Initiation of peritoneal dialysis in a patient with chronic renal failure associated with tetralogy of Fallot: a case report.

BACKGROUND: Tetralogy of Fallot is the most common cyanotic congenital heart disease. Patients with the condition have a high risk of developing chronic kidney disease. Treatment of kidney disease in patients with complex hemodynamics presents unique challenges. However, there are very few reports on the treatment of end-stage renal failure in patients with tetralogy of Fallot. CASE PRESENTATION: We present a rare case of peritoneal dialysis in a 47-year-old man with tetralogy of Fallot who had not undergone intracardiac repair. Peritoneal dialysis successfully removed fluids and solutes without adversely affecting the patient's hemodynamics. Our patient was managed with peritoneal dialysis for 5 years before he succumbed to sepsis secondary to digestive tract perforation. CONCLUSIONS: In this paper, we discuss the importance of monitoring acid-base balance, changes in cyanosis, and hyperviscosity syndrome during peritoneal dialysis in patients with tetralogy of Fallot. Lower leg edema and B-type natriuretic peptide level were useful monitoring parameters in this case. This case illustrates that with attention to the patient's unique requirements, peritoneal dialysis can provide successful renal replacement therapy without compromising hemodynamics in patients with tetralogy of Fallot.

An autopsy case of TAFRO syndrome with membranoproliferative glomerulonephritis-like lesions.

TAFRO syndrome (thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly) is an atypical manifestation of multicentric Castleman's disease. Although overproduction of interleukin-6, vascular endothelial growth factor, and other cytokines may partially explain the pathophysiology of this rare syndrome, the precise mechanisms underlying the renal dysfunction associated with the condition remain unclear. Here, we describe a case of a 69-year-old male with TAFRO syndrome. He was treated with immunosuppressive agents and his renal function improved. Tapering of immunosuppressive agents resulted in a deterioration of renal function and an elevation of C-reactive protein. After 20 months of treatment, the patient died from tuberculous peritonitis and gastrointestinal bleeding. An autopsy revealed miliary tuberculosis, mediastinal lymphadenopathy, and gastric ulcers. Renal histopathology showed a membranoproliferative glomerulonephritis-like appearance. Almost all glomeruli showed lobular formations with mesangial proliferation and duplication of glomerular capillary walls on light microscopy. Immunofluorescence showed deposition of C1q and IgM along the glomerular capillary walls. Electron microscopy showed mesangial expansion and widening of the subendothelial space with a large number of electron-dense deposits. The glomerular lesions might be characteristic of TAFRO syndrome, and were regarded as the main cause of the patient's renal dysfunction.

Isolation and characterization of a SEPALLATA-like gene, ZjMADS1, from marine angiosperm Zostera japonica.

In flowering plants, floral homeotic MADS-box genes, which constitute a large multigene family, play important roles in the specification of floral organs as defined by the ABCDE model. In this study, a MADS-box gene, ZjMADS1, was isolated and characterized from the marine angiosperm Zostera japonica. The predicted length of the ZjMADS1 protein was 246 amino acids (AA), and the AA sequence was most similar to those of the SEPALLATA (SEP) subfamily, corresponding to E-function genes. Southern blot analysis suggested the presence of two SEP3-like genes in the Z. japonica genome. ZjMADS1 mRNA levels were extremely high in the spadices, regardless of the developmental stage, compared to other organs from the reproductive and vegetative shoots. These results suggest that the ZjMADS1 gene may be involved in spadix development in Z. japonica and act as an E-function gene in floral organ development in marine angiosperms.

Isolation and characterization of a cDNA encoding a heat shock protein 70 from a sterile mutant of Ulva pertusa (Ulvales, Chlorophyta).

Synthesis and accumulation of molecular chaperones are universal responses found in all cellular organisms when exposed to a variety of unfavorable conditions. Heat shock protein 70 (Hsp70), which is one of the major classes of molecular chaperones, plays a particularly important role in cellular stress responses, and the Hsp70 system is the most intensely studied in higher plants and algae. Therefore, we isolated and characterized a cDNA clone encoding Hsp70 from a sterile strain of Ulva pertusa (Ulvales, Chlorophyta). The sterile U. pertusa Hsp70 (UpHsp70) cDNA consisted of 2,272 nucleotides and had an open reading frame encoding a polypeptide of 663 amino acid (AA) residues with a molecular mass of 71.7 kDa. Amino acid alignment and phylogenetic analysis of Hsp70s from other organisms showed that UpHsp70 was more similar to cytoplasmic Hsp70s from green algae and higher plants (> or =75%) than to those from other algae and microorganisms. Southern blot analysis indicated that the sterile U. pertusa genome had at least four cytoplasmic Hsp70-encoding genes. UpHsp70 mRNA levels were significantly affected by diurnal changes, rapidly increased by high-temperature stress, and gradually increased by exposure to copper, cadmium, and lead. These results suggest that UpHsp70 plays particularly important roles in adaptation to high-temperature conditions and diurnal changes, and is potentially involved in tolerance to heavy metal toxicity.

Spectrophotometric determination of spermine and related compounds using o-hydroxyhydroquinonephthalein and manganese(II).

A simple and highly sensitive spectrophotometric method for the determination of spermine (Spm) was established based on the ternary complex formation reaction of Spm with o-hydroxyhydroquinonephthalein (QP) as a xanthene dye and manganese(II) as a metal ion in the presence of a dispersion agent. The apparent molar absorptivity at 555 nm and the relative standard deviation of the proposed method were 1.4 x 10(5) dm(3) mol(-1) cm(-1) and 0.50% (n = 10), respectively. In the method for flow-injection analysis (FIA), which employs a single-channel flow manifold system, a good linear relationship was observed over the 2 - 20 pg microl(-1) range of Spm by direct injection.

Spectrophotometric determination of uric acid based on fading of o-hydroxyhydroquinonephthalein-palladium(II)-hexadecyltrimethyl-ammonium complex.

A simple and highly sensitive spectrophotometric method for the determination of uric acid (UA) was established based on fading of the o-hydroxyhydroquinonephthalein-palladium(II)-hexadecyltrimethylammonium complex. In the determination of UA, Beer's law is obeyed in the range of 0.01-0.20 microg ml(-1), with an effective molar absorptivity at 635 nm, the relative standard deviation being 6.5 x 10(5) dm(3) mol(-1) cm(-1) and 1.5% (n = 5). This method is about 20-times more sensitive than the conventional methods. The method was successfully applied to the assay of UA in human urine.

Spectrophotometric determination of anthracycline anticancer agents with aluminum(III) and chromazurol S in a nonionic surfactant micellar medium.

A simple and highly sensitive spectrophotometric method for the determination of anthracycline anticancer agents, such as Daunorubicin hydrochloride (DAU), was established by using aluminum(III) and Chromazurol S (CAS) in a nonionic surfactant micellar medium. In the case of determination of DAU, the apparent molar absorptivity was 1.3 x 10(5) dm3 mol(-1) cm(-1) at 615 nm. Beer's law was obeyed in the concentration range of 0.028 - 2.82 microg ml(-1) for DAU. Owing to no need for solvent extraction, this method could be applied to assays of DAU and related drugs in pharmaceutical preparations.

Spectrophotometric determination of glucosamine and its analogous amino sugars with o-hydroxyhydroquinonephthalein and palladium(II).

A simple and highly sensitive spectrophotometric method for the determination of glucosamine and its analogous amino sugars was established based on fading of the palladium(II)-o-hydroxyhydroquinonephthalein-hexadecyltrimethylammonium complex. In the determination of glucosamine, Beer's law is obeyed in the range of 0.02 - 0.18 microg ml(-1), with an effective molar absorptivity at 630 nm and the relative standard deviation being 8.4 x 10(5) dm3 mol(-1) cm(-1) and 1.08% (n = 10). This method is about 70-times more sensitive than the Elson-Morgan method. The method was successfully applied to the assay of glucosamine in actual samples.

Problems related to rapid methods for erythrocyte sedimentation rate test and their solution.

The erythrocyte sedimentation rate (ESR) test is one of the most common and traditional laboratory tests in the world. It reflects both plasma concentration of acute-phase proteins of large molecular size and anemia (International Council for Standardization in Hematology, 1993). The ESR test method is easy to perform and inexpensive. Therefore, it is used today as a routine test worldwide. However, the ESR has some demerits, in requiring a large volume of sodium citrate or ethylenediamine tetraacetic acid (EDTA) blood and at least 2-hour testing time. When ESR is tested manually, incorrect results are obtained if the ESR test tube is not stood strait-up and vertically (Dobashi et al, 1994). Reading error for the meniscus line and surrounding temperature at the testing site cause inaccuracy (Manley, 1957). The 2-hour testing time is not practical for modernized automated laboratories. Its test procedures present the risk of infection from contact with pathogen-bearing blood (Imafuku and Yoshida, 2001). In this context, several kinds of simple, rapid and safe methods have been developed. Of these new systems, we selected 4 and evaluated their performance. This paper reports critical reviews of such devices.