Quality of life in adult patients after stem cell transplantation.

Many articles pertaining to quality of life (QOL) following stem cell transplantation have been published in the US and western Europe. However, since the actions of health insurance systems and overall cultural aspects are strongly associated with QOL, investigations into QOL should be carried out within all countries. Therefore, we have investigated the QOL of adult patients following stem cell transplantation at 31 hospitals in Japan. The survivors, who were surveyed by mail questionnaire, were 20 years or older at the time of this study. The underlying diseases were acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, non-Hodgkin's lymphoma, Hodgkin's disease, myelodysplastic syndrome, and multiple myeloma. Median age at the time of the study was 36 years, and median interval after transplantation was 35.3 months. Of 383 patients surveyed, 282 (73.6%) responded to the questionnaire. One hundred and ninety-two patients were treated with an allogeneic-related transplantation, 52 with allogeneic-unrelated, and 38 with an autologous transplantation. Our data revealed that the length of time since transplantation and the diagnosis of chronic GVHD were associated with QOL. When unrelated and related transplantation recipients were compared, ratings on relief from pain, stability in weight, and confidence in dealing with daily life were lower among unrelated transplantation patients.

[Therapeutic effect of donor leukocyte transfusion in relapsing marrow transplants in Japan].

The immune reactivity of allogeneic lymphocytes plays a major role in control of leukemia after bone marrow transplantation. We studies the efficacy of donor leukocyte transfusion (DLT) on acute and chronic leukemia in relapse after bone marrow transplantation in Japan. Sixty nine patients with chronic myelocytic leukemia (N = 17), acute lymphoblastic leukemia (N = 25), acute myelocytic leukemia (N = 26), myelodysplastic syndrome (N = 5), non-Hodgkin lymphoma (N = 2) and rhabdomyosarcoma (N = 1) were treated with transfusions of donor lymphocytes. Therapeutic effects were induced by donor leukocyte transfusion in 20 patients (29%) including 3 patients out of 4 (75%) with CML in cytogenetic and chronic phase relapse, 4 out of 5 (80%) patients with myelodysplastic syndrome, 3 out of 13 (23%) patients with CML in transformed phase, 5 out of 25 (20%) patients with acute myelocytic leukemia, and 4 out of 20 (20%) patients with acute lymphoblasic leukemia. Twenty two patients (30%) developed acute GVHD (> or = 2) and 6 out of 73 (8.2%) patients developed fatal GVHD after donor leukocyte transfusion. Patients relapsed within 6 months after marrow transplantation had a probability of having severe acute GVHD (> or = 2) after DLT. Fourteen out of 24 (58%) patients with GVL response were re-relapsed thereafter. Minimal dose of donor leukocytes infused in successfully treated 9 patients without cytoreductive therapy was 2 x 10(7)/kg in total and minimal dose of that in 6 patients with fatal GVHD was 7 x 10(7)/kg in total. The anti-leukemia effect of donor leukocyte transfusion was strongest against CML in cytogenetic and chronic phase and induce a durable complete remission.

Identification and characterization of a family of genes for the plasma membrane H(+)-ATPase of Oryza sativa L.

A cDNA clone (cOSA2) encoding a plasma membrane H(+)-ATPase was isolated from rice. Southern blot analysis indicated that the genes that corresponds to cOSA2 was different from that to cOSA1. Northern blots revealed OSA2 mRNA in roots, calli and shoots. OSA1 transcripts were detected only by RT-PCR in these tissues.

[Clinical evaluation of amikacin by intravenous drip infusion for infections in the field of internal medicine].

Amikacin (AMK) by intravenous drip infusion was given to patients with infections in the field of internal medicine and the results were followings: AMK was administered to 19 patients. Diagnosis included sepsis or suspected sepsis (11 cases), pneumonia (2 cases), chronic respiratory tract infections (3 cases) and urinary tract infections (3 cases). Underlying disease included hematologic disease (13 cases), lung fibrosis (1 case), chronic respiratory insufficiency (1 case), diabetes mellitus (1 case), hepatic coma and bronchial asthma (1 case) and prostatic hypertrophy (1 case). Nineteen episodes responded to single therapy (2 cases) or combined therapy with other antibiotics (17 cases). AMK by intravenous drip infusion (dissolved in not less than 100 ml of saline or glucose) was administered at the dose of 200 mg/day to 600 mg/day divided into 2 or 3 times, over 1 hour to 2 hours. The mean duration of therapy was 10 days and the mean total dose was 4.3 g. Clinical effects: Excellent in 7 cases, good in 7 cases, fair in 3 cases and poor in 2 cases, and efficacy rate was 74%. Bacteriological effects: Disappeared in 3 cases, partly disappeared and unchanged in 3 cases, superinfection in 1 case and newly appeared in 1 case. Four strains out of 7 cases of which were detected the causative bacteria were disappeared. GM resistant bacteria (S. marcescens in 2 strains and C. diversus in 1 strain) were disappeared by the administration of AMK, also some clinical symptoms and signs were improved. No side effects and no abnormalities in laboratory findings were noted in any cases attributed to AMK. In conclusion, high efficacy rate was obtained without any side effects, intravenous drip infusion of AMK seemed to be useful for infections in patients with bleeding tendency (e.g. leukemia) or malignant disease.

[Experience in treatment of Mycoplasma pneumoniae with acetylspiramycin].

Antibiotics of tetracycline and macrolide groups are mainly used in treatment of Mycoplasma pneumonia. In this study, acetylspiramycin (ASPM), an antibiotic of macrolide group, was given to 15 cases of Mycoplasma pneumoniae who visited this institute during the period from January, 1980 to March, 1981, and its clinical effects and side effects were investigated. The therapeutic effects were evaluated by days to the normal body temperature, to improvement in cough and to improvement in X-ray findings. The increase in serum antibody value was adopted as the diagnostic index of Mycoplasma infection. The patients who entered into this study were 7 males and 8 females, ranged from 19 to 60 years of age with an average of 36.3 years. The daily dose of ASPM was 600 to 1,200 mg (potency), and the mean administration period was 18.1 days. The results obtained were as follows. 1. The temperature fell to the normal within 2 to 7 days. 2. Cough disappeared in 2 days at shortest and in 55 days at longest. The mean period of cough disappearance was 14.5 days. 3. In 10 cases who could be followed up, shadows in X-ray films disappeared in 3 days at shortest and in 40 days at longest. The mean period to shadow disappearance was 18.6 days. 4. As regards clinical effects, marked improvement was obtained in 2 cases, improvement in 9, slight improvement in 4, and no change in 0 (improvement rate: 73.3%). 5. As a side effect, nausea was found in 1 case, but it was improved by discontinuance of administration.

[Clinical studies of cefoxitin in the field of internal medicine].

Ten patients with sepsis and pneumonia complicated by leukemia or lung cancer were treated with cefoxitin (CFX) at daily dose of 6 g. The following results were obtained. 1. Clinical effects of CFX were good in 5 patients, fair in 2 and poor in 3 with effective rate of 50%. 2. Out of 8 patients with sepsis, 5 showed good response to CFX and effective rate was 62.5%. 3. Bacteriological outcomes were eradicated in 1, unchanged in 1, replaced in 2 and unknown in 6 cases. 4. Diarrhea was observed in 1 patient but this was not considered related to CFX therapy. 5. No abnormal laboratory finding due to CFX was observed. 6. It should be considered that 6 g or more of CFX is given in case of severe infections, such as sepsis or pneumonia complicated by serious underlying diseases.

[Treatment of spontaneous pneumothorax due to emphysema]. / Contributii la tratamentul pneumotoraxului spontan generat de emfizem

The authors make an analysis of 455 cases of spontaneous pneumothorax hospitalized and treated in the Clinic for Thoracic Surgery from Bucharest between 1952 and 1974. The therapeutic attitude recommended in such cases is the aspiration drainage through minimal pleurotomy (aspiration being carried out in relation with the parenchymal aerial losses). Introduction through the drainage tube of irritating substances will enhance pleural symphisis. The drainage will be maintained for 7--8 days. In the recidivating pneumothorax, or in cases where recovery is not achieved by aspiration drainage, thoracotomy becomes necessary for performing total pleurectomy and atypical resection of emphysema bubbles from the pulmonary cortical, since these are at the origin of the aerorrhagies (the Coman procedure). With the aid of these surgical techniques very good results have been obtained in all cases of spontaneous pneumothorax.