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Biomedical subjects

M Yanai

Publications and source records attributed to M Yanai.

At least 91 records · Page 5Linked to original sources

Responsiveness of and interactions between airways and tissue in guinea pigs during induced constriction.

Mechanical interdependence between airways and tissues can modify the magnitude of induced bronchoconstriction. We questioned whether the guinea pig, an animal with abundant airway smooth muscle, would differ from other species in the relative responsiveness of and interactions between airways and tissues. Therefore we induced constriction with aerosolized methacholine (MCh) and partitioned responses into airway and tissue components. We measured tracheal and alveolar pressures using alveolar capsules in open-chest guinea pigs (n = 9) during mechanical ventilation [frequency = 1 Hz, tidal volume = 6 ml/kg, positive end-expiratory pressure (PEEP) = 5 cmH2O] and calculated the resistance of lung (RL), tissue (Rti), and airway (Raw) before and after administration of aerosols of MCh in progressively doubling concentrations (0.063-16 mg/ml). In separate animals (n = 10), measurements were made at 3-13 cmH2O PEEP. After aerosols of saline and MCh (0.125-32 mg/ml), measurements were repeated at 3, 7, and 11 cmH2O PEEP. At submaximal levels of constriction, the airways and lung tissues demonstrated similar responsiveness. Increasing PEEP increased RL and Rti and decreased Raw under baseline conditions. At low concentrations of MCh, increasing PEEP increased RL but decreased RL at the highest concentration. Increases in PEEP significantly increased Rti at all concentrations of MCh but decreased Raw only at 8 mg/ml of MCh. These observations demonstrate that, in guinea pigs, during submaximal constriction, airways and tissues behave similarly; moreover, airway-parenchymal interdependence is important in determining the level of bronchoconstriction.

Aerosols↗

Kinetics of technetium-labeled heparin in hemodialyzed patients.

Technetium-labeled heparin kinetics studies were undertaken in 12 hemodialyzed patients, where heparin was used over a long term (1 to 10 years) for anticoagulation of the extracorporeal circuit. The 99mTc-heparin (99mTc VECTOSCINT, Solabco Nuclear, Coutras, France) used has a 10 mCi activity and a labeling efficiency of more than 95%. Two healthy subjects served as control. After an i.v. bolus of 2 ml 99mTc-heparin, corresponding to 170 +/- 10 IU, radioactivity of kidney, liver, knee and shoulder was recorded with a gamma camera at t1-h, t3-h and t6-h during 120, 152 and 215 s, respectively. Radioactivity recorded was computerized, giving quantitative data for comparison. In hemodialyzed patients, accumulation of radioactivity (mean +/- SEM 10(6) x activity count) was significantly higher at the knee (11.3 +/- 1.1 vs. 4.9 +/- 0.4; p < 0.05; 13.4 +/- 1.1 vs. 5.7 +/- 0.7; < 0.02; and 14.7 +/- 0.8 vs. 5.3 +/- 0.6; < 0.001), and on the shoulder (17.3 +/- 1.1 vs. 10.7 +/- 1.4; p < 0.05; 19.9 +/- 1.0 vs. 10.9 +/- 1.7; < 0.01; 20.8 +/- 1.1 vs. 10.1 +/- 0.9; < 0.01) at t1-h, t3-h and t6-h, respectively, than in control subjects at the same areas. Although direct evidence is not in hand, accumulation of heparin in bone tissue due to renal excretion failure could play a role in mineral metabolism resulting in osteopenia in hemodialyzed patients.

Bone and Bones↗

Urea rebound and residual renal function in the calculation of Kt/V and protein catabolic rate.

Kt/V-urea and protein catabolic rate (PCR) are used for dialysis prescription and evaluation of protein intake of patients on regular dialysis treatment. The study was undertaken to determine the implication of urea rebound and residual renal function (RRF) on the calculation of Kt/V-urea and PCR for 61 patients. Kt/V-urea and PCR were calculated, implementing or not urea rebound at one hour after the end of dialysis session. Urea and creatinine rebound rate in patients without RRF was significantly higher than in patients with RRF (P < 0.05). In patients without RRF, creatinine generation rate and Kt/V-urea calculated without rebound were significantly higher than calculated with rebound (P < 0.001). On the contrary, calculation of urea generation and PCR is not affected by these parameters. It is concluded that: (1) Rebound rate magnitude of urea and creatinine is dependent on solute molecular weight, RRF and probably on dialysis duration, whereas rebound rate magnitude of phosphorus is not affected, and (2) Rebound should be taken into account in the calculation of Kt/V-urea and creatinine generation rate in patients without RRF, otherwise, they would be overestimated.

Aged↗

The most suitable calculation of Kt/V-urea: Kt/V = ln(Ci/Cf).

Although various simplified calculation formulae of Kt/V-urea based on urea kinetic modeling have been reported, all the formulae include errors such as post-dialysis urea rebound and urea generation during a dialysis session. In the present study, in order to calculate the precise Kt/V-urea, a formula of Kt/V-urea, taking into account post-dialysis plasma urea rebound and urea generation during a dialysis session (Kt/V-P) was proposed, and compared to other formulae already published, in 49 dialysis patients without residual renal function (26 M and 23 F; mean age, 65 +/- 2 years; mean dialysis duration, 70 +/- 7 mos). The precise post-dialysis plasma urea concentration was significantly higher than the actually measured post-dialysis plasma urea concentration by approximately 12%, and Kt/V-P corresponded to Kt/V-urea = ln(Ci/Cf) with the best correlation in the formulae utilized in the present study, around 1 of Kt/V-urea, which is clinically the most important range. It is concluded that Kt/V-urea = ln(Ci/Cf) is the most suitable formula for the calculation of Kt/V-urea, when post-dialysis plasma urea rebound and urea generation during a dialysis session are taken into account.

Aged↗

How long can continuous ambulatory peritoneal dialysis be continued?

We investigated how long continuous ambulatory peritoneal dialysis (CAPD) could be continued in the face of peritoneal sclerosis. 15 CAPD patients with no experience of peritonitis were selected and the time limitation for CAPD was examined retrospectively, based on the dialysate osmolality, serum creatinine concentration, etc.. The values for the dialysate osmolality and serum creatinine concentration increased gradually with the duration of CAPD and were significantly increased from 6 months. 5 patients whose serum creatinine concentration during the first 6 months after initiation of CAPD increased more than 5 mg/dl, could not continue CAPD for more than 24 months because of the appearance of peritoneal membrane failure. When the time limitation for CAPD was assessed in 10 stable patients, close relationships between the mean dialysate osmolality and duration of CAPD (Y = 0.52X + 351.25, r = 0.83, P < 0.01), and between the mean serum creatinine concentration and duration of CAPD (Y = 0.18X + 6.84, r = 0.95, P < 0.001) were recognized. If the practical limitation for CAPD was set at 400 mOsm/l in terms of the dialysate osmolality or 20 mg/dl in terms of serum creatinine concentration, its value became 94.1 months or 73.1 months, respectively. It is concluded that the time limitation for CAPD can be expected to be approximately 6 to 8 years in stable CAPD patients, and we need to resolve CAPD-induced problems involving the peritoneal membrane in order to continue CAPD for more than 10 years.

Adult↗

Oral 1,25(OH)2D3 pulse therapy for the treatment of secondary hyperparathyroidism.

We examined the effect of oral 1,25(OH)2D3 pulse therapy in hemodialyzed patients with secondary hyperparthyroidism (2 degrees HPT). Prescription of 6.0 micrograms 1,25(OH)2D3 once a week combined with calcium carbonate as a phosphate binder during the last 5 days a week for 12 weeks resulted in improvement of mild to moderate 2 degrees HPT despite no significant differences in serum total calcium and phosphate concentration. In addition, the effect was greater in cases with mild 2 degrees HPT. A single administration of 6 micrograms 1,25(OH)2D3 reduced the parathyroid hormone concentration in patients with mild 2 degrees HPT or with a short duration of hemodialysis. Tmax of the serum 1,25(OH)2D3 after single administration of 6.0 micrograms 1,25(OH)2D3 was individually different (range, 0.4-20.9 hrs). It is recommended that early employment of oral 1,25(OH)2D3 pulse therapy be undertaken once a week combined with prescription of calcium salt as a phosphate binder during the last 5 days a week for the treatment of 2 degrees HPT refractory to conventional therapy, since there is no risk of aluminum accumulation with satisfactory control of the serum total calcium and phosphate concentration.

Administration, Oral↗

A case complicated with SLE during maintenance hemodialysis.

A 40-year-old woman suffered from toxemia of pregnancy in 1977 and was admitted to hospital. Thereafter, she developed nephrotic syndrome, underwent a renal biopsy, and a diagnosis of membranoproliferative glomerulonephritis (MPGN) was made. She received steroid therapy, immunosuppressive drug and anticoagulant therapy, and recovered sufficiently to be discharged from hospital in April, 1979. During subsequent ambulatory treatment at our outpatient department, her renal function deteriorated gradually, and maintenance hemodialysis was started from June, 1990. In July, 1991, she was admitted to our hospital with pleurisy and pericarditis. There was no improvement despite antibiotic treatments. Laboratory data revealed leukopenia and lymphopenia. Under suspicion of systemic lupus erythematosus (SLE), relevant tests were carried out. Immunological abnormalities such as positive LE cells and the presence of various autoantibodies, together with clinical signs of hypersensitivity to sunlight, stomatitis and serositis, satisfied the diagnostic criteria of the ARA and a diagnosis of SLE was made. This case did not exhibit any clinical or serological abnormalities except for the renal disorder for a 10-year period after the histological diagnosis of MPGN, but was eventually diagnosed as SLE as a result of the manifestation of SLE symptoms for the first time after one year of maintenance hemodialysis. Immunological abnormalities and SLE during maintenance hemodialysis are discussed in relation to other reports.

Adult↗

Site of airway obstruction in pulmonary disease: direct measurement of intrabronchial pressure.

To partition the central and peripheral airway resistance in awake humans, a catheter-tipped micromanometer sensing lateral pressure of the airway was wedged into the right lower lobe of a 3-mm-ID bronchus in 5 normal subjects, 7 patients with chronic bronchitis, 8 patients with emphysema, and 20 patients with bronchial asthma. We simultaneously measured mouth flow, transpulmonary pressure, and intra-airway lateral pressure during quiet tidal breathing. Total pulmonary resistance (RL) was calculated from transpulmonary pressure and mouth flow and central airway resistance (Rc) from intra-airway lateral pressure and mouth flow. Peripheral airway resistance (Rp) was obtained by the subtraction of Rc from RL. The technique permitted identification of the site of airway resistance changes. In normal subjects, RL was 3.2 +/- 0.2 (SE) cmH2O.l-1.s and the ratio of Rp to RL was 0.24 during inspiration. Patients with bronchial asthma without airflow obstruction showed values of Rc and Rp similar to those of normal subjects. Although Rc showed a tendency to increase, only Rp significantly increased in those patients with bronchial asthma with airflow obstruction and patients with chronic bronchitis and emphysema. The ratio of Rp to RL significantly increased in three groups of patients with airflow obstruction (P less than 0.01). These observations suggest that peripheral airways are the predominant site of airflow obstruction, irrespective of the different pathogenesis of chronic airflow obstruction.

Adult↗

Effective site of bronchodilation by beta-adrenergic and anticholinergic agents in patients with chronic obstructive pulmonary disease: direct measurement of intrabronchial pressure with a new catheter.

To study the effective site of bronchodilators in patients with chronic obstructive pulmonary disease (COPD), a catheter tip micromanometer sensing lateral pressure of the airway was wedged into the right lower lobe of a bronchus, 3 mm inner diameter, in 14 patients with COPD. We simultaneously measured mouth flow, transpulmonary pressure (PL) and intra-airway lateral pressure during quiet tidal breathing. Total pulmonary resistance (RL) was calculated from PL and mouth flow, and central airway resistance (RC) was calculated from intra-airway lateral pressure and mouth flow. Peripheral airway resistance (RP) was obtained by the subtraction of RC from RL. This technique permitted identification of the site of changes in airway resistance. Atropine sulfate (5 mg/ml) was continuously inhaled during tidal breathing for 1 min by seven patients (Group A), and the other seven patients (Group B) inhaled fenoterol (1 mg/ml) for 1 min. The doses that were actually delivered were 0.75 mg for atropine sulfate and 0.15 mg for fenoterol. The baseline resistances of RC and RP were 3.9 +/- 0.8 and 3.7 +/- 0.6 cm H2O/L/s in Group A, and 4.3 +/- 0.5 and 3.5 +/- 0.4 cm H2O/L/s in Group B, respectively. Both atropine sulfate and fenoterol significantly decreased RL by an average of 2.4 and 2.6 cm H2O/L/s, and there was no significant difference between them (p greater than 0.20). The percentage decrease in resistance from the baseline values by fenoterol did not differ significantly between RC and RP (p greater than 0.20). However, atropine sulfate significantly decreased RC more than RP.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗

Partitioning of pulmonary responses to inhaled methacholine in subjects with asymptomatic asthma.

To partition the central and peripheral airway resistance, a catheter-tip micromanometer sensing lateral pressure of the airway was wedged into the right lower lobe of a bronchus with a 3 mm inner diameter in 10 patients with asymptomatic asthma. We simultaneously measured mouth flow, transpulmonary pressure (PL) and intra-airway lateral pressure during tidal breathing. Total pulmonary resistance (RL) was calculated from PL and mouth flow, and central airway resistance (RC) was calculated from intra-airway lateral pressure and mouth flow. Peripheral airway resistance (Rp) was obtained by subtraction of RC from RL. Therefore, our measurement of Rp included lung tissue resistance. The technique permitted identification of the site of changes in airway resistance. The baseline values of resistances were 2.3 +/- 0.2 cm H2O/L/s in RL, 1.5 +/- 0.1 cm H2O/L/s in RC, and 0.8 +/- 0.1 cm H2O/L/s in Rp, respectively. To determine the site of airway hyperresponsiveness, dose-response curves of central, peripheral, and total airways to inhaled methacholine were separately constructed. Bronchial responsiveness was evaluated by a log methacholine unit requiring a 35% decrease (PC35) and a 50% decrease (PC50) in pulmonary conductance (a reciprocal of RL). We calculated the increase of resistances in total (delta RL), central (delta RC), and peripheral (delta Rp) airways from the baseline values at either PC35 or PC50.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Methylguanidine kinetics during oral active vitamin D pulse therapy for secondary hyperparathyroidism].

Active vitamin D (VD) metabolite preparations have been used in the management of secondary hyperparathyroidism (2 degrees HPT) due to impaired calcium and phosphorus metabolism and can allegedly be expected to prevent, to some extent, the progression of this pathological condition. Unfortunately, however, it is not uncommon for us in routine clinical practice to find 2 degrees HPT of moderate or greater severity embarrassingly unamenable to treatment with these VD preparations in ordinary oral therapeutic doses. Recent studies have gradually reported that intravenous administration of 1,25-(OH)2D3 and oral active VD pulse therapy has been therapeutic approach to 2 degrees HPT. Methylguanidine (MG) among other GCs, its precursor is already identified as creatinine and activated oxygen as well PTH and VD are known to participate in the process leading to its formation. In the present study, we administered oral 1,25-(OH)2D3 pulse therapy to patients with chronic renal failure for the treatment of 2 degrees HPT in an attempt to assess the effectiveness of this therapeutic regimen and to explore the clinical effect of MG on responsiveness to the therapy. The purpose of this paper is to present the results thus obtained. Oral 1,25-(OH)2D3 pulse therapy (6 micrograms once a week) was administered to 21 hemodialysis patients with for 12 weeks. Of these 21, 10 patients responded to the therapy with a more than 20% reduction in serum (PTH): (responsive group), whereas the remaining 11 did not (resistant group). Pretreatment serum PTH levels were significantly higher in the latter group than the former.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

Evaluation of parameters for adequate dialysis therapy: (2). Comparison between parameters according to UKM and other laboratory data.

Urea kinetic modeling (UKM) is often regarded as the best method for assessing the dialysis adequacy and consequently for the prescription of treatment time. However, other parameters are involved in the monitoring of end stage renal disease (ESRD) patients. Kt/V-urea and protein catabolic rate (pcr) were evaluated in 53 ESRD patients (25 males and 28 females; mean age, 60 +/- 2 years old; mean duration, 80 +/- 11 months), twice at an interval of 4 months, and pre-dialysis concentration of (pre-DC) plasma potassium, bicarbonate, calcium and phosphate were measured. The pre-dialysis systolic blood pressure and hematocrit were also recorded. The numbers of patients who were within the optimal range of Kt/V-urea and pcr recommended by Gotch and Sargent were 36 (67.9%) and 39 (73.6%), respectively, at the first control period, and 39 (73.6%) and 44 (83.0%) at the second control period. However, only about 50% of the patients were within the optimal range of pre-DC plasma calcium, phosphate and bicarbonate. Furthermore, very few patients fulfilled the conditions for all the parameters. It is concluded that (1) UKM is required to describe the domain of dialysis prescription, and (2) other parameters which are not dependent so much on dialysis should be taken into account for assessing the adequacy of dialysis.

Blood Chemical Analysis↗

Nicotine improves cognitive disturbance in rodents fed with a choline-deficient diet.

The effect of nicotine on learning disturbances was tested in rats. Rats were fed either a choline-enriched or a choline-deficient diet. Concentration of acetylcholine in the whole brain was significantly lower in rats fed with choline-deficient diet than rats fed with choline-enriched diet. Passive avoidance learning shows that rats on a choline-deficient diet showed significantly impaired learning compared to rats on a choline-enriched diet. Nicotine (0.04 mg/kg) administered intraperitoneally significantly potentiated learning in rats on a choline-deficient diet, as well as in rats on a choline-enriched diet. We, therefore, suggest that nicotine may potentiate learning in an acetylcholine-deprived brain.

Acetylcholine↗

Effective site of bronchodilation by antiasthma drugs in subjects with asthma.

We studied the effective sites of airway response to atropine and fenoterol aerosols and to the intravenous injection of aminophylline in patients with stable and spontaneous asthma, by the simultaneous assessment of respiratory resistance (Rrs) and anatomic dead space (VD). Central airway response was determined by VD, and overall response was determined by Rrs. Peripheral airway response was inferred from Rrs when the change in VD was slight. Atropine (4 mg/ml) or fenoterol (0.4 mg/ml) was continuously inhaled during tidal breathing for 5 minutes. Inhalation of both atropine and fenoterol increased Grs (reciprocal of Rrs) (p less than 0.01) with a simultaneous increase in VD (p less than 0.01) in the patients with stable and spontaneous asthma. Fenoterol increased Grs more than did atropine at an equivalent increase in VD in patients with spontaneous asthma (p less than 0.05). Intravenous injection of aminophylline (250 mg) had no effect on either Grs or VD in patients with stable asthma, but it significantly increased Grs (p less than 0.01) without change in VD in patients with spontaneous asthma. These results suggest that the predominant sites of bronchodilation induced by inhaled atropine are the central airways, that those sites induced by intravenous injection of aminophylline are the peripheral airways, and that inhaled fenoterol dilates both the central and peripheral airways in subjects with asthma. Differences among clinically used bronchodilators on the effective sites may be considered in the treatment of bronchial asthma.

Adult↗

The analysis of the defense mechanism against indigenous bacterial translocation in X-irradiated mice.

The defense mechanism against indigenous bacterial translocation was studied using a model of endogenous infection in X-irradiated mice. All mice irradiated with 9 Gy died from day 8 to day 15 after irradiation. The death of mice was observed in parallel with the appearance of bacteria from day 7 in various organs, and the causative agent was identified to be Escherichia coli, an indigenous bacterium translocating from the intestine. Decrease in the number of blood leukocytes, peritoneal cells and lymphocytes in Peyer's patches or mesenteric lymph nodes was observed as early as 1 day after irradiation with 6 or 9 Gy. The mitogenic response of lymphocytes from various lymphoid tissues was severely affected as well. The impairment of these parameters for host defense reached the peak 3 days after irradiation and there was no recovery. However, in vivo bactericidal activity of Kupffer cells in mice irradiated with 9 Gy was maintained in a normal level for a longer period. It was suggested that Kupffer cells play an important role in the defense against indigenous bacteria translocating from the intestine in mice.

Animals↗

Evaluation of parameters for adequate dialysis therapy: (1). Monitoring of parameters by urea kinetic modeling.

In an attempt to evaluate the adequacy of regular dialysis therapy, calculations of Kt/V-urea and protein catabolic rate (pcr) from the data of routine laboratory examinations by means of urea kinetic modeling were performed in 59 regular dialysis patients (28 males and 31 females; mean age, 59 +/- 2 years old; mean dialysis duration, 83 +/- 10 months). The mean values of Kt/V-urea and pcr were 1.10 +/- 0.04 and 0.98 +/- 0.03 g/kgBW.day, respectively. The number of patients who were within the optimal range (0.9-1.4 for Kt/V urea and 0.9-1.5 for pcr) was 37 (62.7%) for Kt/V-urea and 38 (64.4%) for pcr. Furthermore, we inferred that, based on an appropriate dietary protein intake, removal of urea by intermittent dialysis should be adjusted to maintain the patient in equilibrium for a defined pre-dialysis plasma urea concentration. From the data obtained, we concluded that: (1) it is possible to apply urea kinetic modeling on the basis of routine laboratory examinations, (2) it is important to maintain the pre-dialysis plasma urea concentration at more than a certain level, and (3) it is also important to control the post-dialysis plasma urea concentration at a low level.

Creatinine↗