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Volume 30, Issue 5
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—Maintenance of Leukocyte Counts within Normal Range with Busulfan—Tatsuki MATSUO, Masao TOMONAGA, Kazutaka KURIYAMA, Itsuro JINNAI, Tohr ...1989 Volume 30 Issue 5 Pages 625-630
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSTo prolong the survival of patients with chronic myeloid leukemia (CML), 19 patients were treated with busulfan to keep their leukocyte counts within normal range by controlling bone marrow hyperplasia. The duration of chronic phase in these patients was significantly longer than that in historical controls who were treated conventionally with busulfan. This prolongation was not ascribable to the difference in such prognostic factors between the two therapy groups as splenomegaly, leukocyte count and percentage of peripheral blasts. There was a significant difference again in the duration of chronic phase between the two therapy group even when restricted to each 11 patients with intermediate relative risk (0.7∼1.5) according to Sokal et al. Four patients showed thrombocytopenia less than 5×104/μl, but all these patients recovered within 4 months and there was no further critical side effect except subcutaneous bleeding. This study suggests that maintenance of leukocyte count within normal range and suppression of granuloid hyperplasia in bone marrow with busulfan may prolong chronic phase of CML. Probability of clonal evolution may be decreased by reducing the total leukemic cell mass and suppressing cellular turnover of primitive CML stem cells. Another possibility is that prolongation of chronic phase might be dependent on the appearance of normal karyotype clone after long-term bone marrow suppression just like after intensive chemotherapy or α-interferon therapy.View full abstractDownload PDF (457K) -
Youichirou SATOU, Tadami NAGAO, Shigeru ARIMORI1989 Volume 30 Issue 5 Pages 631-637
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSThe influence of bone marrow fibroblasts in healthy subjects and patients with aplastic anemia on normal erythroid colony formation was studied using the methylcellulose method. These fibroblasts were treated with methylprednisolone as well. Bone marrow fibroblasts of healthy subjects and patients with aplastic anemia, and the supernatant of their conditioned medium significantly inhibited normal erythroid colony formation. A significantly marked inhibition of normal erythroid colony formation was observed of bone marrow fibroblasts (or the conditioned medium) of the aplastic anemia, when compared with that of the bone marrow of healthy subject fibroblasts (or the conditioned medium). By treating both groups of the bone marrow fibroblasts with methylprednisolone the inhibition was slightly improved.
From the above experimental results, it was suggested that the bone marrow fibroblasts and the conditioned medium inhibited normal erythroid colony formation through humoral factors secreted by the fibroblasts, and through contact between the fibroblasts and erythroid colony formation cells.View full abstractDownload PDF (564K) -
Tomoko KOHNO, Kazuhiro NAGAI, Kunihiro TSUKAZAKI, Itsurou JINNAI, Masa ...1989 Volume 30 Issue 5 Pages 638-643
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSRecent increase of leukemia among elderly patients prompted us to investigate the types of leukemia which can be induced into remission by low-dose Ara-C (LDAC) regimen.
LDAC regimen was performed in 30 cases with overt acute leukemia (A), hypoplastic leukemia (B), and RAEB (C); Group A consists of M1 (1 case), M2 (4 cases), M3 (1 case), M4 (4 cases), M6 (1 case), and ALL (2 cases), Group B AML (8 cases), ALL (2 cases), and null (1 case), Group C RAEB (2 cases), and RAEB-T (4 cases). Complete remission (CR) rate was 23% (3/13) in group A, 64% (7/11) in group B, 0% (0/6) in group C. Partial remission rate was 33% (2/6) in group C. In group A, patients with M2 were induced into CR. In group B, both AML and ALL were induced into CR. Hypocellar marrow indicating low leukemic burden related to good sensitivity to Ara-C.
Duration of CR was rather short; mean duration being 5.3 months. In group C, 2 PR cases of RAEB showed partial hematological recovery. LDAC regimen is effective especially for most of hypoplastic leukemia and some of M2. Side effects were tolerable, but all CR cases passed through bone marrow hypoplasia and needed supportive cares.View full abstractDownload PDF (387K) -
Hiroki YABE, Fumihiko NAKAMURA, Takayuki ISHIKAWA, Kenichi NAGAI, Shir ...1989 Volume 30 Issue 5 Pages 644-649
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSOne hundred and ninety-five episodes of fever during the neutropenic phase of chemotherapy in 49 patients with acute leukemia from 1984 to 1987 were analyzed with the following results: 1) Febrile episodes ocurred in 80 percent of the neutropenic (<500/μl) phase lasting more than 7 days after chemotherapy. 2) Febrile episodes consisted of 44 (22%) of established septicemia and 111 (57%) of suspected septicemia. 3) The pathogens causing septicemia were 8 GPC, 38 GNB (22 Pseudomonas species) and 6 fungi. Fungemia was confirmed on an average of 4.8 days after the onset of fever. The mortarity of septic events was 10 out of 17 episodes (59%) when treated with antibiotics alone, while 8 out 27 (30%) with the combination of antibiotics plus antifungal drugs. 4) The mortarity of suspected sepsis was only 2 out of 111 episodes. Eighty-three (75%) of these 111 episodes responded to antibiotics alone, while 26 (23%) cases needed antibiotics plus antifungal drugs.
Our results suggest that in febrile neutropenic patient empiric broad-spetrum antibiotic therapy should be initiated which is especially effective for Pseudomonas species, but if fever persists despite more than 4 or 5 days of antibiotic therapy, additional antifungal therapy sould be considered.View full abstractDownload PDF (422K) -
Atsushi TOGAWA, Shin-ichiro SAWADA, Masamichi AMANO, Kazuo OSHIMI, Hir ...1989 Volume 30 Issue 5 Pages 650-658
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSThree patients with multiple myeloma were treated with 3.3∼10×105 u/day intravenous or subcutaneous IL 2 alone. Both their Leu7 and CD 16 positive cells in the peripheral blood and NK and LAK cell activity elevated but no M protein decreased. LAK cells and IL-2 administered to three patients intravenously. Lymphocyte counts in the peripheral blood elevated remarkably in one patient and CD3, 8, 16, 2, 38, Leu7 positive cells and NK cell activity increased in three patients. Though the reduction of M proteins were observed in three patients (17%, 75.8% and 40%, respectively), they returned to pretreatment level in 35 days, 55 days and 200 days after the therapy.
Significance of the therapy against multiple myeloma was discussed.View full abstractDownload PDF (651K) -
Tetsuji KOYAMA, Yoshio OURA, Mitsuhiro HIGUCHI, Eizo KAKISHITA, Kiyoya ...1989 Volume 30 Issue 5 Pages 659-662
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSWe performed a clinical study by measuring the plasma levels of D-dimer, which is derived from the degradation of cross linked fibrin, in some thrombotic disorders using Dimertest EIA kit obtained from AGEN Corp. (Australia). The level of D-dimer in disseminated intravascular coagulation (DIC) were greater than that in thrombotic thrombocytopenic purpura (TTP). These levels of D-dimer in two thrombotic disorders showed a different pathogenesis between them. And also, the levels of D-dimer in some arteriosclerotic disorders, i.e.; aortic aneurysma, cerebral infarction and coronary insufficiency, and in venous thrombosis siginificantly increased compared with normal subjects. The level of D-dimer measured by Dimertest EIA kit was useful marker for detecting a thrombotic tendency in the low level of D-dimer, in which latex agglutination test for fibrin/fibrinogen degaradation products (FDPL test) could not usually detect.View full abstractDownload PDF (277K) -
Masao KOBAYASHI, Chimako YUMIBA, Yoshinori KAWAGUCHI, Yoshito TANAKA, ...1989 Volume 30 Issue 5 Pages 663-667
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSAntineutrophil antibodies in the sera against peripheral blood neutrophils were examined in 8 infants (2 to 12 months of age) with neutropenia (absolute neutrophil count 0 to 480/μl). The antibodies were detected by granulocyte indirect immunofluorescence test (GIIFT) and microleukocyte agglutination test (M-LAT). Three of the 6 serum samples with chronic benign-type neutropenia reacted in both GIIFT and M-LAT. In 2 of these 3 samples, the antibody was proved to be specific to neutrophil antigen NA1 by the absorption experiment. Neither the GIIFT nor the M-LAT showed the antibody in two patients with Kostmann-type neutropenia.
These results suggest that the examination of antibodies against neutrophils is essential to the evaluation of the patients with chronic benign-type neutropenia in infancy.View full abstractDownload PDF (361K)
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Takayuki SHIRAI, Setsuo HASEGAWA, Kazuo NIITANI, Toshiharu NISHIMURA, ...1989 Volume 30 Issue 5 Pages 668-673
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSWe report a 25 year-old male of CML, who repeated lymphoid blast crises twice and finally experienced a myelomonocytoid blast crisis. In the first and the second crises, after 2 years of chronic phase, the blasts were only weakly positive or negative for terminal deoxynucleotidyl transferase. Based on other morphological features of the blasts, however, lymphoid blast crisis was strongly suspected. Actually, he responded well to the vincristine and prednisolone therapy. In the third crisis, the blasts showed myelomonocytoid features. He did not respond to the same regimen, and died of intracranial infiltration during daunorubicin and cytosine arabinoside therapy after one year from the first crisis.
Chromosomal analysis showed the karyotypes of 46, XY, t(9:22) (q34:q11) in the chronic phase, 45, XY, -7, -9, +der(9) t(7;9) (q11;p11), t(9:22) (q34:q11) in the lymphoid blast crisis, and 46, XY, t(9:22) (q34:q11), t(11:17) (q23:q25) in the myelomonocytoid blast crisis.View full abstractDownload PDF (1072K) -
Yoshitaka AOYAGI, Hajime AKIMOTO, Kazuaki YAMAOKA, Akira KOIKE, Masaak ...1989 Volume 30 Issue 5 Pages 674-679
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 73 year-old man suffering from marked anemia for several years admitted in our hospital. Diagnosis was immediately made of refractory anemia with ringed sideroblasts by the existence of ringed sideroblasts. Hemoglobin analysis revealed a high fetal hemoglobin, a low hemoglobin A2, a decreased β/α synthetic ratio, and a decreased Gγ/Aγ synthetic ratio. This aquired hemoglobinopathy resembled δβ-thalassemia. His anemia was remarkably improved because of the responsiveness to anabolic steroid hormone, and this abnormal globin synthetic pattern was identical as those of the normal adult.
We consider this hemoglobinopathy may due to an abnormal expression of globin mRNA.View full abstractDownload PDF (454K) -
Toshiyuki KITOH, Yasuyuki TABATA, Yuichi AKIYAMA, Yukio KIRIYAMA, Masa ...1989 Volume 30 Issue 5 Pages 680-685
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 12-year-old boy with Philadelphia chromosome positive acute lymphoblastic leukemia received bone marrow transplantation (BMT) from an HLA identical sibling during the second remission. The diagnosis was made at the age of nine. Laboratory examination on admission revealed remarkable leukocytosis (92,000/μl) with 93% lymphoblasts in the peripheral blood. Blastic cells were FAB L1 common ALL. Chromosomal study on both peripheral blood and bone marrow cells showed that lymphoblasts had an abnormal karyotype of 47, XY, inv (9), t(9;22), +17. One month later he achieved remission by induction therapy consisting of vincristine, L-asparaginase, doxorubicin, and prednisolone. He was given intrathecal injection of methotrexate and cranial irradiation of 24 Gy for CNS prophylaxis. The cells with Philadelphia chromosome disappeared during remission. Hematological relapse occurred twenty one months later after first remission on April, 1986. He received re-induction therapy including L-Asp VDP, and high-doses of cyclophosphamide, methotrexate and araC. He obtained karyotypic remission on October 1986. Subsequently, bone marrow transplantation was performed following high-dose araC, CY and TBI as preconditioning on December 18, 1986. Methotrexate and cyclosporin A were given intravenously to prevent GVHD. On day 14, karyotypic conversion was detected, suggesting the successful bone marrow grafting. Acute GVHD appeared on day 25, and was treated with prednisolone and cyclosporin A. Prednisolone was tapered by day 80. On day 91, cyclosporin A was discontinued because herpes zoster occurred. Acyclovir was effective, but skin GVHD reappeared. With low-dose prednisolone, skin GVHD improved. Sicca syndrome soon appeared and was followed by chronic GVHD. Remission after BMT had continued for about 8 months. Marked leukocytosis indicated the second hematological relapse on day 239. Additional chromosomal abnormality -Ph1 chromosome plus 11p+, 13p+, 14q+, -6, +17-appeared. Karyotypic evolution occurred after BMT. Mitoxantrone treatment was not effective and he died of systemic Candidasis on day 281.View full abstractDownload PDF (645K) -
Shin CHIYODA, Toshinori MORIKAWA, Kunihiro TSUKASAKI, Yutaka NAKAJIMA1989 Volume 30 Issue 5 Pages 686-690
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSAn autopsy case of IgE myeloma, 85-year-old male is reported. He was admitted to our hospital on November 17, 1987 due to pain of left humerus.
Osteolytic and osteoporotic foci were found in left humerus, ribs, spinal colum and femurs. Complete blood countings were as follows: RBC 3.23×1012/L, Hb 11.3 g/dl, WBC 6.3×109/L, platelet 173×109/L. Blood smear showed red cell rouleaux formation without myeloma cells. Examination of bone marrow revealed hypoplasia with 52% myeloma cells which were stained with anti-IgE and antilambda antisera by peroxidase anti-peroxidase method.
Total serum protein level was 7.7 g/dl. Monoclonal protein was observed at fast γ-region by cellulose-acetate electrophoresis. On immunoelectrophoresis, this monoclonal protein made specific M-bow against anti-IgE and anti-lambda antisera. The IgE level in serum and urine were 7.8×106 IU/ml and 2.4×103 IU/ml by radio-immunoassay respectively.
He was died owing to renal failure on September 7, 1988. Postmortem examination showed infiltration of myeloma cells in bone marrow, spleen, kidneys, lungs and generalized lymph nodes.View full abstractDownload PDF (344K) -
Naohito YOSHIZAKI, Kyuhei KOHDA, Osamu NAKAZAWA, Masakatsu ANDO, Shige ...1989 Volume 30 Issue 5 Pages 691-696
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSAn 81-year-old woman was admitted, complained general malaise, and edema on face and lower extremities. In the peripheral blood, leucocytosis (17,220/mm3), microcytic hypochromic anemia (RBC 348×104/mm3, Hb 9.6 g/dl, Ht 29.2%), and thrombocytosis (130×104/mm3) were present, and many myeloid cells containing of myeloblasts, promyelocytes and so on were observed. Bone marrow aspiration revealed increament of the myeloid series without hiatus leukemicus. The Neutrophil Alkaline Phosphatase score and rate was low, and on bone marrow scintigram using indium chloride, liver and extremities were shown. On admission, proteinuria (21.5 g/dl) and hypoalbuminemia (2.5 g/day) were pointed out, and the renal biopsy specimen showed membraneous proliferative glomerulonephritis (MPGN), so we diagnosed this case that chronic myelogeneous leukemia (CML) complicated with nephrotic syndrome. At first, she was treated with prednisolone, but proteinuria was not entirely improved, then busulfan was given, myeloid cells in peripheral blood were disappeared and proteinuria was gradually decreased. From this coarse, the causality between CML and nephrotic syndrome was verified.View full abstractDownload PDF (663K) -
Satsuki KAIDA, Tohru FUJIKAWA, Shinya ENDOU, Satoshi INABA, Yasushi NA ...1989 Volume 30 Issue 5 Pages 697-701
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSWe examined the expressions of both c-myc and MDR1 in four samples isolated from a CML-bc patient in series during the clinical course. A 46-year-old man was diagnosed as chronic phase of CML in june 1985. In February 1987, the diagnosis of blastic transformation was made because of marked increase of blastic cells. He was initially treated with vincristine (V) and prednisolone (P) successfully. However, the effect of VP therapy was gradually attenuated, so that combined chemotherapies including anthracyclines were started. After the treatments of several courses, tumor cells acquired the refractory to both vincristine and adriamycine. He died in January, 1988.
Northern blot hybridization studies revealed no expression of MDR1 mRNAs. However, the expression of c-myc was increased in the latest sample. These findings suggest that the expression of c-myc mRNA in tumor cells of this case reflects one characteristic of clinically refractory states to chemotherapies.View full abstractDownload PDF (396K) -
Toshinori MORIKAWA, Shin CHIYODA, Yasuaki YAMADA1989 Volume 30 Issue 5 Pages 702-706
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSChronic adult T-cell leukemia with surface phenotype CD 4+5+8-, Leu 7+ at acute crisis was presented.
A 43-year-old female visited our hospital complaining of generalized lymphadenopathy and skin rash in December, 1973. Peripheral blood picture and histological findings of skin led to the diagnosis of malignant lymphoma (leukemic type). Intermittent chemotherapy kept white blood cell count less than 25,000/μl for more than 9 years.
In January, 1983, abnormal lymphocytes began to increase and reached 100,000/μl or over in a few months. Surface marker study showed their phenotype as CD 4+5+8-, Leu 7+ and anti-ATLA antibody was positive in the patient, her son and her daughter. Intensive chemotherapy was ineffective and she died in August, 1983. Histological diagnosis of lymphnodes on autopsy was malignant lymphoma (diffuse, small cell type).
This case is considered unusual in both clinical course and surface phenotype of its leukemic cells.View full abstractDownload PDF (583K) -
Atsuko KOYAMA, Chikashi SHIRAKAWA, Yohichi TATSUMI, Fusanari HORIUCHI, ...1989 Volume 30 Issue 5 Pages 707-712
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSCase 1. A 67-year-old man was admitted to our hospital because of fever, diarrhea and abdominal pain. Hemoglobin was 10.7 g/dl, white cell count 6,900/μl and platelet count 36.7×104/μl. Bone marrow biopsy showed non-lobulated megakaryocytes. The karyotype was 47, XY, +8, -16, 5q-, +mar. We have followed up this case without any special treatment except for red blood cell transfusions. The platelet count has increased to 70.9×104/μl.
Case 2. An 84-year-old man was admitted to our hospital because of tinnitus and headache. Hemoglobin was 7.9 g/dl, white cell count 1,200/μl and platelet count 22.5×104/μl. Bone marrow biopsy showed hypocellular marrow and non-lobulated megakaryocytes. The karyotype was 46, XY, 5q-. We have followed up this case only with red blood cell transfusions. The platelet count has increased to 68.9×104/μl.
The hematological findings and clinical courses of the two cases were similar to those in the 5q-syndrome first described by Van den Berghe et al. in 1974. And these cases are important in relation to c-fms oncogene and hematopoietic abnormalities.View full abstractDownload PDF (662K) -
Akiko TAKIGAWA, Yasuhiko KAJIGAYA, Tetsunori FUNABIKI, Keiji FUKAZAWA, ...1989 Volume 30 Issue 5 Pages 713-718
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSAbstract A seven year-old boy with hereditary stomatocytosis complicated with aplastic anemia was reported. He was admitted to our hospital because of pale and general fatigue. On physical examination, he had severe anemia, petechiae, but no hepatosplenomegaly. Peripheral blood cell count revealed pancytopenia; RBC 103×104/μl, Hb 3.5 g/dl, Ret 21‰, WBC 1,200/μl, Pl 1.3×104/μl, and bone marrow revealed markedly hypocellular marrow. Red cell morphology demonstrated stomatocytosis. Red cell life span (51Cr T1/2) was 12 days, Coombs' test and Ham's test were negative. Indirect bilirubin was 1.1 mg/dl and marked decrease of haptoglobin was found. Family studies showed that his father and sister had stomatocytosis on peripheral blood examination, but no anemia. The patient had severe anemia because of complicated aplastic anemia. Congenital stomatocytosis with aplastic anemia is extremely rare. The authors are interested in a possible relationship between hereditary stomatocytosis and aplastic anemia although the precise mechanism remains to bo elucidated.View full abstractDownload PDF (501K) -
—The Evaluations of Immunological Abnormalities—Atsushi KOHNO, Kenji KOHRIYAMA, Keiji KIRIZUKA, Shigeru HIMEI, Taishi ...1989 Volume 30 Issue 5 Pages 719-725
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSWe reported 3 patients with pernicious anemia associated with chronic thyroiditis and evaluated their immunological abnormalities in this paper. Two patients were females and another was male. They were all advanced in age. Levels of gammaglobulin including IgG was elevated in patients' sera. Values of complement components were within normal ranges. Although organ specific autoantibodies against intrinsic factors, parietal cells and thyroidal tissue antigens were detected, organ non-specific autoantibodies such as anti-DNA and/or anti-ENA antibodies were negative in the patients' sera. Percentage of T cells in peripheral blood remained within normal ranges. However, ratio of helper T/suppressor T cells was reduced considering patients' age. Moreover, Mantoux tests were negative in all of three patients.
These results suggested that impaired cellular immunity, particularly imbalance of T cell subsets, caused by senescence, simultaneously induced pernicious anemia and chronic thyroiditis in these patients.View full abstractDownload PDF (565K) -
Toshiya INABA, Yasuhide HAYASHI, Akihiro YAGINUMA, Ryoji HANADA, Keiko ...1989 Volume 30 Issue 5 Pages 726-730
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 12-year old boy was admitted to Saitama Children's Medical Center because of fever and epistaxis. He had leukocytosis (WBC 40,800/μl, blast 75%), anemia, thrombocytopenia and high levels of serum LDH, lysozyme, Vitamine B12, and plasma histamine. Bone marrow aspiration revealed hypercellular marrow with 31.2% blasts, 15.2% eosinophils, and 14.2% basophils. Blasts had Auer rods and were positive for peroxidase and negative for α-naphthyl butyrate esterase and PAS stainings. Ia, CD13 (My7), and CD19 (B4) antigens were expressed on his leukemic cells. Chromosomal study showed 46, XY, t(7;8) (q35;q22), del (9) (q13q22). Southern blot analysis using immunoglobulin constant region (C) probes revealed germline patterns of Cμ, Cκ, Cλ, and breakpoint cluster region. A diagnosis of acute myelomonocytic leukemia (AMMoL, M4) was made. He attained a complete remission with daunorubicin and cytarabin, and 6 months later he received bone marrow transplantation from HLA-identical sister.
This case had the common breakpoint 8q22 with ANLL with t(8;21) (q22;q22), and was unique AMMoL with proliferation of eosinophils and basophils in bone marrow.View full abstractDownload PDF (618K) -
Yoshiko NOGUCHI, Yuichi HASEGAWA, Masaki NAKAZAWA, Yasuhiro YODA, Tsuk ...1989 Volume 30 Issue 5 Pages 731-735
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 46-year-old female was admitted to our hospital for fever and weight loss in September, 1986. Physical examinations were unremarkable. CBC revealed moderate anemia and leukopenia with abnormal lymphocytes. Examination of the bone marrow (BM) disclosed peroxidase negative blasts and multinucleated or multilobulated giant cells positive for CD30 (Ki-1) antigen. Chest X-ray was negative. CT scan and echography of the abdomen showed minimal enlargement of retroperitoneal lymph nodes (LN). Lymphangiography revealed mild enlargement of the LN without filling defects. Gallium scan was negative. Hence a diagnosis of Hodgkin's disease (HD) stage IVB was made. She was treated with MOPP therapy with modification and obtained a complete remission.
BM involvement of HD occurs mostly in advanced stages. We assumed that this is a rare case of HD in which bone marrow metastasis occurred in a very early stage of the disease or that of bone marrow primary.View full abstractDownload PDF (634K) -
Tetsuko CHUJO, Hirohiko KURATSUNE, Yoshitaka NISHIMORI, Takashi MACHII ...1989 Volume 30 Issue 5 Pages 736-745
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSCase 1. A 34-year-old male was admitted in July, 1986 with a diagnosis of AML (M2). Two courses of BHAC-DMP regimen induced complete remission in October, while marked pyrexia resistant to antibiotics remained.
An ultrasonography (US) and computed tomography (CT) revealed multiple liver and spleen abscesses suspected of micotic etiology. Administration of amphotericin B (AMPH-B) by intravenous injection was difficult owing to its severe side effect. Multiple abscesses increased in the size and number despite treatment with Miconazole (MCZ) and Ketoconazole.
Exploratory laparotomy was performed with splenectomy, and splenic specimens were found to contain Candida oganisms. Soon AMPH-B was administered through a catheter inserted into the portal vein at the same time.
A side effect by AMPH-B was tolerable and his fever resolved to normal in 2 weeks after institution of this therapy, and the sizes of abscesses were markedly reduced. The patient remained in remission through 23 months, free of fungal infection.
Case 2. A 23-year-old female was admitted for relapse of ALL (L2), in April, 1987. Reinduction therapy with BHAC-L-AVP achieved again in May but fever unresponsive to antibiotics occurred. Since multiple liver-spleen abscesses were showed by US and CT suspected micotic etiology, antimicotic therapy with Miconazole and AMPH-B was performed but clinical findings were deteriorated. AMPH-B was administered through a catheter inserted into the hepatic artery for two weeks, following into the splenic artery for a week. Splenic abscesses were resolved in a week and liver abscesses were markedly reduced at three weeks after initiation of intra-arterial antifungal treatment. Through the analysis of these case studies we confirmed the usefulness of intraportal and intrahepatosplenic arterial administration of AMPH-B.View full abstractDownload PDF (814K) -
Shoko KATO, Noriko YAMAMURA, Takashi SUGIMURA, Toshihiko SUMII, Eiichi ...1989 Volume 30 Issue 5 Pages 746-751
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSWe describe a case of adult T-cell leukemia (ATL) with vertebral bone invasion, who developed acute paraplegia and responded well to irradiation and combined chemotherapy.
A 36-year-old man born in Tsushima Island was admitted to our hospital in May 1987, because of a sudden onset of paraplegia, hypesthesia below the level of 7th thoracic vertebra and vesicorectal disturbance. The white blood cell count was 9,500/μl with 16% of abnormal lymphocytes showing lobulated nuclei. The surface maker analysis revealed that CD3, CD4, CD8 and CD25 positive cells were 88.1, 83.9, 6.4 and 1.3% of the peripheral mononuclear cells, respectively. Anti-ATLA antibody was positive. Serum calcium level was elevated. Bone scintigraphy showed multiple vertebral bone lesions. Vertebral bone mass and a compressed spinal cord in the 7th thoracic level were confirmed by CT scanning and MR imaging. Cerebral spinal fluid was negative for tumor cells. A diagnosis of ATL was made. Irradiation and combination chemotherapy improved bone lesions and neurological signs and the disease was well controlled by maintenance chemotherapy up to the present (August, 1988).View full abstractDownload PDF (765K) -
Yutaka SHIGA, Akiko YOKOYAMA, Toshiyuki ISHIBASHI, Tsutomu SHICHISHIMA ...1989 Volume 30 Issue 5 Pages 752-756
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA case of chronic myelogenous leukemia (CML) of 10-year survival in described.
A 44-year old male was admitted to our hospital because of general malaise, abdominal fullness and fever in February, 1977.
On physical examination, giant splenomegaly and hepatomegaly were detected.
Peripheral blood examination revealed leukocytosis without hiatus leukemics, normochromic macrocytic anemia and thrombocytosis. NAP rate and score were 16% and 22. Cytogenetic analysis of PB without stimulator revealed 46, XY, Ph1. Then he was diagnosed as having a typical type of Ph1-positive CML.
He had been successfully treated over 9 years by intermittent administration of busulfan. However, anemia suddenly progressed in February, 1986 followed by leukopenia and thrombocytopenia. Hemorrhage was not detected by the examination. Though he had been received blood transfusion, the anemia progressed rapidly. He was died of cachexia on 4th of August, 1987.
The postmortem examination revealed bone marrow aplasia with no signs of blast crisis nor myelofibrosis.
Secondary hemochromatosis was seen in the liver, spleen, pancreas and some other organs.View full abstractDownload PDF (613K) -
—Report of an Autopsy Case—Yuko HIROSE, Susumu SUGAI, Tomoo TAKIGUCHI, Junko TACHIBANA, Makoto SA ...1989 Volume 30 Issue 5 Pages 757-763
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 37y/o male developed mass formation in right tibia in Oct. 1986. He had generalized lymphadenopathy. Diagnosis of malignant lymphoma of B cell type (follicular, large cell type) stage IV B was made because of bone marrow involvement. Surface marker analysis of pathologic cells in the peripheral blood, bone marrow, lymph nodes revealed that they were of B cell type with positive EAγ rosette formation, positive surface immunoglobulin with IgM-κ and cytoplasmic immunoglobulin with IgM-κ and positive responses to monoclonal antibodies of OKIa1 and B1. He responded partially to VEPAM therapy but in Jan. 1987 he developed Ga accumulation in heart and ECG abnormalities such as depression of ST and inverted T in II, III, AVF, V1∼V6 leads. After treatment with VEP, ECG abnormalities disappeared in a month. The same ECG abnormalities recurred once more and disappeared again. Autopsy findings revealed accumulation of lymphoma cells in epicardium and myocardial degeneration in right ventricle. Ga scan appears to be a valuable method for detection of early casdiac involvement by malignant lymphoma.View full abstractDownload PDF (1336K) -
Yoshio FURUKAWA, Takeshi INOUE, Takahisa YAMANE, Motofumi HIYOSHI, Ats ...1989 Volume 30 Issue 5 Pages 764-767
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSA 49-year-old man was hospitalized because of cutaneous plaques and pancytopenia. Hematological findings, and the skin eruption suggested Sweet's syndrome associated with myelodysplastic syndrome (refractory anemia with excess of blasts; RAEB). Treatment for pancytopenia was attempted without effect. Also we tried treatment with antibiotics. The skin lesions healed and the body temperature returned to normal.
This case was unusual in the association of myelodysplastic syndrome with Sweet's syndrome.View full abstractDownload PDF (587K) -
Masakuni SUGIMOTO, Kiyoshi SAITO, Manabu HASHIMOTO, Seiichi HORIE, Yos ...1989 Volume 30 Issue 5 Pages 768-773
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSThe pathogenesis of Cefmetazole (CMZ) induced agranulocytosis was investigated in the case of a 40 year-old man who developed agranulocytosis while he was under treatment with CMZ.
Although concentration of CMZ in serum is not detected, patient's serum drawn at the time of diagnosis suppressed normal allogeneic marrow GM colonies in vitro. Normal IgG purified from serum had no effect on GM colony formation in vitro. However, patient's IgG purified from serum drawn at the time of diagnosis suppressed normal allogeneic marrow GM colony in vitro without CMZ.
These studies suggest that CMZ-induced agranulocytosis is immunologically mediated through an IgG inhibitor which seems to exert its effect on GM colony formation.View full abstractDownload PDF (409K)
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1989 Volume 30 Issue 5 Pages 774-785
Published: 1989
Released on J-STAGE: February 02, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (1098K)
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