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A Covic

Publications and source records attributed to A Covic.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

[The link between glomerulonephritis and hydatid disease ].

The presence of glomerular damage was evaluated for 338 patients, adults (298) and children (40), with pulmonary or hepatic hydatid disease. A descriptive study was used. The glomerular syndrome was present in 2 children (5%) with hydatid disease, 22 adults (11%) with liver echinococcosis and 28 adults (18%) with pulmonary echinococcosis. An early stage diagnosis and proper treatment will determine the reversibility of glomerulonephritis.

Adult↗
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[Laparoscopic management of peritoneal dialysis catheters].

Continuous ambulatory peritoneal dialysis catheter could be placed also by open laparotomy as well as by laparoscopic techniques. We did a retrospective study on cases to compare the results of laparoscopies. There were included 42 patients which we divided in two groups of 21. Group A underwent 21 cases in which catheters was inserted by open laparotomy. Continuous ambulatory peritoneal dialysis was started in 24 to 48 hours later. Group B incharged 21 patients underwent laparoscopic placement of the catheter between 2000 and 2001. Continuous peritoneal dialysis was started early (after 6 hours). The mean operative time was 28 minutes in group A and 30 minutes in group B. Fluid leakage was noticed in 4 patients in group A and in 3 patients in group B. Peritoneal reactions occurred in 5 patients in group A and in 2 patients in group B. Tip migration occurred in 5 patients in group A (one of which was mobilized accidentaly early after intervention) in which was necessary 4 open reinterventions, and no patients in group B. In group B one patient underwent a simultaneous liver biopsy for cirosis and another female patient underwent ovariectomy for a giant ovary cyst. Laparoscopic placement of dialysis catheter leads to better function than does open procedure, it allows immediate start of dialysis and permits simultaneous performance of other laparoscopic procedures.

Adult↗
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What added value does ambulatory blood pressure monitoring brings to the management of post renal transplantation hypertension?

OBJECTIVE: To evaluate BP control, white coat hypertension (WCH) and abnormal circadian variability in a significant outpatient sample of renal transplant (RTx) subjects, normotensive at the last regular visit. METHODS: ABPM (Spacelab 90217) was performed every 15 min between 07:00-23:00 h and every 30 min between 23:01-06.59 h. in all patients (N = 68, 39M, S-Cr. = 153 +/- 49 mumol/l) normotensive at their last regular office BP (O-BP) measurement and with available BP records for the 12 months preceding RTx and 6 months preceding ABPM. RESULTS: BP values were frequently abnormal in this RTx cohort considered to have a satisfactory BP control. O-BP (measured with a Hawksley random-0 sphygmomanometer on the day of ABPM) was 135.5/80.6 mmHg, 47.1% of the patients with abnormal BP values. By comparison, ABPM showed a lower prevalence of uncontrolled BP: 44.1% for 24 h.-BP and only 35.3% for the daytime awake period, with values of 134.5/80.4 and 135.3/81 mmHg respectively (P = NS from O-BP). The prevalence of WCH was 12%. 24-h SBP is related to O-SBP (r = 0.71, P < 0.01) and Bland-Altman analysis demonstrates that > 95.6% of all differences between systolic ABPM and O-BP values are within +/- 2SD of the identity line. However, although 24-h DBP is equally related to O-DBP (r = 0.64, P < 0.01), on Bland-Altman analysis, 8.8% of the differences between diastolic ABPM and O-BP values are outside +/- 2SD of the identity line. Thus, systolic but not diastolic O-BP correlates with, and can be substituted to ABPM derived values. Non-dipping was frequent, regardless of the definition of normal nocturnal BP fall (10 mmHg or 10% of the daytime SBP): 82.4%, 89.7%. Even if normality was strictly defined as a night/day ratio < 0.90 for SBP and < 0.92 for DBP, non-dipping prevalence was high 73.5%, with more than one-third of the RTx patients having nocturnal hypertension (ratio > 1). CONCLUSIONS: BP control is not optimal in one-third of a typical RTx population. Furthermore, nocturnal hypertension is a frequent and underestimated phenomenon in this population. There is a good agreement between ABPM derived and casual systolic values. Office measurements, due to WCH, are under-evaluating the quality and efficacy of the antihypertensive regimens.

Adult↗
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Atypical post-renal transplantation hyperparathyroidism--further support for "removing all enlarged glands".

Hyperparathyroidism is an important sequela of chronic renal failure, remains a considerable challenge to nephrologists, and can be seen as inevitable in patients undergoing long-term renal replacement therapy. As time with renal disease increases then so does the cumulative risk of hyperparathyroidism, and the eventual need for surgical parathyroidectomy when hyperparathyroidism becomes refractory to medical intervention. Parathyroidectomy before dialysis treatment has started, or after successful renal transplantation, is much less commonly performed than when the patient is receiving dialysis. Increasingly the propensity for residual parathyroid tissue left behind (by design or accident) at an initial parathyroidectomy to undergo progressive hyperplasia under the constant stimulus of uremia, and by so doing result in the need for a second, more complex, neck exploration, has increased support for initial total parathyroidectomy for patients on dialysis. The optimal operative procedure for autonomous hyperparathyroidism after successful renal engraftment is however less clearly established. We discuss two very unusual but instructive cases of post renal transplantation autonomous hyperparathyroidism requiring surgical parathyroidectomy. Using these cases as examples we discuss the various surgical options, and discuss the contentious issue of the place for autografting parathyroid tissue.

Adult↗
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[Total parathyroidectomy with forearm graft in tertiary hyperparathyroidism].

Autonomic and persistent hypersecretion of PTH is a frequent and tormenting complication of the patients with chronic renal dialysis for end stage renal disease (ESRD). In these cases, surgery remains a therapy option with real effects on clinical status of patients, especially in perspective of a renal transplant. The authors present the case of a patient with tertiary hyperparathyroidism for which a total parathyroidectomy followed by autotransplantation of small glandular fragments in forearm muscles was performed. The postoperative clinical and immunological statuses were favorable with the disappearance of pruritus and osteoartralgia with improvement of psychic behavior and normalization of calcium blood level. Considering the parathyroidectomy as a palliative stage in the treatment of ESRD, the authors discussed a hierarchy system of both indications and surgical alternatives to be considered in this condition. In well selected cases this surgical method represents an attractive and easy possibility to control and later adjustment of the hyperfunction of remained parathyroid tissue, avoiding in this way a very risky intervention.

Forearm↗
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[Retrospective study of 97 ANCA-positive patients: epidemiologic and clinical spectrum].

UNLABELLED: We analysed the clinical profile of antineutrophil cytoplasmic antibodies (ANCA) positive patients in a retrospective study including all cases of ANCA positivity (determined by ELISA) from the Nephrology Clinic, Parhon University Hospital Iasi during the interval 1998-2003. There were 97 ANCA positive patients (mean age 43.7 ş18-75ţ years, female/male ratio 1.55), of whom almost two thirds had c-ANCA, almost one third p-ANCA, while 9 patients had both types of antibodies. The incidence was 22.5/pmp for the North-Eastern province of Romania. Just 19.3% from the suspected cases with ANCA-associated disease were positive for these antibodies. 47.7% had systemic vasculitis (10 with microscopic polyangiitis--MA, 6 with Wegener's granulomatosis--WG, 1 with Churg-Strauss angiitis, 29 with non-specific vasculitis--NSV). Twenty-seven (27.8%) had connective tissue disease--CTD (systemic lupus erythematosus, rheumatoid arthritis, polymyositis, systemic sclerosis, mixed connective tissue disease, and sarcoidosis), while in 5 cases ANCA were associated with other diseases. Nine cases presented with rapid progressive glomerulonephritis (RPGN) without signs of systemic involvement, and other ten with advanced chronic renal failure (CRF). The most frequent clinical manifestations involved the kidney (71%), the skin, the muscles and joints, and the cardiovascular system. CONCLUSIONS: ANCA positivity is associated with a wide spectrum of diseases, mostly with CTD and NSV. c-ANCA was predominantly seen in WG and advanced CRF, while p-ANCA was associated with MA. In nonspecific vasculitis and connective tissue diseases, both patterns were present. We recommend ANCA determination as a screening method in all cases with renal dysfunction and nephritic syndrome and/or with signs of systemic vasculitis and/or collagenosis.

Adolescent↗
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Pyrexia of unknown origin and HIV infection in a middle aged woman. A case study.

Pyrexia of unknown origin (PUO) is defined as a prolonged fever of more than 3 weeks duration and which resists a diagnosis after a week in hospital. Here we present a case admitted in our hospital with fever of prolonged duration, esophageal candidiasis, multiple systemic symptoms and infections. She was diagnosed as being infected by HIV and presenting with AIDS related complex with no clear details of the source of infection. There is no significant history of exposure, sexual transmission or blood transfusions. The only mode suggestive of acquiring HIV in this case was probably due to her repeated hospital admissions and repeated intravenous infusions. She also had history of dental procedures which may be a considerable factor.

AIDS-Related Complex↗
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[Minimally invasive approach of the cervical endocrine glands].

Improved preoperative functional and topographic diagnostic techniques and availability of intra-operative hormone monitoring, stimulated the introduction of video-assisted minimally invasive operations in parathyroid and thyroid surgical pathology. The first cases of such pathology operated on in our clinic are presented. The first one is a 62 year old man with renal hyperparathyroidism consecutive to a chronic renal insufficiency and hemodialysis from five and three years respectively. The technique of a minimally invasive gapless resection of all four "adenomised" parathyroid glands using laparoscopic and classic instruments is described. Fragments of one gland are implanted in the left forearm musculature. The second case was a 48 year old woman with a three cm diameter right toxic adenoma. With a lateral 15 mm incision, dissociation of the musculature and adequate moving of the retractors the excision of the thyroid nodule was done in 25'. The video-assisted minimally invasive approach allows magnification and adequate identification and removal of endocrine secreting tissues in thyroid and parathyroid pathology. The authors believe that these techniques represent a feasible and attractive alternative to conventional surgery.

Adenoma↗
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[Biological and evolutive spectrum of patients ANCA present].

AIM: To analyse the immuno-biological profile of patients with antineutrophil cytoplasmic antibodies (ANCA) presents. This is a retrospective study of all ANCA positives cases from Nephrology Clinic Iasi during five years (1998-2003) on a cohort of 97 patients. RESULTS: pANCA was positive in 28, cANCA was positive in 60 and the others had pANCA and cANCA. The diseases ANCA associated were: systemic vasculitis, rapidly progressive glomerulonephritis (GNRP), chronic renal failure of an unknown etiology. ANCA presence was associated with inflammatory syndrome in 83.5%, anemic syndrome in 71.1%. From the patients with renal disfunction (71.1%), half of them presented an increased level of creatinine (>6 mg%). Renal biopsy proven especially crescentic glomerulonephritis. The complications and the diseases were more frequent in cANCA cases. CONCLUSIONS: cANCA presence is a negative prognosis factor in vasculitis; testing ANCA alone cannot be used to guide treatment.

Adult↗
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[Relation between arterial compliance and the prematurity of reflected wave on pulse pressure curve evaluated by tonometric sphygmography].

The effect of antihypertensive drugs on the arterial pressure pulse can usually be explained by a change in the timing or intensity of wave reflection or by alteration in the pattern of ventricular ejection. Alteration in timing wave reflection is believed to cause the characteristic changes of pressure wave such: augmentation, augmentation index, "precocity index of second systolic peek" (P2). After calcium channel blockers augmentation decreases from 15 mmHg to 9.4 mmHg, augmentation index P2/P1 (P1 is the first systolic peek) decreases from 132.2 +/- 20% to 129.2 +/- 19.5% and "precocity index of P2" increases from 68.8 +/- 5% ejection duration to 71.8 +/- 4.6% ejection duration.

Adult↗
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[Correlation between increase of oxidative stress and microalbuminuria in type-1 diabetic patients].

Oxidative stress has an important role in genesis of diabetic complications, especially diabetic nephropathy. The aim of the study was to assess correlations between increase of oxidative stress (OS) and the development of microalbuminuria (MA) in type 1 diabetic patients. We determined the oxidative status by measuring the level of superoxide dismutase (SOD-Minanui method), catalase (CAT-Aebi method), glutathione peroxidase (GPx-Fukuzawa method) and glutathione (GSH-Ellman method) in 87 type 1 diabetic patients (44 with normal urinary protein excretion-group A and 43 with MA-group B) and 38 nondiabetic matched controls, before and 24 hours after a test effort. The results of the study point out that a decreased in activity of SOD or in levels of GSH is associated with an increased MA in type 1 diabetic patients.

Adult↗
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Aortic pulse wave velocity and arterial wave reflections predict the extent and severity of coronary artery disease in chronic kidney disease patients.

BACKGROUND: Increased aortic stiffness markers - aortic pulse wave velocity (PWV) and augmentation index (AIx) - are powerful predictors of survival in ESRD patients - well-recognized for the high prevalence of coronary artery disease (CAD) and unusually high PWV and AIx. Recently, decreased aortic compliance has been shown to be predictive of primary coronary events in hypertensive patients with normal renal function. We aimed to explore relationships between arterial stiffness and CAD in cohorts of patients with chronic kidney disease (CKD). METHODS AND RESULTS: 46 patients with chronic kidney disease (33 males, aged 55.7+/- 13.2 years, 20 on dialysis, 18 post renal transplantation, and 8 with glomerular filtration rate (GFR) between 10 and 25 ml/min) underwent coronary angiography for the assessment of CAD. PWV and aortic AIx were determined from pulse waveform analysis of arterial waveforms recorded by applanation tonometry using a SphygmoCortm device. The atherosclerosis burden score was calculated by adding the percentage luminal reduction of the most severe lesion in each artery. Patients with normal angiograms had significantly less arterial stiffness (as reflected by both a lower PWV=8.42+/-1.53 m/s and a lower AIx=17.9+/-5.55 %) compared with the 35 subjects with evidence of obstructive coronary disease at angiography (PWV=9.21+/-1.15 m/s and AIx=23.4+/-5.4 %, P<0.05 for both). Moreover, as more coronary vessels were affected, PWV and AIx increased proportionally. Based on receiver operating characteristics (ROC) curve analysis mean PWV levels showed an optimal cut-off point at 8.35 m/s (sensitivity=0.77; specificity=0.60), while mean AIx levels showed an optimal cut-off point at 17% (sensitivity=0.87; specificity=0.70). There was a statistically significant linear relationship between the atherosclerosis burden and both measures of arterial stiffness: PWV (r=0.31, p=0.007) and AIx (r=0.46, p=0.003). Independent predictors for the arterial stiffness parameters in this CKD population (multiple stepwise regression analysis) were age (r=0.69 for PWV and r=0.62 for AIx), and mean arterial pressure (MAP) (for AIx, p<0.0001). CONCLUSION: This study provides the first direct evidence in a cross-sectional investigation that PWV and AIx are related to the extent of coronary obstruction in CKD patients.

Adult↗
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[Anatomical and clinical evaluation regarding the removal of the peritoneal dialysis catheter].

AIMS: To describe CAPD technique survival and causes for catheter removal. The study included 320 end stage renal disease (ESRD) patients, initiated on CAPD between 1995-2003. Definitive catheter removal was required in 44 cases (15.1%), 11 of these (3.79%) receiving renal transplant. Causes for catheter removal were: mechanical obstruction by fibrin (8 cases/2.75%), obstruction by tub bower (1 case/0.34%), by omental muff (6 cases/2%); abdominal wall sepsis (30 cases/ 10.3%); non-responsive bacterial peritonitis (13 cases/4.05%), fungal peritonitis (7 cases/ 2.4%), fecal peritonitis (2 cases/0.68%); transfer to hemodialysis program (31 cases/10.6%); renal transplant (11 cases/3.79%); emergency surgical pathology for: necrotic-hemorrhagic pancreatitis (two cases), intestinal occlusions (six cases), locked hernias (three cases) and locked eventrations(three cases), appendicular peritonitis (two cases). Mortality associated with these procedures and underlying pathology was 1.73%.

Catheters, Indwelling↗
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[Major impact of arteriosclerosis on cardiovascular morbidity and mortality].

Arterial stiffness (arteriosclerosis) is a diffuse process affecting the media of large arteries, strongly linked to the process of ageing, but influenced by several other major factors like hypertension and vascular calcifications. Arteriosclerosis has been recognized in recent years as a novel non-traditional cardiovascular risk factor both for renal and non-renal general population. Two of arterial stiffness parameters, pulse wave velocity and the augmentation index--determined by applanation tonometry, are strongly correlated with cardiovascular morbidity and mortality, as well as with the general mortality. Arterial stiffness, due to several factors related to the uremic milieu, is more pronounced in patients with end-stage renal disease compared with patients without renal dysfunction. The authors are briefly reviewing the most recent literature regarding the impact of arterial stiffness on cardiovascular outcome. Identifying the factors associated with reduced arterial compliance may positively influence cardiovascular outcome in the general population, and particularly in renal patients, plagued by a high burden of cardiovascular disease.

Arteriosclerosis↗
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[Drug-induced dermatological pathology in renal transplantation patients].

The broad spectrum of muco-cutaneous manifestations of renal transplantation patients correlates mainly with immunosuppressive therapy. Our study refers to 56 patients with renal transplantation (29 women and 27 men) followed up in the Dialysis and Renal Transplantation Center of Parhon University Hospital Iaşi from November 2000 till October 2003. The most frequent muco-cutaneous manifestations were: infectious complications in 18 cases (32.1%), gum hyperplasia in 14 cases(25%), acne in 11 cases (19.6%), skin hyperpigmentation in 7 cases (12.5%), oral candidiasis in 6 cases (10.7%), vascular fragility in 5 cases (8.9%), hypertrichosis in 5 cases (8.9%), itching in 3 cases (5.3%), facial erythema in 3 cases (5.3%), full-moon facies in 3 cases (5.3%). These manifestations, often with unclear pathogenesis, are dose-related and almost unavoidable.

Adolescent↗
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[Descriptive epidemiologic study of nosocomial infections in "C.I. Parhon" hospital of Iaşi].

Nosocomial infections (NI) represent a major public health problem. The descriptive study was carried out during one year, based on a lot of 12,731 in-patients from "C.I. Parhon" hospital. The objectives of the study were assessment of NI incidence and risk factors as well as monitoring resistance to antimicrobial drugs of bacterial pathogens from the hospital. The results of the study show lower NI incidence rates: 0.27%, most of them (91.5%) being urinary tract infections in the age group 65 y and over. 42.8% of cases were associated with risk factor of diabetes mellitus, neoplasm, skin or cardiovascular chronic conditions. The main etiological agent found for the NI was pseudomonas pyocyanea resistant to antibiotics. The antibiotic sensitivity analysis for the other gram negative rods illustrates gradually acquired resistance to the third or fourth generation of cephalosporins.

Adult↗
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[The progression factors in autosomal dominant polycystic disease].

This study was performed to evaluate prognostic factors in ADPKD progression to ERSF. Previously reported negative factors (male gender, age, hypertension, palpable kidneys and UTI) as well as the extra-renal presence of cysts and proteinuria, were analysed in a group of 45 ADPKD patients (Male/Female, 25/20; Age = 40.1 +/- 19.7 yrs, range 21-69). Palpable kidneys were associated with higher serum creatinine values (955 +/- 689 vs 743 +/- 504 umol/l, p < 0.001) but not with a greater prevalence of renal failure. Renal failure (100% vs 60%), higher creatinine values (981 +/- 495 vs 778 +/- 654 umol/l) and hypertension (50% vs 18%) were related to a higher prevalence of extra-renal cysts (p < 0.05). Older patients (> 40 years) had a greater prevalence of renal failure (96% vs 32%, p < 0.001). Also, subjects with palpable kidneys, and those with extra-renal cysts, were significantly older (52.8 +/- 10.3 vs 30.5 +/- 20.6 yrs, p < 0.025; and 42.1 +/- 21.9 vs 38.1 +/- 18.2 yrs, p < 0.025). Patients with renal failure and those with extra-renal cysts had a greater prevalence of proteinuria (65% vs 0%, p < 0.001; and 100% vs 24%, p < 0.001). No correlation was seen for male gender, hypertension or UTI with any known complications of ADPKD. The extrarenal presence of cysts, older age, proteinuria and palpable kidneys were associated with a worse renal outcome, but for this Romanian population we can't confirm previous reports suggesting a role for male gender and early onset of disease.

Adult↗