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

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

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

Pruritus is a frequent and troublesome consequence of end-stage renal disease. We have surveyed 155 chronic dialysis patients and found pruritus to be a significant problem in approximately 70%. Seventeen patients reporting severe pruritus were treated thrice weekly with total body exposure to either UVA or UVB light. UVB light resulted in resolution of pruritus in all cases. UVA light was without significant effect. Skin biopsies obtained before and after UV phototherapy revealed elevated contents of calcium, magnesium, and phosphorus in all pruritic patients. The resolution of pruritus following UVB treatment was associated with a reduction of skin phosphorus to values comparable with nonpruritic uremics or healthy volunteers. Uremic pruritus may be due to increased skin divalent ion content resulting in microprecipitation of calcium or magnesium phosphate.
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PMID:Uremic pruritus: skin divalent ion content and response to ultraviolet phototherapy. 400 93

A number of different chronic diseases affect the intrahepatic bile radicles or cholangioles. They include primary and secondary sclerosing cholangitis, primary biliary cirrhosis, chronic cholestatic drug jaundice, atresia, and carcinoma. Aetiological factors include infection, immunological changes, hormones, and congenital defects.Patients with chronic cholestasis have decreased bile salts in the intestinal contents and suffer from a bile salt deficiency syndrome. Failure to absorb dietary fat is managed by a low-fat diet and by medium-chain trigly-cerides which are absorbed in the absence of intestinal bile salts. Fat-soluble vitamin deficiencies are prevented by parenteral vitamins A, D, and K(1). Calcium absorption is defective, and improvement may follow intramuscular vitamin D, medium-chain triglycerides, a low-fat diet, and oral calcium supplements.In partial intestinal bile salt deficiency the anionic bile-salt-chelating resin cholestyramine controls pruritus though steatorrhoea increases. Pruritus associated with total lack of intestinal bile salts is managed by methyl-testosterone or norethandrolone, though the jaundice increases.
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PMID:Chronic cholangitides: aetiology, diagnosis, and treatment. 497 Oct 54

In 20 volunteers with normal skin, itching and concomitant erythemas and wheals were produced by mechanical stimulation with a magnetic oscillation system. In a placebo-controlled, randomized double-blind study with twice cross-over, a calcium-vitamin-D-combination as single dose ampoules for peroral application was tested. A significant decrease (p less than 0,001) of the areas of erythema and wheal and itching in treated persons, compared with non-treated and placebo-treated volunteers serving for controls, is showing the antiallergic effectiveness of the tested preparation.
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PMID:[Drug modification of mechanically evoked itching and the concomitant equivalents, erythema and wheals of the skin. Clinico-experimental studies]. 636 Aug 32

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

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

Primary biliary cirrhosis is a disease where small intra-hepatic bile ducts are destroyed as a result of an immunological reaction, presumably by cytotoxic T-lymphocytes on biliary epithelium. Analogies can be made to the graft-versus-host reaction. Hepatic copper retention is secondary to cholestasis. A circulating mitochondrial antibody is virtually constant. A mitochondrial antibody, specific for primary biliary cirrhosis, has been identified. Liver biopsy appearances have been staged but there are difficulties because of the varying rte of evolution in different parts of the liver, the focal nature of the changes and the lack of correlation with the clinical picture. Other diagnostic criteria include female sex, raised serum alkaline phosphatase values and various associated diseases. Many patients are now diagnosed when presymptomatic and such patients, particularly with granulomas in the liver, may have a normal life expectancy. General therapeutic measures include control of pruritus and prevention of fat soluble vitamin and calcium deficiencies. There is no specific treatment but D-penicillamine is useful in the later stages and prolongs survival. The prognosis in those with progressive jaundice is very poor.
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PMID:Primary biliary cirrhosis: critical evaluation and treatment policies. 675 Aug 30

An analysis of different problems raised by secondary hyperparathyroidism. This condition most often follows chronic renal failure responsible for hyperphosphataemia followed by hypocalcaemia which causes parathyroid stimulation with hyperplasia. Clinical features are dominated by osteopathic manifestations and pruritus. The diagnosis is based upon radiological examination of the skeleton, repeated measurement of serum calcium and phosphate levels and above all iliac crest biopsy. Surgical treatment is based essentially on total parathyroidectomy with autologous transplantation of parathyroid tissue into the muscles of the forearm. This is followed by study of 45 cases undergoing surgery with details concerning surveillance and postoperative care. The results were very satisfactory since amongst these 45 patients undergoing total parathyroidectomy, only two continued to suffer from bone pain.
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PMID:[Secondary hyperparathyroidism. Modern concepts of its diagnosis and treatment. Apropos of 45 cases]. 685 22

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


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