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

Over 12 years, 49 patients with hyperparathyroidism secondary to chronic renal failure under treatment with hemodialysis were treated with total parathyroidectomy. A portion of one gland was implanted in the sternocleidomastoid muscle. The operative indications were elevation of parathormone, serum calcium, and phosphorus, levels, pruritus, bone pain, pathologic fractures, and myalgia. Special postoperative complications discussed are hyperkalemia, hemorrhage, and respiratory obstruction. There were no operative deaths. No postoperative tetany was seen. Total parathyroidectomy should be performed in chronic renal failure patients with persistent elevation of serum calcium and parathormone levels, and who have pain, fractures, or soft tissue calcification. All postoperative parathyroidectomy patients should be observed for possible hyperkalemia.
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PMID:Surgical management of renal hyperparathyroidism in the dialysis patient. 708 63

1 alpha-hydroxycholecalciferol [1 alpha (OH)D3], the synthetic analogue of 1,25-dihydroxycholecalciferol, the active metabolite of vitamin D, was administered for a period of 18 to 24 mo to an unselected group of 12 hemodialysis patients and to 2 patients after kidney transplantation. All patients responded with a significant rise in serum Ca and Mg. The whole-body 47Ca retention, used as an index of Ca absorption, rose in eight patients and decreased or remained unchanged in four, but its overall change was not significant. Serum immunoreactive parathormone showed a general tendency to decrease. From the clinical point of view, symptomatic relief of bone pain was seen in most dialysis patients, but no significant change occurred in transplant patients. The main side effects of 1 alpha (OH)D3 treatment were hypercalcemia and pruritus, which generally subsided after the dosage was tapered off.
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PMID:Long-term effects of 1 alpha-hydroxycholecalciferol therapy in chronic hemodialysis patients. 717 69

Sixty-one patients with chronic renal failure and secondary hyperparathyroidism underwent total parathyroidectomy and parathyroid autograft. Symptoms relieved by parathyroidectomy included bone pain, pruritus, soft tissue calcification, muscle weakness and healing of fractures. Serum parathormone levels measured before and after operation in 48 patients returned to normal in all but two patients. Serum alkaline phosphatase levels also returned toward normal after operation, except in one patient with a retained parathyroid gland. Complete radiographic studies before and after operation were available in 30 of 61 patients. Twenty-three of 24 patients with osteitis fibrosa had evidence of healing, and in one patient no change occurred. Osteosclerosis noticed in 23 patients improved slightly in eight patients, did not change in 14 and became worse in one. Pathologic examinations revealed 45 patients to have diffuse hyperplasia and 16 nodular hyperplasia. There were two early postoperative deaths, in the first 30 days, and 16 late postoperative deaths, from four months to four years afterward. In no case did the operation contribute to death. Some patients required the administration of supplemental calcium after operation, but in no instance did profound hypocalcemia occur. No patient developed recurrent hyperparathyroidism.
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PMID:Treatment of secondary hyperparathyroidism in patients with chronic renal failure by total parathyroidectomy and parathyroid autograft. 724 22

Patients with hyperparathyroidism of renal failure fall into two categories: those with hypocalcemia and those with hypercalcemia. If medical management fails and operative indications are present--bone pain or fracture, metastatic calcification, progressive hypercalcemia or uncontrolled pruritus--parathyroid exploration should be done. Total parathyroidectomy and autotransplantation is the procedure of choice when hypocalcemia is present and more than one gland (usually all) is enlarged (which is the case in most patients). Parathyroid adenomectomy is the procedure of choice where autonomy of parathyroid function is established or a single gland is enlarged and all others are small; hypercalcemia is present in these patients. In other instances of hypercalcemia associated with advanced renal disease, total parathyroidectomy and autotransplantation should be performed; that is, in patients in whom more than one gland is enlarged or irregular or in whom all glands are not identified. Continued follow-up is necessary to confirm this rationale of therapy.
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PMID:Management of hyperparathyroidism in patients with renal failure. 725 4

Total parathyroidectomy and autotransplantation of tissue to the forearm was practiced in 50 chronic renal failure patients as treatment for secondary hyperparathyroidism. Four hyperplastic glands were removed in all cases. Followup observation ranged from 3 to 42 months. Serum parathyroid hormone, alkaline phosphatase, calcium and phosphorus levels decreased significantly following the procedure (P less than 0.005) and remained stable during the period of observation. Significant bone pain present in 26 patients improved or ceased in 19; pruritus, present in 39 patients, universally improved. Strong radiographic suggestion of secondary hyperparathyroidism, present in 38 patients, improved or disappeared in 17. Three patients remained functionally hyperparathyroid, requiring further tissue removal. Autograft function 3 to 7 days after transplantation was demonstrated in 3 cases by differential parathyroid hormone concentration determinations. Essentially all patients experienced symptomatic improvement after surgery and most showed objective evidence of improved calcium-phosphorus metabolism and bone healing.
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PMID:Total parathyroidectomy and autotransplantation. 731 61

Secondary (renal) hyperparathyroidism appears in chronic renal failure, sometimes in patients on chronic dialysis. Other causes includes rickets and osteomalacia. These diseases are associated with poor calcium and vitamin D absorbtion from the small bowel. Two patients with chronic renal failure maintained on chronic haemodialysis from two and three years, respectively underwent subtotal parathyroidectomy: removal of three glands and preserving a half of a gland in situ. The diagnosis and surgical indication was made upon clinical (bone pain and severe itching), radiological (demineralisation, ectopic calcifications) and biochemical (hypercalcemia, hyperphosphoremia, increased values of alkaline phosphatases) arguments. Postoperatively the improvement is defined by a return to normal in the clinical, laboratory and radiological parametres. The most appropriate operation for secondary hyperparathyroidism is still unresolved one of two techniques is performed according to the preference of the surgeon: subtotal parathyroidectomy or total parathyroidectomy with autotransplantation of parathyroid fragments into forearm muscle.
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PMID:[Secondary hyperparathyroidism]. 749 11

Some manifestations of secondary hyperparathyroidism affect most if not all patients with chronic renal failure and can affect many different organ systems. Proper medical treatment is essential and should be attempted before considering surgical intervention. The symptoms that most often resolve after parathyroidectomy include bone pain and intractable pruritus. Other useful indications for operation include a marked elevation of the parathyroid hormone level and the elevation of the calcium x phosphate product over 70. Both subtotal parathyroidectomy and total parathyroidectomy with autotransplantation have been advocated as the best operative approach. Each of these procedures has its own advantages and disadvantages which should be considered for each individual case. Localizing procedures should be reserved for patients with persistent or recurrent hyperparathyroidism, as diffuse parathyroid hyperplasia is the most common operative finding in secondary hyperparathyroidism.
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PMID:Indications for parathyroidectomy and extent of treatment for patients with secondary hyperparathyroidism. 774 53

The majority of patients with secondary hyperparathyroidism caused by chronic renal insufficiency are successfully managed medically. However, approximately 5-10 per cent develop refractory symptoms such as bone pain and pruritus requiring palliative surgical treatment. We present a series of 16 consecutive patients who were managed with sub-total parathyroidectomy over a 6-year period. With follow-up of 12-60 months, there were no operative mortalities or significant perioperative morbidities. All patients had significant improvement or resolution of their symptoms. All had biochemical improvement with reductions in their serum calcium and parathormone levels. No patients have required re-exploration for persistent or recurrent hyperparathyroidism, and there have been no cases of permanent hypoparathyroidism. We feel that sub-total parathyroidectomy remains the optimal treatment for refractory secondary hyperparathyroidism. It offers several advantages over total parathyroidectomy with autotransplantation.
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PMID:Surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure by sub-total parathyroidectomy. 803 Aug 24

A 60-year-old man has been suffering from worsening chronic urticaria for 15 years. In recent years the skin changes have been associated with bone pain, intermittent fever and pruritus. X-rays show localized bone condensation. Immunoelectrophoretic analysis documents an IgM kappa monoclonal gammopathy. Bone biopsy and bone marrow aspirate revealed no atypical lymphoid infiltration. This syndrome was first described by Schnitzler et al. Other cases have been reported, most of them by French authors. The pathogenesis of the syndrome remains unclear although anti-interleukin-1-alpha-antibodies have been found in several cases. Symptomatic treatment with ibuprofen seems promising.
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PMID:[Schnitzler syndrome]. 811 42

Twenty-seven patients, eighteen females and nine males, with chronic renal failure and secondary hyperparathyroidism, were treated by subtotal parathyroidectomy. Bone pain, in 24 patients, hypercalcemia in 2 and severe pruritus in 1 were the main indications to surgery. Result evaluation was possible in twenty four patients. Bone pain disappeared or was reduced in 20/22 patients. Serum alkaline phosphatase and PTH returned to normal in 21/24 patients. There patients had persistent hyperparathyroidism because of inadequate surgical exploration. Another group of seven patients with secondary hyperparathyroidism recalcitant to medical therapy or relapsing after subtotal parathyroidectomy was treated with calcitriol ev. After nine months of follow-up PTH and alkaline phosphatase serum levels were reduced to normal value in all patients.
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PMID:[Hyperparathyroidism resulting from chronic renal insufficiency. Diagnosis and therapy]. 850 46


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