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Yutaka Ikeda, Kazuhiro Shoji, Chitho P Feliciano, Shinji Saito, Yukio Nagasaki
Acute inflammatory conditions such as sepsis lead to fatal conditions, including multiple organ failure. Several treatments such as steroidal anti-inflammatory drugs are currently being investigated in order to decrease the blood cytokine level, which increases remarkably. However, any of these therapeutic treatments are not always reliable and effective; none have drastically improved survival rates, and some have mostly ended with failure. Reactive oxygen species (ROS) are signaling molecules responsible for the production of cytokines and chemokines that can mediate hyperactivation of the immune response called cytokine storm...
March 5, 2018: Molecular Pharmaceutics
Yohei Komaru, Ryota Inokuchi, Yoshihiro Ueda, Masaomi Nangaku, Kent Doi
A 35-year-old woman intentionally took 40,000 mg of lithium carbonate, and she was transferred to our hospital with nausea, vomiting, and diarrhea. She was diagnosed as having bipolar disorder 10 years ago and was receiving oral lithium therapy. Blood test results on arrival were remarkable for a negative anion gap of -2.1 and later, the serum lithium level turned out to be as high as 15.4 mEq/L. Intubation was required because of disrupted consciousness, and continuous hemodiafiltration (CHDF) was immediately started in the intensive care unit to obtain constant removal of lithium...
January 2018: Hemodialysis International
Takuya Yamashina, Moeko Tsuruyama, Miki Odawara, Minako Tsuruta, Hirochika Miyata, Aki Kozono, Yasuhiro Tsuji, Takanori Miyoshi, Yosei Kawamata, Yoichi Hiraki
The pharmacokinetics of linezolid clearance (CLLZD) during continuous hemodiafiltration (CHDF) has not been comprehensively analyzed. Here, we examined CLLZD by CHDF in a patient with septic shock and disseminated intravascular coagulation due to methicillin-resistant Staphylococcus aureus. The extraction ratio of LZD by CHDF was 22.6%, and the protein-binding rate was 17.9% ± 7.7%. In addition, it was determined that the calculated total body clearance of LZD was 30.2 mL/min, plasma elimination half-life was 8...
October 2017: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Takeshi Moriguchi, Keiichi Koizumi, Kenichi Matsuda, Norikazu Harii, Junko Goto, Daiki Harada, Hisanori Sugawara, Minako Hoshiai, Hiroaki Kise, Akiyasu Baba
Autoantibodies against cardiac proteins play an important role in the development of dilated cardiomyopathy (DCM). The efficacy and safety of apheresis such as immunoadsorption (IA) or plasma exchange (PE) to remove such antibodies have been reported in adult DCM patients. However, apheresis for pediatric DCM has not been performed because of technical difficulty due to relatively low blood volume and instability of hemodynamics. As we have experiences of preforming apheresis on hemodynamically unstable children, we have preformed ten courses of PE on seven child DCM patients including both patients in chronic and acute phase to assess the safety and efficacy to PE...
September 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Eizo Watanabe, Shingo Yamazaki, Daisuke Setoguchi, Tomohito Sadahiro, Yoshihisa Tateishi, Tatsuya Suzuki, Itsuko Ishii, Shigeto Oda
INTRODUCTION: Recombinant human soluble thrombomodulin (rTM) is reportedly excreted by the kidneys; therefore, the recommended dose for patients with renal impairment is one-third of the standard dose. The aim of this study was to evaluate whether this reduced dose of rTM achieves effective drug concentrations that are comparable to those of the standard dose in treating sepsis-induced disseminated intravascular coagulation (DIC) during continuous hemodiafiltration (CHDF). METHODS: Eight patients in an intensive care unit were randomized to receive either reduced-dose (0...
2017: Frontiers in Medicine
Masafumi Yamato, Yusuke Minematsu, Yuta Ikemiya, Junichi Shibata, Junya Fujii, Takumi Minato, Sachie Miyagawa, Kaori Takaori, Yoko Tomiyama, Ikue Nagayama, Akira Wada, Takahito Ito, Hirotsugu Iwatani
BACKGROUND: Recent studies have shown that fibroblast growth factor-23 (FGF-23) is elevated not only in chronic kidney disease (CKD), but also in acute illnesses such as acute kidney injury, septic shock, and acute heart failure. FGF-23 would be not only a simple biomarker but also a direct toxic factor in acute illness. Therefore, lowering circulating FGF-23 levels in clinical practice would be an exciting and valuable interventional strategy. Continuous hemodiafiltration (CHDF) is often performed for the treatment of the aforementioned acute illnesses...
December 1, 2016: Clinical Laboratory
Jun Watanabe, Kengo Nishimura, Shigeto Miyasaka, Keisuke Morimoto, Takafumi Hamasaki, Shingo Ishiguro
Heparin-induced thrombocytopenia (HIT) is still a relatively uncommon condition and it is not well known how to administer argatroban during continuous hemodiafiltration (CHDF). A 72-year-old man required CHDF with heparin because of the oliguria and hyperpotassemia directly after the open repair of a juxtarenal abdominal aortic aneurysm. As the postoperative blood platelet count dropped and there was a thrombus in the CHDF circuit, HIT was suspected and nafamostat mesilate, but not heparin, was immediately administered for CHDF...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Jing Liu, Vinodh B Kurella, Louis LeCour, Tomas Vanagunas, David K Worthylake
IQGAP1 is a multidomain scaffold protein involved in many cellular processes. We have determined the crystal structure of an N-terminal fragment spanning residues 1-191 (CHDF hereafter) that contains the entire calponin homology domain. The structure of the CHDF is very similar to those of other type 3 calponin homology domains like those from calponin, Vav, and the yeast IQGAP1 ortholog Rng2. However, in the crystal, two CHDF molecules form a "head-to-head" or parallel dimer through mostly hydrophobic interactions...
November 22, 2016: Biochemistry
Takuya Ueno, Toshiaki Ikeda, Takayoshi Yokoyama, Yu Kihara, Osamu Konno, Yuki Nakamura, Hitoshi Iwamoto, Tetsunosuke Shimizu, Martina M McGrath, Anil Chandraker
Early recovery from shock improves prognosis in patients with severe sepsis and septic shock. During this period, cytokine imbalances mediate the development of organ damage and mortality. In Japan, we have access to hemoperfusion using an immobilized polymyxin B fiber column for endotoxin removal (PMX-DHP) and continuous hemodiafiltration (CHDF) as artificial support for patients with septic shock, with the aim of improving hemodynamics and organ dysfunction caused by elevated inflammatory cytokines and mediators...
July 2016: Cytokine
Yoshinobu Maede, Satoshi Ibara, Takuya Tokuhisa, Chie Ishihara, Eiji Hirakawa, Takako Matsui, Daijiro Takahashi, Seiro Machigashira, Hisanori Minakami
BACKGROUND: There have been no previous studies regarding whether combined use of Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) and continuous hemodiafiltration (CHDF) is helpful in the treatment of preterm infants with systemic inflammatory response syndrome (SIRS) and hypercytokinemia. METHODS: A retrospective review was carried out of 18 SIRS infants born at gestational week 24-28. Eight with blood interleukin (IL)-6 ≥ 1000 pg/mL were treated actively with 2 h PMX-DHP followed by 2 h PMX-DHP and CHDF...
November 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Jun Kido, Shirou Matsumoto, Ken Momosaki, Rieko Sakamoto, Hiroshi Mitsubuchi, Yukihiro Inomata, Fumio Endo, Kimitoshi Nakamura
AIM: Wilson disease (WD) in patients with a New Wilson Index (NWI) score ≥ 11 is fatal, and these patients are good candidates for liver transplantation (LT). However, plasma exchange and chelator therapy are indispensable and effective even for WD with a score ≥ 11. Moreover, continuous hemodiafiltration (CHDF) with these treatments is essential for acute liver failure (ALF) in WD with hepatic encephalopathy because CHDF can exclude toxic metabolites that may cause damage to the brain...
March 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Toshiharu Matsuura, Koichiro Yoshimaru, Yusuke Yanagi, Genshiro Esumi, Makoto Hayashida, Tomoaki Taguchi
A massive pulmonary hemorrhage in patients with liver cirrhosis is a life-threatening complication that may result in a contraindication of a liver transplantation because of its high mortality rate. Herein, we present two infant biliary atresia cases that successfully underwent an LDLT that was followed by intensive respiratory care for the pretransplant massive pulmonary hemorrhage. Both cases exhibited severe respiratory failure (minimum PaO2/FiO2; 46 mmHg and 39 mmHg, respectively). To arrest the bleeding, we applied a very high positive pressure ventilation treatment (maximum PIP/PEEP; 38/14 cmH2O and 55/15 cmH2O, respectively), plasma exchange, several FFP transfusions, and recombinant factor VIIa via intrapulmonary administration...
February 2016: Pediatric Transplantation
H Hirasawa
It is widely recognized that endothelial hyperpermeability (EH) plays a pivotal role in the pathophysiology of severe sepsis and septic shock. However, very few attention has been paid to EH when we apply infusion therapy on the patients with severe sepsis and septic shock. And such infusion therapy without the consideration on EH often results in the interstitial edema which is one of the main causes of derangement in microcirculation and dysoxia in sepsis. Dysfunction of endothelial tight junction caused by inflammatory mediators is reported to be important pathophysiological factor of septic EH...
October 2015: Shock
Takeshi Wada, Masaki Kobayashi, Yuichi Ono, Asumi Mizugaki, Kenichi Katabami, Kunihiko Maekawa, Daisuke Miyamoto, Yuichiro Yanagida, Mineji Hayakawa, Atsushi Sawamura, Ken Iseki, Satoshi Gando
The aim of this study was to establish the pharmacokinetics of levofloxacin (LVFX) and determine the optimal dose of this drug in critically ill patients receiving continuous hemodiafiltration (CHDF). The results of in vivo and in vitro studies showed the pharmacokinetics of LVFX total clearance (CLtotal) according to the creatinine clearance (CLCre), dialysate flow (QD), and ultrafiltrate flow (QF), to be as follows: CLtotal (l/h) = 0.0836 × CLCre (ml/min) + 0.013 × body weight (kg) + 0.94(QD + QF) (l/h)...
2015: Journal of Intensive Care
Masato Miyauchi, Makiko Hayashida, Hiroyuki Yokota
BACKGROUND: Benzalkonium chloride (BZK) is widely used as a germicide in hospitals and other places. Although several cases of accidental oral intake of BZK have been reported, there have been few reported cases of BZK toxicity due to intravenous injection. CASE REPORT: A male nurse in his 40 s injected 15 mL of 10% BZK (Osvan S) directly into his left antebrachial vein while at home, as a suicide attempt. The patient was admitted to our hospital 1 hour later. Acute respiratory distress syndrome (ARDS) was diagnosed by blood gas analysis, chest X-ray, and CT scan...
December 2014: Chūdoku Kenkyū: Chūdoku Kenkyūkai Jun Kikanshi, the Japanese Journal of Toxicology
Kosuke Shibamori, Takanobu Yamamoto, Masahiro Matsuki, Yohei Matsuda, Shuichi Kato, Fumiyasu Takei, Masahiro Yanase
Rhabdomyolysis is a rare perioperative complication, however, potentially lead to fatal outcome. We experienced 2 cases of rhabdomyolysis after radical nephrectomy and nephroureterectomy in the lateral decubitus position. (Case 1) A 40-years old man was seen in our hospital because of asymptomatic grosshematuria. Computed tomography revealed right renal pelvic cancer, cT3N0M0. Right radical nephroureterectomy, lymph node dissection, partial cystectomy was underwent, and the operation was finished without any trouble...
October 2014: Nihon Hinyōkika Gakkai Zasshi. the Japanese Journal of Urology
Kenji Shitara, Hiroyuki Fukunari, Tomotaka Kato, Jun Yoshino, Yutaka Nakajima, Chisato Okajima, Tetsuji Hayashi, Gen Watanabe
We encountered a rare case of gastric cancer consisting predominantly of undifferentiated carcinoma.The patient was a 64-year-old man who underwent various tests because of symptoms of dysphagia in September 2012.We found a subcircumferential type II tumor at the gastroesophageal junction.A total gastrectomy, splenectomy, and Rouxen-Y reconstruction were performed.Adhesiotomy was also performed for the ileus on postoperative day (POD)2.The patient subsequently experienced septic shock with disseminated intravascular coagulation (DIC) and acute kidney failure due to complications of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and MRSA colitis...
November 2014: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Minoru Murayama, Osamu Nakashima, Katsuo Yamazaki, Kazuo Koizumi, Tatsuomi Miyauchi, Akira Miyaki, Atsuko Usuda, Kentarou Yamaguchi, Hajime Yokomizo, Shunichi Shiozawa, Kazuhiko Yoshimatsu, Takeshi Shimakawa, Takao Katsube, Yoshihiko Naritaka
Colorectal cancer associated perforation initially develops as pan-peritonitis but easily progresses to septic shock, which can be fatal. As such, it can be hard for patients to recover from this pathological condition. A 79-year-old man who was suffering from pan-peritonitis due to sigmoid colon cancer-associated perforation and also had a metastatic hepatic lesion was admitted to our hospital. He underwent an emergency operation in October 2012. Due to hemodynamic instability, peritoneal lavage and drainage, and stomal formation were performed during the operation...
November 2014: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Yukiko Takahashi, Yusuke Nagamine, Keiko Fujimoto, Kiyoyasu Kurahashi
A 74-year-old man with ruptured thoracoabdominal aortic aneurysm was scheduled for open surgical repair under partial cardiopulmonary bypass. He had a history of diabetes mellitus and a concomitant renal dysfunction, requiring regular intermittent hemodialysis. To maintain electrolytes, acid base as well as water balance within adequate ranges, we planned to use continuous hemodiafiltration (CHDF) during the surgery because there was a high incidence of bolus transfusion to deal with massive bleeding in these surgeries...
October 2014: Masui. the Japanese Journal of Anesthesiology
Hidetoshi Shiga, Hiroyuki Hirasawa, Osamu Nishida, Shigeto Oda, Masataka Nakamura, Kunihiro Mashiko, Kenich Matsuda, Nobuya Kitamura, Yoshihiko Kikuchi, Nobuo Fuke
BACKGROUND/AIM: We investigated the clinical efficacy of continuous hemodiafiltration (CHDF) with AN69ST hemofilter (AN69ST-CHDF) in patients with septic shock. MATERIALS AND METHODS: A prospective, multicenter, single-arm study was conducted. Patients with sepsis and shock defined by hyperlactemia were enrolled. The patients were treated with CHDF and in accordance with the Surviving Sepsis Campaign guidelines (SSCG). RESULTS: Thirty-four patients were enrolled...
2014: Blood Purification
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