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♦ Objectives To assess the efficacy and safety of icodextrin in Japanese patients and to investigate the relationship between net ultrafiltration (UF) during the long dwell and plasma oligosaccharides.♦ Design Open-labeled clinical trial involving patients on continuous ambulatory peritoneal dialysis (CAPD) receiving icodextrin during the 12-hour long dwell for 6 weeks, preceded by and followed by a 2-week baseline period and a follow-up period during which 1.36% glucose was used for the 8-hour long dwell.♦ Setting A prospective, randomized multicenter study done in tertiary medical centers.♦ Patients 18 stable patients on CAPD for 3 months or longer.♦ Main Outcomes Measures Net UF (in milliliters), UF rate (in milliliters per hour), plasma oligosaccharides, serum osmolarity (in milliosmoles per liter), peritoneal absorption of icodextrin, and peritoneal clearances of icodextrin, creatinine, and urea were assessed. Adverse events, laboratory findings, and vital signs were also monitored.♦ Results Long-dwell net UF (544.4 ± 96.7 mL at day 3, p< 0.001; 309.4 ± 60.7 mL at week 4, p< 0.001; and 391.7 ± 61.1 mL at week 6, p< 0.001) and UF rate (48.2 ± 38.8 mL/hour at day 3, p< 0.001; 26.9 ± 22.1 mL/hr at week 4, p< 0.002; and 35.3 ± 22.9 mL/hr at week 6, p= 0.0002) were significantly greater during the icodextrin period than at baseline (-25.9 ± 46.0 mL and -2.2 ± 22.1 mL/hr, respectively). Plasma oligosaccharides reached steady state within 2 weeks, remained stable during the treatment period, and returned to baseline level 2 weeks after discontinuation of icodextrin. Serum osmolarity increased during the use of icodextrin by approximately 5 mOsm/L. No statistically significant relationship was found between plasma oligosaccharides and net UF. Peritoneal absorption of icodextrin (36.3% ± 5.1% at day 3,42.2% ± 5.9% at week 4, and 38.0% ± 6.3% at week 6) and peritoneal clearance of icodextrin (10.1 mL/minute at day 3,10.1 mL/min at week 4, and 10.3 mL/min at week 6) showed no major change over time. Serum sodium and serum chloride both decreased by 5 mEq/L with icodextrin but remained within the normal range during the treatment period and returned to baseline levels immediately after discontinuation. No serious adverse events were observed during the study.♦ Conclusion The results of this study do not support the hypothesis that an increased blood oligosaccharide level and the concomitant elevation in serum osmolarity have a negative impact on peritoneal UF. Therefore, the increase in plasma oligosaccharides appears to be too small to be of clinical significance.

AbstractSince June 1983, 27 kidneys have been shipped to the Kidney Center at the Tokyo Women's Medical College (TWMC) from the United States. These organs were divided into two groups, based on the years of their donation; 13 kidneys were assigned to group 1 and 14 to group 2. The differences between the two groups were as follows: donor age 19.8 ± 10.0 years vs 51.9 ± 14.5 years in group 2 (P <0.0001); total ischemic time 42 h 12 min in group 1 vs 65 h 42 min in group 2 (P= 0.0002); and Euro‐Collins preservation solution in group 1 vs University of Wisconsin (UW) solution in group 2. One hundred percent of the kidneys in group 1 and 85.7 % of those in group 2 recovered their function. The lowest serum creatinine levels averaged 96 + 38.4 µmol/l and 185.8 ± 101.0 umol/l, respectively (P= 0.01). The viability of 9 out of 14 grafts in group 2 were tested using 31P magnetic resonance spectroscopy (31P‐MRS). The results showed that all of the grafts having a monophosphate/inorganic phosphate (MP/Pi) ratio higher than 0.3 recovered their function and those lower than 0.2 did not. The problems associated with international organ sharing are discussed, along with the difficulties encountered at TWMC.

A procedure to measure a polarized triplet–triplet absorption spectrum using a stretched polymer film was described, and this method was applied to determine the polarizations of the triplet–triplet transitions of phenanthrene.

Mammalian S‐adenosylmethionine (AdoMet) synthetase exists as two isozymes, liver‐type and kidney(non‐hepatic)‐type enzymes. The developmental expression of these two isozyme proteins has been investigated in rat liver using immunohistochemical techniques. The liver‐type AdoMet synthetase is expressed only in adult liver, but not in fetal liver. On the other hand, the kidney‐type AdoMet synthetase is predominantly expressed in fetal liver and faintly detected in adult liver. It was also found that both isozymes were localized to the hepatocytes of rat liver. These results clearly show that AdoMet synthetase isozymes are developmentally regulated within hepatocytes. In addition, in rat kidney we have shown that the kidney‐type AdoMet synthetase is predominantly localized to the distal tubule.

Elevations of serum lipid peroxide levels were demonstrated in mice after an equitoxic dose of doxorubicin. When BDF1 mice were injected with doxorubicin (20 mg/kg body weight, IP), lipid peroxide levels in sera were elevated 1 day after the injection and the levels declined on subsequent days. 5-Fluorouracil (400 mg/kg body weight, IP) never changed the peroxide levels in serum. Furthermore, it was found that the co-administration of [dl]-a-tocopheryl acetate or coenzyme Q10 IM strongly inhibited the doxorubicin-induced elevation of lipid peroxides in serum.

We examined 960 urine specimens from 12 renal transplant patients for the presence of thymus-derived rosette-forming cells as a post-transplant study. Active T-rosette-forming cells appeared in the urine before or simultaneously with an increase in serum creatinine during all 14 acute rejection crises. Moreover, the active urinary T-rosette-forming cells disappeared promptly after pulse treatment with large doses of methylprednisolone in 11 rejection crises, which resolved completely, while in patients with continued detection of active T-rosette-forming cells in the urine rejection crises recurred within a few weeks.

Measurements of a polarized triplet–triplet absorption spectrum using stretched polymer films have been attempted at liquid nitrogen temperature. The polarizations of the triplet–triplet transitions of diphenylacetylene were determined, and the molecular structure in the excited triplet state was discussed.

A phase I study ofN4-palmitoyl-1-β-d-arabinofuranosylcytosine (PLAC) was conducted in 88 patients; 36 with solid tumors and 52 with hematological malignancies, using 2 different schedules. Schedule 1 employed a single oral administration and Schedule 2, 5-day consecutive daily oral administration. In Schedule 1, the daily dose was initiated with 1 mg kg−1which was escalated up to 24 mg kg−1according to the modified Fibonacci’s method. Side effects included nausea, vomiting and skin rashes, but myelosuppression was not seen within this dose range. In Schedule 2, the daily dose was started with 1 mg kg−1which was escalated up to 24 mg kg−1. Major side effects were nausea, vomiting and amorexia, and mild myelosuppression was noted at 12 mg kg−1or more. The dose-limiting toxicity was gastrointestinal toxicity, which appeared at 3.3 mg kg−1or more and became frequent at 7 mg kg−1or more. Pharmacokinetic study revealed that the plasma concentrations of PLAC and ara-C, obtained by the oral intake of 3.3 mg kg−1or more of PLAC, were sufficient for these compounds to exert cytotoxic effects on various human leukemia cellsin vitro. Based on these observations and plausible mechanism of action of PLAC, further clinical study should be carried out in a treatment schedule of considerably prolonged administration period with 3.3–6 mg kg−1day−1of PLAC.

HEMORRHAGE from the cut surface is inevitable in the partial resection of liver, pancreas, kidney and spleen. In partial hepatectomy and in partial pancreatectomy the leak of the bile or the pancreatic juice further complicates the cut surface. If the leak continues persistently after operation, it is detrimental to the peritoneum. The use of needles and sutures for stopping the hemorrhage and the leak of the bile or the pancreatic juice may cause additional hemorrhage and the retardation of operation time. To solve this problem, an adhesive, 98% ethyl cyanoacrylate monomer, was used. We have reported that the replacement of methyl radical by the ethyl in the side chain of cyanoacrylate monomer significantly lessens histotoxicity1,2 and that n-butyl, 2-ethylhexyl and isopropyl monomers have no less histotoxicity than ethyl monomer on histologic examination.3 EXPERIMENTAL SURGERY MATERIALS AND METHODS. —Experimental animals were 12 mongrel dogs. The right lobe of the

Direct infusion of ethyl cyanoacrylate monomer into the viscerocutaneous tubular fistula was curative when the fistula was narrower than 5 mm in diameter. A piece of flat rubber or silicone gauze was fixed by cyanoacrylate adhesive on the cutaneous opening of the wide tubular fistula. Gradually the diameter of the fistula shrank from 10 mm or greater to 5 mm or less. Thereafter, direct infusion of ethyl cyanoacrylate monomer into the fistula was curative. Covering of mucosal lips of the labial fistula with a flat rubber piece or silicone gauze by means of ethyl cyanoacrylate monomer or dimethylpolysiloxane failed to cure the labial fistula but relieved local dermatitis, dehydration, and electrolyte imbalance preoperative ly.

RENOVASCULAR hypertension is usually treated with an implantation of either bypass graft or patch graft. This method has been successful to some extent.1 However, we are not completely satisfied with it. The failures seem to have arisen from the fact that the renal artery lies deep in retroperitoneal space. Especially on the right side, the renal artery runs behind the inferior vena cava and this hinders delicate surgical manipulation. Not rarely the failure to establish sufficient blood flow in the renal artery ultimately leads to nephrectomy. Needless to say, reconstruction of the artery necessitates a precise technique. It is not recommended that such a maneuver be performed in a restricted surgical field or even behind the inferior vena cava which is vulnerable to factitial injury.Recent advancement in renal homotransplantation has shown that the nephrectomized kidney functions well after transplantation.2 It therefore occurred to us that the kidney

The polarized absorption spectrum of the conjugate base of 2-naphthoic acid was measured in a stretched PVA sheet. By comparing the polarized absorption spectrum with the results of the PPP calculations including a VESCF and variable β methods, we discussed the electronic structure of the conjugate base.

Purpose We wanted to clarify, in a large population, the reasons that peritoneal dialysis (PD) was interrupted and to propose appropriate strategies that might prolong the use of PD as a renal replacement therapy.Patients and Methods We enrolled 5 391 patients from 439 centers into the study. Each center used a worksheet to report details about patients who either transferred to hemodialysis (HD) or died on continuous ambulatory peritoneal dialysis (CAPD) over a 6-month period from 1 April 2000, to 30 September 2000.Results We collected 252 drop-out cases from 141 centers. Of the 252 cases, 170 (67.5%) involved transfer to HD, and 82 (32.5%) involved death while on PD. Primary renal diseases were chronic nephritis (CN: 51.6%), diabetic nephropathy (DM: 26.6%), nephrosclerosis (4%), and unspecified or other condition (15.8%). Mean duration on PD in drop-out cases was 4.47 years. The age of patients at transfer to HD was younger (53.7 years) than the age of patients at death on PD (65.2 years). Patients with CN remained on PD significantly longer than did patients with DM (5 years vs 2.4 years). The three main reasons for PD discontinuation were overhydration because of ultrafiltration failure (UFF) or poor compliance with salt and fluid restrictions (34.1%); peritonitis (30.1%); and preference of the physician, patient, or family (6.5%). The proportional share represented by those three major reasons varied with the number of years since PD initiation (from 1 year to more than 8 years). Patients who had been on PD for a longer time were more likely to drop out because of UFF and less likely to drop out because of peritonitis. The three major causes of death on CAPD were cerebrovascular accident (22%), ischemic heart disease (14.6%), and sudden death (9.8%).Conclusion Approximately 10% of patients drop out from PD programs annually in Japan. To prolong PD treatment, new solutions that better preserve peritoneal function need to be developed, and patients and caregivers alike need to receive intensive education in preventing and treating peritonitis.