Takashi Horie

Prevention of Limb Amputation in Patients with Limbs Ulcers by Autologous Peripheral Blood Mononuclear Cell Implantation

Abstract:  There are many cases of amputation of ischemic limbs of dialysis patients due to diabetes, despite the availability of medicine therapy and vascular by‐pass operations. As there is extensive ruin of the vascular bed due to diabetes, vascular regeneration therapy by stem cell implantation is effective. Thirty patients with ischemic limbs due to diabetes (not including type‐I) and on dialysis for chronic renal failure (19 cases), diabetes (5 cases), dialysis patients without diabetes (4 cases), and arteriosclerosis obliterans (ASO, 2 cases) were treated by autologous peripheral blood stem cell (PBSC) implantation where imminent amputation was under consideration. Granulocyte Colony Stimulate Factor (G‐CSF: 5 µg/kg/day) was administered subcutaneously for 4 days before PBSC collection, that was carried out using a centrifuge (Spectra and/or CS3000) via the vein. The collected PBSC, containing 4.2 × 107 of CD 34 positive cells, was divided into units of 0.5–1.0 mL and implanted, without any purification, to the ischemic area of the limbs in about 65 points. In 21 cases, normalization of limb temperature was observed by thermograph, and symptoms also improved. The result of this first attempt of PBSC implantation is that we were able to save 22 ischemic limbs. This is the first large report of the application of regenerative medicine to peripheral ischemic limbs.

Liver resection using a water jet

SummaryThe water-jet method has been used during hepatic resection. The instrument cuts the hepatic tissue with the high pressure of the fine water flow, while the exposed elastic intrahepatic vessels are spared injury. A comparative study on the water-jet method with the previously employed conventional methods was undertaken. Hepatic resections were performed on 35 patients using the water-jet method. Cirrhosis of the liver was associated with 10 of the 24 patients with hepatocellular carcinoma. An ordinary saline solution was used as the jet, which was projected at a pressure of between 12 kg/cm2 and 20 kg/cm2 through a 0.15/mm-diameter nozzle. A higher jet pressure was needed to cut the fibrotic hepatic parenchyma. In the case of normal liver, the intrahepatic vessels of more than 0.2 mm were well preserved. In most of the cases, the loss of blood when cutting the hepatic parenchyma can be easily reduced with a jet pressure of 15–16 kg/cm2, thus preserving the fine vessels more than 0.2 mm in diameter without injury. When the same pressure was applied in the cutting of a cirrhotic liver, it took much longer time compared to that of a non-cirrhotic normal liver parenchyma. The cut surface was smooth compared to that after using CUSA, although its disadvantages lie in the formation of air bubbles, which obscure the operative field. The controlled projection of a jet of water under optimal pressure may ensure a safe hepatic resection of both normal and cirrhotic livers. Furthermore, because of its uncomplicated form, a wide range of applications can be expected, while the lower cost will also expedite its large-scale use for economic reasons.

Successful treatment of ulcerative colitis with leukocytapheresis using non-woven polyester filter

Abstract:  Ulcerative colitis is a chronic inflammatory disease of the rectum and colon. Although the pathogenesis of ulcerative colitis is not fully elucidated, cell‐mediated immunity plays an important role in disease pathogenesis. Leukocytapheresis is a newly emerging therapy to eliminate activated leukocyte from systemic circulation. We have studied the effects of leukocytapheresis on patients with ulcerative colitis who had failed to respond to conventional therapy. A total of 51 patients with ulcerative colitis were treated with apheresis using a non‐woven polyester fiber filter (Finecell, Asahi Medical Co., Tokyo, Japan) originally developed as a microcoagulation elimination filter for massive transfusion. Of the 51 patients, 33 (64.7%) achieved clinical remission manifested by clinical activity and colonoscopic findings without any adverse effects. This result suggested that leukocytapheresis using Finecell might serve as an alternative therapy for ulcerative colitis as other leukocytapheresis using centrifugation or column.

Study of prolonged administration of lanthanum carbonate in dialysis patients.

Data of 36 months were accumulated regarding the effects of lanthanum carbonate (LA) on serum phosphate concentrations in dialysis patients. Fifty‐three patients (average age and dialysis history 58.4 years and 9.1 years) were included in this study who have been receiving outpatient treatment since March 2009, and who have been unable to maintain serum phosphate concentrations of ≤6.0 mg/dL via traditional therapeutic agents used for hyperphosphatemia. Patients were given dosage of LA in addition to, or instead of, co‐hyperphosphatemia treatments already being received. Mean dosages of calcium carbonate (CC) and sevelamer hydrochloride (SH) before starting LA administration were 1301.9 mg and 2462.3 mg, respectively. Dosage of LA for all cases was 750 mg at initial dose; 1528.3 mg at 5 months; and 1416.7 mg at 30 months. Dosage of other phosphate binders were 905.7 mg of CC and 820.8 mg of SH at 5 months; and 687.5 mg of CC and 1031.3 mg of SH at 30 months. Serum phosphorus levels (P levels) were significantly decreased at 1 month of LA administration, and continued until 30 months of La treatment. These results suggest that LA successfully controlled serum P and Ca concentrations simultaneously within target ranges without affecting serum intact parathyroid hormone concentration, although further long‐term prospective cohort study on LA would be required.

No-needle blood access device for hemodialysis and no-needle connecting cannula assembly (K-NOBA PAT./JAP2983540)

Our group is developing a no-needle blood access for maintenance hemodialysis. The device is made from titanium. The device is connected at the middle part of the prosthetic graft A-V shunt. It has two wells on the conduit and they are closed by shutters. The specially designed cannulas are inserted in the wells and hemodialysis is performed. Patients have no pain and good QOL. Selfcannulation and home dialysis are possible.

A case of hemolytic transfusion reaction due to Lewis b antibody.

A case of hemolytic transfusion reaction due to Lewis b antibody was reported.The patient, 62-year-old farmer, was suffered from echinococcosis. He has no history to be transfused. His blood types were A, CCDee, Le (a-b-), MNSs, P2, kk, Fy (a+b-), Jk (a+b+), Xg (a+), Di (a-), and he had anti Lea & Leb antibodies.Right hepatic lobectomy was undergone. Total amount of bleeding in this operation was about 3, 000ml. And during the operation, 1, 600ml of Le (a-b-) blood and 800ml of Le(a-b+) blood was given.Two days after the operation, hemolytic jaundice and bleeding tendency from DIC appeared. Some part of the lost blood volume was replaced by incompatible Le (a-b+) blood, because Le (a-b-) blood was difficult to obtain due to its low frequency. Moreover few papers reported on hemolytic reaction by anti Leb antibody. Hemolytic reaction and DIC syndrome became even stronger as the days go by.After the transfusions of Le (a-b-) blood units alone, hemolytic anemia, jaundice and bleeding tendency were improved before long. Anti-Leb antibody titer which elevated initially decreased gradually after stoppage of using Le (b+) blood.According to these clinical features and laboratory data, we concluded that this hemolytic reaction was occured from Le (b+) incompatible blood transfusion.