Shoichiro Saito

Effects of a stable prostacyclin analog on experimental ischemic acute renal failure

The effect of OP-41483, a stable prostacyclin (PGI2) analog, on ischemie acute renal failure (ARF) was investigated in dogs. Administration of OP-41483 for three days after ischemia significantly increased renal cortical blood flow (RCBF) when compared with dogs treated with the saline vehicle. In the OP-41483-treated group, serum creatinine levels remained relatively low during postoperative days 1–3 and mean survival time was prolonged. Injection of a silicone rubber vascular casting compound (Microfil) revealed increased numbers of visible renal cortical glomeruli and microvessels compared to the saline vehicle group. Histologie sections showed only very limited tubular necrosis, whereas sections of kidneys treated with saline showed extensive tubular necrosis. In conclusion, this stable prostacyclin analog provided a significant degree of protection for the kidneys from ischemie injury and may be useful in a clinical setting.

Effect of a stable prostacyclin analogue on canine renal allograft rejection.

The effect of OP-41483 (Ono Pharmaceutical Co., Osaka, Japan), a stable prostacyclin analogue, on canine renal allograft rejection was investigated. Administration for 4 days after transplantation significantly increased renal cortical blood flow and urine output when compared with untreated dogs with renal allografts. Serum creatinine levels remained relatively low during postoperative days 1-4. Mean animal survival time was prolonged. Vascular lesions and mononuclear cell infiltration were greatly diminished in biopsy specimens removed on day 4. This stable prostacyclin analogue provided a degree of protection against canine renal allograft rejection.

A case of fever of unknown origin with severe stomatitis in renal transplant recipient resulting in graft loss.

We present a case of fever of unknown origin and life‐threatening stomatitis developed about 60 months after renal transplantation. He was 15 yr old at the transplantation. Bacterial, fungal, and viral infections were not evident. Fever and stomatitis were resistant to acyclovir and to any anti‐bacterial or anti‐fungal treatment. Graft biopsy revealed a small focus of acute vascular rejection, but the findings were not severe enough to be an etiology of the fever in this case. The administration of cyclosporine (CYA) was stopped 19 d before graftectomy, but the clinical picture was unchanged. Fever and stomatitis was resolved immediately after graftectomy and the discontinuation of immunosuppressants such as mizoribine (MZ) and prednisolone. Pathological changes of the graft included chronic transplant glomerulopathy, acute glomerulitis, and lymphocyte infiltration in peritubular capillaries. Thus we suppose that immunosuppressants were the cause of both fever and stomatitis in this case. We speculate that a fever in this case might be due to the immunosuppressant itself, i.e., CYA or MZ, or viral infection – probably herpes‐simplex virus infection. It is probably the immunosuppressive state per se that may cause the resistance of his muco‐cutaneous lesion to anti‐viral agent.

Identification of carcinoembryonic antigen (CEA) in bile of patients with malignant biliary tract disease

As a diagnostant of malignant hepato-biliary tract disease, carcinoembryonic antigen (CEA) levels in the bile and serum were evaluated in 12 patients with benign and 19 patients with malignant hepato-biliary diseases. Of the 12 patients with benign disease, 3 had a residual choledocholithiasis. CEA levels were determined in 7 patients with cancer of the head of pancreas or of the duodenal ampulla. Bile samples were obtainedvia biliary tract drainage after allowing for sufficient time to exclude the effects of pre-existing bile stasis or inflammation. The average serum CEA levels from 8 patients with benign disease were 1.5±0.23 ng/ml in contrast to 3.3±0.55 ng/ml in 18 with a malignancy (p<0.05). The average CEA levels in bile from 9 patients with benign and 19 with a malignancy were 1.7±0.31 ng/ml and 7.6±1.70 ng/ml respectively (p<0.01). In 3 with residual choledocholithasis, serum and bile CEA levels were 2.0±0.46 ng/ml and 13.1±6.47 ng/ml. The serum and bile CEA levels from 7 patients with cancer of the head of the pancreas or of duodenal ampulla were 2.5±0.32 ng/ml and 8.8±3.3 ng/ml, respectively. Although measurement of both serum and bile CEA levels in patients with hepato-biliary tract disease proved to be useful for differentiation of malignant from benign disease, the high value obtained strongly suggests the presence of a malignancy in addition to the residual choledocholithiasis and cancer of the head of the pancreas or of the duodenal ampulla.

Occurrence of ANTI-AHLG in renal transplant patients on AHLG (anti-human lymphocyte globulin)

Two patients with kidney transplants were prescribed anti-human lymphocyte γ-globulin (AHLG) as an adjunct immunosuppressive treatment. AHLG was prepared from cultured human lymphocytes as antigen and successive anti-AHLG levels were measured using passive hemagglutination tests during and after the AHLG treatment. Anti-AHLG levels began to increase after 10–14 days of daily AHLG administration. There-after, the levels tends to decrease transiently by the further administration of AHLG. The titer rose again after the discontinuation of AHLG administration reaching a plateau which continued for a considerable length of time. Pretreatment levels were reverted after more than three months. The anti-sheep RBC Ab and anti-horse RBC Ab levels followed the same pattern as that seen with anti-AHLG Ab. The anti-AHLG Ab proved to be specific anti-horse γ-globulin Ab. Alterations in the anti-AHLG levels can thus be used to monitor the optimal dosage and period of administration as well as to predict the anaphylactic reaction due to AHLG treatment. Keeping the anti-AHLG level low is mandatory to maintain good immuno-suppressive conditions yet avoid anaphylactic reactions.

Role of thymectomy in the surgical treatment of myasthenia gravis

Of the 26 patients with myasthenia gravis undergone thymectomy, 11 cases had either benign or malignant thymoma as judged not only by hitological examination but also by their clinical and operative findings. Age of initial onset ranged from 13 to 64 years old. Fifteen out of 26 (58 per cent) benefited from thymectomy. Duration of the symptom from the onset to the operation and the presence or absence of the thymoma are not related to their outcome. Benign or malignant nature of thymoma should not be determined by histological examination alone but by combined evaluation of clinical and operative findings. Serial studies of serum immunoglobulin levels before and after thymectomy suggested that this disorder could be associated with humoral antibody (IgG). HLA typing of the patients with myasthenia gravis did not indicate the presence of any specific antigens.