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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 PMX-DHP and continuous hemodiafiltration (CHDF) is helpful in treatment of preterm infants with systemic inflammatory response syndrome (SIRS) and hypercytokinemia. METHODS: A retrospective review on 18 SIRS infants born at gestational week 24 - 28. Eight with blood IL-6 ≥ 1000 pg/mL were treated actively with 2-h PMX-DHP followed by 2-h PMX-DHP and CHDF. Ten with IL-6 < 500 pg/mL were treated conventionally (with neither PMX-DHP nor CHDF) and served for controls...
April 9, 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
Wilson disease (WD) is a rare autosomal recessive disorder of copper metabolism due to a mutation in the ATP7B gene. The prevalence of WD is between 1 in 30,000 and 1 in 100,000 individuals, and it can sometimes present with acute liver failure (ALF). WD is a progressive disease and often remains undiagnosed; yet, it can be fatal if not treated. WD in patients with a New Wilson Index score ≥11 is fatal, and these patients are good candidates for liver transplantation. However, plasma exchange and chelator therapy are indispensable and effective even for WD with a score ≥11...
March 23, 2016: 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
Shiho Tobaru, Shunsuke Izumi, Satoko Saikawa, Yuji Miyata, Manabu Kakinohana
A 62-year-old man was scheduled for transurethral lithotripsy. Systemic shivering, vomiting and decreased blood pressure occurred after extubation. Blood gas analysis showed metabolic acidosis. After 45 minute observation, he became unconsciousness. He was reintubated. Elevated procalcitonin (PCT) and endotoxin activity assay (EAA) brought us to the diagnosis of severe septic shock. He was treated by a standard therapy conforming to early goal direct therapy and PMX-DHP with CHDF. He showed full recovery, and was discharged 9 days after the procedure...
June 2014: Masui. the Japanese Journal of Anesthesiology
Shinobu Tamura, Asumi Koyama, Chieko Shiotani, Toshio Kurihara, Akinori Nishikawa, Yukiharu Okamoto, Tokuzo Fujimoto
Primary plasma cell leukemia (PPCL) is a rare disease that progresses rapidly. In such cases, it is difficult to achieve remission, and early intensive chemotherapy is recommended. We herein describe the case of a 76-year-old man with PPCL complicated by renal failure and pulmonary hypertension. Bortezomib/dexamethasone induction therapy with lenalidomide was administered in association with continuous hemodiafiltration (CHDF). Complete remission was achieved after a single course of treatment, resulting in the cessation of CHDF...
2014: Internal Medicine
Hirokazu Sato, Kengo Tomita, Chihiro Yasue, Rumiko Umeda, Hirotoshi Ebinuma, Sho Ogata, Wenlin Du, Shigeyoshi Soga, Koji Maruta, Yuichi Yasutake, Kazuyuki Narimatsu, Shingo Usui, Chikako Watanabe, Shunsuke Komoto, Toshiaki Teratani, Takahiro Suzuki, Hirokazu Yokoyama, Hidetsugu Saito, Shigeaki Nagao, Toshifumi Hibi, Soichiro Miura, Takanori Kanai, Ryota Hokari
We present the case of a 25-year-old woman at 16 weeks of gestation who presented with non-comatose autoimmune acute liver failure and was at high risk of developing fulminant hepatitis. Predictive formulas indicated a high probability of developing fulminant hepatitis. Unenhanced computed tomography showed marked hepatic atrophy and broadly heterogeneous hypoattenuating areas. The course of her illness was subacute, and the etiology of liver injury was unclear. Considering all of the above, we predicted a poor prognosis...
March 2015: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Akihiro Yanagisawa, Masaru Tobe, Hiroshi Hinohara, Fumio Kunimoto, Tomonori Takazawa, Shigeru Saito
A male infant developed abdominal compartment syndrome (ACS) due to stage-4S neuroblastoma and hepatic enlargement. Because of tumor lysis syndrome by chemotherapy and radiationtherapy, his condition deteriorated and he underwent emergent abdominal counterincision surgical operation in the intensive care unit. General anesthesia was maintained with O2 (100%), midazolam (0.25-0.3 mg x kg(-1) x hr(-1)), fentanyl, and rocuronium infusion. By removal of the ACS, the breathing improved. At the end of the operation, we inserted GamCath catheter from his internal jugular vein for CHDF performed after the operation...
February 2014: Masui. the Japanese Journal of Anesthesiology
S Hagiwara, M Murata, M Aoki, M Kaneko, K Oshima
We report two cases of Klebsiella oxytoca bacteremia. Case 1 was a 56-year-old man who was transferred to our hospital by ambulance due to diarrhea and general fatigue. On arrival, he was clearly conscious. However he was in septic shock. We injected broad spectrum antibacterial agents and started intensive care. Though intensive care included continuous hemodiafiltration (CHDF), he died 22 hours after admission. Case 2 was a 69-year-old man with a history of gastrectomy for gastric cancer. He had been admitted to a previous hospital due to ileus...
April 2013: Hippokratia
Tomonari Oki, Kazuhito Funai, Keigo Sekihara, Kei Shimizu, Norihiko Shiiya
The patient was a 68-year-old male. At the previous hospital, continuous hemodiafiltration (CHDF)was performed through internal jugular vein for diabetic nephropathy. Long term catheterisation caused the abscess of the sternoclavicular joint, which induced methicillin-resistant Staphylococcus aureus( MRSA) empyema. Endoscopic thoracic debridement was performed for the empyema, however inadequate drainage for the abscess. Thereafter, the patient transferred to our hospital. We performed adequate drainage for the abscess under general anesthesia at 5 days after hospitalization, and then open decortication for empyema at 26 days...
August 2013: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Kazutoyo Morita, Ken Shirabe, Tomoharu Yoshizumi, Toru Ikegami, Toshiro Masuda, Naotaka Hashimoto, Yohei Mano, Tatsunori Miyata, Yuji Soejima, Yoshihiko Maehara
End-stage liver and kidney disease (ELKD) is an indication for deceased donor simultaneous liver-kidney transplantation. Although a few cases of living donor liver-kidney transplantation have been reported, the invasiveness remains to be discussed. Living donor liver transplantation (LDLT) is an alternative choice for ELKD, but has never been reported. Here, we report a case of successful LDLT for a patient with ELKD on hemodialysis. The patient was a 63-year-old male and had decompensated hepatitis C cirrhosis with seronegativity for hepatitis C virus...
May 2013: Case Reports in Gastroenterology
Hiromi Yanagimoto, Tsuyoshi Teramatsu, Junko Goto, Masahiko Yanagisawa, Norikazu Harii, Masahiko Suzuki, Takehisa Hanawa, Kenichi Matsuda, Toshio Oguchi
Variation in protein binding ratio (PBR) of teicoplanin (TEIC) was investigated in continuous hemodiafiltration (CHDF) patients. TEIC is classified as a high PBR drug (≧90%), and it was reported that the PBR of TEIC decreased with an decrease in the serum albumin level in hypoalbuminemia patients. However, few reports can be found about the variation of PBR of TEIC for CHDF patient. An antibiotic activity is directly determined by the level of unbound antibiotics species (Cfree) in the target site, namely, an increase in the Cfree enhances the risks of TEIC as well as the therapeutic effect against Methicillin-resistant Staphylococcus aureus (MRSA)...
2013: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
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