Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 32, Issue 7
Displaying 1-22 of 22 articles from this issue
  • Osamu IKEHARA
    1991 Volume 32 Issue 7 Pages 709-711
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Forty one cases of drug-induced blood dyscrasia were seen in the last 10 years in six main hospitals in Okinawa. There were 16 males and 25 females. The average age was 53 year-old. The anticonvulsants were the most common causative drugs (12 cases), followed by the antithyroid drugs (6 cases) and Co-trimoxazole (4 cases). The granulocytopenia was the most common type of blood dyscrasia, comprising 51.0% of all cases. Phenytoin was the most common anticonvulsant (8 cases) and 6 cases received it as a prophylaxis following craniotomy. Three cases of antithyroid drug-induced granulocytopenia developed this complication after readministration of the antithyroid drugs. The intervals between the administation of causative drugs and the onset of blood dyscrasia were less than 3 months, excepet for α-methyldopa, gold, and chlorpromazine. Although 30 cases (73.0%) showed complete recovery, there were 3 fatalities (3.0%) which included bicytopenia due to sodium valproate, aplastic anemia due to Co-trimoxazole, and pure red cell aplasia due to aspirin. It is suggested from this study that drug-induced blood dyscrasia is not uncommon in Okinawa.
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  • Hironobu TOKI
    1991 Volume 32 Issue 7 Pages 712-713
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    The case survey of drug-induced hematologic disorders in Shikoku District (Ehime Prefecture) disclosed 21 patients. Cases were 12 rheumatoid arthritis patients, 2 brain tumor, one epilepsy, 2 liver cirrhosis, one neuralgia, one arthralgia, one hyperthyroidism, and one IBL-like T-lymphoma. Causative drugs for aplastic anemia were Metalcaptase, Shiosol, Voltaren and Emeside. Drug-induced aplastic anemia was so severe that 4 out of 5 patients had died of bone marrow dysfunction. Neutropenia was caused by drugs as Rimatil, Cefobit, Sepatren, Mercazole, Sulpyrin, Aleviatin, Cefamedin and Metalcaptase. The real causes of these drug-induced hematologic disorders have not been clear. Remarkably high incidence among rheumatoid arthritis patients is suggestive several reasons as unique reactivity associated with HLA, suppression on hematologic stem cells by abnormal metabolites, and immunologic dysfunction commonly seen in collagen diseases. Further studies of more accurate incidence of drug-induced hematologic disorders are needed in investigating real causes of unhappy side-effects.
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  • Norihiko HINO
    1991 Volume 32 Issue 7 Pages 714-717
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    23 cases of drug-induced blood disorders were reported from 7 hospitals in Chugoku district. These cases were treated between Oct 1982 and Jun 1990. These included 5 cases of anemia, 2 cases of leukopenia, 6 cases of thrombocytopenia, 1 case of anemia and leukopenia, 2 cases of anemia and thrombocytopenia, and 1 case of leukopenia and thrombocytopenia. There was a case of methemoglobinemia due to Sedes-G®. A patient of agranulocytosis due to cimetidine died of sepsis. The all other patients recovered. The reported drugs which induced blood disorders were analgetica, anticonvulsion agent, chemotherapic agent, antituberclotic agent, and H2 recepter blockade, etc. in order of number. The drugs in 3 cases were definitely thought to be the cause of blood disorders, probably in 18 cases, and possibly in 2 cases.
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  • Shiro NAKAYAMA, Hiroki YABE
    1991 Volume 32 Issue 7 Pages 718-720
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Thirty-six cases of drug-induced blood dyscrasias were collected in Kinki District. They were consisted of 14 agranulocytosis, 9 agranulocytosis with anemia, 7 pancytopenia, 2 anemia (hemolytic anemia and pure red cell aplasia), 2 thrombocytopenia and 2 agranulocytosis with thrombocytopenia. The causative agents were 10 antibiotics, 10 cardiovascular drugs, 5 anti-rheumatic drugs, 3 antithyroid drugs and 3 anticonvulsants. Six patients with advanced age died from sepsis within 14 days after the onset of agranulocytosis.
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  • Yoshiro MURAI
    1991 Volume 32 Issue 7 Pages 721-724
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Ten years experience of 14 hospitals in Kanto district with drug induced blood dyscrasis (DBD) were reviewed. There were 78 patients, male/female ratio was 1:1, and cases more than 80 years old were 10.3%. It was very difficult to identify the causative agents, and only 8 cases were definitive. After disease 9 case were died, and DBD prolonged more than 50 days from onset in 8 patients. Thirty-one patients (39.7%) were due to Antibiotics, beta-lactam were most frequent, 12 cases were due to analgesics, 5 patients were due to thiamazole. In order to elucidate the incidence of DBD, studies had carried out concerning antibiotics and H2 receptor antagonists (H2RA). DBD due to antibiotics increased from 0.5% in 1981 to 4.2% in 1982, because medication of third-generation cephalosporins was began to use. In 109 outpatients with H2RA, there was no DBD, but in 54 hospitalized patients DBD were found in 3.6%. DBD might be more frequent in fact. It is necessary to start big study and to develope new technique for confirmation.
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  • Mitsuyuki FUKUDA
    1991 Volume 32 Issue 7 Pages 725-728
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    One hundred and thirty-four cases were identified in seven prefectures of the Tohoku district. Fifty-seven per cent of them were over 50 years old, and the incidence had no differences between sexes. They consisted of 51 leukopenia, 32 thrombocytopenia, and nine anemia cases which included seven hemolytic anemia and two pure red cell aplasia. Agents associated with blood dyscrasias were those acting on the central nervous system (CNS) (49 cases), cardiovascular drugs (25 cases), and antimicrobial agents (48 cases). Leukopenia occurred to five patients with cinepazidemaleate (Brendil) administration, 11 with thiamazole (Mercazole), and 14 with antimicrobial agents which were mainly penicillins and cefarosporins. Thrombocytopenia was induced by H2-receptor antagonists (six cases) and antimicrobial agnents mostly of penicillins and cefarosporins (12 cases). Anemia contained seven cases of hemolytic anemia, including two patients caused by methyldopa (Aldomet) and two by dried human immunoglobulin (Glovenin). Among 15 cases, 12 out of 19 agents were those affecting the CNS. Six cases were dead from drug-induced blood discrasias.
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  • Isao MAEKAWA
    1991 Volume 32 Issue 7 Pages 729-733
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Patients with drug-induced hematologic disorders were clinically analysed. Fifty-nine cases were registrated from 6 hospitals in Hokkaido. These were 21 cases of male and 38 of female. Age-distribution was 18 to 84 years old. Types of hematologic disorders were as follows, 9 cases of pancytopenia, 16 of bicytopenia and 31 of monocytopenia. Leukocytopenia only and leukocytopenia with another disorders were high incidence (85%). Decision of causal drug are done by DLST (drug lymphocyte stimulation test); 5 cases, drug-rechallenge; 3 cases and clinical course only; 31 cases. In 11 fatal cases by this lesion, there included 7 cases of pancytopenia.
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  • [in Japanese], [in Japanese]
    1991 Volume 32 Issue 7 Pages 734-735
    Published: 1991
    Released on J-STAGE: March 12, 2009
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  • Satoru KOYAMA, Hiroyuki SAITOU, Mitutoshi KASHIWABA
    1991 Volume 32 Issue 7 Pages 736-742
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    We investigated the efficacy of oral etoposide (VP-16) for the patients with acute non-lymphocytic leukemia (ANLL) in relapse or refractory to the standard chemotherapy. Patients were given etoposide orally at the dose of 50 mg/body/day on consecutive days until the leukemic cells in the bone marrow were reduced less than 5%. The duration of administration of oral etoposide ranged from 16days to 50days (average 30days). Seven patients were given very low dose cytosine arabinoside (5∼10 mg×2/day i.s.c.) combination with oral etoposide. Six patients (66.7%) out of 9 achieved complete remission (CR) and 3 patients had no response. Adverse effects such as abdominal discomfort and appetite loss were observed in 3 patients, but they were mild and tolerable. The duration of CR ranged from 2 to 24 (+) months, and the median CR duration is 7 months. The over all CR rate (66.7%) in this group of patients with refractory or relapsed ANLL were encouraging. Further studies, however, are needed to evaluate the efficacy of long term oral administration of etoposide for the patients with leukemia.
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  • Yataro YOSHIDA, Kunitake HIRASHIMA, Shigetaka ASANO, Fumimaro TAKAKU, ...
    1991 Volume 32 Issue 7 Pages 743-750
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Nineteen patients with myelodysplastic syndromes (MDS) were treated with a glycosylated recombinant granulocyte colony-stimulating factor (rG-CSF) for improvement of neutropenia. rG-CSF was administrated intravenously at a dose of 5 μg/kg/day for 14 consecutive days. Most of patients responded to rG-CSF and an approxinately 10 fold increase of the peak neutrophil counts was observed. The neutrophil counts were maintained at high level during the treatment period and returned to pretreatment levels several days after stopping rG-CSF. Consistent with the recovery of neutrophil, infectious complications improved in many cases. Effects of rG-CSF were confined to neutrophils, sparing blast cells and other blood cells. Eruption was observed in one patient as toxicity. We conclude that rG-CSF therapy is effective in improving neutropenia with MDS patients.
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  • Hironori HARADA, Kaori NASU, Yuka HARADA, Youko NIKI, Naomi TOMONO, Ki ...
    1991 Volume 32 Issue 7 Pages 751-757
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Eight cases of acute myelogenous leukemia with (8;21) translocation were reported. As recently reported, they showed following features: M2 morphology in FAB classification (all 8 patients), abnormal granulocyte maturation, i.e. large granules and pseudo Pelger-Huet forms (5), Auer rods (8), occasional eosinophlia (2), frequent loss of one sex chromosome (5), the low neutrophil alkaline phosphatase activity (5), and tumor formation (one). Both CD13 and CD33 antigens were expressed on smaller number of leukemic cells than the other AML (M2) cells, whereas CD34 and HLA-DR antigens were expressed on higer number of cells. Interestingly CD19 antigen was detected on a small to large population of tumor cells from four out of six patients. Despite the high remission rate, many of them relapsed within one year. More intensive postinduction and maintenance therapy should be considered for those patients.
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  • Midori SHIIKI, Nobuaki ARIYOSHI, Toshio NAKAMURA, Akira SHIRAHATA
    1991 Volume 32 Issue 7 Pages 758-765
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Both bleeding and thrombosis are commonly seen in newborn infants because of their imbalance of coagulation and fibrinolysis system. In order to clarify some aspects of the hemostatic characteristics during neonatal period, we measured the levels of antithrombin-III (AT-III), thrombin AT-III complex (TAT), α2-plasmin inhibitor (α2PI) and plasmin α2PI complex (PIC) in 137 normal and sick newborn infants. The results were as follows 1) AT-III levels in normal neonates were significantly low as compared with them in normal adults, and further lower levels were found in sick neonates. 2) TAT levels in sick neonates were significantly higher than those in either normal neonates and adults. In sick neonates, the incidence of abnormally high TAT values increased with DIC score points. 3) No significant difference of α2PI level was seen between normal term neonates and adults. However, α2PI levels in sick neonates were significantly low as compared with them in normal term neonates and adults. 4) PIC levels in either normal and sick infants were significantly higher than those in adults, but there was no significant difference of PIC levels between normal and sick newborn infants
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  • Takaaki SHIKANO, Hiroyuki NAITO, Ryoji KOBAYASHI, Yorikazu ISHIKAWA, M ...
    1991 Volume 32 Issue 7 Pages 766-772
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Cytogenetic study in 53 children (aged less than 15 years) with acute non-lymphocytic leukemia (ANLL) were studied. The cytogenetic findings were compared with those of ANLL patients (136 aged less than 19 years and 747 aged over 20 years) in the Fourth International Workshop on Chromosomes in Leukemia (IV IWCL) and also with those of childhood acute lymphoblastic leukemia (ALL) cases (previously reported as our 124 ALL case). Of the ANLL patients, 77.4% had acquired chromosomal clonal abnormalities. As abnormalities, t(15;17), all cases which were seen in M3 or M3V cases, t(8;21), which was seen in M1 or M2, and rearrangements of 11q23, which were seen in M5, were more frequently seen than was reported at the IV IWCL (20.8%, 17.0% and 7.5% vs 6.3%, 6.3% and 3.2% respectively). 5q-, monosomy 7, t(6;9) and t(9;22), which have been noted previously in this disease, were not seen. Besides structural abnormalities, some cytogenetic differences in numerical abnormality between ALL and ANLL were observed as follows: 1) Hyperdiploidy of greater than 51 chromosomes noted in ALL was not found in ANLL. 2) Isolated trisomy 8 was frequently found in ANLL, but not in ALL. 3) Loss of a sex chromosome was frequently found in ANLL, but not in ALL. Our study revealed a different frequency of non-random chromosome abnormality in children with ANLL as compared with that of adults, and clarified the differences in numerical abnormalities, as well as structural abnormalities, between ALL and ANLL.
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  • Hideo WADA, Kouzou MINAMIKAWA, Mitiaki OHIWA, Toshihiro KANEKO, Yoshit ...
    1991 Volume 32 Issue 7 Pages 773-776
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Plasma Interleukin-6 (IL-6) level was measured in patients with idiopathic thrombocytopenic purpura (ITP), systemic lupus erythematosus (SLE), rheumatoid arthritis and aplastic anemia. Increase in the plasma level of IL-6 was observed in patients with ITP and SLE. The plasma IL-6 level decreased with progression of the treatment for ITP, and it showed weak negative correlations with the platelet count at the onset of ITP. The increases in the plasma IL-6 level suggest the involvement of activation of the immune system in the pathogenesis of ITP.
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  • Kiyohide KAWANO, Hisamitsu UNO, Junzo ISHIZAKI, Hitoshi MATSUOKA, Kazu ...
    1991 Volume 32 Issue 7 Pages 777-781
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A 39-year-old woman was first admitted to our hospital with increased white cell count on May, 1983. Physical examination showed only mild splenomegaly. Hematological examination revealed leukocytosis (14,600/μl) with ATL cells (59%). Serum anti-HTLV-I antibody was positive. Examination of HTLV-I provirus in the abnormal T cells revealed the defective type. She was diagnosed as chronic type of ATL based on the clinical features. Cytogenetic study of the ATL cells revealed 47, xx, +4. For 12 months, she was followed without any therapy. WBC reduced to almost normal range and ATL cells decreased to 3 to 6% for 8 months. On May, 1985, she was readmitted to our hospital because of leukocytosis (32,200/μl), and increased ATL cells (57%). She was diagnosed as crisis of ATL. Investigation of the proviral DNA and chromosome showed the same results as those of the chronic phase, indicating that ATL cells in both the chronic phase and the crisis phase originated from the same clone. She died after 3 months from massive diarrhea. Postmortem examination showed the extensive infiltration of leukemic cell in the small intestine.
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  • Takuya MATSUNAGA, Nobuo MASEKI, Yasuhiko KANEKO, Kazumi SAMPI, Tsuneto ...
    1991 Volume 32 Issue 7 Pages 782-785
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    Two patients of acute myelogenous leukemia (AML) presented with a large intestinal tumor and related symptoms. They had a tumor in the rectum or the ascending colon. Bone marrow cells obtained from both patients showed a karyotype with t(8;21). Chromosomal findings in the former patient has already been reported in detail (Am J Hematol 4,273, 1978). These findings and reports in the literature indicate that large intestinal tumor may not be rare in AML with an 8;21 translocation. Complete remission was achieved after chemotherapy, when their intestinal tumors disappeared.
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  • Shuichi ANNOH, Masanori UMEDA, Nozomi ARAI, Ken SHIKOSHI, Chien-yu SU, ...
    1991 Volume 32 Issue 7 Pages 786-790
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A fifty-one-year-old male patient visited the Department of Dermatology of Toho University Ohashi Hospital with a complaint of generalized exanthema, which was diagnosed assyringoma; at that time his leukocytosis was recognized. He was admitted to our department on August 8, 1988. Physical examination on admission revealed slight hepatosplenomegaly. WBC count was elevated (50,700/μl). He was diagnosed as having Ph1-positive CML in the chronic phase and was treated with IFN-α (HLBI, Sumitomo, 3×106 units/day, daily, I.M.) from August 12, but an elevated lesion was detected at the lower part of his esophagus by endoscopy, and it was diagnosed by biopsy as squamous cell carcinoma. Radical operation for esophageal cancer was performed on September 26; at that time his WBC count was 17,400/μl. After discharge, his WBC level was maintained within normal range by IFN-α. On August 2, 1989, he was readmitted to our hospital because of lymphoblastic crisis. Although he attained transient complete remission, he died of pneumonia after the relapse on January 10, 1990. IFN-α therapy is suggested to be useful for the treatment of CML associated with gastrointestinal cancer because of its possible parenteral administration and mild toxicity.
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  • Koji NAGAFUJI, Tsunefumi SHIBUYA, Kimihiko YANAGIDA, Takashi OKAMURA, ...
    1991 Volume 32 Issue 7 Pages 791-795
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A patient of Coombs negative autoimmune hemolytic anemia was massively transfused of 162 units concentrated red blood cells in 3 months and developed iron overload disease which was confirmed by liver biopsy. Hemolysis was successfully treated with high-dose methyl-predonisolone therapy and splenectomy. To treat iron overload, we administered recombinant human erythropoietin (Epo) in combination with phlebotomy. Total iron removed for 5 months was about 4 g. Thus, combination of Epo and phlebotomy was effective for the treatment of iron overdload disease. Furthermore, we compared a degree of clinical effect of subuctaneous administrarion of Epo with that of intravenous administration in the clinical course and found the former more effective.
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  • Yasunori YAMAZAKI, Satoshi INABA, Tadashi NEMOTO, Kooh IIZUKA, Tohru F ...
    1991 Volume 32 Issue 7 Pages 796-801
    Published: 1991
    Released on J-STAGE: March 12, 2009
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    A 72-year-old man was admitted of generalized lymphadenopathy and oliguria on December 12, 1987. Laboratory findings revealed progressive renal impairment, polyclonal hypergammaglobulinemia, and reduction of serum complements. A cervical lymph node was typically suitable for histology of IBL-like T-cell lymphoma. The surface markers of lymph node were mainly CD2 (+) and CD3 (+) and clonal proliferation of lymphoma cells was proved by TCR-β gene rearrengement. Renal biopsy to examine the pathogenesis of acute renal failure revealed endocapillary proliferative glomerulonephritis without invasion of lymphoma cells. Both lymphadenopathy and renal failure were improved by successful administration of prednisolone and hemodialysis. Although relapsed tumor was partially responded to vincristine and prednisolone, he died of alimentary tract bleeding. We reported a case of IBL-like T-cell lymphoma with actue renal failure due to endocapillary proliferative glomerulonephritis.
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