| 1.
論文(リポジトリ) |
論文(リポジトリ)
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山本, 和男 ; 杉本, 努 ; 上原, 彰史 ; 佐藤, 正宏 ; 滝澤, 恒基 ; 佐藤, 裕喜 ; 吉井, 新平 ; 春谷, 重孝 ; 青柳, 竜治 ; 忰田, 亮平
概要:
約9年間で慢性血液透析患者に対する心臓弁手術を41例 (39症例) 経験した. 男 : 女 =32:7で平均年齢は64歳, 透析歴は平均15年であった. 大動脈弁輸石灰化に対し使用している超音波吸引装置 (CUSA) を僧帽弁輪石灰化 (M
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AC) 症例にも応用し, 僧帽弁手術の適用を拡大することができた. 代用弁は基本的に機械弁を用いた. 周術期の透析管理も標準化・簡素化を図った. 在院死は2例 (4.9%) と良好であり, 中期遠隔成績でも5年生存率53± 11%と比較的良好であった. 透析患者に対しても一般の弁手術より少しだけ高い危険率で弁手術を施行できる可能性が示された.
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| 2.
論文(リポジトリ) |
論文(リポジトリ)
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下条, 文武
概要:
Since 1985, the β2-microglobulin （β2-m） type of amyloidosis has emerged as a frequent and serious complication in patien
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ts on long-term hemodialysis. The retention of β2-m, based on impaired renal function in uremic patients, might be the main pathogenic process underlying amyloid fibril formation. Additional factors including modification of β2-m with advanced glycation end products are also suggested to contribute to the pathogenesis. However, much remains unknown regarding detailed etiology and pathogenesis of the disease. Same as for other types of amyloidosis, no radical treatment has been established. Therapeutic approaches currently taken for the amyloidosis are classified into （1）prevention of onset/progression, （2）symptomatic therapy （conservative treatment, orthopedic treatment, and physiotherapy） and （3）kidney transplantation；that is expected to be a better treatment for the amyloidosis. Because it is possible to actively remove β2-m, the precursor protein of this amyloid, the situation is greatly different from other types of amyloidosis.
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| 3.
論文(リポジトリ) |
論文(リポジトリ)
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西, 慎一
概要:
Hemodialysis associated amyloidosis (HA) is a new type systemic amyloidosis. Gejyo elucidated precursor protein of HA wa
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s β2-microglobulin (β2-MG), which was a low molecular protein accumulating in the serum of long term hemodialysis patients, in 1985. The histological features of this amyloidosis, which are unique in fiblilar structures and histochemical characters, are clearly different from those of other types of systemic amyloidosis, AL and AA. HA shows specific aspects in clinical features, either. The incidence of various bone and articular complications, such as bone cysts, carpal tunnel syndrome and destructive spondylarthropathy, increases according to the duration of hemodialysis. These complications result from the deposition of amyloid fibrils derived from β2-MG and are suspected to be confirmed in all patients who continue the dialysis treatment more than 10 years. The affinity of amyloid deposition to bone and articular tissues supposed to be an interesting key character in the pathogenic consideration of amyloid fibril formation. We discussed clinical and histological features of HA and summarized the recent studies of pathogenesis about amyloidgenesis including in our research results.
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| 4.
論文(リポジトリ) |
論文(リポジトリ)
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草間, 昭夫
概要:
The aim of this study was to determine accuracy of indices of body composition by bioelectrical impedance analysis (BIA)
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. Measurements were performed in 60 normal Japanese volunteers (41 male, 19 female) and in 11 patients with chronic renal failure (7 male, 4 female), aged 25～85 yrs, Resistance was obtained by BIA using a tetrapolar electrode of 500μA and 50kHz current. Weight (Wt), height (Ht), arm circumference and triceps skinfold thickness (TSF) were measured in healthy subjects and twice measured in patients once before and once after dialysis. Lean body mass (LBM) and percentage fat (%BF) were expressed as Ht^2/R and RWt/Ht^2, respectively. Percent ideal body weight (%IBW), body mass index (BMI), body surface area (BSA), weight (BW)^<0.75>, arm muscle circumference (AMC) and arm muscle area (AMA) were calculated from the criterion methods. In healthy subjects, significant correlations were obtained between Ht^2/R and BSA, BW^<0.75>, AMC and AMA, respectively (p<0.01, p<0.01, p<0.01, p<0.01). Significant correlations were found between RW/Ht^2 and %IBW (p<0.05), BMI(p<0.01), and TSF (p<0.01), respectively. There were significant differences in R, Ht^2/R and RW/Ht^2 before and after dialysis (p<0.01, p<0.01, p<0.01). Significant positive correlations were seen between changes in Ht^2/R and both decreases in water (ml) and changes in weight following hemodialysis (p<0.01, p<0.01). The results suggest that the BIA is as reliable a method in determining LBM as anthropometric methods in a healthy Japanese population. The results also suggest that R is sensitive in detecting alternation in TBW. Changes in Ht^2/R are also useful in estimating changes in TBW associated with dialysis.
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| 5.
論文(リポジトリ) |
論文(リポジトリ)
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Wakasugi, Minako ; Kazama, Junichiro James ; Taniguchi, Masatomo ; Wada, Atsushi ; Iseki, Kunitoshi ; Tsubakihara, Yoshiharu ; Narita, Ichiei
概要:
Incidence of hip fracture in dialysis patients is significantly higher than that in the general population. As information is lacking about Asian dialysis patients, we compared the incidence of hip fracture in hemodialysis patients
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with that in the general population in Japan. We conducted a retrospective cohort study using panel data from the Japanese Society for Dialysis Therapy registry. The study included patients without history of hip fracture who received hemodialysis three times per week as of December 31, 2007. We compared the observed number of hip fractures to the expected number derived from a national survey, and calculated standardized incidence ratios (SIRs) and the incidence rate difference. Subgroup analysis was performed according to vintage and diabetic status. During the one-year study period, 1,437 hip fractures were recorded in the 128,141 hemodialysis patients (61.9% male). The overall incidence was 7.57 and 17.43 per 1,000 person-years in men and women, respectively. The SIRs for male and female patients were 6.2 (95% confidence interval [CI]: 5.7 to 6.8) and 4.9 (95% CI: 4.6 to 5.3) compared to the general population, and remained nearly constant until 16 years vintage, but increased steeply thereafter. The incidence rate difference of hip fracture increased with age. The SIRs for diabetics of both genders were higher than those for non-diabetics. Our study provides additional evidence that hip fracture risk among Asian dialysis patients is also significantly higher than in the general population.
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| 6.
論文(リポジトリ) |
論文(リポジトリ)
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筒井, 牧子
概要:
We examined physical exercise capacity and hemodynamics by the use of a treadmill stress test before and after the admin
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istration of recombinant human erythropoetin (rEPO) in chronic dialysis patients. The subjects are 39 cases, 19 males and 20 females, on chronic hemodyalysis who had renal anemia. The range of age was 15 to 57 years and the average was 37.4 years. The multistage treadmill test were carried out before the administration of rEPO and at the times when the hematcrit(Ht.) rose by 5－6%, by 10－12%, and after 2－3 months maintaining the rise of Ht. by 10－12%. The echocardiogram prior to the exercise test was carried out. Results: Ht. value and hemoglobin level improved remarkably. When Ht. rose by 10－12%, the following parameters decreased significantly, Left ventricular diastolic dimension (p<0.01), left ventricular systric dimension (p<0.05), left ventricular enddiastric volume (p<0.01), left ventricular endsystoric volume (p<0.01), cardiac output (p<0.001). Ejection fraction increased significantly (p<0.05). Blood pressure at rest showed significant rise in the diastolic pressure only when Ht. increase by 10-12% (p<0.05). Although the heart rate at rest showed a significantly fall (p<0.05), maximal heart rate on exercise and the maximal pressure rate product did not show any significant change. VO_2 max showed a significant increase (p<0.001), and it remained at a higher level thereafter. The exercise time prolonged significantly (p<0.001). The remarkable improvement of anemia induced by rEPO caused the improvement of physical activity, VO_2 max and cardiac function as well as the reduction of anemic symptomes.
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| 7.
論文(リポジトリ) |
論文(リポジトリ)
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下条, 文武 ; 荒川, 正昭
概要:
The Japanese Society for Dialysis Therapy reported that a total of 80,553 had been on dialysis in our country and 13,094
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(16.3%) of them for more than 10 years at the end of 1987. Among these patients 70.2% are treated with dialysis in the daytime and 26.5% at night in the clinics or hospitals, and others are on CAPD or home hemodialysis. At present 35.7% of total patients, including house wives, are almost fully rehabilitated, working at least 5 days a week. However, many of them have suffered from various complications such as renal anemia, renal osteodystrophy and β_2-microglobulin-related amyloidosis. Renal anemia is frequently sever and often impairs rehabilitation. The mechanisms underlying the anemia are complex but involve a reduction in erythropoietin production. The advent of recombinant DNA techniques has recently allowed the production of the recombinant hormone in quantities sufficient for clinical use. It is now demonstrated that replacement therapy with recombinant erythropoietin represent an efficacious and safe treatment of anemic hemodialysis patients. Among the patients treated with dialysis, those undergoing treatment of CAPD or at home are known to have a higher quality of life than center hemodialysis groups. Since most recipients of kidney transplants who maintain stable renal functions can expect an almost normal level of physical activity and enjoy their life of the pre-illness level of activity, the network for promoting kidney transplantation should be established.
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| 8.
論文(リポジトリ) |
論文(リポジトリ)
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池井, 淳子
概要:
透析患者の睡眠時における無呼吸状態や臨床パラメータと透析患者のQOLとの関係を腎特異疾患尺度(KDQOL)の「包括的QOL尺度(SF-36)」を使用して調べた. その結果, SpO_2(血中酸素飽和度)が90%未満の割合(SpO_2割合)S
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pO_2が90%未満の総時間(SpO_2総時間), 睡眠中の平均SpO_2(平均SpO_2)がQOL尺度の「活力」(過去1ヵ月間において「元気いっぱいだったか」「活力にあふれていたか」「疲れていたか」という問いであり活力を見る項目)と有意な負の相関があることが解った. 重回帰分析の結果SpO_2が90%未満の割合や総時間が睡眠中における平均SpO_2を低下させることを介して透析患者の「活力」のQOLを低下させると考えられた. そのほか, ODI(睡眠中に1時間あたりに3%以上の酸素飽和度(SpO_2)が低下した回数)は「身体的機能」(入浴や歩行などが問題なく行えるかどうかという項目), 「全体的健康感」(自分の健康をどのように感じているかを問うた項目)とSpO_2割合は, 「活力」のほかに「全体的健康感」や「心の健康」(神経質で憂鬱か, 穏やかで落ち着いているか等)であるこの項目とSpO_2時間は「身体機能」, 「全体的健康感」「心の健康」, 平均SpO_2は「全体的健康感」「社会的機能」, 「心の健康」と有意な負の相関が見られた. しかし重回帰分析の結果, 平均SpO_2「活力」以外に, 直接QOLに影響を及ぼしているものはなかった. 臨床パラメータでは透析前の収縮期血圧が「健康の推移」(1年前と比べて), 透析後の拡張期血圧が「日常役割機能身体」(仕事や活動に対する身体的因子の影響)と相関していることが示された. 以上のことから, 透析患者の夜間無呼吸の改善や血圧の制御は, 透析患者の生活のQOLを向上させることに重要であることが示唆された.
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| 9.
論文(リポジトリ) |
論文(リポジトリ)
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山本, 卓
概要:
透析療法は本邦で実用されて50年以上が経過し，いまや一般的な治療となった．しかし，生命予後の改善，腎臓病関連疾患の予防は未だ十分ではなく，さらなる治療法の進歩が必要となる．尿毒症物質の蓄積は透析患者の生命予後や心血管病をはじめとする合併症に
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関連すると考えられ，特に蛋白結合尿毒症物質は現行の透析療法では十分除去できず，細胞・組織への影響も強い．そのため蛋白結合尿毒症物質の除去を向上するなど新たな取り組みが必要であり，吸着を原理とした血液浄化療法の提案を行っている．血液浄化療法の進歩により，透析患者の生命予後だけでなくADL/QOLを改善できると信じて診療・研究を続けていきたい．
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