Ryuji Harada

The prevalence of human T-cell leukemia virus type I infection in patients with hematologic and nonhematologic diseases in an adult T-cell leukemia-endemic area of Japan

In order to clarify the prevalence of human T‐cell leukemia virus type I (HTLV‐I) infection in the Kagoshima district, Japan, a highly endemic area for HTLV‐I, antibodies for HTLV‐I (anti‐HTLV‐I) were examined in the sera of 6167 from healthy residents and patients with various hematologic and nonhematologic diseases. In healthy residents, including blood donors, the prevalence of anti‐HTLV‐I was 11.9% (562/4741 persons). The prevalence increased with age, and was significantly higher in females than in males (P < 0.01). The prevalence of anti‐HTLV‐I in blood donors was 8.5%. In hematologic diseases, the prevalence of anti‐HTLV‐I was 98.3% in ATL, 28.9% in lymphoproliferative disorders except ATL, and 10.6% in myeloproliferative disorders. In nonhematologic diseases, the prevalence of anti‐HTLV‐I was shown to be 29.5% in pulmonary tuberculosis, 25.8% in leprosy, 33.8% in chronic renal failure (CRF), 21.9% in autoimmune diseases, and 47.8% in strongyloidiasis. The various diseases except myeloproliferative disorders had significantly higher prevalence of anti‐HTLV‐I than healthy residents (P < 0.01 or 0.05). For autoimmune diseases, the prevalence of anti‐HTLV‐I in patients with blood transfusion (55.6%) was higher than in those without blood transfusion (8.7%), and healthy residents. In hemodialysis patients with CRF who had received blood transfusions the prevalence of anti‐HTLV‐I increased with the number of blood transfusions. Therefore, HTLV‐I transmission via blood transfusion would partially explain these high prevalence of anti‐HTLV‐I. However, the prevalence of anti‐HTLV‐I in hemodialysis patients with CRF was statistically higher than that in healthy residents, regardless of blood transfusion (P < 0.01). Furthermore, hemodialysis patients showed significantly higher prevalence of anti‐HTLV‐I than healthy residents, even at a younger age. Patients with pulmonary tuberculosis and leprosy showed the same results as hemodialysis patients. These results suggest the possibility that HTLV‐I infection has some relation not only to ATL but also to other diseases. Therefore, it seems very important to halt the spread of HTLV‐I transmission as soon as possible.

Monocyte-Mediated Suppression of Mitogen Responses of Lymphocytes in Uremic Patients

In the present experiment, we investigated the mechanism of the suppressed mitogen responses of peripheral blood mononuclear cells (PBMC) from uremic patients. We used phytohemagglutinin (PHA) and concanavalin A (Con A) as T cell mitogens, pokeweed mitogen (PWM) as a T cell-dependent B cell mitogen, and Staphylococcus aureus Cowan I (STA) as a T cell-independent B cell mitogen. PBMC from uremic patients showed significantly suppressed responses to PHA (p less than 0.05), Con A (p less than 0.05) and STA (p less tha 0.01) compared with those from healthy controls, but there was no significant difference in PWM response. However, these suppressed responses to PHA and Con A were markedly restored by depletion of phagocytic cells from PBMC. Although STA responses were also restored markedly in uremic patients, some patients still showed lower responsiveness to STA indicating the possibility of functional B cell defects. To further clarify the mechanism of the suppressed responses to mitogens, PBMC or nonphagocytic cells from uremic patients were cocultured with control T cells in the presence of PHA, or the effects of adherent cells from uremic patients on PHA responses of autologous or allogeneic control T cells were studied. From these experiments, it was suggested that the suppressed responses of PBMC to mitogens in uremia were mediated by monocytes.

Erythrocyte Membrane Fluidity Decreased in Uremic Hemodialyzed Patients

Erythrocyte membrane fluidity was studied by means of electron spin resonance in 15 uremic, hemodialyzed patients and 14 normal subjects. Erythrocyte membrane fluidity determined using a 16-nitroxide stearic acid spin label probe was of a significantly lower level in the uremic patients, when compared with normal control subjects. Alterations in molar ratios of membrane free cholesterol to phospholipid are probably not a principal factor contributing to this change in fluidity. Significant decreases of phosphatidylcholine and molar ratios of phosphatidylcholine to sphingomyelin were noted in the erythrocyte membrane of uremic patients, and these alterations may relate to the fluidity change.

Lupus nephritis with adult T cell leukemia.

A 64-year-old Japanese male patient with lupus nephritis associated with adult T cell leukemia (ATL) is described. Percutaneous renal biopsy demonstrated findings consistent with membranous lupus nephritis. To our knowledge, this is the first case of lupus nephritis complicated by ATL, suggesting that human T cell leukemia virus type I may be correlated not only to outbreaks of ATL but also to lupus nephritis/systemic lupus erythematosus.

Adult T cell leukemia in hemodialysis patients from the Kagoshima district, an area in which human T cell leukemia virus type I is highly endemic.

We report 2 cases of adult T cell leukemia (ATL) from hemodialysis (HD) patients with chronic renal failure (CRF) in the Kagoshima district, an endemic area of human T cell leukemia virus type I(HTLV-I) in Japan. The positivity of antibodies to ATL-associated antigen(anti-ATLA) in HD patients, regardless of whether or not blood transfusions were given, has been higher than in healthy persons in the district (p less than 0.01). ATL is considered to break out from HTLV-I carriers. Further study should be conducted to clarify the relationship between HTLV-I infection and CRF, and moreover, attention should be directed not only to treatment of HD but accompanying ATL as well, particularly in HTLV-I-endemic areas.

A patient treated with peritoneal dialysis for chronic renal failure complicated with hemophilia A

26歳, 男性の血友病Aの患者が腎不全を合併したため, 腹膜透析 (PD) を施行した.PD開始の2ヵ月前に起した右大腿骨骨折が, 腎機能障害の進行に何らかの影響を与えた可能性はあるが, 腎不全のはっきりした原因は不明である.VIII因子濃縮製剤を補充することにより, 特に大きな腹腔内出血を来たすことなく, 突然の脳出血のために死亡するまでに, 111回のPDを施行し得た.

Psychological analysis in long-term dialysis patients

透析療法の進歩, 普及に伴って長期透析患者が増加しているが, 自己管理の良否につながる心理的問題も透析患者の予後の面に関係していると思われる. 私どもは10年以上の長期透析患者を中心に心理学的分析を加え, 長期生存するための心理的因子を明らかにすべく検討を行った.方法: 1) 種々の合併症を克服しながら12年7ヵ月を迎えた1症例の精神的・心理的経過の面接法による分析, 2) 透析患者60名に対するCornell medical index (以下CMI) およびself rating questionnaire for depression (以下SRQ-D) の2種の心理テストによる分析, 3) 長期透析患者に対するsocial adjustment scale (以下SAS) およびdialysis sentense completion test (以下D-SCT) の2種の心理テストによる分析.結果: 本症例の精神的心理的経過の分析により1) 家族の励ましおよび宗教による心の支えが大きい, 2) 合併症に対してそれぞれ複雑な心理的反応を示している, 3) 経済的な問題が大きく関与する, 4) 透析年数の経過とともに力強くなってきている等が明らかになった. 透析患者60名に対するCMI, SRQ-Dの2種の心理テストの結果, 長期生存者ほど神経症的傾向, 抑うつ的傾向が少ないことがうかがえた. SAS, D-SCTの2種の心理テストの結果, 長期生存者ほど発病前の適応も良く, 発病後の療養生活に対しても良い適応を示していることが明らかとなった.

Immune responses to HBs vaccine in hemodialysis patients

血液透析患者8例に不活化HBsワクチンを投与後, 抗HBs抗体産生能を検討し以下の結果を得た. 1) 血液透析患者では抗HBs抗体産生能の低下および抗体の発現時期の遅延傾向がみられた. 2) 免疫学的検索では患者の抗HBs抗体非産生群でT cell subsetsのうちOKT8陽性細胞の比率の増加がみられた. 3) in vitroのmitogenに対するリンパ球増殖能は抗体産生群と非産生群の間で特に差はみられなかった. 4) 血清免疫グロブリン, 補体, 副甲状腺ホルモンおよび血清フェリチン値は抗体産生能と関係がなかった.以上の事実より, 血液透析患者の抗HBs抗体産生能の低下は, suppressor T cellを介した免疫能抑制の機序が関与しているために起こると考えられた.