1/8. Laparoscopically performed gastric banding in a 13 year-old girl with morbid obesity and end stage renal insufficiency allows lifesaving weight loss and hemodialysis.OBJECTIVE: In adults, laparoscopic gastric banding is applied to treat morbid obesity, usually in combination with dietary and psychological intervention and increased physical exercise. However, little information is available on gastric banding in children. PATIENT AND methods: The 13 year-old girl suffered from end stage renal failure. Complications with hemodialysis catheters due to her extensive subcutaneous fat pads led to a life-threatening deterioration of her uremia. Intensive conventional schedules for weight reduction failed to be effective, so the morbidly obese girl (body mass index [BMI] 37.7 kg/m2, 3.6 standard deviation score [SDS]) underwent laparoscopic gastric banding at the age of 13 years after informed parental consent was obtained. RESULTS: After laparoscopic gastric banding there was a notable weight loss of 14 kg and an eventually adequate hemodialysis was possible. Total weight loss of the now 15 year-old girl was 24 kg (present BMI 28.3 kg/m2, 2.2 SDS). CONCLUSION: Even in childhood, laparoscopic gastric banding may be considered in cases of morbid obesity in critically ill patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Itch: a symptom of occult disease.BACKGROUND: pruritus, (the Latin word for itch), is defined as the 'desire to scratch'. It is a distressing, subjective symptom that may interfere significantly with the quality of a patient's life. OBJECTIVE: This article summarises the systemic causes of pruritus, describes the assessment of a patient presenting with itch without dermatological cause, and discusses the management of itch in patients with cancer. DISCUSSION: patients with pruritus that does not respond to conservative therapy should be evaluated for underlying systemic disease. Causes of systemic pruritus include cholestasis, thyroid disease, polycythaemia rubra vera, uraemia, hodgkin disease, and hiv. A thorough history and a complete physical examination are central to the evaluation of pruritus. In the absence of skin lesions, diagnostic testing is directed by the clinical evaluation and may include a complete blood count, liver function tests, serum creatinine, blood urea nitrogen levels, measurement of thyroid stimulating hormone, and chest X-ray. Removal of the causative agent and appropriate investigation and treatment of the underlying disease are essential first line measures in the treatment of pruritus.- - - - - - - - - - ranking = 6.7969513033489keywords = physical examination, physical (Clic here for more details about this article) |
3/8. cromolyn sodium: a potential therapy for uremic pruritus?Uremic pruritus occurs in up to 50% of patients undergoing chronic hemodialysis. The pathogenesis of this disabling condition is unknown but likely involves multiple pathways involving the peripheral and central nervous system as well as local chemical and inflammatory mediators. Therapy has involved modification of the dialysis procedure, topical medications such as emollients, physical treatments such as ultraviolet light, and several oral medications such as antihistamines, activated charcoal, and gabapentin. Unfortunately, most of these therapies have not been subjected to rigorous clinical trials and clinical success has been variable. Two patients with disabling uremic pruritus refractory to multiple interventions are reported, who showed significant improvement in pruritus severity as assessed by a visual analog scale when they were treated with the mast cell stabilizer cromolyn sodium. Cessation of cromolyn resulted in return of pruritus, which improved with rechallenge with the medication. cromolyn sodium may offer an alternative therapy for patients with refractory uremic pruritus, and should be subjected to a randomized placebo-controlled trial.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Organic manic syndrome associated with advanced uraemia due to polycystic kidney disease.Mania secondary to advanced uraemia caused by polycystic disease of the kidneys in a 62-year-old woman involved a complex interplay of physical, psychological and social factors. psychotherapy and thioridazine led to full recovery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Uremic neuropathy and treatment with renal transplantation.Uremic neuropathy is one of the most debilitating symptoms associated with end stage renal disease. Severity can range from mild weakness in the lower extremities to complete physical disability. The only potential cure for uremic neuropathy is renal transplantation. This article will review the literature and describe the clinical features, the etiology, and the treatment of uremic neuropathy. A case history will follow to illustrate the dramatic change in a patient who was referred to a north carolina institution with severe uremic neuropathy for renal transplantation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. A case of rhabdomyolysis in chronic renal failure.rhabdomyolysis can be induced by a variety of physical and chemical insults to skeletal muscle. Though there are only a few reports of myositis associated with viral diseases, and no reported cases of virus-induced rhabdomyolysis in uremic patients. Chronic uremic states have been known to potentiate a variety of metabolic and immunological abnormalities. Present case had an acute, progressive and fatal rhabdomyolysis which was thought to be induced by virus infection. A 43-year-old man had received hemodialysis therapy for 8 years. He suffered from an upper respiratory tract infection 11 days before admission. On admission, he was diagnosed as rhabdomyolysis with severe lactic acidosis and marked hyperkalemia. Although intensive care had been performed, he died of uncontrollable hyperkalemia (10.0 mEq/L) 2 days after admission. Maximum CPK and GOT levels were 105,200 and 56,800 mU/ml, respectively. Most probable cause of rhabdomyolysis was thought to be Parainfluenza type-3 infection, though histological examination failed to prove virus infection.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Infants of azotemic mothers: a report of three live births.women with severe renal failure rarely conceive, and when they do become pregnant these women often deliver prematurely. The clinical course of mothers with renal failure has been described, but little attention has been given to the offspring. In this report, we provide data on three infants born prematurely to mothers either on dialysis or with severe renal failure. The infants were the appropriate size for gestational age and demonstrated no obvious physical abnormalities. Laboratory data, including renal function, was also within normal limits. Renal size in the two infants studied by ultrasound was near or above the 95th percentile when corrected for gestational age. The premature birth appeared to be a function of maternal complications rather than a primary in utero growth disturbance.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Lipoid nephrosis appearing as acute oliguric renal failure.Acute oliguric renal failure previously was reported to develop in patients with preexisting idiopathic nephrotic syndrome in association with clinical evidence of vascular volume depletion. We describe an 81-year-old man without recent proteinuria or evidence of preexisting nephrotic syndrome in whom acute oliguric renal failure developed. Renal biopsy disclosed minimal change disease. Nephrotic range proteinuria without severe hypoalbuminemia was detected during the 25-day course of oliguric renal failure. Renal vein thrombosis was excluded. urine sodium concentration and fractional sodium excretion were reduced, yet left ventricular filling pressure was not subnormal and could be increased to supernormal levels without improvement in glomerular filtration rate. oliguria and azotemia were corrected following initiation of glucocorticoid therapy. This case suggests that lipoid nephrosis can appear as acute oliguric renal failure without historical or physical evidence of preexisting nephrotic syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |