Mitsumoto Komatsuda

Clinical Evaluation of Combination of Cefmetazole and Piperacillin in the Treatment of Infections in Patients with Acute Leukemia

27 episodes of infection in patients with acute leukemia were treated with combination of cefmetazole and piperacillin. Causative bacteria were isolated in each infection. The patients were treated with 6 g cefmetazole and 15 g piperacillin per day in three divided doses. Among the episodes of infection, 21 (78%) of 27 responded to cefmetazole and piperacillin. Adverse reactions were skin rash in 2 patients, transient elevation of serum glutamic-pyruvic transaminase in 3 patients and elevation of creatinine in 1 patient. Cefmetazole and piperacillin appear to be an effective combination, with acceptable adverse reactions, for the empiric therapy of infection in patients with acute leukemia.

THE CONTINUOUS TREATMENT OF GENERALIZED MYASTHENIA GRAVIS WITH SMALL DOSES OF PREDNISOLONE WITH OR WITHOUT IMMUNOSUPPRESSANTS

重症筋無力症(以下MG)の病因として自己免疫説が注目されてきたにもかかわらず,本症に対しては副腎皮質ホルモンは一般に無効とされていた.最近になつて本剤の大量療法が難治全身型の本症に有効であることが見直されたが,なおその適応には種々の限界がある.わたくし達は胸腺摘出術(以下Thx)施行後の全身型MG8症例およびThx未施行の全身型MG8症例に対してprednisolone 5～10mg/dの少量持続療法を試みた.その結果, Thx施行後あるいは未施行のいずれの群でも60～75%の寛解あるいは著明改善例を認めることができ,効果発現時期は2～3カ月,寛解もしくは著明改善に到達するに要した期間は3～5カ月であつた.本療法開始後の臨床経過では一部の症例に1～2カ月以内に比較的不安定な時期がみられたが,これは抗cholinesterase剤(以下抗ChE剤)に対する神経筋接合部の反応性が増したためcholinergicに傾いたためであり,抗ChE剤を徐々に減量していくことによつて症状は好転し,この時期をすぎた3～5カ月頃には微量の抗ChE剤で安定した効果が得られるようになつた.本療法は少量であるところから従来の大量療法に較べ副作用はほとんどなく,一部の難治例に限られることなく軽症全身型MGにも応用できる点で適応の広い治療法であることが判明した.胸腺組織および末梢リンパ球にも検討を加え,本療法は胸腺(胚中心)ならびにリンパ球に働き,これらの異常を是正するとともに運動神経終板に結合する自己抗体の産生と機能を阻害すると考えられた.

Adult T‐cell leukemia following long‐term remission from non‐Hodgkin's lymphoma

A female patient who had been initially diagnosed with non‐Hodgkins lymphoma (NHL) and achieved complete clinical remission with combined chemotherapy, developed overt adult T‐cell leukemia (ATL) after 9 yr of disease‐free survival. This is the first case of the development of ATL following the complete remission of NHL. Secondary malignant neoplasms are not well‐documented in patients previously diagnosed with Hodgkins disease. Although there have been a few reports concerning the occurrence of secondary malginancy in patients with non‐Hodgkins lymphoma (NHL), there has never been a documented case of ATL following long‐term survival from NHL. Here, we report a case of typical adult T‐cell leukemia (ATL) which occurred after 9 yr disease‐free survival from NHL.