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3.
Transplant Proc ; 46(10): 3523-35, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25498084

RESUMEN

Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) occurring after liver transplantation is a relatively rare complication but it often takes a life-threatening course. However, the detailed etiology and mechanism of VOD/SOS after liver transplantation (LT) remains unclear. We report two cases with rapidly progressive VOD/SOS after ABO-identical LT resistant to various therapies. In case 1, in which the patient underwent deceased-donor LT, the first episode of acute allograft rejection was triggered VOD/SOS, and the presence of donor non-specific anti-HLA antibodies was confirmed. The recipient died with graft failure on day 46 after transplantation. Case 2, in which the patient underwent living-donor LT from the mother, had neither rejection nor mechanical venous obstruction, but condition of the patient rapidly worsened and he died on day 13 after transplantation. This recipient's direct cross-match test for the donor's B lymphocyte was strongly positive, but that for T lymphocyte was negative. In both cases, neither stenosis of hepatic vein outflow tract nor C4d deposition in post-transplantation liver biopsy specimens and autopsy specimen was found. On the other hand, in both cases, the patient was transfusion unresponsive thrombocytopenia and hyperbilirubinemia persisted postoperatively, and glycoprotein Ⅰ bα was strongly stained in the neighboring centrilobular area (zone 3), especially in the space of Disse, and platelet phagocytosis was observed in Kupffer cells and hepatocytes around zone 3 such as clinical xenotransplantation of the liver in post-transplantation liver biopsy specimens. From the viewpoint of graft injury, VOD/SOS was considered that sustained sinusoidal endothelial cells injury resulted in bleeding in the space of Disse and led to around centrilobular hemorrhagic necrosis, and the fundamental cause was damage around centrilobular area including sinusoid by acute cellular rejection, antibody-mediated rejection or ischemic reperfusion injury. The extrasinusoidal platelet activation, aggregation, and phagocytosis of platelets were some of the main reasons for VOD/SOS and transfusion-resistant thrombocytopenia.


Asunto(s)
Rechazo de Injerto/complicaciones , Enfermedad Veno-Oclusiva Hepática/etiología , Trasplante de Hígado/efectos adversos , Donantes de Tejidos , Adulto , Biopsia , Femenino , Rechazo de Injerto/diagnóstico , Enfermedad Veno-Oclusiva Hepática/diagnóstico , Humanos , Masculino , Índice de Severidad de la Enfermedad , Trasplante Homólogo
4.
Hepatogastroenterology ; 61(130): 469-74, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24901164

RESUMEN

BACKGROUND/AIMS: Soft pancreases are susceptible to developing pancreatic fistula following pancreaticoduodenectomy. To reduce the incidence of pancreatic fistula after pancreaticoduodenectomy in patients with a soft pancreas, we developed a triple secured technique. In this study, we describe the details of this technique and also report on the postoperative outcomes. METHODOLOGY: The triple secured technique employed an ultrasonic dissector for pancreatic transection with skeletonizing and ligating of the small pancreatic branch ducts, duct-invagination or duct-to-mucosa anastomosis for main pancreatic duct management, and, finally, four large stitches between the pancreatic stump parenchyma and the jejunal seromuscular layer to prevent minor pancreatic leakage. A total of 28 consecutive patients with a soft pancreas who underwent pancreaticoduodenectomy using our technique were included in this study. RESULTS: Postopetrative complications occurred in 16 patients. Grade B pancreatic fistula developed in 6 patients. However, no grade C pancreatic fistula occurred in this series. Neither any reoperation nor in-hospital mortality was observed in this series. CONCLUSIONS: Our triple secured technique after pancreaticoduodenectomy was feasible and safe, with an acceptable rate of grade B pancreatic fistula and no grade C pancreatic fistula for patients with a soft pancreas.


Asunto(s)
Conductos Pancreáticos/cirugía , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/métodos , Técnicas de Sutura , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/cirugía , Fístula Pancreática/prevención & control , Complicaciones Posoperatorias/prevención & control , Resultado del Tratamiento
5.
Transplant Proc ; 46(4): 1087-9, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24815135

RESUMEN

INTRODUCTION: Anatomical variations around the hepatoduodenal ligament greatly influence surgical procedures and the difficulty of operations. Here, we report the case of a deceased donor with midgut malrotation (MgM) and anatomical variation. We also present an anatomical comparison between MgM and normal cases. CASE REPORT: The donor, a male in his 60s, was diagnosed with MgM based on preoperative computed tomography. Intraoperatively, the liver graft was harvested from the proper hepatic artery (PHA), but its length was too short for reconstruction. Therefore, the hepatic artery was reconstructed at both the left and right hepatic arteries. METHODS: The length of the proper hepatic artery (l-PHA) and main trunk of the portal vein (l-PV) was compared between MgM and control groups (n = 9) using computed tomography. The ratio of PHA (r-PHA) and PV (r-PV), which was calculated as the l-PHA or l-PV divided by the patient's height, was also compared. RESULTS: The r-PV was 1.3% in the MgM group and 1.6% in the control group (P = .09). The r-PHA was 0.23% in the MgM group and 0.92% in the control group (P < .01). Thus, the PHA was significantly shorter in the MgM group. Additionally, anatomical variations of the hepatic artery were confirmed in four cases. CONCLUSION: Preoperative radiological evaluation is not always adequate for identifying anatomical abnormalities in deceased donors. MgM is a rare but important anomaly because of the possibility of associated anatomical variations of the hepatic artery.


Asunto(s)
Anomalías del Sistema Digestivo/complicaciones , Ligamentos/anomalías , Trasplante de Hígado , Hígado/anomalías , Hígado/cirugía , Donantes de Tejidos , Muerte Encefálica , Estudios de Casos y Controles , Anomalías del Sistema Digestivo/diagnóstico , Hepatectomía , Arteria Hepática/cirugía , Humanos , Ligamentos/diagnóstico por imagen , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Vena Porta/cirugía , Procedimientos de Cirugía Plástica , Recolección de Tejidos y Órganos/métodos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
6.
Cancer Gene Ther ; 19(5): 312-9, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22402625

RESUMEN

Suicide gene therapy using the herpes simplex virus thymidine kinase/ganciclovir (HSV-tk/GCV) system combined with monocyte chemoattractant protein-1 (MCP-1) provides significant antitumor efficacy. The current study was designed to evaluate the antitumor immunity of a newly developed membrane-bound form of MCP-1 (mMCP-1) in an immunocompetent mouse model of hepatocellular carcinoma (HCC). A recombinant adenovirus vector (rAd) harboring the human MCP-1 gene and the membrane-spanning domain of the CX3CL1 gene was used. Large amounts of MCP-1 protein were expressed and accumulated on the tumor cell surface. The growth of subcutaneous tumors was markedly suppressed when tumors were treated with mMCP-1, as compared with soluble MCP-1, in combination with the HSV-tk/GCV system (P<0.01). The numbers of Mac-1-, CD4- and CD8a-positive cells were significantly higher in tumor tissues (P<0.05), and tumor necrosis factor (TNF) mRNA expression levels with mMCP-1 were almost five-fold higher than those with soluble MCP-1. These results indicate that the delivery of the mMCP-1 gene greatly enhanced antitumor effects following the apoptotic stimuli by promoting the recruitment and activation of macrophages and T lymphocytes, suggesting a novel strategy of immune-based gene therapy in the treatment of patients with HCC.


Asunto(s)
Quimiocina CCL2/genética , Genes Transgénicos Suicidas , Terapia Genética/métodos , Neoplasias Hepáticas Experimentales/terapia , Animales , Línea Celular Tumoral , Quimiocina CCL2/biosíntesis , Quimiocina CCL2/metabolismo , Quimiocina CX3CL1/genética , Modelos Animales de Enfermedad , Femenino , Ganciclovir/farmacocinética , Ganciclovir/farmacología , Herpes Simple/enzimología , Herpes Simple/genética , Humanos , Neoplasias Hepáticas Experimentales/genética , Neoplasias Hepáticas Experimentales/metabolismo , Ratones , Ratones Endogámicos BALB C , Timidina Quinasa/biosíntesis , Timidina Quinasa/genética , Timidina Quinasa/metabolismo
7.
Clin Exp Immunol ; 163(2): 165-77, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21087443

RESUMEN

Despite curative locoregional treatments for hepatocellular carcinoma (HCC), tumour recurrence rates remain high. The current study was designed to assess the safety and bioactivity of infusion of dendritic cells (DCs) stimulated with OK432, a streptococcus-derived anti-cancer immunotherapeutic agent, into tumour tissues following transcatheter hepatic arterial embolization (TAE) treatment in patients with HCC. DCs were derived from peripheral blood monocytes of patients with hepatitis C virus-related cirrhosis and HCC in the presence of interleukin (IL)-4 and granulocyte-macrophage colony-stimulating factor and stimulated with 0·1 KE/ml OK432 for 2 days. Thirteen patients were administered with 5 × 106 of DCs through arterial catheter during the procedures of TAE treatment on day 7. The immunomodulatory effects and clinical responses were evaluated in comparison with a group of 22 historical controls treated with TAE but without DC transfer. OK432 stimulation of immature DCs promoted their maturation towards cells with activated phenotypes, high expression of a homing receptor, fairly well-preserved phagocytic capacity, greatly enhanced cytokine production and effective tumoricidal activity. Administration of OK432-stimulated DCs to patients was found to be feasible and safe. Kaplan-Meier analysis revealed prolonged recurrence-free survival of patients treated in this manner compared with the historical controls (P = 0·046, log-rank test). The bioactivity of the transferred DCs was reflected in higher serum concentrations of the cytokines IL-9, IL-15 and tumour necrosis factor-α and the chemokines CCL4 and CCL11. Collectively, this study suggests that a DC-based, active immunotherapeutic strategy in combination with locoregional treatments exerts beneficial anti-tumour effects against liver cancer.


Asunto(s)
Antineoplásicos/farmacología , Carcinoma Hepatocelular/terapia , Células Dendríticas/efectos de los fármacos , Células Dendríticas/trasplante , Embolización Terapéutica , Inmunoterapia Activa/métodos , Neoplasias Hepáticas/terapia , Picibanil/farmacología , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/virología , Terapia Combinada , Citocinas/sangre , Citocinas/inmunología , Supervivencia sin Enfermedad , Femenino , Factor Estimulante de Colonias de Granulocitos y Macrófagos/farmacología , Hepatitis C/inmunología , Humanos , Interleucina-4/farmacología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Recurrencia Local de Neoplasia/terapia , Radiografía
8.
Transplant Proc ; 37(8): 3430-2, 2005 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-16298618

RESUMEN

BACKGROUND: Young donors, donors with low body mass index (BMI), and non-heart-beating (NHB) donors are considered nonideal for islet transplantation. In this report, we successfully used a pancreas from a young, low-BMI, NHB donor for islet transplantation. METHODS: The donor was a 15-year-old adolescent boy whose cause of death was rupture of a primary brain tumor. According to Japanese regulations, his pancreas was procured after cardiac arrest. Warm ischemic time was 3 minutes and cold ischemic time was 300 minutes. The pancreas was digested by the automated method of Ricordi, followed by purification using continuous Euro-Ficoll gradients on a Cobe 2991 device. The recipient was a 35-year-old woman with unstable type 1 diabetes mellitus. Her pretransplant C-peptide level was null. She suffered frequent hypoglycemic unawareness. Her pretransplant M value, which is a good marker for glucose instability, was 125. Islet yield was 252,816 IEQ. There were no signs of contamination. Viability of islets assessed by FDA/PI staining was 83%. Stimulation index was 2.7. RESULTS: The patient received 5160 IEQ/kg of islets via the portal vein under local anesthesia. There were no transplant-related complications. Although she required minimal exogenous insulin, her C-peptide level increased to 0.7 ng/mL at postoperative day (POD) 14. Her M value at POD 15 to 19 decreased dramatically to 23.6, indicating good glycemic control. At 3 months posttransplant, episodes of hypoglycemia disappeared. CONCLUSIONS: Although an additional transplant is mandatory to wean patients from insulin, this case shows the possibility of using marginal donors, such as a young, low-BMI, NHB donor, for pancreas islet transplantation.


Asunto(s)
Diabetes Mellitus Tipo 1/cirugía , Trasplante de Islotes Pancreáticos/fisiología , Recolección de Tejidos y Órganos/métodos , Adolescente , Glucemia/metabolismo , Muerte Encefálica , Diabetes Mellitus Tipo 1/sangre , Paro Cardíaco , Humanos , Masculino , Soluciones Preservantes de Órganos , Pancreatectomía , Resultado del Tratamiento
9.
Transplant Proc ; 37(1): 220-2, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15808600

RESUMEN

BACKGROUND: Recently, preservation using oxygenated perfluorocarbon (the two-layer method) has shown beneficial effects on islet yield and viability. In this paper, we apply this concept on isolation processes to examine the effectiveness of oxygenation. METHODS: Rat pancreata were digested using four different methods: (groups 1A, 1B, 2A, and 2B) with or without oxygenated perfluorocarbon in groups 1 and 2, respectively. Adenosine was added into the collagenase solution in subgroup A whereas it is not added in subgroup B. RESULTS: Tissue oxygen tension in group 1 was about 0 during digestion; whereas it rapidly reached about 300 mm Hg and was maintained in group 2. Tissue ATP level just after laparotomy (control) was 4.2 +/- 0.7 micromol/g dry weight. The ATP levels after digestion were 0.12 +/- 0.03 in group 1A (P < 0.01 vs control); 0.70 +/- 0.10 in group 1B (P < 0.01 vs control); 0.30 +/- 0.18 in group 2A (P < 0.01 vs control); and 2.90 +/- 0.80 in group 2B (P = 0.19 vs control). Islet yields (IEQ/pancreas) were 1600 +/- 400 in group 1B; 1400 +/- 400 in group 1B; 1300 +/- 400 in group 2A; and 2400 +/- 100 in group 2B. The amount in group 2B was significantly greater than that in the other three groups. CONCLUSIONS: Oxygen provision by preoxygenated perfluorocarbon itself showed no beneficial effect on islet yield. However, if oxygen provision was associated with adenosine administration into the pancreas, tissue ATP levels after digestion were well maintained, and a greater number of islets were retrieved.


Asunto(s)
Adenosina Trifosfato/metabolismo , Fluorocarburos/farmacología , Islotes Pancreáticos/citología , Animales , Separación Celular/métodos , Islotes Pancreáticos/efectos de los fármacos , Islotes Pancreáticos/metabolismo , Masculino , Consumo de Oxígeno , Pancreatectomía , Ratas , Ratas Endogámicas Lew
10.
J Pharm Sci ; 93(3): 582-9, 2004 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-14762897

RESUMEN

Titanium dioxide (TiO2) has been widely used as a pharmaceutical excipient and is also known to be a strong photocatalyst. An investigation into the relationship between the photocatalytic activity of TiO2 and the photostability of famotidine, which is known as an H2-blocker, is presented. The photocatalytic activity of the anatase form of TiO2, as measured by the four-probe method, is approximately 1.5 times higher than that of the rutile form. Discoloration of famotidine in a binary system containing TiO2 depends significantly on both the wavelength of the irradiating light and the crystal form of the TiO2, with the degree of discoloration of anatase higher than that of the rutile form. Discoloration of famotidine also depends on relative humidity. The relationship between discoloration rate constant and water vapor pressure is linear. These results demonstrate that famotidine is easily discolored by the photocatalytic activity of TiO2 and suggest that the solid-state photocatalytic activity of TiO2 is strongly affected by relative humidity.


Asunto(s)
Famotidina/química , Humedad , Fotólisis , Titanio/química , Catálisis/efectos de los fármacos , Estabilidad de Medicamentos , Famotidina/farmacocinética , Fotólisis/efectos de los fármacos , Titanio/farmacocinética
11.
Br J Surg ; 90(8): 1015-20, 2003 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12905558

RESUMEN

BACKGROUND: Intestinal ischaemia-reperfusion (IR) injury frequently occurs in abdominal surgery. Perfluorochemical (PFC) can be used to oxygenate intestinal organs directly and allows adenosine 5'-triphosphate (ATP) production within the submerged organs during ischaemia. This study was designed to evaluate the protective effect of PFC in IR injury, focusing on cytokine production in rat small intestine. METHODS: The superior mesenteric artery was occluded in rats for 60 min and the small bowel placed in an intestinal bag containing either normal saline (group 1), oxygenated saline (group 2) or oxygenated PFC (group 3). The arterial clip was subsequently removed, allowing reperfusion. The number of rats that survived for 7 days, tissue ATP levels, biochemical variables, tissue lipid peroxidation (LPO), bacterial cultures and histological changes were examined after reperfusion. RESULTS: The use of oxygenated PFC in group 3 improved survival compared with the other groups. Serum creatine phosphokinase and lactate dehydrogenase levels in groups 1 and 2 reflected small intestinal damage, and plasma levels of tumour necrosis factor alpha and interleukin 6 were raised. In contrast, oxygenated PFC decreased these levels, and reduced LPO, bacterial translocation and augmented apoptosis of the small intestine after reperfusion. CONCLUSION: An intestinal bag containing oxygenated PFC showed protective effects during bowel ischaemia.


Asunto(s)
Fluorocarburos/uso terapéutico , Intestino Delgado/irrigación sanguínea , Isquemia/prevención & control , Daño por Reperfusión/prevención & control , Adenosina Trifosfato/metabolismo , Animales , Creatina Quinasa/sangre , Peroxidación de Lípido , Masculino , Ratas , Ratas Wistar , Análisis de Supervivencia , Factor de Necrosis Tumoral alfa/análisis
12.
Nihon Shokakibyo Gakkai Zasshi ; 98(8): 935-41, 2001 Aug.
Artículo en Japonés | MEDLINE | ID: mdl-11524853

RESUMEN

A urine-based enzyme-linked immunosorbent assay kit (URINELISA) for detection of the antibody for H. pylori has recently been developed. We evaluated the diagnostic capability of the URINELISA test in comparison with two serum IgG antibody kits (HM-CAP and Helico G) for H. pylori infection. The subjects of this study were 173 patients. H. pylori was detected by means of culture, immunohistochemical staining and rapid urease test of endoscopically obtained biopsy specimens. A positive diagnosis of H. pylori was when at least one of three tests was positive and a negative diagnosis when all three were diagnosed as H. pylori positive and 23 as negative. We also examined the diagnostic potential of the antibodies in urine and in serum by using the results of the bioptic methods as the gold standard. The sensitivity of both URINELISA and HM-CAP was 93.3% and that of Helico G 94.7%, while their respective specificities were 47.8%, 65.2% and 52.2%. The URINELISA kit thus showed high sensitivity but relatively low specificity. The latter was due to sampling errors in the bioptic procedure because the subjects of this study included many elderly patients with atrophic gastritis. The level of the antibody in urine decreased markedly after 2 months of eradication therapy. We conclude that the URINELISA kit is as effective as serum antibody kits for the diagnosis of H. pylori infection.


Asunto(s)
Anticuerpos Antibacterianos/orina , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/aislamiento & purificación , Juego de Reactivos para Diagnóstico/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/sangre , Estudios de Evaluación como Asunto , Femenino , Helicobacter pylori/inmunología , Humanos , Masculino , Persona de Mediana Edad
13.
No Shinkei Geka ; 28(10): 873-7, 2000 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-11070907

RESUMEN

This report concerns percutaneous endoscopic gastrostomy (PEG) administered in the neurosurgical care unit to a patient with dysphasia. This reliable nutrition route has the major advantage of minimal surgical invasion and can be expected to become a standard nutritional method. Since patients with neurological disorders account for the majority of those who need PEG, neurosurgeons need to be aware of the importance of PEG.


Asunto(s)
Trastornos de Deglución/cirugía , Nutrición Enteral , Gastroscopía , Gastrostomía/métodos , Anciano , Anciano de 80 o más Años , Lesiones Encefálicas/complicaciones , Hemorragia Cerebral/complicaciones , Infarto Cerebral/complicaciones , Trastornos de Deglución/etiología , Femenino , Gastrostomía/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Apoyo Nutricional , Nutrición Parenteral
15.
Hinyokika Kiyo ; 37(1): 21-4, 1991 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-1707215

RESUMEN

Peplomycin emulsified in hydroxypropyl cellulosum (HPC-PEP) was prepared for intravesical chemotherapy. Clinical efficacy of HPC-PEP and tissue concentration of peplomycin (PEP) were studied in 12 patients with bladder tumor. Histopathology showed transitional cell carcinoma; 2 in grade 1,8 in grade 2, and 2 in grade 3. The total volume of 30 ml HPC-PEP was prepared from a mixture of 2% HPC and 90 mg PEP in 15 ml saline, and was intravesically administered through a urethral catheter and retained for two hours. Clinical evaluation 7 days after the initial instillation demonstrated good tumor regression in 2, good response in 5, and no change in 5. The mean PEP level in tumor tissue was 0.36 microgram/gr after 7 days and 0.19 microgram/gr even after 14 days. These clinical observations and tissue levels of PEP suggest that HPC-PEP might be useful as an intravesical instillation agent for bladder tumor.


Asunto(s)
Bleomicina/farmacocinética , Carcinoma de Células Transicionales/tratamiento farmacológico , Celulosa/análogos & derivados , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Vejiga Urinaria/metabolismo , Administración Intravesical , Adulto , Anciano , Bleomicina/administración & dosificación , Bleomicina/sangre , Carcinoma de Células Transicionales/metabolismo , Carcinoma de Células Transicionales/patología , Celulosa/administración & dosificación , Preparaciones de Acción Retardada , Emulsiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peplomicina , Neoplasias de la Vejiga Urinaria/metabolismo , Neoplasias de la Vejiga Urinaria/patología
16.
Hinyokika Kiyo ; 35(7): 1125-8, 1989 Jul.
Artículo en Japonés | MEDLINE | ID: mdl-2478007

RESUMEN

Urinary splitting enzymes and proteins including N-acetyl-b-D-glucosanimidase (NAG), beta 2 microglobulin (beta 2MG), and alpha 1 microglobulin: (alpha 1MG), which are established to be useful in the evaluation of renal dysfunction, especially renal tubular impairment, were measured to determine the extent of renal tubular impairment in relation to the degree of glomerular dysfunction in patients with renal deterioration. In healthy volunteers, urinary NAG, alpha 1MG and beta 2MG levels were 3.5 +/- 1.4 (mean +/- SD) U/g creatinine, 2.5 +/- 2.0 mg/l and 88 +/- 75 micrograms/l, respectively. While serum beta 2MG level (SBMG; microgram/ml) was between 2.0 and 2.9, among the patients with renal dysfunction, NAG, alpha 1MG and BMG levels showed 8.6 +/- 5.5, 9.8 +/- 5.8 and 785 +/- 1,264, respectively, and further elevated to 10.1 +/- 5.0, 16.5 +/- 0.7 and 525 +/- 440, respectively with a SBMG level over 3.0. Thus glomerular function was deteriorated, urinary alpha 1MG level elevated to significantly higher with a parallel to renal dysfunction. In patients with more severe renal dysfunction, the corresponding urinary NAG and alpha 1MG levels became significantly higher. However, urinary beta 2MG level was significantly higher in patients with moderate renal dysfunction compared to healthy volunteers only when SBMG level was more than 2.0. Therefore, it was more valuable to measure urinary alpha 1MG with NAG or beta 2MG at SBMG level of less than 1.9 and to determine urinary NAG and alpha 1MG at greater than 2.0. These results indicated that the measurement of the levels of urinary splitting enzymes and proteins is valuable in the evaluation of proximal tubular impairment, even when the degree of glomerular impairment is minimal.(ABSTRACT TRUNCATED AT 250 WORDS)


Asunto(s)
Acetilglucosaminidasa/orina , alfa-Globulinas/orina , Tasa de Filtración Glomerular , Hexosaminidasas/orina , Enfermedades Renales/fisiopatología , Microglobulina beta-2/orina , Humanos , Túbulos Renales Proximales , Proteinuria/fisiopatología
17.
Hinyokika Kiyo ; 35(4): 571-5, 1989 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-2567570

RESUMEN

Renal toxicity of non-ionic contrast medium (iohexol) for drip infused pyelography (DIP) was studied in a randomized trial of nine patients with normal renal function. Urine samples were collected before and immediately after DIP, and analyzed for albumin, an index of glomerular permeability; gamma-glutamyl transpeptidase (gamma-GTP), a brush-border enzyme; N-acetyl-beta-glucosaminidase (NAG), a lysosomal enzyme; alpha 1 microglobulin (alpha 1MG) and beta 2 microglobulin (beta 2MG), an index to tubular proteinuria; and creatinine. The urinary excretion of enzymes and proteins was compared with urinary creatinine. Urinary excretion of gamma-GTP and NAG increased significantly (P less than 0.001, 0.02) after DIP. Urinary alpha 1 MG and beta 2-MG did not change significantly. The change of urinary albumin was mild. Our data suggest that non-ionic, low osmolal radiocontrast medium ioheol shows a lower renal tubular toxicity, and the brush-border enzyme gamma-GTP and lysosomal enzyme NAG are considered as a good index for renal tubular damage.


Asunto(s)
Acetilglucosaminidasa/orina , Medios de Contraste/efectos adversos , Tasa de Filtración Glomerular/efectos de los fármacos , Hexosaminidasas/orina , Yohexol/efectos adversos , gamma-Glutamiltransferasa/orina , Anciano , Albuminuria , Femenino , Humanos , Túbulos Renales/efectos de los fármacos , Masculino , Persona de Mediana Edad , Urografía
18.
Nihon Hinyokika Gakkai Zasshi ; 80(1): 35-8, 1989 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-2657157

RESUMEN

Transrectal longitudinal ultrasonography was performed in 34 patients with chronic non-bacterial prostatitis. Prostatic stones and cystic lesions were associated with chronic non-bacterial prostatitis in 67.6% and 11.8%, respectively. The annual relapse rates of clinical symptoms were related to the presence of prostatic stones and cystic lesions. Transrectal ultrasonography plays a very important role in predicting the clinical courses of chronic non-bacterial prostatitis.


Asunto(s)
Prostatitis/diagnóstico , Ultrasonografía/métodos , Adulto , Cálculos/complicaciones , Enfermedad Crónica , Quistes/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Enfermedades de la Próstata/complicaciones , Prostatitis/complicaciones , Recurrencia
20.
Hinyokika Kiyo ; 34(9): 1679-82, 1988 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-3213801

RESUMEN

An antifungal agent (Flucytosine) was used to treat urinary candidiasis in 9 patients who had an indwelling catheter and developed fungal colony counts greater than 10(4). Among 9 patients with catheter drainage, urologic underlying diseases were benign prostatic hyperplasia in 7 and a neurogenic bladder in one patient all of whom had accompanied diabetes mellitus. Only one patient was supravesically diverted from the upper urinary tract through an indwelling catheter of bilateral ureterocutaneostomy after the removal of a tumorous bladder. All patients had previously received antimicrobials. Isolated strains of Candida were Candida albicans in 6, Candida tropicalis in 2, and Candida parapsilosis in one patient. Out of 9 patients having received daily administration of 1,500 mg Flucytosine for 2 weeks, 7 patients subsequently had no yield of fungal colony after the treatment. Minimum inhibitory concentration (MIC) of this agent was determined at the range of 0.1 to 0.2 microgram/ml in 5 patients with C. albicans and 0.2 microgram/ml in both patients with C. tropicalis. Otherwise, a high MIC of over 100 micrograms/ml indicating resistance to this agent was observed in only 2 patients with C. albicans and C. parapsilosis. Three of the 7 patients had recurrent urinary Candida infection even 2 weeks after the discontinuation of this antifungal therapy despite rapid and excellent eradication of urinary candidiasis. From these results, Flucytosine may be one of the most promising antifungal agent with a low MIC in the treatment of compromised urinary Candida infection and should be occasionally supplemented with a topical instillation of amphotericin B without any serious complication in the prevention of recurrence.


Asunto(s)
Antiinfecciosos Urinarios/uso terapéutico , Candidiasis/tratamiento farmacológico , Flucitosina/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antiinfecciosos Urinarios/administración & dosificación , Candida/efectos de los fármacos , Candida/crecimiento & desarrollo , Candidiasis/microbiología , Evaluación de Medicamentos , Femenino , Flucitosina/administración & dosificación , Humanos , Masculino , Recurrencia , Infecciones Urinarias/microbiología
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