中井 滋

Drug rash with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS), is a severe adverse drug reaction affecting multiple organs caused by drug treatment. The current report describes a man who was prescribed zonisamide for epilepsy and subsequently developed widespread skin rash, acute kidney injury, high-grade fever, eosinophilia, liver dysfunction, lymphadenopathy and an increase in antihuman herpesvirus-6 immunoglobulin G titer. Hypersensitivity to zonisamide was confirmed by the skin patch test. Based on these findings, the patient was diagnosed with DRESS/DIHS caused by zonisamide. This is the first report of acute kidney injury due to zonisamide-induced DRESS/DIHS.

熱による影響を受けないメンブランフィルター法を用いて培養温度の検討を行った。試料として透析液を3週にわたり週始めの液置換終了後に末端透析装置のエンドトキシン捕捉フィルター前に装着したサンプリングポートより採取した。次に、透析液を孔径0.2μmと0.45μmメンブランフィルターで吸引濾過した。メンブランブイルターの孔径の違いによるコロニー数に差はなかった。培養7日目で温度条件の違いによるコロニー数を比較すると、30℃は20℃に比し6〜22倍多く検出したが、培養14日目のコロニー数では差がなかった。培養14日目を基準に培養7日目のコロニー検出率は、20℃では3〜16%、30℃では73〜100%であった。培養日数におけるコロニー数の推移では、20℃では培養10日目よりコロニーが著しく増加し、12日目でプラトーとなった。30℃では培養5日目より著しく増加し、8日目でプラトーとなった。

菌に対する銀イオン水の殺菌効果を検討した。グラム陽性球菌としてMRSA、E.faecalis、グラム陽性桿菌(有芽胞菌)としてB.subtilis、グラム陰性桿菌としてB.cepacia、S.marcescens、L.pneumophilaを用いた。銀イオン水5ppmを基準とし滅菌蒸留水にて2倍希釈し7系列作成した。B.subtilisに対しては120分作用でも完全な殺菌まで至らず数個のコロニーを確認した。L.pneumophilaに対しては0.5分の作用で有効であった。その他の細菌に対しては0.5分の作用では無効であったが30分以上の作用で有効であった。グラム陽性球菌では30分作用時の最小殺菌濃度(MKC)より60分以上の作用でさらにMKCは低値を示した。120分作用時のMKCを比較するとグラム陽性球菌に比しグラム陰性桿菌でMKCは低値を示した。

2007年末の統計調査は全国の4,098施設を対象に実施され，4,052施設（98.88％）から回答を回収した．2007年末のわが国の透析人口は275,242人であり，昨年末に比べて10,769名（4.1％）の増加であった．人口百万人あたりの患者数は2,154人である．2006年末から2007年末までの1年間の粗死亡率は9.4％であった．透析導入症例の平均年齢は66.8歳，透析人口全体の平均年齢は64.9歳であった．透析導入症例の原疾患ごとのパーセンテージでは，糖尿病性腎症が43.4％，慢性糸球体腎炎は23.8％であった．日本透析医学会基準である透析液エンドトキシン濃度0.05EU/mL未満は，93.6％の施設で，透析液細菌数100cfu/mL未満は97.4％の施設において達成されていた．HCV抗体陽性患者が透析人口全体に占める割合は，1999年末の15.95％から2007年末には9.83％へと大幅に低下した．2007年末の透析人口全体におけるヘモグロビン濃度の平均は10.27（±1.32，s.d.）g/dLであり，過去3年間ほとんど変化していなかった．大腿骨頸部骨折の既往がある患者は，男性が透析人口1万人あたり142.9人，女性は339.0人であり，女性で圧倒的に高かった．また，大腿骨頸部骨折の既往は，低いBody Mass Indexや血清アルブミン濃度，そして糖尿病と関連していた．2007年1年間に新たに透析療法に導入された患者の透析導入時血清クレアチニン濃度は8.34（±3.55）mg/dL，推算糸球体濾過値は5.43（±3.43）mL/分/1.73m²であった．

The Japanese Society for Dialysis Therapy (JSDT) surveyed all dialysis facilities for bacteriological quality of dialysis fluid and quality controls for dialysis fluid in 2006 and 2007. The JSDT collected the data for endotoxin (ET) levels, bacterial count and usage of ET retentive filters (ETRF). The JSDT standard for ET level in dialysis fluid (<0.050 EU/ml) was achieved in 89.0% in 2006 and in 93.6% in 2007. The JSDT standard for bacterial cell counts in dialysis fluid (<100 cfu/ml) was achieved in 96.9% in 2006 and in 97.4% in 2007. The central dialysis fluid delivery system (CDDS) is a unique system developed in Japan which has easy handling for daily maintenance of delivery systems, but it has been pointed out that CDDS has a weak point for the protection of biofilms. However, the bacteriological water qualities of dialysis fluid in CDDS were proven to be extremely high in most Japanese dialysis facilities by JSDT surveys. Bacteriological water quality has a strong impact on the patient outcome. The acceptable level of ET of dialysis fluid should be <0.1 EU/ml based on the results of JSDT survey. The excellent water quality in CDDS might be one of the important factors which help good patient survival in chronic dialysis in Japan. Copyright (C) 2009 S. Karger AG, Basel

Background: Diffuse hyperpigmentation is common in patients with chronic renal failure undergoing hemodialysis (HD) or peritoneal dialysis (PD). We previously reported that serum levels of 5-S-cysteinyldopa (5SCD, a pheomelanin precursor) and pheomelanin were significantly elevated in HD patients. Methods: Skin color was assessed using a Mexameter that measures the melanin index (MI) and the erythema index (EI). The upper inner arms (non-sun-exposed site) and the foreheads (sun-exposed site) of HD and PD patients and control subjects were analyzed. Results: MI values on the upper inner arms and on the foreheads of HD and PD patients were significantly higher than in controls. In HD patients, significant correlations were found for serum 5SCD levels with MI and EI on the upper inner arm, and for EI on the forehead. In PD patients, no such correlations were found. Conclusions: Hyperpigmentation in HD patients results partly from accumulation of pheomelanin in the skin. Copyright (C) 2009 S. Karger AG, Basel

Background/Aims: To clarify the clinical significance of tumor necrosis factor (TNF) receptors in patients with myeloperoxidase (MPO)-anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis, we evaluated the cell surface expression of TNF receptor 1 (TNFR1) and TNF receptor 2 (TNFR2). Patients and Methods: 43 patients with MPO-ANCA-associated vasculitis, 16 patients with chronic renal failure, 10 patients with sepsis, 15 patients with systemic lupus erythematosus, and 18 healthy controls were enrolled in this study, and the surface expression levels of TNFR1, TNFR2, CD63, and CD64 on granulocytes were assessed. In 21 patients with MPO-ANCA-associated vasculitis, soluble TNFR1 (sTNFR1), soluble TNFR2 (sTNFR2), and TNF-alpha in the serum were also measured. Results: The surface expression levels of TNFR1 and TNFR2 on granulocytes were significantly higher in patients with MPO-ANCA-associated vasculitis than in the healthy controls, and positively correlated with the Birmingham Vasculitis Activity Score (BVAS). The levels of sTNFR1, sTNFR2, and TNF-alpha in the serum were also significantly higher in patients with MPO-ANCA-associated vasculitis than in the healthy controls. Serum levels of sTNFR1 and sTNFR2 correlated with serum creatinine, while the surface expression of TNFR1 and TNFR2 on the granulocytes did not. There was no significant correlation between the BVAS and CD63 or BVAS and CD64. Conclusion: The surface expression levels of TNFR1 and TNFR2 on granulocytes were upregulated in patients with MPO-ANCA-associated vasculitis and reflected disease activity. Copyright (C) 2009 S. Karger AG, Basel