Patients with chronic renal failure (CRF) have a great psychological burden before they start hemodialysis and when the treatment begins. We initiated once-a-week hemodialysis program, designed to reduce the psychological burden as well as to keep the residual renal function. A total of 13 CRF patients with an adequate urine volume participated in this program. Nutritional counseling was done in all the patients. They were on hemodialysis for five hours at a time. The blood flow rate of more than 200ml/min was secured. Dialyzers with the largest filtering membrane area possible were used, the physique of the patients taken into due consideration. The weekly hemodialysis treatment was continued, so long as the levels of serum urea nitrogen, serum creatinine and body weight gain were lower than 100 mg/dl, 13.0mg/dl, and 3.0kg/week, respectively. Pre-dialysis urine volume and creatinine clearance were 1, 370±160ml/ day and 4.7±0.4ml/min, respectively. The hemodialysis treatment continued for 25±5 times. There were no significant correlations between the duration and pre-dialysis levels of urine volume, creatinine clearance, serum urea nitrogen, serum creatinine, hematocrit, arterial blood pH and HCO₃^-. Hemodialysis were discontinued when there were increases in body weight (7 patients), the increase in solutes (3 patients), and both (3 patients). The average monthly medical expenses involved in once-a-week hemodialysis was 55.1% of those entailed by hemodialysis treatment three times a week. Once-a-week hemodialysis is suitable for the conditions: 1. Patients have an ad quate urine volume and no severe edema. 2. Serum urea nitrogen and creatinine levels are not extremely high. 3. Patients fully comply with their dietitian's advice. 4. Shunt blood fl ow is kept enough. Provided these conditions are met, our study suggested, once-aweek hemodialysis should be considered as one of the treatment options, because it was proved effective in reducting CRF patients psychological burden, maintaining residual renal function, and cutting medical costs.

The primary purpose of this study was to investigate whether the baseball pitchers have asymmetric characteristics of muscle thickness (MT) in upper extremities, trunk, and lower extremities because of repetitive pitching. The secondary purpose of this study was to investigate the relationship between MT and ball speed. Twenty-six college baseball pitchers participated in this study. Twenty-six sites were selected to quantify the asymmetric characteristics of MT. The MT was measured by a B-mode ultrasound. The ball speed, measured by a radar gun, was used to quantify the pitching performance. The MT of forearm, subscapula, and chest in dominant side (pitching side) were significantly greater than those in nondominant side, and the MT of abdomen, lateral abdomen, and anterior thigh in nondominant side were significantly greater than those in dominant side. On the other hand, the MT of forearm in both sides and the MT of lateral abdomen in dominant side were significantly and positively correlated with ball speed. These results suggest that asymmetric muscle thickness in upper extremity, trunk, and lower extremity in baseball pitchers resulted from repetitive pitching, and the MT of forearm and lateral abdomen are related to the ball speed.

The present study investigates the laterality of muscle thickness (MT) in athletes who perform throwing and hitting motions. Sixty right-handed college athletes (baseball pitchers group, PG; tennis players group, TG; baseball batters group, BG and controls group, CG; all n = 15) participated in this study. Muscle thickness was measured by B-mode ultrasound at the forearm, anterior and posterior upper arm, subscapula, chest, abdomen, lateral abdomen, anterior and posterior thigh and anterior and posterior lower leg. Muscle thickness in the dominant forearm, subscapula, and chest in PG, forearm, chest, anterior and posterior upper arm in TG and the subscapula and chest in BG were significantly larger than those in the non-dominant side. On the other hand, the MT in the non-dominant lateral abdomen in PG, the abdomen and lateral abdomen in TG, and the posterior upper arm and lateral abdomen in BG were significantly larger than those in the dominant side. The ratio of dominant to non-dominant MT was significantly smaller for the internal oblique muscle and total thickness of lateral abdomen in PG, TG and BG than CG. Laterality of the internal oblique muscle and total thickness of lateral abdomen in the non-dominant side is a common characteristic of athletes who perform throwing and hitting motions.

The purpose of this study was to investigate sex differences in the muscle volume (MV) of the iliopsoas, psoas major, and iliacus muscles, normalized by fat free mass (FFM), in the elderly. The subjects were 15 males and 15 females 65 years of age or over. Serial transverse 1.5T magnetic images (10 mm slice) of each subject were taken between the 12^th thoracic vertebrae and the lesser trochanter. FFM was measured with a bioelectrical impedance analyzer. The mean MV of each muscle on the right and left sides were calculated and used for regression analysis of the relationship between MV and FFM.A significant correlation was observed between MV and FFM of the iliacus in both sexes (p<0.01), but not between the MV and FFM of the psoas major. MV normalized by FFM and cross-sectional area (CSA) normalized by FFM^2/3 showed significantly greater values for the psoas major in the males than in the females (p<0.001), but there was no sex difference in the MV or CSA normalized by FFM of the iliacus.These results suggest that elderly males tend to have a greater muscle volume and cross-sectional area of the iliopsoas than elderly females, and that these sex differences are attributable to differences in the psoas major.

The purpose of this study was to investigate the influence of a shoulder injury on rotator cuff muscle thickness and shoulder muscle strength in baseball players. Based on orthopedic medical checks performed by a doctor for 57 male collegiate baseball players, two groups, the pain-free normal group (NOR group, n=19) and the impingement test positive group (IMP group, n=17) volunteered to participate in the study. Muscle thickness of the supraspinatus, infraspinatus and posterior deltoid muscles was measured bilaterally using a B-mode ultrasound apparatus (SSD-500, Aloka) with a 5-MHz transducer. Isometric shoulder abduction strength was measured bilaterally with a hand-held dynamometer in the sitting position with the arm at 45 degrees abduction, and shoulder external and internal rotation strength were measured bilaterally with an isokinetic dynamometer in the sitting position with the upper arm at 90 degrees abduction.
When the two groups were compared, the NOR group showed significantly greater values on the dominant side than on the non-dominant side for muscle thickness of the posterior deltoid. However, the IMP group showed significantly greater values on the non-dominant side than on the dominant side of muscle thickness of the supraspinatus, the muscle strength with the abduction and external rotation (300 deg/sec) and external internal rotation strength ratio (180 deg/sec) .
Also, the IMP group had a significantly weaker dominant/non-dominant ratio of supraspinatus muscle thickness (p<0.05) and abduction strength than the NOR group (p<0.01) .
These results suggest that baseball players with positive impingement show both a morphological and functional decline in the supraspinatus muscle. The dominant side supraspinatus weakness observed in the IMP group of this study may reflect muscle atrophy and chronic fatigue.

The purpose of this study was to investigate muscle volume (MV) and strength characteristics of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis) and deltoid muscles in each shoulder of asymptomatic baseball pitchers. Twelve collegiate baseball pitchers (PG) and ten male students (CG) who never played an overhand sports volunteered to participate in this study. Magnetic resonance imaging (Straits II, Hitachi Medico, 1.5 T) was used to measure the MV of rotator cuff and deltoid muscles in both shoulders of each subject. Since the individual muscles were difficult to identify on MRI scans, the infraspinatus and teres minor were analyzed as one infraspinatus muscle. Shoulder abduction (ABD), external rotation (ER), and internal rotation (IR) strengths were measured each side using a hand-held dynamometer (Power Track II, Jtech Medical Industry) . The MV of deltoid muscle was significantly larger value on the dominant side (DOM) than on the non-dominant side (NDOM) in both the PG and CG groups (p<0.05) . However, no significant differences in the MV of the rotator cuff muscles and the measured shoulder strength (ABD, ER, and IR) were observed between both sides in either group. Similarly, no significant differences in the DOM/NDOM ratio of the muscle volume and the measured shoulder strength were observed between the two groups. These results suggest that the rotator cuff muscle volume and strength does not differ in both sides of the PG, and DOM/NDOM ratios of the rotator cuff muscle volume and strength of the PG does not differ in those of the CG.

This report presents our experience in using a dual-lumen catheter with a Dacron cuff as longterm vascular access for homodialysis in an elderly patient. The female patient who at first treated with continuous ambulatory peritoneal dialysis for chronic renal failure, but the treatment could not be continued because she developed inveterate peritonitis. Thereafter, hemodialysis was performed. However, a lot of blood access troubles occurred and consequently peripheral access was exhausted. Therefore, we placed the catheter into a right internal jugular vein. This procedure made it possible to secure enough and stable blood flow during the hemodialysis session. Thus, the clearence ratios of blood urea nitrogen and serum creatinine and the value of KT/V increased. No complications have been observed since then. We further examined whether the placement of the catheter would affect hemodynamics in brain and upper extremities, using transcranial Doppler ultrasound and plethysmography. No remarkable difference in blood flow between right and left ophthalmic arteries and decrease in arterial blood flow of right finger tips were observed. Furthermore, venous dilatation, swelling in neck and right upper extremities, and facial edema were not found. The catheter, therefore, represents a significant advance, providing immediate, durable and relatively safe access for hemodialysis after repeated blood access troubles and exhausted peripheral access.

It is known that lactic acid bacteria preparations suppress the intestinal putrefaction and improves defecation, and that lactulose acidifies the intestinal contents and stimulates the proliferationof lactic acid bacteria in the intestines and further inhibits the absorption of ammonia from the intestine, resulting in the decrease in the synthesis of urea in the liver. For this clinical study, 15 patients receiving maintenance hemodialysis were selected and were divided into two groups. They received orally either lactic acid bacteria preparations or lactulose earlier for 6 weeks, followed by administration of their combination for 6 weeks. We examined the effects of each administration on the changes in peripheral blood counts, blood chemistries, intestinal bacterial flora in a lower portion of the rectum and bowel habits. Administration of lactulose combined with lactic acid bacteria preparations following the intake of lactulose alone induced a significant decrease in the serum triglyceride levels and a significant increase in serum phosphate levels. However, administration of lactic acid bacteria preparations in combination with lactulose following the intake of lactic acid bacteria preparations alone induced no significant changes. Plasma levels of ammonia and glycohemoglobin remained unchanged. Administration of lactic acid bacteria preparation and lactulose and their combination induced the increase in the percentages of Streptococcus, Enterococcus and Staphylococcus groups in the lower portion of the rectum, whereas Candida albicans was not detected. The improvement of bowel habits was observed after administration of their combination rather than administration of lactic acid bacteria preparations and lactulose alone. These results suggest that the environmental changes of the intestine produced by administration of lactulose earlier than of the combination with lactic acid bacteria preparations are effective in changing blood chemistries, and that administration of their combination has advantages in improving the bowel habits.

To compare the effectiveness of five different muscle training movements on the biceps brachii, latissimus dorsi and trapezius muscles, eight weight-trained men (age, 20.4±0.5 years) were asked to perform three repetitions, at 70% one repetition maximum, of upright rowing (UR) and bent-over rowing (BR) exercises using a barbell ; and seated rowing (SR), front lat pull-down (LPf) and back lat pull-down (LPb) exercises using a Universal Machine. The activities of the biceps brachii, latissimus dorsi, and trapezius during the elbow flexsion and elbow extension phases of each exercise were analyzed using integrated electromyography (EMG) and normalized I-EMG. The results were as follows :1. The mean nrmsEMG values for the biceps brachii were larger during UR and LPf exercises than during BR, SR, and LPb exercises, suggesting that UR and LPf are more effective than the other movements for training the biceps brachii. The mean nrmsEMG values for the latissimus dorsi were larger during SR, LPf, and LPb exercises, followed by BR and UR exercises (in descending order), suggesting that SR, LPf, and LPb exercises are more effective than the other movements for training the latissimus dorsi.2. The mean nrmsEMG values for the upper trapezius were larger during UR and BR exercises than during SR, LPf, and LPb exercises, suggesting that UR and BR exercises are more effective than the other movements for training the upper trapezius. The mean nrmsEMG values for the middle trapezius were larger during BR and SR exercises than during UR, LPf, and LPb exercises, suggesting that BR and SR exercises are more effective than the other movements for training the middle trapezius. The mean nrmsEMG values for the lower trapezius were larger during BR exercise than during other movements, suggesting that BR exercise is more effective than the other movements for training the lower trapezius.3. In all the exercises, each muscle showed a higher nrmsEMG value during the elbow flexsion phase than during the elbow extension phase. This observation suggests that the training method examined in this study should emphasize the elbow flexsion movement.The present results suggest that UR exercise is the most effective movement for training the biceps brachii and upper trapezius, BR is most effective for training the upper trapezius, middle trapezius and lower trapezius, SR is most effective for training the latissimus dorsi and middle trapezius, LPf is most effective for training the biceps brachii and latissimus dorsi, and LPb is most effective for training the latissimus dorsi.

Recent studies showed that high biocompatibility and reduction of uremic toxin contributed to the improvement of freatment outcome in hemodialysis patients.Therefore, a high-flux membrane dialyzer, especially polysulfone (PS) membrane, was generally used in dialysis. However, it was suggested that the higher efficiency of reduction in uremic toxins might cause an increase in the albumin leakage through the dialyzer membrane during dialysis, resulting in a decrease in serum albumin concentration. In this study, we used two different dialyzer membranes with high biocompatibility, namely, ethylenevinylalcohol (EVAL) membrane and improved PS membrane with a very lower leakage of serum albumin. After using these two types of mambrane of six straight months, we examined the effect of each dialyzer membrane characteristic on the serum total protein and albumin concentration. The reduction rates of each uremic solute and serum total protein concentration were significantly higher. The serum albumin concentration and its rate of change with the passing of time tended to increase in the case of the PS membrane. But in the case of EVAL membrane, these values tended to decrease. These results suggested that the differences in the changes in the serum total protein and albumin concentration might result from the differences in the efficiency of the reduction of uremic toxins. Therefore, it is necessary to consider the usage of the dialyzer membrane with a higher reduction of uremic solutes and a lower leakage of serum albumin to add to the higher biocompatibility specially in hemodialysis patients with hypoproteinemia.
Membranes ; Concentration ; Reduction (chemical) ; Serum Albumin ; Hemodialysis