Chinese Journal of Blood Purification

12 July 2012, Volume 11 Issue 7 Previous Issue    Next Issue

Select

Surgical treatment for the intractable secondary hyperparathyroidism ZHANG Ling, YAN Cai-yun, YAO Li 2012, 11 (7):  349-351.  Abstract ( 666 )   HTML ( 0 )   PDF (145KB) ( 418 )   Metrics

Select

Primary investigation of facial deformities in Sagliker syndrome MA Dan-dan, DONG Jing, ZHANG Ling, XU Bao-hua 2012, 11 (7):  352-356.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 314 )   HTML ( 0 )   PDF (396KB) ( 282 )   【Abstract】 Objective To analyze the pathogenesis factors in Sagliker Syndrome (SS) associated with severe secondary hyperparathyroidism (SHPT), and to characterize and measure the craniofacial deformities in SS.  Methods We recruited 8 SS patients and 26 simple SHPT patients diagnosed in the Department of Nephrology and Department of Dental Medical Center, China-Japan Friendship Hospital. Gender, age, cause of SHPT, dialysis age and blood biochemical parameters were compared between SS patients and simple SHPT patients. Liner regression was used to disclose the relationship between blood biochemical parameters and SS. We also selected 8 SS patients and 8 simple SHPT patients to characterize their craniofacial morphology by cephalometry on skull radiographic images. Results The male/female ratio was 0.6:1 and 1:1 (P＜0.05), the average age was 44.38 and 51.15 years (P＜0.05), and the average dialysis vintage was 145 and 125 months (P＜0.05), the average ALP was 1184 U/L and 491 U/L (P＜0.01), and the average iPTH was 2109 pg/ml and 2371 pg/ml (P＞0.05), in SS patients and simple SHPT patients, respectively. In SS patients, the maxillary body enlarged especially in sagittal and vertical directions, the anterior part of mandibula increased in the vertical direction without any other changes in this bone, and the soft tissues around mandibula changed compatible with the osseous deformities but without compensatory transposition of teeth. Conclusions Gender, age, dialysis age and several blood biochemical abnormalities may be the risk factors for SS. Craniofacial changes are found exclusively at specific sites in SS. Several yet unknown mechanisms drive higher serum ALP level and osseous deformities predominantly in craniofacial sites rather than in other skeletons in SS. 通信作者：基金项目：北京市首都医学发展科研基金研究资助项目(2009-3023) Metrics

Select

Application of SPECT-CT 99mTc-MIBI imaging in the diagnosis and therapy of mediastinal ectopic parathyroid in secondary hyperparathyroidism LI Huan, LI Hong-Lei, ZHANG Ling2 YAN Jue 2012, 11 (7):  357-359.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 284 )   HTML ( 0 )   PDF (396KB) ( 285 )   【Abstract】Objective To discuss the value of SPECT-CT 99mTc-MIBI dual-phase imaging in the precise localization of mediastinal ectopic parathyroid in secondary hyperparathyroidism. Methods A total of 98 patients with secondary hyperthyroidism underwent 99mTc-MIBI dual-phase planar and SPECT imaging. All SPECT imaging combined CT scan. Analysis and localization of fusing images were focused on the abnormal radionuclide foci in mediastinum. Results Six mediastinal ectopic parathyroid glands were found (6/98, 6.1%). In the 4 patients after parathyroidectomy, 3 cases were found to have a solitary ectopic parathyroid in mediastinum, and one case had two ectopic parathyroid glands located in the left lobe of thyroid and mediastinum. In the 2 cases treated with medication, one case was found to have a solitary ectopic parathyroid in mediastinum, and one had two ectopic parathyroid glands located in the right posterior lobe of thyroid and mediastinum. Conclusion 99mTc-MIBI SPECT-CT imaging makes a true fusion of anatomical and functional images. This method provides the most effective approach to detect ectopic parathyroid, and helps surgeons limit operation area, shorten operation time and move the gland easier Metrics

Select

Investigation of mineral and bone metabolic disorders in pre-dialysis patients with chronic kidney disease at stage 3 to 5  JIANG Hong, XU Zhi-hong, ZHANG Ling, SONG Han-ming, LI Wen-ge 2012, 11 (7):  360-364.  doi: 10.3969/j.issn.1671-4091.2012.07.00 Abstract ( 478 )   HTML ( 0 )   PDF (244KB) ( 564 )   【Abstract】Objective To investigate the calcium-phosphate metabolic condition in pre-dialysis patients with chronic kidney disease (CKD), and to obtain useful information about the diagnosis and treatment of bone metabolic disorders.  Methods We compared the levels of serum calcium, phosphate, intact parathyroid hormone (iPTH) and alkaline phosphatase (AKP), and the prevalence of secondary hyperparathyroidism (SHPT), and performed correlation analysis for these parameters among patients with different stages of CKD.  Results In CKD patients at stage 3, 4 and 5, serum calcium was 8.62±0.69, 8.48±1.31 and 7.69±1.25 mg/dl, respectively; serum phosphate was 4.37±1.33, 5.50±1.57 and 7.59±2.41 mg/dl, respectively; calcium-phosphate product was 37.64±11.09, 47.13±14.17 and 60.53±21.87 mg2/dl2, respectively; serum AKP was 146.62±130.56, 125.33±92.31 and 131.76±68.85 U/L, respectively; serum iPTH was 155.77±198.95, 353.6±381.93 and 434.37±351.03 pg/ml, respectively. In the patients at stage 3, 4 and 5, the prevalence of hypocalcemia was 22.2%, 29.4% and 68.3%, respectively; the prevalence of hyperphosphatemia was 15.6%, 56.8% and 76%, respectively; the prevalence of SHPT was 47.6%, 56.8% and 80.4%, respectively. With the progression of chronic kidney disease, serum calcium gradually decreased, serum levels of phosphate, calcium-phosphate product and intact parathyroid hormone (iPTH) increased, and the prevalence of SHPT became higher (P＜0.05). Serum iPTH level was negatively correlated with serum calcium and glomerular filtration rate (GFR), and was positively correlated with serum phosphate and calcium-phosphate product. However, serum AKP level was found to have no correlation with other biochemical parameters. Conclusion Metabolic disorders emerge early in CKD patients and deteriorate in association with the progression of CKD. Early intervention should be given to improve their outcomes. Metrics

Select

The significance of color Doppler ultrasonography in the diagnosis of secondary hyperparathyroidism: a clinical analysis ZHOU Yu-kun, LI Kang-feng, TANG Xiao-fang, SHI Ping, ZHANG Yu-xin, Zhang Liang, LI Bing, XUE Yuan-yuan, ZHANG Mei-qi, ZHAO Xue-zhi 2012, 11 (7):  365-368.  doi: 10.3969/j.issn.1671-4091.2012.07.00 Abstract ( 323 )   HTML ( 0 )   【Abstract】Objective To observe the number of proliferative parathyroid glands and the ultrasonic signal characteristics in hemodialysis patients with secondary hyperparathyroidism examined by color Doppler ultrasonography. Methods A total of 86 patients were divided into two groups: dialysis age <8 years group, and dialysis age > 8 years group. The number, length, width, thickness and volume of proliferative glands were evaluated by using color Doppler ultrasonography. Serum biochemical parameters and the color Doppler images were recorded. Surgically removed parathyroid glands were subjected to pathological examination. Results There were statistical differences in number and volume of proliferative glands, serum parathyroid hormone (PTH), and phosphorus levels between the dialysis age <8 years group and the dialysis age > 8 years group. The correlation between PTH level and the volume of proliferation glands was found in the dialysis age > 8 years group but not in the dialysis age <8 years group.  Conclusions Color Doppler ultrasonography is a simple and effective method to detect proliferative parathyroid glands and to provide information about treatment approaches. Metrics

Select

Comparisons of the therapeutic effects between patients with subtotal parathyroidectomy and those with less-than subtotal parathyroidectomy CHEN Hao-xiong, LIU Ri-guang, LI Jian-wen, CHEN Lin, CHEN Lei, FU Jun-zhou. 2012, 11 (7):  369-373.  doi: 10.3969/j.issn.1671-4091.2012.07.00 Abstract ( 2055 )   HTML ( 0 )   PDF (237KB) ( 261 )   【Abstract】Objective To compare the efficacy of subtotal parathyroidectomy and less-than subtotal parathyroidectomy in uremic patients with secondary hyperparathyroidism (SHPT). Methods We retrospectively analyzed 18 patients subjected to parathyroidectomy in this hospital from July 2007 to May 2011. The patients were assigned into two groups: less-than subtotal parathyroidectomy group (n=8), in which 3 of the 4 glands were resected, and subtotal parathyroidectomy group (n=10), in which 3 and a half of the 4 glands were removed. Serum calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca×P), intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP), as well as changes of clinical symptoms and related complications were observed before operation and after the operation for one day, one week, one month and 6 months. Results No statistical differences were found in number of parathyroid nodules, serum Ca, P, Ca×P, iPTH and ALP before operation between the two groups. There were statistical differences in Ca, P, Ca×P, iPTH and ALP before and after operation in each group (P＜0.05). In subtotal parathyroidectomy group, serum Ca was lower after operation for one week and one month (P＜0.05), P and Ca×P were lower after operation for one week, one month and six months, iPTH was lower after operation for one day, one week, one month and six months, while ALP was lower after operation for six months, as compared with those of the less-than subtotal parathyroidectomy group. In both groups, pain symptoms relieved after operation for one week, without differences in relief time and operation complications between the two groups.  Conclusion Subtotal parathyroidectomy is more effective than less-than subtotal parathyroidectomy for the treatment of persistent/recurrent hyperparathyroidism. Metrics

Select

A retrospective analysis of 62 maintenance hemodialysis patients with parathyroidectomy TANG Bing, SONG Zong-wei, HOU Da-wei, ZHAO Qing-hong, CAO Hon-gti, ZHANG Hua, WEN Ping, FANG Li, XIONG Ming-xia, YE Hong, XU Xiao-fei, ZHANG Ping, WANG Wei-wei, YANG Jun-wei 2012, 11 (7):  374-378.  doi: 10.3969/j.issn.1671-4091.2012.07.00 Abstract ( 293 )   HTML ( 0 )   PDF (264KB) ( 431 )   【Abstract】Objection To investigate the clinical manifestations and the effect of parathyroidectomy (PTX) in maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT). Methods We retrospectivelyreviewed 62 MHD patients treated with PTX cases during the period from September, 2008 to July, 2011. Their average age was 48.1±9.2 years old, and their dialysis age ranged 102.1±31.0 months. Symptoms before and after operation, operation complications, pathological findings of the surgical samples, biochemical parameters, serum iPTH, recurrence of SHPT, and prognosis were analyzed.  Results In the 62 PTX cases, 34 cases (54.8%) were subjected to total parathyroidectomy with autotransplantation, and 28 cases (45.2%) were treated with total parathyroidectomy without autotransplantation. Bone pain and pruritus relieved significantly after operation. Two cases had the early operation complication of transient hoarseness. The most prevalent postoperation complication was hypocalcemia, and 96.8% patients required oral or intravenous calcium supplement. All parathyroid samples showed nodular changes on pathological examination, some samples also accompanied with calcification, bleeding or cystic degeneration. Parathyroid adenoma was found in 3 patients (4.8%), and diffuse proliferation of parathyroid gland in 2 patients (3.2%). Serum iPTH, phosphorus and calcium decreased significantly after the operation (P＜0.05). In the 35 patients followed up after operation for more than one year, second PTX was required in 2 patients. Recurrent hyperparathyroidism was found in 6 patients treated with parathyroidectomy plus autotransplantation, of which 2 patients were diagnosed as graft-dependent recurrence and were cured by removal of the graft, and the other 4 cases were treated orally with active from of vitamin D3. Conclusion PTX is a relatively safe and effective method in the treatment of MHD patients with SHPT. Metrics

Select

Multi-center investigation of life quality and its influence factors in patients with maintenance hemodialysis in Taiyuan city WEI Bing1, LI Rong-shan1, QIAO Yu-feng, CHENG Li-juan, DU Xiao-feng, CHEN Zai-bin, WANG Hui, WANG Shuang-gui, LI De-qian, WANG Yu-jie, WEN Tao 2012, 11 (7):  379-383.  doi: 10.3969/j.issn.1671-4091.2012.07.00 Abstract ( 282 )   HTML ( 0 )   PDF (245KB) ( 270 )   【Abstract】Objective This study was designed to evaluate the quality of life (QOL) and the factors affecting QOL in patients on hemodialysis (HD) for more than two years in Taiyuan city, and to obtain information useful for the improvement of patients’ QOL and clinical practice. Methods We used a multicenter questionnaire survey, and recruited 125 patients on HD for more than two years from dialysis units in the 8 hospitals in Taiyuan city. Patients’ general condition and clinical data were collected. The Short Form-36 (SF-36) was used to measure the QOL scores. Results ① The overall SF-36 scores were 107.55±14.50 in patients on HD for more than two years. ② Age (F=4.972, P＜0.05) and gender (t=3.993, P＜0.01) affected the overall score of QOL. ③ Educational level affected QOL in their mental health (Z=-0.838, P＜0.05), residual urine volume related to QOL in their energetic level (Z=-2.465, P＜0.05), and diabetic nephropathy decreased QOL in their physiological function (Z=-2.062, P＜0.05). ④ The source of medical expanse, marital status, and different dialysis modalities had no effect on patients’ QOL. Conclusion QOL of patients on HD for more than two years was higher in Taiyuan city than in other cities. Relatively fewer factors affect QOL. Active compliance with dialysis treatment especially during the first two years is essential to increase QOL and life satisfaction. Metrics

Select

Effects of different incision site on the patency rate of autogenous arteriovenous fistula in elderly maintenance hemodialysis patients LU Zhao-xuan, ZHANG Hui-min, JIA Qiang, LU Fang-ping 2012, 11 (7):  384-387.  doi: 10.3969/j.issn.1671-4091.2012.07.00 Abstract ( 313 )   HTML ( 0 )   PDF (199KB) ( 251 )   【Abstract】 Objective To investigate the effects of autogenous arteriovenous fistula (AVF) at different incision site on patency rate in elderly maintenance hemodialysis patients. Methods A retrospective analysis was made to compare the patency rate of autogenous AVF at lower part of forearm or upper part of forearm between elderly and non-elderly hemodialysis patients. We also compared the patency rate of autogenous AVF between diabetic and non-diabetic elderly patients. Results There was no statistical difference between elderly patients and non-elderly patients in patency rate within 3-48 months after AVF operation. In elderly patients, the patency rate within 3-24 months after operation was higher in AVFs at lower part of forearm than those at upper part of forearm (X2=7.699, P=0.022; X2=6.460, P=0.026; X2=8.271, P=0.009; X2=4.643, P=0.031), the patency rate within 36-48 months after operation was lower in AVFs in diabetic patients than those in non-diabetic patients(X2=5.963, P=0.015; X2=27.388, P=0.000). Conclusion Autogenous AVF at lower part of forearm gives higher patency rate, and is preferable to be used in elderly maintenance hemodialysis patients. Diabetes affects the long-term patency rate of autogenous AVF in these patients. Metrics

Select

Preliminary study on in vitro culture of the parathyroid tissue from secondary hyperparathyroidism patients XIE Ya-ping, GUO Yu-ling, ZHANG Ling, LI Duo, LI Wen-ge, TANG Gong-yao 2012, 11 (7):  388-391.  doi: 10.3969/j.issn.1671-4091.2012.07.00 Abstract ( 290 )   HTML ( 0 )   PDF (332KB) ( 183 )   【Abstract】 Objective To detect the secretory function of the parathyroid tissue after cryopreservation, in order to provide the possibility of autotransplantation in patients with persistent hypocalcemia after total parathyroidectomy (PTX).   Methods Parathyroid tissues were rapidly cryopreserved after isolation from the patients with renal secondary hyperparathyroidism (SHPT). The tissues were thawed after one and three months, and then cultured in vitro to observe the survival of the tissues by morphological examination and intact parathyroid hormone (iPTH) assay. Results We collected parathyroid tissues from seven cases. Parathyroid tissues were confirmed by morphological examination and iPTH assay. The thawed tissues still presented secretory function. There was no difference in secretory function between frozen and fresh tissues (P>0.05). Similar secretory curves with peak at fifth to tenth days were found from frozen and fresh tissues. Transmission electron microscopy showed that integrated cellular ultrastructure was found in fresh parathyroid tissue as well as in recovered parathyroid cells after cryopreservation. Conclusions Secretory function is still presented in thawed parathyroid tissues after being frozen for one to three months, demonstrating the availability of cryopreserved parathyroid tissue for re-transplantation. Metrics