We demonstrated the usefulness of the dipyridamole ECG test (DP-ECG) for evaluating ischemic heart disease (IHD) in patients with chronic renal failure (CRF).
Twenty-four patients (17 males and 7 females, mean age 60±10 years) were studied; the underlying renal diseases were chronic glomerulonephritis in 8 patients, diabetic nephropathy in 4, nephrosclerosis in 4 and miscellaneous disorders in 4. Two of the patients were managed conservatively, 20 were on HD, and 2 were on CAPD. As to complications pertaining to heart disease, 14 had angina pectoris, 7 had acute myocardial infarction, and 3 had old myocardial infarction. For DP-ECG, we injected 0.6mg/kg of dipyridamole intravenously over 4 minutes, and obtained ECG's prior to injection and at 0, 5, 10 and 15 minutes after administration, with additional ECG's taken if necessary. We considered 0.1mV ST segment depression to represent an abnormal ECG. All patients were examined by standard coronary angiography (CAG).
During DP-ECG, 7 patients suffered an anginal attack and 6 had an abnormal ECG without chest pain. These patients were considered to be DP-ECG positive, and the remainder to be DP-ECG negative. By CAG, 11 of the 13 DP-ECG positive patients had significant vessel disease, whereas only 2 of the 11 negative DP-ECG patients showed vessel disease. Accordingly, the sensitivity of DP-ECG was 84.6%, the specificity 81.8%, and the accuracy 83.8%. All angina attacks observed in 7 patients were quickly reversed by intravenous theophylline iniection. Therefore, we conclude that DP-ECG is useful for evaluating significant coronary stenosis in CRF patients with IHD.

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In this study, the serum transferrin receptor (sTfR) values in patients on chronic hemodialysis were obtained and their usefulness as an index of iron metabolism was studied by making comparisons with other iron parameters.
Serum Fe (sFe), serum ferritin (sFt), and sTfR levels in 207 patients on chronic hemodialysis were measured, and iron was then supplemented orally or intravenously in 146 patients suspected of having an iron deficiency. The correlations between the change in Ht values 8 weeks after the onset of iron supplementation (ΔHt) and the iron parameters before the administration of the iron were investigated. Furthermore, the Ht value, sFe, sFt, sTfR, Tf, sFe/Tf, and reticulocyte counts were obtained in 34 iron supplemented cases during the course of the study.
In all subjects, the following significant correlations were recognized; sTfR vs sFe (R=-0.289, p<0.0001), sTfR vs sFt (R=-0.244, p<0.0005), sFe vs sFt (R=0.240, p<0.0005). The correlations between ΔHt in the cases receiving iron supplementation and pre-administration parameters were as follows; sTfR (R=0.428, p<0.0001), sFe (R=-0.224, p<0.01, NS), sFt (R=-0.037, NS). The sTfR value showed the most significant correlation, while the sFt value did not show a definite correlation. Among 34 cases observed over the course of the study, pre-Tf showed a positive correlation with ΔHt (R=0.412, p<0.05). However, as compared with pre-sTfR (R=0.471, p<0.005) this correlation was minimal, and pre-sFe/Tf showed no correlations with ΔHt (R=0.233, NS). The changes in sFe, sFt, Tf, and sFe/Tf values showed the same trend as in non-uremic patients with iron deficiency anemia. The sTfR value showed no significant change after 4 weeks, though adecrease was evident after 8 weeks.
In patients on chronic hemodialysis, the sTfR value correlated positively with the correction of anemia after the administration of iron, as compared with other iron parameters. We conclude that the sTfR value is potentially a highly reliable parameter for assessing the status of iron deficiency.

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Major causes of drop-outs from CAPD treatment include peritonitis and catheter-related problems. Recently, it was reported that catheter-related problems, such as persistent exit-site infections and/or chronic tunnel infections, are often precursors of peritonitis and causes of catheter loss. Several therapeutic approaches, for example administration of antibiotics, unroofing and cuff shaving, have been advocated but the results of these therapies are not yet satisfactory. Thus, we have devised a new surgical approach for persistent exit-site infections and/or chronic tunnel infections of CAPD. In this procedure, there are four important steps; 1) the infectious tissue around the exit-site and superficial cuff is removed with the CAPD catheter including the superficial cuff (not shown in this study, but confirmed histopathologically), 2) with a titanium-extender (Accurate Surgical Co.) the original catheter is connected to a new one which has a new cuff, 3) the titaniumextender is put straight into the wound through the new tunnel, 4) a new exit-site is created just below the original one.
We applied this new approach in 4 patients. Three patients had both persistent exit-site infections and chronic tunnel infections of CAPD, the other only persistent exit-site infections. Neither catheter problems nor recurrence of exit-site infections and/or tunnel infections has occurred in the 56 months, to date, since this procedure was initially performed.
We conclude that this new approach is a useful and efficient treatment for persistent exit-site infections and chronic tunnel infections of CAPD and that it prolongs catheter survival time.

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Analyses were conducted of the adsorption phenomena of psychotherapeutic drugs in dialytic membranes, with the aim of determining whether dosage modification was necessary according to various types of dialyzers and filters.
The 7 subject pharmaceutical products used in the study were sodium valproate (SV), zonisamide (ZS), phenobarbital (PB), phenytoin sodium (PT), nitrazepam (NZ), diazepam (DP) and flutoprazepam (FP), and the membranes used were polyacrylnitrile (PAN), ethylene vinyl alcohol (EVA), polymethylmethacrylate (PMMA), polysulfone (PS) and cellulose triacetate (CA). In the in vitro experiment, adsorption of the products by the dialytic membranes was carried out at 37±1°C for 3 hours, and the following findings were obtained; SV was adsorbed by the PS membrane; FP by the PS, PMMA and CA membranes; NZ by the PS, PMMA and CA membranes; DP by the PMMA and CA membranes; PB by the CA membrane; ZS by the PS, EVA, PMMA and CA membranes; and PT by the PMMA membrane. High levels of adsorptive phenomena were observed in each case.
An experiment on the circulation of solutions of NZ, ZS and PT using dialyzers was conducted to assess the adsorption of these products by the dialytic membranes. After 30 minutes exposure, NZ adsorption returned to near normal levels in every membrane, and no phenomenon of product separation was subsequently seen in the membranes.
Upon exposure to ZS, 45%-96% adsorption was confirmed in every membrane after 1 minute, and further adsorption was observed in the PAN and PMMA membranes. Similarly, upon exposure to PT, adsorption was recognized in every membrane after 1 minute, and again, further adsorption was observed in the PMMA and CA membranes.
Following the above experiment, an observational study of the movement of these products was conducted using various dialytic membranes in patients who were taking NZ, PT, DP and SV. As a result, an adsorptive level of NZ of approximately 20%, or more, was observed in the PMMA, CA and PS membranes during 3 hours of dialysis.
No adsorption of DP was observed in the PS and CA membranes after 15 minutes. With PT and SV, adsorption levels exceeding 30% and 20%, respectively, were confirmed in the PS membrane during 3 hours of dialysis.
As the results of this study indicate that products such as NZ, SV and ZS were eliminated ectosomatically through adsorption by dialytic membranes, the use of the aforementioned products during dialysis must be carefully examined in terms of ectosomatic elimination along with other problems related to dialysis and filtration.

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A 34-year-old woman was admitted to our hospital because of worsening petechial bleeding aflecting all extremities. The patient had been well until 14 years earlier, when she developed systemic lupus erythematosus. She continuously used oral prednisolone, which had been decreased to 7.5mg 10 days prior to the present admission. On laboratory examination, hematological and blood-chemistry studies showed thrombocytopenia, microangiopathic hemolytic anemia, and elevations of LDH and GOT. An anticardiolipin antibody test was positive without a past history of antiphospholipid antibodies syndrome. On the 5th hospital day, a visual field deficit appeared and magnetic resonance imaging of the brain revealed cerebral infarction of the left posterior lobe. These findings indicated thrombotic thrombocytopenic purpura (TTP). Plasma exchange was performed 3 times, resulting in an increase in platelets and a decrease in LDH. However, thrombocytopenia recurred 5 days after ceasing plasma exchange. Fresh plasma was administered intravenously, resulting in remission of TTP after 20 days of treatment. She remains well, as of 4 months after discharge. The involvement of antiphospholipid antibodies was unclear, since this test remained positive after recovery from TTP. However, it is rare for plasma infusion to be as effective in the treatment of TTP as was observed in this case.

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For the management of pseudo-aneurysm formed at the anastomotic site of A-V shunt, we attempted surgical repair aimed at preserving the original blood flow. Detailed procedures were as follows; a portion of the aneurysm maintaining normal vessel structure was left untouched, while only the wall of the portion forming the pseudo-aneurysm conformed to an adequate shape and was then sutured in the folding manner. Although far-more extensive observations are needed to ascertain long-term results, this method is useful in terms of preserving blood access for appropriately selected cases.

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We report a case of successful pregnancy and delivery in a chronic hemodialysis patient. A 34-year-old woman undergoing hemodialysis for eight years, found to be 5 weeks pregnant, was admitted because of threatened premature labor. Hemodialysis was carried out to maintain predialysis levels of BUN and Cr below 60mg/dl and 8mg/dl, respectively. Hematocrit was maintained above 30% by using recombinant human erythropoietin. To prevent premature labor, β-stimulants were administered to the patient after the 15th gestational week. We experienced longterm treatment with intravenous ritodrine hydrochloride and magnesium sulfate in a renal failure patient. As a result, the pregnancy was majntained until the 32th week without severe complications, and she delivered a boy weighing 1, 700g by caesarean section. The baby's Apgar score was 7 points and his general condition was good.
We consider the successful pregnancy and delivery in this patient to have been achieved due to appropriate management with tocolytic agents. The protocols for employing tocolytic agents, i.e., ritodrine hydrochloride and magnesium sulfate, in this patient are thus described herein.

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We report a rare case of tumoral calcinosis at the posterior cervical region successfully treated by surgical resection in a hemodialysis patient.
A 70-year-old female, who had been on hemodialysis since 1979, suddenly developed persistent severe right shoulder and neck pain in January 1989. X-ray and computed tomography revealed marked tumoral calcinosis with cystic degeneration at the posterior cervical region. Laboratory examination showed a high level of serum inorganic phosphorus and the calcium×phosphorus product approached 60. As conservative therapy was not effective, surgical resection was performed. Postoperatively, neck pain disappeared and no evidence of recurrence was precipitated by administration of elcatonin and calcium carbonate.
In conclusion, we recommend surgical treatment under these conditions: 1) conservative therapy for tumoral calcinosis is not effective; 2) local pain is severe; 3) tumoral calcinosis is localized.

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We report a case of pheochromocytoma in a long-term hemodialysis patient. The patient was a 47-year-old man who had been maintained on hemodialysis since November 1977. A right adrenal mass was incidentally discovered on a follow-up CT scan for acquired cystic disease of the kidney (ACDK) in August 1994. He was asymptomatic and endocrine data such as plasma levels of catecholamines (CA), cortisol, aldosterone and ACTH were within normal ranges. He had subsequently been followed periodically, and the tumor tripled in diameter within 17 months. Although MIBG scintigraphy was negative, MRI findings were highly suggestive of pheochromocytoma. A hypertensive attack during the operation was mild and easily controlled by the adminis-tration of low dose nicardipine. As the postoperative plasma CA level was same as that in the preoperative period, the tumor was considered to be endocrinologically inactive. We identified 11 case reports, in the literature, describing long-term hemodialysis complicated by pheochromocytoma. Diagnostic methods and perioperative management are discussed and reviewed herein.

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