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Background Exposing blood serum samples to ambient white light-emitting diode (WLED) light may accelerate bilirubin photoisomer production. We previously demonstrated the quantitative effect of bilirubin configurational isomers (BCI) on direct bilirubin (DB) value using the vanadate oxidation method. However, the effects of bilirubin structural photoisomers (BSI) remain unclear. Methods In Study 1, the relationship between WLED irradiation time and BSI production was examined. Serum samples from five neonates were irradiated with WLED light for 0, 10, 30, 60 and 180 min. Bilirubin isomer concentration and BSI production rates were calculated. In Study 2, we performed quantitative investigation of BSI effect on DB values: Differences in DB, BCI and BSI values before and after irradiation were calculated as ⊿DB, ⊿BCI and ⊿BSI, respectively. Assuming the coefficient of BCI affecting DB values was ‘ a’, relational expression was ⊿DB = a*⊿BSI + 0.19*⊿BCI. Serum samples from 15 neonates were irradiated with green LED light for 10 and 30 s. The respective bilirubin isomer levels were measured, and the coefficient was derived. Results In Study 1, the median BSI production rate was 0.022 mg/dL per min in specimens with an unconjugated bilirubin concentration of 10.88 mg/dL. In Study 2, assuming that ⊿DB-0.19*⊿BCI was Y and ⊿BSI was X, the relational expression was Y = 0.34 X-0.03 ( R2 = 0.87; p < .01) and a = 0.34. Conclusions Under ambient WLED light, serum sample generated 1.3 mg/dL BSIs in 1 h. Approximately 34% (0.44 mg/dL) of BSI concentrations was measured as DB when using the vanadate oxidation method according to the above equation.

非Down症児における急性巨核芽球性白血病 (AMKL) の発症は稀であり, 予後不良である. 症例は1歳4ヶ月の女児. 繰り返す発熱を主訴に他院にて治療されていたが, 末梢血中に芽球が出現したため, 香川大学医学部附属病院小児科に紹介入院となった. 血液検査の結果, 著明な白血球増多と貧血を呈しており, 芽球を2.0%認めたことから, 白血病の可能性を考慮し, 骨髄検査が行われた. 骨髄は高度過形成で芽球様細胞が78.8%認められた. 芽球様細胞は大小不同があり, 細胞質は好塩基性が強く, 辺縁はときにbleb様突起などの不整があり, ミエロペルオキシダーゼ (MPO) 染色は陰性であった. フローサイトメトリー (FCM) による細胞表面抗原はCD33, CD56, CD61, CD117陽性で, CD9, CD34, CD36, CD41, CD110などは陰性を示し, 細胞質内抗原ではTdT, CD3, CD79a, MPOがいずれも陰性であった. FCMの結果からAMKLの可能性を疑い, 細胞質内のCD41とCD61を追加で染色したところ共に陽性を示した. さらに染色体検査の結果が正常女性核型であったことから, 上記の所見と合わせて小児非Down症AMKL (non-DS-AMKL) と診断された. AMKLの巨核芽球は血小板関連抗原 (CD41, CD61, CD42b) のうち一つ以上が陽性を示すとされる. 本症例は形態的にAMKLの特徴を一部有し, 細胞表面のCD61が陽性でAMKLの条件を満たしたが, 非Down症児であることから, 芽球に付着した血小板による偽陽性の可能性を否定できず診断に苦慮した. しかし, 特異性が高いとされる細胞質内CD41, CD61の発現を証明できたことが確定診断をする上で根拠の一つとなり, FCMによる細胞内染色の重要性を再認識した症例であった. Acute megakaryoblastic leukemia (AMKL) in children without Down syndrome is rare and has a poor prognosis. A 16-month-old female, who was treated at another hospital with repeated fever, was referred to the Department of Pediatrics, Kagawa University Hospital, because of the appearance of blast cells in peripheral blood. A blood test showed marked leukocytosis and anemia, with 2.0% blast cells. Bone marrow was markedly hypercellular and 78.8% blast cells were observed. Blast cells were uneven in size, the cytoplasm was strongly basophilic, and the margins were sometimes irregular with bleb-like processes, and myeloperoxidase (MPO) staining was negative. Cell surface antigens by flow cytometry (FCM) were positive for CD33, CD56, CD61, and CD117, and negative for CD9, CD34, CD36, CD41, and CD110. The cytoplasmic antigens were negative for TdT, CD3, CD79a, and MPO. We suspected AMKL from FCM results, and when cytoplasmic CD41 and CD61 were additionally stained, both were positive. Furthermore, because the result of the chromosomal test showed a normal female karyotype, together with the above findings, a diagnosis of pediatric AMKL without Down syndrome (non-DS-AMKL) was made. AMKL megakaryoblasts are said to be positive for one or more of the platelet-related antigens (CD41, CD61, CD42b). This case had some morphological characteristics of AMKL, and the cells were positive for sCD61 which satisfied the conditions for AMKL. But because she was a non-Down syndrome child, the possibility of false positives due to platelets attached to blast cells could not be ruled out, making diagnosis difficult. However, the expression of cyCD41 and cyCD61, which are considered to be highly specific, was one of the criteria for making a definitive diagnosis. This case reaffirms the importance of intracellular staining by FCM.

胃癌に対する化学療法のsecond-lineとしてtaxaneの有効性が注目されている. Stage IV進行胃癌に対しdocetaxel化学療法が奏効し, 切除しえた1例を経験したので報告する. 症例は70歳の男性, 内視鏡検査で胃癌の診断となった. 腹部CTで膵体尾部, 脾門部への浸潤を認め切除不能の診断でTS-1 100mg/日を1クール (4週) 投与するもPDのためCPT-11 100mg/日 (3投2休) 施行した. 治療効果はPRだったが2クール終了後PDとなり, TXT療法開始80mg/回を3週間隔で4クール施行後, 内視鏡上腫瘍病変, また腹部CT上膵臓, 脾門部への浸潤もほぼ消失 (PR) した. その後, 胃全摘術, 膵体尾, 脾, 胆. 切除, リンパ節郭清 (D3) を施行し, 術後12か月現在外来通院中である. 組織学的所見では, 癌細胞は胃固有筋層から漿膜下のごく一部とそれに連続した膵体部のみで, 胃粘膜面には認めなかった. 胃癌におけるTXTの化学療法は有効性が期待できると考えられた.

Recombinant human granulocyte colony-stimulating factor (rhG-CSF) not only enhanced the growth of HL-60 cells, but also significantly increased NBT-reducing ability and alkaline phosphatase (ALP) activity of the cells, which were enhanced by the treatment with retinoic acid (RA). Protein kinase C inhibitors (H-7 and staurosporine) significantly suppressed this induction of ALP. The pretreatment with RA followed by rhG-CSF treatment showed almost the same degree of ALP activity as that induced by the simultaneous treatment with RA and rhG-CSF. This study suggests that RA and rhG-CSF are the potent inducers of ALP activity of HL-60 cells and protein kinase C is supposed to have a role in this induction of ALP.

Contamination of endoscopes and endoscope washers by atypical mycobacteria was studied. Large amounts of atypical mycobacteria were detected with high frequency inside endoscopes and endoscope washers. The species of atypical mycobacteria was Mycobacterium chelonae subsp. abscessus. Antibacterial-effects of glutaraldehyde against isolated atypical mycobacteria were checked. Sufficient antibacterial-effect was not obtained by 2% glutaraldehyde solution for endoscope sterilization. However, after frequent manual washing and brushing of endoscopes, by using 3% glutaraldehyde solution and 70% alcohol, all endoscopic instruments were completely decontaminated. We must pay attention to contamination of endoscopes and endoscope washer at least once a month.

臨床的には比較的まれな疾患である大腸脂肪腫を経験したので報告する.症例は61歳女性.腹痛を主訴として来院.注腸造影で, 横行結腸に表面平滑な腫瘍陰影を認めた.大腸内視鏡検査では, 肛門縁より65cmに可動性に富む有茎性の腫瘍を認めた.腹部CTをfat densityの条件にしてみると, 横行結腸に一致して-80 Hounsfield unitの内部構造が均一な腫瘍が認められた.以上の所見より, 横行結腸の脂肪腫と診断した.全麻下に開腹し, 結腸部分切除術を行った.腫瘍は3×3×7cmの粘膜下腫瘍であり, 病理組織学的にも成熟した脂肪組織であり, 悪性細胞は認められなかった.

Objective. To determine the usefulness of measuring sensitive markers of the coagulation–fibrinolysis system (i.e., thrombin–antithrombin III complex [TAT], D dimer fragments [DD], and plasmin–α2-plasmin inhibitor complex [PIC]) for evaluating disease activity in patients with systemic lupus erythematosus (SLE). Methods. We studied 57 SLE patients. Plasma concentrations of DD were measured by latex agglutination using monoclonal antibodies; TAT and PIC were determined by sandwich enzyme-linked immunosorbent assay. Disease activity was determined by using the SLE Disease Activity Index (SLEDAI). Results. Levels of TAT, DD, and PIC were higher in SLE patients than in healthy controls (P < 0.05). Levels of TAT and DD showed good correlations with SLEDAI scores (for TAT r = 0.66, P < 0.001; for DD r = 0.50, P < 0.001). Elevated levels of TAT, DD, and PIC were decreased following treatment. Conclusion. These results strongly suggest that measurement of molecular markers of hemostasis is useful for evaluating disease activity in patients with SLE.

In the hepatic cytosol fraction of bullfrog, Rana catesbeiana, an alkaline RNase [EC 3.1.4.22] exists in two forms. One is the free form of RNase, which elutes from a carboxymethyl-cellulose column at a concentration of 0.2 M NaC1. The other is a masked or latent form (RNase-RNase inhibitor complex) which is not adsorbed on the carboxymethyl-cellulose column and which can be converted to the free form of RNase by the addition of p-chloromercuribenzoate. Electrophoretically pure RNase was obtained by the following procedure. The unadsorbed fraction of hepatic cytosol on a column of carboxymethyl-cellulose was treated with p-chloromercuribenzoate and then applied to a second carboxymethyl-cellulose column. The molar weight of RNase was determined to be approximately 12,000 by gel filtration and polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. From the results of gel filtration, the molecular weight of the RNase-RNase inhibitor complex was 130,000. The RNase hydrolyzed poly C, poly U, and poly I, but not poly A or poly G. When poly C was used as a substrate, 2',3'-cyclic CMP as an intermediate and 3'-CMP as a final product were identified. The results of amino acid analysis indicated the presence of an unusual component. The general properties of the RNase and the RNase-RNase inhibitor complex are also reported.