【Background】The acute exacerbation of interstitial pneumonia (IP) has an extremely poor prognosis. Recently, direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) has been employed as an effective treatment for the acute exacerbation of interstitial lung disease. However, there have only been a few reports about the use of PMX-DHP to treat the acute exacerbation of IP. 【Materials and Methods】With the aim of investigating the effects of PMX-DHP as a treatment for the acute exacerbation of IP, we retrospectively examined the cases of 14 consecutive patients who were hospitalized at Tokyo Metropolitan Komagome Hospital between 2014 and 2016 due to the acute exacerbation of IP and were treated with PMX-DHP. The ratio of the arterial pressure of oxygen to the fraction of inspired oxygen (PaO₂/FiO₂ ratio) and the patients’ vital signs and laboratory findings were compared between those obtained before and after PMX-DHP treatment. The survival rate from the 1st PMX-DHP treatment to death was also investigated. 【Results】All patients were administered steroid pulse therapy. The other administered medications included cyclophosphamide hydrate in 5 patients, cyclosporine or tacrolimus hydrate in 8 patients, and sivelestat sodium hydrate in 7 patients. The patients’ vital signs and laboratory findings did not change significantly after the PMX-DHP treatment, but the PaO₂/FiO₂ ratio improved significantly from 158 (interquartile range [IQR]: 124-232) to 197 (IQR: 142-245) (p=0.001). At 60 days after the PMX-DHP therapy, 8 patients had died, and 6 patients had survived. In the surviving group, PMX-DHP was initiated significantly earlier than in the non-surviving group (6.5 {IQR 6-7} days vs. 12 {IQR 8.5-21.5} days; p=0.036). 【Conclusions】PMX-DHP might be effective at improving oxygenation in patients that experience the acute exacerbation of IP, and the early initiation of PMX-DHP might improve the prognosis of such patients.

【Purpose】To investigate the efficacy of exercise therapy and the exercise continuation rate among dialysis patients. For this purpose, exercise therapy was conducted three times a week for 12 weeks during dialysis. 【Methods】The study cohort included eight patients that were receiving maintenance dialysis (five males and three females) for at least six months. Various blood test parameters, lower limb muscle strength, exercise tolerance, quality of life, and the exercise continuation rate were examined before and after the introduction of exercise therapy, and the results were compared. 【Results】The exercise continuation rate over the 12-week period was 100%. Of all muscle groups, only the quadriceps femoris demonstrated a significant increase in muscle strength (p<0.05). The results of the survey revealed positive results in six of the eight patients. 【Conclusions】Exercise therapy during dialysis is associated a high exercise continuation rate in patients, and future long-term interventions based on these findings could help to improve the physical functions and enhance the quality of life of such patients.

The number of HIV-infected patients undergoing chronic dialysis therapy in Japan has not been elucidated. We studied the number of such patients based on nationwide data about human immunodeficiency virus (HIV)-infected individuals who regularly visited acquired immunodeficiency syndrome (AIDS) core hospitals. Among the 20,448 HIV patients registered in 2014, 92 (0.45%) were chronic dialysis patients: 10 in the Hokkaido and Tohoku area, 55 (34) in the Kanto (Tokyo) area, 13 (7) in the Chubu (Nagoya) area, 9 (5) in the Kinki (Osaka) area, 3 in the Chugoku and Shikoku area, and 2 in the Kyusyu and Okinawa area. (Proofreader’s note: These numbers add up to 91 rather than 92. Please correct as necessary.) Of the 21,184 HIV patients registered in 2015, 103 (0.49%) were chronic dialysis patients: 7 in the Hokkaido and Tohoku area, 59 (38) in the Kanto (Tokyo) area, 23 (12) in the Chubu (Nagoya) area, 10 (6) in the Kinki (Osaka) area, 2 in the Chugoku and Shikoku area, and 2 in the Kyusyu and Okinawa area. The number of hemophiliacs who had contracted HIV from HIV-tainted blood products was 593 (2.9%) in 2014 and 604 (2.9%) in 2015, respectively. Among them, 10 (1.7%) and 15 (2.5%) of the patients registered in 2014 and 2015, respectively, were receiving chronic dialysis therapy. The proportion of dialysis patients was 4-fold higher in the hemophiliac HIV group (approx. 2%) than in the overall HIV population (approx. 0.5%). Two stable hemophilia patients were treated without any problems at ordinary outpatient dialysis clinics in cooperation with AIDS core hospitals. The outlines of these cases are reported in this article. In conclusion, this study describes the most recent and credible data regarding the number of HIV-infected individuals receiving chronic dialysis in Japan.

A 76-year-old male who had been receiving maintenance hemodialysis with a cellulose triacetate dialyzer in a nearby clinic was admitted to our medical center with a right femoral neck fracture. He had undergone bipolar hip arthroplasty of the right femoral bone. Before and after the operation, he received hemodialysis using a cellulose triacetate dialyzer. In each dialysis session, the accumulation of chylomicron was observed on the venous side of the hemodialysis circuit when blood return was performed with 0.9% saline fluid. The patient had no lipid metabolism abnormalities. Systemic inflammation due to the bone fracture and the trapping of chylomicron by the cellulose triacetate dialyzer were considered to have contributed to the accumulation of chylomicron on the venous side of the hemodialysis circuit in this case. Clinicians should be aware that chylomicron can accumulate in the hemodialysis circuit when hemodialysis is performed in patients in the acute phase of bone fractures.

We report the case of a 71-year-old Japanese female with idiopathic thrombocytopenic purpura (ITP), who was started on hemodialysis because of end-stage kidney disease due to autosomal dominant polycystic kidney disease in 1985. Since 2008, she has been repeatedly hospitalized for bacterial liver and/or kidney cyst infections. In November 2012, she was diagnosed with ITP based on the sudden onset of thrombocytopenia; i.e., a platelet count of 4,000/μL, and a bleeding tendency. Although treatment with 40 mg/day prednisolone (PSL) increased her platelet count, the bacterial liver cyst infection recurred. A test for a Helicobacter pylori infection produced negative results, and splenectomy could not be performed due to the patient’s unstable general condition. We treated her with the thrombopoietin receptor stimulator eltrombopag olamine, but this treatment was discontinued because the patient’s plasma D-dimer level rose. We then treated her with the testosterone derivative danazol. Her platelet count subsequently stabilized, and we were able to taper the PSL dose to 2.5 mg/day.

A 71-year-old male, who had been receiving dialysis for 2 years, presented with a fever and precordial pain. He was diagnosed with left-sided pneumonia and was admitted to our hospital. He was assumed to have bacterial pneumonia and so was treated with ceftriaxone. The antibacterial therapy was not effective, and an inflammatory reaction and pulmonary infiltration developed. Legionella pneumonia was considered during the differential diagnosis of atypical pneumonia. As a Legionella urinary antigen test would have been difficult to perform as the patient was anuric, a serum sample was used instead of a urine sample for the test. The result was antigen-positive. Thereafter, the Legionella urinary antigen test was performed again using a small amount of urine (collected via a urethral catheter), and the result was also antigen-positive. The patient was finally diagnosed with Legionella pneumonia. He was administered levofloxacin, and he recovered immediately. It has been reported that hemodialysis patients are at risk of developing Legionella pneumonia, but it is often difficult to collect urine samples for examination from such patients. Legionella urinary antigen testing using serum samples instead of urine might be useful for diagnosing Legionella pneumonia among anuric dialysis patients.

An 80-year-old male, who was receiving maintenance hemodialysis, presented with extensive exudative erythema and pruritus on his right upper arm, which gradually extended to the left arm after eight months of treatment with vildagliptin for type 2 diabetes. A skin biopsy revealed bullous pemphigoid (BP). A high level of anti-BP180 autoantibodies (380) was detected. Oral prednisolone (PSL) and minocycline hydrochloride (MINO) treatment was started immediately. The skin lesions had improved markedly after two months of the PSL/MINO treatment. However, the vildagliptin treatment was continued. The skin lesions reappeared six months after the discontinuation of the PSL/MINO treatment. The PSL/MINO treatment was restarted. Coincidently, at this time it was reported that BP can occur as a side effect of vildagliptin in elderly Japanese type 2 diabetes patients (Pharmaceuticals and Medical Devices Safety Information). Vildagliptin was immediately discontinued. The skin lesions gradually resolved. The PSL/MINO treatment was discontinued. The patient’s BP had not relapsed at eight months after the withdrawal of vildagliptin.

Few studies have examined the surgical treatment of prostate cancer in patients on hemodialysis. We report two cases in which robot-assisted laparoscopic prostatectomy (RALP) was performed in hemodialysis patients. Patient 1 was a 63-year-old male, who had been put on hemodialysis because of chronic glomerulonephritis-induced chronic renal failure 16 years earlier. He was diagnosed with prostate cancer (cT1cN0M0) via a transrectal biopsy. He underwent RALP. The operation took 4 hours and 55 minutes. The total amount of intraoperative blood loss was 20 mL. The patient’s postoperative course was uneventful, and he was discharged on postoperative day 8. Patient 2 was a 67-year-old male, who had been put on hemodialysis because of diabetic nephropathy-induced chronic renal failure 3 years earlier. He was diagnosed with prostate cancer (cT2cN0M0) based on a transrectal biopsy and underwent RALP. The operation took 4 hours and 30 minutes. The total amount of intraoperative blood loss was 160 mL. The patient’s postoperative course was uneventful, and he was discharged on postoperative day 8. We suggest that surgery for prostate cancer can be effective in selected hemodialysis patients and that RALP is a useful form of minimally invasive surgery in such patients.