ABSTRACT
From 1968 to 1981 6 patients with severe leptospiroses were treated: one with leptospirosis icterohaemorrhagiae (Weil's disease), two with leptospirosis copenhageni and three with leptospirosis grippotyphosa. The diagnosis must at first clinically be made from exposition anamnesis and symptoms. In three patients the agglutination lysis reaction had a negative result still between the 10th and 19th day after the beginning of the disease. In all 6 cases a hypercatabolic acute renal failure with azothaemia of high degree was present. The polyuric phase developed 10 to 18 days after the beginning of the disease, the serum creatinine values normalized 20 to 35 days after the beginning of the disease. The parenteral nutrition and the dialysis therapy were particular points in the complex therapy of the patients. 4 patients were haemodialysed - 3 of them after primary peritoneal dialysis - 2 patients were only peritoneally dialysed. On account of the hypercatabolism and the intestinal paralysis the haemodialysis is to be preferred, as a rule, to the peritoneal dialysis. Also in the haemodialysis of patients with leptospirosis modern developments should be taken into consideration: bicarbonate-containing dialytic solution and in haemorrhagic diathesis the heparin-free dialysis. All 6 own patients survived. When connecting these data with other reports from Central and South Europe the lethality of dialysed cases with leptospirosis is about 42% (25 of the 59 patients died). In 4 of 5 of our patients with leptospirosis a clear hyperamylasaemia was present, apparently the expression of the involvement of the pancreas.
Subject(s)
Acute Kidney Injury/therapy , Leptospirosis/therapy , Renal Dialysis , Acute Kidney Injury/diagnosis , Adult , Diagnosis, Differential , Humans , Leptospirosis/diagnosis , Male , Middle Aged , Weil Disease/therapyABSTRACT
In 7 haemodialysis patients with progressing renal osteopathy a partly subtotal, partly total parathyroidectomy was carried out. Postoperatively in all cases a clinical improvement developed, which, however, in part was only transient. The laboratory parameters showed a rapid tendency to normalisation, the X-ray diagnostic finding and the bone mineral content remained essentially unchanged, also the histological skeletal findings. The results are compiled in form of tables. The value of the diagnostic measures which should precede a subtotal parathyroidectomy is discussed. At present the different postoperative courses apparently cannot be prospectively estimated with the help of the hitherto usual diagnostic measures. On the basis of the partly good results and of the operation risk which is to be thoroughly demanded of a haemodialysis patient it seems that after having used all conservative possibilities the surgical interventions nevertheless indicated in progressing renal osteopathy.
