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Volume 28, Issue 6
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Kazuma OHYASHIKI, Hisao ITO, Junko H. OHYASHIKI, Keisuke TOYAMA1987 Volume 28 Issue 6 Pages 807-817
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSRecent molecular biologic interpretation of the Philadelphia (Ph1) translocation in chronic myelogenous leukemia (CML) was reviewed. The halmark of Ph1 chromosome in CML has been identified as a reciprocal translocation, i.e., t (9; 22) (q34; q11) in most cases of CML. In their leukemia cells, it has been shown that the c-abl gene (normally locates at 9q34) is transposed to 22q11 region which contains 5.8 kb breakpoint cluster region with the DNA rearrangments. According to this transposition, the message of c-abl gene altered to a larger fragment than the normal, and which hybridize with the 5' bcr probe, resulting in a chimeric bcr/c-abl mRNA. We presented here recent interpretation of this change in CML with unusual Ph1 translocations or “masked” Ph1 chromsomes.View full abstractDownload PDF (958K)
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Minoru YOSHIDA, Shinobu SAKAMOTO, Yasusada MIURA, Taminori OBAYASHI, T ...1987 Volume 28 Issue 6 Pages 818-822
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSThe clinical usefulness of the conventional limulus test (Toxicolor, which is activated not only by endotoxemia but also by fungemia) and the new test specific to endotoxin (Endospecy: ES test) was studied for the diagnosis of sepsis.
Among 131 blood samples from febrile patients suspected of having septicemia, 68 (51.9%) were positive with Toxicolor. Among 87 blood samples studied with both Toxicolor and blood culture simultaneously, 10 samples (11.5%) were microbiologically documented and determined to have endotoxemia. Thirty-two (36.8%) samples were microbiologically negative, but were positive with Toxicolor (endotoxemia and/or fungemia). Three samples (3.4%) were negative with Toxicolor but positive with blood culture. Of this group, one patient had gram-positive bacteremia and the other two had gram-negative bacteremia treated successfully with high dose steroid. Forty-two samples (48.3%) were negative with both Toxicolor and blood culture. These results indicate that among 74 patients with suspected septicemia without microbiological evidence, 32 patients (43.2%) were demonstrated to have sepsis with gram-negative bacteria or fungus.
Of 63 samples to which Toxicolor and Endospecy were applied, twenty-eight samples (44.4%) were positive with both tests, and 6 (9.5%) were positive with Toxicolor but negative with Endospecy. Among these 6 patients, 3 patients were proved to have fungal infection. The possibility of diagnosis of fungal infection was demonstrated by a combination of these two tests.View full abstractDownload PDF (388K) -
Tohru TAKADA, Teruo INO, Hiroshi KOJIMA, Fumio MARUYAMA, Ryou SOBUE, N ...1987 Volume 28 Issue 6 Pages 823-829
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSObjective evaluation of bone marrow hematopoietic activity was attempted in 34 patients with aplastic anemia by employing the point counting method. Cellularity was determined as the percentage of cellular components in the bone marrow tissue on clot sections and the hematopoietic index (HI) was calculated by multiplying cellularity with the percentage of hematopoietic cells (erythroid and granulocytic precurosors) on myelogram. Cellularity and HI were evaluated for the correltion with the clinical status and the prognosis of aplastic anemia.
The cellularity (mean±SD, 46±12%) and the HI (22±16) were significantly reduced in aplastic anemia as compared to those of normal controls (56±8%, 47±9). Both indices correlated well with the absolute reticulocyte and neutrophil counts in the peripheral blood but not with the platelet counts. Both cellularity and HI influenced the prognosis of patients with aplastic anemia. Patients with HI less than 10 showed significantly worse prognosis with median survival of 53 days as compared to 44 months of those with HI more than 10.
A few patients showed an uneven distribution of hematopoietic bone marrow, and their prognosis was relatively favorable.View full abstractDownload PDF (674K) -
Teruhisa TAOKA, Tatsuhichiro HAMAMOTO, Yasuaki OKUDA, Yuhki HATA, Yosh ...1987 Volume 28 Issue 6 Pages 830-838
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESS1α, 25 (OH)2D3 is known as one of the inducers of non-lymphoid leukemic cell differentiation. We present two leukemic patients and one RAEB patient treated with 1 hydroxyvitamin D3 [1α (OH) D3] which is converted in vivo to active metabolite of vitamin D3, 1α, 25 (OH)2D3 by liver cells. Case 1 is 77-year-old woman with AML (M1) who has complications of severe cholelithiasis. Case 2 is 47-year-old man with RAEB. Case 3 is 58-year-old man with hypoplastic leukemia AML (M2).
We have also investigated in vitro effects of 1α, 25 (OH)2D3 on leukemic cells isolated freshly from the bone marrow of these three patients. After incubation with 1α, 25 (OH)2D3, the number of adherent cells on the bottom of Petri dish has increased, and those cells have become morphologically quite similar to monocytemacrophage.
These three patients have been administered 4.5-15μg/day of 1α (OH) D3 by mouth. Administration of 1α (OH) D3 has had an effect on abating leukemic cells in bone marrow of these three patients and the dispersed chromatin of leukemic cells has aggregated as heterochromatin. In case 1, atypical lymphocyte-like cells have appeared, which were considered to be differentiated from leukemic cells. In case 3, pancytopenia of peripheral blood has improved.
As an adverse effect of 1α (OH) D3 therapy, hypercalcemia occurred in case 1. However, after discontinuation of drug, hypercalcemia disappeared and the level of serum calcium returned to normal range within three days.View full abstractDownload PDF (2100K) -
Teruo INO, Masataka OKAMOTO, Kouichi SHINKAI, Hiroshi KOJIMA, Fumio MA ...1987 Volume 28 Issue 6 Pages 839-844
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSThirty one untreated patients with diffuse lymphoma, large cell type (Lymphoma Study Group) received C-MOPP (cyclophosphamide, vincristine, procarbazine, prednisolone) therapy during March 1974 to April 1984. The overall complete remission rate was 48% (15/31), and among 26 cases with advanced stage (stage III, IV), twelve (46%) achieved a complete remission. The median survival of patients with advanced stage was 9 months and survival curve became flat at 26% after 32 months. Median survival of 12 complete responders with advanced stage was 27 months with 50% of them still alive after completion of therapy. Survival of complete responders was significantly better than that of no responders (p<0.001). Myelosuppressive toxicity was mild and well tolerated. Progressive neurotoxicity limited the administration of the full dosage of vincristine in 15 patients, and allergic reactions necessitated the discontinuation of procarbazine in 6 patients. This study indicates the effectiveness of C-MOPP therapy for advanced diffuse lymphoma, large cell type in Japan. This therapy appeared to be a useful candidate for a regimen to be included in a non-cross resistant combination chemotherapy with adriamycin containing regimen.View full abstractDownload PDF (451K) -
Zenro KIZAKI, Hiroshi FUKUMOCHI, Takayuki SAWAI, Kazuhisa ISHIMURA, No ...1987 Volume 28 Issue 6 Pages 845-851
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSFour patients with malignant histiocytosis were initially treated with exchange transfusion (150-200 ml/kg×1-2) and ACOP (adriamycin/cyclophosphamide/vincristine/prednisolone). On admission, all the patients, 3 girls and 1 boy, with the median age of 2 yrs 7 mos., ranging from 10 mos. to 14 yrs-old, showed septic-type fever and had DIC syndrome, associated with disturbance of consiciousness. Two of them also suffered from renal failure.
In all 4 cases, after exchange transfusion, abnormal high serum LDH was markedly decreased, and total protein and cholesterol values were normalized, and in two cases, consciousness became clear. Although two patients died on Day 16 and Day 19, the other two recovered completely and maintained complete remission with further treatment until relapse and subsequent death.View full abstractDownload PDF (490K) -
Akira SHIBUYA, Haruhiko NINOMIYA, Masaki NAKAZAWA, Takeshi KAGEOKA, Ya ...1987 Volume 28 Issue 6 Pages 852-856
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSIn order to clarify the incidence of ATL among HTLV-I carriers in an ATL-non-endemic area, we compared the positive rate of anti-ATLA in blood donors with the number of patients with ATL found in Ibaraki Prefecture.
The incidence of anti-ATLA in the donors was 0.26%±0.02% (p<0.05). The estimated number of HTLV-I carriers among the total number of the population eligible to donate blood (i.e. those between 16 and 64 years of age) was 4,771 (4,249-5,074) and that among the population over 65 years of age 731 (674-787) or more.
12 cases of ATL were diagnosed in Ibaraki Prefecture during the past 4 years (Sep. 1982 to Sep. 1986). Ten of these cases were in the age group from 16 to 64, and the remaining 2 cases were in the over-65 age group. It was therefore estimated that one case of ATL developed each year among 1,908 (1,740∼2,030) cfrriers between the age of 16 to 64 and among 1,462 (1,348-1574) in the over-65 age group. These rates are approximately compatible with those in the ATL-endemic area studied.View full abstractDownload PDF (386K) -
Yoshitaka AOYAGI, Masato MAEDA, Masaaki KANAYAMA, Masahiro BANBA, Mako ...1987 Volume 28 Issue 6 Pages 857-864
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSDevelopement of monoclonal antibodies and electron microscopic cytochemistry has made it possible to identify megakaryoblast. On the name of “megakaryocytic leukemia”, many case reports has been discussed. We experimented three cases with acute leukemia in which both megakaryoblast and myeloblast proliferated. Clinical course was placed to be uniformly specific that the percentage of leukemic cells was low, but these diseases's onset was slow and gradual. We stressed that these disorders was a new disease entity, called “Myelomegakaryocytic Leukemia”. Myelomegakaryocytic leukemia is suspected to be an acute leukemia with the simultaneous growth of two leukemic clones, originated from same stem cells, but is never considered to be mixed leukemia.View full abstractDownload PDF (1982K)
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—With Statistical Analysis of 33 Cases Administrated Sodium Valproate—Takeshi TERUI, Kyuhei KTDA, Takako MITANI, Shoki TERADA, Teikichi KURE ...1987 Volume 28 Issue 6 Pages 865-871
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA case of thrombocytopenia caused by sodium valproate (VPA) is reported.
A 67-year-old man who had taken VPA after cereberal hemorrhage was transferred to our clinic because of purpura and thrombocytopenia (20,000/cmm). Morphology of a bone marrow aspirate was normal.
The decreased platelet count recovered to normal after discontinuation of VPA, and reappeared after challenge with the same drug. IgG type autoantibody on patient's platelets was detected by the indirect immunofluorescence test.
Further studies on changes of platelet counts before and after administration of VPA were carried out in 33 adult patients from department of neurological surgery. A marked decrease of platelet counts below 100,000/cmm was observed in 2 patients (6.1%).
It was therefore concluded that thrombocytopenia should be always taken into acount as a side effect when VPA was administrated for a long period.View full abstractDownload PDF (448K) -
Michihiko MASUDA, Hiroko KOKAGO, Kazuo OSHIMI, Hideaki MIZOGUCHI, Masa ...1987 Volume 28 Issue 6 Pages 872-875
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA case of 49-year old male with congenital stomatocytosis is reported. On physical examination, he had anemia and jaundice. Laboratory data revealed that: RBC count was 387×104/μl, Hb 12.8g/dl, Ht 38.5%, reticulocyte count 6.5%, and serum total bilirubin 3mg/dl (indirect bilirubin 2.5mg/dl). Coombs test and Ham's test were negative. Half life of the 51Cr-labeled red cells was shortened to 12.2days. Electrophoretic pattern of hemoglobin, lipid contents of red cell membrane and enzyme activities in erythrocytes were essentially normal. Although red cell sodium efflux and influx were within normal limits, intracellular sodium concentration of erythrocytes was abnormally low. These fidings indicate that this is the new type variant of cogenital stomatocytosis.View full abstractDownload PDF (312K) -
Katsuya HIRANO, Tsunefumi SHIBUYA, Eiji MORIOKA, Yoshiyuki NIHO1987 Volume 28 Issue 6 Pages 876-880
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 71-aged man with chronic lymphocytic leukemia successfully treated with melphalan-dexamethasone combination chemotherapy (M-D therapy) was reported.
While he was in hospital because of pneumonia in February 1984, the diagnosis of CLL was made and then IgG κ M protein and Donath-Landsteiner antibody were found.
Partial remission was induced with VEMP therapy (vincristine, cyclophosphamide, 6-mercaptopurine, prednisone) and maintained with cyclophosphamide or VEMP until December 1984, when he was admitted again becauce of pneumonia.
On admission, physical examination revealed hepatosplenomegaly. The hemoglobin was 8.3g/dl and his blood count disclosed leukocytopenia of 1100/μl with 80% lymphocytes. The bone marrow nuclear cell count was 9.4×104/μl with 91% lymphocytes. The cytoplasmic immunoglobulin was stained with fluorescin conjugated anti-human IgG.
Because both VENP therapy and ACM therapy were found ineffective, M-D therapy (melphalan 10mg/day·5days dexasmethasone 20mg/day·4days) was started with marked improvement. Though M-2 protocol including melphalan had been used for myeloma and advanced CLL, our therapy with melphalan and dexamethasone was the first report for refractory CLL.View full abstractDownload PDF (447K) -
Tsuneo NINOMIYA, Yoichi TAKAUE, Masao HIROSE, Masayuki YAMAZAKI, Noria ...1987 Volume 28 Issue 6 Pages 881-885
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSIntensive chemotherapy significatly improved the prognosis of childhood acute lymphocytic leukemia (ALL), but reports have documented therapy-related endocrine dysfunctions. We studied on the rate of growth velocity (%) in 30 children with ALL in continuous complete remission. The rate of growth velocity was calculated as follows; growth velocity of patient (cm/several months) was divided by age-matched normal growth velocity.
Although the rate of growth velocity was decreased after induction therapy including systemic chemotherapy and cranial radiation, catch up growth was occurred and premorbid growth curve was regained within 1 year in the majority of patients. However, catch up growth was absent in two patients and bone age advancement was delayed. One patient, 10 10/12-year old girl, had a decrease in growth hormone (GH) response (<7ng/ml ) with arginine infusion and insulin induced hypoglycemia. Human GH treatment led to an increase in the growth velocity. The other patient, 12 8/12-year old girl, had a decrease in somatomedin-C (IGF-1) levels, compared with the age-matched control values, which might be associated with maintenance and consolidation therapy including prednisolone and other chemotherapeutic agents.
These findings suggest that endocrine function test is required in patients who show a decrease in the rate of growth velocity after 1 year of induction therapy and appropriate replacement therapy might be needed for the endocrine damage.View full abstractDownload PDF (398K) -
Akira DEGUCHI, Chizuko OHTA, Motoaki TANIGAWA, Noriko SHIMA, Isao TANA ...1987 Volume 28 Issue 6 Pages 886-890
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 35-years-old housewife was admitted to the hospital in May, 1983, with complaints of hypermenorrhea. The diagnosis of acute promyelocytic leukemia (APL) was made based on the proliferation of atypical promyelocytes in the bone marrow. A complete remisson was achieved by the BH-AC·AMP therapy and maintained by the consolidation therapy and the intensification therapy. In January, 1985, she developed paraplegia and anesthesia in the lower extremities. Myelography showed extradural tumor in the lower portion of the thoracic vertebrae. Laminectory disclosed the dark-green tumor in the extradural space, which surrounded the spinal cord (Th10-Th12). The infiltration of leukemic cell was shown histologically, despite of the hematological remission. After partial resection of the tumor, irradiation was required. A hematological relapse occurred in February, 1985, but the second complete remission was obtained by the BH-AC·DMP therapy. Thereafter, she died because of sepsis and cardiac failure in April, 1986, after the second hematological relapse. According to development of intensive chemotherapy for acute leukemia, the tumor forming leukemia during the hematological remission, such as this case, would be increasing. Therefore, we should mind the tumor forming in the treatment of the patients with leukemia.View full abstractDownload PDF (600K) -
Keiko SAKATANI, Taiichi KYO, Hiroo DOHY, Michio KAWANO, Yasuo TAKIMOTO ...1987 Volume 28 Issue 6 Pages 891-896
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 75-year-old man was admitted to our hospital because of general fatigue and exertional dyspnea. Physical examination revealed slight cervical lymphadenopathy and hepatomegaly, but not splenomegaly. In the peripheral blood there was severe anemia, thrombocytopenia and leukopenia of 2900/μl with 32% of blast cells. The bone marrow was hypercellular and contained 98.5% of blast cells. In these cells, peroxidase activity was negative and surface markers of Clg, Slg, EAC, EA were also not detected. In the cytogenetic examination of bone marrow cells, Philadelphia chromonome (Ph1) was observed in the 18 out of 20 metaphases examined. At that time, diagnosis of Ph1 positive-ALL (FAB L2) was made. Then, induction chemotherapy was initiated with ABOP. However he died of lately complicated fungal infection of the lungs. His entire course was about 50 days.
The blast cells were identified by electron microscopy, as immature plasma cells which had clear nucleoli and well developed rough endoplasmic reticulum. This case seems to be the fifth reported Ph1 positive-multiple myeloma or plasma cell leukemia, and these cases would be very interesting for understanding the origin of leukemic cells.View full abstractDownload PDF (1072K) -
Kuniaki ITOH, Kiyoshi HIRUMA, Hisashi WAKITA, Hirotoshi NAKAMURA, Nobu ...1987 Volume 28 Issue 6 Pages 897-901
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 42-year-old woman was admitted to the hospital because of lower abdominal mass. Gynecological examination revealed uterine myoma. There was no splenomegaly.
Blood pressure was 144/90mmHg. Red blood cell count was 668×104/μl and hemoglobin was 20.3g/dl. White blood cell count was 6,800/μl with a normal differential, platelet count was 18.1×104/μl. The neutrophil alkaline phosphatase score was 165. Red cell volume was 32.2ml/kg. Bone marrow aspiration revealed slight erythroid hyperplasia. Erythroid progenitor cells in bone marrow were within normal limits and did not form colonies without erythropoietin. Blood gas analysis was within normal limits. Intravenous pyelogram showed absence of hydronephrosis.
By the method used mouse bone marrow cells, erythropoietin levels were elevated in serum, myoma tissue and myoma tissue conditioned medium.
On Feb. 12, 1985, hysterectomy was performed. Uterine myoma was measured 26×12×18cm and weighed 2,000g. The histology was leiomyoma. After operation, the patient was doing well and a complete blood count returned normal.
Diagnosis of erythrocytosis associated with uterine myoma was made.View full abstractDownload PDF (383K) -
Marohito MURAKAMI, Kousaku SUGIURA, Tsuneo KATAYAMA1987 Volume 28 Issue 6 Pages 902-906
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA seventy-one-year old man was admitted because of dyspnea. Physical examination revealed tachycardia, dilated jugular vein, enlarged liver and leg edema. Chest roentgenograms showed an enlarged cardiac shadow and bilateral pleural effusion. Two dimensional echocardiograms revealed a massive pericardial effusion. A diagnosis of heart failure due to cardiac tamponade was made.
A cytological study of the pericardial effusion showed many mononuclear atypical cells with hyperlobulated nuclei. Monoclonal antibody studies of these cells were positive for Leu2 and Leu4. A computed tomogram of the chest showed an abnormal mass of 4×4cm at the left hilus where the only uptake of gallium was found. A diagnosis of T cell lymphoma was made and the chemotherapy of VEPA was started. After the completion of the chemotherapy, the signs of heart failure, the pericardial effusion and the mass disappeared completely. Although the patient refused the maintenasce chemotherapy, he has been doing well for the past ten months.View full abstractDownload PDF (656K) -
Etsuko UEDA, Takashi MACHII, Kouji WAKI, Masaru SHIBANO, Yoshihisa NAK ...1987 Volume 28 Issue 6 Pages 907-910
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 53-year-old housewife with monocytic leukemia had been suffered from severe oral mucosal lesions not primarily due to leukemic involvement in four courses of chemotherapy. Anti-fungal drugs had no effects on those lesions. To prevent chemotherapy-associated mucosal lesions, PGE2 0.5 mg was topically administered 3 times daily from the start of chemotherapy to the time of recovery from nadir of the peripheral white blood cell counts in the next two courses of chemotherapy. As a result, in the first therapy, no oral lesions appeared. In the second course, not completely prevented, the lesions were apparently much milder compared to the previous ones appeared in the courses without PGE2. And there were no side effects of the topical administration of PGE2. We expect that topical PGE2 is useful for the prophylaxis of chemotherapy-associated oral mucosal lesions.View full abstractDownload PDF (385K) -
Shinji IJICHI, Shinichi IWATA, Fumiho UNE, Mitsutoshi TARA, Akihiro IG ...1987 Volume 28 Issue 6 Pages 911-916
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSWe describe a patient with primary biliary cirrhosis and Sjögren syndrome who developed B cell malignancy. This B cell malignancy was B cell malignant lymphoma, detected as L-3 ALL (acute lymphoblastic leukemia) of FAB classification at first.
The patient was a 26-year-old woman. She developed Sjögren syndrome and asymptomatic primary biliary cirrhosis at the age of 24. Two years later, she gradually developed abdominal enlargement.
The differential cell count of peripheral blood and bone marrow aspirate revealed L-3 ALL. The abdominal echogram confirmed marked hepatomegaly. Intensive chemotherapy was given, and complete remission was maintained for 4 months. However, she relapsed in the form of B cell malignant lymphoma (diffuse, medium-sized cell type).
The association of B cell malignancy with Sjögren syndrome and the relation between Sjögren syndrome and Epstein-Barr virus were discussed.View full abstractDownload PDF (680K) -
—With Special Reference to the Effects of Danazol—Hiroyoko AMITANI, Koichi SHINMYOZU, Shinji IJICHI, Mitsutoshi TARA, Ki ...1987 Volume 28 Issue 6 Pages 917-923
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 76-year-old male was admitted to our hospital because of a large subcutaneous hematoma on his right hip. Coagulation studies revealed that the platelet count and fibrinogen decreased and FDP increased. Abdominal CT scan showed an enlarged portion of the thoraco-abdominal aorta, and a dissection of the aorta was showed by intravenous digital subtraction angiography. Based on these findings, a diagnosis of chronic consumption coagulopathy due to a dissecting aortic aneurysm was made. Anticoagulants such as heparin and danazol, especially the latter resulted in marked normalization of the coagulation abnormalities and the clinical course improved. It is concluded that particularly danazol has a distinct anticoagulant effect and may provide a useful adjunct to anticoagulant treatment in chronic consumption coagulopathy.View full abstractDownload PDF (878K) -
Jun'ichi TAMURA, Kazuo KUBOTA, Hitoshi KURABAYASHI, Takuo SHIRAKURA, Y ...1987 Volume 28 Issue 6 Pages 924-928
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 59-year-old man was admitted to our hospital in July, 1982 for the evaluation of anemia and pretibial edema. He had no history of abdominal operation. Physical examinations revealed no abnormalities except the signs described above. Megaloblastic anemia due to malabsorption of vitamin B12 was suspected by the findings of macrocytic, hyperchromic anemia, megaloblastic bone marrow, low serum level of vitamin B12 (43 pg/ml ), markedly low Schilling test partially improved by intrinsic factor, and a blind loop of the ileum on X-ray films. Serum antibodies to intrinsic factor and parietal cell cytoplasma were both negative. Oral administration of kanamycin and tetracyclin resulted in improvement of pancytopenia. Since serum hypoproteinemia was not improved by the antibiotics therapy, partial resection of the ileum was performed. It was demonstrated that the blind loop was formed by a fistura between walls of ileum. The fistulation was secondary to ulceration caused by Crohn's disease which was diagnosed histologically.View full abstractDownload PDF (456K) -
Harumi SADAMOTO, Yukiro MUTO, Yoshiro FUJII, Taeko MINAMI1987 Volume 28 Issue 6 Pages 929-933
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 28 year old man was admitted for fever, hematuria and atypical lymphocytosis, and was found to have Coombs-positive hemolytic anemia and positive serologic test for Mycoplasma associated with liver dyafunction. Mycoplasma infection seemed most likely to be the cause of transient AIHA, producing cold agglutinin. This is the first clinical report on the Mycoplasma infection that induced transient AIHA without complication of acute pneumonia.View full abstractDownload PDF (519K) -
Mitsuhiro HIGUCHI, Takashi SAKURAI, Tokuo NAKAJIMA, Eizoh KAKISHITA, K ...1987 Volume 28 Issue 6 Pages 934-938
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 78-year-old man was admitted because of subcutaneous hemorrhage spreading over his both arms on May 1, 1985. Coagulation studies revealed mild prolongation of prothrombin time and activated partial thromboplastin time, marked decrease of plasma fibrinogen level, marked increase of serum fibrin degradation products (FDP) and decrease of plasminogen, α2 plasmin inhibitor and antithrombin III activity. Computed tomography and intravenous digital subtraction angiography showed abdominal aortic aneurysm. Based on these findings, a diagnosis of disseminated intravascular coagulation (DIC) complicated in abdominal aortic aneurysm was done. A synthetic thrombin inhibitor, MD-805, was administered to control DIC, resulting in good control and operative repair of the aneurysm was successfully performed on 16th hospital day without unusual blood loss.
We retrospectively evaluated on blood coagulation tests in 113 cases with aortic aneurysm admitted to our departments during January, 1980 to December, 1984. We found no case with overt DIC but 47.5% of these cases with elevated FDP level and 7.0% with decreased platelet counts. It appears that these abnormalities on blood coagulation tests might be related to conditions of this disease.View full abstractDownload PDF (442K) -
Yasuhiko KAJIGAYA, Hideki SASAKI, Koichiro IKUTA, Yoshitaka KOISO, Kei ...1987 Volume 28 Issue 6 Pages 939-944
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 2 months old male, with fever, pallor and hepatosplenomegaly, was admitted on October, 8, 1983.
Clinical manifestations and laboratory data were compatible with juvenile chronic myelogenous leukemia. He died of intestinal bleeding in April, 1984 and autopsy was performed.
The liver and spleen was enlarged, weighing 350 and 250g, respectively. The extramedullary hematopoiesis was seen in the liver.
The Gγ: Aγ ratio of hemoglobin F was 0.68, measured by isoelectric focusing.
Bone marrow or peripheral blood cells were cultured in a single layer, using 10% of human omentum conditioned medium as colony stimulating factor. Large number of colonies were formed by bone marrow as well as peripheral blood cells. Colonies consisting of macrophages were 27% on 7th day of culture.
These results suggest that hemopoiesis of this case was similar to fetal hemopoiesis.View full abstractDownload PDF (617K) -
Susumu MITSUTANI, Toshiaki KOHRIYAMA, Masanori KAMIO, Toshiharu SAITOH1987 Volume 28 Issue 6 Pages 945-950
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSIsolated thrombocytopenia as presenting symptoms of myelodysplastic syndromes (MDS) according to the FAB classification is exceptional.
Case I (42-year-old male), after the stage of isolated thrombocytopenia during 2 years and 6 months, developed RAEB-T followed by overt leukemia (M4). On the first admission, this patient could be predicted of a neoplastic process and be distinguished from ITP by some qualitative blood cell abnormalities as follows: the bone marrow micromegakaryocytes and the peripheral megathrombocytes in the magakaryocytic series, schistocytosis and an increase in HbF levels in the erythroid series, the presence of peroxidase negativegranulocytes and specific granule defective-granulocytes in the myeloid series.
Case II (34-year-old male) showing severe isolated thrombocytopenia was diagnosed clinically as MDS (refractory cytopenia) because of lack of an increase in the bone marrow blasts despite of marked erythroid hyperplasia (>50%). The blood cell morphology showed the Pelger-Huët-like nuclear anomaly, defect of the specific granules in the granulocytes, schistocytosis, megaloblastic change and the micromegakaryocytes. Pathologically, however, the postmortem examination in this patient revealed acute erythremic myelosis (Di Guglielmo's disease) especially by means of immunostaining of the involved lymph nodes.View full abstractDownload PDF (930K) -
Akira YUO, Yoshitomo MUTOH, Hisomu YAMAGUCHI, Toshiyasu TSUKADA, Yuzo ...1987 Volume 28 Issue 6 Pages 951-955
Published: 1987
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 64-year-old man was admitted to Toranomon Hospital because of abdominal distension. Computed tomography of his abdomen showed marked hepatosplenomegaly with multiple space occupying lesions in the liver and spleen. Laboratory examinations revealed normocytic anemia with reticulocytosis, fragmentation of red blood cells, marked thrombocytopenia, decrease of fibrinogen, elevated levels of FDP and indirect bilirubin and strongly positive CRP with normal ESR. These findings indicated that this patient suffered from either a primary or a metastatic tumor in the liver and spleen accompanied with disseminated intravascular coagulation (DIC) and microangiopathic hemolytic anemia (MHA). In spite of intensive examinations, no other sites of tumor infiltration were detected. Hemorrhagic diathesis of this patient prevented us from getting histopathological information by tumor biopsy. Although combined chemotherapy for the tumor had only a small effect, continuous intravenous administration of heparin resulted in almost total disappearance of DIC and marked improvement of hemorrhagic diathesis. MHA was resistant to the therapy. The patient finally died of massive intraabdominal bleeding from liver tumor. At autopsy, histological diagnosis was angiosarcoma, the primary site of which was thought to be the spleen, determined by several clinical and pathological findings.
Though primary splenic angiosarcoma is very rare, it is important in the differential diagnosis of hepatosplenomegaly, especially with DIC and/or MHA. Moreover, in this case, heparin therapy for DIC was markedly effective in spite of advanced infiltration of the tumor.View full abstractDownload PDF (880K)
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1987 Volume 28 Issue 6 Pages 956-959
Published: 1987
Released on J-STAGE: February 02, 2009
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1987 Volume 28 Issue 6 Pages 970-1001
Published: 1987
Released on J-STAGE: February 02, 2009
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1987 Volume 28 Issue 6 Pages 1002-1039
Published: 1987
Released on J-STAGE: February 02, 2009
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