Role of ultrasound in assessment of joint pain among hemodialysis patients

Background: Few studies including limited number of patients assessed the rheumatologic effects of hemodialysis [HD] on joints using ultrasonography. Joint ultrasound has been emerged as a cheap noninvasive tool for assessment of joint pain among HD patients. This was the aim of our study to make use of such tool in such life quality threatening complaint

Objective: to determine the role of ultrasound in evaluation of joint pain and its causes among patients on regular HD

Patients and Methods: One hundred and four patients with end stage renal disease [ESRD] who were regular on HD three sessions per week four hours per session were subjected to history taking, complete physical examination stressing on musculoskeletal examination and ultrasonography of painful joints by a an ultrasonography expert

Results: Dialysis related arthropathy [DRA] was not the only cause of joint pain among HD patients but there were diverse causes in different joints. As regard affected joints, knee was the most affected one then came wrist, shoulder, ankle and elbow respectively. As regard causes of joint pain, DRA was the commonest one then came osteoarthritis, nonspecific ultrasonographic findings and few cases showed normal ultrasonographic studies

Conclusion: This study confirmed that joint pain in HD patients has diverse causes not DRA by necessity but other causes must be considered as well as multifactorial etiologies

Lumbar Disc Surgery in Elderly

By virtue of modern neuroimaging, neurosurgeons are increasingly confronted by patients once deemed too old for lumbar disc herniation. Management of these patients is problematic, as the literature is relatively mute in regard to results and complications within this group. So, the purpose of this study is to review our experience in surgical treatment of elderly patients with this disorder and to provide a surgical reference for elderly regarding the safety of this surgery in terms of adverse perioperative events, duration of surgery, blood loss, surgery-related complications and hospital length of stay. The study included 45 patients in Suez Canal University Hospital from January 2003 to January 2005 diagnosed with lumbar disc prolapse and documented with MRI. The mean age was 66.5 years, 42% were females, 58% were males. The duration of follow up included short-term [1month] and long-term [9months]. The short-term results showed 90% success of pain relief [leg pain], while the long-term results obtained from patient questionnaire showed leg pain relief 85%, back pain relief 80%, satisfaction with surgery 82%, but return to activity 65% [lowest success rate]. The mean time spent in the hospital was 7.1 +/- 2 days postoperatively and the rate of significant complications was 8% [one case of CSF leak treated without surgery and three cases of wound infection lasted three weeks postoperatively for medical treatment]. Lumbar discectomy is relatively safe and highly effective in the elderly patients, with highly prevalent need for decompression of stenotic spine in addition to herniated disc. To resolve a persistently high failure rate we still need better patient selection and meticulous technique

role of parenteral iron therapy in treating the chronic hemodialysis associated anemia, a comparative study between iron saccharate and gluconate

Anemia in hemodialysis patients is a complex syndrome and many factors other than absolute or relative erythropoietin [EPO] deficiency may contribute to it. The most important factor is the presence of iron depletion. The impetus of this study was to assess the safety and efficacy of iron saccharate complex [ISC] and sodium ferric gluconate complex [SFGC] as relatively new parenteral iron preparations in treating anemia in hemodialysis patients. Forty-eight adult anemic patients of both genders [33 males and 15 females] who had an adequate level of both hemodialysis and nutrition status and received neither EPO nor parenteral iron therapy during the preceding 6 months were randomized into two groups. The first group, comprised 22 patients who were treated with parenteral ISC, 100 mg twice weekly for two months and once weekly thereafter. The second group included 26 patients who received SFGC, 62.5 mg twice weekly for two months and once weekly thereafter. The patients were followed up for 6 months. Our results showed that iron stores had been adequately repleted by the use of both parenteral iron formulas. Repletion of iron stores was associated with a significant rise of both hemoglobin and hematocrit% in both groups at the end of follow up period in comparison to their initial values at the start of the study [P < 0.001]. Both parenteral iron therapy preparations were tolerated and comparable with no statistical difference between both groups. Parenteral iron saccharate and gluconate are effective and sale treatment of anemia associated with chronic hemodialysis patients provided that they had an adequate level of both dialysis and nutrition

Prediction of outcome of renal transplant survival, application of artificial neural networks

One of the purposes of the evolving of the field of medical informatics is to develop decision support systems that enhance the human ability to diagnose, treat, and assess prognoses of pathologic conditions. This work is to compare the ability of an artificial neural network and a model of logistic regression to predict individual survival status at 2 years after renal transplant. Artificial neural networks [ANN s] are new computational tools, which once trained, can recall proper outputs for a specific set of inputs never encountered before. Between 1976 and 1997, 1000 patients with End-Stage-Renal Disease [ESRD] were subject to renal transplant. Survival status at 2 years was known in 725 patients, while censored cases with less than that period were excluded. Logistic regression model was built and a neural network was trained on randomly selected 80% of patients [580 patients] to predict individual status at 2 years [status = "1" for "graft loss" and "O" for "graft survival"]. We classified the risk factors into pretransplant, transplant [technical], and post-transplant predictors. The performance of the LR and ANN models, revealed a sensitivity [percentage of correctly predicted deaths] of 10.6% and 87.6%, a specificity [percentage of correctly predicted survivors] of 99% and 84%, with an overall accuracy of 85.3% and 85.8% respectively. The results show that neural network has a higher accuracy in predicting the sensitivity at the 2-years survival status. It has also a better balance between the correct prediction of losses and survivors. Probably, still some new markers are needed to differentiate those, whose survival status was not correctly predicted

Results of microvascular decompression for hemifacial spasm

Ten patients with hemifacial spasm were included in this study. Right spasm occurred in three cases and left spasm in seven. The duration of symptoms ranged from 1-7 years and averaged 4 years. No patients underwent a previous procedure prior to MVD. The operative findings were vascular compression in all cases at the root exit zone. The source of compression was purely arterial in nine cases and mixed in one. No venous compression was found. One patient died and the survivals were spasm free in the immediate postoperative period; but in the median follow up, eight cases were completely spasm free and one had recurrence controlled by re-operation. The operative complications included the morality of one case, decreased hearing in another case and slight facial weakness in a third one. It was concluded that microvascular decompression for hemifacial spasm is a safe and effective method

Study of the effectiveness of gentamycin injection in disc space during lumbar discectomy in prevention of postoperative discitis

This prospective study was performed on 150 patients operated upon by lumber discectomy. Seventy-five cases were treated by an injection of 2 ml ampoule of gentamycin in the disc space that was removed; while in the other 75, 2 ml ampoule of sterile water was injected in the disc space. The study showed six cases of postoperative discitis, all in the placebo group, and three cases were diabetics. All cases were in L4-5 disc space. The frequency of discitis was 6/150. In gentamycin group, the frequency was 0%; while in the placebo group, it was 8%. It was concluded that the intraoperative prophylaxis with gentamycin is effective in the prevention of postoperative discitis