Objective: Patients who undergo hemodialysis with shielding from light reportedly show lower oxidative stress. To elucidate the mechanism of this effect, we examined the generation of reactive oxygen species during the irradiation of human neutrophils with visible light. Methods: A suspension of human neutrophils was irradiated for 60 minutes with visible light from a fluorescent lamp (light intensity at the suspension surface: 14, 000lux). Formation of superoxide in the irradiated suspension and a light-shielded control suspension was estimated based on a change in the absorbance of cytochrome C. Results: The rate of superoxide formation in the irradiated suspension was 2.02nmol⋅106cells/mL/min, while that in the light-shielded control suspension was 0.79nmol⋅106cells/mL/min. Conclusion: Shielding from light during hemodialysis is likely to reduce the generation of superoxide by visible light stimulation of neutrophils in the circulating blood.
This report describes the day-to-day quality control method for electrolyte analysis using standard reference serum or control serum. The day-by-day coefficient of variation (CV) was within 0.8% and 1.1% for the standard reference serum and control serum, respectively. The accuracy and stability of results was higher for the control serum than the standard reference serum. From a cost performance perspective, it is better to use the control serum for monitoring day-to-day variations; and for monitoring the accuracy of the electrolyte analyzer, or verifying its performance, it is better to use standard reference serum. The serum can be used for the purpose of quality assurance if proper consideration is given to the conditions, e.g., correct use of electrolyte analyzer under appropriate circumstances, proper handling of materials, and so forth.
When we insert peritoneal dialysis catheters, we have performed PWAT (peritoneal wall anchor technique) under laparoscopic guidance to prevent dislocation and dysfunction of the catheters. We have also performed PWAT to reposition the dislocated catheters. We need laparoscopic instruments (ports, scopes, forceps and so on) and several peritoneal access ports for these procedures. However, some criticisms have noted that this procedure is expensive and causes an excessive abdominal scar. We devised a novel technique to resolve these issues by a minimally invasive procedure under video-scopic guidance without port. We can use grasping forceps through the working channel of the scope to place catheters in the abdomen.
The patient was a 73-year-old female who had been receiving maintenance hemodialysis due to diabetic nephropathy for 4 years. She was admitted to our hospital for amputation of the severely necrotic foot. During surgery, her blood pressure fell to 50/20mmHg temporarily. Five days after surgery, she developed high fever, and complained of lower abdominal pain and urgency of micturition. Laboratory data showed CRP of 30.2mg/dL, and white blood cell count of 11, 600/μL. On the day, her consciousness was disturbed, and the abdominal had became distended. Abdominal X-ray demonstrated massive air in the intestine, therefore, paralytic ileus was suspected. Abdominal pain exacerbated, and she subsequently died of sepsis. Autopsy demonstrated gangrenous cystitis with bladder perforation and pan-peritonitis. Beta 2-microglobulin derived amyloid was slightly deposited in the bladder wall. In this case, gangrenous cystitis appeared to be caused by ischemia of the bladder wall due to arterial sclerotic lesion, severe hypotension during the surgery and bladder overdistention by diabetic neurogenic bladder. Furthermore, chronic urinary tract infection, which had persisted under the condition of neurogenic bladder and anuria in this compromised host, probably influenced gangrenous cystitis.
Case 1: A 68-year-old man with chronic renal failure and arteriosclersis obliterans was referred to the department of internal medicine because of abdominal cramps, nausea and vomiting. He had been treated with sulindac for left knee joint pain. Laboratory findings revealed severe metabolic acidosis and the elevated levels of serum creatinine and potassium. Hemodialysis was performed immediately although his symptoms worsened. Since computed tomography of the abdomen showed intra-abdominal free air, he was diagnosed as having gastrointestinal perforation. The patient underwent laparotomy, and the ileum was partially resected. An ulcer on the perforated lesion of the ileum was found. Case 2: A 72-year-old man, with a previous history of myocardial infarction and arteriosclerosis obliterans, was admitted to our hospital because of ileus. He had been on maintenance hemodialysis and was treated with loxoprofen for leg pain. Blood cell count showed leukocytosis, and blood chemistry showed an elevated level of CRP. As computed tomography showed abdominal free air and ascites, perforation of the gastrointestinal tract was diagnosed. The patient underwent laparotomy, and perforation of the jejunum was found. Nonsteroidal anti-inflammatory drug (NSAID)-induced small intestinal perforation is relatively rare complication. However, recent studies have confirmed that the small intestine is a common site for adverse effects of NSAIDs. Therefore, intestinal injury and ulceration induced by NSAIDs should be considered in patients with chronic renal failure who complain of chronic pain and are being treated with NSAIDs.
The patient was a 69-year-old woman with end-stage renal disease on hemodialysis, who developed arteriovenous malformation (AVM) of the small itestine with severe gastrointestinal hemorrhage. In 2003, we detected hemorrhagic episodes twice in the same year, but were not able to identify the bleeding source. Severe bleeding occurred in January 2004 and AVM was recognized in the small intestine close to cecum by mesenteric arferiography and scintigraphy. We demonstrated AVM of the small intestine by intraoperative contrast imaging and successfully excised the lesion. However, bleeding recurred half a year later, and we performed artery embolization with Histoacryl. There has not been any further recurrence for one year to date. Because of difficulties in diagnosis and treatment, tendency toward recurrence, and multifocal onset, careful search is required to treat AVM of the small intestine.