Nihon Toseki Igakkai Zasshi
Online ISSN : 1883-082X
Print ISSN : 1340-3451
ISSN-L : 1340-3451
Volume 27, Issue 10
Displaying 1-12 of 12 articles from this issue
  • Masahiko Takada, Erich Steiner, Harry K. Genant
    1994 Volume 27 Issue 10 Pages 1281-1293
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    The term renal osteodystrophy represents a diverse spectrum of skeletal abnormalities encountered in patients with chronic renal failure due to a variety of renal parenchymal disorders. Diagnostic imaging using conventional radiography, computed tomography (CT), magnetic resonance imaging (MRI), scintigraphy, and bone densitometry reveals an array of specific as well as non-specific manifestations. These findings include: bone resorption, brown tumors and osteosclerosis (secondary hyperparathyroidism), coarsened fuzzy trabeculae and Looser's zones (osteomalacia), widened growth plates, splayed and frayed metaphyses (rickets), thinned cortices and insufficiency fractures (osteopenia, aluminum toxicity); cystic juxta-articular lesions, synovial infiltration and vertebral destruction (amyloid deposition), and soft tissue calcifications.
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  • Usefulness in determination of dry body weight in patients who have a high cardiothoracic ratio
    Masashi Mizuno, Yasuhiko Ito, Takashi Suzuki, Mika Baba, Shizunori Ich ...
    1994 Volume 27 Issue 10 Pages 1295-1301
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    We assessed whether human atrial natriuretic peptide (hANP) and cyclic AMP (cGMP) might be suitable markers to determine “dry body weight” in chronic hemodialysis patients, especially those whose cardiothoracic ratio (CTR) is always high. The results are as follows: 1. Plasma cGMP decreased significantly from 31.4±15.9pmol/ml before hemodialysis therapy to 10.4±5.4pmol/ml after hemodialysis therapy (n=22). Plasma cGMP levels are a good indicator of “dry body weight”, the same as hANP levels. 2. Serum hANP levels are correlated with left ventricular diameter as determined by echocardiography, and inversely correlate with left ventricular ejection fraction. Thus plasma hANP levels appear to be a reliable marker for fluid overload. Even when the CTR is greater than 50%, some patients have no clinical signs of hyperhydration on the basis of their physical findings, echocardiography findings or plasma hANP levels. Therefore, in these patients “dry body weight” does not need to be reduced until the CTR is within the normtal range.
    In conclusion, measurement of both serum hANP and cGMP is useful in determining and monitoring the “dry body weight” of hemodialysis patients.
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  • A multicenter study
    Satoru Kuriyama, Yasuo Nomoto, Haruo Tomonari, Masatsugu Noguchi, Taka ...
    1994 Volume 27 Issue 10 Pages 1303-1308
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    CAPD was reviewed on a multicenter basis using a questionnaire. The data were analyzed mainly from the patients' and CAPD care providers' standpoint.
    1) Most of the patients (83%) rated CAPD positively. Physical, psychological and social quality of life (QOL) and compliance with CAPD were good in approximately 80% of the cases. 2) Concerns of the CAPD providers were peritonitis, loss of ultrafiltration after long-term use, need for a 24-hour on-call system, and time consumed in patient education, etc.. These are factors which may hamper wider use of CAPD. Despite these complaints, patients and CAPD providers still preferred CAPD to hemodialysis (HD). 3) The majority of the CAPD care providers stated they would choose CAPD over HD if they became uremic and needed dialysis. 4) Complications in order of frequency are itching, secondary hyperparathyroidism, anemia, peritonitis, bone pain.
    The results of the present study suggest that CAPD can compete, sometimes favorably, with HD with respect to QOL. However, the establishement of well-functioning support systems will be increasingly required in the future if CAPD programs are to be expanded.
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  • Shigeru Tanimoto, Yasushi Saika, Naoya Kodama, Keigo Kimura, Seiki Nak ...
    1994 Volume 27 Issue 10 Pages 1309-1312
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    The number of hemodialysis patients who have diabetic neuropathies is increasing, No effective remedy for these neuropathies has as yet been established. Therefore, care of these patients demands prudent treatment.
    We performed stellate ganglion block (SGB), one of the sympathetic ganglion blocks, on two hemodialysis patients with diabetic neuropathies. The patients have improved in terms of orthostatic hypotension, hypotension during hemodialysis, diarrhea and abnormal perspiration, all of which were caused by autonomic neuropathy. Good curative effects on pain, numbness and temperature sense, which reflect painful neuropathy, were also obtained. The method used was the injection of 1% Carbocain (7ml), for about 1 minute, into the stellate ganglion. The frequency was three slow injections per week and the frequency of injections was decreased to 1 or 2 times after the iritial 25 injections. To our knowledge, this is the first report of SGB treatment being used for hemodialysis patients suffering from diabetic neuropathies.
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  • Yoshiyuki Nakajima, Yoshihiro Kajita, Mitsuru Gima, Tomohiro Yamada, S ...
    1994 Volume 27 Issue 10 Pages 1313-1318
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Thyroid function in hemodialysis (HD) patients is generally considered to be normal in spite of low serum thyroid hormone levels. It is well known that assay of free T4 (FT4) by conventional RIA based on labelled T4 analogue (AN-RIA) shows relatively low levels because of interference by serum proteins, such as albumin and T4 binding globulin (TBG), in HD patients. In this study, we examined FT4 levels in HD patients using a newly developed equilibrium dialysis radioimmunoassay (ED-RIA), and made a comparison with AN-RIA.
    Serum FT4 levels in 32 patients with chronic renal failure just before the first HD, 118 patients on maintenance HD and 43 normal healthy controls were assessed by AN-RIA and ED-RIA. By AN-RIA, 16 out of 32 patients (50%) just before the first HD and 34 out of 118 (29%) on maintenance HD were within normal range. However, by ED-RIA, 29 out of 32 (91%) and 98 out of 118 (83%) were within normal range, respectively. There was no significant correlation between FT4 by ED-RIA and either serum albumin or TBG. There was a good correlation between ED-RIA and AN-RIA (r=0.636). We also measured FT4 in HD patients with permanent or transient hypothyroidism due to Hashimoto's thyroiditis or iodine excess. The values by ED-RIA yielded reasonable results reflecting TSH secretion and clinical course. In conclusion, ED-RIA is very useful for measuring serum FT4 in the assessment and monitoring of thyroid function during the clinical course in HD patients.
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  • The role of vitamin B6 deficiency
    Keiji Ono, Takashi Ono, Yohko Hisasue, Takashi Matsumata
    1994 Volume 27 Issue 10 Pages 1319-1323
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    The mechanisms responsible for the low plasma (p) GOT and GPT activity in hemodialysis (HD) patients remain elusive. This prospective study was undertaken to clarify the relationship between pGOT, pGPT and pyridoxal-5'-phosphate (PLP) levels (active form of vitamin B6) in these patients. A group of 52 HD patients were given oral pyridoxine HCl, 30mg daily, for 5 weeks. Prior to supplementation (Day 0), 17 (33%) of the 52 patients had deficient pPLP levels (Group 1) while the remaining 35 patients had normal pPLP levels (Group 2). Positive correlations were noted between pPLP and both pGOT (r=0.57, p<0.01) and pGPT (r=0.68, p<0.01). The mean pGOT (9.2±0.3: Mean±SEM) and pGPT (8.3±0.7) levels were markedly lower in Group 1 (p<0.05) than in Group 2 (13.4±0.7, 11.4±0.9, respectively). These low pGOT and pGPT levels increased to those seen in Group 2, in which no change from basal values was seen despite vitamin B6 supplementation (Day 35). The administration of vitamin B6 resulted in a significant increase in pPLP in both groups (Day 35) but pPLP dropped to subnormal levels in 5 patients in Group 1 and 7 of those in Group 2 three months after supplementation was discontinued (Day 125). The mean pGOT and pGPT of these pPLP deficient patients became lower than those of the remaining 40 patients with normal pPLP values (p<0.05).
    In conclusion, low pGOT and pGPT levels in HD patients are in part due to a deficiency of pPLP which serves as a coenzyme for these transaminases. The low pPLP, pGOT and pGPT levels can be restored by vitamin B6 (pyridoxine HCl) supplementation.
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  • Minoru Kihara, Yumiko Ikeda, Nobuyoshi Takagi, Hayato Fujita, Satoko M ...
    1994 Volume 27 Issue 10 Pages 1325-1330
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Slow hemodialysis (HD) has benefits for treating renal failure in critically ill patients. However, it is difficult to perform this method continuously over 24 hours in general wards. The present study was designed to improve the schedule and system of slow HD. The extra-corporeal circuit was driven by the blood pump at a flow rate of 80ml/min. A non-sterile bicarbonate containing dialysate was passed into the dialyzer at a flow rate of 30ml/min. The treatment was conducted for 10 hours, during the day, in 28 unstable patients with renal failure. Loaded volume was adequately removed during a session of slow HD without developing further hemodynamic instability. The serum urea nitrogen and creatinine concentrations decreased to 50-60% of the pre-treatment levels. The serum β2-microglobulin level decreased significantly during slow HD using a dialyzer fitted with a high-flux membrane. This approach may allow the performance of efficient renal replacement therapy for unstable patients in general hospitals.
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  • Shigetaka Takamizawa, Makoto Ohta, Shigeaki Satoh, Masanori Utsunomiya ...
    1994 Volume 27 Issue 10 Pages 1331-1335
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    In order to clarify the chronic effects of arteriovenous (AV) fistula on the cardiac function of dialysis patients, we examined CAPD patients before, and one year after occlusion of their AV fistula.
    Disused AV fistulas were occluded in 14 patients and another 14 sex-, age-, and duration of dialysis-matched patients retained their AV fistulas and served as controls.
    Using M-mode echocardiography the following parameters were examined and calculated one year apart in the groups with and without the occlusion of their AV fistula: inter-ventricular septal thickness (IVS), left ventricular posterior wall thickness (PW), left ventricular end-diastolic dimension (LVDd), left ventricular end-systolic dimension (LVDs), left ventricular mass index (LVMI), cardiac index (CI), left ventricular ejection fraction (EF) and mean velocity of circumferential fiber shortening (mVcf). Heart rate (HR), systolic and diastolic blood pressure (sBP, dBP), cardiothoracic ratio (CTR), and hematocrit (Ht) were also determined.
    None of the parameters changed significantly in the control group. On the other hand, LVDd and LVDs were reduced and EF and mVcf had improved in the group with fistula occlusion. CTR was also reduced in this group. When the patients with occluded fistulas were divided into two groups, a group with normal cardiac function with an EF of 50% or more before fistula occlusion, and a group with low cardiac function, CI was found to be reduced in the former, while EF and mVcf had improved and HR was reduced in the latter.
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  • Report of a case with follow-up study of the mother and child for 3 years after delivery
    Shigeko Takatsu, Masashi Miyazaki, Yoshiaki Kokumai, Susumu Uchida, Yo ...
    1994 Volume 27 Issue 10 Pages 1337-1342
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    A 34-year-old woman with ESRD (end-stage renal disease) who was maintained for over 12 years on regular hemodialysis had an 8-year hiltory of amenorrhea. At the patient's request infertility therapy was performed and conception was confirmed after 7 cycles of therapy with an ovulation stimulant. To prevent intrauterine growth retardation (IUGR) subsequent hemodialysis was scheduled 5 times per week (a total of 22.5 hours a week) to maintain her predialysis BUN level under 60mg/dl from the 8th gestational week until delivery. The patient's hematocrit level was maintained over 25% initially with blood transfusions and later by rHuEPO supplementation. At the 34th gestational week she was delivered of a 1, 580g boy by cesarean section. His Apgar score was 8 points. No abnormal findings were detected except for prematurity and a body weight low for gestational age. Although he has shown no abnormalities of mental development as of 3 years of age, he has a rather poor build and is within the lower limits of the standard deviation of Japanese children's physique. It will be important to carefully follow his future physical development. The patient has been in good health over the past 3 years, and the quality of her life has improved considerably.
    On the basis of previous reports of 37 cases in Japan and of our own case, we discuss several essential conditions for successful pregnancy in long-term hemodialysis patients.
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  • Kohei Ozaki, Seishiro Marukawa, Hideyuki Nakagawa, Tsutomu Tabata, Tak ...
    1994 Volume 27 Issue 10 Pages 1343-1347
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    We present a case on continuous ambulatory peritoneal dialysis (CAPD) who developed pulsus alternans during abdominal surgery.
    A 13-year-old female with dilative cardiomyopathy on CAPD underwent partial omentectomy and implantation of a CAPD catheter under general anesthesia (midazolam, pentazocin, nitrous oxide). Pulsus alternans appeared at the start of intra-abdominal procedures, but the surgery was carried out uneventfully under close observation of hemodynamic condition by echocardiographic monitoring. Pulsus alternans persisted throughout the operation, but suddenly disappeared soon after the nitrous oxide gas was turned off at the end of anesthesia.
    Pulsus alternans is generally considered a sign of severe left ventricular dysfunction, usually secondary to dilative cardiomyopathy and aortic stenosis. This patient, however, was not in the state of severe hurt failure and did not have any valvular disease. Although dilative cardiomyopathy might have been an indirect cause of the pulsus alternans seen in this patient, it was suspected that the occurrence of this pulsus alternans was related to the intra-abdominal procedures and general anesthesia, judging from its appearance and attenuation.
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  • Tetsuya Ito, Katsuyuki Kurazukuri, Yoshikazu Katoh, Yoji Morikawa
    1994 Volume 27 Issue 10 Pages 1349-1353
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    This report describes a case of acute renal failure, necessitating hemoialysis, caused by chronic abuse of thinner sniffing. An 18-year-old male, who had inhaled thinner four or five times a week for about a year, visited our hospital for nausea and vomitting. He was administered antiemetics, but his symptoms did not improve, so he returned three days later. He was admitted as the laboratory data showed severe hepato-renal damage. Physical examination revealed no definite abnormalities except for hepatomegaly and epigastric tenderness. Biochemical analyses showed that the serum levels of GOT, GPT, ALP, LDH, γGTP, BUN and Cr were elevated. Abdominal echoraphy showed swelling of the liver and both kidneys. After admission, hepatic functions improved quickly, but the serum levels of BUN and Cr continued to rise. Consciousness became increasingly drowsy, so hemodialysis was begun. After four sessions of hemodialysis, renal function recovered to the normal range. “Glue sniffing” is generally regarded as a relatively harmless practice, but this report shows that it may cause serious organ dysfunction.
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  • Akira Kimura, Kenzo Uchida, Kyoichiro Kamiya
    1994 Volume 27 Issue 10 Pages 1355-1357
    Published: October 28, 1994
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    A 37-year-old male with end-stage renal failure was started on CAPD on March 24, 1993. On April 8, net ultrafiltration was suddenly decreased and he complained of dyspnea. A chest X-ray revealed right pleural effusion. Pleuroperitoneal communication was diagnosed by 99mTc-MAA peritoneography. Pleurodesis with autologous blood by thoracentesis was ineffective, even though combined with a 2-week interruption of CAPD. CAPD was discontinued and he was switched to chronic hemodialysis.
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