Discrepancy between the percentage of hypochromic erythrocytes and the reticulocyte hemoglobin content in hemodialysis patients with recombinant human erythropoietin therapy.

The percentage of hypochromic erythrocytes (%HYPO) and the reticulocyte hemoglobin content (CHr) have been used for the diagnosis of iron deficiency (ID). However, we found a discrepancy between %HYPO and CHr values in some hemodialysis patients. Hemodialysis patients receiving recombinant human erythropoietin (rHuEPO) with ID were defined as patients with a %HYPO value exceeding 5%. Five ID patients with a high CHr (group A) and 3 ID patients with a low CHr (group B) received 120 mg/week iron intravenously for 8 to 12 weeks. Changes in %HYPO, CHr, percentage of macrocytic erythrocytes (%MACRO), absolute reticulocyte count, immature reticulocyte fraction, and soluble transferrin receptor level were investigated over a 20-week period. CHrs were measured with 2 hematology analyzers: the Bayer HealthCare Technicon H*3 and the ADVIA 120. Patients in group A showed a significantly greater mean %MACRO (P < .01) and a lower mean red blood cell number (P < .05) than patients in group B. Even the mean CHr at baseline in group A was significantly higher than the mean CHr in the healthy subjects (P < .01), and hemoglobin levels increased in association with the reduction in rHuEPO dose following iron administration (P < .01). We found a group with high CHr, %HYPO, and %MACRO values among hemodialysis patients. Iron administration enables the rHuEPO dose to be reduced.

Long-term graft survival with or without donor-specific transfusion in cyclosporine era in one haplo-identical living-related renal transplant recipients beyond the first year: a 19-year experience.

With improvement in immunosuppressive drugs, the beneficial role of donor-specific blood transfusion (DST) in the preconditioning of renal allograft recipients has been diminished. This retrospective study was conducted to investigate the influence of DST on long-term graft survival in successful one haplotype-mismatched kidney transplantation in the cyclosporine (CsA) era at Iwate Medical University. Between August 1983 and October 1996, 52 one haplotype-mismatched living related first renal transplants were performed. Fifty grafts survived beyond the first year after transplantation. These 50 patients were divided into two groups according to maintenance immunosuppression, 12 kidney graft recipients received azathioprine (AZA), prednisolone (PSL), CsA, and DST, and 38 recipients received AZA, PSL and CsA. Our DST protocol consisted of three transfusions of 30 ml of donor-specific buffy-coat at 4-week intervals, without immunosuppressive coverage. In recipients receiving DST and CsA, the 5-, 10-, and 13-year graft survival rates were 100%, 83%, and 67%, respectively. In recipients without DST, the 5-, 10-, and 13-year graft survival rates were 95%, 74%, and 69%, respectively. There was no significant difference between the two groups in long-term graft survival. In conclusion, DST and CsA combination treatment in our protocol may not induce long standing donor-specific immunologic hyporesponsiveness. Other strategies are expected to induce immunotolerance.

[Characteristics of various electrodes for transurethral surgery].

The characteristics of four electrodes for transurethral surgery were examined by resection experiments using porcine muscles. The electrodes were a loop type (uroloop, ENDO care), a roller type (STORZ), VAPOR CUT (STORZ) and WEDGE (Microvasive Co). With the stroke rate fixed at 1.2 cm/second and the electrical output changed to 200, 220, 240 W, the electrode was moved manually by 1 stroke for resection. Sections were weighed, histological changes on the cut surface were observed under a microscope and the excised + vaporized layer and desiccated layer were measured. A similar study was also made with the electrical output fixed at 200 W and the stroke rate changed to 0.6, 1.2, 2.4 cm/second. When the output was increased, the excised + vaporized layer and desiccated layer became deep with the roller-type. The excised + vaporized layer became deep and the desiccated layer tended to become deep with the UROLOOP and VAPOR CUT. No change in either layer was found with WEDGE. When the stroke rate was increased, both excised + vaporized layer and desiccated layer became shallow with VAPOR CUT, but only the desiccated layer became shallow with WEDGE. In conclusion, the proper output and stroke rate were considered to be 240 W and not more than 0.6 cm/second with the roller-type, 220-240 W and 0.6 cm/second with VAPOR CUT and 200 W and 1.2 cm/second with WEDGE.