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Biomedical subjects

Q Maggiore

Publications and source records attributed to Q Maggiore.

At least 19 recordsLinked to original sources
PubMed1990

Diabetes mellitus and renal replacement therapy in Italy: prevalence, main characteristics and complications.

A number of reports on dialysis and transplantation for diabetic patients in the UK and USA are available. The aim of the present survey was to assess the prevalence, main characteristics and complications of diabetic patients treated by dialysis and transplantation in Italy. On 31 December 1987 in Italy, 1605 diabetic patients were being treated by dialysis or transplantation. The prevalence was 28 per million compared with the UK and the USA where the corresponding figures were 17 and 78 per million respectively. The annual incidence in 1987 was 9 per million (UK: 4 per million; USA: 33 per million). The mean age of the Italian diabetic patients was 59 years whereas that for British diabetic patients similarly evaluated was 48 years. Of the Italian diabetic patients 67% had NIDDM (UK: 22%; USA: 50%). Haemodialysis was used in 81% of the Italian patients, peritoneal dialysis in 14%, and only 5% were transplanted. This is in contrast to the UK where only 18% of the patients were treated by haemodialysis and 39% were transplanted. Amongst Italian patients who started RRT in 1987, 9% died within the year, and of the remainder 38% had severe bilateral visual impairment (UK 35%), 3% had had amputations (UK 6%), 7% had suffered from disabling strokes (UK 6%) and 7% had had a myocardial infarction (UK 17%). Before 31 December 1987 another 2.2% developed severe bilateral visual impairment, 0.6% underwent amputations, 1.0% had a disabling stroke and 0.6% suffered from a myocardial infarction. The proportion of diabetic patients treated by RRT in Italy is twice that of the UK but only half that of the USA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Complement activated leucopenia during hemodialysis: effect of pulse methyl-prednisolone.

We tested in vivo the effect of methyl-prednisolone (MP) on C5a release and granulocytopenia occurring early in the course of extracorporeal blood circulation through a Cuprophan dialyzer. MP boluses (30 mg/kg) were given to 10 consenting patients suffering from acute renal failure, immediately before blood started to circulate through a hollow-fiber Cuprophan dialyzer. To avoid drug loss through the dialyzer membrane, dialysate flow was withheld during the first hour of treatment and ultrafiltration was kept near zero (sham dialysis). Control procedures were carried out in a similar way, without MP. MP concentration, differential WBC count and anaphylotoxin C5a were serially measured during the procedures. MP pharmacokinetics was evaluated in six other uremic patients off dialysis. As shown by similar C5a levels in dialyzer effluent blood, complement cascade was activated by Cuprophan to a comparable degree whether or not patients received MP. Neutrophil count dropped 68% during the control procedure and 54% during sham dialysis preceded by MP (95% confidence interval of the difference, 1.97-27.2). Sham dialysis did not apparently influence serum MP levels, as shown by similar peak values in patients undergoing sham dialysis (203 micrograms/ml +/- SEM 33) and in patients off dialysis (177 micrograms/ml +/- 42). In vitro aggregometry showed that the uremic milieu does not interfere with the antiaggregating effect of MP. Our results show that MP at the dosage of 30 mg/kg does not affect complement-mediated granulocytopenia in any important way.

Acute Kidney Injury↗
PubMed1989

Acute interstitial nephritis associated with uveitis and primary hypoparathyroidism.

In a study of a patient with acute renal failure and uveitis, renal biopsy showed acute interstitial nephritis. Serum calcium and parathyroid hormone concentrations were persistently low during the acute phase and after the resolution of renal failure. Clinical history was negative for intake of drugs capable of inducing acute interstitial nephritis.

Acute Disease↗
PubMed1989

The 'breakpoint' test, a new statistical method for studying progression of chronic renal failure.

The application of a new statistical method ('breakpoint' test) to the study of the progression of chronic renal failure is described. This test establishes whether the best fit of a series of GFR measurements is linear or broken. Such an approach avoids the analytical constraint of the time of intervention assumed by other methods. Re-analysis by this test of previous studies of low-protein diet suggests that in some cases the effect of the dietary regimen has been overemphasized.

Creatinine↗
PubMed1989

[Deposits with anti-globulin activity in dermatitis herpetiformis].

Skin biopsy specimens from 2 patients with dermatitis herpetiformis were examined by means of direct immunofluorescence with fluoresceinated aggregated human IgG (FAIgG) for the presence of tissue antiglobulin activity. Positive FAIgG staining was seen in both skin biopsy specimens yielding a fluorescence pattern similar to that of immunoglobulin and complement deposits. Tissue antiglobulin activity was no more detectable in a second skin biopsy obtained from one patient whose rash was controlled by Dapsone. These findings suggest an involvement of tissue antiglobulin activity in the pathogenesis of dermatitis herpetiformis. In fact, tissue antiglobulin activity is capable of acting as an immunoabsorbent and binding immunocomplexes from the circulation.

Antibodies, Anti-Idiotypic↗
PubMed1989

Postprandial alterations in arterial pressure control during hemodialysis in uremic patients.

To test the hypothesis that eating may adversely affect the hemodynamic response to ultrafiltration-dialysis, we studied the effect of a standard snack (about 400 Kcal) in 13 patients on RDT. Each patient was studied in random order during two standard hemodialysis sessions (snack-HD and control-HD) performed at identical UF rate. Arterial pressure fell significantly (p less than 0.01) during both the Control-HD (from 135 +/- 8/76 +/- 3 to 121 +/- 10/68 +/- 5 mmHg) and the Snack-HD (from 137 +/- 7/77 +/- 3 to 105 +/- 8/59 +/- 4 mmHg). The rate of fall, however, was significantly higher (p less than 0.01) after the snack than during the corresponding period in the control HD. Consequently, there were more hypotensive episodes requiring saline infusion during Snack-HD (23 in 10 patients) than during Control-HD (12 in 6 patients) (p less than 0.025). In spite of the greater number of interventions, the average fall in arterial pressure after a snack (-22 +/- 3/-13 +/- 2 mmHg) was more marked than during the corresponding period in the control-HD (-13 +/- 3/-9 +/- 2 mmHg). The hypotensive effect of snack was more pronounced in the presence of advanced autonomic neuropathy. Food ingestion impairs the arterial pressure response to UF in patients on RDT. Fasting during hemodialysis may in part prevent hypotension.

Autonomic Nervous System↗
PubMed1988

Double-blind randomized, crossover trial of calcium supplementation in essential hypertension.

In a double-blind, randomized, placebo-controlled, crossover trial, 23 middle-aged patients with mild to moderate essential hypertension were given an oral calcium supplement (1 g/day) for 8 weeks. At the end of this period, eight patients continued with this treatment for an additional 2 weeks but were also given 0.5 micrograms/day of 1,25-(OH)2 vitamin D3. In the 21 patients who completed the study, arterial pressure during the calcium-supplemented phase was almost identical to that of the placebo phase. In eight patients, mean arterial pressure (MAP) had changed by greater than 5 mmHg at the end of the calcium-supplemented period, compared with the end of the placebo phase (six patients showed an increase in MAP and two a decrease). Changes in arterial pressure were unrelated to age, plasma ionized calcium, parathyroid hormone (PTH), plasma renin activity (PRA), plasma aldosterone, 24-h urinary calcium, sodium and potassium and were only weakly related to body weight. In the eight patients who continued with the treatment of calcium plus 1,25-(OH)2 vitamin D3 after the 8-week study period, arterial pressure changed very little and not significantly. These results do not support the suggestion that calcium supplements lower arterial pressure in middle-aged subjects with mild to moderate essential hypertension.

Adult↗
PubMed1988

Aluminum bone content in dialysis osteodystrophy with secondary hyperparathyroidism.

To assess whether parathyroid hormone (PTH) has any effect on bone aluminium (A1) accumulation, we evaluated the relationship between bone quantitative histomorphometry and bone A1 content in 25 dialysis patients with clinical features of secondary hyperparathyroidism. By means of bone biopsy, patients were classified as showing predominant hyperparathyroidism in 17 cases and mixed lesions in 8. The A1 burden was low, judging from the dialysate A1 and the oral A1 assumption. Bone A1 content and serum A1 levels were higher than normal in both groups, particularly so in the patients with predominant hyperparathyroidism. Significant positive correlations were found between bone indexes of hyperparathyroidism and bone A1 content. Moreover, bone and serum A1 concentrations were directly related. Aluminium staining appeared faintly positive only in a minority of bone samples, and was mainly localized at the neutral bone surfaces. We conclude that in dialysis osteodystrophies with features of secondary hyperparathyroidism and in a clinical setting characterized by low-grade A1 burden, PTH may favour A1 accumulation into the bone.

Adult↗
PubMed1987

Effect of blood cooling on cuprophan-induced anaphylatoxin generation.

We investigated whether cooling of the extracorporeal blood during hemodialysis could prevent anaphylatoxin generation and leukopenia caused by blood-cuprophan contact. After preliminary in vitro studies confirming the temperature dependence of C5a generation, we carried out hypothermic dialysis on nine patients by manipulating blood and dialysate temperature in such a way that blood temperature within the dialyzer averaged 25 degrees C. In comparison with the control procedure (blood temperature within the dialyzer 35 degrees C) hypothermic dialysis reduced peak C5a generation from 41.7 +/- 17 ng/ml to 9.7 +/- 3.4 ng/ml (P less than 0.01), and white blood cell fall from 72 +/- 15 to 25 +/- 20% (P less than 0.01). Arterial PO2 decreased less in hypothermic dialysis (-19 +/- 9% of pre-HD value) than in the control procedure (-30 +/- 11%) (P less than 0.05). We conclude that blood cooling attenuates cuprophan-induced anaphylatoxin generation and leukopenia.

Adult↗
PubMed1987

Severe hypothyroidism induced by amiodarone in a dialysis patient.

A 54-year-old man on regular haemodialysis developed severe amiodarone-induced hypothyroidism after an unusually short latency period. The iodide accumulation and/or the derangement in thyroid function associated with chronic renal failure may predispose uraemic patients to this serious side effect of amiodarone. Although the pharmacokinetics of amiodarone are not altered by renal failure, caution is advised in prescribing this drug to uraemic patients.

Amiodarone↗