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M Giannattasio

Publications and source records attributed to M Giannattasio.

49 records · Page 3Linked to original sources
PubMedDate not supplied

[The role of the surgeon in a domiciliary peritoneal dialysis program].

The Authors report their surgical experience with 54 ESRD patients treated with peritoneal dialysis (PD). Guidelines on videolaparoscopic surgical treatment have been described and in 13 patients peritoneal catheter (PC) was inserted by videolaparoscopy (VL). They performed five VL cholecystectomies, in four cases combined with the PC insertion, in one PD patient without PD interruption. In three cases VL was useful in diagnosis and treatment of PC malfunction. A protocol has been done to treat hernias or laparocele before starting PD or during the course of PD and to prevent their recurrence. Two patients were operated for hernia or laparocele before PC insertion, seven patients during PC insertion. Seven patients were operated for hernia or laparocele developed during PD treatment, one of them in emergency for intestinal strangulation. One patient was operated for epigastric laparocele after an hypogastric laparocele correction. Prosthetic mesh repair was performed in every patient.

Abdominal Muscles↗
PubMedDate not supplied

[Credentialing for diagnostic and interventional nephrology].

UNLABELLED: It is necessary to define the credentialing process that allows the nephrologist to achieve certification and accreditation in the following essential procedures of diagnostic and interventional nephrology: renal echography; renal and bone biopsies; the creation of vascular (arteriovenous fistula [FAV], grafts) or peritoneal access for permanent dialysis; the management and treatment of possible complications; and the implantation of central venous catheters for temporary or definitive hemodialysis. BACKGROUND: The acquisition of credentials for the interventional nephrologist includes the completion of training programs, the identification of appraisal indices, certification, possible recertification, and accreditation. The specialist validation allows the nephrologist to act as a tutor and supply the credentials for the interventional procedures in nephrology. The use of echography has remarkably simplified the procedure of percutaneous renal biopsy, a technical diagnostic invasive technique, practiced exclusively by the nephrologist the ecography-guided technique has reduced the risks of greater complications to less than 0.5%. However, guidelines are lacking on the training required to accredit a nephrologist in this technique. The initial placement of a shunt, vascular or peritoneal, to carry out dialysis treatment is usually performed by the nephrologist, radiologist, or surgeon. However, the successful long-term management of the dialysis patient generally demands a multidisciplinary approach. The poor management of the dialysis shunt can contribute to reduced patient life expectancy and increased costs of care. Therefore, it is essential that those who perform such interventional procedures must be certified and accredited according to strict protocol guidelines. In Italy (as opposed to the United States) most peritoneal shunt placements are performed by the nephrologist. However, international scientific society guidelines on this procedure, where they exist, are generic, allowing for the adaptation of particular techniques by various nephrologic centers. The criteria for the acquisition of credentials in one particular procedure must be uniform, logical, consistent, and applicable, comprising of a recognition of the basic procedure and a course of appropriate practical training. The criteria for training and credentialing in diagnostic and interventional nephrology should encompass the following points: The establishment of guidelines for the performance of all procedures that ensures suitable and effective treatment, including during emergencies, and considering the hospital context in which the procedures are performed. The recognition that scientific society guidelines for one specialty or procedure may not be appropriate or applicable to credentialing in another specialty or procedure. The ability of guidelines to adapt to improvements in technique and new technologies. The stipulations of insurance coverage and legal counselling must be taken into consideration whenever accreditation criteria are developed. CONCLUSIONS: An adequately certified and accredited background improves the quality of care, reduces costs and waiting list time, and reduces those complications that could increase the length of hospitalization.

Biopsy↗
PubMedDate not supplied

[Contrast-induced acute renal failure].

The administration of radiocontrast media (RC) can lead to usually a reversible form of acute renal failure (ARF) that begins soon after the contrast is administered. A functional definition of RC-induced ARF varies among different studies: most commonly reported as a proportional rise in serum creatinine (Cr), 25 or 50% above baseline or an absolute rise of 0.5-1.0 mg/dL within 48 hr after exposure to RC. Serum Cr returns to baseline over 8-12 days. Sometimes ARF is irreversible, contributing to an increase in mortality. Iodinated RC are either ionic or non-ionic and, at the concentrations required for arteriography or computed tomography, are of variable osmolality. Considering the main ARF risk factors, a rise in plasma Cr is: negligible with normal renal function, even if the patient is diabetic; 4-11% with mild to moderate renal insufficiency alone (plasma Cr between 1.5 and 4.0 mg/dL); 9-38% with mild to moderate renal insufficiency and diabetes mellitus; > or =50% if baseline plasma Cr is >4-5 mg/dL, particularly in patients with diabetic nephropathy. This risk, however, is increased further by more advanced renal dysfunction, marked volume depletion, severe heart failure, or multiple contrast studies within 72-hr. Pathogenesis is not well understood, but the mechanism by which nephrotoxins induce renal injury is generally by either vascular or direct tubular effects. In the case of RC ARF, there appears to be an influence of both mechanisms, although altered renal hemodynamics predominates. Both are thought to occur from exposure to the hyperosmolar agent. The best treatment for contrast-induced renal failure is prevention. Some preventive measures include the use, if clinically possible, of ultrasonography, magnetic resonance imaging or CT scanning without RC agents, particularly, in high-risk patients; the use of lower contrast doses and the avoidance of frequent repetitive studies; the avoidance of volume depletion or non-steroidal anti-inflammatory drugs; the administration of intravenous saline and the antioxidant acetylcysteine; the use of low or iso-osmolal non-ionic contrast agents, particularly in high risk patients.

Acetylcysteine↗
PubMedDate not supplied

[The kidney and gentamicin].

The parameters that influence the administration of drugs in patients with various degrees of renal insufficiency are described. A series of 51 patients treated with gentamycin is presented. 28 subjects displayed average and serious renal insufficiency. The drug was well tolerated and gave excellent results even in cases of advanced insufficiency.

Acute Kidney Injury↗