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Biomedical subjects

T Agishi

Publications and source records attributed to T Agishi.

At least 73 records · Page 4Linked to original sources
PubMed1997

Plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis of kidney allograft in adult recipients.

Nephrotic syndrome due to focal segmental glomerulosclerosis (FGS) frequently recurs even after renal transplantation and may cause renal allograft failure. From January 1983 though April 1995, 11 adult recipients with primary FGS received 11 kidney transplants at our institution, and 3 of them were treated with pretransplant plasma exchange (PE). Other patients did not receive any preoperative PE, and 4 patients lost their grafts due to recurrent FGS (50%). PE was completed 3 times before the transplantation to prevent posttransplant recurrence of FGS. Two recipients did not have any proteinuria or graft dysfunction without posttransplant PE. One patient had mild proteinuria immediately after transplantation, and histological examination showed recurrent FGS. The patient has been undergoing PE once a month (2 years posttransplant). Her renal function is excellent (sCr 1.2 mg/dl), and her FGS is being well controlled by PE. PE seems to be effective for the prevention of the recurrence of FGS following renal transplantation.

Adult↗
PubMed1997

Neo red cell as an organ preservation solution.

Neo red cell (NRC) was derived from outdated human red cells. The following experimental work has been done in order to investigate if NRC is valid for organ preservation. Hearts were obtained from male Lewis rat (250-350 g body weight). Heart transplantation was performed as Ono-Lindsey's method after 1, 3, 6, 12 and 24 hours simple cold storage. Rats were divided into two groups. Group 1; original NRC as preservation solution, Group 2; modified NRC (NRC suspended with UW solution) as preservation solution. After 1, 3, and 6 hour cold ischemic storage, the transplanted hearts in both groups showed contraction immediately after declamping the aorta and the pulmonary artery. After 12 and 24 hour preservation, the transplanted hearts in group 2 showed contraction. Myocardial ATP levels after 6, 12, 24 hours cold storage compared with 0 hour were 62.3%, 28.3%, 32.8% in group 1 respectively. On the contrary, myocardial ATP levels were 87.2%, 57.6%, 52.2% in group 2 respectively. After 24 hour preservation, pathological change was not remarkable between the two groups. Results of the prolonged preservation time and the myocardial ATP changes suggest that there is a possibility for effective use of NRC not only as blood substitute but also organ preservation solution.

Adenosine Triphosphate↗
PubMed1996

The current status of extracorporeal immunomodulation.

A course of extracorporeal immunomodulation is defined as a treatment which intervenes and consequently modulates or, in other words, activates and/or suppresses the immune mechanisms utilizing an extracorporeal procedure. Such treatment has traditionally depended on administration of drugs, typically steroids and/or immunosuppressants. Most of the apheresis techniques currently available belong to or are very similar to those used for blood purification and involve the removal of the pathogenic substances such as antibody(ies) and/or immune complex(es). The cellular components are also treated in extracorporeal immunomodulation. As some of the extracorporeal immunomodulation techniques have already demonstrated clinical effectiveness that cannot be achieved by conventional therapies, it is appropriate to propose a new therapeutic approach to the immunological disorders.

Blood Component Removal↗
PubMed1996

Removal of anti-A/B antibodies for successful kidney transplantation between ABO blood type incompatible couples.

A growing shortage of cadaveric donors has prompted expansion of the criteria for acceptable living donors. Because of this, ABO-incompatible kidney transplantation has been carried out. To remove anti-A and/or anti-B antibodies, the recipients received one or two sessions of double filtration plasmapheresis (DFPP) and three or four sessions of immunoadsorption prior to transplantation until the anti-A IgG/IgM titers and/or anti-B IgG/IgM titers decreased to 1:16 or less. Our immunosuppressive protocol involved treatment with the drugs methylprednisolone, cyclosporine, azathioprine, anti lymphocyte globulin and deoxyspergualin. The patient survival was 98% at 1 month, 98% at 3 months, 94% at 6 months, and 92% at 1-5 years. Graft survival was 92% at 1 month, 88% at 3 months, 85% at 6 months, 81% at 1 year, and 76% at 5 years. Both DFPP and/or immunoadsorption eliminated anti-ABO antibodies from ABO-incompatible kidney transplant recipients effectively and safely. The results of the ABO-incompatible kidney transplantation were acceptable and not different from those of ABO-compatible cases.

ABO Blood-Group System↗
PubMed1996

Extracorporeal granulocytapheresis for cancer and rheumatoid arthritis.

In cancer and rheumatoid arthritis, granulocytosis is often observed and indicates the progress of disease. We developed a granulocytapheresis system to permit granulocyte reduction. Cellulose acetate was found to be a selective and effective adsorbent. In an in vivo study using an acetate bead column, 9.2 x 10(8) leukocytes were collected. Initially, granulocytapheresis was applied to terminal patients or those with stage IV cancer. Pain, cough and bloody sputum were reduced in spite of no decrease in tumor size. Granulocytapheresis appears to prevent inflammatory damage in or around the tumor site. This granulocyte reduction technique was also applied to patients with rheumatoid arthritis. The Lansbury index markedly improved after treatment. As cytokines and adhesion molecules might contribute to symptoms, granulocytapheresis may be useful in improving the "Quality of Life" in these diseases.

Aged↗
PubMed1996

Low-density lipoprotein adsorption for arteriosclerotic patients.

A wide variety of treatments is now available for arteriosclerosis obliterans (ASO) patients, not very successful in some cases. Low-density lipoprotein (LDL) apheresis using an extracorporeal adsorption column containing dextran sulfate cellulose beads was applied to control lipid levels intensively in ASO patients with accompanying drug-resistant hyperlipidemia. A series of the apheresis procedures had a remarkable impact on clinical symptoms and physiological findings with improvement in intermittent claudication observed in more than 80% of the patients. Improvements in plethysmogram and thermogram readings suggested an increased circulation in lower extremities in more than 80% of patients. In addition, the treatment improved blood rheology, as evidenced by a reduction in blood viscosity. In a follow-up study made by sending a questionnaire to previously treated patients it was revealed that improvements in clinical symptoms were well maintained even after cessation of the treatment. In conclusion, LDL apheresis proved to be a useful therapeutic tool in ASO patients having elevated lipid levels.

Adsorption↗
PubMed1996

Extracorporeal immunomodulation relevant to organ substitutions.

Multiple administration of the generally called immunosuppressing agents is the usual fashion for suppressing/ameliorating the rejection reaction that inevitably occurs after organ allotransplantation. Although a definite mechanism of the rejection reaction has not been elucidated, evidence has accumulated that cellular components, such as T- and B-lymphocytes, and humoral factors, such as antibodies and immune complexes, play a certain role. There also is a possibility that direct removal or functional revolution of those components and/or factors utilizing an extracorporeal procedure influence an immune mechanism of the rejection reaction. Some of the extracorporeal procedures, which have been developed from blood purification techniques, have been evidenced to modify an immune mechanism and, as a result, bring about better graft function to a considerable extent that may not be otherwise achieved by traditional immunosuppressant treatment. The term "extracorporeal immunomodulation" was given to such extracorporeal procedures.

Adjuvants, Immunologic↗
PubMed1996

A variety of clinical applicabilities of immobilized dextran sulphate as lipoprotein adsorbent and avoidance of anaphylactoid (anion-blood contact) reaction in its use.

Dyslipidemia including hyper-LDL(low density lipoprotein) cholesterol which is very often refractory to dietary/medical treatments is known to be a risk factor of many arteriosclerotic lesions. An extracorporeal procedure of plasma adsorption, LDL adsorption, utilizing dextran sulphate as a ligand immobilized on cellulose gel beads has been clinically applied in a variety of dyslipidemic conditions as listed below. Its usefulness in secure reduction of the serum LDL level and consequent symptomatic improvements has been confirmed. Familial hypercholesterolemia(FH): A regular repetition of the LDL adsorption ameliorates hyper-LDL cholesterolemia as resulting in regression of the multiple stenoses in the coronary arteries. Focal glomerulosclerosis(FGS): A seesion of the LDL adsorption improves kidney function and reduces a urinary protein excretion in FGS patients with dyslipidemia. Arteriosclerosis obliterans(ASO): More than 60 ASO patients with dyslipidemia have been treated by the LDL adsorption in our center. In over 80% of the patients, marked improvement in clinical symptoms such as leg pain/intermittent claudication has been brought out. Hemodialysis-relevant dyslipidemia(HDDL): HDDL which develops in the long-term HD patients has been treated. Transplantation-relevant dyslipidemia(TXDL): TXDL with deterioration of the transplanted kideny function has been treated by the LDL adsorption. Kidney function improves. Anaphylactoid reaction which is tentatively explained as a result of release of bradykinin in contact of blood with polyanionic material of the adsorbent, dextran sulphate, develops, in particular, while an angiotensin-converting enzyme inhibitor is administered as a depressant. However, it can be avoided in a use of nafmostat mesilate, a protease inhibitor, as an anticoagulant.

Adsorption↗
PubMed1996

[Treatment of arteriosclerotic obstruction by blood purification].

Almost a half of the patients with arteriosclerotic obstruction in the lower extremities is complicated with dyslipidemia (a blood total cholesterol level > or = 220 mg/dl and/or LDL cholesterol level > or = 140 mg/dl). Currently available plasma purification technics which actively correct dyslipidemia are whole-plasma exchange, double filtration plasmapheresis and LDL adsorption. However, because of the advantage in specificity in removal of LDL cholesterol, the LDL adsorption is most frequently applied in clinical practice. As a result of the LDL adsorption treatment, ten procedures for approximately 3 months as a usual treatment, course, sch as warmness, amelioration in pain and/or disappearance of ulcer in the lower extremities, elongation of a walk distance are obtained. Normalization of a total and LDL cholesterol level is also achieved. A rise in extremity temperature and improvement in plethysmograph are observed. These favorite effects are maintained in 80 to 90% of the patients so treated, respectively in different symptoms even averagely 1.2 years after a completion of the treatment course.

Arteriosclerosis Obliterans↗
PubMed1995

Clinical trial of new polyurethane vascular grafts for hemodialysis: compared with expanded polytetrafluoroethylene grafts.

We developed a new polyurethane vascular access graft coated with gelatin and reinforced with knitted polyester fibers (PE-PEUG). Advantages over expanded-polytetrafluoroethylene graft (E-PTFEG) were previously reported in experimental studies. Between May 1990 and August 1992, 39 PE-PEUGs including 34 loop and 5 straight and 18 E-PTFEGs including 18 loop were implanted to create arteriovenous (AV) fistulas in a total of 52 adult patients on maintenance hemodialysis (HD). They were followed up until October 1994. Hemostasis on the suture line was achieved within 3 min in all patients implanted with PE-PEUGs. Bleeding from the needle holes of PE-PEUG stopped within 10 min with gentle finger pressure. Minimal local edema developed in only a few patients implanted with PE-PEUG while most patients implanted with E-PTFEG developed moderate local edema. One seroma formation was found in an E-PTFE case. Aneurysmal dilatations were observed twice in a PE-PEUG patient 9 and 17 months after the implantation and once in a E-PTFEG patient 2 years after the implantation. The cumulative patency rate at 1 year in the PE-PEUG and E-PTFEG groups were 53.2 and 70.8%, respectively. Our clinical study showed that the PE-PEUG had several advantages over E-PTFEG: prompt hemostasis, no persistent edema and no formation of seroma, no change in elasticity, and sufficient mechanical strength. However, the cumulative patency rate was inferior to that with E-PTFEG implanted in our series. Further modifications are therefore necessary to improve the patency rate.

Adult↗
PubMed1995

The effect of total blood exchange with PHP solution on cardiac xenotransplantation.

Prevention of hyperacute rejection is a difficult and unsolved problem in xenotransplantation. Natural antibodies and complement activation have been known to play an important role in the xenotransplantation between discordant species pairs. In the present study, total blood exchange (TBE) was performed with pyridoxalated-hemoglobin-polyoxyethylene conjugate (PHP) solution (Ajinomoto Co., Inc., Kawasaki, Japan) before cardiac xenotransplantation in order to remove the immunoglobulins and prolong xenograft survival time. Guinea pigs and rats were used as the discordant species combination for donor and recipient. Two groups were established: Group 1, untreated control (n = 8) and Group 2, TBT with PHP solution (n = 8). The exchange blood transfusion was carried out at the rate of 15-20 ml/h utilizing PHP solution using a blood pump. After the blood exchange was processed, hematocrit (Ht) levels dropped to 4 or 5%, and a cardiac xenotransplantation was performed within 24 h. The levels of serum IgA, IgM, and IgG were decreased to less than 25, 25, and 10% of the base line, respectively, after blood exchange. A mean xenograft survival time in Group 2 was prolonged to 472 +/- 74 min and to 10.4 +/- 1.8 min in Group 1 (p < 0.01). A titer of the anti-guinea pig lymphocytotoxic antibody in rat serum was decreased to almost nil. The data from this study suggest that total blood exchange with PHP solution may be useful in preoperative removal of xenograft antibodies in xenotransplantation.

Animals↗
PubMed1994

Complications in blood access for hemodialysis.

We retrospectively analyzed a total of 580 blood access complications that occurred at one institution from January 1991 to December 1992. Dysfunction and thrombosis of arteriovenous fistulas (AVFs) due to insufficient blood flow were the most frequent complications (451, 77.8%). Two hundred sixty-eight (71.5%) patients were treated by reconstructing the AVF at a proximal location in the ipsilateral arm. Sixty seven patients had prosthetic material. Their cumulative patency rates for 1 year were 74.6% with expanded polytetrafluoroethylene and 64.2% with polyurethane grafts. Twenty patients had blood access infections, 15 of whom had artificial grafts. Six patients with infections of artificial grafts were successfully treated by local resection with graft rerouting. Venous hypertension due to deep venous thrombosis developed in 23 patients. Fifteen (65.2%) had no previous trauma, and 18 (78.3%) required closure of AVFs. Aneurysm occurred in 40 patients, which included 13 at an anastomosis site in autogenous AVFs, 13 in repeatedly puncturing shunt veins, 11 in prosthetic grafts, and 3 in superficialized arteries. One patient died from septic shock associated with graft infection, and 1 suffered a fatal pulmonary embolism after replacement with a prosthetic graft. The other patients who received surgical treatment for their complications were successfully treated without life- or limb-threatening consequences. Operations developed to provide adequate blood access for hemodialysis have significant rates of complications. Surgeons performing such procedures need to be well-versed in techniques for creating blood access and for treating attendant complications.

Adolescent↗
PubMed1994

Vascular access device for treatment of cancer patients.

Vascular access devices that are completely implanted have been used for treatment of cancer patients. Vascular access devices are useful for transarterial infusion of anticancer drugs, intravenous hyperalimentation, and drainage of bile juice in obstructive jaundice. These systems have several advantages in the care of patients: they are sealed, they have no external tubes, and they may be useful for blood or biliary sample and intravenous hyperalimentation or chemotherapy. There are only minimal discomforts related to the implantation procedure and no need for routine external catheter care. Most importantly, the quality of the patient's life is dramatically improved without external tubes. For these reasons, we believe that vascular access devices should be indicated for patients with malignant tumors as much as placement of these devices is technically feasible.

Bile↗