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A 64-year-old woman,with more than a 20 year history of polycythemia vera(PV),developed portal hypertension,myelofibrosis and extramedullary hematopoiesis accompanied by massive ascites. Portal hypertension resulted not only from infiltration of the liver sinusoids by hematopoietic cells but also from nodular regenerative hyperplasia of the liver. Wright-stained smears of ascites samples consisted of mesothelial cells and macrophages. However,cultures of mononuclear cells from the ascites showed the presence of hematopoietic progenitor cells including megakaryocyte colony formation and burst forming units. The JAK2-V617F mutation was positive in granulocytes. Contrary to other reports,radiation therapy was not effective and severe myelosuppression continued for more than one month. We present the unusual clinical course for this case of PV and discuss the pathophysiology of refractory ascites. (Kitakanto Med J 2012;62:159~162)

OBJECTIVES Hepatitis C virus infection has often been suggested as a possible cause of various kinds of autoimmune diseases. The aim of this study was to determine the relationship between chronic idiopathic thrombocytopenic purpura (ITP) and hepatitis C virus infection and to characterize the clinical features of anti-HCV antibody (HCVab) positive chronic ITP patients. SUBJECTS AND METHODS We studied HCVab in 79 patients with chronic ITP (25 males, 54 females, mean age 42.3 yr, range 11-86 yr) using the third-generation ELISA method. RESULTS HCVab was detected in 11 of the 79 patients (13.9%). Quantitative HCV-RNA studies showed a high serum concentration of HCV-RNA in these patients. The platelet counts in these 11 HCVab-positive patients (Group 1) were lower than in the 68 HCVab-negative patients (Group 2) [(2.6 +/- 0.9) versus (4.9 +/- 3.0) x 10(10)/L, respectively; p

【背景と目的】群馬大学保健学科検査技術科学専攻4年次学生が総合診療部実習で何を感じ取ったのかを, 2000年度学生と2001年度学生を比較しながら, 論述式の実習レポートから質的手法を用いて分析した.【対象と方法】2000年度学生38名, 2001年度学生38名が対象である.学生1名に外来初診患者1例を割当て, 総合診療部医師による問診と診察を見学させた.「初診患者の今後の検査計画」, 「今後の医療に対して検査技師が貢献すべき点」, 「将来に向けての抱負・夢」の3つの課題について学生が論述した実習レポート76名分を総合診療部の教員3名が独立して分析後, 結果を統合して学生の意識を評価した.【結果】「検査計画」の総合得点は両年度間で差がなかったが, 2001年度の女子は男子を+0.9点上回った(p

A 27-year-old man was found to have a mediastinal tumour and the histological diagnosis was immature teratoma. Remission was achieved by chemotherapy and total resection. However, he developed anaemia and leukoerythroblastosis after 2 years of remission, and was referred to our hospital. Rhabdomyosarcoma cells were detected in the bone marrow and pleural effusion. Moreover, karyotype analysis of peripheral blood and bone marrow cells revealed mosaic-type Klinefelter syndrome. We diagnosed the case as transformation of teratoma into rhabdomyosarcoma in Klinefelter syndrome. Although intensive chemotherapy was performed, the patient died with meningeal infiltration.

To investigate the correlation between granulocyte-macrophage colony formation and the prognosis of acute myelocytic leukaemia, an in vitro colony formation assay using a practical method was performed at diagnosis in 50 patients newly diagnosed with acute myelocytic leukaemia. Granulocyte-macrophage colony counts were significantly lower in acute myelocytic leukaemia patients than in the control group ( n = 5). The diminished colony formation was restored to within the normal range in 15 patients after complete remission was achieved. In eight patients, serial evaluation of granulocyte-macrophage colony formation was performed, and suppression of colony formation was observed at relapse. The comparison of granulocyte-macrophage colony counts at diagnosis between a group of patients with complete remission ( n = 26) and a group of treatment failure cases ( n = 24) revealed a significant difference suggesting that high counts of granulocyte-macrophage colony formation are predictive of a favourable prognosis for acute myelocytic leukaemia.