Biomedical subjects

A Giangrande

Publications and source records attributed to A Giangrande.

At least 37 records · Page 2Linked to original sources

PubMed1996

Prevalence of hyperlipidemia in a cohort of CAPD patients. Italian Cooperative Peritoneal Dialysis Study Group (ICPDSG).

An association between hyperlipidemia and cardiovascular disease is well described in the literature. We conducted an observational study in order to evaluate the lipid profile, the prevalence of hyperlipidemia and its relationship with age, sex, duration of CAPD, peritoneal glucose load (PGL), serum albumin (ALB), serum glucose (GLU), and BMI in a large cohort of uremics undergoing long-term treatment with CAPD. 457 nondiabetic patients (245 males, 212 females; mean age 63.8 +/- 11.9 years; mean duration of CAPD: 41.8 +/- 26.9 months) treated during 1992 in 25 centers participating in the Italian Cooperative Peritoneal Dialysis Study Group (ICPDSG) were studied. The serum lipid parameters evaluated were triglycerides (TG), total cholesterol (CHO), HDL-cholesterol (HDL). Indications given in the New England Journal of Medicine, SI Unit Conversion Guide, 1992, were adopted for normal ranges. In the whole population the evaluation of lipid parameters showed: TG 227.4 +/- 123.3 mg/dl, CHO 232.8 +/- 56.0 mg/dl, HDL 40.7 +/- 12.0 mg/dl. No differences were found between the two sexes with regard to age, BMI, duration of CAPD, distribution of renal diseases, TG, ALB, and GLU; whereas CHO and HDL were significantly lower in males than in females (CHO: 222.2 +/- 53.5 vs. 245.0 +/- 56.5 mg/dl, p < 0.001; HDL: 39.3 +/- 11.4 vs. 42.6 +/- 12.6 mg/dl, p < 0.05). The prevalence of hypercholesterolemia was significantly lower in males than in females (19.7 vs. 35.4%; p < 0.001). The multiple regression analysis indicated that TG were directly correlated to PGL (p < 0.05), and HDL was inversely correlated with TG (p < 0.001). The coexistence of the two variables (TG and HDL) may increase the risk of cardiovascular events. Further strategies should therefore be developed to select and manage CAPD patients to reduce the incidence of hyperlipidemia.

Blood Glucose↗

PubMed1996

Minimal change nephrotic syndrome with cecum adenocarcinoma.

Membranous glomerulonephritis is the most common glomerular disease associated with malignancy, the association of minimal change glomerulopathy with solid tumor is still uncommon. We report a 72-year-old man with nephrotic syndrome due to minimal change glomerular disease; an accurate seek of underlying malignancy revealed a cecum adenocarcinoma. We had a complete remission of nephrotic syndrome after surgery of carcinoma.

Adenocarcinoma↗

PubMed1996

Development and organization of glial cells in Drosophila melanogaster.

Glial cells constitute a crucial component of the nervous system. They wrap the neuronal somata and axons and play a number of roles during normal neuronal development and activity as well as during axonal regeneration after wounding. The availability of cellular markers and genetic tools have made it possible in Drosophila to start identifying the genes and the cell-cell interactions leading to glial cell differentiation. The existence of multipotent precursor cells in the nervous system, the requirement for master genes determining the glial cell fate, the migratory abilities of fly glial cells and the existence of neuron-glial cell interactions during development are some of the features revealed by these approaches. These findings also indicate an evolutionary conservation in the developmental mechanisms between invertebrates and vertebrates. Finally, Drosophila is an ideal model system to determine in vivo the precise roles of glial cells and to study the etiology of pathologies associated with abnormal glial differentiation.

Animals↗

PubMed1995

Hypertension as a factor in chronic renal insufficiency progression in polycystic kidney disease. The Northern Italian Cooperative Study Group.

The aim of this study was to evaluate the role of blood pressure in the progression of chronic renal failure (CRF) in polycystic kidney disease, by analysing the behaviour of 74 affected patients, out of 456 CRF patients with various underlying nephropathies enrolled in a multicentre, formal prospective trial aimed at clarifying the role of protein restriction in retarding CRF progression. Because no difference was found between the patients on a low protein and those on a controlled protein diet, an inductive analysis was made by separating all of the patients into fast progressive or slowly progressive CRF groups. Hypertensive patients were defined as those with a mean resting blood pressure of more than 107 mmHg; of the 62 polycystic patients who completed the study or who reached an end point, 41 patients were hypertensive and 21 normotensive (10 of whom were pharmacologically controlled). The results of the stratified analysis, taking into account the degree of renal function deterioration and the underlying disease, showed a significant relationship between hypertension and CRF progression only in patients with polycystic kidney disease.

Adolescent↗

PubMed1995

Proneural genes influence gliogenesis in Drosophila.

Fly glial cells in the wing peripheral nervous system of Drosophila melanogaster originate from underlying epithelial cells. Two findings indicate that gliogenesis is closely associated with neurogenesis. First, it only occurs in regions that also give rise to sensory organs. Second, in mutants that induce the development of ectopic sensory organs glial cells develop at new positions. These findings prompted a genetic analysis to establish whether glial and sensory organ differentiation depend on the same genes. Loss of function mutations of the achaete-scute complex lead to a significant reduction of sensory bristles and glial cells. Genes within the complex affect gliogenesis with different strength and display some functional redundancy. Thus, neurogenesis and gliogenesis share the same genetic pathway. Despite these similarities, however, the mechanism of action of the achaete-scute complex seems to be different in the two processes. Neural precursors express products of the complex, therefore the role of these genes on neurogenesis is direct. However, markers specific to glial cells do not colocalize with products of the achaete-scute complex, showing that the complex affects gliogenesis indirectly. These observations lead to the hypothesis that gliogenesis is induced by the presence of sensory organ cells, either the precursor or its progeny.

Animals↗

PubMed1995

Dialysis-related amyloidosis in a large CAPD population.

We studied 212 patients from 13 Italian dialysis centers to evaluate the clinical aspects of dialysis-related amyloidosis in continuous ambulatory peritoneal dialysis (CAPD). The mean age was 64.2 +/- 12.3 years and mean time on dialysis was 36.9 +/- 25.1 months. Residual diuresis was 615.7 +/- 554.0 mL/day and plasma beta 2-microglobulin (beta 2M) level was 27.0 +/- 12.8 mg/L. Radiological skeletal examination, neurological problems related to beta 2M, and urinary and dialytic balance of beta 2M were evaluated. Correlations between age, time on dialysis, residual diuresis, beta 2M plasma levels, beta 2M peritoneal and renal removal, carpal tunnel syndrome, and bone disease were studied. Only the number of bone lesions had a significant positive correlation with patient age and negative correlation with residual diuresis. The latter had an inverse relation with beta 2M plasma levels. Dialytic age did not correlate with any of the parameters. No other correlation was observed. Hand lesions were found in 85% of patients with bone dialysis-related amyloidosis. In conclusion, residual diuresis in our patients played a positive role in the number of bone localizations. Only age, but not time on dialysis, had a positive impact on the bone lesions. The high percentage of hand lesions suggests that the observation of this skeletal segment is a simple, safe, and effective modality of bone follow-up for dialysis-related amyloidosis.

Adult↗

PubMed1995

[Specification of glial lineage in invertebrates].

Glial cells in invertebrates have been known for a long time, however, a systematic analysis of the development and the role of these cells has been missing. In the last few years, the development of new markers and the identification of genes specifically expressed in glial cells have shed some light on the mechanisms leading to gliogenesis in Drosophila melanogaster. The organisation of glial cells in the central and in the peripheral nervous system has been described and the origin of some of these cells has also been assessed. Lineage studies have shown that glial cells display different mechanisms of differentiation depending on their position in the nervous system. In some cases, glial differentiation seems intimately associated with neurogenesis, as has already been shown in the vertebrate peripheral nervous system. This suggests that similar developmental mechanisms have been conserved during evolution and that Drosophila can be used as a model system to study glial differentiation in vertebrates.

Animals↗

PubMed1994

Long-term outcome in continuous ambulatory peritoneal dialysis: a 10-year-survey by the Italian Cooperative Peritoneal Dialysis Study Group.

Over a 10-year period, 1,990 end-stage renal disease patients in 30 centers were treated with continuous ambulatory peritoneal dialysis by the Italian Cooperative Peritoneal Dialysis Study Group. At the start of treatment, patients had an average age of 58.4 years, with a 66% prevalence of one or more clinical risk factors for premature death. Patient survival was 51% and 33% at 4 and 8 years on continuous ambulatory peritoneal dialysis, respectively, and technique survival was 62% and 48%, respectively. Occurrences of peritonitis progressively reduced until they reached an incidence of 0.50 episodes/yr in the last 5 years (1985 to 1989). Hernias and catheter-related problems did not influence the dropout rates. These Italian Cooperative Peritoneal Dialysis Study Group results demonstrate that continuous ambulatory peritoneal dialysis is a viable dialysis technique for long-term treatment of chronic renal failure and that it is an effective alternative to hemodialysis, especially for older and high-risk patients.

Adolescent↗

PubMed1994

Chemical parathyroidectomy for recurrence of secondary hyperparathyroidism.

To avoid the risks of reoperation, we treated 15 uremic patients on regular extracorporeal dialysis and affected by hyperparathyroidism recurring after subtotal parathyroidectomy with ultrasound-guided ethanol injection. Follow-up was extended to 12 months after the last injection and for 11 patients to 24 months. Plasma parathyroid hormone concentration, as measured with a carboxyterminal parathyroid hormone (c-PTH) radioimmunoassay (normal, 0.2 to 2 ng/mL), significantly decreased from a basal value of 19.29 +/- 14.73 ng/mL to 11.19 +/- 9.54 ng/mL at 1 month, 7.45 +/- 4.99 ng/mL at 6 months, 6.91 +/- 4.71 ng/mL at 12 months, and 6.51 +/- 3.89 ng/mL at 24 months. Total and bone alkaline phosphatase decreased in parallel. The only remarkable side effect was transient dysphonia, which occurred in two cases. These data suggest that the technique of ultrasound-guided fine-needle ethanol injection might be a valuable alternative to surgery for recurrent hyperparathyroidism after subtotal parathyroidectomy in selected patients. This should be confirmed in larger series of patients and with a more prolonged follow-up.

Adult↗

PubMed1994

Ten years experience of CAPD in diabetics: comparison of results with non-diabetics. Italian Cooperative Peritoneal Dialysis Study Group.

CAPD outcomes were compared between a group of 301 diabetic patients (mean age +/- SD, 58.9 +/- 12.7 years, 55.8% males) and a group of 1689 non-diabetic patients (mean age +/- SD 57.8 +/- 14.8 years, 55.9% males) treated in 30 centres participating in the Italian Cooperative Peritoneal Dialysis Study Group from 1980 to 1989, with follow-up observation periods of 444 years (mean +/- SD, 1.48 +/- 1.24) and of 3502 years (mean +/- SD, 2.07 +/- 1.91) respectively. CAPD was the first modality for 87.2% of diabetics and 78.1% of non-diabetics (P < 0.001). The percentage of patients who needed a partner for CAPD was 45.9% in diabetics and 30.2% in non-diabetics (P < 0.001). In diabetics compared with non-diabetics, cardiovascular diseases and cachexia were nearly twice and infections other than peritonitis more than three times as frequent in causing death. In diabetics, survival was significantly worse (P < 0.0001) and the relative risk of death 2.13 times higher (P < 0.001). The technique survival and the relative risk of drop-out were not significantly different in the two groups. Clinical problems were the most important cause of drop-out among diabetics. The probability and relative risk of drop-out due to peritonitis, as well as of the first peritonitis episode, were not significantly different between the two groups and between diabetics using or not using intraperitoneal insulin. Days per patient year of hospitalization, excluding the first, were 18.4 in diabetics and 14.3 in non-diabetics. CAPD-related problems caused hospitalization in a similar way in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Hypertension and chronic renal insufficiency: the experience of the Northern Italian Cooperative Study Group.

There is general agreement that hypertension is a prognostic index of the progression of chronic renal insufficiency (CRI), although it remains to be clarified whether this is related to the hypertension per se, or to the underlying disease and the level of CRI. In an attempt to clarify this important point, an inductive analysis was made of the behavior of blood pressure values and their relationship to the progression of CRI in 456 patients (pts) who participated in a multicenter prospective formal randomized trial, designed to compare the effects of a restricted and a controlled protein diet on CRI progression. An analysis was also made (on the population as a whole and by separating the pts into fast progressive and slowly progressive groups) of the type and frequency of the antihypertensive drugs used, the number and type of drugs used in association, and their possible relationship to the progression of CRI. Of the 456 enrolled pts, 406 (89%) were defined as hypertensive at entry (mean blood pressure > 107 mm Hg); 324 out of the 380 pts (85.3%) who completed the 24-month follow-up or reached an end point were treated with antihypertensive drugs. There was a significant difference at entry between the supine blood pressure values of the pts with fast progressive CRI (182 pts), and those of the pts with slowly progressive CRI (198 pts). During the follow-up period, no significant differences were observed between the two groups. There was no difference in the blood pressure levels reached with the different drugs used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Development and organization of glial cells in the peripheral nervous system of Drosophila melanogaster.

We have used enhancer trap lines as markers to recognize glial cells in the wing peripheral nervous system of Drosophila melanogaster. Their characterization has enabled us to define certain features of glial differentiation and organization. In order to ask whether glial cells originate within the disc or whether they migrate to the wing nerves from the central nervous system, we used two approaches. In cultured wing discs from glial-specific lines, peripheral glial precursors are already present within the imaginal tissue during the third larval stage. Glial cells differentiate on a wing nerve even in mutants in which that nerve does not connect to the central nervous system. To assess whether peripheral glial cells originate from ectoderm or from mesoderm, we cultured discs from which the mesodermally derived adepithelial cells had been removed. Our findings indicate that peripheral glial cells originate from ectodermally derived cells. As has already been shown for the embryonic central nervous system, gliogenesis in the periphery is an early event during adult development: glial cells, or their precursors, are already present at stages when neurons are still differentiating. Finally, our results also suggest that peripheral glial cells may not display a stereotyped arrangement.

Animals↗

PubMed1993

Ultrastructure analysis of Tenckhoff chronic peritoneal catheters used in continuous ambulatory peritoneal dialysis patients.

The luminal and external surfaces of 18 curled silicone double-cuff catheters removed from patients who had been on continuous ambulatory peritoneal dialysis (CAPD) for 2-77 months (average 37 +/- 21 months) were analyzed by scanning electron microscopy (SEM) and microbiological cultures. Eight catheters (G1) were removed due to recurrent peritonitis or peritonitis refractory to antibiotic management, and the others (G2) due to local or clinical problems. The peritonitis rate was one episode every 24 patient-months in G1, and 80 patient-months in G2. All catheter surfaces were covered with proteinlike granular deposits (0.15 +/- 0.11/cm); 6 catheters were covered by microbial biofilm (0.24 +/- 0.16/cm). Positive cultures of catheter segments were obtained in 6 cases (4 for G1 and 2 for G2) with a preponderance (33%) of Staphylococcus aureus among the cultivated bacteria. Structural defects and small linear tears were present on both luminal and external surfaces in 8 catheters. Structural defects were frequent in the catheters removed for recurrent peritonitis. Linear tears appeared more frequently in the catheters used for a longer time. Structural defects of catheter surfaces were also discovered in the newer devices. The structural defects of the catheter appear to facilitate microbial adhesion and colonization and to predispose the patient to recurrence of peritonitis. A better catheter design and an improvement in the production process should therefore be recommended.

Bacteria↗

PubMed1993

Ten years of continuous ambulatory peritoneal dialysis: analysis of patient and technique survival.

The patient survival (PS) and technique survival (TS) were evaluated in 1990 patients on continuous ambulatory peritoneal dialysis (CAPD) (males: 55.9%, mean age +/- SD: 58.4 +/- 14.8 years), treated in 30 centers participating in the Italian PD Study Group, from 1980 to 1989 (follow-up: 3953 years; mean +/- SD: 2.02 +/- 1.86 years). The total PS was 50.7% at 4 years, compared to 73.3% of patients without clinical high-risk condition (HRC) at the beginning of CAPD. In this group (34.0%) PS was significantly higher (p < 0.001) compared, respectively, to patients with cardiovascular disease (30.5%), diabetes (13.1%), and age > or = 70 years (11.2%). The percentage of death reached the mean value of 11.3% per year without any statistically significant tendency to variation during the follow-up, despite the increased number of patients > or = 65 years old and those with HRC (p < 0.001). Cardiovascular diseases (47.3%) and cachexia (17.8%) were the most frequent causes of death, whereas the mortality due to peritonitis showed a progressive increase in patients with peritonitis incidence 1 ep/year (G4) compared to those with < 0.5 ep/year (G2). Peritonitis (0.68 ep/year) was the most frequent cause of technique failure (30.0%), with clinical complications (18.2%) and peritoneal membrane failure (16.4%) as the second and third causes. The dropout percentage was 8.3% per year with a significant decrease over time (p = 0.012) and a positive correlation with the reduction of peritonitis incidence (p = 0.035). The total TS was 50.1% at 7 years, and it was significantly worse in G4 compared to G2.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

The development of normal and ectopic sensilla in the wings of hairy and Hairy wing mutants of Drosophila.

We have utilized enhancer trap markers to follow the development of ectopic sensillar precursors in the wings of Drosophila induced by the mutations hairy and Hairy wing. Normal sensilla are still present in these mutations, and can be distinguished from ectopic sensilla based upon both the position and the timing of their development. This correlates well with the development of ectopic achaete expression in these mutations: such staining is detected only after the appearance of normal staining. Thus, neither mutation appears to alter the specification of proneural clusters in the wing, as identified with anti-achaete, or the specification of sensillar precursors within these clusters. Rather, both act to induce the formation of a temporally and spatially distinct phase of sensillar development.

Animals↗

PubMed1992

Ultrasound-guided percutaneous fine-needle ethanol injection into parathyroid glands in secondary hyperparathyroidism.

To reduce parathyroid hormone concentrations in uraemic patients refractory or hyporesponsive to calcium supplements and active metabolites of vitamin D, we developed in 1982 a new parathyroid ablative technique consisting of percutaneous fine-needle ethanol injection (PFNEI) into enlarged parathyroid glands under ultrasonic guidance. Fifty uraemic patients have been treated. Decreases in carboxy terminal parathyroid hormone (PTH) were 50% or more in 13 of 50 patients followed up (26%) at 1 month, in 13 of 48 (27%) at 6 months, and in 9 of 25 (36%) at 12 months. Decreases of 30% or more in PTH were obtained in 21 of 50 (42%), in 25 of 48 (52%), and in 15 of 25 (60%). In 'responsive' patients, serum total alkaline phosphatase was significantly reduced [from 579 +/- 645 U/l to 360 +/- 354 U/l (P less than 0.01) at 6 months, and to 273 +/- 311 U/l (P less than 0.01) at 12 months] and bone isoenzyme decreased similarly [from 482 +/- 608 U/l to 256 +/- 344 U/l (P less than 0.005), and to 225 +/- 354 U/l (P less than 0.01)]. The best results were in seven patients who had relapsed after subtotal parathyroidectomy. Declines in PTH of 30% or more were observed in four of seven patients at 1 month, in six of the seven (85%) at 6 months, and in all four patients seen after 12 months. The treatment corrected hypercalcaemia, making it possible to start or to increase daily vitamin D treatment. Side-effects were mild, rare, and transient.

Adult↗

PubMed1992

Comparison of survival in CAPD and hemodialysis: a multicenter study.

We studied 1,622 patients who started regular dialysis treatment between 1985 and 1989 in 19 centers from the Italian CAPD Study Group. There were 962 pts (59%) and on HD; 660 pts (41%) on CAPD. CAPD pts were older and had more risk factors at the start than HD pts (p < 0.0001). Overall patient survival was not statistically different between CAPD and HD at 6 years (42% CAPD; 54% HD). Multivariate analysis (Cox's model) on all population revealed that age and pretreatment risk factors had a statistically significant impact on patient survival (p < 0.0001), but not the type of dialytic treatment (CAPD or HD). When multivariate analysis was applied separately by treatment modalities, in HD group age and risk factors had the same negative influence on survival (p < 0.0001) while in CAPD group the influence of age on survival was less significant (p 0.025). This multicenter study carried out with appropriate statistical methods in a large number of pts demonstrates that patients' survival at 6 years is not different on CAPD and HD (despite the worse patient selection on CAPD) and can be even better on CAPD for aged patients.

Adult↗

PubMed1992

The impact of peritonitis on CAPD results.

The impact of peritonitis on CAPD results was evaluated in 1990 pts (mean age +/- SD:58.4 +/- 14.8 yrs, 55.9% males), treated in 30 centres participating in Italian PD Study Group, during 1980-89, with an overall observation period of 3953 years (mean +/- SD 24.1 +/- 22.3 months). The incidence of peritonitis decreases from 1.21 (1980-84) to 0.48 (1985-89) ep/year (overall:0.68) with a significant (P < 0.001) reduction of the probability of developing the first peritonitis episode (FPE) through the same periods. The probability of developing FPE and the relative risk of peritonitis were significantly lower (P < 0.001) in pts for whom CAPD has been the first treatment (80.1%); on the contrary these parameters did not gain significant difference according to sex, age 65 years, diabetes or cardiovascular disease. As far as the organisms responsible for peritonitis are concerned a significant reduction of S. epid. and an increase of S. aureus, other Gram pos. and Pseudomonas was observed in the second 5-yr periods. Peritonitis episodes caused catheter removal in 8.2% of cases and were associated with catheter infection in 10.8% of cases. Peritonitis accounted for 24.2% of hospitalization causes and for 6.7% and 30.0% of death and of drop-out respectively. The probability of death and drop-out was significantly high (p < 0.001) in pts with a peritonitis incidence > 1 ep/year than in those with < 0.5 ep/year. The probability of drop-out due to peritonitis was not higher in diabetic or older patients.

Female↗