Biomedical subjects
Publications and source records attributed to F Schillinger.
The authors report fungal contamination of the water delivery system in one of their dialysis centers. They emphasize the insufficiency of the legal recommendations for water analysis, as well as the economical and logistical consequences of this type of contamination. Finally, they suggest disinfection procedures allowing eradication of fungi.
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It can be difficult to distinguish between primary hyperoxaluria at end-stage renal failure and secondary oxalosis, all the more as primary hyperoxaluria can be latent for a long time and occur at a late stage. A 57 year-old woman, without family nor personal history of urolithiasis, receives regular hemodialysis for a renal failure discovered at end-stage. Eighteen months later, calcium oxalate deposits appear in the skin, bone marrow and both kidneys, suggesting secondary oxalosis. An other 57 year-old woman presents a chronic renal failure due to bilateral urolithiasis, whose surgery has caused a dramatic decrease of renal function requiring regular hemodialysis. Because of apparition of severe bone alterations, a parathyroidectomy is realized, and because of calcium oxalate deposition in the skin and bone marrow, primary hyperoxaluria is suspected. In both observations, the enzyme activity determination in a liver biopsy gives the diagnosis of primary hyperoxaluria.
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Uremic myopathy is relatively unknown, despite the fact that it can be quite a severe handicap. It is a non-specific proximal myopathy which must be distinguished from uremic polyneuropathy. Several disorders linked to renal insufficiency have been implicated, but these only play an adjuvant role with regard to renal osteodystrophy. Indeed the presence of myopathy in cases of severe osteodystrophy, its similarity to the myopathies associated with different types of osteomalacia and hyperparathyroidism without renal failure, suggest that the most important pathogenic factor is related to disorders of the calcium phosphate metabolism: excessive parathyroid hormone, vitamin D deficiency and/or impaired calcium transport. Treatment will depend on the predominant bone lesions: secondary hyperparathyroidism or osteomalacia. However prevention remains the best course.
After initial scepticism about its reality and despite a few disagreements, many authors now recognize the ovarian vein syndrome as a separate clinical entity, secondary to ureteral obstruction caused by dilation of the ovarian veins, which may cause lumbar pain, recurring pyelonephritis and/or lithiasic complications. The right side most frequently is affected because anatomical configuration of the right ureter is more susceptible to compression, and in fact, pregnancy appears to be an essential initiating or exacerbating factor. Thus, this anomaly might explain why painful and infectious manifestations and hydronephrosis so often develop on the right side (in over 95 p. cent of cases) during pregnancy. Its diagnosis thus must be known to be able to envisage its possible onset, by taking a careful history, and may be confirmed by certain radiological examinations. The latter, as well as treatment, depend on whether or not the patient is pregnant, its term, as well as severity of symptoms. Hence, erroneous diagnoses and incorrectly oriented surgical procedures may be avoided, while appropriate therapy is effective.
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ACKD is frequent in chronic dialysis patients: its incidence is proportional to the length of time on dialysis. It occurs also in uremic patients before dialysis and persists, despite a tendency towards involution, in transplanted patients. ACKD is frequently associated with adenoma which can evolve into adenocarcinoma. Screening studies by sonography, eventually completed by CT, are essential to discover patients with ACKD, to follow them up and propose bilateral nephrectomy if ACKD evolves towards malignancy. ACKD should be considered as a pre-malignancy state.
Since the more frequent use of highly permeable membranes and bicarbonate dialysate, hypersensitivity reactions are more often described during hemodialysis and raise the question of the entry of pyrogens from dialysate towards blood due to high permeability of membranes and to possible backfiltration. During dialysis sessions with such membranes, authors observed a severe collapse in a patient on bicarbonate fluid and a repeated Quincke's edema in another on acetate fluid. After exclusion of other causes of such hypersensitivity accidents, they discuss the role of bacterial contamination of dialysis fluid. They analyse the phenomenons of bidirectional high permeability and of backfiltration linked to these new membranes. They recall the different causes of dialysate contamination and give some means of avoiding these inconveniences which expose on one hand to acute severe reactions and on the other are prejudicial in the long term for the patients because of interleukin 1 production.
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