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

Secondary hyperparathyroidism is a common complication of chronic renal disease. Clinical signs and symptoms tend to be severe and often are not controlled with medical measures. When medical therapy fails, parathyroidectomy becomes necessary. Recurrent hyperparathyroidism is not uncommon following surgery. One cause of surgical failure is parathyromatosis, which has been described as multiple nodules of hyperfunctioning parathyroid tissue scattered throughout the lower neck, superior mediastinum, or the arm if autotransplantation has been performed. Five cases of parathyromatosis in patients with chronic renal failure were identified. Clinical characteristics, course, and prognosis of the patients are reported. All patients had evidence of renal osteodystrophy and complained of severe pruritus and bone and/or joint pain. Three of the five patients had evidence of soft tissue calcification, two complained of muscle weakness, two had multiple fractures, and two eventually died of complications resulting from parathyromatosis. In four of five cases, surgical and medical management were ineffective. The patients described illustrate the severe morbidity and mortality associated with the parathyromatosis in the setting of end-stage renal disease. The pathogenesis remains controversial. Although primary prevention appears to be the most effective means of avoiding this complication, it is mandatory that meticulous care be taken during surgical manipulation. If such measures fail, calcium supplementation, calcitriol, and phosphate restriction may be tried.
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PMID:Secondary hyperparathyroidism complicated by parathyromatosis. 884 Sep 38

Pruritus is a common symptom among patients undergoing long-term hemodialysis. However, its etiology remains unclear. In an attempt to clarify its cause we tried to correlate pruritus and its intensity with several serological variables in 94 hemodialysis patients. Our results show that higher serum aluminum concentrations are found in dialysis patients with pruritus (p = 0.008) and that the intensity of pruritus is also significantly related to the aluminum concentration (p = 0.007). The intensity of pruritus was also correlated with the calcium-phosphate product (p = 0.03). Our findings suggest that prolonged exposure to aluminum in patients with chronic renal failure might be involved in the pathogenesis of uremic pruritus and elevated calcium-phosphate product seems to be an additional factor predisposing to pruritus.
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PMID:Is aluminum toxicity responsible for uremic pruritus in chronic hemodialysis patients? 903 Dec 70

The irritant and allergenic properties of the most important flower bulbs are described, as well as the clinical symptoms they cause. The tulip contains the allergen tulipalin A; sensitization and irritation are responsible for the development of tulip fingers. The same clinical picture can be caused by Alliums like the onion and garlic. The narcissus causes lily rash, a dermatitis rarely caused by sensitization. The hyacinth evokes itching in practically everyone: an irritant reaction caused by calcium oxalate crystals. Patch testing is complicated as the allergens are not all identified.
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PMID:Bulb dermatitis. Dermatological problems in the flower bulb industries. 928 68

The nephrology nurses in collaboration with the nephrologist worked closely to avoid severe symptomatology related to calcium phosphorus imbalance. The surgical team support was discontinued 48 hours after the removal of the autotransplant. The patient exhibited classic signs of secondary hyperparathyroidism, as indicated by laboratory tests, anemia, and pruritus. Despite the level of anemia, the patient did not complain of fatigue or dyspnea. A hypocalcemic crisis was avoided by the ongoing assessment and intervention the patient received from the nursing staff. Four of the five stated goals were met. The patient is free of disability as evidenced by steady gait, normal range of motion, and adequate muscle strength. The calcium and phosphorus levels and the calcium phosphorus product are within acceptable ranges (see Figure 1). J.I. has always had information about diet and medication management but has demonstrated variable adherence to the regimen. However, the nephrology nurses plan to continue with counseling and education as needed.
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PMID:Patient, nurses, and physicians collaborating in the management of a patient following autotransplant parathyroidectomy. 932 98

Once daily topical treatment of psoriasis with tacalcitol ointment (4 micrograms/g) was compared with twice daily treatment with calcipotriol ointment (50 micrograms/g) in a double-blind, randomized study over a treatment period of 8 weeks. The severity of pruritus, erythema, infiltration and scaling was scored on a scale from 0 to 4. These features were scored at the initiation of treatment, after 2, 4, 6 and 8 weeks of treatment, and at 4 weeks after discontinuation of treatment. The sum score was the total score for erythema, infiltration and scaling. Serum levels of calcium, phosphate, ionized calcium and intact parathyroid hormone were used as safety parameters. Two hundred and eighty-seven adults with stable plaque psoriasis participated and were treated at least once. Both tacalcitol and calcipotriol ointments effectively reduced the severity of psoriasis. The mean reduction in the sum score in the intention-to-treat population of 287 patients was 4.03 in the group treated with tacalcitol compared with 5.05 in the group treated with calcipotriol. The mean baseline sum scores were 7.64 and 7.15, respectively. The acceptability of both ointments was excellent, and none of the patients had adverse effects in terms of increased serum calcium or other alterations in calcium metabolism. Although less effective than calcipotriol ointment used twice daily, tacalcitol ointment is an effective and useful once daily treatment of chronic plaque psoriasis.
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PMID:Once daily treatment of psoriasis with tacalcitol compared with twice daily treatment with calcipotriol. A double-blind trial. 939 Mar 35

Determining the possible association of viral hepatitis infection and degree of pruritus is the primary concern of this study. Ninety-six adequately dialyzed CAPD patients (47 male and 49 female) and 526 normal controls (266 male and 260 female) were enrolled. Blood hemoglobin, ferritin, electrolytes, calcium, phosphate, albumin, urea, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase, and bilirubin were analyzed by routine methods. Serum HBsAg was examined, using a radioimmunoassay method and the anti-HCV, an enzyme immunoassay method. All cases were interviewed with a standardized questionnaire. The highest possible pruritus score (PS) was 22. The prevalences of HBsAg(+) and anti-HCV(+) were 14.6% and 17.7%, respectively. The mean PS in all 96 CAPD patients was 11.6 (range 7-22). The mean PS were 11.8 +/- 0.6 and 12.5 +/- 1.0 for patients infected with HBV and HCV, respectively. Both were significantly higher than that (10 +/- 0.9) of patients without hepatitis infection. AST and ALT were significantly higher in patients infected with viral hepatitis than those without. The other biochemical parameters were not significant. Thirty-seven (38.5%) of our 96 patients had mild pruritus (PS < or = 7) and 11 (15.9%) had severe pruritus (PS > or = 15). Of the 83.9% (26/31) patients with viral hepatitis, the grades of skin itching were moderate to severe; whereas those of the patients without viral hepatitis, 53.6% (37/69) belonged to the group of moderate to severe pruritus (p = 0.003, chi 2 test with Yates' correction). The authors recommended screening of viral hepatitis infection to be undertaken for uremic patients with unexplained skin itching.
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PMID:Viral hepatitis infection should be considered for evaluating uremic pruritus in continuous ambulatory peritoneal dialysis patients. 968 Nov 57

Morvan's fibrillary chorea is a rare disease characterised by symptoms which include neuromyotonia, cramping, weakness, pruritus, hyperhidrosis, insomnia, and delirium. The first case of Morvan's fibrillary chorea to be associated with clinical manifestations of myasthenia gravis with thymoma, psoriasis, and atopic dermatitis is reported. Muscle histopathology disclosed chronic denervation and myopathic changes and in vitro electrophysiology demonstrated both presynaptic and postsynaptic defects in neuromuscular transmission. Serum antibodies to acetylcholine receptors, titin, N-type calcium channels, and voltage gated potassium channels were detected. Plasmapheresis, thymectomy, and long term immunosuppression induced a dramatic resolution of symptoms. The association of thymoma with other autoimmune disorders and autoantibodies, and prolonged and sustained remission with chronic immunosuppression, place Morvan's fibrillary chorea on the range of neurological diseases arising as a paraneoplastic complication of cortical thymomas.
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PMID:Morvan's fibrillary chorea: a paraneoplastic manifestation of thymoma. 985 61

The optimal surgical procedure for severe renal secondary hyperparathyroidism (sHPT) is still a point of controversy. Total parathyroidectomy (PTX) without auto-transplantation was abandoned for fear of an adynamic bone condition; however, in the case of autotransplantation recurrent sHPT is frequent and promotes atherosclerosis. We studied 11 hemodialysis patients (age 59+/-12 years) on dialysis for 18 (12-30) years in whom total PTX was performed due to severe sHPT (group I; intact PTH: 1,240+/-230 pg/ml), and 5 patients (age 55+/-10 years) without renal insufficiency who inadvertently received total PTX during thyroid surgery (group II). After total PTX (group I, 26+/-18 [9-59] months; group II, 252+/-188 [22 480] months) both groups showed no measurable intact PTH levels. Calcium homeostasis was maintained by oral substitution with calcium (group I, calcium dialysate of 2.0 mmol/l), vitamin D and calcitriol (serum parameters in groups I and II: calcium 2.4 and 2.2 mmol/l; phosphate 1.8 and 1.1 mmol/l; 25(OH)-vitamin D(3) 21 and 34 ng/ml; 1,25(OH)(2)-vitamin D(3) 32 and 41 pg/ml, respectively). In group I, after total PTX there was a rapid and sustained improvement in bone pain with markedly enhanced physical activity and endurance. High turnover osteopathy markedly improved as indicated by declining levels of native osteocalcin (90+/-17 vs. 26+/-18 ng/ml), bone alkaline phosphatase (74+/-12 vs. 12+/-6 ng/ml), and carboxyterminal cross-linked telopeptide of type-I collagen (65+/-16 vs. 40+/-21 ng/ml) but increasing levels of carboxyterminal propeptide of type-I procollagen (120+/-36 vs. 148+/-41 ng/ml). Recalcification of bone was excellent as demonstrated by X-ray and confirmed by bone histology. Itching extravascular calcific deposits and calcifications of blood vessel and cardiac valves immediately stopped after total PTX. Moreover, 6 sHPT patients suffered from severe atherosclerotic lesions such as thoracic aortic aneurysm (n = 3) or abdominal aortic aneurysm (n = 3) which showed size progression before but not after total PTX when annually controlled by ultrasonography. In group II, even long after total PTX, there was no clinical, radiological, histological or biochemical evidence for low turnover osteopathy. In conclusion, our data indicate that substitution with vitamin D(3) metabolites and calcium can prevent deleterious bone effects of hypoparathyroidism in hemodialysis patients and in patients with normal kidney function and may compensate for the missing PTH action. Over this, a better survival rate is expected as a consequence of the beneficial effect of total PTX on the progression of atherosclerotic lesions. We suggest reconsideration of total PTX without autotransplantation in dialysis patients with severe sHPT who are not eligible for renal transplantation.
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PMID:Long-term results of total parathyroidectomy without autotransplantation in patients with and without renal failure. 1043 1

Uremic itching is an "orphan" symptom, almost equally frustrating patients and physicians. It is an unpleasant sensation and a subjective experience which is difficult to qantitate. Studying the frequency of itching among the chosen group of chronic dialysis patients, there were two questions to be answered: 1) Does the itching correlate causatively to the standard laboratory parameters? and 2) Does the itching disappear with only supplementary treatment? At the commencement of the research a sequence of laboratory parameters, presence and intensity of itching were determined, and the presence of itching 3 months afterwards. Itching of the 3rd, 4th and 5th grade was present in 44 patients (37.9%) at the beginning. Patients with itching did not differ from those without itching regarding mean predialysis values of urea, creatinine, uric acid, hematocrit, calcium, phosphorus, alkaline phosphatase, i-PTH, ALT, bilirubin, Kt/V and total heparin doses received during single dialysis procedure. Among those with itching there were not significantly more patients older than 60 years of age (chi 2 = 0.273; p > 0.05). Three months afterwards itching disappeared without particular treatment in 8 of 44 patients (22.7%), and appeared in 14 of 72 (19.5%) patients without itching at the beginning of the investigation. In conclusion, no correlation was found between uremic itching and standard laboratory parameters. Itching in chronic dialysis patients is considered to be a temporary symptom that often disappears without supplementary treatment.
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PMID:[Does uremic pruritus in hemodialyzed patients disappear only with replacement therapy?]. 1043 54

Vanilloid receptor subtype 1 (VR1), a capsaicin receptor, is expressed in primary sensory neurons and vagal nerves. Heat and protons as well as capsaicin activate VR1 to induce the influx of cations, particularly Ca2+ and Na+ ions. Characteristic effects of capsaicin are the induction of a burning sensation after acute administration and the desensitization of sensory neurons after large doses and prolonged administration. The latter feature made capsaicin cream applicable for the treatment of chronic pain and pruritus. Capsaicin alters several visceral functions, which may be mediated by action on vagal nerves and central neurons. Capsaicin affects thermoregulation after intra-hypothalamic injection and releases glutamate from the hypothalamus and cerebral cortex slices, while VR1-like immunoreactivity is not apparent in these regions. These findings taken together suggest the existence of other subtypes of vanilloid receptors in the brain.
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PMID:Peripheral and central actions of capsaicin and VR1 receptor. 1049 26


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