Renal adenocarcinoma findings from 307 autopsied cases with metastasis to 1 and 2 organs were investigated concerning the mode of metastasis. The lung was the most frequent site of metastasis to 1 organ, although the frequency was rather low (30 per cent), followed by bones (over-all), lymph nodes (over-all) and brain, and involving frequently the thoracic spine and retroperitoneal lymph nodes. In patients with metastases to 2 organs a significant correlation was found between the pulmonary-tracheal lymph nodes and those to the lungs. Potential indications for treatment of metastatic lesions were 1) lymphadenectomy and/or radiation therapy for the retroperitoneal and para-aortic lymph nodes and 2) resection of metastatic lesions in the lungs combined with lymphadenectomy and/or radiation therapy for the pulmonary-tracheal lymph nodes. In patients without lung metastasis lymphadenectomy and/or radiation therapy for the pulmonary-tracheal lymph nodes is not always necessary.

A multicentre study of ABO incompatible kidney transplantation using Biosynsorb was started in Japan in November 1989. A total of 51 cases were registered comprising 23 cases of A incompatibility, 26 cases of B incompatibility and two cases of AB incompatibility. The .removal of antibodies (IgG and lgM) was carried out using Biosynsorb in 16 cases, plasmapheresis in four cases and use of both combined in 31 cases. The treatment using Biosynsorb was repeated 3.4 times on average. Serum titres of anti-A (IgG and lgM) antibodies decreased to 4.9 ± 5.0 and 2.7 ± 1.7 and for anti-B titres decreased to 2.8 ± 3.5 and 2.4 ± 3.2. Rejection was found in 33 cases: hyperacute one, accelerated acute five, and acute 27. In two cases rejection was developed concomitantly with a steep elevation in antibody titres. Three patients died, two with functioning grafts. Eight grafts were lost. Patient and graft survivals at 2 years were 94.1% and 84.3%, respectively. From these results it is concluded that: 1. Biosynsorb and plasmapheresis are effective in removing anti-A and anti-B antibodies; 2. graft and patient survivals are similar to those in ABO compatible cases; 3. anti-A and anti-B titres less than 16 are recommended at the time of transplantation; 4. anti-A and anti-B titres higher than 128 may be considered as a risk factor for rejection in the early stages after transplantation.

The metastatic pattern in primary renal adenocarcinoma with respect to age has been studied by analyzing the necropsy records of 1828 patients. Metastasis‐free cases were noticeably frequent in the patients over 70 years of age. The metastatic pattern varied with age and was classified grossly into four types according to the age‐associated change in frequency: (1) diminishing; (2) increasing; (3) peaked; and (4) invariable. The incidence of hematogenous metastases showed little or no relation to advancing age whereas dissemination, which was possibly lymphogenous, was found to diminish as the age advanced, the latter trend being especially conspicuous in patients with lymph nodes distant from the primary lesion. It has been inferred that organs displaying comparable tendencies of age‐associated change in frequency of metastasis may share the same route of dissemination.

SUMMARYIn immunocompromised patients, cytomegalovirus myocarditis leading to dilated cardiomyopathy is rare, and the duration of myocardial damage in such patients has not yet been determined.We report here one renal transplant recipient with cytomegalovirus myocarditis. This case shows that the myocardial damage secondary to cytomegalovirus may be insidious and persist for a relatively long period in the immunocompromised patient.

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