Is pruritus in chronic uremic patients related to peripheral somatic and autonomic neuropathy? Study by R-R interval variation test (RRIV) and by sympathetic skin response (SSR).

The problem of pruritus in uremic dialysed patients remains unsolved. The etiology of pruritus has not been precisely explained, and sometimes no efficient treatment is available. The aim of this study was to analyse the relationship between somatic neuropathy and pruritus as well as the relationship between pruritus and dysautonomia. Fifty-one patients with end-stage renal failure underwent basic neurological examination, nerve conduction velocity studies, and pruritus assessment by means of a questionnaire. Two tests were used to assess the autonomic nervous system, namely the R-R interval variation test in basal and profound breath conditions (RRIV) and the sympathetic skin response (SSR). Pruritus was found in 63% patients of the sample. Most of them had clinical symptoms and signs of peripheral sensorimotor neuropathy and dysautonomia. About 59% of uremic patients revealed abnormally reduced RRIV. About 45% of patients had abnormal (delayed or absent) SSR. The pruritus in uremic patients occurred significantly more frequently (P < 0.01) in patients with paresthesia. A nonsignificant but sizeable trend towards a relationship of pruritus with hypohidrosis and pathological SSR results was also observed. There was no relationship between the pruritus presence and RRIV results. According to our results the activity of the nervous system might play an important role in the mechanism of uremic pruritus, but paradoxically this latter appeared more tightly related to somatic neuropathy than to autonomic dysfunction. Our results also suggest that SSR may become a useful technique for the assessment of autonomic dysfunction in uremic patients.

[Recurrent Zieve's syndrome: a case report]. / Nawracajacy zespól Zievego--opis przypadku.

We report a case of recurrent Zieve's syndrome, consisting of jaundice, hemolytic anemia and hyperlipoproteinemia, initiated by alcohol abuse. The crucial feature of this syndrome, which allows differentiation with common acute alcoholic hepatitis, is the presence of hemolysis. There is no specific treatment, and restraining from alcohol consumption remains the basic prophylactic measure.

[Uremic neuropathy is more frequent in male patients]. / Neuropatia mocznicowa jest czestsza u mezczyzn.

The aim of this study was to analyse the relationship between clinical and electrophysiological features of somatic and autonomic neuropathy and gender of 51 patients on chronic hemodialysis. Apart from basic neurological examination, conduction velocities in peripheral nerves were determined, and the function of the autonomic nervous system was assessed with the help of two tests: R-R interval variation (RRIV) and sympathetic skin response (SSR). The incidence and intensity of clinical and electrophysiological signs of sensomotor neuropathy were statistically significantly more prevalent among male patients, whereas the symptoms suggesting autonomic involvement were more frequent in women. Results of parasympathetic electrophysiological tests were similar in both groups, but abnormal SSR results prevailed in male patients.

[Coronary disease and hormonal treatment during the perimenopausal period]. / Choroba wiencowa a leczenie hormonalne w okresie okolomenopauzalnym.

Hormone replacement therapy (HRT) is widely recognized as probably most advisable treatment of perimenopausal women with cardiovascular disorders. Whenever HRT is administered for gynecological reasons, special attention should be paid to the presence of cardiological risk factors as these may be potentiated by high doses of gestogens. The authors undertake this problem inspired by a cases of a 53-years old patient (given oral lynestrol fair persisting uterine bleedings) who suffered from several complications, including venous thrombosis and myocardial infarction.

[Uremic neuropathy--I. Is uremic neuropathy related to patient age, duration of nephropathy and dialysis treatment?]. / Neuropatia mocznicowa--czesc I. Czy neuropatia mocznicowa wykazuje zwiazek z wiekiem pacjentów oraz czasem trwania nefropatii i dializoterapii?

The aim of the study was to analyse the relationship between clinical and electrophysiological features of uremic neuropathy and age of patients, duration of kidney disease, renal failure and dialysis treatment. 51 patients with end-stage renal failure without diabetes were examined. Apart from a basic neurological examination, conduction velocities in the sural and tibial nerves were determined, and in order to assess the function of the autonomic nervous system, R-R interval variation and sympathetic skin response were tested. In majority of patients, symptoms and signs of sensorimotor neuropathy were found, and about 50% of them had dysautonomia. A negative correlation between age and R-R interval variation was observed. No relationship was found between neuropathy and the duration of nephropathy, duration of renal nor dialysis treatment.

[Uremic neuropathy--II. Is pruritus in dialyzed patients related to neuropathy?]. / Neuropatia mocznicowa--czesc II. Czy swiad u pacjentów dializowanych ma zwiazek z neuropatia?

The problem of pruritus in dialyzed patients remains unsolved. The aim of this study was to analyse the relationship between pruritus and clinical symptoms and signs, and electrophysiological aspects of peripheral neuropathy, both somatic and autonomic. 51 patients with end-stage renal failure undergoing hemodialysis were examined. Diabetics were excluded. Apart from taking history and physical examination, conduction velocities in peripheral nerves were determined, and R-R interval variation (RRIV: assessment of vagal function) and sympathetic skin response (SSR) tests were performed. Pruritus was present in about 63% of patients. In majority of them, symptoms and sings of neuropathy were also found. A significant relationship between pruritus and paresthesia was noted. This indicates a possible relationship between pruritus and secondary neuropathy.

[Congenital auricular fistula imitating otogenic complication]. / Przetoka uszna wrodzona imitujaca powiklanie usznopochodne.

A 25-year-old man was brought in after a preliminary diagnosis of chronic, exacerbated right otitis media. Following our physical examination a granulated, purulen ear pit was found out behind the right auricle. At the base of the helix a non-purulent external opening of the ear pit was found out. The operation showed that we had to do with preauricular fistula embracing the auricle from above and ending with a purulent cyst above the upper back wall of the external auditory meatus. The ear pit and cyst were extirpated as a whole. A 1,5-year observation period has not shown any recurrence of the disease.