臨床血液
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
28 巻, 10 号
選択された号の論文の30件中1~30を表示しています
綜説
  • 奈良 信雄
    1987 年 28 巻 10 号 p. 1707-1716
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Acute myeloblastic leukemia (AML) is a disorder characterized by excessive proliferation and aberrant differentiation of immature myeloid cells. Leukemic cells are maintained by a small population, leukemic blast progenitors, with self-renewal capacity. The cause of AML and the mechanisms whereby leukemic cell population expand escaping from normal hemopoietic regulation still remain to be determined. The response to growth factors of leukemic blast progenitors and possible mechanisms of growth factor involvement in the leukemic process including the oncogene relationship are reviewed.
臨床研究
  • 大島 充一, 外山 圭助
    1987 年 28 巻 10 号 p. 1717-1722
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    We studied the mean corpuscular volume (MCV), the mean corpuscular diameter (MCD), the morphological abnormalities of red blood cells (RBC), and their correlations to the parameters of liver function in 240 patients of liver disorders, consisting of 45 with acute hepatitis (AH), 72 with chronic hepatitis (CH), 64 with liver cirrhosis (LC), and 59 with LC with hepatocellular carcinoma (HCC). Macrocytosis was observed in 40% of LC patients and less than 10% of AH or CH patients. Thin macrocytosis was found in 57% of LC, 37% of HCC, 29% of CH, and 4% of AH patients. The mean value of MCD in LC patients was significantly higher than that of CH patients. Morphological abnormalities, especially poikilocytosis and polychromasia, were frequently observed in LC and HCC patients. MCD had negative correlation with prothrombin time (PT), and positive with indocyanin green 15 minute retention and GOT in LC patients (p<0.01). The rate of morphological abnormalities of RBC in LC patients correlated with PT and total cholesterol, choline esterase, LDH and GPT in serum.
  • 岡 敏明, 鈴木 豊, 清水 重男, 佐々木 暢彦, 藤田 晃三, 吉岡 一
    1987 年 28 巻 10 号 p. 1723-1728
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    From December 1976 through October 1986, there were 18 episodes of septicemia in 48 children with leukemia and lymphoma at Asahikawa Medical College, Department of Pediatrics. Twenty infectious agents were isolated, and eleven of the organisms isolated (55%) were gram-positive cocci. The most common gram-positive cocci causiog sepsis were streptococcus viridans, staphylococcus aureus, and streptococcus pneumonia. On the other hand, gram-negative bacilii were isolated from only six of our patients. Only 3 of the 10 episodes of exclusively gram-positive septicemia were fatal, whereas 5 of 5 episodes of exclusively gram-negative septicemia were fatal.
    All of the patients who developed septicemia caused by streptococci, had been receiving a combination with Cytosine arabinoside or Behenoyl-AraC. It is suspected that oral and gastrointestinal ulceration caused by cytotoxic chemotherapy provided a portal of entry for the streptococci.
    The increasing incidence of infections with gram-positive organisms as a complication of hematologic malignancies prompts a reconsideration of the current empirical antimicrobial therapy.
  • 谷口 信博, 木谷 照夫, 川越 裕也, 堀内 篤, 正岡 徹, 安永 幸二郎, 岡本 緩子, 大久保 滉, 米沢 毅, 永井 清保
    1987 年 28 巻 10 号 p. 1729-1737
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    FOY has recently been administered to the DIC patients for its anti-coagulative function. In this paper, the effects of FOY on 41 patients associated with DIC, who had hematological neoplastic disorders, were studied. The severity of DIC was shown by score count according to the DIC diagnostic criteria, which was proposed by Maekawa and others, with partial modification.
    FOY was administered at the dose of 1∼2mg/kg/hour by continuous intravenous drip infusion, or by intermittent drip infusion of the same daily dose for more than 4 consecutive days.
    Therapeutic effects of FOY were evaluated by the change of the score counts or clinical symptoms independently.
    The effective rate was 90.0% in AML, 72.7% APL, 77.8% ALL and 70.0% others (mean 75.6%).
    These results indicated that FOY was effective on improving the DIG state in patients with hematological neoplastic disorders. And it was suggested that FOY therapy might be useful especially in DIC patients who were accompanied with low AT-III level or heparin-induced thrombocytopenia.
  • 高橋 徹, 広川 誠, 工藤 和治, 高津 洋, 吉田 廣作, 三浦 亮
    1987 年 28 巻 10 号 p. 1738-1746
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    The regulatory mechanisms on the proliferation and differentiation of leukemic haemopoiesis by 12-0-tetradecanoylphorbol-13-acetate (TPA) through formation of human leukemic myeloid progenitors (L-CFU) derived colony was studied and the combined effects of TPA and fibroblast derived growth factor (FGF) on the formation of L-CFU derived colony was also investigated.
    In the majority of cases studied, macrophage like transformation of L-CFU derived colony forming cells was clearly observed by the addition of TPA at the concentrations above 10-3 M.
    TPA inhibited the formation of normal myeloid progenitors (CFU-c) and L-CFU derived colonies respectively at concentration related fashion, whereas media conditioned by normal human bone marrow mononuclear cells (h BM-MNCs) by TPA at the concentrations below 10-7 M stimulated them. That is to say, production of colony stimulating factors (CSF) from h BM-MNCs by TPA at that range of concentrations was increased.
    Furthermore TPA at the low cocentrations below 10-8 M stimulated the formation of L-CFU derived secondary colony which is considered to signify selfrenewal capacity of haemopoietic stem cells.
    The combined effects with both TPA and FGF on the forming capacity of L-CFU and CFU-F derived colonies was not observed.
    Through these results, it is suggested that increased L-CFU derived-colony formation by conditioned media derived from TPA-stimulated MNCs might be explained through the mechanisms of increased production of CSF from MNCs and selfrenewal capacity of leukemic stem cells.
  • 青柳 愛孝, 稲田 直之, 大塚 正一, 金光 寛承, 笹岡 拓雄, 金山 正明
    1987 年 28 巻 10 号 p. 1747-1753
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Fourty four patients with Adult T cell leukemia (ATL) have been treated in many hospitals in Kanagawa prefecture. 28 of these patints were born in ATL endemic area, southwest of Japan. 7 of them were in Kanagawa prefecture, and most of 7 were born in Miura hemiisland. Clinical features are same that of endemic area.
    Positive rate of HTLV-I antibody in hemodialyzed patients were 5.7%, about tenfold of non-hemodialyzed patients. Cause of HTLV-I infection of them is thoght to be mainly due to blood transfusion. The number of HTLV-I carriers in Kanagawa prefecture are speculated to be 40,000∼80,000.
    Scrrening of sera for the HTLV-I antibody is necessary to prevent the virus transmission due to blood transfusion.
  • ANLL-827およびANLL-861プロトコールの治療成績
    楊井 正紀, 辻 芳郎, 武田 武夫, 岡 敏明, 谷田部 道夫, 菊田 敦, 金子 安比古, 関根 勇夫, 松下 竹次, 内海 治郎, 四 ...
    1987 年 28 巻 10 号 p. 1754-1762
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Sixty-five evaluable children with acute nonlymphoblastic leukemia (FAB categoies: M1, M2, M4, M5) entered into the protocol studies of Children's Cancer and Leukemia Study Group (CCLSG) between February, 1981 and December, 1985. Before October, 1984, 49 cases were treated with protocol ANLL-827; Regimen-I (neo-MINI-COAAP therapy) or Regimen-II (BH-AC DMP therapy). After November 1984, 16 cases were treated with a new protocol ANLL-861 (combined therapy of Regimen-I and II). Three protocol regimens with multi-drug chemotherapy were administered for three years, without aggressive CNS prophylaxis.
    Fifty of 65 children (76.9%) achieved complete remission (CR). There was no difference in CR rate among three protocol-regimens. The rates of cotinuous complete remission (CCR) at 20 months were 40.5%, 18.8%, and 72.7%, respectively in Regimen-I, Regimen-II, and ANLL-861. However, statistically there was no difference in CCR rate among the protocol-regimens. The median duration of CCR was 11.2 months and 18.8 months in Regimen-I and II. Seven patients have been off chemotherapy, and 6 cases of them have remained in CCR. The incidence of CNS involvement with the three protocol-regimens was 9.2% (6/65). A high incidence of CNS involvement occurred in patients with M4 and M5. CR duration in patients with monocytic leukemia (M4, M5) was significantly shorter (P<0.01) than that in patients with M1 or M2.
    These results indicate that current treatment regimens improve prognosis for acute nonlymphoblastic leukemia in childhood.
  • 二宮 恒夫, 広瀬 政雄, 高上 洋一, 渡辺 力, 大内 徹, 佐藤 純子, 小山 哲也, 阿部 孝典, 鈴江 毅
    1987 年 28 巻 10 号 p. 1763-1770
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Cytosine arabinoside (Ara-C) is the major drug in the treatment of acute myelogenous leukemia, but human leukemic cells are heterogenous with respect to their response to the drug.
    We measured in vitro suppression by Ara-C of 3H-thymidine incorporation into leukemic cells which obtained from children with relapsed acute leukemia.
    1∼2×105 leukemic cells suspended in RPMI 1640 with 25 mM Hepes buffer and 30% patient's serum were placed in wells of microtiter plates with Ara-C at final concentration of 30 ng/ml. After 5 and 24 hours of incubation, 0.2 μCi of 3H-thymidine were added to each well and, after 3-hour labelling period, counts of 3H-thymidine uptake were made on aliquots of cells drawn from the well with automated cell harvestor.
    In the leukemic cells of 3 children who achieved complete remission by low dose Ara-C therapy, the degree of suppression of 3H-thymidine incorporation at 5 hours after incubation with Ara-C remained until 24 hours. In contrast, the patient whose cells showed the recovery of 3H-thymidine uptake at 24 hours, though revealed the suppression at 5 hours, did not achieved remission.
    These experience suggests that this in vitro sensitivity test reliably predicts the effectiveness of low dose Ara-C therapy in patients with relapsed acute leukemia.
  • 和田 英夫, 鈴木 彦次, 森 美貴, 出口 晃, 大久保 伊都子, 津田 雅之, 辻 幸太, 森藤 隆史, 山口 哲郎, 加藤 正美, 宮 ...
    1987 年 28 巻 10 号 p. 1771-1777
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    We studied the clinical course and hemostatic parameters in 36 patients with solid cancers associated with microangiopathic hemolytic anemia (MHA). Twenty two patients had stomach cancers and 31 casaes had the metastasis to their bone marrows. ALL cases were associated with disseminated intravascular coagulation (DIC). Patients with solid cancers and MHA had severe clinical symptoms, especially cerebral bleeding (16 cases), cerebral thrombosis (4 cases) and other organ failure (4 cases), and 50% of the patients died within 3 weeks. The mean survival period was 48.0±86.0 days.
    A coagulation study revealed a slightly reduced fibrinogen level and an elevated erythrocyte segmentation rate, making the diagnosis of DIC tobe difficult. However, these patients had markedly elevated FDP values, decreased platelet counts, severe bleeding tendency and thrombosis. DIC could be effectively treated in only a few patients, and these patients survived longer. Frequent examination of blood coagulation and chemistry shuld be performed in patients with solid cancers. In addition, it is necessary to determine the phase at which hemostatic abnormality occurs in these patients and treated DIC in the early stage.
症例
  • 三角 和雄, 戸田 裕, 山口 則夫, 間下 信昭, 有田 匡孝, 桑名 信匡, 北村 創, 前沢 秀憲
    1987 年 28 巻 10 号 p. 1778-1782
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 21-year-old man was admitted to our hospital because of a rapidly progressed spinal cord transverse syndrome. He had been well until he began to suffer from lumbago and weakness of lower extremities only one week before the admission. Firstly he was diagnosed of having a spinal cord tumor by myelography. After an operation could reveal no significant lesions except dural thickening, lymphoblasts appeared rapidly with anemia and thrombocytopenia. Hematologic scrutiny convicted us that the patient had acute lymphocytic leukemia (FAB-L3). He died of infection and bleeding with no remission by chemotherapy. The autopsy disclosed necrotizing myelopathy with massive infiltration of the blasts into the spinal cord. Literature review suggests that acute lymphocytic leukemia may cause spinal cord involvement by direct infiltration, not by compression which is more frequent in chloromas or lymphomas.
  • 繁田 正子, 小野寺 秀記, 菅野 辰生, 小林 裕, 小澤 勝, 丸尾 直幸, 吉川 敏一, 金綱 隆弘, 近藤 元治, 林 英夫
    1987 年 28 巻 10 号 p. 1783-1789
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 45-year-old male, who was born in Miyazaki prefecture, was admitted with epistaxis. Hematological examinations revealed as follows; hemoglobin 6.2 g/dl and platelets 14000/mm3 and leukocytes 10600/mm3 with 67% of leukemic cells with convoluted nuclei.
    Lymphnode and bone marrow biopsies were compatible with diagnosis of adult T-cell Leukemia. Anti-Adult T-cell Leukemia Virus Antibodies were positive. In the examination of phenotype, however, the leukemic cells expressed OKT4 and OKT8 simultaneously. Though conventional chemotherapy was uneffective, treatment with alpha interferon improved the symptoms and laboratory data. From these results, interferon seems useful for the therapy of ATL in cases of unresponsiveness to the conventional chemotherapy.
  • 加川 大三郎, 安藤 精章, 上田 孝典, 中村 徹, 堂前 尚親, 内野 治人
    1987 年 28 巻 10 号 p. 1790-1794
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 28-year-old man, admitted to our hospital complaining of purpura, was found to have chronic myelogenous leukemia. On admission, his peripheral blood leukocyte count was 281×103l and blood glucose level was 15mg/dl, although he showed no signs of hypoglycemia. His leukocyte counts and blood glucose continued to show a significant negative correlation (P<0.001) throughout his clinical course. In vitro studies indicated that increased peripheral blood leukocytes consumed plasma glucose during the period before analysis of glucose level. From this result, we concluded that the decreased glucose level measured in this blood was secondary to the utilization of glucose by cellular elements during storage.
    In 1979, Fox et al. reported that leukocyte consumed oxygen causing an apparent decrease in arterial blood oxygen and called this phenomenon leukocyte larceny.
    Our finding of pseudohypoglycemia is another aspect of leukocyte larceny. To accurately measure blood glucose level it is necessary to stop consumption of blood glucose. We found that chilling the blood sample in an ice bath was more effective in stopping glucose consumption than adding an inhibitor of glycolysis (NaF: 1.25mg/ml, EDTA·2Na: 3.6mg/ml).
  • —診断と臨床像—
    大野 陽一郎, 亀崎 洋, 天野 博之, 今中 孝信, 高橋 豊, 小橋 陽一郎, 赤坂 清司
    1987 年 28 巻 10 号 p. 1795-1800
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 75-year-old female patient was admitted to Tenri Hospital for the progressive disturbance of consciousness. The hematological findings were as follows: Hb 8.1g/dl, Plt 45×103l, WBC 6600/μl. Seventy-four percent of bone marrow nucleated cells were immature plasmocyters which were positive only for cytoplasmic kappa chain by PAP staining. The laboratory data showed hypercalcemia (7.4 mEq/L), hyper-phosphatemia (6.9mg/dl ), increased serum creatinine (5.5mg/dl ), profuse urinary Bence Jones (k) protein (15g/day) and panhypogammaglobulinemia. Although the chest roentgenogram showed no abnormal shadows, a bone scintigraphy using 99m-Tc methylene diphosphonate disclosed uniform and intense accumulation of radioactivity in the lungs. The patient died 4 months after admission from pulmonary and renal failure. Autopsy disclosed metastatic calcification of interalveolar septa with secondary thickening of alveolar walls. According to the analysis of the references, hypercalcemia, hyperphosphatemia and renal failure were uniformly observed in the patients associated with multiple myeloma and diffuse pulmonary calcification. The survival of the patients ranged from 14 days to 6 months, indicating that pulmonary calcification is a serious complication of multiple myeloma.
  • 倉林 均, 久保田 一雄, 田村 遵一, 白倉 卓夫, 佐藤 貞夫
    1987 年 28 巻 10 号 p. 1801-1804
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 60-year-old woman was admitted to a hospital in May 1986 because of bilateral cervical lymphadenopathy and tonsillar swelling. She had a 10-year history of diabetes mellitus. Biopsy of left cervical lymph nodes revealed that she had non-Hodgkin's lymphoma (diffuse, large cell; clinical stage IVA). She developed left peripheral facial palsy thereafter and was referred to our hospital for further evaluation and treatment in July 1986. On physical examination, bilateral cervical, axillary, and inguinal lymphadenopathies and tonsillar swelling were noted. There was, however, no hepatosplenomegaly. In addition to paralysis of all the left facial mimic muscle, salivation and taste perception on the posterior part of the left half of the tongue were impaired. She had no problems of hearing and lacrimation. There were no meningeal signs. Lymphoma cells were recognized in the bone marrow aspirates. While systemic lymph nodes were markedly reduced in size by two courses of chemotherapy which included vincristine, cyclophosphamide, prednisolone, and adriamycin, the facial palsy was not changed at all. A lumbar puncture showed an elevated intracranial pressure of 210 mmH2O, slightly increased protein level of 42mg/dl, and a few lymphoma cells on a Cytospin-preparation. Two intrathecal injections of 10mg methotrexate resulted in dramatic improvement in the facial palsy. These findings suggest that the facial palsy was not due to direct pressure on the nerve by enlarged tumor mass but due to nerve infiltration by tumor cells from the direction of the central side.
  • 寺田 有由, 花田 修一, 植松 俊昭, 宇都宮 與, 政 信太郎, 橋本 修治
    1987 年 28 巻 10 号 p. 1805-1809
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    We reported a 43-year-old man diagnosed as adult T-cell leukemia with scirrhous-like lesion of the stomach. He was admitted because of epigastralgia, systemic lymphadenopathy and eczema on the extremities. Hemogram in admission showed that white blood cells count were 48,200/mm3 with 65% abnormal lymphocytes. These abnormal lymphocytes showed indented or lobulated nuclei and mature T cell phenotypes (E (+), OKT3 (-), OKT4 (+)). Anti-ATL associated antigen (ATLA) antibody was positive. The diagnosis of adult T-cell leukemia was made. A scirrhous-like lesion was revealed in the stomach by X-ray examination. Histological examination of the biopsied specimens from stomach revealed an infiltration of leukemic cells into the entire mucous membrane and submucosal tissue. Scirrhous-like lesion of the stomach in patient with ATL was discussed.
  • 畑江 芳郎, 武田 武夫, 中館 尚也, 畑山 由起子, 信太 知, 有岡 秀樹
    1987 年 28 巻 10 号 p. 1810-1816
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Three cases of acute leukemia have been reported. In those cases, the first manifestation was bone and joint pain with abnormal changes on X-ray film, which led to the surgical biopsy.
    All of them belonged to non-T, non-B ALL, and no abnormal hematological findings were found in the peripheral blood analysis. 99mTc scintigraphy displayed the invasion as a positive picture. Bone and joint pain subsided with effective induction chemotherapy, and bone changes on the X-ray film disappeared, too. The complete remission has continued from 1 1/2 years to about 7 years. In the case of longest survival, the treatment was discontinued for more than three years.
    Judging from our cases, initial bone involvement by roentgenography plays no important role for threatening the prognosis in childhood ALL.
  • 松田 信, 標葉 晴子, 神林 裕行, 酒井 一吉, 樋口 利行, 川口 美智子, 木村 秀夫, 油井 徳雄, 内田 立身, 刈米 重夫
    1987 年 28 巻 10 号 p. 1817-1822
    発行日: 1987年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 58 year-old female was admitted to the hospital because of failure to chemotherapy of chronic lymphocytic leukemia (CLL).
    Anemia, huge spleen and splenic pain were noted on phyical examination. Hemoglobin was 9.0 gr/dl, white cell count 83,700/μl with 91% CLL cells and platelet count 13.1×104l. Bone marrow aspiration showed hypercellular bone marrow with 79.6% CLL cells. The surface marker analysis was positive for IgG-λ, Ia and Bl. CLL cell kinetic study with Indium-111 method showed that CLL cells remarkably accumulated in the spleen and the splenic transit time was 80 hours. Because of rapid improvement of physical finding, splenic irradiation (SI) was given with liniac. First SI was given total 6 Gray and second SI 12 Gray. Disease-related symptoms rapidly disappeared and hematological improvement was obtained. Duration of response to first SI and second SI were 1 and 2 years, respectively.
    The posible mechanism of effectiveness of SI were discussed together with results of CLL cell kinetic study.
例会
第18回血液成分治療研究会
公募演題
特別講演
feedback
Top