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Continuous plasma exchange with dialysis for thrombotic microangiopathy in intensive care unit: Retrospective observational study.
Satoh, K, Okuyama, M, Irie, Y, Kameyama, K, Kitamura, T, Nakae, H
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 2021;(4):377-383
Abstract
Continuous plasma exchange with dialysis is a novel method of blood purification and is a modification of the plasma exchange. Technically, this process suggests a reduction in adverse events, cost-effectiveness, and compatibility with hemodynamic instability. The therapeutic effect of plasma exchange on thrombotic microangiopathies has been established. We present three clinical cases in the intensive care unit that illustrate continuous plasma exchange with dialysis as a flexible blood purification therapy for critically ill patients; a radical treatment, thrombotic microangiopathies; supportive therapy, multiple organ failure; and fluid balance regulator. The retrospective analysis of 13 continuous plasma exchange with dialysis sessions showed that the platelet count increased significantly (p = 0.0096) after its administration. The total protein, albumin, fibrinogen, or calcium did not decrease significantly after continuous plasma exchange with dialysis, suggesting therapeutic efficacy and fewer adverse events. A prospective study on thrombotic microangiopathies for continuous plasma exchange with dialysis is currently underway.
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Late-onset acute liver failure due to Wilson's disease managed by plasmapheresis and hemodiafiltration successfully serving as a bridge for deceased donor liver transplantation: a case report and literature review.
Sukezaki, A, Chu, PS, Shinoda, M, Hibi, T, Taniki, N, Yoshida, A, Kawaida, M, Hori, S, Morikawa, R, Kurokouchi, A, et al
Clinical journal of gastroenterology. 2020;(6):1239-1246
Abstract
Late-onset acute liver failure due to Wilson's disease (WD-ALF) is rare. A 44-year-old female patient presenting acute hepatic decompensation with extreme coagulopathy was transferred to our hospital for evaluation for liver transplantation (LT). Alveolar hemorrhage and Coombs-negative acute hemolysis occurred during workup. Mechanical ventilation, plasmapheresis, and hemodiafiltration with zinc and chelation were started immediately before placing the patient on the waitlist for deceased donor LT (DDLT), with a tentative diagnosis of WD-ALF using the Leipzig score and quick diagnostic criteria suggested by the Acute Liver Failure Study Group Registry. The peak MELD score was 40, and the revised version of King's score for WD was 13. Serum free copper levels and the patient's overall general condition were stabilized with artificial support systems, although triphasic wave on electroencephalogram and liver atrophy were noted. She successfully underwent emergent DDLT approximately 2 weeks after suffering from acute hemolysis and survived. The genetic tests confirmed mutations at 2 loci in the ATP7B gene and, therefore, the diagnosis of WD. This is the first and oldest patient reported in Japan to present late-onset WD-ALF that was successfully treated with emergent DDLT.
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3.
[Bone loss in type 2 diabetes mellitus--diabetic osteopenia].
Takizawa, M, Kameyama, K, Maruyama, M, Ishida, H
Nihon rinsho. Japanese journal of clinical medicine. 2003;(2):287-91
Abstract
Loss of bone mineral content has been recognized as one of the chronic complications of type 2 diabetes mellitus, although its mechanism is not fully documented. A negative calcium balance due to both enhanced urinary calcium excretion and decreased intestinal calcium absorption has been occurred because of alteration of vitamin D metabolism and/or decreased parathyroid function. From the view point of bone cell metabolism, osteoblastic bone formation is suppressed by alternation of vitamin D metabolism, hypoparathyroidism, chronic hyperglycemia and insufficient insulin action. On the other hand, osteoclastic bone resorption is rather enhanced. The functional bone uncoupling system between osteoblast and osteoclast in type 2 diabetes mellitus could result in loss of bone density.
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4.
Effect of subconjunctival steroid injection on intraocular inflammation and blood glucose level after cataract surgery in diabetic patients.
Fukushima, H, Kato, S, Kaiya, T, Yuguchi, T, Ohara, K, Noma, H, Konno, Y, Kameyama, K, Oshika, T
Journal of cataract and refractive surgery. 2001;(9):1386-91
Abstract
PURPOSE To prospectively evaluate the usefulness of a subconjunctival steroid injection given at the completion of cataract surgery in patients with diabetes mellitus. SETTING University of Tokyo School of Medicine, Tokyo, Kaiya Eye Clinic, Hamamatsu, and Jyosai Hospital, Tokyo, Japan. METHODS One hundred four eyes of 104 diabetic patients having routine small incision cataract surgery were randomized into 2 groups. One group received a subconjunctival injection of dexamethasone and the other group did not. Aqueous flare intensity was measured with the laser flare meter preoperatively and 1, 2, 5, 7, and 14 days postoperatively. Another 19 diabetic patients having routine cataract surgery were randomized to receive a subconjunctival steroid injection or not; blood glucose concentration was measured 4 times a day for 3 days postoperatively. RESULTS There was no significant difference between the 2 groups in aqueous flare values at any postoperative time. The subconjunctival steroid injection induced a transient but significant increase in blood glucose on the day of surgery. CONCLUSION A subconjunctival steroid injection given at the completion of cataract surgery in diabetic patients had no beneficial effects.
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5.
[Multiple endocrine neoplasia 1 (MEN 1)].
Kameyama, K, Takami, H
Nihon rinsho. Japanese journal of clinical medicine. 2000;(7):1434-6
Abstract
Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant familial cancer syndrome characterized by tumors in parathyroids, enteropancreatic endocrine tissues, and anterior pituitary. In 1997, the MEN 1 gene was identified and cloned. It is on chromosome 11q13 and has 10 exons. It encodes a 610 amino acid protein called MENIN. However, many different germline mutations in MEN 1 families have reported, there were no hotspot of mutation. The correlation between MEN 1 mutation and clinical datas has not been established yet. Recently, the possible function of MENIN protein has reported. The identification of MEN 1 mutation by employing DNA test, will facilitate early diagnosis and treatment.