【Aim】The aim of this study was to evaluate the safety and feasibility of using the NCV-3 automatic blood return system (Nippro, Tokyo, Japan) in a blood circuit for dialysis during a power outage. 【Method】The time taken to return 300 mL of saline (as a substitute for blood) at 100 mL/min using the NCV-3 automatic blood return system or the conventional manual method was measured 8 times by 4 trained medical engineers in a crossover simulation study. 【Results & Discussion】In the first trial, the time required to achieve saline return using the NCV-3 automatic blood return system was significantly shorter than that required when the conventional manual method was employed (222.0±5.0 sec vs. 344±14.1 sec, p=0.0005). The time required to achieve saline return using the conventional manual method gradually decreased according to the learning curve, and the time recorded in the eighth and final trial was 236.5±9.6 sec (p=0.054 vs. the automatic blood return system). The NCV-3 automatic blood return system might help to reduce the workload of staff in the event of an emergency power outage. 【Conclusion】 Our simulation study proved the safety and feasibility of using the NCV-3 automatic blood return system in a blood circuit during a power outage.

We report three cases in which patients that experienced vascular pain during hemodialysis were effectively treated with auriculotherapy using microcones (Somareson^®). Case 1: a female patient in her 80s developed shoulder pain during dialysis. Auriculotherapy reduced her visual analogue scale (VAS) score from 74 to 0. Case 2: a female patient in her 50s experienced forearm pain at the site of an arteriovenous fistula during dialysis. Auriculotherapy reduced her VAS pain score from 34 to 6. Case 3: a female patient in her 80s was using a hemofiltration catheter, which had been inserted into her right internal jugular vein, for hemodialysis. She developed right upper arm pain during hemodialysis. Auriculotherapy reduced her VAS pain score from 78 to 0. In all three cases, auriculotherapy was carried out before the pain appeared, and the pain disappeared immediately. Auriculotherapy using microcones might be effective at treating vascular pain in hemodialysis patients.

A 69-year-old female who had been on hemodialysis because of chronic glomerulonephritis since the age of 53 was admitted to our department with a complaint of macroscopic hematuria. Bladder fiberscopy revealed a few small bladder tumors, which were removed using transurethral resection (TURBT). Thereafter, plain computed tomography (CT), bladder fiberscopy, and washing cytology were performed to detect recurrence. Three years after the TURBT, plain CT revealed right-sided renal cancer. Therefore, a laparoscopic right-sided retroperitoneal nephrectomy was carried out. A histopathological examination demonstrated right-sided renal pelvic carcinoma. In addition, at 1 month after the nephrectomy plain CT showed left-sided ureteral cancer, and retroperitoneal laparoscopic total left nephroureterectomy, total bladder cystectomy, and residual right ureterectomy were performed. Colpocleisis for a transvaginal enterocele was conducted at 1 postoperative year. The patient has not suffered any other complications since. It is often difficult to detect urothelial tumors in hemodialysis patients because they can suffer from oliguria or anuria; therefore, such tumors tend to be diagnosed late. Many hemodialysis patients develop urinary tract tumors, such as kidney or bladder tumors, and clinicians should examine such patients for accompanying pelvic or ureteral tumors. Here, we report the case of this hemodialysis patient along with a review of the relevant literature.

An 83-year-old female had noticed symptoms of Raynaud’s phenomenon during the past 4 years. She was admitted to the cardiovascular department of our hospital so that the cause of her recurrent syncope could be investigated. The patient was suffering from hypertension, cardiac enlargement caused by pericardial effusion, bilateral pleural effusion, and acute kidney damage. We diagnosed her with sine scleroderma because she exhibited Raynaud’s phenomenon; extension of the nail epithelium; dilated finger pad capillaries; and positivity for anti-nuclear antibody, anti-centromere antibody, and anti-RNA polymerase III antibody, but did have any cutaneous symptoms. She also displayed grade III Keith-Wagener hypertensive retinopathy of the fundus, hemolytic anemia with crushed red blood cells, thrombocytopenia, and elevated renin-aldosterone system activity. As a result, we diagnosed her with sine scleroderma accompanied by a hypertensive scleroderma renal crisis. Finally, hemodialysis was initiated because her renal dysfunction did not improve in spite of good blood pressure control being achieved with calcium antagonists and enalapril. We describe this valuable case with reference to reports of previous cases of sine scleroderma that did not involve diffuse cutaneous sclerosis or rapidly progressive cutaneous sclerosis, which might be risk factors for hypertensive scleroderma renal crisis.

Non-invasive cardiac output monitors are very useful for monitoring circulatory dynamics under numerous clinical settings, including hemodialysis. However, no previous studies have assessed patients’ circulatory dynamics before and after the production of vascular access points using a non-invasive cardiac output monitor. Therefore, herein we evaluated the circulatory dynamics of two patients during the production of vascular access points at the elbow using a non-invasive cardiac output monitor and vascular ultrasound sonography. Case 1 involved an 84-year-old female who underwent surgery to produce a side-to-side anastomosis of the radial artery and cephalic vein. Just after surgery, the patient’s systemic vascular resistance decreased, and her stroke volume increased. Case 2 involved a 91-year-old male who underwent surgery to produce an end-to-side anastomosis of the radial artery and median cubital vein. After surgery, the patient’s circulatory dynamics were not markedly affected; however, he developed steal syndrome and a seroma. The production of vascular access points affects the circulation via a number of mechanisms, e.g., the arteriovenous fistula causes a reduction in vascular resistance, and the shunt flow produces an increase in stroke volume. Furthermore, the circumferential stress-strain relationship between the diameter of and stress within the affected vessels can modify the circulation. In case 2, the inadequate shunt flow volume and the patient’s anatomical factors did not affect his circulation. Non-invasive cardiac output monitors and vascular ultrasound sonography are very useful tools for monitoring circulatory dynamics before and after the production of vascular access points.

We present a case in which a hemodialysis patient with small cell lung cancer (SCLC) was successfully treated with chemotherapy. A mass was detected in the right lower lung field in a 68-year-old hemodialysis-dependent female with end-stage renal failure caused by diabetic nephropathy during a routine chest X-ray. Limited stage SCLC was diagnosed after bronchoscopy and computed tomography. The patient received concurrent chemoradiotherapy involving carboplatin plus etoposide. A complete response was achieved after one course of chemoradiotherapy. Although the patient received four courses of chemotherapy without suffering any severe adverse effects, she stopped receiving radiotherapy because she could not attend the hospital frequently. Sixteen months after the start of the chemoradiotherapy, the lung mass disappeared.