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1.
J Vasc Access ; 23(3): 462-466, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-33579173

RESUMO

We previously described the success and usefulness of two operative techniques for creating a radial artery-first or second dorsal metacarpal vein arteriovenous fistula (AVF) in the first interdigital space of the dorsal hand using the most distal site and autologous veins in the upper limb. These techniques utilize the dorsal metacarpal veins on the radial side of the dorsal hand. Developing these ideas, we devised a novel operative technique for creating a transposed radial artery-third metacarpal vein AVF in the first interdigital space of the dorsal hand using the most distal vein on the ulnar side of the upper limb and most distal site in the upper limb. The distinctive advantage of this technique is that it can be applied to patients whose cephalic vein in the forearm and the dorsal metacarpal veins on the radial side of the dorsal hand are of a poor quality. We herein report the steps of this technique and describe its successful performance in a patient who has been on hemodialysis for 14 months without any additional vascular access interventions or postoperative complications. We consider this technique to be a valuable option in select patients who meet the applicable conditions. The creation of the first AVF as distally as possible is ideal, and it offers a further viable option of distal native vascular access that may be overlooked.


Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Humanos , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Diálise Renal , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Artéria Ulnar/cirurgia , Grau de Desobstrução Vascular
2.
Clin Case Rep ; 9(5): e04105, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34026147

RESUMO

We experienced a case in which improving the renal damage caused by warfarin-related nephropathy took a long time. It is important to follow up for a long time after the initiation of dialysis due to warfarin-related nephropathy.

3.
J Vasc Access ; 22(3): 462-469, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32741248

RESUMO

A brachio-brachial arteriovenous fistula with superficialization of the brachial vein and superficialization of the brachial artery are useful vascular access techniques for hemodialysis patients. However, both typically require a long skin incision from the antecubital fossa toward the axillary fossa. In addition, the brachio-brachial arteriovenous fistula in particular, which is created with not a one-stage but a two-stage procedure, requires a relatively long time of 2-3 months before it can be used for hemodialysis. Furthermore, superficialization of the brachial artery usually requires nonarterialized superficial veins for blood return. In cases where patients have no adequate superficial veins for creating an arteriovenous fistula, we have adopted a one-stage operative technique to create a brachio-brachial arteriovenous fistula with superficialization of not only the brachial vein but also the brachial artery using a short skin incision. This technique of a brachio-brachial arteriovenous fistula with superficialization of the brachial artery has several advantages over traditional approaches, including a minimally invasive procedure and early use for vascular access. To our knowledge, the presently described technique and the related data have not been previously reported in the English literature. We herein report the steps of this technique and the midterm follow-up outcomes.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Tohoku J Exp Med ; 252(2): 153-157, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33028760

RESUMO

Membranous nephropathy (MN) is a common glomerular disease that is characterized by diffuse thickening of the glomerular basement membrane, and a common cause of nephrotic syndrome (NS). MN is often accompanied with malignant disease; The solid tumors are commonly associated with MN, whereas hematological malignancies are rarely found in patients with MN. A 68-year-old man with a history of diabetes mellitus visited a hospital with a chief complaint of general fatigue. He was previously not diagnosed with any complications of diabetes. Computed tomography revealed a pancreatic tumor, and the pathological findings of the biopsied tumor revealed the tumor was diffuse large B-cell lymphoma (DLBCL). Concurrently, he developed severe proteinuria, hypoalbuminemia, systemic edema and hyperlipidemia, consistent with the diagnosis of NS. The biopsied renal specimen revealed minute spike lesions of glomerular basement membrane, and abnormal lymphocytes infiltrated in the kidney interstitially. Anti-glomerular basement membrane antibody, proteinase-3-/myeloperoxidase antineutrophil cytoplasmic antibody and hepatitis B antigenemia, are absent in the patient. Serum anti-phospholipase A2 receptor (PLA2R) antibody (marker for primary MN) was not detected. A diagnosis of secondary MN induced by DLBCL was made. He received rituximab containing chemotherapy for DLBCL, resulting in amelioration of both DLBCL and MN. We report the rare case of a patient co-existing NS and DLBCL. DLBCL might be pathogenesis of NS; the findings are supported by the presence of MN, an underlying malignancy (DLBCL), and the lack of anti-PLA2R antibodies. Although further investigation is warranted, our case suggests that DLBCL is a possible cause of secondary MN.


Assuntos
Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Síndrome Nefrótica/diagnóstico por imagem , Idoso , Membrana Basal/patologia , Terapia Combinada , Complicações do Diabetes , Humanos , Imunoterapia , Inflamação , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Masculino , Síndrome Nefrótica/complicações , Síndrome Nefrótica/patologia , Síndrome Nefrótica/terapia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Receptores da Fosfolipase A2/imunologia , Rituximab/farmacologia , Tomografia Computadorizada por Raios X
5.
Int J Surg Case Rep ; 72: 330-334, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32563097

RESUMO

INTRODUCTION: The creation of the first arteriovenous fistula (AVF) as far distally in the upper limb as possible is ideal. We developed a new operative technique for creating a radial artery-second dorsal metacarpal vein AVF in the first interdigital space. This technique involves the creation of the AVF using the most peripheral site and autologous vein in the upper limb. CASE PRESENTATION: We herein describe the steps of this technique and its successful performance in a 71-year-old man with end-stage renal disease. DISCUSSION: This technique has several advantages including preserving many future vascular access options and providing a long segment of arterialized vein for cannulation. CONCLUSION: We consider this technique to be a worthwhile option and recommend the use in patients with the proper vessels for the creation of the AVF.

6.
J Vasc Access ; 21(5): 790-794, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31686621

RESUMO

A radiocephalic arteriovenous fistula in the anatomical snuffbox (tabatière region) was first described in 1969 as the most peripheral site for arteriovenous fistula in the upper limb. In cases in which the internal diameter of the first dorsal metacarpal vein under avascularization is ⩾2.0 mm, we have adopted a new operative technique for creating a radial artery-first dorsal metacarpal vein arteriovenous fistula in the first interdigital space of the dorsal hand, which lies between the thumb and the index finger. This technique is the creation of the arteriovenous fistula using the first dorsal metacarpal vein and the most peripheral site in the upper limb. To our knowledge, no previous report has described the creation of a radial artery-first dorsal metacarpal vein arteriovenous fistula. We herein describe the steps of the technique and report its successful performance in a patient with chronic renal failure.


Assuntos
Derivação Arteriovenosa Cirúrgica , Mãos/irrigação sanguínea , Falência Renal Crônica/terapia , Ossos Metacarpais/irrigação sanguínea , Artéria Radial/cirurgia , Diálise Renal , Veias/cirurgia , Idoso , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
8.
Ann Vasc Surg ; 61: 466.e7-466.e11, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31349055

RESUMO

A radiocephalic arteriovenous fistula (AVF) in the anatomical snuffbox is the most distal site of AVF in the upper limb. When the cephalic vein distal to the wrist is in poor condition or thrombosed, creating the typical radiocephalic AVF in the distal forearm just proximal to the wrist will likely be considered. However, we have adopted an operative technique for creating a transposed radial artery-dorsal metacarpal vein AVF (RDAVF) in the anatomical snuffbox when possible in such cases. RDAVF is AVF using the most peripheral autologous vein in the upper limb. To our knowledge, the creation of an RDAVF has not been previously reported. We herein describe the steps of the technique and report the successful treatment of a hemodialysis patient who developed occlusion of a radiocephalic AVF in the anatomical snuffbox.


Assuntos
Derivação Arteriovenosa Cirúrgica , Mãos/irrigação sanguínea , Falência Renal Crônica/terapia , Artéria Radial/cirurgia , Diálise Renal , Veias/cirurgia , Idoso , Humanos , Falência Renal Crônica/diagnóstico , Masculino , Artéria Radial/diagnóstico por imagem , Resultado do Tratamento , Veias/diagnóstico por imagem
9.
PLoS One ; 14(4): e0215766, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31013316

RESUMO

Various factors are considered to be mechanisms of the increase in the sizes of cysts in patients with polycystic kidney disease. Vasopressin is one of the causes, and drinking large volumes of water shows an effect of suppressing an increase in cysts. On the other hand, it is known that hydrogen-rich water reduces oxidative stress and has a good effect on kidney injury. We examined whether drinking large volumes of hydrogen-rich water affected the increase in the sizes of cysts. Forty 5-week-old PCK rats were randomly assigned to four groups: C(Control), purified water; W(Water), water with sugar; H(Hydrogen), hydrogen-rich water; WH(Water+Hydrogen), hydrogen-rich water with sugar. They consumed water from 5 to 15 weeks of age. The intake of water in the groups in which sugar was added to the water (W, WH) significantly increased in comparison to C, but there was no significant change in the serum Creatinine concentration. The kidney weight per body weight in W was significantly decreased in comparison to C. The kidney weights in H and WH were significantly increased in comparison to W. There were no significant differences in the ratio of the cross-sectional area of the cysts to the whole area among the groups. This experiment showed that the effect of drinking large volumes of hydrogen-rich water was not significantly different from that of normal water, in terms of preventing an increase in the size of cysts in PCK rats. However, some papers acknowledge the influence of hydrogen water. Significant differences might become obvious if we change aspects such as the administration method or administration period.


Assuntos
Hidrogênio/administração & dosagem , Rim Policístico Autossômico Dominante/tratamento farmacológico , Água/administração & dosagem , Administração Oral , Animais , Modelos Animais de Doenças , Ingestão de Líquidos , Humanos , Rim/efeitos dos fármacos , Rim/patologia , Mutação , Estresse Oxidativo/efeitos dos fármacos , Rim Policístico Autossômico Dominante/genética , Rim Policístico Autossômico Dominante/patologia , Ratos , Ratos Transgênicos , Receptores de Superfície Celular/genética , Fatores de Tempo , Resultado do Tratamento
10.
Int J Surg Case Rep ; 54: 95-98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30572245

RESUMO

INTRODUCTION: Vascular access intervention therapy (VAIVT) is an essential interventional therapy in the field of hemodialysis therapy that allows for the long-term vascular access functionality to be maintained. The venous approach is often performed in VAIVT for arteriovenous fistula. When lesions are present on the upstream and downstream sides from the approach site, it is likely that two sheaths will be inserted from two facing punctures. However, we have adopted a one-sheath inverse method using a guidewire in such cases. CASE PRESENTATION: We herein describe the steps of the technique that we have performed and report the successful treatment of a 77-year-old woman who developed arteriovenous fistula failure. DISCUSSION: To the best of our knowledge, the concrete and detailed technique has not been reported in the English literature to date. The merit of the technique is that it allows VAIVT to be performed using one sheath with one approach site in cases in which lesions are present on the upstream and downstream sides from the approach site. The other benefits include pain reduction, a shortened operation time, and reduced costs. Because vascular access location is usually superficial, the technique can be utilized with relative ease. CONCLUSION: A one-sheath inverse method is useful. We hope that the technique will be more widely recognized, allowing the technique to be applied to more cases.

11.
Clin Nephrol ; 89(3): 181-186, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29035196

RESUMO

BACKGROUND/METHODS: Thyroid function was evaluated in 14 Japanese patients on continuous ambulatory peritoneal dialysis (CAPD) with end-stage renal disease compared with 11 chronic kidney disease (CKD) stage 1+2 patients (glomerular filtration rate ≥ 60 mL/min/1.73m2). RESULTS: The serum free triiodothyronine (fT3) (2.2 ± 0.3 pg/mL, p < 0.05) levels were lower, and the rate of low triiodothyronine (T3) syndrome was higher (4 of 13 cases, 30.8%) in the CAPD patients than in the CKD stage 1+2 patients (1 of 10 cases, 10.0%, respectively) or the 57 age-matched healthy controls. The serum thyroglobulin (Tg) levels were significantly higher in the CAPD patients (39.7 (13.4 - 178.0) ng/mL) than in the CKD stage 1+2 patients (9.9 (5.5 - 28.8) ng/mL, p < 0.05). High serum Tg levels (> 30 ng/mL) were observed in 66.7% of the CAPD patients. CONCLUSION: The finding from our study suggested the deterioration of thyroid function with higher prevalence of low T3 syndrome in the CAPD patients. Although speculation as to the reasons for this would be unwise at this point, we did note that the serum Tg levels were very high in the CAPD patients.
.


Assuntos
Hipotireoidismo/sangue , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Adulto , Idoso , Feminino , Taxa de Filtração Glomerular , Humanos , Hipotireoidismo/complicações , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/terapia , Tireoglobulina/sangue , Glândula Tireoide/fisiopatologia , Tri-Iodotironina/sangue
12.
Clin Nephrol ; 87 (2017)(5): 237-244, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28291505

RESUMO

BACKGROUND: We examined the thyroid function of non-dialysis-dependent chronic kidney disease (CKD) patients in Japan. METHODS: Serum-free thyroxine, free triiodothyronine, thyroid-stimulating hormone (TSH), and thyroglobulin (Tg) levels were evaluated in 37 CKD patients. CKD was defined as sustained kidney damage for more than 3 months and was classified as CKD 1+2 (n = 11), 3+4 (n = 10), or 5 (n = 16), which were defined by glomerular filtration rates of ≥ 60, 15 - 59, or < 15 mL/min/1.73m2, respectively. RESULTS: The prevalence of primary hypothyroidism (TSH ≥ 4.83 mU/L) in CKD 1+2, CKD 3+4, and CKD 5 was 9%, 20%, and 56%, respectively (p < 0.05). Unexpectedly, elevated serum Tg levels (> 30 ng/mL), a marker of the reversible recovery of the thyroid function, were found in 67% of the CKD 5 patients (p < 0.05). The serum TSH and Tg levels became lower, without replacement therapy, after the initiation of hemodialysis and iodine restriction, and there was a significant correlation between the serum TSH and Tg levels in the CKD 5 patients (p < 0.05). CONCLUSION: The high prevalence of reversible hypothyroidism and the TSH-dependent elevation of the serum Tg levels was suggested in Japanese patients with advanced CKD. The excess ingestion and the impaired urinary excretion of iodine may be responsible for this reversible thyroid dysfunction.
.


Assuntos
Hipotireoidismo/epidemiologia , Insuficiência Renal Crônica/sangue , Tireoglobulina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Taxa de Filtração Glomerular , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Diálise Renal , Insuficiência Renal Crônica/fisiopatologia , Tireotropina/sangue
13.
PLoS One ; 10(4): e0123036, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25859658

RESUMO

It is thought that a large amount of albumin leaking from the glomerulus in nephrotic syndrome (NS) is reabsorbed at the proximal tubule and catabolized. Therefore, it is possible the final quantity of urinary protein does not always reflect the amount of leakage of protein from the glomerulus. We experienced two cases without nephrotic range proteinuria thought to involve hypoproteinemia due to the same pathophysiology as NS. On these patients, we performed protein leakage scintigraphy with technetium-99m human serum albumin diethylenetriamine pentaacetic acid (99mTc-HSAD) to exclude a diagnosis of protein-losing gastroenteropathy and observed diffuse positive accumulation in the kidneys with more intense uptake in the kidney than the liver on the anterior view 24 hours after 99mTc-HSAD administration. In healthy adults intravenously given 99mTc-HSAD, the same dynamics are observed as in albumin metabolism, and the organ radioactivity of the liver and kidneys after 24 hours is equal. Therefore, we thought it was possible that the renal uptake 24 hours after 99mTc-HSAD administration was a characteristic finding of NS. In order to confirm it, the subjects were divided into two groups: the NS group (n = 10) and the non-NS group (n = 7). We defined more intense uptake in the kidney than the liver on the anterior view 24 hours after 99mTc-HSAD administration as Dense Kidney (+). Furthermore, we designed regions of interest in the right and left kidneys and liver on anterior and posterior images, then calculated the kidney-liver ratio. Nine of the ten patients had Dense Kidney (+) in the NS group, compared to none in the non-NS group. And the kidney-liver ratio was significantly higher in the NS group than in the non-NS group on each view in the bilateral kidneys. In conclusion, our results suggest that the renal uptake 24 hours after 99mTc-HSAD administration is a characteristic finding of NS.


Assuntos
Síndrome Nefrótica/diagnóstico por imagem , Cintilografia/métodos , Agregado de Albumina Marcado com Tecnécio Tc 99m , Pentetato de Tecnécio Tc 99m , Adulto , Idoso , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
World J Hepatol ; 5(2): 82-5, 2013 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-23646233

RESUMO

A 38-year-old female presenting with a high fever of 39 °C developed severe liver dysfunction and acute renal failure (ARF). In tests for a hepatitis associated virus, an Immunoglobulin M-anti-hepatitis B virus core antibody was the only positive finding. Moreover, the progression of ARF coincided with the pole period of liver damage and all the other assumed causes for the ARF were unlikely. Therefore, this case was diagnosed as ARF caused by acute hepatitis B. ARF associated with non-fulminant hepatitis has been infrequently reported, usually in association with acute hepatitis A. This case is considered to be an extremely rare and interesting case.

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