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Biomedical subjects

Y Asanuma

Publications and source records attributed to Y Asanuma.

At least 19 recordsLinked to original sources
PubMed2001

Effectiveness of combining plasma exchange and continuous hemodiafiltration (combined modality therapy in a parallel circuit) in the treatment of patients with acute hepatic failure.

Plasma exchange has gained widespread acceptance as an effective mode of blood purification in patients suffering from acute hepatic failure. However, it is still undetermined whether a single use of plasma exchange is capable of removing inflammatory cytokines completely or of preventing the development of citrate toxicity inherent with fresh frozen plasma. To clarify these issues we developed combined plasma exchange and continuous hemodiafiltration (CHDF) modality in which CHDF is performed in an opposite direction to plasma exchange. This study was designed to assess the effectiveness of combined modality therapy. Fifteen patients with acute hepatic failure were treated with plasma exchange (plasma exchange group) or plasma exchange and CHDF (plasma exchange + CHDF group), and various biochemical parameters were determined before and after treatment. Although citrate levels increased significantly after treatment compared with pretreatment levels in both the plasma exchange group and the plasma exchange + CHDF group, the percentage of the increase in citrate levels was significantly higher in the plasma exchange group than in the plasma exchange + CHDF group. Bilirubin levels were significantly lower after treatment in both the plasma exchange and plasma exchange + CHDF groups. There were no significant differences in tumor necrosis factor-alpha levels before and after treatment in the plasma exchange group, but they were significantly lower after treatment in the plasma exchange + CHDF group. Interleukin-6 (IL-6) levels increased significantly after treatment in the plasma exchange group, but there were no significant differences in the IL-6 levels before and after treatment in the plasma exchange + CHDF group. Interleukin-8 levels increased significantly after treatment in the plasma exchange group while decreasing significantly after treatment in the plasma exchange + CHDF group. These results indicate that combining plasma exchange and CHDF in a parallel circuit is an effective modality for suppressing the elevation of blood citrate levels and for removing inflammatory cytokines. This finding may have important implications for the development of an effective treatment for patients with acute hepatic failure.

Citrates↗
PubMed2001

Anti-androgenic activity of Myricae Cortex--isolation of active constituents from bark of Myrica rubra.

The aqueous ethanol extract of Myricae Cortex (bark of Myrica rubra Sieb. et Zucc., Myricaceae) showed in vitro testosterone 5alpha-reductase inhibitory activity and in vivo anti-androgenic activity using growth of flank organ in castrated Syrian hamsters and/or hair regrowth after shaving in testosterone-treated C57Black/6CrSlc mice. Three constituents, myricanone, myricanol, and myricetin were identified as the main active principles.

5-alpha Reductase Inhibitors↗
PubMed2001

Appraisal of intra-arterial infusion of prostaglandin E1 in patients undergoing major hepatic resection report of four cases.

In order to reduce risk for postoperative acute liver failure, prostaglandin E1 (PGE1) was administered either from the hepatic artery (HA) or the superior mesenteric artery (SMA) in four high-risk cases undergoing major hepatic resection. Two cases were subjected to HA PGE1 infusion for 3 or 4 days after surgery at a rate of 0.01 microg/kg/min. Both patients had hepatocellular carcinoma (HCC) associated with chronic hepatitis, and ICG R15 was 17.6% and 14.5%, respectively. Right hemihepatectomy and extended right hemihepatectomy were performed. Serum total bilirubin (T. Bil.) peak value was 2.2 mg/100 ml in Case 1 and 2.1 mg/100 ml in Case 2. In Case 1, decreased bile flow was observed immediately after cessation of PGE1. The other two cases were subjected to SMA PGE1 infusion for 5 or 6 days after surgery at the same rate. In Case 3, right hemihepatectomy was performed for HCC on a cirrhotic liver four weeks after right portal vein embolization, in which preoperative ICG R15 was 19.0%. Peak T. Bil level was 3.7 mg/100 ml with uneventful postoperative course. In Case 4 with a huge cholangioma, right trisegmentectomy was performed. Peak serum T. Bil level was 1.7 mg/100 ml in this uneventful postoperative course. In Case 3 and Case 4, portal blood flow, measured by Doppler ultrasonography, was markedly increased by PGE1 infusion. From these results, intra-arterial PGE1 infusion might be useful in prevention of postoperative liver failure after major hepatic resection.

Aged↗
PubMed2001

[Ventilatory failure due to the limitation of chest movement in a case of FPS].

A 72-year-old woman presented with cervicothoracal skin lesions mimicked to scleroderma and muscular atrophy in 1996. Because of the elevation of serum creatinine kinase (CK), muscular biopsy was performed at another institution. Under the diagnosis of polymyositis, she was treated with corticosteroid. Despite of the decrease in serum CK levels by corticosteroid therapy, skin lesions and mascular dystrophy gradually worsened to extend to the regions of major pectoral, paravertebral, and femoral muscles. In 1997, she was admitted to our hospital because of dyspnea. On admission, the limitation of the chest movement was obvious and she developed respiratory arrest due to CO2 narcosis. The femoral magnetic resonance image (MRI) showed increased signal intensity of subcutaneous tissues and fascia on T2-weighted image. The block biopsy specimens obtained from the cervical lesion revealed fibrotic thickness and chronic inflammation of subcutaneous septa, fascia, and perimysium. She was treated by mechanical ventilation and cimetidine and weekly methotrexate were added to the corticosteroid therapy because of the diagnosis of FPS. Thereafter, the skin and muscular lesions as well as the MRI findings were improved. The concept of FPS was proposed by Naschitz et al. This condition is pathologically characterized by cicatrizing fascitis, septal and lobular panniculitis, and perimysial fibrosis and peripheral blood and tissue eosinophilia is not important for diagnosis. FPS includes classical eosinophilic fascitis but is also associated with several disorders such as malignancy. This case is suggestive of the therapeutic consideration of FPS in terms of the response to cimetidine and MTX.

Aged↗
PubMed2000

Palliative treatment with metallic stents for unresectable gallbladder carcinoma involving the portal vein and bile duct.

We report a case of gallbladder carcinoma associated with biliary obstruction and portal vein stenosis caused by massive lymph node metastases. The patient, a 59-year-old woman, was treated with self-expandable metallic stents--a spiral Z-stent in the portal vein, and a Wallstent in the bile duct--and intra-arterial infusion chemotherapy. She returned to work immediately after leaving the hospital, and has been treated with intra-arterial infusion chemotherapy once a week at our outpatient department. At present, she has good quality of life, with patency of both endoprostheses, 8 months after the placement of the metallic stents in the portal vein and the common bile duct. This case shows that portal vein and biliary stenting, together with intra-arterial infusion chemotherapy, can be an effective modality for the palliative treatment of advanced gallbladder carcinoma involving the portal vein and bile duct, to improve quality of life.

Bile Ducts↗
PubMed2000

Continuous infusion of prostaglandin E1 via the superior mesenteric artery can prevent hepatic injury in hepatic artery interruption through passive portal oxygenation.

AIMS/BACKGROUND: Hepatic artery interruption (HAI) causes severe ischemic liver damage, especially following hepatopancreatobiliary surgery. In order to inhibit a decrease in oxygen delivery after HAI, continuous infusion of PGE1 via the superior mesenteric artery (SMA) was administered in pigs and changes in hepatic blood flow and oxygen delivery were investigated. Furthermore, its effectiveness in the prevention of liver injury was evaluated by histology and serum enzyme levels. METHODS: Animals were subjected to HAI without PGE1 infusion (control group n=6) and to continuous infusion of PGE1 (0.02 microg/kg/min) into the SMA (PGE1 group n=6). RESULTS AND CONCLUSION: PGE1 infusion via the SMA not only increased the portal blood flow but also elevated the oxygen content of the portal blood. The reduction in oxygen delivery to the liver was 50% in the control group, and only 13% in the PGE1 group. Serum aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) levels 24 h after HAI in the control group were 3415+/-1283 IU/L and 9839+/-2959 respectively while in the PGE1 group they were 939+/-426 IU/L and 5510+/-1545 IU/L respectively. Histological examination showed massive necrosis in the control group at 72 h but only focal liver cell necrosis in the PGE1 group. Based on this finding and the fact that this treatment can be performed easily and safely, continuous infusion of PGE1 via the SMA may be a useful intervention to prevent severe liver damage after hepatic artery interruption.

Alprostadil↗
PubMed2000

Prostaglandin E(1) continuous hepatic arterial infusion in the treatment of postoperative acute liver failure: basic study on hepatic hemodynamics and clinical application.

AIM: In the treatment of severe liver damage, it is of greater advantage to administer prostaglandin E(1) (PGE(1)) directly to the liver compared with systemic intravenous infusion, because of its high inactivation rate in the lungs. In comparison with intraportal infusion, hepatic arterial infusion is more advantageous because of its easier and safer accessibility. This study was designed to prove the superiority of hepatic arterial infusion to intravenous infusion. METHODS: Changes in hepatic hemodynamics and oxygen delivery accompanying PGE(1) infusion using both methods were investigated in pigs. In addition, continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure, for patients in whom other conventional treatments like plasma exchange failed to improve the functioning of the liver. RESULTS: Hepatic arterial flow increased significantly accompanying hepatic arterial infusion of PGE(1) at a rate of 0.1 microg/kg/min compared with intravenous infusion at the same rate in pigs. Such an increase resulted in elevation of total hepatic blood flow and oxygen delivery to the liver. Correspondingly, bile flow significantly increased accompanying hepatic arterial infusion of PGE(1). Continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure. The infusion was continued for 7-9 days at a rate of 0.01 microg/kg/min without any complications through heparin-coated catheters inserted via the femoral artery. Significant increase in bile flow was observed in 2 cases in whom bile was collected, serum total bilirubin began to decrease in all these 3 cases, and the patients recovered from acute liver failure. CONCLUSION: Hepatic arterial infusion of PGE(1) is very useful and effective in the treatment of acute liver failure.

Aged↗
PubMed1999

Serum lipoprotein(a) and apolipoprotein(a) phenotypes in patients with rheumatoid arthritis.

OBJECTIVE: To determine serum lipoprotein(a) (Lp[a]) concentrations and to analyze the apolipoprotein(a) (Apo[a]) phenotype in patients with rheumatoid arthritis (RA). METHODS: The subjects included 131 patients with RA and 200 healthy control subjects. Serum Lp(a) concentrations were measured by enzyme-linked immunosorbent assay, and the Apo(a) phenotype was determined by immunoblotting. HLA-DR typing was also done. RESULTS: The mean serum Lp(a) level was significantly higher (P < 0.001) in the RA patients (27.5 mg/dl) than in the controls (15.0 mg/dl). The S3 allele was found in 70.0% of the patients versus 39.5% of the controls (P < 0.001). There was no significant difference in HLA-DR4 positivity between patients with and without the S3 phenotype. CONCLUSION: The serum Lp(a) level was increased in patients with RA, possibly partly because of S3 phenotype predominance.

Adult↗
PubMed1999

Tolerance of islet allografts induced by orthotopic liver transplantation.

BACKGROUND: The induction of immunological tolerance by orthotopic liver transplantation (OLT) is donor-specific. Moreover, after the acceptance of a liver, other organs are not rejected. The aim of this study is to clarify characteristics of the prolonged islet survival as a result of immunological tolerance which was induced following simultaneous OLT. MATERIALS AND METHODS: About 2000 islets were isolated from F344 rats. OLT was performed from F344 rats to diabetic LEW rats. Then the islets were transplanted into the transplanted F344 livers of diabetic LEW rats. Survival of the pancreatic islet allografts and deposits of IgM and IgG in the transplanted liver and islets were investigated. RESULTS: Survival time in the group with OLT (mean survival time: 46.4 +/- 38.2 days) was significantly longer than that without OLT (mean survival time: 8.1 +/- 0.8 days) (P < 0.01). Amount of serum antibody against donor lymphocytes was slightly higher in the group without OLT, and was very high in the group with OLT. Histologically, severe lymphocytic infiltration was observed in the Glisson's sheaths in the group with OLT. Islets were lodged, without lymphocytes inside, in small branches of the portal vein 7 days after transplantation. Immunohistologically, IgM and IgG deposits were found in the Glisson's sheaths and along sinusoids; however, they were not found in the islets. CONCLUSIONS: Induction of immunological tolerance and long-term survival of islets are possible by simultaneous OLT. The mechanism of this tolerance could be the host's selection of the liver as a target of preferred immunological attack.

Animals↗
PubMed1999

The application of immobilized polymyxin B fiber in the treatment of septic shock associated with severe acute pancreatitis: report of two cases.

The elimination of endotoxin by direct hemoperfusion over immobilized polymyxin B fiber (PMX-F) was carried out in two patients who developed septic shock associated with severe acute pancreatitis. Parameters such as blood pressure, body temperature, and plasma endotoxin level improved after PMX-F treatment, and the infected lesions were successfully and safely removed by surgery. Although an aggressive operative strategy of debridement with ultimate closure over drains is generally associated with low mortality in patients with this devastating disease, we often hesitate to perform this operation due to the poor condition of the patient in the acute period, with multiple organ failure and/or septic shock status, and also because of the difficulty in diagnosing the pancreatic infection. In this situation, endotoxin elimination using PMX-F is a useful tool for treating secondary pancreatic infections to help the patient recover in preparation for surgery, or for treating perioperative endotoxemia.

Acute Disease↗