Objectives: Plasma exchange or dual-filtration plasmapheresis (DFPP) is used to remove anti-A/anti-B antibodies in ABO-incompatible kidney transplant recipients. However, the substitution fluid used ...for DFPP has a low osmotic pressure, which may cause a decrease in the blood pressure and discomfort due to a decrease in the circulating blood volume during treatment. The aim of the present study was to determine whether DFPP can be performed more safely by adding sodium chloride (NaCl) to the substitution fluid to avoid decrease of the circulating blood volume during treatment. Methods: The study was conducted in 32 patients who needed elimination of anti-A/anti-B antibodies prior to renal transplantation. The first DFPP was performed using 800 ml to 1 L of conventional substitution fluid (a mixture of lactic solution and 20% albumin solution) (control treatment). The second DFPP was performed with substitution fluid to which 20 ml of 10% NaCl had been added (NaCl treatment). Changes in the circulating blood volume (⊿BV) in both treatments were measured every 30 minutes.The blood osmolality and total protein (TP), sodium and hemoglobin (Hb) concentrations were also measured before and after the DFPP. Results: In the NaCl treatment, the osmolality of the substitution fluid increased from 194±12 to 266±18 mOsm. In addition, the ⊿BV was less pronounced from 120 to 210 minutes (P<0.01). The NaCl treatment prevented significant post-treatment plasma osmotic pressure decrease, TP decrease, and Hb increase observed in the control treatment; however, the plasma Na concentration did not change in either treatment. The NaCl treatment was associated with a less pronounced decrease of the blood pressure and less discomfort. Conclusions: Addition of NaCl to the substitution fluid prevented a significant drop in the circulating blood volume during DFPP.
The purpose of this study was to investigate the relationship between the disc positions of temporomandibular joints (TMJ), the vertical and lateral mandibular displacement (VMD and LMD, ...respectively) and age in female adolescents with signs and symptoms of the temporomandibular disorders (TMD). The VMD and LMD were assessed, using posteroanterior (PA) cephalograms. The disc positions were assessed by magnetic resonance imaging (MRI) and categorized as follows: normal disc position, functional disc displacement and functional disc dislocation. Excluding patients with osteoarthritis, the total number of subjects was 54 female adolescents who were grouped into three: the bilateral normal disc position group, the unilateral or bilateral functional disc displacement group, and the unilateral or bilateral functional disc dislocation group. We compared the extent of VMD and LMD between the three groups, and investigated their correlation with age. Results indicate that functional disc displacement and dislocation are related to mandibular displacement, and VMD did not correlate with age but LMD did correlate with age. This study suggests that the onset of disc displacement is related to the mandibular displacement and disturbs normal growth of the mandible three‐dimensionally.
Vitamin D deficiency is a global health concern that is associated with various diseases. The influence of vitamin D on bone metabolism is so important that such a deficiency may cause fractures and ...a reduction in bone mineral density. Natural foods provide a limited intake of vitamin D. Vitamin D is a fat-soluble vitamin that is mainly produced in the skin after exposure to sunlight. UV-B rays convert 7-dehydrocholesterol, a precursor of cholesterol, to pre-vitamin D3, which then isomerizes to cholecalciferol (Vitamin D3.) Vitamin D3 transforms into calcidiol (25(OH)D), which subsequently transforms into the active form, calcitriol (1.25(OH)2D). 1.25(OH)2D maintains calcium and phosphorus homeostasis through vitamin D receptor (VDR). Recent studies have reported that vitamin D is involved in energy metabolism, inflammation, and the immune response. Furthermore, vitamin D deficiency has been reported to influence respiratory diseases, rheumatoid arthritis, cancer, diabetes, and pregnancy-related complications.
In 2002, we introduced the anti-CD20 chimeric antibody, rituximab, for ABO-incompatible kidney transplantation (ABO-IKT). Here, we report the 5-year outcome obtained using rituximab as part of the ...preoperative regimen for ABO-IKT.
Between January 2002 and December 2008, 408 patients underwent living-related kidney transplantation at our department. The patients were divided into three groups: group A (n=280), ABO-compatible kidney transplantation (ABO-CKT); group B (n=63), ABO-IKT without rituximab induction; and group C (n=50), ABO-IKT with rituximab induction. Basic immunosuppression was the same in all three groups except for the use of rituximab, which was administered at 100 mg (n=6), 200 mg (n=26), and 500 to 1000 mg (n=18).
The graft survival rates in groups A, B, and C were 99.2%, 96.8%, and 100% at 1 year, 93.8%, 94.9%, and 100% at 3 years, and 88.4%, 90.3%, and 100% at 5 years after transplantation, respectively. Serum creatinine levels in the three groups were not different at 1, 3, and 5 years after transplantation. The numbers of episodes of acute antibody-mediated rejection in groups A, B, and C were 7 (2.5%), 10 (15.9%), and 2 (4.0%), respectively (P=0.651), and acute cellular rejection was observed in 40 (14.3%), 6 (9.5%), and 2 (4.0%) patients, respectively (P=0.0957). There was no increased risk of cytomegalovirus infection in group C.
In the long term, inclusion of rituximab in the preoperative regimen yielded an even better outcome than that of ABO-CKT and rituximab-untreated ABO-IKT, without any increase in the risk of infection.
Abstract Objective We perform living-related ABO-incompatible kidney transplantations to alleviate the organ shortage in our country. Splenectomy has been performed routinely in these recipients, ...although its clinical significance remains controversial. In this study, we have reported our experience with a hand-assisted laparoscopic splenectomy (HALS) technique. Methods Between April 2000 and December 2006, 50 patients (23 males) underwent ABO-incompatible kidney transplantation with HALS. The mean age and weight of the recipients were 44 ± 13 years and 56 ± 12 kg, respectively. All patients underwent preoperative plasmapheresis to reduce isoagglutinin (A and/or B antibody). In 6/50 patients, a hand-assisted device was placed through a peritoneal window in the right lower abdominal skin incision for kidney engraftment. In the remaining 44 patients, a 6-cm upper midline or periumbilical midline incision was made for the hand-assisted device in the lateral position. Results An ABO-incompatible procedure was completed successfully in all cases. The average HALS time was 118 ± 42 minutes, with an average pneumoperitoneum time of 79 ± 40 minutes and average blood loss of 48 ± 81 g. There were two conversions to open splenectomy because of intraoperative bleeding and suspected pneumothorax. Two other cases required relaparotomy because of hematoma and perforation of the ileum. Successfully operations were achieved through the previous periumbilical incision. Conclusions Although meticulous, rigorous surgical technique is essential, HALS is safe and feasible for recipients of ABO-incompatible grafts with tissue weakness and a bleeding tendency because of renal failure and preoperative plasmapheresis.
summary The efficacy of nitrous oxide (N2O) inhalation on the elevated orofacial muscle tonus during dental treatment in patients with cerebral palsy (CP) was studied by measuring the mean frequency ...of electromyographic (EMG) discharge, blood pressure (BP) and heart rate (HR) taking mentally retarded patients (MR) as a control. At a pre‐treatment stage, the mean frequency of the EMG was higher in the CP patients than in the MR patients. By forcing the jaw open, the mean frequency of the EMG, BP and HR was elevated significantly in both types of patients. The enhanced level of the mean frequency of the EMG was higher in the CP patients than in the MR patients. After inhalation of N2O, the mean frequency was reduced significantly in both types of patients, however, the reduction rate was higher in the CP patients than the MR patients; BP and HR were not affected. These results demonstrate the selective efficacy of N2O in reducing the orofacial muscle tonus in CP patients during dental treatment probably because of the N2O inhibiting the function of the central nervous system. The present study therefore suggests the beneficial properties of N2O induced sedation performed during dental treatment on CP patients.
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