[Transient appearance of asynergy on the echocardiogram and electrocardiographic changes simulating acute myocardial infarction following non-cardiac surgery].

Two-dimensional echocardiography (2-D echo) was performed for six postoperative patients who had acute myocardial infarction (AMI)-like electrocardiographic (ECG) changes. All but one, who had coronary T waves, demonstrated abnormal Q waves in V1-V4, decreased amplitude of R waves, and low voltage in limb leads. ST elevation was also observed. Abnormal Q waves in V1-V4 began to resolve in a few days and the QRS complex reverted to normal within one month; however, coronary T waves were observed for at least three months. In the remainder one, persistent Q waves were present from the onset. 2-D echo, performed simultaneously with ECG, showed akinesis or dyskinesis accompanied by ventricular dilatation, not only at the anterior septum, anterior wall and around the apex, but in more extensive areas in four of five cases with abnormal Q waves in V1-V4. In two other cases, which showed abnormal Q or coronary T waves alone, akinesis was limited to the anterior septum and to the septal site and anterior wall of the apex. All abnormal findings on 2-D echo completely resolved within one month, as the ECG findings returned to normal. Compared with typical AMI showing abnormal Q waves in V1-V4, asynergy was recognized in more extensive areas and abnormal wall motion indices significantly improved in the postoperative cases. In the postoperative cases with AMI-like ECG, the CPK-MB fraction increased; however, the peak level of CPK was lower than that in typical AMI. On the basis of these results, transient AMI-like ECG findings in postoperative cases are due to extensive myocardial damage, which is probably derived from focal myocytolysis.

[Intrathoracic administration of adriamycin with closed tube thoracostomy drainage for malignant pleuritis: observation on the administration dosage].

The effect of intrathoracic administration of adriamycin with closed tube thoracostomy drainage was investigated on patients with various malignant pleural effusions (13 lung cancer and one each stomach, breast, ovarian cancer, respectively). The doses of adriamycin ranged from 50, 30, 20, to 10 mg given to four groups of 4 cases respectively. Comparative study on effective rates, survival period after the administration, side effects and histopathological changes in autopsied cases was performed. The results obtained were as follows: 1. With regard to effective rates and histopathological changes, no difference was observed in the four groups in term of dose escalation of Adriamycin. 2. 50% survival period was similar within the groups administered 20, 30 and 50 mg of Adriamycin. However, the group receiving 10 mg showed slightly shorter survival period. 3. Although serious side effects were not observed in any groups, minor toxicities were mostly encountered in the 50 mg group. 4. It was concluded that in the treatment of malignant pleural effusion, an appropriate dose of intrathoracic administration of adriamycin was about 20-30 mg.

[Comparative evaluation of a combination of daunorubicin and cytosine arabinoside and that of aclarubicin and cytosine arabinoside in remission induction in acute non-lymphocytic leukemia].

A comparative trial of a combination of daunorubicin and cytosine arabinoside (Regimen A) and a combination of aclarubicin and cytosine arabinoside (Regimen B) was performed. Sixteen patients with acute non-lymphocytic leukemia, previously untreated, were entered into this study. Five of 8 patients (62.5%) obtained a complete remission (CR) in Regimen A and B, respectively. The days required for achieving a CR varied from 37 to 46 days in Regimen A and from 22 to 56 days in Regimen B. The total doses of daunorubicin and cytosine arabinoside were from 100 to 240 mg and from 640 to 1,120 mg in Regimen A, respectively. Those of aclarubicin were from 180 to 300 mg and from 660 to 1,000 mg in cytosine arabinoside in Regimen B. In a comparative study on hematological changes, toxic effects on peripheral white blood cell, platelet and nucleated cell counts in bone marrow tended to appear later in Regimen B compared to those in Regimen A. Side effects on digestive system such as nausea and vomiting and vascular pain were more frequently recognized in patients treated with Regimen B, although they were managed by symptomatic treatment. The results indicated the usefullness of aclarubicin in combination chemotherapy for the treatment of acute non-lymphocytic leukemia.

[Clinical management of acute lymphocytic leukemia in adults. 1. Treatment of acute lymphocytic leukemia with VP (vincristine, prednisolone)--DVMP (daunorubicin, vincristine 6-mercaptopurine, prednisolone) regimen].

Eighteen patients with acute lymphocytic leukemia (ALL) were treated with VP (vincristine, prednisolone) followed by DVMP (daunorubicin + vincristine + 6-mercaptopurine + prednisolone) regimen (VP-DVMP regimen). Patients were all previously untreated. Complete remission (CR) was obtained in 11 of 18 patients (61.1%,) by VP alone and 4 patients, by VP-DVMP. The time required for CR varied from 14 to 60 days with a median of 28 days. The duration of CR and survivals in responders were from 1.2 to 42.3 + months with a median of 24.0 months. The hematological toxicities in VP-DVMP regimen were lower than those in NVP (neocarzinostatin + vincristine + prednisolone) and NVMP (neocarzinostatin + vincristine + 6-mercaptopurine + prednisolone) regimens.

Treatment of relapsed acute myelocytic leukemia with a combination of aclarubicin and cytosine arabinoside.

Relapses in nine patients with acute myelocytic leukemia were treated with a combination of aclarubicin (ACR) and cytosine arabinoside (ara-C). ACR, 40 mg/m2/day, was administered daily by intravenous injection from day 1 to day 3 and ara-C, 60-80 mg/m2/day, divided into 2 doses, was given every 12 h by intravenous infusion from day 1 to day 7. Depending on the state of the bone marrow, ACR-ara-C regimen was modified in administration period and repeated after the resting periods of at least 7 days. Complete remission was obtained in 7 of 9 patients (77.8%). The time required for achieving the complete remission varied from 20 to 55 days with a median of 39 days. The duration of complete remission was from 8 to 52 weeks with a median of 22 weeks. Side effects on digestive system such as nausea, vomiting and anorexia, were seen in all patients, although they were managed by symptomatic treatment. The results indicate the effectiveness of this ACR-ara-C regimen in the clinical management of acute nonlymphocytic leukemia.

Treatment of refractory acute leukemia with aclacinomycin-A.

Twelve patients with refractory acute leukemia (7 patients with acute myelocytic leukemia and 5 patients with acute lymphocytic leukemia) were treated with a new anthracycline antibiotic, aclacinomycin-A (ACM). ACM was administrated by intravenous drip infusion at a dose of 20 mg/day for 7 or 14 days and this was repeated after at least 7 days. Four of 12 patients (33.3%) achieved a complete remission; 3 of 7 acute myelocytic leukemia (42.8%) and 1 of 5 acute lymphocytic leukemia (20.0%). The days required for achieving the complete remission ranged from 23 to 78 days (median: 61) and the total doses of ACM used from 180 to 500 mg (median: 310), and the durations of complete remission from 11 to 28+ weeks (median: 21+). The untoward effects on digestive organs, such as nausea, vomiting and anorexia, and hematological toxicities were frequently seen; however, they were controlled by supportive treatment. Alopecia was not observed. Arrythmia was recognized in one patient at the initiation of ACM infusion with complete remission without withdrawal of ACM. These results suggest that ACM is a potentially effective anthracycline antibiotic in the clinical management of acute leukemia.

A case of hand mirror cell variant of acute lymphoblastic leukemia.

A 30 year old female patient diagnosed as acute lymphoblastic leukemia (ALL) with hand mirror like configuration of lymphoblastic-lymphocytic cells is reported. Although the leukemia was resistant to conventional chemotherapeutic regimens, the patient always looked well and survived for more than 20 months. Surface marker analysis showed that the cell was non-T, non-B, and not reactive to antiserum against common ALL antigen. A cytogenetic study of all the analyzable metaphases of the direct bone marrow preparation had a normal female karyotype. The clinical and hematological course is described. The immunological significance and the influence of hand mirror cell on chemosensitivity and prognosis are discussed.

Normal chemotactic activity of granulocytes obtained by filtration leucapheresis.

The chemotactic activity of granulocytes obtained by the Terumo Filtration Leucapheresis System (F.L.) was examined by the method of Boyden's chamber. The number of cells migrating through the Millipore filter was expressed as the chemotactic activity. The mean values were 117 for the F.L. and 122 in a control, in which cells were collected from the same donor blood using dextran sedimentation. The results suggested that the in vitro chemotactic function of granulocytes obtained by F.L. was within normal limits.