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Studies examining risk factors associated with vasovagal reactions (VVRs) during autologous blood donations, especially in younger subjects, have been limited. The aim of the present study was to define risk factors for VVRs during preoperative autologous blood donation in patients, including those younger than 18 years old. We retrospectively analyzed 4192 autologous, preoperative blood donations between 2007 and 2015 at Okayama University Hospital. Eighty-seven (2.08%) of the patients experienced VVRs. VVRs occurred approximately three times as often in patients 0-17 years old (16/320, 5.0%) than in patients 18 years and older (71/3872, 1.8%). In particular, VVRs occurred more frequently in those 10-13 years old, and decreased with older age (P = 0.006). In a univariate analysis, younger age, lower body mass index, lower systolic blood pressure, lower body weight, lower total blood volume, female gender, first-time collection, and higher heart rate were associated with a higher incidence of VVRs. In a multivariate analysis, lower systolic blood pressure (P < 0.001), higher heart rate (P = 0.007), and first-time collection (P = 0.015), remained independent predictors of VVRs. These results emphasize the need for careful attention during blood collection.

岡山大学病院では，1998年に本邦初の生体肺移植が行われて以降2009年3月までに52例の生体肺移植と15例の脳死肺移植の計67例の肺移植が行われた．特に脳死肺移植では，限られた時間内に血液製剤を準備する必要があり，これまでの肺移植における血液製剤使用量から術前準備量について検討を行った． 赤血球製剤の平均準備量は57.4U，平均使用量は33.5U，C/T比（交差試験単位数/輸血血液単位数）1.73であった．FFPの平均準備量は43.3U，平均使用量は19.4Uで，PCの平均準備量は27.7U，平均使用量は19.8Uであった．両肺移植の平均血液使用量が，赤血球製剤37.9U，FFP 21.8U，PC 22.8Uであったのに対し，片肺移植の平均血液使用量は，赤血球製剤11.5U，FFP 7.0U，PC 4.5Uで有意差が認められた．また，赤血球製剤を100U以上準備した症例が5例あり，全て両肺移植で，うち3例が脳死移植であった． 肺移植では，症例毎の癒着の程度の相違等で一律の血液準備量の決定は難しいと考えられるが，今回の肺移植における血液製剤使用量の検討から血液の必要量については，両肺移植か片肺移植であるか，恐らく，人工心肺の使用の有無が大きな因子であることが示唆された．また，緊急の脳死肺移植や大量の血液製剤準備に対応できるよう，日常的に異型適合血の選択を含めた緊急時の対応と診療科等との連携を深めることが必要であると考えられた．

Autologous blood stem cell transplantation (auto-PBSCT) has increasingly been incorporated into the treatment of various malignancies. Auto- PBSCT provides several advantages over auto-BMT, but sometimes requires several collections of PBSC. We have retrospectively analyzed the time requirements and cost effectiveness of PBSC collection in Okayama University Hospital between 1994 and 1997, in which PBSCs were mobilized by chemotherapy and granulocyte colony-stimulating factor in 85 patients. During the 1994-1995 period, PBSCs were collected by apheresis, which was timed by leukocyte count and carried out by attending physicians, and cryopreserved at

症例は生後3カ月の男児。生後2カ月頃より徐々に浮腫が出現し当科入院となった。入院時低蛋白血症，高コレステロール血症，1日尿蛋白10gを認め，ネフローゼ症候群と診断した。腎組織検査はdiffuse mesangial sclerosisであった。ステロイドおよび免疫抑制剤は無効であった。1歳よりACEI (エナラプリル0.06mg/kg/day) 投与を開始したところ尿蛋白は減少し始め，エナラプリル投与を0.2mg/kg/dayまで増加した時点で尿蛋白は消失した。2回目の腎生検 (2歳) では，糸球体硬化病変は進行し，間質への細胞浸潤が増加していた。エナラプリル投与開始2年6カ月後の現在，腎機能は正常範囲を維持し，身体発育，精神運動発達は良好である。またエナラプリルによると考えられる副作用は特に認めていない。したがって本症例のような多剤に抵抗性の乳児ネフローゼ症候群においても，ACEIは試みられるべき治療法と考えられた。

Most patients with X-linked dominant chondrodysplasia punctata (X-DCDP) have whorled, thick, or spiky adherent hyperkeratosis on their whole body. Histopathologically, there are large keratotic plugs of hair follicles where calcium deposits. This is the characteristic finding in this disease. We performed histopathologic examination of skin specimens from two newborn babies with X-DCDP. The desquamated thick scales from the hyperkeratotic lesions had calcium in the center of the keratotic plugs. Histopathologic examination of thick scales is easy and helpful in diagnosing X-DCDP.

Anti-A and/or anti-B antibodies synthesized by lymphoid tissues contained in ABO-mismatched solid organ grafts have been reported to cause hemolytic anemia, but not suppressed red blood cell production. A case of living-donor lobar lung transplantation is presented in which suppression of erythropoiesis was associated with ABO mismatched organ transplantation.