[Study of 54 renal allograft recipients in the cyclosporin A era. What influences acute rejection episode and long-term graft survival?].

During the past 5-year period from 1986 to 1991, a total of 54 patients received living-related renal allograft and has been managed with vagaries of cyclosporin A (CYA) immunosuppressive regimen. In order to determine the ideal form of induction regimen, combination drugs with CYA, the initial dosage of CYA and its blood trough level were retrospectively analyzed with particular reference to the possible factors relevant to the occurrence of acute rejection episode in the first three post-transplant months and graft survival. The combination drugs with CYA were prednisolone (PRD) in 10 patients, PRD + azathioprine (AZA) in 19 and PRD+mizoribine (MIZ) in 25. The initial dosage of CYA was 6 mg/kg B.W. in 6 patients, 8 mg/kg in 17, 10 mg/kg in 15 and > or = 12 mg/kg in 16. Blood trough level of CYA measured principally by high performance liquid chromatography was arbitrarily divided into < 100, 100-150, 150-200, > or = 200 mg/kg ranges for the analysis. By arbitrarily dividing the post-transplant period into four (period I: 0-15th day, period II: 16-30th, period III: 31-60th and period IV: 61-90th), the correlation of the incidence of acute rejection episode and aforementioned factors was studied. Relevance of these factors to the graft survival was also studied. The administration of AZA to MIZ to CYA + PRD had no suppressive effect upon the occurrence of acute rejection during the first three months and similarly it had no effect upon graft survival. Rejection episodes, however, occurred more frequently in the recipients with less than 150 ng/ml of CYA trough level in the period I and less than 100 ng/ml in the period III (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical experience of enoxacin complicated urinary tract infection].

Enoxacin (ENX) was administered to 69 patients with complicated urinary tract infections (UTI). Clinical efficacy and safety were evaluated by the criteria proposed by the UTI Committee, Japan. The overall clinical efficacy was excellent in 60.9%, moderate in 10.1% and poor in 29% of the patients. Of the 76 strains isolated from the patients 61 strains (80.3%) were eradicated. Subjective side effect was observed in one patient who complained of slight nausea. No drug-related aggravation in the laboratory test was observed. These results showed that ENX was effective and safety for the treatment of complicated urinary tract infection.

[Clinical evaluation of ofloxacin in the treatment of acute cystitis].

Ofloxacin (OFLX) was administered to 236 female patients with acute cystitis. Of them 164 patients who satisfied the criteria proposed by the UTI Committee, Japan were examined for the efficacy of the treatment, but all cases were included in the study of the side effects of the drug. In the 65 patients who received 300 mg (3 divided doses) of OFLX per day, the overall clinical efficacy was excellent in 66.2% and moderate in 33.8% of the patients. In the 99 patients who received 600 mg (3 divided doses) of OFLX per day, the overall clinical efficacy was excellent in 79% (P less than 0.076) and moderate in 18.2% of the patients. No failure of the treatment was observed in the two groups. Of 164 bacterial strains isolated from the urine of the patients, 132 strains were identified as E. coli. All bacterial strains were eradicated in the urinary specimens by the treatment. Subjective side effects were observed in 8 (3.4%) of the 236 patients. Gastrointestinal disturbance was complained by 6 patients. No drug-related aggravation in the laboratory test was observed except for one patient who showed mild leukopenia reduced from 3700/mm3 to 2200/mm3. These results showed that the oral administration of OFLX was excellent and satisfactory in the treatment for acute cystitis.

The role of airflow in mucous transport in the trachea.

The role of airflow in mucous transport in the respiratory tract was studied. Seven mongrel dogs were tracheostomised at the caudal end of the neck, and the following two procedures were performed. In procedure (1), a small radiopaque plastic disc was placed on the mucous membrane of the right side wall of the trachea through the tracheostoma, which was then closed to let the dog breathe through the normal respiratory tract. Roentgenograms of the trachea were taken three times at 5-min intervals. Procedure (2) was designed to eliminate airflow from around the disc. A canula was placed in the trachea through the tracheostoma to bypass airflow, and the disc was placed on the mucous membrane slightly more proximal than the cannula. The transport rate was 11.1 +/- 4.1 mm/min (mean +/- S.D.) in procedure (1) and 5.4 +/- 2.7 mm/min in procedure (2), which showed a significant difference. The present results seem to indicate an important role of airflow in mucous transport in the trachea.

[7 cases of congenital multicystic kidney with special reference to its embryogenesis].

We have experienced 7 cases of multicystic kidney. The latest two cases, etiologically of interest, are reported herein with special reference to its embryogenesis. Case 6: A 4-year-old girl was referred to our clinic for further evaluation of mild azotemia and nonvisualization of left kidney. Left kidney was strongly thought to be multicystic kidney from abdominal CT, whereas her contralateral kidney exhibited hydrocalycosis resembling infundibular stenosis with diminished calyceal numbers. Nephrectomy of her left kidney was performed and histological studies confirmed renal dysplasia (primitive duct, metaplastic cartilage, etc.). Case 7: A 7-year-old girl was referred to Hakodate Kyokai Hospital for the evaluation of azotemia and low stature. Her right kidney was not visualized on IVP and her left kidney exhibited hydronephrosis with diminished calyceal numbers. Her right kidney was diagnosed as multicystic kidney on CT-scan. Pyeloplasty of her left kidney was performed. Multicystic kidney is a rather rare congenital disease. Association of various anomalies in contralateral kidney has been emphasized as well as the notion that infundibulopelvic stenosis is a linked in the clinical spectrum extending from cystic dysplasia of the kidney to hydronephrosis. Our last two cases seem to be included in this category of obstruction theory. As shown by microdissection technique (Potter), however, severe ampullary inhibition early in fetal life is also an attractive hypothesis. Diminished calyceal number of contralateral kidneys seen in our recent two cases is compatible with possibility of ampullary damage. Recent experimental study also showed that renal dysplasia is not solely caused by simply mechanical obstruction to urinary drainage, even when the obstruction is imposed at an early stage of renal development.