Administration of leflunomide to a patient with rheumatoid arthritis on haemodialysis.
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Arthritis, Rheumatoid↗
Biomedical subjects
Y Asano
Publications and source records attributed to Y Asano.
Effect of plasmapheresis as initial monotherapy in a case of anti-neutrophil cytoplasmic autoantibody positive crescentic glomerulonephritis.
The effect of plasmapheresis (PP) monotherapy was evaluated in a 77 year old man with crescentic glomerulonephritis (CrGN). Because both anti-neutrophil cytoplasmic myeloperoxidase autoantibody (MPO-ANCA) and circulating immune complex (IC) were positive, removal of these substances was expected to be beneficial. Thus, the treatment was started with PP alone. During 2 month's time, three series of PP monotherapy were performed: three sessions of plasma exchange (PEX) with fresh frozen plasma (FFP); two sessions of double filtration plasmapheresis (DFPP); followed by another two sessions of PEX. The ANCA remained suppressed for 4 weeks after the first PEX, and increased thereafter. Subsequent DFPP caused a rebound in ANCA titer, whereas the second PEX suppressed ANCA for 1 week. Although creatinine clearance (Ccr) improved from 9.3 to 15 ml/min after the first PEX, and this level was maintained, ANCA increased again after the second PEX. Therefore, the patient was treated with methylprednisolone semi-pulse therapy (500 mg/day for 3 days), followed by mild "cocktail" therapy. In 2 weeks ANCA and IC became negative, and Ccr further improved to 20 ml/min. Thus, PP, when performed alone, was shown to be partially effective, arresting the progression of renal damage in the present case. These observations also argue for the advantage of PP, especially PEX, as an adjunct therapy to immunosuppressive therapy in CrGN.
Aged↗
Utility of the inferior vena cava diameter as a marker of dry weight in nonoliguric hemodialyzed patients.
We have previously reported that the maximal inferior vena cava (IVC) diameter during quiet expiration (IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blood volume(2) and proposed using the criteria of IVC diameter to determine dry weight (DW) in anuric hemodialyzed (HD) patients: standard IVCe of pre- and post-HD are 14.9 +/- 0.4 and 8.2 +/- 0.3 mm, respectively (1). However, the same post-HD IVC criterion should not be applied to nonoliguric HD patients because it could result in rapid deterioration of residual renal function due to forced dehydration. Although the biochemical DW marker plasma atrial natriuretic peptide (ANP) is useful to evaluate hypervolemia but not hypovolemia, both hyper- and hypovolemia can be detected by IVC measurement. In the present study, we investigated whether the IVC diameter serves as an optimal evaluation of DW in nonoliguric HD (NO-HD) patients, avoiding not only overhydration but also dehydration. The IVCe and plasma ANP levels were measured in 14 euvolemic patients with chronic renal failure at conservative period (CP-CRF) and 11 NO-HD patients, in whom the average daily urine volume was more than 500 ml/day. In NO-HD patients, DW was adjusted to attain the euvolemic state with normotensive blood pressure, lack of edema, and lack of temporal oliguria after HD. The ANP in CP-CRF patients was 109.3 +/- 15.3 pg/ml, and pre- and post-HD ANP levels in NO-HD patients were 145.3 +/- 23.5 and 97.5 +/- 13.5 pg/ml, respectively. IVCe in CP-CRF was 13.4 +/- 0.9 mm, and pre- and post-HD IVCe in NO-HD patients were 14.2 +/- 1.0 mm and 11.9 +/- 0.9 mm, respectively. Although the post-HD IVCe was greater (i.e., less hypovolemic) than that in anuric HD patients, and close to the IVCe in CP-CRF, pre-HD IVCe was comparable with that in anuric HD patients. In addition, the pre-HD ANP level was no higher than that in CP-CRF. Thus, in NO-HD patients, the post-IVCe of 11.9 +/- 0.9 mm would be a marker for an appropriate DW setting avoiding severe post-HD dehydration as well as excessive hypervolemia during the interdialytic period.
Adult↗
Marked atherosclerosis in a patient with familiar lecithin: cholesterol acyltransferase deficiency associated with end-stage renal disease and diabetes mellitus.
Familial lecithin:cholesterol acyltransferase (LCAT) deficiency is a rare genetic disorder of the lipid metabolism caused by the absence of LCAT activity in plasma. It is not generally accompanied by atherosclerosis in spite of low high-density lipoprotein cholesterol levels nor by diabetes mellitus. However, reports of long-term follow-up or autopsy findings are rare, and the true incidence of atherosclerosis in LCAT deficiency is not clear. We report on the long-term observation of a patient with familial LCAT deficiency who developed renal failure, diabetes mellitus, and marked atherosclerosis. The patient died of sepsis from foot ulcers 7 years after starting hemodialysis and 13 years after the diagnosis. Marked atherosclerosis characterized by medial calcification in small arteries was observed at autopsy. The genesis of the atherosclerosis seemed to be on the basis of a combination of factors.
Arteriosclerosis↗
Sodium ion specifically modifies plasma ionized calcium concentration.
BACKGROUND/AIM: Recently, we observed a progressive decline in the plasma ionized calcium (iCa) concentration after ingestion of Na-free beverage. Although both plasma pH and Na significantly correlated with iCa, the correlation of the latter was stronger than that of the former. Therefore, we explored the effect of Na on plasma iCa. METHODS: Pooled human plasma was diluted with normal saline, 5% glucose, 0.9% KCl, or distilled water to examine the effect of plasma dilution on iCa. Also, to evaluate the effects of an isovolemic increase in ion concentration and osmolarity on plasma iCa, NaCl, KCl, and D-glucose were added to plasma. Electrolytes (Na(+), K(+), Cl(-), iCa, HCO(-)(3)), pH, and osmolarity were measured by using ion-selective electrodes. RESULTS: In the plasma dilution study, although all solutions significantly decreased the iCa concentration, the decrease in iCa concentration in the normal saline treated solution was significantly lower than in others. When the plasma osmolarity was isovolemically increased, the iCa concentration significantly increased in parallel with the increase in osmolarity in the NaCl group (r = 0.604, p < 0.01, n = 50). In contrast, no significant change in the iCa concentration was seen in the other solutions. NaCl did not increase, but rather decreased the iCa concentration when added to a protein-free solution. CONCLUSION: The present study demonstrated that Na specifically affects plasma iCa independently of pH, presumably via modulating Ca binding to plasma proteins.
Analysis of Variance↗
The effect of EGF on electrolyte transport is mediated by tyrosine kinases in the rabbit cortical collecting duct.
Epidermal growth factor (EGF) inhibits amiloride-sensitive Na(+) conductance in the apical membrane of the isolated rabbit cortical collecting duct. However, there is no information on the relationship between electrolyte transport and tyrosine kinase. We examined the effect of EGF on transport of potassium and chloride as well as sodium and the roles of tyrosine kinases in the rabbit cortical collecting duct using in vitro isolated tubular microperfusion. Basolateral EGF depolarized the transepithelial voltage in a dose-dependent manner within a concentration range of 10(-10) in 10(-8) M. Basolateral ouabain and luminal amiloride completely abolished EGF-induced depolarization. However, luminal BaCl(2) did not abolish its depolarization. To confirm the mechanism, sodium, potassium, and chloride fluxes were measured in the presence of 10(-10) M EGF. EGF significantly decreased the lumen-to-bath isotope flux of sodium and chloride from 93.6+/-12.5 to 61.1+/-9.6 pmol/mm/min (n = 5, p<0.05) and from 86.6+/-10.0 to 54. 8+/-9.7 pmol/mm/min (n = 10, p<0.01), respectively. EGF also decreased net potassium secretion from -27.7+/-5.9 to -7.8+/-1.5 pmol/mm/min (n = 6, p<0.01). To examine whether EGF-induced depolarization is mediated by tyrosine kinase, tyrosine kinase inhibitors were applied from the basolateral side. Pretreatment with 1 microg/ml herbimycin A for 120 min completely abolished EGF-induced depolarization (90.9+/-5.4%, n = 4; NS). Herbimycin A itself also did not change the lumen-to-bath isotope flux of sodium and completely abolished the inhibition of Na(+) absorption on EGF action (control 65.4+/-6.8, herbimycin A 61.8+/-6.3, EGF with herbimycin A 60.0+/-4.4 pmol/min/mm, n = 5; NS). In conclusion, EGF depolarizes transepithelial voltage by inhibiting sodium transport primarily and potassium and chloride transport secondarily. These effects were blocked by nonspecific tyrosine kinase inhibitors.
Animals↗
Pyrene fluorescence: a potential tool for estimation of short-range lateral mobility in membranes of living renal epithelial cells.
The excimer-to-monomer (E/M) fluorescence ration of pyrene (p) and its derivatives has been found to correlate with membrane fluidity. We explored the possible use of this method in living renal epithelial cells. In Modin-Darby canine kidney cells, successful fluorescent labeling was obtained with p-cholesterol, p-trimethylammonium (TMA), p-sulfonamidethyl-TMA, p-butyrate, p-propanoate or p-dodecanoate. Among them, the labeling with p-cholesterol was most stable. The whole cell cholesterol content did not significantly increase after loading p-cholesterol and the probe incorporated was not degraded. The E/M ratio changed reproducibly and significantly by temperature change, a standard method to alter membrane fluidity. Thus, the E/M ratio of p-cholesterol fluorescence is suggested to be a potential parameter of membrane fluidity in living renal epithelial cells and might be useful in investigating the relationship between the physical state of the membrane and epithelial function.
Animals↗
Danazol treatment for paroxysmal nocturnal hemoglobinuria.
Danazol was administered to two patients with paroxysmal nocturnal hemoglobinuria (PNH) with a dramatic effect on the hematological findings. The patients, 31- and 41-year-old females, were initially diagnosed as having aplastic anemia, and were initially treated with anabolic steroid and immunosuppressive therapy, respectively. Sugar water and Ham tests turned positive at the start of danazol therapy in the former patient and after two months in the latter patient. This drug produced a dramatic improvement in the hemoglobin level and the platelet count and showed few side effects in the patients. A possible mechanism of action of danazol for PNH is briefly discussed.
Adult↗
Sustained endothelial dependent dilation in pial arterioles after crosslinked hemoglobin transfusion.
Hemoglobin is known to bind nitric oxide (NO) with high affinity. Plasma-based hemoglobin may provide a more effective sink for NO than red cell-based hemoglobin because of a closer and consistent proximity to the endothelium. Despite the known endothelial tight junctions that exist in cerebral vessels, plasma-based hemoglobin may inhibit NO-derived vasoreactive mechanisms in brain. If so, the response to endothelial and non-endothelial dependent vasodilator substances should be affected. In pentobarbital anesthetized cats, we tested this hypothesis by measuring the pial arteriole blood vessel diameter using aa cranial window before and after systemic transfusion of a human crosslinked hemoglobin compound. We than topically applied solutions of endothelial dependent or endothelial independent vasodilators and an NO synthase inhibitor to the surface of the brain within the window and remeasured the arteriole size. Topical acetylcholine (Ach) increased diameter in all arteriole sizes. The corresponding increases in diameter to Ach in time control eats (32% hematocrit) and in albumin transfused cats (18% hematocrit) were similar to those in hemoglobin transfused cats. Likewise, size-dependent dilation to SIN-1 in the hemoglobin group was similar to that in the control and albumin groups. The pial arteriole response to adenosine diphosphate (ADP) and sodium nitroprusside (SNP) also increased arteriole diameter in small, medium and large arterioles. Superfusion with L-nitroarginine to inhibit NO synthase markedly reduced the dilator response to Ach and ADP but not to SIN-1 or SNP. Thus, prior crosslinked hemoglobin transfusion does not interfere with vasodilator responses to either Ach, ADP, SIN-1 or SNP. When dilute solutions of crosslinked hemoglobin were superfused abluminally in the cranial window in anesthetized but non-transfused animals, the dilator response to Ach was unchanged at 10(-4)M hemoglobin, was attenuated at 10(-7) and 10(-6)M hemoglobin, and was completely blocked at 10(-5)M hemoglobin. This finding implies negligible permeation of the blood-brain barrier by crosslinked hemoglobin acutely after the transfusion.
Acetylcholine↗
Three-dimensional CT in isolated dissecting aneurysm of the superior mesenteric artery: a case report.
Isolated dissecting aneurysm of the superior mesenteric artery (SMA) without aortic dissection is a rare condition. We report a case of isolated dissecting aneurysm of the SMA incidentally detected by postcontrast abdominal computed tomography (CT). Three-dimensional CT using helical scanning was helpful for the evaluation of dissecting aneurysmal structures such as the intimal flap, true lumen, and false lumen with thrombosis. CT angiography (CTA) was useful for the assessment of characteristic morphology and three-dimensional relationship between the dissecting portion and SMA branches.
Aortic Dissection↗
Serum levels of tissue inhibitor of metalloproteinases in patients with mixed connective tissue disease.
OBJECTIVE: To determine serum tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2 levels in patients with mixed connective tissue disease (MCTD) and investigate whether these levels were correlated with the clinical or serological features of this disease. METHODS: Serum TIMP-1 and TIMP-2 levels were measured with specific enzyme-linked immunosorbent assays. Serum samples from 26 patients with MCTD and 18 healthy individuals were examined. RESULTS; Serum levels of TIMP-1 were significantly higher in patients with MCTD than those in healthy individuals (mean +/- SD: 218.9 +/- 50.8 ng/ml versus 160.0 +/- 38.7 ng/ml, P < 0.0001). MCTD patients with elevated TIMP-1 had esophageal involvement at a significantly higher incidence than those without (77.8% versus 35.3%, p < 0.05). There was no difference in serum TIMP-2 levels between patients with MCTD and healthy controls (75.6 - 11.9 ng/ml versus 77.3 +/- 10.7 ng/ml). CONCLUSION: These results suggest that TIMP-1 is involved in the pathogenesis of MCTD, and that TIMP-1 may be a serological marker for the presence of esophageal involvement in these patients.
Adult↗
Clinical features of patients with systemic sclerosis accompanied by rheumatoid arthritis.
OBJECTIVE: To determine the incidence of patients with both systemic sclerosis and rheumatoid arthritis (SSc-RA) and the clinical features of those with SSc-RA. METHODS: All 173 patients with systemic sclerosis in our clinic were investigated. RESULTS: Of the 173 patients with systemic sclerosis, 9 (5.2%) developed rheumatoid arthritis (RA). At the first visit, arthritis prior to Raynaud's phenomenon, increased C-reactive protein (CRP), and elevated rheumatoid factor (RF) were seen in patients with SSc-RA at a significantly higher incidence than in those without (44.4% versus 4.8%, p < 0.01; 55.6% versus 13.6%, p < 0.001; 247.2 +/- 312.1 versus 47.9 +/- 54.3 IU/ml, p < 0.001, respectively). Furthermore, in 8 of the 9 patients with SSc-RA, CRP was increased before the diagnosis of RA. CONCLUSION: These results suggest that systemic sclerosis patients with elevated RF and a history of arthralgia prior to Raynaud's phenomenon should be followed up with serial measurements of CRP due to their risk of developing RA.
Adolescent↗
Clinical significance of serum matrix metalloproteinase-13 levels in patients with localized scleroderma.
OBJECTIVES: To investigate the clinical significance of serum matrix metalloproteinase-13 (MMP-13) levels in patients with localized scleroderma (LSc). METHODS: Serum MMP-13 levels were determined by using a peptide substrate cleavage assay in 10 patients with generalized morphea, 10 with linear scleroderma, 10 with morphea, and 10 normal controls. RESULTS: The serum MMP-13 levels in patients with LSc were lower than those in normal controls, but there was no significant difference (64.9 +/- 19.9 versus 73.2 +/- 11.5, p = 0.058). Serum MMP-13 levels in patients with generalized morphea were significantly lower than those in normal controls (54.0 +/- 18.7 versus 73.2 +/- 11.5 ng/ml; p < 0.01). Serum levels of MMP-13 were comparable among normal controls, the patients with linear scleroderma, and those with morphea. The prevalence of muscle involvement was significantly greater in the LSc patients with decreased MMP-13 levels compared with those with normal MMP-13 levels (50% versus 8%, p < 0.05). Serum MMP-13 levels were significantly inversely correlated with the number of linear lesions (r = 0.366, p < 0.05) and the number of involved body areas (r = 0.552, p < 0.005) in patients with LSc, while there was no significant correlation between serum MMP-13 levels and the number of plaque lesions. Furthermore, there was significant inverse correlation between serum MMP-13 levels and the number of involved body areas in patients with generalized morphea (r = 0.631, p < 0.05). CONCLUSION: The serum MMP-13 levels may reflect the disease severity in patients with LSc, especially generalized morphea, the severest form of this disorder.
Adolescent↗
Change in inferior vena caval diameter detected by ultrasonography during and after hemodialysis.
The diameter of the inferior vena cava (IVC) measured by ultrasonography is used as a parameter to estimate right sided cardiac function and central venous pressure. In the current study the IVC diameter during and after hemodialysis (HD) was measured in chronic HD patients to explore the determinant factors of the diameter, and these results were obtained: 1) the maximal diameter of the IVC during quiet expiration (IVCe) can be a marker of circulating blood volume during as well as after HD, because the linear correlation between IVCe and circulating blood volume during and after HD were significant and almost identical; 2) the amount of ultrafiltration is the major determinant of IVCe during HD, because IVCe and circulating blood volume decreased in parallel with the amount of ultrafiltration during HD; and 3) since the recovery of IVCe and circulating blood volume, which correlated with the increase in serum protein concentration during HD, was almost complete while the body weight remained unchanged after HD, plasma refilling rather than body fluid retention was considered important in the recovery of IVCe and circulating blood volume after HD.
Adult↗
Human herpesvirus-7 (HHV-7).
HHV-7 first isolated in 1990 from a healthy individual, is a ubiquitous agent. The second independent isolation of HHV-7 from a chronic fatigue syndrome patient was reported in 1992. The seroepidemiology of HHV-7 suggested that its prevalence rate in the U.S.A. population is > 85%; however, in Japan a low prevalence rate has been reported. HHV-7 can be more readily isolated from the saliva than HHV-6. The primary infection of HHV-7 appears later in life than HHV-6. No disease has been reported that is etiologically linked to HHV-7. HHV-7 is more closely related to HHV-6 and the human cytomegalovirus than other members of the human herpesvirus family.
Adolescent↗
Further electrophysiological characterization of the alpha- and beta-intercalated cells along the rabbit distal nephron segments: effects of inhibitors.
To further characterize the alpha- and beta-intercalated cells (alpha-IC, beta-IC) in the isolated and perfused connecting tubule (CNT), cortical collecting duct (CCD) and outer medullary collecting duct in the inner stripe (OMCDi) of rabbit kidneys, we studied the effects of various transport inhibitors on electrical parameters. They included inhibitors of Cl-/HCO3- exchanger (4-acetamino-4'-isothiocyanostilbene-2,2'-disulfonic acid, SITS), carbonic anhydrase (acetazolamide) and Na(+)-K(+)-ATPase (ouabain). Upon addition of 10(-3) M SITS to the bath, the basolateral membrane voltage (VB) of alpha-IC in the OMCDi and CCD was significantly hyperpolarized by 20.8 +/- 4.6 (n = 5) and 29.8 +/- 5.6 mV (n = 11), respectively. On the other hand, luminal addition of SITS had no effects on VB of alpha-IC in the OMCDi and CCD. Neither bath nor lumen SITS affected VB of beta-IC in the CCD and CNT. When 10(-4) M acetazolamide was added to the bath, VB of alpha-IC in the OMCDi and CCD was significantly hyperpolarized by 20.0 +/- 4.1 (n = 4) and 18.6 +/- 1.7 mV (n = 3), respectively. Similarly, 10(-4) M acetazolamide in the bath caused the basolateral membrane of beta-IC in the CCD and CNT to hyperpolarize significantly by 34.3 +/- 7.9 (n = 6) and 21.6 +/- 2.9 mV (n = 3), respectively. Luminal addition of acetazolamide had no effect on VB of alpha-IC in the CCD and OMCDi and beta-IC in the CCD and CNT.(ABSTRACT TRUNCATED AT 250 WORDS)
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfo↗
Clinical experience with an anatomic snuff box arteriovenous fistula in hemodialysis patients.
The present study was performed to evaluate the clinical usefulness of an anatomical snuff box arteriovenous fistula with special reference to its short-term and long-term patency in 139 hemodialysis patients. A snuff box fistula was established in 139 patients, including 39 with diabetic nephropathy (DN group) and 100 with non diabetic nephropathy (non DN Group). Fistula blood flow was measured by Doppler ultrasound in 18 patients. Early and late obstruction was observed in 24 (17%) of the 139 patients. The long-term patency rate of the snuff box fistula in the non DN group was 87% at 57 months, whereas the patency rate at 57 months in the DN group (72%) was significantly (p < 0.05) lower than that in the non DN group. The increase in arterialized vein blood flow in DN patients was less marked than that in the non DN patients. These results suggest that the high prevalence of late obstruction in DN patients may partly be reflected by an insufficient increase of arterialized vein blood flow at the snuff box site.
Adolescent↗
Diameter of the inferior vena cava as an index of dry weight in patients undergoing CAPD.
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Body Weight↗