Dialysis arthropathy is a major complication being seen in hemodialysis patients treated for more than 10 years. Its characteristic pathological finding is amyloid synovitis. Though low dose steroid administration is effective for arthralgia in dialysis arthropathy, another therapeutic tool without using steroids should be established for the early stage of dialysis arthropathy. Sai-rei-to is thought to show an anti-inflammatry effect similar to that of low-dose steroids, and it has been used for controlling arthralgia of rheumatoid arthritis and systemic lupus erythematosus. Twenty-seven hemodialysis patients with chronic arthralgia due to dialysis arthropathy have been treated with Sai-rei-to without simultaneous steroid administration. There were 15 male and 12 female patients, with an average of age of 55.6. Their duration of hemodialysis is more than 8 years (an average of 17.0 years). The patients were provided with 6.0g of Sai-rei-to (Tsumura Sai-rei-to ^®) a day, and the effect on arthralgia was evaluated after 1 month by each patient. Sai-rei-to was effective in 14 patients (arthralgia was reduced), not effective in 9 patient, and 4 patients had dropped out. This shows an efficacy rate of 60.9%. An effect was observed within one week after the beginning of therapy in the most effective cases. Although Sai-rei-to administration was not sufficiently effective for controlling severe arthralgia, but an analgesic effect was still observed in these patients. There were no severe side effects, although there was a sense of discomfort in the epigastrium (2 cases), edema (2 cases), itching (1 case), eruption (1 case). These results suggest that Sai-rei-to is an effective medicine for controlling arthralgia due to dialysis arthropathy, especially for the patients in the early stage of this disease.

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One hundred patients with hemodialysis carpal tunnel syndrome were treated by endoscopic surgery, and transverse carpal ligament biopsies were performed at the same time.
Deposits of amyloid and β₂-microglobulin (β₂-MG) in those specimens were examined by microscopy. The respective positivity rates for amyloid and β₂-MG were 64% and 72% in primary cases, 77% and 86% in recurrent cases, and 67% and 75% overall.
The findings of endoscopic biopsy are similar to those obtained by open surgery.

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In patients with autosomal dominant polycystic kidney disease (ADPKD), renal size usually continues to increase, and severe complications of the digestive tract are encounterd by its mass effects. External conventional therapies by surgical procedure have not been satisfactory. We attempted renal size reduction therapy in ADPKD patients by interventional procedure of renal transcatheter arterial embolization (TAE) using an intravascular coil. Anuric patients on hemodialysis with markedly distended abdomen or macroscopic hematuria were selected and informed consent was obtained from each patient. Between October 1996 and December 1999, thirty-one patients were treated. In ten cases treated with stainless steel coils, renal sizes decreased to 65±9% after ten months, and in seven cases treated with platinum microcoil to 65±13% after only three months. There have not yet been any serious complications, although this therapy was effective in all patients in this series. This method of internal treatment for ADPKD patients on dialysis by obstructing the renal arteries is a safe and effective way to shrink enlarged kidneys. Renal arteries appear to switch their role from supporting renal function to feeding renal multiple cysts as renal failure progresses. This therapy is expected to become more effective with improvement of the embolizing material.

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We retrospectively studied the relationship among the incidence and attack rates of cerebrovascular diseases (CVD), outcome and underlying renal diseases in 1, 837 maintenance dialysis (MD) patients (1, 113 male, 724 female) treated in our hospital between 1981 and 1996. The diagnosis of CVD was assisted by CT scan.
The number of first CVD events/deaths/incidence of initial attack (per 10⁵ MD patients per year)/mortality (per 10⁵ MD patients per year) were as follows: in transient ischemic attack (TIA) and ischemic stroke [reversible ischemic neurological deficit (RIND) and cerebral infarction (CI)] 79/11/509/71, in intracerebral hemorrhage (ICH) 34/15/219/97, and in subarachnoid hemorrhage (SAH) 8/5/52/32. The number of all CVD events/deaths/attack rate of all attacks including recurrent attacks (per 10⁵ MD patients per year)/mortality (per 10⁵ MD patients per year) were as follows: in TIA and ischemic stroke 104/15/670/97, in ICH 46/23/296/148, and in SAH 8/5/52/32. The number of first events of ischemic stroke (RIND and CI) and its incidence (per 10⁵ MD patients per year), and all events of ischemic stroke and its attack rate (per 10⁵ MD patients per year) were 67 and 432, and 92 and 593, respectively. There was no gender difference in the incidence or the attack rate in MD patients except for a slight gender difference in the attack rate of ICH, which revealed a male: female ratio of 1.4, whereas the incidence and attack rate of ischemic stroke and the incidence and attack rate of ICH in an age-matched general population in Akita prefecture were two-fold higher in the male population. The ratio of the first events of ischemic stroke to the first events of ICH was 2.0, and the ratio of all events of ischemic stroke to all events of ICH was 2.0, indicating that the ratio of the initial events between ischemic stroke and ICH in MD patients was comparable to that in the control, the general population in Akita prefecture. The same held true with the ratio of all events. In comparison with general patients in our hospital, the mortality (%) of all ischemic strokes was 2.9 times, and the mortality (%) of all ICH was 2.6 times. The incidence (per 10⁵ MD patients with underlying renal disease per year) and the attack rate (per 10⁵ MD patients with underlying renal disease per year) of ischemic stroke were 1, 375 and 2, 027 in MD patients with diabetic nephropathy, and 1, 056 and 1, 441 in MD patients with hypertensive nephrosclerosis, whereas these were only 275 and 330 in MD patients with glomerulonephritis.
In conclusion, chronic renal failure increases the risk of CVD, and the ratio of ischemic stroke to ICH is almost equal to that in the general patient population. In MD patients, there was no gender difference observed in the incidence or attack rate for either ischemic stroke or ICH, except for that in the attack rate of ICH, suggesting that factors such as hypertension, long-standing chronic renal failure itself and nonphysiological extracorporeal circulation might have stronger effects on these diseases than does gender difference.

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Long-term prognosis after surgical treatments for arteriosclerosis obliterans (ASO) in chronic hemodialysis (HD) was retrospectively analyzed in 15 consecutive hemodialysis patients who were admitted to our hospital from July 1, 1995 to June 30, 1999. They consisted of 11 males and 4 females, age ranged from 56 to 98 years with an average of 67±11 (SD) years old and the HD duration ranged from 14 to 234 months with an average of 104±61 months. They were subdivided into 2 groups; DM (n=9, male/female=7/2, the mean age of 65±8 years old, the mean HD duration of 91±55 months) and non-DM patients (n=6, male/female=4/2, the mean age of 69±15 years old, the mean HD duration of 124±71 months). Thirty-four surgical procedures were performed. Amputation of leg, foot or toe was ultimately performed for ASO in all patients with DM. For non-DM patients, revascularization procedures could be performed in 5 patients (80%). The rate of amputation in DM patients was significantly higher than that in non-DM patients (p=0.021).
Eleven patients (73%) died within the mean observation period of 20±13 months. In all patients, the first year survival rate was 73%, 42% for the second year and 21% for the third year. The cumulative survival rate in DM patients tended to be worse compared to that in non-DM patients but the difference was not significant.
The most frequent cause of death was cardiovascular disease, but ischemic colitis occurred more frequently than cardiac death. Two patients committed suicide probably due to declining activity of daily life after amputations. Two patients became malnourished and finally died of cachexia.
Based on this analysis, it is suggested that clinical outcome after surgical treatments for ASO in chronic HD patients, especially in diabetic patients, was poor. Earlier assessments and therapeutic approaches are needed to improve the results.

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To elucidate whether Doppler echocardiography could be useful to assess dry weight in dialysis patients with known heart disease, we recorded intracardiac flow velocity patterns by the pulsed and the continuous-wave Doppler method.
The subjects consisted of 11 dialysis patients with known heart disease (6 with valvular heart disease, 4 with dilated cardiomyopathy, and 1 with old myocardial infarction). Transmitral flow patterns (TMF) and pulmonary venous flow patterns (PVF) were recorded by the pulsed Doppler method. Peak early diastolic velocity (E), peak atrial filling velocity (A) and E/A were calculated by analyzing TMF. Peak systolic flow velocity (S), peak diastolic flow velocity (D) and S/D were calculated by analyzing PVF. We recorded peak systolic velocities (V1) from tricuspid regurgitant flow (TR) and end diastolic velocities (V2) from pulmonary regurgitant flow (PR), respectively, by the continuous-wave Doppler method. Systolic pulmonary artery pressure (SPAP) and end diastolic pulmonary artery pressure (DPAP) were estimated by 4(V1)²+10mmHg and 4(V2)²+10mmHg (The modified Bernoulli equation was employed to derive the pressure gradient that equals 4V², 10mmHg for the right atrial pressure.) We estimated that dry weight was excessive following by the index; E/A>1 in TMF, S/D<1 in PVF, SPAP>40mmHg and DPAP>20mmHg.
We could record TMF in 9 patients, PVF in 10 patients, TR in 8 patients and PR in 6 patients. In 10 patients, at least two of the parameters could be employed. Doppler parameters other than TR could not be estimated because of tachycardia and severe mitral regurgitation in one patient. We determined that dry weight was excessive in 5 patients. Doppler parameters improved after resetting the dry weight.
In conclusion, Doppler echocardiography could be useful in assessing dry weight in dialysis patients with known heart disease.

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We report a case of SEP successfully treated by surgical management following total parenteral nutrition (TPN). A 49-year-old woman had commenced CAPD in 1987 because of end-stage renal failure. In May 1996, she developed peritonitis. The peritoneal catheter was removed and transferred to hemodialysis. In August 1996, she presented with abdominal pain, vomiting and diarrhea. SEP was diagnosed. AII oral intake was ceased and she was controlled by TPN. In October 1998, there was no improvement in gastrointestinal function and synectenterotomy was undertaken. Surgery was successfully performed and oral intake was resumed. In December 1999, she had no symptoms related to SEP.

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