Excellent outcome of allogeneic hematopoietic SCT with reduced-intensity conditioning for the treatment of chronic active EBV infection.

Since we reported the first successful case of allogeneic hematopoietic SCT (allo-HSCT), we have performed allo-HSCT for 29 patients with chronic active EBV infection (CAEBV), using either myeloablative conditioning (MAC) allo-HSCT (MAST) or reduced-intensity conditioning (RIC) allo-HSCT (RIST). In this retrospective analysis we compared the outcomes after MAST and RIST to identify the optimal conditioning for patients with CAEBV. Of 29 patients, 11 underwent allo-HSCT with MAC, consisting of TBI (12 Gy), etoposide (900 mg/m²) and CY (120 mg/kg) or melphalan (210 mg/m²), and the remaining 18 patients received allo-HSCT after RIC, consisting of fludarabine (∼ 180 mg/m²) and melphalan (140 mg/m²) or CY (120 mg/kg), with/without antithymocyte globulin and low-dose irradiation. Donor sources were 8 related BM, 2 related peripheral blood, 5 CD34 selected cells from HLA-haploidentical donors, 8 unrelated BM and 8 unrelated cord blood. The 3-year-EFS rate was 54.5 ± 15.0% for MAST group and 85.0 ± 8.0% for RIST group, and the 3-year OS rate was 54.5 ± 15.0% for MAST group and 95.0 ± 4.9% for RIST group (P = 0.016). Allo-HSCT after RIC seems to be a promising approach for the treatment of CAEBV.

[Growth and developmental patterns in Neandertals].

Growth and development in Neandertals have been focused on in terms of the appearance of the human growth pattern in hominid evolution. Recently, more attention has been drawn to the aspects of growth in human evolution, although their significance was recognized from long before. One recently refined method is to use the perikymata counts on the enamel surface, which provide an absolute duration time of tooth crown development and therefore make possible comparisons in timings of developmental events. Another is to evaluate the relative timing and speed of developmental events from teeth, skull, and postcranial bones. In general, the hominid growth pattern would change from ape-like to human-like during the evolutionary process. It is still uncertain, however, when and where the exact event happened and the developmental pattern changed. As for the growth in Neandertals, it has been suggested that they would have grown relatively slowly in their childhood as modern humans do, while the appearance of the adolescent growth spurt and the duration time of their adolescence or childhood period are still obscure. More concrete and precise data are needed for a reasonable understanding of evolution of hominid growth for both modern humans and fossil hominids, in terms of: 1. more data of individual morphological traits applicable to fossil hominids, which increase the number of available fossil specimens; 2. variation of the traits in modern and archeological specimens, particularly in relation to environmental stress; 3. interaction or interrelationship between dental, cranial and postcranial development.

Estimation of stature from the skeletal reconstruction of an immature Neandertal from Dederiyeh cave, Syria.

Skeletal reconstruction of a child Neandertal unearthed at Dederiyeh Cave, Syria in 1993, is undertaken and the acquired stature discussed. Although the skeletal remains were well preserved, the reconstruction required several assumptions to be made because of the immature status of the specimen. The assumptions were mainly concerned with distances between bones in the inter-vertebral spaces and in the joints of the hip, knee, and ankle. These were estimated from X-ray films of modern children and data from previous studies. Stature was directly measured on the reconstruction, and found to be 79.2 cm. After corrections for soft tissue thickness and shrinkage of the casts, the stature became 81.7 cm. This estimate is consistent with estimates based on regression equations of long bone lengths, especially from those of the lower extremity. In comparison with longitudinal data for white American boys, the assessment of stature for Dederiyeh varied according to the estimated age. For a younger estimated age, the stature falls in the lower half of the white American range of variation, but with an older estimated age, it falls below the lower limit of the range of variation. Other immature Neandertals including two European specimens, Roc de Marsal and La Ferrassie 6, fall below the lower limit of the 5th to 95th percentile range based on the estimated statures from their long bone lengths. More comprehensive age assessment covering both fossil and modern humans is required before accurate conclusions in relation to Neandertal growth can be drawn.

Intravenous trimethaphan during epidural plus general anesthesia decreases the direct radial artery pressure lower than the brachial artery pressure.

STUDY OBJECTIVE: To determine whether vasodilators such as sodium nitroprusside (SNP) and trimethaphan (TMP) produce a pressure difference between the radial artery and the brachial artery during epidural plus general anesthesia or simple general anesthesia. DESIGN: Randomized study and prospective study. SETTING: Operating rooms of two hospitals. PATIENTS: 36 and 6 adult patients in the first and second studies, respectively, who received spherical acetabular osteotomy with induced hypotensive anesthesia. INTERVENTIONS: In the first study, 18 patients received epidural plus general anesthesia (epidural group) and 18 patients received general anesthesia alone (general group). All patients received the hypotensive drugs for more than 50 minutes each. In the second study, 6 patients received TMP-induced hypotension for 20 minutes under epidural plus general anesthesia. MEASUREMENTS AND MAIN RESULTS: In the first study, radial intra-arterial blood pressure (RIBP) and tonometric blood pressure (TBP) calibrated with oscillometric blood pressure of the arm were compared. In the second study, RIBP and the brachial intra-arterial blood pressure (BIBP) were compared. In the first study, the bias between RIBP and TBP for systolic, mean and diastolic blood pressure were significantly less during TMP-induced hypotension in the epidural group (-11.5 +/- 2.5 (mean +/- SD), -6.0 +/- 3.1, and -2.8 +/- 3.7 mmHg, respectively] than during SNP-induced hypotension in the epidural group and SNP- and TMP-induced hypotension in the general group (p < 0.01). The precision of systolic and mean pressures were significantly greater during TMP-induced hypotension in the epidural group (11.8 +/- 2.3 and 7.1 +/- 1.9 mmHg, respectively) than the other three hypotension groups (p < 0.01). In the second study, the bias between RIBP and BIBP for systolic, mean, and diastolic pressures were significantly less (p < 0.01), and precision was significantly greater during hypotension than during normotension (p < 0.01). CONCLUSIONS: Our results demonstrate that TMP decreases the direct radial artery systolic and mean pressures to levels below the brachial artery systolic and mean pressures in patients who received epidural plus general anesthesia.

Evaluation of Uniform-Sized Microcapsules Using a Vibration-Nozzle Method.

In order to prepare microcapsules (MC) using polyvinylacetal diethyl-aminoacetate (AEA) gel, we have studied both the unique properties of AEA gel, in which cold-water solution forms a hard gel with exclusion of water at high temperature, and the microencapsulation technique for clarithromycin (CAM), which has an unpleasant taste (1, 2). In our previous paper (3), we described a new uniform-sized microencapsulation machine with a vibration nozzle with 536 holes 100µ in diameter designed for precise regulation of dissolution of CAM from MC.In order to evaluate the MC thus obtained, we prepared syrups (without water) by adding sweetening agents to MC, and conducted a dissolution test at various pHs using the method described in the Japanese Pharmacopoeia (12th edition), a test for bitter taste and a test to determine bioavailability (BA) in human subjects. At pHs below 4.0,100% of CAM in MC was dissolved from the syrup within 5min. However, there was little dissolution of CAM from syrup at pH6.8. The results of the test for bitter taste showed that the syrup preparations, which were administered to 12 male and female volunteers with 20ml water, masked bitter taste completely during the 60min period following administration of the syrup. The mean area under the serum concentration-time curve (AUCo-24) and the maximum serum concentration (Cmax) for administration of syrup preparations to 6 male volunteers were 5.66 ± 0.73µg·hr/ml and 0.66 ± 0.13µg/ml, respectively. Blood concentration was maintained at a level above the minimum inhibitory concentration for gram-positive bacteria for a period of about 14hr after administration, demonstrating the usefulness of the syrup preparation.

[Noonan syndrome associated with atrial septal defect, ventricular septal defect and pulmonary stenosis--a case report].

A 10 year old girl with diagnosis of Noonan syndrome was admitted to our hospital because of easy fatiguability and cardiac murmur. She had a peculiar face with hypertelorism, saddle nose, webbed neck and kyphosis. Chromosomal analysis demonstrated normal 46 XX pattern. Associated cardiac anomalies in this case were atrial septal defect, ventricular septal defect and pulmonary stenosis caused by pulmonary valvular dysplasia. The cardiac anomalies were corrected successfully and postoperative clinical course was uneventful.

[Isolation right ventricular hypoplasia: report of two cases].

Two cases of the hypoplastic right ventricle are reported. Patient 1: A five-year-old boy underwent cardiac catheterization 13 days after birth which revealed that the end-diastolic volume in the right ventricle was 2 ml. It was 20 ml at the age of two years and 40 ml at five years. Thus, the right ventricular hypoplasia lessened with increasing age. Neither pulmonary nor tricuspid valvular malformation was present. Patient 2: A four-month-old boy received two-dimensional echocardiographic examination at the age of two days which revealed: 1) a small right ventricle in the apical four-chamber view, 2) a half-moon-shaped right ventricle in the subxyphoid short-axis view at the level of the great arteries, and 3) normal positioning of the septal leaflet of the tricuspid valve. Pulsed Doppler echocardiography revealed normal blood flow patterns, immediately above the pulmonary valve and below the tricuspid valve. Cardiac catheterization at the age of three months indicated isolated right ventricular hypoplasia, a diverticulum of the right ventricle, and dilated cardiomyopathy. The patient died of congestive heart failure at the age of four months. Autopsy confirmed the above diagnoses.

[Glucagon-producing carcinoid of the rectum--report of a case].

A 22-year-old male who had been receiving insulin therapy to treat uncontrollable hyperglycemia, was diagnosed to have a carcinoid in the lower rectum. The excised tumor was 1.5 cm in diameter, and showed a yellowish-white cut surface. It did not invade into the proper muscle. Numerous glucagon immunoreactive cells were found. The tumor cells contained many rounded neurosecretory granules. After tumor excision, the patient's hyperglycemia did not return in the absence of insulin administration. We suggest that the tumor may have secreted glucagon which may have acted as an antagonist against insulin in the circulation.

[Basic and clinical evaluations of cefmetazole in postoperative wound infections].

The time course of the concentration of cefmetazole (CMZ) in the serum and in skin and intestinal tissues was determined after a single intravenous injection of 2 g of the drug. CMZ moved into them well. Furthermore, 41 patients with postoperative wound infection (superficial in 29 and deep in 12) were treated with CMZ 2-4 g daily. Bacteriological examination of the lesions with simultaneously carried out. As a result, 101 strains of bacteria were isolated and identified. Mixed infection was found in 27 cases (65.9%). Fifteen strains (14.9%) of E. coli, 15 (14.9%) of B. fragilis, 7 (6.9%) of Klebsiella sp. and 7 (6.9%) of Proteus sp., were the main bacteria isolated. Eight cases (19.5%) had mixed infection of E. coli and B. fragilis. The committee (3 members) evaluated CMZ to be effective in 75.6% (31 of 41 cases) and bacteria disappeared in 60.5% (23 of 38 cases). The side effects observed were pyrosis and feeling of gastric malaise in 1 case. The results suggest that CMZ is useful, which exerts an excellent effect on postoperative wound infections.

Operative and postoperative choledochofiberoscopy.

Choledochofiberoscopy is effective for both diagnosis and therapy. It is a valuable diagnostic technic because it permits a definite diagnosis and it allows the surgeon to determine the operative method by direct viewing and by biopsy of the biliary tract wall. Choledochofiberoscopy is therapeutically valuable because it permits cleaning of the bile duct, the removal of retained or remnant stones in the common and intrahepatic ducts, and the removal of granuloma and benign tumor with forceps under direct vision.