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[in Japanese]
1993 Volume 22 Issue 1 Pages
1-2
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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S. OHIRA, M. NAGAYAMA, K. IWAYAMA, T. HANAI, Y. ENOKIMOTO, Y. NITADORI
1993 Volume 22 Issue 1 Pages
3-7
Published: February 15, 1993
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The PAN-15SF(surface area, 1.5m
2), a modified virsion of the PAN-17DX incorporating spacer filaments between its hollow fibers to increase dialysate flow uniformity and thus improve dialyser performance, was clinically evaluated in comparison with the widely used PAN-17DX (1.7m
2), FB-150U (1.5m
2), and F-80 (1.9m
2). The PAN-15SF showed about the same clearance and removal rates for substances of low molecular weight as the PAN-17DX and the F-80, despite its smaller surface area, and significantly higher β
2-microglobulin clearance than the FB-150U of equal surface area. Its overall mass transfer coefficient was significantly higher than that of the PAN-17DX for BUN, and high for other solutes. The results show that the performance of the PAN-15SF equals or exceeds that of the other dialysers, thus clinicaly confirming the improvement of dialyser performance by the incorporation of spacer filaments.
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K SAKASHITA, T TUTUI, A ITO, C YAMAZAKI, K MASUKO
1993 Volume 22 Issue 1 Pages
8-13
Published: February 15, 1993
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The anticoagulative actvity of newly developed polyethylene glycol grafted cellulose membrane (AM-PC) was compared with that of conventional cuprammonium rayon membrane (AM-SD). The minimum requirement dose of heparin with AM-PC was significantly less than that of with AM-SD by 29±10%. The change in the levels of fibrinopeptaid A (FPA). Thrombin antithrombiniIr complex (TAT), β-thromboglobulin (β-TG) and platelet factor-4 (PF-4) during dialysis session was compared between two types of dialysis membrane under the minimum dosage of heparin. The levels of these parameters were increased significantly in both type of membrane after dialysis compared to those of pre-dialysis except PF-4. The change of these parameters was also compared as the ratio of outlet-values per inlet ones. It revealed the significant increase of β-TG was found at 5 minutes following initiation of dialysis and that of FPA, TAT and PF-4 were found at 240 minutes in AM-SD treated group. The increase of FPA, TAT and PF-4 was found at 240 minutes in AM-PC treated group, however, the differences in the rate of outlet per inlet were no significant between two types of membrane. The levels of 6-keto-prostaglandin F1α and 11-dehydro thromboxane B2 were determined under the condition as usual dose of heparin usage. The former showed significant increas in both membranes, however, the latter showed significant increase only in AM-SD. These results demonstrated that the dose of heparin could be reduced by use at AM-PC and suggested that this effect might be derived by less stimulative effect of AM-PC on thrombocyte.
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A. SAITO, K. HORI, E. NAGAMI, H. YAMAZAKI, H. ICHIKAWA, T. KAWASAKI, S ...
1993 Volume 22 Issue 1 Pages
14-17
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Serum calcium concentration (T-Ca), serum ionized Ca (Ca++) and calcium balance were measured in 14 patients on maintenance hemodialysis, using the dialysate with calcium comcentration of 3.5mEq/l (3.5 dialysate), 3.0mEq/l (3.0 dialysate) and 2.5mEq/l (2.5 dialysate), T-Ca and Ca
++ showed a significant increase at the end point of hemodialysis compared with the starting point, when 3.5 dialysate and 3.0 dialysate were used. When 2.5 dialysate was used, T-Ca showed no change, where as Ca
++ was decreased significantly. Ca balance showed negative with any kind of dialysate tested. From these results, 2.5 dialysate can be regarded as most desiarable to be used for the patients who have the posibility of hypercalcemia with the simultaneous administration of active VD
3 and calcium carbonate (CaCO
3). As Ca
++ at the beginning and Ca balance showed significant correlation in each Ca concentration of dialysate and as the concentration difference after subtracting Ca
++ or T-Ca value at the starting point from the actually measured Ca concentration of dialysate (C
Di) significant correlation with Ca balance of all the cases, C
Di, Ca and Ca
++ measured at the starting point can suggest the Ca balance and therefore can be useful indexes when we consider with the dose of VD
3 or CaCO
3 and the optimum Ca concentration of dialysate.
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Y. SANKAI, M. OHTA, T. SANKAI
1993 Volume 22 Issue 1 Pages
18-23
Published: February 15, 1993
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We have proposed an object oriented virtual physiology system of human and a model-based therapeutic control system. The virtual physiology system is described by objective-C which has the relations of the inheritance among classes and subclasses. Therefore, it is easy to modify the model. It is enough to modify only the target subclass. This kind of architecture of the virtual physiology enables a cooperative works. Furthermore, to realize more effective and safety treatment, the model-based therapeutic control system is configured by use of the virtual physiology system. Especially, the approach for the therapeutic control system of hemopurification is mentioned as an example. The optical sensors are used as the non-invasive measurement of blood volume and hemoglobin oxidization. The shunt blood pressure sensor is used as the mean brachial blood pressure. The virtual physiology system is used as the compensator of these sensors, the therapeutic program checker (simulator) and the parameter identifier.
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Takamasa TAKEUCHI, Yasuharu IMAI, Kazuo SAWATARI, Kazuaki ISIHARA, Syu ...
1993 Volume 22 Issue 1 Pages
24-26
Published: February 15, 1993
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A new percutaneously adjustable vessel occluder was developed and successfully applied in 4 patients:three neonates (whose body weight were less than 3kgs) with hypoplastic left heart syndrome (HLHS), and one patient with double outlet right ventricle (DORV) with hypoplastic right ventricle. In the Norwood procedure for HLHS, the occluder was applied around a EPTFE tube employed for systemic-pulmonary shunt to manipulate the pulmonary blood flow volume. It was readjusted on occations during acute postoperative pitied after cardiopulmonary bypass according to changes in pulmonary vascular resistance as the influence of post-perfusion lung. One out of three patients survived the acute postoperative period. In the modified Fontan procedure for DORV, the occluder was placed around the anastomosis between right and left appendages to manipulate the degree of right-to-left shunt for the increment of systemic flow maintaining an acceptable PaO2 level. We conclude that the manipulation of pulmonary or systemic circulation in acute postoperative period can be satisfactorily achieved with this ingenious adjustable vessel occluder, especially in patients who undergo Norwood procedure or fenestrated Fontan procedure.
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N. TOMITA, Y. IKADA
1993 Volume 22 Issue 1 Pages
27-29
Published: February 15, 1993
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Some percutaneous devices are currently in clinical use such as bone-anchored hearing aid and CAPD catheter, but stronger connection between percutaneous device and skin is required for skeletal extension. We tried a new approach by in-situ skin treatments; 1)intracutaneous injection of glutaraldehyde, 2)ethanol treatment, and 3)freezing with liquid nitrogen. Percutaneous devices made of stainless steel were fixed to the treated skin by mechanical clamping. Neither epidermal down-growth nor exfoliation was seen at the interface for the glutaraldehyde-treated skin. Slow epithelization was seen in the treated tissue.
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Hisao SAITOH, Takashi AKIBA, Toshio KOYAMA, Kaoru ABE, Masanobu HOSHIN ...
1993 Volume 22 Issue 1 Pages
30-33
Published: February 15, 1993
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We tried to confirm whether the use of low-calcium dialysate may increase the dose of 1 alpha- hydroxyvitamin D3 (D) and consequently suppress parathyroid hormone secretion in hemodialysis (HD) patients (Pts) with secondary hyperparathyroidism (HP).
Randomized cross-over study was done in eight stable HD Pts with HP. Solubility of granulated dry-chemical dialysate, containing low-calcium (AKDD25, 2.5mEq/l) or conventional calcium (AKDD30, 3.0mEq/l), were checked by measuring their conductivity. They completely dissolved in 6min, which is comparable with conventional powder dry-chemical dialysate. Pts were dialyzed with AKDD25 and AKDD30 for twelve weeks each. Serum PTH levels significantly decreased during HD with AKDD25 comparing with AKDD30. The serum calcium concentrations were maintained within normal range. The dosage of 1, 25-dihydroxyvitamin D3 was significantly increased during AKDD25 comparing with AKDD30. Low-calcium dialysate facilitates sufficient supplement of vitamin D3, and is further effective to suppress PTH oversecretion in maintenance HD patients.
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N. ENDO, M. ABE, I. NAKAGAWA, M. FURUKAWA, F. NAKAMURA, S. HOSINA, Y. ...
1993 Volume 22 Issue 1 Pages
34-38
Published: February 15, 1993
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Because 7.5-10mEq/l of acetate is indispensable for BCHD fluid, the loading of acetate during BCHD is inevitable. In AFBF, neither dialysis fluid nor substitution fluid contain acetate at all. From acetate toxicity aspect, we are interested in such a little difference. Plasma acetate levels and circuratory stabilities in BCHD Were compared with those in AFBF among the 10 clinically stable patients on chronic BCHD. In both 18 sessions, dialyzers, QB, QD, and body weight changes were maintained unchanged. Plasma acetate increased significantly from 0.62 to 1.06mEq/l (p<0.01) in BCHD, while it did not change from 0.56 to 0.55mEq/l in AFBF.7 hypotension episodes needed total 1350ml of saline infusion and 890ml of hypertonic glycerol solution (HGS) in BCHD. While, 5 episodes needed 550ml saline and 490ml HGS in AFBF. But unfortunately, we could not find the significant difference in hypotension episodes appearance lates in the present study. In conclusions, AFBF could possibly decrease the hypotension episodes, depending on the tiny differences of plasma acetate levels. Further study should be requested in this field.
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T. NISHIYAMA, Y. UEZU, H. OKUYAMA, T. KOBAYASHI, T. AKIZAWA, S. KOSHIK ...
1993 Volume 22 Issue 1 Pages
39-42
Published: February 15, 1993
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In order to clarify the clinical characteristics of acetate free biofiltration (AFBF), therapeutic procedures of 6 uremic patients on bicarbonate hemodialysis (BCHD) were changed to biofiltration with acetate containing dialysate (BF) and then to AFBF for 6 months, respectively. Similar kind of high performance membrane dialyzer was used throughout study period, and blood flow rate and therapeutic duration were determined to keep an urea index to be constant. Although maintenance levels of small molecules and electrolytes did not differ among BCHD, BF and AFBF, β
2-microglobulin (β
2 M) was lower in BF and AFBF than that in BCHD. Further, AFBF resulted in smaller β
2M value than BF. HCO
3 levels both before and immediately after the therapy, were greater in BF and AFBF than those in BCHD. Frequency and severity of dialysis disequlibrium symptoms (DDS) and the intensity of the treatment for DDS were minimum in AFBF. These results indicate that AFBF exerts safe and less symptomatic therapy and it may suppress β
2M maintenance levels.
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H. NISHIBORI, K. ITOH, T. OHDAN, H. AMEMIYA, T. KOBAYASHI, T. AKIZAWA, ...
1993 Volume 22 Issue 1 Pages
43-46
Published: February 15, 1993
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Clinical effects of a new dialyzer, of which membrane pore size was enlarged from 70Å (FB-U) to 75Å (FB-F) were compared in 6 maintenance hemodialysis (HD) patients in crossover manner. There was no significant differennce in clearance (CL) of small molecular substances, such as urea, creatinine and uric acid. However, CL of β
2M and myoglobin (MG) was significantly greater in FB-F than FB-U. Comparing to FB-U, significant increases in sieving coefficient (SC) of β
2M were observed in FB-F at 30min and at the end of HD, but the SC of larger molecules than that of MG was not different between two dialyzers. Removal rates of both β
2M and MG were significantly higher in FB-F than in FB-U. There were no significant changes in circulating leucocytes and platelets levels, C3a and C5a, and glanulocyte elastase between two membranes. From these results, it is concluded that FB-F is useful dialyzer in clinical use with higher elimination rates of low molecular weight proteins and excellent biocompatibility than FB-U.
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M. FUKUDA, T. KANAMORI, K. SAKAI
1993 Volume 22 Issue 1 Pages
47-52
Published: February 15, 1993
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Complement activation is reduced by grafting polyethylene glycol (PEG) on the surface of conventional regenerated cellulose (RC) membranes. However, the solute permeability of PEG-grafted RC membranes may be lower than that of conventional RC membranes because of the presence of swollen-layers formed with PEG chains on the PEG-grafted RC membranes. The objective of the present study is to clarify the difference in membrane structure between conventional RC (AM-SD) and PEG-grafted RC (AM-PC) membranes, and to characterize three PEG-grafted cellulosic membranes (AM-PC(l), PC(m), PC(s)) with varying PEG chain lengths based on the tortuous capillary pore model using data on tritium-labeled water (HTO) permeability and filtration coefficient.
The pore radius and surface porosity of the AM-SD, PC (m) and PC (s) membranes were calculated to be 2.8nm and 35%, respectively. On the other hand, the pore radius and surface porosity of the PC(l) membrane grafted with the longest PEG chains were lower than those of the conventional RC membrane (SD). This indicates that the pores of the PC (l) membrane are partially covered with the PEG chains.
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Y. SUZUKI, K. KOKUBO, K. HAGIWARA, T. KANAMORI, K. SAKAI
1993 Volume 22 Issue 1 Pages
53-57
Published: February 15, 1993
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Zeta potential identifies the electric charge of hollow-fiber dialysis membranes; however, there is no well established method to measure it. The objective of the present study is to improve the method of measuring streaming potential necessary for determination of the zeta potential. Both streaming potential and pressure drop were dependent on the packing of hollow fibers in a test cell, its assembled form and aqueous electrolyte concentration. Time-dependent streaming potentials were observed using commonly used aqueous 0.01N KCl. Much time was then required to attain equilibrium. An aqueous electrolyte, the concentration of which is 1/1000 of the aqueous 0.01N KCl was suited for stable and exact determination of streaming potential with the improved cell. Using the improved method, the zeta potential of seven different hollow-fiber dialysis membranes was determined, with a good relationship between the zeta potential and HPO
42- permeability. We conclude that performance of charged hollow-fiber dialysis membranes can be evaluated by the zeta potential calculated from the streaming potential measured by the improved method.
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M. WATANUKI, M. MINESHIMA, T. AGISHI, K. OTA, T. MASUDA, K. FUKUI, K. ...
1993 Volume 22 Issue 1 Pages
58-63
Published: February 15, 1993
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As a new dialysis system, continuous recirculating peritoneal dialysis (CRPD) was introduced in order to improve solute removal efficiency. In CRPD, because peritoneal dialysate in patient peritoneal cavity is recirculated in an extracoporeal system with a newly developed doublelumen catheter and it is purified by an out-side dialyzer continuously, therapeutic efficiency of CRPD strongly depends on performance of the dialyzer. In this study, the optimum design of the out-side dialyzer for CRPD was examined. In CRPD, peritoneal dialysate flows inner side of the hollow-fibers and commercially available dialysate for HD flows outer side of them. If an aimed clearance of the dialyzer was set to 95% of the maximum under 50mmHg of allowable pressure drop, a design specification of 87μm of inner diameter and 11.2cm of length for the hollow-fiber was determined to be optimal. Time averaged concentration of urea (TAC) was calculated tobe 32.2mg/dl in 8hr/day CRPD, using the optimum dialyzer, which would be superior to 45.3mg/dl of conventional HD.
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T. KANAMORI, Y. SUZUKI, K. SAKAI, K. KUWANA, H. NAKANISHI
1993 Volume 22 Issue 1 Pages
64-69
Published: February 15, 1993
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The dependence of diffusive clearance of a high performance dialyzer (SSP-1.5L) for vitamin B
12 on dialysate flow rate was larger than that of a conventional dialyzer (SSP-1.5H) with the same dimension as SSP-1.5L. Diffusive resistance of highly permeable membranes is no longer the sole factor governing removal rate of dialyzers for middle molecule substances. We determined optimal dimensions of high performance dialyzers, using empirical equations for dialysate- and blood-side mass transfer and the tortuous pore model combined with equations for estimating pressure drop and priming blood volume. The fraction of membrane diffusive resistance of SSP-1.5L for vitamin B
12 calculated from the theory was 0.73 times that of SSP-1.5H. The decrease in inner diameter of the membrane highly increased blood-side pressure drop in spite of slight improvement in diffusive clearance for vitamin B
12, leading to optimal inner diameter of approximately 200μm. The decrease in inner diameter of the shell also increased diffusive clearance for vitamin B
12. However, the fiber density of 75% with decreasing inner diameter of the shell was calculated to be the upper limit that would maximize the solute removal performance. Dimension of SSP-1.5L was nearly equal to the optimal one calculated from the theory.
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Noriaki MATSUI, Yoshiro NAKAMURA, Ryoichi ANDO, Renjiro KURIYAMA, Mitu ...
1993 Volume 22 Issue 1 Pages
70-73
Published: February 15, 1993
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Among the six dialysis membranes ethylene vinylalcohol copolymer (EVAL). DAEA cellulose (He), polyethylene-glycol-graft-edcellulose (PC), cellulose diacetate (CA). polymethyi metacrylate (PMMA), and cellulose (OC), having measured ζ potentials ranging from -2.88±0.38 (EVAL) to +0.86±0.14 (He), total protein adsorption was found to be high on He and minimal on PC and CA. Fibrin adsorption was high on EVAL and PMMA, and minimal on the other four membranes. Two dimensional electrophoresis on polyacrylamide gel showed a different pattern of protein adsorption by each membrane, with albumin adsorption moderate to low on EVAL. He. OC. and PC. and very low on PMMA and CA. Immunobrotting analyses showed EVAL. but none of the other membranes, to have adsorbed proteins which reacted with antibodies to high molecular weight kininogen and factor XIII, thus indicating the activation of the intrinsic coagulation system by EVAL. and also showed EVAL PMMA. and CA to have adsorbed low molecular weight proteins which reacted with fibrinogen antibodies, thus indicating the involvement of proteinase other than plasmin. Observation by scanning electron microscopy revealed adsorption of platelets to be particulaly high on the PMMA. high on the OC, and minimal on the EVAL. He. PC. and CA. These results, taken together, indicate that the PC is superior to the other dialysis membranes in its relative freedom f rom membrane-protein interaction, and thus in biocompatibility.
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K KOKUBO, T KANAMORI, K SAKAI
1993 Volume 22 Issue 1 Pages
74-78
Published: February 15, 1993
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Protein adsorption on materials for medical applications may change their thrombus formation and biocompatibility Zeta potential was determined from data on streaming potential measured on a streaming potential analyzer for three kinds of polymer alloy (polyarylate/polyethersulfone) (PEPA) membranes of varying polymer blend ratios and polacrylonitrile (PAN) membrane before and after cytochrome-C adsorption. Adsorption experiments were also made to determine the time-dependent amount of cytochrome-C adsorbed on the membranes. Intramembrane diffusion coefficient of the PEPA membranes for cytochrome-C was greatly lower than that of the PAN membrane, demonstrating that the PEPA membranes were controlled by adsorption and the PAN membrane by diffusion. The zeta potential of negatively charged membranes such as the PEPA and PAN membranes increased after adsorption of cytochrome-C that behaved like a cation in an aqueous solution of a pH of 6.4. The PAN membrane of higher negative charge gave great changes in zeta potential after cytochrome-C adsorption. In conclusion, adsorption of serum proteins that are ampholytes changes the zeta potential of dialysis membranes and may improve thrombus formation and biocompatibility.
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T. MIYAZAKI, H. NAGASAKA, A. FUJIMORI, H. NAITOH, M. AZUMA, Y. HASHIMO ...
1993 Volume 22 Issue 1 Pages
79-82
Published: February 15, 1993
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The surface electric potential of several dialysis membranes was measured. Their surfaces were also observed with a scanning electron microscope (SEM), after they had been used clinically, in order to examine the relationship of the surface potential with protein deposits. The dialysis membranes used for this study were made from 5 materials (6types): Cuprophan (Cup.), EVAL, PMMA, (B2-1.0H and BK-1.6U), Polysulfone and Hemophan membranes. The Cup., with a negative surface potential, had lots of plasma proteins and blood components deposited on its membrane surface while the Hemophan, with a positive surface potential, had fewer deposits of such substances. The PS, EVAL and BK, whose surfaces had a negative charge, also had fewer deposits on their membrane surface than did the Cup. The BK and B2, both made of PMMA, had a similar electric potential, but they showed different levels of deposit formation, suggesting that there was not a close relationship, between the surface electric potential of a pre-use membrane and the deposits found on the surface after use. The deposits on the dialysis membrane surfaces seemed to be strongly influenced by the structural nature of the membrane, not by its electric charge.
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H. NAITOU, M. AZUMA, Y. HASIMOTO, T. MIYAZAKI, H. NAGASAKA, A. FUJIMOR ...
1993 Volume 22 Issue 1 Pages
83-87
Published: February 15, 1993
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The membrane surface and the cross section of several membranes such as cellulose, cellulose diacetate, cellulose triacetate, Hemophan, EVAL, PMMA (B2, BK), PS, PEPA, PAN, and polyamide were observed by SEM before and after used for a 4-hour dialysis session. The cellulose, cellulose diacetate and Hemophan showed a uniform structure with a relatively smooth membrane surface, while the cellulose triacetate displayed a relatively rough membrane surface with a porous structure on it's blood side cross section. In terms of deposits, platelet and leukocytes were found on the cellulose and cellulose diacetate. On the cellulose triacetate and Hemophan, their surface was covered with a thin layer of protein-like substance with deposits of platelets in some places. As reported before, EVAL had few deposits on its surface. On the PMMA (B2, BK), B2 had deposits of blood components while BK showed few deposits of such substances. PS, PEPA and PAN were found to have a micro gradient structure. PA membrane exhibited a macro void structure on their cross section.
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Y. NAKANISHI, O. INAGAKI, Y. TAKAMITSU, Y. FUJITA
1993 Volume 22 Issue 1 Pages
88-91
Published: February 15, 1993
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The aim of this study was to investigate the adsorption of drugs by dialysis membranes via charge in vitro. Three dialysis membranes, that is, polyacrylonitrile (PAN) as a negatively charged membrane, hemophan (HE) as a positively charged membrane, and regenerated cellulose (RC) as a noncharged membrane were tested. Eight drugs, that is, nafamostat mesilate, cimetidine, procainamide and diltiazem as positively charged drugs, and heparin, furosemide, cefotaxime and carbazochrom as negatively charged drugs were studied. The three different membranes were cut into small fibers and incubated in each solution of these drugs for 3 hours at room temperature. The changes of the concentration of each drugs were determined by ultraviolet absorbance. PAN membrane absorbed positively charged drugs and HE membrane adsorbed negatively charged drugs, whereas RC membrane did not adsorb these drugs. These results show that some other drugs with charged portion could be adsorbed on dialysis membrane via an ionic bond.
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Y TADA, Y OHTA, T DOHI, T. HORIUCHI
1993 Volume 22 Issue 1 Pages
92-97
Published: February 15, 1993
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To minimize total amount of glucose required for removing the same volume of water as of bolus use, a continuous infusion of glucose during CAPD was proposed in this study. To evaluate feasibility of this system, computer simulation of water and solute transport through the peritoneal membrane was carried out. In a newly proposed mathematical model, lymphatic drainage of dialysate from the peritoneal cavity to lymphatic ducts was considered in addition to conventional mass transport. According to the results of simulation using our model it was indicated that CAPD with continuous glucose infusion could reduce up to 16% of glucose uptake compared with that of the conventional CAPD at the same dwell time.
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K. KUMANO, A. YAMASHITA, T. SAKAI
1993 Volume 22 Issue 1 Pages
98-102
Published: February 15, 1993
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Adequate conditions as to total dialysate volume (TDV) and tidal volume (TV) on 8 hr-TPD were studied in 4 patients with their peritoneal permeabilities (D/P creatinine at 4 hr) ranging from 0.62-0.91. TDV studied was 10, 16, 22 and 28L and TV, 0.5, 1 and 1.5L with 2L of initial infusion volume (IIV) using PAC-X-II cycler. Dialysis amount was expressed as total amount of urea removed/initial plasma urea levels (M/C
B). Model calculation for M/C
B was also conducted using single pool model. M/C
B was not higher in TPD than in IPD when TDV was less than 16L. Significant improvement by 10-17% in M/C
B was noticed on TPD using TDV of more than 22L. Maximum performance was obtained by 50% of IIV as a TV. Calculated M/C
B was lower than measured one. In conclusion, TPD promises 10-17% higher urea removal performance than IPD when large TDV of more than 22L is used. Adequate TV is 50% of IIV. Eight hour, 22L-TPD provides weekly Kt/V of more than 1.75 in patients with average or high peritoneal permeability.
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A. YAMASHITA, K. KUMANO, T. SAKAI, H. NAKANISHI, R.P. POPOVICH, J.W. M ...
1993 Volume 22 Issue 1 Pages
103-106
Published: February 15, 1993
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A method of continuous external vibration with an electric vibrator was employed for enhancing peritoneal mass transfer rate. A test solution that included high concentration of marker substances was put into a peritoneal cavity of a canine. Concentrations of the marker substances were monitored for three hours. After a complete drainage of the test solution, a new fresh test solution was put into the peritoneal cavity of the same subject and the same experiment was performed with an electric vibrator on the abdomen of the canine. Use of the Fast Fourier Transform made it possible to calculate the frequency of the vibration from the noise that had been introduced in EKG and the frequency was found to be approximately 55Hz. Evaluating the peritoneal mass transfer rates by the peritoneal dialysance, it was concluded that the continuous external vibration could increase the mass transfer rates by about two times both for urea and creatimne.
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Y. ENDOH, R. MOTOKI, H. INOUE, A. USUBA, J. MIURA, T. ABE, T. TAKESHIG ...
1993 Volume 22 Issue 1 Pages
107-112
Published: February 15, 1993
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The hemodynamics in blood purification (BP) patients with multiple organ failure after surgery was measured 150 times. The 8 patinets in intermittent hemodialysis (group I) and the 6 patients in continuous hemofiltration (group C) were studied and both groups were classified into group I (+) or I (-) and group C (+) or C (-) according to the procedure with or without hypotension during BP. The results were as follows 1) During BP left ventricular stroke work index (LVSWI) and total peripheral vascular resistance index (TPRI) were significantly lowere in group I (+) than in group I (-), LVSWI was significantly lower in group C (+) than group C (-), and TPRI was significantly higher in group C (+) than in group I (+). 2) In group I (-) and I (+) LVSWI was significantly lower during BP than before BP. 3) During BP right ventricular storoke work index (RVSWI) was significantly higher in group C (-) than group I (-). 4) In group I (-) LVSWI was significantly lower after BP than before BP. In conclusion, during BPthe blood pressure was primarily related to left ventricular function and peripheral vascular resistance, the left·right ventricular function and compensatory vasoconstriction were better maintained during BP in group C than in gorup I, and continuous hemofiltration was safer and more useful than intermittent hemodialysis.
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H. TAKAGI, J. MIYAUTI
1993 Volume 22 Issue 1 Pages
113-119
Published: February 15, 1993
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miniaturized left heart assist device developed in our laboratory has 2-4ml in capacity and 3-4mm of valve orf ice in inner diameter. This device driven by our new control machine has been tested in mock hemodialysis circuit to substitue for roller pump. Since our machine can keep a constsnt output automatically by adjusting air and negative pressure in response to the arterial and venous pressure, flowrate was always maintained at the set level up to 300ml.
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T. SHIBAMOTO, M. AKIYAMA, K. NISHIYAMA, T. KOBAYASHI, J. ONUKI, T. KAW ...
1993 Volume 22 Issue 1 Pages
120-123
Published: February 15, 1993
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The ultrafiltration control system, AVC-308 (ASAHI CO. LTD.) was newly developed adapting the ultrafiltration control method, in which the difference between inlet and outlet dialysate flow was control by a computer so that removal volume from the dialyzer consists with the target. The data processing is easier due to the memorization of the past running data by the computer. This study was aimed at the determination of the precision of the fluid removal system in the clinical usage. We studies with 15 dialysis patients, and input information about the running situation to the computer and tried the data communications with the manufacturer of this apparatus. The precision for in vitro and in vivo fluid removal studies errors were 1% and 2%. The monitoring of the data by the communications showed that TMP, dialysate pressure and venous pressure were controlled in accordance with the set target volumes. The precision of fluid removal of the AVC-308 dialysis apparatus was verified to be good enough for particular use on the basis of our experiments. This apparatus is fully observed by the computer, which enables to send the information by data communication to the manufacturer. Therefore, maintenance will be possible from distant locations.
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T. NAKAO, H. YAMAMOTO, S. KURIYAMA, H. TOMONARI, H. MATSUMOTO
1993 Volume 22 Issue 1 Pages
124-128
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Screw lock CAPD system (Terumo) was evaluated in clinical use. In the experimental model the tip of connector of the transfer tube was stained with 10
3 of bacteria, however no bacterial growth was found in the culture of stained site after flushing of 90ml of dialysate or covering the tip by concomitant cup. 93% of expert medical staff assessed that screw lock system was easier to manipulate than standard spike system and preventing effect for bacterial contamination was almost equal to UV systems. The duration that 16 patients could master the technique for exchange of CAPD bags was 3.2±1.1 days. Another 5 patients who seemed to be difficult to use other CAPD systems could also master screw lock system in the duration of 9.2±4.3 days. Incidence of peritonitis was 1/39.7 patients·month in this system and was lower than in other system. In conclusion screw lock system offers a safe and easy method for exchange of dialysate bags of CAPD.
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Y. KITAMOTO, H. SOEJIMA, K. MATSUSHITA, Y. KOHJIMOTO, I. TAKAHASHI
1993 Volume 22 Issue 1 Pages
129-132
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Extracorporeal circulation was performed in 14 beagle dogs without anticoagulant with blood flow of 150ml/min for 60min. In 7 dogs, 2.5ml of tricaprilin (TC) was floated over the blood in the venous line air trap chamber and the other 7 dogswere used as a control without TC. Activated clotting time (ACT) and pressure in the circuit were measured and clotting in the chamber and dialyzer was observed at each 20min. In 8 dialysis patients, TC was floated in the chamber and its preventive effect to clotting was studied. Thrombin-ATIII complex (TAT) in the plasma was measured before and after a dialysis with or without TC. In dogs, ACT decreased by extracorporeal circulation in control, but was almost constant in TC group. Clotting observed at the blood-air interface in control was not formed in TC group. In patients using TC, clot formation in the chamber was prevented and TAT generation by dialysis was less in 4 of the 5 patients compared to control. In conclusion, clotting in the chamber was prevented by separating blood from air probably through suppression of thrombin generation at the blood-air interface.
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J MINAKUCHI, S KAWASHIMA, K SUGIURA, T TAKAGI, A SAITO, T MIYAZAKI, H ...
1993 Volume 22 Issue 1 Pages
133-136
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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The continuous hemofiltration therapy was performed and its usefulness for the removal of β2MG was closely examined. The study included 3 chronic hemodialysis patients who were treated with CAVHF using PAN filter (0.3m
2, 0.5m
2). Therapies taken in this study are as follows; (1) Combination of CAVHF (filtrate 5L/day) and HD (1/week) (2) Combination of CAVHF (filtrate 5L/ day) and nightly slow HD (3/week) (3) CAVHF (filtrate 10L/day) It was possible to maintain serum β2MG concentration at 17 to 20mg/L. As for the combination therapy (CAVHF filtrate 5L per day+HD once a week), there are certain problems with the raise of BUN, Cr and K values. On the contraly, it did not present any serious problems with the other 2 therapies. Although, the continuous therapy still leaves many problems to be solved yet, it could be regarded as an effective method for the removal of β2MG.
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Midori HASEGAWA, Kazutaka MURAKAMI, Toshiyuki YANAI, Kuniyoshi KOJIMA, ...
1993 Volume 22 Issue 1 Pages
137-141
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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We clarified that Clq·β2-MG complexes are significantly higher and Clq·SAP complexes are significantly lower in the sera of hemodialysisassociated amyloidosis patients. In this report these complexes were measured before and after hemodialysis and in vitro experiments were done to research absorption of these complexes to dialysis membrane. Clq·β2-MG complexes and Clq·SAP complexes got elevated after hemodialysis (HD) when Cu membrane was used. On the other hand Clq·β2-MG complexes and Clq·SAP complexes got lower after HD when PAN membrane was used.Absorption of these complexes to PAN membrane was suggested from in vitro experiments. So it was speculated that these complexes got lower mainly because of absorption to dialysis membrane.
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H NAGAURA, T TAMAKI, M KOZAKI, T HIRANO, K OKA
1993 Volume 22 Issue 1 Pages
142-146
Published: February 15, 1993
Released on J-STAGE: December 02, 2011
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Fracdonation and purification of lymphocyte blastogenesis Fomoting factors extracted from haemodialysate of patients with chronic renal failure were carried out by high pefformance liquid chromatogaphy techniques. 1) The activity was eluated at capacity ratio (k') ranging from 2.08 to 2.45 (FLA and B). In this fraction, a major peak with an UV absorption maximum of 242nm and a few minor peaks were observed. 2) The established pharmacological agents were not eluated within Frs. A and B. Among these compounds, creatinine and hippuric acid were identified in the haemodialysates at k's of 0.85 and 7.11, respectively. 3) Both Frs. A and B showed the promoting activity in a dose-dependent manner. 4) A significant difference between Fr. B negative and positive haemodialysates was observed (p<0.002). As a result, these data suggested that factors included in hemodialysate would exhibit the promoting effect on lymphocyte blastogenesis.
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H MIYOSHI, K YANAGI, K FURUKAWA, N OHSHIMA
1993 Volume 22 Issue 1 Pages
147-152
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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To assess the perfomances of a packed-bed reactor loaded with 500 pieces of PVF resins (2x2x2mm, mean pore size; 250μm), continuous culture experiments of hepatocytes lasting a week were performed. The conventionally used monolayer culture experiments were also performed as controls. As indexes of activities of cultured hepatocytes, ammonium metabolic rate, urea-N synthetic rate and GPT activity were measured with appropriate intervals under different medium conditions. When serum-free medium or EGF-containing medium was used, ammonium metabolic and urea-N synthetic rates of the reactor showed significant decreases with time. At the end of the culture, these activities reduced to less than 10% of those measured on Day 1 in the perfusion culture. The degree of such deactivations were prominent in the perfusion culture than in the monolayer culture. On the other hand, in the runs performed with serum-containing medium, approximately 50% of these activities obtained on Day 1 were maintained even at the end of culture. Thus, the packed-bed type reactor utilizing PVF resins is expected to be a breakthrough in developing a hybrid artificial liver support system.
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K. TAKESHITA, H. ISHIBASHI, M. SUZUKI, S. TOBE, Y. TAKEI, A. KISHIDA, ...
1993 Volume 22 Issue 1 Pages
153-158
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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It is necessary to establish three-dimensional culture system which can retain differentiated functions and structural organization in developing hybrid artificial liver based on cultured hepatocytes. Furthermore, the immuno-isolation system is necessary in applying the xenogeneic hepatocytes to hybridartificial liver for extracorporeal circulation. In this study, we used the hollow fiber module (Culture flo, Asahi Medical CO., LTD.) for perfusion culture of hepatocytes. The hollow fiber module is not only suited for extracorporeal circulation but advantageous to immuno-isolation. In which, rat hepatocytes were entrapped in a three-dimensional collagen-gel matrix in the extracappillary space and maintained at approximately 40 times density as usual monolayer culture for 14 days. Differentiated functions of hepatocytes such as the secretion of albumin and ureogenesis were maintained at almost the same level of monolayers. And even following Perfusion culture for 8 days, an ability of ammonia removal was maintained at 43% of the initial level. This three-dimensional hepatocyte culture system, which is combined with a hollow fiber module and collagen-gel matrix, has useful advantages for hybrid artificial liver for extracorporeal circulation.
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S KASAI, M SAWA, I TOMITA, M HASHIMOTO, B JIANG, S HIRAI, A KAKISAKA, ...
1993 Volume 22 Issue 1 Pages
159-163
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Biocompatibility of artificial materials is one of the most important subjects for Hybrid Artificial Organs. Cellurose microcarrier attached hepatocytes were investigated of their metabolic activities. Approximately 70% of the seeded hepatocytes attached to 0.03% type IC collagen-coated cellurose microcarriers after intermittent stirring (2min/30min) up to 3h at 37°C. After 24h of incubation, NH
3 and fructose loading tests revealed better metabolic activity in hepatocytes attached to microcarriers than in those in monolayer culture. After 6 days of incubation, the decrease in metabolic rates of NH
3 and fructose was smaller in hepatocytes attached to microcarriers than in those in monolayer culture.
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Y. SAKAI, M. SUZUKI
1993 Volume 22 Issue 1 Pages
164-170
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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To develop a hybrid artificial liver using hepatocyte spheroids, methods of large-scale fomation and stable immobilization of them were investigated. When freshly isolated hepatocytes were cultured in suspension in a spinner flask, they formed aggregates in 24-48 hours of culture. These aggregates were collected and immobilized by re-attachment on polylysine. The aggregates immobilized secreted albumin at the same level as spheroids formed in stationary culture on polylysine. Thus, the aggregates rapidly-formed in suspension culture can be called "spheroids". The spheroids rapidly-formed were immobilized by three methods, which were re-attachment on polylysine, entrapment in Ca-alginate gel and entrapment in collagengel, and maintenance of albumin secretion was examined in culture media containing high concentration of serum and or physiological concentration of hormones only. Though the spheroids secreted a large amount of albumin in hormone-enriched serum-free media irrespective of the differences in immobolizing methods, entrapment in collagen gel was most effective in maintaining albumin secretion of hepatocyte spheroids in culture media containing high concentration of serum and physiological concentration of hormones.
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-Evaluation of ammonia metabolizing activity-
H. IJIMA, T. MATSUSHITA, K. FUNATSU
1993 Volume 22 Issue 1 Pages
171-176
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Spherical multicellular aggregates of adult rat hepatocytes (spheroids) were formed in the pores of polyurethane foam (PUF) which was used as a culture substratum. A prototype of hybrid artificial liver using PUF/spheroid was designed and evaluated in this paper. The module was a type of packed-bed with 15 pieces of PUF plates which immobilized spheroids (packing ratio: 36%, vessel volume: 100cm
3). In serum-free medium supplemented with 1mM-NH
4Cl, urea synthesis rate and ammonia decreasing rate of hepatocytes in this module were 4.28μmol/10
6cells/day and 2.31μmol/10
6cells/day, respectively. 1.53mmol/L-module/day of urea synthesis rate permodule was also obtained. The urea synthesis rate of hepatocytes was the same as and/or more than that of
in vivo level. Moreover, in the medium supplemented with 3mM-NH
4Cl, the urea synthesis rate of spheroids in a module was maintained for about 1 month. These results indicated that PUF/spheroid packed-bed culture system provided a promising prototype of hybrid type artificial liver.
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A. KOBAYASHI, H. OHGAWARA, Y. OMORI, [in Japanese], K. KOBAYASHI, T. A ...
1993 Volume 22 Issue 1 Pages
177-181
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Islets of Langerhans are very sensitive for glucose, so we synthesized glucose carring styrene homopolymer (PVMA). Islet-like cell clusters (ICCs) were obtained from the neonatal pig pancreas and ICCs were embedded in agarose with or without maltose-carrying Polystyrene (HEMA-VMA co-polymer). They remained morphologically intact and a physiological response to acute stimulatin with glucose was obtained, when they were embedded in the agarose containing HEMA-VMA co-polymer. These findings suggest that the ICCs in agarose containing HEMA-VMAco-polymer could be a useful tool for morphological, biochemical and molecular biological studies, and also as a potential source of material for transplantation.
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K. KOBAYASHI, T. OKA, K. KURIYAMA, H. IWATA, H. AMEMIYA
1993 Volume 22 Issue 1 Pages
182-185
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Hamster islets which were microencapsulated in agarose hydrogel were xenogeneically transplanted into diabetic mice. The effect of agarose concentrations on xenograft survivals was studied in this research. The diabetic mice were sensitized by intraperitoneal injection of nonencapsulated hamster islets. Agarose-microencapsulated hamster islets which were precultured in vitro for more than 20 days were transplanted on day 14 after sensitization. The high level of anti-hamster antibody was still detected in plasma of recipients more than 50 days after transplantation of microencapsulated islets. The graft functioning Periods of microencapsulated islets markedly prolonged with an increase of concentration of agarose. Islets in microcapsules made from 7.5% high molecular weight agarose especially maintained the normoglycemia for more than 100 days in four of six animals. In addition, the mobility of human immunoglobulin G (IgG) was estimated in agarose gels of various concentrations by an electrophoresis assay. The graft functioning Periods of microencapsulated islets was revealed to be inversely correlated with the diffusion coefficient of IgG.
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Y AOMATSU, Y NAKAJIMA, H KANEHIRO, T FUKUOKA, M HISANAGA, A YOSHIMURA, ...
1993 Volume 22 Issue 1 Pages
186-189
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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The efficacy was evaluated the bioartificial pancreas as new artificial vessel type in canine allograft model. We developed the bioartificial pancreas enclosing 10% photo-cross linkable polyvinyl alcohol (PVA-AbQ) hydrogel mixed with 70, 000-190, 000 of purified canine islets to the wall of knitted artificial vessel. This bioartificial pancreas was tranaplanted to the abdominal aorta of 5 diabetic dogs totally removed pancreas. We administered exogenous insulin to keep normal insulin after grating (0-10U/day) than that before transplantation (8-16U/day), and no rejection reaction was histologically observed. Bioartificial pancreas of artificial vessel type with PVA-SBQ was newpromising strategy to prevent rejection in islet allotransplantation in contact with blood stream for Type I diabetic patients.
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S. NAKAJI, Y. INUKAI, K. TAKAKURA
1993 Volume 22 Issue 1 Pages
190-193
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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We have developed a biocompatible and high capacity adsorbent with using poly-hydroxyethyl methacrylate (Poly-HEMA) coated porous anion-exchange resin for the treatment of hyperbilirubinemia, In order to improve the biocompatibility of the adsorbent and prevent the release of microparticles from the porous resin, the resin beads were coated with hydrophilic poly-HEMA. With increasing the amounts of the coating, the adsorption of Plasma proteins was markedly reduced, In the in vitro study the coated adsorbent exhibited an excellent adsorptive property for bilirubin and bile acid. For clinical application, the plasma perfusion column, Medisorba BL which contains 300ml of the coated resin beads, sterilized by auto-claving has been developed. In the clinical evaluation, the bilirubin adsorption capacity of this column was estimated to be more than 51 0f treated plasma volume, Medisorba BL was highly effective and useful for the removal of bilirubin in the clinical treatment of hyperbilirubinemia.
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K. OKA, S. NAKAJI, K. TAKAKURA, M. TAKAMORI
1993 Volume 22 Issue 1 Pages
194-197
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Segment 183-200 of the Torpedo californica acetylcholine receptor, involved in the formation of the acetylcoline-binding site and recognizedby a blocking antibody in myasthenia gravis (MG), showed much more potent binding ability than human peptide. Based on this fact we have developed the immunoadsorbent Medisorba MG with the synthetic peptide (Torpedo 183-200) as an affinity ligand to remove a blocking antibody specifically in plasma perfusion. Medisorba MG showed the specific removal of the blocking antibody without reducing IgG and albumin significantly in clinical evaluation and
in vitro study. Clinical treatments effectively improved the myasthenic state (78% of the cases) and no adverse effects were observed in any case. Medisorba MG has been confirmed as a useful device for the treatment of MG.
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K SOEDA, J HORI, Y ITOH, K ISONO, M. ODAKA
1993 Volume 22 Issue 1 Pages
198-203
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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continued over 40 months for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) We experienced 2 cases of steroid refractory CIDP who had undergone DFPP during 52 and 44 months. Times of DFPP were 238 and 105 respectively. After we tried to cease the DFPP therapy, they certainly got worse and were unable to walk with nursing assistants. Futhermore they did well with maintaining DFPP therapy once a two weeks.
Hypoproteinemia, hypocholesterolemia, hypocalcemia and anemia were noted in them but were not serious. Impairement of their neurological symptoms did not always correlate with high level of serum immunoglubulin. Lymphocyte subsets ratio of CD4/8 changed lower after DFPP in case 1, but did not change in case 2. Human plasma albumin had been administrated as replacement fluid for DFPP. We supposed that this should not be recommended. So we started immunological adsorption plasma pheresis (IAPP) without human plasma albumin in case 1. He enjoyed his life also after that. DFPP might be effective for the removal of circulation plasma factors to peripheral nerve component in CIDP patients. Besides, we speculate that other efficacy such as immunomodulation due to DFPP and IAPP would get a better neurological assessment in CIDP.
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Hisataka SHOJI, Masahiro MINAGA, Yoshitada SAKAI, Tetunosuke KUNITOMO, ...
1993 Volume 22 Issue 1 Pages
204-211
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Circulating endotoxin in the blood is considered to be a serious pathogenic factor for septic shock. We have been developing blood purification cartridge which consists of polymyxin B immobilized fiber (PMX-F) to apply to a new treatment by eliminating endotoxin from the blood circulation. Then we studied the relationship between the chemical structure of fixed polymyxin B and its detoxification capacity in
in vitro and
in vivo settings. By the results of experiments, we could derive the important role of primary amino groups in the fixed polymyxin B molecule to detoxify endotoxin. The detoxification capacity of PMX-F was confirmed to decrease following the reducing number of primary amino groups in
in vitro and animal experiment. PMX-F was also confirmed to interact many kinds of endotoxin extracted from different species of gram-negative bacteria. PMX was clinically applied to 16 septic patients. Cardiovascular instabilities were improved in some shock cases. PMX is expected to be useful as one of the therapeutics to treat endotoxemia or septic shock.
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M. SHIMIZU, K. SAKAI
1993 Volume 22 Issue 1 Pages
212-216
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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In case of treating blood, the filtrate flux of a plasma separator decreases with time and is several orders of magnitude lower than that of pure water and plasma. This phenomenon is explained by the enhanced filtration resistance resulted from formation of red blood cell polarization layer, accumulation of RBCs on the membrane and further pore blocking with RBCs. Since the filtrate flux depends on blood-side flow rate, the plasma separation model concerns the red blood cell polarization layer alone. The authors proposed a new model for estimating of the filtrate flux of a plasma separator by considering the variation of diffusion coefficient of RBCs in the blood with hematocrit and pore blocking with RBCs. Constant-pressure filtration experiments with the suspension of washed RBCs were done to clarify the new plasma separation model. In conclusion, the model we have proposed fully accounts for hematocrit dependence of the filtrate flux of a plasma separator at varying hematocrits ranging from 0.5 to 80%.
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T. YOKOTA, T. TANI, K. NUMA, H. ABE, M. KODAMA
1993 Volume 22 Issue 1 Pages
217-219
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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We estimated pure Pokeweed Mitogen (PWM) which was isolated from crude PWM for increasing its stimulating efficacy to the lymphocytes. PWM, one of lectins, is well known for its mitogenic effect to the lymphocytes. PWM is constructed by 5 isotypes. One of isotypes (pure PWM) which molecular weight is 35, 000±5, 000, was isolated by gel filtration method. It has the strongest effect to the T-lymphocytes among five isotypes. For cytotoxicity (%) against K-562 cells and Daudi cells, Lymphocytes which was activated with pure PWM had the stronger antitumor effect than those which was activated with crude PWM. This pure PWM is expected to have the strong and stableability to induce the anticancer lymphocytes and to be a good material when it will be immobilized on the beads.
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M. YONEKAWA, H. KON, M. TAKAHASHI, K. ONODERA, J. MEGURO, K. KUKITA, A ...
1993 Volume 22 Issue 1 Pages
220-225
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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Cryofiltration removes cryogel which is found to be a complex of Fibrinogen (Fbg) and Fibronectin (FN), and to contain pathological substances. The purpose of this study is to measure the plasma and cryogel EDA (+) FN, which is one of the cellular FN which can be measured with a monoclonal antibody newly prepared by Hirano et al, to study the relationship between the EDA (+) FN and clinical symptoms, and to study the reduction efficacy of the EDA (+) FN. Cryogel contained 51 times as much EDA (+) FN much as plasma. Patients with rheumatoid arthritis (RA) showed a high level of the EDA (+) FN in plasma, and the EDA (+) FN level in plasma corresponded with changes of joints pain. The reduction rate, that was expressed as (plasma level before cryofiltration - after cryofiltration)/plasma level before cryofiltration, was 50 to 60% in Fbg and plasma FN (pFN). However that of EDA (+) FN was low, less than 20%, in spite of a large amount of reduction volume in cryogel. We calculated the reduction index, that was expressed as reduction volume/plasma level before cryofiltration, for the comparison of the reduction efficacy. The index of Fbg and pFN was about 1.5L, but that of EDA (+) FN was 2.5 to 3.0L. The study of plasma level change of EDA (+) FN during cryofiltration revealed a temporary elevation. These results suggest that the EDA (+) FN was most efficiently reduced by cryofiltration, would become a good indicator on plasmapheresis, and might move from other tissues into blood during cryofiltration.
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M. YONEKAWA, H. KON, M. TAKAHASHI, K. ONODERA, J. MEGURO, K. KUKITA, A ...
1993 Volume 22 Issue 1 Pages
226-229
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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A washing out procedure of the 2nd filter is required on cryofiltration when the filter is filled with the cryogel. We changed the washing out method for an improvement of albumin loss. The purpose of this study is to compare albumin loss and reduction efficacy of other proteins between the prior method (method A) and the improved method (method B) in 5 patients. Method A was only washing back with 500 ml of saline solution. Method B was that the plasma within the 2nd filter was forced out to patient with 200ml of saline solution and then the filter was washed back with 300ml. Both reduction volume and rate of serum protein was decreased in method B. Those of albumin were significantly reduced in method B in 3 patients, in spite of reduction of albumin supply. As washing out of cryogel became incomplete in method B, the frequency of washing out and the time of treatment increased. The washing out procedure is so complicated that we have now developed an automatic washing out system.
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Y KANAI, K YAMAJI, M SUGIYAMA, H TSUDA
1993 Volume 22 Issue 1 Pages
230-234
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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One of the etiological factors in Raynaud's phenomenon in connective tissue disease is the increase in plasma viscosity. We examined the efficacy of plasmapheresis (PP) as an index of blood and plasma viscosity. We performed double filtration plasmapheresis on 6 patients with connective tissue disease exhibiting Raynaud's phenomenon, who we diagnosed as one case of systemic lupus erythematosus and dermatomyositis, two cases of progressive systemic sclerosis and mixed connective tissue disease. We measured blood and plasma viscosity before and after PP. Blood viscosity was measured by a cone-plate rotational viscometer (Wells-Brookfield, Inc.). Plasma viscosity was measured by a capillary viscometer (Isogai's method). We studied the clinical symptoms of Raynaud's phenomenon, and measured the digital temperature by thermography. No significant difference in blood viscosity was found. Plasma viscosity in patient with Raynaud's phenomenon was higher than in normal controls, and significantly decreased after PP. The digital temperature by thermography tend to rise after PP. We noted an improvement in clinical symptoms by PP. We therfore conclude that PP is a useful way to treat of Raynaud's syndrome.
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K YAMAJI, Y KANAI, M SUGIYAMA, H TSUDA
1993 Volume 22 Issue 1 Pages
235-239
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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We measured the blood and lasmaviscosity in a patient with rheumatoid arthritis (RA) undergoing plasmapheresis (PP) treatment, and investigate the connection between activity of RA, clinical symptoms and laboratory data We performed PP on 18 patients using double filtration. The subjects consisted of 18 patients and we divided into two groups A and B according to their erythrocyte sedimentation rate (ESR) levels. Group A patients had ESR levels of 50mm/hr and higher, and Grou B patients had ESR levels under 50mm/hr. We investigated the changes in viscosity and relevancy to activity of RA and clinical symptoms compared group A with group B. Group A's plasma viscosity was significantly higher than group B's, and plasma viscosity showed a significant tendency to fall by PP in both of groups. Group A's clinical symptoms were more severe. Group A showsa significantly higher Lansbury index than group B and clinical symptoms show a tendency to improve by PP in both groups. Also, Group A's values were significantly higher than group B's with respect to ESR, γ -globulin, IgG, IgA, and Fibrinogen.
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Toshio SHINODA, Hideo ARAKURA, Chang-Sung KOH
1993 Volume 22 Issue 1 Pages
240-242
Published: February 15, 1993
Released on J-STAGE: October 07, 2011
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The efficacy of plasmapheresis was retrospectively evaluated in patients with autoimmune neurologic diseases treated at Shinshu University Hospital during the past 5 years. Subjects were 27 patients; 12 with Guillain-Barré syndrome (GBS), 6 with Fisher syndrome (FS), one with sensory neuropathy (SN), 3 with multiple sclerosis (MS; 2 with Balo disease) and 5 with myasthenia gravis (MG). Plasma exchange (PE) or immunoadsorption plasmapheresis (IAPP) was carried out for the patients and the efficacy was examined. The efficacy was confirmed in patients with GBS, FS, MS and MG as previously reported. In addition, the following was suggested; a) plasmapheresis is effective for SN and Balo disease, and this has not been reported, b) steroid therapy possibly has an additive effect to plasmapheresis in GBS, c) plasmapheresis is effective for patients with FS and SN even in 2 weeks or later after the onset. In conclusion, plasmapheresis is effective for some kinds of autoimmune neurologic diseases. There are some differences in the effect among the diseases with respect to the timing of the initiation of the therapy and an additive effect of steroid therapy.
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