[Contribution of the spleen to the lipid metabolism in plasma and red cells. On hereditary spherocytosis and hereditary high red cell membrane phosphatidylcholine hemolytic anemia]

Clinical and experimental studies on hereditary spherocytosis (HS) and high red cell membrane phosphatidylcholine hemolytic anemia (HPCHA) were performed in relation to lipid metabolism in plasma and in red cells of these patients. In HS, red cell (RBC) membrane lipids (free cholesterol (FC) and phospholipids (PL) such as phosphatidylethanolamine, phosphatidylcholine (PC), sphingomyelin (SM) and lysophosphatidylcholine (LPC] were markedly decreased in unsplenectomized HS. Plasma lipids (total cholesterol, FC, HDL-cholesterol, PL) were also decreased in these patients. After splenectomy, substantial normalization of plasma and RBC lipids were observed. Concerning lipid kinetics, the extents of 14C-PC synthesis in RBC from 14C-LPC in medium and of 14C-PC exchange between RBC and the medium were almost identical to those in normal control in the in vitro incubation conditions. These observations indicate that the decreased RBC lipids may be induced by the shortage of lipid materials in plasma in the presence of the spleen. In unsplenectomized HPCHA, plasma lipids were also decreased same as in HS. In contrast, membrane lipids (FC and PC) were markedly increased. Even after splenectomy, increased PC contents were rather enhanced in their membranes concomitant to developing of hemolytic anemia, although plasma lipids were almost normalized. Thus RBC membrane lipids in HPCHA appeared not to be affected by plasma lipids. In experimental studies on HPCHA, 14C-PC synthesis from 14C-LPC and 14C-PC uptake in these RBC were increased, in spite that large amounts of PC were already accumulated in these RBC.(ABSTRACT TRUNCATED AT 250 WORDS)

Establishment of five human myeloma cell lines

Five human myeloma cell lines, KMM-1, KMS-5, KMS-11, KMS-12-PE, and KMS-12-BM, have been established at Kawasaki Medical School since 1980. As the KMS-12-PE and KMS-12-BM lines were obtained from the same patient, these five cell lines have been derived from four patients with multiple myeloma. The five myeloma cell lines are stably growing at present in RPMI 1640 medium supplemented with 10% fetal bovine serum. They can also grow in a defined culture medium without serum. That these cell lines were human myeloma cells was confirmed by the following findings. Ultrastructurally, all five cell lines showed features characteristic of plasma cells. KMM-1 and KMS-11 cells secreted lambda and kappa chains into the culture medium, respectively, but the other cell lines produced no immunoglobulins. KMM-1 expressed cytoplasmic lambda antigen, KMS-5 showed cytoplasmic delta, and KMS-11 expressed surface kappa, whereas KMS-12-PE and KMS-12-BM cells showed no surface or cytoplasmic immunoglobulins. Regarding reaction with a monoclonal plasma cell antibody (PCA-1), four of the five lines were positive, the exception being KMS-5. Another monoclonal antibody (CD38), which also recognizes plasma cells, responded to KMM-1, KMS-12-PE, and KSM-12-BM. KMS-5 cells expressed acute lymphoblastic leukemia antigens (CALLA). These data suggest that such lines as KMM-1, KMS-11, KMS-12-PE, and KMS-12-BM represent later stages of B-cell differentiation, and that KMS-5 represents a relatively early stage of B-cell differentiation. All the cell lines lacked Epstein-Barr virus nuclear antigen, showed abnormal karyotypes of human origin, and differed from each other in the isozyme patterns examined. Only KMS-5 was tumorigenic when transplanted subcutaneously into nude mice.

Salivary gland function after sialolithiasis: scintigraphic examination of submandibular glands with 99mTc-pertechnetate

Scintigraphic evaluation of 13 cases of submandibular duct sialolithiasis was performed to determine glandular function and to estimate the justification for sialoadenectomy. Twenty-two per cent of these glands showed no function despite sialolithectomy, which suggests that it would be reasonable to excise submandibular salivary glands that have no recovery of function. However, the remaining 78% of the glands showed varying degrees of recovery of function, indicating that sialolithectomy should be done first, followed by 99mTc-pertechnetate scintigraphic examination to determine the necessity of further sialoadenectomy.

[Tracheoesophageal anastomosis for intractable aspiration pneumonia]

Permanent tracheostomy and tracheoesophageal anastomosis were performed as a means of surgical intervention for the treatment of intractable aspiration pneumonia. Conventional method of tracheoesophageal anastomosis has entailed various problems. The improved technique by the authors utilized the special histological features of the situation and makes possible safe and reliable anastomosis. This technique retains the tracheal perichondrium to strengthen the anastomosed portion of the trachea, and can thus prevent suture insufficiency due to tension upon the anastomotic site.

[Cyclosporine as prophylaxis for graft versus host disease in adults undergoing allogeneic bone marrow transplantation]

Fifteen adult patients undergoing allogeneic bone marrow transplantation (BMT) received cyclosporine (CSP) as prophylaxis of graft versus host disease (GVHD). In our patients eleven were hematologic malignancies, and four were severe aplastic anemia. Twelve patients were HLA-matched, and three were one locus mismatched. Three patients received CSP only, twelve received CSP and short term methotrexate. Seven patients had acute GVHD, but GVHD over Grade II were seen in only 3 patients who were transplanted from HLA-one locus mismatched donor. 7 patients had chronic GVHD. CSP were given intravenously at 3-5 mg/kg, starting 1 day before BMT. From about day 30, CSP was given orally. CSP concentrations when patients were given orally were lower in patients who had chronic GVHD. Although hypertension and water retention were seen in 8 patients, and renal dysfunction was seen in 3 patients, the side effects of CSP were mild and transient. There were no correlations between serum concentrations and the side effects of CSP. Three patients had the disturbance of hematopoiesis. Ten of fifteen patients are alive at median follow-up of 18.5 months (8-41 months) after BMT.

[Surgical treatment of malignant skin tumors of the external genital area]

Sixteen cases of malignant skin tumors (extramammary Paget's diseases, 12 cases, squamous cell carcinoma, 4 cases) of the external genital area in the past 7 years are reviewed. In the surgical management of both Paget's disease and squamous cell carcinoma, a wide local excision should be performed in which an excision is made two to five cm from the tumor margin. Therapeutic regional lymph node dissection (ilioinguinal dissection) on the basis of clinical and lymphographic findings should be performed. In most cases the resurfacing of the defect, the split thickness skin graft (often mesh graft) is used as a rule, while the skin flap or the musculocutaneous flap such as gracilis muscle or tensor fascia lata muscle is applied only in some cases in which femoral artery and vein were widely exposed, or the full thickness defect of the lower abdominal wall remained.

[Prolonged thrombocytopenia after autologous bone marrow transplantation]

Thirty two patients with hematologic malignancies and solid tumors were treated with intensive therapy and autologous bone marrow transplantation. In nine out of 32 patients, it took more than 50 days to achieve a sustained platelet count of 50,000/microliter or greater. Significant associations with poor platelet recovery were found for patient age, diseases, period of cryopreservation, the kinds of eradicative therapy and in vitro purging. But most of these factors overlapped each other in the same patients. No correlation was found between platelet recovery and number of cells or CFU-GM infused.

Replacing losses in kind: improved sensation following heel reconstruction using the free instep flap

Two similar patients, with extensive defects of the heel treated by free tissue transfer of the contralateral instep, are discussed. Durable coverage and near normal static two-point discrimination were obtained in both. Improved results are attributed to the proximal interfascicular dissection of the medial plantar nerve and implantation into the posterior tibial nerve as the recipient. This flap may be transferred with only relatively minor donor-site complications. The contralateral instep free flap provides an ideal, durable, and sensate heel replacement, particularly when local tissues are unavailable.

Angiocentric and angiodestructive infiltration of adult T-cell leukemia/lymphoma (ATLL) in the skin. Report of two cases

This report describes the clinical and pathological features of cutaneous lesions observed in a 73-year-old woman with terminal adult T-cell leukemia/lymphoma (ATLL) and a 42-year-old man who had chronic ATLL with persistent nasal stuffiness and rhinorrhea of 2 years' duration. Histology of the skin lesions from these two cases showed large blood vessel (arterial and venous) involvement at the level of the dermosubcutaneous junction, in which angiocentric and angiodestructive infiltration of the tumor cells was prominent and reminiscent of lymphomatoid granulomatosis (LYG) and/or polymorphic reticulosis. ATLL commonly involves the skin. Moreover, it may originate in the skin. The majority of researchers have observed perivascular and periadnexal infiltration, frequent epidermal exocytosis with Pautrier's microabscesses, and the occasional presence of leukemic cells within the vascular lumen; however, vascular involvement like that seen in our cases has not been described before. Our cases suggest that a variety of T-cell malignancies may be angiocentric and angiodestructive in nature, and that so-called LYG and LYG-like malignant lymphomas are not a single disease, but may constitute a heterogeneous group of T-cell malignancies including ATLL.

Expression of proto-oncogenes in normal and tumor tissues of human skin

The expression of c-fos, c-myc, Ha-ras, N-ras, EGF-receptor, and cardiac actin genes was examined in 7 normal epidermis, 3 cellular nevi, and 8 skin tumors including 6 malignant and 2 benign tumors of human origin. These genes were transcribed in most normal and tumor tissues, though no tumor-specific expression of proto-oncogenes (c-fos, c-myc, Ha-ras, and N-ras) could be detected. However, there was a characteristic parallelism between the expression of c-fos and c-myc in normal epidermis, while the parallelism was not always definite in skin tumors. The ratio of c-fos/c-myc transcripts in normal epidermis was constant compared with the expression of other genes examined. These data suggest that c-fos and c-myc are expressed in all normal skin tissues, and that maintenance of a constant ratio of c-fos/c-myc is closely related to ordered cell growth of the tissues.

Paget's extension of esophageal carcinoma. Immunohistochemical and mucin histochemical evidence of Paget's cells in the esophageal mucosa

A 68-year-old male with Paget's disease of the esophagus is reported. The underlying primary esophageal carcinoma was diagnosed as adenosquamous cell carcinoma on the basis of the presence of both adenocarcinoma and epidermoid carcinoma components. There was invasive growth of clear Paget's cells in the esophageal epithelium. Mucin histochemistry disclosed common characteristics of mucin between Paget's cells and adenosquamous cell carcinoma. It was histochemically confirmed that the existence of mucin was a general feature of extramammary Paget's disease. In 13 control esophageal carcinomas including three with adenocarcinomatous elements, Paget's cells were not found in the epithelium. To date only one case of Paget's disease of the esophagus has been described in the literature.

Scintigraphic evaluation of the salivary glands in patients with Sjögren's syndrome

The clinical value of salivary gland scintigraphy (RI-sialography) was studied in 11 cases with definite Sjögren's syndrome. Time-activity curves which were obtained from computer-assisted analysis of RI-sialography were classified into 4 types (N:normal type, M:median type, F:flat type, S:sloped type), and the efficacy of scintigraphy in evaluating salivary gland function and the relationship between time-activity curves and other diagnostic methods are discussed. Flattened time-activity curves such as F- or S-type were more often seen in submandibular glands than in parotid glands. Flattened curves were not seen in the early stage of the inflammatory process; conversely, when we found a flattened curve, it suggested a wide destruction of the salivary gland tissues. Correlation between time-activity curve and sialography showed 90.9%, and correlation between time-activity curve and histopathological change in the minor salivary gland of the lower lip also showed 90.9%.

The effect of agonists at the GABA-benzodiazepine-receptor-complex on the proconflict effect induced by beta-CCM and pentetrazol in rats

The effect of anxiolytics, benzodiazepine (BZP), diazepam (DZP), non-BZP zopiclone (ZOP) and phenobarbital (PBT), on the proconflict effect induced by methyl-beta-carboline-3-carboxylate (beta-CCM) or by pentetrazol (PTZ) was investigated. The proconflict effect of beta-CCM and PTZ was reduced by these anxiolytics and aminooxyacetic acid (AOAA). In addition, isoniazid produced proconflict activity. Therefore, it is suggested that anxiolytics facilitate the GABA-ergic function, causing the inhibition of the proconflict effect. Although both propyl-beta-carboline-3-carboxylate (beta-CCP) and Ro15-1788 did not produce proconflict activity, they reduced the proconflict effect induced by beta-CCM but not by PTZ. These data clearly show that beta-CCM exerts the proconflict effect through interaction with BZP receptor and that there are behavioral similarities between beta-CCP and Ro15-1788. In this study, we additionally observed the time latency until the rat began to drink the water. beta-CCM and PTZ prolonged this latency in a dose-dependent manner. However, AOAA could not reduce the prolonged latency induced by beta-CCM and by PTZ, and anxiolytics and beta-CCP could not reduce the prolonged latency induced by beta-CCM. The mechanism of the prolongation of latency induced by beta-CCM and PTZ seems to be different from that of the proconflict effect.

Squamous cell carcinoma antigen in the serum of oromaxillary cancer

Squamous cell carcinoma (SCC) antigen levels in sera and several tissues were estimated in patients with oral and maxillary cancer. The normal value of serum SCC antigen level was 1.7 ng/ml in this experiment, and 43.3% of squamous cell carcinoma was positively higher than 1.7 ng/ml as a whole, including cases of carcinoma in situ and of recurrence and metastasis in the oral region. In relation to the clinical staging of tumors, 20.0% in stage I, 14.3% in stage II, 42.9% in stage III, and 77.8% in stage IV were positive for SCC antigen. In the group with definite regional lymph node metastases, 80% of patients revealed a higher value than the normal cut-off value. Patients with recurrent SCC demonstrated elevated SCC antigen values in sera except 1 case with an early condition of recurrence. Serum SCC antigen also presented good responses to various cancer treatments. The measurement of SCC antigen does not appear to be useful for the detection of early stage oral and maxillary SCC; however, for detection of recurrence and for lymphatic and/or remote metastases in the follow-up period, it would appear that SCC antigen level would be some value.

Treatment of depression with clonazepam

The antidepressive effect of an anticonvulsant clonazepam was studied with maximum daily dose of 1.5 to 6.0 mg (mean 3.4 mg) in 27 patients with major depression (n = 18) or bipolar disorder (n = 9). Two of them dropped out at an early stage of the treatment, and the antidepressive effect of clonazepam was evaluated for the remaining 25 patients. A marked to moderate improvement was obtained for 21 patients (84%), and the onset of the antidepressive effect of clonazepam appeared within 1 week in most of the cases who responded to the therapy. The total scores on the Hamilton Depression Rating Scale and the Beck Self-Rating Scale were significantly reduced after the clonazepam treatment. Side effects occurred in 14 patients, but most of them were not severe. From these results, it is thought that clonazepam might be useful as an antidepressant for patients in whom conventional antidepressant treatment are contraindicated.

Specific abnormalities of chromosome 14 in patients with acute type of adult T-cell leukemia/lymphoma

Chromosome analysis was performed on 1 patient with diffuse lymphoma of mixed type by histologic diagnosis and on 7 patients with the acute type of adult T-cell leukemia (ATL). Specific abnormalities in chromosome 14 at break band q11 with the assigned locus of the alpha-chain gene of the T-cell antigen receptor were identified in 6 of 8 patients. Inv(14) (q11q32) was found in 2 patients and translocation of chromosome 14 at break band q11 was observed in 4. Donor chromosomes involved in translocation of the 14q11 varied, i.e., chromosomes 3, 7 or X, with the exception of one patient whose donor chromosome origin could not be determined. The breakpoint in chromosome 3 was in band p25, a region reported to include the locus of the c-raf-I oncogene. In chromosome 7, it was in band p11, a region reported to include the locus of the c-erb-B oncogene, and in the sex chromosome X, it was in band q11. One patient also had a chromosome 14 aberration at break band q32. Of the 2 remaining patients, one had lost chromosome 14 and the other had an isochromosome 14q. Our observation and other reported findings suggest that the rearrangement of chromosome 14 at break band q11 is specific for lymphoma-type or acute-type ATL patients, and aberrations of proto-oncogene expression or the coding sequence by recombination involving a T-cell antigen receptor gene due to chromosome inversion or chromosome translocation may play an important role in T-cell neoplasia including ATL.

The effect of agonists at the GABA-benzodiazepine receptor complex on the duration of immobility of mice in the forced swimming test

In the present study, we examined the effect of various agents which affect in a different manner the GABA-benzodiazepine receptor-chloride ionophore complex system in relation to the immobile behavior of mice in the forced swimming test. The benzodiazepines diazepam and flurazepam, the barbiturates pentobarbital and phenobarbital, zopiclone and beta-CCP (propyl-beta-carboline-3-carboxylate) enhanced the immobile behavior in a dose-dependent manner. In the doses used here, these agents produced almost no muscle relaxant action. Ro15-1788 and beta-CCM (methyl-beta-carboline-3-carboxylate) themselves had no effect on the duration of immobility. However, Ro15-1788 and beta-CCM reversed the enhancing effect produced by all 6 drugs. These results indicate that the enhancement of the duration of immobility of mice may be somehow correlated to the anxiolytic action but not to the muscle relaxant action. The effect may be mainly mediated by the benzodiazepine receptor, which forms a part of the GABA-benzodiazepine receptor-chloride ionophore complex. Furthermore it is suggested that there were behavioral similarities in the effects of beta-CCP and benzodiazepines.

Transformation of human leukocytes by co-cultivation with HTLV-1-associated myelopathy patients' leukocytes

Sera and cerebrospinal fluid (CSF) from patients with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy (HAM) were analyzed by Western blotting, and normal human leukocytes were transformed by co-cultivation with HAM patients' leukocytes. The sera and CSF from all HAM patients formed specific bands with HTLV-1 viral proteins, including p19, p24, p28, p32, p40 and p53. After 2-3 weeks of co-cultivation, scattered foci of cell aggregates were noted on macrophage sheets. Surface markers of the transformed cells were OKT3(+), OKT4(+), OKT8(-), IL-2 receptor(+) and EBNA(-). Chromosome analysis showed a normal karyotype. HTLV-1 viral genome was integrated into DNA isolated from transformed cell lines. Electron microscopy revealed type C virus particles in transformed T-cell lines. These results indicate that peripheral leukocytes from HAM patients can transform HTLV-1-negative leukocytes and HAM patients have the potential to acquire adult T-cell leukemia in the future.

Multicentric reticulohistiocytosis accompanied by oral and temporomandibular joint manifestations

A case of multicentric reticulohistiocytosis in a 56-year-old man with oral and temporomandibular joint manifestations is presented, which demonstrates typical clinical features of skin and mucosal nodules, and polyarthritis.

Lymphoepithelial (branchial) cyst and amylase

A case of a branchial cyst with a high amylase activity of the cyst fluid was found in a 58-year-old female. The literature on branchial cysts with high amylase activity is reviewed. Amylase that showed high activity in the cystic fluid was revealed to be due to the salivary isoenzymes (S3 and S4) which migrated more to the anodic side on electrophoresis.

Inherited deficiency of protein S in a Japanese family with recurrent venous thrombosis: a study of three generations

We found a new thrombophilic tendency in a family with protein S deficiency. The propositus, a 38-year-old Japanese man, is an offspring of consanguineous marriage and suffered from recurrent episodes of thromboembolism. Hemostatic studies, including platelet counts, platelet aggregation, assays of coagulation factors, and plasminogen activity were all within normal limits. The levels of antithrombin III, alpha 2-macroglobulin, protein C, and protein C inhibitor were also normal. However, functional protein S activity in plasma was markedly decreased (9%) in the propositus. The family study revealed that the reduced levels of functional protein S, less than 5% to 29% of normal (normal range: mean +/- 2 SD of 15 normal adults were 44 to 180%), were found in 11 members of this family over three generations. Six of 11 members had severe protein S deficiency (less than 5%), whereas five had partial deficiency. Four of eight adults with protein S deficiency had recurrent episodes of thrombosis. Immunologic levels of protein S antigen were variable in this family and did not correlate closely with the functional levels. These results suggest that the recurrent thrombotic disease in this family appears to be associated with an inherited deficiency of functional protein S.

Lipid analyses and fluidity studies by electron spin resonance of red cell membranes in hereditary high red cell membrane phosphatidylcholine hemolytic anemia

Membrane lipid analyses and electron spin resonance (ESR) studies of membrane fluidity were carried out on the red cells of a Japanese patient with hereditary high red cell membrane phosphatidylcholine hemolytic anemia (HPCHA). Increased amounts of phosphatidylcholine (PC) and cholesterol were found in the membrane lipids of the affected patient, despite normal plasma lipids. The order parameter of cholesterol-free pure phospholipid liposomes prepared from this patient's red cells was decreased, apparently because of the increased PC. In contrast, the order parameter of the total red cell lipid liposomes (containing free cholesterol) was essentially normal. The overall fluidity of the intact red cells was determined by ESR with a spin probe, 5-SAL. Again, the order parameters were normal in the intact red cells of the patient with HPCHA. This suggests that the concomitant increase of membrane cholesterol and phosphatidylcholine serves to maintain normal membrane fluidity in the HPCHA red cells.

[Evaluation of pre-operative irradiation therapy for carcinoma of the esophagus]

Prognosis of 43 patients with esophageal squamous cell carcinoma with pre-operative irradiation and that of 50 patients by surgical excision alone were compared by five year survival rate. The pre-operative radiation treatment comprised a daily doses of 2 Gy. given for consecutive days, up to total dosage of 40 Gy. (T.D.F.66). The operative excision was done two weeks after the the completion of the radio-therapy. In early cases (st. I, II), five year survival rate of the pre-operative irradiation group was 59.8% and 74.2% for surgical treatment alone group. In advanced cases (st. III, IV), the radiation group and surgical treatment alone group showed 21.8% and 15.1% respectively. Among advanced cases, the result in relation to the location of tumor in the esophagus was studied. In the cases which the tumor was located at the upper and middle intra-thoracic esophagus, five year survival rate in pre-operative radiation group was 21.4% versus no survivor in surgical excision alone. In contrast, five year survival rate was better by surgical treatment alone among these advanced cases located at the lower esophagus. The pre-operative irradiation treatment is indicated for esophageal cancer which is advanced and located in the upper and middle intra-thoracic esophagus.

[Clinical studies of cefotaxime in infections in internal medicine]

Clinical studies on a new cephalosporin antibiotic, cefotaxime (CTX) were carried out in 79 patients with various types of infections in internal medicine. The efficacy rates were 65.8% in 39 cases of respiratory tract infections, 94.1% in 17 cases of biliary tract infections, 75.0% in 12 cases of urinary tract infections, 80.0% in 11 cases of other infections, and 75.3% in all cases. After CTX therapy, body temperature was improved in 76.7% of all 79 patients, particularly being excellent in all cases of biliary tract infections. Furthermore, symptoms such as cough, dyspnea, chest pain, moist rale and anorexia were improved to a great degree after CTX therapy. Adverse reactions and abnormal laboratory findings consisted of mild liver injury in 1 out of 79 cases. CTX was assessed to be an effective antibiotic for various types of infections in internal medicine.

[Clinical evaluation of tissue polypeptide antigen in patients with esophageal, stomach and colon cancer]

Serum tissue polypeptide antigen (TPA) levels were measured in 33 patients with esophageal cancer, 39 with stomach cancer and 50 with colon cancer. At the same time five glycoproteins, namely immunosuppressive acidic glycoprotein (IAP), alpha 1-antichymotripsin (alpha 1-ACT), acid soluble glycoproteins (ASP), sialic acid and carcinoembryonic antigen (CEA), were measured for comparison. The mean TPA values were 59.0 +/- 15.4 U/l in 61 normal subjects, 103.6 +/- 104.2 U/l (positive rate, 24.2%) in esophageal cancer patients, 111.9 +/- 49.8 U/l (71.8%) in stomach cancer patients and 124.8 +/- 195.5 U/l (40%) in colon cancer patients. The serum TPA levels in patients with stomach cancer rose with an increased number of involved lymph nodes and with a higher degree of infiltrative growth and increased with the advancement of tumor growth postoperatively. Serum TPA levels correlated well with those of alpha 1-ACT, IAP and ASP in stomach cancer patients and with those of CEA, ASP and sialic acid in colon cancer, but not in esophageal cancer patients. It is suggested that the serum TPA might represent one of the reactant proteins and/or tumor-associated antigens that appear to be dependent upon the cancer status.

Disappearance of microspherocytes in peripheral circulation and normalization of decreased lipids in plasma and in red cells of patients with hereditary spherocytosis after splenectomy

A possible mechanism of the formation of microspherocytosis in unsplenectomized patients with hereditary spherocytosis (HS) was investigated in relation to lipid metabolism in plasma and in red cells of these patients. Plasma lipids (total cholesterol, free cholesterol, high density lipoprotein cholesterol, free fatty acids, and phospholipids) were markedly reduced in unsplenectomized HS patients with microspherocytosis. Red cell membrane lipids (free cholesterol and phospholipids such as phosphatidyl ethanolamine, sphingomyelin, phosphatidyl choline, and lysophosphatidyl choline) were also decreased in these unsplenectomized HS patients. After splenectomy, microspherocytosis disappeared concomitant to substantial normalization of plasma and red cell membrane lipids. These observations suggest that plasma lipid decrement in the unsplenectomized HS patients is at least one of the causative factors in pathogenesis of the formation of microspherocytosis. So-called "splenic conditioning" may not imply a physical "loss" of membrane by fragmentation or pitting of the once-formed HS red cells in the peripheral circulation. Instead, the decreased plasma lipids in the presence of the spleen may affect the de novo synthesis of red cell membrane lipids, resulting in the formation of microspherocytosis.