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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ten children with end stage renal disease on chronic hemofiltration (HF) were studied for a 1-yr period to evaluate the efficacy of 1,25-dihydroxyvitamin-D3 (1,25(OH)2D3) therapy on biohumoral parameters of renal osteodystrophy and bone mineral content. In six of these children an acute study was done of the direct effect of the HF procedure on calcium and phosphate balance during 12 HF sessions. During the first 6 months of the study all children were treated with 1,25(OH)2D3 (0.25-0.50 microgram/day) to maintain plasma calcium at 9.5-11.0 mg/dl. There was a significant increase in plasma calcium (p less than 0.05) and a significant decrease in plasma phosphate (p less than 0.01) and alkaline phosphatase concentrations (p less than 0.05). The circulating levels of NH2 immunoreactive parathyroid hormone did not change, remaining at the upper limits of reference values. Immunoreactive parathyroid hormone-COOH terminal fragment levels decreased significantly (p less than 0.05). Bone mineral content rose significantly (p less than 0.01). During the last 6 months of the study, to evaluate the possibility that HF alone might control secondary hyperparathyroidism, 1,25(OH)2D3 treatment was discontinued in five children; plasma calcium and phosphate were well controlled whereas hyperparathyroidism worsened in all five, and one also developed intense pruritus and hypertension. The other five children remained on 1,25(OH)2D3 treatment; two of these were transplanted, and the other three continued to show an improvement of mineral balance. The results of the acute study showed that calcium balance was positive with a mean Ca++ gain of 140 mg/HF session. The mean total phosphate removed per HF run was 574 mg.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of 1,25-dihydroxyvitamin-D3 treatment on mineral balance in children with end stage renal disease undergoing chronic hemofiltration. 375 54

In hyperparathyroidism associated with endstage renal failure, either subtotal, or total parathyroidectomy with autotransplantation have been advocated as potentially curative for those patients non-responsive to medical therapy. Seventeen such patients managed by the Wellington renal unit were reviewed as to indications for, and responses to, surgery. Itch, psychiatric symptoms, joint ache, muscular weakness, gritty eyes and thirst were the major symptoms for which surgery was recommended. Hypercalcaemia (universal in women) and deterioration in bone radiology were additional indications for operation. All showed remarkable postoperative improvement. Symptomatic hypocalcaemia was significant in 41%. This observation has led to intensified pre- and postoperative vitamin D and calcium therapy. Postoperative radiologic improvement at three months was apparent in 80% of patients. We advocate subtotal parathyroidectomy as the effective surgical treatment of choice for uraemic hyperparathyroidism.
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PMID:Parathyroid surgery in chronic renal failure. 386 72

On reviewing the preoperative clinical and laboratory findings and the surgical response seen in our series of 32 patients with renal hyperparathyroidism, the indication for parathyroidectomy was reevaluated. During the 5-year period from 1975 to 1979, parathyroid resection was performed in 9 patients who had various conditions for which surgery had been thought indicated. During the following period from January 1980 to March 1985, parathyroidectomy was carried out on 23 patients all of whom had roentgenologic evidence of generalized fibrous osteitis except for two whose indication for surgery was an elevation of the serum alkaline phosphatase level more than 45 KA units. The resected parathyroid glands had increased to 1 g or more in total weight in all the 25 patients who showed distinct postoperative improvement. Laboratory evidence indicating the presence of generalized fibrous osteitis, such as subperiosteal resorption on phalanx roentgenograms and high serum alkaline phosphatase level, along with marked elevation of the plasma immunoreactive parathyroid hormone level, proved to be a good indicator for medically uncontrollable secondary hyperparathyroidism. Fracture, heterotopic calcification, pruritus or persistent hypercalcemia was not a parameter of severe hyperparathyroidism warranting parathyroid resection, unless there was concomitant evidence of fibrous osteitis. The preoperative use of the recently developed noninvasive techniques for parathyroid localization also proved to be useful in detecting the parathyroid glands large enough to fulfill the requirements for parathyroidectomy.
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PMID:Surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure: reevaluation of indications for parathyroidectomy. 391 15

Results of diagnosis and treatment of renal osteodystrophy are discussed concerning 162 patients with chronic renal failure treated by hemodialysis. In most cases (15%) osteopenia and hyperparathyroidism were revealed. Roentgenologic investigation revealed metastatic calcification mostly in foot vessels, whereas microscopic study of internal organs in the lungs. The increase of calcium concentration in dialysate from 1.75 to 2.5 Mmol/l was not followed by greater calcinosis in patients with hyperphosphatemia. Uremic pruritus was treated by ultraviolet irradiation and administration of prednisolone for 3-5 days. The effect of I alpha-hydroxy-vitamin D3 was studied in 30 patients. Improvement of clinical status and, principally, relief of muscular pains in the extremities was observed as well as positive changes in blood serum biochemical indices.
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PMID:[Renal osteodystrophy and its possible correction in patients on chronic hemodialysis]. 396 79

We studied the relationships between dermal mast cell proliferation and pruritus or hyperparathyroidism in hemodialysis (HD). Skin biopsies were taken from 59 patients in end stage renal failure; 51 were on maintenance HD, and the other 8 were not. As a control, 34 non-renal failure pruritic patients were used. Thirty-one of the 59 end stage renal failure patients (52.5%) had pruritus. The incidences of pruritus found in patients on HD and those not on HD were 56.9% and 25%, respectively. Significantly larger numbers of dermal mast cells were found in HD patients than in the control. There was no clear relationship between dermal mast cell proliferation and serum parathyroid hormone (PTH) levels. We speculated that the cause of pruritus in the patients undergoing maintenance HD was due to an increase of dermal mast cells and a release of histamine as a result of extra-corporeal circulation.
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PMID:Pruritus and mast cell proliferation of the skin in end stage renal failure. 402 25

Secondary hyperparathyroidism is a recognized complication which develops in patients on hemodialysis for chronic renal failure. Parathyroidectomy may be required in patients with severe renal osteodystrophy, intractable pruritus, soft tissue and vascular calcifications or neuromuscular abnormalities. Three different operations have been employed in the treatment of patients with secondary hyperparathyroidism: total parathyroidectomy, radical subtotal (3 1/2 gland) parathyroidectomy and total parathyroidectomy with heterotopic autotransplantation. The last technique has been the procedure of choice in our group because the parathyroid mass is effectively reduced, and the results are comparable to those obtained with other techniques. Furthermore, the complication of graft dependent hyperparathyroidism, should it develop, can be managed by excising a portion of the transplanted tissue under local anesthesia.
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PMID:Surgical treatment of secondary hyperparathyroidism. 635 46

Hormones of the thyroid gland (thyroxine, tri-iodothyronine) control the metabolism of cells and tissue of the body, while parathormone and calcitonine are balancing the intra- and extracellular levels of calcium and phosphorus by governing some metabolic functions of bones, kidney and small intestine. Growth, maturation and metabolic homeostasis of the organism depend, among other intrinsic factors, on a normal production and secretory rate of both thyroidal and parathyroidal hormones. Clinical conditions of hyperthyroidism induce 1. increased metabolic turnover of the body with transcutaneous heat loss, 2. disordered growth of hairs and nails, 3. hyperpigmentation of skin, 4. pruritus with or without urticaria. Pretibial (usually symmetrical) myxedema may be associated with conditions of either hyper- or hypothyroidism (e.g., Hashimoto's thyroiditis); if combined with bilateral exophthalmus and acropachyderma of fingers and toes, it is called Diamond syndrome, or E.M.O. syndrome. In hypothyroidism, the skin feels chilly and dry, looks pale, and may present follicular keratoses with or without secondary eczema. The hair appears dull and sparse due to disordered anagen phase. Skin wounds heal with delay. Diffuse myxedema originates in the papillary and periadnexal connective tissue and eventually extends to the dermis as a whole. Clinical conditions of hyperparathyroidism rarely cause secondary calcification of the skin; they may induce severe pruritus, particularly in secondary hyperparathyroidism due to renal failure. Impetigo herpetiformis or generalized pustular psoriasis, resp., may be set off by excessive surgical removal of the goiter. Congenital maldevelopment of both thymus and parathyroid gland leads to cellular immune deficiency with secondary chronic muco-cutaneous candidosis.
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PMID:[The thyroid gland, the parathyroid gland and the skin]. 648 58

A survey of vitamin D status in 152 patients with chronic gastrointestinal conditions and 104 patients with chronic liver diseases is presented. Mild deficiency was common and severe deficiency, as judged by plasma 25-OHD levels less than 8 nmol/l, was encountered in every disease category tested. In the gastrointestinal disease patients, deficiency was significantly more common in patients following gastroenterostomy than other gastric surgery, in patients with active Crohn's disease than in those with inactive disease and in patients with chronic pancreatitis or pancreatic carcinoma with cholestatic features than in those without cholestatic features. Deficiency was as common in patients with Crohn's disease who had not been treated surgically as in those who had. There was no significant correlation between plasma 25-OHD levels and any laboratory index of malabsorption or malnutrition except for serum albumin in the gastric surgery patients, haemoglobin and ESR in the Crohn's disease patients and albumin and vitamin E in the group of patients with gastrointestinal disorders taken as a whole. In the chronic liver disease patients, those with late primary biliary cirrhosis had lower plasma 25-OHD levels than those with histological Stage I and II disease who all had normal levels, and those with pruritus and jaundice were more commonly severely deficient. Whatever the underlying disease process, patients with other coincidental medical conditions were much more likely to be deficient as were patients with cholestasis. Evidence of secondary hyperparathyroidism and osteomalacia on bone histology indicated the clinical relevance of the vitamin D deficiency. This study showed no relationship between abnormal plasma vitamin D binding protein levels and vitamin deficiency.
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PMID:A survey of vitamin D deficiency in gastrointestinal and liver disorders. 654

Renal hyperparathyroidism can be a major clinical problem in those receiving dialysis treatment and in those having renal transplants. This review of 66 patients during a five year period has led us to believe that laboratory data are useful for confirming the clinical diagnosis or for following the outcome of medical or surgical therapy. The screening for renal hyperparathyroidism should be on clinical grounds and not on isolated biochemical tests. All patients with renal failure, whether receiving dialysis therapy or renal transplantation, are at risk for having renal hyperparathyroidism develop. A careful assessment of the clinical and biochemical data is required to ensure proper patient selection for operation. Bone disease and persistent pruritus unresponsive to medical management remain the principle clinical indications for operation. Our preferred procedure is the standard subtotal parathyroidectomy.
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PMID:Surgical treatment of renal hyperparathyroidism. 662 22

Parathyroidectomy was carried out in 26 patients over a 14-year period. Excellent results were obtained in patients with severe hyperparathyroidism. Vascular calcification, hypercalcaemia and pruritus did not justify surgery unless associated with unequivocal hyperparathyroidism. 13 patients required intravenous calcium infusion for up to 2 weeks to control post-operative hypocalcaemia. Calcium requirements could be predicted from the pre-operative plasma alkaline phosphatase level. Following operation continued treatment with vitamin D was necessary to prevent hypocalcaemia. Hyperparathyroidism recurred in 1 patient after 8 years and 4 patients developed osteomalacia. Since parathyroid hormone may have toxic effects other than those on bone, maintenance of normal levels should be a long-term objective in the treatment of patients with chronic renal failure. Where large parathyroid glands are present, surgical reduction in gland mass is a logical prelude to long-term suppression of parathyroid hormone with vitamin D and phosphate-binding agents.
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PMID:Parathyroidectomy in chronic renal failure. 668 30


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