[A case of rhinocerebral phycomycosis].

Rhinocerebral phycomycosis is an uncommon opportunistic infection with ubiquitous fungi of the class Phycomycetes, starting in the nose and extending to the paranasal sinuses and then intracranially. The condition is often characterized by poor prognosis because of occlusion of the internal carotid artery. This disease is commonly associated with predispositions such as uncontrolled diabetes mellitus, which is the most common, immunosuppressive states and metabolic bankruptcy including leukemia, lymphoma, myeloma, malnutrition, uremic or diarrheal acidosis, severe burns, anemia, carcinoma, radiotherapy, liver cirrhosis, hemochromatosis, tuberculosis, septicemia, long-term medication of steroid, antibiotics and antimetabolite, drug addiction, cytotoxic drug administration and AIDS. Cases with unknown predisposition, however, have been infrequently reported in the literature. The authors report a case of rhinocerebral phycomycosis in which concurrence of Candida species instead of the above-mentioned common predispositions was considered a potential predisposition. To our knowledge, only 1 report in which Candida species are referred to as a potential predisposition for this disease has been previously issued. A 85-year-old man was admitted to our hospital on March 2, 1994 because of generalized convulsion. He had received a total extirpation of an ascending colon cancer in July 1993. On admission, physical inspection showed no abnormalities and neurological examination revealed obtunded consciousness without other abnormalities. He had no diabetes mellitus. Hematological and blood chemistry values were normal except for CA19-9 of 45 U/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunohistochemical study of the cells infiltrating human renal allografts by the ABC and the IGSS method using monoclonal antibodies.

Sixty renal allograft tissues obtained from 29 patients were stained with hematoxylin and eosin. These tissues were histologically classified into 4 patterns according to the distribution pattern of the infiltrating cells: normal, focal, focal-diffuse, and diffuse types. Clinical signs of acute rejection were observed in 88% of the patients with the diffuse type infiltration, and 83% of those with the focal-diffuse type infiltration but in only 13% of those with the focal type infiltration. Twenty-four renal allografts were analyzed by the ABC and the IGSS methods using monoclonal antibodies. The number of T cells (Leu 1) accounted for about 80% of the total number of infiltrating cells; 2-8% of the cells were B cells (Leu 12); about 10% were NK/K cells (Leu 7); and 4-6% were monocytes/macrophages (Leu M3). As to helper/inducer T cell (Leu3a) and killer/suppressor T cell (Leu2a), which are T lymphocyte subsets, there were more Leu3a- than Leu2a-positive cells in focal type tissue, but there were more Leu2a- than Leu3a-positive cells in focal-diffuse and diffuse type tissue. In most cases that developed clinical signs of acute rejection, there were more Leu2a- than Leu3a-positive cells. The Leu3a/Leu2a ratio in most of the AZA-administered cases dropped immediately after the transplantation and maintained a low value, but in the CSA-administered cases it decreased gradually post-transplant.

[Spontaneous urinary extravasation due to chronic ureteral obstruction].

Spontaneous nontraumatic perirenal extravasation of urine is an unusual phenomenon, and the majority of the reported case were caused by acute obstruction with passage of a ureteric calculus. Extravasation due to obstruction of more gradual onset occurs less frequently. We report four cases, three caused by tumor obstruction of the ureter, and one thought to be obstructed by the stricture due to ureteral inflammation. We discuss the diagnosis and treatment of spontaneous urinary extravasation, especially due to chronic ureteral obstruction.