Nihon Toseki Igakkai Zasshi
Online ISSN : 1883-082X
Print ISSN : 1340-3451
ISSN-L : 1340-3451
Volume 31, Issue 10
Displaying 1-8 of 8 articles from this issue
  • Toshio Miyata, Reiko Inagi, Kiyoshi Kurokawa
    1998 Volume 31 Issue 10 Pages 1311-1316
    Published: October 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Proteins are modified with advanced glycation end products (AGEs) during normal process of aging. This process is markedly accelerated in diabetes and contribute to the development of diabetic complications. These discoveries have opened new avenues for research on uremic toxicity. AGEs accumulate markedly in uremic patients: observed serum levels of AGEs, such as pentosidine and carboxymethyllysine (CML), were indeed elevated several times above those of diabetic patients and appeared unrelated to elevated glucose levels. As pentosidine and CML are mainly linked to albumin in the serum, its accumulation cannot be attributed to a decreased removal by glomerular filtration. Recently, gathered evidence has suggested that, in uremia, the increased carbonyl compounds, derived from both oxidative and non-oxidative processes involving both carbohydrates and lipids, modify proteins by not only glycoxidation reaction (leading to augument AGE production) but also lipoxidation reaction (leading to augument advanced lipidation end product, ALE, production). Thus, uremia might be a state of carbonyl overload (“carbonyl stress”) with potentially damaging proteins. Carbonyl stress in uremia appears relevant to long-term complications associated with chronic renal failure and dialysis, such as dialysis-related amyloidosis and accelerated atherosclerosis. The increased levels of AGEs and ALEs in blood and tissues in uremic patients may betray a broad derangement in non-enzymatic biochemistry.
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  • Masanobu Horie, Masahiro Hasegawa, Hiroshi Tsuchiya, Shinichi Ito, Mas ...
    1998 Volume 31 Issue 10 Pages 1317-1321
    Published: October 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    The 1983 NCDS defined adequacy of dialysis by Kt/V and PCR. The 1989 international syposium on ESRD morbidity and mortality reported that US mortality was higher than that in Europe or Japan. Because of these 2 reports, we decided to check and compare their data with our own data and tried to find a method of hypothetically assessing the adequacy of dialysis by Kt/V and PCR values. Daugirdas' and Gotch's formulas used for calculation of Kt/V and PCR. Data analysis was based on 243 patients (pts.), who were divided into 9 groups (3×3 table) by 3 different ranges of Kt/V and PCR.
    TACurea of groups 5, 6, 7, 8, 9 were all under 50mg/dl which was the NCDS recommended value, while groups 7 and 8, presently considered to be receiving overdialysis, may be redefined as adequate in the future. Only 61 pts. (25.1%) belonged to group 5 presently considered to be the adequate dialysis domain, while 126 pts (51.8%) were in groups 7 and 8.
    Therefore, we subdivided groups 7, 8 and 9 (namely high-dose-dialysis group; 140 pts.) into 4 groups by the Kt/V value only, at levels of 1.6-2.0, 2.0-2.5, 2.5-3.0 and over 3.0 for groups a, b, c and d, respectively. There was no significant difference in mean age or years on dialysis among the 4 groups. Significant differences were found in the values for TACurea, β2-MG, Ca and P product between groups a and b only, but not among the other groups. We concluded that the clinically critical point of dialysis dose calculated by Kt/V might be 2.0. Kt/V over 2.0 may be the true ideal dialysis dose for most hemodialysis patients.
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  • in relation to restriction of fluid intake
    Mahito Sogo, Yumiko Omata, Kazue Ito, Sachiko Otani, Masako Furuta, Ke ...
    1998 Volume 31 Issue 10 Pages 1323-1330
    Published: October 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Restriction of daily fluid intake could be important in preventing cardiovascular complications which are a major cause of death in chronic hemodialysis patients. However, a significant number of hemodialysis patients fail to control fluid intake. Therefore, we studied the relationship of personality and fluid restriction in hemodialysis patients using the Minnesota Multiphasic Personality Inventory (MMPI).
    Object and method: From a list of 398 patients undergoing hemodialysis therapy at Seishokai clinics, we selected two groups. The first group (poor control group) consisted of 51 patients (male: 34, female: 17) whose weight increase between hemodialysis therapy (48 hours) was more than 5% dry weight. The second group (good control group) consisted of 33 persons (male: 16, female: 17) whose weight gain between hemodialysis therapy (48 hours) was less than 3% dry weight.
    We conducted the MMPI (New Japanese version, Sankyobo, Kyoto) on these hemodialysis patients, totaling the mean scores of the respective scales between the two groups by male and female, and comparison was thus made. Comparison with 1, 022 normal adults (male: 500, female: 522) was also performed when the MMPI was standardized in Japan.
    Result: We could observe a trend wherein the poor control group showed higher scores on scales for Hs (hypochondriasis), D (depression), Hy (hysteria) and Pd (psychopathic deviation) compared with those in the good control group, but there were no significant differences.
    Compared with the normal adults, both the poor control group and good control group showed significantly high scores at measurements of L (lie), Hs, D, Hy and Es (ego strength).
    Assessment: High scores for Hs, D and Hy in both the poor control group and good control group observed in this study are suggestive of depressive situation and somatic overconcern or anxiety in hemodialysis patients. Elevation of these three scales has been called the neurotic triad. So, dialysis patients have a tendency toward neurotic symptoms with depression and anxiety. Although no significant differences were observed, this tendency was stronger in the poor control group than in the good control group. A low value for Es in both groups indicates the fragility of the ego and suggests the frailty of hemodialysis patients.
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  • Takanobu Toriyama, Masaki Yokoya, Jun Misao, Hirohisa Kawahara
    1998 Volume 31 Issue 10 Pages 1331-1334
    Published: October 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    To assess the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA) in HD patients. Fifty-seven HD patients (total 174 angioplasties in 114 segments) were examined more than 3 months after PTCA treatment. Restenosis was defined as >50% narrowing of expanded coronary lumen. The overall restenosis rate was 45% (78/174) more than 3 months after PTCA. Calcified coronary lesions were observed in 48 patients (85%) and 92 segments (82%). Among 174 angioplasties, 102 cases (non-calcified vs calcified 22:80) were treated with plain old balloon angioplasty (POBA), 23 (5:18) with cutting balloon angioplasty (CBA) and 49 (7:42) with stent implantation (STENT). In overall cases, restenosis rate was significantly lower in STENT (22.5%) than in POBA (54.9%). The use of new devices (CBA: 50.0%, STENT: 23.8%), when compared to conventional PTCA (POBA: 60.0%), significantly reduced the rate of restenosis in calcified coronary lesions.
    These data suggest that new devices such as CBA and STENT are beneficial methods of treating calcified coronary lesions in HD patients.
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  • Kiyotaka Sugihara, Shinichi Fujimoto, Hiroshi Nakano, Hajimu Yamada, Y ...
    1998 Volume 31 Issue 10 Pages 1335-1342
    Published: October 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Analysis of the long-axis motion of the left ventricle is considered useful for detecting cardiac dysfunction at an early stage. This study evaluated the usefulness of this technique in patients receiving maintenance hemodialysis. We examined 32 patients on long-term hemodialysis (Group HD) and 20 healthy controls. We divided Group HD into two subgroups based on total left ventricular wall thickness (TLVT): Group LVH (10 patients with TLVT≥2.4cm), and Group NH (22 patients with TLVT<2.4cm). Echocardiographic examination was performed before a hemodialysis session. In addition to the conventional echocardiogram, the LV long-axis M-mode image was recorded on the left side of the mitral ring from an apical four-chamber view. The following indices were determined: TLVT and fractional shortening (FS) from M-mode echocardiography; early and late diastolic peak velocities (E, A) and E/A from pulsed Doppler transmitral flow signals; and total excursion of the long-axis motion of the mitral ring (TLAM), early diastolic component of TLAM (ELAM), component of TLAM during atrial contraction (ALAM) and maximal velocity of relaxation (max LAM relax) based on longaxis M-mode echocardiography. In Group HD compared with normal controls, TLVT, A and ELAM were increased, and E/A, ALAM and max LAM relax were decreased. FS, E, A, E/A, TLAM, ALAM and max LAM relax did not show any significant differences between Group LVH and Group NH, while ELAM was lower in Group LVH than in Group NH. These results indicate that patients on maintenance hemodialysis show diastolic dysfunction, and that left ventricular hypertrophy have severe diastolic dysfunction from the perspective of the long-axis motion of the left ventricle. We conclude that long-axis M-mode echocardiography is useful for assessing cardiac function in patients receiving maintenance hemodialysis.
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  • Yukiteru Asakimori, Hideki Kawanishi, Etsuo Sakikubo, Junko Kumagai, M ...
    1998 Volume 31 Issue 10 Pages 1343-1346
    Published: October 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    We report a patient with necrotizing fasciitis caused by severe streptococcal infection. The patient was rescued by debridement and on-line continuous hemodiafiltration (CHDF). A 39-year-old male was hospitalized with a complaint of pain in the left thigh and high fever. Sepsis and hypotension subsequently developed, and we diagnosed severe infection due to group A streptococcus. We initiated antibiotic therapy, debridement of the left thigh, and on-line CHDF. The patient recovered gradually, and we stopped on-line CHDF and started intermittent hemodialysis (HD) on the 9th day of illness. Urine volume increased starting the 22nd day of illness, and HD was discontinued on day 30. Mesh skin graft surgery was performed on day 86 of illness. The patient is now in good condition. We consider that antibiotic therapy and debridement are effective, and that on-line CHDF is useful for control of fluid, electrolytes, and acid-base balance. These therapies undoubtedly contributed to the rescue of this patient.
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  • Tatsuaki Yoneda, Takahiro Ueda, Tomoyuki Nawa, Sawako Fukazawa, Koichi ...
    1998 Volume 31 Issue 10 Pages 1347-1350
    Published: October 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    A 40-year-old woman with multiple renal cysts in addition to bilateral renal angiomyolipomas (AML) and tuberous sclerosis who required hemodialysis treatment for chronic renal failure was reported. In spite of the high incidence of the renal involvement in patient with tuberous sclerosis, the occurrence of chronic renal failure is rare. Renal AML alone may have less potential for producing severe renal failure because of its limited growth potential, while renal cysts may enlarge and cause renal impairment by replacing and compressing normal tissues. In light of the concomitant presence of multiple renal cysts, it is extremely rare that end-staged renal failure is the result of bilateral AML. In addition, it is emphasized that careful management is required to prevent intratumoral bleeding from AML when conservative manegement is selected.
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  • Tomomi Takeda, Toshiya Takeda, Yoshito Naiki, Satoru Yonekawa, Mika Sa ...
    1998 Volume 31 Issue 10 Pages 1351-1355
    Published: October 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    A 75-year-old man was hospitalized, because of rapidly progressive glomerulonephritis (RPGN). He noticed lower leg edema and macrohematuria three days before admission. The serum creatinine and blood urea nitrogen (BUN) showed rapid elevation to 85mg/dl and 4.8mg/dl, and high titers of MPO-ANCA (488 EU). Renal histopathological findings indicated vasculitis and fibrinoid necrosis of the interlobular arteries without crescentic glomerulonephritis or vasculitis of the afferent arterioles. Therefore, we diagnosed RPGN due to classical polyarteritis nodosa associated with MPO-ANCA. He was started on methylprednisolone pulse therapy, double filtration plasmapheresis (DFPP) and hemodialysis. After immunosuppressive therapy, the titers of MPO-ANCA decreased and hemodialysis was discontinued. The patient complained of lumbago and using CT and MRI examination that he was diagnosed as having iliopsoas muscle hemorrhage. We considered this patient a rare case of MPO-ANCA positive classical polyarteritis nodosa presenting with iliopsoas muscle hemorrhage.
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