PubMed Health⌕ Search

Biomedical subjects

S Kunikata

Publications and source records attributed to S Kunikata.

At least 19 recordsLinked to original sources
PubMed1992

[Investigation on unsuccessful endoscopic operation for cases with vesicoureteral reflux].

Endoscopic operation of vesicoureteral reflux (VUR) has several advantages such as less invasiveness and technical ease with the procedure and shorter hospitalization for the operation in comparison with coeliotomy, but the cure rate achieved by endoscopic operation compares unfavorably with that by coeliotomy. The unsuccessful cases of VUR by endoscopic operation were investigated to promote the success rate by endoscopic operation. Of 66 ureters in 55 patients 50 were successfully treated with the first operation, and 4 of 8 ureters with the second one. All 15 infants were cured, but the cure rate in females between 17 and 45 year old was significantly low (57%). An equally high cure rate was obtained by the endoscopic operation even in patients who had a high grade VUR, patulous ureteral orifices, an underlying neurogenic bladder, or episodes of urinary tract infection. All ureters were cured just after operation. The recurrence of VUR occurred in 19 ureters (29%) and 16 ureters were discovered at one month examination after operation, which indicates that olive oil dissolving teflon paste was partly absorbed to bladder tissue. Teflon paste shifted to internal urethral orifice in 4 unsuccessful ureters. Based on these findings, the endoscopic operation should be considered to be the preferred treatment among others in the management of VUR and the injection of sufficient volume of teflon paste into submucosal and muscular space of the bladder trigone could promote the cure rate.

Adolescent↗
PubMed1992

[Evaluation of kidney graft function with dynamic MRI--preliminary report].

The value of dynamic magnetic resonance imaging (MRI) in the examination of the function of transplanted kidneys was examined. Dynamic MRI was performed on 14 renal transplant patients. After the injection of Gd-DTPA (dimeglumine gadopentetate), we used small tip angle gradient echo (STAGE) technique with a flip angle of 20 degrees. The cortex was higher in signal intensity of well functioning grafts than the medulla before the injection in Gd-DTPA. Signal intensity of the cortex decreased after 30 seconds. After 1 minute the signal intensity of the cortex recovered and low intensity band meaning passage of Gd-DTPA at corticomedullary differentiation was displayed. Signal intensity of the medulla decreased after 3 minutes. Signal intensity of the parenchyma of transplanted kidney after 5 minutes was much the same as that before injection. Image of poor functioning grafts displayed unclear figures. Time-intensity values of both cortex and medulla in well functioning grafts decreased rapidly after about 2 minutes, and rose thereafter. Time-intensity curves of both cortex and medulla were almost flat on and after 5 minutes. Time-intensity curves of both cortex and medulla in poor functioning grafts were almost flat through out the examination. We concluded that effective parameters of the graft function for the time-intensity curve were delta I1 and delta I2. Dynamic MRI was suggested to be useful in the evaluation of kidney graft function.

Contrast Media↗
PubMed1991

Assessment of the long-term results of ileocecal conduit urinary diversion.

We reviewed our 12.5-year experience with ileocecal conduit (ICC) and report the long-term results of 147 cases of ICC compared with those of our 102 cases of ileal conduit (IC). We usually performed ICC following total cystectomy for carcinoma of the bladder, while we chose IC in cases of high stage or recurrent malignancies. The average follow-up period was 41.7 months in the ICC group and 28.8 months in the IC group. The postoperative mortality (6.1%) and the incidence of early complications (21.1%) in the ICC group were comparable with the reported incidences for IC. In the later period, stomal problems were most frequently encountered. Urinary tract complications are important because they affect renal function in the course of a long period of time. Excretory urogram showed a satisfactory result and serum creatinine remained within the normal limits even in patients followed up for a long time in both groups. The incidences of pyelonephritis and urinary stones in the ICC group were 13.6 and 5.4%, respectively. We had expected a much lower incidence of these complications and ICC could not cover all the drawbacks of IC. However, at present, there is no ideal or perfect method of urinary diversion, ICC should be one of the acceptable options which has a satisfactory long-term result.

Adolescent↗
PubMed1991

[Studies on the multiple-drug induction immunosuppressive therapies with cyclosporine after renal transplantation].

Our induction immunosuppressive therapies were carried out on patients split into three groups. The first group of 25 recipients were treated with regimen I [cyclosporin (CsA); 12 mg/kg/day and prednisolone (Pred)]. The second group of 16 recipients were treated with regimen II [CsA; 6 mg/kg/day, Pred and mizoribine (MIZ) or azathioprine (AZA)]. The third group of 14 recipients were treated with regimen III [CsA; 10 mg/kg/day, Pred and MIZ or AZA]. There was no significant difference among the three groups in renal function three months after renal transplantation. The frequency and grade of rejection were significantly higher in Group II than in the other groups. One of group I had CsA nephrotoxicity and none of group III had liver dysfunction three months after renal transplantation. Group I had a higher incidence of posttransplant hypertension. Hypertension of group I was very severe. We concluded that the triple-drug therapy on group III was the best induction immunosuppressive therapy after renal transplantation of the above three.

Adult↗
PubMed1991

[Experimental studies on the mode of action of cyclosporine and FK506 assessed by proliferation response of human cloned T lymphocytes].

We applied cloned human T lymphocytes established in our laboratory to evaluate the mode of action of Cyclosporine (CsA) and FK506. Phenotypic and functional analysis led us to conclude that HTL403 was a helper T cell clone and HTL805 a cytotoxic one. Susceptibility of HTL-403 to the immunosuppressants demonstrated that alloantigen-driven proliferative response can recover to the rIL2-driven level by the addition of rIL2 at higher concentration of the agents. Although full recovery was not observed in FK506, this finding indicated that FK506 as well as CsA inhibit IL2 secretion from HTL403. FK506 showed remarkable suppressive effect on the proliferative response of HTL-805 even at a considerably low concentration, while CsA suppressed such a response dose-dependently. We concluded that FK506 can be used to reverse ongoing acute rejection as well as to prevent acute rejection.

Cell Division↗
PubMed1991

[Clinical study in infants with vesicoureteral reflux].

A clinical study was performed on 52 infants up to 2 years old with vesicoureteral reflux. We treated 12 of them conservatively. Half of them dropped out within 1 year. It was very difficult to follow up the infants over a long time in the conservative treatment group. As a result of the conservative treatment, reflux disappeared spontaneously in only 2 infants. Forty infants underwent antireflux operations. The reflux disappeared in all cases. However, we injured the peritoneum in 2 cases when the Politano-Leadbetter method was applied. A modified Politano-Leadbetter method was adopted because of the peritoneum injury. As an antireflux operation on infants, the modified Politano-Leadbetter method is desirable. Renal function and growth were studied. Renal function was assessed with 99m-Tc-DTPA renograms. Renal ratio was evaluated by intravenous pyelography. The function of refluxing kidneys Severely damaged was not improved after the antireflux operations. The small kidneys with a high grade or the atrophic kidneys did not demonstrate normalization of renal growth after antireflux operations. In conclusion, it is important to detect the reflux at the early infant stage and perform the antireflux operation at an early stage in the case of high grade or renal impairment.

Child, Preschool↗
PubMed1991

[Effect of the cerebro-metabolism activator (bifemelane hydrochloride) on urinary incontinence and pollakisuria associated with cerebrovascular dementia].

A cerebral metabolic activator was administered to patients with cerebrovascular dementia to treat urinary incontinence or pollakisuria. The results are of interest as discussed in this paper. This study was carried out on 35 patients (15 males and 20 females) with cerebrovascular dementia with the chief complaint of incontinence or pollakisuria averaging in age 78.1 years with a range of 65 to 92. The underlying disease was cerebral hemorrhage in 4 cases, cerebral embolism in 21 cases and sequelae of cerebral apoplexy in 10 cases. ADL was assessed in all cases by cerebral CT or MRI and Hasegawa's test, a simple test for dementia. Bladder function was evaluated by determining urodynamic tests (CMG, UFM, UPP) before and after medical treatment. Test drug was bifemelane hydrochloride, a cerebrovascular metabolic activator. It was administered at a dose of 150 mg/day for periods of 2 months or more. As a result, bladder symptoms improved in 16/35 patients (45.7%), and mental symptoms in 21/35 (60%). Urine voiding and holding as bladder functions determined by urodynamics tests were not affected at all. The effect of this drug on bladder symptoms is secondary to improvement of mental symptoms, and its most pronounced clinical effect was on dementia.

Aged↗
PubMed1990

Clinicopathological study on end-stage reflux nephropathy in renal-transplanted children.

Five children with end-stage reflux nephropathy underwent kidney transplantation at our clinic. Reflux nephropathy was studied clinically and histologically. All children had proteinuria before starting hemodialysis, and hypertension was present in 2 cases. Three children underwent antireflux operations prior to transplantation. The original kidneys exhibiting reflux were removed during renal transplantation. All original kidneys exhibited atrophy and scarring. Focal and segmental glomerulosclerosis was found in 4 cases. PAS deposition in the interstitium, suggestive of Tamm-Horsfall glycoprotein, was found in all cases. No recurrent signs of focal and segmental glomerulosclerosis have been found in the children who have been followed up from 1 to 6 years after transplantation.

Adolescent↗
PubMed1990

[Urinary FDP D-dimer and E fragments in renal transplantation].

Both D-dimer and E fragments in urinary FDP were determined in renal transplantation patients. Urinary D-dimer fragments increased in 14 out of 20 acute rejections (70.0%) and in 6 out of 18 chronic rejections (33.3%). Urinary E fragments increased in 8 out of 9 acute rejections (88.9%) and in 4 out of 5 chronic rejections (80.0%). It is suggested that urinary FDP-E fragment is a better indicator to detect or predict rejection than the whole Urinary FDP. The appearance of D-dimer in the urine indicates intravascular coagulation in glomeruli followed by a secondary fibrinolysis in the course of the rejection reaction. The urinary D-dimer/FDP ratio which was used as the indicator of fibrinolytic activity in glomeruli was obtained in various conditions of renal transplants. The ratios were relatively high in the urines from well functioning grafts. This ratio deteriorated at the onset of rejection crisis and tended to go upward during the course of the recovery when the rejection was reversible. In the cases of irreversible acute rejection and chronic rejection, these ratios remained at a low level. D-dimer/FDP ratio might be useful indicator to predict the reversibility of rejection and the prognosis of renal allograft. Furthermore, these findings suggest that fibrinolytic and thrombolytic therapy by the tissue-type plasminogen activator (t-PA) along with immunosuppressive drugs might be more effective for the treatment of these rejections.

Fibrin Fibrinogen Degradation Products↗
PubMed1990

[Management of hypertension after renal transplantation].

We report the clinical result of our management for post-transplant hypertension in 47 renal allograft recipients who were followed up for more than one year after transplantation. Hypertension developed in 4 (26.7%) out of 15 cases who were treated with conventional immunosuppressive therapy (Group I) and 18 (56.3%) out of 32 cases treated with CsA (Group II). In group I, all the 6 patients who had been nephrectomized their original kidney at the time of transplantation did not develop hypertension. And the blood pressure before transplantation had a marked effect on post-transplant blood pressure. In group II, there were many recipients who had become hypertensive after transplantation though most of them became normotensive with dose reduction of immunosuppressants. Ten normotensive patients before transplantation who had not developed hypertension retained their normal blood pressure throughout the course without any antihypertensive medication. We could find no correlation between graft function and blood pressure, although recipients with poor graft function had a tendency to be hypertensive. A satisfactory fall in blood pressure in the patients treated with CsA was observed when the immunosuppressive regimen was changed to triple therapy to reduce the dose of CsA. The recorded blood pressure were 174.0 +/- 19.0/105.2 +/- 16.5 mmHg after transplantation and 145.2 +/- 15.7/78.4 +/- 17.1 mmHg at the latest follow-up. We performed original nephrectomy in 6 patients whose blood pressure could not have been controlled by the antihypertensive medication. All the venous sampling studies showed that increased renin secretion was confined to original kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[The effects of thromboxane A2 synthetase inhibitor on chronic rejection of kidney transplantation].

There has been no useful treatments for chronic vascular rejection (CVR) after kidney transplantation until now. Recently, however, some reports have suggested that the thromboxane A2 synthetase inhibitor, OKY-046, is useful in reducing proteinuria in nephrotic syndrome and preventing progression of CVR. Five patients with CVR (serum creatinine range: 1.7-2.6 mg/dl) were treated with OKY-046 for over one year and the effect of OKY-046 was evaluated. One patient developed acute rejection and another renal hypertension during this study. Except for the cases of acute rejection and renal hypertension, serum creatinine slightly decreased in 1 case and remained unchanged in 2 cases. Urinary excretion of protein and thromboxane B2 decreased significantly but prostaglandin E2 did not change in the treatment of the deterioration with OKY-046. We concluded that OKY-046 was effective in preventing graft function and decreasing urinary protein excretion in kidney transplant recipients with CVR.

Acrylates↗
PubMed1990

[Clinical studies on hyperuricemia and gout after transplantation].

We performed renal transplantation on 67 patients (living 37, cadaver 30) between November 1975 and December 1987. Twenty-seven of the 67 patients had hyperuricemia (serum uric acid: male greater than or equal to 8.0 mg/dl, female greater than or equal to 7.0 mg/dl) and 2 of them had episodes of gout. However, there was no correlation between serum creatinine and uric acid in 27 hyperuricemic patients. Twelve of 27 hyperuricemic patients were treated with either allopurinol or benzbromarone. These therapies were effective for 9 of them and serum uric acid level controlled well. One of 2 gouty patients developed gout 4 years after cadaveric renal transplantation. She was treated with anodyne and benzbromarone for gout. These treatments were effective and she has been in good condition. We consider it necessary to treat hyperuricemia after renal transplantation and to control serum uric acid well.

Adult↗
PubMed1990

Lymphocyte spontaneous blastogenesis as a monitor of renal allograft rejection.

Spontaneous blastogenesis (SB) of peripheral blood lymphocytes was studied by determining protein synthesis using 3H-leucine to establish an immunological monitoring method after renal transplantation. In acute rejection, the SB level was twice as high as those in ATN and in the quiescent state. A rise in SB level comparable to that in rejection was observed in patients with infection. The SB level was continuously determined postoperatively in eight patients undergoing renal transplantation. Of the eight patients, three showed acute rejection four times in total. Elevation of SB level was simultaneously observed at each rejection episode. Rejection was not noted in any of the other five patients. False positive elevation of SB level was observed five times. The cause of the false positive changes was unknown in three cases and due to infection in two cases. Elevation of SB level is considered to be nonspecific and represents total lymphocyte activity. Due to its simple procedure and quick results, this method should provide a useful clinical parameter of rejection.

Graft Rejection↗