[Use of high-dose furosemide in patients undergoing regular hemodialysis].
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Biomedical subjects
Publications and source records attributed to G Piccoli.
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The effects of gliadin and glyc-gli on leukocyte chemiluminescence response were assessed in vitro. A dose-dependent increase in chemiluminescence response of neutrophils stimulated by zymosan was observed by using gliadin at concentrations ranging between 1 and 20 micrograms. By increasing glyc-gli concentration, a bimodal response was observed with an enhancement up to 50 micrograms/ml, followed by suppressive effects, which were again dose-dependent. The possible implications of these findings in human pathology are discussed.
Serum samples from 115 patients with various kidney disease were studied by means of precipitation in 3.5% polyethylene-glycol (the PEG test) and by inhibition of agglutination of IgG-coated polystyrene particles induced by C1q, two tests developed for the detection of circulating immune complexes. Positive results were found in acute glomerulonephritis, particularly in its early stages, and also in chronic forms of glomerulonephritis: membranous, focal sclerosing, mesangiocapillary and focal glomerulonephritis. High levels of circulating immune complexes were found in lupus nephritis. In most cases the test results showed a good correlation with the clinical course of the diseases.
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A test for the measurement of trace urinary albumin concentrations, which is suitable for the detection of microalbuminuria, was developed. The technique is an indirect enzyme-linked assay (ELISA) in which a fixed amount of anti-albumin antibody is placed into polystyrene tubes coated with human albumin, together with the urine sample to be tested. The albumin in the test specimen competes with the solid-phase albumin for binding to the added antibody. The test is precise (inter- and intra-assay coefficients of variation were 8.2% and 7.8%, respectively), accurate (mean recovery 102-106% for two human albumin preparations), and sensitive (detection limit 0.9 micrograms/ml). These characteristics are not dissimilar from those of the radioimmunoassay reported in the literature, with the advantages of being completely safe, easy to perform, and not requiring expensive equipment. Using this assay the urinary albumin excretion in 20 normal subjects was found to be 2.5 +/- 2.2 micrograms/min (range 0.9-7.5 micrograms/min) after 8 hours of bed rest and 4.5 +/- 5.7 micrograms/min (range 1.5-2.0 micrograms/min) after 8 hours of moderate physical activity.
Neutrophil oxidative metabolism was prospectively assessed in 9 consecutive patients undergoing cardiopulmonary bypass (CPB) with polypropylene hollow fiber oxygenators for open cardiac operations. Blood samples were collected at 10, 20, and 30 min of CPB. The generation of oxygen-free radicals by neutrophils was measured as luminol-enhanced chemiluminescence after stimulation with opsonized Zymosan and Phorbol Myristate Acetate. A significant increase in light emission was detected by using both the chemiluminescence stimulators. These data suggest that the contact of patient blood with foreign surfaces during cardiopulmonary bypass results in activation of phagocyte cells.
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BACKGROUND: In Italy, dialysis reimbursement is regulated by the "Tariffario delle prestazioni ambulatoriali" (G.U. N 216, 14/9/1996), which does not take into account separately the dialysis sessions performed in hospitalised patients. In these cases the dialysis activity is considered within the final DRG (Diagnosis Related Group). Aim of the study was an analysis of production costs of dialysis performed in hospitalised patients, according to the setting in which dialysis is performed (Intensive Care Units (ICUs), other Units, hospital dialysis ward). METHODS: The direct production costs were assessed by the "bottom-up" technique logic (cost definition from the single elements needed for producing the treatment) referring to specific Cost Centres. The main items considered were health-care staff, dialysis supplies and hardware, blood tests, dialysis data recording and transmission. RESULTS: During the year 2000, there were 4,450 treatments performed in 490 patients. They included 924 haemodialyses in ICUs; 2,531 in the nephrology hospital dialysis ward; 602 peritoneal dialysis treatments in ICUs-other wards, 393 in the nephrology ward. Direct cost per haemodialysis treatment ranged from 276.05 E (UF) to 413.46 E (HF) in ICU, from 170.47 E (Bicarbonate Haemodialysis) to 275.36 E (Slow Haemofiltration) in hospital dialysis ward; for peritoneal dialysis between 128.95 E (CAPD in dialysis ward) and 282.10 E (CAPD in ICU/other Units). During the year 2000, the global cost of production was 1,038,346.65 E. CONCLUSIONS: The cost of dialysis in hospitalised patients is high. A dedicated budget is needed to avoid deficits, particularly in highly specialised Units of large referral hospitals.
The Italian Registry of Dialysis and Transplantation (RIDT) was born in 1996 under the aegis of the Italian Society of Nephrology, and it is organized as a federation of regional registries. This study aimed to completely revise the epidemiological data collected during the first 5 yrs (1996-2001) of RIDT activity to evaluate the trends of the main epidemiological features. During this period, regional registries were not always able to assure complete and exhaustive information according to RIDT requirements, owing to different levels of organization and functioning. To avoid any possible error in data analysis, information inadequately assessed was refused. The incidence of end-stage renal disease (ESRD) patients on renal replacement therapy (RRT) in Italy has increased from 114 pmp in 1996 to 139 pmp in 2001, that means an increase of 3.5%/yr, corresponding to 5718 patients during 1996 and 8000 patients during 2001. Primary renal diseases (according to the EDTA) in incident ESRD patients are vascular and diabetic nephropathy. Main dialysis modality in incident patients was hemodialysis (HD) (85%), while peritoneal dialysis (PD) was only 15%; pre-emptive transplantation was a very unusual modality. The prevalence of ESRD patients at 31 December was 693 pmp in 1996 and 827 pmp in 2001; among dialysis patients, the corresponding rates were 575 pmp and 657 pmp, respectively. Consequently, the number of dialyzed patients increased, respectively, from 28892 to 37919. The prevalent dialysis modality was bicarbonate dialysis in 74% of cases, followed by hemodiafiltration (HDF) in 15%, continuous ambulatory peritoneal dialysis (CAPD) in 7% and APD in 3%. The gross mortality rate in dialyzed patients was stable during this period, at approximately 14%, the main causes of death being cardiovascular diseases and cachexia.
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The aim of the study was to evaluate, before and after hemodialysis (HD), the effects of partial correction of anemia with erythropoietin on: cardiac index (CI), stroke index (SI), heart rate (HR), ventricular ejection index (EVI), mean arterial pressure (PAM) and systemic vascular resistance index (SVRI). Cardiac parameters were gathered by means of transthoracic bioimpedance (BoMed). Twelve patients (6 M, 6 F) aged 50.6 +/- 5 years, on HD for 92.8 +/- 15.9 months, were studied twice (basal, end of follow-up). Before rHuEPO therapy, 6 patients had a "pathologic" cardiac response to HD (defined as an increase of CI despite the reduction of pre-load). After rHuEPO, 5 out of 6 patients with a "pathologic" response reverted to a "normal" response, and 1 hypertensive patient from a "normal" to a "pathologic" response. The EVI, CI and SI of patients with "pathological" response significantly improved after rHuEPO as compared with pre rHuEPO values (EVI 1.36 +/- 0.14 vs 1.07 +/- 0.08, p = 0.023; CI 3.18 +/- 0.24 vs 1.78 +/- 0.27, p less than 0.01; SI 43 +/- 3.7 vs 24 +/- 3.8, p less than 0.01). In conclusion, partial correction of anemia with rHuEPO induces an improvement of myocardial performance, without significant hemodynamic adverse effects. Our results suggest also that anemia could play a significant role in the pathogenesis of myocardial disfunction in HD patients.