Hideo Hidai

Rupture of Renal Artery Aneurysm

Rupture of a renal artery aneurysm, although rare, has been considered to be the most catastrophic urological injury. Three cases of ruptured and 1 case of impending rupture are reported. A review of the cases of ruptured renal artery aneurysm is presented together with emphasis on improved prognosis of this morbidity. Surgical indications are discussed.

Immediate Effect of Shakuyaku-kanzo-to on Muscle Cramp in Hemodialysis Patients

We administered 2.5 g of Shakuyaku-kanzo-to granule to 61 patients who had muscle cramp during hemodialysis (HD) sessions and examined its immediate effects. We selected 10 patients who wanted to take the drug at home, out of cases, for whom the drug was effective on the study described above and had them take the drug in the same way at the beginning of muscle cramp at home examined the effects. In the study during HD sessions, muscle cramp and its associated pain disappeared in 5.3 ± 3.9 min on average in 54 out of 61 cases. In the study of patients who took the drug at home, muscle cramp disappeared within 10 min in all cases. Shakuyaku-kanzo-to is thought to be very useful for muscle cramp during HD sessions of hemodialized patients because it has immediate effects by its oral administration on the occasion of cramp. With regard to the muscle cramp, which appears at home after HD sessions, the patients can cope with it by taking the drug by themselves. This is an epoch-making therapy, for it was impossible to cope with muscle cramp except in hospitals because the therapy of muscle cramp was limited to intravenous infusion of hypertonic solutions of dextrose, mannitol, and saline during HD sessions.

The Immediate Effect of Shakuyaku-kanzo-to, Traditional Japanese Herbal Medicine, for Muscular Cramps during Maintenance Hemodialysis

Accessible online at: www.karger.com/journals/nef Dear Sir, Muscular cramps in patients with chronic renal failure undergoing hemodialysis are very common and the incidence reportedly reaches 20% in all patients [1]. Shakuyaku-kanzo-to is a traditional Japanese herbal medicine which is composed of Paeonia root (Shakuyaku) and Glycyrrhiza root (Kanzo) and is used for the treatment of muscular cramps in patients with normal renal function in Japan. We elucidated the effect of this herbal medicine for muscular cramps in hemodialysis patients. The subjects included 23 hemodialysis patients who experienced muscular cramps during hemodialysis (10 males and 13 females; 3 diabetics and 20 nondiabetics; mean age, 57.2 B 9.0 years; mean duration of dialysis, 8.2 B 6.6 years), with a total of 61 episodes of muscular cramps. Shakuyakukanzo-to Extract Granules for Ethical Use (TJ68: Tsumura & Co., Japan) were administered at a single dose of 2.5 g immediately after the complaint of muscular cramps during hemodialysis. Muscular cramps disappeared in 54 (88.5%) of the 61 episodes. The mean time to disappearance of muscular cramps and associated pain was 5.4 B 3.9 min. No adverse reaction occurred at the single use of Shakuyaku-kanzo-to during hemodialysis.

Needle Tract Seeding following Puncture of Retroperitoneal Liposarcoma

9 case of needle tract seeding following percutaneous puncture of an avascular mass, which proved to be a retroperitoneal liposarcoma, is presented.

Bilateral Chromophobe Cell Renal Carcinoma in Tuberous Sclerosis Complex

We report on a patient with tuberous sclerosis complex and polycystic kidney disease who developed bilateral chromophobe cell renal carcinoma. We discuss the tuberous sclerosis complex, associated bilateral renal cell carcinoma, polycystic kidney disease and chromophobe cell renal carcinoma; a recently established subtype with a rather favorable prognosis.

Individual application of the kidney disease quality of life (KDQOL) instrument to monitor the health status of dialysis patients.

Accessible online at: www.karger.com/journals/nef Dear Sir, Recently, the Kidney Disease Quality of Life (KDQOL®) Instrument, consisting of SF-36 and the kidney disease targeted scales, was developed and has been accepted among many countries because of the scientific and statistical accuracy. Originally, these scales were developed for the group comparisons and not for the individual use [1]. Nevertheless, Meyer et al. [2] reported that the SF-36 was useful in monitoring individual dialysis patients’ health status. We speculated that KDQOL questionnaire might be also as useful as the SF-36 for the individual use. Here, we collect individual KDQOL scores and monitor 1 case before and after a medical intervention, as Meyer et al. [2] had tried. 108 seminight hemodialysis patients, mostly socially rehabilitated responded to

Performance of the Newer Type (Lixelle Type S-15) on Direct Hemoperfusion Beta-2-Microglobulin Adsorption Column for Dialysis-Related Amyloidosis

Accessible online at: www.karger.com/journals/nef Dear Sir, Dialysis-related amyloidosis (DRA) is a common complication associated with longterm hemodialysis therapy [1]. There is no effective therapy to prevent and/or treat DRA. However, the elimination of ß2-microglobulin (ß2-MG), the major constituent of the amyloid fibrils in DRA that accumulates in uremic patients [2], from the circulation has been expected to bring some clinical benefit [3]. The direct hemoperfusion ß2-MG adsorption column (Lixelle Model Type S35, KANEKA Corp., Japan) was developed under this background. This column is a blood purification system that adsorbs ß2MG for patients with dialysis-related amyloidosis. This column has been commercially available in Japan in combination with hemodialysis since 1996. The adsorbent mainly absorbs peptides or proteins whose molecular weight (MW) ranged from 4,000 to 20,000 daltons [3]. The adsorbent does not significantly adsorb low-MW substances and electrolytes whose MW are lower than 1,000 daltons. Table 1. ß2-MG removal volume (mg) and rate (%)

In Situ and Ex Situ Renal Artery Aneurysmectomy in the Solitary Kidneys

We report 2 cases of renal artery aneurysms in congenital solitary kidneys, which were treated respectively by in situ and ex situ aneurysmectomy. Hyperosmolar intracellular electrolyte solution was valid in preserving renal function during renal ischemia in both cases. The occurrence of an aneurysm in a solitary kidney, ex situ operation and renal preservation during ischemia are discussed.

Characteristics of Renovascular Hypertension in Japan

Clinical analysis on 285 documented cases of renovascular hypertension reported in the Japanese medical literatures revealed Takayasu’s syndrome occupied 30%, followed by fibromuscular hyperplasia 18%

High efficiency hemodialysis and therapeutic schedule for short-time dialysis

特別製作の新型ダイアライザーを用いて, 基礎体重が59.0kgの患者に対し, 治療時間を4.5時間から3.5時間まで段階的に短縮した. 1回の治療の除去率が不変な30分間の短縮 (4.0時間治療) は容易であったが, 3.5時間の治療を2月間行ううちに, 小分子溶質の濃度レベルの上昇傾向, およびヘマトクリットの降下傾向を認めるとともに, 各溶質の見かけの生成速度の上昇が観測された. このことより, 治療条件は生体機能に直接, 間接の影響を与えることが示唆された.また, 週2回 (7.5時間×2回/週) 治療を施行中の患者を, 週3回 (5.0時間×3回/週) 治療に移行したところ, 2-compartment modelで予想された通り, 濃度レベルの低下を認め, それに見合う治療時間の短時間化が可能と思われた. しかし移行後の濃度レベルの絶対値は, 予想値よりも高値となった. これも見かけの溶質生成速度の上昇として捉えることができるが, 同時に通常のモデルによる治療の長期的なsimulationでは, 傾向を予想することは容易であるが, 絶対値の予測は困難であると思われた.治療の短時間化は, 必ず見かけの溶質生成速度の変化を伴うものと思われ, これが濃度レベルなどの陽因子からは知り得ない生体情報を提供している可能性がある.