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Volume 57, Issue 11
Displaying 1-9 of 9 articles from this issue
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Kensuke JOH2003 Volume 57 Issue 11 Pages 637-638
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSThis special program is focused on proposing an idea to solve the problems, resulting from the reduction of the government payment for the treatment of end-stage renal diseases (ESRD) in recent years. The opinions of experts, who are involved not only in ERSD treatment, including dialysis in renal disease network of national hospitals but also in management of national hospitals of the Ministry of Health, Labor & Welfare, have been exchanged in this program to find the best way to maintain the quality of therapy and deal with the cut of the government's ERSD payment.View full abstractDownload PDF (444K) -
Tetsuya KAWATA, Kanji YAMADA, Yoshie UNE2003 Volume 57 Issue 11 Pages 639-646
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSDialysis therapy and it's related extracorporeal methods are accepted as an ordinary treatment of end-stage renal disease (ESRD). In Japan, the social insurance systems were already well developed in the early days of dialysis technology and methodology development, enabling patients to have easy access to dialysis units and to be treated with uniformly high quality throughout the country. The dialysis population has increased to over two hundred thousand, which is over 1200 patients per one million population, the “top” position in the world. The reimbursement of the therapy cost has been a burden to the national budget for several decades and efforts have been made to cut the ESRD payment. Consequently, the ESRD payment per capita per year has been reduced by about one-third over the past 20 years, however, the survival and quality of life of the ESRD patients has not been sacrificed, which must be maintained even with further reduction of dialysis reimbursement.View full abstractDownload PDF (4253K) -
Yuji INOUE2003 Volume 57 Issue 11 Pages 647-653
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSHaemodialysis medical expenditure, which is crucial for renal patients, has been paid for by medical public insurance and physically handicapped person's welfare law and child welfare law. This paper, by demonstrating the history and structure of the payment by the above payers (public insurer, public sector), will provide a common horizon and background for discussing the theme “haemodialysis, ” which is the main issue of this volume.View full abstractDownload PDF (1038K) -
WHY DO NOT HOME HEMODIALYSIS AND CAPD BECOME POPULARMitsuhiro YOSHIMURA2003 Volume 57 Issue 11 Pages 654-658
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSHome dialysis might be expanded because Japan has to face a society of more aged and less young people, but home hemodialysis (HHD) and CAPD have not become popular. Home dialysis can be an ideal option for patients who value their independence and need to fit in their treatments while working full-time. Also, CAPD patients can maintain residual renal function longer than hemodialysis patients. On the other hand, self-management under home dialysis puts a severe strain to patients, and it is difficult for these patients to do the same amount of work as before. Long-term CAPD increases the risk of encapsulating peritoneal sclerosis (EPS). Patients with endstage renal disease (ESRD) due to diabetic nephropathy and benign-nephrosclerosis, whose number is rapidly increasing, are not positively recommended for HHD and CAPD. Moreover, CAPD patients who require extensive care are not accepted for long-term admission to hospital. In Japan, medical expenses are the same for both HD and CAPD. If the medical expenses for CAPD goes down in price and the savings are passed on to CAPD patients, a breakthrough will come true to resolve the problem of the increasing number of aged ESRD patients.View full abstractDownload PDF (1010K) -
Sakurako HOSHII2003 Volume 57 Issue 11 Pages 659-664
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSThe ultimate goal for treatment of children with end-stage renal disease is the achievement of normal growth and development. Peritoneal dialysis (PD) is the main dialytic modality for children. According to the national registry data on children undergoing PD in Japan, 50-60 new patients under 16 years of age are enrolled each year. One third of patients were under 6 years old, indicating that PD is the treatment of choice in younger children. The data on PD, including patient survival rate, technique survival rate have improved recently. However, these rates were worse in children under 6 years of age. Careful management is needed for this age group. Fluid management with better blood pressure control is important for the prevention for cardiovascular disease, which is a significant cause of mortality. Also, because chronic renal disease results in severe psychological and social stresses in children, the supportive care for both the patients and their family from the beginning of the disease is essential.
Renal transplantation, because of its advantage for QOL, has been considered the most optimal treatment in children with end stage-renal disease. However, the waiting time for renal transplantation is long and the number of cadaver donor transplantation is very low because of a severe national shortage of cadaver donors in Japan. Therefore, patients requiring long-term PD have increased gradually. One major potential solution to improve the rate of renal transplantation in Japan is to enhance renal organ donation. The responsible pediatrician should serve a central role providing the patients and their family both essential information and support about choosing renal transplantation.View full abstractDownload PDF (1139K) -
Kaoru SAKAMOTO2003 Volume 57 Issue 11 Pages 665-669
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSSuccessful kidney transplantation drastically improves the quality of life of patients with chronic renal failure who undergoes hemodialysis. In our country, a very limited number of kidney transplants are performed: 702 cases (551 living related and 151 cadaveric) were performed in 2001. Ten-year kidney graft survival is now more than 50%, which can save millions of yen per patient in medical costs compared to the cost of haemodialysis therapy with the overall result of several billions of yen in saving.
From an economical point of view, it is important to increase the number of kidney transplants, especially cadaveric kidney transplantation, because the case number of living donors are limited in our country. A donor action protocol for our society to promote organ donation may be the only way to solve this issue. The renal disease network of Japanese national hospitals is one suitable system to implement a donor action protocol.View full abstractDownload PDF (911K) -
Takehisa YONEYAMA, Itsuki KOMIYAMA, Masayo FUJIWARA2003 Volume 57 Issue 11 Pages 670-675
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSWe reviewed the diagnostic efficacy for detection of prostate cancer. Digital rectal examination (DRE), prostate-specific antigen (PSA), transrectal ultrasound (TRUS) and prostatic biopsy are useful tools for the diagnosis of prostate cancer.
PSA specificity for detection of prostate cancer is low and it alone is not a perfect screening tool, though it is widely used as a tumor marker for diagnosis and monitoring of prostate cancer.
To show the importance of PSA specificity, four methods are discussed: age specific PSA, PSAdensity (PSAD), PSAvelocity (PSAV), and PSA forms. PSAV and PSA forms may be the most useful in the selection of patients for prostate biopsy. Although ultrasound-guided systematic biopsy is useful for diagnosis of prostate cancer, controversy exists regarding biopsy using TRUE in the presence of a palpable abnormality on DRE.
The interpretation of a biopsy provides important staging information and can predict results of radical prostatectomy.
This article also reviews the value of imaging studies in the clinical staging. Though the role of imaging studies is currently limited, endorectal coil magnetic resonance imaging (MRI) may be assessed in combination with other data, such as PSA.View full abstractDownload PDF (1101K) -
Kazuyasu SHIRAMATSU, Ichiro SUZUKI, Yasuo AOKI2003 Volume 57 Issue 11 Pages 676-679
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSBetween 1989 and 2000, we performed breast-conserving surgery in 27 (47.4%) of 57 patients with non-invasive ductal carcinoma and evaluated the results in the 24 of them in which concurrent radiotherapy was not performed. One of the 24 cases evaluated had been treated by endocrine therapy and surgery, and the other 23 had been treated by surgery alone. Axillary lymph node dissection was performed in only one case. The 5-year disease-free survival rate was 82.4%. The breast recurrence rate was examined in 23 cases after excluding the one case with postoperative regional axillary node metastasis, in which the presence of breast recurrence was not determined. Breast recurrence was diagnosed in three (13.0%) of the cases, and the 5-year breast recurrence rate was 14.1%. Five of 6 cases were treated by additional secondary resection in order to take more than 2cm out of cancer nest border following duct-lobular segmentectomy, so that there were no local recurrences in the case with abnormal discharge from the nipple. The histological type of the recurrent lesions in the breast included non-invasive ductal carcinoma in 2 cases and invasive ductal carcinoma in one case, in which the infiltrated site was microscopic.View full abstractDownload PDF (635K) -
(2) ENDOVASCULAR TREATMENT OF CEREBRAL ANEURYSMS AND CAROTID STENTINGKen UDA, Tooru INOUE2003 Volume 57 Issue 11 Pages 680-682
Published: November 20, 2003
Released on J-STAGE: October 07, 2011
JOURNAL FREE ACCESSDownload PDF (5530K)
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