Clinical significance of the association between atherosclerosis and circulating levels of the chemokine, soluble adhesion molecules, and soluble Fas (sFas) was investigated in 95 patients [70 hemodialysis (HD) patients, 25 non HD patients]. Atherosclerotic disease in both groups was assessed by measuring intima-media thickness (IMT) and Max IMT of the common carotid arteries using an ultrasound scanner, and by measuring brachial ankle pulse wave velocity (baPWV) and ankle brachial pressure index (ABI) using a Colin Waveform analyzer (form PWV/ABI, Colin, Komaki, Japan). Vascular calcification was estimated by the aortic arch calcification index (AACI) on posterior-anterior view on simple chest X-ray film. Circulating levels of serum monocyte chemoattractant protein-1 (MCP-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and sFas were measured by immunosorbent assay (ELISA) in the subjects. The association between these circulating factors and complications of cardiovascular and cerebrovascular diseases, and several atherosclerotic markers described above were analysed.
Compared with non HD subjects, subjects with HD had significantly higher plasma levels of MCP-1, sVCAM-1, sICAM-1, and sFas (p<0.0005, p<0.0001, p<0.05, p<0.0001, respectively). In HD subjects, circulating levels of MCP-1 and sVCAM-1 were elevated in the subgroup of ischemic heart disease (IHD) compared with the subgroup of non IHD (p<0.05, p<0.05, respectively), and the circulating level of MCP-1 was elevated in the subgroup of cerebrovascular disease (CVD) compared with the subgroup of non CVD (p<0.01). In HD subjects, the values of MCP-1, sVCAM-1, sICAM-1, and baPWV were positively correlated with the value of log-transformed high sensitivity C-reactive protein (log HS-CRP) (r=0.259, p<0.05; r=0.236, p<0.05; r=0.279, p<0.05; r=0.350, p<0.005, respectively). The values of MCP-1, sVCAM-1, sICAM-1, and sFas were positively correlated with the value of baPWV in HD subjects (r=0.298, p<0.05; r=0.271, p<0.05; r=0.241, p<0.05; r=0.249, p<0.05, respectively). Multiple regression analysis in HD subjects showed that the values of MCP-1 and sVCAM-1 were independently correlated with IHD (p<0.01). Multiple regression analysis in HD subjects also showed that the value of sVCAM-1 was independently correlated with the value of baPWV (p<0.05).
In HD population, circulating markers such as MCP-1, sVCAM-1, sICAM-1, and sFas were markedly elevated, and there is a possibility that the values of these new markers may be associated with atherosclerosis.

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Aluminum (Al)-containing medicines are prohibited for dialysis patients because of its possible cause of Al-osteopathy and Al encephalopathy. However, when it is used as an inactive ingredient, Al is free from legal restraints, and the Al concentration in such medications is usually unknown. The Al concentration in some over-the-counter drugs that contain Al as an inactive ingredient was determined in this study.
The Al concentrations in Chinese herbal medicines for the stomach, made by the TAISHO Pharmaceutical Company, TAKEDA Pharmaceutical Company, and KANEBO Pharmaceutical Company were 27.6mg, 47.1mg, 29.1mg per day, respectively. It is important to prevent the intake of Al from such medications in dialysis patients, because Al is also readily consumed from various kinds of food and beverages. Since it is also widely distributed in nature, it is impossible to completely avoid Al intake. It is recommended to collect information about medicines with a high Al concentration and to establish measures for providing more precise information for dialysis patients.

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We encountered a hemodialysis patient with simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma in the right kidney. A 66-year-old male with a 25-year history of hemodialysis due to diabetic nephropathy, was referred to our outpatient clinic with a complaint of asymptomatic gross hematuria. Computed tomography demonstrated a solid mass lesion, about 6cm in diameter, in the atrophic and multi-cystic-changed right kidney. We diagnosed the patient as having right renal cell carcinoma. Radical nephrectomy was performed under general anesthesia. Pathological survey demonstrated the existence of three different malignant tumors as follows: 1) renal cell carcinoma, 7.0×6.0×5.0cm in size, clear cell and granular cell carcinoma, grade 2>3, expansive type, INF-alpha, pT1b, 2) renal cell carcinoma, 3.0×3.0×2.0cm in size, clear cell and granular cell carcinoma, grade 2>1, expansive type, INF-alpha, pT1a, 3) urothelial (i.e. transitional) cell carcinoma, 1.3cm in diameter, grade 3. Neither venous nor lymphatic involvement of these three tumors could be found. Every surgical margin was cancer-negative. Based on the patient's strong will and surgical radicality, no adjuvant anti-tumor therapy was given post-operatively. Within the initial 6-month follow-up period to date, there has not been any evidence of recurrence or distant metastasis.

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Nephrectomy is the surgical removal of the affected kidney for treatment of renal cell carcinoma. Recently partial nephrectomy for smaller tumors has become more common, and surgical procedures to preserve renal function have been used. In patients with chronic renal failure whose renal function is already decreased, nonischemic enucleation of renal cell carcinoma has been performed to preserve renal function. However, consideration of performing dialysis before surgery is necessary in patient with large or bilateral tumor mass.
The current case involves a patient with chronic renal failure whose renal tumor was detected by CT scan at an outpatient follow-up. Due to the tumor diameter, tumor enucleation was considered difficult, and a left-forearm internal shunt was surgically created for dialysis after surgery. Partial nephrectomy was performed using a microwave tissue coagulator (MTC) without vascular control. As result, the patient underwent urgent perioperative dialysis but maintenance treatment was not required. At present, the patient receives outpatient services without the need for dialysis.

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A 58-year-old male with a 27-year history of epilepsy complained of nausea, vomiting and dizziness. He has previously demonstrated epilepsy and had been treated with anticonvalsant for thirty-seven years. He was suspected of having phenytoin poisoning since he complained of nystagmus, diplopia, gait disturbance and drowsiness with slurred speech. Laboratory data demonstrated serum phenytoin concentrations of 45.8μg/mL (therapeutic range; 10-20μg/mL). Under the diagnosis of phenytoin poisoning, a single charcoal hemoperfusion was performed. The concentration of phenytoin in the serum decreased from 45.6 to 26.0μg/mL. His general condition rapidly improved after the treatment. He was discharged without any sequelae after 10 days of hospitalization.

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Catheter-related bacteremia often causes serious complications in hemodialysis patients. We report a 72-year-old man on hemodialysis due to diabetic end-stage renal disease who developed catheter-related Stapylococcus aureus (S. aureus) bacteremia, intractable abdominal angina and pyogenic vertebral osteomyelitis. He was admitted to our hospital for progressive dyspnea and we started hemodialysis (HD) with an arteriovenous fistula in his left forearm. However, a dual-lumen catheter was placed in the right femoral vein because of arteriovenous fistula occlusion on the 14th hospital day. On the 35th hospital day, the patient developed a high fever with shaking chills. Because blood cultures from both the catheter lumen and a peripheral vein were positive for methicillin-resistant S. aureus (MRSA), the catheter was immediately removed and intravenous vancomycin administration was started at a dose of 500mg/day, twice weekly. However, treatment with systemic antibiotics alone failed to definitively eradicate the infection and the patient began to complain of intractable abdominal angina within two months. The cause of abdominal angina was unknown despite vigorous systemic examination, including contrast-enhanced magnetic resonance imaging (MRI). On the 120th hospital day, the patient developed severe back pain. On physical examination, there was no apparent neurological deficit, but T2-weighted MRI scan showed a high signal area and Gallium scintigram showed an abnormal accumulation of the isotope in Th12 and L1, suggesting vertebral osteomyelitis. Local drainage of the vertebral abscess as an adjunct to systemic antibiotic therapy was performed for eradication of the infection and amelioration of abdominal angina. We speculate that a disturbed microcirculation, associated with activated cytokine network by cell-surface-associated protein of S. aureus, such as intrleukin-1 and tumor necrosis factor, along with bacterial emboli might have played an important role in abdominal angina. This case has important implications for catheter-related S. aureus bacteremia in hemodialysis patients.

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