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[in Japanese]
1989 Volume 18 Issue 3 Pages
1071
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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[in Japanese]
1989 Volume 18 Issue 3 Pages
1073-1079
Published: June 15, 1989
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1989 Volume 18 Issue 3 Pages
1080-1083
Published: June 15, 1989
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1989 Volume 18 Issue 3 Pages
1084-1086
Published: June 15, 1989
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Y. INAGAKI, I. AMANO, N. TERAMACHI
1989 Volume 18 Issue 3 Pages
1087-1092
Published: June 15, 1989
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The deficiency of the blood flow was observed in 4 out of 20 hemodialysis (HD) patients using flexible double lumen (FDL) catheter as a temporary blood access. Blood was drawn through venous (V) lumen, and then returned through arterial (A) lumen. It is complicated to change A and V lumen during HD sterilely. So, we designed a new circuit including the cross-tube to change A and V lumen without release of the connection.
A new double lumen (DL) catheter and a exclusive circuit were designed and applied for CVVH. The phenomenon that venous wall was stiked on the pores of the A lumen was decreased in using the DL catheters compaired to the FDL catheters. CVVH was performed for 24 hours using the DL catheter and the exclusive circuit in one case with acute renal failure. Circulation dynamics was almost stable during the CVVH.
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I. AMANO, U. INAGAKI, Y. IWAKI
1989 Volume 18 Issue 3 Pages
1093-1096
Published: June 15, 1989
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In order to prevent from skin-exit infections and tunnel infections of catheters in CAPD or HD, We have developped a new transcutaneous connector made of Alumina Ceramics (AC) which is used as biocompatible implant. For the purpose of evaluating AC implant about biocompatibility and adhesion to soft tissue, we observed macroscopically and microscopically AC implanted transcutaneoysly in dogs for 12 weeks. We recognized no inflamation reaction in soft tissue and down growth phenomenon of skin were observed after 3 months. However, these experiments showed the ability of adhesion to soft tissue with AC implant was not so rich. From these results, we have developped subcutaneous AC disc plate with six shall holes arround AC connector. Now, our satisfactory clinical results in 2 patients can be explained by macroscopical observations.
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N. YOSHIYAMA, Y. CHIDA, T. AKIBA, Y. IINO, F. MARUMO, H. AOKI, Y. SHIN
1989 Volume 18 Issue 3 Pages
1097-1100
Published: June 15, 1989
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To prevent bacterial contamination in CAPD for uremic patients, we tried to use a peritoneal catheter combined with a percutaneous access device (PAD), which was made from dense sintered hydroxyapatite ( HAp). Severe downgrowth of the epidermis was observed only along a conventional silicone catheter without the PAD. Two mongrel dogs could survive more than 10 weeks successfully by conventional CAPD using the PAD. A diabetic uremic patient using the PAD catheter has been enjoying his life by CAPD for more than 17 moths without any infection. These results prove the striking biocompatibility and clinical usefulness of HAp.
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Y. TAKEMOTO, T. MATSUDA, T. KITAMORA, T. KOSHIMOTO, M. MAEKAWA, T. AKU ...
1989 Volume 18 Issue 3 Pages
1101-1106
Published: June 15, 1989
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This paper assesses to develop in vitro hybrid internal and external shunts for patients with difficulties in maintenance of blood access. The essential feature of the model developed here is endothelial cell lined-lumen surface of artificial graft. The artificial basement membrane designed is composed of type I collagen and dermatan sulfate. The designed basement membrane enhances adhesion and growth of bovine endothelial cell and significantly suppresses adhesion and spreading of platelet. The confluency of endothelial cell on the artificial graft overlayered by artificial basement membrane exhibited inherent antiplatelet function imparted by endothelial cells.
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H. HASEGAWA, M. MORIKAWA, T. TSUZUKI, T. FUJISHIRO, M. MIZUNO, T. OGAW ...
1989 Volume 18 Issue 3 Pages
1107-1110
Published: June 15, 1989
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C
1q, C
1s, C
1 INH and C
1r-C
1s-C
1 INH complex were measured during hemodialysis to make clear the difference of complement C
1 activation with 4 kinds of membrane. With every kind of membrane, strong activation of C
1 was observed at the initial contact of blood with membrane. The result showed C
1 activation was stronger with Cuprophan and EVA than with PMMA and Polysulphone. All of these C
1-related factors in the arterial blood were increased at the time of 15 to 30 min. after beginning of hemodialysis. This phenomenon suggests that the biological reaction, a kind of acute phase reaction, was induced by blood membrane contact.
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[in Japanese]
1989 Volume 18 Issue 3 Pages
1111
Published: June 15, 1989
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T. MIYAZAKI, H. NAITOH, H. NAGASAKA, S. TAKASHIMA, T. TAKAGI, H. AKASU ...
1989 Volume 18 Issue 3 Pages
1112-1115
Published: June 15, 1989
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Regarding some dialyzers, proteins deposited on the surface and in the microstructure of their hollow fiber membranes were analyzed with different solvents. The extraction of proteins deposited in the hollow fiber's microstructure could be attained by using a mixed solvent of DMF and DMSO whose saline mixing ratios were different. The deposition of proteins varied with the type of membrane: EVAL membrane had a lot of albumin and a small amount of fibrinogen on its surface; in contrast, on the surface of the cellulosic membrane and PMMA membrane lots of fibrinogen were observed. This suggests that the biocompatibility of EVAL membrane is attributable to the formation of a protein layer, mainly composed of albumin, on the membrane surface, but not to the presence of proteins in the microstructure of the hollow fiber.
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H. NAITOH, T. MIYAZAKI, H. NAGASAKA, S. TAKASHIMA, A. KUBOTSU, T. TAKA ...
1989 Volume 18 Issue 3 Pages
1116-1119
Published: June 15, 1989
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The relationship between the hollow fiber's microstructure and the protein layer formed on the membrane surface was studied by observing the conditions of the membrane before and after use. The membrane materials used were EVAL and PMMA. According to the observation by both electron and light microscopes, the EVAL and PMMA membranes showed similarity in their microstructure but their behaviors of protein deposition were different. In conclusion, this study revealed that EVAL membrane had an excellent biocompatibility and a lot of albumin depostion on the surface, but showed a small amount of fibrinogen deposition.
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H. KOBAYAKAWA, T. SHINZATO, I. TAKAI, Y. FUJITA, H. MPRITA, K. MAEDA
1989 Volume 18 Issue 3 Pages
1120-1123
Published: June 15, 1989
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We undertook a series of 6 treatments with push/pull HDF in 36 long-term dialysis patients complaining of joint pain. An Asahi PAN20CX
2 hemodiafilter was employed. Some 80.60 of the patients experienced a remarkable alleviation of their joint pain. On the other hand, we used 6 hemodialysis treatments for 11 long-term dialysis patients who also voiced similar complaints, but no alleviation resulted. Next, we treated 10 patients by push/pull HDF and HD with a PAN20CX
2 hemodiafilter, determining the removal rates for the follawing molecules; β
2 microglobulin, (M. W. 11800), lysozyme (M. W. 14500), prolactin (M. W. 22000), α
1-microglobulin (M. W. 27000), α
1-acid glycoprotein (M. W. 40000). Results showed that removal rates for these substances were higher in push/pull HDF; and the more evident the difference in the removal rates between push/pull HDF and HD were, the larger the molecular weight was. The phenomenon is attributed to the contribution of the convective transport in push/pull HDF.
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T. TATSUGUCHI, K. SAKAI
1989 Volume 18 Issue 3 Pages
1124-1127
Published: June 15, 1989
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This study elucidates permeability characteristics for beta-2-microgl obulin (abbreviated to BMG) of newly-developed cellul osic and synthetic polymer membranes to determine diffusive clearance for BMG. Dialysis experiments were made with
125I labeled BMG to obtain the solute permeability. The cellulose tri acetate membranes CT-190GA had a high solute permeability for BMG. This demonstrates that BMG can be markedly remove by diffusion alone with highly permeable dialysis membranes. Back filtration has been reported to occur during hemodialysis treatment with high flux dialysis membranes. Since value for myoglobin clearance of cocurrently operated equals that of countercurrently operated, back filtration does not affect mass transport of large molecular weight substances.
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K. YOKOTA, T. KOYANO, K. SAKAI, M. TAMURA
1989 Volume 18 Issue 3 Pages
1128-1131
Published: June 15, 1989
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In membrane distil lation, since its driving force is vapor pressure difference, development of polarization layers leads to the decline of its efficiency. In this experiment, we removed water from ethyleneglycol solution and bovine blood, using the technique of membrane distillation with PTFE membranes, to analyze concentration and temperature polarization. The experiment revealed that the theory of ultrafiltration is effective in obtaining solute concentration at membrane surface, and that the value is dependent on vapor pressure difference and wall shear rate. In a blood-water system, we determined solute concentration at membrane surface. And in an ethyleneglycol solution system, vapor pressure drop of blood was calculated from the relation between permeation resistance and a lowering of vapor pressure.
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[in Japanese]
1989 Volume 18 Issue 3 Pages
1132
Published: June 15, 1989
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K. KUMANO, M. NANBU, M. KOYAMA, S. KUSAKARI, K. YOSHIDA, T. SAKAI, [in ...
1989 Volume 18 Issue 3 Pages
1133-1136
Published: June 15, 1989
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Two types of cupra membrane; one with large pore size (UP) and the other with much larger pore size developed newly (SP), were evaluated for removal capacity of B2M. The mechanism of B2M removal was also studied on these membrane dialyzers. Sieving coefficient on in vitro experiment using minimodule of SP and UP membrane was 0.83 and 0.61 respectively. Solute permeability was 7.5 and 3.0x10
-5cm/sec. Clinical study used 2 types of dialyzers with different surface area in each membrane; 1.0 and 1.5m
2 as SP module and 1.5 and 2.1m
2 as UP. Clearance and removal amount showed larger removal capacity with larger pore size and larger surface area membrane. SP dialyzer(1.5m
2) had a largest clearance and removal amont; 26.5ml/min and 280mg respectively. The contribution of diffusion was much larger than that of convection on the B2M removal with these dialyzer. In conclusion, cupra membrane dialyzer with larger pore size succeeded to remove a sufficient amount of B2M by diffusive mechanism rather than convective one.
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H. MORITA, H. SAKAKIBARA, M. SASAKI, N. KASHIWAGI, Y. MATSUMOTO, A. IN ...
1989 Volume 18 Issue 3 Pages
1137-1140
Published: June 15, 1989
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Changes in pore size of regenerated cellulose fibers were studied by alternating conditions during the membrane formation. The sieving coefficients for β2-microglobulin (β2MG) increased to 0.53 (A) and 0.64 (B) under these conditions. On the other hand, no changes in the ultrafiltration rate (UFR) were found. The overall mass transfer coefficients for these membranes were found to be 11.7 (A)and 18.0 (B) μm/min at QB=200ml/min, QD=500ml/min, and 1.2m
2 surface membrane area.The surface structure of the new regenerated cellulose membrane was analyzed by field emission scanning electron microscopy and image processing system. From this result, it was found that the pore diameter was 103Å.
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J. MINAKUCHI, A. SAITO, H. NAITO, M. HIROHATA
1989 Volume 18 Issue 3 Pages
1141-1144
Published: June 15, 1989
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Clinical evaluation was made on EVAL-D
5 which had thinner wall and smaller diameter compared to present EVAL-D. Hemodialysis using EVAL-D
5 continued for 3 months for those patients with complications of pruritus, bone pain, anemia and so on who were not improved by using dialyzers presently in use. As to 3 cases with pruritus, 2 cases were improved and the rest was not. Among 4 cases with bone pain, a case was completely cured, 2 cases were improved, and the remaining case was not improved. Regarding to 7 cases with anemia, Ht value improvement was observed in every case, and the elevation of its value was significant. On the other hand, the elevation of S-Cr and P value was recognized. However, there was no significant change for value of TP, albumin, and lipid. Moreover, β
2MG value was inclined to decrease, however, the change of value was not significant. Consequently, EVAL-D
5 could be considered as effective high-performance membrane.
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Y. NITADORI, Y. SUMA, H. KOBAYAKAWA, T. SINZATO, K. MAEDA
1989 Volume 18 Issue 3 Pages
1145-1149
Published: June 15, 1989
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The performance and removal mechanism of various low molecular weight proteins by new PAN membrane (PAN CX
2) were studied. In vitro experiments showed that cutoff point was 30, 000 dalton and mean pore radius was 45Å in plasma system. Non-specific adsorption of protein was observed only at the beginning of the perfusion. Major contributing factors for the elimination of low molecular weight proteins were found to be diffusion and filtration except for lysozyme which was removed mainly by adsorption because of its high isoelectric point value. Clearances for low molecular weight proteins calculated from determined SC and Pm values showed clear dependence on molecular weight. Clinical results also showed the similar relationship between the reduction rate and molecular weight for low molecular weight proteins. Push and pull HDF treatment demonstrated better reduction rate than HD method.
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H. IWAMOTO, M. SHIMIZU
1989 Volume 18 Issue 3 Pages
1150-1153
Published: June 15, 1989
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To evaluate the mechanism of protein elimination with highly permeable membranes, we performed three modes of one hour dialysis, hemodialysis (HD) without ultrafiltrate, HD with 1L ultrafiltrate and 1L ultrafiltration only, on one patient using a KF201-15C dialyzer. All dialysis and ultrafiltration fluid were collected, and the removed amount of β
2-MG and albumin were measured. In HD without ultrafiltrate, backfiltration within dialyzer occured andthe removed ratio of β
2-MG was 59% by convection and 41% bydiffusion. In HD with 1L ultrafiltrate, the removed ratio of β
2-MG were 75% by convection and 25% by diffusion. Albumin was removed only by convection. In conclusion, convective transfer is a major contributing factor for the removal of β
2-MG and albumin in HD with highly permeable membranes.
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[in Japanese]
1989 Volume 18 Issue 3 Pages
1154
Published: June 15, 1989
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T. YOKOYAMA, H. WATANABE, N. YAMAWAKI, S. MIYATA, R. KODAIRA, K. TOMA, ...
1989 Volume 18 Issue 3 Pages
1155-1158
Published: June 15, 1989
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To search for macromolecular ligands strongly interacting with β
2-microglobulin (β
2-MG) we drew 3-dimentional structure of human β
2-MG by computer graphics (C. G) and evaluated macromolecular ligands presumed from the results by C. G with a newly developed EIA plate method. In result, C. G demonstrated three regions on the molecular surface of β
2-MG, the first rich in hydrophobic amino acid residues, the second rich in hydrophobic and basic amino acid residues, and the third rich in acidic ones. Methylated atelocollagen and stylene-maleic acid copolymer were selected by the EIA method. The molecular structure of these ligands was showed to complement well with thesurface structure of β
2-MG drawn by C. G. The results indicate that the EIA plate method may be of use as an easy method of searching for macromolecular ligands and that an adsorbent for removing β
2-MG in a very high efficiency can be made by conjugating selected ligands on porous particles.
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H. WATANABE, T. YOKOYAMA, N. YAMAWAKI, S. MIYATA, R. KODAIRA, T. AKIZA ...
1989 Volume 18 Issue 3 Pages
1159-1162
Published: June 15, 1989
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We attempted the developmont of a β
2-microglobulin (β
2-MG) adsorbent which was conjugatod with polystyrone-maleic acid (PSt-MA) on polymethylmothacrylate-divinylbenzene (PMMA-DVB) porous particles oncapsulated in 2-hydroxyethyl methacrylate-diethylaminoethyl mothaorylate random copolymer (pHEMA-DE).
In rosult, evaluation in vitro showed an adsorption efficiency of 750mg β
2-MG/300ml adsorbent. Tee adsorbent consisting of PMMA-DVB porous particles encapsulated in pHEMA-DE which was activated by epichiorohydrin, introduced with amino octylamine as a spacer and then conjugated with PSt-MA 3.5mg/ml adsorbent. Moreover, the rate of platelet passage through minicolumn con taining the adsorbont was 85%, and that of activatod charcoal beads coated with PHEMA (Kuraray Co., Ltd., Osaka, Japan was 55%. The results indicate that the adsor bent may be of use in eliminating accumulatod β
2-MG doposits in long-term hemodialytic patients with a high efficiency by diroct homoperfusion.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1989 Volume 18 Issue 3 Pages
1163-1165
Published: June 15, 1989
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We devised a single-pool β
2-m kinetic model consisting of extracellular space having a constant rate of β
2-m generation rate and a rate of β
2-m elimination varying proportion to the plasma β
2-m concentration (intrinsic clearance×plasma concentration). By analyzing the rebound pattern of plasma β
2-m concentration according to the model, we determined the β
2-m generation rate and the β
2-m intrinsic clearance. The results showed that the generation rate was virtually the same for all patients and that the higher the patients' plasam β
2-m concentration was, the lower was the intrinsic clearance, indicating that the key factor in determining the variation of the plasma β
2-m concentration is not the generation rate but the intrinsic clearance.
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T. NIWA, K. MAEDA
1989 Volume 18 Issue 3 Pages
1166-1168
Published: June 15, 1989
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Since protein-bound compounds accumulated in uremic serum could not be effectively removed from blood by conventional hemodialysis, we studied on the removal of the compounds by adsorption in vitro. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid, the albumin binding of which was 98-100%, could not be removed by charged resins nor by activated charcoal. However, indoxyl sulfate, the albumin binding of which was around 90%, was removed completely by cationic and activated charcoal, and comparatively well by Amberlite XAD-7. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid as a free form in water could be removed by cationic resins. In conclusion, albumin-bound indoxyl sulfate could be removed by cationic resins and by activated charcoal, but albumin-bound 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid could not be removed by any resins.
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[in Japanese]
1989 Volume 18 Issue 3 Pages
1169
Published: June 15, 1989
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-THE EFFECT ON BIOCOMPATIBILITY-
K. KINO, N. MAEDA, E. KINUGASA, T. AKIZAWA, T. KITAOKA, S. KOSHIKAWA, ...
1989 Volume 18 Issue 3 Pages
1170-1174
Published: June 15, 1989
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The effect of newly developed surface modification of cellulose hemodialysis membrane (new modified cellulose: New MC) was evaluated by in vitro and clinical studies. The modification was performed to suppress the blood-membrane interaction (BMI) by grafting polyethylene glycol (PEG) upon original cellulose membrane (OC). It is expected that, on the surface of New MC, PEG chain moves randomly and it prevents the contact between blood components and membrane surface, resulting in suppressing BMI. Although membrane characteristics including contact angle and protein adsorption to the membrane, and dialysis efficiency did not change by the modification, complement consumption ratio was remarkably reduced in New MC. In clinical examinations, significant suppressions were observed in dialysis induced complement activation, hemodialysis leukocytopenia and thrombocytopenia, and production of platelet releasing factors. These results indicate that the modification considerably suppressed membrane induced complement and platelet activation, preserving the native membrane characteristics and dialysis efficiency of OC.
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T. HAYASAKA, K. SHOJI, Y. SAKAI, T. SANAKA, K. KUBO, K. ERA, E. ARUGA, ...
1989 Volume 18 Issue 3 Pages
1175-1178
Published: June 15, 1989
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The adsorbability of leukocytes, washing substances from normal and uremic patients to ion exchange were tested by HPLC. The leukocytes and washing substances from HD patients were shown high adsorbability to cation exchange.
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Y. TAKEMOTO, T. MATSUDA, T. KISHIMOTO, M. MAEKAWA, T. AKUTSU
1989 Volume 18 Issue 3 Pages
1179-1184
Published: June 15, 1989
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The enhanced platelet adhesion on adhesive protein-coated surfaces was reduced by the addition of synthetic tetrapeptide, RGDS (Arg-Gly-Asp-Ser), which was identified as a common amino acid sequence of adhesive site of adhesive proteins. This was same as WBC in complement-inactivated serum. No significant effect was observed for WBC in complement-actvated. These indicate that RGDS ligand-receptor mechanism operates on adhesive protein-adsorbed surfaces for both cellular systems and that complement factor (C3b)-membrane receptor (CR3) interaction operates for WBC as complement is activated.
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Y. TAKEMOTO, T. MATSUDA, E. OZEKI, T. KISHIMOTO, M. MAEKAWA, T. AKUTSU
1989 Volume 18 Issue 3 Pages
1185-1190
Published: June 15, 1989
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The principle of novel method measuring intracellular calcium mobilization of platelets is based on the difference in intensities between calcium-binding and calcium-free states of intracellularly-loaded fluorescent calcium indicator, Fura-2. The loaded platelets were passed through the minicolumn prepared from fibers of the commercially-available artificial dialyzers. This novel method developed can give us the information on the signal transduction derived from platelet/material interaction. The biocompatibility evaluated by this method is as follwes; EVAL>Cellulose>Cellulose Acetate=Polyacrylonitrile.
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Y. FUJITA, O. INAGAKI, Y. TAKENAKA, H. NAGASAKA, T. HIRABAYASHI, H. MO ...
1989 Volume 18 Issue 3 Pages
1191-1194
Published: June 15, 1989
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The three different sterilizations (EOG, Autoclave and γ-Ray) for hemophan membrane were studied in eight patients on maintenance hemodialysis. In the changes of white blood cells, platelets, platelet factor-4, β-thromboglobuhn and activated coagulation time during the hemodialysis, there were no significant differences in the three sterilizations. In autoclave dialyser, changes of C
3a and factor XII were slightly greater than in other sterilizations. Ultra filtration rate was decreased in γ-ray sterilization. No differences were seen in clearance of small molecules in the three sterilizations. The results show that autoclave and γ-ray steri-lization make some influence on membrane structure of hemophan.
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[in Japanese]
1989 Volume 18 Issue 3 Pages
1195
Published: June 15, 1989
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I. TAKAI, Y. FUJITA, T. SINZATO, H. KOBAYAKAWA, H. MORITA, K. MAEDA
1989 Volume 18 Issue 3 Pages
1196-1199
Published: June 15, 1989
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Using a continuous hematocrit measuring system and a Swan-Ganz catheter, we investigated the change in the circulating blood volume as well as the change in the hemodynamic parameters before, during and after dialysis-induced hypotension. When the dialysis-induced hypotension occured, the cardiac output dropped sharply, and there were concomitant sudden decrease in the mean pulmonary artery pressure as well as the right atrial pressure. These are attributed to a decrease in the venous return. And since there was no recognizable change in the blood volume when the blood pressure sharply fell, the decrease in the venous return is considered to be caused by a change in blood distribution, possibly associated with a sudden increase in the venous pool.
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Y. FUJITA, I. TAKAI, T. SHINZATO, H. KOBAYAKAWA, H. MORITA, K. MAEDA
1989 Volume 18 Issue 3 Pages
1200-1202
Published: June 15, 1989
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We administered L-carnitine to long-term dialysis patients showing dialysis-inducedhypotension frequently, and its effectiveness was investigated. L-carnitine was given at a daily dose of 1200mg for 12 weeks to 18 long-term dialysis patients having more than 4 occurrences of dialysis-induced hypotension in a 4-week period. We measured pre-dialysis-systolic pressure, diastolic pressure, plasma L-carnitine concentration, body weight and CI at the start of L-carnitine administration, and 4, 8 and 12 months into treatment. Then we measured the frequency of dialysis-induced hypotension at 4-week intervals. The plasma L-carnitine concentration evidenced a marked increase after over 4 weeks of L-carnitine treatment, and the frequency of dialysis-induced hypotension significantly decreased. No change in body weight or CTR was evident during the drug regimen. From the foregoing, we considered that L-carnitine treatment reduces the frequency of dialysis-induced hypotension.
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N. KANAMORI, K. IIZUKA, E. KINUGASA, T. SEKIGUCHI, T. AKIZAWA, T. KITA ...
1989 Volume 18 Issue 3 Pages
1203-1206
Published: June 15, 1989
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In order to clarify the effects of low molecular weight heparin (LH) as an anticoagulant for hemodialysis (HD), we compared the characteristics of LH with those of ordinary heparin (OH) in patients under regular HD. Under the similar plasma anti-Xa concentration, a greater prolongation of APTT and CCT was observed in OH than that in LH. When the same anti-Xa unit of LH or OH was administered, plasma anti-Xa activity was higher in LH than that in OH. Minimum requirement dose for HD of LH was less than that of OH. A significant correlation was observed between Xa coagulation time, which was newly developed for bed side monitoring of LH activity, and plasma anti-Xa activity. HD could be performed only a bolus injection of LH without coagulation episode in extracorporeal circuit. These results incidate that LH has several preferable characteristics to OH, and LH may be useful as an anticoagulant for HD.
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K. SAKASHITA, T. TSUTSUI, N. YAMAMOTO, A. ITO, C. YAMAZAKI, K. MASUKO, ...
1989 Volume 18 Issue 3 Pages
1207-1210
Published: June 15, 1989
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The r-HuEPO is very effective for anemia of the hemodialysis patients and is able to elevate the hematocrit over 30%. We studyed whether the rise of hematocrit affected to the hemodialysis efficiency or not. The dialyzer clearances caluculated from dialysate side demonstrated that the rise of hematocri t significantly lowered the clearances of Cr, UA and P, and slightly of urea. On the amounts of removal solute during hemodialysis measured before and after the rise of hematocrit, there was significant decrease in P only. In spite of the increase of hematocrit (average 11.3%), there were no differences in the removal rates of UN, Cr, UA and P. Predialysis levels of UN, Na, K and Ca did not change significantly during observation terms but the levels of Cr, UA and P showed transient elevation in various periods. Platelet counts increased significantly, but no change was recognized in the coagulation test after starting r-HuEPO replacement therapy. Coagula in dialyzer and blood tube observed at five of the 39 patients administered r-HuEPO, but this problem was solved by increase of heparin dose. Platelet aggregation test and serum platelet-specific proteins showed no difference between r-HuEPO dosed group and non dosed group.
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T. TAKAGI, K. SAKURAI, H. OGAWA, A. SAITO
1989 Volume 18 Issue 3 Pages
1211-1214
Published: June 15, 1989
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The on-line Salt-Amino acid Coprecipitation (SAC) Plasmapheresis was applied for a patient on hemodialysis with malignant rheumatoid arthritis (MRA) who was anatomic stage IV and functional class 4. A SAC method for 2 hours, followed by a hemodialysis for 4 hours was carried out in a day. Another two times of regular dislysis a week were ordinarily performed. There was no significant differences of plasma electrolytes, Na, K, Ca, Cl, and Mg, in a SAC followed by hemodialysis and those in only dialysis. The reduction rate of BUN, creatinine, and uric acid at the former therapy was slightly superior to a hemodiafiltration. The on-line SAC followed by hemodialysis provided safe and effective for a hemodialysis patient with MRA, and no problems was occurred during the therapy.
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[in Japanese]
1989 Volume 18 Issue 3 Pages
1215
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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O. INAGAKI, T. SHONO, Y. TAKENAKA, H. NAGASAKA, T. HIRABAYASI, H. MORI ...
1989 Volume 18 Issue 3 Pages
1216-1219
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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Plasma calcium (Ca) changes during hemodialysis with three different Ca concentration of dialysate studied in 43 patients with chronic renal failure. Equilibrium state of plasma Ca between pre and post-dialysis was calculated by the correlation between the pre-dialysis value of plasma Ca and the changes of plasma Ca during the dialysis. In the three different Ca concentration of dialysate, 3.5, 3.0 and 2.5mEq/l, equilibrium values of plasma Ca were 5.15±0.33, 4.93±0.32, 4.33±0.28mEq/l. Therefore equilibrium values of plasma Ca were different with different Ca concentration of dialysate. The correction of the eqilibrium values of plasma Ca was possible by the correction of plasma Ca changes during the dialysis with blood pH, plasma albumin, dialysis time, blood flow rate and the performance of dialyser. In conclusion, corrected equilibrium value of plasma Ca in each Ca concentration of dialysate is useful for considering with the oputimum concentration of dialysate Ca.
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F. NAKAYAMA, H. OKUYAMA, M. OOTOMO, H. KOJIMA, E. KINUGASA, T. SEKIGUC ...
1989 Volume 18 Issue 3 Pages
1220-1224
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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In order to determine the adequate Ca concentration of dialysate (Dca) for the hemodialysis (HD) patient administrated Ca-carbonate (CC) as a phosphate (P) binder, a crossover open trial of 5 kinds of dialysate was performed on 5 regular HD subjects.
Major compositions of test dialysates were as follows: Ca 3.5, HCO
3 30mEq/l (commercially available, for control); Ca 2.0, HCO
3 30; Ca 2.0, HCO
3 25; Ca 2.5, HCO
3 30; Ca 2.5, HCO
3 25mEq/l.
Negative balance of Ca was observed only in HD with 2.0mEq/l of Dca, and the deterioration of dialysis disequilibrium syndrome was noted in a few case, in whom serum Ca was maintained within lower normal limit. No other adverse reactions occurred throughout the test period. The dose of CC and active vitamine D metabolyte (D) could be increased to the adequate level to control P, Ca and PTH, and in several cases, serum 1.25-(0H)
2-D
3 concentration was elevated to the normal range. These results indicate that low Dca is useful for HD patients to maintain the adequate Ca, p metabolism and to prevent the renal osteodystrophy.
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N. MATSUI, K. GOTO, N. UENO
1989 Volume 18 Issue 3 Pages
1225-1227
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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Ca-free hemodialysis was clinically evaluated as an anticoagulation technique. Five hundreds and sixtythree Ca-free dialyses were performed on 46 patients. Most patients were on bleeding tendency. No aggravation of bleeding were observed. Massive dialyzer clotting were observed three times. Infusion troubles of sodium citrate solution or CaCl
2 solution were obscrved 12 times. But no serious symptomes were developed because Ca ion was checked an hour after the start of every Ca-free dialysis. The adverse effect of citrate loading such as a hypercalcemia or over alkalinization were not observed even 4 hours after the end of dialysis when citrate level in the blood was returned to the starting level. We conclude that in spite of its complicated technique Ca-free hemodialysis is a very excellent regional anticoagulation technique for patients on high risk bleeding tendency.
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Y. SANKAI, M. OHTA
1989 Volume 18 Issue 3 Pages
1228-1231
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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We have developed a new method which estimates initial blood volume during hemopurification treatment based on observer system including a hemoglobinometer (Hb meter) and a body fluid model. In this Hb meter, a pair of optical devices is set to the extracoporeal blood circuit tube, which measures an incident light at photodiode through the blood. The body fluid model adoped here consists from simplified three compartments. This estimation method is a new method which can identify the initial blood volume only by measuring the incident light through the blood without blood sampling. By using this method, the blood volume change can be observed as not only the relative volume but the absolute volume.
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T. AKIBA, T. SHIBAMOTO, T. YAMADA, K. GOTO, Y. IINO, [in Japanese], F. ...
1989 Volume 18 Issue 3 Pages
1232-1235
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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Dialyzer and renal clearance for dextran was measured by high performance liquid chromatography (TSK G 3000 SW). Molecular weight-clearance curves of so-called high performance dialyzers definitely showed enhanced efficiency in eliminating high molecular weight substances comparing with that of Cuprophane dialyzer. This method was useful in characterizing differences between high performance dialyzers.
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[in Japanese]
1989 Volume 18 Issue 3 Pages
1236
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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M. UMEDA, K. UMIMOTO, K. TSURUSAKI, N. IZUMI, M. MZEKAWA, T. ISHIGAMI
1989 Volume 18 Issue 3 Pages
1237-1239
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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To investigate the effect of desferrioxamine (DFO) on red blood cell, serum Al(s-Al), red blood cell Al (RBC-Al) and blood hemoglobin(Hb) levels were measured periodically for 4 months after the administration of DFO for 4 months in 16 patients treated by hemodialysis (HD). The s-Al levels increased by 2 days after the administration of DFO and then decreased by day 7 to almost base line levels, but no significant changes were noticed in the RBC-Al levels until 1 month post infusion. Hb levels increased at 1 month postinfusion. Our data suggested that DFO did not seem to transfer Al into RBC or to remove the Al that had accumulated in these cells.
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K. SHISHIDO, H. AMEMIYA, T. KOBAYASHI, Y. NAKAJIMA, A. YOSHIMURA, M. S ...
1989 Volume 18 Issue 3 Pages
1240-1243
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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Recently, Shaldon, et al. have postulated the hypothesis that the increase in plasma β
2-microglobulin (β
2-M) during hemodialysis (HD) with cuprophan membrane was due to β
2-M shedding from lymphocytes induced by the reduction in plasma osmolality (Posm). To examine this hypothesis, three different HD methods were performed in 17 patients on stable regular HD: HD
1 with ordinary dialysate, HD
2 with high sodium dialysate, and HD
3; sham HD. Blood samples were collected at a half hourly intervals during HD, and Posm, plasma concentration of various low molecular weight proteins, and hematocrit were measured. Although Posm was significantly decreased during HD
1 and was constant during HD
2, plasma β
2-M increased significantly during both HD
1 and HD
2. During HD
3, Posm and β
2-M remained constant. Significant correlations were observed among the changes in Posm, β
2-M, and myoglobin concentration. These results suggest that neither β
2-M shedding from lymphocytes nor the biocompatibility of the membrane materials of dialyzer contributes to the increase in plasma β
2-M during HD, and rather the redistribution of β
2-M from the extra- to intra-vascular pools may be a major contributing factor with an uncertain participation of changes in Posm. In contrast with β
2-M, plasma concentration of retinol binding protein, α
1-acid glycoprotein, and α
1-antitrypsin did not increase significantly. This may be resulted from the lower permeability of these proteins through vascular membrane barrier than that of β
2-M or myoglobin.
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M. UEDA, M. DEGUCHI, S. TAKEMURA, Y. KASAMATSU, K. YANAGIDA, Y. FUKUDA ...
1989 Volume 18 Issue 3 Pages
1244-1247
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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The kinetics of hemodialysis-induced leukopenia and generation of complement fragments including C3a, C5a, C4d, iC3b and Bb were investigated during hemodialysis in 13 patients using cellulose acetate (CA), cuprophan (Cu) and ethylenevinyl alcohol (EVA) membranes. A marked leukopenia with significant plasma C3a and C5a generation in the first 15 minutes were observed in CA and Cu, whereas less in EVA. Plasma iC3b levels was higher in Cu than in CA and EVA. Plasma Bb levels in the first 15 minutes increased significantly in all membranes, and furthermore continued to increase till the end of hemodialysis in CA and Cu. These data suggested that those dialysis membranes activated the complement alternative pathway and that Bb was accumulated during hemodialysis in CA and Cu.
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H. MORITA, T. SHINZATO, I. TAKAI, H. KOBAYAKAWA, Y. FUJITA, K. MAEDA
1989 Volume 18 Issue 3 Pages
1248-1251
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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In our experience, 4.0% of the patients with chronic renal fuilure on haemodialysis were complicated by malignancy, and in some cases, chemotherapy was indicated. However, available data concerning the administrative protochol of antineoplastic agents to these patients seem limited at present. This time we paid attention to UFT and conducted some preliminary experiments on pharmacokinetics and dialyzability of this antineoplastic agent. The results suggest that, in spite of the possible binding to albumin, this agent can be removed almost exclusively from the plasma when 5 hour haemodialysis is completed provided that an appropriate dialyzer, QB, QD etc were chosen.
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T. FUJISHIRO, M. MORIKAWA, H. YAMASHITA, T. TSUZUKI, H. HASEGAWA, M. M ...
1989 Volume 18 Issue 3 Pages
1252-1255
Published: June 15, 1989
Released on J-STAGE: October 07, 2011
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The measurement of myoglobin (Mb), CPK and guanidino compounds in the serum of 98 patients with chronic renal failure, half of them were treated with hemodialysis, was carried out to investigate the influence of guanidino compounds on muscle metabolism. The result showed that there was significant correlationship between Mb and CPK, and less apparent correlationship between Mb and creatinine. However, any relationship was not found between Mb and β
2-MG, and also between Mb and methylguanidine. The serum Mb concentration decreased after PPHDF, was increased again with time until next PPHDF. Moreover, the level of serum Mb elevated gradually with long term treatment of PPHDF. This phenomena suggested that muscle metabolism might be affected by PPHDF, which induced hypoalbuminemia.
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