Recently, allogeneic bone marrow transplantation (allo-BMT) has been established for the treatment of hematological disorders. Fifteen patients had recieved allo-BMT at Tsuchiura Kyodo General Hospital as of April 1999. In this paper, we analyzedthe results and the problems of allo-BMT at our institution. The mean age of patients was 29.2years. Seven patients had AML, 5 ALL, 1 CML, 1 non-Hodgkin's lymphoma and one had severe aplastic anemia. Bone marrow donors were all HLA-identical siblings. Most of the patients were conditioned with a combination of busulfan or totalbody irradiation, cyclophosphamide and etoposide. To prevent GVHD, cyclosporine A and methotrexate were mainly used. Patients with acute GVHD were 4 and patients with chronic GVHD were only two. Three grade I patients with acute GVHD and all with chronic GVHD did not require therapy. In spite of small numbers of transfused cells, no cases of transplant rejection were found. All these engrafted patients achieved a WBC≥1×10³μl after a median of 19.5days and a Plt≥5×10⁴/μEl after a median of 38.1days. Five of the 14 engrafted patient relapsed in a median of 6.7months and all died in a median of 9.6months. Eight are alive in complete remission for 0.2 to 39.4 months (median 21.7months). For the improvement of the disease-free survival rate after allo-BMT, the prevention of relapse and prophylaxis of GVHD and infection are important. At our institution, especially the former is important. The conditioning regimens were stronger than usual but acute and chronic GVHD was very mild, therefore GVL would be weak. If prophylaxis of GVHD is weaken and mild GVHD ans GVL occur frequently, relapse will be prevented and better results will be obtained.

Two uremic patients gradually advanced in years were successfully treated with dialysis, even though they had some medical and social problems. The first case was a 97-year-old female, in whom hemodialysis could be introduced because one of her neighbors offered to support her to get the dialysis therapy. The second case was an 87-year-old male. He had rejected dialyis, when he had suffered from pulmonary edema as a complication of uremia. He finally accepted dialysis after his general condition was remarkedly improved by forced hemodialysis. These two cases show difficulty in initiating dialysis in very old patients. A decision not to offer or to discontinue dialysis should be made after sufficient discussion and counselling among the medical staff, patients, and their families, since it is difficult to establish indication criteria for dialysis therapy in such high-aged patients.

To evaluate a comparison for endovascular repair (EVAR) versus open repair (OR) for the treatment of abdominal aortic aneurysm (AAA). Data of all patients with infrarenal AAA treated electively, both with OR (107 cases) and EVAR (24 cases), at our institute between January 1999 and March 2004 were retrospectively reviewed. No difference was found between the 2 groups for sex, age, and AAA size. Cases of chronic obstructive pulmonary disease (20.8% vs 6.5%, p<0.04) and frequencies of laparotomy (25% vs 2.8%, p<0.001) were significantly more in the EVAR group than the OR group. In the initial results, deployment of the stent grafts was successful in all cases and complete thrombosis of the aneurysm was achieved in 21 cases (87.5%). One graft occlusion and a wound infection occurred in the EVAR group. OR was successfully performed in all cases. These were 6 cases of paralytic ileus, 1 of re-operation for hemorrhage, 1 of respiratory failure, and 1 of ischemic colitis in the OR group. One hospital death occurred in each group. Mean blood transfusion (0ml vs 238±345ml) and operation time (131±53min vs 250±76min) were significantly less in the EVAR group than the OR group. In the long term results, the cumulative survival rate was 88.0±6.5% at 1 and 2 years, 80.6±9.2% at 3 years in the EVAR group; 99.0±0.9% at 1 year, 94.1±2.6% at 2 years, 87.7±3.9% at 3 years in the OR group, with no difference between the 2 groups regarding survival rate. Four new endoleak and 3 graft infections were encountered in the EVAR group. Freedom from stent graft-related complications was 81.3±8.5% at 1 year, 61.4±11.9% at 2 years, 47.8±12.6% at 3 years in the EVAR group, but 100% at 1, 2 and 3 years in the OR group. Freedom from procedure-related complications in the EVAR group was significantly lower than that in OR group. In the long term results, EVAR was associated with more procedure-related complications. This finding may justify reappraisal of currently accepted EVAR for AAA management strategies.