Recently, it has been reported that glycoprotein (gp) 130 is a common signal-transducing receptor subunit for the IL-6 cytokine family, and in the non hemodialysis (HD) patients, plasma levels of its soluble form (soluble gp 130; sgp 130) are elevated in association with the severity of heart failure. However, in HD patients, the relationship between the damage of cardiomyocytes and sgp 130 is unclear, so we performed an echocardiogram and investigated all echocardiographic measurements and also measured several blood chemistry tests and the plasma levels of sgp 130 according to the manufacturer's instructions with an enzyme-linked immunosorbent assay purchased from R & D Systems (Minneapolis, MN, USA) in 108 patients (74 HD patients, 34 non HD patients).
In the HD group, the plasma level of sgp 130 was significantly greater than that in the non HD group (p<0.05). In the HD group, sgp 130 was positively correlated with left ventricular mass index, left ventricular relative wall thickness (RWT), inter ventricular septal thickness and left ventricular posterior wall thickness (r=0.248, p<0.05; r=0.356, p<0.005; r=0.405, p<0.0005; r=0.337, p<0.005, respectively), and was also negatively correlated with ejection fraction, percent fractional shortening, stroke volume, cardiac output and cardiac index (r=-0.327, p<0.005; r=-0.268, p<0.05; r=-0.348, p<0.005; r=-0.269, p<0.05; r=-0.288, p<0.05, respectively). In the HD group, sgp 130 level was significantly greater in the RWT high group (RWT≥0.45) than in the RWT low group (RWT<0.45) (p<0.0005), and sgp 130 level was significantly greatest in the left ventricular concentric hypertrophy group (p<0.005). In the HD group, multiple regression analysis of sgp 130 demonstrated that left ventricular systolic dysfunction and RWT were significantly influential factors. In the HD group, for the detection of left ventricular systolic dysfunction, the area under the ROC curve was 0.822 (p<0.0001) for sgp 130, and the cut-off value was 383 (ng/mL).
In conclusion, the signal-transducing pathway via activation of gp 130 may play an important pathophysiological role in heart failure, cardiac remodeling, and cardiomyopathy in HD patients.

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There have been very few systematic reports on physical examination procedures for dysfunctional arteriovenous fistula (AVF), and for the most part these are biased toward auscultation in Japan. The significance of physical examination in dysfunctional AVF is studied in this paper. The AVF cases were divided into two groups according to the observation procedure used: The first group was retrospectively investigated by conventional methods based on auscultation between July 1996 and December 2004, and the second group was prospectively evaluated by overall physical examination including inspection and palpation between January and December 2005. Physical findings were observed in cases showing venous stenosis of 60% or greater decrease in lumen diameter measurement on diagnostic angiography. There were 181 findings obtained from 102 stenotic AVF in the former group and 69 findings from 31 AVF in the latter group. Furthermore, AVF venous stenosis was classified into three types: 1) juxta-anastomotic type, 2) upstream type and 3) mixed type of former two types. In the first group, serious findings such as blood flow failure including occlusion was relatively prominent. In the second group, serious findings decreased substantially. In the former group, three types of stenosis could not be distinguished by auscultation. Meanwhile in the second group, each type showed distinctive findings: attenuation of the first thrill on juxta-anastomotic type, a firm dilated pulsatile vein and second thrill on upstream type, and second thrill accompanied by slight venous dilatation on the mixed type, respectively. Physical examination with the eyes, hands and ears makes early diagnosis of access failure or stenosis easy and precise, and thus helps to improve access by percutaneous transluminal angioplasty.

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We report an autopsy case of a 69-year-old male with anal amyloid tumor (amyloidoma) who had been treated with hemodialysis for 17 years. The autopsy examination showed that multiple amyloidomas had formed not only on the anus but in the abdominal cavity, subcutaneous tissues and other sites. Immunohistochemical study demonstrated that all of the amyloidomas were stained positive with anti-β₂ microglobulin antibody. Although he had a latent IgGκ type monoclonal gammopathy of undetermined significance, the amyloidomas were stained negative with anti-IgG antibody and anti-κ antibody. These findings confirmed that they were dialysis-related amyloidosis due to long-term hemodialysis treatment. Here, we report this rare case of multiple dialysis-related amyloidomas involving several organs including the anus, with reference to autopsy findings.

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We report a case of proctitis developed in a diabetic patient receiving chronic hemodialysis. A 69-year-old Japanese woman with an approximately 22-year history of type 2 diabetes mellitus, and she had initiated maintenance hemodialysis at 60 years of age (October 1995). She had also experienced ectopic pregnancy treated surgically at 25 years of age. The patient had been unable to walk for several days due to progressive coxalgia, so that she had been admitted to the dialysis clinic on July 1, 2004. White blood cell was 25, 600/μL on July 7, and she was transferred to our hospital on July 12. On admission, hemoglobin Alc was 7.7%. Although the patient complained of severe coxalgia, pelvic magnetic resonance imaging and computed tomography examinations demonstrated normal-appearing hip joints and circumferential thickening of the rectal wall. Colonoscopy demonstrated mucosal hemorrhage and erosions, localized from the dentate line to 4-7cm. After proctitis was diagnosed, the patient was started totally-parenterally nourished, and antibiotics were administered. Although the symptoms, endoscopic and radiographic findings improved after treatment, the disease flared twice during the following 3 months. Therefore, we continued parenteral alimentation for 21 days then for the following 54 days the patient was given a liquid diet and antibiotics were administered for 45 days. Thereafter, she entered remission. The origin of the proctitis was obscure, but there has not been any apparent episode of recurrence to date.

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