Human T-cell leukemia virus (HTLV-I), one of a family of T-cell lymphotropic and pathogenic retroviruses, is highly prevalent in the southwestern district of Japan. We examined the incidence of hemodialysis patients (HP) positive for antibody against adult T-cell leukemia virus-associated antigen (ATLA) in the Fukui district, since HP given multiple transfusions and frequent extracorporeal circulation treatment could be a high-risk group for infection even in a non-endemic area. ATLA antibody was determined by two-step test using the enzyme-linked immunosorbent assay with Eitest ATL kits (Eizai, Tokyo). The study was carried out in 142 HP, 76 healthy controls, 62 patients with miscellaneous diseases and patients with specific diseases including 11 patients with leukemia (4 acute myelogenous, 5 chronic myelogenous and 2 acute lymphatic), 5 patients with lymphoma (4 Hodgkin's and 1 non-Hodgkin's), 7 patients with myeloma and 10 patients with high titers of antinuclear antibody (ANA). While there were no positives among the healthy controls and patients with miscellaneous diseases, 3 HP, 1 leukemia and 2 ANA-positive patients, were found to be positive at the first step. At the second step, sera from 2 HP were finally verified to be positive, and the remaining 4 false-positive. These 2 HP with ATLA antibody were both males, aged 32 and 62 years, and both had been born in the Hokuriku district. They had no family members with ATLA antibody or ancestors from an HTLV-I endemic area. They had a history of multiple blood transfusions, through which they were strongly suspected to have been infected. At the time of examination, they had no abnormalities in the morphology and differential count of peripheral leucocytes or in the distribution of lymphocyte subsets.
The incidence of ATLA-positive HP was 1.4%. Although this figure does not appear to be high, it is more than four times higher than that for the local population in this district (<0.3%). The amount of blood transfusions in HP has decreased due to recent developments in this field, but many HP still require blood transfusions, thus posing a risk of HTLV-I infection. In addition, patients with ATLA antibody may pose a potential risk of infection to other patients through hemodialysis therapy. It is concluded that even in a non-endemic area, more attention should be paid to the prevention of HTLV-I infection among HP, as in the case of hepatitis B virus.

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Sequential changes in serum lipids, apoprotein and post-dextran sulfate lipolytic activity were studied in long-term CAPD patients. Hypertriglyceridemia was temporally accelerated after 7-12 months of CAPD, but this acceleration was gradually corrected by continuation of CAPD over 2 years. HDL-cholesterol increased slightly after 7-12 months of CAPD, but this was not statistically significant. LCAT activity gradually decreased during long-term CAPD and apo-A₁, A₂ decreased after 37 months of CAPD. Apo-B and apo-E showed no significant changes during CAPD. The changes in these various parameters were considered responsible for the early development of atherosclerosis. However, it is considered that a less marked change in apo C₂/C₃ ratio and a slight increase in LPL, HTGL activity as a result of long-term CAPD may protect against atherosclerosis in CAPD patients. Further studies will thus be needed to overcome these problems.

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In this study, GM (gabexate mesilate; Panabete^® of KODAMA Inc.) was used for the hemodialysis in 5 patients with hemorrhargic tendencies related to renal transplantation. During the hemodialysis we used the double bubble trap circuit and the dosage of GM was determined in each patient by the hematocrit values (Ht) and the activated partial thromboplastin time (APTT). Clinically, 500-800mg/hr. of GM without heparin or with added low-dose heparin is recommended for safe regional anticoagulation. We successfully hemodialyzed all of the patients. There was no augmentaed bleeding during and after hemodialysis, and the dose of GM which we suggest is lower than that reported by others.

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The author performed a study on serum prostaglandins (PG), especially their relation to blood pressure and aortic pulse wave velocity (PWV). A total of 94 end-stage renal disease (ESRD) patients and 27 healthy volunteers (HV) were selected for this study. The ESRD patients were divided into 3 groups as follows; undialysed patients (UD, n=15), maintenance-dialyzed patients (MD, n=74), and anephric patients (AN, n=5). The measured PGs were PGE₂, PGF_2α, thromboxane (TX) B₂, which is a stable metabolite of TXA₂, and 6-keto-PGF_1α, which is a stable metabolite of prostacyclin (PGI₂). The PGs were measured by specific isotope-labelled immunoassay after separation with a silicic acid colum.
Results: 1) In the HV group, there was a significant positive correlation between age and the TxB₂ level and TXB₂/6-keto-PGF_1α ratio, and there was a significant negative correlation between age and 6-keto-PGF_1α level. 2) In the UD group, the TXB₂ level was high and the 6-keto-PGF_1α level was low. However, in the MD group, the TXB₂ level was not so high and 6-keto-PGF_1α level was not particularly low. Also in the UD group, TXB₂/6-keto-PGF_1α ratio was significantly high in comparison with the MD group. These results suggested that an imbalance between PGs was found in ESRD patients, and that the introduction of dialysis therapy improved this abnormality. It was also apparent that in ESRD patients, the PGF_2α level was high. 3) The 6-keto-PGF_1α level was low in the undialyzed hypertensive patients and high in the dialyzed hypotensive patients. There was a significant negative correlation between the 6-keto-PGF_1α level and blood pressure. There was also a significant negative correlation between dialysis patient month and blood pressure, and a positive correlation between dialysis patient month and the 6-keto-PGF_1α level. These results suggested that PGI₂ played a pathophysiological role in hypertension and hypotension in addition to renin and volume factors. 4) There was a significant positive correlation between PWV value and the TXB₂ level and TXB₂/6-keto-PGF_1α ratio. There were also significant correlations between the 6-keto-PGF_1α level and the level of total cholesterol triglyceride, phospholipid and β-lipoprotein. These results suggested that TXA₂ and PGI₂ play a pathophysiological role in atherosclerosis.

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We studied 27 stable patients on maintenance hemodialysis (HD) for the effect of changing the dietary contents of phosphate (p) and calcium (Ca) on serum P, Ca and parathyroid hormone (PTH). Aluminum hydroxide and 1α-hydroxyvitamin D₃ were kept constant during the study period. Dietary contents of Ca, P and protein were calculated from the intake table written by each patient twice at an interval of one year and expressed as mg per kg dry weight. Blood was withdrawn on the same day before HD to determine serum electrolytes, PTH and alkaline phosphatase (Al-P). Statistical analysis was performed to examine correlations between changes in dietary P and Ca and those of serum Ca, P and c-PTH.
Dietary Ca was very low (8.3±0.8mg/kgBW, M±SE) compared with the average intake of healthy persons, and dietary P was very high (19.5±0.9mg/kgBW). There was no correlation between changes in dietary elements and changes in either s-Ca, PTH or Al-P. However, changes in s-P were inversely correlated with changes in dietary Ca (r=-0.61, p<0.001). Although this correlation was not affected by the serum concentration of c-PTH nor administration of aluminum hydroxide, the slope of this relationship in patients without 1α-hydroxyvitamin D₃ was larger than that in patients with 1α-hydroxyvitamin D₃.
It is suggested that not only dietary phosphate restriction but also greater intake of calcium is necessary for patients on maintenance hemodialysis with hyperphosphatemia who have not yet been administered 1α-hydroxyvitamin D₃.

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