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[in Japanese]
1986 Volume 15 Issue 3 Pages
1171
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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M. KONISHI, N. TSUSHIMA, M. SAKAKURA, M. KABA, H. TOIKAWA
1986 Volume 15 Issue 3 Pages
1173-1176
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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After 23 hemodialyses of chronic glomerulonephritis, hemorheological and microcirculatory examination were carried out. Ht, TP, Alb, and Fib significantry increased. Systoric blood pressure significantly decreased, while diastolic blood pressure did not change significantly. Body weight decreased significantly. Viscosities of whole blood and plasma in high shear and low shear rate increased significantly. Viscosity, and TP, Alb, Ht, Fib, rate of body weight loss and diastolic blood pressure showed positive correlative tendencies. Internal diameters on microvessels of bulbar conjunctiva increased significantly as a whole, but flow velocitis decreased significantly. Flow valumes did not changes significantly. Internal diameter and rate of body weight loss had a negative correlative tendency.
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K. ERA, T. AGISHI, T. HOSHINO, I. KANEKO, U. SASAKI, M. MINESHIMA, S. ...
1986 Volume 15 Issue 3 Pages
1177-1180
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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According to the statistics of the Japanese Society for Dialysis Therapy, the causes of deaths for more than a half of patients on maintenance hemodialysis are related to cardio-vascular diseases will be more frequently undertaken for treatment of the cardiovasucular complications in hemodialysis patients. Since body fluid control, electrolyte balancing and/or azotemia correction should not be expected by their own kindney function in hemodialysis patients, hemodialysis needs to be performed in combination with a heart-lung machine procedure during the open-heart surgery. Reported herein is a technique of fluid removal, kalium elimination and azotemia correction which was successfully performed in three openheart surgery patients.
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Y. SANKAI, M. OHTA, Y. KUMAGAI, J. IKEBE
1986 Volume 15 Issue 3 Pages
1181-1184
Published: June 15, 1986
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We have developed a hematcrit detector to measure the blood volume continuously, to prevent the hypotension during HD treatment. A pair of optical devices were set to the exetracorporeal blood circuit, which measures an incidentlight at photodetector through blood. Using the observer system which consists from a three-compartment model and state feedback circuit, it is possible to estimate not only the blood volume and its decreasing rate but also trends of liquid volume in each compartments. This system will be able to maintain a preferable circulating condition for HD Patient.
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Y. ENDOH, R. MOTOKI, H. INOUE, A. USUBA, J. MIURA, K. SUGAWARA, S. HAG ...
1986 Volume 15 Issue 3 Pages
1185-1189
Published: June 15, 1986
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We studied the hemodynamics during hemodialysis (HD) in acute renal failure (ARF) cases using Swan-Ganz catheter. The results were as follows: 1) The hemodynamic patterns in ARF cases were classified into 4 types (Hyperdynamic, Overhydration, Hypovolemia, Cardiac failure), but they were not always specific. 2) In the cases of unstable blood pressure during HD, some had a tendency to become cardiac failure, and others were hypotensive because the ultrafiltration volume by HD was excessive. 3) The ultrafiltration volume should not be excessive, and pulmonary wedge pressure had to be kept higher than 4mmHg. In our study the V-V method as a blood access was more effective than A-V method. 4) HD could be stable and effectively performed using dopamine, dobutamine and IABP in the cardiac failure type.
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M. YAMAGISHI, T. NAKAO, T. KAZUI, O. YAMADA, T. SASAKI, S. KOMATSU
1986 Volume 15 Issue 3 Pages
1190-1193
Published: June 15, 1986
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Continuous hemofiltration (CHF) was performed in 11 patients with renal failure and hemodynamic instability. Blood access was obtained with a FDL catheterinserted from the subclavian vein. Blood flow was maintainedbya blood pump. Ultrafiltration rates of over 800ml/hr were obtained by control of blood flow with the pump and the pressure of the venous line. Substitution fluid was infused using an infusion pump while monitoring systemic blood pressure, central venous pressure, heart rate, and pulmonary arterial pressure. Four patients were successfully weaned from CHF. In one patient, CHF was replaced with hemodialysis after the hemodynamics became stable. Six patients died of cardiac pump failure. Our clinical findings suggest that CHF can be introduced and maintained without markedly affecting hemodynamics, and it prevents the significant increase in serum BUN and creatinine levels during the acute phase of renal failure. CHF appears to be a useful procedure for the treatment of renal failure especially in patients with unstable hemodynamics.
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Y. YAMASAKI, R. YOSHIMURA, T. SUGIMURA, S. YAMAGAMI, T. KISHIMOTO, M. ...
1986 Volume 15 Issue 3 Pages
1194-1196
Published: June 15, 1986
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The method and effct of continuous arteriovenous hemofiltration (CAVH) in treating multiorgan failure were studied. In order to obtain blood access with enough blood flow, an external shunt or catheter with a large diameter was used. Amicon Diafilter-20, Asahi PAN-50P and PAN-60 were used as the filters, and membrane area was 0.25, 0.5 and 0.6m
2, respectively. In 25clinical cases even at a systolic blood pressure of 70 to 80mmHg, a filtrate of 60 to 90ml/h was obtained. In 10 out of the 25 cases, the patient survived even though temporarily. These results suggest that this treatment method helped the cardiorenal function at an early time, and the treatment of the cause will be important.
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N. MUROTANI, H. HIRASAWA, H. KOBAYASHI, K. SOEDA, [in Japanese], [in J ...
1986 Volume 15 Issue 3 Pages
1197-1200
Published: June 15, 1986
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The changes in extravascular lung water (EVLW) and hemodynamics with continuous arteriovenous hemofiltration (CAVH) in overhydrated dog. The present study was undertaken to investigate the efficacy of CAVH in removing excess water from overhydrated uremic dons in search of its potential role i n the treatment of critically ill ohverhydrated patients. The changes in EVLW and muscular water contents indicate that excess water could be removed by CAVH effectively. The changes ih hemodynamics such as cardiac index and CVP were minimal despite of massive water removal. These results indicate that the CAVH is a safe and effective treatment for the critically ill overhydrated patients who do not respond diuretics.
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[in Japanese]
1986 Volume 15 Issue 3 Pages
1201
Published: June 15, 1986
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K. SHISHIDO, K. TAKAYAMA, H. KOJIMA, E. KINUGASA, F. NAKAYAMA, K. TAKA ...
1986 Volume 15 Issue 3 Pages
1202-1204
Published: June 15, 1986
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This study was performed to make clear the effects of protein permeable hemodiafiltration (PPHDF) on the uremic symptoms such as severe renal anemia, bone pain, and peripheral neuropathy, which had not improved by conventional hemodialysis. And concerning to anemia, the combined effect of anabolic steroid and PPHDF was also examined. As a result, one of three patients with severe renal anemia, two of three patients with bone pain, and one patient with peripheral neuropathy improved by PPHDF. The anemia of two patients, not improved by PPHDF alone, markedly improved by the combined therapy with anabolic steroid. Furthermore, the anemia of four patients, not responded to anabolic steroid for more than five months, improved in all patients by the combination therapy with PPHDF. From these findings, we can conclude that this combined therapy of anabolic steroid and PPHDF, the former increases erythropoiesis in bone marrow and the latter eliminates inhibitory factors of erythropoiesis, is very effective on severe renal anemia.
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-Hydrous cerium Oxide
M. OGURA, T. AKIBA, H. IWAMOTO, T. SHIBAMOTO, S. NAKAGAWA
1986 Volume 15 Issue 3 Pages
1205-1207
Published: June 15, 1986
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Since the first description of aliminum-related encephalopathy in patients on regular dialysis treatment, toxicity of alminum is well recognized. Another aluminum-related diseases such as vitamin D resistant osteomalacia and microcytic anemia were also reported. In the present study, as a new non-aluminum phosphate binder, hydrous cerium oxide, a rare earth compound, was investigated. Cerium oxide and hydroxyaluminum were mixed at the ratio of 1.0g/l in solution of phosphate compounds in which phosphate ion concentrations were 2.0mM and stirred for one hour. Cerium and alumina were also compared around neutral range.
The adsorptive effect of cerium oxide was fourth as much as that of hydroxyaluminum. Direct hemoperfusion was performed with cerium oxide column in acutely induced hyperphosphatemia dog. The serum phosphate concentrations declined from 16.7mg/dl to 4.5mg/dl until 60 minutes. Also calcium concentrations declined from 3.8mEq/l to 1.2mEq/l. In conclusion, alternative phosphate binderr in place of aluminum gel is in emergent need and this substance is worth being studied and tested further.
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SHINICHI HOSOKAWA, TORU KOIKE, HIROSHI NISHITANI, TOSHIJI NISHIO, KENJ ...
1986 Volume 15 Issue 3 Pages
1208-1212
Published: June 15, 1986
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Aluminum transport and dialysance during hemodialysis were examined in thirty chronic hemodialysis patients. Serum aluminum levels in thirty volunteer outpatients tended to decrease after 5-hour dialysis (6.35±3.02μg/dl before hemodialysis; 5.41±2.60μg/dl after hemodialysis). Serum aluminum levels were 0.6±0.2μg/dl in normal subjects. The decrease was mainly due to diffusion despite hemoconcentration evidenced by a significant increase in the hematocrit and total serum protein during dialysis. To study the changes resulting from diffusion, we measured aluminum in the arterial blood and in the dialysate at the inflow and outflow sites of the dialyzer. Aluminum diffused across the dialyzer from the blood to the dialysate in twentythree cases and into the blood in seven others. Aluminum dialysance of 30 patients was 13.34±22.1ml/min. The relationship between aluminum dialysance and ultrafiltrable aluminum levels was a significant correlation (r=0.80, p<0.005).
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T. KUNITOMO, H. KATAOKA, Y. SAKAI, M. ONOHARA, H. KOBAYASHI, I. SAKAI, ...
1986 Volume 15 Issue 3 Pages
1213-1218
Published: June 15, 1986
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Al removal was studied as a test case of removal of deposited solutes by combining extracorporeal procedure with medication. 1) 1: 1 complex formation between DFO and Al in H
2O was confirmed by FAB-MS. 2) DFO in blood and dialysate can be analyzed by HPLC using reverse phase column. 3) Increase in plasma Al induced by DFO infusion significantly correlates with duration of HD. 4) Al and DFO permeability of a protein-leaking membrane is higher than that of a conventional membrane. 5) Following its rapid drop soon after DFO infusion, the plasma DFO levels off and the formation of the stable Al-DFO complex is suggested.
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M. NAMBU, K. KUMANO, S. KUSAKARI, S. YOKOTA, K. SAKURAI, T. SAKAI
1986 Volume 15 Issue 3 Pages
1219-1222
Published: June 15, 1986
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The removal capacity of Al was compared among the various modes of hemopurification in 5 maintenance hemodialysis (HD) patients who was intravenously administered DFO 30mg/kg after each dialysis session. The serum Al concentration was significantly increased from 39.6±20.5μg/l to 399.0±209.6μg/l 42 hours after loading of DFO. DFO loading decresed protein binding with Al from 84.9±8.7% to 21.1±9.8% and incresed the dialyzable Al which made a complex with DFO. The removal capacity of Al was following: DHP+PPHD>HDF>HF>HD.
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S. NAKASE, F. NISHIBORI, O. MATUMURA, H. AMEMIYA
1986 Volume 15 Issue 3 Pages
1223-1226
Published: June 15, 1986
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The accumulation of aluminum in the tissue, as a causative factor of encephalopathy and osteomalacia, is a serious problem in managing patients undergoing hemodialysis (HD) for a long term. In recent years, there have been some reports, supporting the effectiveness of Desferrioxamine (DFO). However, the doses of administration have not defined as yet. This paper is a case report that a patient, probably suffering from aluminum osteomalacia, was successively treated by both the infusion of DFO and protein leaking hemodialyzer (PLHD). Case; 24 years old female. She was first treated by HD in Mar. 1978 and well maintained for 5 years until 1983 when she began to complain of bone pain. In Feb. 1984, her left humerus was fractured, followed by right femur fracture 3 months later. She was managed by conventional treatment, but the course was unsatisfactory. From Oct. 1984, she was treated by DFO (1000mg) and PLHD (5 hours). Serum levels of aluminum increased 7.20±1.8 times as compared with pretreatment levels and the amounts of removal by PLHD was 71.7±5.3% (N=11). The decrease of serum aluminum level was noted 4 months after the initiation of treatment. Clinically, bone pain was disappered 1 month later and she could ambulate from Dec. 1985. As for serum level of Fe and ferritin, the level of ferritin was decreased slightly by PLHD. In conclusion, the infusion of DFO in combination with PLHD was effective against aluminum osteomalacia.
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Y. INAGAKI, I. AMANO, T. YOSHIDA, N. TERAMACHI
1986 Volume 15 Issue 3 Pages
1227-1232
Published: June 15, 1986
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Ligature of both ureters was done in mongrel dogs to study the feature of BBB in renal failure. The dogs were divided into two groups: Serum (S) and Cerebro-spinal fluid (C) were obtained daily in one group and during hemodialysis (HD) performed in the fourth day in another group. Electrolytes, BUN, Cr and Osmotic pressure (Osm) of S and C were measured in both groups. Na and Cl in S and C were changed in same direction. Although S-K and S-Ca and S-P were changed greatly, the changes of C-K, C-Ca and C-P were very small. S-BUN was decreased more significantly compared to C-BUN during HD and this phenomenon resulted in the following conditions: S-BUN<C-BUN and S-Osm<C-Osm. S-Cr was changed greatly but the change of C-Cr was very small. These features of the BBB are thought to relate with uremic encephalopathy, dialysis disequilibrium syndrome or dialysis dementia.
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[in Japanese]
1986 Volume 15 Issue 3 Pages
1233
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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Y. KITAMOTO, K. SUZUKI, G. FUTAKI, Y. TAGUMA, H. UEDA, H. MONMA, M. IS ...
1986 Volume 15 Issue 3 Pages
1234-1237
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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Femoral vein catheter has been used as a transient blood access for extracorporeal circulation since Shaldon reported its usefulness. However, the catheters now being used do not have enough antithrombogenicity, so that continuous infusion of heparin or urokinase solution was necessary for retaining their patency. Such catheters have many demerits such as to accelerate bleeding tendencies of the uremic patients, to impose patients certain volume load and to restrict patients' movement. To solve these problems, we investigated urokinase immobilized femoral vein catheter (UKFC) with urokinase immobilized plug and applied it to 21 patients for therapeutic extracorporeal circulation. UKFC is a single-lumen type polyurethan catheter with 9 Fr diameter and 22cm length. Twenty catheters were placed in 19 patients for 2 to 30 days and used for 1 to 13 extracorporeal circulations. The patency of the UKFC was retained in all cases, even after 30 days placement. The UK activity after use was 1.1±0.6% of that before use, but the catheters had still enough ability of fibrinolysis. The excellent antithrombogenicity of the UKFC was due to both the fibrinolytic activity of immobilized UK on the catheter and the protective effect of the plug from blood influx during the replacement in the vessel.
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-Especially recirculation rate-
E. KUSHIMA, M. SATOH, M. OKI, M. TOMITA, M. AKIMOTO
1986 Volume 15 Issue 3 Pages
1238-1240
Published: June 15, 1986
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It is usefullness double lumen catheter (DLC) for temporary blood access as hemopurification. However, it seems a little effect on hemodialysis. We modelled on experimental systems of vessel tubing. Modelling vessel system consists of silicone tube, running water (Qw) in vessel tube from 200ml/M. till 400ml/M. Outflow rate (QB) in arterial side of DLC from I00ml/M. to 250ml/M. ran. DLC recirculation rate is measured by PSP solution. On change of Qw 400ml/M flow rate is the best, on change of QB I00ml/M flow rate is the most effective. Therefore, DLC recirculation rate is not only QB but also Qw most influenced. For the reasons mentioned above, as for Qw of much volume DLC is effective.
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I. AMANO, U. INAGAKI
1986 Volume 15 Issue 3 Pages
1241-1244
Published: June 15, 1986
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Now, we have developped a new wearable catheter as permanent blood access, made of silicon tube with dacronmesh. The new catheter has spiral wire in silicon wall. The catheter with dacron mesh is effective in prevention of bacteria infections. Spiral wire as elastic tube was usefull in maintenance of well blood flow rates through the catheter. Clinical experiences with the catheter has made in three patients for a month.
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H. KOBAYASHI, H. HIRASAWA, K. SOEDA, [in Japanese], N. MUROTANI, Y. IT ...
1986 Volume 15 Issue 3 Pages
1245-1248
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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The FDL catheter was applied as a blood access for the acute hemopurification in 36 critically ill patients. These patients included 10 acute renal failure patients, 5 acute hepatic failure patients, 11 hyperbilirubinemic patients, 7 acutely deteriorated chronic renal failure patients and 3 patients with acute drug intoxication. The hemopurification with the FDL catheter could be performed without significant complications, showing the satisfactory results. These data indicate that the FDL catheter is a safe and convenient blood access for the hemopurification among critically ill patients.
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Shohei FUCHINOUE, Satoshi TERAOKA, Hayakazu NAKAZAWA, Ichiro NAKAJIMA, ...
1986 Volume 15 Issue 3 Pages
1249-1252
Published: June 15, 1986
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Totally implantable vascular access divice, Vascular Access Port (VAP, Norfork, U.S.A.), were used for total parental hyperalimentation. The VAP is consist of a stainless steel injection reservor and silicon catheter. In this series, catheter were inserted into central vein through cephalic vein and reservor were implanted in anterior chest wall. The cyclic hyperalimentation were done during night time and the patients were completly free during day time. There was no limitation of the patients' activity and no requring dressing changes and there were no serious complication concerning VAP. Home hyperalimentation, Vascular Access Port.
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Y. SASAKI, K. MATSUMOTO, K. ERA, K. KUDO, T. SUZUKI, K. OHTA, A. WADA, ...
1986 Volume 15 Issue 3 Pages
1253-1256
Published: June 15, 1986
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Chronic hemodialysis requires a wellfunctioning blood access. We examined 24 patients in our hemodialysis center by ultrasonography with 7.5MHZ transducer (LS-300).
The results were stenosis in 3 patients, abnormal dilatation of vein in 3 patients, the others were thrombosis, aneurysm, wall irregularity, extravascular hematoma. Non invasive ultrasonography is expected as the initial imaging procedure.
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Y. INAGAKI, I. AMANO, T. YOSHIDA, N. TERAMACHI
1986 Volume 15 Issue 3 Pages
1257-1261
Published: June 15, 1986
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Single needle dialysis (SND) is inferior to double needle dialysis in efficiency because it is always accompanied by ineffective flow and recirculation. We reported previously that Volume Reservoir (VR) in venous (V) circuit can decrease the number of switching for the A and V phases, and increase the effective flow (EF). The efficacy of the VR was increased by using the thinner latex or Silicone rubber for the materials of the balloon parts. As super extensible balloon has less ability to constrict for itself, we applied the additional power in V phase to increase the EF. The endurance test using mongrel dogs revealed that it is no problem to use for more than 6 hours and clinical use below the fixed maximum V pressure.
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[in Japanese]
1986 Volume 15 Issue 3 Pages
1262
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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F. NAKAYAMA, M. WAKASA, N. KANAMORI, K. TAKAYAMA, H. KOJIMA, T. SEKIGU ...
1986 Volume 15 Issue 3 Pages
1263-1266
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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22 uremicc patients with multi-organ failure were treated with continuous hemofiltration and bicarbonate substitution fluid (CHF). 71 CHF procedure, for 88hr at maximum (average 9.65±10.6hr) duration, were performed by three kinds of PAN hemofilters (ASAHI) and by a polyethersulfone filter (Teijin). 8 cases out of 22 (36.4%), successfully treated by CHF, and the other patients died. Among fourr kinds of hemofilters, polyethersulfone filter showed the highest filtration fraction and maintained the performance for the longest period. These results indicate that CHF is preferable therapeutic procedure to treat the severe patients with multi-organ failure.
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G. TAKAHASHI, T. YOSIDA, M. HIROSE, M. MITACHI, T. UTUMIYA, A. OGAWA, ...
1986 Volume 15 Issue 3 Pages
1267-1270
Published: June 15, 1986
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We manufactured a Bicarbonate dialysis unit (Bc. unit) which is capable of performing also Bicarbonate dialysis, making use of the proportioning pump with which an existing Acetate dialysis device (Ac. device) has been equipped. Its external dimensions are 40(W) x 60(H) x 60(L)cm and capacity is 2.5/min. (1) When main stock solution containing no Bicarbonate is diluted in the Ac. device and poured into the quantitative tank within the Bc. unit, Bicarbonate solution is fed into the quantitative tank using a roller pump and agitated. Then, the concentration is checked forr supplying. (2) After this method has been used for dialysis, all functions properly operated and the electrolyte and pH of the dialysate were both stable.
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T. WATANABE, O. OTUBO, N. IWADATE, K. IGARASHI, N. KUBO, Y. KUROMATSU, ...
1986 Volume 15 Issue 3 Pages
1271-1274
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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With a view to eliminating urea, the most important point which has so far been considered from the viewpoint of miniaturizing the artificial kidney, we have developed a urea adsorbent composed of an enzyme (urease) and an inorganic adsorbent. As an approach to an artificial kidney of portable and wearable type, we have devised an artificial kidney system with regenerative dialysate using some urea adsorbent. Three hours of application of the artificial kidney system with regenerative dialysate to experimental uremic dogs resulted in an improvement of their uremic symtoms.
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T. KIHARA, N. GOYA, H. NAKAZAWA, M. MINESHIMA, H. TOMA, T. AGISHI, K. ...
1986 Volume 15 Issue 3 Pages
1275-1279
Published: June 15, 1986
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Six mongrel dogs were divided into two experimental groups, DHP (4 dogs) and control (2 dogs). CDDP, an anticancer agents, was administered in dose of 3mg/kg into the either side of renal artery taking for ten minutes in each group. Direct hemoperfusion using activated charcoal was performed on DHP group for 180 minutes immediately after administration of CDDP. Blood, tissue and urine concentration of CDDP were measured in each group at certain interval. Concentration of CDDP of blood and tissue of the liver and the kidney of non-injected side were significantly lower in DHP group (p<0.01). On the other hand, there was no significant difference in the tissue concentration of CDDP of the kidney of injected side between two groups. Estimated adsorption rate of CDDP in DHP group was between 15 to 25% of administered dose. Urine excretion rate of CDDP were between 7 to 8% in DHP group and 10 to 12% in control group respectively. These results suggest the effectiveness of DHP to alleviate the system toxicity of CDDP.
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K. OTA, Y. HIRASAWA, N. MIMURA, S. NAKAGAWA, Y. KAWAGUCHI, T. KISHIMOT ...
1986 Volume 15 Issue 3 Pages
1280-1283
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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To decrease the incidence of peritonitis in CAPD patients, Flamelok joint has made a considerable contribution. However, the joint made from ZrO
2 was occasionally broken causing peritonitis. A new ceramic joint made from Si
3N
4 is produced and examined clinically. Thirty nine patients treated with CAPD system having a joint made from ZrO
2 were switched to use a system having Si
3N
4 joint. Break of joint was observed 1/8420 exchanges during ZrO
2 but none in Si
3N
4 period. Occlusion of the joints, however, was observed 1/1289 exchanges during Si
3N
4 compared with 1/1530 exchanges in ZrO
2 period. Peritonitis directly related to the joints developed 1/276 patient-months during ZrO
2 and none during Si
3N
4 period. If the peritonitis episodes caused by unknown reasons were added to the above, the incidence increased to 1/30.6 patient-months in the former and 1/67.9 patient-months in the latter. From these reasons it is concluded that the joint made from Si
3N
4 is superior to that made from ZrO
2.
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Shinji YOKOTA, Katsuto SHINOHARA, Kazuo KUMANO, Tatsuo SHIMIZU, Kenich ...
1986 Volume 15 Issue 3 Pages
1284-1287
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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A reliable catheter is the cornerstone of successful CAPD. Each patient should be approached with careful attention to the detail of catheter placement. The present study was aimed to compare the complications of CAPD catheter among the several surgical techniques of catheter placement. At our institution, we treated 40 patients at their age of 1-83 with CAPD for these 5 years, using a total of 59 peritoneal catheters. The common complications were catheter occlusion and exit site/tunnel infection. Catheter occlusion could be prevented by prophylactic omentectomy and by the use of curled Tenckhoff cahteter. Cuff extrusion and exit site/tunnel infection became a minor problem with an application of long subcutaneous tunnel more than 5cm from the 2 nd cuff to exit which passed around umbilicus. These two techniques, omentectomy and long subcutaneous tunnel seems to be effective to reduce the catheter complications.
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[in Japanese]
1986 Volume 15 Issue 3 Pages
1288
Published: June 15, 1986
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-Investigation of NAHD by Hemochron time (HT)-
N. TAKAGI, H. ODA, Y. TOKITA, T. ISHIKAWA
1986 Volume 15 Issue 3 Pages
1289-1292
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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We tried to perform NAHD by the same priming with heparinized saline (from 5000 to 10000 unit) as usual heparinized hemodialysis. We have succesfully performed with total of 154 dialysis for nine patients with high bleeding risk. HT was correlated significantly with Lee-White coagulation time (r=0.90, P<0.001) and HT during NAHD shortened more than HT during heparinized hemodialysis. Our simple NAHD was useful method to avoid bleeding on patients with high bleeding risk and HT was useful index to assess coagulation time during hemodialysis.
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T. SEKIGUCHI, K. TAKAYAMA, K. TAKAHASHI, T. AKIZAWA, M. SATO, T. KITAO ...
1986 Volume 15 Issue 3 Pages
1293-1296
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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A specific thrombin antagonist argipidine (A) has been examined as an anticoagulant for hemodialysis (HD) for 24 months in 12 regular HD patients. A showed similar anticoagulant activity to heparin, and several clinical advantages such as the prevention of antithrombin III consumption, improvement in lipid metabolism and so on were brought about by the use of A. Furthermore A was extremely effective to treat the patients with allergy to heparin. These results indicate that A is a very useful anticoagulant especially for the patients with hyperlipidemia and/or heparin allergy.
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T. AKIZAWA, T. SEKIGUCHI, E. KINUGASA, M. SATO, T. KITAOKA, T. IDEURA, ...
1986 Volume 15 Issue 3 Pages
1297-1300
Published: June 15, 1986
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A specific thromboxane A
2 (TxA
2) blockade OKY-046 (OKY) was utilized as an anticoagulant for hemodialysis with mongrel dogs. About 300μg/kg/min of OKY clearly prevented blood coagulation in blood circuit, while small dose or very high dose of OKY failed to prevant the clotting. In the latter case, the inhibition of cyclooxygenase by OKY had contributed to that result. Reduction of platelet counts was significantly suppressed during hemodialysis with OKY compared to that with heparin. These results indicate that extracorporeal circulation can be performed by the inhibition of intrinsic platelet functions.
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S. NAGANUMA, K. TAKAHASHI, T. SUZUKI, K. OTA
1986 Volume 15 Issue 3 Pages
1301-1305
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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Prostacyclin derivative (CS-570) with strong suppression on platelet aggregation was examined as an anticoagulant for haemodialysis. Thirty stable dialysis patients were dialyzed using this drug. CS-570, 50-150ng/kg/min, was continuously infused into the blood line with or without heparin. As a result, blood coagulation was effectively suppressed by the drug in the blood line. Haemodialysis is maintained by proper dose of CS-570 without adverse effect. These results strongly suggest that CS-570 is a promissing antiplatelet drug applicable to haemodialysis treatment.
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Y. KITAMOTO, Y. ZANMA, T. HARIU, K. NAGAI, T. MAKINO, A. MAKI, Z. NIWA ...
1986 Volume 15 Issue 3 Pages
1306-1310
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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Coagulation ability and susceptibility to anticoagulants vary in each hemodialysis patient. During the patients with clotting troubles and those with no troubles, significant difference was found as to the activated clotting time (Hemochron time) just before starting dialysis. We prepared and evaluated the manual for setting the dose of gabexate mesilate (GM) in dialysis on the basis of Hemochron time. Forty-five dialyses of 22 paients were carried out following this manual by using the special circuits with 3 venous line air trap chambers placed in parallel. The infused dose of GM per hour in dialyses was 589±31mg when 150 unit of heparine was used for priming the circuits and 694±23mg when 50mg of GM was used for priming the circuits.
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Y. KITAMOTO, T. MAKINO, Y. ZANMA, K. CHIBA, M. AOKI, T. KOYAMA, T. HAY ...
1986 Volume 15 Issue 3 Pages
1311-1314
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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Activated clotting time (ACT) is often used as a guide for heparinization at hemodialysis. However the ACT for proper anticoagulation is still controversial. We proceeded low dose heparinization of 10 patients guided by Hemochron time (HT) as ACT. Special dialysis circuits with 3 venous line air trap chambers arranged in parallel were used and clotting was monitored when the chambers were exchanged.
Initial dose of heparin including that for priming the circuits decreased from 1360±35u to 540±227u and continuously infused dose decreased from 940±313u/H to 480±140u/H. At the low dose of heparin arrived, HT just after starting dialysis located under 180 seconds and HT at the end of dialysis was near that before dialysis. Serum concentration of heparin rised about 16% just after starting dialysis but falled to intial value thereafter during dialysis.
The bleeding tendencies of the patients were improved and the dialysis efficiency did not fall in low dose heparinization.
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K. UMIMOTO, N. IZUMI, T. MAEKAWA, Y. KATO, S. YOSHIMOTO, H. TANAKA, T. ...
1986 Volume 15 Issue 3 Pages
1315-1317
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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It has been reported that platelet counts decrease and plasma levels of β-TG and PF-4 increase during the initial phase of hemodialysis (HD). In order to study the effect of heparin itself on these phenomena, platelet counts, platelet volume distribution, β-TG and PF-4 were measured at 30 min after intravenous injection of 2000 units of heparin equivalent to priming dose of HD. Platelet counts were significantly decreased after 30 min of heparin injection. In platelet volume distribution, large platelet counts were significantly decreased. The plasma levels of β-TG was not changed, but that of PF-4 was significantly increased after heparin injection. These result suggest that heparin as well as extracorporeal circuration in HD affect the changes in platelet counts and plasma level of PF-4 during initial phase of HD.
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[in Japanese]
1986 Volume 15 Issue 3 Pages
1318
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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I. TAMAKI, M. KOZAKI, E. SAKURAI, K. MIYAMOTO, K. LO, Y. OKOUCHI, T. N ...
1986 Volume 15 Issue 3 Pages
1319-1322
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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Forty-two cadaver kidneys were preserved using preservation machine LPS-11 which we devised with Nikkiso Co., Ltd in Japan. and the following results were obtained. 1) 2 to 3 hours of hypothermic perfusion preservation of kidneys preserved for long time by simple cold storage before transplantation were useful to check viability of these kidneys, namely, the kidneys which showed low perfusion flow and high perfusion pressure were not suitable for transplant. 2) It is possible to improve function of cadaver kidneys by graft conditioning during hypothermic perfusion preservation.
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K. SAKASHITA, T. TSUTSUI, H. KAGAMI, A. ITO, C. YAMAZAKI, K. MASUKO
1986 Volume 15 Issue 3 Pages
1323-1326
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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We have studied the relation between blood LAL-RM of hemodialysis patients and dialyzers using Toxicolor Test. LAL-RM of patients who are just entering on maintenance hemodialysis reveal the same value as controls. LAL-RM of A (cuprophan dry type dialyzer) group is of high value after first hemodialysis, keeping high level hereafter. That of C (cellulose acetate or synthetic polymer membrane dialyzer) group does not change and B (cuprophan wet type dialyzer) group is between A and C groups. LAL-RM of three patients is measered in series on first hemodialysis. An elution of LAL-RM from membrane is observed at 15-30 minutes after starting hemodialysis. The LAL-RM in one an hour reaches nearly the same value as that three hours later. In the maintenance hemodialysis, LAL-RM is very high in A group and the same value as cotrols in C group. B group exhibits the midway. After exchange of dialyzer from A group to B or C group, the decrease of LAL-RM up to level of B or C might neccessity about three months. There is no relation between blood LAL-RM and hemodialysis terms in A group.
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S. YAMAGAMI, R. YOSHIMURA, K. SUGIMURA, H. YOSHIWARA, T. KISHIMOTO, M. ...
1986 Volume 15 Issue 3 Pages
1327-1329
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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A Limulus-positive substance has been known to exist in cellulose membrane dialysers, and it has been found to be a β-glucan-like substance and not an endotoxin. A new method, consisting of the C system specific to endotoxins and the G system activated by -glucan, was applied in hemodialysis patients using cellulose membrane dialysers and healthy volunteers by injecting them with the washed solution of cellulose membrane dialysers. As a result, a higher concentration of a β-glucan-like substance was found in the patients using cellulose membrane dialysers. Moreover, the decrease in its serum level was lower. Platelet coagulation and complement activation were unaffected.
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T. SHIMIZU, H. YAMAGUCHI, H. TSUCHIDA, S. MOTOYASU, A. HAKOSHIMA, N. A ...
1986 Volume 15 Issue 3 Pages
1330-1333
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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As a cause of anemia in patient with chronic renal failure, shortened RBC survival is known. RBC deformability that may have a deep concerning of RBC survival rate, reduced compared with normal control group. (p<0.01) In 11 cases of hemodialyzed patients who have no transfusion episode, RBC deformability correlates between blood hemoglobin concentration. (r=0.67 p<0.01)
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With particular respect to the effects of culture periods on lymphocytes from pre-dialysis, 15 minutes after the start of dialysis and at the end of dialysis
T. NAGANO, M. NAKAGIMA, H. SUGIZAKI
1986 Volume 15 Issue 3 Pages
1334-1339
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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In chronic hemodialysis patients, lymphoblastogenesis induced by PHA or Con A was studied in order to relate lymphocyte function to autologous plasma or human AB serum in different culture periods. Lymphocytes were collected obtained before dialysis, and that obtained at the arterial and the venous sides of the dialysis unit 15 minutes after the commercement of dialysis and at the end of dialysis. The highest response was seen both in lymphocytes from pre-dialysis blood and 15 minutes after commercement in three day cultures. The mitogen responsiveness of lymphocytes from blood obtained at the end of dialysis showed a tendency to decline with in days of culture. Addition of AB serum resulted significantly higher and more specific reactions to lymphocytes from blood obtained 15 minutes after dialysis commercement. Moreover lymphocytes from Cuprophan and PMMA membranes revealed differences in transformation capacity.
Autologous plasma as well as homologous serum showed specific response to lymphocytes from blood obtained 15 minutes after commercement of dialysis. Different ability was found between the arterial and the venous sides. Recognition of autologous plasma and homologous serum by lymphocytes from hemodialysis patients seemed fairly distinct.
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T. OKA, K. HANASAWA, T. YOSHIOKA, Y. ENDO, K. MATSUDA, T. TANI, M. KOD ...
1986 Volume 15 Issue 3 Pages
1340-1344
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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Previous studies have indicated that large amounts of anaphylatoxins are produced in blood perfused artificial organs. These anaphylatoxins are reinfused to patients. The reduction of reinfusing anaphylatoxins was attempted by charcoal adsorption and complement inhibitor (FUT). Activated charcoal adsorbed anaphylatoxins in serum and blood. Charcoal hemoperfusion (HP) was combined to clinical hemodialysis (HD). The peak of C3a decreased from 2700ng/ml (HD) to 700ng/ml (HD with HP). Transient neutropenia was suppressed in some HD by charcoal hemoperfusion. FUT was used for inhibiting complement activation in clinical plasmapheresis. The concentration of anaphylatoxins was lower with FUT than with heparin. Neutropenia was not affected with 20-100mg/hr of FUT.
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[in Japanese]
1986 Volume 15 Issue 3 Pages
1345
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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S. TAKESAWA, S. OUMI, Y. KONNO, K. SAKAI, M. SEKIGUCHI, SHIMOKOSHI, T ...
1986 Volume 15 Issue 3 Pages
1346-1349
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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Sterilization strongly affects the permeability of dialysis membranes and their structure. The clearance of hemodialyzer composed of regenerated cellulose membranes with higher porosity is lowered by autoclave compared to the other sterilizations (Gamma-ray and EOG). Gamma ray sterilization under dry conditions greatly decreases the hydraulic permeability of regenerated cellulose membranes with lower porosity less than 50%. However, there exists no difference in the clearance of urea and creati ni ne among the varying sterilizations except that of VB
12. Pore theory calculation reveals membrane shrinking resulted from Gamma-ray sterilization.
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H. OHASHI, R. MIMURA, K. OZAWA, S. TAKESAWA, K. SAKAI
1986 Volume 15 Issue 3 Pages
1350-1353
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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A newly-improved method using radioisotope-labeled urea was employed to determine solute permeability for four tubular membranes before and after treatment. Both solute and hydraulic permeability allow determination of structural changes in membrane pore. The pure water permeability decreases after the treatment with blood for any dialysis membranes tested. The slight decline in the pure water permeability was observed for the regenerated cellulose membranes because of their weak binding capacity to various solutes in blood.
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T. KOBAYASHI, K. TAKAHASHI, T. AKIZAWA, T. KITAOKA, S. KOSHIKAWA, H. K ...
1986 Volume 15 Issue 3 Pages
1354-1357
Published: June 15, 1986
Released on J-STAGE: October 07, 2011
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In order to prevent the suppressive effects of mal-distribution of dialysate on dialysis efficacy, we developed new hollow fiber (HF), outer surface of which had equally distributed six fins. By the use of urea as a model solute, the dialyser composed of HF with fin showed 78% decrease in dialysate side resistance (RD), and 29% increase in overall mass transfer coeffecient (K
A) compared to those of dialyser without fin. The elevation of K
A with the increase in dialysate flow rate was significantly high in the dialyser without fin compared to that with fin. These results indicate that the increase in K
A observed in newly developed HF with fin may be mainly induced by the improvement in the mal-distribution of dialysate, in other words by the increase in the effective membrane surface area.
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