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Biomedical subjects

J Bernardini

Publications and source records attributed to J Bernardini.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Daily bifractionated split course radiotherapy in non-anaplastic, non-metastatic, non-resectable cancers of the lung. A preliminary study. Apropos of 129 cases].

Between January 1980 and December 1986, 326 cases of lung cancer were treated at the Centre de Télégammathérapie Saint-Dominique in Marseille. 232 cases, including 129 non-anaplastic, non-metastatic, unresectable tumours, received bifractionated treatment; each patient received at least one cycle of radiotherapy (8% of stage I, 41% of stage II, 25% of stage IIIa, 26% of stage IIIb, 70% of squamous carcinomas, median age: 69.1 years). The protocol consisted of two cycles of 20 Gy in 10 fractions of 5 to 7 days, 2 sessions per day separated by an interval of 6 hours and with a split of 3 weeks. One hundred and twenty two patients received two cycles ("TDF 89" = 55 Gy) and, in view of the excellent tolerance, 44 patients received, 6 to 8 weeks later, a third cycle consisting of either 12 Gy in 6 fractions over 3 days ("TDF 110" = 68 Gy) or 16 Gy in 8 fractions over 4 days ("TDF 120" = 74 Gy) to a target volume reduced to the tumour zone. For the overall group, the tolerance was good or very good in 90% of cases, the median survival was 8.2 months, the objective response rate was 86% with a complete response rate of 11% and the loco-regional failure rate at the time of death was 41%. The important prognostic factors were: general status, oncological contraindications to surgery, the type of response (complete response: median survival: 12 months), the limited or advanced stage (median survival: 11.3 months versus 6.3 months) and the number of cycles, in particular: a third cycle was well tolerated and increased the survival (the median survival increased from 8 to 11 months, p = 0.01), allowed a curative dose to be administered, as the rates of complete, by more than 75%, partial and objective remission increased significantly from 9 to 16%, from 42 to 73%, from 77 to 82% and from 86 to 98% respectively. Fibroscopy returned to normal or was limited to simple infiltration in 80% of cases and the local failure rate was 36%. A comparative study of 364 patients treated with monofractionation at the CHU Timone is underway and the preliminary results appear to be very favourable.

Adenocarcinoma↗
PubMed1989

Catheter infections as a factor in the transfer of continuous ambulatory peritoneal dialysis patients to hemodialysis.

The effect of peritoneal catheter infections on the transfer of continuous ambulatory peritoneal dialysis (CAPD) patients to hemodialysis over a 9-year period were examined. Twenty-seven percent (68/247) of all patients were transferred permanently to hemodialysis after a mean of 15 +/- 14 months of CAPD. An additional 29% transferred temporarily one or more times during the study period (mean time of peritoneal dialysis, 35 +/- 23 months). The reasons for permanent transfer to hemodialysis were catheter infections (15/68, 22%), peritonitis (13/68, 19%), catheter infections associated with peritonitis (10/68, 15%), patient preference (9/68, 13%), mechanical problems (4/68, 6%), noncompliance (7/68, 10%), inadequate clearance or ultrafiltration (6/68, 9%), with other reasons for the remainder (4/68, 6%). Temporary transfers to hemodialysis were also mainly due to catheter infections (32%), peritonitis (23%), and simultaneous catheter infections and peritonitis (24%). Catheter infection rates were much higher in the groups that permanently and temporarily were transferred to hemodialysis in comparison with those patients who remained on peritoneal dialysis. We conclude that catheter infections are a leading cause of both temporary and permanent transfer of CAPD patients to hemodialysis.

Bacterial Infections↗
PubMed1989

Exit-site location does not influence peritoneal catheter infection rate.

Peritoneal catheter infections are a cause of peritonitis, catheter loss, and permanent transfer of continuous ambulatory peritoneal dialysis (CAPD) patients to hemodialysis. Risk factors for catheter infections have not been delineated. We investigated the location of the peritoneal exit-site location as a risk factor for catheter infection and loss. There was no relationship between catheter infection rates and exit location. Catheters exiting on the beltline had a median infection rate of 0.5 episodes/year, as opposed to 1.2 episodes/year for catheters exiting above the beltline and 0.9 episodes/year for catheters exiting below the beltline (ns). The percentage of catheters that became infected and required removal was the same for catheters exiting above, below, or on the beltline. Although we recommend avoiding the beltline for patient comfort, exit-site location is not an important determinant of infection rates or catheter outcome.

Catheters, Indwelling↗
PubMed1987

Analysis of continuous ambulatory peritoneal dialysis-related Pseudomonas aeruginosa infections.

The outcomes of all continuous ambulatory peritoneal dialysis-related infections due to Pseudomonas aeruginosa (n = 33) were analyzed and compared with the outcomes of infections due to all other microorganisms (n = 663) over a seven-year period. There were 16 catheter infections (exit site or tunnel infection or both), seven episodes of peritonitis, and 10 episodes of catheter infections associated with peritonitis due to P. aeruginosa. Catheters were removed in 58 percent (19 of 33) of the infections due to P. aeruginosa, but in only 16 percent (104 of 663) of the infections due to other organisms (p less than 0.01). All P. aeruginosa catheter infections associated with P. aeruginosa peritonitis resulted in catheter loss. P. aeruginosa catheter infections not associated with peritonitis also often did not resolve with antibiotic therapy (nine of 16 or 56 percent of catheters removed compared with 42 of 317 or 13 percent of catheters removed for other organisms, p less than 0.01). However, P. aeruginosa peritonitis episodes that were not associated with a catheter infection were no more likely to result in catheter loss than were peritonitis episodes due to other organisms (one of seven compared with 37 of 256, 14 percent for both). It is concluded that catheter infections due to P. aeruginosa with or without associated peritonitis usually require catheter removal. Conversely, P. aeruginosa peritonitis without a catheter infection often does not require catheter removal.

Aminoglycosides↗
PubMed1987

A five-year study of the microbiologic results of exit site infections and peritonitis in continuous ambulatory peritoneal dialysis.

We studied the culture results from 321 continuous ambulatory peritoneal dialysis (CAPD) related infections (exit site, tunnel infections, and peritonitis) in 137 patients over a 5-year period to determine the contribution of exit site and tunnel infections to peritonitis and catheter loss. Seventeen percent of peritonitis episodes were associated temporally and by microbiologic results with exit site or tunnel infections. Twenty-one percent of exit site and tunnel infections and 20% of peritonitis episodes resulted in catheter loss. Peritonitis due to Staphylococcus aureus was more likely to be associated with an exit site or tunnel infection and was more likely to result in loss of the catheter than peritonitis due to Staphylococcus epidermidis. Peritonitis and exit site infections due to Pseudomonas sp also frequently resulted in catheter removal. We found that exit site infections cause significant morbidity in CAPD patients. Further studies in this area are needed.

Catheters, Indwelling↗
PubMed1987

Experimental observation of silver and gold penetration into dental ceramic by means of a radiotracer technique.

A radiotracer technique was used to study silver and gold diffusion into dental porcelain under experimental conditions close to the real conditions in prosthetic laboratories for porcelain bakes. It was clearly shown that these non-oxidizable elements were able to diffuse into the ceramic as well as oxidizable ones. The penetration depth varied widely according to the element. The ratio DAg/DAu was about 10(3) around 850 degrees C. In contrast to gold, the silver diffusion rate was high enough to allow silver, from the metallic alloy, to be present at the external ceramic surface after diffusion into the ceramic. Hence, the greening of dental porcelains baked on silver-rich alloys could be explained mainly by a solid-state diffusion mechanism.

Chemical Phenomena↗
PubMed1986

The influence of peritoneal catheter exit-site infections on peritonitis, tunnel infections, and catheter loss in patients on continuous ambulatory peritoneal dialysis.

The importance of exit-site infections (ESIs) as a source of peritonitis and catheter loss in continuous ambulatory peritoneal dialysis (CAPD) patients is unknown. We collected data on 137 CAPD patients over a 5-year period (2,052 cumulative patient months). Patients with a history of ESIs were more likely to have peritonitis and tunnel infections than patients without a history of ESIs. A larger percentage of patients with a history of ESIs lost catheters and transferred to hemodialysis than those without such a history, independent of the effect of peritonitis. These data confirm the importance of reducing the incidence of ESIs. More information is needed to determine the nature of the relationship between ESIs and peritonitis.

Adult↗
PubMedDate not supplied

Patient survival with renal replacement therapy in heart transplantation patients.

Long-term survivors of cardiac transplantation are at risk for nephrotoxicity caused by many years of immunosuppressive therapy with cyclosporine or tacrolimus. We report on 12 patients who received heart transplants at the University of Pittsburgh, with subsequent development of end-stage renal disease (ESRD), who received renal replacement therapy at the university affiliated dialysis program. Patients were grouped by initial dialysis modality as intent to treat. Four patients were on chronic hemodialysis (HD) and eight on peritoneal dialysis (PD). Six patients died, two on HD and four on PD. There were 451 deaths per 1000 patient years for patients on PD compared with 273 deaths per 1000 patients years for patients on HD (p < 0.0001), both significantly higher than the United States Renal Data System rate of 178 per 1000 patient years for patients with ESRD who were of similar age and race, p < 0.0001. The survival rate for patients on PD seemed to be worse, but that may be because unstable patients with failing heart transplants were directed toward PD. Efforts should be made to minimize nephrotoxicity after cardiac transplantation.

Adult↗
PubMedDate not supplied

Gender differences in normalized clearances in CAPD: role of body size and normalizing parameters.

OBJECTIVE: To compare raw (not normalized) and normalized urea and creatinine clearances between women and men on continuous ambulatory peritoneal dialysis (CAPD). To study whether potential gender differences are due to the normalization process. DESIGN: Retrospective analysis of clearance studies. SETTING: Dialysis units of four academic medical centers. PARTICIPANTS: The study included 302 subjects (135 women and 167 men) on CAPD with four daily exchanges and a 2-L exchange volume. INTERVENTION: Measurement of urea and creatinine clearances (261 in women, 352 in men) by standard methods. Body water (the volume of distribution, V, for both urea and creatinine) was estimated by the Watson anthropometric formulas. MAIN OUTCOME MEASURES: Comparison of raw and normalized clearances between women and men. Urea clearance was normalized by V (Kt/Vur), while creatinine clearances was normalized by both V (Kt/Vcr) and body surface area (BSA) (Ccr). RESULTS: Mean values of weekly total (peritoneal plus renal) raw clearances were higher in men (urea clearance: women 67.1 L, men 77.4 L; Ccr: women 61.7 L, men 78.3 L). Raw renal clearances were higher in men, while raw peritoneal clearances were comparable. Mean weekly total Kt/Vur was higher in women (2.19 vs 1.94 in men), mean weekly total Kt/Vcr did not differ between the genders (women 2.01, men 1.95), while mean weekly Ccr was higher in men (73.0 vs 64.7 L/1.73 m2 in women). When clearances differed, the differences were significant at p < 0.001. Men had greater height and weight, while women had greater body mass index. On the average, V in men exceeded V in women by 31%, while BSA in men exceeded BSA in women by only 12%. CONCLUSIONS: Normalization of clearances by V creates relatively higher clearance values in women, while normalization by BSA creates relatively higher clearance values in men. Thus the normalization process may create artificial differences in the normalized clearances between genders.

Body Constitution↗
PubMedDate not supplied

Normalization of clearances in peritoneal dialysis using a formula for body water derived from an end-stage renal disease population.

OBJECTIVE: To compare body water (V) estimates from the Chertow formula (Vc), which was derived in an end-stage renal disease population, to V estimates from the Watson formulas (Vw) in continuous ambulatory peritoneal dialysis (CAPD) patients. To identify CAPD patients in whom Vc is preferred to Vw for clearance studies. DESIGN: Retrospective analysis of clearance studies. SETTING: Dialysis units of four academic medical centers. PARTICIPANTS: 302 subjects on CAPD. INTERVENTION: 613 clearance studies by standard methods. MAIN OUTCOME MEASURES: Comparisons between Vc and Vw, and between urea clearance normalized by Vc [(KtVc)ur] and Vw [(Kt/Vw)ur]. RESULTS: Vc exceeded Vw by 3.5 +/- 1.6 L (p < 0.001), or 9.6% on average. This degree of overestimation of Vw is in the range of body water estimates found in CAPD subjects with severe volume overload (> 5% of body weight) in previous studies. Total (Kt/Nw)ur exceeded total (Kt/Vc)ur by 8.6%. By linear regression, Vc = -0.589 + (1.112 x Vw), r = 0.983. Vw exceeded Vc in only 12 studies. Young age, short height, low body weight, and low prevalence of diabetes characterized the studies with Vw > Vc. Total (Kt/Vw)ur was adequate (> or = 2.0 weekly) in 276 studies. Among these, 74 studies had inadequate total (Kt/Vc)ur (< 2.0 weekly). By logistic regression, the predictors of inadequate (Kt/Vc)ur, when (Kt/Vw)ur was adequate, included the presence of diabetes, great height, and long duration of CAPD. CONCLUSIONS: Vc provides estimates of body water exceeding those provided by Vw in a great majority of CAPD patients. Consequently, approximately 25% of the clearance studies that are adequate when Vw is used as the normalizing parameter may be inadequate when Vc is used. Vc may provide a more appropriate estimate of body water than Vw in CAPD patients with volume overload.

Body Water↗
PubMedDate not supplied

Peritoneal dialysis clearance can replace residual renal function.

OBJECTIVE: There is controversy whether increasing peritoneal clearance effectively substitutes for declining residual renal function. We studied the impact of renal and peritoneal clearances on outcome, controlling for comorbidity. DESIGN: Registry database. SETTINGS: Four dialysis centers. PATIENTS: Incident peritoneal dialysis patients. METHODS: Data were collected prospectively on 90 incident patients between 1991 and 1999. At the end of their first year on peritoneal dialysis, patients were divided into groups based on the first year's clearance results: group 1 (n = 62) had weekly Kt/W greater than or equal to 2.0 and creatinine clearance (CCr/1.73 m2) greater than or equal to 60 L throughout the first year; group 2 (n = 28) fell below these targets due to loss of residual renal function and then reached targets due to prescription change. MAIN OUTCOME MEASURES: Patient and technique survival. RESULTS: Both groups were similar in baseline characteristics except age (57 years vs 49 years, p = 0.02) and initial albumin (34.4 g/L vs 37.5 g/L, p = 0.001). One-year patient survival after grouping was similar in both groups (86.3% vs 80.9%, p = 0.72). Cox proportional hazard model, controlling for comorbidity, did not show "group" to be a significant predictor of outcome (p = 0.96). One-year technique survival after grouping was similar in both groups (77.3% vs 83.2%, log rank p = 0.89). For technique failure, Cox proportional hazard model showed peritonitis (p = 0.004) to be the only significant predictor of worse outcome. CONCLUSIONS: Peritoneal dialysis patients with improved clearances due to prescription changes had survival comparable to patients who never fell below target. This suggests that loss of residual renal function may be replaced by increasing peritoneal dialysis clearance. A large multicenter trial to study this important question further is needed.

Female↗