[Immunoblastic lymphadenopathy (IBL)-like T cell lymphoma associated with granulocytopenia and autoimmune hemolytic anemia].

A 65 year-old woman was admitted in May 1990, because of fever, generalized lymphadenopathy and eruption. Laboratory examination showed granulocytopenia, polyclonal hypergammaglobulinemia, positive Coombs' test, positive cold antibody and positive anti-E erythrocyte antibody. 7 days after admission autoimmune hemolytic anemia developed. The appearance of the anti neutrophil leukocyte antibody was suspected because of the absence of the segmented neutrophils in marrow specimen. Histological findings of the biopsied lymph node and the marker study of the tumor cell disclosed IBL-like T cell lymphoma. The patient was treated with G-CSF and VEPA chemotherapy. Granulocytes increased and she showed marked symptomatic improvement with complete remission. Our case showed various clinical pictures with hemolytic anemia and granulocytopenia, which could be based on the autoimmune mechanisms.

Effects of lisinopril and low-dose trichlormethiazide on lipoprotein metabolism in patients with mild to moderate hypertension.

Fifty-six hypertensive patients were recruited to participate in a 12 week, randomised, multicentre trial to compare the effects of lisinopril (n = 31) and low-dose trichlormethiazide (n = 25) administration on blood pressure and lipoprotein metabolism. Both systolic and diastolic BPs decreased significantly after administration of lisinopril (5-40mg/day, mean dose 11 mg/day) and trichlormethiazide (2.0-4.0 mg/day, mean dose 2.2 mg/day). There were no significant changes in lipids, lipoproteins or apolipoproteins with either drug for 12 weeks and no significant differences between the two drugs for these parameters. It is concluded that lisinopril and low-dose trichlormethiazide administration are effective antihypertensive measures without any adverse effects after 12 weeks on lipoprotein metabolism in patients with mild to moderate essential hypertension.

Allergic bronchopulmonary aspergillosis caused by Aspergillus terreus presenting lobar collapse.

A case of allergic bronchopulmonary aspergillosis (ABPA) is described which presents left upper lobe collapse caused by Aspergillus terreus, an organism rarely found in ABPA. It is unusual for initial radiographic findings of ABPA to include extensive collapse.

Hiatal herniation of the colon with digestive tract bleeding--a case report.

A 71 year old woman with hiatal herniation was admitted to our hospital with anemia and melena. A barium enema revealed hiatal herniation of the transverse colon in conjunction with the stomach, which seemed to be strangulated by the esophageal hiatus. She underwent surgery, for which Hill's gastropexy method was employed and has had no signs of bleeding since. By presenting this case, we stress the importance of marking a careful differential diagnosis due to the variability in symptoms of digestive tract bleeding.

[An epidemiologic study of anti-ATLA (antibody to adult T-cell leukemia-associated antigen) by category of disease in the Karatsu and Higashimatsuura districts of northern Kyusyu by enzymeimmunoassay].

The Kyusyu district is known as an endemic area of HTLV-I. But the prevalence of anti-ATLA in Saga prefecture was reportedly relatively low. In this study, in order to determine the distribution of antibody to ATL-associated antigen (anti-ATLA) in the Karatsu and Higashimatsuura districts of the northern Kyusyu, the determination of anti-ATLA status of patients in Karatsu Red Cross Hospital was carried out from September to October, 1985. Sera from 757 patients were tested for presence of anti-ATLA by Enzyme immunoassay (EIA) prepared by Eisai Co., Ltd. Tokyo, Japan. Results obtained are as follows: 1) Overall prevalence of anti-ATLA was 13.7 per cent (104 of 757 individuals). Prevalence of anti-ATLA increased with age, reaching a maximum of 21.1 per cent for people from 60 to 69 years old. 2) Prevalence of anti-ATLA was 9.5 per cent (36 of 376) in males and 17.8 per cent (68 of 381) in females. A significant difference by sex was recognized. (p less than 0.001) 3) The positive rates of patients with non-malignant diseases were high in the Chinzei, Hizen, and Hamatama areas facing the Sea of Genkai. The positive rate of the seaside area was significantly higher than that of the mountain area. (p less than 0.001). 4) Anti-ATLA was most prevalent in the patients with neoplasms (26.1%). The positive rate of ATL patients was 100 per cent, and that of patients with malignancies other than ATL was 25.9 per cent. These results suggest that HTLV-I infection is likely to increase the incidence of other types of malignancy.

Effects of a new calcium channel blocker, TA 3090, on serum lipoprotein levels in mild to moderate essential hypertension.

The 25 hypertensive patients received 20 to 40 mg of TA 3090 daily for 12 weeks. Blood pressures declined significantly during treatment, from a mean of 162/98 to 145/88 mmHg. There were no significant changes in levels of total or very low-density lipoprotein cholesterol or triglyceride, in levels of low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol, HDL2 cholesterol, HDL3 cholesterol, or in levels of apolipoprotein (apo) B, C-II, C-III, or E. Apo A-I and A-II levels increased significantly from 130 and 29.2 mg/dl before treatment to 152 and 31.4 mg/dl at 12 weeks. Mean serum creatinine levels decreased significantly from 0.92 to 0.80 mg/dl. No other drug-related changes in laboratory test results or side effects were noted. It is concluded that TA 3090 is a safe and effective treatment for mild to moderate hypertension.

[Therapeutic effect of recombinant interferon alpha on Takatsuki disease].

A case of Takatsuki disease, 57-year-old male associated with monoclonal IgA, lambda-type immunoglobulin was treated with recombinant alpha-interferon daily by intramuscular injection with an initial dose of 3 X 10(6) U/day. Four weeks later, gynecomastia was improved and breast pain disappeared. Increases of cholesterol from 84 mg/dl to 135 mg/dl and cholinesterase from 0.24 delta pH to 0.48 delta pH were observed, 8 weeks later. Though, there was no reduction in serum M protein, no decrease in the number of bone marrow tumor cell and no restoration of muscle atrophy and polyneuropathy. No predominant side effect was observed. We conclude that rIFN alpha has a some potential role in the treatment of Takatsuki disease and additional chemotherapy should be considered. Significance of the therapy against Takatsuki disease was discussed.

Central nervous system involvement in adult T-cell leukemia/lymphoma.

Central nervous system (CNS) involvement was reviewed in 99 patients with adult T-cell leukemia/lymphoma (ATLL). Fifteen episodes of CNS involvement developed in ten of 99 patients (10.1%); nine had leptomeningeal involvement, whereas two developed intracerebral invasion, one developed cord involvement, and one developed both. CNS involvement was more frequent in the lymphoma type than in the other types of ATLL. Nuchal rigidity was not common (33%) and a syndrome of inappropriate secretion of antidiuretic hormone (ADH) occurred in association with CNS involvement (40%). Three episodes of marked hypoglycorrhachia also were noticed. The systemic progression of ATLL was the most common setting of CNS involvement (80%) and the major cause of death (80%). As for the acute and lymphoma types of ATLL, no significant difference was observed in survival between patients with and those without CNS involvement. These results indicate that CNS involvement is not an essential prognostic factor of ATLL and that it should be treated with systemic chemotherapy coupled with intrathecal chemotherapy. The control of systemic ATLL is important for the prophylaxis of CNS involvement.

Incidence of adult T-cell leukemia/lymphoma among human T-lymphotropic virus type I carriers in Saga, Japan.

Using a population-based cancer registry, we tabulated 69 definite adult T-cell leukemia/lymphoma cases (36 males and 33 females) and 2.20 expected cases (0.95 for males and 1.25 for females) diagnosed from 1981 to 1983 in Saga, Japan. The number of human T-lymphotropic virus type I carriers was computed by applying sex- and age-specific anti-human T-lymphotropic virus type I antibody positive rates among blood donors at the blood center in 1986 to the whole population of Saga Prefecture in 1982. The age-specific incidence rates among male human T-lymphotropic virus type I carriers from 40 to 79 yr of age per 100,000 were significantly higher than those of female carriers (P less than 0.05), and the rates from 60 to 69 yr of age were the highest in both sexes. The annual crude incidence rates among carriers were 115.9 for males and 66.4 for females. The summary incidence rates with 95% confidence intervals were 115.9 (58.4 to 193.0) for males and 65.9 (30.0 to 115.9) for females. The cumulative risks were 4.5% (0.8 to 11.0) for males and 2.6% (0.3 to 7.0) for females. These morbidity figures were assumed to be underestimated partly due to the newly proposed clinical entity of adult T-cell leukemia/lymphoma.

[A case of CSF (colony-stimulating factor)-producing lung cancer and a review of the literature].

A 36-year-old man with large-cell carcinoma of the lung showed marked leukocytosis of up to 109,300/mm3. As high CSF activity was detected in the pleural effusion and the supernatant of cell cultures originating from the effusion, a diagnosis of CSF-producing lung cancer was made. Twenty-one CSF-producing lung cancers have been reported in Japan. They comprised 13 large-cell carcinomas, six squamous cell carcinomas, one adenocarcinoma and one small cell carcinoma.

A new electrophoretic variant of hemoglobin (Ogi) in which a leucine residue is replaced by an arginine residue at position 34 of the alpha-chain.

Hemoglobin Ogi, in which an arginine is substituted for a leucine residue at position 34 of the alpha-chain, was detected in a Japanese family. Although slightly increased oxygen affinity is associated with this amino acid substitution in the alpha 1 beta 1 contact, it is without obvious deleterious effect on the hematological parameters of the individuals heterozygous for this variant.

Frequency and distribution of structural variants of hemoglobin and thalassemic states in Western Japan.

Hemolysates from 100,000 people who visited the Kyushu University Hospital and affiliated hospitals during the past 15 years were screened for hemoglobinopathies using electrophoresis on thin-layer starch gel; those exhibiting an abnormality were characterized further on clinical, biochemical, and genetic grounds. Of about 97,000 adult and 3,140 cord blood samples, 29 contained electrophoretically detectable abnormalities in the heterozygous condition. Another 17 samples had quantitative changes in the levels of the minor hemoglobin components. Of the thalassemic conditions, 12 involved beta-thalassemia, 3 alpha-thalassemia, 1 delta beta-thalassemia, and 1 delta-thalassemia. Among 45 carriers of beta-thalassemia from 12 families, 5 were noted to have thalassemia intermedia since they exhibited much more severe hemolytic syndromes than those with typical beta-thalassemia minor. The frequency with which we could detect a structural variant of Hb A in the adults by electrophoresis was one in 3,800 samples. About one in 8,000 carried a beta-thalassemia gene.

Increased oxygen affinity for hemoglobin Sawara: alphaA4(6) aspartic acid replaced by alanine.

The oxygen binding property of Hb Sawara (alphaA4 Asp replaced by Ala) was studied at different pH values with and without addition of 2,3-diphosphoglycerate. The oxygen affinity of Hb Sawara was shown to be increased, the difference of the log P50 value between normal and abnormal hemoglobins being 0.37 at pH 7.0. Both the magnitude of the alkaline Bohr effect and the effect of 2,3-diphosphoglycerate upon oxygen affinity of Hb Sawara were comparable to those of Hb A. The amino acid substitution of alanine for alphaA4 aspartic acid might result in the loss of a stabilizing force for ionic interaction between the alpha-amino group of NA (1)alpha1 valine and the alpha-carboxyl of HC3(141)alpha2 arginine in the deoxy-form.