巻号一覧
29 巻, 2 号
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臨床研究
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芦田 隆司, 石川 博之, 浦瀬 文明, 下間 庸光, 佐藤 充重, 末吉 章浩, 椿 和央, 入交 清博, 堀内 篤1988 年 29 巻 2 号 p. 109-115
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありTwenty-four adult patients with acute promyelocytic leukemia (APL) were studied on results of treatment during the past 11 years. Chemotherapy was carried out in 22 of them, and the complete remission (CR) was attained in 54.5%. Excluding early death within 20 days, the CR rate was elevated to 80% (12/15). The median duration of first CR was 13 months, and the median survival of CR patients was 17 months. Twelve patients were alive two months after diagnosis, and all of them achived CR. According to schema for the classification of remission induction failures proposed by Preisler, two patients were grouped into Type I (absolute drug resistance), one into Type IV (death during hypoplasia), and seven into Type V (inadequate trial of therapy). None belonged either into Type II (relative drug resistance), Type III (regeneration failure) or Type VI (extramedullary persistance). Percent of leukemic cells in the bone marrow was significantly lower in CR patients than in non-responding ones. Causes of early death were hemorrhages in 58.3% of patients.抄録全体を表示PDF形式でダウンロード (502K) -
牧野 茂義, 荒木 康彦, 田村 和夫, 清田 正司, 鳥越 淳一郎, 河内 実世1988 年 29 巻 2 号 p. 116-122
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありNineteen patients diagnosed as having myelodysplastic syndrome (MDS) were analysed for laboratory findings, treatment and prognosis. They were classified into four subtypes according to French-American-British (FAB) classification; 7 patients with refractory anemia (RA), 6 with refractory anemia with excess of blasts (RAEB), 5 with RAEB in transformation (RAEB in T), and one with chronic myelomonocytic leukemia (CMMoL).
The patients with RA had a relatively chronic clinical course only with a conservative therapy.
One patient with CMMoL has been successfully treated with administration of busulfan followed by esquinone and blood transfusion.
Three patients with RAEB or RAEB in T developed overt leukemia and survived for 1, 1, and 2.5 months after leukemic transformation. Remaining 3 patients with no leukemic transformation was also expired from infection. Their survival was only 1, 1, and 4 months.
In terms of treatment a low-dose Ara-C was given to 2 patients (RAEB, RAEB in T) and 4 patients (RAEB 2, RAEB in T 2) received recombinant gamma interferon. However, there was no good response. Anti-leukemic chemotherapy and bone marrow transplantation were also tried. One patient with RAEB obtained complete remission with a combination of vincristine, 6-MP and prednisolone lasting for 2 months. Bone marrow transplantation was performed on a 26 year-old RAEB in T patient with hematological improvement, but died of encephalitis. Thus far treatment for MDS is still a challenging problem. Pathogenesis of MDS and a well-defined treatment strategy should be investigated in the future.抄録全体を表示PDF形式でダウンロード (475K) -
堀部 敬三, 小島 勢二, 松山 孝治, 平田 亮, 吉田 潤, 加藤 剛二, 吉田 京, 岩村 春樹1988 年 29 巻 2 号 p. 123-129
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありFourteen patients with acute leukemia were conditioned with cyclophosphamide and total body irradiation, and were given marrow grafts from their HLA-matched siblings except one case from her HLA-DR-mismatched sibling. For graft-versus-host disease (GVHD) prophylaxis methotrexate was used in 11 cases, and ciclosporine A in 3 cases.
Engraftment was obtained in all cases. None of fourteen cases had severe GVHD, while 5 cases had grade I or II GVHD. Six patients are alive from day 346 to day 1278 after grafting. Four of them were in their post-transplant remission (PTR), while two were in remission following bone marrow or testicular relapse. Eight patients died from day 53 to day 1036 after grafting, in whom two cases died of interstitial pneumonia, one case of bronchiolitis, and five died following systemic relapse. The disease-free survival probability of patients transplanted in first remission was 42% (three of six are in PTR), whereas that of patients transplanted in subsequent remission was only 12.5% (one of eight is in PTR). While GVHD was mild in our pediatric cases, post-transplant leukemia relapse were so frequent (7 of 14 cases) that pre-transplant conditioning therapy and time for transplantation have to be refined.抄録全体を表示PDF形式でダウンロード (543K) -
児玉 雅彦, 桑水流 康夫, 斎藤 毅, 牧野 虎彦, 魚住 公治, 寺田 有由, 福田 稔朗, 石橋 和明, 宇都宮 與, 植松 俊昭, ...1988 年 29 巻 2 号 p. 130-136
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありThe prognosis of Adult T-cell Leukemia-Lymphoma (ATLL) has been very poor. One of main causes of poor prognosis is due to complication of severe pulmonary infection, unresponsive to antibiotic chemotherapy. We studied on pathogenic microorganisms which caused fatal pulmonary infection and its antibiotic therapy in 10 autopsied cases with ATLL who died of pulmonary infection.
The detected microorganisms which caused lethal pulmonary infection were revealed to be fungus (5 cases), bacteria (3 cases), Cytomegalovirus (3 cases) and Pneumocystis carinii (P. carinii) (1 case) by bacteriological and pathological examination of affected tissue of lung at autopsy. In 3 cases, more than 2 kinds of microorganism were seen in same tissue. It was difficult to determine microorganisms which caused pulmonary infection from chest X-ray findings. Fever of unknown origin was frequently seen before outbreak of pulmonary infection in many cases of ATLL and the survival duration after onset of that was very short. So it seemed to be necessary to carry out aggresive and appropriate antibiotic therapy for those microorganisms (fungus, bacteria, virus, P. carinii and so on) as soon as possible to prevent pulmonary infection in patients with ATLL when fever of unknown origin was seen.抄録全体を表示PDF形式でダウンロード (547K) -
—小児急性非リンパ性白血病の治療成績からみたM3例の特殊性—東道 伸二郎, 新川 正治, 長井 隆夫, 綱本 健太郎, 橋田 哲夫, 江角 典子, 清水 芳隆, 藤原 史博, 日比 成美, 吉原 隆夫 ...1988 年 29 巻 2 号 p. 137-143
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありDuring the past 6 years from 1981 through 1986, a total of 33 new cases of childhood acute non-lymphoblastic leukemia (ANLL) were treated with an intensive multi-drug chemotherapy at the Department of Pediatrics, Kyoto Prefectural University of Medicine and other affiliated pediatric clinics.
Excluding 2 cases still receiving early induction therapy, 24 of the remaining 31 cases (78%) attained complete remission (CR); a half of which relapsed or died within 15 months, but another half had, or has been in continuous complete remission (CCR) for over 24 months after beginning of the induction therapy.
All of the 5 M3 patients attained CR and had or has been in CCR over 24 months, indicating that M3 cases easily achieve long term CR. On the other hand, 19 of the other 26 ANLL cases attained CR but only 7 cases had or has been in CCR over 24 months. However, late relapse after 24 months occurred in 3 of the 5 M3 cases, compared with 1 in the 7 other ANLL cases.
Our results may suggest that protocols for M3 cases should be modified to include more intensified, and long-duration maintenance chemotherapy, in order to prevent late relapse.抄録全体を表示PDF形式でダウンロード (544K) -
三比 和美, 柵木 信男, 桜井 雅温, 服部 理男1988 年 29 巻 2 号 p. 144-148
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA total of 52 previously untreated patients with advanced Hodgkin's disease and unfavorable type of non-Hodgkin's lymphoma were treated with a variety of combination chemotherapy between 1975 and 1981: 50 were considered evaluable. Treatment consisted of CVP (6 patients), C-MOPP (8 patients), VP (one patient), and adriamycin-based combination chemotherapies (35 patients). Of the 50 patients. 26 achieved a complete remission, and 18 were alive and disease-free. Clinical factors of prognostic importance for survival included age of less than 60 years and no constitutional symptoms. A 5-year survival for all patients was 36%, while an actuarial disease-free survival curve of all responders plateaued at 69%. A unique finding was that there were long-term survivors in the diffuse medium and diffuse mixed type as well as in the diffuse large cell type of non-Hodgkin's lymphoma.抄録全体を表示PDF形式でダウンロード (340K) -
宮村 耕一, 竹山 邦彦, 松下 正, 木村 之彦, 南 三郎, 吉田 潤, 松山 孝治, 小寺 良尚, 山内 辰也, 平岩 明和, 伊藤 ...1988 年 29 巻 2 号 p. 149-155
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありThe prognosis of patients with Burkitt's lymphoma in Japan is usually poor, compared with that of the American and European cases, and the median survival period of the patients with “Stage IV” has been reported to be 2.3 months. Three cases of Burkitt's lymphoma (Stage IV) were treated with allogeneic bone marrow transplantation following a high dose chemoradiotherapy during their remission (2 in the 1st and 1 in the 2nd remission).
All were conditioned with cyclophosphamide (60 mg/kg/day) in day -5 and -4 and total body irradiation (10-12Gy) in day-2 and -1 and one received additional cytosine arabinoside and cerebrospinal and local irradiation. Two were grafted from HLA compatible siblings and another was from a DR-incompatible sibling. Engraftment was confirmed in all cases. One patient transplanted during 2nd CR died of relapse on the 160th day after the BMT. Remaining two cases, transplanted in their first remission, survived for more than 12 and 60 mos after the BMT without a recurrence of the disease. Allogeneic bone marrow transplantation for the treatment of Burkitt's lymphoma (Stage IV) might be a curative procedure, if it is performed in the 1st CR.抄録全体を表示PDF形式でダウンロード (554K) -
花田 尚1988 年 29 巻 2 号 p. 156-160
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありProtein C (PC) was measured by means of enzyme-linked immunosorbent assay in plasmas from 25 patinents with childhood DIC. PC level of all patients was significantly low in comparison with the age-matched normal value. PC level was positively correlated with plasma antithrombin III (AT III) level. Disturbance of γ-carboxylation was detected by measurement of PIVKA-II in 7 out of 25 patients. PC level began to increase within 4 days after initiation of the heparin therapy. These findings suggested that low PC level in DIC was due to mainly consumption of PC and that disturbance of PC production was also associated with low PC level in some patients.抄録全体を表示PDF形式でダウンロード (366K) -
竹中 武昭, 近田 千尋, 坂野 輝夫, 北原 武志, 湊 啓輔, 飛内 賢正, 下山 正徳1988 年 29 巻 2 号 p. 161-166
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありThe therapeutic effect of combination chemotherapy on 49 non-Hodgkin's lymphoma patients aged 70 or older who had been treated at the National Cancer Center Hospital over 24 years was analyzed on the basis of their response rates, duration of remission, and survival from treatment. The group [ADM (+)], treated with regimens including adriamycin, was compared with the group [ADM (-)] treated with regimens excluding adriamycin.
There were no statistically significant imbalances between these two groups with respect to age, sex, primary site, clinical stage or histologic subtype.
Complete response was seen in 10 out of 21 patients (46.4%) and in 11 out of 28 patients (39.3%) for the ADM (+) group and the ADM (-) group, respectively. The period of complete remission of the ADM (+) and ADM (-) groups was compared using the log-rank method. The duration of the former was significantly (p<0.05) loner than that of the latter and the median duration of remission was 20 months and 4 months, respectively. The median survival time from treatment was 22 months for the ADM (+) group and 14 months for the ADM (-) group, but no significant difference was observed between the two groups.
Therapy-related mortality or serious complications were not observed in both groups.抄録全体を表示PDF形式でダウンロード (424K) -
阿部 和弘, 小熊 信夫, 今村 展隆, 稲田 富成, 藏本 淳1988 年 29 巻 2 号 p. 167-173
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありIn vitro colony formation of hematopoietic stem cells and chromosomal studies of bone marrow cells, and analysis of T-cell subsets of peripheral blood was carried out in 19 patients with MDS. According to the FAB classification, they were divided into five groups; PARA (6), PASA (1), RAEB (8), RAEB-T (3), CMMoL (1).
One case of PARA, 2 of RAEB and 3 of RAEB-T developed overt leukemia.
Even without addition of erythropoietin, many CFU-E formations, were observed in 6 cases and three of them showed leukemic changes. Twelve out of 18 cases showed chromosomal abnormalities. Three of them had major karyotype abnormalities (MAKA) and 2 from these cases developed leukemia. Level of serum immunoglobulins, IgG or IgA were increased in 11 out of 17 cases. The increment of OKT4/OKT8 (CD4/CD8) ratio was found in 7 out of 14 cases and three of them showed leukemic changes.
The study suggests that MDS is a result of both quantitative and qualitative abnormalities of hematopoietic stem cells, involving colony formation, chromosomal and immunological changes. The most important factors which contribute to the development of leukemia remains undetermined up to this time. Further studies are necessary to clarify the factors surrounding such disorders.抄録全体を表示PDF形式でダウンロード (482K)
症例
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—In vitro Colony Assayを中心に—宮野 孝一, 河内 暁一, 須藤 善雅, 横山 〓, 佐藤 雄一1988 年 29 巻 2 号 p. 174-179
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA five-year-old girl with prulent meningitis due to Hemophilus influenzae was treated with Latamoxef, 260mg/kg/day, which induced agranulocytosis. Latamoxef was discontinued. She was referred to our hospital for the management of agranulocytosis in a clean room. Three days after discontinuation of Latamoxef the granulocytes began to appear in the peripheral blood. After recovery from agranulocytosis the influence of Latamoxef on the growth of bone marrow granulocytemacrophage progenitor cells was examined using in vitro colony assay (CFU-C). Latamoxef significantly inhibited CFU-C growth in concentrations from 4×10-5 to 4×10-8 mol/l. The addition of patient's serum collected during the agranulocytic period did not inhibit colony growth further. The serum antineutrophil antibody and HLA antibody were not detected. Latamoxef did not stimulate patient's lymphocyte blastogenesis.抄録全体を表示PDF形式でダウンロード (412K) -
仁保 美和子, 佐野 文明, 小池 満, 長谷川 誠一, 田中 正顕, 藤野 法康, 金子 久美子, 倉持 恒雄, 井上 眞夫, 石田 尚志 ...1988 年 29 巻 2 号 p. 180-185
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありMany cases of ATL (Adult T cell Leukemia) have been reported since 1977, when the first report was made by Takatsuki et al. We report a case of chronic ATL with severe punched out osteolytic lesions and a long course of 10 years. Leukocytosis and punched out osteolytic lesions were found on the first admission, 1977, in a 57 year-old female who had suffered many fractures previously. Multilobular abnormal lymphocytes were detected in her peripheral blood. We demonstrated the lymphocyte surface maker, ATL-associated antigen, proviral DNA and made a diagnosis of chronic ATL. A course of 10 years are also uncommon. The pathological findings of bone in such a case require futher study.抄録全体を表示PDF形式でダウンロード (952K) -
遠藤 安行, 岩本 恵子, 伊藤 俊広, 三浦 亮, 桑山 明久, 西村 茂樹1988 年 29 巻 2 号 p. 186-188
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありAlthough thrombotic complications during treatment for hemorrhagic diathesis with tranexamic acid (T-AMCHA) were occasionally seen, deep vein thrombosis (DVT) induced by T-AMCHA in idiopathic thrombocytopenic purpura (ITP) has not been reported. We recently experienced an 83-year-old male of ITP associated wist DVT showing the depression in fibrinolytic activity due to administration of T-AMCHA for 16 months. His thrombosis was dissolved by urokinase.抄録全体を表示PDF形式でダウンロード (235K) -
稲葉 俊哉, 花田 良二, 中島 匡博, 林 泰秀, 山本 圭子, 西田 俊朗1988 年 29 巻 2 号 p. 189-194
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありWe report here a childhood MDS with inv(11)(p15q23). A 7-year-old boy with mild thrombocytopenia had been observed without medication since May 1983. In November 1984 he became pancytopenic. A diagnosis of aplastic anemia was made according to his markedly hypocellular bone marrow. He was treated with prednisolone and oxymetholone with good response. In June 1986, myeloblasts with Auer's rods were seen in peripheral blood; bone marrow was hypercellular with 6.2% of myeloblasts. A diagnosis of RAEB-T was made. In September 1986, WBC count was increased to 75,500/μl, but its majority were mature neutrophils, and NAP score was 0 (0%). A diagnosis of CMMoL (FAB) was made and he was treated with low dose aclarubicin and cytarabin, but died of intracranial bleeding on October 9, 1986.
Nine cases have been reported so far on non-lymphocytic leukemia with chromosome abnormalities involving band 11p15. Three of them and present case showed blood pictures similar to CML. It is suggested that leukemia with 11p15 break is a subgroup which shows CML like blood picture.抄録全体を表示PDF形式でダウンロード (616K) -
伊東 俊夫, 中井 真通, 北嶋 直人, 児玉 一司, 武中 睦美, 岸原 道三, 稲留 哲也, 猪尾 力, 大前 義文, 清水 静夫, 中 ...1988 年 29 巻 2 号 p. 195-202
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA 70-year-old male was admitted with complaints of Raynaud's phenomenon, arthralgia, gingival hemorrhages and systemic lymphoadenopathy. CBC showed moderate leukopenia. Antinuclear antibody, anti-ENA antibody, anti-Sm antibody and LE cell were positive, but anti-DNA antibody negative. A Lymph node biopsy showed histological findings of reactive follicular hyperplasia. The bleeding time was markedly prolonged. Platelet aggregation was found to be decreased in ristocetin aggregation. Platelet adhesiveness, VIII: C, vWF: Ag and RCoF were decreased. In crossed immunoelectrophoresis of vWF: Ag, there was a marked decrease in the large multimer. No inhibitor of VIII: C, vWF: Ag or RCoF were observed. After oral administration of prednisolone, the hemorrhagic tendency gradually improved and the bleeding time turned to be normal. VIII: C, vWF: Ag and RCoF were also normalized. In crossed immunoelectrophoresis of vWF: Ag, the decrease in the large multimer normalized. Antinuclear antibody titers also decreased. With respect to the mechanism of complication of the acquired von Willebrand syndrome followed, 1) the underlying disease was SLE, 2) marked improvement was seen with adrenocortical hormone treatment, and 3) vWF: Ag and RCoF tended to decrease at an early time with the administration of DDAVP or AHF. Therefore, an autoimmune mechanism appears to be involved in the pathogenesis.抄録全体を表示PDF形式でダウンロード (617K) -
阿部 和弘, 今村 展隆, 藏本 淳, 横崎 宏1988 年 29 巻 2 号 p. 203-207
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA 20 year-old female was admitted to our clinic with a one month history of fever elevation up to 40°C. Laboratory findings on admission were as follows: Hb 8.7g/dl, platelet count 130,000/μl, WBC 3,000/μl with 26% abnormal lymphoid cells. These lymphoid cells had abundant pale cytoplasm with large azurophilic granules and a large nucleus. Flow cytometric analysis of lymphocytes expressed OKT-11, OKIa1, and N901 (NKH-1) which is considered to detect a portion of the NK cell subset.
Chemotherapy regimen with VEPA was almost ineffective. The patient died of perforating esophageal ulceration, interstitial pneumonia, and intestinal bleeding 4 months after admission in spite of intensive supportive therapy in ICU station.
We considered that such a unique finding associated with abnormal immune reaction and poor prognosis might belong to a new clinical entity which originate from NK cell subset.抄録全体を表示PDF形式でダウンロード (392K) -
田中 久夫, 浦瀬 文明, 長谷川 廣文, 椿 和央, 入交 清博, 堀内 篤1988 年 29 巻 2 号 p. 208-213
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA 23-year-old male was found continuous high fever and nausea since February, 1986.
On March he was admitted to Kinki University Hospital because of severe eosinophilia. The temparature was 38°C. The liver was palpable 4 cm below the right costal margin. The spleen was not palpable. Hematological examination revealed leucocyte count of 53,000/μl with 80.3% eosinophils, hemoglobin of 14.2g/dl, platelet count of 276,000/μl. A bone marrow aspirate was hypercellular consisted of 80% eosinophils without deformity. Cytogenetic analysis revealed a normal karyotype. Chest X-ray films showed bilateral hilar lymph nodes swelling. On the 23rd hospital day, a diagnosis of sarcoidosis was made with histological findings by TBLB. Cryptococcus mycosis was obtained from several culture of blood and cerebral fluid. He was treated by various kinds of drugs including Miconazole, Amphotericine-B and 5-FC. After all, eosinophils was decreased, meningitis and sepsis was cured completely. We considered that severe eosinophilia is caused by cryptococcus infection.抄録全体を表示PDF形式でダウンロード (746K) -
森岡 義仁, 杉本 徹, 今宿 晋作, 松村 隆文, 東道 伸二郎, 長井 隆夫, 小池 正1988 年 29 巻 2 号 p. 214-220
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありAcute megakaryoblastic leukemia (AMKL) in a 9-month old girl and in a 2-year-2-month old boy are reported. Both patients did not have any phenotypes for Down's syndrome and presented with anemia and severe thrombocytopenia. In both cases, blasts were positive for acid phosphatase but negative for myeloperoxidase, naphthol AS-D chloroacetate esterase or α-naphthyl butyrate esterase. A majority of blasts showed positive reaction to KOR-P77 and anti-GPIIb/IIIa monoclonal antibody. The platelet peroxidase reaction (PPO) was mostly negative in one case but positive in another case. Partial remission was obtained after BH-AC/ACM therapy in both cases. In one case, complete remission (CR) was attained by subsequent MTX/VCR/L-asp/Pred therapy.
Analysis of 28 pediatric AMKL cases in the literature and our 2 cases demonstrated; Median age was 1.5 year old, Down's syndrome 9/30, PPO negative 4/27, chromsome abnormalities 20/23 (15 with NO. 21/7 with NO. 7 abnormalities) and CR rate 19/28.抄録全体を表示PDF形式でダウンロード (772K) -
高井 和江, 真田 雅好, 本間 慶一1988 年 29 巻 2 号 p. 221-226
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA 53 year-old female was admitted because of fever and lumbago. The blood smear showed leucoerythroblastosis and thrombocytosis with giant platelets. Bone marrow biopsy revealed hyperplastic marrow with reticulin fibrosis. Splenectomy was performed with suspicion of splenic abscess, but removed spleen showed marked extramedullary hematopoiesis with several foci of infarction.
She suffered from high fever and painful erythema on bilateral soles which was diagnosed as erythromelalgia. She was treated with anti-platelet drugs and busulfan, but clinical and hematological effect was not ovbious. Chromosomal analysis of marrow cells revealed abnormal karyotypes mixed with normal one (46, XX/46, XX, -7, +22q-/47, XX, -7, +22q-, +mar). Although she was treated with prednisolone, melphalan, α-interferon and hydroxyurea, blastic cells increased in peripheral blood and bone marrow two years later. Chromosomal analysis revealed abnormal karyotype (46, XX, -C, +mar) in 100% of metaphases of marrow cells. She became resistant to small dose of Ara-C and died with meningeal infiltration one year later.
At autopsy, bone marrow was heavily infiltrated by leukemic cells but obvious fibrosis was not seen.
She was seemed to be a case of atypical myeloproliferative disorder which had high potentiality to develop AML.抄録全体を表示PDF形式でダウンロード (859K) -
津田 明瑞, 岩淵 篤敬, 矢口 誠, 北条 均, 木島 道夫, 宮坂 康彦, 外山 圭助1988 年 29 巻 2 号 p. 227-231
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありAutoimmune hemolytic anemia (AIHA) accompanied by carcinoma is very rare, though etiology of AIHA in such a case is unknown.
We report the first case of AIHA associated with ovarian carcinoma in Japan.
A 56-year-old female underwent bilateral salpingo-oopholectomy and hysterectomy because of right ovarian tumor in December, 1983.
Pathological diagnosis of the tumor was a serous adenocarcinoma. After surgery, she had been in good health until April 1986, when she was pointed out to have anemia and jaundice.
She was admitted to Tokyo Medical College Hospital on June 17, 1986. Laboratory examination revealed Hb 7.4g/dl, reticulocytes 190‰, LDH 3059U/dl, T-Bil 4.6mg/dl. Both direct and indirect Coombs' tests were possitive.
As any signs of the recurrence of ovarian carcinoma could not be found at first, the diagnosis of idiopathic AIHA was made.
Hemolysis was ameriorated temporarily by prednisolone therapy, but later did not respond to prednisolone pulse or antimetabolite therapy.
In the end of October, her laboratory data showed disseminated intravascular cougulation and echography revealed recurrence of the carcinoma. She died of cerebral infarction on November 11.
Autopsy disclosed extensive metastases of ovarian carcinoma.抄録全体を表示PDF形式でダウンロード (437K) -
山崎 徹, 高嶋 清次, 松井 俊二郎, 南部 修二, 矢崎 明彦, 井上 恭一, 佐々木 博1988 年 29 巻 2 号 p. 232-236
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA 44-year-old male who had been diagnosed as primary myelofibrosis in 1981 was admitted on March, 1985 because of splenomegaly, thrombocytopenia and leucocytosis with 28% blast cells. In cytochemical findings, a large number of blast cells were peroxidase-negative, PAS-negative, α-naphthyl acetate esterase positive, and acid phosphatase positive. These blasts were also positive for monoclonal antiplatelet glycoprotein IIb/IIIa complex antibody. A few blasts were myeloperoxidase positive. Immune electron microscopic examination also revealed that platelet peroxidase reaction was positive in many blast cells and myeloperoxidase reaction was positive in a few blast cells. Chromosome analysis of the peripheral blood showed t(3q-, cq+). From these findings he was diagnosed as having primary myelofibrosis terminating in magakaryoblastic crisis. He did not respond to a chemotherapy and expired in February 26th in 1986. Autopsy was not done.抄録全体を表示PDF形式でダウンロード (707K) -
片岡 孝江, 鈴木 久三, 石田 靖雅, 尾山 淳, 栗田 宗次, 有吉 寛, 太田 和雄, 小池 考一, 須知 泰山, 灰本 元, 林 弘 ...1988 年 29 巻 2 号 p. 237-242
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA 46-year-old male was admitted to our hospital and was diagnosed as acute myelomonocytic leukemia (AMMoL) on August 14, 1986. On admission, peripheral white blood cell count was 201×103/μl with 90.5% leukemic cells, monocytoid 5.0%; red blood cell count 1.65×106/μl; hemoglobin 6.1g/dl; hematocrit 17.2%; and platelet count 16×103/μl. With the combination chemotherapy consisted of behenoyl-ara-C, daunomycin, 6-mercaptopurine and prednisolone, he was successfully induced in complete remission, and consolidation therapy was carried out. But suddenly on September 29, serum GOT and GPT levels rose up to 8,580 U and 8,074 U, respectively. On October 1, the clinical diagnosis of fulminant hepatitis (perhaps with non-A, non-B virus) was made. Hematological data showed WBC 16×103/μl with 75% of atypical lymphocytes, RBC 2.18×106/μl and platelets 69×103/μl. The lymphocytosis disappeared on Oct. 4 and he recovered from hepatitis. The Southern blot analysis of this case showed germ line patterns of immunoglobulin and T cell receptor genes from peripheral mononucleated cells digested with restriction endonucleases on admission; on the other hand, digested with BamHI, rearrangement of the gene for the beta chain of the T cell receptor was found when T8 lymphocytosis appeared. Therefore, it is suggested that monoclonal proliferation means not necessarily neoplastic.抄録全体を表示PDF形式でダウンロード (558K) -
長島 倫雄, 鈴木 淳爾, 青山 彰, 福田 正高, 辻 守史, 鈴木 則之, 別所 正美, 斉藤 昌信, 平嶋 邦猛, 南久松 真子1988 年 29 巻 2 号 p. 243-248
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA 65 year-old woman complaining of fever and dyspnea was admitted to Saitama Medical School in July, 1986. Physically marked pallor was noted. Laboratory examination revealed pancytopenia. A bone marrow aspiration showed a normocellular marrow with 26.6% blast cells positive for peroxidase reaction. Morphological abnormality was observed in the red cell, neutrophil, and megakaryocyte series.
A diagnosis of refractory anemia with excess of blasts in transformation (RAEB-t) was made, and supportive therapy with antibiotics and blood transfusion was started. However, her blast cells increased and a diagnosis of overt leukemia was made at 49th day after the admission. Although a treatment with a low-dose Ara-C was tried, she died at 63th day after the admission. When her lymphocytes were cultured in the presence of PHA and distamycin A, the fragile site (FS), fra (17) (p12) was detected on No. 17 chromosome. As the fra (17) (p12) was also detected in her sister and son, it was demonstrated to be heritable.
At the present time, this is the first clinical report of MDS where fra (17) (p12) was demonstrated. Since some FSs are known to be located at or near the breakpoint of chromosome rearrangement characteristic of specific human cancers, we assume fra (17) (p12) plays a possible role in the etiology of MDS.抄録全体を表示PDF形式でダウンロード (508K) -
山田 晋一, 生野 茅子, 岡村 純, 田坂 英子1988 年 29 巻 2 号 p. 249-253
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありA 12 year-old girl having common acute lymphoblastic leukemia and impairment of renal function at diagnosis was found to have massively enlarged kidneys. The kidneys dramatically decreased in size after initiation of induction chemotherapy as well as local irradiation to one side of kidneys. As a consequence of rapid leukemic cell lysis, hyperuricemia, hyperphosphatemia and hypocalcemia associated with elevation of serum BUN and creatinine occurred. The clinical course of the patient was further complicated with acute pancreatitis, diabetes mellitus and fungemia which were successfully managed. The patient finally obtained complete remission in 4 weeks and remains in continuous complete remission 23 months after diagnosis.
We would like to discuss about the role of local irradiation and systemic chemotherapy for the patient with leukemia who present with enlarged kidneys and abnormal renal function.抄録全体を表示PDF形式でダウンロード (571K) -
服部 豊, 原田 契一1988 年 29 巻 2 号 p. 254-257
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありWe present a case of multiple myeloma associated with hereditary spherocytosis. The combination of these two diseases is very rare. In addition, this patient revealed ambiguous physical and laboratory findings of anemia that bewildered us to make diagnosis.
A 71-year-old male had yellowish discoloration since juvenile but made no clinical visit for it. On Oct. 1, 1986, he had onset of sudden frontal headache. On Oct. 14, he was admitted to our hospital because of conspicuous pallor, jaundice and splenomegaly. Skull X-ray revealed multiple punched-out lesions. In the bone marrow, myeloma cells were increased up to 26% of nucleated cells. L chain (κ) was detected in urinary immunoelectrophoresis. From these findings, Bence Jones type multiple myeloma was diagnosed. Anemia was unusually severe for an early phase of multiple myeloma, and eminent splenomegaly and icterus were difficult to be explained by myeloma alone. Family history, existence of spherocytosis on peripheral blood smear, positive osmofragility test of red blood cell and negative Coombs test strongly suggested hereditary spherocytosis. Splenectomy was not performed on this patient, because of the high risk of infection.抄録全体を表示PDF形式でダウンロード (516K)
例会
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1988 年 29 巻 2 号 p. 258-280
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありPDF形式でダウンロード (2156K)
研究会
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1988 年 29 巻 2 号 p. 281-285
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありPDF形式でダウンロード (476K) -
1988 年 29 巻 2 号 p. 286-289
発行日: 1988年
公開日: 2009/02/02
ジャーナル 認証ありPDF形式でダウンロード (373K)
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