Five cases of quadriceps tendon rupture in patients receiving long-term hemodialysis are presented. The mean age of patients was 39.0±6.1 years and the mean duration of hemodialysis prior to tendon rupture was 10.1 years.
In all cases, severe secondary hyperparathyroidism (2°HPT) and renal osteodystrophy (ROD) requiring parathyroidectomy (PTX) were present.
In 4 out of 5 cases, PTX was carried out after on episode of tendon rupture and hyperplasia of the parathyroid was confirmed.
Four (Nos. 1, 3, 4 and 5) out of 5 cases had bilateral tendon rupture and the remaining one (No. 2) had unilateral rupture.
In 2 (Nos. 1 and 3) out of 4 PTX patients, operative treatment for the ruptured tendons was carried out and the ability of the knee joint was improved markedly one year after surgery. However, in the remaining 2 cases (Nos. 4 and 5) who did not receive tendon suture, the ability of the knee joint was not improved and restriction of joint movement remained.
It is considered that tendon rupture in hemodialysis patients might contribute to the weakening of bone strength and structure caused by bone resorption and metastatic calcification in 2°HPT.
Thus PTX and surgical treatment might be useful for the repair of tendon rupture in long-term hemodialysis patients with severe 2°HPT.

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The pharmacokinetics of gabexate methylate (GM) (five consecutive administrations) during hemodialysis were studied by measuring the plasma levels of its metabolites (GCA, EPHB, PHB, and glucuronide conjugate of EPHB and PHB). Plasma levels of GM metabolites did not change after the third GM hemodialysis. They decreased after GM had been replaced by heparin, and GM metabolites were no longer detected in plasma after one month.

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A blood purification system has been developed for use in an artificial liver support system using urthane-sheet embedded with powdered charcoal (UPC, BESPORETM) prepared mainly for the purpose of effectively adsorbing protein-bound and middle-molecular substances. This system consists of UPC-plasmaperfusion followed by supplementary therapy with plasmaexchange for the purpose of performing both removal and supplementary therapy at the same time. This liver support was performed in and the remaining two cases of chronic hepatic failures (Primary and secondary biliary cirrhosis) for 6 months (21 times) and 3 months (15 times), respectively, reculfing in prolonged life. The amounts of bililubin and bile acids removed by UPC-plasmaperfusion was 40%.

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In order to clarify the effect of plasmapheresis on systemic amyloidosis, we performed plasma exchange (single-filtration plasmapheresis) on 2 patients with primary amyloidosis (AL type) and 1 patient with secondary amyloidosis due to rheumatoid arthritis (AA type). Fresh frozen plasma (3.2-4.5 liters each time) was used as replacement solution. Because amyloid deposition was already severe in all cases at the start of therapy, plasmapheresis did not extend the life of the patients. However, we found that plasma exchange delayed amyloid deposition in 1 patient with primary amyloidosis who was simultaneously receiving dimethyl sulfoxide treatment. We suggest, therefore, that plasma exchange therapy might extend the life of a patient if started at an earlier stage of systemic amyoidosis.

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Total parathyroidectomy and autotransplantation of parathyroid tissue were performed in ten hemodialysis patients. During the preoperative period, bone pain appeared in all patients, pruritus in 4, calcaneus fracture, rib fracture and Achilles tendon rupture in one respectively, and clubbed fingers in 4. Salt and pepper appearance of the skull x-ray and subperiosteal resorption in hand x-ray appeared in all patients. Preoperatively the averaged serum calcium (Ca) was 5.1mEq/l, phosphorus (P) 4.8mg/dl, alkaline phosphatase (ALP) 53.0KA units and PTH 38.3ng/ml.
The parathyroid glands of all patients were visualized by computed tomography (CT) and/or scintigraphy with ²⁰¹TICI and ^99mTcO₄^-. Total parathyroidectomy and autotransplantation of parathyroid tissue were performed in all patients by Wells' method, and they were followed up from 3 to 16 months (mean, 10 months).
Four or more glands were removed in 9 out of ten patients. Only one gland was removed in one patient. Excised parathyroid tissues were immediately autografted into a forearm muscle. The removed parathyroid glands weighed from 787 to 8, 100mg/patient (mean 3, 819mg/patient). The weight of the removed parathyroid glands was significantly correlated with the preoperative PTH level (r=0.706, p<0.05). Histological appearances were chief cell hyperplasia in all patients and oxyphil cell hyperplasia in one patient. CT and/or scintigraphy visualized 22 of 25 parathyroid glands (88%), weighing more than 500mg/gland.
Itching, bone pain, bone fracture and tendon rupture were improved, but clubbed fingers did not recover. PTH decreased immediately after parathyroidectomy. The function of the autografted tissue of the parathyroid was demonstrated by the PTH from the anticubital vein of the grafted arm compared with that of the nongrafted arm. Bones were examined radiologically 3 to 24 months after parathyroidectomy. The salt and pepper appearance of the skull was improved in 8 out of ten patients, and subperiosteal resorption of the fingers was significantly improved in 9. Two patients complained of bone pain without elevated PTH one and 15 months after parathyroidectomy, respectively.
Total parathyroidectomy and autotransplantation of the parathyroid tissue were performed safely and were effective in treating the secondary hyperparathyroidism in chronic hemodialysis patients. But in two patients, bone pain reappeared. The indication of total parathyroidectomy will be further considered more precisely.

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