A 47 year-old man with frequent attacks of ventricular tachycardia (VT) due to arrhythmogenic right ventricular dysplasia (ARVD) developed severe right heart failure following cryoablation of the multiple VT focuses. Inotropic support and intraaortic balloon pumping failed to maintain the systemic circulation, so that we performed the right heart bypass (RHB) using a heparin-coated tube and roller pump. With the use of RHB, systemic circulation improved. We attempted to wean the patient off after 14 days RHB support. However this was unsuccessful because of poor RV function, and RHB was recommenced. The patient finally died of multiple organ failure on the 21st postoperative day, but the major organ function was well maintained for at least two weeks. The heparin-coated tube and roller pump system is easy to handle, and is suitable as a short term lifesaving adjunct for severe right ventricular failure.

Our overall surveys of medical consultations for balneal therapy and of balneal curation at the Namekawa Spa, Yamagata Prefecture may be summarized as follows.
1) The Namekawa Spa is one in the Iegatayama Spa family located in the border of Fukushima and Yamagata Prefecture, which is saline hydrogen sulphide spring in character.
There is only one hot-spring inn in this resort (Fukushimaya Inn). It is rich in natural scenery, without the atmosphere of an amusements center and isolated from the wordly things. It is purely a spa for balneal treatment.
2) The larger number of visitors to this spa are from within the prefecture, especially from the towns and villages around the spa, but, because of its nearness to Fukushima Prefecture, quite a number of visitors are from this prefecture.
The visitors are mostly farmers, especially those of advanced age.
Half the visitors have been at the spa before and many of them are in the habit of revisiting the spa year after year.
3) A majority of visitors come to the spa for therapy of diseases and for recuperation, which shows that this spa has the character of balneal therapy.

OBJECTIVETo analyze the urine of renal recipients for the presence of donor DNA in an attempt to establish an alternative diagnostic means of acute rejection.

METHODSSixty-four renal transplant recipients were examined. Thirty-seven were normal after transplantation, while 22 others developed acute rejection, based on serum creatinine levels and/or needle biopsy findings of the graft. Five developed drug-induced renal dysfunction. In female recipients with a male graft, we examined urine for the presence of Y chromosome (SRY and DYZ-1) and in recipients receiving an HLA mismatched graft, we looked for HLA-DR gene (DRB1) using PCR.

RESULTSAmong the 14 female recipients with male grafts demonstrating stable renal function, only one was positive for SRY and DYZ-1 on the Y chromosome. However, SRY and DYZ-1 were found in the urine of four female patients with acute rejection, but these DNA fragments were not detected in 3 of the 4 after anti-rejection therapy. The last patient was referred to hemodialysis. Of 23 recipients of a graft from HLA mismatch donors with stable renal function, DRB1 was negative in 21 (91%). Of 18 patients with acute rejection, DRB1 was positive in 16 (89%) and negative in 2. These DNA fragments were no longer found in 13 patients after anti-rejection therapy. In all patients with drug induced renal dysfunction, donor-derived DNA was negative.

CONCLUSIONSPresence of door specific DNA in the urine of the recipient is strongly associated with acute rejection. Analysis of DNA derived from donor cells in urine was an effective and accurate method for the diagnosis of acute rejection of a renal transplant.

Acute Disease ; DNA ; urine ; Female ; Graft Rejection ; diagnosis ; Histocompatibility Testing ; Humans ; Kidney Transplantation ; immunology ; Male ; Polymerase Chain Reaction ; methods ; Polymorphism, Single-Stranded Conformational ; Tissue Donors

BACKGROUND:Splenectomy in patients with liver cirrhosis (LC) is expected to become more common owing to its efficacy on portal hemodynamics. In this report we describe an alarming case of group B streptococcus (GBS) infection after splenectomy in a patient with LC. METHODS:A 72-year-old woman with a history of LC was admitted to our emergency department because of respiratory failure. The patient had received left lateral segmentectomy of the liver and splenectomy three months before admission. Pulmonary examination revealed significant wheezing during inspiration and expiration, but no crackles and stridor. Chest radiography and CT showed no infiltrates. A presumptive diagnosis of bronchial asthma caused by upper respiratory infection was made. Four days after admission, GBS infection was confirmed by blood culture and penicillin G was administered. Antibiotics were given intravenously for a total of 12 days. RESULTS:The patient was discharged on the 12th day after admission. CONCLUSIONS:Although efficacy of splenectomy in patients with LC has been reported, immune status should be evaluated for a longer period. Patients who have undergone splenectomy are highly susceptible to bacteria; moreover, LC itself is an independent risk factor for mortality in patients with sepsis. Since prophylaxis against GBS has not been established, immediate action should be taken. Emergency physicians should be aware of invasive GBS infection in the context of the critical risk factors related to splenectomy and LC, particularly the expected increase of splenectomy performed in LC patients.