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Biomedical subjects

C Ponticelli

Publications and source records attributed to C Ponticelli.

At least 235 records · Page 13Linked to original sources
PubMed1984

Hemodialysis without anticoagulants: efficiency and hemostatic aspects.

In 29 patients with high risk of bleeding, 111 hemodialyses have been performed without heparin (WHD) or other anticoagulants. The same patients were switched to low dose heparin dialysis (LDHD) as soon as the bleeding risk had ceased. The dialyzer had to be changed in 11 and the drip chamber in 20 WHDs because of partial clotting. This phenomenon did not occur during LDHD. The comparative efficiencies of the two techniques were evaluated by measuring the urea and creatinine clearances of the dialyzers. No significant difference between LDHD and WHD clearances was observed. In 7 of 29 patients, hemostasis variables were studied before, during and after both modes of treatment. Fibrinogen, platelet count, antithrombin III and prothrombin time did not differ with the different dialysis procedures. During dialysis, platelet factor 4 (PF4) levels were significantly higher than baseline values (P less than 0.01), with no difference between WHD and LDHD. Plasma fibrinopeptide A (FPA) levels remained normal during LDHD, but significantly increased during WHD (P less than 0.001). Our data indicate that WHD is feasible, with a low risk of extravascular coagulation. The bleeding risk is not increased during or after dialysis, and the danger of intravascular coagulation is low as confirmed by the isolated elevation of FPA plasma levels, unaccompanied by changes in other variables.

Acute Kidney Injury↗
PubMed1984

Branched chain and aromatic free amino acids in plasma and skeletal muscle of uremic patients undergoing hemodialysis and CAPD.

Plasma and skeletal muscle free amino acids were measured in patients submitted to Hemodialysis (HD) or Continuous Ambulatory Peritoneal Dialysis (CAPD) in order to evaluate the effects of these different dialysis modalities on amino acid pools; the data were compared with those obtained in control subjects and in patients with advanced Chronic Renal Failure (CRF) not submitted to Regular Dialysis Treatment (RDT). Our findings show low intracellular concentrations of VAL, total Branched Chain Amino Acid (BCAA) and TYR in uremic patients treated with CAPD but not in those undergoing HD. The observed differences in muscle amino acid pattern could be well explained by a changed amino acid metabolism regulation in CAPD, possibly related to the sustained hyperinsulinism and to an increased rate of hepatic protein synthesis.

Adult↗
PubMed1983

Prospective controlled trial of a Y-connector and disinfectant to prevent peritonitis in continuous ambulatory peritoneal dialysis.

A controlled study in two centres compared the efficacy of the standard continuous ambulatory peritoneal dialysis (CAPD) system with that of a new method consisting of a Y-shaped set filled with sodium hypochlorite during the dwelling time. 62 new CAPD patients were randomly allocated to the standard method (group A: 30 patients; age 55.5 +/- 17.5 years) or to the Y-system (group B: 32 patients; age 55.1 +/- 14.3 years). In group A, there were 31 peritonitis episodes in 17 patients (57%) during a cumulative period of 351 months--1 episode every 11.3 patient-months. In group B, there were 11 peritonitis episodes in 10 patients (31%) during 363 months--1 episode every 33 patient-months. Life-table analysis showed a significant difference between the incidence of peritonitis in the two groups. The Y-system method is simple and economical and the frequency and the severity of side-effects appears to be acceptable.

Adolescent↗
PubMed1983

De novo focal glomerular sclerosis in an identical twin renal transplant recipient.

A patient with end-stage renal failure caused by bilateral kidney stones received a kidney transplant from his identical twin. No immunosuppressive therapy was given. After a few days he developed a urinary fistula from a polar artery section, which spontaneously healed. Renal function remained subnormal, blood pressure and urinalysis were normal. After one year proteinuria appeared, and after about four years it entered a nephrotic range. Renal biopsy showed focal glomerular sclerosis (FGS). In the following years progressive renal insufficiency and arterial hypertension developed, and the patient had to be submitted to regular dialysis about 9 years after transplantation. As far as we know this is the first case of late renal failure in an isograft related to the development of de novo FGS. It is suggested that de novo FGS in this isotransplant was related to the partial loss of renal mass caused by polar necrosis, which caused glomerular hyperfiltration. Another possible contributing factor may be kidney denervation, which removes an important mechanism for adjustment of renal arterial flow.

Adult↗
PubMed1983

Extracapillary glomerulonephritis with necrotizing vasculitis in D-penicillamine-treated rheumatoid arthritis.

Rapidly progressive glomerulonephritis occurred in a woman with rheumatoid arthritis (RA) who had been treated with D-penicillamine for 3 months. Light microscopy study of the kidney showed severe glomerulonephritis with crescent formation in 50% of glomeruli and necrotizing vasculitis. Immunoflurescence revealed IgA and C3 granular deposits diffusely distributed along the capillary walls. The patient was treated with steroid 'pulse', antiplatelet agents and heparin and a partial recovery of renal function was observed after 2 months of anuria. This renal picture is unlike that reported in RA and a causative role for D-penicillamine is suggested.

Arthritis, Rheumatoid↗
PubMed1983

Cutaneous manifestations in renal transplant recipients.

Out of 105 renal transplant recipients 100 had skin lesions: 55% iatrogenic, 74% infectious, 12% precancerous or cancerous and 4% miscellaneous. Many of these lesions were at least in part transient, and steroid-related skin lesions became less frequent as years progressed. The more frequent infections were the fungal ones, followed by viral and bacterial infections with different patterns of onset. All the precancerous lesions appeared late and were almost exclusively represented by actinic keratoses; 2 evolved into squamous cell epitheliomata. 2 patients died due to Kaposi's sarcoma and melanoma. The high incidence of skin cancers in transplanted patients and the rapid evolution of dyskeratoses into spinaliomas warrants close dermatological surveillance.

Adolescent↗
PubMed1983

Controlled trial of monthly alternated courses of steroid and chlorambucil for idiopathic membranous nephropathy.

Forty-nine patients with membranous nephropathy (MN) and nephrotic syndrome (NS) were randomly allocated to supportive or specific therapy. The latter consisted of steroids or chlorambucil given in alternate months for a cumulative period of six months. Three patients in the experimental group were dropped from the study because of therapy related side-effects. At the end of follow-up there were significantly more patients in complete or partial remission in the experimental group than in the controls. The mean serum creatinine did not change in treated patients, but it significantly increased in controls.

Chlorambucil↗
PubMed1983

'Y' connector system for prevention of peritonitis in CAPD: a controlled study.

To compare the efficacy of the standard Oreopoulos CAPD system with that of a new method consisting of a Y-shaped set filled with sodium hypochlorite during the dwelling time, a randomised controlled study was performed in 62 new CAPD patients. Life table analysis showed a significantly (p less than 0.001) less frequent incidence of peritonitis in the group treated with the Y connector system. This study shows that the Y system appears to be effective in reducing the incidence of peritonitis, as compared with the standard technique, in patients on the CAPD programme. The method is simple and economical and the incidence and the severity of side effects appear to be acceptable.

Adolescent↗
PubMed1983

Acetohydroxamate in struvite stones: in vivo study.

This report describes the results obtained with a combination of acetohydroxamic acid (AHA) and antibacterial agents in 13 patients with recurrent struvite stones complicated by refractory infections with urease-producing bacteria. Intravenous antibiotic pulses plus oral AHA achieved urine sterilisation in all. Then oral chemotherapy plus AHA was given for a mean period of 10.8 +/- 5.4 months. In four patients, the urine remained sterile, but in all the patients urinary pH remained below 6.4 and urinary NH4+ below 40 mg/dl. Despite the persistence of urea-splitting bacteria, the radiographic data showed an arrest of stone growth during the first year of treatment.

Anti-Bacterial Agents↗
PubMed1983

Intravenous methylprednisolone pulse therapy in essential mixed cryoglobulinemia nephropathy.

In 15 patients with essential mixed cryoglobulinemia, 24 exacerbations of renal disease, characterized by an increase in plasma creatinine (13 episodes) and/or proteinuria (18 episodes), were treated by 3 intravenous pulses of methylprednisolone (1 g each), followed by oral prednisone (0.5 mg/kg/day). Plasma creatinine levels fell within a week (P less than 0.025), while a significant decrease in urinary protein excretion was observed only after one month (P less than 0.05). After therapy, plasma creatinine levels remained stable in 8/10 patients for 3 to 60 months. These beneficial results suggest that MP pulses may be useful in the treatment of cryoglobulinemic nephropathy.

Adult↗
PubMed1983

Dopamine-frusemide therapy in acute renal failure.

In 16 patients with ARF and in three with hepatorenal syndrome we infused dopamine (3 micrograms/kg/min) and frusemide (10-15 mg/kg/day) for 6-24 hours. This treatment produced in all patients a significant diuresis and natriuresis without any modification of blood pressure, pulse rate, and central venous pressure. In three patients with hepatorenal syndrome diuresis was established during dopamine and frusemide infusion, but severe oliguria again reappeared when drug infusion was stopped. This experience suggests that this therapy may avoid fluid overload and hyperkalaemia in oliguric patients reducing the need for dialysis. It is also the first successful approach in the treatment of hepatorenal syndrome although its effect is transient.

Acute Kidney Injury↗
PubMed1982

Detection of circulating released platelets after renal transplantation.

In recipients of renal transplants, the biochemical defect(s) that underlies increased deposition of platelets in the graft and their shortened survival in the circulation are poorly understood. Forty-six recipients of kidney allografts, with and without rejection signs (13 acute rejections (ARs), 15 chronic rejections (CRs), and 18 functioning transplants (FTs), had lower platelet serotonin (5HT) and higher plasma beta-thromboglobulin than normal controls (NCs). These abnormalities were more pronounced in patients with ARs than with CRs but were also present in patients with FTs. All groups of transplant recipients showed an abnormal metabolism of platelet arachidonate, as expressed by low serum levels of thromboxane B2. In AR, plasma fibrinopeptide A (FPA) was significantly high whereas FPA levels were unchanged in CR and in FT. These findings suggest that in patients with renal transplants, the platelet release reaction has occurred in vivo, resulting in the secretion of granule-bound substances and the circulation of partially empty platelets. Vasoactive, mitogenic, and proaggregatory substances released from platelets might damage the graft and aggravate the rejection process.

Acute Disease↗