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T Matsumae

Publications and source records attributed to T Matsumae.

16 recordsLinked to original sources
PubMed2001

Relationship between fluctuation pattern of blood pressure during hemodialysis treatment and cardiovascular morphology: an autopsy study of 53 cases.

BACKGROUND: Cardiovascular morphological changes are often conspicuous in autopsy examination of chronic hemodialysis (HD) patients. On the other hand, the fluctuation pattern in blood pressure (BP) during HD treatment varies from one patient to another. Cardiovascular changes may correlate with clinical findings including BP fluctuation patterns during HD, although no autopsy studies have previously examined this issue. METHODS: In this study, 53 autopsies of patients who had been on chronic HD were reviewed. We determined the relationship between BP fluctuation during HD treatment along with stable and cardiovascular morphology, including heart weight, ventricular wall thickness, circumferences of the valves and the severity of aortic arteriosclerosis and coronary stenosis. Patients were divided into 4 groups according to the pattern of BP fluctuation during HD treatment at about 6 months before death: group 1 (n = 13), symptomatic hypotension and/or decline pattern during HD; group 2 (n = 11), continuously high BP during HD treatment; group 3 (n = 17), continuous normal BP during HD treatment, and group 4 (n = 12), continuously low BP without symptomatic hypotension during HD treatment. RESULTS: Heart weight and ventricular wall thickness were greatest in group 2. The scores for aortic arteriosclerosis in groups 1 and 2 were higher than in groups 3 and 4. The coronary stenosis index was significantly higher in group 1 than in the other groups, and that in group 2 was higher than in group 4. Multiple regression analysis showed that age, HD duration and pulse pressure were independent variables for the score of arteriosclerosis, and the decline pattern of BP fluctuation during HD and pulse pressure were independent variables for coronary stenosis index. CONCLUSIONS: Our results suggest that certain clinical parameters including BP during HD may reflect cardiovascular morphological changes in stable HD patients, although further examination, such as 24-hour blood pressure measurement is recommended to elucidate the pathophysiology of cardiovascular diseases in HD patients.

Adult↗
PubMed2001

Suppression of experimental membranous glomerulonephritis in rats by an anti-MHC class II antibody.

BACKGROUND: We previously reported that idiopathic membranous nephropathy (IMN) strongly correlated with HLA-DRB1*1501-DRB5*0101-DQAI*0102-DQB1* 0602, a specific haplotype of human major histocompatibility complex (MHC), in Japanese patients. To investigate the role of MHC in the development of rat Heymann nephritis (HN), an animal model of membranous nephropathy, a monoclonal antibody (mAb) specific to rat MHC class II antigen (RT1B) was administered, and its effectiveness in inhibiting HN was assessed. METHODS: Active HN was induced in HN-sensitive Lewis rats by administering brush border proteins of rat proximal uriniferous tubules (FX1A). Rats were divided into four groups: rats treated with 1,000 micorg anti-rat MHC class II mAb, rats treated with 100 microg anti-rat MHC class II mAb, rats treated with murine myeloma IgG, and rats that did not receive either FX1A or any other mAb. We examined the differences in 24-hour urinary protein excretion and serum alloantibody titers against FX1A between groups at different time intervals, and the histologic features of kidneys at the end of the study. RESULTS: HN was induced in Lewis rats by inoculation with FX1A antigen. Administration of anti-MHC class II mAb successfully lowered urinary proteins, production of anti-FX1A alloantibodies, and the development of glomerular lesions in a dose-dependent manner. CONCLUSION: The present results demonstrated that the MHC class II molecule itself is directly involved in the pathogenesis of HN, and suggest that this therapy would be any better (or less toxic) than nonselective immunosuppressants in the treatment of IMN.

Animals↗
PubMed1999

Clinical and morphometrical interrelationships in patients with overt nephropathy induced by non-insulin-dependent diabetes mellitus. A light- and electron-microscopy study.

To clarify the relationships between clinical and renal structural findings in non-insulin-dependent diabetes mellitus (NIDDM), we studied 19 renal biopsy specimens from patients with overt diabetic nephropathy induced by NIDDM. By a conventional biopsy examination using light, immunofluorescent and electron microscopy, we excluded patients with any non-diabetic renal diseases which may have caused urinary abnormalities. Using standard stereological methods, the glomerular filtration surface area per nephron (S-Filt/neph), mesangial volume per glomerulus (V-Mes/glom), mesangial matrix volume per glomerulus (V-MM/glom) and the width of the glomerular basement membrane (GBM) were measured in nonoccluded glomeruli. The hyaline change in the arteriole was analyzed semiquantitatively using light microscopy as an index of arteriolar hyalinosis. Light-microscopic findings demonstrated minimal lesions in 4 cases, focal and/or segmental sclerotic lesions in 4 cases, and diffuse mesangial expansion in 11 cases (with and without nodular lesions in 9 and 2 cases, respectively). Mean glomerular volume of an open glomerulus in diabetic patients was 1.6 times the reference value obtained from nondiabetic patients with mild proteinuria and/or hematuria and normal renal function. Clinical parameters, including the duration of diabetes, urinary protein excretion and creatinine clearance were all related to S-Filt/neph, V-Mes/glom, V-MM/glom and the width of the GBM. In addition, V-MM/glom, the width of the GBM and the index of arteriolar hyalinosis were closely interrelated. Based on these findings, diabetic renal changes, including an increase in the mesangial matrix, thickening of the GBM and arteriolar hyalinosis, appeared to progress in parallel, and may reflect various clinical manifestations in patients with overt diabetic nephropathy induced by NIDDM without nondiabetic renal lesions.

Adult↗
PubMed1999

[Circulatory disaster following infiltration of epinephrine contained in local anesthetic].

There are many case reports regarding unexpected circulatory responses such as hypertension, dysarrythmias, pulmonary edema and catecholamine myopathy, following infiltration of epinephrine into surgical fields. These cases occurred under general anesthesia, whereas we report a case which occurred with local anesthetic use only, with manifested severe circulatory system response to a small dose of epinephrine administered with lidocaine. The case is a 53 year old female with tongue cancer. A skinflap of the formerly operated tongue was infiltrated with 4 ml of 0.5% lidocaine and 0.0005% epinephrine for local anesthesia and hemostasis prophylaxis. Soon thereafter, the patient developed ventricular tachycardia, severe hypertension and pulmonary edema, but was treated successfully. It is important to recognize the risk of severe circulatory system response which may be elicited by a small dose of epinephrine contained in local anesthetics whether under general anesthesia or not.

Anesthetics, Local↗
PubMed1998

Two different pathways of glomerular enlargement in adults with focal and segmental glomerulosclerosis: a morphometric study.

The renal biopsy specimens obtained from 15 adults with focal and segmental glomerulosclerosis (FSGS) and 15 adults with minimal change nephrotic syndrome (MCNS) were morphometrically analyzed using light and electron microscopy. Moreover, initial biopsy specimens obtained from 10 adults who were diagnosed as MCNS and developed FSGS, based on repeat biopsy findings ('MCNS'-FSGS), were also analyzed using electron microscopy. After comparing the actual values between the groups of FSGS and MCNS, the mean glomerular volume, the capillary volume per a glomerulus, the capillary filtration surface per a glomerulus, and the capillary diameter (Cap-D) were all larger in the FSGS group than in the MCNS group. In regard to the morphological values in the 'MCNS'-FSGS group, both values of the surface density of the capillary filtering surface and the capillary diameter at the first biopsy specimens as well as those in the FSGS group were higher than those in the MCNS group. When analyzing the structural parameters, in the FSGS series, we found a high association of the percentage of obsolescent glomeruli (%SG) with the mean glomerular volume, the capillary volume per a glomerulus, the capillary filtering surface per a glomerulus and the capillary length per a glomerulus, however we failed to demonstrate the correlation between the %SG and the Cap-D. Thus, the glomerular structure in the 'MCNS'-FSGS patients, even at the first renal biopsy, resembled that in FSGS, suggesting FSGS to be a distinct entity from MCNS. These data indicate that the enlargement of the capillary volume, resulting from the widening of the capillaries, was the initial structural event for adults with FSGS, while the elongation of the capillaries appeared to reflect some compensatory process for the decrease in the functioning nephron.

Adult↗
PubMed1996

The clinico-pathological characteristics and outcome in hemolytic-uremic syndrome of adults.

Twenty-eight adults who developed hemolytic-uremic syndrome (HUS) underwent a renal biopsy during the period from 1973 to 1993, and the specimens were analyzed both clinically and pathologically. The observed etiologic antecedents of HUS were infectious disease in 7 cases, medication, mainly due to cytotoxic drugs in 7 cases, post-partum in 7 cases, progressive systematic scleroderma in 1 case and unknown in 6 cases. Histologically, 17 cases were glomerular type, 3 cases were arterial type, 6 cases were mixed type and 2 cases demonstrated cortical necrosis. The preceding conditions and the histological findings appeared not to be related to each other. In the acute phase of the disease, of 11 patients who fell into severe acute renal failure (ARF) with an increase in the serum creatinine level of more than 5 mg/dl, 8 patients needed dialysis therapy while 4 patients did not recover from the disease (3 died and 1 was introduced to maintenance dialysis therapy). The incidence of thrombus in the glomerular capillaries and fibrinoid necrosis of the arterioles, the index of the expansion of glomerular subendothelial lucent zone (Glom-SE-ex), the index of glomerular sclerosing and the index of the intimal thickening of the arterioles were higher in the severe ARF than in the mild ARF. After analyzing the prognostic factors on renal survival, severe ARF, the presence of fibrinoid necrosis, severe glomerular endothelial damage and severe intimal thickening of the arterioles appeared to have a significantly adverse effect. Moreover, high Glom-SE-ex and the presence of fibrinoid necrosis also independently influenced renal survival. We thus conclude that the etiology of HUS in adults demonstrates a greater variation than that in children. Therefore, it is very difficult to predict the outcome of this disease based on the clinical findings alone, and thus a renal histological examination is considered to help in determining the long-term outcome.

Acute Kidney Injury↗
PubMed1994

Thin glomerular basement membrane in diabetic patients with urinary abnormalities.

To clarify the clinical and pathological significance of thin glomerular basement membranes (Thin-GBM) appearing in evident diabetics, we examined the renal biopsies from 179 diabetes mellitus (DM) patients with urinary abnormalities in which the number of non insulin dependent diabetes mellitus cases was 140 cases while the remaining 39 cases had insulin dependent diabetes mellitus. In addition, 17 of these cases were found to have either segmental or diffuse Thin-GBM by electron microscopy. The clinical and morphological parameters between the diabetics with Thin-GBM (DM-Thin-GBM) and the diabetics without Thin-GBM (the controls) were significantly different regarding DM duration (DM-Thin-GBM vs control: 5.3 +/- 5.5 vs 9.8 +/- 6.5 years, p < 0.01), Ccr (67.0 +/- 25.5 ml/min vs 45.6 +/- 24.4 ml/min, p < 0.01), the incidence of hematuria (52.9% vs 24.5%, p < 0.05) and hypertension (13.3% vs 51.3%, p < 0.05). The severity of glomerular damage was mild in the DM-Thin-GBM group as compared to the control. The renal survival rate from the onset of urinary abnormalities was higher in the DM-Thin-GBM group than in the control (p < 0.01). In the case of DM-Thin-GBM, the grade of proteinuria correlated with the mean width of the thickened GBM (p < 0.01) and the spread of the thickened GBM which was more than 500 nm in width (p < 0.001). The severity of microscopic hematuria correlated with the spread of the Thin-GBM (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Basement Membrane↗
PubMed1990

[Inhalation anesthetic therapy of status asthmaticus].

Status asthmatics is characterized pathologically by bronchial smooth muscle spasm, and mucous plugging of the small airways. Clinically, it is characterized by the disturbance of gas exchange. In severe cases, unresponsive to standard therapy (including oxygen, epinephrine, aminophylline and steroids, artificial ventilation, tracheobronchial lavage and inhalation), anesthetic therapy should be started without delay. Inhalation anesthetics, halothane or ether, have potent bronchodilating properties which facilitate the removal of mucous plugging. We reported nine cases with status asthmatics treated by inhalation anesthetic therapy. Halothane (0.5-3.0%) was used in all cases, ether (1.5-3.0 ml/kg) was used in five cases. The duration of anesthesia was 0.5 to 13.5 hours. In three halothane anesthesia cases, blood pressure was reduced before there was improvement in wheezing, so we were forced to change halothane to ether. In all cases, the symptoms of status asthmatics were improved, but two patients died due to other complications. We recommended the following method, viz that halothane be administered at first, and be changed to ether in order to maintain circulatory movement.

Adult↗
PubMed1984

[Experimental model producing global brain ischemia by clamping the aorta in dogs].

Canine cerebral blood flow is supplied not only through carotid and vertebral arteries, but also through rich network of collaterals. Therefore, it is said that total body arrest is requested to assure the global brain ischemia. The global ischemic models, reported previously, were by the simultaneous occlusion of aorta and vena cava. In our model, however, the global cerebral ischemia was produced by clamping only the ascending aorta. Cardiovascular changes such as increases in left ventricular and pulmonary arterial pressure, and decrease in left ventricular dp/dt followed after ceasing of ascending aortic blood stream. The heart continued to beat during 60 minutes of the clamping. Despite of increased central venous pressure, sagittal sinus pressure and intracranial pressure remained unchanged during the aorta clamping. Ten-minutes of total cerebral ischemia was produced in 46 dogs and successful studies on cerebral and systemic variables were carried out in 68% of them. The method of clamping the aorta without occlusion of vena cava seems to be unsuitable for long term survival study because of severe loading of lung circulation. However, we conclude that this simple model is of great use for short term experiment on global brain ischemia.

Animals↗