Subjective global assessment of nutritional status of patients with chronic renal insufficiency and end stage renal disease on dialysis.

OBJECTIVES: (1)To assess the nutritional status of chronic renal insufficiency (CRI) and dialysis patients using the subjective global assessment (SGA) method. (2) To validate SGA in assessing the nutritional status of this group of patients. PARTICIPANTS: The nutritional status of 81 patients was evaluated using dietary recall, anthropometry, biochemical parameters and SGA. There were 51 males and 30 females. Their mean +/- SD age was 53.8 +/- 14.3 years. There were 27 patients with (CRI) on conservative management, 38 patients with end stage renal disease (ESRD) on maintenance hemodialysis (HD) and 16 patients with ESRD on continuous ambulatory peritoneal dialysis (CAPD). METHODS: SGA was done using seven variables derived from medical history and physical examination. Each variable was scored from 1-7 depending on the severity. The SGA scores were correlated with the standard methods. RESULTS: Thirteen (48%) patients with CRI, 22 (58%) patients on HD and 8 (50%) patients on CAPD were malnourished. It was seen that the dietary protein & calorie intake and serum albumin level did not correlate well with the SGA scores. The anthropometric measures correlated with the SGA scores (Skinfolds and SGA r = 0.2, MAC and SGA r = 0.5 and MAMC and SGA r = 0.5). CONCLUSION: Malnutrition is an important complication in CRI patients and ESRD patients on dialysis. SGA is a reliable method of assessing nutritional status. Most important is the fact that it can detect the changing trend of nutritional status, which may be missed by one-time anthropometry and biochemical methods.

Terrible triad of the elbow: a case report of a new variant.

The usual terrible triad of the elbow consists of posterior dislocation of the elbow, radial head fracture and coronoid fracture. We describe a new variant of the terrible triad of the elbow consisting of fracture of the capitellum involving the full length of the trochlea and posterolateral dislocation of the elbow associated with coronoid fracture (type 1 Regan-Morrey). A 25-year-old girl was brought to the emergency ward with the history of having jumped from the third floor with an intention of committing suicide. She sustained multiple fractures, i.e, fracture ribs, bilateral intra-articular fracture of the lower end of the radius, left-side elbow injury, left subtrochanteric fracture femur and left zygomatic fracture with head injury. The elbow was stable after stabilization of the capitellum fracture through a collateral approach. Coronoid fragment was left alone, as it was a very small fragment.

Severe muscle weakness due to hyperkalemia.

Hyperkalemia is a commonly encountered electrolyte disturbance in patients with renal insufficiency. It develops very rapidly when potassium is supplemented while a patient is on a potassium-sparing diuretic. Most often it remains asymptomatic and manifests in the form of electrocardiographic changes. Muscle weakness and paralysis although described is seldom observed in clinical practice. We report one such case.

Cytomegalovirus nasal polyp after renal transplant.

Infection is a major problem after transplantation. Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients. We describe a case of CMV infection with rare clinical manifestation in the form of nasal polyp. Patient presented 6 weeks following renal transplantation with history of fever and stuffy nose. On evaluation he was found to have nasal polyp which was excised. Histopathology revealed characteristic CMV inclusion bodies. Patient responded to ganciclovir therapy and is presently doing well eighteen months after transplantation.

Alpha-fetoprotein production by rhabdomyosarcoma of the urinary bladder.

Alpha-fetoprotein has emerged as a useful diagnostic tool for hepatic tumour and tumours of germ cell origin. However, isolated case reports of association of this tumour marker with tumours of the lung and non-germ cell tumours of the ovary are reported. We present a case of a Rhabdomyosarcoma, a generally non-secretory tumour that showed raised levels of AFP in serum and reacted positively for the same in a PAP technique for AFP. Cross striations were visible in many cells on II & E stained sections.

Intraductal hepatocellular carcinoma with normal liver--case report.

Hepatocellular carcinoma commonly invades the portal vein but is rarely seen in the bile duct. When seen, a minor intraductal component usually accompanies a prominent hepatic involvement. We report a case of hepatocellular carcinoma that entirely involved the common bile duct, the hepatic involvement was undiscernible at operation or ultrasonography. The patient had obstructive jaundice both at first presentation and at recurrence. The liver was normal at both explorations. The elevated AFP levels returned to normal after second resection. The diagnosis was confirmed by electron microscopy.

Uraemia--a rare presentation of non-Hodgkin's lymphoma.

Kidney involvement by Non-Hodgkin's lymphoma is very common microscopically but rarely a cause of uraemia even when the parenchymatous involvement is considerable. Renal failure in cases of lymphoma is secondary to ureteral obstruction, hypercalcaemia, urate nephropathy, gammopathy or immunologically mediated nephrosis. This is a case where the patient presented to the ophthalmic O.P.D. with blurring of vision and admitted with full blown uraemia. He could not be saved and at autopsy, a gastrointestinal lymphoma was found in the caecum. His uraemia was due to massive parenchymatous involvement of the kidney, there being no ureteral obstruction, hypercalcaemia, urate or immunologically mediated nephropathy. Very few cases are reported in literature with such a presentation.