Haemodialysis alters peripheral nerve morphology in end-stage kidney disease

Publication date: Available online 1 October 2016
Source:Clinical Neurophysiology
Author(s): Adeniyi A Borire, Ria Arnold, Bruce A. Pussell, Natalie C. Kwai, Leo H. Visser, Luca Padua, Neil G. Simon, Matthew C. Kiernan, Arun V. Krishnan
ObjectiveWe explored the nerve ultrasound (US) characteristics of 15 patients with end-stage kidney disease (ESKD) and correlated these findings with clinical severity and electrophysiological parameters of neuropathy.Methods15 ESKD patients on thrice-weekly high-flux haemodialysis and 15 healthy controls were enrolled. Sonographic and electrophysiologic studies were conducted before and after a single session of haemodialysis. Serial measurements of median nerve cross-sectional area (CSA) and hypoechoic fraction (HF) were performed at the same non-entrapment site in the mid-forearm. Neuropathy severity was quantified using the Total Neuropathy Score (TNS).Results86.7% of the ESKD cohort had neuropathy (TNS >1). ESKD patients had significantly higher baseline CSA (8.9±1.2 mm² vs 7.5±1.0 mm², p<0.05) and HF (56.0±1.0% vs 54.0±1.1%, p<0.05) compared with the control group. The CSA correlated significantly with TNS (r=0.826; p<0.0001) and other electrophysiological parameters. There was a reduction in both the CSA (8.3±1.4 mm²; p<0.01) and HF (55.0±1.6%; p<0.05) after a single session of HD. A significant relationship was also found between the change in CSA and change in serum K⁺ after dialysis (r=0.782, p<0.01).ConclusionsThis study shows that peripheral nerves in ESKD patients are larger and more hypoechoic and that these morphological abnormalities may be reversed by dialysis.SignificanceUS may be useful as an early marker of neuropathy in ESKD.



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Haemodialysis alters peripheral nerve morphology in end-stage kidney disease

Neuropathy is the most common neurological complication of end-stage kidney disease (ESKD) occurring in 60 – 90% of patients (Krishnan and Kiernan, 2009; Hojs-Fabjan and Hojs, 2006; Laaksonen et al., 2002; Van den Neucker et al., 1998). The most prominent clinical features are paraesthesia, numbness, reduction in deep tendon reflexes, impaired vibration sense, muscle atrophy and weakness, which are indicative of damage to large myelinated nerve fibres. Typically, symptoms progress in a length-dependent fashion, with greater lower-limb than upper-limb involvement (Tilki et al., 2009; Krishnan et al., 2009; Krishnan and Kiernan, 2007).

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Diffuse Hepatic Hemangiomatosis of rapid growth after Bariatric Surgery

A 59 year-old man with severe obesity was referred to our hospital for an evaluation to undergo Bariatric Surgery (BS). At the time of evaluation, his Body Mass Index was 41.9kg/m2. An abdominal Magnetic Resonance Imaging showed nodular formation of unknown cause in the liver (Fig. 1A and B). A Histopathological Exam (HE) was then performed, which demonstrated hepatic hemangiomas. After evaluation, the patient underwent a laparoscopic gastric bypass surgery without any post-operative complications.

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Interest in Collaborative, Practice-Based Research Networks in Pediatric Refugee Health Care

Abstract

Over the last decade, approximately 200,000 refugee children have resettled across the United States. This population is dispersed, resulting in limited data. Collaborative research networks, where clinicians across distinct practice sites work together to answer research questions, can improve the evidence base regarding clinical care. We distributed a web-based survey to pediatric refugee providers around North America to assess priorities, perceived barriers and benefits to collaborative research. We recruited 57 participants. Of respondents, 89 % were interested in collaborative research, prioritizing: (1) access to health care (33 %), (2) mental health (24 %) and (3) nutrition/growth (24 %). Perceived benefits were "improving clinical practice" (98 %) and "raising awareness about the needs of pediatric refugees" (94 %). Perceived barriers were "too many other priorities" (89 %) and "lack of funding for data entry" (78 %). There is widespread interest in collaborative networks around pediatric refugee healthcare. A successful network will address barriers and emphasize priorities.

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Diffuse Hepatic Hemangiomatosis of rapid growth after Bariatric Surgery

A 59 year-old man with severe obesity was referred to our hospital for an evaluation to undergo Bariatric Surgery (BS). At the time of evaluation, his Body Mass Index was 41.9kg/m2. An abdominal Magnetic Resonance Imaging showed nodular formation of unknown cause in the liver (Fig. 1A and B). A Histopathological Exam (HE) was then performed, which demonstrated hepatic hemangiomas. After evaluation, the patient underwent a laparoscopic gastric bypass surgery without any post-operative complications.

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Evaluation of focal liver lesions by magnetic resonance imaging and correlation with pathology

2016-10-01T06-28-21Z
Source: International Journal of Research in Medical Sciences
Uma Maheswara Rao M., Lakshman Rao Ch..
Background: The goals of imaging in focal liver lesions is to assess the number, size, location and characterize the lesions as benign / malignant with newer imaging modalities and confirmation of pathology by Fine needle aspiration cytology or by biopsy. This is essential for treatment planning and prognosis. Methods: A total of 42 patients detected to have focal lesions in liver on ultra-sonogram were characterized on MRI on the basis of morphology, signal characteristics, enhancement patterns. Extra hepatic spread is suggested by capsular breach, peritoneal metastases and lymph node enlargement. Tissue diagnosis was obtained by fine needle aspiration cytology/ Tru cut biopsy/ surgery. Hemangiomas and simple cysts were followed up for an average period of 7.5 months by imaging without biopsy. Results: Out of 42 patients, 28 were males (68%) and 14 were females (32%). The age range was 20 to 70 years with a mean age of 51 years for malignant lesions. The right lobe of liver was involved in 26 (62%), left lobe in 7 (17%) and both lobes in 9(21%) cases. There were 24 benign and 18 malignant lesions. The mean ADC value was 2.092 X 10-3 sec/ mm2 and 1.241 X 10-3 sec/ mm2 for benign and malignant lesions respectively. The difference in mean ADC values in both the groups was significant (p


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Anal metastasis from rectal adenocarcinoma

Abstract

The metastasis of rectal cancer to the anus is rare. Here, we report a case of advanced rectal cancer, which had a diffuse venous invasion with anal metastasis and multiple lymph node and liver metastases. The patient was a 72-year-old woman who complained of perianal pain and fresh blood in the stools for 6 months. She had neither history of fistula-in-ano nor anal surgery. Digital examination revealed a 2-cm tumor at the 7 o'clock position, and the barium enema and colonoscopy confirmed advanced rectal cancer. Abdominal computed tomography revealed thickness of the upper rectum wall, right inguinal lymph node of 10 mm and multiple liver metastases. Laparoscopically assisted anterior resection, anal tumor resection, and right inguinal lymph node resection were performed, and the histopathological examination of the resected primary and metastatic tumors confirmed similar findings of moderately differentiated adenocarcinoma, suggestive of metastasis of the rectal cancer to the anal region. In the next procedure, she had the liver lesions resected. This case suggested the importance of the careful examination of the anus during colonoscopy, or digital examination for the detection of anal metastasis.

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Corrigendum

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Editorial Board

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Editorial board

Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164





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