Clinical transplantation requires nonspecific immunosuppressive agents to prevent graft rejection. The use of such agents decrease morbidity and mortality from its associated side effects. Therefore, clinical application of the donor-specific tolerance is needed. We have proposed two transplantation tolerance systems. One is drug-induced tolerance and the other is monoclonal antibody-induced tolerance system. In this article, we reviewed our own donor-specific transplantation tolerance systems and argue its possibility of clinical application.

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Background and Purpose : Although more cases abuse in high-risk babies are admitted to the Neonatal Intensive Care Unit (NICU) than among normal babies, few studies have been published comparing motherhood awareness among the 2 types of mothers, We identified ways to support new mothers of high-risk babies in developing sound motherhood awareness.
Subjects and Methods : Subjects were 55 mothers of high-risk newborns and 85 mothers of ten normal delivery administered questionnaires on motherhood awareness, feelings toward children and Japanese versions of State-Trait Anxiety Inventory (STAI). Mothers of high-risk babies were asked to fill out questionnaires 6 and 12 days after birth and mothers of normal babies 5 days after delivery. Questionnaires were collected on the same day or the next. Analysis was made by comparing motherhood awareness, feelings toward babies, and state and anxiety scores through the t-test. Pearson's correlation coefficient on each parameter was calculated separately for the 2 types of mothers.
Results : Mothers of high-risk babies showed a similar level of development of motherhood awareness as mothers of normal babies, satisfied with their pregnancies and deliveries. They were, however, suffering from greater anxiety and could not relax while trying to acquire an appropriate response to specific needs of a baby.
Conclusion : It is necessary to provide nursing care in response to accidental crises among mothers of high-risk babies.

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Background & Aims : Zinc (Zn) deficiency cause a variety of disorders including dermatological, neurological and immunologic abnormalities.
Methods : To investigate the relation between serum levels of Zn ion and suppression of protective immunity, we measured the levels of Zn of 10 elderly patients with repeated infections (group 1), and compared with those of other 10 elderly without infections (group 2).
Results and conclusions : The levels of serum Zn in group 1 were higher than those in group 2 (58.0±5.2μg/dl vs. 72.3±4.1μg/dl, P=0.0375 ; n=10, 10, respectively). Our result suggested that Zn deficiency might be a risk factor of infections in elderly.

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Background and Aim : The breasts are symbols of a woman's femininity, and losing them because of cancer results in marked changes in a woman's body image. Appropriate nursing assistance that accurately grasps influencing factors is needed for breast cancer patients to confront the changes in body image, which is their greatest crisis, and to accept them. The purpose of this study was to elucidate changes in the body image of breast cancer patients before and after surgery.
Subjects and Methods : The subjects were 10 patients from whom consent to participate in this study was obtained among the patients admitted to National Takasaki Hospital for surgical treatment after being diagnosed with breast cancer. The method consisted of giving the subjects a questionnaire sheet prepared by the investigators containing three categories of items : body cathexis, body esteem, and body control, and collecting them at a later date. The t test was applied to four variables : age, occupation, marital status, and surgical procedure. In addition, a verbatim record of their content was prepared from preoperative and postoperative interviews.
Results : The preoperative scores for body cathexis were higher in the 60-year-old and under group than in the 61-year-old and over group, and the degree of concentration of consciousness on the body was higher in the group that underwent breast-conserving surgery or reconstructive surgery than the group that underwent mastectomy. Preoperatively, the scores for body esteem were higher in the 60-year-old and under group than in the 61-year-old and over group, and it had become difficult to have esteem for their own body. It had become more difficult for those who were employed than those who were unemployed and for the group that underwent breast-conserving surgery or reconstructive surgery than the group that underwent mastectomy to think of their body as valuable. In the body esteem category, postoperatively, the employed group had significantly higher scores than the unemployed group (p < 0.01). The group that underwent breast-conserving surgery or reconstructive surgery had significantly higher scores than the group that underwent mastectomy (p <0.02), and it had become difficult to esteem their bodies. In regard to body control, postoperatively the employed group had higher scores than the unemployed group (p < 0.04), and their sense of control over their bodies was low. Sense of control over their bodies in the group that underwent breast-conserving surgery or reconstructive surgery was lower than in the group that underwent mastectomy.
Conclusions : Differences in body cathexis were observed preoperatively in the age and surgical procedure items. Differences in body esteem were observed preoperatively in the age, occupation, and surgical procedure items, and postoperatively in the occupation and surgical procedure items. Differences in body control were observed postoperatively in the occupation and surgical procedure items. The results suggested the importance of nursing care in regard to body cathexis, body esteem, and body control.

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Background and Aim : Nurses who provide care to terminal cancer patients are thought to be exposed to severe stress because they are engaged in the practice of nursing designed to mitigate physical, mental, and spiritual pain during the process in which the patient and the patient's family come to accept death. Nurses who work in palliative care units are placed in more stressful situations than in ordinary hospital units because of the special characteristics of the patients under their care. With that in mind, the purpose of this study was to elucidate the stress of nurses working in palliative care units.
Subjects and Methods : The subjects were 16 nurses working in the palliative care unit of National Nishigunma Hospital. The method consisted of first using Kazuo Hasegawa's checklist to rate their degree of stress, then divide them into two groups, a high-stress group and a low-stress group, and analyze them in relation to the content of 43 stress items that had been prepared. The questionnaire sheet was the self-administered, anonymous type, and the sheets were collected from the head nurse on the unit a week later. The differences between mean values in the high-stress and low-stress groups were compared and subjected to the t test.
Results : According to the Hasegawa Checklist, 6 nurses were not in a state of stress (scores : 0-2), and 10 were in a state of mild stress, including borderline stress (scores : 3-10). None of the nurses were in a state of moderate or severe stress (scores : 11-20). The 6 nurses who were not in a state of stress had more years of experience than the 10 who were in a state of stress (p<0.04), and they were significantly older (p<0.04). At least 8 of the 16 subjects felt stress in regard to 19 of the 43 items, and 7 or fewer felt stress in regard to 20 of the items.
Conclusions : Of the 16 nurses working in the palliative care unit, 10 were in a state of mild stress according to the Hasegawa Checklist. The low-stress group had significantly more years of clinical experience and months of experience on the palliative care unit than the high-stress group. Eight or more nurses answered “yes” to 19 of the 43 items, and 7 or fewer answered “yes” to 20 of the items. The results suggested the need for stress management for nurses working in palliative care units.

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Background and Objectives : This study is to identify maternal identity during pregnancy and study formation and change in the identity of mothers of twins to develop psychological support for them.
Subjects and Methods : Subjects were 13 women pregnant with twin fetuses who provided informed consent. Nine were primiparas and 4 multiparas. Semiconstitutive interviews were made on maternal identity and feelings to word babies during early, middle, and late pregnancy. The study was conducted between January and May 1999.
Two questions were asked on maternal identity “How do you feel what be coming a mother?” and “At what time did you become aware that you were a mother?”. Questions on feelings to word the babies were “When did you feel the presence of 2 infants?”, “What are your feelings toward each baby?” and “What are your concerns about delivery and childcare ?”
Results : During early pregnancy, they had no clear idea that they were having twins. Maternal identity emerge when they were informed they would have twins by doctors at regular checkups, and shown the 2 babies by echography and/or had of multiple fetuses confirmed. As in single pregnancies mothers, expressed specific feelings toward each baby as they become aware of fetal movement. Their awareness was intensified if problems emerged concerning continuation or development of the fetus. If there are any problems of mothers and/or fetus identified, psychological support should be provided as well as obstetrical management by doctors. In late pregnancy, doctors informed mothers of plans for delivery, intensifying maternal identity. Multiple pregnancy presents a marked increase in abdominal size, causing problems such as low back pain, gastric discomfort and frequent urination. Mothers also expected to feel more psychological stress since they felt they had to do their best for the sake of their babies. It appears that multiple pregnancy therefore affects the formation of maternal identity.
Maternal identity of women with multiple fetused is formed by the ultrasound image before they become aware of fetal movement. After fetal movement becomes obvious, maternal identity is influenced by fetal development and health. With delivery plans presented, they have more concrete image of childcare, enabling them to prepare to be the mother of twins.

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Background and Objectives : This study is to identify the relationship between self-evaluation mothers found in their experience of delivering twins and maternal identity during the early postpartum period.
Subjects and Methods : Subjects were 11 mothers with twins, 7 primiparas and 4 multigravidas. Seven received infertility treatment and 4 had natural pregnancies. Two of 11 had vaginal delivery and 9 caesarean section. The study was conducted between February 1999 and August 2000. Interviews were given on the third postpartum day for mothers with vaginal delivery and after stabilization of their general condition for mothers of caesarean section. Before interviews, we confirmed that subjects were free of wound pain. Interview was semiconstitutive with 2 categories of questions on delivery experience and maternal identity. On delivery experience, the questions were “How was your delivery?”, “What score do you give to your delivery experience?”, and “What is the reason for the score ?” On formation and change in maternal identity we asked, “When did you feel you were a mother?”, “What is your satisfaction about being a mother ?”, “What do you think about your child's care?”, and “What do you think about your child's growth?” Interviews were recorded and transcribed for self-evaluation of the delivery experience and analysis of maternal identity.
Discussion : Self-scoring of delivery experience satisfaction (100 points maximum) did not show any difference in the mode of delivery. It was totally influenced by personal situations.
Factors affecting self-evaluation of the experience did not differ from those of mothers of one baby previously studied by Tokiwa et al (2000). They included the health status of mothers during pregnancy, informed consent of delivery plans, satisfaction with delivery, health status of newborns, contact with newborns right after delivery, and attitude and involvement of obstetric staffs.
Mothers who found positive value in the experience took active involvement in childcare. Some mothers who had negative value sometimes refused breast feeding and others grew out of the feeling that babies were lovely, these mothers were identified as having greater need for psychological support by experts.

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