In November 2006, The Japanese Society for Dialysis Therapy (JSDT) announced its first guideline, "The guideline for the management of secondary hyperparathyroidism in chronic dialysis patients," which gives the recommended range of management target values, especially for serum phosphorus, corrected serum calcium and serum intact parathyroid hormone concentrations. Recent studies have suggested that these factors are independently associated with mortality, especially increased cardiovascular mortality. In this research we focused on the serum phosphorus concentration because it is the highest clinical factor among these three. We systematically reviewed almost all documents that discussed the relation between serum phosphorus concentration and mortality as well as the "range of the management target value" specified by foreign guidelines from the US, UK, Canada, Australia and other countries. We summarized the finding concerning the serum phosphorus value of dialysis patients (especially the upper bound value). As a result, it was found that the "range of the management target value" varied among these guidelines. The reasons for this variation likely included differences in the measurement day, in the categories of serum phosphorus concentration, and in the exposure conditions among the studies to which the guidelines referred. Moreover, it was concluded that the Japanese guideline announced by the JSDT should be updated based on the results of future studies.

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We report a rare case of a very large nonfunctioning endocrine tumor of the pancreas without malignant histological features. A 63-year-old woman referred for appetite loss and general fatigue was found to have a tumor in the pancreas head. Computed tomography demonstrated a well-defined pancreatic tumor 45mm in diameter with hypervascular staining in the pancreas head. Angiography showed a hypervascular tumor of the pancreas head and a dilatation of the anterior superior and posterior superior pancreaticoduodenal arteries. The preoperative diagnosis was an endocrine tumor of the pancreas, with undeniable malignancy. Pylorus-preserving pancreaticoduodenectomy was performed. The histopathological diagnosis was a benign nonfunctioning endocrine tumor of the pancreas based on immunohistochemical staining for Chromogranin A, Synaptophysin, and NSE, but not for hormones. The tumor revealed a low labeling index (<2.0%) of Ki-67 indicating its benign character. No tumor recurrence has been identified in the 18 months since surgery.

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