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Biomedical subjects

F Gejyo

Publications and source records attributed to F Gejyo.

At least 163 records · Page 9Linked to original sources
PubMed1995

[Quantitative urine microscopic examination using disposable counting chamber for diagnosis of urinary tract infection].

Routine urinalysis is performed as a screening test for urinary tract infection (UTI) in out-patients or in-patients. We assessed the usefulness of microscopic examination of unspun and unstained urine using a disposable slide with counting chambers (Kova Slide 10 grid, Miles-Sankyo) for diagnosis of significant bacteriuria. 173 fresh urine samples were obtained from 173 subjects (89 male and 84 (female), including 117 inpatients, aged from 0 to 96 years. Urine samples were examined for bacteriuria by the standard culture method and counting chamber method. Significant bacteriuria was defined as 10(5)/ml or more of bacilli for midstream urine and urine collected by bags and 10(4)/ml or more for urine collected by catheterization and from indwelling catheters. Urine leukocytes were also counted on disposable slide. The rapid dipstick test (N-multistix-SG-10, Miles-Sankyo) of leukocyte esterase activity and nitrite were measured in the urine specimens read by a photometer (Clinitek-10, Miles-Sankyo). Significant bacteriuria was diagnosed by standard culture method in 67 urine samples. Close correlation was obtained between bacterial counts determined by the bacterial culture and counting chamber method (Spearman's correlation coefficient p < 0.001). Sensitivity and negative predictive value for significant bacteriuria were 94.0 and 95.1%, respectively, when bacteriuria or pyuria was present in the counting chamber. Dipstick test had a sensitivity and negative predictive value of 86.6 and 89.9%, respectively, when either leukocyte esterase activity of + or more, or nitrite of + was found. In out-patients, both sensitivity and negative predictive value were as high as 100% in counting chamber method. Thus, we can conclude that urine microscopy on disposable counting chambers is a very sensitive, simple, time-saving and lost-effective method for diagnosis of UTI.

Adolescent↗
PubMed1995

131I-beta 2-microglobulin scintigraphy in patients with dialysis amyloidosis.

The noninvasive detection of amyloid deposits has recently become possible using scintigraphy with radiolabelled amyloid precursor protein (131I-beta 2-M). We studied 131I-beta 2-M scintigraphy in 15 dialysis patients with special attention to the mechanism of the localized accumulation of tracer. Scintiscans were positive in 8 of the 15 patients. Those with histologically proved amyloid deposits had positive images at the large joints with a continuous accumulation of tracer after 48, 72 and 144 hours. The most significant accumulation occurred bilaterally in the hip joints, followed by the shoulders and knees. Mild uptake was observed in the hands, elbows and feet. No apparent uptake of tracer occurred in patients with secondary hyperparathyroidism, pseudo-gout or AA-type amyloidosis. Three patients were operated for CTS during this study. The radioactivity of tissue excised during the operation was 2-18 times higher than that of fat or plasma. Study of synovial tissue showed that some of the cells surrounding the amyloid deposits took up the radiolabelled tracer. The present study suggests that circulating 131I-beta 2-M is taken up by the cells surrounding the amyloid deposits and detected as a positive scan. It is not known whether these cells react secondarily to amyloid deposits, or whether they take up beta 2-M and form amyloid fibrils.

Adult↗
PubMed1994

Autosomal dominant polycystic kidney disease complicated by primary aldosteronism. Case report and review of the literature.

We report the case of a 42-year-old woman with autosomal dominant polycystic kidney disease complicated by primary aldosteronism. She had a history of hypertension for 12 years and was found to have hypokalemia and polycystic renal and hepatic disease. Endocrinological tests revealed hyporeninemia and hyperaldosteronemia. Adrenal scintigraphy and venography demonstrated a left adrenal adenoma. Blood sampled from the adrenal veins confirmed hyperaldosteronemia originating from the left adrenal gland. Left adrenalectomy was performed. After surgery, plasma renin activity, plasma aldosterone titer, and serum potassium level normalized. The mechanism for the development of primary aldosteronism with autosomal dominant polycystic kidney disease may be related to the activation of the renin-angiotensin system. Four years after left adrenalectomy, hepatic but not renal cysts showed a remarkable increase; the improvement in hypokalemia may have delayed the progression of kidney cysts.

Adenoma↗
PubMed1994

Acquired type II protein C deficiency in a long-term hemodialysis patient.

We present a 57-year-old man with end-stage renal failure due to chronic glomerulonephritis, who had been on hemodialysis for 13.5 years and had suffered from recurrent painful swelling of the left leg for 4.7 years. A diagnosis of deep venous thrombosis was made by the phlebography. Coagulation studies showed decreased protein C activity despite a normal protein C antigen level. None of his relatives had decreased protein C activity, and the levels of the other coagulation factors synthesized by the liver were all normal. Accordingly, the patient was diagnosed as having acquired type II protein C deficiency.

Glomerulonephritis↗
PubMed1993

A new therapeutic approach to dialysis amyloidosis: intensive removal of beta 2-microglobulin with adsorbent column.

Amyloidosis, in which amyloid protein consists of beta 2-microglobulin (beta 2-M), is both a common and a serious complication of long-term hemodialysis. The mechanism of its development is not completely understood. Since beta 2-M is an amyloid protein, it is essential to try to remove as much of it as possible. A specific adsorbent of beta 2-M has been developed for use in direct hemoperfusion. The adsorbent is a porous cellulose bead to which hydrophobic organic compound is bound covalently. A combination of a high-flux membrane dialyzer and an adsorption column (BM-01) would make it possible to efficiently eliminate beta 2-M. Dialysis with a combination of direct hemoperfusion (DHP) and an adsorption column led to the elimination of more than 200-300 mg of beta 2-M. We observed 5 patients who received treatment with this column (BM-01) in combination with high-flux dialysis 3 times a week for periods of 1 week (3 patients), 6 months (1 patient), or 14 months (1 patient). It is demonstrated that the adsorbent column (BM-01) provides an intensive method to eliminate beta 2-M from the blood with no serious adverse effect. It thus has the potential to suppress the progression of dialysis amyloidosis. The use of this adsorbent column (BM-01) in combination with a high-flux dialyzer may present an improved approach to removing beta 2-M from the body.

Adsorption↗
PubMed1993

Long-term complications of dialysis: pathogenic factors with special reference to amyloidosis.

Amyloidosis, caused by amyloid containing beta 2-microglobulin (beta 2m), is a frequent complication of long-term hemodialysis. The precise mechanism of its pathogenesis is not known. While beta 2m is an amyloid protein, other factors likely are involved in the pathogenesis of such amyloidosis. In treating patients with dialysis-related amyloidosis, it is essential to remove as much beta 2m from the blood as possible. In this respect, progress has been made in developing a column to adsorb beta 2m from the blood. Using a combination of a high-flux dialyzer and an adsorption column, it becomes possible to efficiently eliminate beta 2m. We have treated four patients with this column in combination with a high-flux dialyzer three times a week for periods of one month or one year. The absorbent column eliminates beta 2m from the blood, and may thus halt or slow the progression of beta 2m-related amyloidosis. However, such treatment is still in a preliminary phase; long-term studies are required to determine clinical efficacy.

Amyloidosis↗
PubMed1992

Antithrombogenicity of polyacrylonitrile-polyethyleneoxide hollow fiber membrane developed for designing an antithrombogenic continuous ultrafiltration system.

To develop a continuous arteriovenous hemofiltration (CAVH) system, which does not need systemic anticoagulation, for patients of acute renal failure having bleeding tendencies, a totally antithrombogenic continuous ultrafiltration system (ACUS) was designed, which consists of an antithrombogenic polyacrylonitrile-polyethyleneoxide (PAN-PEO) hollow fiber membrane and ionically heparin-bound catheter, tubing, and module header. Antithrombogenicity of PAN-PEO membrane, which occupies more than 90% of total inner surface area of ACUS, was considered to be due to highly concentrated PEO near the inner surface of the membrane and the finely dispersed (less than 500 A) microstructure of the inner surface. ACUS was applied to 24 patients without systemic anticoagulation, and one filter worked for an average of 32 h without deteriorating their bleeding tendencies. Any significant changes in major parameters of biocompatibility during those treatments were not observed. More than 200 ml/h of ultrafiltrate was obtained even under very low mean blood pressure, less than 70 mm Hg. Based upon these results, ACUS was concluded to be suitable for mild and sustained treatment to control fluid and electrolyte balance in patients of acute renal failure with bleeding complications.

Acrylic Resins↗
PubMed1992

Immunohistological localization of beta-2-microglobulin in renal tissue as an indicator of renal dysfunction.

To elucidate the relationship between localization of beta 2-microglobulin (beta 2-MG) and renal lesions or dysfunction, 119 patients with various renal diseases and various degrees of renal injuries were examined: patients with beta 2-MG deposition (group 1, n = 69), and patients without renal beta 2-MG deposition (group 2, n = 50). beta 2-MG was found mainly in the tubular epithelium and tubular casts. No significant difference in the degree of proteinuria and hematuria were found between the two groups. Group 1 had a significant decrease in glomerular filtration rate (GFR; p less than 0.01): the average values of GFR in group 1 and 2 were 61.1 +/- 35.7 and 95.4 +/- 34.5 ml/min. Group 1 had a significant decrease in the phenolsulfonphthalein excretion test (p less than 0.01) and the maximum urine specific gravity in Fishberg's concentration test (p less than 0.02). Group 1 had a significant high incidence of glomerular sclerotic lesions (p less than 0.001), arteriolar elastosis (p less than 0.01), tubulo-interstitial changes (p less than 0.001) and renal deposition of lysozyme (p less than 0.001). The present study demonstrates that the immunohistological study of renal beta 2-MG deposition is a reliable method to identify renal dysfunction and renal injuries, especially the presence of tubulo-interstitial changes, in various renal diseases.

Adolescent↗
PubMed1992

Clinical studies of destructive spondyloarthropathy in long-term hemodialysis patients.

Destructive spondyloarthropathy (DSA) has recently been recognized in hemodialysis patients. This study was undertaken to assess the prevalence, preferred sites, risk factors, early radiological manifestations, magnetic resonance imaging (MRI) and relation to other radiological features and biochemical variables in DSA. In 405 patients undergoing dialysis for 0.2-20.5 years (average 8.2) with a mean age of 51.9 years (range 24-84), a diagnosis of DSA was made for 37 (9.1%). The preferred site of DSA was the lower cervical spine. MRI indicated a low signal intensity of the involved vertebral regions on both T1- and T2-weighted images and thus appeared useful in the exclusion of osteomyelitis showing high-intensity T2-weighted images. The patients were divided into three groups according to radiological findings: those showing (A) the presence of DSA, (B) vertebral rim erosion (VRE) without DSA, and (C) the absence of DSA and VRE. Patient age at onset of dialysis (p less than 0.01) and duration of hemodialysis (p less than 0.05) appeared to be the associated risk factors for DSA. DSA was found correlated with carpal tunnel syndrome (p less than 0.01), carpal bone cystic radiolucency (p less than 0.01), and amyloid deposit (p less than 0.01). All the groups were essentially the same with respect to the incidence of ectopic calcification, secondary hyperparathyroidism, biochemical markers and sex distribution. The results of this study show DSA to be associated with dialysis amyloidosis.

Diagnosis, Differential↗
PubMed1992

Cystic radiolucencies of carpal bones, distal radius and ulna as a marker for dialysis-associated amyloid osteoarthropathy.

Patients on long-term hemodialysis (HD) are known to develop amyloid osteoarthropathy, evidenced as cystic radiolucencies on X-rays of the affected joints. To study the relationship between cystic radiolucencies and amyloid osteoarthropathy in 394 patients, we classified the severity of the cystic radiolucencies seen in the wrist joint on a 4-point scale and evaluated the association between lesion severity (grade) and several parameters. Biopsy was performed in 8 patients with 11 bone cysts of the wrist joint who had been operated for carpal tunnel syndrome. HD for 10 years or longer, age 50 or older and the presence of carpal tunnel syndrome were associated with severe cyst rating. There was no association between lesion grade and serum level of PTH-C, aluminum or beta 2-microglobulin (B2M). Ten of the 11 biopsied bone cysts in 8 patients with carpal tunnel syndrome demonstrated amyloid deposits which reacted with B2M. We conclude that a cystic radiolucency observed in the wrist joint of a patient undergoing HD indicates the deposition of amyloid. The cyst grade provides a useful marker for the severity of amyloid osteoarthropathy in HD patients.

Adult↗
PubMed1992

Primary localized amyloidosis of the bladder: a case of AL (lambda) amyloid protein and combination therapy using dimethyl sulfoxide and cepharanthin.

We report a case of primary localized amyloidosis of the bladder with amyloid deposits which was characterized as being of immunoglobulin light chain origin (AL) including lambda type (A lambda) and P component (AP) using the KMnO4 pretreatment method and immunohistochemical procedures. The patient was treated successfully with intravesical dimethyl sulfoxide instillation and oral administration of high-dose cepharanthin after transurethral resection. Combination therapy with dimethyl sulfoxide and cepharanthin was shown to be useful for primary localized amyloidosis of the bladder.

Aged↗
PubMed1991

Development of a new antithrombogenic continuous ultrafiltration system.

By interfacing a polyacrylonitrile (PAN)-polyethyleneoxide (PEO) membrane with an ionically heparin-bound catheter, tubing, and module header, a totally antithrombogenic continuous ultrafiltration system (ACUS) was developed and its performance, persistent antithrombogenicity, and well-maintained ultrafiltration level were confirmed through animal experiments. Although the amount of heparin released and accumulated in vitro from those heparinized parts was very low and stable (on the order of 1 x 10(-2) U/cm2/min), partial thromboplastin time evaluated in vivo was not elongated during passage through the ACUS. Extracorporeal circulation time with the ACUS in unheparinized dog model was 458 +/- 302 min (n = 24), whereas those of partially modified (antithrombogenic) system did not exceed 100 min. As compared with that in a conventional continuous arteriovenous hemofiltration system, an extracorporeal circulation with the ACUS in an unheparinized dog model revealed significantly less fluctuation of platelet count, and no adherent platelets were observed on the surface of the PAN-PEO membrane. An ACUS consisting of a PAN-PEO membrane and heparinized parts was thus demonstrated to have good platelet compatibility. An ACUS with a surface area of 0.25 m2 was applied to two patients with acute renal failure. Hemofiltration without systemic heparinization lasted for 44 h per hemofilter, and a stable level of ultrafiltration was maintained. This system seems to be applicable for the clinical management of volume overload, especially in patients with bleeding tendencies or postoperative bleeding.

Acrylic Resins↗
PubMed1991

A magnetic resonance imaging study of destructive spondyloarthropathy in long-term hemodialysis patients.

It is most important to differentiate destructive spondyloarthropathy (DSA) from vertebral osteomyelitis (VOM), both showing similar roentgenographic findings and evaluate the spinal involvement of DSA. Magnetic resonance imaging (MRI) is useful for morphological and biochemical analysis of spinal lesions, but few studies have been conducted on DSA. The authors detected 20 patients with DSA among 237 hemodialysis patients and conducted a study on 4 of them. The involved vertebral regions all showed low signal intensity on T1- and T2-weighted images. VOM can be visualized as areas of high signal intensity on T2-weighted images. In 2 of the patients, impingement was noted on the thecal sac both anteriorly and posteriorly. From the results of this study, MRI of DSA was shown to facilitate the exclusion of infectious processes and evaluation of spinal involvement.

Aged↗