Biomedical subjects

A Mandressi

Publications and source records attributed to A Mandressi.

At least 37 records · Page 2Linked to original sources

PubMed1992

Long-term followup after extracorporeal shock wave lithotripsy treatment of kidney stones in solitary kidneys.

A total of 64 treatments by the Dornier HM3 lithotriptor was performed on 52 solitary kidneys with stones. A slight increase but no significant variations in serum creatinine was noted in 15 patients without obstruction just after treatment (p greater than 0.05). No significant increases in serum creatinine were found even at the short-term, mid-term and long-term followup. After 12 to 56 months hypertension developed in only 1 previously normotensive patient. Of 37 patients at mid-term followup (12 to 24 months) 62% were stone-free, 24% had passable fragments, 8% had recurrent stones and 5% had regrowth of the residual fragments. At long-term followup (24 to 56 months) 50% of 26 patients were stone-free, 19% had dust or passable fragments, 19% had recurrences and 11% had regrowth of the residual fragments. The demonstrated effectiveness, small number of complications at the short-term followup, lack of sequelae at the long-term followup and relatively small number of recurrences confirm that extracorporeal lithotripsy is not only effective but also safe. It can be proposed as the treatment of first choice even when the stone is in a single remaining kidney.

Adult↗

PubMed1992

Urinary excretion of citrate, glycosaminoglycans, magnesium and zinc in relation to age and sex in normal subjects and in patients who form calcium stones.

One hundred and ninety-seven healthy subjects and 104 patients with idiopathic calcium stone disease had their urinary excretion of citrate, glycosaminoglycans, magnesium, and zinc measured and the results correlated with sex and age. In normal subjects the daily excretion of citrate, magnesium, and zinc increased with age to a maximum during the fifth decade and remained relatively constant until the eighth decade when they decreased. The daily excretion of magnesium and zinc were higher in men than in women, which was attributed to the higher body weights of the men. The urinary excretion of citrate, magnesium, and zinc related to creatinine remained relatively constant with age in adult life; analyses of magnesium and zinc excretion rates divided by urine creatinine did not distinguish men from women. There was no significant difference between men and women for citrate excretion in 24 hour urine, but the citrate:creatinine ratio was significantly higher in women than men. The higher citrate excretion in women may explain the lower incidence of calcium stones in women. The highest glycosaminoglycan excretion rates were seen during the first two decades which is why children and teenagers are less prone to develop calcium stones in spite of high urinary calcium concentrations. Urinary citrate and magnesium excretion were lower, and glycosaminoglycan and zinc excretion were higher, in stone formers than in controls. It seems that a decreased excretion of citrate and magnesium together with an increased excretion of calcium, may contribute to the formation of calcium stones. The role of urinary glycosaminoglycans and zinc in the formation of calcium stones remains uncertain.

Adolescent↗

PubMed1992

[Recurrence of lithiasis after extracorporeal lithotripsy, percutaneous surgery, and open surgery for calculi of the upper urinary tract].

The safety and short-term effectiveness of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) have already been well established. However, long-term follow-up studies are essential to prove that the recurrence rate after PCNL and/or ESWL is equal or even better than that of surgery. We reviewed 57 patients treated with ESWL monotherapy, 45 patients treated by PCNL (or by PCNL combined with ESWL for complete staghorn stones) and 59 patients treated by open surgery who all had at least three years of follow-up. The overall recurrence rate for ESWL was 37% for PCNL and for open surgery 39%. ESWL, PCNL and open surgery all showed a higher rate of recurrence and persistent bacteriuria when associated with residual stones. Therefore every effort should be made to remove residual fragments following stone treatment. We conclude that because of its efficacy and low morbidity ESWL should be the treatment of choice for most of renal calculi. Complete staghorn calculi are best treated with open surgery because the complete elimination of all calculous material and the eradication of infection are achieved at a higher rate than by PCNL and ESWL.

Adult↗

PubMed1991

The influence of diet on urinary risk factors for stones in healthy subjects and idiopathic renal calcium stone formers.

The daily intake of 103 recurrent idiopathic calcium stone formers and 146 controls was assessed by means of a computer-assisted 24-h dietary record. Timed 24-h urine samples were collected over the same period to assess the relationship between dietary intake of nutrients and urinary risk factors for calcium stones. After standardisation for sex, age and social status a total of 128 subjects underwent final statistical analysis; 64 renal stone formers and 64 controls. Significant increases in the consumption of animal and vegetable protein and purine were identified as the nutritional factors that distinguished renal stone formers from controls. As expected, the daily urinary excretion of calcium and oxalate was higher and the daily urinary excretion of citrate was lower in stone formers than in controls. No difference with respect to daily urinary uric acid excretion was recorded. Daily urinary excretion of calcium was correlated to dietary protein intake while daily urinary oxalate was correlated to dietary vitamin C intake. It was concluded that renal stone formers could be predisposed to stones because of their dietary patterns. A link between the protein content of the diet and urinary calcium was confirmed, but dietary animal protein had a minimal effect on oxalate excretion.

Adult↗

PubMed1991

[Interleukin immunotherapy of progression].

IL-2 is a lymphokine which as variety of in vivo immunomodulatory effects. The administration of IL-2 can mediate enhancement of cellular immune response, induction of lymphocyte proliferation and production of cytokines. The availability of large quantities of recombinant IL-2 has enabled investigator to examine its therapeutic potential, with of without lymphokine-activated killer cell, in the treatment of metastatic renal cancer. Several studies have documented the ability of IL-2 administration to cause durable tumor regression in a good percentage of patients. Otherwise there were a number of problems which had to be resolved. First, the high-dose bolus or low-dose continuous infusion? Indeed, administration by the intravenous or subcutaneous routes? Last but non least, what is the place of lymphokine-activated Killer cells? Toxicity of therapy is dose related and is mediated by a vascular capillary leak syndrome, lymphocytic infiltration and the release of cytokines secreted in response to IL-2 administration. The side effects are completely reversible upon cessation of therapy. The patients undoubtedly require much more careful monitoring than with standard oncological treatments but rapid recovery of the preexisting conditions before therapy suspension must certainly be stressed.

Humans↗

PubMed1991

[Adjuvant chemotherapy].

The authors treated 10 advanced renal cell carcinoma with circadian venous continuous infusion of 5-Fluoro 2-Deoxyuridine (FUDR). The drug was delivered by Medtronic Synchromed implantable pump in 14-day cycles alternating with 14-day intervals of physiologic saline infusion. Of the patient observed for at least 8 months (range: 8-32, median: 22.1) 1 showed progression. Circadian continuous central venous infusion of FUDR is minimally toxic. The FUDR can be delivered safely and conveniently in this way for long spans. This therapy is administrated in on entirely out patient setting, and associated with a normal quality of life.

Adult↗

PubMed1990

Urinary NAG excretion after anesthesia-free extracorporeal lithotripsy of renal stones: a marker of early tubular damage.

Second generation lithotripters require a higher number of shocks per session as well as an increased rate of secondary treatments for complete stone disintegration compared to the original spark gap lithotripter. The clinical relevance of biological side effects caused by such treatment are less known. We evaluated urinary excretion of N-acetyl-glucosaminidase (NAG) before and after lithotripsy in 50 patients treated with a low pressure spark gap lithotripter (Dornier HM3) and in 36 patients treated with a piezoelectric lithotripter (Wolf Piezolith 2200) in an attempt to evaluate their side effects on renal tissue. The urinary excretion of NAG increased after both spark gap lithotripsy using the modified HM3 and piezoelectric lithotripsy. These changes may be associated with slight tubular damage that would occur after anesthesia-free lithotripsy in patients subjected both to a high number of shocks and to secondary treatments.

Acetylglucosaminidase↗

PubMed1990

Secretory immunoglobulin A and inhibitory activity of bacterial adherence to epithelial cells in urine from patients with urinary tract infections.

To assess the role of local immune response against bacterial invasion of the urinary tract we studied 168 patients with bacteriuria. Urinary secretory immunoglobulins A (sIgA) were measured using radial immunodiffusion or enzyme-linked immunosorbent assay (ELISA). In particular, ELISA is a very suitable assay for measuring the low levels of sIgA in urine. Furthermore, we used a quantitative in vitro adherence assay to investigate the attachment of Escherichia coli to human uroepithelial cells after incubation in urine from patients with urinary tract infection. Urine from patients with ileocystoplasty was significantly more potent in inhibiting bacterial adherence than was urine from other groups of patients with urinary tract infection. The presence of high urinary sIgA may help explain the increased antiadherence activity of urine in patients with ileocystoplasty. Mean urinary sIgA in patients with upper urinary tract infection was higher than in patients with uncomplicated infection in the lower urinary tract. Alterations in mucosal immune functions may account for the propensity toward bacterial colonization in women prone to uncomplicated urinary tract infection.

Bacterial Adhesion↗

PubMed1990

[Neoadjuvant chemotherapy of locally advanced tumors of the bladder: introduction].

The locally advanced bladder cancer cannot be cured only with cystectomy: in this case the surgery has a palliative meaning and do not relieve the patient from the disease. Adjuvant or neoadjuvant treatments have been proposed to transform a palliative treatment in a curative method. Mainly radiotherapy and chemotherapy have been performed to achieve this goal. In fact radiotherapy failed to cure the locally advanced bladder cancer but in increasing survival in T3 cystectomized patients. So far chemotherapy with MP and M-VAC regimens demonstrated a good efficacy in achieving an early response rate in advanced diseases. In many urological centers chemotherapy has been carried out before cystectomy in order to have a pathological control of the response when cystectomy had been performed, and to verify an hypothetical increase in survival rates. The experiences among a group of urologists in Lombardy are reported in this issue. The preliminary results and the problems arisen in treating such patients and in following up both the cured and the relapsing patients are reported in short papers. The clinical problems are further discussed in the final panel discussion.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

[Neoadjuvant chemotherapy using methotrexate and cisplatin in locally advanced urothelial cancer of the bladder].

Thirty-one consecutive patients with clinically and histologically documented urothelial cancer of the urinary bladder of category T3-T4a, N0, M0 underwent a trial of neoadjuvant chemotherapy before radical cystectomy. All patients received 2 courses of methotrexate 300 mg/m2 day 1 followed by folinic acid rescue days 2 and 3 and cisplatin 100 mg/m2 day 4, q. 3 weeks. Only responders were to receive 2 further courses of chemotherapy. The protocol was violated in 5 cases and all did poorly. Of the remaining 26 patients, 19 (73%) had a partial or complete remission to neoadjuvant chemotherapy. The actuarial disease-free survival was very encouraging at 18 months (87% for responders versus 43% for the 7 non responders), but at 30 months the difference became minimal (60% versus 43%). Furthermore, all 3 responders who had refused radical cystectomy relapsed locally. Postoperative randomized trials are necessary to prove the advantage of neoadjuvant therapy with a long term survival and bladder preservation.

Adult↗

PubMed1989

Ceftriaxone in chemoprophylaxis and therapy of urinary tract infections.

We analysed eight prospective randomized trials describing the use of ceftriaxone (Rocephin) in short-term prophylaxis in patients undergoing urologic surgery. The results of these trials show that chemoprophylaxis with ceftriaxone is effective. In the therapy of postoperative infections in urologic surgery the single daily dose of ceftriaxone represents a considerable advantage both regarding patients' compliance and clinical convenience. From March 1987 to January 1988, 25 patients with postoperative infections after urologic surgery were treated with ceftriaxone 1 g i.m. once daily. Quick resolution of signs and symptoms of infection occurred in all cases.

Bacterial Infections↗

PubMed1989

[Extracorporeal lithotripsy with low pressure shockwaves using a modified Dornier HM3 lithotriptor: preliminary results].

Extracorporeal shock wave lithotripsy is a well established procedure for the treatment of the renal and ureteral calculi. The technical innovations of the low-pressure generator with a modified ellipsoid installed into the Dornier HM3 lithotripter leads to decrease the pressure in the second focus F2 lowering the painful sensation linked to the treatment and allowing to perform lithotripsy without general or epidural anae sthesia. From January to March 1988 132 patients underwent 144 treatment by modified Dornier Lithotripter HM3, we performed the treatments under a combination of anxiolytic and analgesic drugs in 125 patients (94.6%), only 7 patients needed the general or epidural anaesthesia, because of complex endoscopic pretreatment instrumentations. An average of 2150 Shock waves was applied with a range of 500 to 3800, the shock wave energy was administered at an average 20 Kvolts (16-26 Kv). Stone fragmentation had a success rate of 94.6%. The average postoperative stay was 4.5 days. After a month of follow-up 50.9% of the patients was free of stones, 27.8% had sand or spontaneously passable fragments and 11.1% had residual fragments larger than 4 mm. The treatment was judged as free of pain or with tolerable pain in 60% of the patients, 40% of the patients needed additional medication. The number of secondary treatment was, in our review, 9% but it could increase because we observed after a month of follow-up that 11% of the patients treated presents fragments larger than 4 mm.

Equipment Design↗

PubMed1989

[Enoxacin in the treatment of bacterial prostato-cystitis].

Thirty-three patients suffering from acute, subacute or chronic prostatovesiculitis were admitted to an open, non comparative trial. Enoxacin was administered at the daily dosage of 400 mg every 12 hours for 10 days starting from the enrollment. A second cycle of treatment was performed if cure was not obtained with the first cycle. Treatment efficacy was established by assessing patient symptoms related to the infection, such as pollakiuria and dysuria, consistency and volume of prostate and spermatic vesicles (evaluated by rectal examination and transrectal ultra-sonography); bacterioscopical and bacteriological evaluations of prostate/vesicles secretion with sensitivity testing were also carried out. All observations were collected at baseline, 5 and 30 days after the end of the first cycle and 5 days after the end of the 2nd cycle of treatment. After the first cycle of treatment, cure was obtained in 22 subjects (67%) and clinical improvement in 24 (73%). All but one patients still infected at the end of the first treatment period, showed improvement (5; 45.5%) or cure (6; 54.5%). The end of the second cycle None of the 22 patients cured with one cycle of treatment relapsed within 30 days after the end of treatment, confirming they really achieved cure. Side effects were observed only in 1 case (mild vertigo); no drop outs were observed. These results suggest that enoxacin may be successfully used in the treatment of prostato-vesiculitis.

Acute Disease↗

PubMed1989

[A new classification of reno-ureteral lithiasis].

The Authors suggest a change in their surgical classification of renal calculi to conform the description to the new techniques in the treatment of renal calculosis. Category "C" describes the morphology and topography of renal stones in five degrees (C1-C5); small letters "p, s, m, i" indicate the pelvis, superior, middle, inferior calyces; "n" and "a" symbolize stone having a size similar to or exceeding normal shaped renal cavities. "Cu" indicates ureteral calculi; small letters "l, i, p" indicate lumbar, iliac, pelvic ureteral stones. "N" describes the nature of the calculi. Category "E" stands for the excretory tract; "+" and "-" indicate the presence or absence of dilatation, the small letters "e, i" show the extra or intrarenal position of renal cavities; "no" and "o" indicate absence or presence of intrinsic obstruction of the excretory tract. "R" points out the number of surgical recurrences. Category "P" indicates the function of the parenchyma; numbers 1, 2, 3, refer to normal renal function, moderate or serious insufficiency. "U" stands for unique functional or anatomical kidney; "I" indicates the presence of infection.

Humans↗

PubMed1989

[Extracorporeal lithotripsy using the HM3 Dornier lithotriptor and the modified HM3 lithotriptor].

Extracorporeal shock waves lithotripsy is a well established procedure for the treatment of renal and ureteral calculi. From January 1985 to December 1987, 1034 patients underwent 1152 treatments with the Dornier HM3 lithotripter; from January 1988 and December 1988, 466 patients underwent 566 treatments with the modified Dornier HM3. Treatments with the original HM3 were performed mainly under general anaesthesia (97%). Only 2.4% of modified Dornier HM3 treatments have been performed under general anaesthesia; the 97.6% were treated under a combination of anxiolytic and analgesic drugs. An average of 1900 and 2300 shock waves was applied with the original HM3 and the modified one, respectively. The rate of secondary treatment increased from 10.3% to 17.4% respectively. At three month follow-up the 85.6% of the patients treated with the original HM3 and the 76.7% of those treated with the modified Dornier were free from stones. Low energy lithotripsy with the modified semi ellipsoid has proved to be equally effective as the older generators working with high shock wave pressure.

Follow-Up Studies↗

PubMed1989

[An overview of extracorporeal lithotriptors in current clinical use: technical notes].

ASWL ten years ago opened a new era for kidney stone treatment and recently it's showing a new therapeutical approach to biliary stones. Dornier HM3 is since 1983 the first lithotripter with a wide clinical employment. Actually we know about twenty extracorporeal lithotripter in clinical use. Our review try to classify old and new extracorporeal lithotripsy devices looking at technical aspects and lithotripsy center organization.

Cholelithiasis↗

PubMed1988

Renal tubular damage after renal stone treatment.

50 patients were studied with respect to renal tubular damage related to open operative, percutaneous and extracorporeal shock wave treatment of renal stones. Preoperative and postoperative urinary N-acetyl-glucosaminidase (NAG) levels were measured as a marker of renal damage. There was no significant evidence of renal tubular damage in patients who underwent a conventional or percutaneous nephrolithotomy; urinary NAG excretion was significantly increased after ischaemic surgery. After extracorporeal shock wave lithotripsy (ESWL) serum NAG levels increased, probably because a damage of the white blood cells in cutaneous and renal circulation, but a slight increase of urinary NAG excretion could suggest a mild renal tubular damage especially in case of more than 2,000 shocks.

Acetylglucosaminidase↗

PubMed1988

Familial aggregation of renal calcium stone disease.

The question of a familial predisposition towards stone formation in primary nephrolithiasis has not been explored completely. In a sample of 214 calcium stone patients, and 428 age and sex-matched controls we observed a higher frequency of stones among the first degree relatives of stone patients compared to the relatives of controls. A family history of renal stones was more common among the female (45 per cent) than among the male patients (31 per cent). There was no relationship between family history of renal stones, and abnormal calcium and oxalate excretion rates. A significant association between a family history and a higher urinary pH was observed among the female calcium stone patients. A genetic defect in urinary acidification with variable expressivity might be associated with a high frequency of stone formation. Moreover, uric acid excretion was higher in male stone patients with a family history of stones. Finally, the parents and siblings of the renal stone patients were affected more by calculi than were the corresponding relatives of their spouses.

Age Factors↗