Between December, 1966 and June, 1985, 137 hemodialyzed patients underwent 74 elective and 63 emergency operations at our institute. The number of patients who died within one month after emergency surgery was significantly greater than that following elective surgery. Many severe infections and inadequate perioperative management were pointed out in the cases of emergency surgery. Parameters of self-defence mechanisms such as cell-mediated immunity, reticuloendothelial phagocytic index and complement system (C₃, CH50) were evaluated and were found to be depressed among the hemodialysis patients.
Before emergency surgery, hemodialysis using bicarbonate dialyzate and an EVAL membrane dialyzer without heparin was performed with transfusion of packed red blood cells and fresh frozen plasma. The aims of the preoperative dialysis were to ensure maximum metabolic control, to avoid fluid overload and hyperpotassemia and to correct levels of hematocrit and serum protein. After surgery, parenteral nutrition, administration of immunoglobulin and replacement of opsonic proteins should be done for enhancement of depressed host defence mechanisms. Administration of a biological response modifier, OK-432 were tried in several cases in order to prevent infectious complications. Our perioperative management consists of hemopurification, enhancement of self-defence mechanisms against infection, glucose insulin therapy and parenteral nutrition. The first hemodialysis after surgery was performed successfully on the 3rd postoperative day.
Since 1973, ten radical operations for cancers of the digestive system have been performed without severe complications. The diseases were five cases of gastric cancer and one case each of tongue cancer, esophageal cancer, rectal cancer, hepatocellular carcinoma and gall bladder-colon double cancer, respectively. The numbers of patients of all ages receiving dialysis have been rising considerably recently so that the number of reports on such patients with malignancy will increase. Efforts to rule out the likelihood of malignant disease at an early stage should therefore be made using upper GI series, ultrasonography and so on. Because of the poor prognosis of chronic renal failure per se, indications for anti-tumor agents and aggressive surgery in these patients should be considered carefully and are still controversial.

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With the striking advances being made in the field of dialysis treatment, indications for dialysis have been further extended so that this method has become feasible for aged patients and those with diabetic renal failure, for whom the method had previously been considered unsuitable.
Consequently, dialysis patients have increased in number and there have been miscellaneous reports on psychological problems seen among them.
The authors have also reported on the psychological problems among dialysis patients who have been on long-term dialysis treatment for more than 10 years and have described the importance of maintaining a favorable rapport between patients and medical staff.
This paper reports the results of investigations on patients with diabetic renal failure accompanied by agonizing complications and physical conditions, dialysis of aged people, psychological aspects for better adaptation to the treatment and how to maintain dialysis on such patients without any trouble, as well as the psychological stresses inflicted and how to cope with them while giving necessary assistance to the patients.
As a result, it was revealed that both diabetic renal failure and chronic glomerulonephritis patients groups took their diseases “uneasily”. However, the diabetic renal failure patients expressed their fears for the disease in diverse ways, while the chronic glomerulonephritis patients showed their anxieties for the disease in the form of being “horrible” which was invariably common among them. In their daily lives the general behaviors of diabetic renal failure patients was usually “escapist”. On the other hand there were no statistically significant differences between the diabetic renal failure and chronic glomerulonephritis groups in terms of their attitudes towards dialysis treatment, reliance on medical staff and modern medicine and their desire for support in the course of receiving treatment.
Comparison between aged and younger dialysis patients revealed that the former ostensibly showed a “take-it-easy” attitude towards receiving dialysis treatment, while both groups were found to be in an almost similar condition psychologically concerning their desire for support in receiving dialysis treatment and accompanying agonizing problems, which indicated that both aged and younger patients had been subjected to an equal degree of psychological stress by the dialysis treatment itself.

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The main characteristic of CAPD is self-care and home treatment, and it is considered to have various benefits, such as an excellent effect in improving uremic condition and full rehabilitation in comparison with HD. However, this modality is used for those patients who are considered to be at some disadvantage with frequent HD. During the last 5 years at Saiseikai Yahata Hospital, 22 patients, 16 males and 6 females, whose mean age was 53.1 years, were managed on CAPD for more than one year. The reason for selecting CAPD were aged people in 5, pediatric patient in 3, cardiovascular trouble in 4, diabetes in 4, trouble with HD in 3 and better rehabilitation in 3. Of these patients, 16 were still on CAPD, 2 dropped out due to tunnel infection and 4 died due to heart failure (2), peritonitis (1) and emaciation (1) by January 31 1985. These patients had 60 episodes and 70.6 months hospitalization during 548.4 months of observation period, or 1.31 episodes and 47.1 days per patient-year. The causes of hospitalization were peritonitis in 21, inadequate body weight control in 12, exit or tunnel infection in 4, inconvienency of their helper in 8, trouble at the time of dialyzate in or out in 5, re-education in 2, ileus in 1, hernia of the abdominal wall in 1, Adams Stokes syndrome in 1, unknown fever in 1 and emaciation in 1. Twenty-one cases of peritonitis developed in 13 patients and the incidence was one episode for every 26.1 patient-months. sixty-two percent of peritonitis was caused by contamination occuring at the time of bag exchange and 19% was caused by tunnel infection. The former occurred frequently in the 2nd year of CAPD and in the latter cases catheters had to be removed.
In ordes to succeed and develop long-term CAPD, it is important to improve the technology of the connecting systems of the CAPD bag and peritoneal catheter, and to establish on individual CAPD program in each hospital managed by nephrologists and well educated nurses. A CAPD nurse should care for her patient continuously and make an effort to educate and cooperate with other nurses in the ward.

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Over the last 7 years, we have operated upon 92 patients receiving chronic hemodialysis therapy (except for minor surgery and renal transplantation). Surgical disorders in these patients were gastroduodenal ulcer bleeding (6 cases), gastric cancer (5 cases), ileus (8 cases), choledocholithiasis (4 cases), acute appendicitis (4 cases), colon perforation due to ischemic colitis (2 cases), hyperparathyroidism (31 cases), thyroid cancer (2 cases), infectious renal cyst (10 cases), lung cancer (1 case) and others (13 cases). The operative death rate of 92 patients was 9.3% while the corresponding rate for emergency cases was 24.7% but that for elective cases was 1.7% (only one case in 59 patients). The cause of death in this one case was apoplexia at 3 weeks after gastrectomy. We think that surgical therapy for patients on chronic hemodialysis is not so difficult if the surgeon has a knowledge of the pathophysiology of chronic renal failure.
Forty-one patients with gastro-duodenal ulcer bleeding were treated by conservative therapy and/or pure ethanol injection therapy using endoscopy but 6 cases had to be given 4/5 gastrectomy with selective vagotomy. We consider that gastro-duodenal ulcer bleeding with chronic renal failure is due to stress ulcer, so that 2/3 gastrectomy is inadequate. Patients treated for secondary hyperparathyroidism, liver cancer and ischemic colitis are presumed to increase in number.

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We performed peritoneal dialysis (PD) on a 26-year-old male patient with renal failure complicated with hemophilia A.
Although fracture of the right femur 2 months before the start of PD might have played a certain role in the advance of renal dysfunction, we could not get firm evidence of the cause of renal failure.
We were able to performed PD on him 111 times with the administration of factor VIII concentrates without any remarkable intraperitoneal hemorrhage until he suddenly died from intracerebral hemorrhage.

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This study was performed to investigate possible differences in erythrocyte metabolism between short-term and long-term hemodialysis patients, especially before and after each hemodialysis (HD).
The subjects were 30 short-term (shorter than 1 year), and 30 long-term (longer than 5 years) hemodialysis patients with chronic renal failure, and 10 healthy adults as a control group.
Measured parameters were G6P, F6P, FDP, DHAP, GA3P, 2, 3-DPG, 3PG, 2PG, PEP, pyruvate, and lactate as glucose metabolites and ATP, ADP, and AMP as high-energy phosphates. Arterial blood gas analysis and measurement of serum electrolytes (Na, K and Cl) were also performed.
G6P, F6P, FDP, GA3P and 2, 3-DPG increased in the order of control group, <short-term HD group<long-term HD group, indicating accelerated glucose metabolism in erythrocytes. Significant increases in G6P and F6P in both HD groups, and more importantly, increase in FDP in the long-term HD group suggested activated phosphofructokinase, which is one of the rate-limiting factors in the glycolytic pathway. However, G6P, F6P and FDP decreased in the post-HD period compared with the predialysis period in both HD groups.
ATP and ADP increased significantly in both HD groups compared with the control group. These two nucleotides decreased in the post-HD period. However, energy charge in all three groups was almost at the same level in the predialysis period and was unchanged after HD. There was a linear relationship between 2, 3-DPG and the duration of HD. Multivalent mathematical correlation analysis of the measured parameters revealed a clear and marked difference between long-term and short-term HD groups, which indicated that a difference in homeostasis was established according to the duration of HD.
These results suggest that glucose metabolism of erythrocytes is activated by the activation of phosphofructokinase in hemodialysis patients with chronic renal failure, and that its extent is related to the duration of hemodialysis, while activated glucose metabolism is brought towards normal after each hemodialysis.

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The Terumo TAF08W (regenerated cellulose) with a higher cut-off point than the conventional type, the Terumo TE10W and the Asahi Neo-10 (cuprophan) were used on patients with disequilibrium syndrome over a three-monthperiod. Changes in clinical condition in the course of hemodialysis treatment were observed and the ultrafiltrate obtained from the dialyzers was analyzed by Sephadex G-15 gel column chromatography, SDS-Polyacrylamide gel electrophoresis (SDS-PAGE) and two-dimensional electrophoresis (TDE). Disequilibrium symptoms such as a drop in blood pressure during hemodialysis treatment were improved by introduction of the regenerated cellulose membrane. No differences in the clearances of low-molecular-weight substances could be observed in the dialyzer. However, the TAF08W showed greater removal of the highest molecular-weight fraction and middle molecular-weight substances compared with the other two dialyzers. In the TAF08W, a little albumin and β₂-microglobulin were detected by TDE and several bands of low-molecular-weight protein were apparent by SDS-PAGE, these proteins not being detected in the other two dialyzers.

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