A study was made of 29 patients with monoclonal gammopathies to detect aberrations in immunoglobulin (Ig) light chain isotype expression in lymphocytes at various levels of B-cell differentiation, ...namely, circulating surface Ig positive (SIg+) cells, Ig-secreting cells (plaque forming cells, PFC) and mitogen-induced PFC. By using kappa-lambda analysis, two major phenotypes of aberrant Ig light chain isotype expression were found in circulating B cells at these three levels of differentiation: an absolute increase in B cells bearing the same Ig light chain isotype as that of monoclonal protein (clonal B-cell excess), and a relative decrease in those B cells (isotypic discordance). Isotypic discordance (ID) was found to be essentially negative in patients with monoclonal gammopathy of undetermined significance (MGUS) provided that they were in a stable condition. In myeloma patients, ID was found only in stage I, except for a remission case of stage III (4/7 in stage I, 0/8 in stage II, and 1/6 in stage III). ID was not restricted to a circulating SIg+ cell level but was also demonstrable at a spontaneous or pokeweed mitogen-induced PFC level. However, ID was negative at a PFC level induced by Staphylococcus aureus Cowan I. Clonal B-cell excess (CE) was frequently found in patients with active myeloma but not in stable patients (0/8 in MGUS, 1/7 in stage I, 8/8 in stage II, and 4/6 in stage III). CE was positive not only at a circulating SIg+ cell level but also at a circulating PFC level. Furthermore, patients with CE at a PFC level were found to have a higher proliferating capacity, defined as a percentage labelling index of marrow myeloma cells, than those without CE at a PFC level (P less than 0.02). ID and CE can therefore be considered as useful markers for discriminating between MGUS and myeloma, evaluating the clinical stability and predicting the clinical course.
症例は72歳男性.入院5日前より微熱,咽頭痛あり.入院当日,トイレで意識消失発作を起こしたが数分で回復した.その後も同様の意識消失発作を起こし当院入院となった.心電図上,完全房室ブロックと5秒以上の心停止を認めたため,一時ペーシングを施行した.翌日には38℃ 台の発熱が出現するようになった.入院8日目に心機能の低下と上室性不整脈,心室頻拍,torsades de ...pointesが出現,その翌日,心原性ショックとなり心室細動が出現,大動脈内バルンパンピング(IABP)を開始し,人工呼吸器の管理とした.強心剤,血管拡張剤,利尿剤を使用して心不全のコントロールはついたが,非持続性の多形性心室頻拍が頻回に出現し,心室細動の再発を認め,電気的除細動で対処した.リドカイン,メキシレチンの静脈内投与は効果がなく,アプリンジンの投与にて不整脈は完全に抑制された.その後,徐々に心機能は回復し,IABP,人工呼吸器を離脱した.安定期の冠動脈造影,左室造影,右心カテーテル検査,心筋シンチでは異常は認められなかった.各種ウイルス抗体価のペア血清において有意な上昇を認めなかったが,感冒様症状が先行し,急激な心機能低下と致死的不整脈の出現から,劇症型の急性心筋炎が考えられた.今回,IABP,塩酸アプリンジンが救命に大きく貢献したので報告する.
Erosion process of soft cohesive material which deposited naturally on a river bed is the objective of the present paper. Extensive series of experiments, the condition of which were set ...systematically, were conducted to evaluate the erosion rate by running water in a closed conduit. The test sample was the mixture of silica sand. clay and water. the composition of which was set to be a variable. The main factors which govern this process were found to be the clay content ratio, the water content ratio, a frictional velocity of flow, a water temperature, and the size of silica sand. The effects of these parameters on the erosion rate were evaluated quantitatively. The correlation between the erosion rate and the adhesive strength of the sediment was also investigated by conducting the soil mechanical test. Erosion rate formula was also derived on the basis of experimental results.
Erosion rate of cohesive sediment has been investigated experimentally to understand the effect of some major factors, such as the clay content ratio, the water content ratio, a water temperature and ...etc., on the erosion rate. Based on the experimental results, a simple erosion rate formula was also developed. In the present study, several check tests were conducted to verify the validity of the previous results. Soil mechanical test was also conducted to evaluate the shear strength of the test sample. Correlation between the shear strength (cohesion) and an erosion rate was explained in the present paper.
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