[Thoracoscopic repair of diaphragmatic thinning for pleuroperitoneal communication; report of a case]

A 53-year-old man presented with massive right hydrothorax just after introduction of continuous ambulatory peritoneal dialysis (CAPD). Because the glucose concentration of pleural fluid was markedly high compared with that of serum, we diagnosed pleuroperitoneal communication. Thoracoscopic surgery was performed and thinning of the diaphragm was found. We sutured the diaphragm to repair the thin portion and performed pleurodesis with 50% glucose solution. He restarted CAPD 1 month post-operatively and continued at home without pleural effusion. Eight months post-operatively, he experienced dyspnea again and chest X-ray showed right hydrothorax. Although the cause of recurrent hydrothorax is unknown, it may be that not only surgical repair but also more intense pleurodesis is needed.

Esophagogastrostomy reconstruction after limited proximal gastrectomy

BACKGROUND/AIMS

Recent advances in diagnostic techniques have led to the detection of an increasing number of early gastric cancers in the upper third of the stomach. The objective of this study was to determine the most appropriate surgical treatment for these cancers.

METHODOLOGY

The clinicopathologic characteristics of 35 patients with early gastric cancer in the upper third of the stomach who underwent three different types of gastrectomies were reviewed retrospectively from hospital records between January 1992 and August 1999.

RESULTS

Patients undergoing limited proximal gastrectomy with esophagogastrostomy reconstruction had shorter operation times and less blood loss than those for patients undergoing total gastrectomy or proximal gastrectomy with jejunal interposition. No lymph node metastasis was identified in any of these patients. Heartburn due to reflux esophagitis was seen in a few patients of each group, but they were successfully treated by antacids. The extreme reduction in food intake volume was more frequently experienced in patients with total gastrectomy than those with both proximal gastrectomies. When mortality due to other disease was excluded, all patients survived without recurrence.

CONCLUSIONS

A limited proximal gastrectomy with esophagogastrostomy reconstruction decreased surgical risk and realized preservation of maximal function.

Synthesis and pharmacokinetics of a novel macromolecular prodrug of Tacrolimus (FK506), FK506-dextran conjugate

A novel macromolecular prodrug of Tacrolimus (FK506), FK506-dextran conjugate, was developed and its physico-chemical, biological and pharmacokinetic characteristics were studied. The conjugate was estimated to contain 0.45% of FK506 and the coupling molar ratio was approximately 1:1 (dextran-FK-506). Adsorption experiments using ion exchangers indicated that FK506-dextran conjugate acted as a weakly negatively charged macromolecule. Low molecular weight radioactive compound(s), which was eluted in the same fractions as [(3)H]FK506, was released from [(3)H]FK506-dextran conjugate by chemical hydrolysis with a half-life of 150 h in phosphate buffer. In vitro immunosuppressive activity of the conjugate, as assessed by the rat lymphocyte stimulation test, was almost comparable to that of free FK506, suggesting that biologically active FK506 could be liberated from the conjugate. In vitro biodistribution studies demonstrated that conjugation with the dextran derivative dramatically changed the pharmacokinetic properties of FK506 after intravenous injection in rats. AUC of the FK506-dextran conjugate was almost 2000 times higher than that of free FK506 and organ uptake clearances of the conjugate were significantly smaller than those of the free drug. Thus, the present study has demonstrated that the FK506-dextran conjugate behaves as a prodrug of FK506 with an extended blood circulating time and can be expected to have an improved therapeutic potency.

[A case of cardiac rupture which occurred 34 years after mastectomy]

We experienced a case of cardiac rupture associated with mastectomy. A 78-year-old woman, who underwent left mastectomy 34 years before, complained of bleeding from a chest tumor located on the operative scar of the left mastectomy and postoperative irradiation. The tumor was noticed 10 months prior and became larger and repeated bleeding. It was first diagnosed as hemangioma by nearby practitioner. She was referred to the university hospital because of uncontrollable bleeding from the tumor. Without definite diagnosis, the tumor ruptured suddenly 52 days after the admission and the patient lapsed into the state of hemorrhagic shock and cardiopulmonary resuscitation was performed. Following emergency operation was performed on stand-by of cardiopulmonary bypass (CPB). The operation was successful with the aid of partial CPB and the final diagnosis of cardiac rupture was determined during the surgery. A case of cardiac rupture after mastectomy and radiation is rare, and this is the first report in the Japanese literature to date. The patient could be saved because the operation was performed on stand-by CPB.

Long-term prognosis of renal transplant surviving for over 10 yr, and clinical, renal and rehabilitation features of 20-yr successes

Long-term mortality and morbidity was evaluated in 267 patients with a minimum follow-up of 10 yr and the physical status, graft function and quality of life in 15 patients with a functioning graft surviving for over 20 yr were reviewed. Actual patient and graft survival rates were 80.2% and 51.1% at 10 yr (n = 267) and 56.4% and 32.7% at 20 yr (n = 55), respectively. Although the rate of graft failure due to rejection was 4 times higher than that of patient death within 10 yr, it decreased to the level of patient death in the second decade. Dominant causes of death in patients with graft surviving for over 10 yr were hepatic failure due to viral hepatitis and malignancies. In 15 patients with graft currently surviving beyond 20 yr, while all patients have excellent graft function, malignancy occurred in 5, viral hepatitis in 3, aseptic necrosis in 3, and diabetes mellitus in one patient. No patient has suffered cardiovascular complications. Despite a high rate of morbidity, they show a satisfying status of rehabilitation (full time working 11/ 15, 73.3%). In order to attain more improved QOL in patients with long-term surviving renal transplant, close follow-up aiming at diminution of complications is required throughout the period after transplantation.

Immunological study of unresponsive state in rat hepatic transplant model. 2. Immunosuppressive factor in the serum from the tolerant hosts

Our previous study demonstrated that Lewis (LEW) rat recipients engrafted with Brown-Norway (BN) rat liver displayed a long-term graft survival and that phenotypic and functional analyses of graft-infiltrating cells on day 6 postgrafting showed a lower proportion and activity of cytotoxic cells in long-term surviving hosts than LEW recipients engrafted with DA rat liver which showed acute rejection on day 9 postgrafting. In order to assess the immunological mechanisms of unresponsiveness, we analyzed the lymphocyte and serum from LEW recipients engrafted with BN liver. Spleen cells from tolerant LEW recipients on day 6 posttransplantation had no suppressor effect on the one-way mixed lymphocyte culture (MLC) reaction. On the other hand, when serum was added to MLC at a concentration of 6% of the total volume, it suppressed the mixed lymphocyte reaction (MLR) toward donor BN cells by 45.6%, but not toward third-party DA stimulator (-0.4%). Adoptive transfer of the serum from tolerant LEW hosts into the virgin secondary LEW hosts significantly prolonged the graft survival of BN kidneys from 7.8 +/- 0.2 to 14.7 +/- 1.6 days (p < 0.01), but not of third party DA kidney graft (mean survival time = 9.5 +/- 1.3 days). The in vitro study demonstrated that the suppressor factor in the serum inhibited the production of IL-2 as well as gamma-IFN in MLR. The suppressor factor was absorbed by LEW cells stimulated with BN cells in vitro, indicating that this factor was directed against recognition sites on responder T lymphocytes. These results showed that an antigen-specific tolerogenic factor which recognized the idiotype of the donor was released into the circulation through the process of BN liver grafting.

Immunological study of unresponsive state in rat hepatic transplant model. 1. Phenotypic and functional analyses of infiltrating cells

In order to elucidate the immunological characteristics of rat liver transplantation, graft-infiltrating cells (GIC) isolated from rat hepatic allografts were analyzed phenotypically and functionally. GIC from long-surviving recipients (Brown Norway livers into Lewis hosts) and acutely rejecting recipients (DA livers into Lewis hosts) were compared. The relative proportions of all T cells and activated T cells determined by flow cytometry were significantly higher in acutely rejecting Lewis recipients than in long-surviving recipients on day 6 after grafting. Phenotypic kinesis of GIC on days 6, 14, and 45 after transplantation from long-surviving Lewis hosts was analyzed. Each proportion of all T cells, OX8-positive cells (cytotoxic T and natural killer cells), and OX39-positive cells (IL-2 receptor), was greatest on day 6 and decreased by day 45. Cytotoxic activity of GIC toward donor lymphocytes on day 6 was greater in acutely rejecting versus long-surviving recipients. These results demonstrate that an immunosuppressive mechanism is already present on day 6 posttransplantation, and that infiltration or activation of cytotoxic T cells is inhibited in the long-surviving rat hepatic allografts.

Induction of transplantation tolerance by chimeric donor/recipient class I RT1.Aa molecules

Donor-specific transplantation tolerance was induced by administration of chimeric antigens in which four donor immunogenic amino acids (a.a.) were substituted onto the host class I MHC protein. We constructed chimeric rat RT1.Aa cDNA molecules by substituting nucleotides in the alpha1 helical region that encode 10 Lewis (LEW; RT1.A1) a.a., namely Asp58, Arg62, Glu63, Gln65, Lys66, Gly69, Asn70, Asn73, Ser77, and Asn80 ([alpha(1h)1]-RT1.Aa). The chimeric [alpha(1h)1]-RT1.Aa cDNA sequence was verified before transfection into Buffalo (BUF; RT1b) hepatoma cells. Interestingly, the helical regions of LEW rats (alpha(1h)1) and Wistar Furth (WF; RT1u) rats (alpha(1h)u) share four a.a. (Arg62, Glu63, Gln65, and Gly69). Consequently, subcutaneous administration of [alpha(1)1]-RT1.Aa transfectants (20x10(6); day -7) immunized BUF rats to reject in rapid fashion either LEW heart allografts (mean survival time [MST] = 4.2+/-0.4 days vs. 5.6+/-0.5 days in controls; P<0.001) or WF heart allografts (MST=4.4+/-0.6 days vs. 6.0+/-0.0 days in controls; P<0.002). Subcutaneous immunization of ACI (RT1a) rats with [a(1)1]-RT1.Aa transfectants (bearing 10 LEW donor a.a.) accelerated the rejection of LEW hearts (MST=5.0+/-0.8 days vs. 8.2+/-0.4 days in controls; P<0.001). In contrast, the same [a(1)1]-RT1.Aa transfectants (bearing only four WF donor a.a.) injected subcutaneously into ACI rats modestly prolonged the survival of WF hearts to 14.0+/-10.3 days from 5.4+/-0.5 days in controls (P<0.001). Furthermore, ACI recipients were rendered tolerant to WF heart allografts by a single injection via the portal vein of soluble [a(1)1]-RT1.Aa (but not RT1.Aa, RT1.Au, or [a(2)1]-RT1.Aa) antigens in conjunction with brief oral gavage treatment with cyclosporine. Thus, selected donor immunogenic a.a. (Arg62, Glu63, Gln65, and Gly69) of class I MHC antigens become tolerogenic when flanked by host sequences.

Synergistic interaction of 3 M KCl-extracted donor antigens (e-HAg) with cyclosporine or cyclosporine/sirolimus for prolongation of rat heart allograft survival

Extracted donor histocompatibility antigens (e-HAg) may potentiate the effects of drugs to protect organ allografts from rejection. We examined the capacity of e-HAg when combined with cyclosporine (CsA) alone, sirolimus (rapamycin, RAPA) alone, or CsA/RAPA combinations to prolong heart allograft survival in rats. Wistar-Furth (WF; RT1u) rats that received CsA (10 mg/kg/day) by oral gavage for 3 (days 0, 1 and 2) or 7 (days 0, 1, 2, 3, 4, 5 and 6) consecutive days displayed modest prolongation of Brown Norway (BN; RT1n) heart allograft survival from a mean survival time of 7.2 +/- 0.8 days in untreated controls to 12.2 +/- 1.1 days and 18.6 +/- 2.7 days, respectively (p < 0.01). Although administration on the day of transplantation (day 0) of a single intravenous (i.v.) dose of BN e-HAg (5 mg/kg) failed to affect allograft survival, both three (days 0, 1 and 2) and five (days 0, 1, 2, 3 and 4) injections significantly potentiated the effect of a 3-day course of oral CsA (18.6 +/- 1.3 days (p < 0.01) and 20.0 +/- 1.4 days (p < 0.01), respectively) and of a 7-day course of oral CsA (25.3 +/- 4.4 days (p < 0.05) and 33.5 +/- 9.3 days (p < 0.01), respectively). Median-effect analysis confirmed a synergistic interaction between CsA (0.5 mg/kg x 7 days, i.v.) and e-HAg with combination index (CI) values less than 0.7 (CI = 1 shows additive interactions, CI < 1 synergistic, and CI > 1 antagonistic, interactions). In contrast, e-HAg failed to affect the immunosuppressive effect of RAPA. However, e-HAg (5.0 mg/kg x 3 days) significantly potentiated the effects of a 7-day or 14-day course of RAPA (0.01 mg/kg)/CsA (0.5 mg/kg) combination therapy, namely from 26.0 +/- 4.8 days with a 7-day treatment of CsA/RAPA alone to 32.6 +/- 3.6 days (p < 0.01) and from 28.2 +/- 2.7 days with a 14-day course of CsA/RAPA alone to 42.0 +/- 4.9 days (p < 0.05), respectively (CI = 0.2-0.5). Thus, e-HAg potentiates the immunosuppressive effects of CsA alone and of the CsA/RAPA combination, but not of sirolimus alone.

Membrane-bound or soluble truncated RT1.Aa rat class I major histocompatibility antigens induce specific alloimmunity

Transfectants that express membrane-bound (MB) or secrete soluble truncated (TR) rat class I RT1.Aa major histocompatibility (MHC) antigens induce alloimmunity in vivo. The MB-RT1.Aa was produced by transfecting the full-length RT1.Aa cDNA, including the alpha 1, alpha 2, and alpha 3, transmembrane and intracellular domains. The TR-RT1.Aa cDNA insert included only the extracellular alpha 1, alpha 2, and alpha 3 domains; a stop codon was placed in front of the transmembrane domain. Following full-length sequencing, MB-RT1.Aa and TR-RT1.Aa cDNAs were translated in vitro into glycosylated MB-RT1.Aa (45 kDa) and TR-RT1.Aa (36 kDa) proteins, respectively. Each cDNA construct was individually subcloned into the pSG5 vector before transfection into Buffalo (BUF; RT1b) hepatoma cells. FACscan analysis with anti-RT1.Aa-specific R2/15S monoclonal antibody (MAb) confirmed surface expression of RT1.Aa molecules on the MB-RT1.Aa, but not on the TR-RT1.Aa, transfectants. In contrast, enzyme-linked immunoadsorbent assays documented the presence of soluble RT1.Aa molecules in supernates from cells transfected with the TR-RT1.Aa, but not from cells transfected with the MB-RT1.Aa, cDNA. Subcutaneous injection of MB-RT1.Aa or TR-RT1.Aa transfectants to BUF or Wistar Furth (WF; RT1u) rats induced accelerated rejection of ACI (RT1a) but not third-party Brown Norway (RT1n) heart allografts. Furthermore, supernates of TR-RT1.Aa, but not of MB-RT1.Aa, transfectants immunized WF hosts toward ACI hearts. Thus, both intact MB-RT1.Aa and soluble TR-RT1.Aa class I alloantigens induce potent sensitization against alloantigens.

Mechanism for species-specific induction of Leydig cell tumors in rats by lansoprazole

Lansoprazole is a substituted benzimidazole which inhibits gastric acid secretion by inhibiting the hydrogen-potassium ATPase (proton pump) in the parietal cell. The finding of Leydig cell hyperplasia and Leydig cell tumors in 2-year oral studies in Sprague-Dawley rats but not in CD-1 mice prompted investigative studies to determine the mechanism for the Leydig cell changes. hCG challenge studies in Sprague-Dawley rats revealed decreased testosterone responsiveness in rats treated orally for 1 or 2 weeks with lansoprazole. After 4 weeks of daily oral treatment increases in serum LH and decreases in serum testosterone were detected within a few hours after dosing. In a study where 9-month-old male F344 rats were given testosterone supplementation via Silastic implants and then treated with lansoprazole for 6 months, a high incidence of Leydig cell tumors was seen in lansoprazole-treated, unsupplemented rats, whereas no Leydig cell tumors were seen in testosterone supplemented rats. This implied that reduction of the normal feedback inhibition at the level of the hypothalamus and/or pituitary due to reduced testosterone levels, thus giving rise to elevated levels of LH, was involved in the induction of Leydig cell tumors by lansoprazole. In vitro studies with Leydig cells from rats using various stimulators and precursors of testosterone biosynthesis demonstrated that the most sensitive site for inhibition of testosterone synthesis by lansoprazole is the transport of cholesterol to the cholesterol side chain cleavage enzyme. The IC50s for inhibition of LH or hCG-stimulated testosterone synthesis in Leydig cells from rats, mice, and monkeys were 11-12, 8, and 24.7 micrograms/ml, respectively. In vitro studies with metabolites of lansoprazole revealed that three metabolites were more potent inhibitors of testosterone synthesis than the parent drug, two of them being at least 10 times more potent. These metabolites are present in rats at substantial levels but are undetectable in humans. The lack of induction of Leydig cell tumors in mice, lower sensitivity of primate Leydig cells, and the absence of testosterone synthesis-inhibiting metabolites in man suggest that Leydig cell tumors found in rats represent a species-specific sensitivity and does not imply a risk for clinical use in man.

[A case report of posterior urethral polyp in a child]

The urethral polyps in children are different from those in adults because the polyps usually originate at the proximal vermontanum, and are covered with transitional epithelium. A case of posterior urethral polyp in a child is reported herein. In this case, 5 years of age, the polyp was thought to be the cause of urinary tract infection (UTI) and histological findings revealed fibrous non-prostatic tissue. Transurethral resection of polyp was performed successfully.

[Evaluation of bladder tumor staging by submucosonography]

Submucosonography to stage tumors of the esophagus and stomach is well reported. Here we report our experience with a modified procedure to evaluate the stage of bladder tumor cystoscopically and compare the results of staging by other methods. The evaluation was carried out on accuracy 10 patients (10 bladder tumors). A water soluble contrast medium (CM: lohexol 33 mg/ml) was injected into the submucosa of the bladder cystoscopically. Usually the injected point was one centimeter to the urethral margin of the tumor and up to three points were selected. Within 30 minutes after the injection, the lateral and frontal X-ray pictures were taken. The accuracies of staging by submucosonography were compared with the results of other methods, i.g., ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI). By submucosonography, three categories depending on the diffusion of CM were classified as follows. Type I: (diffuse type) without disturbance of diffusion. Type II: (borderline type) between type I and III. Type III: (defect type) local disturbance of diffusion. Overall accuracies of each were 70.0% (submucosonography), 62.5% (US), 44.4% (CT), 66.7% (MRI) respectively. The accuracies of submucosonography were high in stage Ta, above stage T2 and low in stage T1.

[The effect of perioperative portal venous inoculation with donor lymphocytes in combination with immunosuppressive agents on rat cardiac allograft survivals]

The synergistic effects of inoculation with donor lymphocytes via portal vein (PV) in combination with FK506 or monoclonal anti-T lymphocyte antibody (OX19) on cardiac allograft survival were investigated in rat heart transplant model (Lewis engrafted BN heart). The recipients were divided into the six groups. A) Control B) FK506 group C) PV group D) FK506+PV group E) OX19 group F) OX19+PV group. The recipients of PV group and FK506 group displayed a prolongation of cardiac allograft survival [MST: 11.2 +/- 1.0 and 12.4 +/- 1.0 days] compared with control group [MST: 7.3 +/- 0.3 days]. However, MST of FK506+PV group was 10.6 +/- 0.8 days, showing no synergistic effect of FK506 with PV administration. Significant prolongation of the graft survivals was not observed between OX19 group and OX19+PV group [MST: 17.2 +/- 2.1 and 15.0 +/- 1.2 days]. Serum from PV-treated hosts on day 7 after transplantation had suppressor effect (92.7%) on the MLR of Lewis responder cells toward donor BN cells. On the other hand, suppressor effect of serum from FK506+PV group was significantly reduced (5.8%) compared with PV alone. These results indicate that FK506 might inhibit the generation of suppressor factor which was induced in the serum after administration of donor lymphocytes, and that generation of suppressor factor might be dependent on T cell.

Clinical factors which influence the long-term survival of kidney allografts donated from haploidentical donors

All patients with renal transplants are very much concerned about their chance of long-term graft function. Chronic rejection is the most common cause of decline in function and graft failure, and after the first post-transplant year, 3-4% of recipients lose their graft every year. However, the cause, time of onset and mechanism of decline in graft function are not clear. Also unclear is whether clinical and laboratory parameters may predict patients who are at risk of developing chronic rejection. The aim of this study was to find the marker which may determine long-term graft survival in the azathioprine era and in the cyclosporine era.

Distribution of two types of infiltrating helper T cells among rat renal allografts, spleen, peripheral blood, and regional lymph node cells

Cytokine production by graft-infiltrating cells (GIC) of helper T cell (Th) subtypes were investigated in rat kidney allograft compared to those infiltrating the spleen, those in peripheral blood, and in regional lymph nodes. The relative proportion of OX-22 positive cells (Th type 1) and the W3/25-positive cells (Th) of GIC was 49.4 +/- 2.1% on day 3 and 52.7 +/- 2.2% on day 6, whereas those in spleen cells was 80.3 +/- 4.1% (p less than 0.05) and 95.5 +/- 2.5% (p less than 0.01), respectively. GIC produced more B cell-stimulating factor 2 (BSF-2, 106.3 +/- 8.2 U/ml) when compared to spleen cells (15.9 +/- 4.6 U/ml; p less than 0.01), peripheral blood mononuclear cells (4.2 +/- 1.0 U/ml; p less than 0.01) or lymph node cells (24.9 +/- 4.0 U/ml; p less than 0.01) upon stimulation with donor BN lymphocytes in vitro. However, GIC produced less interleukin 2 (IL-2, less than 1.0 U/ml) and IL-3 (less than 1.0 U/ml) than produced by spleen cells (5.1 +/- 0.9 U/ml, p less than 0.05, and 10.5 +/- 2.3 U/ml, p less than 0.01, respectively) or lymph node cells (4.5 +/- 0.4 U/ml, p less than 0.01; 23.5 +/- 3.1 U/ml, p less than 0.01, respectively). These results demonstrate that the subtype of Th cells which produce BSF-2 migrates selectively to allografts.

[Clinical studies on chronic prostatitis and prostatitis-like syndrome. (5) Evaluation of prostatitis complicated by anal disease]

We analyzed the incidence of anal disease in patients with nonbacterial prostatitis (NBP) or with prostatitis-like syndrome (PLS), and evaluated the clinical efficacy. The complicated rate of anal disease in these patients was 29.7% (31.8% for NBP and 28.1% for PLS), and the overall incidence of active anal disease was 15.4% (16.2% for NBP and 14.8% for PLS), it yielded a significantly higher complicated rate than other urological disease (p less than 0.01). The most common type of anal disease was hemorrhoids, especially piles. The clinical cure rate for anal disease in NBP patients was 71.4%, and in PLS patients was 58.2%. The high incidence of hemorrhoids (especially piles) was in these patients by clinico-statistical observation suggests that the development of anal disease may be etiologically correlated with NBP and PLS. Furthermore, we noted that Kampo treatment (Keisibukuryogan) was useful in the treatment of prostatitis complicated by anal disease, especially when combined with anti-hemorrhoidal suppositories against active anal disease in PLS patients (p less than 0.05).

Prolongation of renal allograft survival in the rat treated with amniotic fluid

To assess the role of amniotic fluid (AMF) in the maintenance of pregnancy, immunosuppressive effects of AMF were studied in vivo, and the mechanisms of suppressor activity were analyzed immunologically in vitro in the rat. Female Lewis (LEW, RT-1l) rats mated with Brown-Norway (BN, RT-1n) rats for 14 days were sacrificed and cell-free AMF was obtained. AMF was diafiltered with PBS (PH 7.2) and reconstituted to 2 OD units measured at 280 nm. Untreated LEW hosts rejected BN renal grafts at 7.8 +/- 0.2 days (n = 10). Five days of intravenous inoculation of AMF into LEW hosts remarkably enhanced BN graft survivals (MST = 20.3 +/- 4.4 days, n = 12) compared with controls (P less than 0.01), and slightly prolonged third-party DA (RT-1a) graft survivals (MST = 9.4 +/- 0.8 days, n = 7) compared with control LEW hosts engrafted with a DA kidney (MST = 7.6 +/- 0.2 days, n = 6). Five days of intravenous inoculation of pregnant sera into LEW hosts had no effect on BN graft survival. The AMF suppressed the proliferative response of LEW lymphocytes against not only irradiated BN stimulator cells but also irradiated third-party DA stimulators. The AMF also suppressed allokiller T cell generation of normal LEW lymphocytes against BN cells by 70.1% and 51.3%, and against DA cells by 64.9% and 38.9% at concentrations of 25% and 12.5%, respectively (P less than 0.01). To dissect the immunosuppressive activity of AMF, the effect of AMF on cytokine production and interleukin 2 (IL-2) receptor expression of concanavalin A-stimulated lymphocytes were investigated. AMF suppressed interferon and IL-2 production. Interestingly, however, AMF did not suppress interleukin 3 (IL-3) and interleukin 6 (IL-6) production, as well as IL-2 receptor expression. These results demonstrated that rat AMF displayed a strong immunosuppression in vivo as well as in vitro, and that AMF might play an important role in the maintenance of pregnancy.

[The effects of perioperative administration of donor lymphocytes via portal vein in rat skin transplant model]

The effects of perioperative portal venous (P.V.) administration of donor lymphocytes on skin allograft survival were investigated in rat skin transplant model. Heterotopic skin transplantations were performed form Brown-Norway (BN, RT-1n) to Lewis (LEW, RT-1(1] male rats. P.V. administration of donor BN lymphocytes (1 x 10(8] resulted in significant prolongation of BN skin graft survival (MST = 13.4 +/- 3.9 days, p less than 0.05) compared with I.V. administration of same number of donor lymphocytes (8.6 +/- 1.2 days) or with PV administration of third party DA (RT-1a) rat's lymphocytes (7.4 +/- 0.8 days) or with untreated controls (9.0 +/- 1.4 days). These results suggested that this effect was antigen specific. P.V. administration of donor lymphocytes prevented recipient which received BN skin graft form developing delayed-type hypersensitivity responses to donor antigen. Serum from LEW recipients which induced unresponsiveness by PV administration with donor BN lymphocytes had significant antigen specific suppressor effect (77.0 +/- 5%) on the MLR proliferative reaction of LEW responder cells toward donor BN cells, but not third party DA stimulation. Moreover, this immunological unresponsiveness was transferable by the serum in kidney transplant model. These results indicate that PV administration of donor lymphocytes induces recipient's unresponsiveness to donor alloantigen in rat skin transplant model, and this effect is transferable by the suppressor factor in the serum.

[Clinical evaluation of the bladder tumor marker "Tu-MARK-BTA"]

Bladder tumor antigen (BTA) is a tumor marker isolated from the urine of individuals with TCC of the bladder. This antigen can be detected by the Tu-MARK BTA test, a simple and rapid slide latex agglutination test performed on freshly voided urine. Sensitivity and specificity of BTA were calculated, and the correlation with pathological grade, histological stage, and urinary findings were statistically evaluated (chi 2-test) in 110 patients (72 male, 38 female; age: 16-91, mean age 54.4) examined between September, 1989 and April, 1990 including 46 TCC of the bladder (primary 28, secondary 18; grade 1:10, grade 2:27, grade 3:9, pTis: 2, pTa: 2, pT1: 23, pT2: 5, pT3: 4, pT4: 2), and 64 benign diseases. Sensitivity was 45.6%, specificity was 60.9%. In bladder tumor cases a correlation was seen between BTA and stage (p less than 0.02), and between BTA and grade (P less than 0.05). The positive ratio was higher in T1-T4 (55.9%) than in Tis.Ta (p less than 0.02). A high positive ratio of BTA was seen in bladder tumor cases with hematuria (70%, p less than 0.01) and pyuria (86.7%, p less than 0.01). This method is easy and rapid and the values are highly correlated with stage. Therefore, it should be useful for not only screening but followup of bladder tumor. Furthermore, BTA in combination with urine cytology is a more useful way for diagnosing TCC of the bladder.

[The effect of combination therapy of cyclosporine with steroid on the production of gamma-interferon and interleukin-1 in kidney transplant recipients]

The present study examined the effects of CsA administered with steroid in vivo on the capacity of kidney transplant recipient mononuclear cells to generate cytokines and their gene expression at the level of messenger RNA (mRNA). Peripheral blood mononuclear cells (PBMC) from CsA-Prednisolone (Pred) treated recipients displayed 66.9% inhibition (54.3 + 12.4 IU/ml, n = 42, p less than 0.01) of gamma-IFN production compared with normal individuals (134.6 + 18.6 IU/ml, n = 23). Azathioprine (Az)-Pred treated recipients displayed significantly less inhibition of gamma-IFN generation (96.0 + 16.1 IU/ml, n = 22, p less than 0.05) than CsA treated patients. Macrophages (m phi) from CsA-Pred treated recipients displayed 60.0% inhibition (5.1 + 0.7 U/ml, n = 20, p less than 21). These result were confirmed by the experiments using cDNA probe for gamma-IFN or IL-1 (alpha, beta). High levels of gamma-IFN mRNA in PHA-stimulated PBL or IL-1 (beta) mRNA in LPS-stimulated m phi were present in normal individuals, but not in CsA treated recipients as judged by hybridization to a cloned human gamma-IFN or IL-1 (beta) cDNA probe. These studies demonstrated that combination therapy of CsA with steroid inhibits both gamma-IFN and IL-1 gene expression at the level of mRNA at physiological concentration.

[Phenotype and function of cells infiltrating rat renal allograft]

Phenotype and function of graft infiltrating cells (GIC) from rat renal allografts were investigated in comparison with those of spleen (SP) cells, peripheral blood mononuclear cells (PBMC), and regional lymph node (LN) cells of the recipient. Relative proportions of all T cell, suppressor/cytotoxic T cell, helper T cell, and antigen-activated cell displayed significant increases in GIC during ongoing rejection assessed by flow cytometry. Cytolytic activity (using 51Cr release assay) of GIC on day 3 was much higher (20.2%) than those of SP (6.0%), PBMC (3.8%), and LN (3.2%) on BN target cells and this activity gradually increased during ongoing rejection up to 53.1% (GIC), on day 6. In vitro production of cytokines (IL-2, IL-3, gamma-IFN, and BSF-2) from these groups of cells were investigated. GIC demonstrated the most remarkable increases of cytokine production from day 3 to day 6. Especially, GIC on day 6 produced higher amount of BSF-2 compared with SP cells, PBMC and LN cells. These results demonstrated that alloactivated Th cells as well as Tc cells accumulated within the allografts and that the subtype of Th cells which produce BSF-2 preferentially assembled to the allograft.

[Examination by densitometer on visualization of non-ionic contrast medium (iohexol) in excretory urography. 1. Visualization by bolus injection]

The visualization of non-ionic contrast medium (Omnipaque 300) in the excretory urography by bolus injection was examined with regard to the normal sided urinary tract in patients with urolithiasis using a densitometer and further compared with that of ionic contrast medium (60% Urografin). In relation to the photographing method, both contrast media showed an increasing frequency of high opaque site in the order of Tomo, A-P and P-A images, which tended to shift from the upper to the lower urinary tract. In relation to the site of determination, both agents showed a good image in the upper urinary tract by the each photographings, while P-A image was better than A-P image in the lower urinary tract, suggesting their high usefulness for the imaging diagnosis. The visualization in relation to the contrast medium used was better in Omnipaque 300 groups than in 60% Urografin group with a significant difference (P less than 0.05-0.01) in the calyx and pelvis of the kidney by the each photographings, suggesting a high usefulness of non-ionic contrast medium. A densitometer seemed to be a useful means for evaluation and examination of the visualization with excellent objectivity as compared with conventional macroscopic methods.

[Examination by densitometer on visualization of non-ionic contrast medium (iohexol) in excretory urography. 2. Changes in visualization by DIP]

Changes in the visualization of non-ionic contrast medium (Omnipaque 300) in the urography by DIP were monitored for the normal sided urinary tract in patients with urolithiasis using a densitometer. In addition, changes of the visualization in relation to the dose of contrast medium used was examined and compared with that of ionic contrast medium (60% Urografin). The optimum photographing time was 15 minutes in the upper urinary tract (nephrogram, calyx, pelvis, upper ureter) and 20 minutes in the lower urinary tract (lower ureter, urinary bladder). Visualization of high usefulness appeared to be obtainable for the imaging diagnosis by DIP in subjects with normal renal function even when the photographing was completed 20 minutes after infusion of contrast medium. In relation to the doses of contrast medium used, no difference was observed in the variation pattern but a better imaging was obtained in the 100 ml group than 50 ml group with a significant difference (P less than 0.01) in the 15-20 minute images of the calyx and pelvis of the kidney and urinary bladder in particular, this suggested the high usefulness of 100 ml dosing for the imaging diagnosis. In the visualization of ionic contrast medium, some difference was observed in the variation pattern and the visualization was better in Ominpaque 300 groups than in 60% Urografin group with a significant difference (P less than 0.01) in the 15-20 minute images of the calyx and pelvis of the kidney and urinary bladder. This suggested the high usefulness of non-ionic contrast medium.