Abnormalities of pulmonary blood flow during cold exposure in systemic lupus erythematosus

The aim is to determine whether pulmonary blood flow is altered during cold exposure of the hands in individuals with systemic lupus erythematosus (SLE). Cold exposure was induced by immersion of the hands, one at a time, in 10 degrees C water in nine SLE patients in whom pulmonary fibrosis had been ruled out by a routine examination. Lung perfusion was measured by continuous venous infusion of krypton 81 m. Cold exposure to at least one of the hands caused an 8 to 22% decrease of pulmonary blood flow in five of the nine patients. A 10 to 33% increase in flow developed in three of the nine patients during cold exposure of the hands. We conclude that these abnormalities in pulmonary blood flow during cold exposure were revealed in SLE patients with scarcely any clinical symptoms.

A familial case of insulin dependent or non-insulin dependent diabetes mellitus associated with hearing loss

Aggregation of diabetes and hearing loss in a family is observed in some hereditary disease. All members of the present family are affected with sensory hearing loss and diabetes mellitus. Diabetes types observed were insulin dependent diabetes mellitus (IDDM) in the proposita and the sister, non-insulin dependent diabetes mellitus (NIDDM) in the brother, and impaired glucose tolerance in the mother. The combination of hearing loss and diabetes and the concordant expression of IDDM or NIDDM in the siblings have not hitherto been described in any hereditary syndrome. This family may exhibit a new hereditary syndrome which is characterized by diabetes and hearing loss.

Bone marrow fibroblasts-conditioned medium regulates the proliferation of leukemic cells

The effect of normal human bone marrow fibroblasts-conditioned medium (BMF-CM) was studied on the proliferation of K562 cells, and on leukemic cells from patients with acute myelocytic leukemia at the time of diagnosis and chronic myelogenous leukemia (CML) at chronic phase. BMF-CM was obtained from normal human bone marrow fibroblasts by using long-term liquid cultures. BMF-CM suppressed the proliferation of K562 cells and leukemic cells from patients with undifferentiated type of leukemia (M1 in FAB classification). However it stimulated the proliferation of leukemic cells from patients with differentiated type of leukemia (M2 in FAB classification), and it slightly stimulated that from patients with CML. These results suggest that normal human BMF regulate the proliferation of leukemic cells in their various stages of differentiation in the bone marrow by releasing a humoral factor.

Platelet volume and intraplatelet adenine nucleotides in various hematologic disorders

By recent advanced techniques, blood platelets have proved to be varied in size and metabolism in various hematologic disorders. We examined platelet volume and intraplatelet adenine nucleotides in 36 patients with various hematologic disorders in order to clarify the quantitative platelet abnormalities. Platelet volumes were smaller in patients with acute leukemia and aplastic anemia, and larger in patients with immune thrombocytopenic purpura (ITP). The amount of intraplatelet ADP was decreased and ATP/ADP ratio was increased in acute leukemia, aplastic anemia and myeloproliferative disorders (MPD), which strongly suggested the presence of storage pool deficiency in these patients. Intraplatelet ADP per volume was decreased in acute leukemia, aplastic anemia and MPD, and ATP per volume was decreased in aplastic anemia. ATP content was increased in ITP in proportion to the increased platelet volume. These parameters were examined in 36 patients with the following hematologic disorders: 7 acute leukemia treated with cytotoxic chemotherapy, 5 aplastic anemia, 3 paroxysmal nocturnal hemoglobinuria (PNH), 9 immune thrombocytopenic purpura (ITP), 5 hypersplenism and 7 myeloproliferative disorders (MPD).

Effective methylprednisolone "pulse" therapy in myeloerythroid aplasia associated with systemic lupus erythematosus: case report and literature review

We report a rare case of myeloerythroid aplasia associated with systemic lupus erythematosus (SLE). The erythroid aplasia was completely reversed after treatment with 60 mg of prednisolone daily, but methylprednisolone "pulse" therapy was necessary to improve the myeloid aplasia.

Report of a case with chronic myelomonocytic leukemia: demonstration of leukemic monocytes lacking nonspecific esterase by flow cytometry using monoclonal antibodies

Chronic myelomonocytic leukemia (CMML) is a rare leukemia, which is now included in myelodysplastic syndromes. In a small number of patients with CMML, problems in the diagnosis have been reported, especially when atypical morphological features in both monocytic and granulocytic cells due to dysmyelopoiesis are prominent, or when cytochemical characteristics are lost in the leukemic cells. The case history of a sixty-seven year-old male patient with CMML is described. The diagnosis of CMML in the patient was supported by the following evidence: chronic course of his disease; increased monocyte-like cells without other cause; normocytic anemia; immature granulocytic cells with hypogranular feature and giant platelets were observed in the peripheral blood. The bone marrow showed myeloid hyperplasia. Serum muramidase and vitamin B12 levels were increased, while neutrophil alkaline phosphatase score was low in the peripheral blood. Ph' chromosome was negative. The monocyte-like cells completely lacked nonspecific esterase. However the cells were confirmed as monocytic cells by flow cytometry using monoclonal antibodies to monocytes (OKM5).

Adult T-cell leukemia following long-term remission from non-Hodgkin's lymphoma

A female patient who had been initially diagnosed with non-Hodgkin's lymphoma (NHL) and achieved complete clinical remission with combined chemotherapy, developed overt adult T-cell leukemia (ATL) after 9 yr of disease-free survival. This is the first case of the development of ATL following the complete remission of NHL. Secondary malignant neoplasms are not well-documented in patients previously diagnosed with Hodgkin's disease. Although there have been a few reports concerning the occurrence of secondary malignancy in patients with non-Hodgkin's lymphoma (NHL), there has never been a documented case of ATL following long-term survival from NHL. Here, we report a case of typical adult T-cell leukemia (ATL) which occurred after 9 yr disease-free survival from NHL.

Platelet aggregation and intraplatelet adenine nucleotides in diabetic retinopathy

Twenty non-diabetic controls, 50 diabetics without retinopathy and 29 diabetics with retinopathy, all well-matched age groups, were studied in males and females, respectively. Moreover, diabetic patients with retinopathy were divided into the following two subgroups: mild retinopathy and severe retinopathy. Platelet aggregation was elevated in the male diabetics with mild or severe retinopathy. There was no difference in platelet volume between the groups. Intraplatelet ADP contents were significantly decreased in the female diabetics with severe retinopathy showing no high platelet aggregability. There was no significant difference in intraplatelet ATP contents between groups. These results indicated not only that platelet aggregation might be generally high in the diabetics with retinopathy, but also that dense granule release might occur readily in vivo in the female diabetics with severe retinopathy and therefore platelet aggregation was not elevated in the group.

Reduction of platelet aggregation induced by euglycaemic insulin clamp

To examine the effect of serum insulin independent of the level of blood glucose in vivo on platelet aggregation in healthy individuals, a euglycaemic insulin clamp was applied up to 4 h. During the clamp, blood glucose at 5.0 mmol/l and insulin levels at 100 microU/ml were maintained. Blood samples were drawn before, 2 and 4 h after the start of the insulin clamp. The platelet aggregation induced by 1 mumol/l and 2 mumol/l ADP, 1 microgram/ml collagen and 2.7 mumol/l epinephrine was measured in the blood samples. Platelet aggregation induced by adenosine diphosphate, collagen and epinephrine in the 4 h sample was significantly reduced from the pre-clamp value of 8.4% to 3.9% (p less than 0.05), 26.2% to 7.0% (p less than 0.01) and 31.8% to 9.1% (p less than 0.01), respectively. On the other hand, when the same individuals were infused with physiological saline and blood glucose (4.4 mmol/l) and insulin level (10 mIU/l) were kept within normal values, there was no difference between the values of induced platelet aggregation in samples drawn before and during the insulin infusion. It was concluded that hyperinsulinaemia reduces platelet aggregation in vivo when euglycaemia was maintained.

A case of intrasellar craniopharyngioma

A 71-year-old man was referred to Tokai University Hospital because of cold intolerance, slow speech and slowing down of his intellectual and motor activities. Free thyroxine index, and free T-4 and T-3 levels were low (1.4, 0.7 ng/dl and 0.4 ng/ml, respectively) with normal TSH (2.5 microIU/ml). A skull X-ray showed enlargement of the sella turcica and his CT scan revealed an intrasellar mass. LH, FSH, ACTH and PRL did not rise in response to the intravenous administration of LH-RH and insulin. A diagnosis of pan-hypopituitarism due to a pituitary tumor was established. The release of ACTH and cortisol was restored under stimulation of CRF or lysine vasopressin. TSH responded to TRH in a delayed manner. The pituitary tumor was removed by a transsphenoidal operation and diagnosed histologically as craniopharyngioma. Our hospital has experienced nine cases of craniopharyngioma in the last 10 years but the present case was the only intrasellar craniopharyngioma.

Abnormal regulation of granulopoiesis by bone marrow fibroblasts in leukemia

Effects of human bone marrow fibroblasts (BMF) on the differentiation of human colony forming units in culture (CFU-C) were investigated in five normal adults, 10 patients with acute leukemia (AL) at the time of diagnosis, five patients with AL at complete remission (CR) and six patients with chronic myelogenous leukemia (CML). To determine the effects of BMF on granulopoiesis, normal bone marrow cells were cultured in agar medium on BMF liquid-phase cultures, and the numbers of CFU-C were counted. BMF from either normal subjects, AL at the time of complete remission (CR) or CML enhanced the growth of CFU-C in a few spontaneous CFU-C groups (less than 3 colonies/10(5) cells), whereas BMF obtained from AL at the time of diagnosis failed to enhance the growth. In contrast, BMF from either normal subjects, AL at the time of diagnosis and CR, or CML inhibited the growth of CFU-C in many spontaneous CFU-C groups (greater than 10 colonies/10(5) cells). BMF from AL at the time of diagnosis showed significantly higher inhibitory effect than those from normal subjects (p less than 0.01). When giant cell tumor-conditioned medium was used as a source of colony stimulating factor, 26 BMF in total from various subjects inhibited the growth of CFU-C except for four cases (two normal subjects and two AL patients at CR). The degree of inhibition of CFU-C growth by BMF from AL at the time of diagnosis was significantly higher than in normal subjects (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Factor VIII, von Willebrand factor and platelet adhesiveness in diabetic retinopathy

Thirteen non-diabetic controls, 40 diabetics without retinopathy and 19 diabetics with retinopathy, approximately matched for age and sex, were studied for plasma levels of F VIII:C, vWF:Ag and R Cof, and platelet adhesiveness. F VIII:C was elevated in both diabetic groups compared with normal controls, but no differences were found between the diabetic groups. vWF:Ag was significantly higher in both diabetic groups than in normal controls, and it was also elevated in diabetics with retinopathy compared with those without. R Cof was higher in diabetics with retinopathy than in normal controls or in diabetics without retinopathy, but there were no differences between normal controls and diabetics without retinopathy. We could not find any differences in platelet adhesiveness between the groups. The results in the present study suggested that F VIII/vWF might play an important role in the pathogenesis of diabetic retinopathy.

A case of pheochromocytoma with transient hyperinsulinemia and reactive hypoglycemia

Hyperglycemia is a common symptom of pheochromocytoma. In the present paper, a 57-year-old man with transient hyperinsulinemia and reactive hypoglycemia is reported. His blood pressure was 100/50 mmHg. Following 75 g oral glucose intake, his blood sugar and insulin levels were 150 mg/dl and 15 mu Iu/ml at 0 min, 373 mg/dl and 757 mu Iu/ml at 60 min and 34 mg/dl and greater than 1,000 mu Iu/ml at 120 min, respectively. High plasma epinephrine and norepinephrine levels and histological findings of adrenal tumor confirmed the diagnosis of pheochromocytoma. Pheochromocytoma should be considered as one of the diseases which account for unexplained transient hyperinsulinemia with reactive hypoglycemia.

Association between HLA and Sjögren's syndrome in Japanese patients

Japanese patients with primary Sjögren's syndrome (SS), patients with SS and rheumatoid arthritis (SS-RA), and patients with SS and connective tissue disease without RA (nonrheumatoid connective tissue disease [SS-CTD]) were typed for HLA antigens. Patients with primary SS and those with SS-RA had higher frequencies of DRw53 than did those who had SS-CTD; however, the group with SS-CTD showed a negative correlation with DRw52. These data indicate that Japanese and white patients with SS have different HLA specificities, and that genetic factors involved in the development of SS-CTD might be different from those in primary SS and SS-RA.

Small-dose cytosine arabinoside in the treatment of elderly patients with acute leukemia and refractory anemia with excess of blast

Five elderly patients with acute nonlymphocytic leukemia (ANLL) and four patients with refractory anemia with excess of blast (RAEB) were treated with small doses of Ara-C (5-30 mg/day, subcutaneous injection) for 10-28 days. Three patients achieved complete remission and four patients partial remission. Side effects were severe bone marrow suppression in eight patients and gastrointestinal symptoms in three patients. From these results it was indicated that a small-dose Ara-C regimen provides alternative therapy in selected elderly patients with ANLL and RAEB.

Alloimmunization following platelet transfusions in patients with acute nonlymphocytic leukemia

Lymphocytotoxic (LCT) antibodies were measured in 20 adult patients with acute nonlymphocytic leukemia (ANLL) who received remission induction chemotherapy and multiple platelet transfusions. Nine (45%) became LCT positive and refractory to the platelet transfusions. This frequency of alloimmunization in ANLL patients was significantly lower than that in aplastic anemia patients (p less than 0.05). In one male with acute promyelocytic leukemia (APL), the LCT antibody disappeared during intensive chemotherapy and recovery of transfused platelets improved remarkably. The incidence of alloimmunization in the patients with APL appeared to be especially low. Six out of 9 LCT positive patients with ANLL became alloimmunized with less than 10 units of platelet transfusions. Three out of 11 LCT negative patients never became alloimmunized with more than 100 units. These facts indicated that there was no relationship between the number of platelet transfusions given and the development of alloimmunization. In addition, the remission rate also did not correlate with the development of alloimmunization.

Nodular sclerosing Hodgkin's disease with massive skin invasion

Skin invasion is a rare manifestation in cases with Hodgkin's disease and if present mortality rate is very high. In general, almost all patients with advanced skin lesions die of the underlying disease in spite of any chemotherapy, however in case the patient recovered after intensive chemotherapy and irradiation. Moreover, the type of skin manifestation in this case is unique and quite different from the usual. This report describes a well-controlled case of Hodgkin's disease with massive and atypical skin invasion.

Familial Sjögren's syndrome in the Japanese: immunogenetic and serological studies

Serological abnormalities and HLA haplotypes were studied in a Japanese family of two patients with Sjögren's syndrome (SS) associated with other autoimmune diseases. In contrast to the reports in the U.S.A. and Europe, we found a significant excess of HLA-DRw53 antigen in the family members. Two family members, mother and niece of the probands, had suffered from other connective tissue diseases. Although none of the siblings of probands had manifestations of connective tissue diseases, two siblings had several autoantibodies. No consistent segregation, however, was found between the HLA haplotypes and the serological abnormalities in the relatives. Therefore, HLA alone can not explain the familial clustering of autoimmune diseases including SS and of autoantibodies.

A case report of aldosterone producing adenoma with masked hyperaldosteronemia

A 50-year old female with primary aldosteronism and masked hyperaldosteronemia is reported. Her blood pressure was 176/110 mmHg with no paralysis of hypokalemia. Serum potassium, aldosterone and renin activity were 4.3 mEq/L, 17 ng/dl and 0.6ng/ml/h, respectively. Following a stimulation test by sodium loading and furosemide plus standing, neither aldosterone nor renin activity responded. Adrenal computed tomographic scanning, ultrasonography and cortical scintiscanning failed to reveal the tumor mass. A definite diagnosis of aldosterone producing adenoma was made after adrenal venous sampling in which the concentration of aldosterone was 15-fold greater in the right adrenal vein than in the left. The diagnosis of right adrenal cortical adenoma was confirmed by surgery. Thus, this case indicates the usefulness of the sampling technique in making an accurate diagnosis for primary aldosteronism with normo-kalemia, normo-aldosteronemia and normo-reninemia.

Increased collagen synthesis of bone marrow fibroblasts by materials released from platelets of chronic granulocytic leukemia and polycythemia vera

Collagen synthesis stimulated by materials released from platelets (MRFP) of patients with chronic granulocytic leukemia (CGL) and polycythemia vera (PV) was measured in human bone marrow fibroblasts derived from normal individuals. The MRFP of patients with CGL and PV stimulated normal fibroblast collagen synthesis significantly compared to the response from normal MRFP. Platelets derived from patients with CGL and PV may have some factors that dramatically stimulate collagen synthesis which is relevant to the frequently observed myelofibrosis in these diseases.