Hemodialysis-related lesions of the hand

Chronic hemodialysis patients often have lesions of the hands characterized by distinctive etiopathogenic mechanisms and functional consequences. We conducted a prospective cross-sectional study in 116 patients with a mean age of 55.9 years and a mean hemodialysis duration of 8.17 years. Carpal tunnel syndrome was present in 28.4% of patients. Median nerve entrapment was bilateral in a large proportion of cases. Wasting of the lateral thenar muscles was often present at diagnosis, denoting advanced nerve compression. Amyloid was demonstrated in the carpal tunnel in 74% of cases of carpal tunnel syndrome. Digital flexor tendon lesions responsible for trigger finger or restriction of active flexion were seen in 21.5% of patients. Erosive arthropathy manifesting as deformities, pain and loss of function affected the distal interphalangeal joints in 11% of patients and the proximal interphalangeal joints or trapeziometacarpal joint in a smaller proportion of patients. Thirty per cent of patients had bony cysts located in the carpometacarpal area, carpal bones, or distal forearm bones; communication with the adjacent joint space was seen occasionally, and intracarpal derangement was a feature in some patients. Most patients had several types of lesions. The rate of occurrence of hand lesions increased markedly after ten years on hemodialysis, with devastating functional consequences.

The anatomical value of technetium-thallium subtraction scanning in detection and location of parathyroid adenomas

99mTechnetium-201Thallium subtraction scanning was performed in 24 patients with primary (N = 5) and secondary (N = 19) hyperparathyroidism. The preoperative scintigraphy (N = 12) detected 21 of 23 enlarged glands surgically removed and was helpful for detecting abnormal location especially in the mediastinum. Postoperative scanning in patients with recurrent hyperparathyroidism confirmed the excessive growth of the remaining half parathyroid after subtotal parathyroidectomy or a missing fifth parathyroid after total parathyroidectomy and autotransplantation. False negative results were due to tumor hyperplasia. The technique is recommended prior to repeated exploration in patients presenting persistent disease to predict the location of adenomas generally unsuccessfully detected by ultrasonography and computed tomography.

Aluminium transfer in bicarbonate dialysis using a sorbent regenerative system: an in vitro study

Because of the known presence of aluminium oxide in the Redy cartridge and the increased solubility of aluminium (A1) in alkaline solution, an in vitro study was performed to measure the release of A1 from the Redy cartridge and its potential transfer across a dialyser membrane. The use of bicarbonate rinsed Redy cartridges was associated with significant release of A1 and its subsequent transfer across the cellulose acetate membrane. Bicarbonate dialysis with the Redy system is not recommended for maintenance haemodialysis.

Sorbent regeneration of ultrafiltrate as a long-term treatment of end-stage renal failure

A sorbent system (Redy D 11 cartridge) capable of on-line regeneration of ultrafiltrate during hemofiltration (Amicon 0.5 m2) has been developed and applied on a 3 X 4 hr/week schedule to three patients with end-stage renal failure previously treated for up to six months with hemodialysis. Total experience, to date, is sixteen patient months (three to seven months). Tolerance to fluid removal improved with the new system. Patient well-being and rehabilitation have been maintained. The system offers the potential of hemofiltration without sterile replacement fluid or expensive fluid-balancing machines.