Toshio Shinoda

Kawakita General Hospital · Dialysis Center

Importance Among patients with hyperphosphatemia undergoing dialysis, it is unclear whether non–calcium-based phosphate binders are more effective than calcium-based binders for reducing cardiovascular events. Objective To determine whether lanthanum carbonate reduces cardiovascular events compared with calcium carbonate in patients with hyperphos...

Objectives: High prevalence of iron deficiency (ID) and cardiomyopathy have been observed in patients with end-stage kidney disease (ESKD). Our objective was to clarify associations between ID and cardiac remodeling in patients with ESKD. Design and methods: A cross-sectional study was conducted using 1974 Japanese patients with ESKD at the init...

Vitamin D receptor activators (VDRA) may exert pleiotropic effects on cardiovascular disease, malignancy, and infections among dialysis patients, but recent studies have mainly focused on cardiovascular outcomes. Among 8,675 patients who started dialysis in 2007 and who survived until January 1, 2010, listed in the Renal Data Registry of the Japane...

Background The goal of the present study was to explore the differences in effects between erythropoiesis-stimulating agent (ESA) types on hemoglobin (Hb) level at the initiation of maintenance dialysis. Methods This was a cross-sectional study. From January 2006 to October 2012, 2920 patients with end-stage kidney disease commenced hemodialysis (H...

Background: Nausea is a major uremic symptom and a frequent indication for starting dialysis. However, preventive medication for uremic nausea has not yet been identified. Vitamin D receptor activators (VDRAs) may prevent uremic nausea via their pleiotropic actions. The objective of this study was to explore whether VDRA administration during the...

Since 2009, the peritoneal dialysis (PD) registry survey has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this report, the current status of PD patients is presented on the b...

Preventive medications for dialysis-requiring congestive heart failure (CHF) in non-dialysis Japanese patients with Stage 5 chronic kidney disease (CKD) are unknown. Our aim was to explore which CKD medication was associated with a reduced prevalence of dialysis-requiring CHF in non-dialysis Japanese patients with Stage 5 CKD. The present multicent...

The present study explores associations between hemoglobin (Hb) levels and patients with cardiac enlargement in end-stage kidney disease (ESKD) to help prevent cardiac remodeling during the predialysis phase of chronic kidney disease (CKD). This cross-sectional study included 2,249 patients with ESKD (age, 67 ± 13 years; male, 67%; diabetic kidney...

A nationwide statistical survey of 4279 dialysis facilities was conducted at the end of 2012, among which 4238 responded (99.0%). The number of new dialysis patients was 38055 in 2012. Since 2008, the number of new dialysis patients has remained almost the same without any marked increase or decrease. The number of dialysis patients who died in 201...

Context: PTH is a critical factor in mineral homeostasis, and chronic kidney disease mineral and bone metabolism disorder is a very important problem in patients with renal failure. Abnormal levels of PTH, serum phosphate, and calcium influence chronic kidney disease mineral and bone metabolism disorder, but there is little information about the i...

Introduction and Aims: Regulation of erythropoiesis and the maintenance of erythroid homeostasis rely on modulation of erythropoietin (EPO) gene expression in response to tissue oxygen tension. The mechanisms underlying this regulation at renal and non-renal tissues remain to be fully elucidated, in particular in some pathological conditions as is...

In 2009, we started the peritoneal dialysis (PD) registry with the cooperation of the Japanese Society for Peritoneal Dialysis as part of the annual nationwide survey conducted at the end of each year by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy. In this study, we examined the current status of PD patients on the...

The effects of lanthanum carbonate on MBD parameters were investigated in 59 hemodialysis patients who were taking calcium carbonate. Lanthanum carbonate (initial dosage: 750mg/day), as a replacement for or in combination with calcium carbonate and/or sevelamer hydrochloride, was administered for 12 months with increase/decrease of dosages. Lanthan...

A nationwide statistical survey of 4226 dialysis facilities was conducted at the end of 2010, and 4166 facilities (98.6%) responded. The number of new patients introduced into dialysis was 37 512 in 2010. This number has decreased for two consecutive years since it peaked in 2008. The number of patients who died in 2010 was 28 882, which has been i...

The goal of the present study was to explore the effect of medications that are commonly prescribed for CKD patients on uremic state. This was a cross-sectional study. From January 2006 to October 2009, 1,623 patients with end-stage kidney disease (ESKD) commenced hemodialysis (HD) at the 9 participating hospitals. The criteria for exclusion from t...

A nationwide statistical survey of 4196 dialysis facilities was conducted at the end of 2009, and 4133 facilities (98.5%) responded. The number of patients undergoing dialysis at the end of 2009 was determined to be 290 661, an increase of 7240 patients (2.6%) compared with that of 2008. The number of dialysis patients per million at the end of 200...

The aim of this study was to investigate the factors influencing serum parathyroid (PTH) levels, including medications for treating chronic kidney disease-mineral and bone metabolism disorder (CKD-MBD) in patients with end-stage renal disease. We enrolled 1,076 patients in nine Japanese facilities who had begun hemodialysis (HD) due to ESRD. We inv...

The objective of this study was to evaluate the effect of early referral (ER) to nephrologists on the type of vascular access (VA) available for use at the time of initiation of maintenance hemodialysis (HD). In patients who have been followed by nephrologists for less than 3 months, management before the initiation of HD is often insufficient and...

We investigated the effects of online hemodiafiltration (HDF) using acetate-free bicarbonate dialysis (AFD) fluid on bioincompatibility as represented by inflammatory markers in patients undergoing maintenance hemodialysis therapy and compared it with conventional acetate-containing bicarbonate dialysis (ACD) fluid. A total of 24 maintenance hemodi...

Japanese hemodialysis (HD) patients have two remarkable characteristics, that is they have a longer period of chronic HD and better clinical outcome than American and European HD patients. This might be partly explained by the very low prevalence of renal transplantation in Japan. As a result, younger HD patients without serious comorbid conditions...

A nationwide statistical survey of 4124 dialysis facilities was conducted at the end of 2008 and 4081 facilities (99.0%) responded. The number of patients undergoing dialysis at the end of 2008 was determined to be 283,421, an increase of 8179 patients (3.0%) compared with that at the end of 2007. The number of dialysis patients per million at the...

The correct selection of anticoagulation in acute blood purification is crucial for avoiding exacerbation of bleeding in critical care patients with acute renal failure, as these patients frequently exhibit hemorrhagic complications. The mode of acute blood purification is determined mainly by the patient's hemodynamic stability, and continuous ren...

A nationwide statistical survey of 4098 dialysis facilities was conducted at the end of 2007, and 4052 facilities (98.88%) participated. The number of patients undergoing dialysis at the end of 2007 was determined to be 275 242, an increase of 10 769 patients (4.1%) compared with that at the end of 2006.The number of dialysis patients per million a...

There has been remarkable medical and technological progress in Japanese dialysis therapy where more than 270 thousand patients had been treated with dialysis by the end of 2007. Clinical engineering technologists have played an important role not only in the safety treatment but also in the technological development of dialysis therapy. It is very...

A statistical survey of dialysis patients for the year 2006 was carried out for 4051 medical facilities across Japan, and responses were received from 3985 (98.37%) facilities. There were 264 473 dialysis patients (including 9003 peritoneal dialysis patients) in Japan at the end of 2006, which showed an increase of 6708 (2.6%) from the end of 2005....

The extent of end stage renal disease (ESRD) has not been well documented in anorexia nervosa (AN). We herein describe a 47-year-old female with ESRD who required maintenance hemodialysis (HD) following a 27 year history of AN, and seven years of diuretic and purgative abuse. In spite of HD treatment, her serum inorganic phosphorus level remained e...

A 69-year-old Japanese man underwent pancreaticoduodenectomy for the resection of carcinoma at lower part of the common bile duct. Hemodialysis had already begun to treat chronic renal failure. He had been admitted for obstructive jaundice due to the carcinoma four months earlier. The serum total bilirubin was then 38.5 mg/dL, and the serum creatin...

A statistical survey conducted at the end of 2005 covered 3985 medical facilities across Japan, and 3940 facilities (98.87%) responded. The dialysis population in Japan at the end of 2005 was 257,765, which showed an increase of 9599 patients (3.87%) from the end of the previous year. The number of patients per million was 2017.6. The crude death r...

Hypertension is common in chronic hemodialysis (HD) patients. However, its prevalence and determinants have not been studied in a large HD population. We analyzed the database of the Japanese Society for Dialysis Therapy (JSDT) registry, which conducts an annual survey of chronic dialysis patients throughout Japan. We compiled those who were on HD...

An 81-year-old man, with chronic renal failure due to chronic glomerulonephritis on maintenance hemodialysis (HD) for 4.5 years, was admitted to our hospital because of rapidly developing hyperglycemia and hypertension. He had been under good control on HD with no history of hyperglycemia. One month prior to admission he felt thirsty and generally...

A statistical survey of 3932 nationwide hemodialysis (hereafter, dialysis) facilities was carried out at the end of 2004, and 3882 facilities (98.73%) responded. The population undergoing dialysis at the end of 2004 was 248 166, an increase of 10 456 patients (4.4%) from that at the end of 2003. The number of dialysis patients per million people wa...

The Japanese Society for Dialysis Therapy (JSDT) has annually conducted a nationwide statistical survey of all dialysis facilities in Japan. The Society conducted this survey of 3625 dialysis facilities at the end of 2002, and responses were received from 3612 facilities (99.61%). Based on the survey investigation results tabulated at the end of 20...

Because the contribution of residual renal function (RRF) to total solute clearance is often significant in continuous ambulatory peritoneal dialysis (CAPD), loss of RRF over time can lead to inadequate dialysis if appropriate prescription management strategies are not pursued. Additionally, declines in ultrafiltration caused by increases in perito...

Clean dialysate should be used in dialysis with a high-flux dialysis membrane to avoid contamination of endotoxin into blood circuits. For this purpose, we should not only clean up the end stream dialysate by endotoxin-cut filters, but also prevent bacterial growth in dilution water lines. Delivery lines of the prepared dialysate from a central dia...

The study was designed to examine the time-course of iodine elimination by hemodialysis to determine a desirable duration for dialysis after angiography to prevent contrast media nephropathy (CMN) in patients with renal failure. Reduction rates of iodine by hemodialysis (DRR) of 1 to 3 h and the renal elimination of iodine (RER) for 20 h after hemo...

The immunological and genetic pathogeneses of inflammatory bowel disease (IBD) have been well elucidated in the recent years. The pharmacologic treatment of IBDs accordingly becomes to focus upon the individual pathologic step (targeting therapy), whereas the therapeutic action is not yet a pinpoint one. It has been known recently that new drugs su...

A 67-year-old man being treated with allopurinol, furosemide, digoxin, and tamocapril for congestive heart failure and paroxysmal atrial fibrillation was admitted to our hospital because of intermittent fever, general fatigue, and liver dysfunction. On admission, myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) was positive, and the...

We report a case of infectious endocarditis in a 77-year-old woman who was undergoing maintenance hemodialysis therapy, and who was also having a prosthetic aortic valve replacement. The disease resulted from a local skin infection at the needle puncture site of the arteriovenous fistula. Ampicillin-resistant Staphylococcus aureus was the causal or...

We prospectively examined the effect of leukocytapheresis (LA) on the maintenance of remission in 7 patients with ulcerative colitis (UC) who were initially refractory to corticosteroid therapy (steroid resistant or steroid dependent). The patients with refractory UC had been in remission due to LA (induction LA) in combination with the steroid the...

The annual statistical survey conducted at the end of 2000 by the Japanese Society for Dialysis Therapy collected responses from 3358 (99.94%) of 3360 institutions. Japan's total dialysis patient population at the end of the year 2000, as identified by this survey, was 206 134, an increase of 8921 (4.5%) over 1999. This translates to 1624.1 patient...

A statistical survey at the end of 1999 by the Japanese Society for Dialysis Therapy resulted in responses from 3, 220 (99.66%) of 3, 231 institutions providing dialysis. The survey found 197, 213 chronic dialysis patients in Japan, an increase of 6.4% (11, 891 patients) from the 1998 survey. The 1999 survey found a slight decrease in the gross ann...

A 67-year-old male hemodialysis patient with abdominal aortic aneurysm and triple vessel coronary heart disease required autologous blood donation because of his blood type of Rh(-) before cardiovascular surgery. We performed autologous red blood cell and plasma collection by the switch back method with recombinant human erythropoietin therapy duri...

A patient with Bickerstaff's brain stem encephalitis (BBE) associated with anti-GQ1b antibody developed coma, severe weakness, and respiratory distress. The patient required ventilatory support. After having failed to improve on steroids, she was treated with plasmapheresis. She improved concomitantly with the plasmapheresis treatment and made a co...

Active vitamin D3 is extensively used for the treatment of secondary hyperparathyroidism in hemodialysis patients. But it is often impossible to administer enough dose to suppress parathyroid hormone (PTH) level, because of hypercalcemia and hyperphosphatemia. New modalities with higher specificity for PTH suppression are desirable. We conducted a...

A patient with Bickerstaff s brain stem encephalitis (BBE) associated with anti-GQ1b antibody developed coma, severe weakness, and respiratory distress. The patient required ventilatory support. After having failed to improve on steroids, she was treated with plasmapheresis. She improved concomitantly with the plasmapheresis treatment and made a co...

The prognosis for haemodialysis patients is reported to be more favourable in Japan than in Europe or North America. Consequently, evaluation of the death predictors for haemodialysis patients in Japan is of considerable interest outside Japan. The Patient Registration Committee of the Japanese Society for Dialysis Therapy annually surveys the indi...

Beginning in 1966, the Patient Registration Committee of the Japanese Society for Dialysis Therapy has conducted a survey once a year on renal replacement therapy in Japan. As of 1983, the survey covered the life/death of patients in the survey years, as well as the case mix of individual patients. In 1990 several laboratory variables were added to...

A case of sarcomatoid renal cell carcinoma with widespread metastases to liver and bones in a cadaver renal transplant recipient is reported in this article. The patient underwent a kidney transplant at the age of 43 and was treated with various immunosuppressive agents after surgery. Twelve months after the transplantation, multiple tumors were fo...

Beginning in 1966, the Patient Registration Committee of the Japanese Society for Dialysis Therapy has conducted a survey once a year on renal replacement therapy in Japan. As of 1983, the survey covered the life/death of patients in the survey years, as well as the case mix of individual patients. In 1990 several laboratory variables were added to...

The prognosis for haemodialysis patients is reported to be more favourable in Japan than in Europe or North America. Consequently, evaluation of the death predictors for haemodialysis patients in Japan is of considerable interest outside Japan. The Patient Registration Committee of the Japanese Society for Dialysis Therapy annually surveys the indi...

Mortality rates associated with cardiovascular disease (CVD) are high in long-term dialysis patients. Increased levels of plasma fibrinogen (FBG), coagulation factor VII (FVII), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) as well as hyperlipidemia are regarded as important risk factors for CVD. To investigate...

A prospective study was performed to determine whether low-density lipoprotein (LDL) apheresis, when performed only immediately before and after percutaneous transluminal coronary angioplasty (PTCA), is effective in preventing restenosis of coronary artery lesions following PTCA. Thirty-six patients with coronary heart disease (CHD) and hypercholes...

The effects of hyperthyroidism on uric acid metabolism were investigated. First, the serum uric acid level was measured in 92 patients with hyperthyroidism due to Graves' disease, eight patients with subacute thyroiditis, six patients with hypothyroidism, and 70 sex- and age-matched controls. Second, the correlation between serum thyroxine (T4) and...

A 67-year-old man with thrombocytopenia, and amegakaryocytic but otherwise normal bone marrow, was evaluated. Antibody against thrombocytes was negative and the half-life of thrombocytes was normal. In vitro clonal culture of the patient's bone marrow cells yielded no megakaryocyte colony with normal granulocyte-macrophage and erythroid colony form...

We report a 49-year-old Japanese male with nephrotic syndrome associated with Kimura's disease. Renal biopsy revealed diffuse podocytic detachment from the glomerular basement membrane (GBM). He had an episode of nephrotic syndrome when complete remission was induced with steroid therapy six years prior to the present admission. However, complete r...

透析患者の予後を考える上で心血管病変の評価は極めて重要である. 心エコー図法で認められる大動脈弁の輝度増強は冠動脈硬化を示唆する所見の一つと考えられている. そこで心エコー図法を用いて, 血液透析 (HD) 患者と持続性自己管理腹膜透析 (CAPD) 患者の大動脈弁輝度増強の頻度を比較し, 動脈硬化促進因子について検討した.対象はHD患者17例 (男性6例, 女性9例, 平均年齢48.1歳, 平均透析期間153.9か月) とCAPD患者16例 (男性10例, 女性6例, 平均年齢40.7歳, 平均透析期間49.5か月) で全員に心エコー図を施行するとともに, 血清カルシウム, リン, 総コレステロール, 中性脂肪, HDLコレステロール, β-リポ蛋白, リポ蛋白 (a) [Lp(a)] を...

A quantitative analysis of the molecular weight (MW) profile of urinary protein by SDS-PAGE was performed in streptozotocin (STZ)-injected, non-ketotic diabetic rats (DM group), diabetic rats receiving dipyridamole (DM-DIP group), normal rats (C group) and STZ-injected rats with near-normal glycemia due to insulin treatment (DM-INSULIN group). In t...

A 56-year-old male patient on chronic hemodialysis developed liver cirrhosis. He received a total of 20 liters of blood transfusion. Bronze pigmentation of the skin and iron deposition to the liver, spleen, pancreas and thyroid gland, which was demonstrated by computed tomography and magnetic resonance imaging studies, and histological demonstratio...

Ninety-four overweight subjects with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT) were followed for 10 years. No one from the NGT group developed diabetes, however 32% of the IGT subjects did develop diabetes. Initial data of the IGT subjects who developed diabetes were significantly different from those who did not develop di...

In 77 untreated patients (16 males and 61 females, aged 12 to 65 years) with hyperthyroid Graves' disease, and in 107 control subjects (36 males and 71 females, aged 13 to 78 years), blood urea nitrogen (BUN), serum creatinine (Scr) levels, and BUN to Scr ratios (BUN/Scr) were determined. In 53 patients, the determinations were performed before tre...

Hypothyroidism may result from the production of antibodies that block the actions of thyrotropin. How often these thyrotropin-blocking antibodies are a cause of hypothyroidism and whether their production may cease, causing hypothyroidism to disappear, have not been extensively studied. We determined the frequency with which thyrotropin-blocking a...

A 60-year-old uremic patient treated with hemodialysis for 13 years developed acute hypotension during hemodialysis and overt heart failure subsequently in a period of relatively mild hypocalcemia after parathyroidectomy. Blood pressure during hemodialysis was maintained by continuous calcium infusion alone. Cardiomegaly was improved by normalizati...

We report a case of "steroid and immunosuppressant-resistant" polymyositis that was successfully treated with immunoadsorption. A 46-year-old man was admitted to Shinshu University Hospital on June 2, 1989, with the chief complaint of muscle weakness and pain. He had a 1.5-year history of frequent episodes of Raynaud's phenomenon. Five months befor...

Plasma atrial natriuretic peptide (ANP) levels were examined in 66 patients with non-insulin-dependent diabetes mellitus (NIDDM), and in 9 age-matched normal controls and 18 hypertensive controls. The diabetic patients were classified into three groups according to random urine albumin/creatinine ratio (ACR, mg/g or mg/88.4 nM); group 1 (normo-albu...

Low molecular weight heparin (LMH) acts as an anticoagulation agent mainly through its anti-activated coagulation factor X (Xa) activity. Thrombelastography (TEG) is expected to be useful to monitor the dosage of LMH during hemodialysis because reaction time on TEG (TEG-r) is considered to reflect blood thromboplastin formation time, which depends...

We studied the effects of epidermal growth factor (EGF), 12-O-tetradecanoylphorbol-13-acetate (TPA), and 1-oleoyl-2-acetyl-glycerol (OAG) on cytoplasmic pH (pHi) and cell growth in cultured porcine thyroid cells. pHi was measured using 2',7'-bis(2-carboxyethyl-5,6-carboxyfluorescein (BCECF), an internalized fluorescent pH indicator. EGF, TPA, and O...

The effect of 150 mg/day dipyridamole p.o. on urinary albumin excretion (UAE) was studied in 48 patients with diabetes mellitus without clinically discernible nephropathy. In 42 patients who were followed at an outpatient clinic, albumin/creatinine ratio (Ualb/Ucreat: mg/mmol) of untimed urine obtained from the same subjects repetitively was employ...

Marked gastric dilatation and the carpal tunnel syndrome developed concurrently in a 58-year-old man treated with hemodialysis for 14 years. Despite extensive examinations, no attributable organic lesion was demonstrated in the gastrointestinal tract. However, amyloid deposition, which was immunohistochemically identified as beta-2 microglobulin, w...

Plasma atrial natriuretic peptide (ANP), plasma renin activity (PRA) and aldosterone were consecutively measured during methimazole treatment in patients with hyperthyroidism due to Graves' disease. ANP values of untreated hyperthyroid patients varied greatly from patient to patient, but decreased progressively with a decrease of serum thyroid horm...

The relationship between the urinary excretion of calcium (Ca2+) and uric acid was investigated in 151 Type 2 diabetic patients and 48 normal subjects. In the diabetic patients, uric acid clearance/creatinine clearance (Clurate/Clcr) was higher and the serum level of uric acid was lower than in the normal subjects (Clurate/Clcr: 10.9 +/- 5.8 vs 8.1...

In a 49-year-old woman with empty sella syndrome, corticotropin (ACTH) deficiency and various abnormalities, including increased thyrotropin (TSH) secretion, growth hormone (GH) deficiency, and inappropriately high insulin with early phase hypoglycemia, during an oral glucose tolerance test were found. Existence of serum antipituitary antibody sugg...

Acute effects of coronary vasodilators (nifedipine, nicardipine, and nitroglycerin) on atrial natriuretic peptide (ANP) and the renin-angiotensin-aldosterone system were studied in normal subjects and patients with essential hypertension. Nifedipine lowered blood pressure both in normal subjects and in patients and elevated ANP, plasma renin activi...

A long-term hemodialysis patient with a giant intracranial vascular channel, which has been called a giant serpentine aneurysm, is presented. A 50-year-old man with an eight-year history of hemodialysis treatment was admitted because of headache, nausea and double vision. Computed tomographic scans and nuclear magnetic resonance revealed intracrani...

Three patients with the syndrome of inappropriate secretion of antidiuretic hormone had elevated uric acid clearances. Their uric acid clearances decreased markedly after the administration of pyrazinamide. Probenecid was given to two of them and it produced large increases in uric acid clearance. These data suggest that enhanced secretion in the r...

The association of progressive multifocal leukoencephalopathy (PML) with prolonged hemodialysis treatment (PHT), not previously reported, was observed in a 56-year-old Japanese man who received PHT for 11 years. He suffered from recurrent bouts of fever and progressive neurological signs, such as irritability, speech disturbance, gait disturbance a...

The association of progressive multifocal leukoencephalopathy (PML) with prolonged hemodialysis treatment (PHT), not previously reported, was observed in a 56-year-old Japanese man who received PHT for 11 years. He suffered from recurrent bouts of fever and progressive neurological signs, such as irritability, speech disturbance, gait disturbance a...

The role of the kallikrein system in the natriuresis of SIADH was studied in 3 patients. Following free water intake, serum Na decreased. Urinary Na excretion, urinary aldosterone excretion and urinary kallikrein-like activity (UKaV) increased. Significant relationships were observed between UKaV and urinary aldosterone excretion during the study....

In order to evaluate the effect of heparin on abnormal lipid metabolism in patients on regular dialysis treatment (RDT), hemodialysis without heparin was performed for 6 weeks on 8 RDT patients using as anticoagulants, synthetic proteinase inhibitor, gabexate mesilate and small doses of aspirin. Various parameters as to lipid metabolism were checke...

Prostaglandin D2 (PGD2), a potent antiplatelet agent, was evaluated as an antithrombotic agent for haemodialysis in comparison with prostaglandin E1 (PGE1) and prostaglandin I2 (PGI2). When antiplatelet action was evaluated, taking the degree of associated hypotension into consideration, PGD2 was found to be superior to PGE1 and PGI2 as the latter...

To elucidate the contributory role of heparin to abnormal lipid metabolism in patients on regular haemodialysis (RDT), six week haemodialysis without heparin was performed using gabexate mesilate in combination with low dose aspirin. Total cholesterol and beta-lipoprotein were significantly increased at the fourth week after the start of the study....

Summary A twenty-two-year-old nurse was admitted because of oliguria and mental disturbance. She had suffered from prodromal symptoms of high fever, headache and vomiting for one week. Two days before admission jaundice and oliguria were noticed. On admission, she was at the grade 2 hepatic coma associated with acute renal failure. Pathogen was no...

昏睡と高度の低ナトリウム血(118mEq/1)をおこした患者を検索し,それが下垂体前葉機能不全症とADH分泌異常症の合併によるものと判断したので報告する.このような両者の合併例はまだわが国では報告されていない.副腎皮質ホルモンの投与によつて,患者の血清ナトリウム値は正常となり,あらゆる症状が改善された.また,治療前のADHは6.Oμu/mlで正常値上限の約2.5倍を示したが,副腎皮質ホルモンの投与で,この値が2.6μu/mlに下つたことから,ADH過剩と副腎皮質ホルモンの間に関連性があるとみなした.また,血清ナトリウムの改善に伴い,脳波では主にθ波の消失を,心電図では第I度A-Vブロックが消失して正常化するのを観察した.この患者の昏睡状態は血清ナトリウムの急激な低下によつて招かれたものと考え...