We measured the radial cortical bone mineral density (C-BMD), relative cortical area (RCA) and trabecular bone mineral density (T-BMD) by peripheral quantitative computed tomography to monitor the annual changes and changes after parathyroidectomy (PTX) for secondary hyperparathyroidism in hemodialysis patients. All patients with mid-region parathyroid hormone (PTH) higher than 40000pg/ml (Hi-PTH group) showed an annual decrease of C-BMD, although patients with PTH lower than 5000pg/ml (low-PTH group) did not. RCA in the Hi-PTH group also decreased time-dependently. Since some patients in the low-PTH group showed a marked decrease of RCA, bone strength may have decreased in these cases. Recovery of C-BMD after PTX was less than 10% and observed only in young patients, leading to the proposal that interventions such as PTX should be considered before significant cortical bone loss occurs. Recovery of RCA after PTX was greater than that of C-BMD, suggesting that RCA is a more sensitive marker to monitor bone changes after PTX. T-BMD did not change time-dependently or after PTX. Therefore, T-BMD is not a good parameter to evaluate bone change in dialysis patients.

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The incidence of arteriosclerotic obliterans (ASO) has rapidly increased in hemodialysis (HD) patients because a greater number of diabetic and elderly patients have received HD therapy. In addition, arteriosclerotic disease has become an important complication in younger patients receiving long-term HD. The present study was designed to evaluate the effectiveness of interventional treatment in HD patients with ASO.
PTA was performed in 25 HD patients (including 19 diabetic and 6 non-deabetic patients) with a total of 50 arteriosclerotic lesions (>Fontaine Grade II). Eleven lesions were located in the illiac artery (IA), 26 in the femoropopliteal artery (FPA) and 13 in arteries below the knee (BK). The restenotic rate was evaluated more than 3 months after PTA by angiography.
A total of 43 lesions (86.0%) in 22 patients, including 11 lesions (100%) in IA, 22 lesions (84.6%) in FPA and 10 lesions (76.9%) in BK, showed improvement of stenosis immediately after PTA. Improvement of clinical symptoms was observed in 19 patients (86.9%) after PTA. However, restenosis (narrowing>50%) occurred in 26 patients (60.5%). Restenosis was more frequent in diabetics (23/37, 63.9%) than in non-diabetics (3/7, 42.9%). In diabetic patients, the restenosic rate was significantly higher in BK (8/8, 100%) than in IA (5/11, 45.5%) and FPA (10/17, 58.8%).
We concluded that PTA is useful for ASO in HD patients, and that further development of technical devices are needed to prevent restenosis in diabetic patients, especially that of peripheral arteries.

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The prognosis of paraquat poisoning is poor despite various treatments. Measurement of the plasma paraquat concentration is useful to determine the prognosis, but this measurement cannot be performed at all hospitals. In this study, the relationship between arterial blood gas analysis and the prognosis in paraquat poisoning was analyzed in 12 cases at Uwajima City Hospital between 1989 and 1996. The survival group (n=4) showed higher HCO₃- and base excess levels than the fatal group. Patients in the fatal group (n=8) were in a state of metabolic acidosis. We demonstrated that arterial blood gas analysis is an easy and useful method to make a prognostic judgement of paraquat poisoning.

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Analysis of intestinal microflora revealed an imbalance in its composition characterized by overgrowth of aerobic bacteria in feces of hemodialysis patients. Balance was restored by administration of a Bifidobacterium capsule, which increased the level of Bifidobacterium. A significant decrease in the amount of putrefactive products such as fecal ammonia, phenol, and scatole was observed. No adverse effects were observed. These results indicate the usefulness of Bifidobacterium for hemodialysis patients.

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Purpose: We investigated the effects of hemodialysis on the serum levels of free prostate specific antigen (PSA), total PSA and free-to-total PSA ratio.
Materials and Methods: Serum free PSA and total PSA were measured before and after hemodialysis in 36 patients with end stage renal disease. No patients (mean age of 64.2 years and mean hemodialysis period of 59 months) were diagnosed as having prostate cancer clinically. Serum free PSA and total PSA levels were determined by research monoclonal enzyme immunoassays.
Results: The mean ± standard deviation for all pre-hemodialysis free-to-total PSA ratio, 46.0±9.0%, was significantly higher than that of normal renal function controls, 29.4±9.7% (p<0.05). However, hemodialysis exerted no significant effect on the values of free PSA, total PSA, or free-to-total PSA ratio, and there were no correlations between these markers and hemodialysis periods.
Conclusions: Our results suggest that the elevation of free-to-total PSA ratio in patients with end stage renal disease is only slightly effected by hemodialysis.

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Biocompatibility involves numerous interactions among blood elements and the hemodialysis (HD) membrane, such as neutrophil degranulation, complement activation and release of cytokines during HD.
Recently, interleukin-6, 8 (IL-6, 8) was identified as a releasing factor of polymorphonuclear neutrophil elastase (PMNE). Furthermore, the production of cytokine-induced nitric oxide (NO), an endothelial derived relaxing factor, was suggested to be involved in HD hypotension.
Therefore, we investigated the changes in these substances during HD in two different kinds of dialysers membranes, namely the biocompatible membrane and bioincompatible membrane.
The subjects were five patients with chronic renal failure undergoing maintenance HD in our hospital. We compared the changes in the parameters between the regenerated cellulose (RC) membrane as a bioincompatible membrane and polysulfone (PS) membrane as a biocompatible membrane by the crossover maneuver. We determined blood levels of PMNE, IL-6, IL-8 and NO in addition to white blood cells (WBC) and platelet (Plt) counts, before, 15 min after the start, and just before the end of HD.
1) WBC count 15 min after starting HD decreased by 21% of pre-HD in PS and by 71% in RC. The decreasing rate was significantly higher in RC than that in PS. 2) Plasma levels of PMNE increased after HD, but not at 15 min in either membrane. The increasing rate, however, was significantly higher in RC than that in PS. 3) Serum levels of NO decreased at 15 min and after HD in both membranes. There was, however, no significant difference between RC and PS. 4) Serum levels of IL-6 increased significantly after HD in RC compared to that in PS. There was a significant positive correlation between IL-6 and PMNE. 5) Serum levels of IL-8 did not change during HD. There was no significant correlation between IL-8 and PMNE in either membrane.
These findings suggest that serum levels of IL-6, in addition to WBC, Plt, and PMNE, can be used as an index of biocompatibility of dialysis membranes.

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We report a case that received treatment of double filtration plasmapheresis for E-incompatible pregnancy.
The patient was a 30-year-old pregnant woman. Her blood type was CCDee, and her husband was ccDEE. At the age of 27, she delivered her first baby. We began double filtration plasmapheresis from 11 weeks of gestation, once a week to prevent hemolytic disease of the fetus and the newborn (HDN).
As her serum anti-E antibody titer was 1: 1024 after 1 week, we increased plasmapheresis to three times a week. The serum anti-E antibody titer stabilized at 1:64. Puncture of amniotic fluid was performed every two weeks from 28 weeks and 1 day of gestation. ΔOD450 values were plotted into zone II using amniotic fluid spectrophotometric readings. Placental thickening, fatal hepatomegaly, splenomegaly, ascites, pleural effusion and cardiomegaly were not found by ultrasonography. At 36 weeks and 6 days of gestation, she delivered a female infant. The baby showed a hemoglobin level of 7.0g/dl, and the direct Coomb's test was positive. We performed exchange transfusion and light therapy and the subsequent course was uneventful.
We performed plasmapheresis according to the data of OD450 and the findings of ultrasonography. However, in some cases, it may be important to examine the IgG subclass and the umbilical vessel blood to prevent HDN.

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A hemodialysis patient with fulminant hepatitis type A was successfully treated with plasma exchange (PE) and hemodiafiltration (HDF) using a highly permeable membrane (FB-130U^®). A 62-year-old woman, who was treated with hemodialysis for 2 years, was admitted to our hospital due to severe general fatigue and icterus. Laboratory examinations on admission included; ALT 157IU/l, AST 185IU/l, ammonia 58μg/dl, total bilirubin 7.6mg/dl, and prothrombin time 84%. Her consciousness became disturbed. Since hepatitis type A viral antibody was positive, she was diagnosed as having fulminant hepatitis due to type A hepatitis. On the 19th hospital day, plasma exchange and hemodiafiltration were started using a highly permeable membrane (FB-130U^®). A total of 7.2l of plasma was exchanged by 3 courses of PE (2.4l) and 80l of filtrate was replaced by 10 courses of HDF (4hours).
After starting these procedures, her consciousness level became clear, and on 39th hospital day, she returned to conventional hemodialysis treatment. Since the bleeding tendency was severe, liver biopsy was not performed. Thus, the concomitant treatments of PE with HDF are considered effective for a fulminant course of hepatitis A in hemodialysis patients.

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