HLA typing using IL-2 activated T lymphocytes: usefulness in pediatric candidates for allogeneic bone marrow transplantation.

Following a preliminary study in healthy blood donors, we have performed serological HLA-A, B, C, DR and DQ typing using recombinant IL-2 activated T lymphocytes (IL-2.aTLs) in pediatric candidates for allogeneic bone marrow transplantation. In such patients, it is often difficult to obtain the quantity of lymphocytes required for HLA typing, particularly for class II typing using B lymphocytes, considering the timing of sampling and the volume of blood to be collected. Peripheral blood mononuclear cells (PBMCs) were activated and expanded with IL-2 until a sufficient number of IL-2.aTLs of good viability were available for the typing. In the first 10 cases, analyses of surface markers (CD2, CD20, CD25, CD36, HLA-DR and HLA-DQ, CD2/HLA-DR: two color) of IL-2.aTLs were done using flow cytometry at the time of HLA typing and indicated that IL-2.aTLs expressed HLA-DR and DQ antigens sufficient for evaluation. A small number (less than 10(6] of fresh or cryopreserved PBMCs, even those containing leukemic blast cells, were sufficient to induce and expand IL-2.aTLs for HLA typing. To date we have been able to successfully HLA-A, B, C, DR and DQ type 20/20 pediatric candidates. The HLA antigens identified on the patients' IL-2.aTLs were confirmed by a family study.     

Pyoderma gangrenosum associated with ulcerative colitis and subcutaneous and splenic abscesses

Pyoderma gangrenosum is a rare, chronic, inflammatory ulcerative skin disease of unknown etiology and pathogenesis. It is often associated with systemic disease. We describe a patient with pyoderma gangrenosum associated with ulcerative colitis and aseptic abscesses of the subcutis and spleen, which have been rarely reported previously. These manifestations were cleared by combined therapy with minocycline hydrochloride and diaphenylsulfone.     

Preliminary study on the effects of bar placement on the thorax after the nuss procedure for pectus excavatum using bone scintigraphy.

AIM: Bone scintigraphy was performed to elucidate the effects of the Nuss procedure for pectus excavatum on the bony thorax. METHODS: Eight boys and 6 girls (5 - 24 years of age) underwent bone scintigraphy, using (99m)Tc-HMDP. Eleven patients were studied 5 to 21 days after the Nuss procedure; 6 were studied 20 to 24 months after the operation before bar removal. Three of 14 were studied twice after the Nuss procedure and before bar removal. RESULTS: In the early postoperative phase, RI accumulation was found at the sternum and ribs in only 1 of 6 patients under 9 years of age, whereas in all 5 older patients, RI had accumulated at the sternum. Scintigrams before bar removal revealed, regardless of age, hot spots at the lateral ribs in contact with the bar and at the costochondral junctions where the bar passed through the intercostal spaces. Furthermore, chest roentgenograms showed the deformed lateral ribs in contact with the bar. CONCLUSIONS: The Nuss procedure creates minute fractures at the sternum and the ribs, especially in older patients. The bar deforms the ribs and restrains the growth of the thorax. Furthermore, it constantly rubs against the ribs and can therefore cause late complications. Bone scintigraphy may determine the appropriate timing for bar removal.     

Disseminated intravascular coagulation after hepatic resection

Disseminated intravascular coagulation (DIC) after hepatic resection is a serious complication that leads to a fatal outcome unless prompt treatment is instituted. Between April 1973 and June 1988, DIC occurred postoperatively in 18 of 192 patients who underwent hepatic resection because of a variety of diseases of the liver and biliary tract. The diagnosis was made on the basis of changes in platelet count, fibrinogen level, serum level of fibrin degradation product (FDP), and protamine sulfate test. Heparin was used in an earlier series but has been discontinued because of difficulty in determining the optimal dose in patients undergoing liver resection. Instead, we now use gabexate mesilate, which blocks the coagulation cascade without the aid of antithrombin III and works as an anticoagulant. Fifteen patients had uneventful recoveries, but three died. Two died of aggravation of DIC, which was a result of reoperation performed under the diagnosis of surgical bleeding. The other patient died of liver failure after fever of unknown cause persisted for 4 months. The rationale for the diagnosis and treatment of DIC after liver resection is documented, and the problems involved are discussed.     

High-dose methylprednisolone therapy for nephrotic syndrome in Henoch-Schoenlein nephritis

Twelve patients with nephrotic syndrome (NS) in Henoch-Schoenlein (HS) nephritis were treated with a high dose of intravenous methylprednisolone (MP) on each of nine alternate days followed by oral prednisolone for 4 to 6 months. Renal biopsy was performed on 10 of the 12 patients. The glomerular change in 5 patients, which was accompanied by crescents and/or sclerosis, with NS and acute nephritic syndrome (ANS) at onset, was more severe than that of the other 5 patients with NS and hematuria at onset. The renal insufficiency or hypertension in these 5 patients with NS and ANS improved within 2 weeks on this MP therapy. After a mean follow-up period of 40.5 months, all patients except 2 revealed normal physical findings and renal function as well as urinary findings. Repeated biopsies in the 2 patients with NS and ANS at onset demonstrated an improved renal pathology in comparison with their initial biopsies. No severe side effects related to high-dose intravenous MP followed by oral prednisolone therapy were encountered in any of the patients. Our results suggest that high-dose intravenous MP therapy can lead to a favorable outcome in patients with NS in HS nephritis.     

Prevalence rates and risk factors for allergic symptoms among inhabitants in rural districts

In order to determine the prevalence of allergic disorders and their association with agricultural factors, a total of 3,717 inhabitants of rural districts in Kumamoto Prefecture were ashed to fill out a questionnaire concerning their allergic status. The results obtained were as follows: One or more items of allergic symptoms were reported by 44% of the subjects. The prevalence rate of each symptom was 8% for respiratory organs, 5% for delayed type of respiratory disorders, 10% for nasal mucosa, 16% for eyes, 16% for urticaria-like derma and 26% for eczema-like derma. Twenty-one percent of the subjects had past histories of allergic diseases such as asthma (3%), nasal allergy (3%), urticaria (6%), contact dermatitis (9%) and so forth. These allergic conditions were seen to be more common among farmers than non-agricultural workers, and also among subjects with allergic constitution than those without such constitution. The highest (62%) prevalence of allergic symptoms was observed in farmers engaged in poultry raising, followed by those engaged in raising flowers (58%), tobacco (58%), cortinellus shiitake (55%), cucumber in plastic greenhouse (53%) and mandarin orange (53%). Among the symptomatic subjects, 12-38% of those with each symptom gave farm work as the direct causative factor for developing the corresponding symptom. Pesticide spraying was the most common agent among those factors.     

Carcinomatous Infiltration into the Submucosa as a Predictor of Lymph Node Involvement in Early Gastric Cancer

n = 25) and node-negative ( n = 81) groups. Among several pathologic factors, the diameter of the tumor and lymphatic involvement were significantly correlated with nodal involvement. Within the submucosal layer the depth of invasion and the horizontal cancerous expansion also correlated with lymph node disease ( p < 0.05). The size of the tumor did not correlate with the length of submucosal infiltration ( r = 0.12, p = 0.1). Patients with both slight invasion into the submucosa and less than 5 mm of horizontal expansion were often negative for lymph node involvement and thus may benefit from local surgery as an alternative to gastrectomy.