Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 43, Issue 2
Displaying 1-14 of 14 articles from this issue
  • Yasuo HIRAYAMA, Sumio SAKAMAKI, Yasushi TSUJI, Tamotsu SAGAWA, Takahar ...
    2002 Volume 43 Issue 2 Pages 97-101
    Published: 2002
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 43-year-old woman was admitted for examination of fever, an elevated transaminase level, LDH, skin eruption, sore throat and bicytopenia. As bone marrow examination revealed an increased proportion of histiocytes and active phagocytosis, hemophagocytic syndrome (HPS) was diagnosed. After admission, the peripheral blood counts recovered spontaneously and the HPS subsided, but other symptoms persisted and the neutrophil count increased. At this time, we diagnosed the patient as having adult Still's disease. All the symptoms disappeared after administration of prednisolone. The markedly increased concentrations of TNF-α and IFN-γ in the peripheral blood at the time of HPS declined gradually, and the IL-6 concentration increased at the time of diagnosis of Still's disease. However, all of these concentrations normalized after administration of prednisolone. As HPS and Still's disease have a common etiology, and each shows high concentrations of IFN-γ, IL 6 and TNF-α, the symptoms are similar in both diseases. In particular, a relationship between HPS and high concentrations of TNF-α and IFN-γ is suspected.
    Download PDF (412K)
  • Kazuhiko KAKIHANA, Daisuke MIZUCHI, Mitsuko YAMAGUCHI, Chizuko SAKASHI ...
    2002 Volume 43 Issue 2 Pages 102-106
    Published: 2002
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 45-year-old man with chronic myelogenous leukemia (CML) in the accelerated phase was admitted to our hospital because of lower back pain and hypercalcemia. On admission, he was confused and found to have massive splenomegaly. The hypercalcemia and splenomegaly improved significantly after administration of incadronate, hydroxyurea, vincristine and prednisolone. Splenomegaly recurred after cessation of the chemotherapy, and examination of the peripheral blood showed 31% blasts, positive for both CD13 and CD33, on which basis myeloid blastic transformation was diagnosed. Vindesine, cytarabine and prednisolone were administered, and the splenomegaly improved again. On admission, when the patient's serum calcium level was 16.0 mg/dl, his serum parathyroid hormone-related protein (PTHrP) level was elevated to 118.3 pmol/l. Furthermore, RT-PCR analysis revealed that the patient's CML cells expressed PTHrP mRNA, and a high level of PTHrP was detected in the supernatant of cultured mononuclear cells derived from the patient's peripheral blood. These findings indicated that the hypercalcemia was due to production of PTHrP by the leukemic cells. Several cases of PTHrP-mediated hypercalcemia associated with CML have been reported previously, and are reviewed here.
    Download PDF (403K)
  • Takero SHINDO, Yoshikazu YUMOTO, Michiaki YOSHIDA, Tetsuya OKUDA
    2002 Volume 43 Issue 2 Pages 107-111
    Published: 2002
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 78-year-old woman was admitted to our hospital because of lumbago and appetite loss. Blood analysis revealed anemia, hypercalcemia and circulating plasma cells. Bone marrow aspiration showed an elevated ratio (43%) of plasma cells, which expressed CD38 in the absence of CD19 and CD56 expression. Spinal MR imaging revealed multiple compression fractures and suggested diffuse invasion of plasma cells into the spinal bodies. No M-protein was detectable in serum or urine by immunoelectrophoresis and immunofixation, but cytoplasmic M-protein (IgG-κ) was detected by enzyme antibody staining. On the basis of the history and data, nonsecretory primary plasma cell leukemia was diagnosed. First, the patient was given modified VAD therapy (vincristine, doxorubicin, and prednisolone) and complete remission was obtained. Then MP therapy (melphalan and prednisolone) was instituted, and remission has since been maintained for 11 months. Like many other cases of primary plasma cell leukemia, this case suggests that CD56 may act as an adhesion molecule between neoplastic plasma cells and bone marrow stromal cells. Our experience with this exceedingly rare case suggests the superiority of combination chemotherapy as an induction therapy and the effectiveness of MP therapy as maintenance therapy for this disease.
    Download PDF (468K)
  • Takayoshi SHIMOKAWA, Minoru SAITOH, Yumi KOJIMA, Hideo TAKEYAMA
    2002 Volume 43 Issue 2 Pages 112-116
    Published: 2002
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    We report a case of myeloid/NK cell precursor acute leukemia, which was successfully treated with allogeneic peripheral blood stem cell transplantation (allo PBSCT). A 31-year-old woman was admitted to our hospital with general fatigue, anorexia and leukocytosis. Bone marrow aspiration showed infiltration of many atypical blasts. She was diagnosed as having myeloid/NK cell precursor acute leukemia by morphological and immunohistochemical analysis. Complete remission was achieved by induction chemotherapy, but as myeloid/NK cell precursor acute leukemia is reported to have an extremely poor prognosis due to frequent relapse, the patient underwent allo PBSCT from her HLA-identical father, together with a myeloablative conditioning regimen. She suffered several transplantation-related complications including acute graft versus host disease (grade II) and ischemic enterocolitis associated with thrombotic microangiopathy, but these were overcome by supportive therapy. She was discharged on day 168 after allo PBSCT, and so far there has been no evidence of relapse during a follow-up period of 15 months.
    Download PDF (488K)
  • Yasunobu ABE, Koichiro MUTA, Nobuhisa HIRASE, Ilseung CHOI, Takamitsu ...
    2002 Volume 43 Issue 2 Pages 117-121
    Published: 2002
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    Vitamin K2 is reported to induce apoptosis or differentiation of leukemic cell lines in vitro. We administered a vitamin K2 analog, menatetrenone, at 45 mg daily to 23 patients with myelodysplastic syndrome (MDS): 13 patients with RA, 2 with RARS, 6 with RAEB and 2 with RAEB-T. Good response (GR) and partial response (PR) were defined as an increase of hemoglobin concentration exceeding 2 g/dl and 1∼2 g/dl without transfusion, respectively. Six of the RA patients showed improvement of anemia (GR, 3 patients; PR, 3 patients). RA patients who did not have a hypocellular bone marrow and were transfusion-independent tended to be responsive to vitamin K2 therapy in combination with vitamin D3 or anabolic steroids. No adverse effect of vitamin K2 was observed, and the time required to obtain the hematological response was short, being 3 months on average. We believe that vitamin K2 therapy has potential as a treatment for patients with MDS.
    Download PDF (365K)
  • Daisuke WAKAO, Nobutaka KAWAI, Yoshio KUWAYAMA, Motohiro MISUMI, Yasut ...
    2002 Volume 43 Issue 2 Pages 122-127
    Published: 2002
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    Systemic capillary leak syndrome (SCLS) is a disorder characterized by hypotension, edema, and an increased hematocrit (Ht) due to sudden leakage of plasma into the extravascular space through some unknown mechanism, in which monoclonal gammopathy is observed. A 30-year-old man visited our emergency department because of abdominal pain, and was admitted to our hematology department because of a markedly increased hemoglobin concentration reaching 26.2 g/dl. The polycythemia was thought to be pseudo-polycythemia due to hemoconcentration, and we diagnosed the patient as having SCLS based on the triad of increased hematocrit, whole-body edema which was especially marked in the lower extremities, and monoclonal gammopathy. The patient recovered after administration of extracellular fluids and albumin, but the attacks recurred. Prophylaxis with terbutaline sulfate, theophylline and corticosteroid reduced the frequency of severe attacks. Because there is possibility that patients with SCLS may be admitted to hematology departments due to severe erythrocytosis, we report this case to increase the awareness of hematologists that SCLS is one of the important differential diagnoses of erythrocytosis.
    Download PDF (451K)
  • Tsuyoshi MUAT, Takashi OKAMURA, Koichi OSHIMA, Masahiro KIKUCHI, Yoshi ...
    2002 Volume 43 Issue 2 Pages 128-131
    Published: 2002
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    An 84-year-old man was admitted with pleural lymphomatous effusion and bone marrow infiltration. The abnormal cells from the effusion showed abundant basophilic cytoplasm, large atypical nuclei, and small nucleoli with frequent mitosis. The abnormal cells were found to be CD5+, CD10+, CD19+, and CD20+ by flow cytometry, and had clonal rearrangements of the IgH-JH gene, indicating the existence of a clonal B-cell population. No bcl-1, bcl-2, bcl-6, or c-myc rearrangement was found. Neither human herpesvirus 8 (HHV-8) nor Epstein-Barr virus was detected in the abnormal cells. Tetraploid chromosomal abnormality was present. After administration of prednisolone, transient disappearance of the effusion was obtained.
    Download PDF (301K)
feedback
Top