Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 27, Issue 3
Displaying 1-26 of 26 articles from this issue
  • —A Comparative Study with Polycythemia Vera—
    Akimichi OHSAKA, Akihiro TSUBOYAMA, Yasuhiko KANO, Yusuke FURUKAWA, Ko ...
    1986 Volume 27 Issue 3 Pages 285-291
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    Essential thrombocythemia (ET) is a clonal myeloproliferative disorder (MPD), characterized by persistant elevation of platelet count in the absence of known causes. Since thrombocytosis may occur in other forms of MPD, differential diagnosis, especially for polycythemia vera (PV), is not always easy.
    Eight patients with ET and nine patients with PV were studied from May 1975 to June 1984. Followings were observed: (1) Predominancy in females was observed in patients with ET, (2) Thrombohemorrhagic complications and splenomegaly were observed in a half of the patients with ET, (3) Hematologically, the significant differences were found in hemoglobin level (p<0.01) and platelet count (p<0.05) between ET and PV, (4) Spontaneous in vitroe rythroid colony formation (BFU-E and/or CFU-E) was observed in some patients with ET (2/6), while it was found in almost all the patients with PV (6/7), and (5) Only one patient of ET transformed into acute leukemia.
    From our study, although we can draw a line between ET and PV in most cases, there are some perplexing cases between the two in which differential diagnosis is difficult. We assume that ET and PV might be different manifestations of the same disease process.
    Download PDF (517K)
  • Masatoshi HAYASHI, Yoshihiko WATANABE, Yasushi HIRASAWA, Takashi FURUY ...
    1986 Volume 27 Issue 3 Pages 292-298
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    Twenty-five cases of acute myelomonocytic leukemia (AMMoL) and acute monocytic leukemia (AMoL) treated at the Kitasato University Hospital from 1975 to 1984 are reviewed in respect of the incidence, clinical course, treatment and prognosis of the central nervous system (CNS) and skin involvement. Morphological diagnosis of acute leukemia was made according to the FAB classification. CNS involvement was present in 6 (24%), and skin involvement proven by biopsy in 9 (36%). Those patients with younger age, superficial lymphadenopathy, hepatomegaly, splenomegaly, high peripheral white blood cell count, and elevated serum LDH and lysozyme activities on admission showed a high incidence of CNS and skin involvement during thier clinical course. Radiotherapy and surgical resection were temporarily effective for the treatment of leukemic skin infiltration. However, leukemic skin lesions were generally so multiple and extensive that all patients with skin involvement required systemic chemotherapy. In 5 patients, CNS infiltration ocurred at the time of hematological recurrence, and was refractory to the treatment. All patients with CNS involvement were treated with intrathecal methotrexate, cytosine arabinoside and hydrocortisone, and only one of them achieved CNS remission. Therefore, prophylactic treatment for CNS involvement is necessary in patients who have risk factors as listed above. The high incidence of CNS and skin involvement in patients with AMMoL and AMoL is thought to be related to the prolongation of survival due to the recent improvement of treatment as well as the characteristics of leukemic cells.
    Download PDF (548K)
  • Takeshi ISHIZAKI, Kazuko HASHIZUME, Noriko OOBA, Hiroshi HORITA, Hisak ...
    1986 Volume 27 Issue 3 Pages 299-306
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    In twelve allogenic bone marrow transplanted patients with hematologic and other malignancy and in eight autologous bone marrow transplanted patients, serial hemostatic changes were evaluated at -14, -7, 0, +7, +14 and +28 bone marrow transplanted days. Hemostatic parameters such as plasma fibrinogen, factor V, fibrin degradation products (FDP) and α1 proteinase inhibitor (α1PI) tended to increase and activated thromboplastin time (APTT) to prolong after bone marrow transplantation. On the contrary, antithrombin III (AT III), α2 plasmin inhibitor (α2PI) and plasminogen had a tendency to decrease in each level after bone marrow transplantation with relatively stable values of α2 macroglobulin (α2M) and prothrombin time (PT). The same pattern were noticed typically and severely in 3 cases of hepatic venooccluslve disease and 2 cases of interstitial pneumonia, in whom disseminated intravascular coagulation (DIC) developed.
    From the facts that the dynamic changes ln levels of ATIII and plasminogen were well correlated with concentrations of albumin and total protein in plasma, and that the presence of α2PI-plasmin complex and antlthrombin III-thrombin complex was not found in bone marrow transplanted patients, it was concluded that the mechanisms of decline of ATIII, plasmlnogen and α2 PI are not due to active consumption like intravascular coagulation but to decreased production in the llver.
    Download PDF (587K)
  • Toshiyuki SHINDO, Susumu NISHINARITA, Hazime SHIMADA, Kotaro TOMURA, S ...
    1986 Volume 27 Issue 3 Pages 307-314
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    The relationship between clinical staging and survival time in 34 patients with multiple myeloma was studied. Patients were classified into 10 cases of IA, 5 cases of II A, 13 cases of III A and 6 cases of III B. Eight of 9 patients with BJP type were found in stage III. Fifty percent survival time of all cases showed 45 months and a marked difference in 50% survival time was observed between stage I+II group (90 months) and stage III group (20 months). High serum value, high concentration of myeloma protein or BJP and renal dysfunction were important factors which determine the survival time of myeloma patients. No influence of anemia or osteolytic changes, on the other hand, on the survival time was found. Fifty percent survival time in the patients with more than two of the above factors was significantly shorter than that in those with only one risk factor (45 months vs 7 months).
    These results lead to the conclusions that in the randomized trial of myeloma patients the stratification is essential for the comparison of different types of chemotherapy.
    Download PDF (593K)
  • Fumio KAWANO, Yasuhiro TEJIMA, Hiroyuki TAJIMA, Sung-Yul LEE, Akira SH ...
    1986 Volume 27 Issue 3 Pages 315-320
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    Nine patients with acute myelocytic leukemia, 7 in relapse and 2 refractory to conventional therapy, were treated with intermediate dose cytosine arabinoside (ID Ara-C) in combination with doxorubicin and vincristine.
    This schedule consists of 1h infusions of Ara-C in a dose of 500 mg/m2 every 12h for 4 days (days 3∼6), in combination with doxorubicin 50 mg/m2 on day 1 and vincristine 1 mg/m2 on day 2.
    In 9 evaluable courses, 5 courses (55.5%) achieved complete remission (CR).
    Duration of the CR was 1.5, 2 and 2.6 months. respectively. Other two courses are still in CR (more than 1 and 7.2 months in duration).
    Side effects were similar to those in the conventional treatment.
    These preliminary data suggest that the therapeutic results of this ID Ara-C regimen are not inferior to comparable schedules with HD Ara-C as reported by others while toxicity is less severe.
    Download PDF (433K)
  • Ritsuko YAMAMOTO, Hirokazu KURATA, Kenji IKEBUCHI, Akiyoshi MIWA, Yosh ...
    1986 Volume 27 Issue 3 Pages 321-326
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    From January 1979 to March 1985, febrile episodes occurring in 35 aged patients (maen age 76 years old) with leukemia were reviewed. There were 2.2 febrile episodes per patient on an average. Eighty-two percent of the febrile episodes was due to documented infections. The most common types of infections were septicemia and pneumonia, which together accounted for 61% of the total infections.
    Causative microorganisms were identified in 59% of the total febrile episodes. Gram-negative bacilli were responsible for only 46% of the microbiologically documented febrile episodes, while 40% of episodes was caused by gram-positive cocci. The use of new broad-spectrum antibiotics seems to have increased the frequency of gram-positive-cocci infections. Twenty-nine percent of the patients had repeated episodes of infections caused by the same organisms.
    As has been generally pointed out about the infection in the aged, infections caused by multiple organisms were very frequent. The most common combination, gram-positive cocci and gram-negative bacilli, accounted for 64% of these infections.
    Sixty-seven percent of febrile episodes occurred when the patients had neutropenia (less than 500/mm3), while 29% of the episodes occurred when the patients had enough neutrophils (more than 1,000/mm3). The fatality rate during febrile episodes was higher when the patients had neutropenia. The longer the duration of severe neutropenia (less than 100/mm3), the higher the susceptibility of febrile episodes was observed.
    Disseminated intravascular coagulation (DIC) occurred in 21 patients during the follow-up period, 80% of which was related to febrile episodes. The fatality rate for infections complicated by DIC was 82%.
    Download PDF (453K)
  • Hiroya TONO, Umihiko SAWADA, Ichita AMAKI, Hiroyuki TAKASHIMA, Yuji SH ...
    1986 Volume 27 Issue 3 Pages 327-337
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    In order to improve treatment of malignant lymphoma, a multidisciplinaly study group for the treatment of malignant lymphoma has been established at Nihon University School of Medicine in December, 1980. The members of the group consist of specialists of internal medicine, surgery, otolaryngology, radiology and pathology. The members meet together regularly and discuss about staging and treatment plans for each patient with malignant lymphoma. Since December, 1980, one hundred four cases (NHL 81 and HD 23) were entered into the group study. We compared these with 46 cases (NHL 39 and HD 7) which were treated prior to starting this group study as control.
    The conclusions were as follows:
    (1) Procedures for staging, including lymphography, CT scanning, Galium scanning, bone marrow aspiration, and bone marrow biopsy were performed more frequently in this group study.
    (2) Frequency of organ invasions by lymphoma was higher in this group study.
    (3) Since starting this group study, the relapse rate of NHL in stage I and II was reduced significantly from 42% to 13% in 6 months and 60% to 31% in 12 months respectively.
    Download PDF (844K)
  • Tadatoshi KURATSUJI, Eisuke TAKAHASHI, Ja Yung LEE, Hiroyuki SHIRO, Ka ...
    1986 Volume 27 Issue 3 Pages 338-343
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A Japanese girl with congenital stomatocytosis with severe hemolytic anemia is reported. Her mother was well and had no drugs during her gestation. The patient was born uneventfully and a mild neonatal jaundice of which peak serum total bilirubin was 9.6 mg/dl on three days of age. She had been noticed to have a pale face since two weeks of age, but had no complaints. Severe anemia had been pointed out and she has admitted to the Yamato City Hospital for further examinations and treatment.
    On physical examination, she had anemia, hepatosplenomegaly, but no jaundice. Laboratory data revealed stomatocytes 60∼80% on peripheral blood film, RBC 1.93 106l, Hb 5.4 g/dl, Ht 16.0%, reticulocytes 21.0%, erythroid hyperplasia in bone marrow, serum total bilirubin 3.9 mg/dl (indirect bilirubin 3.7 mg/dl), negative Coombs' test, normal enzyme activities of red cells, and normal electrophoretic pattern of hemoglobin. The extraordinary points of data were normal sodium influx and efflux, and normal cation contents of red cells inspite of increased osmotic fragility of red cells.
    This case seems to be a new type of stomatocytosis.
    Download PDF (478K)
  • Sumito CHO, Hitoshi KATADA, Kiyoshi NISHIKAWA, Kohji KOJIMA, Yasuko MI ...
    1986 Volume 27 Issue 3 Pages 344-348
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A Case of 63-year-old female whose hemolysis and anemia were ameliorated by administration of anabolic steroid is reported.
    The patient was first found to have anemia, leucocytopenia and thrombocytopenia with bone marrow hypoplasia in 1976, and had been treated with corticosteroid for six years. In January 1982, she noticed passage of red urine and acute exacerbation of anemia.
    The diagnosis of PNH was made based on increased reticulocyte count in peripheral blood, slight icterus and positive acidified serum lysis test (Ham test).
    She was administered anabolic steroid, hemolysis dramatically ameliorated and anemia alleviated. After administration for about two years and a half, we considered that the effect of anabolic steroid on this case depended on its dosage.
    Download PDF (367K)
  • Hiroo FURUKAWA, Tadashi OHNAKA, Takamichi OKADA, Michio HIRAI, Takayuk ...
    1986 Volume 27 Issue 3 Pages 349-354
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A 53-year-old male was first admitted with a chief complaint of abdominal fullness in September 1981. A diagnosis of primary myelofibrosis was made. WBC increased gradually after admission up to 40,000 and giant platelets were observed. A criterion of a diagnosis of polycythemia vera was satisfied.
    Findings of a sternal bone marrow biopsy revealed trpical myelofibrosis and lymph node biopsy an extramedullary hematopoiesis.
    Selenectomy was performed in March 1983, because of abdominal fullness aggravated due to a huge spleen. Histologic examinations of the resected spleen, which weighted 6,400 Gm., revealed an extramedullary hematopoiesis.
    After splenectomy hepatomegaly progressed and at the end of June a normocellular aspirate of the bone marrow led to a suspicion of AMMoL. In July, abnormal cells appeared in the peripheral blood and a definite diagnosis of AMMoL was made. The size of the platelets grew larger. Low dose Ara-C and Indomethacin treatments were ineffective. Leukemic changes were considered in all the three hematopoietic systems.
    He died in October. A diagnosis on autopsy was ileus of the small intestine due to the oppression of a huge liver (4,100 Gm.), AMMoL and myelofibrosis.
    Download PDF (628K)
  • Masahiko KATO, Yukio OSHIMA, Hikaru KOYANAGI, Noriyuki SUETAKE, Toshij ...
    1986 Volume 27 Issue 3 Pages 355-359
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A three-year-old girl was admitted because of petechiae and fever. The white blood cell count on admission was 21,400/μl with 78% blasts. Bone marrow aspirate showed a nucleated cell count of 36×104l with 55.6% blasts, 2.0% promyelocytes, 12.0% myelocytes and 8.8% neutrophils. A diagnosis of acute myeloblastic leukemia (M2 in FAB classification) was made. Auer rods were observed not only in blasts but also in mature neutrophils. A complete remission was obtained by a combination consisting of cyclophosphamide, vincristine, cytosine arabinoside and prednisolone. Auer rods in mature neutrophils almost disappearead after complete remission as previously reported but the number of them increased during the induction chemochemotherapy therapy.
    Download PDF (405K)
  • Yoshitaka ONO, Teruo INO, Toru TAKADA, Masataka OKAMOTO, Kachiko MORIK ...
    1986 Volume 27 Issue 3 Pages 360-368
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    In 6 of 20 cases with blast crisis of chronic myelogenous leukemia (CML), predominant proliferation of megakaryocytic series was documented. The megakaryocytic nature of cells in these cases was identified by their morphology, demonstration of platelet peroxidase and demarcation membrane electron microscopically and/or cytoplasmic factor VIII related antigen cytochemically. In one case diagnosed as myelomegakaryoblastic transformation, blasts with various sizes were observed and some of the smaller cells had cytoplasmic blebs. Electron microscopic examination revealed the presence of myeloperoxidase positive myeloblasts as well as platelet peroxidase positive promegakaryolasts. Marrow fibrosis ensued in the later stage. In the other 5 cases proliferation of immature and mature megakaryocytes with atypical features was a prominent finding and in 3 of these cases megakaryoblasts also proliferated, and in the remaining 2 cases myelofibrosis was a predominant feature since early phase of their slowly progressing transformation. Thus, the megakaryocytic transformation of CML encompasses a spectrum of cases characterized by the proliferation of promegakaryoblasts, megakaryoblasts, immature and mature megakaryocytes, associated with varying intensity of marrow fibrosis. Increasing platelet count, fever, bone pain and mass formation sometimes destructing bones appeared to be major manifestation of these cases.
    Download PDF (1139K)
  • Mihiro OKABE, Kazuhiko MATSUNO, Osamu SASAKI, Nagahito SAITO, Shuji NI ...
    1986 Volume 27 Issue 3 Pages 369-375
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A 81-year-old female with abnormal proliferation of large granular lymphocytes (LGL) showing peculiar properties is presented. The expanded LGL had receptors for sheep erythrocytes but no Fcγ receptors. By phenotypical analysis using monoclonal antibodies, they were positive for OKT 3, 4 and 8 but negative for OKT 6, 10. HNK-1 antigen could be identified on almost all expand cells. However, OKM1 antigen could not be detected. By functional analysis of these expanded cells, they showed natural killer (NK) activities and could proliferate exponentially by the 4th week after the begining of culture with the addition of IL-2. These functions are though to be consistent with those of LGL. Nevertheless, they could also respond to T-cell mitogen, PHA and concanavalin A. The relationship between abnormal proliferation of LGL and chronic T-cell proliferative disorders is discussed in this paper.
    Download PDF (589K)
  • Masayuki SUZUKI, Toshiyuki NODA, Hiroyuki KODAMA, Koichi SAHASHI, Atsu ...
    1986 Volume 27 Issue 3 Pages 376-380
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    An 82-year-old man admitted to our hospital with complaints of pyrexia and dyspnea in January, 1984. He had had exertional dyspnea and acrocyanosis on cold stimulation for several years.
    Examination revealed the following abnormalities to establish a diagnosis of Waldenström's macroglobulinemia with cold agglutinin disease. (1) tuberculous pneumonitis and pleurisy, (2) hepatosplenomegaly and superficial lymphadenopathy, (3) paraproteinemia of IgM K type, (4) high cold agglutinin (CA) titer (IgM K type, anti-I specificity), hemolytic anemia, and IBL-like appearance of biopsied lymph node. He was treated with chemotherapy for tuberculosis, prednisolone and warming, without anti-neoplastic agents. He died of cachexia 10 months after admission.
    Autopsy disclosed; (1) IBL-like lymphadenopathy with monoclonality of IgM K type, (2) infiltration of monoclonal lymphoid-plasmacytoid cell in the liver, spleen, Kidneys, bone marrow, etc. (3) active tuberculous lesion in the lung, (4) amyloid deposit in the lung, pancreas and lymph nodes.
    We showed that the M-protein had CA activity, and discussed the possibility that the M-protein with CA activity was produced by neoplastic B-lymphocytes.
    Download PDF (437K)
  • Synichi OSHIMA, Fumio KAWANO, Ryoichi NAKAI, Kiyoshi TAKATSUKI, Yohko ...
    1986 Volume 27 Issue 3 Pages 381-385
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A 39-year-old woman with refractory anemia with excess of blasts developed auto-immune hemolytic anemia during the course of her illness. The association between auto-immune hemolysis and myelodysplastic syndromes is extremply rare. An even more unique finding is the nature of the auto-antibody which was identified as anti-nl.
    Download PDF (330K)
  • Ayumi ITO, Masakazu NITTA, Akiyo UEMURA, Katsumi OGAWA, Keiju KOSAKA, ...
    1986 Volume 27 Issue 3 Pages 386-390
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A case of adult T-cell leukemia (ATL) (chronic type) in which peripheral T-cells have helper activity on immunoglobulin production of B-cells is reported. The patient, 48 years of age female, was born in the Gotoh Islands, Nagasaki Prefecture. She had skin lesion which made frequent appearance for four years, lymphnode swelling and leukocytosis with a few lymphoid cell which nuclei were convoluted. ATL-cell associated antigen (ATLA) and antibody to ATLA by indirect immunofluorescent method were possitive. The surface marker study of these peripheral lymphocytes was as follows: 77% E rosset forming cells, 76% react with OKT3, 86.8% react with OKT4, and 6.3% react with OKT8. Mitogenic activities of these lymphocytes were very low and natural killer cell activity against K 562 cells were also low. Polyconal hypergammaglobulinemia was observed and peripheral T-cells, mainly ATL-cells, showed helper activity on PWM-induced immunoglobulin production on normal B-cells. It is supposed that, in the present case, ATL-cells act as helper T-cells on immunoglobulin production of B-cells in vivo, because polyclonal hypergammaglobulinemia was recognized and her T-cells showed helper function in vitro.
    Download PDF (589K)
  • Manabu MUSASHI, Masaki NAKANO, Yuko ITASAKA, Ryoko MITANI, Wenjer TENG ...
    1986 Volume 27 Issue 3 Pages 391-397
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A case with hairy cell leukemia (HCL) who achieved a complete remission after treatment with recombinant interferon-α (rIFN-α) is reported.
    A 58 year-old male with leukocytosis was admitted to our ward for further examination in November, 1982. On admission, leukocyte count was 10.7×109/l with 72% hairy cells (HC). Hb was 9.3g/dl and platelet count was 105×109/l. Bone marrow aspiration was failed and bone marrow biopsy findings were consistent with HCL. Splenectomy was not indicated in this case because of a mild splenomegaly and bone marrow dysfunction, so he was discharged for further observation in out-patient state. But a progression of anemia and thrombocytopenia, 7.0g/dl and 43×109/l, respectively resulted in re-admissisn in March, 1984.
    3×106 IU of rIFN-α daily intramusclar injection was chosed with great benefit. Five months later, when total IFN doses were 140×106 IU, Hb, WBC and platelet counts were normalized. The differentlal count showed reappearance of neutrophils and monocytes, whereas HC was absent in the peripheral blood. At the same time, bone marrow biopsy showed a disappearance of HC and a recovery of normal hematopoiesis, indicating in a complete remission. Remission duration reached 12 months with 3×106 IU of rIFN-α weekly intramuscular injection. Although the therapy of this patient with rIFN-α achieved in great success, the mechanism of this action remained to be clarified. But it was suggested that IFN-α acted as an antiproliferative agent rather than as a potentiator of natural killer (NK) cell because his NK cell activity was not improved by IFN-α treatment.
    Download PDF (802K)
  • Kenji ODA, Koji IWATO, Kazuyuki MIURA, Yasuo TAKIMOTO, Nobutaka IMAMUR ...
    1986 Volume 27 Issue 3 Pages 398-402
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A female patient with multi-drug resistant malignant lymphoma who had bulky abdominal mass, in clinical stage IV A (DSC, B-cell type) was treated by high-dose methotrexate (MTX), (5g. followed by 7g.) with CF rescue. MTX serum concentration decreased under 1×10-6 M at 72 hours, but remained toxic concentration over 1×10-7 M for 68 days. The patient died ten days after the day when MTX could not detect in her serum. At autopsy, MTX was detected 4.4×10-7 M in the liver and 4.0×10-8 M in the tumor tissue. The patient maintained good urinary flow and creatinin clearance keeping always over 70ml/min. The cause of delayed clearance of MTX in this case was thought to be “re-entry” of MTX from the tumor. On High-dose MTX therapy, bulky mass was assumed to be a risk factor for delayed clearance of MTX due to “re-entry”. Severe myelotoxicity could be prevented by ordinary CF rescue therapy. But hepatocellular dysfuncotin without elevation of hepato-biliary enzyme in her serum might be related with MTX hepatotoxicity.
    Download PDF (582K)
  • Takuo OGAWA, Masato TANAKA, Noboru ARAKI, Hiroshi YOGO, Kazuyuki NAITO ...
    1986 Volume 27 Issue 3 Pages 403-406
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A 34-year-old man, who suffered from a chest discomfort and was admitted on the first consultation day, was diagnosed as a benign gastric ulcer through an endoscopic examination. Soon, he was treated with cimetidine (800mg/day, p.o.). During this medication, platelet counts in his peripheral blood decreased abruptly from 12×104l to 3.7×104l. His myelogram revealed an ITP pattern (increased immature megakaryocytes and poor production of plastelets in spite of normal erythropoiesis and granulopoiesis). Then, no signs of a viral infection and an autoimmune disease were noticed despite of extensive examinations. 8 weeks after an interruption of cimetidine, his platelet counts increased to 11.2×104l. In a coculture experiment with cimetidine, his peripheral lymphocytes incorporated 3H-thymidine significantly, in contrast to a healthy person.
    Download PDF (318K)
  • Junji KATO, Yoshiro NIITSU, Seishi ISHIGAKI, Naofumi YAMAUCHI, Yoshika ...
    1986 Volume 27 Issue 3 Pages 407-411
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A 19-year-old male repeatedly suffered nasal bleeding and multiple phlegmones of the skin since his childhood. Hematological study on admission (March, 1984) included RBC of 490×104/cmm, Platelet of 3.9×104/cmm and WBC of 2,200/cmm with neutropenia (19%). A biopsy specimen from the bone marrow showed hypocellularity with increasing adipose cells.
    CFU-C formation of the bone marrow cells from the patient was impaired. The clinical picture, therefore, corresponds to the rare disorder, called Chronic Hypoplastic Neutropenia which is characterized according to Dameshek et al by an increased susceptibility to infections especially of the skin, bleeding tendency, hypoplasia of the granulocytic elements and megakaryocytes of the marrow and its prolonged and relatively benign clinical course. Familial survey revealed that his mother also had pancytopenia. By hematological study, scintigram and biopsy of the bone marrow, CFU-C assay, etc, she was diagnosed to have a typical Aplastic Anemia. This is the first case report of familial occurrence of Chronic Hypoplastic Neutropenia and Aplastic Anemia.
    Download PDF (411K)
  • —Clinical Importance of the Enzyme in Leukocytes and Platelets—
    Yukiharu TOMITA, Minoru INAGAKI, Masashi TAKI, Takuma MIURA, Nobuo SAI ...
    1986 Volume 27 Issue 3 Pages 412-419
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    NADH cytochrome b5 reductase in erythrocytes, granulocytes, lymphocytes and platelets was investigated in two siblings with hereditary methemoglobinemia and in their parents.
    NADH cytochrome b5 reductase levels were markedly low in the erythrocytes derived from the propositus and her brother. Based on the findings that the NADH cytochrome b5 reductase abnormality was limited to thye erthrocytes (erythrocyte type), it was suspected that the mental development of these patients should be normal. A follow-up study on their mental development was carried out in order to confirm whether or not this was true. At present, the propositus, who is 2 years and 11 monts old, and her brother, who is 3 years and 10 months old, have developed without any signs of mental retardation.
    These findings indicate that the determination of the type of NADH cytochrome b5 reductase abnormality (erythrocyte type or generalized type) might be useful in anticipating the complication of mental retardation in hereditary methemoglobinemia.
    Download PDF (654K)
  • Yoshio HATAE, Takeo TAKEDA, Takuya HATTORI, Hisaya NAKADATE, Motoi NIS ...
    1986 Volume 27 Issue 3 Pages 420-425
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    From January 1978 to June 1985, 75 children with acute leukemia (63 acute lymphocytic leukemia and 12 acute non-lymphocytic leukemia) were treated at Sapporo National Hospital. Eye involvement due to leukemia cells was detected in 6 children, 5 had ALL and 1 had acute monocytic leukemia. Six cases were reported in this paper. As a first manifestation, impaired vision, color blindness, photophobia and eye pain were observed. Most cases involved bone marrow relapse or meningeal leukemia at the time of ocular abnormality. All patients received prophylactic cranial radiotherapy or high dose methotrexate therapy except for a case of AMoL. Radiotherapy had beneficial effects on the ocular manifestations of leukemia.
    It was impossible to establish whether or not the eye should be excluded from the field of cranial radiation. Further studies on this point and on the most appropriate dose of cranial radiation are needed.
    Download PDF (996K)
  • Sumio KAI, Hisato KIGASAWA, Hirokazu NISHIHIRA, Yasuhide HAYASHI
    1986 Volume 27 Issue 3 Pages 426-431
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A 6-year-old boy was admitted because of fever, purpura and upper abdominal tumors.
    Hematological study revealed hemoglobin 10.2 g/dl, platelets 64,000/cmm, leukocytes 3,800/cmm with 12% blasts. Bone marrow smear showed 82.5% blasts which were large in size, abundant in basophilic cytoplasm and had a round nucleus with lacy chromatin and 2 or 3 nucleoli. The blast cells were negative for myeloperoxidase and weakly positive for PAS. About 85% blasts were positive for α-naphthyl butylate esterase staining which was inhibited in the presence of NaF. A diagnosis of acute monoblastic leukemia (FAB, M5a) was made.
    The cytogenetic study of the blast cells showed an abnormal Karyotype of 47, XY, +8, ins (2; 11) (p25; q13q23).
    Abdominal CT revealed large tumors occupying the whole abdominal cavity, which was interpreted as peritoneal involvement by the leukemic cells.
    He was treated with ACMP 2-step therapy and a complete remission was obtained. However, relapse occurred after 2 months in the central nervous system and after 3 months in the bone marrow. Reinduction chemotherapy was done but no remission was achieved.
    Chromosome 11q rearrangement with a breakpoint of q23 is possibly related to acute leukemia with monocytic differentiation.
    Abnormal Karyotype of ins (2; 11) (q25; q13q23) has not been reported in acute monoblastic leukemia previously.
    Download PDF (567K)
  • Akira YOSHIOKA, Ichiro MOMITA, Kenichiro KINOSHITA, Michito ICHIMARU, ...
    1986 Volume 27 Issue 3 Pages 432-436
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    The virological and immunological findings of adult T cell leukemia (ATL) have been accumulated markedly, but the ultrastructural studies of ATL cells have not been done so many. We found two types of intracytoplasmic structures, namely, striated strip structure (SSS) and tubuloreticular structure (TRS), in the cells of one case of ATL. The former is not known well up to now. SSS had a slightly curved strip form of 38 nm thick, 60 nm wide and about 900 nm long, and had striated substructures. The incidence of SSS and TRS were 1.5 and 3.0% respectively. Ultrastructural studies of other five cases of ATL revealed TRS in two cases, but SSS in none. This report is the second case of SSS in ATL, SSS has not been reported in the diseases other than ATL, so SSS may be a specific structure to ATL.
    Download PDF (670K)
  • Hideko TASAKA, Jun OKAMURA, Yoshiko IKUNO, Makoto MIYOSHI
    1986 Volume 27 Issue 3 Pages 437-441
    Published: 1986
    Released on J-STAGE: February 02, 2009
    JOURNAL RESTRICTED ACCESS
    A three year-old boy with monosomy 7 received, as primary treatment, ablative chemotherapy and total body irradiation followed by bone marrow transplantation (BMT) from his HLA identical sister. Twenty three days after BMT he developed grade II GVHD which was treated with oral predonisolon. Chromosome showed normal female karyotype and no monosomy 7 on day 28.
    Although platelets count trended to be low, bone marrow showed full recovery and his performance status was 100%.
    He developed interstitial pneumonia on day 80 and died of respiratory failure on day 90.
    In light of the poor prognosis of monosomy 7, bone marrow transplantation may represent the treatment of choice for patients who have an appropriate donor.
    Download PDF (333K)
feedback
Top