The nerve conduction velocities and thresholds in motor and sensory fibers of the right median nerve were assessed in 19 normal subjects and 72 patients on hemodialysis for end-stage renal failure. Some patients were examined twice or more periodically. In the normal control group, nerve conduction velocities in motor fibers were significantly decreased with age and thresholds were elevated. The sensory fibers had the same tendencies as the motor fibers, but this was not significant statistically. The conduction velocities of patient group decreased significantly with age in both motor (p<0.05) and sensory fibers (p<0.001). The threshold increased significantly in both motor (p<0.001) and sensory fibers (p<0.05).
The conduction velocities of the motor fibers were slower, and thresholds were higher at all ages in the patient group than in the control group. There was no significant difference in conduction velocities of sensory nerve in control and patient groups at any age. But the thresholds in the patient group were much higher than those in the control group at all ages.
The slowing of conduction velocity and the increase in threshold in patients with renal failure were thought to be a result of demyelination secondary to axonal degenaration, and the same mechanisms seemed to occur in the aging process. The increment of thresholds suggests the beginning of these degenerations.

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A-49-year old man receiving regular hemodialysis for about 4 years developed infective endocarditis due to vascular access infection. Streptococcus faecalis was detected in his blood culture. Although inflammatory signs disappeard with antibiotic therapy, congestive heart failure with aortic and mitral regurgitation developed. The CAPD was introduced in place of hemodialysis to control the preoperative condition. Aortic valve replacement and mitral plasty were performed successfully using the cardiopulmonary bypass accompanied with bicarbonate hemodialysis. The CAPD system was continued after operation to prevent heart failure and vascular access infection. The patient has been well with CAPD and has been back to his previous position for 34 months.

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Experience with 30 patients (19 males, 11 females) surviving 10 years of hemodialysis treatment was reviewed. Medical data were obtained by retrospective review of medical charts, and the patients' quality of life was studied by questionnaire. Their mean age at the start of dialysis treatment was 31.1 years. BUN and serum creatinine were 104mg/dl and 13.2mg/dl respectively. Comparative analysis of clinical data between 1 year and 10 years after dialysis revealed that 1) pre-dialysis BUN did not change, while the excretion rate of urea during dialysis was greater after 10 years. 2) Hematocrit increased from 22% to 28%. 3) Mean blood pressure decreased to a normal level after 10 years. Normalization of blood pressure seemed to reflect sufficient water and Na removal, despite a high-Na dialysate during dialysis sessions. With regard to diet, 81% of the patients are currerthy having a free diet at home and more than 90% eat out. Minimum limitation of diet would be one of the most important factors for the patients to enjoy their social lives. As for the patients' present condition, 86% are fully rehabilitated, continuing their jobs without problem, although 14% of the patients are unemployed. All patients feel happier at present than earlier. Parathyroidectomy was performed on 4 patients, but other complications were rarely seen. Conclusion: 1) The blood pressure and CTR have decreased while Hct level has increased. 2) Dialysis patients feel happiest at present, after 10 years of treatment. 3) All of the night dialysis patients are fully rehabilitated. 4) Most of the patients are eating a free diet. 5) Complications are rarely observed at present, but bone complications are likely to increase in future.

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Although it is thought that female patients on chronic hemodialysis have much difficulty in becoming pregnant and bearing a child, we recently experienced a 31-year-old woman on 3-year hemodialysis, whose second pregnancy continued uneventfully leading to the delivery of a child with subsequent normal courses of both the mother and child. We report this case, with some additional considerations from the viewpoint of nursing.
Her primiparity occurred during the second year of hemodialysis, but at the 26th week of pregnancy she prematurely delivered because of a rupture of the marginal sinus. The baby, weighing 880g, died 17 hours after birth due to premature lungs. During the third year of hemodialysis she became pregnant again and entered the department of obstetrics before the onset of abdominal turgescence at the 16th week of pregnancy. In view of the experience with regard to her primiparity, a co-operative system was established between the dialytic room and the department of obstetrics, with the aim of continuing pregnancy until the 32nd week at least. Then, from the viewpoint of nursing, we aimed at 1) continuing the pregnancy and helping both the mother and child to face delivery at their best conditions, and 2) making efforts to alleviate her anxiety and pain. Nursing points included 1) abdominal turgescent symptom due to uterine muscular contraction, 2) occurrence of hypotension during hemodialysis, 3) anxiety about the child, and 4) generalized itchy sensation, and pain due to prolonged hemodialysis. These points being taken into consideration, the nursing was developed as follows: From about the 20th week of pregnancy, hypotension and abdominal turgescence appeared during hemodialysis, which we controlled through both careful and close observations and repeated examinations, permitting us to perform satisfactory hemodialysis. Anxiety about the child and pain during hemodialysis were alleviated as far as possible, and it was very important for both her husband and family to encourage her. Together with liver dysfunction during pregnancy, a generalized itchy sensation appeared, which, however, disappeared postnatally. The patient was transvaginally delivered of a boy weighing 1, 802g at the 34th week of pregnancy. Both mother and child are now doing well with uneventful courses.

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Most physicians concerned with hemodialysis treatment recognize that obstinate shoulder pain is common in long term hemodialysis patients. From August 1985 through December 1985, entrapment neuropathy of the suprascapular nerve was diagnosed in 2 male and 4 female hemodialysis patients. The duration between the first dialysis treatment and the occurrence of symptoms was 76-121 months (mean 107 months), and 5 out of 6 had functioning A-V fistula on the affected site. Diagnosis was done by orthopedic examination of the shoulder joint, experimental nerve block at the suprascapular notch, arthrography of the shoulder joint and measurement of suprascapular nerve latency to supra and infraspinatus. Prolongation of suprascapular nerve latency was noticed at the affected site compared with the contralateral site or axillar nerve latency. The suprascapular notch was approached by a transverse skin incision above the scapular spina and blunt dissection of the trapezium and suprascapular muscle under general anesthesia with intubation. Surgical decompression was done by cutting off the trasverse suprascapular ligament. This series was followed up for between 7 and 10 months. Shoulder pain and tenderness at the region of the suprascapular notch was relieved in 5 cases, and impairment of abduction, external rotation and scapular protraction were improved in 5 out of 6 patients. The mean value of the suprascapular nerve latency was shortened from 6.4msec to 3.9msec on supraspinatus and from 7.3msec to 5.1msec on infraspinatus. No surgical complication such as hematoma, wound infection, nerve injury or limitation of movement in the shoulder joint was encountered. The result of surgery for this series was estimated as excellent in 3 patients, good in 2 and poor in 1. Thickened suprascapular transverse ligaments were noticed, but these did not contain amyloid material histologically.

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The purpose of the present study was to investigate the limiting factors of maximal aerobic work capacity in patients on chronic hemodialysis. Thirty-five stable chronic hemodialysis patients (HD patients) and fifty-two normal controls were used as subjects. HD patients were not complicated by valvular heart disease or coronary heart disease, and none had been given digitalis or β-blocker agents. Abnormal electrocardiograph results and blood pressure responses were excluded because of exercise stress in HD patients. In all subjects, functional aerobic impairment (FAI), left ventricular impairment (LVI) and peripheral circulatory impairment (PCI) were calculated using Bruce's formula. Hemoglobin concentration was determined before exercise stress test in HD patients. The results obtained were as follows.
FAI, LVI and PCI in HD patients were significantly higher than those of normal control subjects. PCI was higher than LVI in HD patients. FAI was significantly correlated with both LVI and PCI in normal control subjects, whereas FAI was significantly correlated with only PCI in HD patients. Additionally, FAI was not significantly correlated with hemoglobin concentration in HD patients.
In conclusion, the present observations suggest that the limit of maximal aerobic work capacity depends upon peripheral circulatory impairment with the exception of lower hemoglobin concentration level in chronic stable hemodialysis patients.

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In order to investigate the abnormalities of intermediate-density lipoproteins (IDL) in patients on maintenance hemodialysis (HD), we determined the percentage chemical compositions and the apolipoprotein (apo) distributions of IDL using the single radial immuno diffusion method. Electrophoretic mobility and molecular size in IDL were also analyzed. All determinations were compared between HD and sex-or age-matched normal controls (C). 1) HD produced a significant increase in the total amounts of IDL 2) With respect to the chemical compositions of IDL in HD, there was a significant increase in total cholesterol and a tendency for increased protein, while there was a significant decrease in triglyceride and the cholesterol esterification ratio. 3) HD produced a significant increase in apo B and a significant decrease in apo C-II, C-III and E. 4) The electrophoretic migration and elution patterns of IDL showed similarities between HD and C.

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Twelve patients with generalized amyloidosis who were treated with hemodialysis due to renal failure were studied. One of them was deemed to have multiple myeloma, 4 primary, and 7 secondary. Three of those with secondary amyloidosis had associated rheumatoid arthritis, one had enteritis, one had otitis media, one had tuberculosis and one had Behcet's disease.
The commonest initial symptom was proteinuria (seven cases). Other symptoms were diarrhea (three cases), macroglossia (one case), and a sense of numbness (one case). Nephrotic syndrome was found in eight cases and was difficult to control.
Hemodialysis had to be urgently initiated in cases of cardiac amyloidosis because of pulmonary congestion when azotemia was mild, but death occurred early after introduction of hemodialysis. Hemodialysis was started early in cases without cardiac amyloidosis because of pulmonary congestion or anasarca, also. Many abnormal findings of ECG and echocardiography were found even in some cases that were not clinically diagnosed as cardiac amyloidosis. These cases were resistant to treatment and were assumed to be cardiac amyloidosis. Futhermore, cardiac amyloidosis appeared in one cases after introduction of hemodialysis, and death occurred due to of disturbances of conduction system. Therefore it is concluded that cardiac amyloidosis is the most important factor determining the prognosis of amyloidosis patients on hemodialysis therapy.
Except for renal and cardiac dysfunctions, complications of other organs, such as hypotension during hemodialysis, impairment of arteriovenous fistula, involvement of the gastrointestinal tract (especially diarrhea and abdominal pain), itching and hypothyroidism were found and were difficult to treat.
However, HDF and thyroid hormone administration were effective for improving itching and hypothyroidism.

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