[Chronic lymphocytic leukemia associated with multiple myeloma].
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Biomedical subjects
Publications and source records attributed to Y Kiryu.
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A 59-year-old man was admitted complaining of substernal pain and anorexia. Upper GI series revealed a benign gastric ulcer in the posterior wall, and gastrofiberscopy was done. Besides the benign lesion, two early carcinomas of type IIc were found. Biopsy specimens of both lesions showed malignancy and gastrectomy was performed. Histological investigation revealed poorly differentiated adenocarcinoma in the anterior wall and well differentiated tubular adenocarcinoma in the posterior wall. Both lesions were absolutely independent and isolated. In most instances, multicentric or multiple early gastric carcinomas manifest similar histological features, but in our case, the lesions were of different types.
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We describe a case of a 47-year-old man with retroperitoneal poorly differentiated myxoid liposarcoma. The retroperitoneal invasion of the sarcoma caused hydroureter-nephrosis, rectal stenosis and also exaggerated steroid induced diabetes mellitus. A remarkable regression was achieved by systemic combination of chemotherapy with prednisolone, cyclophosphamide, vincristine sulfate and actinomycin D. This combination chemotherapy is worth trying if a patient has inoperable liposarcoma. It can also be used to reduce local recurrence rate after surgical or radiation therapy, or both, against liposarcoma.
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Plasma histamine level (PHL) was evaluated by a modified fluorometric assay (Suzuki) in the patients with various forms of liver disease as well as rabbits with liver injury. And the data obtained were compared with liver function tests in assessing the stage and prognosis of hepatic dysfunction. In acute hepatitis, if its prognosis was "good", as was also shown in the animal group with single dose administration of CCl4, the level of plasma histamine attained a peak before that of serum transaminases, and returned to normal prior to that of the latter. In persistent and chronic hepatitis, although correlation between PHL and other liver function tests was poor and variable, PHL remained high. And the estimation of PHL during the course of this state showed that it was elevated prior to that of serum transaminases, in dicating high level of plasma histamine in this state, even in apparent "steady state", worsening of the disease. In liver cirrhosis PHL correlated with the degree of serum transaminases as well as serum gammaglobulin. In "poor prognosis" group (patients with hepatic coma and rabbits treated with consecutive administration of CCl4) PHL increased extremely high, which was contrasted with the lowered levels of transaminases. These results strikingly suggest that histamine is involved in liver injury and estimation of PHL in the course of hepatic disorder is useful for a prediction of prognosis.
The effect of orally administered histidine decarboxylase inhibitor on liver function tests and histological appearance as well as on plasma histamine level were evaluated in biopsy proven 13 patients with chronic active hepatitis, whose liver function tests were refractory to other measures. Tritoqualine was used as histidine decarboxylase inhibitor and was administered in dose levels of 600 to 1,600 mg per day. Before treatment the average value of SGOT, SGPT and plasma histamine showed 252 +/- 24U, 318 +/- 152U and 15.2 +/- 5.5 microgram/L, respectively. Results obtained at six weeks' treatment, however, gave significantly improved values, indicating SGOP 57 +/- 24 (p less than 0.001), SGOP 40 +/- 28 (p less than 0.001) and plasma histamine 8.6 +/- 0.4 (p less than 0.001). Serum gammaglobulin also tended to fall (p less than 0.1). Marked improvement was noted in reexamined biopsied specimen, representing disappearance of fibrogenesis as well as round cell infiltration in and around the portal tract, together with pericellular fibrosis. Four cases have been proven to be healed. Despite long-term administration, no obvious side effect was observed. Investigation for HBsAg revealed to be positive in 4, however, no conspicuous difference was seen from that of negative cases in the improvement.
An adult case of herpes simplex encephalitis was studied after autopsy. Postmortem examination revealed necrotizing encephalitis associated with Cowdry type A intranuclear inclusion bodies in glial cells. Herper simplex virus type 1 was isolated from the removed brain. Herpes simplex virus antigens were detected diffusely in wide areas of the brain by immunofluorescent test and viral particles characteristic to herpes simplex virus were demonstrated by electron microscopy. There was an apparent discrepancy between severity of histological changes and distribution of virus antigen.
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Experimental studies, using albino rabbits, showed that following the sensitization with histamine and homologous liver antigen conspicuous liver injury, closely resembling chronic active hepatitis, which progressed into liver cirrhosis with pseudolobulus formation, could be induced. The splenic weight, obtained after the administration of several hepato-toxic substances, had intimate relation with serum gammaglobulin levels. Furthermore, in a group in which splenectomy was performed after the development of hypergammaglobulinemia, serum gammaglobulin resulted in a rebound increase in comparison with extremely low level of serum gammaglobulin in a group in which splenectomized prior to sensitization. These results may suggest that (1) autoallergic mechanism should never be ignored. (2) splenomegaly in chronic liver diseases should not be considered from hemodynamic disturbance alone, but one of the important reacting sites where many factors including antigen antibody reaction are involved.
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