent antimicrobial treatment can improve the prognosis of these grave complications in compromised hosts.
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