DIAGNOSIS AND TREATMENT OF CARPAL-TUNNEL SYNDROME

被引：6
作者：
BARTOVA, V
ZIMA, T
机构：
[1] Hemodialysis Unit, Llnd Department of Internal Medicine, Charles University Nábr, Prague, L Svobody 2
[2] Czechoslovakia 1st Department of Biochemistry and Medical Chemistry, Charles University Medical School, Katerinska 32
来源：
RENAL FAILURE | 1993年 / 15卷 / 04期
关键词：
D O I：
10.3109/08860229309054970
中图分类号：
R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];
学科分类号：
1002 ; 100201 ;
摘要：
Secondary amyloidosis is a complication typical for patients on long-term hemodialysis. The first clinical signs are usually shoulder joint pain and carpal tunnel syndrome (CTS). We have questioned 74 patients who were on regular hemodialysis (HD) treatment and divided them into 3 groups according to the length of HD. Group 1-on HD for 1-4 years: There were 35 patients in this group, 15 of them (i. e., 43%) had shoulder joint pain and/or CTS. None of these patients had symptoms that would require surgical treatment. Group II-on HD for 5-9 years: There were 22 patients in this group, 15 of them (i. e., 68%) had shoulder joint pain and/or CTS. Three patients from this group had severe night pain and were therefore indicated for surgical treatment for CTS, each of them on 1 hand only. In 2 cases amyloid was present in the histological examination. Group III-on HD for over 10 years: There were 17 patients in this group, 13 of them (i.e., 76%) had shoulder joint pain and/or CTS. Five patients from this group were operated on both hands for severe night pain due to carpal tunnel syndrome. Only 1 patient had positive amyloid on both hands in the histological examination. All the 8 patients (i.e., 13 hands) were examined by EMG before the operation, showing reduction of motor conduction on n. medianus by 30.7 +/- 15.1%. After the operation the EMG control was done in 4 patients (7 hands), showing no improvement in 2 cases and in 5 cases the conduction on the n. medianus was found to be in the normal range. Therefore we conclude: (a) EMG only confirms the diagnosis of carpal tunnel syndrome; (b) the indication for surgical treatment is the onset of severe night pain; (c) surprisingly, only in 4 cases, (i.e., 31%) were the histological examinations amyloid positive.
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页码：533 / 537
页数：5
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共 12 条
  • [1] Floege J., Nonnast-Daniel B., Gielow P., Brandis A., Spindler E., Hundshagen H., Koch K.M., Shaldon S., Specific imaging of dialysis-related amyloid deposits using 131 I-Beta-2-micro-globulin, Nephron, 51, pp. 444-447, (1989)
  • [2] Hoekman K., Nieuwkoop J., Willemze R., The significance of beta 2 microglobulin in clinical medicine, Neth J Med, 28, pp. 551-557, (1985)
  • [3] Homma N., Gejyo F., Isemura M., Arakawa M., Collagen-binding Affinity of beta-2-microglobulin, a preprotein of hemodialysis-associated amyloidosis, Nephron, 53, pp. 37-40, (1989)
  • [4] Kachel H., Altmeyer P., KUHn K., Koch K., Baldamus C., Deposition of non-amyloid material in connective tissue in uremia, Blood Purification, 2, pp. 142-148, (1984)
  • [5] Kleinman K.S., Coburn J.W., Amyloid syndromes associated with hemodialysis, Kidney Int., 35, pp. 567-575, (1989)
  • [6] Knauf M., Eren S., Hahn P., Hettich R., Das Karpaltunnelsyndrom bei Dialysepatienten, Medwelt, 42, pp. 431-435, (1991)
  • [7] Knudsen P.J., Leon J., Ah-Kau N.G., Shaldon S., Floege J., Koch K.M., Hemodialysis-related induction of beta-2-microglobulin and interlukin-1 synthesis and release by mononuclear phagocytes, Nephron, 53, pp. 188-193, (1989)
  • [8] Linke R.P., Hampl H., Lobeck H., Ritz E., Bommer J., Waldherr R., Eulitz M., Lysine-specific cleavage of β2-microglobulin in amyloid deposits associated with hemodialysis, Kidney Int, 36, pp. 675-681, (1989)
  • [9] Marangnoni R., Civardi F., Savino R., Manfredi A., Masi F., Avanzi C., Lino S., Haemofiltration haemoperfusion performed in series of β2 microglobulin elimination, Čas. Lék. čces., 39, pp. 1217-1220, (1989)
  • [10] Nishi S., Ogino S., Maruyama Y., Honma N., Gejyo F., Morita T., Arakawa M., Electron-microscopic and immunohistochemical study of beta-2-microglobulin-related amyloidosis, Nephron, 56, pp. 357-363, (1990)
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