The effects of long-term administration of Desferrioxamine (DFO) were evaluated in 7 patients with AI or Fe deposition in bone.
Bone pain was alleviated in all patients after the administration of DFO. Deposition of AI and Fe was observed at the bone calcification front in 6 of the 7 patients who underwent bone biopsy before the administration. Although AI deposition was noted in 2 patients during treatment and in others after treatment, Fe deposition disappeared or decreased in some patients, suggesting that Fe is removed earlier and to a greater extent than AI by the administration of DFO. Also, complete histoloical cure is considered to be unlikely even inpatients who showed marked clinical improvement after treatment. Moreover, as both AI and Fe were deposited at the calcification front even in patients with AI deposition in bone, AI deposition must always be regarded as AI-Fe deposition.
Serial bone scintiraphy performed during treatment demonstrated improvements after the disappearance of bone pain in most patients. Improvements in scintirams are considered to be an important index of the duration of DFO administration required to produce clinical improvement.

View full abstract

The purpose of this study was development of a new easy-to-handle nocturnal peritoneal dialysis (NPD) machine functionally controlled with time.
The size of this machine is only 40 by 40 by 160cm. A clinical dialysis program starts daily at 9 p.m, repeating 4 cycles at 2 hour intervals with a 20 minute drainage period and 8 minutes of infusion. The program finishes at 7 a.m. Preset adequate volumes of premixed dialysis solutions are certain to flow into the peritoneal cavity by means of the digital time devices and intraabdominl pressure and gravity.
We used this equipment in a 67-year-old male patient suffering from dissecting aneurysm of the aorta (Debakey III b) associated with renal failure. Initially, he had received hemodialysis. But, because of repeated shunt failure and artificial blood vessel infections, he had been receiving CAPD since December 1989. In February 1991, this NPD system was initiated. He has been well enough to resume his normal daily activities.
In conclusion, the Fukui-type automatic PD fluid exchanger may be clinically useful.

View full abstract

We developed a questionnaire on conditions of stress in dialysis nursing staff and on their methods of coping with and relieving such stress.
Valid answers were received from 171 nursing staff members at 35 different institutions.
When computing the burn-out score by the Inaoka method, it was found that 24.5% of the staff had reached burn-out level in a dialysis ward, indicating that the environment is as high stress as that of the ICU and the operation theatre.
To clarify the factors leading to burn-out, the subjects of each reply were divided into a “healthy” (normal group) and a burn-out group and were then examined by the x² method. As a result, it became clear that, at a consciousness level of 1%, the differences in interpretation of 5 psychological, 5 personality, 2 physical, 6 social and 6 personal subjects (a total of 24 in all), emerged as factors leading to burn-out.
Moreover, differences could be seen between the “healthy” group and the burn-out group in their respective ways of coping with and relieving stress.
A majority of the “healthy” group coped with stress by “disposing of work in order of precedence (importance) in an unhurried manner”; the next most prevalent method was “thinking things over with other staff members” in other words a method of solving problems in a positive way.
On the other hand, the burn-out group's method was “by compromise rather then confrontation”; next came “overcoming problems within oneself” and “not having too great expectations about anything”. Thus, many in this group had a tendency to resort to “unhealthy prevention methods” which amounted to avoidance of the problems involved.
Regarding relief of stress, whereas the healthy group sublimate their stress by indulging in extroverted methods of relief, the burn-out group resorted mainly to introverted methods.
It appears, therefore, that extroverted methods of stress relief are a necessity in preventing burn-out among dialysis nursing staff.

View full abstract

A 60-year-old female with a 3-year history of hemodialysis was hospitalized to undergo detailed gastrointestinal tract examinations.
A gastrointestinal series disclosed no definite abnormalites but a round dense echogenic mass was identified at the annular position of the posterior mitral leaflet by two-dimensional echocardiography. On pulmonary arteriography, the calcified mass projected into the left atrium and was observed to be subendocardial. Selective coronary angiography showed no abnormal vessels. We could not completely rule out cardiac tumor but there was a slight possibility of tumor embolism. The patient was discharged and followed. Two months later, the patient died of cerebral bleeding. Autopsy disclosed that the mass consisted of muddy nodular calcinosis.
Mitrai annular calcification (MAC) is a degenerative change which occurs mainly in older patients. Some studies have reported a frequent occurrence of MAC in patients with chronic renal failure. Abnormal calcium-phosphorus metabolism has been suggested as the most likely cause. On radiographs, MAC are generally “J”, “C”, or “U”-shaped. We have found no other reports of this type of nodular calcinosis in the heart in a patient on maintenance hemodialysis.

View full abstract