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Biomedical subjects

P Zucchelli

Publications and source records attributed to P Zucchelli.

At least 109 records · Page 6Linked to original sources
PubMed1988

Glomerular dysfunction in diabetic nephropathy.

In the early stages of insulin-dependent diabetes mellitus (IDDM) in humans and in animals the renal plasma flow (RPF) and the glomerular filtration rate (GFR) have often been found higher than normal. Moreover, in a subset of IDDM patients, early abnormalities in protein excretion, termed 'subclinical proteinuria' or 'microalbuminuria' have been found. This finding is thought to be a predictor of clinically overt diabetic nephropathy. Hence, it has been proposed that high glomerular hydraulic pressure and/or plasma flow rate may be responsible for causing both proteinuria and the progression of diabetic nephropathy. However, other abnormalities such as the impaired synthesis of prostaglandins, an abnormal production of cationic polyamino-acids found in IDDM, may cause both proteinuria and nephropathy. So the role of increased glomerular pressure in initiating diabetic nephropathy is being debated. To verify whether increased GFR and proteinuria are causally linked, we have randomly allocated 12 IDDM patients (age range 25-58, mean 35 years; six males, six females) with increased GFR (131-165 ml/min, mean 145 ml/min), microalbuminuria above the normal range (range 35-130 micrograms/min, mean 80 micrograms/min) and moderate hypertension (mean blood pressure above 110 mmHg) to take a low protein diet with their standard antihypertensive therapy or their usual diet together with captopril administration (25-50 mg/day) for 4 weeks each. After low protein diet we found a significant decrease in GFR (P less than 0.05) and also in albuminuria (P less than 0.01). After captopril administration we found a small, statistically insignificant decrease in GFR with a moderate increase in filtration fraction and a significant decrease in albuminuria (P = 0.05). No correlation was found between the GFR and albuminuria variations during the low protein diet or during captopril administration. In conclusion, both the low protein diet and the captopril administration significantly decrease protein excretion. However, our data suggest that the proteinuria decrease does not correlate with the decrease in GFR, so other mechanisms besides hyperfiltration seem to be involved in the proteinuria of IDDM patients.

Adult↗
PubMed1988

Long-term effects of parathyroidectomy on cardiac and autonomic nervous system functions in haemodialysis patients.

Ten patients receiving regular haemodialysis therapy who underwent parathyroidectomy for secondary hyperparathyroidism were investigated to evaluate the effects of parathyroid hormone on left ventricular and autonomic nervous system functions. The study which included M-mode echocardiography and autonomic nervous system tests (hormonal and cardiovascular response to the postural test, cold pressor test, handgrip test, diving reflex test and Valsalva manoeuvre) were performed prior to parathyroidectomy, and 5-8 months after, on a nondialysis day. The cardiovascular response and plasma noradrenaline changes to postural test remained unchanged following parathyroidectomy. The resting heart rate decreased from 73.1 +/- 2.4 to 66.4 +/- 2.3 beats/min (P less than 0.05) but mean blood pressure did not change post-parathyroidectomy. Mean blood pressure and heart rate changes during the cold pressor test, handgrip test, diving test and Valsalva manoeuvre were unaffected by parathyroidectomy. End-diastolic and end-systolic dimensions, fractional fibre shortening, mean velocity of fibre shortening and the ratio of the pre-ejection period to the left ventricular ejection time were normal prior to parathyroidectomy and remained unchanged following it. This study suggests that the reduction in parathyroid hormone concentrations obtained by parathyroidectomy does not significantly modify heart function and autonomic nervous system activity in the long term.

Adult↗
PubMed1988

Long-term results of CAPD in Italy: a report from the Italian CAPD Study Group.

Begun in 1979, the Italian CAPD Study Group monitored prospectively six years of CAPD experience (1980-1985) in 24 centers with 1107 end-stage renal disease (ESRD) patients (age 56.4 +/- 13.7 years). Compiled yearly, the clinical and therapeutical data were processed on a PDP 11-32 computer, according to UCLA BMPD-1L procedure. The survival rate was conditioned by age (more than 70) and by major clinical risk factors, with a large fraction of the deaths due to cardiovascular causes (40.6%) and cachexia (17.8%). The progressive reduction of peritonitis incidence (1/18.5 episodes/patient-month globally reached at the end of 1985) was due mainly to the wide spread adoption of the "Y" connection set (76% for 1985) and contributed to a decrease in drop-outs to 7.5% of 676 patients on CAPD during 1985.

Female↗
PubMed1988

The advantages of immunosuppressive therapy in renal disease.

The beneficial effects of steroids and/or immunosuppressive drugs in idiopathic nephrotic syndrome are rarely disputed. On the other hand, there are contrasting ideas on the usefulness of this therapy in some forms of glomerulonephritis (GN) such as rapidly progressive GN and membranous GN with nephrotic syndrome. Many observations suggest that methylprednisolone pulse and/or plasma exchange associated with cyclophosphamide may significantly improve the natural course of rapidly progressive GN. Moreover, our treatment schedule consisting of methylprednisolone and chlorambucil alternatively given for 6 months significantly increases the chances of a complete remission of the disease in patients with membranous GN and nephrotic syndrome.

Chlorambucil↗
PubMed1988

A digital computer model for optimal programming of hemodialytic treatment.

A mathematical model of hydroelectrolyte exchanges and arterial pressure regulation in the human body during dialysis has been set up. It is conceived as a tool for a new dialysis unit which will be able to "interpret" the signals supplied by suitable instruments connected to the patient and modify the machine set-points in real time in order to obtain clinical results defined by the physician. The main aim is the prevention of hypotensive episodes during treatment. An experimental protocol has been developed for parameter estimation of each patient during a single dialysis. Clinical tests illustrated the model's ability to fit the patient's state during dialysis. This is the first step in the more general task of validation of the model, necessary for the achievement of a closed-loop dialysis unit.

Computer Simulation↗
PubMed1987

Kelfiprim versus co-trimoxazole in recurrent and persistent urinary tract infections: multicenter double-blind trial.

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.

Anti-Infective Agents, Urinary↗
PubMed1987

Effects of pK variability on bicarbonate balance evaluation in dialysis patients.

Bicarbonate balance is usually calculated from the Henderson-Hasselbalch equation under the assumption that pK is constant. To evaluate the pK variability and its effects on bicarbonate computed with autoanalyzers in dialysis patients, we studied 44 patients on maintenance hemodialysis. The pH, PCO2, total CO2, and pK were determined in each patient before and after the dialysis session. The mean total CO2 calculated (22.5 +/- 2.7 meq/L) from pH and PCO2 values was significantly higher (p less than 0.001) than that directly measured (20.4 +/- 3.0 meq/L) with total CO2 analyzer. The mean (+/- SD) pK value was 6.14 +/- 0.06 (range 6.05-6.28). The percentage error in computed bicarbonate due to pK variations from the traditional pK value of 6.1 ranged between -11% and 52%. The pK value changed during dialysis in the majority of our patients, thereby confirming that pK consistency does indeed vary. Thus, investigation of acid-base balance based on pH and PCO2 determination may lead to erroneous results determined by pK abnormalities.

Acid-Base Equilibrium↗
PubMed1987

Renal histological lesions and clinical syndromes in multiple myeloma. Renal Immunopathology Group.

This retrospective multicenter study, based on 42 patients affected by renal damage due to multiple myeloma, analyzes the renal biopsy results, the clinical data at the time of biopsy and the subsequent renal outcome in order to clarify the correlations existing between clinical and histological changes. Plasmocytoma components were Bence Jones alone in 55% of the patients and light-chain excretion was present in over 90%. Rapidly progressive renal failure was the most frequent clinical presentation (27 cases). The histological lesions directly attributable to multiple myeloma were subdivided into 3 basic categories: related to light-chains, direct tumor involvement of renal parenchyma and attributable to systemic effects of neoplastic disease. Light-chains seemed to cause renal lesions in 59.4% of the cases. Myeloma cast nephropathy was the prominent bioptic diagnosis established (20 cases). Among the clinical, laboratory and histological parameters studied, only the degree of tubular-interstitial damage was significantly correlated to the renal outcome in the 32 patients who had an adequately documented follow-up period.

Acute Kidney Injury↗