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Volume 37, Issue 11
Displaying 1-20 of 20 articles from this issue
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Makoto MURATA, Tadaharu KANIE, Hirofumi TAJI, Motohiro HAMAGUCHI, Sabu ...1996 Volume 37 Issue 11 Pages 1245-1252
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSThis retrospective study analyzes the result of bone marrow transplantation in 28 patients with unrelated donors compared with 75 patients transplanted from identical HLA sibling donors at a single institute during the same time period. One unrelated donor patient with severe aplastic anemia died without evidence of engraftment. The incidence of grade III-IV acute graft-versus-host disease (GVHD) in unrelated donor patients (19%) was higher than sibling donors (0%) and the probability of survival more than 30 years was lower compared with sibling donors. However, the probability of survival without grade III-IV acute GVHD was similar in the two groups, 62% (n=21) vs. 65% (n=75), and there was no significant difference in relapse-free survival, good prognostic factors; 76% (n=11) vs. 66% (n=37), higher risk factors; 30% (n=11) vs. 31% (n=21). Death due to viral infection were significantly higher among unrelated donor patients. We conclude that bone marrow transplantation for patients younger than 30 years old from unrelated donors should be considered equally to sibling donors with great care to engraftment for severe aplastic anemia, grade III-IV acute GVHD and viral infection.View full abstractDownload PDF (563K)
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Yasuo TAKIMOTO, Fumio IMANAKA1996 Volume 37 Issue 11 Pages 1253-1258
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 32-year-old female was admitted due to splenomegaly and leukocytosis in September, 1993. The leukocyte count was 26,900/μl with 29% monocytes (7,800/μl). A diagnosis of the chronic phase of chronic myelomonocytic leukemia was made. On November 19, 1993, splenic arterial embolization was performed. After the embolization, the leukocyte count rapidly increased, and acute respiratory failure developed. The respiratory condition was improved by methylprednisolone (m-PRED) pulse therapy. Subsequently, the effectiveness of chemotherapy gradually decreased, and there was an increase in the leukocyte count. Respiratory failure developed again but was successfully treated with m-PRED pulse therapy in addition to aclarubicin. On July 4, 1995, splenectomy was performed. The leukocyte count rapidly increased, and acute respiratory failure again developed. She did not respond to m-PRED pulse therapy, but the respiratory condition was markedly improved by leukoplasmapheresis. The respiratory failure in this patient may be associated with capillary leak syndrome due to neutrophilia. In addition, stasis of increased monocytes in the pulmonary capillaries and their infiltration into the pulmonary parenchyma and alveoli was thought to have occured.View full abstractDownload PDF (697K) -
Shoutaro HAGIWARA, Akira YUO, Mari NAGAI, Naoki TAKEZAKO, Yasusi SODA, ...1996 Volume 37 Issue 11 Pages 1259-1264
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSAn 84-year-old woman was admited with acute non-lymphoblastic leukemia transformed from myelodysplastic syndrome. We examined the signal transduction of the leukemic blasts. Stimulation of the blasts by macrophage colony-stimulating factor (M-CSF) resulted in tyrosine phosphorylation of several cellular proteins. In vitro proliferation of leukemic blasts was stimulated by M-CSF, but not by granulocyte colony-stimulating factor. Based upon these findings, combined therapy with M-CSF and low dose cytosine arabinoside (ara-C) was successfull. After her recovery, we confirmed marked reduction of blasts and disappearance of M-CSF-responsive cells. These results suggest that M-CSF could enhance the cytotoxic effect of ara-C on leukemic blasts via its intracellular signaling pathway linked to proliferation.View full abstractDownload PDF (439K) -
Michihiro NAKAYAMA, Masafumi TAKATA, Motohiro KATO, Ken SHIKOSHI, Masa ...1996 Volume 37 Issue 11 Pages 1265-1270
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 28 year-old woman in the 26th week of pregnancy was admitted to our hospital on February 6, 1993, because of anemia and thrombocytopenia. On admission, her hemoglobin was 8.2 g/dl, platelet count 6.3×104/μl, and WBC 6,300/μl with 43% blasts. The bone marrow examination showed hyperplastic bone marrow with 38.8% blasts. She was diagnosed as having 8;21 translocation acute myelocytic leukemia (M2). In the 30th week of pregnancy, she gave birth to a 1449 g male infant by induction delivery. After DCMP therapy, complete remission was obtained. She has been in complete remission for 32 months and her child is growing healthy after overcoming an underweight condition due to premature birth, respiratory distress syndrome, circulation insuficiency and hyperbilirubinemia. This case suggests that in the event of second trimester pregnant patients with acute leukemia, we should wait for the proper time at which successful delivery can be expected, and then intensified remission induction chemotherapy should be carried out after the delivery.View full abstractDownload PDF (939K) -
Michihiro NAKAYAMA, Satoshi TAKAHASHI, Tokiko INOUE, Fumitaka NAGAMURA ...1996 Volume 37 Issue 11 Pages 1271-1275
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe report a patient who underwent allogeneic bone marrow transplantation for ALL. The patient presented low grade fever, cough and dyspnea at day 3 after after bone marrow transplantation. Imaging studies showed bilateral patchy infiltrates on chest X-ray and chest CT. Though treated by antibiotics, chest auscultation recognized marked bilateral inspiratory crackles. Transbronchial lung biopsy performed on day 34 showed bronchiolitis obliterans and an organizing interstitial pneumonia. The patient was treated with methylprednisolone and follow up computed tomography findings improved.View full abstractDownload PDF (1116K) -
Takehisa KIKUTA, Chihiro SHIMAZAKI, Hideyo HIRAI, Toshiya SUMIKUMA, Yo ...1996 Volume 37 Issue 11 Pages 1276-1282
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSThree cases of secondary acute myeloid leukemia (AML) that developed after long term treatment with oral etoposide were reported. Case 1 was a 72-year-old male in whom small cell lung cancer was diagnosed in January 1987. He developed AML (M4) in February 1993 after long-term treatment with oral etoposide (total dose 14,650 mg) t(9;11)(p21;q23) with rearrangement of MLL genes was recognized. Case 2 was a 68-year-old female non-Hodgkin's lymphoma (NHL) was diagnosed in February 1989. AML (M4Eo) with inv(16)(p13q22) developed in March 1994 after long-term treatment with oral etoposide (total dose 5,100 mg). Case 3 was a 39-year-old male in whom NHL was diagnosed in January 1991. He developed AML (M2) with t(11;19)(q23;p13) in May 1994 after long-term treatment with oral etoposide (total dose 20,450 mg). These three cases suggest that long-term treatment with oral etoposide may be associated with a risk of developing a secondary AML in patient with malignancies.View full abstractDownload PDF (611K) -
Hiroyuki OKUDA, Tohru TAKAHASHI, Toshiaki HAYASHI, Tetsuya TOKUNOH, Hi ...1996 Volume 37 Issue 11 Pages 1283-1288
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 38-year-old female was admitted to our hospital because of pancytopenia in April 1992. She was diagnosed as aplastic anemia by bone marrow biopsy and other examinations. Then she was treated with methyl-prednisolone pulse therapy followed by administration of ciclosporin in out-patient clinic. Though the modest improvement of peripheral blood count was observed, the worsening of pancytopenia was developed in association with tapering of ciclosporin. Anabolic steroid was given from June 1994 and gradual improvement of peripheral blood count was observed. On June 1995, she developed sudden onset of swelling and discoloration of a lower extremity, and thrombosis in the femoral vein was detected by Doppler ultrasonography. She was positive for lupus anticoagulant and anticardiolipin antibody, thus a diagnosis of antiphospholipid syndrome was made. Aplastic anemia associated with antiphospholipid syndrome has never been reported as far as we know. This case will be of importance for analyzing the cause of thrombosis in aplastic anemia.View full abstractDownload PDF (980K) -
Mitsuru TSUDO, Toshinori MORIGUCHI1996 Volume 37 Issue 11 Pages 1289-1292
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSEvans syndrome is a rare disease defined as autoimmune hemolytic anemia plus immune thrombocytopenia. We describe a 57-year-old man with Evans syndrome whose thrombocytopenia was refractory to conventional therapy, including prednisolone, danazol, azathiopurine, cyclophosphamide, vincristine, gamma-globulin and splenectomy. The patient was then treated with three cycles of pulsed high-dose dexamethasone (40 mg/day for 4 sequential days every 4 weeks) follwed by cyclosporine A therapy (300 mg/day). The platelet counts dramatically increased from 2,000/μl to 200,000/μl. Although thrombocytopenia appeared again with the tapering of cyclosporine A, the platelet counts recovered by re-increase of cyclosporine A, and have remained above 100,000/μl for more than 14 months. Treatment with cyclosporine A can provide an effective therapeutic choice for refractory Evans syndrome.View full abstractDownload PDF (307K) -
Tadashi KANOH1996 Volume 37 Issue 11 Pages 1293-1296
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSPleural involvement in primary (AL) amyloidosis was reported. Pulmonary involvement in patients with primary amyloidosis is not so uncommon, but the pleura is regarded as an unusual site for amyloid deposition. A woman, born in 1942, was referred for evaluation of a four-month history of edema of eye lids and lower legs in 1987. Nephrotic syndrome with Bence Jones (lambda-type) proteinuria was demonstrated. She was diagnosed of having renal amyloidosis. In 1990, X-ray films incidentally demonstrated a small amount of right pleural effusion. A needle biopsy of the pleura was performed. Congo red stain demonstrated amyloid deposition in the pleura. The following clinical features indicating systemic amyloidosis occurred in succession: orthostatic hypotension, diarrhea or constipation, carpal tunnel syndrome, and weight loss. In 1993, sudden death due to cardiac arrest occurred. The patient survived 6 years after the diagnosis of renal amyloidosis. A combined use of melphalan, prednisolone, colchicine, and dimethyl sulfoxide (DMSO) might have contributed to the long survival of the patient. At postmortem examination, systemic deposition of type AL amyloid was confirmed. In patients with pleural effusion and multiorgan involvement or monoclonal gammopathy, a closed pleural biopsy should be performed, especially if the effusion is transudative.View full abstractDownload PDF (522K) -
Hiroshi KAZAMA, Masako AOYAMA, Yuichi SAMESHIMA, Masanao TERAMURA, Mic ...1996 Volume 37 Issue 11 Pages 1297-1302
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSHere we report a case of acute myelogenous leukemia (M2, FAB classification) presenting with cytogenetic abnormalities of ins(21;8), +del(8) without t(8;21). A 8;21 chromosome translocation is frequently found in acute myelogenous leukemia, especially in the M2 subtype. The translocation results in a fusion transcript between AML1 and MTG8 (ETO), assigned on chromosomes 21 and 8, respectively. Among patients with a t(8;21) abnormality, solid leukemic tumor deposits outside the marrow or good response to chemotherapy are observed frequently. Decrease in neutrophil alkaline phosphatase score and positive rate, and eosinophilia in bone marrow or the blast cells with Auer rods expressing CD19, CD56 antigens occur at a relatively high rate. Although our case lacked these clinical, cytological and cytochemical features, expression of chimeric AML1-MTG8 mRNA was detected. AML1-MTG8 fusion transcript may play a critical role in leukemogenesis of AML M2. Studies on this case may help to reveal the oncogenic function of the AML1-MTG8 fusion gene in AML M2.View full abstractDownload PDF (1228K) -
Midori SHIMA, Yoshikatu SAWAMOTO, Masaki KAMISUE, You SHIBATA, Shizuko ...1996 Volume 37 Issue 11 Pages 1303-1308
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA hemophilia A patient with high responder inhibitor had been treated by (activated) prothrombin complex concentrates (A) PCC and activated factor VII until the occurrence of intracranial bleeding at the age of 6 years. Since the inhibitor titer was decreased less than 1 Bethesda Units/ml, high dose of factor VIII was given followed by the infusions of factor VIII concentrates (100 units/kg) three times a week. In spite of previous episodes of anamnestic responses by factor VIII products before, the inhibitor titer did not increase and disapeared completely 6 months after the FVIII infusion therapy. The specific anti-factor VIII IgG subclasses of the inhibitor were IgG2 and IgG4. The inhibitor recognized both light and heavy chains. He have no bleeding episode for 6 months since the beginning of the prophylactic with factor VIII concentrates.View full abstractDownload PDF (455K) -
Tadashi KANOH1996 Volume 37 Issue 11 Pages 1309-1313
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSNecrotizing fasciitis is a rare but often fatal soft-tissue infection primarily involving the superficial fascia and fat tissue resulting in extensive undermining of surrounding tissues. Skin is initially spared, but as necrotizing fasciitis spreads, all the soft-tissue components, including the skin, become involved. The progression of necrotizing fasciitis is often fulminant, and the prognosis depends to a large extent on the rapidity of correct diagnosis and surgical treatment (debridement). Most of the patients affected with necrotizing fasciitis have some risk factors: chronic general or local diseases, leukopenia, immunodeficiency diseases, malignancies, and an age of 50 years or more. The author reported the occurrence of necrotizing fasciitis in a 69-year-old man with multiple myeloma during the granulocytopenic phase after chemotherapy. The successful treatment of necrotizing fasciitis in the present case relied not only on surgical debridement, but also on G-CSF administration.View full abstractDownload PDF (705K)
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Masae KUNITAMA, Norio KOMATSU, Yasusada MIURA1996 Volume 37 Issue 11 Pages 1314-1317
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSThe inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme-A (HMG-CoA) reductase, pravastatin and simvastatin, are widely used clinically as anti-hypercholesterolemic drugs. To determine whether these drugs affect hematopoiesis, we examined the effect of the drugs on colony formation by human bone marrow cells. Simvastatin strongly inhibited both erythroid and granulocyte-macrophage colony formation by total or CD34-positive bone marrow cells at the concentration of 10μM, which is about 100-1,000 fold higher than the pharmacologically effective level. On the other hand, the inhibitory effect of pravastatin was much weaker than that of simvastatin. These findings show that these drugs, especially pravastatin have little effect on hematopoiesis.View full abstractDownload PDF (304K) -
Takayuki OKAMURA, Youg-Dong PARK, Masami INOUE, Masahiro YASUI, Mina U ...1996 Volume 37 Issue 11 Pages 1318-1321
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSHybrid fusion genes are specific tumor markers of several leukemic subtypes. The use of reverse transcription-polymerase chain reaction (RT-PCR) to amplify chimeric cDNAs allows sensitive detection of the leukemia clone. The clinical relevance of minimal residual disease (MRD) remains controversial. In this report, an infantile acute lymphoblastic leukemia with t(4;11)(q21;q23) was analyzed after each treatment for the presence of MRD by RT-PCR amplification of the MLL/LTG4 fusion gene which became available recently. The patient soon achieved a hematological CR, after induction therapy, and underwent autologous BMT following consolidation chemotherapy for 9 months. However, he relapsed three months after the BMT. MRD was always detectable during his clinical course. These findings suggest that the detection of MRD of the MLL/LTG4 fusion transcript is a useful tool for monitoring MRD and selecting treatment.View full abstractDownload PDF (347K) -
Satoru TANAKA, Naoki SAWADA, Masanori KAMIO, Toshihiro MOCHIZUKI1996 Volume 37 Issue 11 Pages 1322-1324
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 61-year-old man with multiple subcutaneous, ileocecal and neurologic manifestations was reported. Histological examination of subcutaneous and ileocecal mass showed non-Hodgkin's lymphoma (diffuse medium cell type [LSG classification]), B-cell type. Headache, somnolence and incontinence of urine were considered owing to the CNS involvement by lymphoma cells. The cranial CT findings showed diffuse spread involving the lateral and third ventricle and hypothalamus with adjacent edema. Then he was treated by VEMP regimen and repeated intrathecal MTX injections. The neurologic remission with improvement of cranial CT findings was obtained and he has been free of the disease for 15 years.View full abstractDownload PDF (632K) -
Ken TANAKA, Akihiko SAKAMOTO, Kaori SHIRAISHI, Masahisa TANAKA, Shigek ...1996 Volume 37 Issue 11 Pages 1325-1327
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe report a case of anemia due to chronic lead poisoning. A 46-year-old female was admitted to our hospital because of general fatigue and anemia. A peripheral blood smear showed basophilic stippling. There was basophilic stippling and nuclear dysplasia of erythroblasts in the bone marrow. Laboratory findings were as follows: RBC 296×104/μl, Hb 8.5 g/dl, blood lead concentration 67 μg/dl, urinary lead concentration 309 μg/l, blood δ-ALA dehydrase 0.03 μmol/ml, urinary δ-ALA 25.2 mg/l, urinary coproporphyrin 8,810 μg/g·Cr, and blood protoporphyrin 612 μg/dl. Chronic lead poisoning was diagnosed and she was treated with Ca-EDTA.View full abstractDownload PDF (399K) -
Takashi YAMAMOTO, Takako KINO, Kazuroh YAGI, Hiroshi MIYATA, Kazuo YOS ...1996 Volume 37 Issue 11 Pages 1328-1330
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA case of acute thrombocytopenic purpura following rubella vaccination is reported. A 3-year-old boy developed purpura on the 22nd days after rubella vaccination. His platelet count was 34×103/μl. Platelet-associated IgG was elevated, but the amount of megakaryocytes in bone marrow aspirates was within the normal range, suggesting immune mechanism-associated thrombocytopenia. He recovered spontaneously within one month. Thrombocytopenic purpura is a well-documented complication of natural rubella infection. Attention should be paid rubella vaccination-associated thrombocytopenia, though it seems to be less frequent than after natural infections.View full abstractDownload PDF (197K) -
Masataka OKAMOTO, Toshiyuki NOMURA, Tetsushi YAMAGUCHI, Motohiro TSUZU ...1996 Volume 37 Issue 11 Pages 1331-1333
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 53-year-old woman was admitted to our hospital in April 1995, because of nasal obstruction, bloody rhinorrhea and hearing disturbance. She had no lymphadenopathy or skin eruptions. Laboratory examinations revealed a WBC count of 2.7×109/L without abnormal cells, positive serum anti-HTLV-I antibody, normal lactate dehydrogenase and normal calcium level. MRI showed an epipharyngeal mass. No involvement was detected by CT scanning of the chest and abdomen, 67Ga scintigraphy and bone marrow biopsy. The pathological diagnosis of the biopsied specimen from the epipharyngeal mass was T-cell diffuse lymphoma, pleomorphic type. Monoclonal integration of HTLV-I proviral DNA was detected in lymphoma cells, which confirmed a diagnosis of extranodal adalt T-cell leukemia cymphoma primarily involving the epipharynx. She was treated with CAMBO-VIP regimen followed by adjuvant involved-field radiotherapy and she continues to be in complete remission as of April 1996.View full abstractDownload PDF (636K) -
Kazuya KODAMA, Tetsuhiko NOMURA, Kenichi YASUI, Takefumi MATSUO1996 Volume 37 Issue 11 Pages 1334-1336
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSOn June 29, 1995, a 49-year-old man was admitted with acute onset of fever, petechiae on his legs, and mental confusion He had suffered hypertension since 6 months previously and was on nicardipine (60 mg/day), ifenprodil (60 mg/day) and ticlopidine (300 mg/day). He had been on ticlopidine for 4 weeks and on the other drugs for 6 months. Soon after admission he had frequent grand mal seizures and needed mechanical ventilation. A diagnosis of TTP was made. He was treated with plasmapheresis (50 ml/kg per day), aspirin 81 mg/day and dipyridamole 300 mg/day. On the sixth day his mental status returned to normal. He recovered gradually from microangiopathic hemolytic anemia, thrombocytopenia and elevated serum creatinine. We reviewed the literature and discussed the possible mechanism of TTP related to the use of ticlopidine.View full abstractDownload PDF (205K)
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1996 Volume 37 Issue 11 Pages 1337-1351
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (1434K)
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