A Newly Developed On-line Monitoring System for the Determination of Serum Electrolytes and Urea During Hemodialysis

Continuous monitoring of serum solute concentrations throughout a dialysis session could be beneficial for the prevention of intradialytic morbidity such as hypotension and for the confirmation of dialysis adequacy. In this paper, we introduce a new on-line monitoring system for use during hemodialysis sessions, a system developed for the continuous observation of serum biochemical data. Using this system, we also show the possibility of clinical applications. Intradialytic hypotension could be prevented by the observation of filtrate sodium concentration and the control of dialysate sodium concentration. The termination of a dialysis session could be decided by the observation of the filtrate urea nitrogen, on the basis of the Kt/V urea ratio. Because monitoring for other solutes such as calcium and creatinine is theoretically available, clinical applications will continue to increase in the future.     

Characterization of a transmissible growth-promoting agent derived from CSF of schizophrenic patients which is active on human neuroblastoma cells

A growth-promoting agent for the human neuroblastoma cell line SK-N-SH(EP) (SH-EP) has been detected in human cerebrospinal fluid (CSF) derived from schizophrenic patients. Following treatment with the CSF, a number of properties of the SH-EP cells changed permanently. These included an accelerated rate of growth, an increased cell density at confluence, a change of cell shape, and an increased ability to form colonies in soft agar. All of these changes are consistent with further cellular transformation of the SH-EP cells. Once the cells' properties had changed following CSF treatment, the growth-promoting activity was found to be present in freeze-thawed cell extracts and in the culture medium, and could be passed to untreated SH-EP cells. The activity could be detected in culture media diluted as high as 10⁸. It was inactivated by proteinases, chloroform, or heat but passed through a 0.22-μm filter. The growth-promoting activity can be banded on a Percoll gradient, suggesting that it is particulate rather than a soluble growth factor. © 1993 Wiley-Liss, Inc.     

A clinical trial of creatine monohydrate in muscular dystrophy patients]

To investigate the effects of creatine monohydrate on muscle performance and cognitive functions in muscular dystrophy patients, we made an open trial. Twenty-nine individuals, including 14 myotonic dystrophy (DM), seven facioscapurohumeral muscular dystrophy (FSHD), two limb-girdle muscular dystrophy and six healthy volunteers, were enrolled in this study and 27 participants completed it. All participants took creatine 20g/day for an initial week and 5g/day for successive eight weeks. Somatotonic measurements, global subjective assessment, muscle performance, cardiopulmonary function, cognitive function, laboratory studies and magnetic resonance spectroscopy (MRS) were evaluated at both pre and post examination. Subjective improvements were reported from twelve individuals. Contrary adverse effects were also complained from ten individuals, although all these problems were not serious. Quantitative muscle power was slightly but significantly increased in the patients and the number of the patients who failed to complete cycle ergometer test was decreased. Phosphocreatine concentrations of left calf muscle were not different between pre and post trial examination. No obvious changes were detected in cardiopulmonary assessment, cognitive function and laboratory date. Creatine has certain expectance for muscular dystrophy patients in motor performance. The effect may be achieved not only by increase of energy buffer, because clinical improvements were observed in our study nevertheless no increase was detected in phosphocreatine concentration. The usage of creatine should be managed under medical monitoring since ideal protocol has not yet been established and adverse effects can not be ignored.     

EFFECTS OF ZAPRINAST ON RENAL NERVE STIMULATION-INDUCED ANTI-NATRIURESIS IN ANAESTHETIZED DOGS

1. We examined whether zaprinast, a putative cGMP-specific phosphodiesterase inhibitor, affects neural control of renal function in pentobarbital-anaesthetized dogs. 2. Renal nerve stimulation (1Hz, 1ms duration) reduced urine flow rate, urinary Na⁺ excretion (UNaV) and fractional excretion of Na⁺ (FENa) with little change in either renal blood flow (RBF) or glomerular filtration rate (GFR). 3. Intrarenal arterial infusion of zaprinast (10 and 100 μg/kg per min) increased basal urine flow rate, UNaV and FENa but not RBF or GFR. Zaprinast infusion (100 μg/kg per min) also increased renal venous plasma cGMP concentration and urinary cGMP excretion. 4. Renal nerve stimulation-induced reductions in UNaV and FENa were attenuated during zaprinast infusion, whereas the reduction in urine flow rate was resistant to zaprinast. 5. Renal nerve stimulation increased the renal venous plasma noradrenaline concentration and renal noradrenaline efflux, which remained unaffected during infusion of zaprinast (100 μg/kg per min). 6. The results of the present study suggest that zaprinast induces natriuresis and counteracts adrenergically induced anti-natriuresis by acting on renal tubular sites in the dog kidney in vivo.     

Relationship between liver cirrhosis and arteriosclerosis: Evaluation by pulse wave velocity, carotid arterial echotomography and autonomic nervous activity

Background: It has been reported that patients with liver cirrhosis (LC) rarely suffer complications from arteriosclerotic disorders such as coronary artery disease. However, recent studies have reported that the measurement of pulse wave velocity (PWV) facilitates objective evaluation of the severity of arteriosclerosis, suggesting a relationship between LC and arteriosclerosis. Objective: In the present study, we evaluated the relationship among the PWV, augmentation index (AI), and stage of LC from the perspective of urine levels of NO metabolites (NO₂ and NO₃) and autonomic nervous function. Methods: Forty elderly LC patients who were 65 years or older (LC group) were classified into the following three groups based on the Child’s classification of LC: LC‐A group (15 patients with Child A); LC‐B group (15 patients with Child B); and LC‐C group (10 patients with Child C). The results from these LC subgroups were compared to those of 25 healthy volunteers (N group). The PWV and AI were measured using a blood pressure and pulse wave monitoring device. Furthermore, we measured the urine levels of NO₂ and NO₃ and autonomic nervous activity and evaluated these by the measurements and by spectrum analysis of heart rate variability. In addition, the intima media thickness (IMT) in the carotid artery was measured by common carotid artery echotomography in each group. Results: The IMT increased with the stage of LC. Both the HF powers significantly decreased and LF : HF ratio increased in the LC group as the Child stage of LC advanced. The AI and PWV were significantly higher in the LC‐A and LC‐B groups than in the N group. However, PWV and AI of the LC‐C group were measured to a low value because the urine levels of NO₂ and NO₃ were significantly increased as the Child stage of LC advanced, and arteriosclerotic diagnosis seems to tend to be reduced in LC‐C patients. Conclusions: The increase in PWV and AI of LC‐A and LC‐B might suggest a relationship between advances of LC and arteriosclerosis. However, the hyperdynamic state in LC from the results of heart rate variability analysis, which is induced by NO production with the progression of the stage of LC, might have influenced the PWV and AI.     

Primary mucosa-associated lymphoid tissue-type lymphoma arising in the kidney

Abstract:   We report a case of primary low-grade lymphoma of mucosa-associated lymphoid tissue (MALT) arising from the kidney in a 30-year-old man with an abdominal mass in the right flank detected by ultrasonography. Radical nephrectomy was performed under a preliminary diagnosis of renal cell carcinoma. The final histological diagnosis was MALT-type lymphoma. To the best of our knowledge, only five reports of primary MALT-type lymphoma in the kidney have been published in the literature so far. All cases were surgically treated and only one case went on to chemotherapy postoperatively.     

Two-step biliary external stent removal after living donor liver transplantation.

Biliary stenting plays an important role in living donor liver transplantation (LDLT) as the rate of biliary complication is higher in LDLT than in diseased donor whole LT. We use a 2-mm tube for stenting at the biliary anastomosis, externalize it through the lower common bile duct, and fistulize it using duodenal serosa. After 3 months without biliary complications ensured by a cholangiogram, the stent tube is removed in a two-step manner, allowing bile to drain under a fluoroscope. The incidence of local peritonitis was lower, and the hospital stay was shorter with the two-step procedure. We herein report on the method of the two-step removal and its efficacy.     

Effects of Synthetic Salmon Calcitonin on C Cells of the Thyroid

The effects of long term administration of synthetic salmon calcitonin (TZ-CT) on thyroid C cells of rats were evaluated immunohistochemically and electron microscopically. Low dose (0.075, 0.75 and 7.5 IU/kg/day) administration caused no significant changes in the C cell population, whereas high doses (30 and 120 IU kg day) caused C cell suppression. The area ratio of C cells to total cells in the thyroid was measured on sections immunoperoxidase stained for calcitonin. The average C cell ratio was compared among the experimental groups. This mor-phometric analysis of the high-dose and control groups confirmed the differences in C cell populations statistically (30 IU/kg vs. control, pgO.05; 120 IU/kg vs. control, p ≦ 0.05). The suppressive effect of TZ CT on C cells was reversible after cessation of administration for one month. Electron microscopic examination on the C cells in the high dose groups revealed no particular ultrastructural differences. These results may suggest a negative feedback mechanism on C cells by exogenous CT. Acta Pathol Jpn 39: 545-550, 1989.