Search PubMed⌕ Search

Biomedical subjects

M Salomone

Publications and source records attributed to M Salomone.

At least 19 recordsLinked to original sources
PubMed2000

Steroid and cyclophosphamide in IgA nephropathy.

BACKGROUND: IgA nephropathy is associated with a wide spectrum of possible lesions. Therefore, different responses to anti-inflammatory or immunosuppressive therapies should be expected with acute inflammatory changes, which are predominantly reversible, and with prevalently sclerotic lesions. METHODS: The effects of a combined schedule of prednisone and cyclophosphamide was analysed in the specific subset of IgA nephropathy patients with acute inflammatory histologic changes associated with haematuria and proteinuria. Two groups of patients, with similar histologic lesions and clinical presentation, were considered. The first group (12 patients) was treated within 1 week after renal biopsy; starting with three pulses of methylprednisolone (1 g) followed by oral prednisone (0.8 mg/kg body weight for 2 weeks, 0.6 mg/kg for another 2 weeks, 0.4 mg/kg for an additional 4 weeks, then slowly tapered by 5 mg each month until discontinuation) and 1.5 mg/kg cyclophosphamide for 2 months. A second sample of eight untreated patients served as a control group. Treated and untreated patients had diffuse mesangial proliferation with florid crescents (8-60% in treated and 10-40% in untreated patients) with mild degree of glomerular sclerosis and interstitial changes. Basal creatinine (167 micromol/l, range 79-371 vs 132 micromol/l, range 79-256) and proteinuria (3.0 g/24 h, 1.0-4.9 vs 3.3 g/24 h, 1.0-13.7) were not statistically different between treated and untreated patients respectively. Nine treated and six untreated patients were hypertensive. Blood pressure treatment did not include ACE-inhibitors. RESULTS: Untreated patients' 5-year renal survival, as assessed by the Kaplan-Meier method, was found to be significantly lower than treated patients (37.5 vs 91.6%, log-rank P=0.01 and Breslow test P=0.008; relative risk to reach the endpoint of a 100% increase in serum creatinine=3.58, P=0.03). CONCLUSION: This short course of therapy with prednisone and cyclophosphamide has been effective in a subset of IgA nephropathy patients with florid glomerular changes and major urinary abnormalities, turning off phlogistic activity and preventing subsequent progression toward renal failure.

Adolescent↗
PubMed1999

Catastrophic antiphospholipid syndromes in systemic lupus erythematosus.

The objective of this study was to look for the occurrence of catastrophic antiphospholipid syndromes (APS) and to try to detect discriminating factors for predicting a worse prognosis, related to Lupus anticoagulant (LA) and antiphospholipid antibodies (aPL), in systemic lupus erythematosus (SLE) with main renal involvement. Regression, recursive partition and logistic regression analyses were applied to our 80 SLE patients prospectively followed up since 1980. Immunologic and other laboratory parameters including beta 2-glycoprotein 1 dependence, resistance to activated protein C caused by a substitution on the coagulation factor V gene, induction of monocyte procoagulant activity. Regression studies demonstrated an overall worse prognosis in term of both thrombosis and death for the group of LA/aPL positive patients (33/80). However, recursive partition analysis was able to isolate a small high risk-subgroup (8/33) characterized by persistent LA/aPL antibodies positive result, widespread signs of noninflammatory vasculopathy (skin, brain, kidney) and renal pathology mimicking that of thrombotic microangiopathy or arteriolosclerosis, also in the absence of classic SLE-nephritis. Only in this subset, three catastrophic APS were recorded, while, in traditional SLE nephritis, even persistent LA/aPL positive results (sometimes after one previous thrombosis) did not seem to imply a particularly severe prognosis. All serologic criteria employed are unable to identify high-risk patients. We conclude that catastrophic APS is a rare event in renal SLE. Before more predictive serologic markers become available, a simple algorithm, dealing with clinical data and renal histologic patterns, may help physicians to identify putatively high risk-LA/aPL antibodies in SLE patients with main renal involvement. This ominous subset does not belong to the group of classic SLE-nephritis.

Adolescent↗
PubMed1998

[Vascular access for chronic hemodialysis: current status and new directions in the Piedmont].

Long survival on dialysis and wide admissions of very old and high risk patients, have focused attention to the problem of vascular access in uremic patients. The situation is critical in the USA, where PTFE/bovine grafts are utilized in about 75% of the cases. conversely, AV fistulas are the main type of access in Piedmont, where their use approaches 90% of the cases, Cimino-Brescia fistulas account for 58% of vascular accesses versus 25% and 9% of proximal AV fistulas and PTFE/bovine grafts, respectively. However, the latter progressively increase as age and time on dialysis increase. Snuff box fistulas are used only for 3% of the cases and this figure is steadily decreasing. In the meanwhile basilic vein superficializations, even if limited in numbers (1%), provided in some centres satisfactory results in term of survival and function. However, the type of access that deserved in the last few years the highest interest is the internal jugular vein cannulation (Canaud/Tesio catheter). In a preliminary series of 51 cannulations in 47 patients, this vascular access was permanent in 28 cases. A possible future routine utilization of jugular vein catheters is advisable in cases where a waiting period (up to a few months) is requested to allow a new fistula to mature or to maintain an empty abdomen in a patient temporarily withdrawn from peritoneal dialysis. Due to the heavy engagement for catheter maintenance and the high number of removals for systemic (9.8%) or skin exit infections (13.7%), a longer stay of indwelling catheters, although actually safe, should be limited to selected cases.

Adult↗
PubMed1998

[Comorbidity factors in the dialysis registries and the experience of the Piedmontese Registry].

The parameters used at present by the Dialysis and Transplant Registries of various countries to evaluate dialyzed patients' comorbidity show great differences, mostly owing to the different epidemiological, social and racial characteristics of the studied populations. Moreover, the typology of the dialyzed patient is changing: the mean age is increasing, patients with high-risk conditions as vasculopathy and diabetes are widely accepted to the treatment. Thus the Piedmont Registry will be implemented as follows: new fields about comorbidity for clinical (blindness, cachexy and dementia), social (smoking, alcohol and drugs addiction) and diagnostic (type of diabetes, of neoplasm, of cardiovascular problem) parameters, and questions needing dichotomic response (vasculopathy yes or no) will be added. The exact time of appearance of any risk factor will be requested, and a field for "others" risk factors will be added as well, trying to deeply identify the dialytic population not affected by any comorbidity factor. Finally, a new improved control system of the collected data will be used: our registry needs to be implemented in the future by such evaluations, to go on giving useful informations about epidemiology of the dialyzed patients.

Adolescent↗
PubMed1998

[Analysis of cause of death in the 1st and last periods of the Piedmontese Dialysis and Transplantation Registry].

The aim of this study is to assess the mortality causes in dialysis in the Piedmont Region, using the data of the Dialysis and Transplantation Register (DTR). Data of a 15-year use of the DTR regarding 5519 hospital dialysis admissions were considered. Mortality seems to be particularly due to cardiac causes analyzing, also the incidence of other causes of death such as: cachexia, sudden death and infection causes.

Adolescent↗
PubMed1998

[Critical review of renal transplantation data from the Piedmontese Regional Dialysis and Transplantation Registry].

On 31/12/1995 a total of 1,128 Piedmontese uremic patients had undergone kidney transplantation, with 65% of operations performed by the Regional Reference Centre and 35% by extra-regional centres. Waiting time for dialysis was less than 5 years in over half of the patients most of whom were aged between 40 and 60 years old. In overall terms, the patient survival rate was 94%, 87%, 75% at 24, 60, 120 months respectively, with a statistically significant improvement when the curve was evaluated in the patient-pool treated with cyclosporine (84% versus 87% at 7 years). Organ survival was 76% at 21 years and 42% at 10 years, and results were again improved by the use of cyclosporine. Pathologies affecting the transplanted organ represent the main cause of morbidity; drop-out during dialysis is caused above all by immunological diseases. Infectious pathologies were responsible for the majority of deaths in this population.

Adolescent↗
PubMed1998

[Cachexia during dialysis].

In the Italian language, the term cachexia is a rather picturesque synonym of "marasma senile", "senile marasmus", an old definition involving not only old-age, but specifically senility, the end of the ageing process and marasmus, a stagnant and hopeless situation in which all superior organised functions have disappeared. The problem of cachexia during dialysis is complex and several discordant opinions exist at this regard, partly accounted by different definitions of this sluggish entity (or non entity). Actually, the basic question is very simple: is cachexia the cause or the effect of failure of dialysis treatment? The aim of this study was an evaluation of epidemiological data from the Dialysis and Transplantation Registry of Piedmont, a northern Italian Region with about 4,350,000 inhabitants, 22 public dialysis Centers, open acceptance to dialysis since the mid seventies, a multiple choice dialysis system developed in the eighties. In the period 1981-1995, 764 patients died in conditions of cachexia. This figure is 20.9% of all deaths recorded, 27.4% over age 65 and 34.7% over age 75. Despite a likewise significant increase in age and presence of comorbid factors, an improvement of patients survival, that reach statistical significance in the old age group (> or = 65 yrs), was observed.

Aged↗
PubMed1998

[Social rehabilitation, state of the disease and quality of life. What are the parameters to evaluate rehabilitation of the patient under dialysis in the '90s?].

The parameters used at present by the Piedmont Dialysis and Transplant Register to evaluate rehabilitation and quality of life of the dialyzed patients have been useful in the past, but they will no longer be so in the future, as the typology of the dialyzed patient is changing: the mean age is increasing, patients with high-risk conditions as vasculopathy and diabetes are widely accepted to the treatment. Thus, rehabilitation has to be evaluated not only from a social and professional viewpoint, but also as "illness situation" and "quality of life" and this can be done using the Karnofsky scale and the test of Spitzer: our Register needs to be implemented in the future by such evaluations, to go on giving us useful information about rehabilitation of the dialyzed patients.

Female↗
PubMed1997

[Uremic pruritus].

Among the various dermatologic abnormalities that can be associated with advanced chronic renal failure and dialysis therapy, pruritus is certainly the most disturbing disorder. Pruritus is an unpleasant, vexing sensation that provokes an intense desire to scratch. In the past the pruritus was considered from the neurophysiologic point of view as a submodality of pain, but more recent research showed that pain and pruritus are sensations which are carried through different populations of primary sensory neurons. The causes of pruritus in uremic patients are still unknown: xerosis, intradermic microprecipitation of divalent ions, hyperparathyroidism, peripheral neuropathy, allergic reactions and hypersensitivity, histamine and others have been considered as pathogenetic factors. The uncertainty on the causes is in part responsible for the different approach and results, unsatisfactory in many cases. In this paper we will review the neurophysiology, the pathogenesis and the possible therapeutic approaches to uremic pruritus.

Cations↗
PubMed1996

Prevalence of hyperlipidemia in a cohort of CAPD patients. Italian Cooperative Peritoneal Dialysis Study Group (ICPDSG).

An association between hyperlipidemia and cardiovascular disease is well described in the literature. We conducted an observational study in order to evaluate the lipid profile, the prevalence of hyperlipidemia and its relationship with age, sex, duration of CAPD, peritoneal glucose load (PGL), serum albumin (ALB), serum glucose (GLU), and BMI in a large cohort of uremics undergoing long-term treatment with CAPD. 457 nondiabetic patients (245 males, 212 females; mean age 63.8 +/- 11.9 years; mean duration of CAPD: 41.8 +/- 26.9 months) treated during 1992 in 25 centers participating in the Italian Cooperative Peritoneal Dialysis Study Group (ICPDSG) were studied. The serum lipid parameters evaluated were triglycerides (TG), total cholesterol (CHO), HDL-cholesterol (HDL). Indications given in the New England Journal of Medicine, SI Unit Conversion Guide, 1992, were adopted for normal ranges. In the whole population the evaluation of lipid parameters showed: TG 227.4 +/- 123.3 mg/dl, CHO 232.8 +/- 56.0 mg/dl, HDL 40.7 +/- 12.0 mg/dl. No differences were found between the two sexes with regard to age, BMI, duration of CAPD, distribution of renal diseases, TG, ALB, and GLU; whereas CHO and HDL were significantly lower in males than in females (CHO: 222.2 +/- 53.5 vs. 245.0 +/- 56.5 mg/dl, p < 0.001; HDL: 39.3 +/- 11.4 vs. 42.6 +/- 12.6 mg/dl, p < 0.05). The prevalence of hypercholesterolemia was significantly lower in males than in females (19.7 vs. 35.4%; p < 0.001). The multiple regression analysis indicated that TG were directly correlated to PGL (p < 0.05), and HDL was inversely correlated with TG (p < 0.001). The coexistence of the two variables (TG and HDL) may increase the risk of cardiovascular events. Further strategies should therefore be developed to select and manage CAPD patients to reduce the incidence of hyperlipidemia.

Blood Glucose↗
PubMed1996

[Epidemiology and clinical course in hepatitis C-positive patients treated with dialysis in Piemonte. Work group of the RPDT].

The high prevalence of HCV positivity in dialysis patients has recently prompted several studies on this controversial subject. The aim of the study was an evaluation of HCV positivity and of influence on clinical outcome in 2,404 patients on dialysis in Piedmont (Northern Italy Region, about 4,400,000 inhab., 20 Dialysis Centers) at December 1993 (32.7% HCV-positive according to the Regional Registry of Dialysis and Transplantation). As expected, a strong correlation was found with time on dialysis (94.4% in patients with treatment follow-up > or = 20 years) and blood transfusions (41.3% HCV positivity in transfused patients versus 22.6% in not transfused ones; p < 0.0001). Dialysis in a hospital setting is confirmed as at high risk of infection, since HCV positivity was 19.6% in patients always treated by bicarbonate dialysis in hospital versus 8.9% in those treated only by CAPD (start of dialysis in 1992-1993). Despite the high prevalence of HCV positivity, however, death rates for liver disease and for all gastrointestinal causes are very low, regardless of HCV antibody status (1.2% in HCV positive versus 2.3% in HCV negative, NS). Whether this depends upon different clinical features of HCV infection in dialysis patients or merely deflects a relatively short follow-up will be matter of discussion in the future.

Adult↗
PubMed1996

[Clinical and epidemiologic characteristics of selected long-term survivors undergoing dialysis].

At the end of December, 1993, 389 patients treated by means of dialysis for more than 15 years were registered in the Piedmont Dialysis and Transplantation Register; among them, 183 were alive. Characteristics of these patients as age at the beginning of dialytic treatment, casual nephropathies, causes of death, high risk conditions, dialytic schedules, vascular access, hospitalization requirements, rehabilitation, dialysis efficacy, gross mortality, were compared with those of patients treated for a shorter time, concluding that a very long dialytic survival can be achieved with a good clinical and social rehabilitation.

Cause of Death↗
PubMed1996

[Patients with neoplastic disease or older than 80 years of age: dialysis survival].

In several European countries, including Italy, the resident population is ageing. This process is at the basis of the progressive increase in incidence of new elderly patients starting dialysis and, to a lesser degree, of patients affected by severe comorbid conditions, such a neoplasia. The aim of the study was an analysis of the situation in Piedmont (Northern Italy, 4,400,000 inhabitants): out of 4483 new entries in 1981-1993, 192 were aged 80 years and 87 were affected by renal neoplasia or by multiple myeloma. Incidence of patients aged 80 increased throughout the period; use of high tolerance techniques increased in the meantime allowing an improvement in survival results. The high incidence of vasculopathic patients and the high rates of death from cachexia pinpoint how much still has to be done in the field of prevention, even before dialysis starts.

Age Factors↗
PubMed1996

[Diabetes mellitus is currently one of the most frequent causes or associated causes of uremia. Data from the Piedmont registry of dialysis and transplantation (update, December 1993)].

A regular dialytic treatment of diabetic patients is until accepted from about twenty years in many areas. Aim of this work was a retrospective analysis of main clinical and survival data of diabetic patients (diabetic nephropathy or diabetes as comorbidous factor = 659 cases) admitted for dialysis in Piedmont (Northern Italy Region about 4,400,000 inhabitants) in the period 1981-1993 (functional recovery and follow-up < 1 month excluded). A progressive increment in incidence of diabetic patients was seen mostly in the aged. At 12/31/1993, 263 of 2404 patients admitted for dialysis were diabetics (10.9%); the majority of them was treated in Hospital Centers with bicarbonate haemodialysis (54.4%), while a small group was treated with CAPD (12.9%). During the years ¿80 was seen a progressive leaving of CAPD as first choice method in this population and in the last period the orienteering is the utilization of mixed methods (diffusive-convective as first choice). As regards the survival are not prominent significant differences between this cohort and the cohort affected by vasculopathy as comorbidous factor (86.2 and 54.2% in diabetics vs 78.6 and 55.2% in patients affected by vasculopathy at 1 and 3 years--p = 0.3481; patients aged 45-64 years). In conclusion the cohort of diabetic patients represent a good marker of the clinical problems of the elder population with high clinic risk, in progressive increasing in our Region.

Adult↗