Fatty Acid Composition of the Erythrocyte Membranes Varies between Early-Term, Full-Term, and Late-Term Infants in Japan

BACKGROUND

Term infants can be categorized into 3 sub-groups: early term (37w0d to 38w6d), full term (39w0d to 40w6d), and late term (41w0d and beyond). However, the fatty acid composition among the 3 groups of term infants has not been investigated. The association between fatty acid composition and gestational period of term infants in Japan is unclear.

METHODS

We assessed the fatty acid composition of maternal erythrocyte membranes in the third trimester and of cord erythrocyte membranes at birth in 212 healthy term Japanese infants using data from a prospective hospital-based cohort study.

RESULTS

In maternal erythrocyte membranes, docosahexaenoic acid (DHA) levels and omega-3 index were significantly higher in the late-term group than in the early-term group. In cord erythrocyte membranes, DHA levels were not significantly different between the 3 groups; late-term infants showed significantly higher DHA/arachidonic acid (ARA) and lower 20: 3n-6 and ARA levels compared to early-term infants. Gestational period positively correlated with the DHA status in maternal and cord erythrocyte membranes.

CONCLUSIONS

Fatty acid composition in maternal and cord erythrocyte membranes varies between early-, full-, and late-term infants, and the greater gestational period may contribute to the relatively high n-3 polyunsaturated fatty acids status in term infants. Furthermore, maternal DHA status in the third semester directly correlates with gestational period in pregnant Japanese women.

Relationship between Changes in Fatty Acid Composition of the Erythrocyte Membranes and Fatty Acid Intake during Pregnancy in Pregnant Japanese Women

OBJECTIVE

Docosahexaenoic acid (DHA) is an important nutrient required by pregnant women and fetuses. Several studies suggest that fatty acid composition changes during pregnancy. However, the association of longitudinal changes in erythrocyte fatty acid composition and dietary fatty acid intake during pregnancy is not well understood. We assessed the relationship between fatty acid composition of the erythrocyte membranes and fatty acid intake at each trimester in pregnant Japanese women.

METHODS

We conducted a prospective hospital-based cohort study. We investigated fatty acid composition of the erythrocyte membranes and intake of fatty acids during the three trimesters in 178 healthy, pregnant Japanese women.

RESULTS

The eicosapentaenoic acid and arachidonic acid percentage of the erythrocyte membranes significantly decreased. The percentages of linoleic acid and α-linolenic acid significantly increased during pregnancy. The DHA percentage in the erythrocyte membranes decreased from the second to the third trimester. The DHA percentage in the erythrocyte membranes positively correlated with DHA intake in the third trimester.

CONCLUSION

In pregnant Japanese women, the fatty acid composition of the erythrocyte membranes markedly changed throughout pregnancy. The DHA intake in the third trimester may be insufficient to maintain DHA percentage in the maternal erythrocyte membranes.

Development of fibrinogen gamma-chain peptide-coated, adenosine diphosphate-encapsulated liposomes as a synthetic platelet substitute

BACKGROUND

The dodecapeptide HHLGGAKQAGDV (H12), corresponding to the fibrinogen gamma-chain carboxy-terminal sequence (gamma 400-411), is a specific binding site of the ligand for platelet GPIIb/IIIa complex. We have evaluated H12-coated nanoparticles (polymerized albumin or liposome) as platelet function-supporting synthetic products.

OBJECTIVES

To strengthen the hemostatic ability of H12-coated particles as a platelet substitute, we exploited installation of a drug delivery function by encapsulating adenosine diphosphate (ADP) into liposomes [H12-(ADP)-liposomes].

METHODS AND RESULTS

Via selective interaction with activated platelets through GPIIb/IIIa, H12-(ADP)-liposomes were capable of augmenting agonist-induced platelet aggregation by releasing ADP in an aggregation-dependent manner. When intravenously injected into rats, liposomes were readily targeted to sites of vascular injury as analyzed on computed tomography. In fact, comparable to fresh platelets, liposomes exhibited considerable hemostatic ability for correcting prolonged bleeding time in a busulphan-induced thrombocytopenic rabbit model. In addition, the liposomes showed no activating or aggregating effects on circulating platelets in normal rabbits.

CONCLUSION

H12-(ADP)-liposome may thus offer a promising platelet substitute, being made with only synthetic materials and exerting hemostatic functions in vivo via reinforcement of primary thrombus formation by residual platelets in thrombocytopenia at sites of vascular injury, but not in circulation.

Successful treatment with allogeneic peripheral blood stem cell transplantation and granulocyte transfusion for severe aplastic anemia with sinusitis

A 43-year-old woman with severe aplastic anemia (SAA) received anti-thymocyte globulin and cyclosporin A (CyA) and achieved hematological remission. Although she had maintained hematological remission, the disease relapsed 10 months after arbitrary discontinuance of maintenance therapy with CyA. Resumption of CyA therapy was not effective, and her condition became complicated with progressive sinusitis with bone destruction, which was refractory to antibiotics, antifungal agents, granulocyte colony-stimulating factor, and surgical drainage. Because of the necessity for early neutrophil recovery (to resolve the infection), we proceeded with a combination therapy using allogeneic peripheral blood stem cell transplantation (PBSCT) promptly followed by granulocyte transfusion (GTX) from the same human leukocyte antigen-identical donor rather than carrying out a second immunosuppressive therapy. The patient showed temporal resolution of infection on the second day after a single GTX. Although the patient had pneumonia on day 11, it was resolved promptly after engraftment on day 16. This report suggests the clinical utility of a salvage therapy with allogeneic PBSCT followed by GTX in a particular case of recurrent SAA with refractory infections.

A novel splice site mutation of the thiazide- sensitive NaCl cotransporter gene in a Japanese patient with Gitelman syndrome

Gitelman syndrome (GS, MIM 263800) is an inherited disorder characterized by metabolic alkalosis with hypokalemia, hypomagnesemia, and hypocalciuria. The genetic abnormalities causing GS are known to lie in the thiazide-sensitive NaCl cotransporter (TSC), which is expressed in the distal tubule of the kidney. The TSC gene, located at chromosome 16, consists of 26 exons and encodes the protein containing 12 putative transmembrane domains with long intracellular amino and carboxy termini. Most of the abnormalities identified in GS were missense mutations, distributed throughout the TSC gene without a hot spot. A 42-year-old Japanese man was introduced for close examination of hypokalemia. In renal clearance studies using furosemide or thiazide, chloride clearance was increased after furosemide but not after thiazide administration. Furthermore, the distal fractional chloride reabsorption was dramatically decreased by furosemide but not thiazide administration, suggesting a defect in the distal tubule. We then analyzed the TSC gene to confirm the diagnosis of GS, and identified a novel G to T mutation at the acceptor splice site preceding exon 14, resulting in disruption of a conventional 3'AG consensus splice site. Abnormal splicing by this mutation is predicted to cause the formation of truncated TSC with a partial deletion of the transmembrane domain, which will loose the function of transporter. In conclusion, we have identified a unique novel splice site mutation of the TSC gene in GS. The predicted structure of this mutant TSC can conceivably cause an impairment of the transporter activity and thereby be responsible for the development of GS in our patient.

Treatment with low-dose cytosine arabinoside followed by administration of macrophage colony-stimulating factor prolongs the survival of patients with RAEB, RAEB-T, or leukemic phase myelodysplastic syndrome: a pilot study

The treatment of patients with aggressive subclasses of myelodysplastic syndrome (MDS) remains a challenge. In an effort to improve the survival of patients with refractory anemia with excess blasts (RAEB), RAEB in transformation (RAEB-t), or acute myelogenous leukemia transformed from MDS (MDS-AML), we conducted a small trial in which 28 such patients were treated with low-dose cytosine arabinoside (LDAraC) followed by administration of macrophage colony-stimulating factor (M-CSF). The overall rate of response to the treatment was 61%, including 39% with a complete response, which is higher than rates obtained in previous studies in which LDAraC alone was administered to patients with MDS. Median survival was 23.5 months in cases of RAEB, 16.7 months in cases of RAEB-t, and 19.7 months in cases of MDS-AML. The overall survival of the study group appeared to be prolonged in comparison with a historical control group of patients treated with LDAraC alone. It is suggested that M-CSF added to the administration of LDAraC plays an active role in the therapy. No therapy-related death occurred. Some unique actions of M-CSF were suggested in this trial. It is concluded that therapy with LDAraC + M-CSF is a useful treatment option for patients with aggressive subclasses of MDS and MDS-AML to provide better response and survival.

Induction therapy consisting of alternating cycles of ranimustine, vincristine, melphalan, dexamethasone and interferon alpha (ROAD-IN) and a randomized comparison of interferon alpha maintenance in multiple myeloma: a co-operative study in Japan

This pilot study evaluated the efficacy of a new combination chemotherapy with a newly developed nitrosourea derivative ranimustine and evaluated the efficacy of interferon alpha (IFN-alpha) maintenance in previously untreated patients with multiple myeloma (MM). The induction therapy (ROAD-IN) was a 6-week regimen consisting of chemotherapy with ranimustine, vincristine (Oncovin), melphalan (Alkeran) and dexamethasone starting on day 1 and IFN-alpha, which was administered three times weekly for 3 weeks starting on day 22. This was repeated for three cycles. The responders were subsequently randomized into two groups that received or did not receive IFN-alpha as maintenance therapy. Of the 164 patients registered, 161 were evaluated. An objective response to induction therapy was seen in 75% of patients; complete remission (CR) in 38 (24%) and partial remission (PR) in 82 (51%). The median survival for all patients was 3.6 years from registration. The survival of responders (CR + PR) was significantly better than that of non-responders (median survival 4.3 years vs. 1.4 years; 7-year survival rate 32% vs. 9%; P < 0.0001). The IFN-alpha maintenance did not show any advantage for either response duration or survival. This pilot study demonstrated that a comparatively short period of induction therapy with the ROAD-IN regimen produced a rather high response rate and a similar survival rate to those achieved with other longer induction regimens, and that good responders to the initial therapy survived significantly longer than non-responders.

[Collaterals after flow alternation in pelvic arteries: precondition for pelvic reservoir therapy]

To determine the best flow alternation in the internal iliac arteries for regional chemotherapy using a reservoir to treat pelvic malignancies, collateral arteries that arose after arterial flow alternation were evaluated on follow-up pelvic angiographies. Follow-up angiographies were obtained in 11 patients with 21 embolized arteries; six male and five female patients including three with urinary bladder cancer, two with prostate cancer, four with uterine cervical cancer and two with bone metastasis. The interval until follow-up angiography ranged from one to-28 months (mean 8.9 months). Three radiologists interpreted the angiographic results and evaluated collateral vessels. Among 21 embolized arteries, 19 were well occluded, while two were not blocked completely. The two arteries with incomplete embolization did not induce collaterals. Eight internal iliac arteries occluded at the proximal portion enhanced retrogradely via collaterals from the ipsilateral external iliac arteries. Collaterals between the bilateral internal iliac arteries were noted only in four of them. In conclusion, embolization at the proximal point of the internal iliac arteries usually induced collaterals from the ipsilateral external iliac arteries and did not always from collaterals between the bilateral internal iliac arteries, which were necessary for regional chemotherapy. This should be considered when pelvic malignancies are treated with reservoirs.

[Prognosis in 75 cases of chronic lymphocytic leukemia and second malignancies]

Clinical prognosis and analysis of causes of death of 75 CLL cases were evaluated. Median survival was 43.7 months. Major causes of death were infection (36%), primary CLL (16%), secondary malignancies (16%), cardiac failure (8%), brain hemorrhage (7%) and so on. There were 10 deaths (13%) with second or double cancers and 2 deaths with malignant lymphomas. In terms of deaths from CLL complicated by cancer, there were 4 deaths from stomach cancer, 3 from lung cancer, 1 from liver, pancreas, or prostata cancer. Cancer risk, which did not vary according to initial treatment category, was also constant across all time intervals after CLL diagnosis.

Primary biliary cirrhosis associated with idiopathic thrombocytopenic purpura

A case of primary biliary cirrhosis (PBC) associated with idiopathic thrombocytopenic purpura (ITP) is reported. The patient is a 59-year-old man. When he was 49 years old, he was diagnosed with ITP and received steroid therapy that successfully increased platelet numbers. However, the steroid therapy failed to normalize the elevated gamma-glutamyl transpeptidase. Ten years after this episode, he suffered from general itching and malaise and exhibited a gradual increase of serum biliary enzyme levels. Immunologically, IgM was increased and anti-mitochondrial antibody was positive. Histological findings of liver needle biopsy showed chronic non-suppurative destructive cholangitis, confirming the diagnosis of PBC. To date, very few PBC cases associated with ITP have been reported. Our case is the second one in Japan. PBC and ITP in our patient seemed to develop simultaneously, but the effect of steroid therapy on the two conditions was different. This result suggests that the autoimmune process may have been different in PBC and ITP in the present patient.

Administration of rhG-CSF increases complete remission rates after CHOP and ProMACE/CytaBOM for non-Hodgkin's lymphoma: a pilot study. Hokkaido Study Group of Malignant Lymphoma and rhG-CSF

To evaluate the clinical effects of the administration of recombinant human granulocyte-stimulating factor (rhG-CSF) post chemotherapy for patients with advanced-staged intermediate-grade or high-grade non-Hodgkin's malignant lymphoma (NHL), we conducted this multicenter study and compared the responses between both the regimens, CHOP as a first-generation chemotherapy and ProMACE/CytaBOM as a third-generation chemotherapy, when combined with the rhG-CSF administration. In this multicenter study, where forty patients were registered, patients in both the CHOP and ProMACE/CytaBOM groups were treated with the original regimen designs without the necessity of reducing drug dosages when combined with the administration of rhG-CSF. The administration of rhG-CSF post both of the cytotoxic therapies brought about much higher rates of complete remission in both the groups (CHOP, 75 percent; ProMACE/CytaBOM, 75 percent), as compared with those of the previous study without the rhG-CSF administration. Regarding response rates according to the International prognostic factor index, the CHOP group showed a lower rate of complete remission in patients with risk factors, compared with ProMACE/CytaBOM group. This result suggested that the administration of rhG-CSF may offer one important approach for improving the first-line therapy for aggressive NHL with high risk factors.

Effects of rhG-CSF on infection complications and impaired function of neutrophils secondary to chemotherapy for non-Hodgkin's lymphoma. Hokkaido Study Group of Malignant Lymphoma, and rhG-CSF, Japan

It has been previously demonstrated that the administration of recombinant human granulocyte-colony stimulating factor (rhG-CSF) ameliorates the decrease of the polymorphonuclear neutrophils (PMNs) count after the cytotoxic chemotherapies, thereby reducing the infection complications associated with neutropenia. In this multi-center study, we studied the prophylaxtic effect of rhG-CSF administration on infection complications in patients with non-Hodgkin malignant lymphoma, who received cytotoxic chemotherapies (CHOP or ProMACE/CytaBOM). rhG-CSF administration reduced the frequency of infection complications, and there was no obvious difference in it's frequency between the CHOP-treated and the ProMACE/CytaBOM-treated groups when administered with rhG-CSF, thereby indicating that third generation therapy for NHL may be safely completed in Japanese in combination with rhG-CSF administration. Furthermore, we investigated both the in vitro and the in vivo effects of rhG-CSF on the function of PMNs in patients with NHL and healthy donors, and revealed that the administration of rhG-CSF for NHL patients receiving cytotoxic chemotherapy brought on an improvement of the production of active oxygen but did not affect serum levels of IFNs, IL-1-beta, and IL-6, inspite of a slight elevation of TNF-alpha. Consistent with these results, in vitro treatment of PMNs with rhG-CSF induced no significant production of these inflammatory cytokines and their mRNA expressions. Furthermore, rhG-CSF administration showed no significant effects in vivo on the expression of CD11a, CD11b and LECAM-1 on PMNs and integrins on platelets.

Prevalence of human T-cell leukemia virus type 1 (HTLV-I) in family members of adult T-cell leukemia (ATL) patients in non-ATL-endemic Hokkaido of Japan

Family members of patients with adult T-cell leukemia (ATL) in non-ATL-endemic Hokkaido, the northernmost part of Japan, were assessed for the prevalence of HTLV-I infection. Immunofluorescence assay showed that 53 out of 133 (39.8%) healthy family members of 23 ATL patients were positive for antibodies to HTLV-I. When general inhabitants in Hokkaido were examined, 3 out of 18 (16.7%) family members of 5 seropositive healthy persons had HTLV-I antibodies. The overall seropositivity in Hokkaido was 0.7%. Of 26 family members of 6 patients with non-T-cell leukemia seroconverted by blood transfusion, none (0%) was seropositive.

Prevalence of human T-cell leukemia virus type 1 (HTLV-I) in adult T-cell leukemia (ATL) in non-ATL-endemic Hokkaido of Japan

Sera and peripheral blood lymphocytes of 40 adult T-cell leukemia (ATL) patients in non-ATL-endemic Hokkaido were examined for the prevalence of human T-cell leukemia virus type 1 (HTLV-I). All patients had HTLV-I-specific antibodies. When the peripheral lymphocytes were assessed after short-term cultivation, HTLV-I antigens and virus particles were detected. The seroprevalence in 96 cases of non-T-cell leukemias and lymphomas and in 30,056 healthy individuals in Hokkaido were 3.1% and 0.7%, respectively. HTLV-I seropositive inhabitants of Hokkaido can be estimated at about 40,000, and one out of every few thousand HTLV-I carriers is likely to develop ATL.

[The present status and the issues of the nosocomial infection at Asahikawa Municipal Hospital]

The prophylactic strategy against nosocomial infection at Asahikawa municipal hospital is discussed. The issues of the prophylactic strategy are; (1) Establishment of a bacterial surveillance system and a series of bacterial examination at fixed sites in the hospital organized by our own nosocomial infection committee. A quick response and a reaction by the committee according to the results obtained from a series of bacterial examinations, (2) Education of the practical guide of patient care, sterile technique and management method of disposed stuffs according to the anti-infection manual, (3) Improvement of the health care system for the hospital staffs, and (4) Planning and carrying out of the well-designed improvement plan of the hospital environment.

Establishment and characterization of a new Ph1-positive ALL cell line (ALL/MIK) presenting bcr gene rearrangement on bcr-2 and ALL-type bcr/abl transcript: suggestion of in vitro differentiation to monocytoid lineage

A new Ph1-positive acute lymphoblastic leukemia cell line, designated as ALL/MIK, has been developed from a patient with Ph1-positive acute leukemia. The ALL/MIK cells showed an immunophenotype of common ALL with rearranged JH and Jk genes. The ALL/MIK cells showed no M-bcr rearrangement using Southern blot analysis with either 3' or 5' M-bcr probes, but had the bcr gene rearrangement on bcr-2 within the first intron of the bcr gene. Consistent with this result, the reverse transcriptase-dependent polymerase chain reaction (RT-PCR) assay revealed that the ALL/MIK cells contained the transcript derived fusion of the first exon of bcr gene and the second exon of abl gene. Although the ALL/MIK cells were defined as early pre-B cells by immunophenotypical and genotypical analyses, they were capable of differentiating into monocytoid lineage by when cultured with TPA. Furthermore, another Ph1-positive ALL cell line, (TOM-1), was investigated for its ability to differentiate to monocytoid lineage. TOM-1 was also induced to monocytoid lineage by TPA. Thus, the present study suggested that the leukemic transformation in some Ph1-positive ALL may occur at the level of multipotential hematopoietic cells capable of differentiating towards lymphoid and myelo-monocytoid lineage.

[A case of gastric amyloidosis developing into Bence-Jones type multiple myeloma, treated effectively by cyclo-VAMP chemotherapy]

A 65-year-old man was admitted because of bleeding from gastric ulcer. A massive deposition of AL lambda type amyloid proteins in the gastric lesion was found. There were a few Bence-Jones (BJ) proteins in the urine, but serum M proteins and bone lesions were not found. Bone marrow puncture showed no dysplastic change of plasma cells. Moreover, there were no amyloid proteins deposited anywhere in the digestive tract examined, except for the stomach, nor were they found in the bone marrow, prostata, liver or kidney. Gastric amyloidosis was diagnosed. Gastrectomy was performed because of uncontrollable bleeding. Sixteen months later, bone swelling occurred in the sternoclavicular joint and the 3rd rib. At that time, plasma cells with dysplasia and increasing levels of urine BJ protein were revealed. BJ type multiple myeloma was finally diagnosed. For remission induction, cyclo-VAMP chemotherapy was given in 3 courses. Decreased levels of urine BJ protein, diminished bone lesion, normalization of bone marrow and fewer amyloid deposits were seen, and partial response was obtained. The patient is well with no signs of recurrence evident 42 months after treatment. This is an interesting case of initial gastric amyloidosis that developed into BJ type multiple myeloma and was effectively treated with cyclo-VAMP chemotherapy.

[Issues in the AIDS medicine based on the analysis of medical worker's recognition of the disease]

We analysed problems on the front line of the AIDS medicine through our experience of a with hemophilia A, who had HIV infection developed to ARC and the AIDS and in addition, had non-Hodgkin's lymphoma in his rectum and died of pneumonitis caused by pneumocystis carinii. We have learned from the poll on medical worker's recognition of the disease through the experience of this case that the nurses who were concerned with the care of this patient did not have opinions against acceptance of patients with AIDS, although they have a fear, from the professional point of view, to a possibility of infection of the virus from patients with AIDS. What should be done in the practical part of the AIDS medicine are (1) a repetitive education of accurate knowledge of the disease, (2) completion of practical guide lines for medical care of patients with AIDS and (3) legal establishment of an insurance system for accidental infections of HIV to medical or paramedical staffs.

The development of an enzyme immunoassay for placental tissue protein 17 (PP17) and its clinical significance

We developed an enzyme immunoassay (EIA) for placental protein 17 (PP17) using avidin biotin binding, and measured the serum-PP17 levels of 37 healthy men, 103 nonpregnant women, 48 pregnant women, and 86 patients with gynecologic malignancies. The mean level was 12.8 ng/ml in healthy men and 44.2 ng/ml in nonpregnant women (p < 0.05). The calculated upper limit of normal was 97.8 ng/ml (mean + 2 sigma). The serum PP17 concentration was remarkedly reduced postmenopausally. Pregnant women showed a mean serum level of 19.2 ng/ml, which was significantly lower than that of nonpregnant women. Immunoserological results strongly suggest that PP17 is produced far more in the normal endometrium than in the placentae and decidua. Patients with gynecologic malignancies had obviously lower mean serum PP17 levels (8.3-19.9 ng/ml) than those found in healthy nonpregnant women. Measurement of the serum PP17 concentration might be useful in distinguishing gynecologic malignancies from various normal conditions.

[Successful oral administration of etoposide therapy for refractory malignant lymphoma treated with frequent combination chemotherapy]

A 67-year-old man was diagnosed as non-Hodgkin lymphoma (diffuse, mixed cell type, B cell) with clinical stage IV in March 1989. He had been treated many times with salvage chemotherapy on admission including CHOP-etoposide and ProMACE-Cyta BOM. Recurrence, however, occurred in two or three months after any therapy. He had a therapeutic history of chronic daily administration of etoposide. In November 1991, recurrence was found in the peripheral lymph node and the colon. A new regimen of oral administration of etoposide, 50 mg/day four times a week, was employed. Two months later, the peripheral lymph node swelling disappeared. Seven months later, the patient showed no signs of recurrence by Ga-scintigraphy. This therapy is being continued. It is suggested that anti-neoplastic activity of etoposide is dependent on the schedule of administration. This regimen is suggested to be effective in the treatment of patients with refractory malignant lymphoma.

Antitumor activity of acemetacin in mice bearing colon 26 carcinoma: a preliminary report

The antitumor activity of acemetacin (ACM) was examined in mice bearing colon 26 carcinoma and its effect was compared with indomethacin (IND). The addition of ACM (0.001-0.003%) to drinking water prolonged the survival time of mice bearing colon 26. On the other hand, prostaglandin E2 (PGE2) reduced the effect of ACM. The results suggest that the antitumor activity of ACM may be associated with the reduction of PGE2 levels.

[Assay of flow cytometry for the effect of cepharanthine on resistance to doxorubicin]

The biochemical activity of cepharanthine and the possible mechanism by which it reverses the resistance to doxorubicin in P388 leukemia cells were examined in vitro. The microfluorometric analysis of the cellular level of doxorubicin in drug-resistant cells showed that cepharanthine markedly enhanced the sensitivity of doxorubicin against resistant cells in the cellular level. Cepharanthine also enhanced the inhibitory effect of doxorubicin on the incorporation of thymidine into DNA in resistant cells. The analysis of DNA histogram obtained by flow cytometry showed that doxorubicin exerted its growth-inhibitory effect by blocking the cell cycle at the G2 phase in P388 cells. At higher concentrations, doxorubicin prolonged the S phase and inhibited cell cycle progression to the G2/M phase in cells. The treatment with cepharanthine potentiated these blocking effects induced by doxorubicin in cells. It seems that the modifications of the biological effect of doxorubicin by cepharanthine are due to the change of their ability to induce DNA damage in cells.

[A case of primary intracerebral malignant lymphoma in systemic lupus erythematosus]

The patient, a 44-year-old female, was admitted to our department because of right hemiparesis and left oculomotor nerve palsy on February 7, 1986. Neither lymphadenopathy nor hepatosplenomegaly was present. She had been treated with prednisolone for systemic lupus erythematosus (SLE) for one and a half year before admission. The CT scan revealed a homogeneously enhanced mass lesion from the midbrain through the thalamus on the right side. The whole body gallium scintigram showed no abnormal uptake except in the brain. Stereotaxic biopsy was performed. Histopathological diagnosis was malignant lymphoma, diffuse, large cell type (International Working Formulation). The enhanced mass lesion disappeared after radiation therapy. Subsequently, she received chemotherapy. She remained well until May 1988 when she died because of the systemic lymphadenopathy. The association of malignant lymphoma and SLE has appeared occasionally in the literature. Primary intracerebral malignant lymphoma associated with SLE is much rarer but it should be considered in the differential diagnosis of symptoms of the central nervous system in a patient with SLE. Therefore, biopsy of a cerebral mass lesion is mandatory if appropriate therapy such as radiation and chemotherapy is to be administered.

[The roles of anesthetics and daily used drugs in cardiovascular changes during normovolemic hemodilution (NVHD)]

The changes of cardiovascular parameters and serum cathecholamine levels associated with normovolemic hemodilution (NVHD) were studied under three different conditions: Group 1; the patients for cardiac surgery who were taking cardiac drugs, and were anesthetized with fentanyl 30 micrograms.kg-1, Group 2; the patients with no-cardiac disease and taking no drugs, who were anesthetized with fentanyl 30 micrograms.kg-1 and Group 3; the patients with no-cardiac disease and taking no drugs, who were anesthetized with 0.75% halothane. Cardiac function was compared among three groups. After NVHD, blood pressure and heart rate of group 3 were significantly higher than those of group 1 and 2. Moreover, serum epinephrine and norepinephrine were elevated significantly after NVHD in only group 3. From this study, we conclude that, (1) daily used drugs do not predict hypotension during NVHD, and (2) high dose fentanyl anesthesia is associated with hypotension during NVHD.

[An investigation of drug-induced hematologic disorders in Japan--result of Hokkaido]

Patients with drug-induced hematologic disorders were clinically analysed. Fifty-nine cases were registered from 6 hospitals in Hokkaido. These were 21 cases of male and 38 of female. Age-distribution was 18 to 84 years old. Types of hematologic disorders were as follows, 9 cases of pancytopenia, 16 of bicytopenia and 31 of monocytopenia. Leukocytopenia only and leukocytopenia with another disorders were high incidence (85%). Decision of causal drug are done by DLST (drug lymphocyte stimulation test); 5 cases, drug-rechallenge; 3 cases and clinical course only; 31 cases. In 11 fatal cases by this lesion, there included 7 cases of pancytopenia.

Effect of chlorpromazine on the toxicity of doxorubicin in mice

The effect of chlorpromazine (CPZ) on the toxicity of doxorubicin (DOX) were investigated in mice. CPZ significantly enhanced the acute toxicity and bone marrow toxicity induced by DOX. These results suggest the potentiation of DOX toxicity by CPZ is due to increase of sensitivity of mice to DOX.

HTLV-I associated myelopathy (HAM) after blood transfusion in a patient with CD2+ hairy cell leukemia

Hairy cell leukemia complicating hemolytic anemia developed in a 46-year-old woman. Morphologically and cytochemically typical hairy cells were found to express both CD20 and CD2 antigens. Expression of surface IgG of kappa-chain type and the rearrangement of Ig but not T-cell receptor beta genes confirmed a B-cell origin of the leukemia. Blood transfusion was followed by disappearance of the hemolysis and a marked improvement of the leukemia. However, the patient developed progressive spastic spinal paraplegia about seven months after transfusion and was diagnosed as having HTLV-I associated myelopathy (HAM) by the demonstration of HTLV-I antibodies in serum and cerebrospinal fluid. HTLV-I infection via the transfusion may have been involved in the hematologic improvement seen in this patient. Autopsy showed demyelination, vacuolar degeneration, gliosis, and perivascular cuffing in the white matter of spinal cord without evidence of leukemic infiltration.

Potentiation of antitumor activity of pirarubicin by chlorpromazine in mice bearing doxorubicin-resistant P388 leukemia

Chlorpromazine enhanced the cytotoxicity of pirarubicin against doxorubicin-resistant P388 leukemia cells in colony forming assays. Chlorpromazine also prolonged the survival of mice bearing doxorubicin-resistant P388 leukemia, when given in combination with pirarubicin.

Reversal of resistance to doxorubicin with cepharanthine in murine P388 leukemia cells

Cytotoxic effect in vitro and antitumor effect in vivo of doxorubicin (DOX) combined with cepharanthine were investigated on DOX-resistant murine P388 leukemia (P388/R) cells. Cepharanthine was minimally cytotoxic in the cell line, but reversed DOX-resistance in a dose-related manner in P388/R cells. The administration of cepharanthine to mice bearing the P388 leukemia enhanced the antitumor activity of DOX. These results indicate that cepharanthine is an effective agent to reverse DOX-resistant cells.

An autopsy case of malignant fibrous histiocytoma of the mediastinum, presenting multiple metastases to the small intestine and to the brain--a rare case report with a review of the literature

An autopsy case of malignant fibrous histiocytoma (MFH) of the mediastinum in a 25-year-old Japanese man is described. He initially complained of general fatigue and intermittent tarry stool, and was radiographically revealed to have a huge mass within the mediastinum as well as multiple nodules within the abdominal cavity, respectively. The mediastinal tumor could not be resected because of direct tumor invasion into surrounding tissues. Within the abdominal cavity, three distinct tumor nodules were discovered in the jejunum, which could be resected surgically. Histopathologically, the components of both lesions were very similar, and the present case was interpreted as multiple metastases of mediastinal MFH to the intestinal wall. In spite of various kinds of treatment, the mediastinal tumor rapidly enlarged, causing SVC syndrome. Brain CT findings suggested multiple metastases which were considered to be the cause of death. Autopsy confirmed that the main tumor nodule was located within the mediastinum, with brain metastases. The present case of mediastinal MFH is considered to be the youngest case as well as the first case presenting intestinal metastases.

An autopsy case of triple cancers including signet-ring cell carcinoma of the breast--report of a rare case with reference to a review of the literature

A 67 year old Japanese woman who had been suffering from general fatigue was diagnosed as having metastasis of signet-ring cell carcinoma of the bone marrow from a biopsied specimen. A clinical effortive search to the systemic organs revealed a tumor of 4 x 3 cm in size in the lower part of her left breast, which was subsequently diagnosed as the primary site histopathologically. The patient was immediately treated surgically, however, her general condition generally deteriorated and she expired 5 months after the operation. Autopsy revealed dissemination of tumor cells in the bone marrow, bilateral pleura, and soft tissue around the operated site. The autopsy additionally revealed squamous cell carcinoma of keratinizing type in the uterine cervix and well differentiated tubular adenocarcinoma in the gallbladder. A review of the literature revealed this case to be the first reported case of triple cancers including signet ring-cell carcinoma of the breast, proven by autopsy in Japan.

[Tumor lysis syndrome at the induction therapy of the first remission in two cases of T-ALL]

The anti-tumor therapy followed by tumor lysis syndrome may cause the metabolic disorders including hyperkalemia, hyperphosphatemia and hyperuricemia. It should be known that it occurs frequently in lymphoproliferative diseases, especially in Burkitt's lymphoma. Two cases of T-ALL accompanied by this syndrome, from which the patients were recovered, at the induction therapy of the first complete remission are reported here. Case 1. A 28-year-old man received VP therapy under the diagnosis of T-ALL with massive hepatosplenomegaly and bilateral enlarged kidneys. During the therapy, metabolic disorders with both renal failure and ventricular tachycardia happened. They were resolved by certain series of treatments. The patient was brought to a complete remission with normal size of liver, spleen and kidneys. Case 2. A boy aged 15 having received the intrasubarachnoidal infusion of MTX and 1-Ad-VP therapy under the diagnosis of T-ALL accompanied by this syndrome which was improved by an appropriate treatment, and the patient was lead to the remission. The risk factors of this syndrome, such as 1-high drug sensitivity of the tumor; 2-renal dysfunction; 3-rapid cytokinetics of the tumor cell; 4-bigger size of the tumor, as well as the preventive treatment of this syndrome are reviewed.

[Hairy cell leukemia of European-American type with dual T and B-cell phenotype]

A 46-year-old woman was admitted because of palpitation and conjunctival jaundice. Physical examination revealed hepatosplenomegaly and purpura without lymphadenopathy. Blood count showed 4.7 g/dl hemoglobin with increased reticulocytosis. The platelet count was 1.5 X 10(4)/microliters and the leukocyte count was 6,000/microliters with 17% abnormal mononuclear cells (hairy cells). Hairy cells had nuclei of frequently folded shape and abundant cytoplasma with irregular edges on blood films. The hair-like cytoplasmic projections of the cells were clearly seen under the phase-contrast microscopy. Hairy cells were strongly positive for tartrate resistant acid phosphatase. Bone marrow aspiration was unsuccessful. The biopsy specimens showed small patchy and scattering infiltrations by hairy cells. Surface marker studies of hairy cells revealed that they were strongly positive for SmIg (IgG kappa). They also reacted with alpha B 1, alpha Tac, alpha Leu-M 5 monoclonal antibodies and a rabbit anti-hairy cell serum (alpha HC-M). 53% of hairy cells were shown to react with alpha B 1 and alpha OKT 11 simultaneously by double labelling. The southern blot analysis of peripheral blood mononuclear cells showed IgH chain genes rearrangement and germ line patterns of T-cell receptor genes. Hemolysis was promptly disappeared after blood transfusion. Moreover, the red blood cells, platelets and leukocytes have spontaneously returned to normal levels with disappearance of circulating hairy cells and palpable spleen one year after admission.

[Measurement of antibodies to human T-lymphotropic virus type-1 (HTLV-1) in cerebro-spinal fluid in patients infected HTLV-1 by blood transfusion]

Although determination of the presence of antibodies to HTLV-1 in cerebro-spinal fluid (CSF) is very important for the diagnosis of HTLV-1-associated myelopathy (HAM), these antibodies in CSF have not yet been completely investigated so far in patients without overt HAM. We examined antibodies to HTLV-1 in CSF of leukemia patients who were infected with this virus via blood transfusion. All of 5 patients showed positive antibody titer, one of 5 patients was a patient with overt HAM. According to Western-blotting analysis in CSF, IgG p-19, 24 and 28 antibodies were positive in 4 patients without overt HAM, but IgM antibody was negative. In contrast, IgG antibodies as well as IgM p-24 antibody were positive in patients with overt HAM. These results suggest that further studies on antibodies to HTLV-1, especially on IgM antibody, in CSF of HTLV-1 infected patients with or without overt HAM may be helpful to better understanding of the mechanism on onset of HAM following blood transfusion.

[Clinical analysis of 82 patients with non-Hodgkin's lymphoma--mainly on the evaluation of therapeutic efficacy]

A retrospective study of eighty-two patients with non-Hodgkin's lymphoma whom we had treated for the past ten years was performed to discuss the prognosis (50% survival duration (50%s) and 5-year survival rate (5ys)) of the histopathological types, clinical stages and therapeutic regimens respectively. Patients were staged according to the Ann Arbor criteria and classified histopathologically according to the Lymphoma Study Group (LSG) and new Working Formulation. The treatment programs consisted of radiotherapy alone (Co alone), VEP regimen (vincristine, cyclophosphamdde and prednisolone), VEPA regimen (VEF + adriamycin) and radiotherapy followed by adjuvant chemotherapy (co + chemotherapy). Survival curve was calculated by the method of Kaplan and Meier. Camparisons in remission duration and survival were analyzed by the Logrank test.

RESULTS

1. In 82 evaluable patients, 50%s was 27 months and 5ys was 31%. For patients with complete remission (CR), partial remission (PR) and no response (NR) 50%s was 49, 6 and 4 months respectively (CR vs. PR: p less than 0.01). 2. For the several histopathological types 50%s was the following: d-medium (6 months) less than lymphoblastic (17 months) less than d-large (27 months) less than d-small (32 months) less than pleomorphic (43 months). There was difference in 50%s and 5ys for three grade malignancies classified by new Working Formulation (p greater than 0.10). 3. For clinical stages (Cs) 50%s was the following: Cs I; 40 months, Cs II: 49 months, Cs III: 43 months and Cs IV: 6 months respectively. There was no difference in its duration in Cs I, II and III (p less than 0.10). However, in 5ys Cs I was superior to Cs II, III and IV in order (Cs III vs. Cs IV: p less than 0.01). 4. For initial therapy the prognosis was better with VEPA regimen (50%s: 49 months, 5ys: 39%) than with VEP regimen (50%s: 24 months, 5ys: 24%) (p greater than 0.10), and with Co + chemotherapy (50%s: 54 months, 5ys: 30%) than with Co alone (50%s: 18 months, 5ys: 25%) (p greater than 0.10). 5. For localized lymphoma (Cs I, II) the prognosis was better with VEP regimen (50%s) 80 motnths, 5ys: 62%) than with Co alone (50%s: 32 months, 5ys: 27%) (p greater than 0.10), and the remission duration was significantly longer with VEP regimen than with Co alone (p less than 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)

Non-T, non-B acute lymphocytic leukemias: cellular origin based on molecular analyses of immunoglobulin and T-cell alpha- and beta-chain receptor gene rearrangements

Fifteen non-T, non-B acute lymphocytic leukemia (ALL) cases were investigated for determining cellular origin based on molecular (immunoglobulin and T-cell alpha-receptor (TcR alpha) and T-cell beta-receptor (TcR beta) genes) and immunophenotypical analyses. As defined by monoclonal antibodies, they were classified into 2 groups; 12 cases as common ALL antigen (CALLA)-positive ALL and 3 cases as CALLA-negative ALL. Southern blot analysis revealed that 11 CALLA-positive ALL cases contained rearranged JH gene and 2 of them contained rearranged Jx genes, similar to recent views that most CALLA-positive leukemic cells are neoplastic B-cell precursors. One CALLA-positive ALL case, whose leukemic cells were also Leu-1 positive, showed no rearrangement of JH and TcR beta genes. On the other hand, non-T, non-B CALLA-negative ALL, so called null ALL, consisted of heterogenous groups with regard to lymphocyte differentiation and lineage; one out of 3 null ALL cases may be truely undifferentiated as shown neither JH nor TcR beta gene rearrangement, but other 2 cases showed either JH or TcR beta gene rearrangement. Dual rearrangements of Ig and TcR beta genes occur frequently in 3 out of 15 non-T, non-B ALL cases, but all cases of bigenotype showed no doubly marked profile and retained a completely fidelous immunophenotypic pattern. We further investigated the possibility that analysis of TcR alpha gene may be useful for determining cellular origin of non-T, non-B ALL leukemic cells.

[Smoldering adult T-cell leukemia complicating severe respiratory failure--an autopsy case report]

An autopsy case of smoldering adult T-cell leukemia (ATL) is presented. 67 year-old woman was admitted to our hospital with complaints of fever, cough and increasing dyspnea on October 2, 1985. Laboratory findings revealed high LDH, azothermia and slightly leukocytosis with low percentage of flower cells. CRP was strongly positive. Gas disturbance was markedly. Anti-ATLA antibody using indirect immunofluorescence method was X40 positive. Subsets of peripheral lymphocytes showed OKT 4 dominant. (OKT 3; 67.5%, OKT4; 60.6%, OKT8; 8.8%). A chest X-ray film revealed cardiomegaly and fine granular shadows in bilateral lower pulmonary fields. Diagnosis of interstitial pneumonitis was defined in transbronchial lung biopsy (TBLB) specimen. O2 therapy, steroid therapy added antibiotics were ineffective, respiratory failure and renal failure were progressive, she died by septic shock in 39th hospital days. In autopsy, no characteristic histological changes of ATL were found in lymph node, bone marrow, spleen, liver, kidney and lung. Sepsis was the cause was of death. Finally this case diagnosed smoldering ATL and pulmonary fibrosis due to bronchial ectasia with repeated pulmonary bacterial infections. The pulmonary complications of patients with ATL were discussed.

[Adult T-cell leukemia and non-Hodgkin's lymphoma in brothers]

Adult T-cell leukemia/lymphoma (ATL) is an endemic disease in the Southwestern districts of Japan. Intrafamilial cluster of ATL and other T-malignancy frequently reported in these area. We reported cases of ATL and non-Hodgkin's lymphoma in brothers, they were born in Hokkaido where is non-endemic area of ATL. The first case (ATL) is 53 y. male and the second case (non-HD), younger brother of the first case, is 55 y male. Anti-ATLA (ATL-virus associated antigen) antibody were positive in both of them, their elder sister, wife and child of the first cases. Examination of anti-ATLA antibody and follow up study is necessary in the family members of ATL, because they may be in a high risk group of ATL outbreak.

[Epidemiological studies of adult T-cell leukemia virus in patients with adult T-cell leukemia (ATL) and ATL-related diseases in Hokkaido District of Japan]

Sera and peripheral blood lymphocytes in 40 clinical cases of adult T-cell leukemia (ATL) and 66 cases of mature T-cell malignancies in Hokkaido district, the most northern part of Japan, were examined for the infection with ATL virus (ATLV). All of the 40 ATL patients (100%) had antibodies to ATLV-associated antigen (ATLA) and 13 (19.7%) of the 66 patients with mature T-cell malignancies other than ATL were also positive for anti-ATLA. When the peripheral ATL lymphocytes were assessed after short time cultivation, both ATLA antigen and C type virus particles were detectable. In contrast to the high prevalence of ATLV antibodies in these patients, the positivity in 30,000 control individuals in this district was 0.73%. It was calculated that 8 patients of a 40,000 seropositive population are diagnosed annually as ATL in this particular northern part of Japan.