Sodium and dialysis: a deeper insight.
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Biomedical subjects
Publications and source records attributed to F Locatelli.
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Kelfiprim (KP) is a new bactericidal agent containing trimethoprim (T) and sulfametopyrazine (S), a long-acting sulfonamide (ratio 5:4). The posology is one capsule (T 250 mg + S 200 mg) daily, after a loading dose of two capsules on the first day. To evaluate the clinical value of Kelfiprim (KP) vs co-trimoxazole (CO) in urinary tract infection (UTI) a controlled multicenter double-blind trial (MDBT) was carried out in 76 patients suffering from persistent and recurrent UTIs. About 90 per cent response rate (sterile urine at the end of treatment) was obtained for KP and about 85 per cent for CO in recurrent UTI. In persistent UTI the rate of recovery was 66.8 per cent and 53 per cent for KP and CO, respectively. Safety of treatments was excellent in 97 per cent of patients treated with Kelfiprim and 87 per cent treated with co-trimoxazole. Two patients, one in each group, were dropped from the study because of adverse reactions.
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The aim of this study was to investigate the possible influence of arteriovenous fistula (AVF) on nerve conduction velocity in patients on intermittent hemodialysis and its relevance to the pathogenesis of carpal tunnel syndrome (CTS). The data on 22 patients showed no statistically significant differences in the electrographic parameters considered. This suggests that AVF by the end-to-end method plays no significant part in the alteration of nerve conduction. Possibly radial steal phenomena, which occur with other types of AVF, are at least partly responsible for the reported cases of CTS.
There are reports that 1,2-dichloropropane, a constituent of many commercial solvents and stain removers in Italy, has caused severe liver damage and, sometimes, acute renal failure. Between 1980 and 1983 three cases of 1,2-dichloropropane intoxication (1 by ingestion, 2 by inhalation) were observed. Clinical features included severe liver damage, acute renal failure (2 patients), haemolytic anaemia, and disseminated intravascular coagulation. The most surprising features were haemolytic anaemia and disseminated intravascular coagulation which have not been reported before. The clinical picture was similar despite different modes of exposure.
The kinetics of sodium across dialysis membranes were studied during diffusion and during convection utilizing cuprophan and cellulose hydrate membranes. During diffusion the changes in plasma water sodium concentration are correlated to the sodium concentration gradient between plasma water and dialysate but an increase also occurs when the gradient is annulled, due to the Donnan effect. During convection the plasma water sodium concentration increases during the passage through the dialyzer and the ultrafiltrate sodium concentration is significantly lower than the plasma water sodium concentration; this is due to the fact that the plasma proteins, as anions unable to cross the membrane, affect the kinetics of the sodium cations. Therefore, during diffusion the kinetics of sodium are mainly affected by the sodium concentration gradient and by the plasma protein concentration, while during convection the plasma protein concentration is the main factor affecting the kinetics of sodium.
Serum aluminum levels, significantly higher in dialysis patients than in normal subjects, were also found to be significantly higher in patients on PD than in those on HD. This could be related to a higher AI transport rate across membrane during PD than during HD. The easier contamination of PD dialysates and their acidic pH could account for this trend to a positive AI balance in PD. On the basis of our observations, however, the significance of the serum aluminum level could be very low, since aluminemia does not seem to reflect the cumulative amount of AI ingested and might not readily help predict the risk of AI intoxication.
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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.
The authors report their experience with the microcolpohysteroscope of Hamou. This instrument allows a magnification from 0 to 150 times. Its fine caliber (4 mm) allows to work easily also in the interior of the cervical canal, without preventive dilatation. The instrument allows the in vivo vision of the cellular arrangement at the superficial level, after vital staining. The purpose of this research is the discussion of the potentiality of the microcolpohysteroscopy as complementary mean to colposcopy, citology and histology in the management of the Cervical Intraepithelial Neoplasia (CIN). The authors conclude showing the advantages of this technique underlining as this method does not interfere with the natural evolution of the pathologic process, allowing at the contrary to determine the nature and the extension of the lesion. Then, without opposing or to citology or to colposcopy or to histology, it is not only a valid complementary diagnostic mean, but in particularly it contributes to a more rational therapeutic decision.
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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.
The monitoring of potentially neoplastic lesions is based on the determination of the histopathologic characteristics of the lesion, which is done either by large surgical resection of the lesions "in toto" or by biopsy of the lesion. Chronic vulvar dystrophy may develop into carcinoma, the supposed likelihood varying according to the various Authors. The lesion which is histologically defined as atypical keratoacanthoma is the most frequent precursor of carcinoma. Most Authors agree in believing that lichen scleroatrophic does not often develop into carcinoma. It is, nevertheless, the most frequent precursor of leukoplakia which is, on the other hand, a risk lesion. However, any chronic vulvar irritation may increase the risk of cancer and must therefore be carefully monitored by multiple biopsies to be examined at regular intervals.
Forty three uremic patients on regular hemodialysis treatment (4 hours 3 times/week) were dialyzed for a period of 28.95 +/- 14.46 months with a dialysate sodium concentration (NaD) of 142 mEq/l, similar to their plasma water sodium concentration corrected for the Donnan factor ("physiological" NaD). Blood pressure (BP) and body weight (BW) dropped significantly. During two following periods, lasting 18 and 14 months, with NaD 148 mEq/l, similar to the patients' plasma water sodium concentration ("pharmacologically high" NaD), cardiovascular stability improved and BP did not show significant increase. Using "physiological" and "pharmacologically high" NaD the removal of water and sodium by convection improves the cardiovascular stability and the patients' well being, without bringing about the feared long-term cardiovascular side effects, if an appropriate dry body weight is achieved, because of better correction of the cellular overhydration.
Endometrial carcinoma has an absolutely unfavourable prognosis when it involves the cervix. Clinical staging, which is essential to a correct therapeutical approach, has proven quite wrong when relying on endocervical curettage. This work deals with the use of Hamou's microhysteroscope to assess the endocervical diffusion of endometrial cancer. Thanks to its very high sensitivity (100%), high specificity (89%) and diagnostic accuracy (92%), this method has proven extremely reliable in the clinical staging of endometrial carcinoma.
Forty-three uraemic patients were studied for 60.95 +/- 14.46 months of haemodialytic treatment (4 hours, 3 times/week). After a first dialysis period of 28.95 +/- 14.46 months with a dialysate sodium concentration (NaD) of 142 mEq/L blood pressure (BP) and body weight (BW) showed values significantly lower (p less than 0.001). During a following period of 32 months with NaD 148mEq/L BP did not show significant changes. A more 'physiological' removal of water and sodium by convection does not bring about the feared long term cardiovascular side effects if an appropriate dry BW is achieved, probably because of better correction of the cellular overhydration.