| The CDR ratings for cognition memory, orientation, judgement and problem solving ; and function community affairs, home and hobbies, personal care ; were assessed by consensus of the Patients were excluded if evidence of other patient's assessment team, including neurologic or psychiatric disorders i.e.: the caregiver stroke, Parkinson's disease, schizophrenia ; , dementia complicated by other organic Length of follow-up: 54 weeks disease, delirium DSM-IV ; 290.30 or 290.11 ; , depression DSM-IV 290.21 or 290.13 ; , or AD with significant delusions DSM-IV categories of 290.20 or 290.12 ; . Additional exclusion included history of alcoholism or drug misuse, hypersensitivity to cholinesterase inhibitors, or use of any investigational drug or tacrine within 1 month of screening. Patients were also excluded if they were without a reliable caregiver Characteristics of participants: see below.
Supply, the lobe based on the a. thoracica interna intercostalis made prosthetic techniques much safer. It is a well known fact that the blood supply of the skin is ensured by the so-called musculocutan perforans originating from the muscle below it. This was recognised and elaborated for use in clinical medicine by a Columbian surgeon, Ortichochea. In the head and neck region the following musculocutaneous lobes can beconsidered: platysma, sternocleidomastoideus, temporalis, trapezius, pectoralis major, latissimus dorsi. Several Hungarian authors have described their use. The heroic surgical interventions performed due to head and neck neoplasms may be accompanied by various severe complications, among them the development of pharyngocutaneous fistulas, which are undesirable side effects of the surgery of expanded oral-pharyngeal and laryngeal neoplasms. Their incidence is 2-66% in the literature. The solution of cases not healing by conservative treatment is a difficult surgical task.: random lobes next to the fistula and axial lobes found in the region may be used for this purpose. For reconstructive surgery, musculocutaneous lobes and fasciocutaneous lobes transplanted by microsurgey may be employed. In such cases, a significant alteration in speech, mastication, bite forming and swallowing is seen. The individual's appearance changes, surgical traces on the face are conspicuous. This may have more serious psychological consequences in young patients: deterioration in the quality of life and social isolation due to esthetic injuries. Several problems may emerge during the rehabilitation of tissue deficiencies in the maxillofacial region. The structural changes resulting from edentation may usually be corrected by up-to-date prosthodontic methods in an acceptable way for the patient. Complex rehabilitation including hard and soft tissue substitution, implantation for anchoring dental prostheses and permanent prosthetic rehabilitation - is essential after resection of tissue deficiencies resulting from trauma or oral neoplasms, for instance, hcl.
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I. F. Schwartz and A. Iaina neuron specific enolase NSE ; immunoreactive nerve fibers: evidence for sprouting in uremic patients on maintenance hemodialysis. Neurosci Lett 1989; 99: 281286 Fantini F, Baraldi A, Pincelli C. Neuron specific enolase-- immunoreactive fibers in uremic patients letter ; . Acta DermVenereol 1990; 70: 363364 Blanchley JD, Blankenship DM, Menter A, Parker TF III, Knochel JPI. Uremic pruritus and skin ion content. J Kidney Dis 1985; 5: 236241 Pederson JA, Matter BJ, Czerwinski AW et al. Relief of idiopathic generalized pruritus in dialysis patients treated with activated oral charcoal. Ann Intern Med 1980; 93: 446448 Graf H, Kovarik J, Stummvoll HS, Wolf A. Disappearance of uremic pruritus after lowering dialysate magnesium concentrations. Br Med J 1979; ii: 14781479 Masi CM, Cohen FP. Dialysis efficacy and itching in renal failure. Nephron 1992; 62: 257261 Carmichael AJ, Mottugh MM, Martin AM. Serological markers of renal itch in patients receiving longterm hemodialysis. Br Med J 1988; 296: 1575 Balaskas EV, Oreopoulos DG. Uraemic pruritus. Nephrol Dial Transplant 1992; 21: 192206 Cole DEC, Boucher MJ. Increased sweat sulfate concentrations in chronic renal failure. Nephron 1986; 44: 9295 Prompt CA, Quinton PM, Kleeman CR. High concentrations of sweat calcium, magnesium and phosphate in chronic renal failure. Nephron 1978; 20: 49 Massey SG, Popovtzer MM, Coburn JW, Makoff DL, Maxwell MH, Kleeman CR. Intractable itching after subtotal parathyroidectomy. New Engl J Med 1968; 279: 697700 Morachiello P, Landini S, Fracasso A et al. Combined hemodialysishemoperfusion in the treatment of secondary hyperparathyroidism of uremic patients. Blood Purif 1991; 9: 148152 Hampers CL, Katz AI, Wilson RE, Merrill JP. Disappearance of `uremic' itching after subtotal parathyroidectomy. N Engl J Med 1968; 279: 695697 Matsumoto M, Ichimari RK, Horie A. Pruritus and mast cell proliferation of the skin in end stage renal failure. Clin Nephrol 1985; 23: 285288 Dimkovic N, Djukanovic L, Radmilovic A, Bojic P, Juloski T. Uremic pruritus and skin mast cells. Nephron 1992; 61: 59 Mettang T, Fritz P, Weber J, Machleidt C, Hubel E, Kuhlmann U. Uremic pruritus in patients on hemodialysis or continuous abdominal peritoneal dialysis. The role of plasma histamine and skin mast cells. Clin Nephrol 1990; 34: 136141 Gilchrest BA, Rowe JW, Mihim MC. Clinical and histological cutaneous findings in uremia: evidence for a dialysis-resistant transplant responsive microangiopathy. Lancet 1980; 2: 12711275 Stockenhuber F, Sunder-Plassmann G, Balcke P. Increased plasma histamine levels in chronic renal failure. N Engl J Med 1987; 317: 386 Stahle-Backdahl M. Uremic pruritus: clinical and experimental studies. Acta Derm-Venereol 1989; 145 [Suppl ]: 138 De Kroes S, Smeerk G. Serum vitamin A levels and pruritus in patients on hemodialysis. Dermatologica 1983; 166: 192202 Delacoux E, Evstigneff T, Leclercq M et al. Skin disorders and vitamin A metabolism disturbances in chronic dialysis patients: the role of zinc, retinol-binding protein, retinol and retinoic acid. Clin Chim Acta 1984; 137: 283289 Rollino C, Goitre M, Piccoli G, Puiatti P, Martina G, Formica M. What is the role of sensitization in uremic pruritus? An allergologic study. Nephron 1991; 57: 319322 Kessler M, Moneret-Vautrin DA, Cau HuuT, Mariot A, Chanliau J. Dialysis pruritus and sensitization letter ; . Nephron 1992; 60: 241 Mettang T, Thomas S, Kiefer T, Fischer FP, Kuhlmann U, Wodarz R. Uraemic pruritus and exposure to di 2-ethylhexyl ; phthalate DEHP ; in haemodialysis patients. Nephrol Dial Transplant 1996; 11: 24392443 Ponticelli C, Bencini PL. Uremic pruritus: a review. Nephron 1992; 60: 15 Virus RM, Gebhart GF. Pharmacologic actions of capsaicin.
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Correspondence to: Dr. James J. Bieker, Mount Sinai School of Medicine, Box 1126, One Gustave L. Levy Place, New York, NY 10029-6374.
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Anucha Puapairoj1 , Koichi Honma2 . 1 Pathology, Faculty of Medicine, Khon Kaen University, Muang, Khon Kaen, Thailand; 2 Pathology, Dokkyo University, Mibu, Tochigi, Japan Kidneys involvemennt in occupational exposured patients were sporadically reported. We had done the light microscopic review of kidneys from autopsy materials of occupational exposed patients who died during 19802000 at Rosai hospital for Silicosis, Japan. Among 375 patients, there were 6 cases that showed light microscopic changes compatible with membranous glomerulonephritis 2 ; , mesangial proliferative glomerulonephritis 2 ; , and rapidly progressive glomerulonephritis 2 ; . Immunoperoxidase studies of Immunoglobulin G, M, A and complements C3and C1q showed no different from the primary glomerulonepritis. We concluded that in occupational exposured could cause kidney injury, however no specific pattern of glomerulonephritis to distinguished them from the primary glomerulonephritis. Some patients died of acute renal failure.Clinician should look for glomerular injury in occupational exposured patients who have renal impairment.
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S641 SURGERY FOR RETINOPATHY OF PREMATURITY -- DECISION MAKING AND SURGICAL TECHNIQUE IN STAGE IV & V ROP Rajvardhan Azad, India Surgery in retinopathy of prematurity ROP ; is seen more with awe than benefit. Recent advancement in instrumentation and better understanding of surgical anatomy has made it possible to salvage even stage V ROP cases from going to blindness. In Stage IV ROP lens sparing vitrectomy is beneficial in relieving traction on retina more so in temporal periphery. Surgery in this stage is advocated when traction leads to resultant retinal detachment in infants. Stage V ROP usually demands extensive surgery as adhesions are too many and too strong and in the extreme periphery. A Pars plana lensectomy is therefore advocated along with surgical pupilloplasty to have a wider pupillary area to remove traction in the peripheral areas. Decision making in stage V ROP depends much on configuration on USG. An open funnel usually carries a good prognosis as compared to a closed one. A wider pupilloplasty helps in preventing reproliferation and closure of funnel, as the tendency to fibroblast formation is more in this age group. The goal of surgery should be clear to retinal surgeon and parent counselling is essential especially with respect to visual outcome to ensure expectation. Recognizing objects, moving freely within home i.e. actual navigating vision should be the goal if not a very useful vision to the child.
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