Acta Medica Okayama volume46 issue1

Theta activity in EEG was found to be augmented in the frontal midline area in 5 young women while they played classical piano pieces and during related mental tasks. This activity was considered to be a frontal midline theta rhythm with the maximal amplitude mostly in Fz and of the frequency ranging from 5 to 7.5 Hz. This theta activity was observed to increase depending on the degree of the subjects' concentration on piano playing or related tasks. In bilateral parietal derivations, increases in the power value of alpha activity were observed in some subjects while they were listening to music, suggesting that alpha activity was involved in appreciation of music.

A 70-year-old woman with Waldenstroem's macroglobulinemia developed bilateral pleural effusions due to Cryptococcus neoformans. She was found to be a carrier of HTLV-I. It is speculated that the opportunistic infection occurred as the result of an impaired cellular immunity secondary to HTLV-I infection.

A retrospective study was carried out in 110 cadaveric kidney transplant recipients to compare the effects of low doses of cyclosporine (CsA), azathioprine (AZP) and steroids (triple-drug therapy) with those of higher doses of steroids plus AZP (conventional immunosuppression). Graft survival rate in the triple-drug therapy was 77%, 69%, and 69% at 1, 3, and 5 years, respectively. This was significantly better than 48%, 34%, and 29% in conventional immunosuppression. The incidence of acute rejection episodes was significantly lower in the triple-drug therapy than in conventional immunosuppression (25% vs 58%). In conclusion, our study shows that triple-drug therapy using low-dose cyclosporine is the safest of the immunosuppressive regimens and provides a beneficial effect on the long-term survival of cadaveric kidney transplants.

Thirteen patients with rectal carcinoma seen between December 1980 and December 1990 have been reviewed to determine the risk of lymph node metastasis and its implication for subsequent treatment. The mean age was 64 years (from 38 to 79; 9 males, 4 females). The site of the tumor was predominantly in the lower rectum (53.8 percent). The polypoid (I) and flat-elevated ulcerated (IIa + IIc) subtypes were detected in seven and six lesions, respectively. Sphincter-saving techniques were carried out in eight cases, and five cases required Miles' operation. Neither postoperative complications nor deaths were noted. The mean follow-up period was 57 months (6 to 133 months). No recurrence or distant metastasis was found during this follow-up. IIa + IIc subtype lesions with deep submucosal invasion at or beyond Smlc level were closely related with lymphatic and vascular invasion. Although this association was not necessarily accompanied by an increased number of involved lymph nodes, major surgical resection is suggested in such IIa + IIc cases due to an increased possibility for lymph node metastasis.

The taurine concentration and uptake in platelets obtained from normal pregnant women and gestosis patients with edema, proteinuria and hypertension (EPH gestosis) were investigated. The taurine concentration in platelets showed a marked increase in severe EPH gestosis compared with normal pregnancy or mild and moderate EPH gestosis, while the plasma taurine concentration did not change significantly. Taurine uptake in platelets paralleled the severity of EPH gestosis. The Vmax of the uptake in severe EPH gestosis was about 2.4 times higher than that in normal pregnancy or mild and moderate EPH gestosis, but no significant difference was seen in the Km value among these groups.

<P>Glycocalyx is suggested to play an important role in the pathogenesis of biomaterial-centered infection. Using an accurate and sensitive method to quantify glycocalyx and bacterial adherence, we have demonstrated that the producer of the most glycocalyx also exhibited the highest adherence index, whereas low producers exhibited the least (p less than 0.01). Additionally, at various concentrations the high producer had the greater tendency to adhere and grow on stainless steel wires and tubes (p less than 0.001). The adherence index, referred as the ratio of tritiated thymidine uptake on wires to colony forming units (CFU), was also the highest in high producers. The adherence index increased as the glycocalyx index increased. It was suggested that glycocalyx production enhanced the adherence of Staphylococcus epidermidis to biomaterials and caused persistent and intractable infections. In short, the glycocalyx index and the adherence index can be reliable indices of biomaterial-centered infection.

A rare case of primary retroperitoneal mucinous cystadenocarcinoma in a 44-year-old woman is reported. The cystic tumor was delineated by CT and echography. The tumor was removed intact in the presence of bilateral normal ovaries and demonstrated an infiltrating malignant process. This neoplasm may have arisen from a supernumerary ovary. The patient died of recurrence 4 months after surgery. A comparison of the known cases indicates that aggressive treatment by hysterectomy with bilateral salpingo-oophorectomy in addition to cyst extirpation may improve prognosis.

One-hundred-nine HLA-haploidentical living related renal transplants have been retrospectively analysed to compare the effect of donor-specific blood transfusion (DST) and different immunosuppressive regimens on graft survival and acute rejection. The recipients were divided into four groups according to the immunosuppressive therapy. Group 1 (n = 44): conventional therapy with posttransplant azathioprine (AZP) + methylprednisolone (MP). Group 2 (n = 25): pretransplant DST + posttransplant AZP + MP. Group 3 (n = 12): triple-drug therapy with posttransplant AZP + MP + cyclosporine (CS). Group 4 (n = 25): pretransplant DST + posttransplant AZP + MP + CS. The five-year actuarial survival rates for groups 1, 2, 3 and 4 were 48%, 73%, 79%, and 89%, respectively. The graft survival rate in group 3 was significantly (p less than 0.01) better than that in group 1. The transfusion effect was reduced, and appears as a 10% improvement in the graft survival in the cyclosporin era compared with a 25% improvement at pre-cyclosporin era. Furthermore, the incidence of the first rejection episode was decreased in recipients that received DST. The present study revealed that DST, as pretransplant conditioning has a definite impact on rejection-free long-term graft survival in HLA-haploidentical living-related kidney recipients and the most favorable outcome in such patients could be achieved by DST pretreatment in conjunction with posttransplant triple-drug therapy including cyclosporine.

Reported clinical and experimental observations indicate that heart grafts in combined heart-lung transplantation are less frequently rejected than heart grafts transplanted alone. In order to elucidate the mechanism of this difference, twenty-eight inbred male Lewis rats receiving heterotopic allografts from inbred male Fisher rats were evaluated for surface markers of graft infiltrating lymphocytes (GIL) and peripheral blood lymphocytes (PBL) using flowcytometry. Monoclonal antibodies investigated in this study were W3/25 (anti-helper T lymphocyte), OX8 (anti-suppressor/cytotoxic T lymphocyte), OX39 (anti-interleukin 2 receptor), and OX6 (anti-MHC class II antigen). In the acute study, a heart transplanted group (n = 7) and a heart-lung transplanted group (n = 7) without immunosuppression were studied. In the chronic study, cyclosporine (10 mg/kg/day i.m.) were administered in the heart transplanted group (n = 7) and the heart-lung transplanted group (n = 7). Both in the acute and chronic studies, the proportion of W3/25 positive cells in GIL of heart grafts of the heart transplanted group was significantly higher than that of heart grafts and lung grafts of the heart-lung transplanted group. OX8 positive cell proportion in GIL of heart grafts and lung grafts of the heart-lung transplanted group were significantly higher than that of heart grafts of the heart transplanted group. These results lead us to speculate that suppressor T lymphocytes are an important distinguishing factor in the rejection processes of heart allografts and heart-lung allografts as observed in clinical experience.

Clinical features were studied in 125 patients with sarcoidosis (72 females and 53 males) diagnosed at Okayama University Hospital during a recent 10-year period. The age distribution had two peaks in patients in their 20s and the 50s. Over half of the patients were detected at health screening check and were asymptomatic, while the remaining were symptomatic. Twelve patients were in stage 0, 41 were in stage I, 54 were in stage II, 16 were in stage III, and 2 were in stage IV according to the chest x-ray findings. Serum angiotensin converting enzyme levels and serum lysozyme levels were elevated in 60% and 76% of the patients, respectively. The bronchoalveolar lavage fluid showed lymphocytosis, especially of helper T-cells. The clinical features of sarcoidosis appear to depend on the duration of the disease.