Letter: Specific uremic cardiomyopathy.
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Biomedical subjects
Publications and source records attributed to E Ritz.
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18 married men on home dialysis and 10 of their wives were interviewed (structured interview) to evaluate sexual adjustment. The frequency of intercourse prior to the onset of their disease was reported to be 3.4/week by the patients and 2.4/week by their wives. During maintenance hemodialysis, frequency was reported to be 1.7/week by the patients and 1.0/week by their wives. If libido prior to the disease was rated 100%, the patients reported their libido at the time of the interview as 66+/-34%; only 5 rated their libido as less than 50% of their libido prior to the onset of their disease. After the start of dialysis, considerable time was required before a stable state of sexual activity was reached (13.9+/-7.4 months), presumably reflecting the time required for adaptation to the procedure, loss of anxiety and restoration of physical well-being. Except in older patients, there was good agreement between the feeling of physical fitness as reported by the patients and sexual performance as reported by both the patient and his spouse.
Bone histology (iliac crest biopsies; undecalcified sections; micromorphometry) was studied by repeated biopsies in 19 patients on maintenance hemodialysis. Sampling error was assessed by taking two biopsies at one time. After an initial biopsy, patients were dialyzed either against 3.6 mEq Ca/l dialyzate or 3.9 mEq Ca/l dialyzate for 9-16 months before a second biopsy was taken. Bone histology failed to normalize irrespective of the dialyzate Ca concentration. Surface density of endosteal fibrosis diminished in a considerable proportion of the patients (9/19). Volumetric density of osteoid fell in 5 and rose in 4 of the patients.
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M. quadriceps and diaphragm were studied in Wistar rats 2, 3, und 4 weeks after 5/6 nephrectomy. Control animals were sham operated and pair fed. In 10 mu transverse cryostat sections, the following histochemical reactions were performed: NADH-dehydrogenase, myofibrillar ATP-ase, modified trichrom stain, hematoxylin-eosin. Three fibre types (I, II, intermediate) were analysed quantitatively by planimetry. Sarcolemnal nuclei per unit area and fibre cross section area were determined. In muscle specimens from uremic animals, a uniform atrophy of all three fibre types could be demonstrated. In contrast to findings in man, preferential atrophy of one of the three fibre types, increase of sarcolemnal nuclei per fibre cross section area or structural abnormalities within single muscle fibres could not be detected. Neurogenic damage could be excluded (electrophysiology, sciatic nerve planimetry). The fibre changes point to a primary disturbance of muscle metabolism.
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An arteriovenous (Cimino) shunt in both right and left forearms clotted during an episode of acute pancreatitis in two patients on chronic haemodialysis. Systemic hypercoagulability (circulating fibrin monomers, shortening of r and k time in the thrombelastogram and shortening of the PTT-time) occurred in association with inhibition of fibrinolysis (prolongation of euglobulin lysis time). Localized thrombosis at the shunt is thought to be due to superimpostition of systemic hyper-coagulability on a local increase in platelet adhesiveness.
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