Two cases of pheochromocytoma incidentally discovered in long-term hemodialysis patients are reported. Case 1 was a 47-year-old-man who had been receiving hemodialysis for 18 years. Case 2 was a 33-year-old woman who had been receiving hemodialysis for 12 years. Both cases were normotensive, and no specific symptoms suggesting pheochromocytoma were seen. Plasma norepinephrine (NE) levels were not elevated in both cases; however, the level of epinephrine (E) was double the normal range in Case 2. After surgery, plasma E level returned to the normal range in Case 2; however, the level of NE remained almost the same as the preoperative value in both cases. Plasma catecolamine levels in long-term hemodialysis patients with pheochromocytoma are reviewed in the present report, and the efficacy of imaging methods in the diagnosis of pheochromocytoma are discussed.
Key words:dialysate temperature, blood temperature, puncture the upper extremity pain 〈Abstract〉 Numbers of dialysis patients are increasing annually in Japan, and improvements of the quality of dialysis and life are required. We investigated the association between the temperature of a dialysate used in hemodialysis and pain of the upper limb on needle prick as a complication in hemodialysis. First of all, how the blood temperature in the external circulation changed by varying the temperature of the dialysate was examined. The study involved a crossover test every three weeks, and the influence of the temperature of the dialysate on pain was examined. When the temperature of dialysis liquid was set as 36.0℃ or less, the blood temperature which passed the dialyzer fell. Moreover, when the temperature of dialysis liquid was set as 36.5℃, the blood temperature which passed the dialyzer was changeless. When the temperature of dialysis liquid was set as 37.0℃, the blood temperature which passed the dialyzer rose. Next, when the temperature of dialysis liquid was set as not less than 36.5℃, pain of the upper limb on needle prick decreased intentionally. When the temperature of dialysis liquid was set as not less than 36.5℃, the measures against the pain of the upper limbs on needle prick decreased intentionally. It was thought that a setup of dialysis liquid temperature was an effective means which can ease the pain of the upper limbs on needle prick which arise during dialysis.
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