术中应用曲安奈德对腰椎间盘突出症术后早期神经根水肿反应性疼痛的影响

目的 术后水肿期(一般为术后2~6d)的疼痛会严重影响病人康复,通过比较腰椎间盘突出症病人是否行术中神经根局部应用曲安奈德治疗的术后疼痛情况,评估术中局部应用曲安奈德对减轻术后早期神经根水肿反应性疼痛的疗效.方法 回顾性研究2010年9月至2015年9月我院收治的腰椎间盘突出症病人185例,男99例,女86例,年龄为16~67岁,平均为(41.5±11.2)岁.根据手术情况分为:术中神经节应用曲安奈德组96例(给药组)和未使用曲安奈德89例(对照组).两组病例一般资料比较,差异均无统计学意义(均P>0.05).在行腰椎间盘髓核摘除术结束后缝合伤口前,在给药组病人神经根周围放入含有曲安奈德的明胶海绵;对照组则放入不含任何药物的明胶海绵.对比两组发生神经根水肿反应的发生率.记录和比较其中发生神经根水肿反应的病人术前,术后即刻、6 h、12 h和1~12 d时腰臀部以及手术侧下肢的疼痛视觉模拟量表(visual analogue scale,VAS)评分.结果 两组病例术后神经根功能在术后即刻均获得良好的恢复.两组在水肿期均有不同程度地发生神经痛,给药组疼痛率为36.5%,低于对照组的57.3%(P<0.05).两组中发生神经根水肿反应的病人比较,给药组水肿期VAS评分均低于对照组,差异有统计学意义(P<0.05);水肿期发生前后,两组均较术前达到良好改善水平,且两组的VAS评分差异无统计学意义(P>0.05).结论 腰椎间盘髓核摘除术中神经根周围局部应用含曲安奈德的明胶海绵,操作简单、安全,能有效地减少腰椎间盘突出症术后早期神经根水肿反应性疼痛的发生率、减轻疼痛的程度.     

神经根周围应用甲基强的松龙对腰椎间盘切除术疗效的影响

目的:探讨腰椎间盘切除术中在减压后的神经根周围应用甲基强的松龙(MP)对患者术后神经根性痛和神经功能改善的影响。方法:76例腰椎间盘突出症患者行小切口单纯髓核切除术,其中36例髓核切除后在减压的神经根周围以甲基强的松龙80mg浸润的明胶海绵覆盖(治疗组),另40例行同样手术,但在减压的神经根周围以生理盐水浸润的明胶海绵覆盖(对照组)。术前和术后6h、1d、3d、1周采用VAS法进行疼痛评分,术前和术后3个月采用JOA评分评估患者神经功能恢复情况。结果:治疗组患者在术后1周内的神经根性疼痛程度明显低于对照组(P<0.01或P<0.05);术后3个月治疗组JOA评分略高于对照组,但无显著性差异(P>0.05)。结论:腰椎间盘切除手术时在神经根周围给予甲基强的松龙可明显减轻腰椎间盘突出症患者术后神经根性疼痛,但对患者神经功能恢复的影响不显著。     

TESSYS手术联合神经根阻滞治疗脱垂型腰椎间盘突出症对术后早期疼痛的影响

目的探讨神经根阻滞在减轻脱垂型腰椎间盘突出症行TESSYS术后早期疼痛的临床效果。方法选择2014年9月～2016年9月治疗的130例脱垂型腰椎间盘突出症患者,随机分为两组各65例:观察组采用TESSYS技术联合神经根阻滞治疗,对照组仅采用TESSYS技术治疗,术后对比两组疼痛程度、疗效以及并发症情况。结果与术前相比,两组术后VAS、JOA评分均获得显著改善(P0.05),且观察组术后1 d的VAS评分显著低于对照组(P0.05);术后3、12个月的治疗优良率对比,两组差异无统计学意义(P0.05);观察组术后疼痛发生率显著低于对照组(P 0.05)。结论脱垂型腰椎间盘突出症患者采用TESSYS技术联合神经根阻滞治疗,有利于进一步减轻术后早期疼痛,有一定的应用价值。     

甲基强的松龙病灶处理对预防腰椎间盘术后疼痛的前瞻性研究

目的探讨术中局部应用小剂量甲基强的松龙预防腰椎间盘术后早期腰腿痛的效果。方法对118例腰椎间盘突出症患者采用随机双盲法分为对照组和实验组。常规予以后路髓核摘除手术,对照组术中局部放置浸润生理盐水的明胶海绵,实验组予以浸润20mg甲基强的松龙的明胶海绵,定期收集术后VAS以及ODI评分。结果 112例患者得到随访,实验组有0/58例患者出现腰腿痛,而对照组是7/54;而且实验组比对照组疼痛程度轻并下降以及腰部功能恢复更快。结论 LDH术中局部应用甲基强的松龙是一种有效而且简便的预防术后腰腿痛的方法。     

椎管镜下腰椎间盘摘除术与改良小切口开窗椎间盘摘除术在腰椎间盘突出症的疗效对比

目的探究在治疗腰椎间盘突出症中采用椎管镜下腰椎间盘摘除术与改良小切口开窗椎间盘摘除术的疗效。方法将我院2014-03-2016-03诊疗的140例腰椎间盘突出症患者作为研究对象,均分为观察组与对照组,每组70例。对照组行椎管镜下腰椎间盘摘除术,观察组行改良小切口开窗椎间盘摘除手术,评价两组术后腰痛评分(JOA)及疼痛视觉模拟评分(VAS),对比两组患者手后并发症情况,以对比椎管镜下腰椎间盘摘除术与改良小切口开窗椎间盘摘除术在腰椎间盘突出症的疗效。结果两组患者术前JOA评分及VAS评分不存在显著差异(P0.05);术后3周及6个月JOA评分及VAS评分均较术前明显改善,但差异不具有统计学意义(P0.05);从术后并发症发生情况看,观察组术后并发症发生率(1.4%)低于对照组(2.8%),然对比不具有统计学意义(P0.05)。结论改良小切口开窗椎间盘摘除术能取得与椎管镜下腰椎间盘摘除术一致治疗疗效,且改良小切口开窗椎间盘摘除术操作相对简便,可以作为治疗腰椎间盘突出症新的手术方式。     

经皮椎间孔镜下髓核摘除术联合医用几丁糖对腰椎间盘突出症的疗效观察

目的 研究经皮椎间孔镜下髓核摘除术联合医用几丁糖治疗腰椎间盘突出症的临床意义。方法 将60例腰椎间盘突出症患者随机分为两组各30例。对照组行经皮椎间孔镜下髓核摘除术,实验组在此基础上联合几丁糖治疗。对比两组手术前及术后2周的腰腿痛简化McGill疼痛问卷(simplified McGill pain questionnaire, SF-MPQ)评分,以及腰椎活动功能JOA评分变化情况,以及手术并发症。结果 两组患者术后2周的SF-MPQ评分、JOA评分均较手术前改善,且实验组SF-MPQ评分显著低于对照组,JOA评分显著高于对照组(P<0.05);实验组总有效率为96.67%,显著高于对照组的70.00%(P<0.05);实验组术后并发症发生率显著低于对照组(P<0.05)。结论 经皮椎间孔镜下髓核摘除术联合医用几丁糖治疗腰椎间盘突出症效果显著,有利于缓解腰腿痛,改善患者腰椎功能,降低术后并发症及腰椎手术失败综合征的发生率,值得推广应用。     

PLD联合腰背肌功能训练治疗腰椎间盘突出定疗效观察

目的：观察经皮腰椎间盘摘除术（PLD）联合腰背肌功能训练治疗腰椎间盘突出症的治疗效果。方法：腰椎间盘突出症患者730临床病例,随机分为治疗组和对照组。对照组行PLD＋局部理疗,治疗组在此基础上给予腰背肌功能训练．记录治疗前和治疗后1、7、14、30d的疼痛VAS评分、1年随访复发率。结果：两组1月后VAS评分没有显著差异．但1年随访治疗组复发率明显低于对照组。结论：腰背肌功能训练有助于降低PLD术后腰椎间盘突出症的复发率低,提高远期效果。     

两阶段功能训练监督干预对腰椎间盘突出症患者术后腰椎功能的影响

目的研究两阶段功能训练监督干预对腰椎间盘突出症患者术后腰腿疼痛程度、直腿抬高角度及肌力影响。方法选择2014-01-2015-08行开窗髓核摘除术的腰椎间盘突出症患者180例。随机分为对照组和观察组,观察组患者给予两阶段功能训练监督干预,对照组给予常规护理和指导。比较两组患者的JOA评分、VAS评分、直腿抬高角度和肌力情况。结果观察组患者术后的JOA评分高于对照组,VAS评分低于对照组(P0.05)。术后3个月观察组患者的直腿抬高角度明显大于对照组(P0.05),且肌力更好(P0.05)。结论两阶段功能训练监督干预可以明显减轻腰椎间盘突出症患者术后的腰腿疼痛程度,增大直腿抬高角度,改善肌力和腰椎功能。     

Wallis棘突间动态稳定系统在腰椎间盘突出症治疗中的早期疗效观察

[目的]比较髓核摘除术结合Wallis系统与单纯髓核摘除术治疗腰椎间盘突出症的早期疗效.[方法]2008年2月～2010年2月采用髓核摘除术结合Wallis系统治疗腰椎间盘突出症患者18例,以同期行单纯髓核摘除术治疗腰椎间盘突出症的18例患者为对照组.术后12个月为观察点,采用下腰痛及腿痛的视觉模糊评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)等指标来评估2组疗效.[结果]36例患者均获12 ～24个月随访,平均16个月,两组患者术后12个月的VAS评分及ODI指数均有明显下降,较术前比较有统计学意义(P=0.0000＜0.05),Wallis组术后12个月的下腰痛VAS评分及Oswestry指数与对照组比较有统计学意义(P =0.000 0 ＜0.05),而腿痛的VAS评分两组比较无统计学意义(P =0.074 ＞0.05).[结论]Wallis系统置入简单,创伤小,结合髓核摘除术治疗腰椎间盘突出症能提高疗效.     

经皮椎间孔镜间盘摘除术治疗青壮年与中老年腰椎间盘突出症的短期疗效比较

目的比较经皮椎间孔镜间盘摘除术(PELD)治疗青壮年与中老年腰椎间盘突出症的短期疗效。方法回顾性分析自2016-07—2016-12采用PELD治疗的121例腰椎间盘突出症,年龄45岁57例(青壮年组),年龄≥45岁64例(中老年组),比较2组复发腰椎间盘突出症情况,术后3个月、1年、2年腰部疼痛VAS评分、腿部疼痛VAS评分、ODI指数。结果 121例均顺利完成手术并获得完整随访,随访时间平均24.87(23～28)个月。中老年组出现2例残留下肢疼痛,影像学复查显示无明显压迫现象,对症处理后缓解。2组腰椎间盘突出症复发情况及术后3个月腰部疼痛VAS评分、腿部疼痛VAS评分、ODI指数比较差异无统计学意义(P0.05),术后1年、2年青壮年组腰部疼痛VAS评分、腿部疼痛VAS评分、ODI指数较中老年组低,差异有统计学意义(P 0.05)。结论 PELD具有创伤小、康复快、麻醉风险小等优点,是青壮年腰椎间盘突出症治疗的优先选择,治疗中老年腰椎间盘突出症也可以取得满意疗效。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Prolongation of lung xenograft survival in rats with a short course of deoxyspergualin and cyclosporin A

The efficacy of 15-deoxyspergualin (DSG), cyclosporin A (CyA), and splenectomy-alone or in combination-in prologing the survival of concordant lung xenotransplants was studied in the hamster-to-rat model. In the untreated group, rejection occurred within 3 days, with an elevation of lymphocytotoxic antibody titers. The rejected lung revealed that ED1+cells were more prevalent than MRC OX8+cells in the perivascular infiltrates. In the DSG group, the antibody response was suppressed and median survival increased to 7.5 days. The rejected lungs demonstrated a highly significant depression in ED1+cellular infiltration and a moderate MRC OX8+cellular infiltration. When maintenance CyA was combined with a short course of DSG, survival dramatically increased to beyond 100 days. There were no deposits of IgM, IgG, or C3 or of any cell infiltrate in the grafts of two animals sacrificed 107 and 119 days post-transplantation. We conclude that initial treatment with DSG combined with continuous CyA can suppress acute rejection in the hamster-to-rat lung xenograft model, resulting in longterm graft survival.     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

Synergistic effect of donor-specific blood transfusion and a short course of deoxyspergualin in rat kidney transplantation

Deoxyspergualin (DSG), an analogue of spergualin produced by B. laterosporus, has a strong immunosuppressive effect in various transplantation models. We have investigated the mechanism of donor-specific prolongation of survival time in rat kidney grafting by donor-specific blood transfusion (DST) and a short course of DSG. Lewis (LEW) kidney allografts were transplanted into fully allogeneic BN rats. Fresh, whole LEW blood 1.0 ml, was injected i.v. into BN rats 2 days prior to transplantation. Then, DSG, 6 mg/kg per day, was administered by i.m. injection on days 0, 1, and 2 after transplantation. The recipients were divided into five groups: group 1 (n=6) no treatment: group 2 (n=6) DST only; group 3 (n=7) DSG only; group 4 (n=7) DST and DSG; and group 5 (n=6), third party (ACI rats) blood transfusion and DSG. Lymphocytes (cervical lymph nodes) and serum were harvested from BN recipients on day 7 postgrafting. For suppressor cell assays, lymphocytes from BN recipients in each group were added as a third cell to the mixed lymphocyte reaction (MLC) between nontransplanted BN lymphocytes (responder) and LEW or other third party (PVGC, ACI, WKA rats) lymphocytes (stimulator). Antidonor lymphocytotoxic antibody (ADLA) was checked by microcytotoxicity assays. Median survival times (MST) for each group were: group 1, 10 days; group 1, 10 days; group 3, 13 days; group 4, 75 days; and group 5, 13 days. Remarkable prolongation of MST was only noted in group 4. In the suppressor cell assay, group 4 showed significant suppression (40%; P<0.05); the other groups did not show any suppression. This suppressive activity in group 4 was effective only during the MLC between BN and LEW, not during the MLC of third party-BN combinations. Thus, suppressor cells from DST/DSG-treated BN recipients appear to be donor-specific. In the microcytotoxicity assay, the only group that showed any ADLA was group 2, which was not treated with DSG. These results clearly show that both induction of donor-specific suppressor cells and inhibition of ADLA production are associated with the remarkable donor-specific prolongation of kidney allograft survival in DST/DSG-treated recipients.