Eleven hemodialysis patients who developed refractory secondary hyperparathyroidism, despite conventional vitamin D therapy, were treated with large oral doses of 1,25-dihydroxycholecalciferol [1,25(OH)2D3]. Therapeutic regimen was a single oral dose of up to 8.0 jug administered once weekly following hemodialysis. A maximum serum level of 1,25(OH)2D occurred four hours after the 8.0 jig dose. A positive correlation (Y=84.3X-22.1: P<0.01) was found between the maximal serum 1,25(OH)2D concentration (Cmax) and the dose of 1,25(OH)2D3 when plotted on a logarithmic scale. Forty-eight hours after the administration of the 8.0 jag dose, the parathyroid hormone (PTH) level and the alkaline phosphatase activity (ALP) were markedly decreased without evidence of hypercalcemia. A significant inverse relationship was found between the Cmax of 1,25(OH)2D and the percent change in the PTH level measured after 48 hours, either with carboxy-terminal (C-PTH) or the highly sensitive mid-portion assay (HS-PTH). From these results, the level of serum 1,25(OH)2D required to blunt the rise in serum PTH was 168 pg/ml and 203 pg/ml, respectively; these serum levels were achieved by the oral administration of doses of 6.0-8.0 |LLg or higher. There were no adverse effects of treatment. Following this study, one patient was continuously treated with 8.0 jig of 1,25(OH)2D3 orally once a week for 18 months. There was a therapeutic effect (as evidenced by PTHsuppression, ALPsuppression and the disappearance of subjective complaints) without the development of severe hypercalcemia or hyperphosphatemia. This treatment may help to prevent or treat secondary hyperparathyroidism in patients receiving long-term dialysis.

An adult case of von Recklinghausen disease who became hepatitis B virus (HBV) carrier after post-transfusion hepatitis B was reported. Eight weeks after blood transfusion, a transient elevation of serum transaminases was noted without an elevation of serum bilirubin. HBsAg, HBeAg, and HBV-DNA-polymerase were positive after transfusion and have remained positive for more than 2 years. Histological findings showed chronic persistent hepatitis. It is suggested that HBV carrier state of this case may be related to immunological abnormalities due to von Recklinghausen disease or large amount of blood transfusion.

Background. Metastatic lung calcification (MLC) is an important complication in long-term dialysis patients, causing respiratory disturbance. We used single photon emission computed tomography (SPECT) in lung (L-SPECT) to detect the distribution of MLC. Methods. L-SPECT with 99m technetium hydroxymethylenediphosphonate was performed in 59 patients who had been on maintenance dialysis for more than 5 years. The accumulation count ratios were calculated from counts in the upper lung field (UL), lower lung field (LL), basal lung field along the diaphragm (BASE), and the cardiac pool (POOL). Distribution patterns of radionuclide were classified into four groups. Pulmonary function tests and blood examinations were performed.