Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 36, Issue 11
Displaying 1-17 of 17 articles from this issue
  • Yoshihisa AKIMOTO, Taijiro ISHIYAMA, Hideyuki UENO, Ken-ichiro HINO, S ...
    1995 Volume 36 Issue 11 Pages 1247-1251
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    Increased levels of soluble interkeukin-2 receptor (sIL-2R) have been noted in the sera of patients with various diseases such as adult T cell leukemia, malignant lymphoma and autoimmune diseases. Using an enzyme-linked immunoabsorbent assay, we assessed sIL-2R levels in the sera of 16 patients with multiple myeloma (MM) and 27 normal subjects. There was a significant increase in the levels of sIL-2R in the patients with myeloma (963±523 U/ml) compared to normal subjects (213±80 U/ml). The levels of sIL-2R corresponded well with the clinical stage, M-protein, serum IL-6 and serum β2 microglobulin levels. Taking the evidence that the CD4/CD8 ratio decreased as the disease worsened into consideration, the increase in the serum sIL-2R levels of the patients with MM is considered to have some correlation with B and T cell activation through various cytokines including IL-6. Furthermore such evidence would support the role of sIL-2R as a disease monitor of MM.
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  • Yoshihiro OKAMOTO, Tetsuhito KOJIMA, Akira KATSUMI, Tomio YAMAZAKI, Mo ...
    1995 Volume 36 Issue 11 Pages 1252-1256
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    Hemophilia A is an X-linked hemorrhagic disorder caused by heterogeneous mutations in the factor VIII gene. Recently, it was reported that approximately 50% of the cases of severe hemophilia A may be caused by a common inversion in the factor VIII gene. In this study, we analyzed 33 Japanese patients with severe hemophilia A for the presence of this inversion mutation using the non-RI Southern blotting, and detected inversion mutations of the factor VIII gene in 12 patients (36.4%). We also showed that the inversion analysis of the factor VIII gene was useful for carrier detection and prenatal diagnosis in a hemophilia A family, which we had not been able to diagnose by the analysis of restriction fragment length polymorphisms (RFLPs) of the factor VIII gene. The detection of inversion mutations in the factor VIII gene using non-RI Southern blotting analysis appears to be very useful for the genetic counseling for severe hemophilia A.
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  • Hideo TAKEYAMA, Hironori YAMADA, Nobuhiko EMI, Hidehiko SAITO, Akihiro ...
    1995 Volume 36 Issue 11 Pages 1257-1265
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    The effect of granulocyte colony-stimulating facator (G-CSF) on neutropenia and infection was studied in a randomized trial in patients receiving intensive chemotherapy for acute leukemia. Fifty seven patients with acute leukemia (35 cases of refractory acute myeloid leukemia, 19 cases of acute lymphoblastic leukemia and 3 cases of blast crisis of chronic myeloid leukemia) were given G-CSF under either of the following two coditions; 1) Group A: starting G-CSF (200 μg/m2iv) administration 24 hrs after chemotherapy, 2) Group B: the same dose of G-CSF administration after a febrile episode of 38°C with neutropenia (less than 1,000/μl). Five patients were excluded from the study. Group A (27 patients) showed a shorter febrile period (2.15±2.98 days) than the 25 patients of Group B (3.40±4.78 days), but the difference was not statistically significant. Compared to Group B, Group A showed significantly early recovery of neutrophil counts as well as early recovery from documented infections. There was no evidence that early administration of G-CSF accelerates the growth of leukemic cells nor causes early relapse of acute leukemia.
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  • Yutaka TAKAHASHI, Hiroshi UMADOME, Yoichiro OHNO
    1995 Volume 36 Issue 11 Pages 1266-1273
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    Ferroerythrokinetic data including erythron transferrin uptake (ETU) calibration of 134 cases of control, hemolytic anemia, hypoplastic anemia and ineffective erythropoiesis (IEP) were subjected to canonical discrimination analysis. Axis rotation was then performed for the second variate so as to be parallel to the long axis of distribution ellipsoid of IEP group. The process yielded three variates. The first one, V-1, was assumed to represent the amount of effective erythropoiesis, the second one, V'-2, its efficiency ratio and the third one, V'-3, the rate of peripheral hemolysis. A definite correlation (r=-0.872) was obtained in IEP group between V'-2 and ETU, i.e. reduction in efficiency and compensatory hyperplasia in erythropoiesis. On the plane with concised parameters of V-1 and V'-2, an ellipse of 95 percent confidence of IEP group and three discrimination lines delineated five areas representing five patterns of ferroerythrokinetics, i.e. IEP, hemolytic, hypoplastic, IEP combined with hemolytic or with hypoplastic ones. This method is considered to be useful for application to those erythropoietic disorders having partial or complicated factors described above, where routine ferroerythrokinetic parameters may be indecisive.
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  • Kunio YANO, Yasuyuki NAKANO, Masahide KOBAYASHI, Kazuhiro TOMITA, Nori ...
    1995 Volume 36 Issue 11 Pages 1274-1278
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 30-year-female with chronic myelogenous leukemia received allogeneic bone marrow transplantation (BMT). On day 104, low-grade fever, cough, and general malaise developed, resulting in hospitalization 10 days later. Chest X ray revealed diffuse infitrates, suggesting cytomegalovirus interstitial pneumonia. Ganciclovir (DHPG) was given daily and all symptoms disappeared three days later. However, a very few vesicular lesions appeared on her trunk and her two children had chickenpox at that time. Chest CT was taken and disclosed diffuse nodular shadows. Clinical course and chest CT suggested varicella pneumonia. DHPG administration was stopped and acyclovir PO started to be given. She was discharged in excellent condition. In this report, we show a rare case of varicella pneumonia after allogeneic BMT and efficacy of DHPG for the treatment of varicella pneumonia.
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  • Hiroshi FURUYA, Toshio WAKAYAMA, Junko TANAKA, Mitihiro TSUMORI, Toshi ...
    1995 Volume 36 Issue 11 Pages 1279-1283
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    Pure red cell aplasia (PRCA) was found in a male patient with chronic myelocytic leukemia after major ABO incompatible bone marrow transplantation (BMT). He had blood grpup O, and received BMT from an HLA identical sibling (blood group A). Erythrocyte-depleted marrow was transplanted. Methotrexate for short time and cyclosporine (CyA) were used for graft versus host disease (GVHD) prophylaxis. Engraftment of neutrophils and platelets were observed on day 14 and 22, respectively. The Ph1 chromosome disappeared on day 133. However engraftment of erythrocytes was not observed on day +280. Bone marrow puncture revealed depletion of erythrocyte precursors. Anti-A isoagglutinin was persisted. There was no evidence of acute or chronic GVHD. Administration of prednisolone, discontinuance of CyA and subcutaneous infusion of recombinant human erythropoietin failed to improve PRCA. Bolus methylprednisolone (m-PSL) therapy started on day 284 resulted in rapid increase in reticulocyte counts within 6 days, which was followed by normal hemoglobin concentrations. We conclude that bolus m-PSL may be one treatment for PRCA after BMT.
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  • Kazunori NAKASE, Masaki HASEGAWA, Yoshinori SUZUKI, Shigehisa TAMAKI, ...
    1995 Volume 36 Issue 11 Pages 1284-1288
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 37-year-old man was admitted because of pancytopenia with leukoerythroblastosis and anisocytosis in January 1986. Bone marrow aspiration resulted in a dry tap and biopsy showed marked myelofibrosis. Threea months after admission, generalized lymph node swelling and multiple skin tumors were recognized. A biopsied lymph node revealed lymphoblastic lymphoma. The surface markers of lymphoma cells showed an immature T-cell phenotype, whereas T-cell receptor β and γ chain genes showed germ line configuration. The patient was treated with combination chemotherapy in June 1986. A month later, he developed leukemic transformation with features of acute myelocytic leukemia and he died of pneumonia. Autopsy disclosed extramedullary hematopoiesis in the liver and spleen. Primary myelofibrosis complicated by T-cell lymphoma is extremely rare.
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  • Kenji SHIMOSEGAWA, Yohko ONO, Takeshi SUGAWARA, Hideharu NUMAOKA, Hiro ...
    1995 Volume 36 Issue 11 Pages 1289-1294
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    We encountered a 71-year-old female with acute myelogenous leukemia (AML, Ml), who maintained a steady hematological state for 22 months under ubenimex monotherapy. At the first medical examination in our hospital, the marrow cellularity was approximately 40% containing leukemic myeloblasts of 41.4% in the total nucleated cells, and the marrow cytogenetic studty revealed 47, XX, +8 in 13 of 20 cells analyzed. Nineteen months later, the bone marrow showed definite hypoplasia with leukemic blasts of 39.8% and chromosome finding of 46, XX, ins (10;?)(q11;?) in all cells analyzed. During the course, the patient has been doing well without transfusin of red blood cells or platelets.
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  • Katsuyasu SAIGO, Toshitaro NAKAGAWA, Ryukichi RYO, Nobuo YAMAGUCHI
    1995 Volume 36 Issue 11 Pages 1295-1299
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    Trisomy 13, as a sole karyotypic abnormality in acute leukemia, has been reported in several cases. However, in chronic myelogenous leukemia (CML), only two cases with this abnormality were reported so far. We describe herein a 68-year-old case with Philadelphia chromosome-negative CML and trisomy 13. Leukocytosis was pointed out during the treatment for other diseases. After 7 months, abrupt increase in leukocyte count (108,000/μl) and splenomegaly developed. Decreased neutrophil alkaline phophatase activity and morphological features fulfilled the diagnostic terms for CML. However, the karyotypic analysis revealed trisomy 13 instead of Philadelphia chromosome, and the BCR gene rearrangement was not detected. In cases with acute leukemia accompained by trisomy 13, malignant transformation of an immature hematopoietic precursor cell has been suggested by the expression of antigens characteristic of both the myeloid and lymphoid lineage. In a few cases with myelodysplastic syndrome, a multipotent stem cell disorder, trisomy 13 has also been reported. From these standpoints, there might be a possibility that trisomy 13 as a sole abnormality in hematologic disorders would be related to tumorigenesis in the levels of multipotent stem cells.
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  • Norihiro AWAYA, Masaki TAKAO, Hiromiki NATSUDA, Takemori YAMAWAKI, Nor ...
    1995 Volume 36 Issue 11 Pages 1300-1304
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 57-year-old female was diagnosed being in the blastic phase of chronic myelogenous leukemia (CML) on her second admission in May 1993. The patient was previously treated with vincristine and prednisolone in the accelerated phase of CML in December 1991 without improvement. Other chemotherapeutic agents such as BHAC-DMP (enocitabine, daunorubicin, mercaptopurine, prednisolone), interferon, mercaptopurine and ranimustine were also administered. After the second chronic phase was achieved, she was treated with busulfan as an outpatient. On her second admission, the diagnosis of erythroblastic transformation was made, and cytogenetic study revealed t(9;22)(q34;q11) with the additional chromosomal abnormalities, t(6;9)(p23;q34). This karyotype rearrangement has been reported neither in Ph-positive CML nor in blastic crisis.
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  • Masataka OKAMOTO, Hitoshi MIYAZAKI, Motohiro TSUZUKI, Teruo INO, Kohji ...
    1995 Volume 36 Issue 11 Pages 1305-1310
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 44 year-old woman with acute myeloid leukemia (AML, FAB, M4E) developed heart failure during treatment with anthracyclines for AML. She had not experienced heart disease and her left ventricular ejection fraction (LVEF) was 59% at the end of a successful remission induction therapy. Because her LVEF decreased to 33% after early consolidation therapy, the chemotherapy for AML was discontinued. The cumulative dose of daunorubicin, aclarubicin and mitoxantrone was 486 mg/m2, 135 mg/m2 and 55 mg/m2, respectively. In October 1990, four months after the end of the chemotherapy, heart failure (class III, NYHA) developed and did not improve by treatment consisting of dobutamin, digoxin and diuretics. Anthracycline cardiomyopathy was histologically confirmed by endomyocardial biopsy. Then we administered selective β1-antagonist, metoprolol (Seloken®), with an initial dose of 5 mg/day which was doubled 3 times every 4 or 8 weeks to 40 mg/day, according to the treatment schedule of dilated cardiomyopathy. She recuperated satisfactorily (Class I, NYHA), and was discharged on February '91. Her LVEF gradually improved and it has been maintained at above 50% on an outpatient basis. The patient has been in complete hematological remission during this period. It seems that low dose selective β1-antagonist therapy has a potential to improve myocardial function in some patients with anthracycline cardiomyopathy.
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  • Yasunori KAWACHI, Ayako WATANABE, Toshio NISHIHARA, Tatsumi UCHIDA, Ko ...
    1995 Volume 36 Issue 11 Pages 1311-1315
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    We describe a 69-year-old man who developed chylothorax after a 9-year remission of malignant lymphoma. The patient was admitted to our hospital and received exploratory laparotomy for ileus in February 1986. Bulky masses in the posterior mediastinum and the retroperitoneum, and also a jejunal tumor were observed. Fibrosis of the liver was also observed. The jejunal tumor was removed and histological findings revealed diffuse large B-cell malignant lymphoma. He was treated by combination chemotherapy and remission was achieved. He was discharged in June and remained in remission, but was readmitted for right pleural effusion in October 1994. Effusion was chylous and the chylomicron level was estimated to be 181 mg/dl. Liver cirrhosis also developed but there was no chylous ascites. Chylorrhea disappeared after continuous aspiration, but recurred in December. Continuous aspiration was ineffective, therefore 10 KE of OK-432 was administered twice into the pleural cavity, and chylorrhea again disappeared. No findings suggestive of malignant lymphoma were not detected by computerized tomography and gallium scintigram. He was discharged in March 1995 and chylothorax has not recurred since. These findings suggest that the fragility of the thoracic duct which had been infiltrated by malignant lymphoma might increase, resulting in rupture, even if in remission.
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  • Tetsuya OKUDA, Yoshikazu YUMOTO
    1995 Volume 36 Issue 11 Pages 1316-1320
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 66-year-old male was admitted to our hospital because of persistant fever. Laboratory data revealed leukopenia, thrombocytopenia, marked elevation of serum lactic acid dehydrogenase and ferritin levels, as well as disseminated intravascular coagulophathy (DIC). Bone marrow aspiration showed increased numbers of mature histiocytes with hemophagocytosis and a diagnosis of reactive hemophagocytic syndrome was made. In the broad spectrum of this syndrome, we suspected virus-associated hemophagocytic syndrome (VAHS) but no causative viral infection was detected. Since DIC is known to be a poor prognostic factor, he was given combination chemotherapy containing VP-16 in addition to pulse therapy of methylprednisolone. He completely recovered after the treatment. Chemotherapy is one option in the treatment of adult onset reactive hemophagocytic syndrome.
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  • —A Case Report—
    Takeshi INAMITSU, Mitsuse INOUE, Hidetaka AKIYOSHI, Keiko HONDA, Tsune ...
    1995 Volume 36 Issue 11 Pages 1321-1325
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    We performed 8-methoxypsolaren and ultraviolet A (PUVA) therapy as a second line treatment for stage +++ cutaneous acute graft-versus-host disease (GVHD) in a 10-year-old girl who had undergone unrelated bone marrow transplantation. Although prednisolone as first line therapy was not effective, the cutaneous lesion began to improve after several times of PUVA treatment and completely disappeared following 11 times of irradiation without additive systemic immunosuppressive therapy. PUVA therapy was considered as a useful treatment for cutaneous acute GVHD.
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