All issues
Volume 41, Issue 1
Displaying 1-13 of 13 articles from this issue
- |<
- <
- 1
- >
- >|
-
Yoshihiro HATTA, Takeyoshi ITOH, Masumi BABA, Hiromi SHIMOJIMA, Tsuyos ...2000 Volume 41 Issue 1 Pages 1-7
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSTo evaluate the effects of prior chemotherapy on pulmonary function after bone marrow transplantation (BMT), pulmonary function tests were performed prior to and after BMT on 7 acute leukemia (AL) and 13 chronic myelogenous leukemia (CML) patients given with CY (60 mg/kg×2 days), total body irradiation (3 Gy×4 days, 10 cGy/min), and CyA plus short-term MTX. No patient had graft-versus-host disease or lung complications. Pulmonary function after BMT did not deteriorate in the AL patients; however, both %Vital Capacity (%VC) and DL/VA decreased significantly in the CML patients (%VC before BMT: 112.1±11.5%, after BMT: 93.7±9.4%; DL/VA before BMT: 79.2±14.6%, after BMT: 54.1±10.6%). Although prior regimens of busulfan (BU) or interferon (IFN) were equal risk factors for decreased %VC after BMT, decreases in DV/VA were more significant in CML patients who received IFN. CML patients, especially those who have received BU or IFN, should be carefully monitored for pulmonary function to prevent respiratory failure after BMT.View full abstractDownload PDF (574K) -
Ken OHMINE, Tohru IZUMI, Kazuo MUROI, Ritsuko SHIMIZU, Shigehiko IMAGA ...2000 Volume 41 Issue 1 Pages 8-11
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSPrednisolone (PSL) is widely used for the treatment of idiopathic thrombocytopenic purpura (ITP). We compared the effects of a relatively low dose (0.5 mg/kg/day, LD group) of PSL and the conventional dose (1.0 mg/kg/day, CD group) on 59 ITP patients. Twenty-six patients were treated with low-dose PSL, and 23 patients with the conventional dose. No statistically significant difference was observed in the complete remission rates for the LD group (35%) and the CD group (39%). However, the mean duration of hospitalization was significantly (p<0.001) shorter for LD group patients than for patients in the CD group (20 days versus 50 days, respectively). In conclusion, low-dose PSL may be as effective as the conventional dose and capable of reducing the cost of hospitalization, thus, improving the quality of life for patients with ITP.View full abstractDownload PDF (318K) -
Akiko MORIYA, Shin-ichiro MORI, Masahiro KAMI, Tomoko MATSUMURA, Takas ...2000 Volume 41 Issue 1 Pages 12-19
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSTo estimate the length of hospitalization following bone marrow transplantation (BMT), we conducted a retrospective study of 190 patients who had received allogeneic BMTs at our institution. By our criteria, patients were considered ready for discharge if they were afebrile, did not need intravenous chemotherapy or blood transfusions more than 2 times per week, had maintained these conditions for 1 week or more, and also had no medical history of hepatic veno-occlusive disease, grade-II-or-higher graft-versus-host disease, interstitial pneumonitis, or severe hepato-renal dysfunction. The median length of hospitalization was 108.5 days. Of 82 patients who satisfied our discharge criteria by their 70th hospital day, 10 experienced mild complications during the next 30 hospital days. Of 89 patients who were considered ready for discharge by the 40th hospital day, 30 and 38 experienced complications during the next 30 and 60 hospital days, respectively, and 16 required emergency treatment. No significant baseline characteristics distinguished the patients who experienced complications from those who did not, either after 40 or 70 hospital days. This compounded the difficulty of predicting the development of complications in patients who satisfied our discharge criteria. Although management on an outpatient basis should be safe and feasible for BMT patients who meet our discharge criteria by the 70th day of hospitalization, caution is advised for early discharges after only 40 hospital days.View full abstractDownload PDF (630K)
-
Hideki AKIYAMA, Takashi INOUE, Yasushi OKOSHI, Shin-ichiro MORI, Kazut ...2000 Volume 41 Issue 1 Pages 20-24
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSOf 264 patients aged 15 years or more who underwent hematopoietic stem cell transplantation between 1989 and September 1998 at the Tokyo Metropolitan Komagome Hospital, 47 were infected by the varicella-zoster virus (VZV). In 2 patients, visceral disease preceded cutaneous dissemination. One of these patients exhibited gastrointestinal symptoms followed by disseminated skin rash 6 days later. In the other patient, epigastralgia developed and was followed by seizures secondary to meningitis; the appearance of a skin rash 5 days after these initial symptoms yielded the diagnosis. Early diagnosis and treatment of VZV infection are important, especially for patients who present with visceral symptoms suspected to be due to VZV.View full abstractDownload PDF (420K) -
Kunihisa NAKAI, Ken-ichirou TAJIMA, Yuji KISHIMOTO, Kaoruko KATSURA, M ...2000 Volume 41 Issue 1 Pages 25-31
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSIn October 1996, a 26-year-old woman was given a diagnosis of acute myeloblastic leukemia, FAB subtype M1. Treatment with combined chemotherapy achieved a complete remission (CR). In May 1997, the patient received an allogenic bone marrow transplant (BMT) from an HLA-identical sibling donor. Cyclosporine (CsA) and short-term methotrexate were given for graft-versus-host disease (GVHD) prophylaxis. Successful engraftment was obtained and signs of acute or chronic GVHD never developed. Five months after BMT, the patient experienced low-grade fever and blurred vision. Retinal examination demonstrated intraretinal hemorrhages, cotton-wool spots, and retinal detachments, which were presumably attributable to multiple thrombosis of retinal microvessels. The patient also exhibited hemolytic anemia with red cell fragmentation, thrombocytopenia, elevated lactate dehydrogenase, and renal impairment, and was thus given a diagnosis of BMT-associated thrombotic microangiopathy (BMT-TM). Discontinuation of CsA and administration of ticlopidine and prednisolone induced successful recovery from BMT-TM. Three months after the onset of BMT-TM, however, the patient experienced generalized clonic-tonic seizures with consciousness loss. Single-photon-emission computed tomography revealed blood-flow disturbances in the brain, suggesting the recurrence of microthrombosis. Accordingly, multiple transfusions of fresh frozen plasma were administered together with dipyridamole and aspirin. The patient gradually recovered and remained asymptomatic through the following 13 months. Currently, early diagnosis of BMT-TM is considered to be difficult. We suggest that careful examination of the ocular base may be useful for the early detection of BMT-TM.View full abstractDownload PDF (710K) -
Michiaki KOIKE, Iwao SEKIKAWA, Yasuko YOSHIOKA, Noboru IIDA, Syun-ichi ...2000 Volume 41 Issue 1 Pages 32-36
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 54-year-old woman was admitted to Juntendo Izunagaoka Hospital on Aug. 29, 1998, after experiencing cough and fever for 19 days. Chest X-ray films disclosed infiltrates in the left lung field. The abnormal lung shadows progressed despite antibiotic therapy, and enlargement of superficial lymph nodes and hepatosplenomegaly developed. Peripheral blood examination disclosed cleaved lymphoid cells without granular cytoplasm. Anti-HTLV-I antibody titer was ×320, and the monoclonal integration of HTLV-I provirus was confirmed by Southern blot analysis. Surface marker analysis of lymph node cells was positive for CD2, CD3, CD4, CD5, CD56, and HLA-DR. The above results yielded a diagnosis of adult T-cell leukemia. LSG-4 therapy alleviated the lung infiltrations and dyspnea. This case was considered unusual because of the expression of the natural killer cell marker CD56 on leukemic cells and the presentation of abnormal lung shadows possibly due to leukemic cell infiltration.View full abstractDownload PDF (390K) -
Kanako UNO, Satoru KOJIKA, Naohiko MIYAMOTO, Noriko SUZUKI, Takeshi IN ...2000 Volume 41 Issue 1 Pages 37-41
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSWe encountered 4-year-old boy who developed paroxysmal cold hemoglobinuria (PCH) in the middle of August. He was admitted due to progressive jaundice and pallor following fever and nausea. Laboratory data revealed severe anemia, increased serum indirect bilirubin and LDH, and decreased serum haptoglobin. Direct/indirect Coombs tests were positive. These findings yielded a diagnosis of autoimmune hemolytic anemia. Serological test for syphilis was negative. The patient's symptoms and signs promptly subsided after treatment with prednisolone, which was started on the 2nd hospital day. The patient has been in a disease-free state for 16 months without any medication. After discharge, he was finally given a diagnosis of PCH because a Donath-Landsteiner test was positive. The antibody belonged to an IgM subclass and showed anti-I specificity. Considering that development of PCH is common in winter, this case was unique because it developed in August. We speculated that exposure to a cool air-conditioned atmosphere prior to hospitalization and the cooling mechanism of the body after admission were involved in the summer onset of PCH and its prolonged clinical course.View full abstractDownload PDF (396K) -
Masako YASUYAMA, Kiyotaka KAWAUCHI, Hajime SUGIYAMA, Shin-ichiro OHKAW ...2000 Volume 41 Issue 1 Pages 42-47
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSAn 83-year-old woman received a diagnosis of moderate aplastic anemia in November 1990. Immunosuppressive therapy consisting of anti-lymphocyte globulin combined with high-dose corticosteroids was effective until pancytopenia developed in August 1993. The patient was hospitalized again and recurrence of aplastic anemia was diagnosed on the basis of hematologic findings, including RBC 129×104/μl, Hb 5.5 g/dl, Ret 23,200/μl, WBC 2,200/μl with 27% neutrophils, platelets 2.2×104/μl, and hypoplastic bone marrow. Recombinant human granulocyte-colony stimulating factor (G-CSF) of 125 μg/day combined with recombinant human erythropoietin (EPO) of 6,000 U/day were started in November 1993. The doses of G-CSF and EPO were increased to 250 μg/day and 12,000 U/day, respectively. We stopped combination therapy in March 1995, after trilineage hematopoietic cell recovery had been achieved. Complete recovery in peripheral blood was sustained for more than 2 years despite the termination of G-CSF and EPO therapy. Combination therapy with G-CSF and EPO may be safe and effective for elderly patients with aplastic anemia when the choice of therapy is limited.View full abstractDownload PDF (557K) -
Takeshi HARA, Hisashi TSURUMI, Koutaro YOSHIMURA, Kiyoyuki TAKENAKA, H ...2000 Volume 41 Issue 1 Pages 48-53
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSWe report 2 cases of orbital non-Hodgkin's lymphoma (NHL) with hemophagocytic syndrome (HPS). Patient 1 was a 64-year-old man with a diagnosis of peripheral T-cell lymphoma originating in the right orbita (clinical stage: IV B). Epstein-Barr virus DNA was demonstrated in tissue specimens by polymerase chain reaction. Laboratory findings on admission were WBC: 4,700/μl, Hb: 12.1 g/dl, Plt: 14.6×104/μl, LDH: 951 IU/l, sIL-2R: 2,553 IU/ml, and ferritin: 5998.1 ng/ml. Patient 2 was a 73-year-old man with a diagnosis of diffuse large B-cell lymphoma originating in the right orbita (Clinical stage: IV B). Laboratory findings on admission were WBC: 9,100/μl, Hb: 7.7 g/dl, Plt: 15.4×104/μl, LDH: 1,043 IU/l, sIL-2R: 10,090 IU/ml, and ferritin: 2079.3 ng/ml. Both patients had high-grade fever and extremely high serum cytokine levels. Bone marrow aspiration disclosed many histiocytes with hemophagocytosis. In both cases, combined chemotherapy was transiently effective, but patient 1 died of relapse of HPS and patient 2 of cerebral bleeding. Orbital non-Hodgkin's lymphoma with HPS is rare. These cases were interesting in terms of the relationship between HPS and the primary site of lymphoma.View full abstractDownload PDF (490K) -
Yuji WANO, Kazumi EBATA, Yasufumi MASAKI, Shouichi TAKESHITA, Chang Gi ...2000 Volume 41 Issue 1 Pages 54-60
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSAfter 2 years of steroid therapy that had effectively controlled her systemic lupus erythematosus, a 37-year-old woman presented with fever, erythema (face, upper chest), and low CH50. Increased oral steroid (prednisolone from 15 mg to 40 mg) and intravenous methylprednisolone (mPSL) (80 mg for 3 days) alleviated these symptoms except for the fever. Subsequently, the patient's fever worsened and leukocytopenia, abnormal liver function, lymphadenopathy (neck, axilla), and salivary gland swelling developed. Lymph node histology revealed features characteristic of Kikuchi-Fujimoto's disease (KFD). Laboratory examinations showed WBC 600/μl, Hb 9.5 g/dl, platelets 90,000/μl, GOT 766 IU/l, GPT 646 IU/l, LDH 4,228 IU/l, TG 1,622 mg/dl, and ferritin 6,330 ng/ml. Serum interferon gamma was also elevated (673 U/ml). Because a bone marrow smear revealed hemophagocytosis, mPSL pulse therapy (1 g for 3 days) was started for treatment of hemophagocytic syndrome. The fever promptly disappeared, and the patient's clinical symptoms resolved within 2 weeks. The abnormal laboratory data related to KFD and hemophagocytosis returned to normal within 4 weeks after the initiation of mPSL pulse therapy. We speculated that the hemophagocytosis and salivary gland involvement in this patient were also symptoms of KFD. This case indicated that corticosteroid pulse therapy is effective for KFD with serious clinical symptoms.View full abstractDownload PDF (676K)
-
Koji CHIBA, Mitsutoshi KUROSAWA, Takeshi KONDO, Sachiko SUZUKI, Manabu ...2000 Volume 41 Issue 1 Pages 61-64
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 55-year-old man was admitted to our hospital because of leukocytosis and microcytic anemia with hypochromia, target cells, and increased levels of hemoglobin A2 and hemoglobin F. The results of a gene analysis yielded a diagnosis of chronic myelogenous leukemia and β-thalassemia minor. A gradual increase in hemoglobin was observed during hydroxyurea therapy, which was performed over a 12-week period. This increment appeared to be due to suppressed production of myeloid cells. It has been reported that hydroxyurea increases total hemoglobin due to increased hemoglobin F synthesis in patients with β-thalassemia. However, hydroxyurea had no clear influence on hemoglobin concentration in this case.View full abstractDownload PDF (279K) -
Seiko IKI, Yoshiaki OHBAYASHI, Akio URABE2000 Volume 41 Issue 1 Pages 65-67
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 41-year-old woman who had been given a diagnosis of aplastic anemia 14 years before was admitted because of recurrence of the disease. Despite therapy, the anemia progressed gradually. The patient refused blood product transfusions for religious reasons. Angina pectoris-like chest pain without ischemic changes on electrocardiograms appeared at a hemoglobin concentration (Hb) of 1.6 g/dl. The patient died of heart failure at Hb 1.5 g/dl. Autopsy showed enlargement of the heart, fatty changes in the myocardium and liver due to chronic hypoxia, and no changes in coronary arteries.View full abstractDownload PDF (245K) -
Momoko HORIKOSHI, Utako MACHIDA, Motoshi ITIKAWA, Satiko SEO, Shigeo M ...2000 Volume 41 Issue 1 Pages 68-71
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSIn March 1990, a 61-year-old man was given a diagnosis of essential thrombocythemia with a normal karyotype and subsequently treated with hydroxyurea. In November 1995, he underwent surgery for gastric cancer with thereafter received tegafur/uracil for 2 years. Refractory anemia with excess of blasts in transformation and chromosomal abnormalities including -5, -7, 20q- developed in August 1998. Combined chemotherapy with daunorubicin, cytarabine, mercaptopurine, and prednisolone, had only limited effectiveness. Acute myeloid leukemia was finally diagnosed in October 1998, and chromosomal analysis disclosed inv(3) in addition to -5 and -7. The appearance of inv(3) might be related to leukemic transformation of hematopoietic stem cell disease with an increase in the number of megakaryocytes and platelets.View full abstractDownload PDF (272K)
- |<
- <
- 1
- >
- >|