Efficacy and safety of haemodialysis treatment with the Hemocontrol biofeedback system: a prospective medium-term study.
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BACKGROUND: Hypovolaemia has been implicated as a major causal factor of morbidity during haemodialysis (HD). A model biofeedback control system for intra-HD blood volume (BV) changes modelling has been developed (Hemocontrol), Hospal Italy) to prevent destabilizing hypovolaemia. It is based on an adaptive controller incorporated in a HD machine (Integra), Hospal Italy). The Hemocontrol biofeedback system (HBS) monitors BV contraction during HD with an optical device. HBS modulates BV contraction rates by adjusting the ultrafiltration rate (UFR) and the refilling rate by adjusting dialysate conductivity (DC) in order to obtain the desired pre-determined BV trajectories. METHODS: Nineteen hypotension-prone uraemic patients (seven males, 12 females; mean age 64.5+/-3.0 SEM years; on maintenance HD for 80.5+/-13.2 months) volunteered for the present prospective study that compared the efficacy and safety of bicarbonate HD treatment equipped with HBS, as a whole, with the gold-standard bicarbonate treatment equipped with a constant UFR and DC (BD). The study included three phases: Medium-term studies started with one period of 6 months of BD and always had a follow-up period of HBS treatment ranging from 14 to 30 months (mean 24.0+/-1.6); short-term studies started in September 1999, when all patients went back to BD treatment for a wash-out period of 4 weeks and a short-term study period of a further 3 weeks (phase A). Afterwards, they once again started HBS treatment for a wash-out period of 4 weeks and a short-term study period of a further 3 weeks (phase B). Every patient underwent acute studies during a single HD run, once during phase A and once in phase B. Resistance (R) and reactance (Xc) measurements were obtained utilizing a single-frequency (50 kHz) tetrapolar bioimpedance analysis (BIA). Extracellular fluid volume (ECV) was calculated from R, Xc, and height and body weight measurements using the conventional BIA regression equations. RESULTS: The overall occurrence of symptomatic hypotension and muscle cramps was significantly less in HBS treatment in both medium- and short-term studies. Self-evaluation of intra- and inter-HD symptoms (worst score=0, best score=10) revealed a statistically significant difference, as far as post-HD asthenia was concerned (6.2+/-0.2 in HBS treatment vs 4.3+/-0.1 in BD treatment, P<0.0001). No difference was observed between the two treatments when comparing pre- and post-HD lying blood pressure, heart rate, body weights and body weight changes in medium- and short-term studies. The residual BV%/ Delta ECV% ratio, expression of the vascular refilling, was significantly higher during HBS treatment in acute studies. CONCLUSIONS: HBS treatment is effective in lowering hypovolaemia-associated morbidity compared with BD treatment; this could be related to a greater ECV stability. Furthermore, HBS is a safe treatment in the medium-term because these results are not achieved through potentially harmful changes in blood pressure, body weight, and serum sodium concentration. (+info)
A randomized, double-blind, placebo-controlled trial of supplementary vitamins E, C and their combination for treatment of haemodialysis cramps.
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BACKGROUND: Muscle cramps that improve after carnitine or vitamin E therapies are common in haemodialysis (HD) patients. Because vitamin C participates in carnitine biosynthesis, and its levels are reduced in uraemia, subclinical vitamin C depletion may contribute to HD cramps. Our aim was to determine the effects of vitamins C, E and their combination on the frequency and intensity of HD cramps. METHODS: In this placebo-controlled, double-blind study, 60 HD-patients were randomized into four therapeutic groups. Each group (n=15) received six identical capsules daily for 8 weeks, containing one of the following: vitamin E (400 mg), vitamin C (250 mg), their combination, or placebo. RESULTS: The frequency and intensity of HD cramps decreased significantly in all three vitamin groups compared with the placebo group at the end of the trial, and compared with the pre-treatment values. At the end of the trial, vitamins E, C, their combination, and placebo produced cramp reductions of 54, 61, 97 and 7%, respectively. The percentage cramp reduction had no significant correlation with age, sex, aetiology of end-stage renal disease, serum electrolytes or HD duration, but showed a positive correlation (r=0.33, P=0.01) with the type of therapy. No vitamin-related adverse effects were encountered during the trial. CONCLUSION: Short-term treatment with the combination of vitamins E and C is safe and effective in reducing HD cramps; however, its safety for prolonged therapy has yet to be evaluated in HD patients. (+info)
Rabbitfish ("aras"): an unusual source of ciguatera poisoning.
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BACKGROUND: Ciguatera poisoning is the commonest fish-borne seafood intoxication. It is endemic to warm water tropical areas and is caused by consumption of bottom-dwelling shore reef fish, mostly during spring and summer. The causative agent, ciguatoxin, is a heat-stable ester complex that becomes concentrated in fish feeding on toxic dinoflagellates. The common clinical manifestations are a combination of gastrointestinal and neurologic symptoms. Severe poisoning may be associated with seizures and respiratory paralysis. OBJECTIVE: To describe a series of patients who sustained ciguatera poisoning in an uncommon region and from an unexpected source. PATIENTS: Two families complained of a sensation of "electrical currents," tremors, muscle cramps, nightmares, hallucinations, agitation, anxiety and nausea of varying severity several hours after consuming rabbitfish ("aras"). These symptoms lasted between 12 and 30 hours and resolved completely. The temporal relationship to a summer fish meal, the typical clinical manifestations along with the known feeding pattern of the rabbitfish suggested ciguatera poisoning. CONCLUSIONS: The Eastern Mediterranean basin is an unusual region and the rabbitfish an unusual source for ciguatera poisoning. There are no readily available and reliable means for detecting ciguatoxin in humans. A high index of suspicion is needed for diagnosis and a thorough differential diagnosis is essential to eliminate other poisonings, decompression sickness and encephalitis. Supportive therapy is the mainstay of treatment. (+info)
Cramp finding: can it be used as a new diagnostic and prognostic factor in lumbar disc surgery?
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In this prospective study, the validity and the importance of a new finding (cramp finding) in the diagnosis and outcome after lumbar disc surgery were tested. The test is performed with the person in prone position. Against a forceful knee flexion, the examiner holds the leg with one hand and applies a force to overcome the knee flexion. The finding is positive if the examined person feels a disturbing cramp in the leg or thigh. The study was performed between October 1997 and December 1999. Besides the cramp finding, the classical disc herniation examination, including mechanical and neurological findings, magnetic resonance (MR) imaging tests, and laboratory findings were checked pre- and postoperatively. The positive cramp finding in the operated group was 72% (n=133) preoperatively and straight leg raising (SLR) test was positive in all of them. Cramp finding was positive in 70%, 52%, 34%, and 8% of patients postoperatively in the first, 3rd, 12th and 24th months, respectively. The presented finding appears to be as valuable as the SLR, and especially contralateral SLR, tests in lumbar disc surgery. Cramp finding is also important in outcome evaluation. (+info)
The health of the workers in a rapidly developing country: effects of occupational exposure to noise and heat.
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Occupational hygiene and safety have not been high on the agenda of industrial management in developing countries for a variety of reasons. This cross-sectional study was undertaken to assess the exposure to noise and heat, and to study the level of occupational hygiene practiced, at a foundry in a rapidly developing country (Dubai, United Arab Emirates). Audiometry, muscle cramps and visual acuity were measured in workers at a foundry and compared with the results from workers at a soft-drink bottling plant. Thermal stress, relative humidity, ventilation, illumination and noise levels were measured at different work units at the foundry and at the soft-drink bottling factory. Thermal stress index was high while relative humidity and ventilation were low at the foundry compared with the bottling plant. Noise levels were also high at the foundry, exceeding 90 dB at almost all work units except the fabrication workshop. Mild or moderate visual defects were observed among 31% of foundry workers, compared with 19% of the bottling plant workers.Muscle cramps were reported by 30% of all workers at the foundry, compared with 5% at the bottling plant. Visual disability was the highest among furnace operators and fabricators. Mean hearing disability was 8.69 +/- 1.08% among foundry workers, compared with 4.56 +/- 0.82% among bottling plant workers. The high thermal stress, noise levels and exposure to non-ionizing radiations at the foundry might have contributed to the higher frequency of muscle cramps and the greater hearing and visual disabilities, respectively, among these workers. Non-use of personal protective equipment and poor occupational hygiene and safety measures were also seen to affect eye and ear health adversely among the workers at the foundry. (+info)
Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson's disease.
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OBJECTIVE: To investigate the efficacy of chronic pallidal deep brain stimulation (DBS) on off period dystonia, cramps, and sensory symptoms in advanced Parkinson's disease (PD). METHODS: 16 patients (6 women, 10 men; mean age at surgery 65 years) suffering from advanced PD were followed up prospectively for one year after implantation of a monopolar electrode in the posteroventral lateral globus pallidus internus. Unilateral DBS was performed in 9 patients. 10 patients had bilateral procedures (contemporaneous bilateral surgery in 7 and staged bilateral surgery in 3 instances). The decision whether to perform unilateral or bilateral surgery depended on the clinical presentation of the patient. Patients were formally assessed preoperatively, at 3-5 days, 3 months, and 12 months after surgery. RESULTS: In patients who underwent unilateral surgery, pain was present in 7 (78%), off dystonia in 5 (56%), cramps in 6 (67%), and dysaesthesia in 4 (44%). In patients who underwent bilateral surgery, pain was present in 7 (70%), off dystonia in 6 (60%), cramps in 7 (70%), and dysaesthesia in 4 (40%). With unilateral DBS, contralateral off period dystonia was improved by 100% at 1 year postoperatively, pain by 74%, cramps by 88%, and dysaesthesia by 100%. There was less pronounced amelioration of ipsilateral off period dystonia and sensory symptoms. With bilateral DBS, total scores for dystonia were improved by 86%, for pain by 90%, for cramps by 90%, and for dysaesthesia by 88%. The benefit appeared early at the first evaluation 3-5 days after surgery and was stable throughout the follow up period. CONCLUSIONS: Pallidal DBS yields major improvement of off period dystonia, cramps, and sensory symptoms in patients with advanced PD. (+info)
Creatine monohydrate treatment alleviates muscle cramps associated with haemodialysis.
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BACKGROUND: Muscle cramp is a common complication of haemodialysis. The exact mechanism of this complication is still unknown. Many approaches have been used to relieve the muscle cramping but have had variable effects. One of the possible mechanisms of haemodialysis-associated muscle cramps (HAMC) is the disturbance of muscle energy metabolism. Creatine monohydrate can enhance muscle metabolism. We evaluated the clinical effect of creatine monohydrate on HAMC. METHODS: Ten patients with frequent muscle cramps during haemodialysis were randomly selected into two groups, control and placebo. In a double-blind manner, 12 mg of creatine monohydrate or placebo was given to each patient before each dialysis session for 4 weeks. The incidence of muscle cramp during haemodialysis was compared between the two groups. Dialysis adequacy, haemodynamic status, and side-effects were also evaluated. We continued to observe and compare the patients during a 4-week washout period to verify the effect of creatine monohydrate. RESULTS: The frequency of symptomatic muscle cramps decreased by 60% in the creatine monohydrate treatment group (6.2+/-0.8 vs 2.6+/-1.8 times/4 weeks, P<0.05) during the treatment period. This decreasing incidence of muscle cramps disappeared in the washout period in the creatine group (6.6+/-1.1 times/4 weeks). There was no difference in the incidence of muscle cramps in the placebo group. The haematocrit, Kt/V, serum albumin, and haemodynamics remained unchanged in both groups during the treatment and washout periods. Serum creatinine increased slightly after creatine monohydrate treatment (10.7+/-3.2 vs 12.4+/-3.2 mg/dl, P<0.05). No adverse effect was found in either group during the treatment and washout periods. CONCLUSION: These data suggest that creatine monohydrate can reduce the incidence of HAMC and that it may be a safe agent. (+info)
Nocturnal leg cramps in older people.
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Nocturnal leg cramps are common in older people. Such cramps are associated with many common diseases and medications. Physiological methods may be useful for preventing cramps in some people, but there have been no controlled trials of these approaches. Quinine is moderately effective in preventing nocturnal leg cramps. However, there are concerns about the risk/benefit ratio with this drug. In patients with severe symptoms, a trial of 4-6 weeks' treatment with quinine is probably still justified, but the efficacy of treatment should be monitored, for example using a sleep and cramp diary. (+info)