[Caloric nystagmus in the lateral recumbent position in normal subjects--the possibility of a participation of velocity storage and other non-convection factors]

To clarify the role of central velocity storage in caloric nystagmus, 20 normal subjects in the lateral recumbent position underwent recording and analysis using ENG and an infra-red video camera in darkness. The caloric stimulus was applied by pouring 10 ml of water at 20 degrees C for 20 seconds into the ear canal. After irrigation, each subject then turned to an ear-up or an ear-down lateral position. Ninety-nine percent of the rapid phases of the horizontal components were directed to the up-side ear with no relation to the irrigated ear. Sixty-six percent of the vertical components showed vertical nystagmus toward the lower eyelid, and the remaining 34% of the vertical components showed no vertical nystagmus. The direction of the torsional components was from the up-side ear to the leg with no relation to the irrigated ear. After the first phase, the nystagmus was more significantly reversed in the ear-up lateral position than in the ear-down lateral position (p < 0.01). The maximum slow-phase velocity of the first phase horizontal component and the nystagmus frequency of the first phase horizontal and vertical components were significantly smaller in the irrigated ear-up lateral position than in the ear-down lateral position (p < 0.01). The maximum slow-phase velocity of the first phase vertical component was also smaller in the ear-up lateral position (p < 0.05). However, the duration of the first phase vertical component revealed no difference between the two positions. These findings indicate that factors other than endolymph convection are involved in the first phase horizontal and vertical components. A role for central velocity storage in the vertical, components was suggested. When caloric nystagmus was analyzed as one response, including not only the horizontal component but also the vertical and torsional components, the possibility of otolithic involvement was suggested as one of the non-convection factors.

Molecular, cytogenetic, and hematologic effects of ethylene oxide on female hospital workers

Women comprise the majority of workers exposed to ethylene oxide during sterilization of medical instruments and supplies. This article evaluates molecular, cytogenetic, and hematologic effects of ethylene oxide on 68 women workers employed in nine hospitals in the United States and one hospital in Mexico. Workers were classified by three exposure categories: none (0), low (> 0-32 ppm-hrs), and high (> 32 ppm-hrs). Hematologic effects were evaluated using complete blood count with differential, which has been questioned as a test for screening ethylene oxide-exposed workers. A statistically significant decrease in hematocrit (n = 0.02) and hemoglobin (P = 0.03) levels, an increase in lymphocyte percentages (P = 0.04), and a relative decrease in neutrophil percentages (P = 0.03) with exposure were observed in US workers. The absolute number of lymphocytes, however, showed no relationship with exposure. No statistically significant results were seen for Mexican workers, although hematocrit decreased with exposure. An exposure-response relationship for the percentage for lymphocytes (positive) and neutrophils (negative) in US subjects and for neutrophils (positive) in Mexican subjects was seen. No overall relation with exposure was observed for total number of white cells. Molecular and cytogenetic results are also reported for the 68 women, who constitute a subgroup from a previous report. US women workers showed a statistically significant exposure-response relationship for ethylene oxide and hemoglobin adducts (P = 0.0002) and sister chromatid exchanges (P = 0.001). For micronuclei, the difference (P = 0.02) between low and high exposure was statistically significant. In Mexican workers, an exposure-response relationship was observed (P = 0.002) for hemoglobin adducts but not for sister chromatid exchanges or micronuclei.

[A case of advanced gastric remnant carcinoma with Virchow's metastasis treated with neoadjuvant chemotherapy (low dose CDDP + 5-FU) followed by surgical resection]

The patient was a 64-year-old woman. At hospitalization she had gastric remnant carcinoma with Virchow's and paraaortic lymph node metastases, extensive local infiltration and obstructive jaundice. The lesions were considered nonresectable, and the patient was placed on neoadjuvant chemotherapy consisting of low-dose CDDP and 5-FU, which resulted in the disappearance of Virchow's and paraaortic lymph node metastases. She was considered to have a partial response (PR) and underwent lower esophageal resection, total remnant gastrectomy and splenectomy. Eight months after surgery, however, she died of disseminated carcinomatosis of bone marrow. Since this therapy was associated with only slightly adverse events (< or = Grade 1), this treatment modality appears to be safe. However, further studies will be necessary to identify what type of recurrence is responsive to this therapy and to evaluate its effect on patient survival.

Clinical information on serum IGFBP-3 levels and IGFBP-3 proteolytic activity in childhood

In this review paper, three pieces of clinical information in childhood are presented: (1) IGFBP-3 may replace GH provocation tests in the diagnosis of GH deficiency (GHD); (2) IGFBP-3 levels are regulated by IGF-I levels in a short period, and (3) ratio of free IGF-I to total IGF-I is high in serum of early infancy, similarly to serum of pregnancy, only partially owing to the presence of IGFBP-3 proteolytic activity. Each paper will be published soon.

Purification and characterization of a novel membrane-bound arginine-specific serine proteinase from porcine intestinal mucosa

A novel membrane-bound serine proteinase has been purified from the microsomal membranes of porcine intestinal mucosa. It was solubilized from the microsomal membrane fraction with 1% sodium deoxycholate, then purified by a series of column chromatographic steps on DE52, butyl-Toyopearl, Bio-Gel P-150, Mono Q, and benzamidine-Sepharose in the presence of 0.02% Lubrol PX. Its molecular mass was estimated to be 50 kDa both by SDS-polyacrylamide gel electrophoresis under non-reducing conditions and by gel filtration, and to be 32 kDa by SDS-polyacrylamide gel electrophoresis under reducing conditions, suggesting that the enzyme may exist as a homodimer in which two subunits are linked by disulfide bond(s). It had a pH optimum at around 9 and did not require Ca2+ for activity. It cleaved several peptide 4-methylcoumaryl-7-amide substrates almost exclusively after arginine residues, the best substrate among those tested being t-butyloxycarbonyl-Gln-Ala-Arg-4-methylcoumaryl-7-amide. Various neuropeptides were also cleaved by this enzyme after arginine, mainly between paired basic amino acid residues, Arg-Arg or Arg-Lys. Activity toward protein substrates was scarcely detected. Further, its partial amino acid sequences were highly homologous, but not identical, with those of trypsin-type serine proteinases. These results indicate that the present enzyme is a novel arginine-specific trypsin-like endopeptidase, possibly involved as a processing proteinase in the production of certain gastrointestinal neuropeptides or peptide hormones from their precursors, or their specific degradation.

[Serum levels of intact molecular osteocalcin in children with growth hormone (GH) deficiency during GH therapy: an early predictor of GH therapy]

Recently we developed a sandwich enzyme immunoassay (EIA) specific for intact molecular osteocalcin (I-OC), produced only by osteoblast cell and partially released into blood circulation, to establish a specific biochemical marker of bone formation. In order to confirm whether serum I-OC levels constitute a specific marker for bone formation and to assess the relationship between serum I-OC levels and growth response to growth hormone (GH) therapy, we measured the serum I-OC in serial serum samples using this EIA from 61 children with GH deficiency who showed significant bone growth during GH therapy. The serum I-OC levels in children with GH deficiency before GH therapy were slightly lower than those in normal children (Kanzaki S. et al., J. Clin Endocrinol Metab. 1992;75:1104-9), and had a wide distribution overlapped with the normal range. These levels were apparently increased during GH treatment; that is, in contrast to the levels of 22.9 +/- 1.5 ng/ml (mean +/- SE) before GH treatment, the levels after 1 and 2 months of GH treatment were 29.1 +/- 1.6 ng/ml and 32.5 +/- 1.8 ng/ml, respectively. However, they decreased slightly at 3 months and then they gradually rose to 37.5 +/- 2.8 ng/ml after 12 months, I-OC ratios, represented by the I-OC level at each month of GH therapy in relation to pretreatment level, correlated well with the growth response (growth velocity, growth velocity SD score and delta growth velocity SD score) after 12 months of GH treatment. Correlation coefficients of the growth velocity versus I-OC ratio at 1 and 6 months of GH treatment were 0.677 (p < 0.001, N = 58) and 0.752 (p < 0.001, N = 55), respectively. However, both IGF-I and ALP ratios represented in the same way as the I-OC ratio, correlated poorly as compared with the I-OC ratio. These results demonstrate that the change of serum I-OC levels indicates a direct and sensitive reflection of bone formation, because serum I-OC levels significantly increased with the growth response to GH therapy. The measurement of serum I-OC levels after 1 month of GH treatment may be a useful tool in predicting improved growth velocity during long-term GH therapy.

Transglucosylation with 6'-chloro-6'-deoxysucrose and immobilized isomaltulose-producing microorganisms using 2,2-dimethyl-1,3-dioxolane-4-methanol and its related compounds as acceptors. Steric and chemical requirement of the glucosyl acceptor

Enantioselective and diastereoselective alpha-D-glucosylation of 2,3-O-isopropylidene-erythritol was observed in transglucosylation with a synthetic donor using three kinds of immobilized isomaltulose-producing microorganisms. Several related compounds, including an 2,3-O-isopropylidenated aldotetrose dimethyl dithioacetal and an aldotetronic acid ester were also glucosylated in moderate or good yield, depending on the microorganism utilized. Steric as well as functional group factors are discussed in relation to the substrate specificity of the glucosyl acceptor.

Isolation of genes differentially expressed between the Yoshida sarcoma and long-survival Yoshida sarcoma variants: origin of Yoshida sarcoma revisited

The Yoshida sarcoma (YS) is characterized by growth as "free cells" in ascites. Long-survival Yoshida sarcoma (LY) variants, which develop after transplantation of YS into immunologically conditioned Donryu rats, in contrast, form "islands" in ascites. A representational difference analysis (RDA) approach was adopted to isolate genes differentially expressed between YS and LY variants to elucidate the molecular mechanism of their development. Fifteen clones presenting differences in expression were characterized. Nine genes (those encoding for the high-affinity IgE receptor gamma chain, pJG116 repetitive sequence, non neuronal enolase, proteasome subunit RC1, cytotoxic T lymphocyte-associated gene transcript CTLA-1, interleukin-2 receptor gamma chain, and three unknown sequences) expressed mRNA in YS, but showed lower or no expression of mRNA in LYs. The mRNAs of the other six genes (those encoding for cytokeratin 8, cytokeratin18 (Endo B), TIMP2 and three unknown sequences) were not found in YS, but were present in LYs. Interestingly, CTLA-1 is a non-epithelial (hematopoietic) cell-specific gene in terms of transcription, while cytokeratin 8 and cytokeratin 18 are both epithelium-specific genes. Immunohistochemically, YS expressed T-cell specific antigens CD2 and CD3, and T cell receptor beta and gamma chain genes were rearranged in YS, but not in LYs. Moreover, using restriction fragment length polymorphism probes, we found that LYs exhibited different cell lineage from YS. Thus, our present findings, unexpectedly, raise fundamental questions concerning the cellular origins of YS and LY variants rather than pointing to any specific mechanism to explain the LY phenomenon.

An early gallstone clearance following repeat piezoelectric lithotripsy

Piezoelectric extracorporeal litotripsy was performed in 128 symptomatic patients with radiolucent gall-bladder stones to assess the significance of disintegration in fragment clearance. Up to 10 repeat lithotripsy sessions were scheduled to achieve a fragment target size of < 3 mm. Fragmentation assessed by the size of the largest fragments after the last session was graded into three classes. I: sludge-like disintegration, 18%; II: < 3 mm (mean +/- s.d., 1.7 +/- 0.5 mm), 56%; and III: > or = 3 mm (3.3 +/- 0.6), 26%. All patients were initially subjected to lithotripsy alone. Bile acid dissolution therapy was started only when ultrasonography failed to show the evidence of decrease in the < 3 mm fragments during a 1 month follow up. Finally, 69 patients (54%) were treated by lithotripsy alone, and the remaining 59 received additional dissolution therapy at a mean period of 2.5 months after the initial lithotripsy. The rate of complete clearance in class I, II and III patients was 91, 42 and 10% at 6 months and 100, 68 and 49% at 18 months, respectively. Significant differences were noted between the three fragmentation grades (I vs II, III, P < 0.0001; II vs III, P < 0.02). The patients with complete clearance within 6 months were seen only in those treated by lithotripsy alone, while the majority (87%) of patients with complete clearance during the later period were seen in those treated by additional dissolution therapy. We conclude that a high degree of fragmentation appears to lead stones to an earlier period clearance, and reduce the need for dissolution therapy.

Hypopituitarism with invisible pituitary stalk: two case reports of males with micropenis suggesting fetal onset of hypopituitarism

The presence of hypopituitarism and invisible pituitary stalk on a magnetic resonance image (MRI) is commonly attributed to birth trauma. Two patients with severe hypopituitarism and invisible pituitary stalk are presented. One was born by breech delivery, the other by Cesarean section. The presence of a micropenis since early infancy in these two patients suggested that their hypopituitarism might have begun during early fetal life thus effecting penile growth during the second and third triministers of gestation. These findings raise the possibility that the association of hypopituitarism and invisible pituitary stalk may have multiple etiologies including hormonal abnormalities during early fetal life.

1,25-Dihydroxyvitamin D3 and 22-oxa-1,25-dihydroxyvitamin D3 in vivo nuclear receptor binding in developing bone during endochondral and intramembranous ossification

Target cells for 3H-labeled 1 alpha, 25(OH)2 vitamin D3 [1,25(OH)2D3, vitamin D] and its analog 3H-labeled 22-oxa-1 alpha, 25(OH)2 vitamin D3 (OCT) have been identified during endochondral and intramembranous ossification in developing, undecalcified, unembedded bone, using thaw-mount autoradiography. Two-day-old neonatal rats were injected with [3H]1,25(OH)2D3 or [3H]OCT; after 2 h leg, spine, and head were frozen and sectioned. In the epiphyseal-metaphyseal region specific nuclear concentrations of [3H]1,25(OH)2D3 and [3H]OCT were observed in identical cell populations, being low in cells of the articular and resting zone, intermediate in the proliferating zone, and highest in hypertrophic chondrocytes and in osteoblasts and precursor cells. In the primary spongiosa intertrabecular spaces there were a large number of cells with nuclear labeling--probably osteoblasts and precursor cells. In contrast, in the secondary spongiosa intertrabecular spaces, apparent blood-forming cells were mostly unlabeled. Osteoblasts along bone spicules and compact bone in long bones, vertebrae, and head also showed strong nuclear labeling, as did cells of the periosteum. These data suggest that 1,25(OH)2D3 and OCT regulate development, differentiation, and activities of chondrocytes and osteoblasts, including differentiation of resting chondrocytes into proliferating and hypertrophic chondrocytes that involve "chondroclastic" enlargement of lacunae and "trans-differentiation" of surviving hypertrophic chondrocytes; differentiation of stroma cells into osteoblasts; and in periosteum and other regions of intramembranous ossification differentiation of precursor cells and osteoblasts. Nuclear receptor binding and their selective and hierarchical distribution during cell differentiation appear to correspond to multiple genomic effects toward growth, regeneration and repair. The findings indicate a physiological significance and therapeutic potential of 1,25(OH)2D3 and in particular of its less hypercalcemic analog OCT.

[A study on stressful life events of workers in Japan]

The experience rates of eighteen life events of Japanese workers were surveyed and the strength of each of the events was evaluated by a self-reported questionnaire. The fifteen professions surveyed included construction, transport, mailing, chemical production, banking, newspaper, TV services, commercial publishing, advertising, teaching and civil service. The number of workers who answered was 18,657 males and 4,443 females, aged 20 to 59 years. The male workers were divided and analysed in six job groups: clerical workers (n = 5,866), professionals (n = 3,696), blue collar day workers (n = 1,623), blue collar night or shift workers (n = 3,191), drivers (n = 1,663) and construction workers (n = 2,466). They were divided into groups and compared according to job, sex and five different age groups. The highest experience rate in each of the life events such as family trouble for both sexes, death of a family member, financial trouble and anxiety, death of a close friend, dissatisfactory transport to workplace or job, respectively. Comparing the experience rates between males and females we found no significant difference for five items. However, other items had higher experience rates for males than for females with the exception of family trouble. In regard to the age characteristics of each of the life events, as the age increased the experience rates of health-related life events such as the death of a spouse, child, family member or close friend and one's own illness or injury became higher. In contrast, the experience rates of items such as moving to a worse residence and failure in a school or training program became lower as the age increased for both sexes. Among job groups, construction workers had the highest experience rates of most life events except for the item of dissatisfactory transport to the workplace or job. Among other job groups, drivers had higher experience rates in the following four items: re-employment, death of spouse, divorce and financial trouble and anxiety. Blue collar day workers had higher rates for failure in school or training program and family trouble. The blue collar night or shift workers had higher rates for failure in school or training program and dissatisfactory transport to the workplace or job. The mean values of strength in six life events: re-employment, death of a family member, death of a close friend, serious physical illness, dissatisfactory transport to the workplace or job and family trouble were stronger in females than in males.(ABSTRACT TRUNCATED AT 400 WORDS)

Bovine heart fructose 6-P,2-kinase:fructose 2,6-bisphosphatase mRNA and gene structure

Previously we described the coding region of bovine heart Fructose 6-P,2-kinase:Fructose 2,6-bisphosphatase as determined from cDNA. We have isolated several overlapping clones and determined the DNAs which encode the entire mRNA of bovine heart bifunctional enzyme, including the 5'- and 3'-noncoding regions. the exon-intron structure of the 27-kb gene was determined and shown to consist of 16 exons. There are one primary and two secondary transcription initiation sites with the coding region beginning at exon 2. Exons 3-7 encode the Fructose 6-P,2-kinase domain, and exons 9-14 encode the Fructose 2,6-biphosphatase domain. Exon 15 is a unique exon for the heart type isozyme and contains the phosphorylation sites for protein kinases A and C. Alternative splicing of this exon accounts for the expression of two heart type isozymes in cardiac muscle. Exon 16 (also unique), 1820 bp long and located 7 kb downstream of exon 15, encodes the short C-terminus of the enzyme and is completely different from that of the rat heart bifunctional enzyme gene.

The use of a human dura mater allograft for the repair of a contaminated abdominal wall defect: report of a case

A case report of an infected full-thickness abdominal wall defect treated successfully with a human dura mater allograft is presented. A review of the literature and a discussion of prosthetic abdominal wall repair is also included. A 46-year-old woman presented with multiple small bowel perforations and a large abdominal wall defect due to a motor vehicle collision. A gamma-irradiated human dura mater prosthesis was used to repair the large abdominal wall defect which had been infected by a jejunal fistula. After more than 4 years of follow-up, the patient is free of complications, including wound infection, herniation, and ileus. The human dura mater allograft is thus considered to be a useful prosthesis for repairing potentially infected wounds.

The crystalline structure of pancreatic calculi

The present study was carried out to investigate the ultrastructure and composition of crystals of pancreatic calculi. Microradiography showed that they were irregularly mineralized with radial or stratified zones of low mineralization. The crystals were identified as calcite composed of CaCO3 in X-ray and electron diffraction studies. Scanning electron microscopy (SEM) revealed that the calculi consist of aggregations of rhombohedral, fang-shaped, botryoidal, foliaceous, and plate-shaped crystals. Some of them showed signs of partial dissolution on their surface. Transmission electron microscopy (TEM) showed crystals of various sizes and shapes either solitary or in clumps. The direct measurement of crystalline lattice intervals obtained from each crystal was 0.386 nm in accordance with the diffraction data. Exocrine pancreatic cell debris are present in pancreatic calculus matrices.

Coronary collateral circulation and diastolic function

Patients with coronary artery disease reportedly have an impaired left ventricular filling. To evaluate the effects of coronary collaterals on diastolic function in patients with effort-induced angina, resting radionuclide ventriculography was performed in 14 patients with severe isolated (> or = 90% diameter) stenosis of the left anterior descending coronary artery and in seven normal subjects. Contrast ventriculography showed normal wall motion in all patients. Functional indices obtained by radionuclide ventriculography were compared between those patients with collateral vessels, Rentrop classification grades 1 (n = 7) and 3 (n = 1), and those patients without (n = 6) collateral vessels. Global peak filling rate was significantly (P < 0.01) reduced in the patients with collaterals. The septal, apical and lateral peak filling rates were also reduced in patients with collateral vessels, with the reduction in lateral peak filling rate being statistically significant (P < 0.05). The indices of systolic function and the temporal diastolic asynchronous index were similar, irrespective of the presence of collaterals. The exercise tolerance as evaluated by the rate-pressure product at peak treadmill exercise stress testing in 12 patients was significantly (P < 0.01) lower in those with collateral vessels. Angiographically visible collaterals could be a marker for more severe coronary stenosis in patients with effort-induced angina, and an indicator of the severity of deterioration in left ventricular diastolic function.

Scoliosis associated with central core disease

A 12-year-old Japanese girl who had progressive severe scoliosis but with minimal muscle weakness in the extremities was found to have central core disease. In her muscle biopsies obtained from the biceps brachii and paraspinous muscles, there was type 1 fiber atrophy and predominance, as is commonly seen in congenital myopathies, but the core structure was identified only in the former. To determine whether scoliosis is a prominent feature of this disease, we reviewed 10 patients with central core disease in our laboratory and found 6 ambulant patients who had mild-to-moderate scoliosis. Since kyphoscoliosis becomes prominent as muscle weakness progresses to loss of ambulation in most muscle diseases, this disproportionate spinal involvement in central core disease appears to be a striking feature. All patients with 'idiopathic' scoliosis deserve a careful neurological evaluation, even if they have minimal muscle symptoms in the extremities.

Incomplete androgen insensitivity associated with a thermolabile androgen receptor

One infant and a cousin with incomplete androgen insensitivity syndrome were reported. The familial pedigree showed that the disorder was inherited in three generations in X-linked recessive fashion. An androgen binding study of cultured genital skin fibroblast from patients showed normal maximum binding capacity and a normal apparent dissociation constant. Heat stability assay showed binding decreased to less than 30% at 41 degrees C compared with the amount at 30 degrees C, indicating that the androgen receptor was thermolabile.

Expression of type-IV collagenases in human tumor cell lines that can form liver colonies in chick embryos

Chick embryo has been used as a model system for evaluating the metastatic potential of tumor cells. We have previously demonstrated that expression of the tissue inhibitor of matrix metalloproteinase-I (TIMP-I) gene can suppress liver colonization of tumor cels in chick embryo, probably by inhibiting the activity of matrix metalloproteinases (MMP) produced by tumor cells. In an attempt to identify MMP associated with liver colonization, we examined 24 human tumor cell lines for their potential to form metastatic colonies in chick-embryo liver after the cells had been inoculated into the chorioallantoic membrane (CAM) vein. We compared the results with the mRNA expression of MMP (MMP-I, MMP-2, MMP-3, MMP-9) studied previously. Three of 8 cell lines from mesenchymal tumors (fibrosarcoma HT1080, osteosarcomas SK-ES and MNNG/HOS) and 2 of 16 cell lines from epithelial tumors (gastric carcinoma KKLS and bladder carcinoma T24) proliferated in the livers. MMP-2 and MMP-9 were the enzymes whose transcripts were more frequently expressed in these 5 metastatic cell lines (MMP-1; 2/5, MMP-2; 4/5, MMP-3; 0/5, MMP-9; 3/5), but other cell lines that did not form liver colonies expressed the transcripts at lower frequency (MMP-2; 7/19, MMP-9; 3/19). Although either or both MMP-2 and MMP-9 transcripts were expressed in 4 of the 5 metastatic cell lines, they were undetectable in T24 cells. However, induced expression of both enzymes was detected by immunostaining in the T24 cells colonized in the liver. Thus, type-IV collagenases expressed by tumor cells may play a role in facilitating colonization in chick embryos.

Japanese type of spondylo-metaphyseal dysplasia

Five members of a Japanese family with a new form of spondylo-metaphyseal dysplasia (SMD) are reported. Another member was also probably affected. The disease was characterised by severe coxa vara, moderately severe metaphyseal changes of the long bones of the lower limbs, mild changes in the long bones of the upper limbs and grossly normal short tubular bones. Platyspondyly, present in the boys, was less marked in their father, whereas two affected aunts had normally shaped vertebral bodies.

Malignant thymoma in a patient with growth hormone deficiency during growth hormone therapy

Malignant thymoma was found in an 8-year-old Japanese boy with growth hormone (GH) deficiency who had received GH therapy for 3 years and 5 months. There may be a possible relationship between the occurrence of malignant thymoma and GH therapy.

Bone marrow transplantation for late infantile metachromatic leukodystrophy: pathogenic investigation for graft rejection

A Japanese boy aged 2 years 11 months with late infantile metachromatic leukodystrophy underwent bone marrow transplantation (BMT) from his human leukocyte antigen (HLA) identical but mixed lymphocyte culture reactive father. Chimerism and increased arylsulfatase A activities of leukocytes had been observed with retarded progression of neurological deterioration during the first 3 months post-BMT. Graft rejection gradually occurred and donor cells were almost completely eliminated from the patient at 1 year after BMT. The process of neurodegeneration progressed clinically and neuroradiologically. Three possible reasons for the pathogenesis of graft rejection are: (i) T cell depletion of donor marrow cells as graft-versus-host disease (GVHD) prophylaxis; (ii) a slightly weak conditioning regimen: and (iii) a small number of marrow cells transplanted. It is stressed that as BMT is still a preliminary therapy for metachromatic leukodystrophy indications, conditioning, and GVHD prophylaxis for BMT should be considered individually.