Distribution of C3-step regulatory proteins of the complement system, CD35 (CR1), CD46 (MCP), and CD55 (DAF), in hematological malignancies

The distribution and levels of three membrane proteins, CD35, CD46, and CD55, which serve as complement regulators, were examined in normal peripheral blood and hematologically malignant cells. CD35 was negative in most leukemia cells regardless of the type of leukemia, although granulocytes, monocytes, and some populations of lymphocytes were CD35+. CD46 was present in all blood cells except erythrocytes, and levels were 2-8 times higher in most leukemia cells than in their mature counterparts, particularly in CML and CLL cells, except for those of B cell lineage. CD55, a widely-distributed phosphatidyl inositol-anchored protein, was more frequently lost in NHL cells than in other types of hematological malignancies. In this review, we discuss the roles, mechanisms, and clinical applications of cell-associated complement regulatory proteins in hematological malignancies.

Marked increase of CD8+S6F1+ and CD8+CD57+ cells in patients with graft-versus-host disease after allogeneic bone marrow transplantation

Peripheral blood lymphocytes (PBL) from 24 allogeneic bone marrow transplant (BMT) recipients were studied serially using flow cytometry and two-color analysis. Dual labelling with two monoclonal antibodies (moAbs), CD8/S6F1 (CD11a) and CD8/CD57 was used to analyze the surface phenotypes of PBL after allogeneic BMT. In patients with acute and chronic GVHD, CD8+S6F1+ cells were markedly increased from the onset of GVHD and recovered to normal range 6 years after transplantation. By contrast, CD8+S6F1- cells fell below normal range and remained markedly decreased for 2-3 years after transplantation in patients with acute and chronic GVHD. A slight but significant increase of CD8+CD57- cells was observed with clinical signs of acute GVHD. On the other hand, CD8+CD57+ cells were increased after the onset of acute and chronic GVHD and recovered to normal range 6 years after transplantation. These results suggest that these subsets of CD8+ cells may play important roles in the pathophysiology of GVHD.

Nationwide randomized comparative study of daunorubicin and aclarubicin in combination with behenoyl cytosine arabinoside, 6-mercaptopurine, and prednisolone for previously untreated acute myeloid leukemia

Aclarubicin was evaluated in combination chemotherapy for adult acute myeloid leukemia in a randomized trial involving 58 institutions throughout Japan. Behenoyl cytosine arabinoside (BH-AC).daunorubicin, 6-mercaptopurine, and prednisolone (DMP) was compared with BH-AC.aclarubicin, 6-mercaptopurine, and prednisolone (AMP). In the 360 evaluable cases among the 433 cases enrolled, complete remission (CR) rates were 63.7% (116/182) for BH-AC.DMP and 53.9% (96/178) for BH-AC.AMP (P = 0.0587). Median survival periods and 7-year survival rates were 15.8 months and 19.3% for BH-AC.DMP and 9.5 months and 20.2% for BH-AC.AMP (P = 0.0091 according to the generalized Wilcoxon test [GW], P = 0.196 according the log-rank test [LR]). Median disease-free survival periods were 15.4 months for BH-AC.DMP and 14.1 months for BH-AC.AMP (P = 0.851 by GW, P = 0.439 by LR). Among the 346 cases of extramurally confirmed FAB subtypes, CR rates were 67.9% (19/28) with BH-AC.DMP and 31.8% (7/22) with BH-AC.AMP for subtype M3 (P = 0.011) and 63.3% (93/147) with BH-AC.DMP and 56.8% (84/148) with BH-AC.AMP (P = 0.254) for subtypes M1, M2, M4, and M5. Diarrhea, ileus, pneumonia, and renal failure were more frequent with BH-AC.AMP than with BH-AC.DMP. The results indicate, at least on the basis of the long-term outcome, that BH-AC.AMP has antileukemic effects on subtypes M1, M2, M4, and M5 that are comparable with those of BH-AC.DMP.

Nation-wide randomized comparative study of doxorubicin, vincristine and prednisolone combination therapy with and without L-asparaginase for adult acute lymphoblastic leukemia

A randomized clinical trial of combination chemotherapy for adult acute lymphoblastic leukemia (ALL) with doxorubicin, vincristine and prednisolone with and without L-asparaginase (AdVP vs L-AdVP) was conducted, involving 58 institutions throughout Japan. After reaching complete remission (CR), patients were treated with the same regimen for more than 2 years. Among 166 evaluable cases of the 198 cases enrolled, CR rates were 63.1% (53/84) with AdVP and 64.6% (53/82) with L-AdVP (P = 0.837). Median survival times and 7-year survival rates were 12.7 months and 21.2% with AdVP, and 16.0 months and 22.3% with L-AdVP (P = 0.955 by generalized Wilcoxon test [GW], P = 0.952 by log-rank test [LR]). Median disease-free survival times and 7-year survival rates were 13.5 months and 23.8% with AdVP and 17.0 months and 30.6% with L-AdVP, showing some increments for L-AdVP but no statistical significance (P = 0.141 by GW, P = 0.300 by LR). Among the cases of extramurally confirmed FAB subtypes, CR rates were 75.9% (63/83) for the L1 subtype and 51.3% (39/76) for the L2 subtype (P = 0.001). As to adverse effects, pancreatitis was complicated more frequently in L-AdVP than in AdVP (P = 0.039). Other side effects such as hyperbilirubinemia, diabetes mellitus, diarrhea and hypofibrinogenemia were observed more frequently with L-AdVP, but with no statistical significance. Thus, addition of a single course of L-asparaginase in the induction phase of combination chemotherapy with doxorubicin, vincristine and prednisolone did not significantly enhance the effect of antileukemic treatment of adult ALL.

[An early phase II study of CPT-11 (irinotecan hydrochloride) in patients with hematological malignancies]

An early phase II study of CPT-11 (irinotecan hydrochloride) was conducted in patients with hematological malignancies by 4 administration regimens in a cooperative study involving 13 institutes in Japan. The overall response rate was 23% (7/30) for non-Hodgkin's lymphoma, 33% (1/3) for Hodgkin's disease, 18% (2/11) for acute lymphoblastic leukemia and 7% (1/15) for acute myelogenous leukemia. One PR was also obtained in a patient with chronic myelogenous leukemia. Among responders, 6 relapsed and refractory malignant lymphomas (ML) and 2 relapsed and refractory acute leukemias (AL) were involved. The response rates in ML with the regimens B (40 mg/m2 for 5 days every 3-4 weeks) and C (40 mg/m2 for 3 days every weeks) were 31% (5/16) and 33% (3/9), respectively. The other regimens (regimen A, 200 mg/m2 once a day every 3-4 weeks and regimen D) resulted in no response. Responses in AL were only observed in regimen D (20 mg/m2 twice a day for 7 days every 3-4 weeks). Major toxicities were leukopenia (91%), nausea/vomiting (74%), diarrhea (73%) and anorexia (64%). The incidence of severe gastrointestinal symptoms was higher in regimen B than regimen C. Further studies are warranted to confirm the effectiveness and safety of CPT-11 against ML and AL. The recommended administration schedule was regimen C for ML and regimen D for AL.

[Two cases of acute myelogenous leukemia with Bacillus cereus bacteremia resulting in fatal intracranial hemorrhage]

This manuscript reports Bacillus cereus sepsis in two cases with acute myelogenous leukemia (AML) who suffered complications of fatal intracranial hemorrhage during remission induction therapy. The first case was 43-year-old male with AML (M0) receiving first consolidation chemotherapy who developed sudden diarrhea, abdominal pain and spiking fever. Two days later, he died of intracranial hemorrhage. The second case was 15-year-old male with AML (M5b) who was receiving first induction chemotherapy. He developed headache and vomiting following spiking fever and diarrhea. He died of subarachnoid hemorrhage the next day. In both cases, Bacillus cereus was isolated from blood culture. Fatal intracranial hemorrhage due to severe bleeding tendency caused rapid to death in both cases. These bleeding tendencies might have been induced by B. cereus sepsis. In addition, we should not overlook B. cereus as contamination, but rather consider it as a potential pathogen, when isolated from blood culture.

Pregnancy decreases the threshold for cocaine-induced convulsions in the rat

The objective of this study was to test our hypothesis that pregnancy modifies the central nervous and cardiovascular toxicity of cocaine. Ten chronically catheterized term pregnant rats and 13 chronically catheterized nonpregnant female rats were infused with cocaine (2 mg/kg/min) intravenously to observe the sequential toxic manifestation of cocaine from mild central nervous stimulation (hyper-locomotor activities) to fatal cardiovascular collapse. Arterial blood samples were withdrawn at the onset of major toxic signs or symptoms--namely convulsion, hypotension, and circulatory collapse--for determination of cocaine concentrations and plasma cholinesterase activity. The dosage and plasma concentrations of cocaine associated with the onset of convulsions and cardiovascular depression were significantly lower in pregnant rats when compared with the nonpregnant animals. The mean time required to develop convulsions in the pregnant rat was significantly shorter (21 minutes) than that in the nonpregnant animal (33 minutes). However, once convulsive activity had developed, the time interval to achieve circulatory collapse was similar in both groups. Although the baseline plasma cholinesterase activity was higher in the pregnant rats than in the nonpregnant ones, the values in the samples obtained from the pregnant group at the onset of circulatory collapse were similar to the baseline values for the nonpregnant group. These findings suggest that a higher enzyme activity does not protect the development of toxic manifestations in the pregnant rat as compared to the nonpregnant animal when cocaine was administered at the same infusion rate.

[A late phase II comparative study of idarubicin + cytarabine and daunorubicin + cytarabine in adult patients with acute non-lymphocytic leukemia. Idarubicin Study Group]

In adult patients with acute non-lymphocytic leukemia (ANLL), idarubicin (IDA) and daunorubicin (DNR) were compared for efficacy and safety in combination with cytarabine (Ara-C). IDA 12 mg/m2/day and DNR 40 mg/m2/day were administered iv bolus for 3 consecutive days (day 1-3), respectively, in combination with Ara-C 80 mg/m2 given by 2-hour intravenous infusion, every 12 hours for 7 consecutive days. The number of evaluable patients was 32 for each group previously untreated. The rates of complete remission (CR) were 59.4% (19/32) in the IDA group and 40.6% (13/32) in the DNR group. The clinical equivalence test with delta = 10% demonstrated that the IDA group is equal or superior in remission rates (p = 0.010) compared to the DNR group. In addition, the Cochran-Mantel-Haenszel test for response means with scores of 3 (CR), 2 (PR) and 1 (NR) showed the significant superiority (p = 0.044) of the IDA group to the DNR group. The duration needed to attain less than 5% leukemic cells in bone marrow tended to be shorter in the IDA group (p = 0.072), and in the CR patients the number of days needed to reach the nadir value in leukemic cells were significantly fewer in the IDA group (p = 0.037). The nadir value of WBC was significantly lower in the IDA group (p = 0.022). As for adverse reactions, high incidences of diarrhea and stomatitis were observed in the IDA group, while the incidences of other adverse reactions were similar between the two groups. When effects of the drug on the ECG were examined, significant changes in ECG parameters were observed in the DNR group after treatment but not in the IDA group. From the above, remission induction in adult AN LL, IDA + Ara-C therapy showed better efficacy than DNR + Ara-C therapy, and IDA was considered to be a drug of first choice in the treatment of ANLL patients.

Implication of membrane factors other than DAF and CD59 in complement-mediated lysis of paroxysmal nocturnal hemoglobinuria erythrocytes

Erythrocytes from two patients (F.K. and A.M.) with paroxysmal nocturnal hemoglobinuria, which were almost completely deficient in decay-accelerating factor and CD59, were found to differ in their susceptibility to homologous complement. Whereas 50-70% of F.K. erythrocytes were lysed, almost 100% of the erythrocytes from A.M. were lysed. These observations were seen under both acidified and nonacidified conditions, and regardless of whether or not the normal human serum was adsorbed with normal erythrocytes to remove natural antibodies. Erythrocytes from two other patients, J.S. and Y.K., about 85% of which did not express CD59, showed lytic profiles similar to those of patient F.K. The differences between patients were not related to levels of natural antibody or other membrane regulatory proteins such as complement receptor type I or membrane cofactor protein. Erythrocytes from F.K. and A.M. differed in their reconstitution with decay accelerating factor and CD59. While erythrocytes from F.K. were reconstituted with CD59 in a unimodal pattern, erythrocytes from A.M. showed a bimodal pattern of reconstitution assessed by flow cytometry. After reconstitution with CD59, erythrocytes from F.K. and A.M. differed in their protection against homologous complement. It is concluded that erythrocyte membrane constituents other than the known inhibitors differ in these patients.

Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) after chemotherapy in patients with non-Hodgkin's lymphoma; a placebo-controlled double blind phase III trial

To assess the clinical and hematopoietic effects of rhGM-CSF, a placebo-controlled double blind multicenter phase III study was undertaken in patients with non-Hodgkin's lymphoma receiving cytotoxic chemotherapy. Sixty-two patients who had granulocytopenia (< 1 x 10(3)/microliters) after the first cycle of chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone were enrolled. After the second cycle of chemotherapy with the same regimen, patients randomly received either rhGM-CSF (125 micrograms/m2/day) or placebo for 14 days (rhGM-CSF; 31 patients and placebo; 31 patients). Administration of rhGM-CSF induced a significant increase in granulocytes mainly with neutrophils, eosinophils and monocytes, but elevation of lymphocytes, platelets, and reticulocytes was not induced. Median days of granulocytes less than 1 x 10(3)/microliters in patients receiving rhGM-CSF were significantly shorter than in patients receiving placebo (p = 0.001). Adverse reactions encountered with rhGM-CSF, and observed in 58% of the patients were never life-threatening and always rapidly reversible. They included fever, nausea and vomiting, diarrhea, skin eruption, and malaise. These results suggest that rhGM-CSF can be safely administered to prevent neutropenia after chemotherapy in patients with non-Hodgkin's lymphoma.

[A late phase II study of idarubicin hydrochloride in adult patients with acute lymphocytic leukemia. Idarubicin Study Group]

A late phase II study of idarubicin hydrochloride combined with vincristine and prednisolone was conducted in adult patients with acute lymphocytic leukemia (ALL) in the first relapse as a multi-center joint research project. The dosages used were idarubicin 12 mg/m2/day i.v. for 3 consecutive days (day 1-3), vincristine 1.4 mg/m2 i.v. (day 1) and prednisolone 60 mg/m2/day po for 5 consecutive days (day 1-5). The number of evaluable patients was 20. The patients showed responses including 3 complete remissions (CR) and 10 partial remissions (PR), with an efficacy rate (CR + PR) of 65.0%. Adverse reactions occurred in 19 of 20 patients. The main symptoms were gastrointestinal symptoms including anorexia, nausea/vomiting, and stomatitis and fever, infection, and alopecia. Abnormal laboratory data were observed in 6 of 20 patients with 13 events. Although one case of an increase in GPT with WHO grade 3 was observed, the other cases were not of significance. From the above study, idarubicin hydrochloride was considered to be effective in relapsed ALL patients in combination therapy with vincristine and prednisolone.

Acute promyelocytic leukemia with CD59 deficiency

CD59 is a phosphatidyl inositol-anchored protein (which is lost in paroxysmal nocturnal hemoglobinuria (PNH) cells) with the capacity to block the formation of membrane attack complex, and protects host cells from autologous complement-mediated cytolysis. We found a patient with acute promyelocytic leukemia (APL) accompanied by disseminated intravascular coagulation (DIC), the cells of which were CD59-negative. Although the CD59 deficiency in the malignant cells was not related to PNH, we offered the possibility that DIC was induced by APL lysis secondary to the deficiency of CD59.

[Intracavitary suction for treating giant bulla]

Examination was made of 9 consecutive patients who underwent intracavitary suction for giant bulla. A second operation was required for one patient who had multiple giant bullae. In the other 8 patients, improvement of pulmonary function and symptoms was obtained immediately following the operation. This was particularly more apparent in patients with poor pulmonary function. The following results were obtained. Functional recovery was evident from the early postoperative phase. A one-stage operation was possible. Reduction in postoperative drainage time was realized by bronchial occlusion. The present operation is particularly applicable to compromised patients. Computed tomography scanning is essential for evaluation of the drainage site. For giant bulla with some septation and multivesicular, the present mode of treatment would not be indicated.

[Granisetron oral phase III clinical trial--study on the inhibitory effect of granisetron for nausea/vomiting induced by chemotherapy for tumors in the hematopoietic organs]

The efficacy and safety of oral granisetron against nausea and vomiting induced by chemotherapy for tumors in the hematopoietic organs were investigated. Depending on the day of anticancer drug administration, single administration or 2 to 6-day repeated administration of granisetron at 2 mg once daily was conducted. The clinical efficacy rate against nausea and vomiting was 91.6% on the first day of administration of anti-cancer drugs and 90% or over on and after the second day of administration. Compared with the status at the previous chemotherapy, a significant decrease in vomiting frequency was observed during the present trial. Adverse events which were suspected to be related to granisetron included 1 case of mild feeling of residual urine and another demonstrating very mild eosinophilia. From the above results, it was confirmed that granisetron was a safe and effective antiemetic against nausea and vomiting induced by anticancer drug administration.

Histometric changes in connective fibers of the lung following paraquat administration in rats

Pulmonary fibrosis induction by paraquat was studied histometrically using an image analyzer. Rats were given a subcutaneous injection of paraquat (7 or 25 mg/kg) and autopsied 3, 6 or 9 days later. The percentage of the area of connective fibers per unit area, and lung prolyl hydroxylase activity, as a biochemical parameter, were measured. Rats treated with 25 mg/kg of paraquat showed an increase in the percentage of the area of the connective fibers per unit area and also an increase in lung prolyl hydroxylase activity 6 days later. Thus, pulmonary fibrosis was confirmed both morphologically and biochemically. It is concluded that histometric examination using an image analyzer provides a very accurate method for the evaluation of pulmonary fibrosis.

A randomized controlled study of granulocyte colony stimulating factor after intensive induction and consolidation therapy in patients with acute lymphoblastic leukemia. Japan Adult Leukemia Study Group

To determine the efficacy and optimal daily dose of recombinant human granulocyte colony-stimulating factor (rG-CSF) after intensive chemotherapy, a prospective randomized study was conducted with daily intravenous administration of 2, 5 or 10 micrograms/kg G-CSF after induction therapy, and 0, 2, 5 or 10 micrograms/kg after consolidation therapy, until neutrophil counts recovered to more than 2000/mm3. The subjects were 41 adult patients with newly diagnosed acute lymphoblastic leukemia (ALL). After the induction therapy, neutrophil recovery to more than 1000/mm3 was significantly faster in the 5 (P = 0.047) and 10 micrograms/kg groups (P = 0.011) than in the 2 micrograms/kg group, but did not differ between the 2 former groups. The median days of neutrophil recovery to more than 1000/mm3 were 8.5, 9 and 12 days, respectively. After the consolidation therapy, neutrophil recovery to more than 1000/mm3 was significantly faster in the 2, 5 and 10 micrograms/kg groups than in the no rG-CSF group (P < 0.001, respectively), but did not differ among the 3 former groups. The median days of neutrophil recovery to more than 1000/mm3 were 12, 11, 10, and 23 days, respectively. Febrile neutropenia and incidence of documented infection tended to be less in the 5 and 10 micrograms/kg groups than in 0 and 2 micrograms/kg groups. A dose of 5 micrograms/kg rG-CSF given by a 30 min infusion daily seems to be an effective and optimal daily dose to accelerate neutrophil recovery after intensive remission induction and consolidation chemotherapy in adults with acute lymphoblastic leukemia (ALL).

Gender-related differences in cocaine toxicity in the rat

To test our hypotheses that gender-related differences in cocaine toxicity exist in the rat, cocaine (2 mg/kg/min) was infused intravenously in chronically catheterized male and ovariectomized or intact female rats until the onset of circulatory collapse. Sequential manifestations of cocaine toxicity from mild central nervous stimulation to fatal cardiovascular collapse were observed. Arterial blood was withdrawn at the onset of the toxic signs or symptoms for determination of cocaine concentrations. Dosages and plasma concentrations of cocaine required to produce cardiovascular toxic manifestations were significantly lower in male and ovariectomized rats than in intact females. Plasma cholinesterase activity was lowest in the male animals and highest in intact females. These data suggest that systemic toxicity of cocaine is enhanced in male rats, because lower doses and plasma concentrations are required to induce toxic signs and symptoms.

[A case of intrapleural rupture of pulmonary arteriovenous fistula]

The hemothorax due to rupture of arteriovenous fistula is very rare and only 6 cases of this complication have been reported in Japanese literature. 44-year-old male complained of chest pain and dyspnea. A chest roentgenogram revealed right pleural effusion and an abnormal pulmonary shadow. By further examination including pulmonary angiography, the rupture of pulmonary arteriovenous fistula into right pleural cavity was diagnosed. Partial resection of the right lung containing arteriovenous fistula was successfully performed and postoperative course was uneventful.

Effect of dehydroproline as a collagen synthetic inhibitor in paraquat-induced pulmonary fibrosis in beagle dogs

To investigate the effect of 3,4-DL-dehydroproline (DHP) on paraquat (PQ)-induced pulmonary fibrosis in beagle dogs, 25 beagles without distinction of sex were allocated at random into 2 groups; 17 dogs were PQ-dosed and 8 were saline-dosed. The 17 dogs were given 1 mg PQ/kg/d sc for 7-11 d; 14 of the 17 had decreased body weight on day 11 and were selected, 2 of which were determined at random and necropsied. The remaining 12 dogs were randomly divided into 2 groups of 6 dogs each (DHP-treated or saline-treated). They received either 25 mg DHP/kg/d sc or saline for 14 d and were sacrificed for measurement of lung lipid peroxide and lung hydroxyproline (Hyp) concentrations on day 25 or 180 after the PQ administrations started. Two of the 17 dogs (11.8%) given 1 mg PQ/kg/d sc died on days 9 and 11 of the administration. One dog (5.9%) had no signs of PQ toxicity including no decrease in body weight. The remaining 14 dogs (82.4%) had decreased body weight until day 11 of the PQ administrations. No significant differences in erythrocyte superoxide dismutase, blood catalase and serum-lipid peroxide occurred from the PQ dosing; however, lung lipid peroxide increased 4-fold. On day 180 the lung lipid peroxide of the PQ + saline treated group was still 4-times elevated, while the PQ + DHP treated group had about 1/2 that value. Lung Hyp concentrations in the PQ dosed dogs were significantly increased.(ABSTRACT TRUNCATED AT 250 WORDS)

[Early phase II study of Idarubicin combined with cytarabine in acute myelogenous leukemia. Idarubicin Study Group]

An early phase II study of a combination regimen consisting of Idarubicin and Cytarabine was performed in patients with acute myelogenous leukemia. Idarubicin at a dose of 10 mg/m2 or 12 mg/m2 was given by 5-min. iv bolus, once daily for 3 consecutive days and Cytarabine at a dose of 80 mg/m2 was given by 2-hour iv infusion, twice daily for 7 consecutive days. Of 19 patients treated, 17 were evaluable for responses. The patients who showed a response (complete or partial remission) were 4 of 10 (40.0%) in the 10 mg/m2 group, 6 of 7 (85.7%) in the 12 mg/m2 group, and in total, 10 of 17 patients (58.8%), respectively. Analysing relationship between prior chemotherapy and responses, all of 3 patients without pretreatment, 6 of 10 patients (60.0%) in the first relapse, and 1 of 4 patients (25.0%) whose disease had been refractory to induction therapy after relapse responded. Seven of 14 patients (50%) who had received prior anthracycline therapy, showed a response. The principal adverse effects were gastrointestinal symptoms, alopecia, fever and infection, similarly to those observed in Idarubicin single therapy. When combined with Cytarabine, Idarubicin increased the incidence and severity of gastrointestinal symptoms. Considering effectiveness and safety, the clinical optimal dosage of Idarubicin when used concomitantly with Cytarabine was judged to be 12 mg/m2 once daily for 3 consecutive days.

[Early phase II study of Idarubicin, a new anthracycline anticancer drug, in acute leukemia. Idarubicin Study Group]

An early phase II study of Idarubicin was performed in patients with acute leukemia. The dosages administered were 10 mg/m2, 12 mg/m2, or 15 mg/m2 by iv bolus, once daily for 3 consecutive days. The treatment was given to 47 patients who were in relapse or whose diseases had been refractory to remission induction therapy. Of the 47 patients, 35 were evaluable for response. The patients who showed a response (complete or partial remission) were 9 of 14 patients (64.3%) in the 10 mg/m2 group, 1 of 12 patients (8.3%) in the 12 mg/m2 group, and 3 of 9 patients (33.3%) in the 15 mg/m2 group, respectively. Remissions were achieved in 10 of 23 (43.5%) patients with acute myelogenous leukemia, and in 3 of 6 (50.0%) of those with chronic myelogenous leukemia in blast crisis. However, no remission was achieved in 6 patients with acute lymphocytic leukemia. As for patients who had received prior anthracycline therapy, remissions were achieved in 11 of 29 patients (37.9%), and so clinical cross resistance between idarubicin and other anthracyclines was thought to be partial. The principal adverse effects were gastrointestinal symptoms, alopecia, fever and infection. In the 15 mg/m2 group, there was an increased number of adverse events of WHO's grade 3 or over. The result indicated that Idarubicin is a useful drug for the treatment of acute leukemia, and the clinical optimal dosage estimated was either 10 mg/m2 or 12 mg/m2 once daily for 3 consecutive days.

[Hygienic handling in cardiac surgery]

Some points regarding the hygienic handling in cardiac surgery are mentioned. The sternal infection or mediastinitis is still one of the most important complications after cardiac operation especially when ITA is used for CABG. After we paid much attention to these points, the postoperative sternal infection has decreased obviously.

Chlorpromazine and paraquat poisoning

The effects of chlorpromazine hydrochloride (CPZ) on paraquat (PQ) poisoning were examined using male and female beagle dogs. Twenty-six dogs were divided into 3 groups of 21 PQ-poisoned dogs and a control group of 5 saline-treated dogs. Thirty minutes after the 21 dogs were given 20 mg PQ dichloride/kg body weight sc, groups of 7 dogs received 3 mg CPZ/kg im, 5 mg CPZ/kg im or 0.5 ml saline/kg im daily for 5 d. PQ-treated dogs exhibited dyspnea. Serum angiotensin I converting enzyme (AICE) activity of the PQ-treated dogs was elevated during days 1-3. Lung AICE activity of the PQ-treated dogs was slightly lower than the control group. Lung hydroxyproline content was not elevated in either dying or surviving dogs. Based on our biochemical evaluations, PQ-induced pulmonary fibrosis did not occur during the 24 d of this study. From days 2-12 post-PQ dosing, all the dogs in the PQ + CPZ (3 mg/kg) group died. Dogs in the PQ + CPZ (5 mg/kg) group and the PQ + saline group had 6/7 and 5/7, respectively, die from days 2-24. The survival rate of the PQ + CPZ-treated dogs was not prolonged when compared to the PQ + saline group. The expected CPZ-induced increased in survival times, concurrent reductions in mortality rates, and effects on serum and lung AICE activities were not observed.