Takao Shoji

Ten Years’ Survey of Dialysis-Associated Tuberculosis

Tuberculosis associated with dialysis was studied at the Renal Unit of the Tokyo Medical and Dental University and Yokosuka Mutual Aid Hospital Kidney Center, in both of which the treatments of chronic renal failure are the same. There are 12 tuberculosis patients out of 367 patients on maintenance hemodialysis from January 1967 to December 1976, an incidence of 3.3%. This was 6-16 times greater than that in the general population of this country according to yearly statistics. The characteristics of dialysis-associated tuberculosis include a high incidence of miliary tuberculosis, especially in aged patients and difficulty in establishing the diagnosis before death. Clinical features which are helpful in the early diagnosis are intermittent high fever of unknown origin, weight loss, anorexia, abnormalities of the central nervous system, erythrocyte sedimentation rate over 100 mm/h, leukocytosis and high value of the C-reactive protein. With the increasing number of dialysis patients, an increase of dialysis-associated tuberculosis is expected and this will be one of the major problems of dialysis patients in future.

Health-Related Quality of Life of Predialysis Patients with Chronic Renal Failure

Background: Health-related quality of life (HQOL) of predialysis patients with chronic renal failure (CRF) has received less attention than that of dialysis patients. We investigated changes in SF-36 over 1 year and examined associations between clinical parameters and SF-36 in predialysis CRF patients. Methods: Subjects were 471 predialysis CRF patients. SF-36 and clinical parameters were measured every 8 weeks for 48 weeks. Of the 471 subjects, 294 underwent one or more follow-ups. We analyzed the pooled dataset of the 294 CRF patients and 2002 subjects from Japanese general population using analysis of covariance. Results: After adjustment for age and sex, the 1-year declines in SF-36 domains were significantly greater in the predialysis patients than in the general population. For a 10% decline in hematocrit from the baseline survey value, the decline in vitality of SF-36 was 4.5 points (p = 0.003), while for a 10% increase in serum creatinine from the baseline survey value, respective declines in physical functioning, role-physical and mental health were 1.2 (p = 0.004), 1.9 (p = 0.035), and 1.0 points (p = 0.008). Conclusion: Among these predialysis CRF patients, the decline in HQOL was faster than that in the general population, and was associated with an increase in serum creatinine and decline in hematocrit.

The Effect of CAPD on Lipid Abnormalities Detected by Apoproteins and Ultracentrifugal Lipid Subfractions

The hyperlipidemic tendency of CAPD patients (CAPD) has been described elsewhere without detailed data on apoproteins and ultracentrifugal lipid subfractions. In order to understand the details of hyperlipidemia, especially in light of the protective role of apoproteins, we compared the total cholesterol (TC), free cholesterol (FC), phospholipid (PL), triglyceride (TG), their ultracentrifugal subfractions, and apoproteins A-I, A-II, C-II, and E present in the uremic serum of CAPD with those in hemodialysis patients (HD) and in healthy normal controls (N).

A case of virilizing Leydig cell tumor of the accessory adrenal

男性化症状を呈する21才,女性を精査したところ,まれな副副腎Leydig細胞腫であったので報告する.患者は初潮がなく, 17才時顎髯と下肢体毛に気づいた. 18才時のホルモン投与も20才時の卵巣楔状切除術も無効であった.血中testostterone,尿中17-KSは異常高値で,血中DHEA-S, androstenedioneも高かった. CTにて左腎の上に副腎像と腫瘍像,シンチでは左副腎付近に集積がみられ,選択的副腎静脈採血でも同部位の異常が確認できた.腫瘍は98gで正常副腎に付着しており, Reinke結晶を有するLeydig細胞,骨髄様脂肪化生巣より構成されており,病理学的には悪性副副腎Leydig細胞腫であった.本腫瘍はまれで,病理学的,発生学的に貴重な1例である.