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Respiratory medicine physicians prescribe many different kinds of medications depending on patient's condition. To examine an outside pharmacy's ability to meet the demand of our respiratory prescription services, we developed a questionnaire for all the patients who came to our outpatient department from November 1, 2015 to January 31, 2016. A total of 298 of 330 patients answered the questionnaire. Overall, 169 patients mainly went to the pharmacy near our hospital, whereas 64 patients mainly went to another pharmacy. Specifically, 23 of 219 patients who answered the question "When you went to the pharmacy with prescription, have you ever been not immediately given medication?", were not immediately given medication by the pharmacy. The results show that the other pharmacy significantly delayed medication compared with the one near our hospital. Interestingly, there were many types of inhaler cases that were out of stock in both pharmacies. Also, we found that 9 of 11 patients who were not provided medication on the spot acquired the medication within 1 or 2 d. Further, 10 of 20 patients who were not provided medication on the spot were only able to obtain the medication once. We did not observe any changes in patients' physical condition due to the delay in medication.

A 54-year-old man was admitted to our hospital because of fever, dyspnea, and low back pain. Chest computed tomography showed a 30-mm mass in the left lung and bilateral pleural fluids, multiple bone lesions, enlarged lymph nodes, and skin abscesses. Mycobacterium avium was isolated from his sputum, a pleural fluid sample, the right cervical lymph node, and a precordial skin abscess. We thus diagnosed his illness as disseminated nontuberculous mycobacterial infection (DNTM) and treated him with multiple chemotherapeutic agents. However, the disease progressed, and he ultimately died. He was not in an obvious immunocompromised state. DNTM with multiple bone lesions in a healthy adult is very rare and we therefore report this case.

Objectives: The metabolic syndrome defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) is a predictor of cardiovascular events. However, the significance of metabolic syndrome for cardiovascular events has been not clarified in Japan. The impact of metabolic syndrome and diabetes mellitus on cardiovascular events was investigated, especially in the high risk group after percutaneous coronary intervention., Methods: We studied 456 patients (mean age 63 +/- 10 years, range 36-88 years) without ischemia on stress thallium-201 single photon emission computed tomography after percutaneous coronary intervention. The diagnosis of metabolic syndrome was made according to the modified NCEP ATP III criteria. Cardiovascular events were examined for mean 3.7 +/- 1.8 years (range 2.0-8.7 years). There were 196 patients without diabetes mellitus or metabolic syndrome (Group D - M -), 89 patients without diabetes mellitus but with metabolic syndrome (Group D - M +), 61 patients with diabetes mellitus but without metabolic syndrome (Group D + M -), and 110 patients with both diabetes mellitus and metabolic syndrome (Group D + M +)., Results: The event-free survival curve in Group D - M + was significantly lower than that in Group D - M - (p < 0.05), but not different from that in Group D + M -. The survival curve was markedly lower in Group D + M + than that in Group D - M + (p < 0.005). The Cox proportional hazard model revealed that diabetes mellitus and metabolic syndrome were independent significant risk factors for events., Conclusions: The diagnosis of metabolic syndrome was helpful for identification of patients with high cardiovascular event rate even in patients after percutaneous coronary intervention. The combination of metabolic syndrome and diabetes mellitus markedly increases the risk for cardiovascular events.

Thalidomide was used in 73 patients with refractory myeloma in 15 of 45 institutes participating in the Japan Myeloma Study Group. The mean age and male/female ratio were 63.8 years and 0.92 (35/38), respectively. Thirty-four patients (47%) were treated with only thalidomide, 27 patients (37%) were treated with thalidomide and steroids, and 12 (16%) were treated with thalidomide and chemotherapy. The mean initial, maximum, and maintenances dose of thalidomide were 111.0, 204.8, and 163.0 mg/day, respectively. Almost all of the patients were maintained on low-dose thalidomide between 100-200 mg/day. Complete, near complete and partial response was obtained in 31 patients (42.5%). The progression-free and overall survivals after thalidomide therapy were 9.8 and 21.3 months, respectively. The most common adverse effects were gastrointestinal disturbance, peripheral neuropathy, psychological signs, and skin eruption. In contrast to reports from Europe and America, no deep vein thrombosis was observed in this study. On the other hand, leukopenia was relatively frequently observed, and might be recognized as a serious adverse effect in myeloma patients. In conclusion, low-dose thalidomide is a useful and safe tool for the treatment of refractory myeloma.

A 67-year-old man was referred to our hospital for treatment of hemophagocytic syndrome. Hypotension, hypoxemia, pleural effusion, severe anasarca, and splenomegaly were noticed at the time of admission. Laboratory findings showed anemia (7.7 g/dl), thrombocytopenia (4.5 x 10(4)/microliter), an increase of serum LDH (1,466 IU/L) and severe hypoalbuminemia (1.9 g/dl). Bone marrow aspiration revealed an increase of reticulum cells with active hemophagocytosis and the presence of immature lymphocytes (6.0%). Lymphoma was suspected, but effective chemotherapy could not be performed because of progressive hypoxemia and severe hypoalbuminemia, and the patient died of the disease 2 weeks after admission. Autopsy revealed large lymphoid cells packed within systemic vessels as well as invasion into organs such as the liver, lungs, and spleen. The postmortem diagnosis was intravascular large B-cell lymphoma. Hypoalbuminemia and hypoxemia appear to be important clinical features of intravascular large B-cell lymphoma.

We investigated the effects of anaphylactic challenge on nonadrenergic noncholinergic (NANC) relaxation response to electrical field stimulation (EFS) or to aminophylline in sensitized guinea pig tracheal smooth muscles. An anaphylactic challenge with ovalbumin (OA) reduced the relaxation response to EFS (20 V. 5 Hz. 300 pulse. duration 1 msec.), but the relaxation response to aminophylline was not affected by OA exposure. NG-monomethyl L-arginine, a nitric oxide (NO) synthesis inhibitor, reduced the relaxation response to EFS in the OA sensitized guinea pig. While the relaxation response to EFS on the sensitized guinea pig tracheal smooth muscle was significantly attenuated compared with that on the non-sensitized guinea-pig, there was no significant difference between the tracheal strip of OA challenge group and that of control group in sensitized guinea-pig under the existence of NO synthesis inhibitor. These results suggest that the attenuation of NANC relaxation response associated with sensitization plays an important role in airway hyperreactivity and is responsible for the decrease in NO amount.

We have conducted a phase I clinical study of fludarabine phosphate, a new purine nucleoside derivative, in patients with chronic lymphocytic leukemia and adult T-cell leukemia/lymphoma. The patients were given intravenous administration at a dose of 15 mg/m2/day followed by 20 mg/m2/day and 25 mg/m2/day, each dose given consecutively for 5 days. The dose limiting factors were thrombocytopenia and neutropenia. The thrombocyte count and neutrocyte count dropped to their lowest value in week 1 to 2 after administration, but the changes were reversible, and these counts recovered in most patients. The maximum tolerated dose of the study drug was 25 mg/m2/day, and it was decided to administer 20 mg/m2/day as the recommended dose for the subsequent phase II clinical study.

Psychiatric studies were made on 26 inoperable patients with lung cancer or thymic cancer to exam the possible correlation of chemotherapy and chemotherapy-induced nausea and vomiting. All patients were informed of their disease and how to undergo the therapy. Psychiatric tests of CMI (Cornell Medical, Index), MAS (Manifest Anxiety Scale), SDS (Self-Rating Depression Scale) and QOL questionnaire were performed just before the chemotherapy. SDS and QOL questionnaire were also done after chemotherapy. The patients were given chemotherapy including CDDP (80 mg/m2) and anti-emetic agents of 30 mg of azasetron, 750 mg of methylprednisolone and 1,800 mg of domperidone. The patients showing neurosis, anxiety or depression had significantly high nausea scores, so we concluded that psychiatric support was needed to improve these patients' QOL in chemotherapy.

We present a 15-year-old woman with acute myelomonocytic leukemia without marrow eosinophilia, M4 in the FAB classification. She was admitted to our hospital with nausea and headaches. Upon admission, the leukocyte count was 284,000/microliters with 95% leukemic cells. The bone marrow aspirate was hypercellular with 74.8% blasts and 0.2% eosinophils. Leukemic cells were positive for myeloperoxidase and esterase staining. Initially, the karyotype of the bone marrow cells on admission was considered to be normal. However, the PEBP2 beta/MYH11 fusion transcript was detected in the bone marrow mononuclear cells by using the reverse transcriptase-polymerase chain reaction (RT-PCR). Reevaluation of karyotypes showed a t(16;16) (p13;q22) in the bone marrow cells. After achieving complete remission, she was treated with low-dose etoposide. Chromosome analysis showed a normal karyotype and no amplified chimeric transcripts were observed. This case indicates that the molecular analysis of PEBP2 beta and MYH11 genes is a useful tool to detect inv (16) and t(16;16) which were often difficult to find, and that leukemic cells from some cases of M4 without marrow eosinophilia have these chromosome abnormalities.

Genetic manipulation of somatic cells may be of therapeutic value in a variety of infectious diseases, particularly in human immunodeficiency virus (HIV) infection. Stable insertion of "resistance genes" into cells, susceptible to HIV, could reduce the viral burden in infected individuals and potentially retard the characteristic progressive immune dysfunction. Alternatively, ectopic expression of genes that encode viral antigens, might induce potent antiviral immune responses and form the basis for novel prophylactic and therapeutic vaccines. While laboratory studies have proved that the approach works in principle, preclinical and clinical studies will be necessary to evaluate the therapeutic benefits of such gene-based therapies. Currently, more than 400 patients have already been treated by this innovative therapeutic strategy in the US. In Japan, the Expert Committee on Gene therapy was set up in the council on Science and the Public Health and Welfare in 1991. Recently, gene therapy for ADA has been approved. It is thought that the first gene therapy against HIV infection in Japan is not far away.

Anti-cancer effect of anthracyclines are well established. In vitro inhibitory effects of a new anthracyclin-derivative drug, menogaril (TUT-7) which is developed for oral administration, on three human T-cell leukemia virus type-I (HTLV-I) infected T-cell lines, a HTLV-I non-infected T cell line, and fresh tumor cells from four adult T-cell leukemia (ATL) cases are evaluated and compared to those of doxorubicin. The inhibitory effects of TUT-7 is almost as much as those of doxorubicin. Both TUT-7 and doxorubicin induced apoptosis to a HTLV-I infected cell line and inhibited proliferation of fresh tumor cells from ATL of chronic, acute and lymphoma type in a dose dependent manner. We have already reported that skin eruption of ATL patient improved by oral administration of TUT-7. This new anthracyclin-derivative would be useful in treating ATL patients even in out-patients clinic keeping a good quality of life.

Interstitial pneumonia has been reported to be a side effect of treatment with interferon, and Sho-saiko-to (Xiao-Chai-Hu-Tang) may enhance this side effect. It is well known that activated neutrophils are important mediators of pulmonary fibrosis, so we studied the effects of interferon and Sho-saiko-to on neutrophil activation. Homogenized lung myeloperoxidase (MPO) activity was assayed after intraperitoneal injection of interferon with or without pretreatment with Sho-saiko-to. Although Sho-saiko-to alone did not change the lung MPO content, MPO in the lung was significantly increased by interferon administration. The increase was enhanced further by pretreatment with Sho-saiko-to. When the accumulated neutrophils are activated by some cytokines, such as TNF alpha or IL-1 beta from monocytes/macrophages, they may damage lung tissue. We therefore studied the effects of Sho-saiko-to and interferon on TNF alpha production in freshly isolated human monocytes. Sho-saiko-to increased the production of TNF alpha, but interferon did not. In addition, Sho-saiko-to significantly increased the production of TNF alpha by monocytes stimulated by lipopolysaccharide. Taken together, these data indicate that interferon causes neutrophils to accumulate in the lung. Sho-saiko-to alone may not injure lung tissue, but it increases the effect of interferon. When stimulated by some antigen, Sho-saiko-to may overstimulate the neutrophils. Granulocytes elastase and oxygen radicals released from activated neutrophils may damage lung tissue. The fibroblasts that repair the damaged tissue may increase the risk of pulmonary fibrosis.

A new artificial carrier particle agglutination test using polyamino acid (polyamino PA) was developed for anti HTLV-I assay. We carried out the comparative study on anti-HTLV-I among polyamino PA, gelatin PA, EIA and WB methods. All of 76 ATL, 20 HAM/TSP, 53 patients with uveitis and 50 HTLV-I carriers were seropositive and 50 HTLV-I non carriers were seronegative with four methods. Eighteen of 503 patients include autoimmune diseases showed seropositive by polyamino PA and gelatin PA. One of 19 seropositives by EIA was false positive. All of 25 sera showed non-specific reaction by the gelatin PA were clearly negative by the polyamino PA. This is due to the fact that the polyamino acid particle has a greater specific gravity as carrier. The final judgement was got within 45 minutes. It was earlier more 30 minutes than the gelatin PA. The polyamino PA is a simple, rapid, sensitive and specific method. Therefore, it is useful for mass screening and clinical diagnosis.

To study the differences in bronchial responsiveness to inhaled methacholine and salbutamol between patients with mitral valve disease those with bronchial asthma a bronchial provocation test (Astograph) and pulmonary function tests were done in 25 patients with mitral stenosis (MS) and 18 patients with bronchial asthma (BA). We derived an index of airway reloxability from the effect of salbutamol after precontraction with inhaled methacholine. This index was the change in respiratory conductance (Grs) over time during inhalation of salbutamol (SGrs-d). It was computed as SGrd = delta Grs/delta t. Eighteen patients with MS (72%) showed bronchial hyperresponsiveness (BHR) to methacholine. The MS patients with BHR (MS(+)) had lower values of the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV/FVC) and maximal expiratory flow at 25% of vital capacity (V25) than MS patients without BHR (MS(-)). There was a significant correlation between V25 and the log cumulative dose producing a 35% decrease in respiratory conductance (PD35Grs) in MS(+). The mean log Dmin of MS(+) was significantly higher than that of the patients with BA (0.14 +/- 0.64 log units and -0.30 +/- 0.65 log units, p < 0.05, respectively). The mean log PD35Grs of MS(+) was also significantly higher than that of the patients with BA (1.09 +/- 0.53 log units and 0.45 +/- 0.66 log units, p < 0.01, respectively). Indices of relaxability (SGrs-d and SCrs-d/Grs-d) in MS(+) were significantly lower than in BA patients. Indices of hyperresponsiveness and relaxability were both significantly lower in patients with MS than in patients with BA.(ABSTRACT TRUNCATED AT 250 WORDS)

A 23-year-old male patient with plasma cell leukemia showed characteristic clinical features: accelerating heart failure and consciousness disturbance accompanied with an increase of plasma cells in peripheral blood. Evaluation of cardiac function revealed a hyperdynamic cardiac state with low somatic vascular resistance, indicating high-output cardiac failure. However no disorders causing high-output cardiac failure were found. Consciousness disturbance and hyperammonemia with serum amino acid abnormality of unknown origin were also demonstrated. After intensive combined chemotherapy (MVD + VAD), high-output cardiac failure and hyperammonemia improved with disappearance of plasma cells, suggesting that these symptoms were closely related with progression of plasma cell leukemia.

A 57-year-old male patient with multiple myeloma showed an aggressive course with characteristic clinical features: rapid progression of plasmacytoma in the thoratic cavity, high serum levels of lactate dehydrogenase (LDH), which is usually not elevated in myeloma patients, and neutrophil infiltration in pleural effusion. Despite treatment with vincristine, doxorubicin and dexamethasone, the tumor mass had become non-responsive to chemotherapy and been increasing in size in correlating with the increase of serum levels of LDH. The patient died of respiratory failure 4 months after treatment. Thus the serum level of LDH is thought to be a useful clinical marker to monitor disease activity as well as other markers such as monoclonal immunoglobulin and beta 2-microglobulin. To investigate the cause of neutrophil infiltration into pleural effusion, we cultured plasma cells obtained from the effusion for 3 days in serum-free medium and examined the activity of neutrophil chemotaxis in the culture supernatant. The results showed chemotactic activity in the supernatant as high as in positive controls stimulated with a chemotactic factor, formyl-methionyl leucyl phenyl-alanine, suggesting that tumor cells produced neutrophil chemotactic factor(s).

The clinical features of human T-lymphotropic virus type (HTLV-I) uveitis, an idiopathic uveitis in HTLV-I seropositive patients, were analyzed in a hospital located in an area where HTLV-I was endemic (Miyakonojo, Miyazaki). A total of 61 patients (25 males and 31 females) with HTLV-I uveitis were the subjects of the analysis. Intermediate uveitis with moderate to severe vitreous opacities accompanied by mild iritis and retinal vasculitis was the most characteristic feature, and was observed in the majority of the patients (66% of all or 84% in young adult patients between 20 and 49 years of age). The uveitis affected one eye in 57% and both eyes in 43% of the patients, with subacute onset of floaters and foggy vision. The uveitis responded well to therapy with topical or systemic corticosteroids, but recurred in many cases. A significant number of patients (15% of all and 25% of female patients) had a previous history of Graves' disease with hyperthyroidism.

The presence of proviral DNA of human T-lymphotropic virus type I (HTLV-I) in the inflammatory cells in the aqueous humor was examined by polymerase chain reaction. The proviral DNA was detected in all the tested patients (n = 9) with HTLV-I uveitis. On the other hand, the provirus was not detected in 2 out of 3 HTLV-I seropositive patients with other types of uveitis, i.e., Behçet's disease, toxoplasmosis and Vogt-Koyanagi-Harada's disease. None of the 11 seronegative patients with other types of uveitis or senile cataract had proviral DNA in the aqueous humor. Thus, the fact that HTLV-I-infected cells were present in the aqueous humor of all HTLV-I uveitis patients suggests significant involvement of HTLV-I in the pathophysiology of the uveitis.

A seroepidemiological study was carried out to find out if human T-lymphotropic virus type I (HTLV-I) was closely associated with uveitis in two hospitals: one in an area where HTLV-I was highly prevalent (Miyakonojo, Miyazaki) and the other in an area where HTLV-I was less prevalent (Kurume). In the highly prevalent HTLV-I area, the seroprevalence in patients with idiopathic uveitis (78/206, 37.9%) was significantly higher than in patients with non-uveitic ocular diseases (73/380, 19. 2%) or in patients with uveitis with defined etiologies (8/80, 10.0%). A more striking finding was that the seroprevalence in the younger group (20-49 years) with idiopathic uveitis in the area was 40/82 (48.8%), but only 9/114 (7.9%) in the other two reference groups. The odds of contracting idiopathic uveitis for HTLV-I infected persons was estimated at 11.0 in the younger group, and 2.0 in the older group. Similar observations were recorded even in the less prevalent area (Kurume). These data thus suggest that HTLV-I infection is a risk factor for idiopathic uveitis.

A 4-year-old boy was referred for treatment of papillary tumor at the urethral meatus. He was well until December 1990, when his mother noticed a tumor at the urethral meatus. The tumor was resected elsewhere. However, a similar tumor was noted again at the urethral meatus in May, 1991. The patient was admitted on September 16, 1991. Retraction of the phimotic foreskin revealed a well-demarcated papillary mass, approximately 2 x 2 mm in diameter, at the urethral meatus. There were no tumors on foreskin or glans. Under general anesthesia endoscopy was performed to locate other tumors at the urethra and bladder. No tumors were found elsewhere. Then the meatal tumor was resected surgically. Pathology was condyloma acuminatum. There was no recurrence one year after surgery. We also reviewed 24 boys with condyloma acuminatum, including 13 boys with a solitary condyloma at the urethral meatus, reported in Japan.

A 34-year-old female was admitted on June 25, 1990, for the evaluation of alveolar hypoventilation which worsened after her second delivery. She showed impairment of both hypercapnic and hypoxic ventilatory responses, and marked desaturation due to hypopnea and apnea during sleep. Although administration of methylxanthine and medroxyprogesterone was not very effective, after treatment with low flow oxygen, there was a marked decrease in the frequency and duration of desaturation during sleep and improvement of arterial daytime blood gases, which suggested the existence of hypoxic ventilatory depression in the pathophysiology of her nocturnal desaturation. Furthermore, the use of a negative pressure ventilator for 3 hours in the daytime for 10 days resulted in marked improvement of symptoms, arterial blood gases, respiratory muscle strength, and the frequency and duration of sleep desaturation. These findings suggest that both low flow oxygen therapy during sleep, and daytime negative pressure ventilation may be beneficial in patients with primary alveolar hypoventilation and central sleep apnea syndrome.

Six of 14 patients with acute myeloblastic leukemia (AML) complicated reactive histiocytosis during initial remission induction therapy. All six patients had a high fever without signs of infection during initial chemotherapy, and periods of myelosuppression were prolonged. Histiocytes with a mature appearance, some of which phagocyted erythrocytes, thrombocytes or neutrophils, increased in the bone marrow. All of 3 patients tested showed high serum levels of ferritin. Two of 3 patients treated with 125 mg/day methylprednisolone achieved complete remission. In the remaining 3 patients, one patient achieved complete remission, but the others died of fungal pneumonia or sepsis. Thus, reactive histiocytosis is one of the severe complications in patients with AML undergoing chemotherapy.

Expression of multidrug resistance (mdr 1) gene, which encodes a transmembrane efflux pump referred to P-glycoprotein, leads to the decreased intracellular accumulation of various lipophilic drugs, such as vinca alkaloids, anthracyclines and epipodophyllotoxins. As these drugs are commonly used in chemotherapy for acute leukemia, it is of importance to determine whether mdr 1/P-glycoprotein expression is associated with clinical resistance. In several reports, some leukemia cells from untreated patients have expression of mdr 1/P-glycoprotein. We quantitatively detected low levels of mdr 1 expression in all cases of untreated acute leukemia and normal hematopoietic cells, using the reverse transcriptase-polymerase chain reaction. Carefully designed clinical trials including mdr 1 reversing agents may have significant consequences for the treatment of acute leukemia.

A patient with Münchhausen syndrome who had severe iron deficiency anemia (IDA) is reported. A 31 year-old female presented with irregular genital bleeding. However, gynecological examination disclosed no evidence of specific disorders causing bleeding. Tests for bleeding tendency and hemolysis were all negative. Although massive bleeding was absent, she had three episodes of a rapid fall in Hb level associated with marked fatigue and weakness, and subsequently rapidly developed serious IDA afterwards. Factitious bleeding was strongly suspected. Blood transfusion performed when the patient was not being watched failed to increase Hb, while transfusions given while the patient was watched were effective. She was not cooperative throughout the hospital course and was discharged on her own request. In outpatient clinic, the diagnosis was confirmed by the evidence that she diluted her own blood samples.

Dr Kira et al. (Lancet 1991, 338: 64-65) stress the high incidence of the co-infection with HTLV-I and HTLV-II in the HTLV-I associated myelopathy or tropical spastic paraparesis (HAM/TSP) detected by a polymerase chain reaction (PCR). They showed that 67% of HAM/TSP patients and 6% of healthy carriers had the co-infection. They suggested the co-infection might be important for the development of the myelopathy. Recently, we have analyzed the seropositivity of antibodies to HTLV-I and II in Adult T-cell Leukemia (ATL), HAM/TSP and carriers in Japan using SELECT-HTLV (IAF Biochem International Inc., Montreal, Canada). This system was a solid phase enzyme immunoassay utilizing synthetic peptides to differentiate between antibodies to type I and II. We examined 101 samples (31 ATL patients, 20 HAM/TSP and 50 carriers) which were all positive with the particle agglutination (PA, Fujirebio, Tokyo) and ELISA (Eisai, Tokyo). All samples were negative with HTLV-II and positive with HTLV-I. The results of our serological survey suggested that HTLV-II did not associate with the etiology of ATL and HAM/TSP in Japan.

ATL (adult T-cell leukemia) is the first human cancer known to be caused by a retrovirus. ATL cells show usually positive for CD2, CD3, CD4, CD25 and HLA-DR, but negative for CD8. They produce a variety of cytokines, including IL-1, IL-2, TNF, ADF and PTHrP. PTHrP is considered to be responsible for hypercalcemia which is frequently observed in ATL. Recently, we reported two unusual cases of HTLV-I associated malignancy; 1) a case of CD4 and 8 double negative tumor affecting mainly gastrointestinal tract and 2) a case mimicking small cell lung cancer. IL-2-toxin, a conjugate of IL-2 and diphtheria toxin, has been prepared as a recombinant product and evaluated for the suppressive effect to ATL cells. Clinical trail of IL-2-toxin is now anticipated.

We evaluated Retrovirus EIA kit (Roche Co.), in which virus components of three different viruses, HIV-1, HIV-2, and HTLV-I were used antigens. All the specimens from the patients with ATL, HAM, HTLV-I carrier, AIDS and AC, and from HIV-2 infected individuals were found to be positive. Four out of 40 specimens from hemophiliacs not infected with HIV-1 were found out to be positive. These specimens were confirmed to contain antibody against HTLV-I. Pseudo-negative or -positive reactions were not found in this study. Therefore, Retrovirus EIA kit should be evaluated more extensively, for the possible applications for screening of blood donors, and for selecting the sources of blood products as well as for clinical diagnoses.

The brief record of a 25 y. o. male patient with AML (FAB M1) is shown, in whom the blast cells did not express any of the 5 myeloid antigens or the other-lineage related antigens, as detected with the monoclonal antibodies. The blast cells were induced to express CD13 antigen after a short-term culture in vitro. This result suggests that CD13 antigen can be expressed virtually by all AML cells, since CD13 antigen is known to cover fresh AML cells at the highest incidence. No unusual clinical feature was noted in this patient as AML case. The collected documentation of antigen-free AML cases seems necessary for the relevant understanding of AML heterogeneity.

Serum deoxythymidine kinase activities (s-TK) of the patients with adult T-cell leukemia (ATL), carriers and healthy persons were measured, using a recently developed TK assay with 125I-iodo-deoxyuridine as a substrate. The mean s-TK values were 3.3 +/- 2.7 U/l (n = 21) in normal subjects (HTLV-1(-)), 4.7 +/- 5.0 U/l (n = 35) in carriers, 9.8 U/l (n = 3) in smoldering ATL and 26.7 U/l (n = 6) in chronic ATL. In the patients with acute ATL, the mean s-TK values before and after chemotherapy were 80.9 U/l (n = 2) and 11.6 U/l (n = 4), respectively. In the follow-up studies of the patients with acute ATL, the changes of s-TK levels revealed earlier than those of serum LDH levels. It is suggested that s-TK activity is more useful than LDH as a parameter of monitoring treatment in ATL.

EIA (Eitest: Eisai) and Gelatin Particle Agglutination: PA (SERODIA: Fujirebio) assays were performed for the detection of HTLV-I antibodies with 10,780 sera from patients since 1986. Eleven point five percent were reactive by both EIA and PA, while 1.1% was PA(+), EIA(-), these PA false positive occurred on low titer. Conversely 0.2% on EIA positive seems PA false negative because of Western blot (WB) positivity. Zero point nine percent was EIA(+), PA(-), of these 80.6% were not inhibited by EIA confirmatory test. The main cause of EIA false positive was due to reactivity of auto antibody with MT-2 cell lysate. We used new EIA (ED-007: Eisai) coated with HTLV-I antigen purified from supernatant of culture medium of MT-2 cell. The results completely matched with EIA confirmatory test and WB. Cut off index value of sera from SLE patients were down to 0.2 (mean +/- SD) from 0.7 +/- 0.4 of Eitest ATL. EIA (ED-007) are probably useful and more specific assays for the detection of HTLV-I antibodies, especially, the sera of patients with autoimmune diseases.

A 30-year-old female patient with malignant lymphoma was admitted to the hospital because of large mass in the left pelvic cavity and of severe anemia. Since she had refused blood transfusion (Jehovah's witness), recombinant human erythropoietin (Epo) was used together with both chemotherapy and irradiation; this led to rapid recovery of the anemia and marked reduction of the mass volume. These findings may suggest the possible application of Epo administration as a supportive therapy in treatment of malignancy.

To test the possible participation of activated leukocytes in the pathogenesis of gastric ulcer, plasma levels of polymorphonuclear leukocyte-elastase-alpha 1-proteinase inhibitor complex (PMN-EC), a discerning indicator for the activation of leukocytes, were determined in patients with gastric ulcer. Plasma levels of PMN-EC in patients with gastric ulcer (185.2 +/- 21.6 micrograms/l, mean +/- S.E.M.) were significantly higher than those in normal healthy subjects (67.6 +/- 4.4 micrograms/l, p less than 0.01). On the other hand, plasma levels of C-reactive protein and sialic acid increased in only 17.8% and 7.1% of patients with gastric ulcer, respectively. No significant correlation was observed between PMN-EC and the plasma levels of CRP or sialic acid. Plasma levels of PMN-EC decreased with the healing of the ulcerative lesion as judged by gastro-endoscopic observation. These findings suggested that activation of leukocytes might deeply be correlated with the pathologic mechanism of gastric ulceration and the measurement of PMN-EC might be useful for monitoring the patients with gastric ulcer.