今回, 東海造血器疾患感染症研究会において, 重症感染症を併発した血液疾患患者152例に対し, 新抗生物質であるImipenem/Cilastatin sodim (IPM/CSチェナム (R)) による治療を試み, その臨床効果及び副作用について検討した。
1.評価可能症例138例における本剤の臨床効果は, 著効41例, 有効55例, やや有効19例, 無効23例であり, 全体での有効率は69.6% (96例) であつた。
2.先行治療を受けていない症例の有効率が86.5%であつたのに対し, 受けていた症例の有効率は59.3%であつた。
3.治療前後の末梢好中球数の推移についての検討において, 100/mm3以下の好中球数である患者における有効率は全体の有効率に比べ有意に低かった。すなわち, 治療前後共に100/mm3以下である場合の有効率は42.3%であつた。
4.同定された起因菌の数は35株で, そのうち, 効果判定可能株は21株であつた。その21株についての消失率は76.2% (16株/21株) であつた。
5.安全評価対象症例152例において, 副作用が15例 (9.9%), 検査値異常が19例 (12.5%) に観察されたが, いずれも重篤なものではなかつた。
以上の結果から, IPM/CSは血液疾患に随伴する重症感染症に対し第1次選択されるべき抗生物質であり, 臨床的にも優れた有用性を有することが確認された。

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We experienced 10 patients with maxillary sinus cancer who underwent selective intraarterial chemotherapy via superficial temporal artery and conventional concurrent radiotherapy from 2003 to 2010 at Yokosuka Kyosai Hospital.
Under the T classification only 1 case was T2, and the other 9 cases were T4a.
Between 2003 and 2007, 6 patients were given intraarterial chemotherapy with cisplatin (or nedaplatin) and 5-fluorouracil. After 2008, 4 patients were given intraarterial chemotherapy with docetaxel, cisplatin (or nedaplatin), and 5-fluorouracil.
The CR rate of CRT was 80%. The 5-year overall survival rate was 66.7%, and the 5-year disease specific survival rate was 74.1%.
This method demonstrated good efficacy in patients with locoregionally advanced maxillary sinus cancer.

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Cellular kinetics in chronic myelocytic leukemia (CML) was studied by flow microfluorometry (F. M. F.) which showed DNA histogram and TLC separation of dansyl polyamines (Putresine, Spermidine and Spermine).
Normal blood, which consisted of mature cells alone, had monopeak of diploid (2N), and normal bone marrow, which consisted dividing compartment (myeloblasts, promyelocytes, myelocytes and immature erythroblasts), had two peaks of diploid and tetraploid (4N). AML, ALL and CLL had the same DNA histogram as normal blood and bone marrow, because leukemic cells in blood were long resting cells (nondividing compartment).
CML blood with splenomegaly had two peaks as bone marrow. But CML blood without splenomegaly or post-splenectomy had diploid peak alone as normal blood.
Leukemoid reaction and polycythemia vera blood, which contained immature cells as CML blood, had also diploid peak alone, but myelofibrosis blood had two peaks.
In some AML polyamine contents level were very high, but in CML and others not so high. In general, polyamine contents were higher in the bone marrow than in the blood (PB<BM), but in some cases with CML they were higher in the blood than in the bone marrow (PB>BM) at chronic phase and PB<BM at remission and PB>BM again at blastic crisis.
As a conclusion, it was guessed that dividing compartment of immature cells in CML blood came out of spleen and/or liver and nondividing compartment of immature cells and mature cells came out of spleen and/or liver and bone marrow.

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症例は46才,男性. Philadelphia(Ph¹)染色体陽性の慢性骨髄性白血病(CML)の経過中に血便,発熱と体重減少が出現し多発性小腸大腸潰瘍を認め,激烈な経過で死亡.骨髄像,末梢血液像とも芽球の増加は認めず,骨髄血の染色体分析では+8, +Ph¹の付加的染色体異常を認めた.剖検所見で,各成熟段階のCML細胞の浸潤増殖による下部消化管の著しい潰瘍形成を認めた.腸管浸潤を伴う強い消化器症状を呈したCMLの症例を報告した.

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Twenty-one newly-diagnosed cases of non-Hodgkin's lymphoma (NHL) were treated with the same therapeutic protocol in our department between January 1984 and December 1986.
One patient had a recurrence, and five died. The following results were obtained.
1. With combined radiotherapy, VAPE chemotherapy and OK-432 immunotherapy the mean survival rate and the relapse-free survival rate were 76.2% and 71.4%, respectively.
2. Adriamycin is useful for NHL. We conclude that even in the early stage, NHL should be treated with full dose VAPE therapy.
3. Surgical therapy is presumably useful for a solitary lesion which resists to all conservative therapies.
4. Second line chemotherapy for patients who are resistant to VAPE therapy should be established. MTX, CDDP, BLM and Etoposide have possibilities of usefulness as second line chemotherapy.

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沈鬱と削瘦を示す黒毛和種雌牛に，急性赤血病（純赤芽球性白血病）が認められた．白血球数は高値ではなかったが，血液塗抹において腫瘍細胞比率が高かった．肉眼的には脾臓といくつかのリンパ節が高度に腫大していた．腫瘍細胞は脾臓，リンパ節，胸腺をほぼ完全に置換していた．この細胞にはヘモグロビン（Hb）がときどき発現していたが，その他のリンパ造血系マーカーは陰性であった．以前の報告では成熟した赤芽球系細胞が存在していたのに対し，今回の症例では大型の芽球が大部分を占めていたため，芽球型急性赤血病と診断したが，牛ではこの型の腫瘍の報告は初めてである．赤芽球系腫瘍の診断は，動物では血液または骨髄の塗抹標本を用いて行われることが多いが，今回の研究で，塗抹標本や組織切片でHbに対する免疫染色を使えば，診断はより正確になることが示唆された．

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不応性貧血と診断されていた46歳，男性が高熱と大腿部の潰瘍を伴う浸出性紅斑で入院した。末梢血はWBC 31,500/μl（好中球90%）の白血球増加，Hb 8.6 g/dlの貧血を認めた。抗生剤の投与にもかかわらず皮膚潰瘍は壊死を伴い大腿部に拡大した。皮膚病変は無菌的で組織は真皮に好中球浸潤を認めた。副腎皮質ステロイド剤の投与により解熱し皮膚病変も改善した。減量に伴い他部位に結節，紅斑ができ再発したがステロイド剤の増量により軽快した。臨床的にはSweet症候群と壊疽性膿皮症の両方の要素をもつ皮膚病変であった。好中球機能（好中球遊走能，O₂^-産生能）の低下をはじめ免疫能の低下を示した。本例における皮膚病変はneutropilic dermatosis of MDSとしてとらえることができ，これらの皮膚病変にはステロイド剤が著効する。

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Eight neuroblastomas and 1 ganglioneuroma of human subjects, 1 serial transplanted neuroblastoma in nude mice and C-1300 mouse neuroblastoma cell line were studied on its cell kinetics by flow-microfluorometry (FMF). The specimens resected from stage IV neuroblastoma patients and nude mouse were freezen in liquid nitrogen. The tumor of about 1 cm^3 block was minced and tumor cell suspensions were prepared by treatment with 0.25% Trypsin solution. Following fixation by 50% ethanol, Propidium Iodide staining was carried and DNA histogram was obtained by FMF (4800A biophisics U.S.A.). DNA histograms were divided into three different types ; unimodal, bimodal and intermediate types. Furthermore, cell population ratio of near 2C compartment were calculated. About 4×10^3 to 3×10^4 of cells were measured. Control cells were chicken red blood cells and human lymphocytes which showed 2C unimodal pattern. Five of 8 cases showed near 2C unimodal pattern. The other neuroblastomas and a ganglioneuroma were with intermediate pattern. Serial transplanted tumor in nude mice was with bimodal pattern. C-1300 mouse neuroblastoma cell line was with multimodal pattern. The specimens excised after high dose cyclophosphamide therapy showed relatively low population of 2C compartment cells compared with non-treated cases. It is still not clear how cell cycle of neuroblastoma changes by various therapeutic methods. This cytofluorometric analysis is expected to make therapeutic schedules more reasonable and effective.

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液疾患に合併した重症感染症例に対して, Amikacin (AMK), Cefbxitinの併用療法を試み, 有効性と安全性を検討した。有効性では11例中7例 (64%) の有効率を示し, 安全性では薬剤投与を中止しなければならないような副作用はみられなかつた。免疫能の低下した症例では常在化している弱毒菌が病原性を発揮するため, 培養検査でPseudomonasが常在するようになつた場合, AMKなどのアミノ配糖体系抗生物質をFirst choiceしなければならない。

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造血幹細胞移植後の造血機能の回復を知るために，顆粒球の量的および質的動態を反映する顆粒球エラスターゼ(GE)を，移植後，経時的に測定し，GEと血球の回復状況の比較，造血因子や移植幹細胞が異なる条件下でのGEの変動を検討した。移植後，GEは同種移植で3.0日，自己移植では2.3日，末梢白血球より早期に上昇し，末梢血白血球が増加する以前に顆粒球産出が開始されている事が示された。また，幼若網状赤血球や単球よりGEの回復が先行する事から，移植後の造血機能評価としてGEがもっとも鋭敏と考えられた。G-CSF投与群とM-CSF投与群とで移植後のGE回復日数に差を認めず，両群の顆粒球刺激効果には差がないと判断された。移植後のGEの変動では，末梢血幹細胞移植は骨髄移植と比較し有意にGEの最低値が高く，末梢血幹細胞移植時の持続的な顆粒球産出が推測された。GE測定は白血球回復を敏感に捕え，また顆粒球増殖の全体像を反映する事から，移植前処置の骨髄抑制の指標やサイトカインによる顆粒球産出の評価に応用できると考えられた。

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A 52-year-old man with chronic myeloid leukemia, for whom elective splenectomy had performed in chronic phase in order to prolong the survival period, developed thrombocytosis, more than 250×10⁴/mm³, with resultant angina-like symptoms and syncopal attacks between 3 and 6 years after splenectomy. Treatment with ACNU and periodic thrombopheresis had partial success. Seven years after splenectomy, he admitted because of weakness, jaundice, ascites, edema and shortness of breath. Examination resulted in the discovery of hepatic insufficiency, earry stage of blast crisis, ARDS and prerenal azothemia, and he died in a few days. Autopsy revealed esophageal varices and marked cell infiltraion into many organs, especially in the liver, kidney and lung. There were vigorous cell infiltratin and extramedullary hematopoiesis in the hepatic sinusoid with many small noduls containing monotonous blastoid cells leading to atrophy, degeneration and loss of hepatic cells.
Only one case of chronic myeloid leukemia, which converted blast phase by hepatic insufficiency as to the first manifestation, has been descrived.

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