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T Kazama

Publications and source records attributed to T Kazama.

At least 37 records · Page 2Linked to original sources
PubMed1999

Lithium dilution cardiac output measurements using a peripheral injection site comparison with central injection technique and thermodilution.

OBJECTIVE: The lithium dilution technique for the measurement of cardiac output by the central injection of lithium chloride was introduced by Linton et al. in 1993. In the present report, we compare lithium dilution cardiac output measurement (LD) by the peripheral injection of lithium chloride (pLD) and by central venous injection (cLD), cardiac output determined by electromagnetic flowmetry (EM), and conventional thermodilution cardiac output measurement (TD) on ten swine. METHODS: The animals were monitored with a pulmonary artery catheter, a femoral artery catheter, and an electromagnetic flowmeter placed around the ascending aorta. cLD, pLD, TD, and EM were determined at the baseline, then in a hyperdynamic state produced by dobutamine administration, at a second baseline, and finally in a hypodynamic state induced by propranolol during deep anesthesia. Data were analyzed by linear regression analysis and the comparison method described by Bland and Altman; bias and precision were calculated using the method of Sheiner and Beal. RESULTS: The correlation coefficient between pLD and EM (0.86) was significantly less than that between cLD and EM (0.96), however it was not significantly different from that between TD and EM (0.85). The precision value of pLD (0.14) was the same as that of TD (0.14). CONCLUSION: The results of the present study indicate that pLD is a reliable technique.

Anesthesia, General↗
PubMed1999

Less core hypothermia when anesthesia is induced with inhaled sevoflurane than with intravenous propofol.

UNLABELLED: Hypothermia after the induction of anesthesia results initially from core-to-peripheral redistribution of body heat. Sevoflurane and propofol both inhibit central thermoregulatory control, thus causing vasodilation. Propofol differs from sevoflurane in producing substantial peripheral vasodilation. This vasodilation is likely to facilitate core-to-peripheral redistribution of heat. Once heat is dissipated from the core, it cannot be recovered. We therefore tested the hypothesis that the induction of anesthesia with i.v. propofol causes more core hypothermia than induction with inhaled sevoflurane. We studied patients undergoing minor oral surgery randomly assigned to anesthetic induction with either 2.5 mg/kg propofol (n = 10) or inhalation of 5% sevoflurane (n = 10). Anesthesia in both groups was subsequently maintained with sevoflurane and 60% nitrous oxide in oxygen. Calf minus toe skin temperature gradients <0 degrees C were considered indicative of significant vasodilation. Ambient temperature and end-tidal concentrations of maintenance sevoflurane were comparable in each group. Patients in both groups were vasodilated throughout most of the surgery. Nonetheless, core temperatures in patients who received propofol were significantly lower than those in patients who received inhaled sevoflurane. These data support our hypothesis that even a brief period of vasodilation causes substantial redistribution hypothermia that persists throughout surgery. IMPLICATIONS: Core temperatures in patients who received i.v. propofol were consistently lower than those in patients who received inhaled sevoflurane, although anesthesia was subsequently maintained with sevoflurane in nitrous oxide in both groups. This suggests that even a brief period of propofol-induced vasodilation during anesthetic induction causes substantial redistribution hypothermia that persists throughout surgery.

Adult↗
PubMed1999

Intraoperative phenylephrine infusion decreases the magnitude of redistribution hypothermia.

UNLABELLED: Core hypothermia during the first hour after induction of general anesthesia results largely from an internal core-to-peripheral redistribution of body heat. This redistribution results from both central inhibition of tonic thermoregulatory vasoconstriction in the arteriovenous shunt and anesthetic-induced vasodilation. We therefore tested the hypothesis that acute administration of phenylephrine, a pure alpha-adrenergic agonist, reduces the magnitude of anesthetic-induced core-to-peripheral redistribution of body heat. Patients undergoing minor oral surgery were randomly assigned to an infusion of 0.5 microgram.kg-1.min-1 phenylephrine i.v. or no treatment (control). The phenylephrine infusion was started immediately before anesthesia was induced with 2.5 mg/kg propofol i.v. Subsequently, anesthesia was maintained with sevoflurane and 60% nitrous oxide in oxygen. Calf minus toe, skin-temperature gradients < 0 degree C were considered indicative of significant arteriovenous shunt vasodilation. Ambient temperature and end-tidal concentrations of maintenance sevoflurane were comparable in each group. Although there were no significant differences in skin-temperature gradients, core temperatures in the untreated patients decreased significantly more (1.2 +/- 0.4 degrees C) than in those given phenylephrine (0.5 +/- 0.2 degree C, P < 0.001). These data suggest that maintaining precapillary vasoconstriction of blood vessels, not in the arteriovenous shunt reduces the magnitude of redistribution hypothermia. IMPLICATIONS: Core hypothermia immediately after induction of general anesthesia results largely from core-to-peripheral redistribution of body heat. Core temperature reduction during the first hour of anesthesia decreased less in patients given phenylephrine than in untreated controls. These data suggest that maintaining precapillary vasoconstriction possibly reduces the magnitude of redistribution hypothermia.

Adrenergic alpha-Agonists↗
PubMed1999

Comparison of the effect-site k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients.

BACKGROUND: Drug effect lags behind the blood concentration. The goal of this investigation was to determine the time course of plasma concentration and the effects of propofol demonstrated by electroencephalogram or blood pressure changes and to compare them between elderly and young or middle-aged patients. METHODS: A target-controlled infusion was used to rapidly attain and maintain four sequentially increasing, randomly selected plasma propofol concentrations from 1 to 12 microg/ml in 41 patients aged 20-85 yr. The target concentration was maintained for about 30 min. Bispectral index (BIS), spectral edge frequency, and systolic blood pressure (SBP) were used as measures of propofol effect. Because the time courses of these measures following the started drug infusion showed an exponential pattern, the first-order rate constant for equilibration of the effect site with the plasma concentration (k(eO)) was estimated by fitting a monoexponential model to the effect versus time data resulting from the pseudo-steady-state propofol plasma concentration profile. RESULTS: The half-times for the plasma-effect-site equilibration for BIS were 2.31, 2.30, 2.29, and 2.37 min in patients aged 20-39, 40-59, 60-69, and 70-85 yr, respectively (n = 10 or 11 each). The half-times for SBP were 5.68, 5.92, 8.87, and 10.22 min in the respective age groups. All were significantly longer than for BIS (P < 0.05). The propofol concentration at half of the maximal decrease of SBP was significantly greater (P < 0.05) in the elderly than in the younger patients. CONCLUSIONS: The effect of propofol on BIS occurs more rapidly than its effect on SBP. Age has no effect on the rate of BIS reduction with increasing propofol concentration, whereas with increasing age, SBP decreases to a greater degree but more slowly.

Adult↗
PubMed1998

Comparative carbon dioxide output through injured and noninjured peritoneum during laparoscopic procedures.

Tension pneumoperitoneum may force gas into a small injured vessel if the opening is kept patent by surrounding tissues. However, the amount of carbon dioxide (CO2) that penetrates through injured or noninjured peritoneum has not been systematically determined. In 25 patients undergoing elective laparoscopic ultrasonography and cholecystectomy, CO2 output (VCO2) and O2 uptake (VO2) were measured at baseline and during anesthesia, pneumoperitoneum, laparoscopic surgical procedure (Surgery), and after hemostasis of the surgical field (Postsurgery). Before anesthesia, VCO2/BSA and VO2/BSA were 97.7 +/- 11.3 and 116.0 +/- 10.0 ml x min(-1) x m(-2), respectively. During anesthesia, they fell to 72.3 +/- 6.0 and 89.8 +/- 7.6 ml x min(-1) x m(-2), respectively (p < 0.05). VCO2/BSA increased to 96.0 +/- 11.1 at pneumoperitoneum (p < 0.05) and increased further to 126.1 +/- 11.0 ml x min(-1) x m(-2) at Surgery. It fell to 111.7 +/- 10.9 ml x min(-1) x m(-2) Postsurgery. VO2/BSA remained unchanged during pneumoperitoneum. Minute volume increased from 2.24 +/- 0.20 in anesthesia to 2.89 +/- 0.25, 4.01 +/- 0.32, and 3.46 +/- 0.28 L x min(-1) x m(-2) during pneumoperitoneum, Surgery, and Postsurgery, respectively, to maintain PaCO2. We conclude that the amount of CO2 absorbed following pneumoperitoneum prior to surgery is lower than that during Surgery or Postsurgery. The amount of CO2 absorbed through the surgical field was 2.3 times higher than that through the nonsurgical field while that from the peritoneum after hemostasis of surgical field was 1.6 times higher.

Absorption↗
PubMed1998

Application of confocal laser scanning microscopy to differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita.

We applied confocal laser scanning microscopy to fluorescence overlay antigen mapping (FOAM) for differential diagnosis of bullous pemphigoid (BP) and epidermolysis bullosa acquisita (EBA). FOAM of tissue-bound IgG and marker basement membrane components (BMCs) including integrin beta 4, laminin-1, laminin-5 and type IV collagen, showed that tissue-bound IgG in perilesional skin samples from five patients with BP was localized on the epidermal side of type IV collagen, and colocalized with some of the other three BMCs, whereas IgG in a sample from a patient with EBA was on the dermal side of all the BMCs. FOAM of binding sites of autoantibodies in patients' sera and markers including integrin beta 4, laminin-1, type IV collagen and type VII collagen, showed that the binding sites of autoantibodies from 16 patients with BP were localized on the epidermal side of type IV and type VII collagens, and localized above or codistributed with integrin beta 4 and laminin-1, whereas those from five patients with EBA were codistributed with type IV and type VII collagens, and localized on the dermal side of integrin beta 4 and laminin-1. These spatial relationships are compatible with their previously described ultrastructural locations. Thus, this method appears to be useful in the differential diagnosis of BP and EBA.

Antigens, CD↗
PubMed1998

Propofol concentration required for endotracheal intubation with a laryngoscope or fiberscope and its interaction with fentanyl.

UNLABELLED: The administration of fentanyl with propofol reduces the blood concentration of propofol required to achieve adequate anesthesia for tracheal intubation. However, different intubation procedures have variable intensities of noxious stimulation and may require different levels of anesthesia. The goal of this study was to determine the propofol blood concentration at which 50% of patients did not respond to stimulation (Cp50) for laryngoscopy, intubation with a laryngoscope, insertion of a slotted oral-pharyngeal airway (Ovassapian airway), and intubation with a fiberscope when administered in conjunction with fentanyl. Patients undergoing elective surgery were given varying amounts of propofol or propofol with fentanyl, and their responses to the four procedures listed above were assessed. These experiments demonstrated that the propofol concentration required for intubation with a laryngoscope was similar to that for intubation with a fiberscope, and that the required level was reduced by fentanyl. Hemodynamic responses to intubation were lower with a fiberscope than with a laryngoscope. We conclude that almost the same concentrations of propofol or fentanyl are necessary for suppressing both of the somatic responses to tracheal intubation with a fiberscope or a laryngoscope. Hemodynamic responses were attenuated more during intubation with a fiberscope. IMPLICATIONS: The propofol blood concentrations at which 50% of patients did not respond to stimulation for laryngoscopy, tracheal intubation with a laryngoscope, and tracheal intubation with a fiberscope were 10.9, 19.6, and 19.9 microg/mL, respectively. These were reduced by fentanyl. Hemodynamic responses to intubation were less with a fiberscope than with a laryngoscope.

Adult↗
PubMed1998

Awakening propofol concentration with and without blood-effect site equilibration after short-term and long-term administration of propofol and fentanyl anesthesia.

BACKGROUND: The propofol awakening concentration can vary. However, the effect site awakening propofol concentration will be a fixed value. The purpose of this study was to determine the awakening propofol concentrations obtained from infusion Schede using abrupt discontinuation of propofol (half-maximal effective concentration [EC50]) or a descending decrease in concentration to allow blood-effect site equilibration (EC50eq). METHODS: Patients undergoing short-term (group 1) and long-term (group 2) elective surgery were anesthetized with computer-assisted continuous infusion of propofol and fentanyl, with both groups receiving the same propofol (3 microg/ml) and fentanyl (1 ng/ml) concentrations 20-30 min before the end of surgery until the end. Then both groups were further divided into two subgroups: subgroup A abrupt discontinuation, and subgroup B descending concentrations of propofol (15-min duration per concentration). In the A subgroups, the response to verbal command was evaluated every 30 s. In the B subgroups, the blood propofol concentrations just permitting and just preventing response to command were averaged individually. The EC50 and EC50eq values were determined by probit analysis. RESULTS: The EC50 of group 1A was 1 microg/ml, which was significantly less than the 1.6 microg/ml of group 2A (P < 0.05). The awakening time of group 1A was 5.2 +/- 1.8 min, which was significantly shorter than the 9.3 +/- 3.5 min of group 2A (means +/- SD). The EC50eq of both groups 1B and 2B was 2.2 microg/ml. CONCLUSIONS: The EC50eq was independent of propofol infusion length, compared with the EC50. Thus the potential for hysteresis during emergence from propofol anesthesia was confirmed.

Adult↗
PubMed1998

The pharmacodynamic interaction between propofol and fentanyl with respect to the suppression of somatic or hemodynamic responses to skin incision, peritoneum incision, and abdominal wall retraction.

BACKGROUND: Sufficient propofol or fentanyl doses necessary to prevent the response to skin incision do not necessarily attenuate hemodynamic responses during surgery. The goal of this study was to characterize the pharmacodynamic interaction between propofol and fentanyl with respect to the suppression of somatic or hemodynamic responses after three stimuli: skin incision, peritoneum incision, and abdominal wall retraction. METHODS: Propofol and fentanyl were administered via computer-assisted continuous infusion to provide equilibration between plasma-blood and biophase concentrations. Patients were randomized to nine groups that received predetermined concentrations of fentanyl (from 0 to 9 ng/ml). Each patient was administered different target concentrations of propofol. Somatic and hemodynamic responses were measured before and after each of three different stimulations: skin incision (si), peritoneum incision (pi), and abdominal wall retraction (ret). The propofol plasma concentrations at which 50% of the patients did not respond to each type of stimulation (Cp50si, Cp50pi, and Cp50ret) were calculated by fitting the Loewe synergistic model. RESULTS: For propofol alone, Cp50si, Cp50pi, and Cp50ret were 12.9, 17.1, and 19.4 microg/ml, respectively. Increasing the fentanyl concentration markedly reduced propofol Cp50si, Cp50pi, and Cp50ret for somatic response, indicating the potential synergistic interaction of both drugs. During the prestimulation period, fentanyl did not decrease systolic blood pressure; however, propofol specifically decreased systolic blood pressure. Both drugs had a synergistic drug interaction on the systolic blood pressure increase after various surgical stimulations. Fentanyl and propofol concentrations that suppressed both the 50% probability of somatic response and the 50% probability of moderate hemodynamic change defined by the 15% systolic blood pressure increase over the prestimulation value were 3.6 ng/ml and 2.5 microg/ml for skin incision, 8.4 ng/ml and 1.6 microg/ml for peritoneum incision, and 5.9 ng/ml and 5.1 microg/ml for wall retraction, respectively. CONCLUSIONS: The anesthesia requirements for stimuli that are more intense than skin incision should be considered during abdominal surgery. Somatic and hemodynamic responses varied depending on the type of surgical stimuli.

Abdominal Muscles↗
PubMed1998

[Total intravenous anesthesia with propofol is advantageous than thiopental-sevoflurane anesthesia in the recovery phase].

A randomized, prospective and multi-institutional study was performed to investigate whether different anesthetic methods affected differently the quality of recovery from anesthesia. Two hundred and eleven patients were allocated to one of two groups; total intravenous anesthesia (TIVA) with propofol and fentanyl (group P, n = 107) and general anesthesia with thiopental, sevoflurane and nitrous oxide (group TS, n = 104). The rapidity of emergence from anesthesia and postoperative incidence of nausea, vomiting, and headache were compared between the two groups. The group P showed significantly shorter emergence times for verbal command responses (7.4 +/- 5.6 min), extubation (10.0 +/- 6.0 min) and orientation (13.1 +/- 7.8 min) than the group TS (9.1 +/- 5.0 min, 11.7 +/- 6.2 min, 16.4 +/- 7.9 min, respectively). The postoperative incidence of vomiting was not significantly different between the two groups (3.7% in the group P and 9.6% in the group TS), but the postoperative incidences of nausea and headache were significantly lower in the group P compared with the group TS (10.3%, 17.8%, respectively in the group P and 34.6%, 29.8%, respectively in the group TS). We conclude that TIVA with propofol is advantageous than thiopental-sevoflurane anesthesia in the recovery phase.

Adult↗
PubMed1997

Reduction by fentanyl of the Cp50 values of propofol and hemodynamic responses to various noxious stimuli.

BACKGROUND: Propofol and fentanyl infusion rates should be varied according to the patient's responsiveness to stimulation to maintain satisfactory anesthetic and operative conditions. However, somatic and autonomic responses to various noxious stimuli have not been investigated systematically for intravenous propofol and fentanyl anesthesia. METHODS: Propofol and fentanyl were administered via computer-assisted continuous infusion to provide stable concentrations and to allow equilibration between plasma-blood and effect-site concentrations. The propofol concentrations needed to suppress eye opening to verbal command and motor responses after 50-Hz electric tetanic stimulation, laryngoscopy, tracheal intubation, and skin incision in 50% or 95% of patients (Cp50 and Cp95) were determined at fentanyl concentrations of 0.0, 1.0, 2.0, 3.0, and 4.0 ng/ml in 133 patients undergoing lower abdominal surgery. The ability of propofol with fentanyl to suppress hemodynamic reactions in response to various noxious stimuli also was evaluated by measuring arterial blood pressure and heart rate before and after stimulation. RESULTS: The various Cp50 values for propofol alone (no fentanyl) for the various stimuli increased in the following order: Cp50loss of consciousness, 4.4 microg/ml (range, 3.8-5.0); Cp50tetanus, 9.3 microg/ml (range, 8.3-10.4); Cp50laryngoscopy, 9.8 microg/ml (range, 8.9-10.8); Cp50skin incision, 10.0 microg/ml (range, 8.1-12.2); and Cp50intubation, 17.4 microg/ml (range, 15.1-20.1; 95% confidence interval). The reduction of Cp50loss of consciousness, with fentanyl was minimal; 11% at 1 ng/ml of fentanyl and 17% at 3 ng/ml of fentanyl. A plasma fentanyl concentration of 1 ng/ml (3 ng/ml) resulted in a 31-34% (50-55%) reduction of the propofol Cp50s for tetanus, laryngoscopy, intubation, and skin incision. Propofol alone depresses prestimulation blood pressure but had no influence on the magnitude blood pressure or heart rate increase to stimulation. Propofol used with fentanyl attenuated the systolic blood pressure increases to various noxious stimuli in a dose-dependent fashion. CONCLUSIONS: The authors successfully defined the propofol concentration required for various stimuli. Tracheal intubation was the strongest stimulus. The absence of somatic reactions for propofol does not guarantee hemodynamic stability without fentanyl. Propofol with fentanyl was able to suppress motor and hemodynamic reactions to various noxious stimuli.

Adult↗
PubMed1996

Gonadotropin therapy in males with hypogonadotropic hypogonadism: factors affecting induction of spermatogenesis after gonadotropin replacement.

Sixteen patients with hypogonadotropic hypogonadism received gonadotropin replacement therapy. Two patients treated with HCG alone showed induction of spermatogenesis 2 and 12 months after the start of treatment. Three subjects receiving combination therapy showed sperm appearance 6-28 months after treatment. The patients showing sperm appearance, whose testicular volume was > or = 4 ml, showed a higher sperm count and impregnated their partners, although no relationship was found between pretreatment testicular volume and sperm appearance. The response to HCG test correlated with sperm appearance after gonadotropin therapy. Sperm appearance was not observed in any subject except for one who showed no response to luteinizing hormone-releasing hormone (LH-RH) test and none of the patients without response of FSH to LH-RH demonstrated any induction of spermatogenesis. In conclusion, the responses to LH-RH test and possibly to HCG test could predict the induction of spermatogenesis after gonadotropin replacement therapy, and a large testicular volume is associated with post-treatment fertility.

Adolescent↗
PubMed1996

Carbon dioxide output in laparoscopic cholecystectomy.

In pneumoperitoneum, carbon dioxide eliminated in expired gas (carbon dioxide output) contains both metabolic and absorbed carbon dioxide from the peritoneal cavity. When elimination of carbon dioxide is much higher than carbon dioxide output, storage of tissue carbon dioxide and arterial carbon dioxide concentrations change. Finally, the rate of carbon dioxide eliminated in expired gas is not a match for the real rate of metabolic production and absorbed carbon dioxide from the peritoneal cavity. During and after insufflation of carbon dioxide, changes in carbon dioxide output were elucidated under constant arterial carbon dioxide pressure (PaCO2), the same as the preinduction level. We studied patients undergoing elective laparoscopic cholecystectomy. Carbon dioxide output, oxygen uptake, respiratory exchange ratio (RER), expired minute ventilation (VE), deadspace to tidal volume ratio (VD/VT ratio) and arterial to end-tidal carbon dioxide partial pressure difference (PaCO2-PE'CO2) were determined before induction, and during anaesthesia, pneumoperitoneum and recovery. By controlling ventilatory frequency (f) every 1 min, PaCO2 was adjusted to concentrations before induction. Constant monitoring of end-tidal carbon dioxide partial pressure (PE'CO2) and intermittent measurement of (PaCO2-PE'CO2) (15-min intervals) were conducted to predict PaCO2). Carbon dioxide output and oxygen uptake decreased significantly from mean values of 83.5 (SEM 5.2), 101.6 (5.1) to 68.5 (4.2), 81.1 (4.6) ml min-1 m-2 (ATPS, P < 0.05) with sevoflurane anaesthesia, and RER did not change. During carbon dioxide pneumoperitoneum (intra-abdominal pressure 8 mm Hg), carbon dioxide output increased by 49% (102.4 (5.0) ml min-1 m-2) (P < 0.05) while oxygen uptake remained stable and RER increased from 0.84 (0.02) to 1.16 (0.03) (P < 0.05). It was necessary to increase VE during pneumoperitoneum by 1.54 times that during anaesthesia to maintain individual PaCO2 values constant. After removal of carbon dioxide from the abdominal cavity, the regression equation of excess carbon dioxide output/BSA best fitted a two-compartment model. The time constants of the rapid and slow compartments were 8.2 and 990 min, respectively. Excess carbon dioxide output/BSA was still 5.5 ml min-1 m-2, 30 min after pneumoperitoneum.

Adult↗
PubMed1996

The localization of plasminogen activator inhibitor-1 in glomerular subepithelial deposits in membranous nephropathy.

In this study, the localization of plasminogen activator inhibitor-1 (PAI-1) and its association with glomerular subepithelial deposits of vitronectin (VN) in membranous nephropathy (MN) was evaluated. Renal biopsy tissue from 30 patients with MN along with specimens of normal kidney removed from six patients with renal tumors were examined for glomerular deposits of urokinase-type plasminogen activator, tissue-type plasminogen activator (t-PA), PAI-1, VN, and fibrinogen by using immunofluorescence and immunoelectron microscopic techniques. Deposits were characterized by pretreating the frozen sections with arginine, glycine, and t-PA to dissociate the VN-PAI-1 complexes, thus providing evidence of PAI-1 binding to VN. Glomeruli isolated from normal frozen kidney and from frozen kidney tissue with MN were subjected to immunoblot analysis. VN was found in the mesangial area and t-PA was observed along the capillary wall of normal glomeruli. Coarse granular deposits of VN, PAI-1, and t-PA were observed along the glomerular basement membrane in MN. Immunoelectron microscopy showed the presence of VN, PAI-1, and t-PA in the subepithelial immune deposits. Pretreating the samples with arginine decreased or abolished immunofluorescence staining for PAI-1 and t-PA, but not for VN. Pretreatment with t-PA decreased the immunofluorescence staining for PAI-1, but not for VN. Pretreatment with glycine decreased or abolished the staining for all three proteins. Immunoblot analysis revealed the presence of VN, PAI-1, t-PA, and t-PA-PAI-1 complex in glomeruli with MN as well as the presence of VN, but not of PAI-1, t-PA, or complex in the normal glomeruli. The findings from this study strongly suggest that PAI-1 was deposited in the glomeruli in MN as a result of binding to VN. Thus, VN-associated PAI-1 may injure the integrity of the fibrinolytic system in glomeruli affected by MN.

Biopsy↗
PubMed1996

Proliferation of macrophage-lineage cells in the bone marrow, severe thymic atrophy, and extramedullary hematopoiesis of possible donor origin in an autopsy case of post-transplantation graft-versus-host disease.

A case of proliferation of CD68-positive macrophage-lineage cells in the bone marrow accompanied by severe thymic atrophy associated with graft-versus-host disease (GVHD) in a boy given allogeneic bone marrow transplantation (BMT) is reported. A 7-year-old boy was treated for posthepatitic severe aplastic anemia by BMT from his HLA-identical, mixed lymphocyte reaction-negative sister. After the transplantation his peripheral blood group converted to the donor type. However, the patient suffered from acute and chronic GVHD and slowly progressive anemia, and he died of multiple organ failure 21 months after BMT. At the autopsy diffuse and monotonous proliferation of CD68-positive macrophage-lineage cells was found to be replacing the blood-forming cells in the bone marrow. The thymus was almost empty of T lymphocytes, and remaining strands of extremely atrophic epithelial cells showed focal cystic change. Extramedullary hematopoiesis was found in the spleen. Analyses of microsatellite markers suggested the hematopoietic cells in the spleen to be of donor origin.

Atrophy↗