Comparison of rehabilitation in patients undergoing home dialysis

Article Abstract:

The United States Congress marketed and later funded the renal (kidney) program to provide life-sustaining treatment to patients who would then be able to continue as fully employed members of society. Medicare funding resulted in the expansion of patients selected for dialysis treatment (the artificial filtration of the blood to remove wastes), and patients with little potential for a full return to society were included. Home dialysis requires that a patient take responsibility for his or her care. The willingness and ability of a patient to perform self-care may indicate an interest in the disease process as well as the possibility for subsequent return to work or school. However, one study showed that no more than 50 percent of patients using home peritoneal dialysis were employed. The proportion of patients on various forms of home dialysis who were returning to functional roles in society was assessed. The forms of dialysis evaluated included home continuous ambulatory peritoneal dialysis (CAPD), cyclic peritoneal dialysis (CCPD), and home hemodialysis (HHD). Specifically, rehabilitation was assessed in 67 CAPD patients, three CCPD patients, and 76 HHD patients. There were more blacks and diabetics among patients undergoing either CAPD or CCPD as compared to the HHD group. The percentages of patients who were working for gain, in school, homemakers, and not working were similar. Although the HHD group was more educated than the CAPD and CCPD group, the illiteracy rates were similar in all groups. If unemployable persons, such as the elderly and debilitated, were excluded, full rehabilitation was excellent in all groups. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Evaluation, Rehabilitation, Dialysis, Dialysis (Chemical process), Self-care, Health, Self care (Health)

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Clubbing in hypersensitivity pneumonitis: its prevalence and possible prognostic role

Article Abstract:

Hypersensitivity pneumonitis (HP) is a lung disease generally caused by inhalation of various dusts present in large amounts in certain occupations or hobbies. This disease results from complex immune processes that are triggered by antigens, or substances that are capable of provoking an immune response. It is characterized by inflammation of the lung parenchymal tissue, including the alveoli, interstitial tissue, and bronchioles. Pigeon breeder's disease (PBD), a form of HP reported in Mexico, is characterized by development of fiber-like tissue in the interstitial portion of the lungs. There are few tests that can predict the development of the chronic fibrotic (fiber-like) changes in HP. Digital clubbing is a condition associated with certain medical disorders such as lung disease, and is characterized by curving of the nails and enlargement of the soft tissue surrounding the nails. The relationship of finger clubbing to the prognosis of PBD was assessed in 82 patients with HP due to an avian (bird) antigen. Each patient was followed for a period ranging from one to five years. Patients were classified into three groups based on clinical, X-ray, and functional evaluation at admission to the study and one year later. Digital clubbing was diagnosed by physical examination. The results showed that 44 of 82 patients had digital clubbing at the time when PBD was diagnosed. Lung disease had worsened in 16 of 44 patients with digital clubbing and only 5 of 38 patients without clubbing. Thus, digital clubbing often develops in PBD and may be a useful predictor of whether the disease will become more severe. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Pneumoconiosis, Black lung disease, Hypersensitivity pneumonitis, Extrinsic allergic alveolitis

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Digital clubbing due to secondary hyperparathyroidism

Article Abstract:

Hyperparathyroidism is a condition resulting from increased activity of the parathyroid glands, which release hormones that control calcium and phosphorus metabolism. Cases are described of five patients receiving dialysis, a procedure to artificially filter toxic wastes from the blood, who developed clubbing, an abnormal structural change in the fingers characterized by the curving of nails and enlargement of the fingertips. The clubbing was painful and fingers were tender when touched. These changes were associated with severe hyperparathyroidism. The parathyroid gland was surgically removed in all cases between June 1986 and December 1987. The parathyroid tissue that was removed was hyperplastic, meaning it was characterized by the overgrowth of normal cells. After surgery, the symptoms of hyperparathyroidism and digital (finger) changes were improved. At this particular medical center, these five patients represented 0.6 percent of dialysis patients and 17.8 percent of patients requiring removal of the parathyroid. It is suggested that clubbing is associated with severe hyperparathyroidism and should be tested for in dialysis patients with renal osteodystrophy, or abnormal changes in the bone associated with renal failure and increased parathyroid gland activity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Kidney diseases, Hemodialysis, Hyperparathyroidism

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