Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 32, Issue 11
Displaying 1-20 of 20 articles from this issue
  • Masayuki SHINOHARA, Takashi MIZUGUCHI, Masaaki KOSAKA, Shiro SAITO
    1991 Volume 32 Issue 11 Pages 1403-1409
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    The effect of erythroid differentiation factor (EDF) on the colony formation of erythroid cells (CFU-E and BFU-E) inhibited by the sera from the patients with chronic renal failure (CRF) was evaluated by methylcellulose assay. EDF restored the inhibited formation of CFU-E colony irrespective of the absence or presence of the accessory cells. In addition, EDF was considered to recover BFU-E colony formation through the burst promoting activity (BPA) secreted by the adherent cells. A suicide experiment using 3H-thymidine revealed that EDF acted to induce BFU-E from resting phase to S phase of the cell cycle. Moreover, the number of circulating BFU-E and the secretion of BPA by the mononuclear cells, both of which were significantly low in CRF patients, were also moderately increased by the addition of EDF. These data suggest that EDF could be utilized as a therapeutic agent for pathogenetic factors except hypoproduction of erythropoietin on the anemia of the patients with CRF.
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  • Nobuyuki MIZUNUMA, Makoto OGAWA, Yasunobu KURAISHI, Noboru HORIKOSHI, ...
    1991 Volume 32 Issue 11 Pages 1410-1415
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Thirty-three patients with advanced Hodgkin's disease were treated with a combination chemotherapy consisting of vincristine 1mg/m2 iv on day 1, 8, cyclophosphamide 500mg/m2 iv on day 1, procarbazine 100mg/m2 p.o. day 1-7, and prednisolone 40mg/m2 p.o. day 1-7. Twenty patients received this regimen every 4 weeks (VCPP II regimen). Furthermore, we conducted higher dose intensive VCPP II-2 regimen which was repeated every two weeks for thirteen patients. Complete response rate of both regimens was 63% (VCPP II 45%, VCPP II-2 85%). The median duration of CR was 37+ months. Leukopenia, neurotoxicity and gastrointestinal toxicity were commonly observed but were clinically manageable. These results indicate that high dose intensive chemotherapy is effective for achieving high CR rate for advanced Hodgkin's disease.
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  • Atsuko KOYAMA, Kiyohiro IRIMAJIRI
    1991 Volume 32 Issue 11 Pages 1416-1424
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    We studied peripheral blood mononuclear cells, bone marrow cells and lymph node cells from 30 patients with non-Hodgkin's lymphoma by DNA hybridizaion. Clonal JH or TCR β gene rearrangements were detected in peripheral blood or bone marrow mononuclear cells from 15 of 30 (50.0%) patients studied, including 31.8% of those without evidence of tumor cells by morphological method. Four of 9 cases demonstrated identical clonal gene rearrangements at diagnosis and in remission phase in peripheral blood mononuclear cells. The presence of clonal gene rearrangemetns roughly correlated with the clinical stage of disease. And the proportion of clonal rearrangements was higher in the groups with small & medium sized cell types (64.3%) than in the group with large cell type (33.3%). So, we concluded that Southern blot analysis was more useful than morphological method to detect monoclonality of circulating lymphoma cells and minimal tumor cells.
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  • Takanori ABE, Yoichi TAKAUE, Keiko MATSUNAGA, Shinichi SAITO, Atsushi ...
    1991 Volume 32 Issue 11 Pages 1425-1432
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Thirty children (1-16 y.o.; median, 10 y.o.) with acute leukemia or non-Hodgkin's lymphoma (NHL) associated with high-risk features underwent high-dose chemotherapy without total body irradiation and peripheral blood stem cell autografts (PBSCT). Eighteen patients had acute lymphoblastic leukemia (ALL), 6 had acute non-lymphoblastic leukemia (ANLL), 2 had mixed-lineage leukemia and 4 had NHL. Twelve patients with two or more high-risk features (WBC>10×104l, T- or B-phenotypes, infancy, massive organ infiltration, or induction failure) underwent PBSCT in 1st CR. Twelve patients underwent PBSCT in 2nd CR, and 4 in the subsequent remission≥3rd CR). Two patients were treated at refractory relapse. After PBSCT the number of days required to achieve a granulocyte count of 0.5×109/l and a platelet count of 50×109/l was 6-39 (median, 13) and 9-427 (median, 16), respectively. The disease-free survival rate was 6/12 in 1st CR group (6-41 mo) and 6/16 in the patients who underwent PBSCT in 2nd or subsequent remission (2-35 mo). The data justify the incorporation of PBSCT in the design of salvage protocol for children with leukemias or NHL. However, the application of the procedure as part of initial therapy in patients still remaining in 1st CR should be regarded as highly experimental and deserve further clarification.
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  • Masafumi YOSHIMURA, Hitoshi YOSHIDA, Tatsurou MATSUNASHI, Shirou HIDAK ...
    1991 Volume 32 Issue 11 Pages 1433-1438
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    This report presents the analysis of leukemic relapse of 52 patients who received allogeneic bone marrow transplantation between July 1984 and May 1990. Conditioning regimen consisted of TBI+CY and GVHD prophylaxis consisted of cyclosporin-A and methotrexate. The relapse ratios of chronic myelogeneous leukemia (CML) (21 in chronic phase, 1 in accelerated phase, 1 in blastic crisis), acute nonlymphocytic leukemia (ANLL) (all 17 in 1st CR), acute lymphocytic leukemia (ALL) (all 12 in 1st CR) were 13%, 18%, 25%, respectively, and 3 year disease free survival (DFS) was as follows, CML 68%, ANLL 72%, ALL 49%. Regarding acute GVHD grading and chronic GVHD presence, 3 year DFS was as follows, acute GVHD 0º: 59%, Iº: 78%, IIº-IVº: 53%, chronic GVHD (+): 82% GVHD (-): 77%. In our center leukemic relapse has been the major cause of death after BMT since 1984. Among 9 relapsed cases, one reccurred more than 3 years after BMT, and another one got reccurrent leukemia of donor origin.
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  • Ichiro TSUKIMOTO, Akira OHARA, Nobuyuki TAGUCHI, Sumio MIYAZAKI, Junic ...
    1991 Volume 32 Issue 11 Pages 1439-1446
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    As a general rule, diagnostic criteria of aplastic anemia in children are the same as adult criteria. However, blood counts of normal children show wide age-related variation, therefore we must establish a system of adjustment for diagnosis of aplastic anemia in children. The data of children with aplastic anemia visiting our institutes from 1966 to 1990 were evaluated for this study. RBC below 350×104l, WBC below 4,000/μl or neutrophils below 1,500/μl, platelets below 8×104l, reticulocytes below 4×104l and lymphocytes over 60% were seemed to satisfy the diagnostic criteria of aplastic anemia proposed by the Study Group of hemopoietic Disorders sponsored by the Ministry of Health and Welfare of Japan. Fifteen children (4.6%) did not meet these criteria and as such were diagnosed as atypical aplastic anemia. Thirteen of them were in a pre-aplastic state and developed typical aplastic anemia within 6 months to 8 years after the initial diagnosis. Clinical findings of these patients showed the decrease in number of megakaryocytes and committed stem cells in bone marrow. Three of these patients developed acute non-lymphocytic leukemia, and 2 of them were diagnosed as Fanconi's anemias.
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  • Nozomi ARAI, Akihiro HARA, Masanori UMEDA, Tatsuo SHIRAI
    1991 Volume 32 Issue 11 Pages 1447-1452
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    COP-BLAM III therapy was given to 18 patients with non-Hodgkin's lymphoma, and the therapeutic effects as well as adverse effects of the treatment were examined. Of the 18 patients 16 had a complete remission (CR) and 2 showed an partial remission (PR) with a total response rate of 100%. In terms of the stage of disease, CR was achieved in all patients in stage III and in 11 of 13 patients in stage IV. Patients with neutrophil counts less than 1,000/μl were given rhG-CSF (1.5 μg/kg/day, sc), which significantly shortened the duration of neutropenia and decreased the number of days with episodes of fever when compared with those not given rhG-CSF, consequently facilitating the treatment without prolonging the dosing intervals. No serious infection was observed. Adverse effects included neutropenia of less than 1,000/μl in 6 of the 18 patients (33.3%), thrombocytopenia less than 5×104l in 3 (16.7%), nausea and vomiting in 8 (44.4%), peripheral neuropathy in 4 (22.2%) and stomatitis in 4 (22.2%). There were no fatalities caused by the treatment. The above findings indicate that COP-BLAM III therapy is capable inducing high frequency of complete remissions in non-Hodgkin's lymphoma and that its combination with G-CSF can improve the results of the therapy and relieve adverse reactions.
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  • Hiroyuki HIRAGA, Hiroki YABE, Kenichi NAGAI, Shiro NAKAYAMA
    1991 Volume 32 Issue 11 Pages 1453-1457
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    This paper reports on a patient with congenital Pelger-Huet anomaly who developed myelodysplastic syndrome (MDS). A 45-year-old female was referred for investigation of pancytopenia of 6 months' duration. Hereditary Pelger-Huet anomaly was diagnosed by family study 7 years prior to admission. On admission, Hb was 6.5 g/dl, Ht 19.9%, Platelets 1.8×104l, and WBC 1,200/μl with 2% myelocytes, 9% metamyelocytes, 14% bands, 2% segmented neutrophils, 58% lymphocytes and 5% monocytes. Most of the granulocytes were Pelger-Huet type with strikingly clumped nuclear chromatin. Bone marrow aspirate demonstrated 3.6% blasts and dysplastic changes including megaloblastoid features in erythroid series and micro-megakaryocytes compatible with refractory anemia, a subtype of MDS. The association of hereditary Pelger-Huet anomaly and MDS is discussed.
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  • Yasunobu ABE, Koichiro MUTA, Shoko KATO, Shingo SADAMURA, Junji NISHIM ...
    1991 Volume 32 Issue 11 Pages 1458-1462
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A 52-year-old female was admitted to our hospital because of anemia in March 1987. Monoclonal protein (IgA, κ) was detected and a diagnosis of multiple myeloma was made. Partial remission was obtained after VAD therapy with α-interferon. In December 1989, she was readmitted because of a pathological fracture of the left humerus. A white blood cell count was 4400/μl with 30% myeloma cells and the urine protein (Bence Jones protein) was 26 g/day. Systemic chemotherapy was not effective. She developed pleural and pericardial effusions, bone mass, disturbance of consciousness and died of respiratory failure only 3 months after readmission. The pleural and pericardial fluids contained many myeloma cells. c-myc gene rearrangement was detected in myeloma cells obtained from the pleural fluid using c-myc exonl and exon2 probes. The level of interleukin-6 (IL-6) measured by ELISA was 107.4 pg/ml in serum, 56.2 pg/ml in pleural fluid and 780.0 pg/ml in pericardial fluid. Because of the lack of any overt infectious focus, the level of IL-6 appears to have been related to aggressive proliferation of myeloma cells. It was of interest that C-reactive protein, induced by IL-6, was a good marker reflecting disease activity.
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  • Shin CHIYODA, Toshinori MORIKAWA, Osamu TAKAHARA
    1991 Volume 32 Issue 11 Pages 1463-1468
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A case of 56 year-old man with Ki-1 (CD30) lymphoma is reported. He noticed cervical lymph node swelling and was admitted with temporary diagnosis of gastric adenocarcinoma in Feburuary 1986. His physical examination showed several from 1 to 4 cm size enlarged cervical and axillary lymph nodes. His first lymph node biopsy demonstrated the histological picture of malignant lymphoma. After 20 days his second lymph node biopsy demonstrated the picture of necrosis. Second gastric biopsy showed the picture of neither gastric cancer nor malignant lymphoma, in spite of his first gastric biopsy finding with adenocarcinoma that turned out to be malignant lymphoma by later reinvestigation. Afterword those lymph nodes disappeared and have not been palpable for about ten months. In Octover 1987, elevated LDH value, lymph node swelling and gastric lesion were again observed and sixth gastric biopsy demonstrated the picture of malignant lymphoma. He was treated with anti-lymphoma drugs. After his partial remission, he died of gastrointestinal bleeding in April 1988. Specimens of both first lymph node biopsy and sixth gastric biopsy were examined with cell makers for infiltrated cells and were positive for Ki-1/Ber-2H. His final diagnosis was Ki-1 lymphoma.
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  • Shogo BANNO, Masakazu NITTA, Toshiyuki NODA, Hirokazu KOMATSU, Shinsuk ...
    1991 Volume 32 Issue 11 Pages 1469-1474
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    We report a case involving mixed hematopoietic chimerism after an allogeneic bone marrow transplantation (BMT) from a sex mismatched donor. A 31 year-old-man who was diagnosed as having chronic myelogeneous leukemia in the accelerated phase received an allogenic BMT from his HLA-identical sister in March, 1989. To determine the mixed chimerism we used the Y-chromosome specific repeated sequence of DNA using a specific probe (PHY 10). The donor's DNA 3.5 kb band appeared in 1∼10% of male DNA by Southern blot hybridization in the peripheral blood 21 days after BMT. The Y-chromosome DNA band decreased day by day, and disappeared 110 days after BMT. The Y-chromosome DNA band could be detected, even though few metaphases were obtained immediately after BMT. Thus this method is very sensitive for determining which cells contain the Y-chromosome, and is therefore useful for detecting mixed chimerism after sex-mismatched BMT. Using this method the clinical significance of mixed chimerism can be assessed.
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  • Hisashi TSURUMI, Takeshi TAKAHASHI, Yasukazu KOSHINO, Masami OYAMA, Ke ...
    1991 Volume 32 Issue 11 Pages 1475-1480
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A 64-year-old man was admitted to our hospital with leukopenia. On admission, leukocyte count in the peripheral blood was 1,600/μl, containing 24.5% blasts of lymphoid appearance, which were negative for myeloperoxidase. A bone marrow aspiration showed hypoplasia with increased blasts (31.6%). The blasts were ultrastructurally positive for platelet peroxidase (PPO) and positive for platelet membrane glycoportein IIb/IIIa complex. A diagnosis of acute megakaryoblastic leukemia was made. Chemotherapy with behenoyl-ara C (BH-AC) (150 mg/day) was transiently effective. However, after three months, numerous nodules without itching appeared over the entire body, particularly on the anterior chest. A biopsy of the skin lesion revealed a diffuse fibrosis with infiltrations of the blasts. Bone marrow aspirations were dry tap, and a bone marrow biopsy showed marked myelofibrosis. Then, severe headache, vomiting, and loss of consciousness developed, and a lumbar puncture revealed infiltrations of blasts. Although methotrexate was intrathecally injected, he died due to the respiratory failure. As far as we know, a case of acute megakaryoblastic leukemia with leukemia cutis and meningeal leukemia is quite rare. In addition, it is interesting that megakaryoblastic leukemia was accompained with both the fibrosis of skin and the myelofibrosis.
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  • Kenjiro HAMAMOTO, Hirokazu TANIGUCHI, Shigetoshi OHGA, Takahiro NAGANO ...
    1991 Volume 32 Issue 11 Pages 1481-1485
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A 83-year-old man was diagnosed with primary myelofibrosis based on the presence of leukoerythroblastosis, splenomegaly, chromosome 46 XY, a dry tap bone marrow aspiration and fibrosis on bone marrow biopsy, when he was admitted for herpes zoster in June 1987. He was admitted for a second time with multiple subcutaneous tumors over his entire body in July, 1989. He had mild splenomegaly, but no hepatomegaly nor lymphadenopathy. Laboratory tests were as follows: RBC 214×104l, Hb 5.1 g/dl, Ht 17.7%, WBC 3,200/μl with leukoerythroblastosis, platelets 11.6×104l, s-lysozyme 251 μg/ml, u-lysozyme 770 μg/ml, NAP ratio 98%, score 278. Bone marrow aspiration resulted in a dry tap. Bone marrow biopsy showed marked fibrosis. Histologic examination of subcutaneous tumor biopsy specimens revealed a diffuse infiltration of monocytes with flexuous nuclei. These cells were positive for α-naphtyl butyrate esterase stain, and negative for peroxidase, α-naphtol ASD chloroacetate esterase stain and platelet glycoprotein IIb/IIIa stain (APAAP). Ultrastructurally, these cells were mostly monocytes and promonocytes, while phenotypically, CD11b, CD13, CD14, CD33 and HLA-DR were positive. These date indicated that the subcutaneous tumors originated from monocytes.
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  • Shinsuke IIDA, Genji TAKEUCHI, Hirokazu KOMATSU, Shougo BANNO, Atsushi ...
    1991 Volume 32 Issue 11 Pages 1486-1491
    Published: 1991
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    We report an autopsy case of acute erythremia which terminated in generalized infiltration of immature blasts similar to proerythroblasts. A 61-year-old man was admitted because of general fatigue and fever in June, 1990. Mild anemia and severe thrombocytopenia were noted. The bone marrow was hypocellular with 25.5% blasts similar to proerythroblasts and 36.5% erythroblasts, many of which were polynuclear and megaloblastoid. The blasts were cytochemically negative for POX, but positive for PAS staining. Therefore he was diagnosed as having acute erythremia. Partial remission was achieved by BHAC-EV therapy. But three months later, his marrow was replaced by 52.7% blasts as seen in admission. Those blasts were negative for lymphoid, myelocytic, megakaryocytic markers and anti-glycophorin A, but positive for OKT 9. Electron microscopy revealed that some of blasts had characteristics of immature erythroblasts. In spite of low dose Ara-C therapy, he died of sudden gastrointestinal bleeding in December, 1990. The autopsy disclosed widespread infiltration of blasts, involving liver, spleen, lung, kidney and stomach. It was interesting that dysplasia had been confined to erythroid lineage throughout his clinical course. He seemed to be a rare case of blastic form of acute erythremia which should be distinguished from erythroleukemia.
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  • Ippei SASAGAWA, Hisakuni NISHIMORI, Sakae FUTAGAWA, Naoki SADAMORI, Ta ...
    1991 Volume 32 Issue 11 Pages 1492-1497
    Published: 1991
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    This report describes three of primary bilateral adrenal lyphoma. Case 1 was an 87-year-old female. She was admitted to our hospital because of anemia. Masses in the bilateral adrenal glands were noted on abdominal computed tomography (CT). After combination chemotherapy, bilateral adrenal masses transiently showed a remarkable reduction, but they soon enlarged and she died. The pathological diagnosis at autopsy was non-Hodgkin lymphoma (diffuse medium sized cell type). Case 2 was a 77-year-old male. He visited our hospital complaining of general malaise. Masses in the bilateral adrenal glands were noted on abdominal CT and he was admitted. The left adrenal was biopsied under echo guidance. The pathological diagnosis was non-Hodgkin lymphoma (diffuse medium sized cell type). The bilateral adrenal masses transiently responded to combination chemotherapy, but soon enlarged again and he died. Case 3 was a 75-year-old male. He visited our hospital complaining of general malaise. Masses in the bilateral adrenal glands was noted on abdominal CT and he was admitted. The left adrenal was biopsied under echo guidance. The pathological diagnosis was non-Hodgkin lymphoma (diffuse medium sized cell type). Combination chemotherapy was followed by a complete remission and discharge of the patient.
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  • Masako FUKUDA, Hiroshi FURUYA, Kazumi NOTSU, Chieko TAKAGI, Yohji SUYA ...
    1991 Volume 32 Issue 11 Pages 1498-1502
    Published: 1991
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    A 78-year-old female suffered from idiopathic paroxysmal cold hemoglobinuria (PCH). Her symptom occurred immediately after she worked outside in the cold early morning. This case is characterized by the eldest case with non-syphylitic PCH reported in Japan and by the most advanced anemia (Hb 4.2 g/dl) possibly due to prolonged hemolysis after cold exposure. Analysis of the serum revealed positive Donath-Landsteiner antibody of IgG type, which could react to hemolyse not only below 15°C but also at 15-20°C in vitro.
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  • Yoshio HATAE, Yukiko HATAYAMA, Motoi NISHI, Tomoaki MURAKAMI, Kazumi N ...
    1991 Volume 32 Issue 11 Pages 1503-1508
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Methotrexate (MTX) is now widely used for the treatment of acute leukemia and non-Hodgkin lymphoma in the pediatric oncology field and is thought to be one of the key drugs for this treatment. A regimen utilizing high dose MTX (HD-MTX) with leucovorin rescue is being investigated as effective chemotherapy in the patients with these kinds of cancer. Relatively large amounts of MTX (225mg/m2) are given to such outpatinets by intravenous push as a course of maintenance therapy. It is said that those amounts will infuse safely. However, we experienced two serious cases-patients T.H. and M.Y.-which developed into severe side effects after this treatment. Both patients showed acute renal failure, severe myelosuppression, erosion around the oral and anal region, and continuous diarrhea. Judging from the serum concentration of MTX, patient T.H. was exposed to more than the maximum allowance serum MTX level for 9.6 days, patient M.Y. for 6.5 days. This suggests physicians must pay attention to the clinical symptoms even after treatment using MTX without HD-MTX.
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  • Shuji OZAKI, Yasunori KAWACHI, Toshiro IGAKI, Nozomi OGASAWARA, Tatsum ...
    1991 Volume 32 Issue 11 Pages 1509-1514
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A 62-year-old woman was admitted to our hospital because of general malaise in May, 1987. No hepatosplenomegary, skin eruption or lymphadenopathy was detected. Laboratory examinations showed mild anemia, thrombocytopenia, normal leukocyte count with no lymphocyte abnormality, hypogranular neutrophils, elevated serum lactic dehydrogenase, increased C-reactive protein and hypoxia. Bone marrow aspirate was normocellular with dysplastic changes in erythroid and megakaryocytic lines which agree with a diagnosis of myelodysplastic syndrome (MDS). She was treated with prednisolone which relieved her symptom but she developed high fever, hemiplegia and disturbance of consciousness and died in August, 1987. Necropsy of the kidney revealed large mononuclear cells within the lumen of small blood vessels. Immunohistochemical study of these malignant cells showed positive reaction to the anti-LCA and anti-L26 antibodies. And electron microscopy showed no azure granules in these cells. Then we diagnosed as neoplastic angioendotheliosis (NAE). To our knowledge, this is the first report of NAE with abnormalities in myeloid, erythroid and megakaryocytic lineages. These results suggest that NAE with MDS originate from a multipotent stem cell.
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  • Shin MATSUDA, Tohru OHKOSHI, Hiroyuki KANBAYASHI, Tetsugoro TANAKA, Hi ...
    1991 Volume 32 Issue 11 Pages 1515-1520
    Published: 1991
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    We report a case of paroxysmal nocturnal hemoglobinuira (PNH) and review the literature regarding transfusion of red blood cells in PNH patients. A 42-year-old woman with myelodysplastic syndrome (MDS) complaining of right hypochondralgia and high fever was admitted to the hospital for acute cholecystitis with gall stone. Blood examination revealed bicytopenia (leukocytes, 1,700/μl and hemoglobin, 8.5 g/dl) and bone marrow examination showed normocellular but hypererythroid bone marrow and dyshematopoiesis, which suggested MDS. Laboratory data revealed obstructive jaundice and hemolytic anemia. Positive sucrose and Ham tests, which were compatible with the diagnosis of PNH. Cholecystectomy was necessary hecause of the obstructive jaundice with cholecystitis. A total of 1,200 ml leukocyte-depleted washed red blood cells was transfused within one week before the operation. Cholecystectomy was successful, and the patient showed no postoperative complications of increased hemolysis or thrombosis. As hemoglobin level gradually decreased for the first two postoperative weeks, filtrated white cell-depleted red blood cells (total, 1,000 ml) were transfused instead of washed red blood cells. No side effects of the transfusion were noted. On the basis of findings in this case and those reported in the literature, it is concluded that in some case of PNH, the use of washed red blood cells is unnecessary, and that the use of white cell-depleted red blood cells is indicated.
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  • Nozomi ARAI, Akihiro HARA, Masanori UMEDA, Tatsuo SHIRAI
    1991 Volume 32 Issue 11 Pages 1521-1525
    Published: 1991
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    The patient was a 60-year-old man who had complained of left cervical swelling from the end of June, 1984. He was diagnosed as having Hodgkin's disease (mixed-cell type) by lymph node biopsy, and was admitted to our hospital for thorough examination and treatment on July 23rd. Diagnosis of stage IA Hodgkin's disease involving only the left cervical lymph node was made. On admission, laboratory data revealed that the LDH activity in his serum and erythrocytes consisted of only type 1 (LDH-H4), hence LDH-M subunit deficiency (homogenous type) was diagnosed. However, the muscle rigidity, myoglobinuria, and skin lesions that are usually seen in this abnormality were not observed. After two course of C-MOPP therapy, beggining on August 1st. complete remission was obtained. He was subsequently given a total of 6 courses of C-MOPP therapy and 40 Gy of irradiation on an outpatient basis. He eventually died of heart failure on November 3rd, 1986. Only five families with LDH-M subunit deficiency have been reported to date in Japan. This is the first report in Japan of the condition being complicated by Hodgkin's disease.
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