Hideari Ihara

Analysis of the Arterial Blood Flow Patterns of Normal and Allografted Kidneys by the Directional Ultrasonic Doppler Technique

AbstractThe arterial blood flow of the allotransplanted kidney was examined 52 times in 40 recipients and that of the normal kidney 6 times in 6 donors by means of the directional ultrasonic Doppler technique.The blood flow patterns showed a rapid forward phase in systole and a slow forward phase in diastole but nothing indicative of a reverse flow was found. A significant correlation was observed between the acceleration time of flow component and graft function, while there were no correlations among diastole/systole ratio, appearance time and graft function. The arterial blood flow patterns of the grafts were classified into 3 groups based on acceleration time: I—excellent, II—intermediate and III—poor graft functions.Additionally, in pursuit of possible relationships between the ultrasonic Doppler flow patterns of the grafts and their morphological features, histopathology and angiography were done for 20 and 15 recipients, respectively. As a result the histologic vascular changes with interstitial da...

Predictability of renal allograft prognosis during rejection crisis by ultrasonic Doppler flow technique

Using the ultrasonic Doppler technique, renal blood flow was measured in 67 patients who underwent living related renal transplantation from January, 1976 to December, 1979. In 58 of 67 cases, 81 acute and 9 chronic rejection episodes occurred. In the initial stage of acute rejection, there are no particular changes in the pattern of systolic blood flow and by contrast marked changes of diastolic flow. The disappearance of the diastolic phase is indicative of an advanced stage of rejection, the reappearance indicative of recovery from rejection, and persistent loss accompanied by changes of systolic flow indicative of an unfavorable prognosis of rejection. In chronic rejection, there are rapid changes of neither systolic nor diastolic flow though the acceleration time in the systolic phase lengthens gradually. The ultrasonic Doppler flow technique for blood flowmetry of a transplanted kidney is a useful means of knowing the prognosis of rejection and provides an index for corticosteroid bolus therapy.

The immunosuppressive mode of action of mizoribine.

Mizoribine (MIZ) suppressed the mitogen response and mixed lymphocyte reaction (MLR) significantly at doses of 100 micrograms/ml and 10 micrograms/ml in a dose-response analysis. The 50% inhibition dose (ID50) was between 10 micrograms/ml and 1.0 microgram/ml, both in the mitogen response and MLR. In a kinetic study of the MLR, the degree of suppression with MIZ at a given dosage was essentially the same as the degree of suppression observed in the dose-response analysis when MIZ was added to MLR cultures from day 0 to day 4. In addition, MLR was more susceptible to the suppressive activity of MIZ at 100 micrograms/ml when MIZ was added near the peak of lymphocyte proliferation. This experiment also showed that MLR suppression induced by MIZ at 10 micrograms/ml was reversible and MLR activity had completely recovered 6-8 hr after its removal. MIZ had no inhibitory action on MLR-derived cytotoxic cells or the effector phase of cell mediated lymphocytotoxicity. These results clearly demonstrate that MIZ suppresses lymphoproliferation, but has no effect on the recognition phase or effector phase of cytotoxic lymphocytes.

Ocular complications after renal transplantation

Seventy-two post-renal transplant patients were studied for ocular complications. Of 72 patients, 56 (77.8%) showed some ocular abnormality. Steroid cataract was the most common complication, occurring in 45 patients (62.5%). Eleven patients (18 eyes) had undergone operations for cataract. The average of their ages was 39.7 years and the period from renal transplantation to cataract operation was 3.3 years. Postoperative visual acuity was over 20/20 in most cases. Increased intraocular pressure was encountered in 9 patients (12.5%), cytomegalovirus ocular infection in 2 (2.8%), hypertensive retinopathy in 2 (2.8%), branch retinal vein occlusion in 1 (1.4%), and subconjunctival hemorrhage in 15 (20.8%). A new immunosuppressant, cyclosporine, increased renal graft survival more than azathioprine. However, ocular complications such as steroid cataract occurred frequently in spite of the use of cyclosporine, as in the azathioprine era. In conclusion, it is necessary for renal transplant patients to receive a periodical ophthalmological check-up.

Delayed graft function does not influence long-term outcome in cadaver kidney transplants without mismatch for HLA-DRB1

The currently study focused on the influence of delayed graft function on the long-term graft success rate in cadaver kidneys without any mismatches for HLA-DRB1. Donor-recipient HLA-DRB1 was determined by the significant two-locus linkages of HLA-B and-DRB1. The overall 5-year graft success rate was 88% in an HLA-DRB1-compatible group, significantly higher than the 69% in an HLA-DRB1 mismatch group (P<0.05) and the 66% in an HLA-DR mismatch (P<0.01). Delayed graft function was observed in 182 of 223 transplants. This high incidence of 82% is due to the fact that, in Japan, kidney procurement may only occur after cardiac arrest. The incidence did not differ in eaach group. The 5-year success rate for grafts with delayed function was 87% in the HLA-DRB1-compatible group, again significantly superior to the 68% in the HLA-DRB1 mismatch group and the 63% in the HLA-DR mismatch cases (P<0.05). There was, thus, no difference in graft success rate for each group, with or without delayed graft function. Consequently, we feel that delayed graft function has no impact on the long-term outcome in transplants without mismatches for HLA-DRB1.

Long-term graft survival rate of zero-mismatch kidney transplants for HLA-DRB1.

Abstract The study of a two‐locus association between HLA‐B and ‐DRB1 revealed a significant 43 linkage disequilibrium. Donorrecipient HLA‐DRB1 was determined by these 43 linkages. Zeromismatch for HLA‐DRB 1 had a significant effect on the graft survival rate in living related and cadaver transplants. The 5‐year graft survival rate was 94% in the zero‐mismatch group for HLA‐DRB 1, 96% for related transplants, 92% for cadaver cases, and 94% in HLA identical siblings. A statistically significant difference was found between the zeromismatch group for HLA‐DRB 1 and mismatch groups for HLA‐DRB 1 or HLA‐DR (P<0.01). The zero‐mismatch group for HLADRB 1 had mismatches for HLA‐A and/or HLA‐B in 46 of 70 cases (66%). No significant differences in the rejection rate was observed between zero‐mismatch and mismatch cases for HLA‐A and/or ‐B in the zero‐mismatch group for HLA‐DRB l. In the second step, genotyping was conducted in 118 cases. The 5‐year graft survival rate was 93% in the zero‐mismatch group for HLA‐DRB 1 and 86% in mismatch group (not a significant difference). We concluded that zero‐mismatch transplant for HLA‐DRB l had a better long‐term graft survival rate regardless of HLA class I.

Pyelosinus backflow: A case with an unusual pyelographic appearance

In a 60-year-old man who complained of sudden onset of left costovertebral angle pain, intravenous pyelography showed spontaneous extravasation of urine from the left kidney with an unusual appearance of pyelosinus backflow mimicking a “double pyelocalyceal system.” Computerized tomography showed a “double lumen” structure of the left renal pelvis, and retrograde pyelography revealed an obstruction of the left lower ureter.

Successful treatment of low-flow priapism associated with phenothiazine therapy

Abstract We present a case of low‐flow priapism that was successfully treated. A 21‐year‐old man with a history of schizophrenia was admitted with a painful complete erection. He had taken propericiazine, phenothiazine derivatives, before hospitalization and was treated with a glandular–cavernosal shunt (El‐Ghorabs procedure). Currently, he is able to have erections without any changes in his quality of life.