Successful treatment with allogeneic peripheral blood stem cell transplantation and granulocyte transfusion for severe aplastic anemia with sinusitis.

A 43-year-old woman with severe aplastic anemia (SAA) received anti-thymocyte globulin and cyclosporin A (CyA) and achieved hematological remission. Although she had maintained hematological remission, the disease relapsed 10 months after arbitrary discontinuance of maintenance therapy with CyA. Resumption of CyA therapy was not effective, and her condition became complicated with progressive sinusitis with bone destruction, which was refractory to antibiotics, antifungal agents, granulocyte colony-stimulating factor, and surgical drainage. Because of the necessity for early neutrophil recovery (to resolve the infection), we proceeded with a combination therapy using allogeneic peripheral blood stem cell transplantation (PBSCT) promptly followed by granulocyte transfusion (GTX) from the same human leukocyte antigen-identical donor rather than carrying out a second immunosuppressive therapy. The patient showed temporal resolution of infection on the second day after a single GTX. Although the patient had pneumonia on day 11, it was resolved promptly after engraftment on day 16. This report suggests the clinical utility of a salvage therapy with allogeneic PBSCT followed by GTX in a particular case of recurrent SAA with refractory infections.

[Neoadjuvant chemotherapy for elderly advanced gastric cancer: a case report of MTX/5-FU sequential therapy followed by radical gastrectomy].

A 70-year-old-male was diagnosed as having gastric cancer (Borr. 2, 78 mm in size on the body region; mod. dif. adenocarcinoma). CT scan revealed direct invasion of the liver. A course of MTX/5-FU sequential therapy was started (MTX 100 mg/m2, 5-FU 500 mg/m2, i.v., weekly; interval, 2 hours) on March 23, 1992. The gastric tumor showed 67% reduction on week 8 and 86% on week 10. The liver invasion had almost disappeared by CT scan (total doses, MTX 1,040 mg, 5-FU 6,750 mg). On June 25, the tumor was completely resected by radical.gastrectomy. The pathological specimen showed a "submucosal carcinoma" (10 mm in size, Stage I). Twenty-two months after the operation, the patient is alive and in good health. No cancer recurrence has been found without post-operative chemotherapy.

Magnetic resonance imaging of patients with intention tremor.

We evaluated the magnetic resonance images of the patients with intention tremor. Five patients out of seven had some atrophic structures or changes in signal intensity in the cerebello-rubral thalamic tract. Moreover, the T2-weighted images of the patients group detected the dentate and red nuclei more poorly than those of our control group. From these results, the etiological significance of the tract was confirmed and the mechanism of the intention tremor onset was discussed.

[Allogeneic bone marrow transplantation after the treatment of alpha-IFN and high-dose SNMC in two cases of acute myeloblastic leukemia with post-transfusional non-A, non-B hepatitis].

Two patients of acute myeloblastic leukemia (M2) with post-transfusional hepatitis (non-A, non-B) were treated with alpha-IFN and high-dose SNMC before allogeneic bone marrow transplantation. Bone marrow transplantation from HLA identical and MLR negative sibling donor was carried out when their hepatic functions were almost normalized. In the early phase after bone marrow transplantation, the hepatic function in both two cases has been stable, thus indicating that this treatment should be tried for reducing hepatic dysfunction and for safety bone marrow transplantation.

Postoperative evaluation of fecal continence after sphincter-preserving operations for rectal cancer.

Seventy-eight sphincter-preserving operations for rectal cancer were evaluated from the viewpoint of postoperative fecal continence. Operative procedures consisted of 39 anterior resections and 39 pull-through operations and Maunsell-Weir's operation. Postoperative fecal continence was evaluated by questionnaires and anorectal examinations including (1) the distance from the anal verge to the anastomosis, (2) the length of sensation to light touch in the anal canal, (3) electromyography of the sphincter, (4) internal sphincter reflex (5) pressure profile of the anal canal, and (6) barium enema radiography. Patients' evaluations of their continence were good when the distance of the anastomosis was over 5 cm from the anal verge, and mostly poor under 3 cm. Good or fair evaluations were obtained when the internal sphincter reflex or high pressure zone of the anal canal were preserved. Size of the reservoir was measured using a planimeter on the lateral view of the barium enema up to 6 cm from the upper margin of the anal canal. Good or fair evaluations were obtained when size was 30 cm2.

Adrenoleukodystrophy progressed from frontal lobes--clinico-pathological, electron microscopic and chemical study of a case.

A young male patient with adrenoleukodystrophy progressed from the frontal to the parieto-occipital region was reported. The spreading pattern of the brain lesion in this patient was confirmed by a serial examination of Technetium scintigrams and the neuropathological findings. The high uptake area of the isotope in the scintigrams seemed to represent the active demyelinating and infiltrative-reactive process in the white matter. A chemical analysis of the frozen white matter tissue of the patient revealed the existence of long chain fatty acids mor than C 22 in cholesteryl esters and gangliosides. It is suggested by this case that the demyelination process can start in the frontal white matter also in adrenoleukodystrophy as well as in Schilder's disease.