Nagano Prefecture (Nagano) is an area typified by farm villages and is an area with one of the most elderly populations in Japan. However, there is an interesting medical phenomenon in Nagano; the medical expenses for elderly men are very low and there is a high average life span. We extracted the data of the present status of Nagano from “an overview of dialysis treatment in Japan (as of Dec. 31, 1997).” A questionnaire investigation for epidemiology of dialysis patients in each dialysis unit was performed.
The dialysis patients in Nagano occupied 1.7% of the whole country in the same way as the total population, and the dialyzed population rate per million people was almost equal to the national average. However, the rate of hospitalized dialysis patients was low. The average age of the patients who started dialysis in Nagano was higher than that of the whole country by 1.2 years. In Nagano, the patients who started dialysis due to chronic glomerulonephritis were much more numerous than those of the whole country, and those who started dialysis due to diabetic nephropathy were fewer. In the cause of death of dialyzed patients, the rate of heart failure was low, but that of cerebrovascular disease was high. Regarding dialysis staff members, the number of nurses was sufficient, but there were insufficient numbers of doctors and medical engineers.
The questionnaire investigation divided Nagano into 4 areas. The south part of Nagano, where the population density is lowest, had a high patient pick-up rate, and short time and distance from each dialysis unit. The presence of the super-aging society in Nagano will require some special consideration for future medical administration.

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Geometry, together with densitometry, of the radial cortical bone in hemodialysis patients was analyzed by peripheral quantitative computed tomography (pQCT) to study the chronic skeletal changes and the effects of parathyroidectomy (PTX). Transverse slices 2.5mm thick were obtained at the point 15% from the distal end of the radius. The cortex was defined as the area with a bone mineral density higher than 690mg/cm³. Using the LOOP program, cortical bone mineral content (CONT), cortical bone mineral density (DENS), and cortical bone area (AREA) were determined, as well as polar area moment of inertia (IP) and Strength Strain Index (SSI), which are parameters for bone strength. In patients with midregion PTH higher than 40000pg/ml, decrease rates in CONT (-17.4%), AREA (-12.5%), IP (-12.9%), and SSI (-15.4%) were greater than that in DENS (-6.3%). Geometric and densitometric changes were much smaller in patients with midregion PTH of less than 5000pg/ml. Although increase in DENS at 1 year after PTX was 6.1%, greater increases were observed in CONT (30.1%), AREA (22.8%), IP (29.1%), and SSI (35.5%). These results indicate that the geometric parameters are useful tools to evaluate skeletal alteration in uremic patients. It seems that PTX produced considerable recovery of bone strength through increase of cortical area, although the response of bone mineral density was modest.

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If percutaneous transluminal angioplasty (PTA) of a hemodialysis shunt cannot induce sufficient dilation due to heavy calcification of the vessel, such a lesion has a high possibility of restenosis. We introduced the parallel wire technique (PWT) for rigid lesions, and investigated the effectiveness of the PWT.
PTA was perfomed in 37 lesions of 21 patients. Lesions were divided into two groups: conventional angioplasty techniques were used in 28 lesions and PWT was used in 9 lesions. Initial success rate and long-term patency rates were compared in the two groups.
The initial success rate was the same (100% vs. 100%), but long-term patency rates were greater in the PWT group than in the conventional angioplasty techniques group (patency rates after 24 months were 100% with PWT and 41.2% with conventional angioplasty techniques).
These results suggest that PWT is useful for dilation of rigid lesions of stenotic fistulas and produces good long-term patency rates.

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To clarify the mechanism of renal anemia in hemodialysis patients, we made a comparison between patients not receiving rHuEPO since the start of HD or for 1 year after improvement of anemia due to administration of rHuEPO (non-rHuEPO group, n=14) and patients who had received rHuEPO intravenously three times a week (rHuEPO group, n=14).
The hematocrit of these patients was more than 30% during the 5 months of the observation period.
RBC, Hb, TIBC, UIBC, and transferrin levels were significantly higher in the non-rHuEPO group than in the rHuEPO group, and ferritin was significantly lower in the non-rHuEPO group than in the rHuEPO group.
There were significant negative correlations between ferritin and transferrin, and between ferritin and Ht, respectively. However, there was a significant positive correlation between transferrin and Ht in the non-rHuEPO group alone.
This study suggests that transferrin is an important factor in assessing nutritional status and anemia in hemodialysis patients.

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The patient was an 82-year-old man. He had experienced general fatigue and loss of appetite in September 1997. A hematological test showed a blood urea nitrogen level of 49mg/dl and a serum creatinine level of 5.3mg/dl. Computed tomography revealed dilatation of the bilateral renal pelvis and a ureters and a soft tissue density mass shadow around the abdominal aorta at the level of L₂-L₅. Retrograde pyelography showed marked stenosis of the bilateral ureters, probably due to external compression. Left nephrostomy and biopsy of retroperitoneal tissues surrounding the left ureter were performed on October 28, 1997. Under the pathological diagnosis of retroperitoneal fibrosis, we started steroid therapy. One month later, stenotic change of the left ureter improved. Six months later, we removed the left nephrostomy tube. The level of blood urea nitrogen is now 25mg/dl, and the serum creatinine level ranges from 1.3 to 1.4mg/dl.
The present patient had idiopathic retroperitoneal fibrosis associated with renal failure, and steroid therapy was effective for reduction of the lesion and improvement of the renal function.

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A 39-year-old man complained of the sudden onset of right lower abdominal pain during hemodialysis. His desire for voiding continued even after he excreted 300ml of urine. A urethral catheter was inserted, after which a large volume (3000ml in one hour) of fluid flowed out and his ascites disappeared. Rupture of the urinary bladder was confirmed by cystography. His vital signs were unstable, so he was followed without surgery. Fortunately, the rupture closed spontaneously. An abscess developed near the bladder, but was cured and healed with percutaneous drainage.

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