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Biomedical subjects

R Boero

Publications and source records attributed to R Boero.

72 records · Page 4Linked to original sources
PubMedDate not supplied

[Inadequate treatment and control of arterial hypertension in patients with type 2 diabetes mellitus].

BACKGROUND: Aim of this study is to evaluate the treatment and control of arterial hypertension in patients with type 2 diabetes. METHODS: We identified 5815 diabetic patients in our health-care district (191,568 inhabitants) through prescriptions for insulin and/or hypoglycaemic drugs in the first 6 months of 2000; 3810 of them (65%) also had prescriptions for antihypertensive drugs. We evaluated a randomly selected sample of 171 patients with type 2 diabetes, 100 of whom were receiving antihypertensive drugs (94 males and 77 females, mean age 66.6 +/- 8 years, mean diabetes duration 12+/-9 years). RESULTS: Fifty-seven out of 71 patients not treated with antihypertensive drugs (80.3%) had a BP = 130/85 mmHg; 24.4% of them had a diastolic BP = 85 mmHg and 79% had a systolic BP = 130 mmHg. Thirteen out of 100 treated patients (13%) had a BP < 130/85 mmHg. Among the patients treated with antihypertensive drugs 36% received one drug, 36% two drugs and 28%=3 drugs; mean 1.98 +/- 0.9 drugs/patients. Among the patients treated with monotherapy 36.1% received ACE-inhibitors, 36.1% dihydropyridinic calcium-antagonists, 11.1% alpha-blockers, 11%, diuretics, 2.8% non-dihydropyridinic calcium-antagonists, and 2.8% angiotensin II antagonists. Patients treated with two antihypertensive drugs received more frequently an ACE-inhibitor plus a diuretic (31%) or an ACE-inhibitor plus an alpha-blocker (23%) or an ACE-inhibitor plus a dihydropyridinic calcium-antagonists (20%). A diuretic was used in 40% of the patients with two antihypertensive drugs and in 78% of those with >= 3 drugs. CONCLUSIONS: Many hypertensive type 2 diabetic patients are left untreated and only a minority of those treated reach optimal blood pressure control. The importance of an elevated systolic pressure is underestimated, and the number of antihypertensive drugs prescribed is suboptimal.

Aged↗
PubMedDate not supplied

[Effects of saline infusion on the activity of erythrocyte sodium-potassium pump in normal subjects and in patients with essential hypertension].

The effects of a 2 litre isotonic saline infusion on erythrocyte Na,K pump activity and urinary sodium excretion (UNaV) were evaluated in 20 patients with essential hypertension and 15 normotensive subjects. The effect of preincubation of normal erythrocytes in plasma from hypertensive patients on erythrocyte Na,K pump was also studied. Before saline infusion no significant differences were found between normotensive and hypertensive subjects in the mean values of intracellular sodium and potassium concentration, ouabain-sensitive Na efflux in erythrocytes and urinary sodium excretion. Erythrocyte Na,K pump activity decreased significantly (p less than 0.01) after saline infusion in both groups of subjects. The reduction was significantly lower in hypertensives than in normotensive. delta UNaV was significantly higher in hypertensive patients than in normotensive subjects (25 +/- 4 vs 14 +/- 2 mmol/h; p = 0.04). Only in normal subjects a significant correlation was found between the difference in Na,K pump activity pre and post saline infusion and delta UNaV (r = 0.52; p less than 0.05). Plasma from hypertensive patients obtained before saline infusion significantly (p less than 0.01) inhibited Na,K pump of erythrocytes from normal subjects; plasma taken after saline infusion produced a marked increase of this inhibition, significantly (p less than 0.01) higher than serum taken before the infusion.

Adult↗
PubMedDate not supplied

[Changes in cellular ion transport and arterial pressure in renal transplant recipients undergoing cyclosporin treatment].

Arterial hypertension is a common side effect of cyclosporine A (CyA). Aim of the study was to evaluate the activity of erythrocyte (RBC) Na transport in two groups of patients with a well functioning renal graft (Crs less than 1.7 mg/dl) treated by prednisone+azathioprine (10 pts), or prednisone+CyA (21 pts), in relationship with blood pressure status. Twenty-one age matched healthy subjects were studied as a control group. Na,K pump and Na,K cotransport were significantly lower in CyA than in AZA patients (2,184 +/- 106 vs 3,089 +/- 162 and 58 +/- 8 vs 187 +/- 28 mumol/l RBC/h: p less than 0.01), without differences between normotensive and hypertensive patients. Na,K pump efflux in normal subjects was 2334 +/- 66 mumol/l RBC/h (p less than 0.01 vs AZA), NA,K cotransport was 205 +/- 18 mumol/l RBC/h (p less than 0.01 vs CyA). Significant correlations were found between RBC Na,K pump activity and trough plasma CyA levels (p less than 0.02) and between systolic pressure and plasma creatinine in CyA patients (p less than 0.01). Trough plasma CyA levels were higher in hypertensive than in normotensive CyA patients (64 +/- 5 vs 46 +/- 4 ng/ml; p less than 0.01).

Adult↗
PubMedDate not supplied

[Atherosclerotic vascular nephropathy. Description of 2 clinical cases and review of the literature].

Atheromatous nephropathy, due to a reduction of arterial blood flow caused by stenosis or thrombosis of renal arteries, is now recognized as an important cause of chronic renal failure in the elderly. It has been shown that renal revascularization may allow a recovery of renal function up to the withdrawal of dialytic treatment. Digital arteriography is the preferred diagnostic method, but doppler scan and renal scintigraphy after administration of captopril may also prove useful, specially in the follow-up of the patients. Therapeutic means include percutaneous transluminal angioplasty and surgical revascularization; both treatments may improve or stabilize renal function. Surgery may allow better results in the long term, but is loaded by a significant morbidity. Our experience confirms the possibility to obtain a significant long term improvement of renal function after bilateral surgical revascularization.

Acute Kidney Injury↗
PubMedDate not supplied

[Effects of erythropoietin on the cardiovascular system and the intradialytic hemodynamic behavior].

The aim of the study was to evaluate, before and after hemodialysis (HD), the effects of partial correction of anemia with erythropoietin on: cardiac index (CI), stroke index (SI), heart rate (HR), ventricular ejection index (EVI), mean arterial pressure (PAM) and systemic vascular resistance index (SVRI). Cardiac parameters were gathered by means of transthoracic bioimpedance (BoMed). Twelve patients (6 M, 6 F) aged 50.6 +/- 5 years, on HD for 92.8 +/- 15.9 months, were studied twice (basal, end of follow-up). Before rHuEPO therapy, 6 patients had a "pathologic" cardiac response to HD (defined as an increase of CI despite the reduction of pre-load). After rHuEPO, 5 out of 6 patients with a "pathologic" response reverted to a "normal" response, and 1 hypertensive patient from a "normal" to a "pathologic" response. The EVI, CI and SI of patients with "pathological" response significantly improved after rHuEPO as compared with pre rHuEPO values (EVI 1.36 +/- 0.14 vs 1.07 +/- 0.08, p = 0.023; CI 3.18 +/- 0.24 vs 1.78 +/- 0.27, p less than 0.01; SI 43 +/- 3.7 vs 24 +/- 3.8, p less than 0.01). In conclusion, partial correction of anemia with rHuEPO induces an improvement of myocardial performance, without significant hemodynamic adverse effects. Our results suggest also that anemia could play a significant role in the pathogenesis of myocardial disfunction in HD patients.

Adult↗
PubMedDate not supplied

Serological and molecular studies of HLA in insulin-dependent diabetes mellitus in Sardinia.

This study was carried out in Sardinia, an Italian region with a very high IDDM incidence. HLA class I and class II antigens were studied in 97 unrelated IDDM patients, 33 complete families with at least one affected member each, and 559 healthy controls. Molecular typing of the DQB1 alleles was carried out in 31 patients and 61 controls. The haplotypes were determined by family studies. The HLA-DR3, DQw2, and DR4 antigens were positively associated with IDDM. The DR3 antigen was nearly always associated to B18 and frequently carried by the extended haplotype A30 Cw5 B18 3F130 DR3 DQw2. The genotype analysis of the patients showed a strong increase of the DR3/DR4 heterozygotes with a relative risk higher than that of the DR3 and DR4 homozygotes. The DR2 antigen was negatively associated with IDDM in the central island districts but not in the southern districts. The DQB1 molecular analysis showed only three alleles in the patients: DQB1*0201 (75.8 per cent), DQB1*0302 (16.1 per cent), and DQB1*0502 (8.1 per cent). These alleles are non Asp 57, so it would seem that nearly if not all Sardinian IDDM patients are NA/NA homozygotes. The DQB1*0502 allele, extremely rare in other Caucasian populations, represents in Sardinia about 70 per cent of the HLA-DR2 haplotypes, contributing to the increase of the pool of IDDM susceptible genes. Moreover it is carried in 27 per cent of the DR2 positive individuals with the extended haplotype A2 Cw7 Bw58 3F31 DR2 DQw1.AZH.

Alleles↗
PubMedDate not supplied

[Biofiltration without buffering substances in the dialysate].

A new hemodiafiltration technique, acetate free biofiltration (AFB), has been recently introduced in the treatment of chronic uremia. It is performed with a buffer free dialysate and a simultaneous infusion in post-dilution mode of a sodium bicarbonate solution (concentration 145-166 mEq/l; infusion rate 1.2-2 l/h). A polyacrylonitrile hollow fiber AN69 HF 1.2 sqm dialyzer is employed. In acute studies pCO2 remains stable throughout the treatment, as well as pCO2. We have found a significant inverse correlation between delta[HCO3-] pre and post treatment and basal [HCO3-] (r = -0.88; p less than 0.001), with an excellent correction of uremic acidosis, avoiding post dialytic alkalosis. Our long term experience on 6 patients followed up to 31 months, allows us to consider AFB as a feasible and safe treatment, offering a good correction of uremic acidosis and an excellent hemodynamic tolerance. We propose AFB as a competitive technique with respect to bicarbonate hemodialysis, hemodiafiltration and standard biofiltration.

Acidosis↗
PubMedDate not supplied

[Course and significance of various biochemical parameters in 1,25-dihydroxyvitamin D3 therapy of uremic osteodystrophy].

Thirty-seven osteodystrophic and chronically haemodialyzed patients have been treated for 1-22 months by means of 1,25(OH)2D3. Under treatment a marked improvement of symptomatology and radiographic findings has been observed in the majority of cases; from the haematochemical viewpoint a rise of calcemia and phosphoremia, a fall in alkaline phosphatase and a variable course of PTH have been observed. Several episodes of asymptomatic hypercalcemia ceased with posology reduction; only 3 cases needed stopping the treatment for this reason, one of them definitively; 12/37 cases needed hypophosphoric diets and increase in oral aluminium hydroxide doses to control hyperphosphoremia. The Authors conclude that, to achieve a correct management of a 1,25(OH)2D3 therapy for renal osteodystrophy, is mandatory a strict and accurate biochemical control: in this way is possible to obtain an effective modulation of the posology avoiding the appearance of side-effects as hypercalcemia and ectopic calcifications.

Adult↗
PubMedDate not supplied

[Specificity, sensitivity and reproducibility of 2 methods of determining serum immunocomplexes (solid-phase C1q and polyethylene glycol precipitation)].

In the last years a few tests for the detection of circulating immune complexes (CIC) have been published. Nevertheless the data concerning their sensitivity and reproductibility are often partial. The Authors have here analysed, following this point of view, two methods for the detection of CIC, based on different mechanisms and therefore able to identify different kinds of CIC; the tests are: the PEG precipitation test and the C1q solid phase method. The reproductibility of the two methods is good, even when the samples have been many times thawn or kept at 20 degrees C for a few weeks; C1q test sensibility appears distinctly better than PEG test sensibility. By the two methods, but particularly with the PEG, it is possible to identify fluctuation of the IC levels during the day. The contemporaneous use of these two techniques can give results really useful to clinically monitorize some immune complexes diseases, such as many human glomerulonephrites.

Antigen-Antibody Complex↗
PubMedDate not supplied

[Quantitative and qualitative determinations and clinical and histological correlations of cryoglobulins in glomerulonephritis].

The Authors have investigated the presence of cryoglobulins in sera from 91 GN patients, 69 of whom had a renal biopsy. Cryoglobulins have been found in 12.5% of the idiopathic glomerulonephritis (GN), in 22.2% of the ones related to systemic diseases. Also 4 cases of GN with mixed essential cryoglobulinemia have been studied. Quantitative analysis has shown a IgG and IgM prevalence, the last ones of monoclonal type in 77.8% of the cases, with anti IgG activity in 44.4%. Concerning cryoglobulins found in idiopathic GN, the Authors observed a high incidence in the forms with cellular proliferation and glomerular exudation, as rapidly progressing GN, the acute post-infectious GN, and the mesangio-capillary GN. Among the GN related to systemic diseases, high incidence of cryoglobulins has been observed in lupus nephritis and polyartheritis. In both diseases (idiopathic GN and GN related to systemic diseases) a good correlation was found between clinical-ordinary activity and immunological parameters such as circulating immune complexes and complement breakdown products. The correlation between cryoglobulins level and disease activity is less evident in the mixed essential cryoglobulinemia G.N. Furthermore the Authors discuss here the pathogenesis of cryoglobulins in human G.N.

Antigen-Antibody Complex↗
PubMedDate not supplied

[Rosette E and active rosette E tests in the evaluation of cell-mediated immunity in uremic patients].

To evaluate cellular immunity in uremia, we studied 235 uremic patients (178 on regular hemodialysis and 57 on medical treatment). E-rosettes were significantly lower (p less than 0.01) in all patients. The active E-rosettes test was found less significant to study T lymphocyte markers. The kind of correlations made with primary disease, small molecule levels, rehabilitation, suggests that cell-mediated immunodeficiency in uremia is a premature phenomenon and scarcely influenced by adequate hemodialysis treatment.

Adolescent↗
PubMedDate not supplied

[Solid-phase conglutinin tests for circulating IgA immunocomplexes].

In some renal, gastroenterological and dermatological diseases the pathogenic role of circulating immune complexes (CIC) of IgA type has been defined. The methods so far proposed to investigate CIC are for the most part able to identify IgGIC, while only few can do the same for IgAIC. The Authors discuss in details the technique and the sensibility and specificity of a new test for IgAIC based on the linkage with the conglutinin in solid phase and propose this test for the clinical study of IgA diseases.

Antigen-Antibody Complex↗
PubMedDate not supplied

[Acute renal failure and multiple trauma].

Only recently the relationship between trauma and acute renal failure has been described on a rational basis. Shock is commonly a major pathogenetic factor in tubulo-interstitial damage often associated with other causes, such as toxic agents, toxins, immunologic and coagulation mechanisms. The Authors consider the various patterns of acute renal failure such as the "functional, tubulo-interstitial, cortical necrosis" and analyze the different etiopathogenesis. Finally they report the mortality rate of acute renal failure in S. Giovanni Hospital of Turin from 1969 to 1979.

Acute Kidney Injury↗
PubMedDate not supplied

[Hemofiltration: present and future].

Four thousand hemofiltrations have been performed in 22 patients with low tolerance to conventional hemodialysis (20 cases), and severe arterial hypertension (2 cases). In comparison with hemodialysis, hemofiltration had a low incidence of intradialytic collapses, vomit and cramps, and allowed a better state of well-being during interdialytic periods. In hypertensive patients hemofiltration has accomplished a better control of arterial pressure and pharmacotherapy has been reduced. In this study, we report the data concerning metabolism, electrolytes, acid-base balance during our experience utilizing bicarbonate in the replacement fluid. Our experience further supports the impression that hemofiltration may have some advantages in patients with low tolerance to conventional dialysis and/or severe dislipemia and hypertension. The possibility to reduce dialysis duration to 3 hrs, stimulates further application of this new treatment in a wider number of patients on RDT.

Acute Kidney Injury↗
PubMedDate not supplied

[Regular dialytic treatment in the Piedmont region. Results and prospects].

The Piedmont planning for the prevention and treatment of chronic uremia started in 1976, with the purpose to extending full treatment of the whole region, through the development of home and self care dialysis and intensive use of hospital short dialysis. Hospital dialysis would be reserved either for new treatments or complicated or uncooperative patients. Thank to an intensive exploitation of the existing hospital centers, a 68.7% increment in the number of treated patients was achieved and costs were kept down to a limited acceptable range. With the development of home and self care dialysis, 27% of the patients were located in out-of-hospital centers, and 17% at home. The Piedmont planning concerned itself with the patients' data collected by the Regional Registry under the following items: a) characteristics of dialysis population; b) the present modes of treatment; c) the number of patients apt to varying treatments and renal transplantation; d) the epidemiology of uremia causing nephropathies. At the present time results are only preliminary. Nevertheless, the first observations showed a long and difficult work with good possibilities of success for computerized facilities in the field of dialysis, particularly in respect to regional areas which in the reformed Health Service are now considered to be operating as autonomous.

Adolescent↗